Cardio 14 Flashcards
a common symptom of Chagas disease?
Megacolon
Dilated cardiomyopathy
Pathophysiology of DCM?
chronic myocarditis
most sensetive PE finding in renovasculer HYTN?
abdominal bruit
common age of RVH?
> 55
best time for hearing of pericardial cknock?
Early diastole
What will be the cause of holosystolic murmur that heard on apex and disapear after duretic therapy with patients In decompensated HF?
Secondary MR due to LV dilitation
Mechanism of MR in thise case?
LV papilary muscle displacement
Dilation of cusps
Cause of cardiogenic syncop?
AS/HCM Vtech sick sinus syndrome Advanced AV block Torsades de Pointes
AS/HCM
during exercise
Vtach?
No preceding symptom
cardiomyopathy or previous MI
sick sinus syndrome?
Preceding fatigue or dizziness
Sinus pause on ECG
advanced AV block?
bifesicular block
increased PR interval
Dropped QRS complex
Torsades de Pointes?
No preceding symptom
Medicmiya
Hypomagnisimiaation
Hypokalemia
CVS sign of AS?
Narrow PP
Increase impulse of PMI
Ejection systolic murmure
Niacin S/E
Pruritis
Flushing
Mechanism?
Increase histamine and prostaglandin release
Management?
Low dos Asprin.
Approach for a patient with Chest pain?
Low risk–No further testing
Intermediate–stress test
High risk–Coronary angiography
Positive stress test?
Coronary angiography
For high risk?
Start management
statin mediated myopathy mechanism/
inhibit COQ synthesis–affect energy production
other S/E
liver toxicity
A common manifestation of atheroembolism?
Dermatologic
- –Blue toe syndrome(blue finger with an intact pulse)
- —Livedo reticularis
- —Gangreen
- —Ulcer
Commonly occur when?
vascular procedure like coronary stenting
Which patients are at risk
Aged Obese HYN Smoking Hypercholesterolemia DM
Other symptoms?
RF Pancreatitis GI bleeding Mesenteric ischemia Stroke Hollenhorst plaque
Hollenhorst plaque?
Bright, yellow refractile plaque on the retinal artery(indicate proximal source like carotid)
Management?
suportive
statin
reuce risk
Prevent recurence
when to occur?
Earley or lately >30 days
Amidadrone s/e in tyroid mechanism and treatment?
4 mehanism(2 hypotroid and 2 hypertyroidism)
1(hypo)
Inhibition of pheripherial T3 conversion
Inc T4, Dec T3, normal or decreased TSH
No treatment needed
2(Hypo)
Decrease synthesis
low T3,T4 but high TSH
Treat with levothyroxine
3(AIT type 1)
Increase synthesis(pt with nodular goiter or latent grave disease)
HIgh T3, T4 but low TSH
High RAIU and vascularity on U/S
treat with antithyroid drug
4(AIT type 2)
Destruction
HIgh T3,T4 but low TSH
Low RAIU and vascularity on U/S
treat with steroid
Most common cause of AS in young?
supravalvular aortic stenosis
CM of SVAS?
Systolic murmur at right 1st ICS(unlike AS)
Unequal carotid pulse
Unequal upper extremity B/P(due to high flow speed in ascending aorta)
Palpable thril in suprasternal noch
exercise-induced chest pain(due to LV hypertrophy which increases myocardial o2 demand or associated coronary artery congenital stenosis0
cause of HF with normal EF?
LV diastolic dysfunction
Valvular disease
Pericardial disease
high output HF
LV diastolic dysfunction causes?
Concentric hypertrophy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Valvular disease cause?
AS/AR
MS/MR
pericardial disease cause?
Constrictive pericarditis
cardiac temponade
Pathophysiology in pericardial and LV dysfunction?
LV stiffness–increase LVEDP–P transmit to atria and pulmonary vein–Left side HF
The absence of an S3 gallop excludes what in MR?
Sever chronic MR(except in case of pt with HF)
What is the cause of Dyspnea in MR with clear lung?
decrease CO
What causes fixed splitting in AS?
Equalization of pressure in left and right atrium
common artery for RVI?
RCA
common artery for PMI?
RCA(PMPM)
common artery for VSD?
RCA(Basal)
LAD(Apical)
common artery for FWR?
LAD
common artery for Anurythm?
LAD
What does the murmur grade indicate In PMR?
mostly soft
the more low grade the more severe
What maneuvers can we teach patients with vasovagal syncope?
Counter pressure technique
- -crossing leg with tensing muscle
- -hand grip
- -tensing muscle with clenching fist
When to do?
When prodromal symptom occur
mechanism?
Increase venous return–abort syncopal episode.
Digoxin toxicity treatment?
Drug discontinuation
Hydration
If sever Fab AB
A most sensitive measure of CHF?
BNP>400–High sensitivity
BNP<100 —High NPP
ECG fuure of acut pericarditis/
PR depression(atrial myocardium) ST segment elevation(Ventricular myocardium0
Management of acute pericardium?
NSAID(If Asprin it should be high dose) with colchicine in case of viral/idiopathic case.
Corticosteroid if the patient fails to take this combination (e.g in case RF)
Skin manifestation amyloidosis?
Waxy skin thikning
Easy bruzing
Beta-blocker toxicity manifestation?
Bradycardia Heart block Hypotension Bronchospasm Seizure and delirium
Management?
- -IV fluid
- -Atropine
- -Glucagone
- -NE/Epinephrin
- use successively
What glucagon can be used?
CCB
Treatment Dressler syndrome?
The same to the idiopathic one
Avoid anticoagulant–the risk of hemorrhagic pericarditis
When do we consider rhythm control medication in AF?
Unable to adequate HR control
Recurrent symptom(dizziness, palpitation…..)
Heart Failure
HR controlling medication?
Beta-blocker
CCB
Digoxin
