Ck Cardiology

7/25/2019 Ck Cardiology

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CARDIOLOGY TiKi TaKa ______________________

. ISCHEMIC HEART DISEASE "IHD" = CORONARY ARTERY DISEASE "CAD":______________________________________________________________________________________________________________________________. Risk factors:________________. DM THE SINGLE !ORST OR MOST DANGEROS RISK #ACTOR O# CAD is DIA$ETESMELLITS%.. HTN. Most COMMON risk factor is &'()rt)*sio*%.. S+oki*,.. H'()r-i(i)+ia.. /)ri(&)ra- art)r' is)as).. O0)sit'.

. #a+i-' H1O #a+i-' +)+0)r +2st 0) 'o2*,3f)+a-) r)-ati4) 5 67's 8 +a-) r)-ati4)5 77's%.

. IHD CHEST /AIN NOT CHANGING !ITH $ODY /OSITION or RES/IRATION 9__________________________________________________________________. D2-- (ai*.. Locat) s20st)r*a--'.. Lasts ;7)rtio*.. Raiat)s to t&) -o?)r @a? or -)ft ar+.

. C&a*,)s ?it& r)s(iratio* = /-)2ritic (ai* /*)2+o*ia (-)2ritis /E /*)2+ot&ora>%.. C&a*,)s ?it& (ositio* = /)ricaritis.. T)*)r*)ss o* (a-(atio* = Costoc&o*ritis.. T&) +ost co++o* ca2s) of c&)st (ai* t&at is NOT CARDIAC i* ori,i* is GERDACID RE#L 9__________________________________________________________________________________________. E>: (t co+)s to t&) ER ?it& c&)st (ai* i* t&) )(i,astri2+ 8 associat) )B sor)t&roat3. A 0a +)ta--ic tast) i* t& +o2t& 8 co2,& is (r)s)*t.. A (roto* (2+( i*&i0itor O+)(rao-)% tria- s&B 0) o*).

. D.D. of CHEST /AIN:__________________________________________

. ; . Costoc&o*ritis:_______________________ C&)st ?a-- t)*)r*)ss.


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Do (&'sica- )>a+i*atio*.

. . Aortic iss)ctio*:_________________________ Raiatio* to t&) 0ack. *)F2a- $./. 0)t?))* 0ot& ar+s.

CR: !i)*) +)iasti*2+. Co*r+ ?it& C&)st CT or TEE Tra*s)so(&a,)a- )c&ocario,ra(&'%.

. < . /)ricaritis:____________________ /ai* ?ors) ?it& -'i*, at3 0)tt)r ?&)* sitti*, 2(. ECG ST )-)4atio* i* a-- -)as ?it& /R )(r)ssio*.. . D2o)*a- 2-c)r is)as):

______________________________. E(i,astric isco+fort (ia* is 0)tt)r o* )ati*,.. E*osco(' is co*r+ator'.

. 7 . Gastro)so(&a,)a- r)2> is)as) "GERD":_______________________________________________. $a tast)3 co2,& 8 &oars*)ss.. R)s(o*s) to //Is "O+)(rao-)".

. 6 . /*)2+o*ia:_________________. Co2,&3 s(2t2+ 8 &)+o(t'sis.. D> CR.

. J . /2-+o*ar' )+0o-is+:__________________________. S2)* o*s)t SO$3 &'(o>ia3 tac&'caria.. C>R C-)ar -2*,s.. S(ira- CT 1 sca* DDi+)r.. Most acc2rat): /2+o*ar' a*,io,ra(&'.

. . /*)2+ot&ora>:____________________. S&ar(3 (-)2ritic (ai* ?it& trac&)a- )4iatio*.. CR is ia,*ostic.

. . /a*cr)atitis:____________________. A-co&o-ic (t ?it& c&)st (ai* raiati*, to t&) 0ack.. Na2s)a 8 4o+iti*,.. D> C&)ck a+'-as) 8 -i(as) -)4)-s.. ; . C&o-)c'stitis:

______________________. Ri,&t 2(()r F2ara*t t)*)r*)ss 8 +i- f)4)r.


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. D> A0o+i*a- 1 for ,a-- sto*)s.

