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is to say that it's been, like streamed. It would just have this. I got out there, town. I'm going to get bone and check that it is actually going for you. Okay, Today's and thank you to him. So how could start whenever you want me to Just give me the knowledge or the intro? Yeah, Yeah, it's only been on it the moment, a long time And what you can speak for a long as you're like, honestly, But we last time, I think it went on until about 8. 15 s o doctor, Don't know who had from here a 45 minute, 15 minute talk on Then we had a like a 10 15 minute quizzes the end on drum. The feedback from the last event that was very useful, like students found that it was nice to consolidate that in. And, um, at the end on kind of makes them listen to start as well. Just to say Tania, life stream seems to be working there on, but it seems to be working well with it. And delay, which is good, are big. Okay, we give it about three minutes and then start on seven o'clock. So at 7. 12 anyway, smiles Did you have that? You think that I don't? You, um just if you put it on your phone and the perfect amazing, very professor, you're good plan in time. You know, I was scared of not doing what I was told then. Okay, we have 36 members on it. The moment on for the last drug. I think the numbers do, you know, go up by about 7. 10 past seven. So I think we should just make a start. It That's okay. Okay. So I know everyone. My name's tear in. And I'm secretary for the Queen's GP Society, and I'm here with Markus today. Who's president off? Queens, Child. How stock? I don't think so much for coming to our second talk of the series, which is on heart disease. And Children, which is gonna be delivered by doctor, understands not a sound. Is a consultant pediat, pediatric cardiologist on. He'll be taking us through the talk. If you have any questions during the talk, you just typed them into the chat function. That's just next to the video on. He can address them up the end. There's like They're also available on the downward on the event page out. But you do have to open the vent page up on either Internet Explorer or Google Chrome to be able to download them properly on Just before I handle the Docksides. I wanted to make you aware that we have report prepared a short quiz to, um, kind of use at the end of the session to consolidate your learning. So do you stick around for that as well? So, yeah, that's all for me and on to that sounds. First of all, thank you very much. Time for the introduction of Thank you for the invitation to come in. It'll save me and you'll see the date on This is from a month ago when I started Harry. I've tried to put together a few different things from other talks that I've given on day, I hope. And let me know if you can't hear me on. Don't stop trying to sort that out for you trying to advance my slides, which no, actually changing this is It's like water. We'll find out upper sounds. If you maybe just collect on your slides, it might bring it on to the right thing. First of all, just here you go. Work. So let me just pull back. Yeah, Okay, that's better. So I mean, you probably know that much of congenital heart disease and Children are much of the heart disease. It's congenital I'm having for almost 1% of life. Earth's affected by congenital heart disease. Quite a lot of the night is diagnosed intimately going to say a little bit about acquired heart disease as well. Traditionally, we often break up congenital heart disease in to sign off a Sinus condition. So I guess I'd say a little bit about that, too. Talk a bit of my presentation symptoms and signs off heart disease in kids on the Byetta by heart rhythm problems. Too much so something that management of heart disease. And then we'll talk. Probably fair bit of I associate it concerns because many of you will be familiar with hurt something of congenital heart disease before. But increasingly, over the last few years, we've not seen lots of referrals about miscellaneous type. Heart conditions are man fact help assist your heart. All things like Jaspin palpitations, sudden cardiac death screening for congenital on for heart. Heart disease is so I hope that that will get you the overview served work what we do. Um, particularly of relevance, I think to the general practitioner, though if I stretch it beyond that, you feel correct Me. Bring me back to things that interest you. Let me think of a congenital heart disease. Many of you might have seen this slider one like for thinking of silent conditions on the left hand side. Not we include things like transposition. Great arteries challenge your follow Looking almost for maybe in a strange trees on the other side basically have the conditions that are so called left right chumps of the ST ST Get this on any obstructive lesions. Homelessness. It's a wart. It's most is cortication of the order on at the bottom. Hyperplastic left parts of you. We could talk, my friend, are about any of these conditions Family on the B cell. Really bored. You asked me to stop. Quite sure, quite reasonably. But we'll come back to this slide again. So, um, make the point of covering some of the issues bit more detail. I hope you can see this side because I'm going to start until a few stories as well. In the midst of on this presentation, this reminds me, assumes I look at this, I feel my pulse sort of increasing. And I become slightly nervous because I remember the night this particular child present very well. This was a little one who represented first LDL is in the hospital on she waas under a week of age. She who presented to any GP surgery shacks he presented you pee surgery and and very and then went up to me out of between dance of each typical story presented with holler the others just her. She had her color relish. It's fitting body have developed this very stressed. This was after going home pretty early. Um, probably about $63. She was a third child. Just family. This is the typical presentation of time with quantitation of your typically is the doctor's closes. You begin to see a child. I hope you can see this little moving images Well, because here we see descending aorta coming. I rather torches raggedly We're just to be or not just here just for the doctors plugs in. And this is after being on prostate gland. And for sometime we see that rare jets little back up into the duct and hormonally are shoe this very tight area of coarctation of narrowing. So this child, presented in severe heart failure really struggling. I'm at about three days of each, having gone home really well and we'll pulses weren't palpable. The baby had a big liver was tackled me, contacted, carted, so typical signs of congested. So this is a classic example of duct dependent last heart obstruction. On the weekend we got we see youngster still presenting in this fashion, I would say that one of the reasons that is the difficulty was 19. It'll diagnosis of coarctation of the aorta on the fact that on these little ones tend to be discharged from pretty early, reductive, still open. And if doctors begins to those and if there is a serious quantity issue, then the chances are that's when they're going to get into trouble, as it was mentioned already. So for the, uh, doctor in primary care, this is certainly sort of patient. You can well make some stage. Somebody is going to run it. So what do we do about it? Well, I suppose I have already mentioned that we started last exam When you're seated again, going back to this little bit Here, you see the doctor open their initial. It was moved up Jeff off fluid in the center, like blue Jeff with barely there. So giving cross that opens up the duct, it helps to bypass the instruction on Relax. The very doctor area buys you time trying to turn the clock back, if you like, by a day or two when the doctors more widely open in the child was in better condition. So we also often given the troops in this situation other types of that hardened structure that lasted sending in that situation and in my spirit reintroduces must keep the pulmonary artery pressure high said blood is forced on the pulmonary artery, right to left through the duct into the season. Well, thanks for coarctation of the Ortho. Every correction is possible and Children tend to be very well on the 50% chance of reintervention. Obviously, if you've got a high fasting left, heart will not something that really is amenable to surgery. Well, in the search correction. So that's why I've not really the issue or she just depending on the type of left stretch. This is a classic and really important present issue off conditions such as cooptation of the order. Hyperplastic left heart Medical aortic stenosis is our interrupted. The aorta? Yeah, I've moved to slide on tee shows something slightly. Dan. I'm thinking of newborns of stiff. So I'm thinking of a child. You again is presented time we can without several of these Children. Recently, I would say whole issue of cold and lock down has spent it with a number of Children presenting well of late. Later they might otherwise percent. Often more people ring up and say, Is there a baby that is just That's what somebody has described in dusty off means they're they're worried about scientists. Now I hear lots of stories of lax, loose eat do hands so that little picture on the bottom left is a fit. This bush no actual central cyanosis. Where's the baby? On the bottom, right? Clearly has central Sinuses. And if you could see that babies time, it's really so when people are worried about Sinus. So I would say we'll have a look at the tongue. It's a little service really pretty stiff in a warm bath might into the room electric the flu issue of Harry a little Sinus. Just don't worry so much I ever those were told him that congenital heart disease and stroke heart disease. At this point, this is somebody's truly signers. Little bit Initial actions from here that you should is dusty. Somebody says, You know, we're hearing well, it is really important now is to check the oxygen saturation is most practices, I think. Have you been looking like to check Saturations, Not just the battle sport. Children is. Well, it's slightly different. Prove past your saturation a little bit differential by sees. Well, I always think that when cyanosis in newborn babies, it really boils. Started one of two things. Either there is a general heart disease or that this severe risk for disease, I mean, has to be severe. More on to tell the difference. Well, traditional way is get oxygen get high source for five minutes. On doing so. You expect these lung disease saturations were improvements the mid nineties, whereas if it's true, congenital heart disease, that's not like, you know, like you left the MRI of sciences classification is that you shouldn't give Foster for long periods of time with sign off heart disease. That might end because it tends to constrict with this. So but I can, uh, definitive diagnosis on. I'm not going to say maybe three months. It's in to say, Well, what are the things that cause that science is in a small baby? I just mentioned the child. Maybe that's possible It early on. It's fine substance. The scientist, simple transposition and I should see track there. You have blood coming in from I see SPCA into like a tree down into like people going to run the It's going to that they left are she's into pile else sets here, the unproductive love going all the line systemic, sir, on the's. Davies would be an immense