Cardiolo1

Question 1

What 2 mechanism leads to volume overload?

Answer 1

Systolic dysfunction (CM, MI, IHD...)
Volume overload (MR, AR..)

Question 2

What 2(early and late) mechanisms make the patient asymptomatic in case of volume overload?

Answer 2

1) Early–Frank starling force–increase contractility

2) late–Eccentric hyperthrophy–increase compliance and contractility

Question 3

How do they help?

Answer 3

Increase cardiac output

Question 4

When become symptomatic?

Answer 4

Eccentric .H–Maladaptive(increase wall stress)–myocardial dysfunction—HF symptom

Question 5

How is MI related to arterial embolism?

Answer 5

Large MI–Aneurysm–ballooning during contraction and formation of thrombus.

Question 6

Risk factor?

Answer 6

Delay in tx of MI (>8 hr)

Question 7

How we diagnose?

Answer 7

Transthoracic echocardiography.

Question 8

HIT?

Answer 8

Commonly occur in 5-10 days of treatment.

venous thrombosis is more common

Question 9

How is the warfarin(coumarin) effect altered?

Answer 9

Diet,Antibiotic,acetaminphen and cyp450 afecting drug.

Question 10

Diet how?

Answer 10

Green vegetables–increase substrate for Vit K dependent clotting factor–decrease its effect

Question 11

Antibiotics how?

Answer 11

Decrease GI bacteria synthesize VIT K–increase toxicity.

Question 12

Acetaminophen how?

Answer 12

Alter recycling of Vit K in liver–increase warfarin toxicity risk.

Question 13

CYP450 affecting drug?

Answer 13

two class

Question 14

Make increase CYP450 activity?

Answer 14

Carbamazepin
phenitoin
Phenobarb
Rifampin
st.jhon swart

Question 15

Make Decrease CYP450 activity?

Answer 15

Antibiotics(Macrolide and metrindazole)
Azoles
Amiodarone
cimetidine 
grapefruit juice

Question 16

What decreases venous return?

Answer 16

Straining phase of Valsalva and standing.

Question 17

Effect on murmur?

Answer 17

Increase MVP and HCM but decrease all others.

Question 18

What increases venous return?

Answer 18

The relaxing phase of Valsalva,raising leg and squatting

Question 19

effect on murmur?

Answer 19

reciprocal to standing and SPV

Question 20

Effect of squatting?

Answer 20

increase venous return
increase afterload
increase regurgitant flow

Question 21

Handgrip?

Answer 21

Increase B/P
Increase afterload
increase regurgitant flow

Question 22

Squatting?

Answer 22

Increase AR.MR/VSD

Decrease HCM and MVP

Question 23

Handgrip?

Answer 23

Increase AR.MR/VSD

Decrease HCM and AS

Question 24

Effect of squatting on MVP?

Answer 24

Increase LV size–Delay valve prolapse—later click and shorter murmur but it may increase the intensity of the murmur due to increase afterload.

Question 25

MVP syndrome symptoms?

Answer 25

Atypical chest pain, palpitation, dyspnea, dizziness, anxiety, and panic attack.

Question 26

Indication for statin therapy?

Answer 26

Primary and secondary prevention

Question 27

Secondary?

Answer 27

``` ASCVD Acute coronary syndrome Stable Angina CABG Stroke, TIA, and peripheral disease. ```

Question 28

Primary?

Answer 28

LDL>190 mg/dl Age>40 with diabetes Mellitus Estimated 10 years risk of ASCVD 7.5%-10%

Question 29

Cardiovascular risk calculator(assess the 10-year risk of ASCVD)

Answer 29

``` Age Sex Ethnicity Total colestrol HDL DM Smoking status Hypertension ```