. EALATION O# CHEST /AIN IN THE EMERGENCY DE/ARTMENT:_______________________________________________________

#oc2s) H1O 8 /1E Ass)ss 4ita- si,*s O0tai* 4)*o2s acc)ss P _______ STA$LE ______________NSTA$LE_______ P P . O0tai* ECG 8 CR . Sta0i-i) &)+o'*a+ics. . A+i*ist)r as(iri* if . C&)ck for 2*)r-'i*, ca2s)s -o? risk of aortic iss)ctio* P ECG co*sist)*t ?it& AC Q P

_______________________________________________ P P YES NO P P _______________________ CR ia,*ostic QQ P P P STEMI NSTEMI __________YES_________NO___

P P P P Tr)at ?it& )+)r,)*c' Tr)at ?it& Tr)at ca2s) Ass)ss for /2-+o*ar')+0o-is+ cat&)t)riatio* or a((ro(riat) Ass)ss for ()ricaritis

t&ro+0o-'tics a*ticoa,2-atio* Ass)ss for aortic iss)ctio*

. N.$.. #2rt&)r t)sti*, for coro*ar' art)r' is)as) CAD%:. s&B NOT 0) o*) ro2ti*)-' i* -o? risk (ts as t&)' fr)F2)*t-' ca*B4) fa-s) 4)r)s2-ts.. E>)rcis) EKG or (&ar+aco-o,ica- str)ss t)sti*, is +ost 2s)f2- i* i*t)r+)iat) risk(ts.. Hi,& risk (ts s&B start (&ar+aco-o,ica- t&)ra(' 8 2*)r,o coro*ar' a*,io,ra(&'3. if t&)' &a4) sta0-) a*,i*a.

. /&'sica- )>a+i*atio* *i*,s:_________________________________. Distr)ss) (t ?it& SO$ 8 c-2tc&i*, c&)st.. S< ,a--o( = Lt 4)*tric2-ar i-atatio*.. S ,a--o( = Lt 4)*tric2-ar &'()rtro(&'.. 2,2-o4)*o2s ist)*sio*.. $i-at)ra- 0asa- -2*, ra-)s.


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. LL ))+a.

. Dia,*osis:____________. $)st i*itia- t)st EKG.

. N.$. If t&) cas) is 4)r' c-)ar ?it& ia,*osis of isc&)+ic (ai* 8 t&) ,i4)* c&oic)sar):. EKG 8 As(iri* Nitrat)s O>',)* Mor(&i*)% ... CHOOSE TTT ;st 9

. N.$. CKM$ is t&) 0)st to )t)ct REi*farctio* a f)? a's aft)r t&) i*itia- i*farctio*:__________________________________________________________________________________________. $ot& CKM$ 8 tro(o*i* -)4)-s ris) )rcis) to a tar,)t &)art rat) of 7U of +a>i+2+.. CO/D.. A+(2tatio*.. !)ak*)ss 2) to a (r)4o2s strok).. Mor0i o0)sit'.

. N.$.. Di('ria+o-) 8 coro*ar' st)a- (&)*o+)*o*:


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. Di('ria+o-) ca* 0) 2s) 2ri*, +'ocaria- ()rf2sio* sca**i*,3. to r)4)a- t&) ar)as of r)strict) +'ocaria- ()rf2sio*.. T&) r)istri02tio* of coro*ar' 0-oo o? to "No*is)as)" s),+)*ts 0'Di('ria+o-)3. is ca--) "Coro*ar' st)a- (&)*o+)*o*".

. !&)* o 'o2 or)r EERCISE THALLIM TEST or STRESS ECHOCARDIOGRA/HY Q________________________________________________________________________. !&)* EKG is NREADA$LE for isc&)+ia 9. Lt $$$.. Di,ita-is 2s).. /ac) +ak)r is (r)s)*t.. !&)* o 'o2 or)r a SESTAMI$I NCLEAR STRESS TEST Q

______________________________________________________. O0)s) (ts ?it& -ar,) 0r)asts.

. ANGIOGRA/HY is t&) MOST ACCRATE TEST to )t)ct coro*ar' art)r' is)as).