trouble. Still way. We're not for some connections that babysat asleep, Doctor. I'm so starting across the ground and on this procedure also this one for years and years ago that have permission to show and boys, Now you're in his twenties. Um, but this is a balloon being blown up within the left atrium. I passed the castle on the family in up into right atrium across the atrial. Second, feel a little in. I pulled the billing back across the actual second tear. A hold of me. What about dogs? If you go back there, you see that as the effect of increasing the size of the foreign body means more take blood. Yes. Call citrates septum done here, down here. So that little procedure I have to buy time in prison else is in saturations. This baby wants to begin with, I should say the cardiac surgery for babies. No, it's not. It's more than any more. This foot instep tossed to me was done worse than doing the exhortation. But see, stating that all together so babies, with this type of a math, you have osteo done usually double knot under surgery. Where you doing arterial switching issue for this transecting that you're working on the switch. So transposition is the most common cause of sign of heart disease. Babies During the first two days of life, collagen followers, the homeless cause of sign of heart disease in your overall time with your family, where you put a V E S t you want to override across the vst obstruction about beyond the valve or all. See, And you got consequent right from this is the four elements make up travel. Just follow. Well, that was the to sign all the conditions of this. I want people to know a bit about what's known about strategy of follow transposition of the heart is between million types of sign off disease. That and what suppose managing? Sure. On, uh, the general management is getting Doctor, baby. Okay, let me take a little movie line with distraction to single bites. Another type of presentation system heard in the 41. Boy, they're all sort of differential is here. This is a very common present. Issue off lots of, well, Children. Well, Children about this when they are, they fought off their inspection very often. I remember this is system record. I stole it. Um, other. Any hot? Sometimes prison. What's the greatest moment? Investigations quite often sponsored The CGM primary cameras be helpful, but this is the typical the nickel present issue in this murmur. Ever said, call my people ask. You know, you don't need this time to come back and we'll know we don't different and, uh, dark A nutrition sweetie often will see these patients before you continue on your cardiology. Actually, general practitioners care conditions will see more of the murmur should be systolic only part of being a summons that you heard of. She's a great story or less so. More succeeded. Thrill. Okay, Heart son should be normal, but also help with position classically with a little vibratory murmur. So, uh, my oldest dishes since the child forward, remember? Also, there was a lot quieter They typically are. Well, Children was normal and that's traditions remembers often sent. You have a different directs, a lot of running harder and faster. Okay, Moving one again. Teo. Consider another element of 80 after a hearty ology that is hard rhythm problems. And he seemed different and then days with Children with heart rhythm problems. So I have one in intensive care and one just like a weekend. Another one coming up for doubling happily. Most Children heart. It's it just right only lost three bears, but we certainly have a visitor too slow and I had a little baby born not so very long ago was congenital. Secondly, to look, this not be nice, that's pretty uncommon. More common of those that are going to fast that's present, typically with super ventricular tachycardia. Want to take them? If I What isn't abnormally fast heart rate? We do need some idea, or what the normal heart rate is for each each of child. Well, typically, we think off babies during the first six months of life been able to manage heart rates to like 200. Maybe just a little about it particular on the way I look. If it gets about that, it's 2 20 in the bus. Begin to think, Let's do fast the Sinus. This is the sort of thing that you might see. I hope you can see the CCP. This is one a while back, but this is a classic example. This creates you. See this very typical Soltys. Lots and lots in where is going very, very fast and you rated by 400 BPM. Night ventricles don't respond. Have responded quite back ribs on, so you tend to get to do one or 321 atrial interested. Get a dream going 400 on the bench, going to to one heavy block atrial flutter. This child had a success are the aversion which I corrected. Problem. Very nice. Yeah. Another ACG on very typical super average, narrow, complex tachycardia. Some routine to 223 100 BPM on off managed fitness. She is that anything House, every blocked record. Cardio one just the other day, who have heart heart aversion to you? Just the same effect. Okay, back to this little slide again just to remind me not to forget by talking about some of the other conditions of the other group that I won't mention. We talked a little bit about transposition of the arteries to travel to your follow. I'm not safe. Too much of these other teas time here. This list is number five teens. I want to talk a bit about the left. Right chance the lesions because flow excessive flow left to right across several defects in the line. This is a sort of thing that we're talking about where there is a sizable contributor said, Do you think Here you see a hold Jember left right, successive. So going up to the home a reaction. This is a habit. Or forcing more more blood up into the lung sometimes twice a much blood on three times four times much backwards on the RC on around the aorta. Because blood loss to the half a least resistance on doing so, you get lots of blood returning to the left atrium last time. Trouble causing stretch for enlargement of the left side. Yeah, this is the signs this Communist sort of left right shunt are his follows the small ones very well tolerated. They often get smaller with time they close larger. BST certainly cause dyspnea her fitting go with you. And, um, that's what you hear from history from such a time on the mentioned to you the Santyl with the covert situation with the number of presentations of BS. These because I think there's been a difficult seeing Children that time. If I should increase the care on second careful and matter, I'm for Jerry. Certain times parents have been a bit to bring your Children to see medical professionals. So the signs of heart failure is with some time this attack. Yeah, that's the classic for trial or signs of congenital are signs of heart failure and small gives terms of treatment. We think of diuretic season Hypotears you're certainly help me. And stay we may do is jump system getting the nutritionist like Lamen Surgical or sometimes Casodex actively passenger there. Plus being been for his doctor sometimes will be ST and certainly for a s t three, right? That any list should congenital versus wired. And I wouldn't want you to think that there are some acquired forms of practice is important. Pretty compensated disease. What types of arteritis robotic are disease, myocarditis, endocarditis. That's a miscellaneous conditions as well. Anything that I should add in here is that falls into the Microtus, have a sack, a group of different quite a number of Children. It on this in multi system inflammatory condition, Colonel, for six weeks after cruel infection variously the virtuous and misty s or um I s C syndrome. But we've had a number of quite sick doing with varying degrees of my head itis, uh, managed. Usually it's in well being high dose steroid titers aspirin. So that's been another thing with this sort of come alone to complicate our lives over the last one started, he's been sitting primary care with some frequency of the moment. It's important that you mention it down. Heart is Is it just by Children? It's a little of grown up with congenital heart disease, sometimes valve relations. Stone center, Javal home. Yes, he's very commonly don't present um, toe. The person is quite a bit older. Sometimes your pregnancy in a state will come to light. Um, interestingly, Cortication of the aorta, so called adult forte shins sometimes doesn't present much better. I recall very well A GP weight correctly sent a young woman 24 years of you checked. It was really marked hypertension, systolic pressure of like 220 no mission Mercury GP, very y Z and correctly said, I can't see with animals, but you're not. That young woman had severe watching issue quiet standing in the center here funder way through the newness of the trouble that you saw. My first patient I mentioned correct Asians. There are some models three with management would want to develop severe. Let's bring the only to the second part is it's more on because quite often you were referred to you know, this sort of run of the metal, congenital heart disease, structural, rather miscellaneous type of symptoms, chest pain, palpitations, underlying all of us. This kind of questions can. Here she is, whatever it is hurting. I've been asked a lot of these questions. Yes, Doctor, that's fine. Your PSA is that this is ms but on It's an interesting question. I think what it's asking. There's actually a sighting. Different queer is this is my chances is the chance of being cardiac in our risks? Um, yeah, yeah, those kind of things, actually. Well, this is This is underlies nice Gym 108 in the mindset. Professionals, too come back to that. That's what This script, for one she things that we might have sort of is very soft known cardiac things before, but actually and yeah, I've become quite a big chunk of the work that we do. Wasn't primary care a little Children. I'm indeed my rolling for the general pediatrician's well, so things like syncope, pre syncope, palpitations, relapse After you know, say too much more this year. This year with exercise, Don't think very grasses used to it all really well, nice breathless may want to run the pitch screening for heart a mile. With these things chance PMS old chest in which on and I don't think you used to see much of this. It'll but increasing easy, which is problem that I have on. Maybe you will have a swell is a chance for him. To most people, names, fractures is okay. Chrisley Justine is really, really common Children on Truthfully, harpy in is really, really rare. As you can see from loose figures, that's a 5%. Just in seven Children will be anything there message to lot of constant chondritis. Uh, also just you never really find out where the chest ones. But I think people equate chest skin very much with parking. I was startled. You know, what can you against Chance is almost no chances, anything to do with our borders If I just Well, it was a fair sense. It's my heart. There's some of the multitudinous forces of chance for you. I'm going to see them all in detail and try this, um, lots of things in the chest wall. So spiritually things of dominance easy second cardiogenic to So their last note, says Muscularis, think it is what it turns out to be. There are cardiac causes, chest pain, uh, dwelling too long because they don't want to get the wrong idea too much on them to show you a couple of calls once a week, maybe see a little more common are very hard. I just type of thing slow, great, pretty young business off the chest. This is a whole