Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1528 Ventricular Septal Defect (VSD) Ventricular Tachycardia

management

■Endocarditis prophylaxis indicated

specific therapy

■Surgical closure recommended when pulmonary to systemic shunt

ratio >2:1, patient develops symptoms or significant aortic insuffi-

ciency is present

follow-up

■Leak of VSD patch may occur-detected by echocardiography

■Endocarditis prophylaxis for first 6 months after surgery

complications and prognosis

Complications

■Most common congenital heart defect to lead to Eisenmenger’s syn-

drome (right-to-left shunting associated with pulmonary hyperten-

sion)

Prognosis

■May close spontaneously up to age 20

■Small VSDs (“maladie de Roger”) have benign course

■Uncorrected larger VSD’s in adults have a 76% ten-year survival

VENTRICULAR TACHYCARDIA

EDMUND C. KEUNG, MD

history & physical

History

■Often associated with structural heart diseases, most commonly

coronary artery disease, especially acute myocardial ischemia and

infarction

■Risk factors include prior myocardial infarction and reduced LV func-

tion.

■Related to antiarrhythmic drug treatment (torsades de pointes)

■Arrhythmogenic right ventricular cardiomyopathy

■Can occur in the absence of structural heart disease: congenital long

QT syndrome, Brugada syndrome, idiopathic left ventricular tachy-

cardia and idiopathic right ventricular outflow tachycardia