TABLE A-1
RECURRENCE RISKS GIVEN ONE SIBLING WHO HAS A CARDIOVASCULAR ANOMALY
| Anomaly | Suggested Risk (%) |
|---|---|
| Ventricular septal defect | 3.0 |
| Patent ductus arteriosus | 3.0 |
| Atrial septal defect | 2.5 |
| Tetralogy of Fallot | 2.5 |
| Pulmonary stenosis | 2.0 |
| Coarctation of the aorta | 2.0 |
| Aortic stenosis | 2.0 |
| Transposition of the great arteries | 1.5 |
| Atrioventricular canal (complete endocardial cushion defect) | 2.0 |
| Endocardial fibroelastosis | 4.0 |
| Tricuspid atresia | 1.0 |
| Ebstein’s anomaly | 1.0 |
| Persistent truncus arteriosus | 1.0 |
| Pulmonary atresia | 1.0 |
| Hypoplastic left heart syndrome | 2.0 |
Modified from Nora JJ, Nora AH: The evaluation of specific genetic and environmental counseling in congenital heart diseases. Circulation 57:205-213, 1978.
TABLE A-2
AFFECTED OFFSPRING GIVEN ONE PARENT WITH A CONGENITAL HEART DEFECT
| Defect | Mother Affected (%) | Father Affected (%) |
|---|---|---|
| Aortic stenosis | 13.0–18.0 | 3.0 |
| Atrial septal defect | 4.0–4.5 | 1.5 |
| Atrioventricular canal (complete endocardial cushion defect) | 14.0 | 1.0 |
| Coarctation of the aorta | 4.0 | 2.0 |
| Patent ductus arteriosus | 3.5–4.0 | 2.5 |
| Pulmonary stenosis | 4.0–6.5 | 2.0 |
| Tetralogy of Fallot | 6.0–10.0 | 1.5 |
| Ventricular septal defect | 6.0 | 2.0 |
From Nora JJ, Nora AH: Maternal transmission of congenital heart disease: New recurrence risk figures and the questions of cytoplasmic inheritance and vulnerability to teratogens. Am J Cardiol 59:459-463, 1987.
TABLE A-3
NEW YORK HEART ASSOCIATION FUNCTIONAL CLASSIFICATION ∗
| Class | Impairment |
|---|---|
| I | The patient has the disease, but the condition is asymptomatic. |
| II | The patient experiences symptoms with moderate activity. |
| III | The patient has symptoms with mild activity. |
| IV | The patient’s condition is symptomatic at rest. |
∗ This is a classification of functional impairment in exercise capacity based on symptoms of dyspnea and fatigue. It is simple and useful in the evaluation of cardiac patients.
TABLE A-4
SUMMARY OF ANTIARRHYTHMIC AGENTS
| Class | Mechanism of Action | Examples | Remarks |
|---|---|---|---|
| I | Sodium channel blockers Delays phase 0 of the action potential and slows conduction velocity in the tissue | Has a significant proarrhythmic effect | |
| IA | Slows the rate of rise of phase 0 and prolongs the refractory period | Quinidine Procainamide | Major effect on QTc and QRS prolongation |
| IB | Minimal effect on phase 0 and refractory period | Lidocaine Mexiletine | Least proarrhythmic among class I agents |
| IC | Marked depression in conduction velocity with minimal effects on refractoriness | Flecainide Propafenone | Major effect on PR and QRS duration |
| II | Beta-blockers | Propranolol (β1 + β2) Atenolol (β1) Nadolol (β1 + β2) Esmolol (β1) | Minor effects on ECG |
| III | K-channel blockers Delaying repolarization | Amiodarone Sotalol Dofetilide Ibutilide | Has a significant proarrhythmia Major effect on QT prolongation |
| IV | Ca-channel blockers (slows inward Ca 2+ current) Slows conduction velocity and increases refractoriness in the AV node | Verapamil Diltiazem | Minor effects on ECG |
AV, Atrioventricular; ECG, electrocardiogram.
TABLE A-5
EFFECTS OF ANTIARRHYTHMIC AGENTS ON THE ECG
| Class | Drug | PR | QRS | QT |
|---|---|---|---|---|
| I | ||||
| IA | Quinidine | ± | ↑↑ | ↑↑↑ |
| Procainamide | ± | ↑ | ↑↑ | |
| IB | Lidocaine | ± | ± | ± |
| Mexiletine | ± | ± | ± | |
| IC | Flecainide | ↑↑ | ↑↑ | ↑ |
| Propafenone | ↑↑ | ↑↑ | ± | |
| III | Amiodarone | Acu ± Chr ↑ | Acu ± Chr ↑ | Acu ± Chr ↑↑↑ |
| Sotalol | ↑ | ± | ↑↑↑ | |
| Dofetilide | ± | ± | ↑↑↑ | |
| Ibutilide | ± | ± | ↑↑↑ |
Acu, Acute effect; Chr, chronic effect
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
