SUMMATIVE LECTURE

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

PROTOTYPE

Early SSx

MAIN Rx

Prevention

PERICARDIAL DISEASE

MYOCARDIAL DISEASE

ENDOCARDIAL DISEASE

RHD

Late SSx

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

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MITRAL

AORTIC

STENOSIS Failure to Open

INSUFFICIENCY Failure to Close

APEX APEX

BASE BASE

DIASTOLIC murmur SYSTOLIC m

SYSTOLIC m DIASTOLIC m

LUB-DUB-Brrrr ZHHHHHHHH-DUB

SSSSHHHH-DUB LUB-dhuu

Inability to fill Poor forward flow

Poor forward flowPoor forward flow

Vasodilators

Vasodilators

Slow Down the HR

Surgery

PROTOTYPE

Early SSx

MAIN Rx

Prevention

RHD

Easy Fatigue, mild LVF, poor forward flow, dyspnea

Rx; valve replacement

Worse LVF -> RVF

Worse SOBOERVF edema

Late SSx

ANATOMIC CATEGORIES OF CV DISEASE

PERICARDIAL DISEASE

MYOCARDIAL DISEASE

ENDOCARDIAL DISEASE

IHD(others: IE)

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

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ACUTE THROM.

LIPID STREAK ASXIC PLAQUENORMAL SIGNIF. OBST.

REORGANIZ. CHRON. OBST.

Angina

Acute MI

CHF

Chronic recurrent mild chest pain on exertion

Acute severe chest pain

SOBOE, orthopnea, PND, RVF

Sx Severity Stress Test

Residual Sx Stress Test

Check for angina

Screen for surgical ds.Common SSx

Nitrates, ASA, statins, BB, ACE-I,or ARB

IV Thrombolytics, LMWH, ASA, BB, ACE-i,, clop, statins, ARB, nitrates

ASA, BB, ACEi, Digitalis (desperate), diu (edematous)

Medication

Clinical

Enzymes, ECG, pain

2DE

Confirmation

PROTOTYPE

Early SSx

MAIN Rx

Prevention

CP

Pleuritic chest pain

RVF

surgery

IHD

Angina, mild LVF

Rx; PTCA, CABG

MI or UAP Worse LVF->RVF

RHD

Easy Fatigue, mild LVF

Rx; valve replacement

Worse LVF -> RVFLate SSx

ANATOMIC CATEGORIES OF CV DISEASE

PERICARDIAL DISEASE

MYOCARDIAL DISEASE

ENDOCARDIAL DISEASE

(others: IE) (others: IDC, RCM)

2DE: NORMAL VS CP

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PROTOTYPE

Early SSx

MAIN Rx

Prevention

CP

Pleuritic Chest pain

Surgery

TB control

“RVF”; usually no SOB

IHD

Angina, mild LVF

Rx; PTCA, CABG

Risk Factor Control

MI or UAP Worse LVF->RVF

RHD

Easy Fatigue, mild LVF

Rx; valve replacement

Rheumatic Fever and IE prophylaxis

Worse LVF -> RVFLate SSx

ANATOMIC CATEGORIES OF CV DISEASE

PERICARDIAL DISEASE

MYOCARDIAL DISEASE

ENDOCARDIAL DISEASE

(others: IE) (others: IDC, RCM) (others: AP)

A man is as old as his arteries

Thomas Sydenham 1684

WHO IS AT RISK?

OBES=12/55%

ESTIMATED NO. OF DEATHS ESTIMATED NO. OF DEATHS FROM CAD AND CVDFROM CAD AND CVD

DM = 4.6% 4.0 4, 148 2.4

CHOL=8.5% 1.8 5, 730 2.9

not sure by how much

8, 046 2.3

HPN=17% 4.4 14, 015 2.6

SMK=35% 4.8 28, 694 4.7

RF REVALENCE

RR for STROKE

DEATHS IN 2004

RR for CAD

PRELIMINARY DATA DO NOT DISSEMINATE

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

ALCOHOLRR = 0.79

Females

Males

0

0.2

0.4

0.6

0.8

1.2

1.4

1.6

1.8

1.01.0

0.0

-0.9

1.0

-1.9

2.0

-2.9

3.0

-3.9

4.0

-4.9

5.0

-5.9

6.0

+

NO

NE

Relative Risk of Dying

Daily Alcohol Consumption

INSIDE STORY: BADMINTON CHAMPS

EXERCISE RR = 0.72

SOCIAL CONNECTEDNESSRR = 0.55

FRUITS AND VEGETABLES

ALCOHOL

EXERCISE

PSYCHOSOCIAL STRESS

0.70

0.79

0.72

0.55

DYSLIPIDEMIA

HYPERTENSION

DIABETES

OBESITY (WHR)

