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Chinese, Simplified
Chinese, Traditional
Japanese, Romaji
Math / Symbols
Azerbaijani
Belarusian
Chinese, Pinyin
Chinese, Simplified
Chinese, Traditional
Indonesian
Japanese, Romaji
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Luba-Kasai
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143 Cards in this Set
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Criteria for Brugada Syndrome?
ECG + 1 or & of 6 : Documented
(VF) or polymorphic ventricular tachycardia (VT)FH of sudden cardiac death at &45 yCoved-type ECGs in family membersInducibility of VT with programmed electrical stimulation SyncopeNocturnal agonal respiration
Most Common Arrythmia Post MI?
Ventricular Ectopics
Drugs CI in Cardio? AF+IHD: Junctional Tachy: AF+WPW:Aortic Dissection: HOCM: HF:
AF+IHD,WPW: FlecainideJunctional Tachy: FlecainideAF+ WPW: Digoxin or Verapamil Aortic Dissection: CCB HOCM:? ACE-I ? Inotropes, Nitrates (AIN)HF: Verapamil and diltiazem
+ve or -ve qrs concordance?
?? ?????? ?? ?? ???? ????? ?? ???? ???
HT a/w which type of HF?
Diastolic Dysfunction: EF&50%
Hyer or HypoTHYROID IN DCM?
HyperHypo cause Pericardial Effusion
??????????? ???? ??? ?????? ?????? ???? ????? ????????
ECG Changes in Pericarditis?4 stages?
PR Depression with AVR ElevationST Elevation in All Leads+ AVR Depress
stage I: ST elevation in all leads. PR depression (depression between the end of the P-wave and the beginning of the QRS- complex)stage II: pseudonormalisation (transition)stage III: inverted T-wavesstage IV: normalisation
Mx of Acute Pericarditis?
???? ??? ???? Anticogulaed if Recurrent: Steroids
if Infected, Malignancy , Not resolved in 3 months: SurgeryAvoid RCU
Most Forgotten cause for P.Eff?
Hypothyroidism
Mx of Temponade?
Pericardiocentesis
CI: in Malignancy, DissectionGo for Surgery
Indications of Pericardiectomy in Pericarditis?
Constrictive pericarditis,
Effusive C pericarditis, or
Recurrent pericarditis + multiple attacks, steroid dependence, and/or intolerance to other medical management.
Poor Prognosis in HOCM?
? syncope ? FH of sudden death? young age? non-sustained VT on 24 or 48-hour Holter monitoring? Abnormal BP changes on exercise ? increased septal wall thickness
CHA2DS2-VASc ?
????? ????? ?????? ?? ??? ???????????
C Congestive heart failure 1H Hypertension (or treated hypertension) 1A2 Age &= 75 years 2D Diabetes 1S2 Prior Stroke or TIA 2V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1A Age 65-74 years 1S Sex (female) 1
Score Anticoagulation In NonV0 No treatment is preferred to aspirin1 Oral anticoagulants
dabigatran is an alternative2 or more O dabigatran is an alternative
Agents with proven efficacy in the pharmacological cardioversion of atrial fibrillation?
Amiodarone? flecainide (if no structural heart disease)? others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone
Less effective agents? beta-blockers (including sotalol)? calcium channel blockers? digoxin? disopyramide? procainamide
5 WPW Associations (4 Structural 1systemic) and Mx?
Associations of WPW? HOCM? mitral valve prolapse? Ebstein's anomaly? thyrotoxicosis? secundum ASD Management? definitive : radiofrequency ablation of the accessory pathway ? medical therapy: sotalol**, amiodarone, flecainide*in the majority of cases, or in a question without qualification,
???? ????? ????? : ????? ???
??????? ??? ???? ??? ?????**sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AVnode may increase the rate of transmission through the accessory pathway, increasing the ventricular rate andpotentially deteriorating into ventricular fibrillationsyndrome is caused by a congenital accessory conducting pathway between theatria and ventricles leading to a atrioventricular re-entry tachycardia (AVRT). As the accessory pathway does notslow conduction AF can degenerate rapidly to VF
Two important updates on mx of Hypertension
? calcium channel blockers are now considered superior to thiazides? bendroflumethiazide is no longer the thiazide of choice
AHA-ACC-CDC Advisory
Bp Mx Recommendation?
o BP goal of & 139/89 mmHg o Stage I HTN (SBP 140-159 or DBP 90-99 mmHg) o Lifestyle modifications o +/- Thiazide diuretico Stage II HTN (SBP & 160 or DBP & 100 mmHg) o Thiazide + (ACE-I or ARB) or + Calcium channel blockero Titrate doses if not at goal or add different drug class
Bp Classification?
