cardio 9 Flashcards
How we treat AF in patients with WPD?
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
A complication of AF in patients with WPD?
The atrial activity bypasses the AV node and uses an accessory pathway–rapid ventricular response–If persist–Risk of V.fib occur
Risk of using drug slow AV activity in WPD?
Increases risk of V.Fib
Symptom of sinus bradycardia?
Fatigue Dizziness lightheadedness Hypotension Syncope Angina Heart failure
Causes of SB?
SSS M.Ischemia/Infarction Hypothyroidism OSA ICP Medication
Management of Sinus bradycardia?
1) Monitoring and evaluation
2) Atropine
3) NE/D/Peace maker
In whom do Monitoring and evaluation is considered? what be done in all cases of SB
- -Have no indication for atropine
- treat underlying cause
- Iv line, cardiac monitoring
- 12 lead ECG
- -Pulse oximetry
What is an indication of atropine?
1) Hypotension/Shock
2) Ischemic chest pain
3) Heart failure
4) Acute mental status change
What will be done if they do not respond to atropine?
We will give NE/Dopamin or peacemaker
Pulmonary hypertension management?
1) Idiopathic9primary)–vasodilators
2) Secondary–treat the underlying cause
What is idiopathic(primary) hypertension?
If pulmonary hypertension occurs in
BMPR2 mutation
connective tissue disease(SS)
HIV
What are drugs used for PPH/IPH
Bosentan(E-1 blocker)
Alprostadil(PGE2)
Sildinafil(PDE5 inhibitor)
Pulmonic Valve stenosis cause?
- 1-congenital
- 2-acquired–carcinoid,RF
Symptom?
HF in children--- if sever symptom in adult--- if mild crescendo - Decreasendo systolic murmur Systolic ejection clic Widening of S2 splitting during systole
Diagnosis?
Echocardiography
Management?
Percutanous valvutomy(preferd) Surgery(If indicated)
How to differentiate flow murmur (In ASD and anemia) from that of PS?
flow murmurs occur in mid systole and have not wide splitting
Common cause and valve involved of IE in IV users?
- -S.Aureus
- -triscupid valve
A complication of tricuspid valve Vegetation?
septic pulmonary embolism
Symptom of septic pulmonary embolism?
Cough
Chest pain
Hemoptysis
Imaging?
Multiple nodule in CXR
The major cause of right side HF?
Constrictive pericarditis
A common cause of constrictive pericarditis?
TB
Chest radiation
Surgery
Sign, symptom, and imaging future of C.P?
RSHF
Elevated JVP
Hepatojugular Reflex
Kussmaul sign
pericardial knock
Pericardial calcification in CXR,CT or MRIWhat is pericardial knock?
an ihigh-pitched, early diastolic sound that occurs when unyielding pericardium results in sudden arrest of ventricular filling.
what is an ejection click?
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.
What are Canon A waves?
-Is the enlargement of A waves of jugular vein
Mechanism?
simultaneous contraction of atria and ventricle
Cause?
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
symptom?
Haw pain
Headache
The feeling of pulsation at the neck
A cardiac complication of sarcoidosis?
Heart block(AV, RBB) Restrictive cardiomyopathy(early) Dilated cardiomyopathy(Late) Valvular dysfunction HF SCD(HB or arrhythmia)
Diagnosis?
- combine symptom, ECG and CXR
- Endomyocardial biopsy has a low sensitivity
Treatment of STEMI?
O2 Antiplatelet Nitrate anticoagulation Beta-blocker PCI/Fibrnolytic Statin
o2?
If SO2 < 90
Antiplatelet?
Asprin and p2y12 receptor blocker
Nitrate?
be cautious in patients with hypotension, RVI, and severe AS
helps for pain also(if not add morphine)
anticoagulant?
Heparin
beta-blocker?
conscious in Bradycardia, Cardiogenic shock, and severe HF
PCI
If the patient present within 12 Hr of symptom
should be given within 90 min of patient arrival
Fiibrnolytics?
if we have no access to PCI within 12 hr of symptom.
Statin
as secondary prevention
As soon as possible
