Prep for ABIM

 Advanced Search  
    Register          Login        



Prep4abim.com » ABIM Forum

Previous Topic | Next Topic Key points -Cardiology 


Author 11 Posts
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:30 PM report   #1
Empiric treatment of wide complex tachycardia presumes that it is Ventricular tachycardia. This means that few drugs are contraindicated. They are Verapamil, Diltiazem, ß blockers etc.

Thus the drugs that can be used for treatment are Lidocaine, Procainamide, Amiodarone, etc.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:31 PM report   #2
The CAST study has revealed an increase in mortality,with the use of class 1c drugs such as Flecainide in people with coronary disease if used for suppression of arrhythmias.

The only anti-arrhythmic drugs shown to be useful in such patients are Amiodarone and beta blockers.

In life threatening arrhythmias, AICD is superior to antiarrhythmics
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:32 PM report   #3
Digoxin levels are increased by the following- Quinidine, Verapamil, Diltiazem (not Nifedipine) and diuretics. All of them decrease the excretion of Digoxin. Diuretics in addition may cause hypokalemia which by itself can worsen toxicity.

Antacids and Cholestyramine on the other hand decrease absorption of Digoxin by binding to it in the gut.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:36 PM report   #4
manifestations of an acute ventricular septal defect.


About 3-7 days post MI a patient who goes into sudden cardiogenic shock and has a new holosystolic murmur in an area other than the mitral area-best heard in the parasternal area. Confirm the diagnosis by using echo with doppler or by inserting a swan Ganz catheter to see a step up of oxygen saturation from RA to RV by more than 5%.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:38 PM report   #5
One should also suspect secondary causes for HTN in patients <35 years of age.

They include:

Renal cause- Renal artery stenosis (high renin and adosterone- diagnosed best using a renal radionucleide flow scan with Captopril challenge.)

Angioplasty is Rx of choice for fibromuscular dysplasia (FMD) which is seen as a distal lesion whereas

Surgery is Rx of choice for artherosclerosis which occurs proximally - adjacent to the atherosclerosis seen in the aorta.

Endocrine cause- Aldosteronism, Pheochromocytoma, Cushing's and acromegaly.

Drugs- ETOH -5-10 % HTN; NSAID; NSAIDs- decreases anti HT effect of B block + Ca Chromosome block, Cyclosporin- decreases diuretics, Ca, Channel block, ACE I
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:39 PM report   #6
In patients with renovascular HTN - cause is Artherosclerosis in 2/3 >50 yrs age

In patients with hypertension of all causes under the age of 30, FMD will be found in 1/3
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:41 PM report   #7
Drugs acceptable for treatment during pegnancy:

1. Methyldopa
2. Hydralazine
3. Beta blocker- Labetalol
4. Diuretics or Ca channel blockers may be continued if patient already on them

Never give Ace I in a pregnant patient

James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:41 PM report   #8
Ambulatory Monitoring is helpful in the following situations:

White coat HTN, borderline hypertension, abrupt onset, resistant BP
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:42 PM report   #9
The best stress test in general is exercise stress testing but patients with intermittent claudication cannot exercise adequately. In such patients a chemical stress test needs to be performed.

Dipyridamole stress is preferred over Dobutamine but in a case with obstructive lung disease Dipyridamole may produce bronchospasm whereas Dobutamine would not- therefore Dobutamine stress test would be the test of choice in a patient like this.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:43 PM report   #10
presentation of cholesterol emboli after angiography

In patients with a lot of plaque in the aorta there is a high chance of breaking atheroma and throwing cholesterol emboli during angiography(arterial catheter insertion for any reason. These patients present with blue toes, livedo reticularis /stroke or renal failure that occurs 2 days after the procedure. Unfortunately one cannot do anything for these patients except supportive care. It may also happen in patients with degenerate aortic valves.

Athero-emboli can also be showered in those on anti-coagulants.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/12/11 - 11:44 PM report   #11
Dressler's syndrome or Post MI syndrome occurs few days to upto 6 weeks after an MI.

It presents with fever and pleuropericardial chest pain.

Salicylates are drugs of choice. Glucocorticoids may be used in cases not responding to Salicylates. Do not give anticoagulants.








You don't have permission to post. Log in, or Register if you haven't yet.