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medicin Flashcards

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1
Q

How to anticoagulant in Afib Pt?

A

CHADs
C= CHF
H=HTN
A=age >75 60-74 one point
D=DM

S=stroke
S=female sex
or vsacular diseas

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2
Q

antigoagulant to use in Afib Pt ?

A

regarding to score :
man 0 or women 1=> no indication
man 1 or women 2 => risk/benift
man 2 or more woment 3 or more => direct anticoagulant (apixaban)

Warfarin (vitamin K antagonist) may be used:
If DOACs are contraindicated (e.g., mechanical heart valves, severe mitral stenosis).

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3
Q

neurocardiogenic syncope meaning and trigger ?

A

Neurocardiogenic Syncope (Vasovagal Syncope) MC*
is when autonomic response lead to bradycardia/hypotension = cerebral perfusion decrease

trigger by : emotional / heat exposure

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4
Q

what is situational syncope ?

A

syncope related to viseral affernt stimulation => autonimic stimulation => bradicardia/hypotension :
like urination
defecation swolloing
recuurent at same stimulay , no delay or prodorm symptome - diffrentiat from nuerocardiogenic (vasovagal)

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5
Q

first investigation to order in HF ?

A

ECG => BNP

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6
Q

Pt before medical procedure get unconscious with jerky movement , diagnosis ?

A

vasovagal attack
different from seizure by
no postictal symptoms - tung bitting - with prodorm symptom ( sweating lightheadedness)
had a trigger emotional or stress

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7
Q

part
Pt present with recent MI , and new pansystolic mermer / mechanism and type?

A

papillary muscle rupture => Mitral Regurgitation (MR) => pansystolic murmurm at apex radiat to axila

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8
Q

ROSH
how mitral vulve prolaps (MVP) present ?
diagnosis?

A

present mainly asymptomatic
midsystolic click and + late systolic murmur
Dx : clinically confirm by echo => 2mm prolapsing

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9
Q

ROSH
how to diagnose infective endocarditis ?

A

by duck criteria

2 majore
2 majore + 3 minor
5 minor

👻 BE FEVER

MAJORE :
B: Blood cultures positive for typical organisms (e.g., S. aureus, Viridans strep, Enterococci, HACEK)

E: Echo shows evidence of endocardial involvement (e.g., vegetation, abscess, new regurgitation)

F: Fever ≥38°C

E: Echo findings not meeting major criteria or predisposing heart condition (e.g., prosthetic valve)

V: Vascular phenomena (e.g., Janeway lesions, emboli, ICH, pulmonary infarcts)

E: Evidence from immunologic phenomena (e.g., Osler nodes, Roth spots, glomerulonephritis, RF+)

R: Risk factors – IV drug use or microbiologic evidence not meeting major criteria

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10
Q

ROSH
how aortic regurge present ?
RF (MOST common cause) ?

A

decrescendo diastolic murmur

rhumatic heart disease (MC) , bicuspid vulve ,

extra sign :
Bounding water-hammer peripheral pulses

Head bobbing with systole (de Musset sign)

Prominent nail pulsations (Quincke pulse)

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11
Q

ROSH
how aortic stenosis present?
RF?

A

traid of : dyspnea + syncope + chest pain
crescendo decrescendo ejection systolic murmur at Rt 2ed intercostal radiat to carotid

RF : advanced age ,DM,HTN =>

extra: most common arrhythmia relate is atrial fibrillation

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12
Q

ROSH
mitral stenosis , presentation most common cause?

A

diastolic murmur best heard at apex , with opining snap
MCC rheumatic heart disease

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13
Q

ROSH
MCC of aortic stenosis?

A

rheumatic heart disease

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14
Q

ROSH
MCC arrhythmia related to material stenosis ?

A

atrial fibrillation

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15
Q

ROSH
Tricuspid Regurgitation presentation ? cause ?

A

Patient presents with signs of right-sided heart failure: ascites, edema, RUQ pain

PE will show JVD and a blowing holosystolic murmur best heard at the left sternal border that becomes louder during inspiration

Most commonly caused by RV dilatation

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16
Q

ROAH
normal mitral vulve diameter , when to consider stenosis ?

A

normal diameter 4cm stenosis if >1.5cm

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17
Q

lecture
Type of syncope?

