CVS

Question 1

GUidelines for Primary PCI when managing STEMI

Answer 1

1. within 12 hours from starting symptoms AND
2. within 90 min from medical contact at capable facility
3. within 120 min at a non-capable facility

Question 2

Treatment on hypertension in Pregnancy

Answer 2

First line: betablockers (labetalol) , calcium channel blockers (nifidipine) , hydralazine, methyldopa
Second line: clonidine, thiazides,

Question 3

Treatment of HTN in nonpregnant

Answer 3

First line: thiazide, Ca channel blockers, ACEI/ARB

Question 4

characteristics of hypertrophic cardiomyopathy

Answer 4

1. asymmetric LV wall thickening favoring septum
   2.reduced LV cavity size
   3.Left atrial enlargement
2. ECG showing prominent Q waves and Twave inversion in 2 leads

Question 4

Initial management of STEMI

Answer 4

oxygen
Aspirin (chewed)
clopidogrel
nitroglycerin
betablocker(meto/ateno)
anticoagulation (heparin)

Question 4

Vasospastic Angina
-pathophysiology
-risk factors
-clinical presentation
-diagnosis
-treatment

Answer 4

1. hyperactivity of coronary smooth muscles (similar to reynaud)
   2.smoking, age <50
2. recurrent chest pain at rest or during sleep resolves in 15 min
3. ECG (ambulatory)will show st elevation transient
   Cath will not show coronary artery disease
   5.Ca channel blocker is preventative
   nitroglycerin abortive

Question 4

Management of Primary Mitral Regurg

Answer 4

-Surgery if LVEF 30-60%
consider surgery if success if likely in : –>asymptomatic >60%
>symptomatic <30%

Question 4

Characteristics of Athletes Heart

Answer 4

1. Eccentric LV hypertrophy with enlargement of LV mcavity size and slight increase in wall thickness
2. enlarged RV cavity size
   3.increase stroke volume (no change in EF)
3. abscence of Left atrial enlargement
4. sinus bradycardia

Question 5

Pre-op evaluation of valvular heart disease

Answer 5

-If mild: can go ahead with their noncardiac surgery
-moderate/severe?
if symptomatic: repair valve first
if asymptomatic and pt is undergoing intermediate or high risk surgery then assess the valve for EF and pulm htn if present repair first

Question 6

chronic aortic regurgitation etiologies

Answer 6

-congenital bicuspid aortic valve
-Post inflammatory(rheumatic heart disease or endocarditis)
-aortic root dilatation (Marfan/syphillis)

Question 7

chronic aortic regurgitation clinical findings

Answer 7

-decrescendo diastolic murmur
-widened pulse pressure
-water hammer pulsation
-abrupt carotid distension and collapse (pistol shot femoral pulses)

Question 8

what are the cardiovascular effects of hyperthyroidism

Answer 8

1. increased rate:tachycardia/palpitations, afib
   2.increased contractility: increased EF and CO, increased myocardial oxygen demand, increase pulmonary artery pressure
   3.peripheral vasodilation: decreased SVR
   4.decreased diastolic pressure, increased systolic
   5.increased pulse pressure
2. high output heart failure