. ACTE CORONARY YNDROME AC% MANAGEMENT:______________________________________________________________________________________. NSTA$LE ANGINA EKG: ST s),)+)*t )(r)ssio* 8 4) CKM$%.. NONST SEGMENT ELEATION MI "NONSTEMI" EKG: No ST s),+)*t )-)4atio* 84) CKM$%.. ST SEGMENT ELEATION MI "STEMI" EKG: ST s)+)*t )-)4atio* 8 4) CKM$%.

. N.$. ST s),+)*t )-)4atio* i* -)as 3


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. T&) 0)st i*itia- t&)ra(' for a-- AC.. ANTI/LATELET r2,.. LO!ERS MORTALITY.. Gi4)* i* aitio* to Nitrat)s3 o>',)* 8 Mor(&i*).. CLo(io,r)a- or /ras2,r)- ar) ,i4)* i* cas) of co*tai*icatio* to As(iri* ).,.A--)r,'.

. T&)' ar) a-so ,i4)* i* (ts 2*)r,oi*, a*,io(-ast' or t&)r) is ac2t) MI.

VW THROM$OLYTICS 8 ANGIO/LASTY /CI%:_______________________________________. $ot& -o?)r +orta-it'.. A*,io(-ast' +2st 0) ()rfor+) ?it&i* +i*2t)s of arri4a- at t&) )+)r,)*')(art+)*t.. If it ca*Bt 0) ()rfor+) ?it&i* +i*s T&) (t s&B r)c)i4) THROM$OLYTICS.. Co*trai*icatio*s to t&ro+0o-'tics Ma@or 0-))i*, R)c)*t s2r,)r' S)4)r) HTN%.. Co+(-icatio*s of a*,io(-ast' R2(t2r) of coro*ar' art)r' R)st)*osis H)+ato+a%.

Vicit'.. Stati*s i*&i0it i*trac)--2-ar HMGCoA r)2ctas) )*'+)3. (r)4)*t co*4)rsio* of HMG coA to +)4a-o*ic aci 8 NO of c)-- +)+0ra*) LDLr)c)(tors. Stati*s a-so co)*'+) ; s'*t&)sis i*4o-4) i* +2sc-) c)-- )*)r,' (ro2ctio*3. so .. It co*tri02t)s to stati*i*2c) +'o(at&'.. C/K -)4)-s s&B 0) c&)ck) i* a*' (t o* a stati* ?&o (r)s)*ts ?it& +'a-,ias.. If &i,&-' )-)4at)3 t&) ;st st)( is to isco*ti*2) t&) stati*.

. N.$. Hi,& os) Niaci* t&)ra(' +a' ca2s) c2ta*)o2s 2s&i*, 8 (r2ritis.. T&is si) ))ct is 2) to /ROSTAGLANDIN INDCED /ERI/HERALASODILATATION.. Ca* 0) r)2c) 0' -o? os) as(iri*.

. DI##ERENT THERA/IES 8 THEIR MORTALITY $ENE#IT:________________________________________________X AL!AYS LO!ER MORTALITY:__________________________. As(iri*.. T&ro+0o-'tics.. /ri+ar' a*,io(-ast'.. $$ "M)to(ro-o-".


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. Stati*s.. C-o(io,r)- or (ras2,r)-.

X LO!ER MORTALITY IN CERTAIN CONDITIONS:_________________________________________. ACEIs 8 AR$s if t&)r) is -o? )@)ctio* fractio* Lt 4)*tric2-ar 'sf2*ctio*%.

X DO NOT LO!ER MORTALITY:

__________________________. O>',)*.. Mor(&i*).. Nitrat)s.. CC$s.. Liocai*).. A+ioaro*).

. !&)* o 'o2 ,i4) Ca-ci2+ c&a**)- 0-ock)rs "CC$s" Q_____________________________________________________

. I*to-)ra*c) to $$s S)4)r) ast&+atic (t%.. Cocai*) i*2c) c&)st (ai*.. Coro*ar' 4asos(as+ /ri*+)ta-Bs a*,i*a%.

. !&)* o 'o2 (-ac) a (ac)+ak)r Q__________________________________. ',)* )+a*.

. N.$. T&) +ai* +)c&a*is+ for (ai* r)-i)f i* (ts ?it& a*,i*a- (ai* ttt ?it&NITROGLYCERIN. ENODILATATION DILATATION of CA/ACITANCE ESSELS% 8 i* 4)*tric2-ar (r)-oa.

