Cardio Conditions

Question 1

• MASSIVE heart with R/L S3 & S4 sounds
• Alcohllism/thiamine deficiency, myocarditis, chemo
• Arrhythmias

What do you suspect? Next step & treatment?

Answer 1

Dilated Cardiomyopathy

Echocardiogram*, BNP, ECG

Treatment:

• Same as CHF = ACEi, ARB, Beta blocker, aldosterone antagonist, cardiac glycosides, vasodilators, antiarrthmics

Question 2

What does BNP measure?

Which suspected conditions would you order them for?

Answer 2

B-type natriuretic peptide, is a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume.

Cardiomyopathy, CHF

Question 3

• Autosomal dominance inheritance (chromosome 14)
• Hypertrophy of the ventricular septum than the left ventricular wall
• Palpitations, angina with exertion, split S2/S4, palpble double apical impise

What do you suspect? Next step and tx?

Question 4

• Etiology: amyloidosis/sarcoidosis, myocardial fibrosis after open surgery, or radiation.

Feature:

• Elevated JVP with gradually worsening SOB, progressive exercise intolerance, fatigue.
• Loud early diastolic filling sound (S3)
• Mitral & tricuspid valve regurgitation

Answer 4

Wchocardiogram

Chest x ray

vesntricular biopsy

Diurretics**

Question 5

Which valve is most commonly affected in Endocarditis

Question 6

Staph aureus and viridans

prostethis heart valve

opportunity bacterium

Clinical features:

petechiae on lefs, janeway legs, splinter hemorrange on nail

Answer 6

Enedocarditis

Question 7

Janeway’s Lesion

Question 8

Roth’s spot

Answer 8

Endocarditis

Question 9

Osler’s node

Question 10

A potential complication of endocarditis?

Answer 10

Echocardiogram blood culture

Question 11

Endocarditiss teratment

Answer 11

IV antibiotics 4-6 weeks

Question 12

Myocardits is usually ___ origin, __ valve is the most common valve involved (heart murmur). The gold standard to dx this treatment is ___.

Fever, chest pain, pericardial friction rub. elevated JVP

Question 13

Myocarditis Tx

Question 14

• Diffuse ST elevation and PR depression accompanied with chest pain and friction rub.
• Better leaning forward, worse leaning back

Answer 14

Acute pericarditis

ESR, CRP, Triponins I and T, serum creatinine kinase MB

ER!!!

Question 15

Jones criteria

joint, carditis, subcutaneous nodules, erythema marinatum, subcutaneous nodules

Answer 15

Pediatric rheumatic heart disease

elevated level of anti sreptococcal antibodies

Penicillin and aspirin prednisone

Question 16

CHF Tx

Answer 16

EMERFENT referral

use cardio meds

Question 17

Ischemic heart disease

Angina

Stable angina worse with exertion

*BETA BLOKER

Prinzmetal angina/variant angianna- same sxs as stable but occurs at rest (between midnight and 8 AM)

NO AND CCB

Unstable angina

• at rest (>20 min)

NO and heparin

Question 18

Chronic ischemic heart dz.

Answer 18

stress test and echo

Question 19

My chest feels like there’s an elephant sitting on my chest! The pain radiates upwards and lasts 20 minutes to several hours. Doesn’t get better with rest or nitroglycerin.

Answer 19

MONA BASH: Oxygen, aspirin

Question 20

A fibTx

Answer 20

can cause stroke

Question 21

Atrial premature beats

common in healthy heartd

Question 22

Arrhythmia gold standard investigation

Answer 22

ECG

Question 23

Ventricular Premature Beats

Question 24

When do you give pacemaker?

Answer 24

For second and third degree heart block

Question 25

Dizziness, lightheadedness, hypotension, chest pain

Question 26

Heart beats 100-300 bpm

Question 27

Ankle Brachial Index value

Answer 27

Chronic arterial insufficiency/occlusion (\<0.4 = ischemia) Peripheral vascular disease (\<0.9 = PVD)

Question 28

Tx for chronic rterial insufficiency

Answer 28

Aspirin, clopidogrel, pentoxifylline

Question 29

Chronic venous insufficiency women \> 50 yo leathery , flakym itchy skin feels full painless ulcer formation abode medial mallepuos

Answer 29

Ulcer →

Question 30

Painful, cold extermities, finger and toes. NUmbe dry akin wu uclerations.

Question 31

WOmen smoking with fingers tyrning pale, blue, then red. Has cold, burning pain and numbness, Tx\>

Question 32

Stasis Dermatitis

Question 33

A 55 y/o F of Northern European ascent PTC with abrupt monocular loss of vision, jaw claudication, and scalp tenderness. Also has a severe throbbing headache. PMHx: polymyalgia rheumatica Dx? Next step? Tx?

Answer 33

Temporal Arteritis/Giant cell arteritis **Biopsy of the temporal artery\*\*** High dose prednisone for pain

Question 34

A 65 y/o M PTC with pain in the thorax.

Answer 34

Aortic Anyurism Abdominal Ultrasound\*\* Monitor

Answer 35

Varicose Vein

Question 36

Brodie-Trendelenburg Test

Answer 36

Varicose Vein

Question 37

Atherosclerosis Tx

Answer 37

1. Life style: Diet, No smoke, exercise 2. Antiplatelet: Aspirin 3. ACE inhibitors, ARB 4. Stains

Question 38

A 45 yo M with numbness in the extremities. He noticed cyanosis and thinning of his skin. He has increased sensitivity o cold

Question 39

50 yo M with leg pain that is relieved by rest. Noticed blue legs, ankles, and feet. His lower extremities feels colder and noticed some ulcer formation. What do you suspect?

Answer 39

Peripheral vascular disease Tx: avoid vasocontricrivve drugs, cold temp, risk factors antiplatelet durgs Amputation

Question 40

D-dimer lab test

Answer 40

DVT, DIC, PE

Question 41

What imaging do you use for Thrombophlebitis?

Answer 41

Doppler US to differentiate from DVT?