suggestion. This is a patient that was like three years of age I had suffered from Hamasaki disease because an infant, this is quite a old angiogram. And see the last column here has been catheterized dice injected into the left arm. It's a large blue light or aneurysm just on the proximal circumplex coronary. Are this little one extensive aneurysms initially and then they improved. Sample left. It's really nasty. Aneurysm endangering. Don't develop the stenosis if the circumplex cause he by chest. This is a really interesting kiss. This is considered here, isn't there? Is gone up from it's either die from. That's fine. We'll have to be passed up with them. ELottery, Just since about your it's coming off here just right. You see that are coming on the injections right over there. Card doesn't seem like it's been why this is a little boy presented, actually, but I I ski make living treadmill reaction. Here's a right. If you see all the network little currently feeding blood crossed into the left arm, it's something that retrospectively here, the left corner spelling retrogressive from loss of collateral lessons from this big life, this patient actually have congenital trees, the office being stand coronary artery on the left. So the left carnage about here. But in fact, it never gets the your was a gap about half a centimeter, right? 3 May or time to start back. Never fully formed this young man Initially bypass grafting actually grafted mammary artery. I didn't certain very well. So ultimately will be just the left coronary reimplanted your since done very well. So yes, young Children, young people do get coronary problems. It's pretty when it comes to Jaspin, you don't doubt most proofs. That's pretty fair. A sensitivity disputing examination. Um, if they do come this far is a pediatric GI. We may not be much more than that to summarize it. I think it's just important to re emphasize that just being this common in young people, our deck test is exceptionally rare. Risk. It's, I wish, you know, on often print lines that is under the reason there. It's really Bornstein. This this is extra election, Ms Paper, Young people, you last do a suddenly with some heart attack death. This is, I suppose, for people really become worried. A fresh full hand. Make that leap, if you like from just really into this time. So it's appropriate to say maybe a bit of a sudden cardiac. Yeah, because again, primary care clinicians will get a lot of this inside. Look this way. Coming from families who don't have heart disease certainly cause some cardiac death. Hypertrophic 100 miles isn't what I call in some attached to carry months is rarely, I think school channelopathy So these air senator level with I Am channels. It's a little it was like with a cardiogenic RV. Cardio my Parkinson's like rarely. Well, listen this year, because it's a little bit of the Congress, a little bit more homeless. It well, it's no. Various studies have been kind of tight, particularly the natural rich. But Leah also like it states. It's well, you see, it's a home home, and find me is more effective several times when it comes to a half weeks. That's exercise and just sudden death is enormously like No, no, it's in the average person mess in 10% occurred getting exercise. So it's good, for example, is know that no heart, nothing sometimes this is the This is this is the first time again from some years ago. Boy, you can adults, but like to see in some kind of trauma. Got a fractured wrist, of all things. We noticed it got some topics. And when we exercise, this is the start of this treadmill in there. Ted know gets going. He starts person completely into continues on that, You know, we stopped pretty quickly and it goes back into Sinus rhythm. So this is exercise just, um, perfectly tea. So there are old kisses for this skills for sure. Sometimes you just coincidence. Let me think of young people in a young of extended 30 30 years of a change in the hundreds of the car, miles are very significant large, which, when you get order than 30 years, are in the office disease. It's certainly younger group mild. If it were teenagers, young adults with majestic right from trickier cardiomyo say maybe in two car in the problems. But channel Young athletes again. Habit of cardiomyopathy tops a list in athletes This in coca bullshit Cortisporin sudden blow to the chest wall. In one study that I fired, Myron suggested this actually relatively common cause, kind of for festival deaths. It's sort of sudden mood chance wall, presumably in just in there. And this is the some of the data that referred Teo from Italy through that. Did you see him sort of things harder on my disease and coronary disease? With this followed by some channel is think I am flux. What about it? Sudden cardiac? Ask those a card here. You heard about it on the news. You have seen some tragic cases. This happened, Um, how many instances by 1.4 year? Well, we have a very limited populations. It's, um yes, it's the media are very aware. Publicize. That case is we have people. It's a movement so scared because neighbors child has That's possibly perhaps we can get a full basement house. Even living same area seems might happen to their child. Want to be referred to cardiology for that reason so you can see how the anxiety pills within conditions. I worry just doesn't go right. Want to kind of mild. He's mainly the hypertrophy mild. These are the ones that we worry about the seven sudden cardiac death we do screen for this condition. Maybe don't look in her out. You know what's going around? The prevalence of honey He's supposed to sustainable problem with our ms. How about some disease we talked about is well over six. William isn't talking. She's are you? It's week another. It's