A
  1. Reflex Syncope

A. Vasovagal – Triggered by pain, emotional stress, prolonged standing
B. Situational – Triggered by coughing, urination, swallowing
C. Carotid Sinus Hypersensitivity – Triggered by neck pressure (tight collars, shaving, head turning)

⸻

  1. Orthostatic Syncope

A. Hypovolemia – From dehydration or bleeding

B. Vasodilator Medications – e.g., alpha-blockers, calcium channel blockers

C. Autonomic Neuropathy – Seen in diabetes, Parkinson’s disease

⸻

  1. Cardiogenic Syncope

A. Arrhythmias
 a. Tachyarrhythmias – VT, VF
 b. Bradyarrhythmias – AV block (2nd or 3rd degree)

B. Mechanical Causes
 a. Impaired Contractility – Myocardial infarction, HFrEF

 b. Impaired Filling – Cardiac tamponade, tension pneumothorax, constrictive pericarditis

 c. Obstructed Outflow (↑ Afterload) – Aortic stenosis, HCM, pulmonary embolism

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18
Q

lecture
Diagnostic Approach to Syncope?

A
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19
Q

lecture
Syncope vs Seizures
What are the key differences?

A
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20
Q

how to diagnose heart failure , clinically ?

A

clinically : Framingham criteria :
2 Major / Major 2 minor :

MAJOR :
acute lung edema/rals , cardiomegaly , S3 , orthopnea PND / jugular distention hepatojugular reflex

MINOR: :
pleural effusion / tachycardia , dyspnea on exertion , night cough / hepatomegaly , lower limb edema

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21
Q

most common cause for HF?

A

acute coronary syndrome

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22
Q

what is NYHS classification ?

A

classified HF based on symptom :

CLASS I
no limitation / ordinary activity does not cause fatigue or dyspnea

CLASS II
slight limitation / ordinary activity causes symptoms (fatigue, dyspnea, palpitations)

CLASS III
marked limitation / less than ordinary activity causes symptoms

CLASS IV
unable to carry out any activity / symptoms at rest

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23
Q

other cause of elevated BNP rether than HF ?

A

CKD

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24
Q

medication used in HFrEF ? and its role and main instruction ?

Study These Flashcards
A

1 diuretic : symptom improvement , NO mortality benefit
2 ACE : decreased mortality => ARBs second line
3 B blocker : decreased mortality in all stable Pt (not overload)
4 spironolacton : decreased mortality in NYHA III-IV + CrCl >30 + K<5
5 SGLT inhibitor : HF + DM = decreased hospitalisation
6 hydralazine : decreased mortality in black pepole

