clinical conference by faizul haque date presented: 12/4/2007 department of cardiology university of...
TRANSCRIPT
![Page 1: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/1.jpg)
CLINICAL CONFERENCE
CLINICAL CONFERENCE
By Faizul Haque
Date Presented: 12/4/2007
Department of Cardiology
University of Illinois at Chicago
By Faizul Haque
Date Presented: 12/4/2007
Department of Cardiology
University of Illinois at Chicago
![Page 2: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/2.jpg)
• 58 y/o F who had initially presented to outside hospital for severe palpitations + lightheadedness:– she states the sx of palpitations started within
2d prior to recent admission: she has had intermittent hx of palpitations since 2003
– she has had some associated LH: denies any syncopal episodes
– patient denies any CP/SOB/DOE per review– Patient referred to UIC EP for further
evaluation/management
• 58 y/o F who had initially presented to outside hospital for severe palpitations + lightheadedness:– she states the sx of palpitations started within
2d prior to recent admission: she has had intermittent hx of palpitations since 2003
– she has had some associated LH: denies any syncopal episodes
– patient denies any CP/SOB/DOE per review– Patient referred to UIC EP for further
evaluation/management
CASE
![Page 3: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/3.jpg)
• pMHx/pSurghx:– Hx of mitral stenosis + severe MR
• MVR+TV repair in 4/2004 at outside hospital• Redo bioprosthetic MVR + TV repair recently in
8/07 at outside hospital
– Hx of HTN– Hx of depression– Hx of HL
• pMHx/pSurghx:– Hx of mitral stenosis + severe MR
• MVR+TV repair in 4/2004 at outside hospital• Redo bioprosthetic MVR + TV repair recently in
8/07 at outside hospital
– Hx of HTN– Hx of depression– Hx of HL
Past Hx
![Page 4: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/4.jpg)
• O: V/S – 97.1 – 104/60 - ~100bpm• Gen: NAD; resting upright• Neck: JVP at 6cmH20• Chest: b/l CTA; no wheezes or crackles
noted• CV: rr nl s1s2 no s3s4 noted; no RV
impulse • Abd: +BS• Ext: no b/l LEE noted
• O: V/S – 97.1 – 104/60 - ~100bpm• Gen: NAD; resting upright• Neck: JVP at 6cmH20• Chest: b/l CTA; no wheezes or crackles
noted• CV: rr nl s1s2 no s3s4 noted; no RV
impulse • Abd: +BS• Ext: no b/l LEE noted
Physical Exam:
![Page 5: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/5.jpg)
• Medications: current– Metoprolol 12.5mg BID– ASA 325mg qD– Lasix 20mg qD– Zocor 20mg qHS
coumadin 5mg + 2.5mg alternating qD
• Medications: current– Metoprolol 12.5mg BID– ASA 325mg qD– Lasix 20mg qD– Zocor 20mg qHS
coumadin 5mg + 2.5mg alternating qD
Med Hx:
![Page 6: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/6.jpg)
![Page 7: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/7.jpg)
![Page 8: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/8.jpg)
• TTE: 11/07– 1. Left atrium mildly dilated: 4.41cm– 2. Global normal LV function: EF 50-55%– 3. Global normal RV size + function– 4. Peak TV TR at 2.7m/sec, PA 38mmHg
• TTE: 11/07– 1. Left atrium mildly dilated: 4.41cm– 2. Global normal LV function: EF 50-55%– 3. Global normal RV size + function– 4. Peak TV TR at 2.7m/sec, PA 38mmHg
Clinical Questions:
![Page 9: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/9.jpg)
• Prototypic macroreentrant atrial rhythm
• Typical/atypical atrial flutter:• Reentrant rhythm in the R atrium constrained
anteriorly by the tricuspid annulus and posteriorly by the crista terminalis and eustachian ridge
• Typical atrial flutter usually defined by counterclockwise versus clockwise rotation along the macroreentrant circuit
• Prototypic macroreentrant atrial rhythm
• Typical/atypical atrial flutter:• Reentrant rhythm in the R atrium constrained
anteriorly by the tricuspid annulus and posteriorly by the crista terminalis and eustachian ridge
• Typical atrial flutter usually defined by counterclockwise versus clockwise rotation along the macroreentrant circuit
Atrial Flutter: Basics
![Page 10: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/10.jpg)
Hx
![Page 11: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/11.jpg)
• Typical atrial flutter [Type I]• Identically recurring sawtooth flutter [F] waves best
visualized in II, III, AVf + V1• Inverted [negative] flutter waves in II, III, AVf due to
counterclockwise reentry• Upright [positive] flutter waves in II, III, AVf present
during clockwise reentry• Involves the cavotricuspid isthmus [CTI]
• Atypical atrial flutter• Not involving CTI: could be from prior atrial
surgery/ablation, idiopathic fibrosis, L atrial origination around the mitral annulus
• Typical atrial flutter [Type I]• Identically recurring sawtooth flutter [F] waves best
visualized in II, III, AVf + V1• Inverted [negative] flutter waves in II, III, AVf due to
counterclockwise reentry• Upright [positive] flutter waves in II, III, AVf present
during clockwise reentry• Involves the cavotricuspid isthmus [CTI]
• Atypical atrial flutter• Not involving CTI: could be from prior atrial
surgery/ablation, idiopathic fibrosis, L atrial origination around the mitral annulus
Aflutter: ECG Criteria
![Page 12: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/12.jpg)
• Which patients are considered ideal candidates for catheter-based atrial flutter ablation?
• Ideally patients with cavotricuspid isthmus dependent atrial flutter or typical atrial flutter as opposed to atypical CTI-independent scenarios
• Which patients are considered ideal candidates for catheter-based atrial flutter ablation?
• Ideally patients with cavotricuspid isthmus dependent atrial flutter or typical atrial flutter as opposed to atypical CTI-independent scenarios
Clinical Questions:
![Page 13: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/13.jpg)
Aflutter Ablation
![Page 14: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/14.jpg)
Clinical Questions:
![Page 15: CLINICAL CONFERENCE By Faizul Haque Date Presented: 12/4/2007 Department of Cardiology University of Illinois at Chicago By Faizul Haque Date Presented:](https://reader036.vdocument.in/reader036/viewer/2022062423/56649f0e5503460f94c2296b/html5/thumbnails/15.jpg)
Clinical Questions: