Podcast
Questions and Answers
What is the most likely cause of symptoms in a young, healthy patient feeling doom and hyperventilating?
What is the most likely cause of symptoms in a young, healthy patient feeling doom and hyperventilating?
What characterizes orthostatic hypotension?
What characterizes orthostatic hypotension?
Which factor is a significant risk for developing orthostatic hypotension?
Which factor is a significant risk for developing orthostatic hypotension?
What is a characteristic symptom of vasovagal syncope triggered by stress?
What is a characteristic symptom of vasovagal syncope triggered by stress?
Signup and view all the answers
What mechanism is involved in carotid sinus hypersensitivity?
What mechanism is involved in carotid sinus hypersensitivity?
Signup and view all the answers
What is a typical presentation of costochondritis?
What is a typical presentation of costochondritis?
Signup and view all the answers
Which diagnostic procedure can confirm vasovagal syncope symptoms?
Which diagnostic procedure can confirm vasovagal syncope symptoms?
Signup and view all the answers
What should be considered when diagnosing panic disorder over mitral valve prolapse?
What should be considered when diagnosing panic disorder over mitral valve prolapse?
Signup and view all the answers
What condition is characterized by sharp lateral chest pain due to intercostal muscle spasm?
What condition is characterized by sharp lateral chest pain due to intercostal muscle spasm?
Signup and view all the answers
In which condition would you expect the creatine kinase (CK) levels to be normal?
In which condition would you expect the creatine kinase (CK) levels to be normal?
Signup and view all the answers
Which examination technique is the first step in diagnosing arterial disease?
Which examination technique is the first step in diagnosing arterial disease?
Signup and view all the answers
What distinctive feature does arterial disease present in patients over 50 with risk factors?
What distinctive feature does arterial disease present in patients over 50 with risk factors?
Signup and view all the answers
Which condition can cause angina-like pain in a patient who does not have cardiovascular disease?
Which condition can cause angina-like pain in a patient who does not have cardiovascular disease?
Signup and view all the answers
What is the primary mechanism of action of statins?
What is the primary mechanism of action of statins?
Signup and view all the answers
How do bile acid sequestrants primarily affect cholesterol levels?
How do bile acid sequestrants primarily affect cholesterol levels?
Signup and view all the answers
Which type of angina is characterized by predictable chest pain during exercise?
Which type of angina is characterized by predictable chest pain during exercise?
Signup and view all the answers
What is the primary action of nitrates in treating stable angina?
What is the primary action of nitrates in treating stable angina?
Signup and view all the answers
Which drug is contraindicated with PDE-5 inhibitors like Viagra due to the risk of low blood pressure?
Which drug is contraindicated with PDE-5 inhibitors like Viagra due to the risk of low blood pressure?
Signup and view all the answers
What commonly appears on the ECG during unstable angina?
What commonly appears on the ECG during unstable angina?
Signup and view all the answers
Which condition is known for causing chest pain that occurs unpredictably and may arise at rest?
Which condition is known for causing chest pain that occurs unpredictably and may arise at rest?
Signup and view all the answers
What is another name for vasospastic angina?
What is another name for vasospastic angina?
Signup and view all the answers
What is the primary empiric treatment for endocarditis that targets gram-positive bacteria, including MRSA?
What is the primary empiric treatment for endocarditis that targets gram-positive bacteria, including MRSA?
Signup and view all the answers
Which of the following is NOT an indication for endocarditis prophylaxis prior to a dental procedure?
Which of the following is NOT an indication for endocarditis prophylaxis prior to a dental procedure?
Signup and view all the answers
Which of the following conditions results from Streptococcus pyogenes infection and is characterized by a cross-reactivity with the mitral valve?
Which of the following conditions results from Streptococcus pyogenes infection and is characterized by a cross-reactivity with the mitral valve?
Signup and view all the answers
What symptom is NOT part of the JONES criteria associated with rheumatic fever?
What symptom is NOT part of the JONES criteria associated with rheumatic fever?
Signup and view all the answers
What should be administered to a patient with a history of heart transplant and valvular regurgitation prior to a dental procedure?
What should be administered to a patient with a history of heart transplant and valvular regurgitation prior to a dental procedure?
Signup and view all the answers
Which of the following is characteristic of the autoimmune response in rheumatic fever?
Which of the following is characteristic of the autoimmune response in rheumatic fever?
Signup and view all the answers
Which medication is typically used to treat a Group A Streptococcus infection to prevent rheumatic fever?
Which medication is typically used to treat a Group A Streptococcus infection to prevent rheumatic fever?
Signup and view all the answers
Which of the following heart conditions does NOT require prophylaxis for endocarditis?
Which of the following heart conditions does NOT require prophylaxis for endocarditis?
Signup and view all the answers
Which bacterial organism is the most common cause of acute endocarditis in IV drug users?
Which bacterial organism is the most common cause of acute endocarditis in IV drug users?
Signup and view all the answers
Which of the following conditions is most likely to lead to subacute endocarditis?
Which of the following conditions is most likely to lead to subacute endocarditis?
Signup and view all the answers
What is the significance of performing blood cultures before initiating antibiotic treatment in suspected endocarditis cases?
What is the significance of performing blood cultures before initiating antibiotic treatment in suspected endocarditis cases?
Signup and view all the answers
Which echocardiography method is preferred for confirming a diagnosis of endocarditis?
Which echocardiography method is preferred for confirming a diagnosis of endocarditis?
Signup and view all the answers
Which of the following clinical findings would most likely indicate endocarditis?
Which of the following clinical findings would most likely indicate endocarditis?
Signup and view all the answers
Which of the following statements about Staphylococcus aureus is true in the context of endocarditis?
Which of the following statements about Staphylococcus aureus is true in the context of endocarditis?
Signup and view all the answers
Reactive thrombocytosis in the context of endocarditis could indicate what?
Reactive thrombocytosis in the context of endocarditis could indicate what?
Signup and view all the answers
What symptom might suggest a septic embolus in a patient with endocarditis?
What symptom might suggest a septic embolus in a patient with endocarditis?
Signup and view all the answers
What is the main treatment for Prinzmetal angina?
What is the main treatment for Prinzmetal angina?
Signup and view all the answers
What defines a hypertensive emergency?
What defines a hypertensive emergency?
Signup and view all the answers
Which of the following medications should be avoided in patients with Prinzmetal angina?
Which of the following medications should be avoided in patients with Prinzmetal angina?
Signup and view all the answers
In managing a hypertensive emergency, blood pressure should not be reduced by more than what percentage in the first hour?
In managing a hypertensive emergency, blood pressure should not be reduced by more than what percentage in the first hour?
Signup and view all the answers
Which type of shock is characterized by early increased systemic vascular resistance (SVR)?
Which type of shock is characterized by early increased systemic vascular resistance (SVR)?
Signup and view all the answers
What condition is indicated by hypertensive urgency?
What condition is indicated by hypertensive urgency?
Signup and view all the answers
What is a key indicator of cardiogenic shock on pulmonary capillary wedge pressure (PCWP)?
What is a key indicator of cardiogenic shock on pulmonary capillary wedge pressure (PCWP)?
Signup and view all the answers
Which drug is commonly used for the management of urgent hypertension?
Which drug is commonly used for the management of urgent hypertension?
Signup and view all the answers
Study Notes
Cardiomyopathy
- Dilated Cardiomyopathy (DCM): Characterized by diffuse 4-chamber dilation and systolic dysfunction (reduced ejection fraction, typically <55%).
- Causes of DCM: Alcohol, thiamine deficiency (wet beriberi), viral infections (coxsackie B virus, cocaine, Chagas disease), drugs (doxorubicin), pregnancy, hemochromatosis, rheumatic heart disease, and heart failure from hypertension.
- Hypertrophic Cardiomyopathy (HCM): Characterized by diastolic dysfunction, with a normal ejection fraction but difficulty with ventricular expansion.
- Causes of HCM: Genetic mutations, particularly in beta-myosin heavy chain genes.
- Hypertrophic Obstructive Cardiomyopathy (HOCM): A subtype of HCM characterized by asymmetric septal hypertrophy, sometimes obstructing the left ventricular outflow tract.
- Restrictive Cardiomyopathy (RCM): Characterized by decreased ventricular compliance, often due to conditions like amyloidosis, hemochromatosis, or radiation-induced fibrosis.
Atherosclerosis
- Risk factors: Diabetes Mellitus (types I and II), smoking, and hypertension (in descending order of impact).
- Mechanism: Atherosclerosis involves plaque buildup in arteries. High blood pressure accelerates this process by increasing damage to the inner lining of the carotid arteries. Plaques can calcify, and greater calcium signifies greater maturity of the plaque.
- Clinical Significance: Atherosclerosis is a key risk factor for strokes, transient ischemic attacks (TIAs), and retinal artery occlusions. In older patients with risk factors and accelerated hypertension, renal artery stenosis is worth considering.
Angina
- Stable Angina: Predictable chest pain, typically triggered by exertion or stress and relieved by rest or nitroglycerin.
- Causes: Atherosclerotic plaques, usually > 70% occlusion, often calcified.
- ECG findings: ST depressions are classically observed.
- Treatment: Nitrates (like isosorbide dinitrate) increase cGMP and relax venous smooth muscle, reducing venous return and myocardial oxygen demand. However, avoid nitrates with PDE5 inhibitors to prevent dangerous hypotension.
- Unstable Angina: Unpredictable chest pain, often occurring at rest and not relieved by nitroglycerin or rest; more severe.
- Treatment: Diltiazem, nitrates, and potentially cardiac catheterization are potential treatments; more severe cases may necessitate hospitalization.
- Prinzmetal (Variant) Angina: Spasms of the coronary arteries causing chest pain, typically at rest, but can occur with exercise and stress.
- ECG findings: ST elevations.
- Treatment: Nitrates, dihydropyridine calcium channel blockers (e.g., nifedipine). Avoid a1 agonists and nonselective beta-blockers.
Hypertensive Emergency and Urgency
- Emergency: Blood pressure >180/120 mmHg accompanied by symptoms of end-organ damage (e.g., hypertensive encephalopathy, acute heart failure, or nephropathy).
- Urgent: Blood pressure >180/120 mmHg without significant end-organ damage.
- Treatment: Rapid reduction of blood pressure to prevent further damage, using IV medications like sodium nitroprusside, nicardipine, labetalol, or oral medications like captopril.
Endocarditis
- Causes: Bacterial infections, with Staphylococcus aureus being a common cause for acute endocarditis in intravenous drug users and Streptococcus viridans in patients with pre-existing valvular abnormalities or prior dental procedures.
- Clinical presentation: New murmur accompanied by fever.
- Diagnosis: Blood cultures and transesophageal echocardiography (TEE).
- Treatment: Empiric antibiotic therapy, often a combination of vancomycin (aimed at gram-positive bacteria) plus gentamicin (against gram-negative bacteria) or penicillin/cefoxitin.
Rheumatic Heart Disease
- Causes: Immunological response to Group A streptococcal (GAS) pharyngeal infection.
- Clinical Manifestations: Can lead to mitral valve issues, including acute mitral regurgitation and later mitral stenosis.
- Jones criteria: Joints (polyarthritis), Carditis (valve damage), Subcutaneous nodules (small lumps under the skin), Erythema marginatum (characteristic rash), Sydenham chorea (neurological movement disorder).
- Treatment: Penicillin administration is vital.
Arterial Disease
- Causes: Atherosclerosis with plaque buildup in arteries.
- Symptoms: Diminished peripheral pulses, shiny/glabrous lower legs, small, punched-out arterial ulcers on the tops and bottoms of the feet and toes.
- Diagnosis: Ankle-brachial index (ABI), Doppler ultrasound or arteriography.
- Treatment: Lifestyle modifications (diet and exercise), medications (antihypertensives, statins, antiplatelet agents), and potentially surgery for severe cases.
Venous Disease
- Cause: Valvular incompetence or venous obstruction.
- Symptoms: Edema, varicose veins, stasis dermatitis (brown discoloration/hyperpigmentation), venous ulcers (large, sloughy ulcers located at the medial malleolus).
- Diagnosis: Venous duplex ultrasonography.
- Treatment: Compression stockings and potential sclerotherapy or surgical vein ligation.
Cardiac Stress Testing
- Purpose: Evaluate the patient's capacity for exercise tolerance and assess the risk of cardiovascular compromise and/or perioperative myocardial infarction.
- Methods: Exercise treadmill tests (EKG monitoring and pulse oximetry) or pharmacologic stress testing (dipyridamole; dobutamine).
- Clinical Interpretation: EKG changes (ST depression) or ischemia, or exertion-induced symptoms (dyspnea).
Knee Trauma and Popliteal Artery Injury
- Clinical scenario: Trauma with absent distal pulses, where knee dislocation or penetrating trauma is suspected.
- Diagnostic Approach: Initial physical exam for knee stability and palpation for pulses followed by arteriography.
- Treatment: Arteriography to confirm diagnosis and intervene; surgical exploration if the diagnosis is confirmed.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on various medical conditions and symptoms such as orthostatic hypotension, vasovagal syncope, and panic disorder. This quiz covers important diagnostic considerations and presentations for each condition. Perfect for students in healthcare fields looking to reinforce their understanding of these topics.
