Pearls_05

Question 1

Patient with a systolic murmur that worsens on Valsalva and standing (improves with squatting and hand grip)

Dx?
avoid what?

Answer 1

HOCM (or MVP) -> avoid strenuous exercise

Question 2

if symptomatic HOCM (dyspnea/chest pain)…

First line tx?
- two other options?

Answer 2

beta blockers (1st line)
,verapamil, or disopyramide

Question 3

Extra HOCM stuff:
- if progressive heart failure then septal myectomy or alcohol septal ablation…name two procedures to do

If + family history of sudden cardiac death -> what do they need?

Answer 3

ICD

Question 4

When do HOCM pts need an ICD?

Answer 4

if (+) fam hx of sudden cardiac death

Question 5

HOCM
- worsens with what two maneuvers?

• improves with what two maneuvers?

Answer 5

worsens with:
- valsalva and standing

improves with:
- squatting and hand grip

Question 6

How do you tx pt with asymptomatic Wolff parkinson white (delta waves) = see EKG in evernote board pearls_05



Answer 6

NOTHING

- if asymptomatic and no other arrythmias

Question 7

What meds do you avoid in pt with WPW and why?

Answer 7

AV nodal blockers (BB, CCB)

- bc they would then encourage the impulse to cont going through the altenate pathway

Question 8

If WPW converts to crazy arrythmias (see EKG in evernote board pearls_05):

• emergent tx?
• then what?
• then what, once stable?

Answer 8

procainamide emergently –> cardiovert –> ablate once stable

Question 9

beck’s triad?

Answer 9

HoTn
increased JVP
distant heart sounds

Question 10

cardiac tamponade has what triad and what extra finding?

Answer 10

becks triad

- HoTn / Inc JVP / distant ht sounds / pulsus paradoxus

Question 11

what is pulsus paradoxus and what condition is it in?

Answer 11

drop in SBP > 10mmHg with inspiration

Cardiac Tamponade
imaging heart sitting in fluid, decreased BP with insp

Question 12

EKG finding on cardiac tamponade (see evernote board pearls_05)

Answer 12

electrical alternans

Question 13

pt has BP of 85/60, inc JVP, and distant heart sounds. You order an EKG and it shows alternating amplitudes of R intervals

Dx?
Tx?

Answer 13

Cardiac Tamp
- tx with:

1. cards c/s
2. pericardiocentesis

Question 14

SBP decreases > 10mmHg, increased JVP, HoTn, distant heart sounds, with EKG of electrical alternans.

Dx?
- and should you decrease their preload bc you see inc JVP?

Answer 14

cardiac tamp

- DONT decrease their preload because (it has something to do the need for a little extra fluid ealry on in tamponade)