Dirty Laundry

UNEXPLAINED SYNCOPE Arrhythmic Causes Sinus node dysfunction Tachyarrhythmias AV Block Cause of syncope undetected in 50% of patients 1 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 children Symptoms my be unrelated to the gradient, but my relate to the onset of atrial fibrillation Death is most often sudden & difficult to predict Young age of diagnosis (<30) Malignant family history Hypertensive response to exercise Genetic abnormalities associated with SCD Ominous history of syncope (childhood) NSVT

MANAGEMENT OF H.O.C. M. Symptoms Diuretics 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 tolerated Amiodarone ? improves prognosis Sotalol experience is limited Avoidance of Strenuous Exercise Conversion of Atrial Fibrillation Defibrillator Implantation Septal Ablation Myomectomy & mitral valve repair Transplantation.

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 dissection When pain is anterior, 90% +had involvement of the ascending aorta Pain in the neck, throat, jaw or face predicted aortic root involvement

Graphic Credits Heart Disease Manual of Cardiovascular Medicine 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