anomalous. Harm is a bit like the one that mentioned that you did and your grants for really not channel locks. These here, but seems like a long heating central Brugada. Actually, um, independent polymorphic ventricular. Things like short todo Yeah, but the top ones So long. QT is harmless. Most important one, I guess. And this is lots of babies being born. Mom, it's a problem. Eating said Operation Children with the Long QT is really Uh huh. One of 500 in terms of calmness is role of genetic testing. Yes, a lot of change causing Lee types of long team C t one t o on the t score some class before gene testing on well, 40% present sudden cardiac Just pretty good. I should say that that you may see missions with long You been like this, um qt interval which measures the imaginable corrected QT interval dosing visits formula and let me make a diagnosis like this. We'll get you a list of drugs to take to their their family doctor drugs it for the last week. You would tell him to avoid swimming and all from sports. Well, sometimes this is for Goddess in ms is dressed just for these to needs to be one of the two for got a partner It's really unusual sort of ST second issue. So crude powder on the ST segments goddess and trying to get this could call sudden cardiac death of my officers with exercise sometimes associate director seeing Children that generates with important sensitivity very rare may be familial, uh, mortality associated with it on even on the the should be pretty bad calmest in defects. They found it in the Septra, which is good fluxes after my heart or left. This is what it don't. If this is going along and typically with exercise, you start to get some appointments coming in on. This tends to degenerate to by directions. Very disorganized. I was that comes to screening for sudden cardiac death, but we did it for Channel Opens in the score. How do you open these? It's really difficult to scream and scream if you know how to screen, so we don't really wonderful past. That's a lot of these problems. I often the screaming when you stop screaming. So these are things that I've been great evil. The answers to what I would say is that you can't scream first degree relative. So it's with my hope, Aziz, because we may be inherited. My parents or siblings affected. See another seven? Um, if we have a genetic task you do that makes life a lot easier on. But we often start gets her bit of irritable. 12 for cardiomyopathies medication were asked to see you quite often. We get a report saying some some My adult has passed away someday, but he's going to scream the whole family. And I remember how many from Saitama on where I got sent. 30 referrals. One began. Lucky? Yes, with watching to, uh uh huh. I was over there trying to screaming because it tends not to be a one off your baby brother probably did every year. It's a major problems that screening off, since you don't want to see her under branch well about conduction. So your screening needs to be focused on Jewish based on the history that's right. Might have heard of Cry organization, which is kind of a risk in the I remember it would also spring still taking. It's for taking when you should be done by way screening for a pre participation in sports at school. I don't think this is another tricky area. Syncope can affect lots of people. It's very common, you know, you think that I knew. I think it's good assembly one day and I said, Exactly. And even if you haven't sent it will offend shalt centered Stop some states principal. So after 15% get it real well on this one. So we'll come in and see me. I'll see if we can to see it off after pretty common told said. Individuals occurring anybody has to be recurrent off. You know it's been on satisfying because you don't really find the cause. Read History again is really it asked. My diurnal variation means My wife always helps a check from with the sliding because simple be usually it's just does it feel? What if it's a friend with a lot of noise preceding? Sometimes that might be the surgeon general. Talk about something else like Long UTI too more independent anymore. Do you like a second surge of adrenaline? Some reason to be was actually be aware of is that it's a bit unusual. I think people are lying down. No more common thing looked, Should you just described to you? He's a bagel syncope. Further investigation. I think. I believe that abnormal movements A band, a bit old neurological cause I found the history. It's a sudden cardiac death that's unexplained or just a very old she. Just mind you syncope damn thing. Usually it's just not just a simple pipes, very immediate versus on a bagel. Types of precipitated. One of the most common, most frequently seen sort of nearly movie is prickly. These neuro cardiogenic syncope is unnecessary. Typical scene with the understanding with assemblies are warts on. Do you begin to feel this, uh, ringing in your ears weren't stocks? Take sugar. Get further away from yourself. Disappearing right of the situation. And then the next day, couple for you twitching after suits they lie on before Pressure's just doesn't happen. You know, it's just part of martial standards do to your heart. You know, pressure on the six to try 10 bucks. Haven't better get you on the grind on BP is back in the car. She recovers, and it's fine. This impostor orthostatic card is in the pots syndrome, Mother said. They've been a few cases in the media listen, of people campaigning for better service. This is We are seeing that with long this part's situation, where young people apparently have difficulty getting up a position like a bit high in the sponsors. They are right, quite a challenge if you try to do it different prognosis is I'm gonna go through this in detail when