Most likely Dx

Question 1

what is most important patient hx of hypertrophic cardiomyopathy?

Answer 1

Familty history (death)

Question 2

What is important prevention and tx of HCM

Answer 2

1. If sx -> BB to control sx, then consider ICD
2. Prevention - NO aggresive exercise
3. Myodectomy often bring good result

Question 3

Most common cause sx and dx of hypertrophic cardiomyopathy?

Answer 3

Sx - dypnea, sudden syncope

Dx - echo

Question 4

what is PE of HCM?

Answer 4

hear murmur increase - standing, valsalva

hear murmur decrease - hand grip, lay down, Squatting

Question 6

AV block

• Constant prolong PRI (0.2<) - ID/Tx
• P wave No related with QRS - ID/Tx
• Progressively prolonged PRI and Drop QRS - ID/Tx
• Constant PRI and Drop QRS - ID/Tx

Answer 6

• 1st / Tx: observation
• 3rd / Tx: PPM
• 2nd Mobitz 1
  
  • No sx - Observation
  • Sx - Atropine
• 2nd Mobitz 2 / Tx: PPM

Question 7

ECG shows saw tooth pattern + regular rate

ID/Tx

Answer 7

• ID: Atrial Flutter
• Tx
  
  • Stable: Vagal, BB, CCB
  • Unstable: DCC (50J)
  • Definitive: Ablation

Question 8

Irregularly irregular

ID/Tx

Answer 8

• ID: A Fib
• Tx (rate control 1st and rhythm 2nd)
  
  • Stable: BB, CCB
  • Unstable: DCC (200J)
  • After tx - warfarin 4-6 weeks

Question 9

OTc more than 450

Risk/Dx/Tx

Answer 9

• Risk: TCA, Macrolide use
• Dx: ECG (QT prolonged (QTc 440<)
• Tx: BB

Question 10

What is two type of anticoagulant after A fib?(benefit) and how should you treat?

Answer 10

• Dabigatran (non vit K oral anticuagulant)
  
  • No need to check INR
• Warfarin (antitode Vit K)
  
  • INR 2-3
• Usually tx for 4-6 weeks after a fib

Question 11

QRS Narrow and regular + palpitation

QRS Wide and regular + palpitation

Tx?

Answer 11

1.