. N.$. #o--o?i*, MI3 4)*tric2-ar )+o)--i*, occ2rs.. R)+o)--i*, -)as to ,ra2a- i-atatio* of t&) -)ft 4)*tric-) ?it& t&i**i*, of ?a--s.. T&is ca* r)s2-ts i* CH#.. ACE i*&i0itors ar) ,i4)* to -)ss)*s 4)*tric2-ar r)+o)--i*,.. ACEIs s&B 0) i*itiat) ?it&i* &o2rs of MIi* a-- (ts ?it&o2t co*trai*icatio*s.

. N.$.


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. GERD is c&aract)ri) 0' a r)trost)r*a- 02r*i*, s)*satio* aft)r )ati*, 8 -'i*,o?*.. It +a' 0) acco+(a*i) 0' &oars)*)ss 8 c&ro*ic co2,& )s()cia--' ?&i-)r)c2+0a*t.. I*itia- ttt is a* Hr)c)(tor 0-ock)r or /roto* (2+( i*&i0itor.

. N.$. Di&'ro('rii*) CC$ Nif)i(i*)% ca* ?ors)* cariac isc&)+ia3. $)c. t&)' ca2s) ()ri(&)ra- 4asoi-atatio* 8 r))> tac&'caria.. so t&)' ar) co*trai*icat) i* (ts ?it& ac2t) coro*ar' .

. N.$. NONDi&'ro('rii*) CC$ Di-tia)+ 8 )ra(a+i-% ca* 0) 2s) i* STEMI aft)r$$3. $T .. T&)' o NOT i+(ro4) +orta-it'.

. N.$. Isc&)+ic a+a,) i* MI +a' -)a to iasto-ic 'sf2*ctio* 8 sti -)ft 4)*tric-)3. r)s2-ti*, i* a* atria- ,a--o( S t& &)art so2*%.

. N.$. /ts (r)s)*ti*, to t&) )+)r,)*c' )(art+)*t ?it& c&)st (ai* 8 s2s()ct)

AC3. s&o2- 0) a+i*ist)r) AS/IRIN ASA/.. Ear-' a*ti(-at)-)t t&)ra(' ?it& as(iri* r)2c)s t&) rat) of MI 8 o4)ra-- +orta-it'.

. COM/LICATIONS of Ac2t) MI:____________________________

V;W CARDIOGENIC SHOCK:_______________________. D> Ec&o 8 S!ANGAN Rt &)art cat&)t)riatio*.. T> ACEIs 8 2r,)*t r)4asc2-ariatio*.VW ALE R/TRE:

___________________. D> ECHO.. T> ACEIs3 Nitro(r2ssi) 8 i*traaortic 0a--oo* (2+( as a 0ri,) to s2r,)r'.

V2s%.. Ta+(o*a) co+(r)ss)s t&) Lt ?a-- 4)*tric-)8 )cr)as)s strok) 4o-2+) $/ 8 HR.. EKG Lo? 4o-ta,) RS co+(-)>)s 8 E-)ctrica- a-t)r*a*s.. D> ECHO.. T> /)ricarioc)*t)sis 8 S2((orti4) car) 8 2r,)*t s2r,ica- r)(air.

VW INTERENTRICLAR SE/TAL R/TRE:


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_____________________________________. Aro2* 7 a's aft)r i*farctio*.. /r)s)*ts ?it& (rofo2* c&)st (ai* 8 (rofo2* s&ock.. I*t)r4)*tric2-ar ?a-- r2(t2r) ca2s)s a 4)*tric2-ar s)(ta- )f)ct.. S2)* o*s)t of &'(ot)*sio* co*,)sti4) 0i4)*tric2-ar fai-2r) Ri,&t(r)o+i*a*t%.

. Lo2 &o-os'sto-ic +2r+2r &)ar 0)st at t&) -o?)r -)ft st)r*a- 0or)r.. D> Ec&o 8 S!ANGAN Rt &)art cat&)t)riatio*.. St)(2( i* o>',)* sat2ratio* fro+ Rt atri2+ to Rt 4)*tric-).. T> ACEIs3 Nitro(r2ssi) 8 2r,)*t s2r,)r'.V7W /A/ILLARY MSCLE R/TRE:

______________________________. 8 a>i--ar'raatio*%

. Ac2t) s)4)r) MR ca2s)s &'(ot)*sio* 8 (2-+o*ar' ))+a.. No ST s),+)*t )-)4atio*.

