Cardiolo1 Flashcards
What 2 mechanism leads to volume overload?
Systolic dysfunction (CM, MI, IHD...) Volume overload (MR, AR..)
What 2(early and late) mechanisms make the patient asymptomatic in case of volume overload?
1) Early–Frank starling force–increase contractility
2) late–Eccentric hyperthrophy–increase compliance and contractility
How do they help?
Increase cardiac output
When become symptomatic?
Eccentric .H–Maladaptive(increase wall stress)–myocardial dysfunction—HF symptom
How is MI related to arterial embolism?
Large MI–Aneurysm–ballooning during contraction and formation of thrombus.
Risk factor?
Delay in tx of MI (>8 hr)
How we diagnose?
Transthoracic echocardiography.
HIT?
Commonly occur in 5-10 days of treatment.
venous thrombosis is more common
How is the warfarin(coumarin) effect altered?
Diet,Antibiotic,acetaminphen and cyp450 afecting drug.
Diet how?
Green vegetables–increase substrate for Vit K dependent clotting factor–decrease its effect
Antibiotics how?
Decrease GI bacteria synthesize VIT K–increase toxicity.
Acetaminophen how?
Alter recycling of Vit K in liver–increase warfarin toxicity risk.
CYP450 affecting drug?
two class
Make increase CYP450 activity?
Carbamazepin phenitoin Phenobarb Rifampin st.jhon swart
Make Decrease CYP450 activity?
Antibiotics(Macrolide and metrindazole) Azoles Amiodarone cimetidine grapefruit juice
What decreases venous return?
Straining phase of Valsalva and standing.
Effect on murmur?
Increase MVP and HCM but decrease all others.
What increases venous return?
The relaxing phase of Valsalva,raising leg and squatting
effect on murmur?
reciprocal to standing and SPV
Effect of squatting?
increase venous return
increase afterload
increase regurgitant flow
Handgrip?
Increase B/P
Increase afterload
increase regurgitant flow
Squatting?
Increase AR.MR/VSD
Decrease HCM and MVP
Handgrip?
Increase AR.MR/VSD
Decrease HCM and AS
Effect of squatting on MVP?
Increase LV size–Delay valve prolapse—later click and shorter murmur but it may increase the intensity of the murmur due to increase afterload.
MVP syndrome symptoms?
Atypical chest pain, palpitation, dyspnea, dizziness, anxiety, and panic attack.
Indication for statin therapy?
Primary and secondary prevention
Secondary?
ASCVD Acute coronary syndrome Stable Angina CABG Stroke, TIA, and peripheral disease.
Primary?
LDL>190 mg/dl
Age>40 with diabetes Mellitus
Estimated 10 years risk of ASCVD 7.5%-10%
Cardiovascular risk calculator(assess the 10-year risk of ASCVD)
Age Sex Ethnicity Total colestrol HDL DM Smoking status Hypertension