25
medication used in HFpEF ? its role ?
loop diuretic : relife symptom SGLT : decrease hospitalisation
26
management of ADHF?
.
27
how to diagnosed HF ? lab wise , gold stander?
main lab is BNP : best for exclude heart failure , secret from LV as response to stress , work as water and Na exertion , inhipt rennin path way gold stander ECHO
28
what is initial management of ACS ?
Prevent thrombus propagation → ASA + Clopidogrel + Heparin Reduce anginal chest pain → Nitroglycerine, Beta-blocker, Morphine Revascularize coronary vessels → PCI or CABG or tPA Prevent stent thrombosis → DAPT × 1 year Prevent ventricular remodeling → ACE Inhibitors Prevent plaque progression → Statins
29
different type of ACS ?
unstable angina : ST depression , no trop ishemia dose not cause infarct non STEMI : ST deprresion , Trop+ sever ischemi with partial infarction STEMI : ST elevation , Trop+ no o2 supply full thickness infarction
30
when to chose PCI over thrombolytic agent ?
time : 120 min from symptome to PCI => PCI
31
medication used after PCI?
dual antiplatlete for 1 year , then we can chose 1 ACE to prevent remodling of ventricle beta bloker / nitroglysrin
32
in MI , witch artry affect each part in how that reflect in ECG ?
LAD → LV (anterior wall) + septum + part of lateral wall → V1, V2, V3, V4 → Anterior MI RCA → RV + inferior wall + AV node → II, III, aVF → Inferior MI LCX → Lateral wall of LV → I, aVL, V5, V6 → Lateral MI
33
when age consider risk factore for CAD in men and women ?
Men: Age ≥ 45 years Women: Age ≥ 55 years
34
pattern of Afib in ECG? Main pathophysiology ? Mangment?
1 no distinct P wave (fibrillate) 2 irregular irregular pattern 3 narrow QRS complex These cause by automaticity in multiple foci make it irregular Management : stable rate control : bb/ccb Consider rythem ( Amiodarone in Hf and sotalol in CAS ) . No respone => Electric cardioversion Consider anticoagulant chads score Ablation if no response Unstable : cardio version Heparin with in 24 houer If able to delay give non bit k for 3 week prior to cardio vesrion
35
cause of hypertrophic cardiomyopathy ? heart sound ? management what give what not ?
Autosomal dominant mainly Like aortic stenonsin cresendo decresendo systolic murmur But increased with vulslva Asymptomatic: mainly no treatment Protactive treatment: bb propranolol - ccb ( prevent arrythmia) If hx of suncope cardio version device
36
most common heart sound related to HTN ?
S3
37
MCC cause of death and HCM ?
Arrhythmia
38
MC dysarrethmia associated with HCM ?
Ventricular fib
39
ECG characteristic for LBBB ?
40
what is presentation of sick sinus syndrome ? ECG pattern ? what is MC tachydysarrytmia associated with ? definitive treatment ?
Pre Suncope - plaptaion - chest pain Bradycardia => sinus tachcardia Aplasion
41
gold stander to diagnose Afib after stroke ?
implantable loop recorde : indication : diagnose after stroke palpitations frequency less than month
42
ECG of torsad de pointe ? causes ? management ?
Tachycardia > wide QRS > irrigular polymorphic (random) Cause by triggered activity Mangment : Magnesium sulfate 2 g IV over 15 min • Stop QT-prolonging drugs • Defibrillate if unstable
43
ECG pattern of premature ventricular contraction ? presentation ? management ?
One wide QRS Followed by pause Asymptomatice No management
44
presentation of diluted cardiomyopathy ? causes ? management ?
Diluted present like Rt side heart failures Genatic - alchoal
45
most common cardiomyopathy ?
Diluted cardiomyopathy
46
***ninja*** pathophysiology of different type of tachydyarethmia ?
main mechanism : Increased automaticity, re-entry, triggered activity in sinus tachy arythmai the causes : Hypoxia, hypotension, hypercapnia, increased temperature, increased thyroid hormone, sympathomimetic . and these condition mainly start other mechanism re entry : remodlying , fibrosis , over streching triggered activity : Prolonged QT interval caused early after depolarizations
47
***NINJA*** diagnostic approach of tachy dysarrethmia ?
1→ Evaluate QRS ⸻ If QRS > 120 ms → Wide Complex Tachycardia 2 → regular or irrigular : A. Regular RR Interval → Wide & Regular Tachycardia Differential Diagnosis (DDx): 1. Ventricular Tachycardia (VT) 2. PSVT with aberrancy (no pre-existing ECG for comparison) B. Irregular RR Interval → Wide & Irregular Tachycardia Differential Diagnosis (DDx): 1. Ventricular Fibrillation 2. Torsades de Pointes (Polymorphic VT) 3. Atrial Fibrillation with aberrancy ⸻ If QRS < 120 ms → Narrow Complex Tachycardia 22→ regular or irrigular: A. Regular RR Interval → Narrow & Regular Tachycardia Differential Diagnosis (DDx): 1. Sinus Tachycardia 2. Paroxysmal Supraventricular Tachycardia (PSVT) 3. Atrial Flutter (2:1 block) B. Irregular RR Interval → Narrow & Irregular Tachycardia Differential Diagnosis (DDx): 1. Atrial Fibrillation 2. Multifocal Atrial Tachycardia (MAT) • Identified by ≥3 morphologically distinct P waves