Stage : Clinic BP &= 140/90 and subsequent ABPM &= 135/85Stage 2: Clinic BP &= 160/100 and subsequent ABPM &= 150/95Severe hypertension Clinic systolic BP &= 180 , or clinic diastolic BP &= 110 mmHg
Direct renin inhibitors? e.g. Aliskiren (branded as Rasilez)?
? by inhibiting renin blocks the conversion of angiotensinogen to angiotensin I? no trials have looked at mortality data yet. Trials have only investigated fall in blood pressure. Initial trials suggest aliskiren reduces blood pressure to a similar extent as angiotensin converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists? adverse effects were uncommon in trials although diarrhoea was occasionally seen? only current role would seem to be in patients who are intolerant of more established antihypertensive drugs
Bp Targets?
& 80 years 140/90 135/85 & 80 years 150/90 145/85
?? ???? ???? : ??? ???? ??? ?? systolic ??? ?? standard
Agents used to maintain sinus rhythm in of atrial fibrillation?
? sotalol? amiodarone? flecainide? others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine
Factors favouring rate control
Older than 65 yearsHistory of ischaemic heart disease
? beta-blockers? calcium channel blockers? digoxin (not considered first-line anymore as they are less effective at controlling the heart rate during exercise. However, they are the preferred choice if the patient has coexistent heart failure)
Factors favouring Rhythm control?
Younger than 65 yearsSymptomaticFirst presentationLone AF or AF secondary to a corrected precipitant (e.g. Alcohol)Congestive heart failure
Pericarditis Causes?
? viral infections (Coxsackie)? tuberculosis? uraemia (causes 'fibrinous' pericarditis)? trauma? post-myocardial infarction, Dressler's syndrome? connective tissue disease? hypothyroidism
MI: Secondary Prevention?
All patients:? ACE inhibitor? beta-blocker? aspirin? statinClopidogre? STEMI: patients treated with a combination of aspirin and clopidogrel: first 24 hours & for at least 4 weeks?NTEMI): clopidogrel 12 months if the 6 month mortality risk* is &1.5%
Aldosterone antagonists? patients who have had an acute MI and who have symptoms and/or signs of heart failure and leftventricular systolic dysfunction, treatment with an aldosterone antagonist licensed for post-MI treatment(e.g. eplerenone) should be initiated within 3-14 days of the MI, preferably after ACE inhibitor therapy
Mild OLD + HF?
BB can be given?
beha majal
Bnp interptetation affected by?
Obesity ↓ age, women CKD ↑
??? ????? ???? ??? ??? ????? ???? ????? ??? ???? ????? ??? ????? ???? ??????
When to use High sensitive crp?
Recassify Intermediate risk CAD
Mx of AV ????? + bicuspid ?
?? root ????? ????
Donedarone on Kidney
↓ Crcl but not GFR
Whats eptifebatide MOA?
GP 2B3A inhibitor
Indications for GP IIb/IIIa inhibitor ?
Majorongoing chest pain, dynamic electrocardiographic changes, elevated troponin on presentation, Minorheart failure, and diabetes mellitus.
Specific Echo/CXR features in Constrictive pericarditis?
LVH, Ventricular independence with Respiration (Increase Variations)Flow Velocity transMitral Annulus: & restrictive & 12, & 8 respectively.
if in bw : nonDx(so but not Sens) Hepatic venous flow reversal — reverses during expiration in constrictive pericarditis but reverses during inspiration in restrictive cardiomyopathy. ± Ventricular end-diastolic pressures — Right and left ventricular end-diastolic pressures (RVEDP and LVEDP) are equal or nearly equal in constrictive pericarditis, while LVEDP is usually higher than RVEDP in restrictive cardiomyopathy
Calcification(by CT&& or Echo): Highly specific but not sensitive Absent pul. Congestion
Causes of Kussmaul signs?
