Atrial fibrillation

Koch’s triangle- Tricuspid ring, tendon of Todoro, coronary sinus(base), near the His bundle (apex), anterior third(fast pathway), posterior third(slow) Characteristic- Sustained arrhythmia, easy diagnosed, hard to treat Mechanism  1.Multicircuit reentry- atrial enlargement, structural heart disease 2.Macroreentry with fibrillatory conduction(mother wave)- young, no structural heart disease, pulmonary vein ablation 3.Hyperexcitably(rapid firing atrial foci) Pattern 1.paroxysmal: 25%, […]

Aneurysm

Definition- Diameter>1.5 fold, 1~1.5 fold called ectasia Site- Abdominal aorta> thoracic aorta> abdominal+iliac> thoracic+abdominal> iliac> popliteal> femoral Risk factor- Aging, male, HTN, smoking, HyperTG, Marfan syndrome Type 1.True aneurysm- 3 layers 2.False aneurysm- 1 or 2 layers 3.Fusiform aneurysm- Artherosclerosis, AAA(95%infrarenal) 4.Saccular aneurysm- Syphilis, ascending and arch 5.Degenerative aneurysm- atherosclerosis 6.Infected(mycotic) aneurysm 7.Traumatic/dissection 8.Microaneurysm- HTN(Charcot-Bouchard […]

Aortic dissection

Definition- Tunica media and adventitia form false lumen Acute- <14 days Type 1.Stanford- Type A(Ascending aorta, ⅔ ), Type B(Not involve ascending aorta, ⅓ ) 2.Debakey- Tpe I(Ascending and descending), Type II(Ascending), Type III(Descending) Etiology- HTN, Marfan, Artherosclerosis, CoA, trauma, Pregnancy 3rd trimester Presentation- Chest tearing pain, back pain, diaphoresis, dyspnea Complication- Coronary(AMI), Aortic valve(HF), […]

Hypertensive urgency and emergency

Hypertensive urgency- SBP≥180 and/or DBP≥120  Hypertensive emergency- With organ damage Evaluation- Head injury, neurological symptoms(generalized, focal), papilledema, nausea, vomiting, chest discomfort, acute back pain, dyspnea, pregnancy Treatment- 1st hr reduced 10~20%(<180/<120 mmHg), 5~15%(<160/<110 mmHg) the next 23hrs Exception: 1.Ischemic stroke- Patient received reperfusion therapy with BP≥185/110 mmHg or BP≥220/120 mmHg for who cannot received reperfusion […]