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25 Cards in this Set

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295. Where is the site of the block usually w/Mobitz II?
a. His-Purkinje system.
296. Tx of Mobitz II?
a. Pacemaker implantation is necessary.
297. Third-degree (Complete) AV block?
a. Absence of conduction of atrial impulses to the ventricle; no correspondence between P waves and QRS complexes.
298. What types of heart block require pacemaker?
a. Mobitz type II and 3rd-degree.
b. A ventricular pacemaker (escape rhythm) maintains a ventricular rate of 25-40 bpm.
299. General characteristics of Dilated cardiomyopathy?
a. Most common type of cardiomyopathy.
b. An insult (e.g., ischaemia, infarction, alcohol, and so on) causes dysfunction of left ventricular contractility.
c. Poor prognosis- many die w/in 5 yrs of the onset of sx.
300. Causes of dilated cardiomyopathy?
a. CAD
b. Other causes include:
1. Toxic: alcohol, doxorubicin, Adriamycin
2. Metabolic: thiamine or selenium deficiency, hypophosphatemia, uraemia.
3. Infectious: Viral, Chagas’ disease, Lyme disease, HIV.
4. Thyroid: hyper/hypo
5. Peripartum cardiomyopathy
6. Collagen vascular disease: SLE, Scleroderma
7. Prolonged, uncontrolled tachycardia
8. Catecholamine-induced: pheochromocytoma, cocaine
9. Familial/genetic
10. Idiopathic
301. Clinical features of dilated cardiomyopathy?
a. Sx and signs of left and right-sided CHF develop.
b. S3,S4, and murmurs of mitral or tricuspid insufficiency may be present.
302. Diagnosis of Dilated cardiomyopathy?
a. ECG, CXR, and echocardiogram results consistent w/CHF.
303. Tx of dilated cardiomyopathy?
a. Similar to tx of CHF: digoxin, diuretics, vasodilators, and cardiac transplantation.
b. Remove the offending agent if possible.
c. Anticoagulation should be considered bc pts are at increased risk of embolization.
304. General characteristics of hypertrophic cardiomyopathy?
a. Most cases are inherited as an autosomal dominant trait.
305. Pathophys of Hypertrophic cardiomyopathy?
a. The main problem is diastolic dysfunction due to a stiff, hypertrophied ventricle w/elevated diastolic filling pressures.
b. These pressures increase further w/factors that increase due to a stiff, hypertrophied ventricle (e.g., the Valsalva maneuver).
c. Pts may also have a dynamic outflow obstruction due to asymmetric hypertrophy of the IV septum.
306. Symptoms Hypertrophic Cardiomyopathy?
a. Dyspnea on exertion
b. Chest pain (angina)
c. Syncope (or dizziness) after exertion or the Valsalva maneuver
d. Palpitations
e. Arrhythmias (AFib, ventricular arrhythmias)-due to persistently elevated atrial pressures.
f. Cardiac failure due to increased diastolic stiffness
g. Sudden death-sometimes in a young basketball player; may be the first manifestation of disease.
307. Signs of Hypertrophic Cardiomyopathy on physical exam?
a. Sustained PMI
b. Loud S4
c. Systolic ejection murmur
i. Decreases w/squatting, laying own, or straight leg raise (due to increased LV filling)
ii. Intensity increases w/Valsalva and standing (decreases LV size and thus decreases left ventricular filling.
iii. Decreases w/sustained handgrip (increased systemic resistance leads to decreased gradient across aortic valve.
iv. Best heard at left lower sternal border.
308. Pulse w/Hypertrophic cardiomyopathy?
a. Rapidly increasing carotid pulse w/2 upstrokes (bisferious pulse).
309. Diagnosis of hypertrophic cardiomyopathy?
a. Echo establishes dx.
b. Clinical diagnosis and family hx.
310. Tx of Hypertrophic cardiomyopathy in asymptomatic pts?
a. Generally do not need tx, but this is controversial.
b. All pts should avoid strenuous exercise.
311. What should be the initial DOC in Tx of Hypertrophic cardiomyopathy in symptomatic pts?
a. β-blockers
b. They reduce sx by improving diastolic filling (as HR decreases, duration of diastole incrases), and also reduce myocardial contractility and thus oxygen consumption.
312. Tx of Hypertrophic cardiomyopathy in symptomatic pts?
a. β-blockers.
b. Calcium channel blockers (Verapamil)
c. Diuretics-used if fluid retention occurs.
d. If AFib is present, treat accordingly.
e. Surgery
f. Pacemaker implantation has had variable results.
313. When should Calcium channel blockers be used in Hypertrophic cardiomyopathy in symptomatic pts?
a. If pt is not responding to β-blockers.
b. Reduce sx by similar mechanism as β-blockers.
314. Surgery for Tx of Hypertrophic cardiomyopathy in symptomatic pts?
a. Myomectomy has a high success rate for relieving symptoms. It involves the excision of part of the myocardial septum. It is reserved for pts w/severe disease.
b. Mitral valve replacement may improve symptoms.
315. General characteristics of Restrictive Cardiomyopathy?
a. Infiltration of myocardium results in impaired diastolic ventricular filling due to decreased ventricular compliance.
b. Systolic dysfunction is variable and usually occurs in advanced disease.
316. Causes of Restrictive Cardiomyopathy?
a. Amyloidosis
b. Sarcoidosis
c. Hemochromatosis
d. Scleroderma
e. Carcinoid syndrome
f. Idiopathic
317. Clinical features of Restrictive Cardiomyopathy?
a. Elevated filling pressures causes dyspnea and exercise intolerance.
b. Right-sided signs and symptoms are present for the same reason.
318. Diagnosis of Restrictive Cardiomyopathy?
a. Echo: Thickened myocardium and possible systolic ventricular dysfunction.
b. Increased Right and Left Atrium size w/normal LV an RV.
c. In amyloidosis, myocardium appears brighter or may have a sparkled appearance.
d. ECG
e. Endomyocardial biopsy may be diagnostic.
319. Restrictive Cardiomyopathy on ECG?
a. Low voltages or conduction abnormalities, arrhythmias, AFfib.