IHD, CMP Flashcards
EKG finding in pericarditis
- ST elivation everywhere
- pR segment depression- most specific.
Constrictive pericarditis clinical features
- Sxs of rt heart failure, sharp x and y descent;
- kusmaul sign( increase in JVD on inspiration);
- pericardial knock- in diastole (early after s2)
Unique physical finding in cardiac tamponade
Pulsus paradoxus
Chest pain in a young woman who smokes occurring in the middle of the night, precipitated by exercise, cold exposure, hyperventilation, emotional distress, cocaine
Dx?
Rx?
Prinzmetal’s angina
Rx- CCB, beta blockers
Cardiac myxomas clinical presentation
- additional heart sound
- systemic sxs
- cardiac sxs
Mostly located in the left atrium=> obstruction of blood flow mimicking MV disease producing early diastolic sound( tumor plop)
- fatigue cough dyspnea pulmonary edema or hemoptysis
Systemic embolization - TIA, stroke, splenic infarcts
Constitutional sxs due to IL-6 production
Secondary hypertension in a pt with hypercalcemia, renal stones, n neuropsychiatric sxs is most likely as a result of ?
Hyperparathyroidism
How? Unclear
The primary mechanism responsible for the effect of nitroglycerin to treat anginal pain is?
Dialation of veins (capacitance vessels)—> decreases preload n heart size—> reduced oxygen requirements
Blue toe, livedo reticularis , cerebral or intestinal ischemia, AKI, in a pt who has undergone cardiac catheterization or other vascular procedures recently is suggestive of the dx of?
Cholesterol embolism
Define resistant hypertension
The most common n correctable cause is?
Persistent htn despite using 3or more antihypertensive drugs of different classes one being a diuretic
Renovascular(eg renal aa stenosis)
Renovascular htn is suspected when —, —, —
- elevation in serum Cr>30% from baseline after starting ACE inhibitors or ARBs
- severe htn in a pt with recurrent flash pulmonary edema,
- severe htn in pts with diffuse atherosclerosis
- onset of severe htn after age 55
- in a pt with asymmetric kidney size or a small atrophic unilateral kidney
- presence of abd brui
Mx of alcoholic DCMP other than drugs
Total abstinence from alcohol which may reverse the CMP if employed early in the course of the disease
Best initial test in constrictive pericarditis?
CXR which shows calcification n fibrosis.
CT n MRI r both more accurate. Echo is also done to exclude RV hypertrophy or CMP
Common cause of constrictive pericarditis in developing countries
TB
Pathognomonic EKG finding for pericardial effusion
Electrical alternans ( due to the swinging movement of the heart in the pericardial cavity that causes a beat to beat variations in QRS axis n amplitude) Low voltage QRS
What’s dressler’s syndrome? Mx?
Pericarditis occurring weeks after MI
Rx- NSAIDs
Best therapy for HOCMP
Drugs contraindicated
B-blockers, since they slow the heart n prolong diastole-> increased filling-> less outflow obstruction. Their antianginal effect helps as well.
CCBs like verapamil in pts who can’t tolerate B- blockers
- diuretics r contraindicated
A non-hypertensive pt presenting with unexplained CHF predominantly diastolic dysfunction, conduction abnormalities, proteinuria n easy bruising
Echo shows increased ventricular wall thickness with normal LV cavity dimensions
Cardiac Amyloidosis
Use of B blockers, ACEIs/ARBs, diuretics, spironolactone, digoxin in the different types of CMP
Hypertrophic- Yes (diuretics, spironolactone ); No ( beta blockers, digoxin); unclear benefit (ACEIs, ARBs)
Dilated CMP- all of the above can be used
- In HOCMP, ACEIs n diuretics definitely do not help. This is the main difference between HOCMP and HCM
HOCMP is worsened by drugs n maneuvers such as?
worsened by anything that decreases LV chamber size: ACEIs, ARBs, Digoxin, hydralazine, valsalva n standing
Among the infiltrative disorders the one commonly associated with DCMP, CHF, conduction abnormalities like sick sinus syndrome is
Hemochromatosis
A pt admitted 5 days ago for a myocardial infarction has a new episode of chest pain. The most specific method to establish the dx of a new infarction is? CK-MB Troponin Echo Stress testing Coronary angiography
CK-MB is the answer. Because it returns to normal in 2-3 days after MI.
Troponin can remain elevated for 2wks
Angiography can detect stenosis/obstruction but not myocardial necrosis
Stress test should never be performed in a pt having current chest pain.
Echo will show decreased wall movement but this could have been present from previous cardiac injury.
