TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 41

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 41. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Preoperative Assessment Chapter 14 383 Cardiac Assessment Cardiovascular abnormalities are most commonly caused by pulmonary hypertension secondary to chronic hypoxia and hypercapnia . Right ventricular hypertrophy and cor pulmonale may develop as a result of the elevated pulmonary resistance. ECG changes associated with pulmonary hypertension and right atrial enlargement P wave greater than mm R greater than S in V1 and V2 may be seen but are usually not evident until late in the disease process. Scoliosis is also associated with congenital heart abnormalities 30 . Mitral valve prolapse is common in patients with idiopathic scoliosis with a prevalence of about 25 . If a murmur is heard on physical examination an echocardiogram is recommended. Marfan syndrome may be associated with mitral valve prolapse dilatation of the aortic root and aortic insufficiency. Prophylaxis against infective endocarditis should be administered to patients who have mitral valve prolapse or other lesions resulting in disturbances of flow. Neuromuscular Disease The most common neuromuscular disease is Duchenne muscular dystrophy with an incidence of one in 3 300 male births. It is inherited as a sex-linked recessive condition affecting skeletal cardiac and smooth muscle. Over 90 of these patients develop a progressive scoliosis when they become wheelchair bound. Patients lack the membrane cytoskeletal protein dystrophin and typically present between the ages of 2 and 6 years with progressive weakness of proximal muscle groups. Up to one-third of patients have intellectual impairment. Duchenne muscular dystrophy patients have a high incidence of deteriorating lung function and cardiac abnormalities 50 70 . In the later stages of the disease a dilated cardiomyopathy may occur associated with mitral valve incompetence. Dysrhythmias occur and up to 50 of patients have cardiac conduction defects 31 . Cardiac arrest in patients with Duchenne muscular dystrophy has been reported during .

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