V6W SINS $RADYCARDIA:_______________________. D> EKG.. T> Atro(i*)3 fo--o?) 0' (ac)+ak)r if s'+(to+s ar) sti-- (r)s)*t.VJW COM/LETE EKG 8 Ca**o* "a" ?a4)s.. T> Atro(i*) 8 /ACEMAKER )4)* if s'+(to+s r)so-4).VW RIGHT ENTRICLAR IN#ARCTION:

__________________________________. Associat) ?it& NE! IN#ERIOR !ALL MI.. 2) to occ-2sio* of t&) Rt coro*ar' art)r'.. HY/OTENSION 8 S&ock 8 D 8 C-)ar -2*, )-s.. EKG ST )-)4atio* i* RR6 Rt 4)*tic2-ar -)as%.. T> Hi,& 4o-2+) 2i r)(-ac)+)*t.. A4oi *itro,-'c)ri* ?i-- ?ors)* &'(ot)*sio*%.

VW ENTRICLAR ANERYSM A%:_______________________________. Lat) co+(-icatio* occ2ri*, ?))ks to +o*t&s (ost MI.. Scarr) or 0rotic +'ocaria- ?a-- 2) to &)a-) tra*s+2ra- MI.. +a' (r)s)*t ?it& &)art fai-2r)3 r)fractor' a*,i*a3 4)*tric2-ar arr&'t&+ia or)+0o-is+.. HALLMARK EKG /ERSISTENT ST s),)+)*t )-)4atio* aft)r a r)c)*t MI DEEEE/ ?a4)s 9. Lar,) A ca* -)a to (ro,r)ssi4) L )*-ar,)+)*t3 arr&'t&+ia3 +2ra- t&ro+02s.


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. D> ECHOCARDIOGRA/HY D'ski*)tic ?a-- +otio* of a (ortio* of t&) -)ft4)*tric-).

V;W ACTE /ERICARDITIS:_________________________. !it&i* ;< a's (ost MI.

. S&ar( (-)2ritic or (ositio*a- c&)st (ai* ?it&i* t&) ;st s)4)ra- a's (ost MI.. It is ?ors) i* s2(i*) (ositio* 8 i+(ro4) 0' sitti*, 2( 8 -)a*i*, for?ars.. A ()ricaria- frictio* r20 +a' 0) &)ar.. Di2s) ST )-)4atio*s )s()cia--' ?it& /R )(r)ssio*s ar) t'(ica- ECG+a*if)statio*s.. Dr)ss-)rBs is (ost MI ()ricaritis i++2*)+)iat)% occ2ri*, ?))ks to +o*t&s(ost MI. #)4)r3 -)2koc'tosis 8 ()ricaria- frictio* r20.. T> NSAIDs.

V;;W /OSTIN#ARCTION ANGINA R)c2rr)*t cariac isc&)+ia%:__________________________________________________________

. R)c2rr)*t c&)st (ai*.. N)? or ?ors)*i*, ECG c&a*,)s of isc&)+ia ).,. ST )-)4atio*.. It +a' ca2s) 4)*tric2-ar tac&'caria or 0ri--atio* ?&ic& +a' ),)*)rat) i*toas'sto-)

. N.$. I!MI ?it& Ri,&t )*tric2-ar I*farctio* +a*a,)+)*t:_________________________________________________________. Ac2t) +a*a,)+)*t of a STEMI ,)*)ra--' i*c-2)s r)()rf2sio* T&ro+0o-'sis or/CI%3. a*ti(-at)-)t t&)ra('3 +or(&i*)3 &)(ari*3 *itrat)s 8 $$.. Nitrat)s 8 $$ ar) co*trai*icat) i* c)rtai* circ2+sta*c)s.. ).,. AS3 r)c)*t (&os(&oi)st)ras) i*&i0itor 2s) or Ri,&t )*tric2-ar I*farctio*.

. R MI ?it& I!MI ar) associat) ?it& &'(ot)*sio* 8 D.