Constrictive Preri. Restrictive MyopAthy Others RV Infarction in Inf MIMassive pulmonary embolismPartial obstruction of the vena cavaeRight atrial and right ventricular tumorsOccasionally tricuspid stenosis congestive heart failureRarely
cardiac tamponade
tamponade: x descent, absent y constrictive pericarditis: (prominent x and y descent),
Rx of chronic cP?
Drugs css cP
Hydralazine, Procainamide, Doxuribicin
???? ???? ???? ???? ???? ?? ?? Ca
Single drug cause rCMP
Anthracyclin
Other idiopathic,
infiltrative,
Non infiltrative,
Pulsus Paradoxus css ?
Have high Negative Predictive value not specificity
Af + IHD or structural?
Amiodarone
Indication of operative PS mx?
AnnulusModerate to sever MRSupra/suv valvular PS
Maze precedure?
AF mx in PostTOF repair mx
Preffered CCB IN UA CI BB?
Amlodipine for Associated HT
End stage HF + Hypot?
Ass for Transplant
Radiation Hx + Murmur?
INR Decrements (Inducers)? RifampIn-ducerINR Increments (Inhibitors)? Iso- Inhibitor
RifampinAprepitantBarbituratesCarbamazepinCholestyramineGriseofulvinMercaptopurineMesalamineMethimazoleNafcillinRifabutin
IsoniazidAlcoholAmiodaroneCimetidineCiprofloxacinCitalopramClofibrateDiltiazemErythromycinFenofibratFluconazole, Miconazole, Voriconazole, MetronidazoleNSAIDs/COX-2 inhibitors, OmeprazoleQuinidinesSulfinpyrazoneTamoxifenTMP-SMZ
Riampicin ??? ?? ???? ????? ???? ?????
3 days post MI,
Fever + SOB+ elevated Cardiac enzymes?
Myopericarditis UPOW
Akin to MINo JVP distention
Features of IE + PR prolongation?
Aortic Root AbcessGo for Surgery
Restrictive CMP most imp Echo finding?
Diastolic dysfunction with preserved systolic functionNB: PAH PRESENTNote: Also cP have so it is not a feature of Diff.
Unlike the other cardiomyopathies that are classified according to morphological criteria, i.e. hypertrophic, dilated, right ventricular;Restrictive is a functional classification
Echocardiographic features of amyloid infiltration of the heart
Increased LV wall thicknessIncreased RV wall thicknessSmall, well, or poorly contracting LVEnlarged LAValve thickening (all valves)Mitral regurgitation (usually mild)Thickened atrial septumE/A ratio &1Pericardial effusion (advanced disease)
Indications for a temporary pacemaker?3 Tri
? symptomatic/haemodynamically unstable bradycardia, not responding to atropine? q-ANTERIOR MI: Mobits type 2 or complete heart block*? trifascicular block prior to surgery
BI sphereience Not Alternate Pulse?
Mixed Aortic Valve disease
2nd line in Mx of SVT ?
Verapamil esp if adenosine CI
Duke Criteria of IE?
Infective endocarditis diagnosed if? pathological criteria positive, or? 2 major criteria, or? 1 major and 3 minor criteria, or? 5 minor criteria
Pathological Criteria?
Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue,vegetations, embolic fragments or intracardiac abscess content)
Major Criteria?
Positive blood cultures? two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or? persistent bacteraemia from two blood cultures taken & 12 hours apart or three or more positive bloodcultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or? positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or? positive molecular assays for specific gene targetsEvidence of endocardial involvement? positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation ordehiscence of prosthetic valves), or? new valvular regurgitation
Minor Criteria? 5
? predisposing heart condition or intravenous drug use? microbiological evidence does not meet major criteria? fever & 38?C? vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, petechiae or purpura? immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots, Janeway lesions
3 differnces bw Thrombosis and stenosis in post Cath?
T(1)rombosis:1 month 1-2 % M1 presentasion
S(5)tenosis5 months25 % Angina Symptoms
Myocardial action potential Nemonic?
???????? ??? ???? ???? ?? ??? ???? ??????? ????? ?? ?????????? ?? ?????????? ???? ?????? ?????? ?????? ???????2 ??? ????????? ??? ???? ??? ??????? ??? ???? ???? ?????????? ???? ???????? ???? ???? ????????? ?????? ??????? ?????? ????????