it comes to Cardiacs, and we arranged since known cardiac investigation Eugene CT. MRI and I think the things that are most useful basically see you. Well, you sure I didn't quite a few treadmill tests, Something just for reassurance. Holter monitor. Gee, unproductive, actually, not really tilt table test. Quite this with you really need to demonstrate it is the upright posture that causes the tendon and secret, often a very dramatic response. If you put somebody up right away, suddenly their BP will go down very quickly or their heart rate okay, suddenly on there Horrible's together BP, so to do. But let's see that one, for the majority of it of education. Reassurance is not always predict when you're going to see him trying to avoid situations sick earlier in Christopher than significant. And I always ask people, How much do you drink? A man? Whatever figure they give, I said. Well, Mr, twice a month is that on Know all the form of water? But it's almost, I see benefit of trying to influence the second issue again. Really? So having extra salt that as well but important something really shouldn't say, shouldn't say the word of people young people defendants. Some use for major cortisone. Is it? Nine again, might a dream. I used Doxil beta block sometimes be helpful even increasingly, I think for things like parts, um, sometime was seems like it's tied up with postural training and exercise so you can go through all of these things but also getting dialysis. Far as this is nearly more education on increasing the salt. Yeah, when politicians can't lost lots of Children with competition, a good history is important. Vacations. Ray. Just wearing a salt your heart beating I don't want to be here, described it for your impressions. I'm bed at night, and that's the way most off, so they're good. History is important, but what happened with exercise? What's the only set? Do they start suddenly disappear? Something 50 s fifties. Come on like lights. That's cool off like a light switch, whereas some of the other card is it benign list and warm up crude. I'm like a Sinus type that's with medications. Happen intake with the young point. Also, very longer he wants a mad king red food river and literally cans and cans a day and the execution of interest in relation. It's pretty common in young. He was working 15 bread will in just because wouldn't do. The examination was supposed to be saying this check for any more emergent signs of heart disease. On travel, it comes two calls as well, because of the palpitations may be nothing very much a toll, maybe a bit of anxiety fever. It's exercise. Recent hypothyroidism turn. This is about rarely times a day business. Well, it's well, it's It was expensive opticians, super ventricular tachycardia we talked a bit about already. In summary, particular tachycardia cause palpitations. This well, obviously rather more serious cause of competition so hard to seems like 80 blocks. It's a restless Well, this is what we tend to be, and I'm almost finished night. But when it comes to palpitations, can't do this. People's issues helping you plus minus for our kids. Don't consider that, um, if there is, um, But I would say, if we worried about those kind of things we may extend to MRI a swell on we will usually treat for diagnosing. There is in your or sores or not solely on the best issues. That's important thing to say. And even if you don't hear in there, only gas left thumb with heart, really blockers and such, because you can certainly make the patient last well, Robin better by waiting and with treatment with drugs. So we're back to this question again. But doctor, whether it's dinner practitioner, whether it's a pediatrician, count sheets before it's okay for a movie. What to do about that question after this test? Remember, the chest pain is rarely cardiac. Opportunity is, are off. The nine super ventricular heart is reason to call to see it not usually on its treatable can see more of a nuisance in life. That that's not syncope is usually just that issue. Just a few. Just beware something that doesn't feel right off the teachers that's occurred well last year. This point at the bottom on I really think it's worth, um size of this. I always think it's know with limitations on extra weight. I'm by somebody. Exercise are exercise, other sport until they seem cardiologists. I think they think that we do the test that makes it safe. Um, we don't have a test, so I try not It's limitation from exercising less really good reason for it. And so on. Really strong, like, yeah, I haven't heard you another to do. I'm gonna leave it there. I'm going to thank you for your it. There are some things that interest there. I'm happy to take some questions, whether through the up or other mechanisms. Um, so I got a couple questions already for me. If I shall. I go ahead and take these. Marcus, is that okay? That would be great. Doctor. Son gets thanks much. I'm going to do that to me. It's It's kind of keep you diagnosed and all numbers. Answer is no old members don't want to be seen back here. Just most murmurs, I would say, may have welcome TOB attrition her system. So we usually say to people, if you have any less invasion but on slightest on which that you have less again next time on this the murmur has gone. Be relaxed about pretty actress sticks out like farmers. If numbers persistent, I would suggest that you be should send you fish after cardio is this We shouldn't deserted me to see a lot of restrictions, man. Lauren more has asked any business been looked spellers. If you don't mind, just try. How was he Slide season with your only surgery. So do you follow what gets a test that you get a copy card? It's time to try to be crossed. You have obstruction here. The last of