Mksap 16 Cardio Part 7

Front 1

treatment of ARVC/D

Back 1

avoid exercise, ICD; no medical therapy to delay progression; B blockers, sotalol, amio and cath ablation can reduce ICD shocks

Front 2

treatment of symptomatic bradycardia (4)

Back 2

atropine, if ineffective, dopamine and epinephrine, until transcutaneous or transvenous pacing is initiated (ADEPt)

Front 3

NOTE: In infections of cardiac devices,

Back 3

it is important to not attempt aspiration of the device site because this can damage the leads.

Front 4

x most common cause of acute pericarditis

Back 4

viral infection

Front 5

How is diagnosis of pericarditis confirmed?

Back 5

2 of 3 classic findings: CP, pleuritic; friction rub; diffuse ST segment elevation; if (+) unexplained pericard effusion on echo, only 1 of 3 necessary

Front 6

unique feature of chest pain in acute pericarditis

Back 6

worsens in recumbent position

Front 7

pericardial friction rub is best auscultated at

Back 7

left lower sternal border during suspended respiration while leaning forward

Front 8

EKG in myopericarditis

Back 8

concave downward ST segment elevation like MI

Front 9

likely etiology of recurrent pericarditis

Back 9

autoimmune

Front 10

primary treatment for acute pericarditis

Back 10

antiinflammatory meds - (high dose ASA or NSAIDs), tapered weekly over 3-4 weeks [caution with NSAIDs in MI]

Front 11

NOTE: The COPE trial

Back 11

supports colchicine as an adjunctive agent for acute pericarditis; recurrence rate at 18 months decreased from 32% to 10.7% with 3 months of colchicine.

Front 12

when is corticosteroids indicated in acute pericarditis

Back 12

refractory cases or C/I to asa, nsaids and colchicine

Front 13

can anticoagulation be started in patients with acute MI who develop acute pericarditis?

Back 13

permitted provided pericard effusion does not develop or if present, does not increase in size

Front 14

pericardiectomy in pericarditis?

Back 14

Pericardiectomy is not effective for acute pericarditis or recurrent pericarditis.

Front 15

work-up for pericardial effusion (5)

Back 15

CBC, BUN Crea + [TAT-PB] TSH, ANA, tuberculin skin response; pericardiocentesis (culture, cytology, ADA activity, -- and rarely helpful, cell counts, LDH, total protein, glucose); surgical pericardial biopsy (for malig and sys inflammatory disease)

Front 16

treatment of malignant pericardial effusion

Back 16

prolonged catheter drainage, pericardial sclerosis, surgical decompression, and percutaneous balloon pericardiotomy.

Front 17

treatment of early or subacute tamponade

Back 17

serial monitoring, volume resuscitation, treat cause

Front 18

preferred method of drainage for malignant pericardial effusions or tamponade caused by aortic dissection

Back 18

surgical rather than pericardiocentesis

Front 19

NOTE: Caution with tamponade and mech ventilation and deep sedation

Back 19

may potentiate hemodynamic compromise (high PEEP reduces venous return, deep sedation reduces compensatory sympathetic drive)

Front 20

common causes of constrictive pericarditis in the US (4)

Back 20

viruses, surgery, irradiation, CTD

Front 21

diagnostic modality to differentiate constrictive pericarditis from restrictive CMP

Back 21

echo

Front 22

the only effective treatment for chronic constrictive pericarditis

Back 22

pericardiectomy

Front 23

when is pericardiectomy indicated?

Back 23

NYHA class II or III HF

Front 24

prognosis of constrictive pericarditis in TB

Back 24

resolves within 6 months of anti-TB treatment