1. RJS How and why the heart goes wrong

2. RJS What there is to go wrong

3. RJS How and why the heart goes wrong VALVES MUSCLE VESSELS ELECTRICS

4. RJS How and why the heart goes wrong MUSCLE VALVES VESSELS ELECTRICS

5. RJS How and why the heart goes wrong

6. RJS How and why the heart goes wrong

7. RJS How and why the heart goes wrong MUSCLE Malformed connections holes Cardiomyopathy hypertrophic dilated restrictive Hypertensive disease Remodelling

8. RJS How and why the heart goes wrong VALVES Congenital malformed Acquired rheumatic fever infective endocarditis trauma degenerative floppy senile calcification

9. RJS Heart Valve lesions Mitral stenosis Aortic stenosis Pulmonary stenosis Tricuspid stenosis Prosthetic stenosis Mitral regurgitation Aortic regurgitation Pulmonary regurgitation Tricuspid regurgitation Prosthetic regurgitation

10. RJS

11. MS echo

12. RJS Aortic Stenosis - aetiology Congenital – bicuspid valve Acquired –Rheumatic –Senile/degenerative

13. RJS Aortic stenosis

14. RJS Echo AS

15. RJS AR - xray

16. RJS AR - Echo

17. RJS How and why the heart goes wrong VESSELS Malformed Atheromatous disease stenosis narrowing myocardial ischaemia angina occlusion blockage myocardial infarction dilatation aneurysmal dissection

18. RJS

29. How and why the heart goes wrong ELECTRICS Malformed inadequate connection excessive connection Molecular instability Degenerative Bystander MI, infection, cardiomyopathy

30. RJS

34. Sinus node disease

35. RJS AV node disease Complete (3rd degree) heart block

36. RJS What there is to go wrong

37. RJS Atrial flutter

38. RJS Atrial fibrillation

39. RJS What there is to go wrong

40. RJS AV nodal re-entry tachycardia

41. RJS What there is to go wrong

42. RJS Ventricular tachycardia

43. RJS Torsades de Pointes

44. RJS Rhythm Strip During Episode of Sudden Death

45. RJS Implanatable defibrillator in-situ

46. RJS How and why the heart goes wrong

47. RJS

48. How and why the heart goes wrong

49. RJS Mitral regurgitation – pathophysiology Leaking mitral valve  LV emptying  LV filling  LV dilatation LV stretch  contractile failure  LA pressure LA stretch Atrial arrhythmia (atrial fibrillation) Thrombo-embolic risk –stroke (cerebrovascular accident) –heart attack (myocardial infarct)

50. RJS Mitral regurgitation – pathophysiology Leaking mitral valvevalve  LV emptying  LV filling  LV dilatation LV stretch  contractile failuremuscle  LA pressure LA stretch Atrial arrhythmia (atrial fibrillation)electrics Thrombo-embolic risk –stroke (cerebrovascular accident) –heart attack (myocardial infarct)vessels