1. Cardiology

Question 1

Hypertrophic Cardiomyopathy

Patho/Sx/Dx/Tx

Answer 1

• Patho: Genetic (AD) (Thick left ventricular)
  
  • Obstruction - due to thick septum
  • Dystolic dysfunction - stiffness (can’t refill)
• Sx: Dyspnea, hx of cardiac death
• PE
  
  • Increase sound - standing, valsalva
  • Decrease sound - Sitting, lying down
• Dx: Echo
• Tx
  
  1. ICD placement + BB
  2. No aggresive exercise
  3. Surgical: myodectomy

Question 2

Dilated Cardiomyopathy

Patho/Sx/Dx/Tx/Prevention

Answer 2

• Patho: Systolic dysfuction (dilated and weak heart)
• Risk: Idiopathic (MC), ETOH, Pregnancy,
• Sx: Dypsnea, Edema
• Dx: Echo
• Tx: ACEI + BB + Diuretics, AICD if 30-35% EF
• Prevention: Stop drinking, Smoking

Question 3

Restrictive Cardiomyopathy

Patho/Risk/Sx/PE/Dx/Tx

Answer 3

• Patho: Ventricular rigidity (stiff)
• Risk: hx of amyloidosis or sarcoidosis
• Sx: R side HF
• PE: Kussmaul
• Dx: Echo (normal wall + atria dilated)
• Tx: No tx, Predisone for symptomatic tx

Question 4

Takotsubo cardiomyopathy

Patho/Risk/Dx/Tx

Answer 4

• Patho: catecholamin surge makes Left ventricular bigger (balloon)
• Risk: Emotional stress
• Dx: ECG (ST elevation)
• Tx: No specific tx, BB helpful symtomatic

Question 5

Sinus Rhythms

• NSR
• Tachy - tx
• Brady - tx
• Arrhythmia
• Sick Sinus syndrome - risk, tx

Answer 5

• NSR - 60-100 bpm, PQRST Normal sequence
• Tachy - 100 more
  
  • Tx: Underlying
• Brady - 60 below (50s ok for athlete)
  
  • Tx: Atropine
• Arrhythmia - benign inspiration - increase
• Sick Sinus syndrom - Brady-Tachy
  
  • Risk: corrective cardiac surgery, A Fib
  • Tx: PPM

Question 6

AV block

• 1st degree AV block - ECG/Tx
• 2nd degree AV block (Mobitz 1 - wenckebach) - ECG/Tx
• 2nd degree AV block (Mobitz 2) - ECG/Tx
• 3rd degree AV block - ECG/Tx

Answer 6

• 1st - Constant prolong PRI (0.2<)
• 2nd Mobitz 1 - Progressively prolonged PRI and Drop QRS
  
  • No sx - Observation
  • Sx - Atropine
• 2nd Mobitz 2 - Constant PRI and Drop QRS
  
  • Tx: PPM
• 3rd - P wave No related with QRS
  
  • Tx: PPM

Question 7

Atrial Flutter

Patho/ECG/Tx

Answer 7

• Patho: Irratible foci signal circle around
• ECG: Saw tooth wave (no P wave)
• Tx
  
  • Stabe: BB, CCB
  • Unstable: DCC (50J)
  • Definitive: Ablation

Question 8

Atrial fibrillation

Patho/Risk/ECG/Tx/Special Note

Answer 8

• Patho: Radical foci array signal makes Quivering atria may lead to thrombi
• Risk: ETOH (holiday heart)
• ECG: Irregularly Irregular
• Tx (control Rate first then rhythm)
  
  • Stable: BB, CCB
  • Unstable: DCC (200J)
  • After a fib tx - Anticoagulation 4-6 weeks
• Special Note: Most Common cardiac Arrythmia

Question 9

Long QT syndrome

Patho/ECG/Tx

Answer 9

• Patho: Macrolide, TCA medication use
• ECG: QTc more than 440
• Tx: BB for symptomatic
  
  • Definitive: AICD

Question 10

Anticoagulation

Medication

Answer 10

• NKOAC (NonVitK oral anticoagulant)
  
  • Benefit: NO INR check (preferred)
  • Med name: Dabigatran
• Warfarin
  
  • Benefit: Better with HIV, CKD,
  • INR check 2-3

Question 11

PSVT

2 Main type/2 Conduction pattern/ECG/Tx

Answer 11

• 2 Main type
  
  • AVRT - 1 pathway in AV node and second pathway out side of AV node (WPW)
  • AVNRT - 2 pathway within in AV node
• 2 Conducion pattern
  
  • Orthodromic - Narrow tachy
  • Antidrommic - Wide tachy
• ECG: Regular with Narrow or wide tachy
• Tx
  
  • Stable (narrow): vagal (1st), adenosine
  • Stable (wide): procainamide
  • Unstable: DCC
  • Definitive: Ablation

Question 12

WPW

Patho/ECG/Tx

Answer 12

• Patho: bundle of kent (extra pathway) preexcites the ventricle -> slurred wide QRS
• ECG: Delta wave, wide QRS, Short PRI
• Tx
  
  • Stable: Procainamide
  • ABCD avoid: adenosine, BB, CCB, Digoxin
  • Unstable: DCC
  • Definitive: Alation

Question 13

WAP vs MAP

ECG difference

Answer 13

• WAP: less than 100 bpm + more than 3 morphology P wave
• MAP: More than 100 bpm + more than 3 morphology P wave
  
  • Strong asocciation with COPD

Question 14

Juntional dysrhythmias

Patho/ECG/3 type

Answer 14

• Patho: Dominant AV node become pacemaker
• ECG: Inverted P wave
  
  • 3 type
    
    • HR 40-60 - juntional
    • HR 60 - 100 - accelerated
    • HR 100 more - juntional tachy

Question 15

Ventricular dysrhythmia

• PVC
• VT
• Torsade de pointes
• V fib
• Pulseless Electrical activity

Patho/ECG/Tx

Answer 15

• PVC
  
  • Patho: Premature beat
  • ECG: Wide, bizzare ORS
  • Tx: None
• VT
  
  • Patho: PVC more than 3, usually start with prolong QT interval
  • ECG: Regular rhythm with wide QRS embaded P wave
  • Tx
    
    • Stable: PAL (procainamide, amiodarone, lidocaine, procainamide)
    • Unstable with pulse: DCC
    • VT with no pulse: Defib then CPR
• Torsade de pointes
  
  • Patho: prolong QT due to medication (hypomg, HypoK, HypoCa)
  • ECG: ploymorphic ventricular, Twisting
  • Tx: Mag sulfate
• V fib
  
  • Patho: No rhythm No regularity
  • ECG: fine, coarse
  • Tx
    
    • if time known - Defib then CPR
    • if time unknow - CPR then defib
• Pulseless Electrical activity
  
  • Rhythm on monitor but no pulse
  • Tx: CPR + Epinephrine