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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
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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 SOBOERVF 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
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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
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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