. !&)* t&) Rt 4)*tic2-ar strok) 4o-2+) )cr)as)s3 t&) CO/ is i+(air).. So .. A*' +)icatio* t&at r)2c)s (r)-oa ).,. Nitrat)s or i2r)tics% ?i-- !ORSENit.

. so .. T&) ;st st)( i* R MI is ,)*)ra--' I #LID RESSCITATION to R strok)4o-2+).. Nitrat)s s&o2- 0) a4oi).

. N.$.. Ac2t) MR ca* occ2r 2) to (a(i--ar' +2sc-) 'sf2*ctio* i* (ts ?it& ac2t) MI.. Ac2t) MR c&aract)ristica--' ca2s)s a ris) i* LE#T ATRIAL /RESSRE.. NO CHANGE i* Lt atria- si) Lt 4)*tric2-ar si) Lt 4)*tric2-ar E#%.

. /OSTMI DISCHARGE INSTRCTIONS:_________________________________


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. As(iri*3 c-o(io,r)-3 $$3 Stati* 8 ACEIs.. !ait 6 ?))ks 0)for) r)s2+i*, s)>2a- r)-atio*.. A*>i)t' is t&) +ost co++o* ca2s) of )r)cti-) 'sf2*ctio* (ostMI.. Nitrat)s ar) co*tai*icat) i* cas) of S-i)*a- 2sa,) $ot& s)4)r)&'(ot)*sio*%.

. NONSTEMI MANAGEMENT:_______________________. No t&ro+0o-'tic 2s).. HE/ARIN is 2) ro2ti*)-'.. LM! &)(ari* is (r)f)rr) to t&) I for+.. G-'co(rot)i* 01


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. N.$. T&) +ai* i)r)*c) 0)t?))* sa(&)*o2s 4)i* ,rafts 8 i*t)r*a- +a++ar'art)r' ,rafts. is t&at 4)i*s ,rafts start to 0)co+) occ-2) aft)r 7 ')ars3. 02t i*t)r*a- +a++ar' art)r' ,rafts ar) oft)* (at)*t at ; 's.

. INDICATIONS for CA$G:________________________. < coro*ar' 4)ss)-s ?it& J U st)*osis.. L)ft +ai* coro*ar' art)r' st)*osis.

. CORONARY ARTERY DISEASE EIALENTS:_______________________________________. DM /AD AAA CAD.

. LI/ID MANAGEMENT:____________________

. T&) si*,-) stro*,)st i*icatio* for a "stati*" i* a (t ?it& AC 8 a* LDL ;


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X /A/ILLARY MSCLE R/TRE:____________________________. Ti+) co2rs) Ac2t) 8 ?it&i* a+ S&ock 8 c&)st (ai* N)? &o-os'sto-ic +2r+2r $i4)*tric2-ar fai-2r).. Ec&o Lt to Rt s&2*t at 4)*tric2-ar -)4)- 8 st)( 2( of o>',)* -)4)- 0)t Rt AT 8T.X ENTRICLAR #REE !ALL R/TRE:

_________________________________. Ti+) co2rs) !it&i* ;st 7 a's ?))ks.. C2-(rit coro*ar' art)r' LAD.. E>a+ S&ock 8 c&)st (ai* D Dista*t &)art so2*s Ta+(o*a) si,*s%.. Ec&o /)ricaria- )2sio* ?it& ta+(o*a).

. N.$. ARIANT ANGINA = /RINMETALBs ANGINA:____________________________________________. Ca2s) 0' t)+(orar' s(as+ of coro*ar' art)ri)s.. Yo2*, ?o+)* ar) c-assica--' a)ct).. T&) ,r)at)st risk factor is s+oki*,.. Asi) fro+ s+oki*,3 t&)r) is a0s)*c) of cario4asc2-ar risk factors.. Associat) )B ot&)r 4asos(astic isor)rs Ra'*a2Bs (&)*o+)*o* 8 Mi,rai*)&)aac&)%.. E(iso)s occ2r at t&) +i-) of t&) *i,&t to a.+.. Tri,,)rs )>)rcis)3 &'()r4)*ti--atio*3 )+otio*a- str)ss3 co- )>(os2r) 8 cocai*)2s).. A*,i*a- )(iso) is acco+(a*i) 0' tra*si)*t ST )-)4atio*s ?it& r)t2r* to 0as)-i*).. T> CC$s "Di-tia)+" or Nitrat)s.. No* s)-)cti4) $$ 8 As(iri* s&o2- 0) AOIDED 0)ca2s) t&)' ca* (ro+ot)4asoco*strictio*.

