arotic stenosis

sugery indication:

-aortic stenosis include a gradient of 50 mmHg or more,

– or associated symptoms such as syncope, breathlessness and episodes of pulmonary oedema.

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flash pulmonary edema

In medicine, flash pulmonary edema (FPE), is rapid onset pulmonary edema.

-It is most often precipitated by acute myocardial infarction or mitral regurgitation, but can be caused by aortic regurgitation, heart failure, or almost any cause of elevated left ventricular filling pressures. Treatment of FPE should be directed at the underlying cause, but the mainstays are ensuring adequate oxygenation, diuresis, and decrease of pulmonary circulation pressures.

Recurrence of FPE is thought to be associated with hypertension[1] and may signify renal artery stenosis.[2] Prevention of recurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure

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Atrial septal defect

types :

1 Ostium secundum atrial septal defect

The ostium secundum atrial septal defect is the most common type of atrial septal defect, and comprises 6–10% of all congenital heart diseases.

Most individuals with an uncorrected secundum ASD do not have significant symptoms through early adulthood. More than 70 percent develop symptoms by about 40 years of age. Symptoms are typically decreased exercise tolerance, easy fatigueability, palpitations, and syncope.

Complications of an uncorrected secundum ASD include pulmonary hypertension, right-sided heart failure, atrial fibrillation or flutter, stroke, and Eisenmenger’s syndrome.

2 Patent foramen ovale

A patent foramen ovale (PFO) is a small channel that has some hemodynamic consequence; it is a remnant of the fetal foramen ovale. Clinically it is linked to decompression sickness, paradoxical embolism and migraine. On echocardiography, there may not be any shunting of blood noted except when the patient coughs.

There is debate within the neurology and cardiology communities about the role of a PFO in cryptogenic (i.e. of unknown cause) neurologic events such as strokes and transient ischemia attacks (TIAs) without any other potential cause.

3 Ostium primum atrial septal defect

A defect in the ostium primum is occasionally classified as an atrial septal defect,[9] but it is more commonly classified as an atrioventricular septal defect.[10][11] Ostium primum defects are less common than ostium secundum defects.

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JVP wave

JVP waveform The Jugular Venous Pressure WaveformThe jugular venous pulsation has a biphasic waveform.

-The ” a ” wave corresponds to right Atrial contraction and ends synchronously with the carotid artery pulse. The peak of the ‘a’ wave demarcates the end of atrial systole. The ” x ” descent follows the ‘a’ wave and corresponds to atrial relaXation and rapid atrial filling due to low pressure.

-The ” c ” wave corresponds to right ventricular Contraction causing the triCuspid valve to bulge towards the right atrium.  tricuspid valve closure  is marked by c  wave

-The ” x’ ” (x prime) descent follows the ‘c’ wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole. The x’ (x prime) descent can be used as a measure of right ventricle contractility.

-The ” v ” wave corresponds to Venous filling when the tricuspid valve is closed and venous pressure increases from venous return – this occurs during and following the carotid pulse.

-The ” y ” descent corresponds to the rapid emptYing of the atrium into the ventricle following the opening of the tricuspid valve.

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long QT vs shortened QT

long QT causes:

– hypokalemia,  hypocalcaemia, hypomagnesaemia,

-med: antipsychotics, antidepressants(TCA, SSRI),  anti-histamin (terfenadine/Seldane), antiarrythmics(class 1a and 3), antibiotics( Erythromycin), antifungals, diabetic meds, choleterol control meds,

 

shorten QT:

-Hypercalcaemia, hypermagnesaemia,

– digoxin, or thyrotoxicosis

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down’s syndrome

-21 trisomy ,
– flat face, slanting eyes, epicanthic fold, small ear, simian creases, short stubby fingers, learning difficulties, hypotonia,
– congenital heart diseases: 50%
– An atrioventricular septal defect (endocardial cushion defect) is the most common form (40% )
ventricular septal defect that affects approximately 35% of patients

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xanthoma and hyperlipidaemia

1 hypertriglyceridaemia: eruptive xanthoma(skin), rentinal vein thrombsis
2 hypercholesteralaemia: tendon xanthoma(Axilles tendon, finger tendons),
3 Remnant hyperlipidaemia: increased triglyceride and LDL, low HDL, tuberous xathoma(elbow, knee) ,palmar crease xanthoma(diagnostic)

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