Cardio 13

Question 1

What is the best treatment for a patient with hyperthyroidism and AF?

Answer 1

Beta-blocker(propranolol, atenolol..)

Question 2

Why?

Answer 2

Treat the underlying cause by decreasing pheripherial conversion of T3 to T4 inanition to HR decreased.

Question 3

Why not amiodarone?

Answer 3

Used for paroxysmal one

Exacerbate hyperthyroid symptom

Question 4

AVNRT CM?

Answer 4

The most common cause of SVT
Common in females
Intermittent palpitation
Chest pain, lightheadedness, and dyspnea during an attack

Question 5

Pathophysiology?

Answer 5

Presence of fast and slow pathway in RA–Normally fast pathway transmit signal–Slow pathway transmits a signal back to atrium when FP is refractory period–form circuit–atrial preexitation.

Question 6

What differentiates it from AVRT?

Answer 6

the pathways like AV node But in AVRT the pathways like ventricular myocardium

Question 7

What maneuver decreases symptoms?

Answer 7

Vegal (Valsalva, aye ball pressure, cold water imersion..)

Question 8

FMD screning indication?

Answer 8

female age <50 with one of following
age <35 with a family history
Sever/resistant hypertension
sudden rise in BP
Increase creatinin 0.5-1 mg after ACE/ARB started without BP-lowering effect
systolic-diastolic bruit

Question 9

What Is the CM Cerebrovascular FMD involvement?

Answer 9

Brain ischemia sign include
amaurosis fugags
Horner syndrome
TIA
Stroke

Question 10

What Is the CM carotid and vertebral artery FMD involvement?

Answer 10

Unexplained Headache
Pulsatile tinnitus
Dizziness

Question 11

What artery other than mentioned can be involved?

Answer 11

all but comonly
Subclavian
visceral
iliac

Question 12

Diagnosis

Answer 12

Doppler u/s or CT angiography

If inconclusive on CT/U/S–catheter-based angiography

Question 13

management?

Answer 13

Medical–Evry 3-4 month Cr and B/P
6-12 month ultrasound
Asprin if cerebral and vertebral involvement
percutaneous angioplasty if indicated

Question 14

Plasma aldostrone /renin Ratio?

Answer 14

normal is <20

If >20—indicate primary hyperaldosteronism.Hyperkalemia

Question 15

managment of vasovagal syncope?

Answer 15

reasurance

Avoidance of trigers

Question 16

Which drugs used for cardiac disease in patients with digoxin will develop toxicity other than Lasix?

Answer 16

Quinidine
Verapamil
Amiodadron

Question 17

How?

Answer 17

Decrease digoxin tissue binding–Increase serum level.

Question 18

what are these symptoms?

Answer 18

GI(anorexia, nausea, vomiting, and abdominal pain)dominate in acute toxicity.
Neurologic(Fatigue, confusion, weakness, and loss of color vision)–Dominate in chronic toxicity

Question 19

what will be the long-term effect of ISCHEMIC disease including MI that results in systolic dysfunction not treated?

Answer 19

Eccentric hypertrophy(which occur also in chronic volume overload)

Question 20

What pathology eccentric hypertrophy produce?

Answer 20

Muscle hypertrophy
Scaring
dilated ventricle

Question 21

What is the complication of this pathologic change?

Answer 21

systolic dysfunction

Arythemia–SCD

Question 22

How we prevent this pathologic progresion?

Answer 22

ACE/ARB
Beta-blocker
Aldostron antagonists

Question 23

what about antiplatelets?

Answer 23

Reduce CVS event in 1 year but have no role in preventing remodeling

Question 24

CM os sick sinus syndrome?

Answer 24

elderly
bradycardia(fatigue,lightheadedness,syncope..
Brady-techy arrhythmia(AFib, palpitation)-due to atrial fibrosis

Question 25

Why elderly?

Answer 25

Due to degeneration of sinus node and conduction system

Question 26

Other cause?

Answer 26

Infiltrative diseases like sarcoidosis and amyloidosis

Question 27

ECG?

Answer 27

sinus bradycardia
sinus pause (delayed P wave)
SA node exit block(dropped P wave)

Question 28

management.

Answer 28

peacemaker

blocker in case of tachyarrhythmia