Cardiac CTCalcium

Taylor et al – PACC Study – JACC 2005

-2000 patients, mean age 43

-Coronary calcium was associated with an 11.8-fold increased risk for incident coronary heart disease (CHD) (p  0.002) in a Cox model controlling for the Framingham risk score.

-In young, asymptomatic men, the presence of coronary artery calcification provides substantial,

cost-effective, independent prognostic value in predicting incident CHD that is incremental to measured coronary risk factors.

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Pacemakers & defibrillators

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TREATMENT OF HYPERTENSION

This chapter reviews the currently available classes of drugs used in the treatment of hypertension. To best appreciate the complexity of selecting an antihypertensive agent, an understanding of the pathophysiology of hypertension and the pharmacology of the various drug classes used to treat it is required. A thorough understanding of these mechanisms is necessary to appreciate more fully the workings of specific antihypertensive agents. Among the factors that modulate high blood pressure, there is considerable overlap. The drug treatment of hypertension takes advantage of these integrated mechanisms
to alter favorably the hemodynamic pattern associated with high blood pressure.

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Simulation training Curriculum

Constrictive Pericarditis

-64 year old female

-1 Year s/p 3-vessel CABG 

-Presents with 6 months of progressive dyspnea and atypical chest pain 

-At angiography, all grafts are patent

-Hemodynamics

Restrictive Cardiomyopathy

-43 year old female presented with predominant right heart failure (peripheral edema, ascites)

-Hemodynamic tracings suggest constrictive-restrictive physiology

-Exploratory thoracotomy excluded the presence of constrictive pericarditis

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Sex and the Heart

When can I start having sex again?

After myocardial infarction or CABG

After angioplasty or stent

After myocardial infarction or CABG

--After 2-3 weeks

After angioplasty or stent

--After 2-3 days

What about sex with my angina?

If stable angina and

-Can walk 1 mile in 20 minutes on the flat or

-Can walk down 13 steps in 10 seconds

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ACC Heart Failure Guidelines

LIMITNG/CONTROLLING FACTORS IN THE MARINE ENVIRONMENT

-OCEAN CURRENTS/CIRCULATION

-TEMPERATURE

-DEPTH

-LIGHT

-SALINITY

-NUTRIENTS

TEMPERATURE

-Temperature as the most important abiotic factor in the environment for most marine organisms.

-It regulates metabolism growth and reproduction

-It limits geographic ranges and regulates interactions with other environmental variables.

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Is Hyperdynamic Left Ventricular Ejection Fraction a Poor Prognostic Factor?

Background

Left ventricular function is an important factor to predict mortality in patients. However it has not been well studied if hyperdynamic left ventricular ejection fraction has the same prognosis as normal left ventricular ejection fraction.

Methods

We studied 11469 patients undergoing exercise stress echocardiogram at Kansas university medical center.  

Patients with EF (55%) were included in the study. 

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Right heart hemodynamics

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Heart Anatomy and Physiology II

Heart Defects

=Septal defect - condition in which there is an opening in the interatrial or interventricular septum, allowing improper movement of blood 

=Atrial defects allow blood to move from right to left, while ventricular defects allow blood to move from left to right 

=Septal defects result in pulmonary hypertension, difficulty in breathing and fatigue

=They can be fatal if left untreated in childhood 

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How to perform and interpret an Exercise Test

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Key Points of Exercise Testing

-Manual SBP measurement (not automated) most important for safety

-Adjust to clinical history (couch potatoes)

-No Age predicted Heart Rate Targets

-The BORG Scale of Perceived Exertion

-METs not Minutes

-Fit protocol to patient (RAMP)

-Avoid HV and cool down walk

-Use standard ECG analysis/ 3 minute recovery/ use scores

-Heart rate recovery 

-Expired Gas Analysis?

How to read an Exercise ECG

-Good skin prep

-PR isoelectric line

-Not one beat

-Three consistent complexes

-Averages can help

-Garbage in, garbage out

-Three minute recovery 

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Hypertension: New Concepts, Guidelines, and Clinical Management

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Laboratory Tests

--Routine Tests

 -Electrocardiogram 

 -Urinalysis 

 -Blood glucose, and hematocrit 

 -Serum potassium, creatinine, or the corresponding estimated GFR,and calcium

 -Lipid profile, after 9- to 12-hour fast, that includes high-density and

--low-density lipoprotein cholesterol, and triglycerides  

--Optional tests 

-- Measurement of urinary albumin excretion or albumin/creatinine ratio  

More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved

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How to be a Successful Interventional Fellow

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