. N.$. COCAINE A$SE INDCING ASOS/ASM:________________________________________. Di-at) (2(i-s 8 0-oocr2st) *os) s2,,)st cocai*) a02s).. Cocai*) i*&i0its cat)c&o-a+i*)s r)2(tak) fro+ *)2ro*a- s'*a(s)s S'+(at&o+i+)tic.. Cocai*) i*2c) 4asos(as+ +'ocaria- isc&)+ia 8 or i*farctio*.. /t (r)s)*ts ?it& c&)st (ai* 8 ST )-)4atio*s.. Cocai*) i*2c) STEMI is ttt sa+)?a' as c-assic STEMI ?it& /CI 8 t&ro+0o-'sis.


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. As(iri* 8 *itrat)s ar) a-so a((ro(riat).. $$ SHOLD $E AOIDED !ORSEN THE S/ASM.. T> CC$s.

. CONGESTIE HEART #AILRE:___________________________

___________________________. DYS/NEA SO$% is t&) )ss)*tia- f)at2r).. Ort&o(*)a !ors) ?&)* -'i*, at3 r)-i)4) ?&)* sitti*, or sta*i*,%.. /ri(&)ra- ))+a.. $i-at)ra- -2*, ra-)s.. 2,2-ar 4)*o2s ist)*sio* D%.. /aro>'s+a- *oct2r*a- 's(*)a /ND% "S2)* ?ors)*i*, at *i,&t 2ri*, s-))(".. S< GALLO/ Diasto-ic so2* @2st aft)r S = L)ft 4)*tric2-ar fai-2r)%

. o-2+) o4)r-oa Cariac 'sf2*ctio* /r)ss2r) o4)r-oa.. S'sto-ic 'sf2*ctio* LO! EECTION #RACTION HEART DILATATION.. Diasto-ic 'sf2*ctio* /RESERED EECTION #RACTION.

. HY/ERTENSION ca2si*, cario+'o(at&' is t&) +ost co++o* ca2s) of s'sto-ic'sf2*ctio*.. MYOCARDIAL IN#ARCTION ca2s)s i-at) cario+'o(at&' 8 E#.. IN#ARCTION DILATATION REGRGITATION CH#.. D> E4)r' CH# (t +2st 2*)r,o ECHOCARDIOGRA/HY to )4a-2at) )@)ctio*fractio*.. Ot&)r t)sts 2s) to )t)r+i*) t&) )tio-o,' of CH#: . EKG MI or &)art 0-ock. . CR Di-at) cario+'o(at&'. . Ho-t)r +o*itor /aro>'s+a- arr&'t&+ia. . Cariac cat&)t)riatio* To )t)ct 4a-4) ia+)t)rs 8 s)(ta- )f)cts. . T&'roi f2*ctio*s $ot& &'(o 8 &'()r t&'roi stat)s ca2s) CH#. . C$C A*)+ia.. T> SYSTOLIC DYS#NCTION LO! E#%:

_______________________________________. ACE Is 8 AR$S if associat) r' Co2,&%3 $ot& ACEIs 8 AR$s ca2s) HY/ERKALEMIA9. $$s M)to(ro-o- 8 Car4)i-o-%.. S(iro*o-acto*) A*tia-ost)ro*) Si) ))cts G'*)co+astia H'()rka-)+ia%.. Di2r)tics Loo( i2r)tics ).,. #2ros)+i)%.. Di,o>i* i*&i0its NaK AT/as)%.

. N.$. ;. Gi4) AR$s i*st)a of ACEIs i* associat) r' co2,&.. N.$. . $$ ar) *)4)r ,i4)* i* ttt of ac2t) &)art fai-2r) 9. $$ ar) ,i4)* as a c&ro*ic ttt of CH#.. $$ &a4) a*tiarr&'t&+ic 8 a*tiisc&)+ic actio* ao t&)' (r)4)*t s2)* )at&.


