By Ross H.
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Extra resources for Cardiology
CONT. 75 cm2 or pressure gradient > 50 mmHg) ❏ small orifice ––> outflow obstruction ––> fixed output ––> forward failure • symptoms • syncope (especially with heavy exertion) • fatigue ❏ small orifice ––> pressure overload ––> concentric LVH (fibers in parallel) ––> 8 LVEDP • symptoms • dyspnea (initially exertional) • PND/orthopnea • peripheral edema + CHF (10% develop RV failure) ❏ 8LVEDP ––> 9 subendocardial flow and 8 myocardial O2 demand • symptoms • angina • palpitations ❏ TRIAD: syncope, CHF, angina Signs of AS ❏ pulses • apical-carotid delay • pulsus parvus et tardus (slow upstroke and late peaking) • brachio-radial delay • thrill over carotid and suprasternal notch ❏ precordial palpation • sustained +/– diffuse apex beat • +/– palpable S4 • systolic thrill in 2nd RICS +/– along LLSB ❏ precordial auscultation • SEM - diamond shaped (crescendo-decrescendo), peaks progressively later in systole with worsening AS, intensity not related to severity, radiates to neck, musical quality of murmur at apex (Gallavardin effect) • +/– diastolic murmur of associated mild AR • S2 - paradoxical splitting (severe AS), or single (A2 absent) • ejection click (more common in mild AS, absent if severe) • S3 - late in disease (if LV dilatation present) • S4 - early in disease (decreased LV compliance) Investigations ❏ 12 lead ECG • LVH and strain +/– LBBB, LAE/AF ❏ chest x-ray • post-stenotic aortic root dilatation, calcified valve, LVH + LAE, CHF (develops later) ❏ echocardiography • gold standard for diagnosis • valvular area and pressure gradient (assess severity of AS) Cardiology 40 MCCQE 2000 Review Notes and Lecture Series VALVULAR HEART DISEASE .
G. g. AR) ❏ systemic response to ineffective circulating volume • activation of sympathetic nervous and renin-angiotensin systems result in • salt and H2O retention with intravascular expansion • increased heart rate and myocardial contractility • increased afterload ❏ “compensated” heart failure becomes “decompensated” as cardiac and systemic responses overshoot ❏ treatments are directed at these compensatory overshoots Table 9. “Overshooting” of Compensatory Responses in Heart Failure Compensatory Response Result of Excess hypertrophy increased O2 consumption diastolic dysfunction dilatation impaired myocardial function salt and H2O retention venous congestion increased heart rate and contractility increased O2 consumption increased systemic vascular resistance decreased cardiac output SYSTOLIC vs.
CONT. ) • failure of maximal medical/surgical therapy • poor 6 month prognosis • absence of contraindications • ability to comprehend and comply with therapy ❏ 1 year survival 85%, 5 year survival 70% ❏ complications: rejection, infection, graft vascular disease, malignancy CARDIOMYOPATHIES Definition ❏ disease of the myocardium not secondary to coronary artery disease, valvular heart disease, congenital heart disease, hypertension or pericardial disease ❏ diagnosis of any of the following conditions mandates exclusion of the above conditions ❏ dilated cardiomyopathy ❏ hypertrophic cardiomyopathy ❏ restrictive cardiomyopathy ❏ myocarditis DILATED CARDIOMYOPATHY Etiology ❏ idiopathic ❏ peri-partum ❏ inflammatory ❏ infectious • post-viral (Coxsackie), Chagas, etc...