0 Rapid depolarisation :Rapid sodium influxThese channels automatically deactivate after a few ms1 Early repolarisation Efflux of potassium2 Plateau Slow influx of calcium3 Final repolarisation Efflux of potassium4 Restoration of ionic concentrations
In of ASD closure?
Rt side enlargement - PAH (absent)
HOCM + RTA+Shock? MX
Phenylpherine
How to dx ASD L-R shunt?
Agitated sline echo
Mechanism of Action of Hydralazin?
Direct Vasodilator
Mechanism of Action of Nitroprusside?
Vascular Smooth muscle Relaxant
Mx of IE Cause of Prosthetic Valave
o young patient with acute history o?chest pain, SOB + Hx of Toxoplasmosis inf?
Myocarditis
? wide pulse pressure? JVP: cannon waves in neck? variable intensity of S1
Complete Heart Block
T wave inversion in leads V1- 3 associated with a notch at the end of the QRS complex
Arrhythmogenic right ventricular cardiomyopathy / An epsilon wave is found in about 50%MX by Satolol
Management? drugs: sotalol is the most widely used antiarrhythmic? catheter ablation to prevent ventricular tachycardia? implantable cardioverter-defibrillator
triad of ARVC, palmoplantar keratosis, and woolly hair
Naxos diseasevariant of ARVC
? left anterior hemiblock ? left bundle branch block ? Wolff-Parkinson-White syndrome* - right-sided accessory pathway ? hyperkalaemia ? congenital: ostium primum ASD, tricuspid atresia ? minor in obese people
LAD : ???? ???? ???? ???? (????? :???? ??? ?? ?????? ??? ??? ????? ?? ??? LLBBB, LAHB
??? ???? ???? ??? ???? ???? ????? ??????? ??? ??????? ???? ???? ????? ?????? ???? ??? ?? ???
? left anterior hemiblock ? left bundle branch block ? Wolff-Parkinson-White syndrome* - right-sided accessory pathway ? hyperkalaemia ? congenital: ostium primum ASD, tricuspid atresia ? minor LAD in obese people
LAD : ???? ???? ???? ???? (???? ??? ?? ?????? ??? ??? ????? ??? ?????? ??? ???? ???? ??? ???? ???? ????? ??????? ??? ??????? ???? ???? ????? ??????? ??? ?? ??? ????
Hypertension in DM Mx?
ACEI even if Old age
Centrally Acting Antihypertensives
? methyldopa? moxonidine NOT Minoxidi? clonidine
MVP Associations
(Cardio2, Arrythmia2, Rheumato5, Endocrine1, Nepro1)
? congenital heart disease: PDA, ASD? cardiomyopathy? Wolff-Parkinson White syndrome? long-QT syndrome? Turner's syndrome? Ehlers-Danlos Syndrome? Marfan's syndrome, Fragile X? osteogenesis imperfecta? pseudoxanthoma elasticum? polycystic kidney diseaseNo Dawn Syndrome
In MX of Any Case With AF or Aortic valve Look for?
Prinzmetal Anginal Definition & Mx?
Coronary Vasospasm rather than ischemic Pathology CCB
Exposure to cold weatherStressMedicines that tighten or narrow blood vesselsSmokingCocaine use
1st Line Rx in HF, IHD resp ?
ACEI, Aspirin Take care
Anti Hypertensive Drugs may cause lithium toxicity?
Diuretics, ACE-i Nephrotoxicity: Verapamil or Deltiazem
Amlodipine is safe
PPH Mx Steps?
1st : treating underlying conditions,2nd acute vasodilator testing
A + response: oral CCBsB - response : 1 of 3 1 prostacyclin analogues: treprostinil, iloprost2 endothelin receptor antagonists: bosentan3 phosphodiesterase inhibitors: sildenafil
Endothelin : ??????? ???? ???????????? ??? ???????
Hypertension/NF1 associations?
1 coexistant essential hypertension2 phaechromocytoma3 renal vascular stenosis secondary to fibromuscular dysplasia
Atrial flutter 2 Mx tricks ?
