1. Dirty Laundry

4. 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

10. 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

11. 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.

16. 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

23. 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