Premature Ventricular Contractions - Significance:
- Symptoms (SOB, Frequent cause of palpitation)
- Cardiomyopathy
- Not all patient with PVC have cardiomyopathy
- Burden above 10-25 % if often implicated
- Chicen or Egg?
- Mortality
- increased Mortality after MI
- increased mortality with LVH
- EF < 35 %
- Frequency did not provide prognostic information in this patient group
- Short coupled PVCs
- < 300 ms. Risk of increased V. Tach
- R on T phenomenon
- Suggest short QT
- Family history is relevant for appropriate risk stratification
- Exercise test in select few patients
- Esp if ischemia is a concern
- If provoked by exercise
- Location of PVC
- mostly outflow tract
- RVOT foci
- LVOT foci
- Difficult to identify the foci
- Outfolow tracts are inter winded to each other
- valve annulus
- others...
- Mechanism of PVC
- cAMP mediated Ca dependent delayed activation
- few have macrorenterant mechanism
- Treatment
- Usually dictated by symptoms
- No specific therapy
- Meds:
- BB (if they can tolerate)
- 10-15 % patient will have 90% reduction
- CCB (less data)
- Fasicualr PVC, Short coupled
- Anti-arrythmic drugs
- may be better, but may not have survival advantage
- Surgery:
BRADYCARDIA: 1st / 2nd / 3rd degree / Sinus - Symptomatic / Asymptomatic - etiology (drugs, MI etc) - treatment plan.
Pacemaker - Indications
- SN dysfunction: HR < 40
- AV Block
- Symptomatic any type
- Aymptomatic
- 3rd AV Block, Infra-husian 2nd (EP study parameters), any Mobitz II
- 2nd AV block with rates < 40 bpm or pauses > 3s
- Bifascicular AV block
- Alternating BBB, syncope of unknown cause
- Neuromuscular Diseases
- Post-MI
- Neurocardiogenic Disorders
- Carotid Sinus Hypersensitivity
- ? Vasovagal syncope
- References
Role of Thrombin
- Causes Fibrin formation,
- Also, causes platelet activation and stabilizes the clot
Caution in a fib vs MAT
Atrial tissue does not rely on coronary vasculature for oxygen. Hence, Stress test is done only in a symptomatic patient.
|
|