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Transcript
SUMMATIVE LECTURE CARDIOVASCULAR DISEASE Antonio L. Dans, MD UP College of Medicine OUTLINE 1. Anatomic Categories of CV Disease 2. Disorders of the Conduction System 3. Congenital Heart Disease ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE PROTOTYPE Early SSx Late SSx MAIN Rx Prevention RHD MYOCARDIAL DISEASE PERICARDIAL DISEASE G.G. 24F CONSULTED FOR DYSPNEA SOBOE ASCENDING EDEMA 3-PILLOW ORTHOPNEA PAROXYSMAL NOCTURNAL DYSPNEA SOCIAL AND FINANCIAL COSTS CARDIAC CACHEXIA 2DE: NORMAL VS RHD QuickTime™ and a YUV420 codec decompressor are needed to see this picture. QuickTime™ and a YUV420 codec decompressor are needed to see this picture. STENOSIS Failure to Open MITRAL AORTIC INSUFFICIENCY Failure to Close APEX APEX DIASTOLIC murmur SYSTOLIC m LUB-DUB-Brrrr ZHHHHHHHH-DUB Inability to fill Poor forward flow Slow Down the HR Vasodilators BASE BASE SYSTOLIC m DIASTOLIC m SHHHH-DUB SSS LUB-dhuu Poor forward flow Poor forward flow Surgery Vasodilators ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PROTOTYPE RHD (others: IE) IHD Early SSx Easy Fatigue, mild LVF, poor forward flow, dyspnea Late SSx Worse LVF -> RVF Worse SOBOERVF edema MAIN Rx Prevention Rx; valve replacement PERICARDIAL DISEASE E.H. 70M CONSULTED FOR CHEST DISCOMFORT TIGHTNESS RATHER THAN PAIN ON PHYSICAL EXERTION FEW MINUTES DURATION RELIEVED WITH REST WALK-THROUGH PHENOMENON 1-2X A WEEK PSYCHOSOCIAL CONSEQUENES 2DE: NORMAL VS DCM QuickTime™ and a YUV420 codec decompressor are needed to see this picture. QuickTime™ and a YUV420 codec decompressor are needed to see this picture. NORMAL ACUTE THROM. LIPID STREAK ASXIC PLAQUE REORGANIZ. CHRON. OBST. SIGNIF. OBST. Screen for surgical ds. Common SSx Confirmation Angina Chronic recurrent mild chest pain on exertion Clinical Sx Severity Stress Test Acute MI Acute severe chest pain Enzymes, ECG, pain Residual Sx Stress Test CHF SOBOE, orthopnea, PND, RVF 2DE Check for angina Medication Nitrates, ASA, statins, BB, ACEI,or ARB IV Thrombolytics, LMWH, ASA, BB, ACE-i,, clop, statins, ARB, nitrates ASA, BB, ACEi, Digitalis (desperate), diu (edematous) ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD (others: IE) IHD (others: IDC, RCM) CP Early SSx Easy Fatigue, mild LVF Angina, mild LVF Pleuritic chest pain Late SSx Worse LVF -> RVF MI or UAP Worse LVF->RVF RVF MAIN Rx Rx; valve replacement Rx; PTCA, CABG Prevention surgery 2DE: NORMAL VS CP QuickTime™ and a YUV420 codec decompressor are needed to see this picture. QuickTime™ and a YUV420 codec decompressor are needed to see this picture. ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD (others: IE) IHD (others: IDC, RCM) CP (others: AP) Early SSx Easy Fatigue, mild LVF Angina, mild LVF Pleuritic Chest pain Late SSx Worse LVF -> RVF MI or UAP Worse LVF->RVF “RVF”; usually no SOB MAIN Rx Rx; valve replacement Rx; PTCA, CABG Surgery Prevention Rheumatic Fever and IE prophylaxis Risk Factor Control TB control A man is as old as his arteries Thomas Sydenham 1684 WHO IS AT RISK? PRELIMINARY DATA DO NOT DISSEMINATE ESTIMATED NO. OF DEATHS FROM CAD AND CVD RR for CAD RF REVALENCE RR for STROKE DM = 4.6% 4.0 2.4 4, 148 CHOL=8.5% 1.8 2.9 5, 730 2.3 8, 046 OBES=12/55% not sure by how much DEATHS IN 2004 HPN=17% 4.4 2.6 14, 015 SMK=35% 