Emergency Medicine EOR Exam

Dilated Cardiomyopathy: most common cause is ____. Others? - Answer alcohol; may also be idiopathic, myocarditis, or drugs (doxorubicin) -- 1 in 3 cases of heart failure are caused by dilated cardiomyopathy What PE and EKG changes are seen with dilated cardiomyopathy? - Answer PE: S3, JVD, crackles - possible mitral regurg EKG: nonspecific ST and T wave changes, LBBB Hypertrophic cardiomyopathy: is due to hypertrophy of the _____. PE reveals mitral regurgitation, a ____heart sound, and prominent left ventricular impulse. EKG reveals LVH - Answer cardiac septum; S4 Restrictive cardiomyopathy: often caused by a ____process, or post-radiation or post open-heart surgery. What is the most common first symptom? - Answer --infiltrative process - amyloidosis, sarcoidosis, and hemochromatosis -- changes in myocardium --most common first symptom is exertion intolerance and fluid retention, signs of right heart failure Atrial fibrillation - regularly irregular - the most common sustained arrhythmia in adults - what three treatments are used? - Answer 1. rate control w BB, CCB, or digoxin 2. Anticoagulation w heparin & warfarin 3. rhythm control w amiodarone or cardioversion Atrial flutter - sawtooth pattern in II, III, aVF - what three treatments are used? - Answer 1. cardioversion if no contraindications 2. acute rate control tx w BB, CCB - amiodarone, sotalol, quinidine, or procainamide 3. If site of reentrant is known, catheter ablation Multifocal atrial tachycardia - noted in patients with COPD or severe systemic illness - EKG shows multiple shaped P waves and differing PR intervals. ____are agents of choice? - Answer CCB BLOCKS 1. ____=prolonged PR interval 2.____=progressive increase in PR until Pwave is blocked. 3._____=sudden block in P wave w no change in PR 4._____=atrial and ventricular rhythm are independent of each other. - Answer First degree; Wenckebach Mobitz type I; Mobitz type II, Third degree block A _____may develop after acute MI, PE, aortic stenosis and is due to a conduction delay in the right or left bundles. - Answer Bundle branch block Paroxysmal supraventricular tachycardia is a reentry tachycardia, commonly noted in elderly patients with underlying heart disease. What treatment may be helpful before using adenosine ie. the drug of choice? - Answer vagal maneuvers or antianxiety medication What are some drugs associated with Torsades de pointes? - Answer tricyclic antidepressants, erythromycin, ketoconazole, haloperidol, cisapride, disopyramide, pentamidine, sotalol, class I anti-arrhythmics CHF - Systolic dysfunction means a problem with the ____. What drug is contraindicated? - Answer pump; CCB! CHF - Diastolic dysfunction means a problem with the ____. - Answer compliance or relaxation of the heart during ventricular filling