2.90

2.60

2.40

2.30

SMOKING 4.70

THE BIG 9

ANATOMIC CATEGORIES OF CV DISEASE

PROTOTYPE

Early SSx

MAIN Rx

Prevention

PERICARDIAL DISEASE

CP

Pleuritic Chest pain

Surgery

TB control

RVF; usually no SOB

MYOCARDIAL DISEASE

IHD

Angina, mild LVF

Rx; PTCA, CABG

Risk Factor Control

MI or UAP Worse LVF->RVF

ENDOCARDIAL DISEASE

RHD

Easy Fatigue, mild LVF

Rx; valve replacement

Rheumatic Fever prophylaxis

Worse LVF -> RVFLate SSx

(others: IE) (others: IDC, RCM) (others: AP)

ARRHYTHMIAS

TACHYARRHYTHMIAS

BRADYARRHYTHMIAS

MECHANISMS OF ARRHYTHMIAS

Automaticity

Automaticity

Conductivity (re-entry)

Conductivity (blocks)

SINUS RHYTHM

RE-ENTRY eg - AVNRT

SA Nodal

Ventricular

ANATOMIC ORIGINS OF ARRHYTHMIAS

Atrial

Atrioventricular

Accessory Pathways

Sinus Tach Sinus BradySinus Pause/ArrestSA exit block

TACHY BRADY

Sinus Tach

Sinus Brady

Sinus Pause/Arrest

SA exit block

SA Nodal

Ventricular

ANATOMIC ORIGINS OF ARRHYTHMIAS

Atrial

Atrioventricular

Accessory Pathways

Sinus Tach Sinus BradySinus Pause/ArrestSA exit block

PAC’sAtrial flutter

Atrial fibrillationAtrial tachycardia

TACHY BRADY

PAC’s

Atrial flutter

Atrial fibrillation

Atrial tachycardia

SA Nodal

Ventricular

ANATOMIC ORIGINS OF ARRHYTHMIAS

Atrial

Atrioventricular

Accessory Pathways

Sinus Tach

PAC’s

Sinus BradySinus Pause/ArrestSA exit block

Atrial flutter

Atrial fibrillationAtrial tachycardia

AVNRT 1 AVB2 AVB (Mobitz I)

3 AVB 2 AVB (Mobitz II)

PNC’s

TACHY BRADY

AVNRT

1 AVB

2 AVB (Mobitz I)

3 AVB

2 AVB (Mobitz II)

PNC’s

SA Nodal

Ventricular

ANATOMIC ORIGINS OF ARRHYTHMIAS

Atrial

Atrioventricular

Accessory Pathways

Sinus Tach

PAC’s

AVNRT

Sinus BradySinus Pause/ArrestSA exit block

Atrial flutter

Atrial fibrillationAtrial tachycardia

1 AVB2 AVB (Mobitz I)

3 AVB 2 AVB (Mobitz II)

PNC’s

PVC’sVTVF

TACHY BRADY

PVC’s

VT

VF

SA Nodal

Ventricular

ANATOMIC ORIGINS OF ARRHYTHMIAS

Atrial

Atrioventricular

Accessory Pathways

Sinus Tach

PVC’s

PAC’s

AVNRT

Sinus BradySinus Pause/ArrestSA exit block

Atrial flutter

Atrial fibrillationAtrial tachycardia

1 AVB2 AVB (Mobitz I)

3 AVB 2 AVB (Mobitz II)

PNC’s

VTVF

WPWLGL

TACHY BRADY

WPW

LGL

SA Nodal

Ventricular

ANATOMIC ORIGINS OF ARRHYTHMIAS

Atrial

Atrioventricular

Accessory Pathways

Sinus Tach

PVC’s

PAC’s

AVNRT

Sinus BradySinus Pause/ArrestSA exit block

Atrial flutter

Atrial fibrillationAtrial tachycardia

1 AVB2 AVB (Mobitz I)

3 AVB 2 AVB (Mobitz II)

PNC’s

VTVF

WPWLGL

TACHY BRADY

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

ACYANOTIC

Shunts (PDA, VSD, ASD)

Stenoses (PS, AS, TS, MS, Coarct)

CYANOTIC

Eisenmengerization

Complex anomalies (TGA, TOF, APVR)

SUMMARY: CONGENITAL HEART DS

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