1. 1 - TV endocarditis usually presents "lith a holosysto lic murmur of tricuspid regurgitation that becomes accentuated
with inspiration (rather than an early diastolic murmur strongly suggestive of AR); and cardiac conduction abnormalities
are more common with aortic valve than with TV involvement
2- the localization of this patient's STsegment elevation in leads corresponding with his recently stented left anterior
descending artery (ie, V1-V4) makes stent thrombos is much more likely; pathophys iologically, the occlusion is not due
to plaque rupture but rather to stent thrombosis. ST-segment elevation in the lateral (ie, I, aVL, V5-V6) or inferior (ie, II,
111, aVF) leads v,ould be consistent v,ith atheroscle rotic plaque rupture.
3- Elevated brain natriuretic peptide levels and an audible third heart sound are signs of increased cardiac filling
pressures and are noted in patients vvith congestive heart failure due to left ventricular systolic dysfunction.
4- Digitalis toxicity causes increased ectopy and increased vaga l tone. Atrial tachycardia with AV block occurs from the
combination of these tv;o digitalis effects, and is relatively specific for digitalis toxicity.
5- Unsynchronized cardioversion (defibrillation) during resuscitation efforts in patients with pulseless cardiac arres t v,ho
have a shockable rhythm (ie, ventricular fibrillation, pulseless ventricular tachyca rdia).
6_ Patients with persistent tachyarrhythmia (narrow- or vtide-complex) causing hemodynamic instability should be
managed with immediate synchronized cardioversion.
7- Syncope in a yo ung patient v,ith a cresce ndo-dec resce ndo murmur at the lower left sternal border is most likely
due to hypertrophic obstructive cardiomyopathy (HOCM)
8- Carotid endarterectomy (CEA) is reco mmended for symptomat ic patients with high-grade carotid stenos is (generally
70%-99% for symptomatic lesions)
9- Torsades de pointes (TdP) refers to polymorphic ventricular tachycardia that occurs in the setting of a congenital or
acquired prolonged QT interval. Immediate defibrillation is indicated in hemodynamically unstable patients with TdP,
while intrave nous magnesium is the first-line therapy for stable patients with recurrent episodes of TdP.
10_ Dihydropyridine calcium channel blockers(amlodipine) can cause peripheral edema and should always be
considered in the differential diagnosis of this condition, along with other causes, such as heart failure, renal disease,
and venous insufficiency.
11-Electrical alternans v,ith sinus tachycardia is a highly specific sign for large pericardia! effusion. This is due to the
swinging motion of the heart in the pericardia! cavity causing a beat-to-beat variation in QRS axis and amplitude.
Patients with cardiac tamponade and hemodynamic compromise should have emergency pericardiocentesis. + lung infe
12- Patients with cardiac tamponade due to preicadial effussion due to URTI usually have clinical features of Beck's triad:
hypotension, distended neck veins, and muffled heart sounds. These symptoms are due to an exaggerated shift of the
interventricular septum toward the left ventricular cavity, which reduces left ventricular preload, stroke volume, and
cardiac output
13- Patients with Wolff-Parkinson-White syndrome v,ho develop atrial fibrillation with a rapid ventricular rate should be
treated with cardioversion or antiarrhythmics such as procainamide. Atrioventricular nodal blocke rs such as beta
blockers, calcium channel blockers, digoxin, and adenosine should be avoided as they can cause increased conduction
through the accessory pathway. and lead to degeneration of AF into VF.
14- Lidocaine is used for ventricular arrhyt hmias and is not indicated for AF .
2. 15- Patients with symptomatic sinus bradycardia should be treated initially with intravenous atropine. In patients Vfith
inadequate response, further treatment options include intravenous epinephrine or dopam ine, or transcutaneous
pacing.
16- Peripheral edema is a common side effect of dihydropyridine calcium channel blockers (CCBs ) such as amlodipine
and nifedipine . Addition of a renin-angiotensin system antagonist (angiotensin-converting enzyme inhibitor or
angiotensin receptor blocker) can reduce CCB-associa ted peripheral edema.
17- High-output heart failure usually results from increased cardiac output in response to a reduction in systemic vasc
ular resistance (eg, arteriovenous fistula). It involves hyperdynamic circulation (evidenced by widened pulse pressure
and brisk carotid upstroke) and increased cardiac venous return leading to peripheral and pulmonary edema.
18- Isolated systolic hypertension, an important cause of hypertension in elderly patients, is caused by increased
stiffness or decreased elasticity of the arterial wall. It is associated with an increase in cardiovasc ular morbidity and
mortality, and management should be similar to that of primary hypertension, with lifestyle modifications and
pharmacologic therapy.
19- Loop diuretics (Furosemide) cause hypokalemia and hypomagnesemia. These electrolyte abnormalities can cause
ventricular tachyca rdia, and also potentiate the side effects of digoxin.
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