Medicine 1 Flashcards
The drugs of choice in HOCMP are?
Beta blockers- decrease myocardial contractility and prolong diastole.
Verapamil n disopyramide are also used
A 50 yr old man comes with blurry vision for 6 months. BP is 130/80, PR is 78. Funduscopy- narrowed retinal venules at the intersection point with arterioles and appear to bulge on either side. ECG shows increased QRS complex voltage n T wave inversion in leads V5 n
V6.
- ophthalmologist evaluation is recommended. What is the best additional step in the evaluation of this patient?
Ambulatory blood pressure monitoring - an average 24 hour BP>135/85 is diagnostic of HTN. The pt most likely has isolated ambulatory hypertension AKA masked hypertension. Typically have normal BP during clinic visits ; they initially present with evidence of hypertensive end organ damage [retinal arteriovenous nicking (hypertensive retinopathy), increased QRS complex voltage (LV hypertrophy)]
A man underwent PCI performed via the right femoral aa revealing proximal LAD occlusion; stenting performed n medical therapy initiated. 6 days later he comes with severe left leg pain. Cold mottled left lower leg, absent pedal pulse. Right pedal pulse is present. Which of the following imaging is considered to confirm the most likely cause?
Echocardiography
She has acute limb ischemia (ALI) most likely due to embolization of LV mural thrombus. (Post MI LV aneurism ➡️thrombus)
Weak n delayed (slow rising) carotid pulse is usually due to?
Other auscultatory findings?
Severe AS - pulsus parvus et tarsus
- LATE PEAKING crescendo-decrescendo systolic murmur
- SOFT n SINGLE S2
A 38 yr old comes with occasional palpitation. Apical impulse is displaced to the left, third heart sound is heard, holosystolic murmur that’s loudest at the apex, radiating to the axilla.
The most likely cause of her condition is?
Myxomatous degeneration of the mitral valve- mitral valve prolapse is the most common cause of chronic MR in developed countries.
A pt with known CMP on furosemide, carvedilol, lisinopril, digoxin came with palpitation. Rivaroxaban n amiodarone were added to his existing drug regimen and 2 weeks later, he comes with profound anorexia, nausea and generalized weakness. The most likely cause of his current sxs is? It could have been prevented by?
Digoxin toxicity- because amiodarone increases serum level of digoxin ( verapamil, quinidine, propafenone also do)
-it’s recommended that digoxin dose be decreased by 25-50% when initiating these drugs.
ECG in viral myocarditis would show?
Non specific ST segment changes
Coarctation of the aorta auscultatory findings?
- Systolic murmur (blood flow through the constricted aorta) heard at the left infraclavicular anteriorly n left interscapular posteriorly OR
- continuous murmur- if collateral vessels r present.
- a fourth heart sound due to hypertension induced LV hypertrophy May also b present
A 25 yr old comes with occasional unprovoked episodes of palpitation which generally resolve with cold water immersion. This maneuver works by what mechanism?
Altering AV node activity.
- she’s having paroxysmal supraventricular tachycardia (PSVT) - AV nodal reentrant tachycardia (AVNRT) being the most common form; caused by dual electrical pathway ( slow and fast in the AV node)
- other similar maneuvers include carotid sinus massage, valsalva, eye ball pressure)
A pt develops acute onset SOB n confusion on the fourth day of admission after successful PCI for MI. BP-70/40, PR-120,regular, cold clammy extremities and diaphoresis, raised JVP, bibasilar chest crackles, a harsh loud systolic murmur at the left sternal border with palpable thrill, hepatomegaly, ECG- deep T wave inversion in V1-V5. The most likely cause of sxs is?
Echocardiography n pulmonary aa catheterization would show?
Rupture of interventricular septum
- 3-5 days after MI(LAD or RCA)
- acute cardiogenic shock
- harsh holosystolic murmur with palpable thrill at left sternal border (papillary mm rupture- the murmur of acute MR is soft n there’s no palpable thrill)
- DX - pulmonary aa catheterization- left to rt shunt with a step-up in oxygen saturation from the right atrium to rt ventricle
- Echocardiography- visualization of the septal defect
A pt with chest pain, diaphoresis, raised JVP, positive kussmaul’s sign is found to have ST segment elevation in leads ll, lll, aVF. BP is 80/50, the most likely cause of her hypotension is?
RV infarction- seen in 30-50% of inferior wall MI (ll, lll, aVF)➡️RV failure
- diuretics n nitrates should b avoided and should b treated with IV fluid to increase the preload
A 24 yr old woman comes with sub sternal chest pain that occurs with exercise. No other associated sxs. She was told to have murmur as a child. BP-130/70 on the right n 105/55 on the left. Loud midsystolic murmur best heard at the first right intercostal space. A palpable thrill is present in the substernal notch
Most likely cause of her chest pain?
Supravalvular aortic stenosis- congenital LV outflow tract obstruction- due to discrete diffuse narrowing of the ascending aorta
- systolic murmur similar to that of Valvular AS but this one is best heard at the first right intercostal space, higher than where valvular AS is best heard. Differential BP, Supra sternal thrill r other features
🚩can develop LV hypertrophy➡️INCREASED OXYGEN DEMAND or coronary aa stenosis as an associated anomaly, both leading to angina
A 34 yr old is found to have premature atrial complexes found on a routine ECG. He has no sxs. He smokes cigarette n drinks 1-2beer a day. The next step in the mx is?
Advise him to stop alcohol and tobacco
- no treatment is needed unless symptomatic or develops supraventricular tachycardia
Murmur of hypertrophic obstructive cardiomyopathy is described as?
Crescendo-decrescendo systolic murmur along the left sternal border
Most common focus of origin of arrhythmia in Afib is? (Picture)
Pulmonary veins
Cardiac tissue extends into the PVs and normally functions like a sphincter to reduce reflux into the PVs during atrial systole. This tissue has different electrical properties n is prone to ectopic/aberrant conduction.