More sensitive to cardioversion :lower energy levels usedRadiofrequency ablation of the tricuspid valve isthmus is curative for most patients Not Accessory Pathway
Flutter waves may be visible following carotid sinus massage or adenosine
2 Steps in Mx of MAT
1 correction of hypoxia and electrolyte disturbances2 rate-limiting CCB used first-line
Cardioversion and digoxin are not useful in the management of MAT
Who blindly considered High Risk CAD chest painers?
All men & 70 years who have typical anginal symptoms
Forgotten Causes of DCMP?
Iherited (30%)? nutritionale.g. Kwashiorkor, pellagra, B1, selenium deficiencyInfections e.g. Coxsackie A and B, HIV, diphtheria, parasitic? Duchenne muscular dystrophy? Doxorubicin
Infiltrative causes may also be a cause
1st line mx in Stable Angina?
BB or CCB: Monotherapy: rate-limiting: verapamil or diltiazem Combination: Long Acting DHP (nifedipine or Felodipine) / Risk of CHB long-acting nitrate, ivabradine, nicorandil or ranolazine
Combination no Benefit:
Why to Check electrolytes with
Amiodarone?
Risk of Hypokalemia
? thyroid dysfunction? corneal deposits? pulmonary fibrosis/pneumonitis? liver fibrosis/hepatitis? peripheral neuropathy, myopathy? photosensitivity? 'slate-grey' appearance? thrombophlebitis and injection site reactions? bradycardia
Second heart sound (S2)?? loud:? soft:? fixed split? reversed split:
? loud: hypertension? soft: AS? fixed split: ASD? reversed split: LBBB
Pregnancy Induced Hypertension?
half of pregnancy (i.e. after 20 weeks)No proteinuria, no oedema
Occurs in 3-5% of pregnancies && in older women
How to Prevent recurrence of SVT?
BB? radio-frequency ablation
Hepatic Inducers
******** CRAP GPS induces my rage! St. John's wort Carbamazepine Rifampin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbital Sulfonylureas
Sulphonylurea anD PHenytoin
CYP450 inhibitors VICK'S FACE All Over GQ stops ladies in their tracks.
Valproate Isoniazid Cimetidine Ketoconazole Sulfonamides Fluconazole Alcohol (acute) Chloramphenicol Erythromycin (macrolides) Amiodarone Omeprazole Grapefruit juice Quinidine
Quinines: Anti-MalarialsEven Qweens in Africa shuold take AntiMalarialsSulphonamide:
AntimicrobialsDiuretics:
Thiazide and LoopSulphonylureaSulphasalazine
Mx of hyperCa in Sarcoid?
&& presentation of SLE manifestations?
Mx of Sarcoid?
???? ?????? ???All of the following used in Mx of Sarcoid except ? ???? ?? Behjet
Dx of Whipple?
Post Pharangitis 3 weeks what u suspect?
Pharynx → Heart → Cerebellum, Joints and Skin Rarely
Extraglandular Manif. Of Sjogren?
Arithritis& Reynauds& Lung & Vasculitis& Lymphoma 5 %
PR Interval interp?
Acetozalamide SE?
VT Triad of Association? / pacemaker Imdication?
S3Soft S1 + Heave loud, palpable P2, heard best when lying on the left side
Murmur in Atrial Myxoma
Mid diastolic (Tumor plop)
Wt Loss ass
3 Ass of Bicuspid Aortic Valve
Left Coronary Dominence*
???? ??????????? ???????? ?? ??????????? ?? ?? ?? ???? ????????
3 forgotten features of PDA
Wide pulse pressureCollapsing pulse (Large volume) Heaving Apex beat
Factors ↓ BNP (F-ve)
ObesityAntiHT (unless Alpha blockers)
Forgotten PP in IE
Low Complements
STAPH Aureus also
2 forgotten F of AS?
common: Soft S2S4Narrow, Slow PulsdDelayed ESMDuration of, Murmur
Ichemic chest pain May be repeoducible by palpationsTrue or False?
?????? ????
Verapamil is CI in patient with CI to BBC unlike other CCBsT or F?
