Dirty Laundry
Mar 20, 2016
Dirty Laundry
UNEXPLAINED SYNCOPE
Arrhythmic CausesSinus node dysfunctionTachyarrhythmiasAV Block
Cause of syncope undetected in 50% of patients1 year mortality is 6%! (unknown cause)1 year morbidity is 12% (non-cardiovascular)1 year mortality is 20-30% (cardiovascular) (untreated)Mortality & incidence of sudden cardiac death are determined by the presence of underlying heart disease
NATURAL HISTORY OF H.O.C.M
Annual mortality 3% in adults, 6% in childrenSymptoms my be unrelated to the gradient, but my relate to the onset of atrial fibrillationDeath is most often sudden & difficult to predictYoung age of diagnosis (<30)Malignant family historyHypertensive response to exerciseGenetic abnormalities associated with SCDOminous history of syncope (childhood) NSVT
MANAGEMENT OF H.O.C. M.SymptomsDiuretics for pulmonary congestions only
Beta Blockers-mainstay of treatment for angina, dyspnea, presyncope Not known if BB prevents SCD
Verapamil can be tried if BB not toleratedAmiodarone ? improves prognosisSotalol experience is limited
Avoidance of Strenuous ExerciseConversion of Atrial FibrillationDefibrillator ImplantationSeptal AblationMyomectomy & mitral valve repairTransplantation.
PAIN IN AORTIC DISSECTION
Pain is often morbidly appropriate to the actual event ( tearing, ripping, stabbing )Pain tends to migrate from point of origin to other sites along the path of the dissectionWhen pain is anterior, 90% +had involvement of the ascending aortaPain in the neck, throat, jaw or face predicted aortic root involvement
Graphic Credits The Cardiology Intensive Board Review Question Book Cho,Griffin,Topol
Heart Disease Braunwald,Zipes,Libby
Manual of Cardiovascular Medicine Griffin, Topol
Early Medical Photography in America Burns