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