FNifedipine is
Forgotten Changes in Cardiogenic Shock?
hypokalemiahypomagnesemiaacidosis
Correction is essential
Distributive Shock Causes
Septic + O SIRS due to noninfectious inflammatory conditions such as bu toxic shock syndrome (TSS); reactions to drugs or toxins, including insect bites, transfusion reaction, and h
h and neurogenic shock due to brain or spinal cord injury
Any cause of LVF may lead to
pulmonary hypertensionT or F?
TBy pulmonary venous congestion and hence PH
Frog Sign?
(prominent venous pulsations in the neck due to cannon A waves seen in AV dissociation) on physical examination is frequently present and suggests simultaneous atrial and ventricular contraction→ AVRT
Imp MKSAP Question?
17 even if asymptotic HF → BB unless pulmonary edema or low CO 19 Bicuspid → SURGERY 4 ROOT & VALVE,24bNYHA class 3-4 on Acei & BB → Add Aldactone ,31 Ascending AD → Urgent surgery ,37 CHADS2 &2 no bridging just in RF subtherpetic, & 2 → theraptic 42 Mechanical Valve + Surgery→ no risk factor → 43 PS → SEE VHD DIAG47→ Down → AVSD → ↑ risk of eisenminer / COA: ECG
→ LVH, O/E→CXR : figure 3 sign + Rib notch
sys mrmr in infraclav. Or over back → , E ANOMALY→ TR + RT HEART enlargement → ECG
Himalayan P waves+ prolonged QRS , RBBB , preexitation → CXR _→ Rt heart enlarge+ small pul.AsCyanosis in PFO + SEVER TR or ASD with reversed shunt
52 AF ABLATION → 3 months continue warfarin and chk,57 Angina + CI to BB → CCCB → Be 1st Line ???? ???? ?? angina,58 acute HF + ARF → DIURETICS,63 acute MR → Surgery 73 ? Trip methoprin DIDNOT cause Long QT ?? U wave ?? ????? ?????
???????? ?? ??? ?? ?????? ?? ??? ????? ?????
,78 see VHD 80 acute edema + discharge → within 1 week hospital check,81, & 5.5 AAA + comorbid condition → Conservative 82 New HF + RF like DM → CAD → CATH ,84 Resolving Constrictive Pericarditis → Continue Mx86 Asymptomatic sever MR + PHT→Repair Surgery
,87 Cardiac allograft VASCULOPATHY &&
COMPLICATION OF Transplant
90, exercise test in AS in LV Systolic Dysfunction ? low gradient 92 → LBBB, ventricular pacing , st t changes Ventricular preexitation
→ Stress with IMAGING → Incapable → Pharmacological stress Echo test
95 D(Dilated)oxurubicin induced CMP
96 → Myopericarditis → HF due to MI + pericardiis
Post MI syndrome didn't cause HF ,102 →
ACE I CI in HF (↑k or ↓ GFR)→ hydralazine + Dinitate ,108, → Sarcoidosis → cmr not Biopsy 111 Marphan + Thoracic AA → SURGERY 113 Cyanotic , Congenital heart disease + HB 15.5
+ ↓ Ferritin → Masking of anemia → Rx
???? ???? CHF ????? PAD ??? ??? ???? ????(???? ?????) ?? ???? ???? ?
cilastazol
???? ???? HF ???? ?? loop diuretics ?????? ???? af ??? ???? ?????? ?????
amiodarone
??? ??? ???? ??toxicity ?????? ????? ?? hypokalemia
ABCDE Mx of HOCM?CI?
Amiodarone· Beta-blockers or verapamil for symptoms· Cardioverterdefibrillator· Dualchamber pacemaker· Endocarditis prophylaxis
NAINitratesAceI Inotropes: Digoxin, Milrenone, Insulin
+ve Inotropes?
AmiodaronCalciumDopamineDobutamineEpinephrine (adrenaline)Isoprenaline (isoproterenol)Norepinephrine (noradrenaline)DigoxinProstaglandins[1]Phosphodiesterase inhibitorsMilrinoneTheophyllineGlucagonInsulin
Positive: Increase Myocaridal C
-ve Inotropes?
Beta blockersVerapamilDitiazemClass 1A ProcainamideDisopyramideClass 1CFlecainide
Negative : Decrease Myocardial Contarctility
Dental Extraction AB Prophylaxis
prosthetic cardiac valve or prosthetic material used for cardiac valve repair a history of infective endocarditisa cardiac transplant that develops cardiac valvulopathy the following congenital (present from birth) heart disease:aunrepaired cyanotic congenital heart disease, including palliative shunts and conduitsa completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedureany repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device (that inhibit endothelialization)
ECG changes in ASD?
