What would you do now?

A 7-2year-old man presents with increasing symptoms of dyspnea and chest pain
on exertion over the past 6 months. He had 2 episodes of near syncope
while climbing stairs. No prior cardiac history.
■ BP 130/50 mmHg and pulse 70 bpm
■ JVP normal and 2 carotid delay
■ LV sustained and displaced; S4 present
■ 2/6 SEM at the base with mid peak
■ 2/6 diastolic decrescendo murmur
Echocardiography
■ Moderately dilated LV cavity
■ Mild LVH
■ Mild LA enlargement
■  Calcified Aortic Valve
■ Mean aortic valve gradient 25mmHg
■ AR probably mild

What would you do now?
a. TEE
b. Coronaries then AVR
c. TMET
d. Cardiac catheterization with arterial-venous gradient, CO, root, and coronary
angiography
e. Medical observation




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What do you Think ?

A 16-year-old girl was admitted to the CCU after an aborted
sudden cardiac death. The patient was awakened to answer a telephone call and
suddenly collapsed. The fall was witnessed by people and a rapid 911 call allowed the paramedics
to arrive within couple of minutes. The patient was in VF and was successfully
defibrillated with single shock. She remained comatose and was immediately intubated and
transported to the local hospital.
On physical examination she was intubated and withdrew to painful stimuli. Her
pupils were dilated, but they were reactive to light symmetrically. Her past medical history
is remarkable for 3 brief fainting episodes. She was not using any medication. The mother denied knowledge of substance abuse. Her family history is notable for a sister who died suddenly at the age of 20 years.

What can be the most probablediagnosis at this time?
a. Brugada syndrome
b.  HCM
c. RVOT tachycardia
d.  Idiopathic VF
e. Long QT syndrome


 
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Risk Factors for Myocardial Infarction (Heart Attack)

• Diabetes Mellitus
• Hypercholesterolemia (High Levels of Cholesterol in the Blood)
• Low HDL
• High Level of Triglycerides
• Hypertension or High Blood Pressure
• Positive Family History of Ischemic Heart Disease
• Obesity
• Age Factor - Man is at risk coronary artery disease at the age of 45 on he other hand women acquire an independent risk factor at the age of 55
• Hyperhomocystenemia ( It is a toxic amino Acid which rises in the body in case there are insufficient levels of Vitamin B12, B6 and B2
• Occupational or Domestic Stress
• Prolonged Intake of high quantities of Alcohol
• Intake of combined Oral contraceptive pills in Women

Causes of Atrial Fibrillation

• Hypertension or High blood presure
• Coronary Artery Disease
• Mitral Stenosis due to Rheumatic Heart Disease
• Mitral Regurgitation
• Pericarditis
• Congenital Heart Disease
• Previous Heart Surgery
• Lung Cancer
• Pneumonia
• Pulmonary Embolism
• Sarcoidosis
• Binge Drinking
• Carbon Monooxide poisoning
• Dual Chamber Pacemakers in Presence of Normal AV conduction
• Friedrich`s Ataxia
• Family History of Atrial Fibrillation