the heart goes, the more obstruction. They tend to have our year, partly because the heart's beating so fast to get dynamic obstruction developing in the some pulmonary area. Because of that, it's affecting your form. Over the end of the pressure goes up in here behind the instructions, forcing more blue blood. I stay here, doctor, on the So that's what that smell is tachycardia increasing Eiffel Tract obstructions. You get less and less blood into the pulmonary artery. More blue blood forcing itself either on the order causing hyper sinal. So, typically with saturations and forties fifties, reduced, conscious level, we usually treat that was fairly aggressively putting Children any chance position. What about dolls is actually increase the systemic increases. Depression left contracts. This one the right to that. Okay, push working. Give him 100% oxygen fluid. Bolus if needed. Used to give him a bit of lockers on intravenously Can try and limit the world. Beta blocker is night. Um uh, There was a terrible things that we can before to college. It's still about helps a bit any other questions or queries. Think about starting those very informative. And if anyone has any questions, they just want to add them into the chat night on. Then we'll proceed shortly onto our quiz. Levaquin. I didn't have anything open. It's okay. I don't offend. You were in Did I did some blockage inside, but I usually have people to draw Heart's. We'll get them to pick a card. Multiple Buren. Something like to travel to be a follow under a card in it turned over and they draw it on a chart, you know, but it actually helps it. Some understanding the visuals. You can actually draw a heart with tetralogy or with Trump. It's arterial system. And okay, governments of the ST it's not you. I hope yours is easier. Mine's multiple choice Who put it on, keep things a bit more simple. Okay, You want me to stay on line when you do that, Or she's like, Oh, you're more than welcome to join us. But if you and if you prepared ahead all Nothing problem at all. Thank you so much for your dog. Oh, we don't tell you that. You're really what's wanting to be there for me? Of course. Absolutely. So everyone I'm just gonna and share screen here. Two seconds. I'm just load up the this will stop your stream chair adoption. So It's just a super one. The so clear from can see the good GM pins were in the operating off tonight So far from congest. Open that up for us, please on the kingpin there. 636 yet 117. If there's any problems accessing that, you just put it into the chat. But it looks like so marston far in some people have joined us already. We'll just get out of minutes that everyone got low gone. Okay, so just make a start with the question. Anyone Conjointin any siege with this? So again, it's just a hoot. About 636 it 117 just the interest of time and nothing will make us start here. So naproxen will percentage of old births are congenital. Heart disease is present. You got 30 seconds down. So each of these questions well instead, guys is 1% Oh, birth. Get an expression. Which of the following is a sign of like a congenital heart disease? Most PGA. So if the swelling is not a feature of an innocent murmur, So it's not feature medicine, remember? No, the diastolic only what is the most common identifiable calls chastity and and Children. That's cost to chondritis. So what is the most common cause of sudden cardiac there? And people aged 30 years or younger? I did see him. So what? Cardiac written could be produced by long Q T. And it's really clue there in the picture. That's for the more for PT. So pain awful Crescent. Which the following occurs? Other worrying feature of a syncopal episode. So which of these things to be a worrying feature of a syncopal episode? Yeah, it was a preceding lord noise or a fright. And then the last question for tonight. So which medications often recommended as first line treatment for reflex syncope? Yeah. Then So that was for his. Um, thanks very much for taking part in that quiz there tonight, guys. That was that little little pudding and come up. We'll see you was first time. So, you know, to get on the fastest time was a F two. Thanks very much for joining us for that. Be prescribed. I'll just stop my screen share there, and I'm gonna hand over annoying back to Tarrant, who's just going to close the event for this evening. Maybe. Thinks Marcus, I am for getting the quest on for us. Thank you dot Sounds boards Taking the time to speak to us today I'm really hope that everyone that was watching enjoying tonight's event on learned something new or was able to consolidate, been learning from previous I'm learning. Anyways, um, we would really appreciate if you could complete the feedback form, which I'm gonna send in to the shot soon. Just let us know what you enjoyed about the event and how we can improve the next time on completing that form. And you'll also receive a generated certificate on your on. A great you can use for your portfolio on through your medal account as well on. Finally, if you haven't already do register for our next event, which is on pediatric gastroenterology, and it's going to be next Monday and delivered by two consultant pediatricians, doctor Jonathan Henderson on Doctor Jenny years and who's our are going to be talking about common presenting plates, which is diarrhea, vomiting, feeding troubles as well as food allergies as well on Dad. To this registrations for our last three vents on dermatology infectious to see this and renal medicines are also now open on our metal event page just under key. Be jumpy society. So I'll send those think links into the chopped. Now, if you could complete those, um, and that's all from a central much coming. Don't have a good evening.