PR prolongationAxis Deviation (1 L 2 R)Incomplete RBBB
main indications for (ASD) closure is ?
RV En without PHwith or without symptoms (eg, exercise intolerance, fatigue, dyspnea, heart failure, paradoxical emboli, arrhythmias) [1]. 2. paradoxical embolism or documented orthodeoxia-platypnea
any patient with an unexplained elevation in JVP, particularly if there is a history of a predisposing condition such asMalignancy, prior cardiac surgery, or prior radiation therapy.
Pericardial constriction should be considered in
RCMP due to Amyloid \ which drug should avoid?
Digoxinas it is thought that digoxin may bind to amyloid fibrils and lead to increased toxicity. There I some suggestion that calcium channel blockers and beta blockers should also be avoided.
Post MI PW
chest pain, shortness of breath, hypotension, biventricular failure, and shock within hours to days. Patients often present with a new, loud, and harsh holosystolic murmur. This murmur is loudest along the lower left sternal border and is associated with a palpable parasternal systolic thrill. Likely Dx?
Ventricular Septal Rupture
RV and LV S3 gallops are common.
Post MI one week pw Arrythmia, and features of Cardiogenic Shock with Recurrent ST elevations ?
FVWR usually aw Pericardial effusion and Temponade involve the Anterior wall Treat by PCI
Mx of VSR?
Hemodynamic stabilization with the administration of oxygen and mechanical support with use of an intra-aortic balloon pump, administration of vasodilators (to reduce afterload and thus LV pressure and the left-to-right shunt), diuretics, and inotropic agents.Cardiac catheterization urgent surgical repair.
A 62 year old woman undergoes thrombolysis for a myocardial infarction. After 48 hours you are asked to review here as she is complaining of shortness of breath and her saturations have dropped to 92 per cent. Her blood pressure is 100/65 mmHg and is tachycardic 110 bpm. On auscultation she has a systolic murmur, loudest at the apex, and bilateral crackles to mid zone. What is the likely cause for her deterioration?
Papillary muscle Rupture
Tall R wave in V1 + Inverted T wave ?
1st ECG change in MI?
Hyperacute T wave
Dxtic Criteria of SLE?
SOAP BRAIN MD
S: Serositis O:Oral UlcersA: ArthralgiaP: phtosensitivityB: Blood disorders (1 of 4) R: Renal Disease A: ANAI: Immune : Abs N: Neuro : Seizure or PsychosisM:Malar RashD: Discoid Rash
Classification for CA Indication?
Diff bw segment & interval?
Interval : begining to EndSegment:
End to Begining
Main management of Cholesterol emboli Syndrome
Supportive :)
Which cardiac Chamber mostly involved in Radiation toxicity?
At which level Warfarin shod be avoided?
Emberyopathy3rd:
Risk of ICH of fetus
3 Novel Drugs used in Mx of Peripartum CMP?
Immune globulinPentoxyphillineBromocriptine
In addition to anti failure Drugs
In women with LV dysfunction below 35%?How to AntiCoagulate?
Warfarin with INR (2-3)
Increased Risk of PP CMP?
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When to Prefer Cesarean delivery in CVD pregnant
Obstetric causesWarfarin UseSever PHTDilated Ascending Aorta
Earliest Feature of Radiation Cardiotoxixity?
Reduced Contractile Reserve
Absence of Significant ↑ in EF after stress echo
Which type of CMP will occur late after Receiving Cardiotoxic Chemotherapy?
DCMPPoor prognosis
Wch type of CMP occur acc Period of Exposure? 1. 2-5 m2. 7 y3. 10 - 25y4. Years5. Years to Decade
1. Pericarditis (pericardial eff) 2. CAD (may manifest as MI) 3. Valvular fibrosis & Regurgitation4. Myocardial fibrosis, DD, RCMP5. Dysrythmia, Bradycardia, HB6. ??? ??
Whats the meaning of Ulcerative Plaque?
It means Irregular Surface → high risk for clot formation
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