cardio 9

Question 1

How we treat AF in patients with WPD?

Answer 1

Hemodynamically unstable do cardioversion Hemodynamically stable rhythm control with ibutilide or procainamide
Avoid AV blocking drugs–they increase accessory pathway activity—exacerbate the ventricular response

Question 2

A complication of AF in patients with WPD?

Answer 2

The atrial activity bypasses the AV node and uses an accessory pathway–rapid ventricular response–If persist–Risk of V.fib occur

Question 3

Risk of using drug slow AV activity in WPD?

Answer 3

Increases risk of V.Fib

Question 4

Symptom of sinus bradycardia?

Answer 4

Fatigue
Dizziness
lightheadedness
Hypotension 
Syncope 
Angina
Heart failure

Question 5

Causes of SB?

Answer 5

SSS
M.Ischemia/Infarction
Hypothyroidism
OSA
ICP
Medication

Question 6

Management of Sinus bradycardia?

Answer 6

1) Monitoring and evaluation
2) Atropine
3) NE/D/Peace maker

Question 7

In whom do Monitoring and evaluation is considered? what be done in all cases of SB

Answer 7

• -Have no indication for atropine
• treat underlying cause
• Iv line, cardiac monitoring
• 12 lead ECG
• -Pulse oximetry

Question 8

What is an indication of atropine?

Answer 8

1) Hypotension/Shock
2) Ischemic chest pain
3) Heart failure
4) Acute mental status change

Question 9

What will be done if they do not respond to atropine?

Answer 9

We will give NE/Dopamin or peacemaker

Question 10

Pulmonary hypertension management?

Answer 10

1) Idiopathic9primary)–vasodilators

2) Secondary–treat the underlying cause

Question 11

What is idiopathic(primary) hypertension?

Answer 11

If pulmonary hypertension occurs in
BMPR2 mutation
connective tissue disease(SS)
HIV

Question 12

What are drugs used for PPH/IPH

Answer 12

Bosentan(E-1 blocker)
Alprostadil(PGE2)
Sildinafil(PDE5 inhibitor)

Question 13

Pulmonic Valve stenosis cause?

Answer 13

• 1-congenital

- 2-acquired–carcinoid,RF

Question 14

Symptom?

Answer 14

HF in children--- if sever
symptom in adult--- if mild
crescendo - Decreasendo systolic murmur
Systolic ejection clic
Widening of S2 splitting during systole

Question 15

Diagnosis?

Answer 15

Echocardiography

Question 16

Management?

Answer 16

Percutanous valvutomy(preferd)
Surgery(If indicated)

Question 17

How to differentiate flow murmur (In ASD and anemia) from that of PS?

Answer 17

flow murmurs occur in mid systole and have not wide splitting

Question 18

Common cause and valve involved of IE in IV users?

Answer 18

• -S.Aureus

- -triscupid valve

Question 19

A complication of tricuspid valve Vegetation?

Answer 19

septic pulmonary embolism

Question 20

Symptom of septic pulmonary embolism?

Answer 20

Cough
Chest pain
Hemoptysis

Question 21

Imaging?

Answer 21

Multiple nodule in CXR

Question 22

The major cause of right side HF?

Answer 22

Constrictive pericarditis

Question 23

A common cause of constrictive pericarditis?

Answer 23

TB
Chest radiation
Surgery

Question 24

Sign, symptom, and imaging future of C.P?

Answer 24

RSHF
Elevated JVP
Hepatojugular Reflex
Kussmaul sign
pericardial knock
           Pericardial calcification in CXR,CT or MRI

Question 25

What is pericardial knock?

Answer 25

an ihigh-pitched, early diastolic sound that occurs when unyielding pericardium results in sudden arrest of ventricular filling.

Question 26

what is an ejection click?

Answer 26

Ejection clicks are high-pitched sounds that occur at the moment of maximal opening of the aortic or pulmonary valve. They are heard just after the first heart sound.

Question 27

What are Canon A waves?

Answer 27

-Is the enlargement of A waves of jugular vein

Question 28

Mechanism?

Answer 28

simultaneous contraction of atria and ventricle

Question 29

Cause?

Answer 29

A disease that affects the communication of atria with ventricle--simultaneous atrial and V. contraction--rise Atrial P main let during contraction b/c it push against closed TV Ventricular tachycardia Complete heart block (disociation) Frequant premature VTAC

Question 30

symptom?

Answer 30

Haw pain Headache The feeling of pulsation at the neck

Question 31

A cardiac complication of sarcoidosis?

Answer 31

``` Heart block(AV, RBB) Restrictive cardiomyopathy(early) Dilated cardiomyopathy(Late) Valvular dysfunction HF SCD(HB or arrhythmia) ```

Question 32

Diagnosis?

Answer 32

- combine symptom, ECG and CXR | - Endomyocardial biopsy has a low sensitivity

Question 33

Treatment of STEMI?

Answer 33

``` O2 Antiplatelet Nitrate anticoagulation Beta-blocker PCI/Fibrnolytic Statin ```

Question 34

o2?

Answer 34

If SO2 < 90

Question 35

Antiplatelet?

Answer 35

Asprin and p2y12 receptor blocker

Question 36

Nitrate?

Answer 36

be cautious in patients with hypotension, RVI, and severe AS | helps for pain also(if not add morphine)

Question 37

anticoagulant?

Answer 37

Heparin

Question 38

beta-blocker?

Answer 38

conscious in Bradycardia, Cardiogenic shock, and severe HF

Question 39

PCI

Answer 39

If the patient present within 12 Hr of symptom | should be given within 90 min of patient arrival

Question 40

Fiibrnolytics?

Answer 40

if we have no access to PCI within 12 hr of symptom.

Question 41

Statin

Answer 41

as secondary prevention | As soon as possible