4.8 4.7 28, 694 Waist: Between lowest rib and hip Hip: Level of ant. Sup. Iliac spine WOMEN > 0.85 MEN > 1.0 FRUITS AND VEGETABLES RR = 0.70 ALCOHOL RR = 0.79 1.8 1.6 1.4 1.2 1.0 0.8 Females 0.6 Males 0.4 0.2 Daily Alcohol Consumption 6.0 + 5.0-5.9 4.0-4.9 3.0-3.9 2.0-2.9 1.0-1.9 0.0-0.9 0 NONE Relative Risk of Dying INSIDE STORY: BADMINTON CHAMPS EXERCISE RR = 0.72 SOCIAL CONNECTEDNESS RR = 0.55 THE BIG 9 SMOKING 4.70 DYSLIPIDEMIA 2.90 HYPERTENSION 2.60 DIABETES 2.40 OBESITY (WHR) 2.30 FRUITS AND VEGETABLES 0.70 ALCOHOL 0.79 EXERCISE 0.72 PSYCHOSOCIAL STRESS 0.55 ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD (others: IE) IHD (others: IDC, RCM) CP (others: AP) Early SSx Easy Fatigue, mild LVF Angina, mild LVF Pleuritic Chest pain Late SSx Worse LVF -> RVF MI or UAP Worse LVF->RVF RVF; usually no SOB MAIN Rx Rx; valve replacement Rx; PTCA, CABG Surgery Prevention Rheumatic Fever prophylaxis Risk Factor Control TB control ARRHYTHMIAS MECHANISMS OF ARRHYTHMIAS TACHYARRHYTHMIAS Automaticity Conductivity (re-entry) BRADYARRHYTHMIAS Automaticity Conductivity (blocks) SINUS RHYTHM RE-ENTRY eg - AVNRT ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY SA Nodal Atrial Atrioventricular Ventricular Accessory Pathways Sinus Tach BRADY Sinus Brady Sinus Pause/Arrest SA exit block Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY SA Nodal Sinus Tach Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular Ventricular Accessory Pathways BRADY Sinus Brady Sinus Pause/Arrest SA exit block PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY SA Nodal Sinus Tach Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular AVNRT PNC’s Ventricular Accessory Pathways BRADY Sinus Brady Sinus Pause/Arrest SA exit block 1 AVB 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB AVNRT PNC’s 1 AVB 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY SA Nodal Sinus Tach Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular AVNRT PNC’s Ventricular PVC’s VT VF Accessory Pathways BRADY Sinus Brady Sinus Pause/Arrest SA exit block 1 AVB 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB PVC’s VT VF ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY SA Nodal Sinus Tach Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular AVNRT PNC’s Ventricular PVC’s VT VF Accessory Pathways WPW LGL BRADY Sinus Brady Sinus Pause/Arrest SA exit block 1 AVB 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB WPW LGL ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY SA Nodal Sinus Tach Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular AVNRT PNC’s Ventricular PVC’s VT VF Accessory Pathways WPW LGL BRADY Sinus Brady Sinus Pause/Arrest SA exit block 1 AVB 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB CONGENITAL HEART DISEASE NORMAL CV CIRCUIT ATRIAL SEPTAL DEFECT ATRIAL SEPTAL DEFECT ATRIAL SEPTAL DEFECT VENTRICULAR SEPTAL DEFECT VENTRICULAR SEPTAL DEFECT PATENT DUCTUS ARTERIOSUS PATENT DUCTUS ARTERIOSUS PATENT DUCTUS ARTERIOSUS SUMMARY: CONGENITAL HEART DS ACYANOTIC Shunts (PDA, VSD, ASD) Stenoses (PS, AS, TS, MS, Coarct) CYANOTIC Eisenmengerization Complex anomalies (TGA, TOF, APVR) TRANSPOSITION OF THE GREAT ARTERIES TETRALOGY OF FALLOT SUMMARY 1. Anatomic Categories of CV Disease 2. Disorders of the Conduction System 3. Congenital Heart Disease THANK YOU
