SUMMATIVE LECTURE

1. SUMMATIVE LECTURE CARDIOVASCULAR DISEASE Antonio L. Dans, MD UP College of Medicine

2. OUTLINE 1. Anatomic Categories of CV Disease 2. Disorders of the Conduction System 3. Congenital Heart Disease

3. ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD Early SSx Late SSx MAIN Rx Prevention

4. G.G. 24F CONSULTED FOR DYSPNEA SOBOE ASCENDING EDEMA 3-PILLOW ORTHOPNEA PAROXYSMAL NOCTURNAL DYSPNEA SOCIAL AND FINANCIAL COSTS CARDIAC CACHEXIA

7. 2DE: NORMAL VS RHD

8. STENOSIS Failure to Open INSUFFICIENCY Failure to Close APEX APEX MITRAL DIASTOLIC murmur SYSTOLIC m LUB-DUB-Brrrr ZHHHHHHHH-DUB Inability to fill Poor forward flow Slow Down the HR Vasodilators BASE AORTIC BASE SYSTOLIC m DIASTOLIC m SSSSHHHH-DUB LUB-dhuu Poor forward flow Poor forward flow Surgery Vasodilators

9. ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD IHD (others: IE) Early SSx Easy Fatigue, mild LVF, poor forward flow, dyspnea Late SSx Worse LVF -> RVF Worse SOBOERVF edema MAIN Rx Rx; valve replacement Prevention

10. 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

13. 2DE: NORMAL VS DCM

14. LIPID STREAK NORMAL ASXIC PLAQUE SIGNIF. OBST. REORGANIZ. CHRON. OBST. ACUTE THROM.

15. Screen for surgical ds. Common SSx Confirmation Medication Angina Chronic recurrent mild chest pain on exertion Clinical Sx Severity Stress Test Nitrates, ASA, statins, BB, ACE-I,or ARB IV Thrombolytics, LMWH, ASA, BB, ACE-i,, clop, statins, ARB, nitrates Acute MI Acute severe chest pain Enzymes, ECG, pain Residual Sx Stress Test CHF SOBOE, orthopnea, PND, RVF 2DE Check for angina ASA, BB, ACEi, Digitalis (desperate), diu (edematous)

16. ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD IHD CP Pleuritic chest pain RVF surgery (others: IE) (others: IDC, RCM) Early SSx Easy Fatigue, mild LVF Angina, mild LVF Late SSx Worse LVF -> RVF MI or UAP Worse LVF->RVF MAIN Rx Rx; valve replacement Rx; PTCA, CABG Prevention

17. 2DE: NORMAL VS CP

18. ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD IHD CP (others: IE) (others: IDC, RCM) (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

19. A man is as old as his arteries Thomas Sydenham 1684

20. WHO IS AT RISK?

21. 4.0 2.4 4, 148 1.8 2.9 5, 730 not sure by how much 2.3 8, 046 4.4 2.6 14, 015 4.8 4.7 28, 694 PRELIMINARY DATA DO NOT DISSEMINATE ESTIMATED NO. OF DEATHS FROM CAD AND CVD RR for CAD RF REVALENCE RR for STROKE DEATHS IN 2004 DM = 4.6% CHOL=8.5% OBES=12/55% HPN=17% SMK=35%

22. Waist: Between lowest rib and hip Hip: Level of ant. Sup. Iliac spine WOMEN > 0.85 MEN > 1.0

24. FRUITS AND VEGETABLES RR = 0.70

25. ALCOHOL RR = 0.79

26. 1.8 1.6 1.4 1.2 1.0 0.8 Females 0.6 Males 0.4 0.2 0 NONE 0.0-0.9 2.0-2.9 1.0-1.9 4.0-4.9 5.0-5.9 3.0-3.9 6.0 + Relative Risk of Dying Daily Alcohol Consumption

27. INSIDE STORY: BADMINTON CHAMPS EXERCISE RR = 0.72

28. SOCIAL CONNECTEDNESS RR = 0.55

29. THE BIG 9 SMOKING 4.70 DYSLIPIDEMIA 2.90 2.60 HYPERTENSION DIABETES 2.40 OBESITY (WHR) 2.30 FRUITS AND VEGETABLES 0.70 0.79 ALCOHOL EXERCISE 0.72 PSYCHOSOCIAL STRESS 0.55

30. ANATOMIC CATEGORIES OF CV DISEASE ENDOCARDIAL DISEASE MYOCARDIAL DISEASE PERICARDIAL DISEASE PROTOTYPE RHD IHD CP (others: IE) (others: IDC, RCM) (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

31. ARRHYTHMIAS

32. Automaticity Conductivity (re-entry) Automaticity Conductivity (blocks) MECHANISMS OF ARRHYTHMIAS TACHYARRHYTHMIAS BRADYARRHYTHMIAS

33. SINUS RHYTHM

34. RE-ENTRY eg - AVNRT

35. ANATOMIC ORIGINS OF ARRHYTHMIAS Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block TACHY BRADY SA Nodal Atrial Atrioventricular Ventricular Accessory Pathways

36. Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block

37. ANATOMIC ORIGINS OF ARRHYTHMIAS PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation TACHY BRADY SA Nodal Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block Atrial Atrioventricular Ventricular Accessory Pathways

38. PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation

39. 1 AVB AVNRT PNC’s 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY BRADY SA Nodal Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular Ventricular Accessory Pathways

40. AVNRT PNC’s 1 AVB 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB

41. PVC’s VT VF ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY BRADY SA Nodal Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular 1 AVB AVNRT PNC’s 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB Ventricular Accessory Pathways

42. PVC’s VT VF

43. WPW LGL ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY BRADY SA Nodal Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular 1 AVB AVNRT PNC’s 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB Ventricular PVC’s VT VF Accessory Pathways

44. WPW LGL

45. WPW LGL ANATOMIC ORIGINS OF ARRHYTHMIAS TACHY BRADY SA Nodal Sinus Tach Sinus Brady Sinus Pause/Arrest SA exit block Atrial PAC’s Atrial flutter Atrial tachycardia Atrial fibrillation Atrioventricular 1 AVB AVNRT PNC’s 2 AVB (Mobitz I) 2 AVB (Mobitz II) 3 AVB Ventricular PVC’s VT VF Accessory Pathways

46. CONGENITAL HEART DISEASE

47. NORMAL CV CIRCUIT

48. ATRIAL SEPTAL DEFECT

49. ATRIAL SEPTAL DEFECT

50. ATRIAL SEPTAL DEFECT