By Phillip A Kalra
Crucial Revision Notes For MRCP- Jaypee Brothers scientific -Phillip A Kalra-2015-EDN-4
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Often imaging is performed during the procedure to guide valve placement. It has particular usefulness in congenital heart disease. It can be performed using either transthoracic or transoeophageal approaches. Intravascular ultrasonography (IVUS) is performed by placing a small probe mounted on a catheter on an intracoronary wire during coronary angioplasty. It provides high-resolution imaging of coronary arteries for measurement of stenosis severity and plaque characteristics, and assessment of the success of stent deployment.
Treatment is aimed at ventricular rate control, cardioversion, prevention of recurrence and anticoagulation. Catheter ablation is indicated in symptomatic individuals who are resistant to, or intolerant of, medical therapy. With AF, a major decision is whether to control rate or alter the rhythm: Surprisingly, rhythm control does not reduce the risk of stroke (indeed paroxysmal AF carries the same stroke risk as chronic AF) and therefore does not affect the indications for anticoagulation • Cardioversions, multiple drugs and ablations are all used to alter rhythm • In asymptomatic individuals, rate control is recommended.
Fixed splitting of the second heart sound is the hallmark of an uncorrected ASD. There may be a left parasternal heave and a pulmonary ESM due to increased blood flow. There are three main subtypes: • • • Secundum (70%): central fossa ovalis defects often associated with mitral valve prolapse (10–20% of cases). ECG shows incomplete or complete RBBB with right axis deviation. Note that a PFO (slit-like deficiency in the fossa ovalis) occurs in up to 25% of the population, but this does not allow equalisation of atrial pressures, unlike ASD Primum (15%): sited above the AV valves, often associated with varying degrees of MR and TR and occasionally a VSD, and thus usually picked up earlier in childhood.