summative lecture
DESCRIPTION
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. MYOCARDIAL DISEASE. - PowerPoint PPT PresentationTRANSCRIPT
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