48
how 3ed degree heart block look in ECG ? mangment?
Distortion of relations between P and QRS
49
***NINJA*** when arrhythmia consider unstable ?
Altert mental status : syncope / confusion Chest pain - hypotension = heart dose not give enough Cardiac output
50
***NINJA*** antidote of B blocker / CCB / digoxine ?
Bb glucagon Ccb calcium Digoxin
51
***NINJA*** pathophysiology of brady arrhythmia ?
Sinus Bradycardia • Pathophys: ↓ SA node firing → ↓ atrial-to-ventricular conduction. • Causes: • Nodal Blockers: • Beta blockers: ↓ Ca²⁺ entry → antidote: Glucagon. • Calcium channel blockers: ↓ Ca²⁺ entry → antidote: Calcium. • Digoxin: ↑ vagal tone + ↑ K⁺ → antidote: Digibind. • Hyperkalemia: ↑ RMP → inactivates Na⁺ channels → antidote: Calcium. • ↑ Vagal Tone: • Via ↑ ICP → ↑ vagus → ↑ ACh → M2 receptor stimulation → ↓ conduction. • Hint: Cushing’s triad (↓ HR, ↑ BP, irregular breathing). • ↓ Sympathetic Tone: • Seen in hypothyroidism → ↓ beta-receptor sensitivity. • Hints: Hypothermia, myxedema, ↓ T₄. ⸻ AV Node Block • Causes: • Nodal Destruction: • Ischemia (Inferior MI/RCA supplay AV Node). • Fibrosis (aging). •
52
type of heart block ?
Types of AV Block: 1. 1st Degree AV Block • PR-I: Prolonged • All QRS complexes conducted (no dropped beats) 2. 2nd Degree AV Block – Mobitz I (Wenckebach) • Progressive prolongation of PR-I • Followed by dropped QRS 3. 2nd Degree AV Block – Mobitz II • Constant PR-I • Intermittent dropped QRS • Higher risk of progression to complete block 4. 3rd Degree AV Block (Complete Heart Block) • AV dissociation • Atria and ventricles beat independently • P waves and QRS complexes are unrelated • Often with wide QRS due to ventricular escape rhythm
53
Multifocal atrial tachycardia main cause ? ECG ?
Mainly HYPOXIA - COPD >3 diffrent P wave morphology
54
***ninja*** Mangment of unstable bradycardia ?
1. Bradycardia • HR < 50 bpm + signs of instability (hypotension, altered LOC, ischemic chest pain) ⸻ 2. Administer Atropine • Dose: 0.5 mg IV bolus every 3–5 minutes • Max total dose: 3 mg ⸻ 3. No response or suspected infranodal AV block (e.g., wide QRS)? → Go to next step. ⸻ 4. Administer Epinephrine (IV infusion) • Dose: 2–10 mcg/min IV infusion • Titrate to patient response ⸻ 5. OR Administer Dopamine (IV infusion) • Dose: 2–10 mcg/kg/min IV infusion • Titrate to effect ⸻ 6. OR Administer Isoproterenol (less commonly used) • Dose: 2–10 mcg/min IV infusion ⸻ 7. If refractory to medical treatment: → Begin Transcutaneous Pacing (pads on chest) ⸻ 8. Then bridge to: → Transvenous Pacing (temporary wire through vein) ⸻ 9. Long-term solution: → Permanent Pacemaker
55
Management of stable bradycardia ?
Mange underline cause : The 5 H’s: 1. Hypovolemia → Common cause of PEA; treat with IV fluids 2. Hypoxia → Ensure airway, oxygen, ventilation 3. Hydrogen ion (Acidosis) → Check ABG, give bicarbonate if needed 4. Hypo-/Hyperkalemia → Check electrolytes; treat accordingly (e.g., calcium, insulin + glucose for hyperkalemia) 5. Hypothermia → Rewarm the patient ⸻ The 5 T’s: 1. Tension pneumothorax → Needle decompression 2. Tamponade (cardiac) → Pericardiocentesis 3. Toxins (drug overdose) → Consider antidotes (e.g., naloxone, calcium, digoxin Fab) 4. Thrombosis (pulmonary embolism) → Thrombolysis 5. Thrombosis (myocardial infarction) → PCI or thrombolysis
56
Pattern of fluter in ECG ? Mangment
Saw tooth in lead II III aFV Management : Unstable : cardio version stable : rate control : bb/ccb rythem Electrical cardio vrsion Ablation if no response Consider anticoagulants like Afib
57
ECG for paroxysmal super ventricular tachycardia? Management ?
Tachycardia > narrow QRS > regular > no p wave Mangment : Acute Termination: • Vagal maneuvers (e.g., Valsalva, carotid massage) • Adenosine (6 mg IV push, then 12 mg if no effect) • Alternatives: verapamil, diltiazem if adenosine contraindicated Chronic Management: • BBs or CCBs to prevent recurrence • Catheter ablation is curative in many cases • No need for anticoagulation
58
Ecg of ventricular tachycardia? Mangment
TACHYCARDIA > wide QRS> regular monomprphic Amiodarone: 150 mg IV over 10 min → infusion • Alternatives: • Procainamide: 20–50 mg/min IV • Lidocaine: if ischemic VT or amiodarone contraindicated • If refractory → consider synchronized cardioversion Long term : AICD

part 1 (7 decks)

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