Cardiology

Question 1

WPW

Answer 1

1. short PR, delta wave (slurred upstroke of QRS) and long QRS
2. some develop tacchyaarythmias
   Tx: catheter ablasion in symptomatic arrythmias

Question 2

INR

Answer 2

SUPRATHERAPEUTIC INR
1. INR9+ no bleeding: hold warfarin and administer high dose oral vit k
4. any+ serious bleeding: hold warfarin give IV vitK adn FFP
INR in mechanical valve:
2-3: bileaflet mechanical valves (aortic) in normal rhythm
2.5-3.5: mechanical valve in afib
2.5-3.5 (use asp for those who have systemic thrombus)

Question 3

A. Fib

Answer 3

1. unstable: cardioeversion
2. stable: control rate with beta blockers, verapamil and digoxin
   anticoagulation depends on chads score:
   if less than 1: aspirin
   greater than 3: warfarin
3. paroxysmal a-fib: patients may be asymptomatic- should be tx with amiodarone if patient has structural heart disease. (amiodarone increase levels of warfarin)

Question 4

Mitral Stenosis

Answer 4

1. opening snap with diastolic murmur

2. MCC is rheumatic fever

Question 5

Drugs Reactions

Answer 5

1. Drug induced lupus: Hydralazine, procianamide, INH, diltiazem,
2. manifests as flu like symptoms, fever malaise arthralgias myalgias and maculpapular rash
   * antihistone ab*

Question 6

Chest pain

Answer 6

Cocaine use: may use benzos and nitro, avoid beta blockers

Question 6

Cardiac Tamponade

Answer 6

1. becks triad: muffled heart sounds, hypotension nad elevated JVD
2. On echo there is collapse of right atrium and ventricle during diastole
3. Drop of BP >20mmHg in CT