EXAM Flashcards
Patient with stable angina with all possible therapy again have attacks, chest pain has become more frequent and more severe, what are you going to do?
A. Heparin
D. Digoxin? may increase myocardial oxygen consumption and exacerbate the situation.
C. Thrombolytic therapy? for documented myocardial infarction
Heparin
Problem with breathing and weakness but no chest pain.
ECG shows nonspecific ST-T changes. It is painless myocardial infarction
Myocardial Infarction(The classic presentation of acute myocardial infarction (MI) involves heavy or crushing sub-sternal chest pain or pressure.)
However, 15 to 20% of infarctions may be painless, with the greatest incidence in diabetics and the elderly. Dyspnea or weakness may initially predominate in these patients)
Dressler syndrome post myocardial infarction syn
Recognize it and therapy
A. Autoimmune pleuritis, or pericarditis characterized by fever and pleuritic chest pain, with onset days to 6 weeks post cardiac injury, as after a cardiac operation, cardiac trauma, or MI.
B. Therefore the most effective therapy is a non-steroidal anti-inflammatory drug or occasionally a glucocorticoid.Pneumonia would be with dyspnea.
After myocardial infarction develop CHF which
medication you will give
ACE I angiotensin converting enzyme inhibitor . This has been shown to prevent or retard the development of heart failure in patients with left ventricular dysfunction and to reduce long-term mortality when begun shortly
after an MI. This relates to inhibition of the renin-angiotensin system and to reduction overload
Patient with hypertension presents with new onset of mild hemiparesis without the complicating factors
A. The Antihypertensive
Aspirin alone might be sufficient for such a patient
B. In patients with atrial fibrillation
risk of stroke approaches 30%, therapeutic anticoagulation with warfarin (Coumadin) reduces the incidence of future stroke
Myocardial infarction (NSTEMI) symptoms and therapy
The Initial therapy for acute coronary syndrome includes aspirin, nitro-glycerine, anticoagulation, and morphine. A cardio selective beta-blocker, such as metoprolol, is frequently given in the immediate management of ACS to decrease myocardial oxygen demand, limit infarct size, reduce pain, and decrease the risk of ventricular arrhythmias
Crescendo-decrescendo murmur at the upper right sternal border, would you perform stress test (Aortic stenosis)
Cardiac auscultation suggests aortic stenosis, a contraindication to stress testing
Low-pitched diastolic rumbling murmur
is faintly heard toward the apex Dg
The etiology of mitral stenosis is usually rheumatic, rarely congenital
Ventricular septal defect auscultation finding?
A holosystolic murmur at the mid-left sternal border is the murmur most characteristic of a ventricular septal defect
hypertensive encephalopathy (emergency)and asthma th
Nitroprusside is indicated (vasodilatation)
**Recognize rheumatic fever .. Dx.
An antistreptolysin O antibody is necessary to diagnose the disease by documenting prior streptococcal infection.
Most experts recommend the use of glucocorticoids when carditis is part of the picture of rheumatic fever. Penicillin should also be given to eradicate group A β-hemolytic streptococci
18 year a syncope episode on sport training Echocardiogram will reveal symmetric or asymmetric hypertrophy of the ventricle, with the septum most commonly involved. If the patient’s ECG and echocardiogram are normal, consideration could be given to pursuing an electrophysiological study.
When to return him to sport
Until the results of the ECG and echocardiogram are available, the patient may not return to sports.
***1h chest pain, acute ST segment elevation blood pressure is 80/40 mm Hg, HR 40 therapy?
caused by increased vagal tone and not by destruction of the SA node. When associated with hypotension, therapy ?
A. th ?…atropine; ventricular tachycardia in the context of cardiac ischemia warrants the use of amiodarone;
In idioventricular rhythm the rate is 30-45 bpm. The QRS complexes are wide (> 0.12 sec, often > 0.16 sec) because the ventricular signal is transmitted by cell-to-cell conduction between cardiomyocytes and not by the conduction system.
B. Accelerated idioventricuar rhythm is a rapid form (60-120 bpm) of idioventricular rhythm associated with reperfusion during myocardial infarction. This is a benign rhythm and rarely degenerates into ventricular tachycardia or other serious arrhythmia; so observation is the appropriate choice.
*Recognize (PAD). …Therapy ?
Initial intervention should focus on lifestyle modification, most notably smoking cessation. Claudication can be improved by a graduated exercise regimen. Cilostazol, a phosphodiesterase inhibitor ( inhibition in platelet aggregation), improves exercise tolerance
*screening examination for
overweight, hypertensive, 70 year old
The US Preventive Services Task Force recommends that all males between the ages of 65 and 75 with any history of smoking undergo one-time screening for abdominal aortic aneurysm (AAA).
