Cardio 13 Flashcards
What is the best treatment for a patient with hyperthyroidism and AF?
Beta-blocker(propranolol, atenolol..)
Why?
Treat the underlying cause by decreasing pheripherial conversion of T3 to T4 inanition to HR decreased.
Why not amiodarone?
Used for paroxysmal one
Exacerbate hyperthyroid symptom
AVNRT CM?
The most common cause of SVT
Common in females
Intermittent palpitation
Chest pain, lightheadedness, and dyspnea during an attack
Pathophysiology?
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.
What differentiates it from AVRT?
the pathways like AV node But in AVRT the pathways like ventricular myocardium
What maneuver decreases symptoms?
Vegal (Valsalva, aye ball pressure, cold water imersion..)
FMD screning indication?
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
What Is the CM Cerebrovascular FMD involvement?
Brain ischemia sign include amaurosis fugags Horner syndrome TIA Stroke
What Is the CM carotid and vertebral artery FMD involvement?
Unexplained Headache
Pulsatile tinnitus
Dizziness
What artery other than mentioned can be involved?
all but comonly
Subclavian
visceral
iliac
Diagnosis
Doppler u/s or CT angiography
If inconclusive on CT/U/S–catheter-based angiography
management?
Medical–Evry 3-4 month Cr and B/P
6-12 month ultrasound
Asprin if cerebral and vertebral involvement
percutaneous angioplasty if indicated
Plasma aldostrone /renin Ratio?
normal is <20
If >20—indicate primary hyperaldosteronism.Hyperkalemia
managment of vasovagal syncope?
reasurance
Avoidance of trigers
Which drugs used for cardiac disease in patients with digoxin will develop toxicity other than Lasix?
Quinidine
Verapamil
Amiodadron
How?
Decrease digoxin tissue binding–Increase serum level.
what are these symptoms?
GI(anorexia, nausea, vomiting, and abdominal pain)dominate in acute toxicity.
Neurologic(Fatigue, confusion, weakness, and loss of color vision)–Dominate in chronic toxicity
what will be the long-term effect of ISCHEMIC disease including MI that results in systolic dysfunction not treated?
Eccentric hypertrophy(which occur also in chronic volume overload)
What pathology eccentric hypertrophy produce?
Muscle hypertrophy
Scaring
dilated ventricle
What is the complication of this pathologic change?
systolic dysfunction
Arythemia–SCD
How we prevent this pathologic progresion?
ACE/ARB
Beta-blocker
Aldostron antagonists
what about antiplatelets?
Reduce CVS event in 1 year but have no role in preventing remodeling
CM os sick sinus syndrome?
elderly
bradycardia(fatigue,lightheadedness,syncope..
Brady-techy arrhythmia(AFib, palpitation)-due to atrial fibrosis
Why elderly?
Due to degeneration of sinus node and conduction system
Other cause?
Infiltrative diseases like sarcoidosis and amyloidosis
ECG?
sinus bradycardia
sinus pause (delayed P wave)
SA node exit block(dropped P wave)
management.
peacemaker
blocker in case of tachyarrhythmia