15/53

. N.$. icit'. To>icit' A*or)>ia3 Na2s)a 8 4o+iti*,% 8 $i4)*tric2-ar tac&'caria 8 ')--o?4isio*.. Most co++o* arr&'t&+ia 2) to Di,ita-is is ATRIAL TACHYCARDIA !ITH ARIA$LEA $LOCK 9. T> of Di,o>i* to>icit' NaK AT/ASE3 Liocai*) 8 Di,i0i* A0s a,ai*st Di,ita-is%.

. N.$. 6. DRGS LO!ERING MORTALITY IN CH# ACEIs AR$s $$ S/IRONOLACTONE 8 AS/IRIN. H'ra-ai*) 8 *itrat)s &a4) 0))* (ro4)* to -o?)r +orta-it' i* CH#.

. I+(-a*ta0-) )0ri--ator -o?)rs +orta-it' 8 (r)4)*ts s2)* )at& 2) toarr&'t&+ia.. N.$. J. Di,o>i* 8 -oo( i2r)tics "#2ros)+i)" DO NOTTTT -o?)r +orta-it'.. N.$. . EECTION #RACTION E#%:. $)st i*itia- t)st TRANSTHORACIC ECHOCARDIOGRA/HY TTE%.. Most acc2rat) t)st MGA sca* or *2c-)ar 4)*tric2-o,ra(&'.

. N.$. . A NORMAL $N/ )>c-2)s CH# 9

. N.$. ;. If t&)ir is &'()rka-)+ia r' to ACEIs3 o*Bt ,i4) AR$s A-so ca2s) K%9. Gi4) HYDRALAINE DIRECT ACTING ARTERIOLAR ASODILATOR% i*st)a.. N.$. ;;. A H1O of 2(()r RTI fo--o?) 0' s22)* o*s)t cariac fai-2r) i* a &)a-t&'(t3. is s2,,)sti4) of i-at) cario+'o(at&'.. It is t&) )* r)s2-t of +'ocaria- a+a,) 2) to to>ic3 +)ta0o-ic or i*f)ctio2sa,)*ts.. ira- +'ocaritis is +ost co++o*-' s))* fo--o?i*, Co>sacki) 4ir2s $ i*f)ctio*.. ira- +'ocaritis +a' ca2s) i-at) cario+'o(at&' 4ia ir)ct 4ira- a+a,).. D> Ec&ocario,ra+ Di-at) 4)*tric-)s ?it& i2s) &'(oki*)sia.. Lo? E# S'sto-ic 'sf2*ctio*%.

. N.$. ;. M)c&a*is+ of ))+a i* co*,)sti4) &)art fai-2r):. I* &)art fai-2r)3 t&)r) is )f)cti4) circ2-ati*, 0-oo 4o-2+) CO/.. CO/ R)*a- &'(o()rf2sio* Acti4atio* of R)*i* A*,iot)*si* A-ost)ro*)s'st)+.. i* co*c)*tratio* of 0ot& A*,iot)*si* 8 A-ost)ro*).. A*,iot)*si* R)*a- 0-oo o? 0' co*stricti*, t&) ))r)*t r)*a- art)rio-).. A-ost)ro*) Na R)a0sor(tio* ?at)r r)t)*tio* E)+a.


16/53

. N.$. ;tracariac +a*if)statio*s (rot)i*2ria 8 )as' 0r2isa0i-it'% ar) t&) k)' ?ors9. Co++o* ca2s)s of a+'-oiosis i*c-2) +2-ti(-) +')-o+a AL a+'-oiosis%.. C&ro*ic i*a++ator' is)as)s ).,. r&)2+atoi art&ritis AA a+'-oiosis%.

. D)(ositio* of a+'-oi 0ri-s i* t&) ki*)' (rot)i*2ria.. A+'-oi 0ri-s 0i*i*, to -i4)r coa,2-atio* factors s'*t&)sis Eas'0r2isa0i-it'. A+'-oi 0ri-s )(ositio* i* t&) &)art R)stricti4) cario+'o(at&'.. R)stricti4) cario+'o(at&' is 2) to t&ick)*) 4)*tric2-ar ?a-- 8 iasto-ic'sf2*ctio* . S'sto-ic f2*ctio* is r)-ati4)-' ?)-- (r)s)r4).. )*tric2-ar i+)*sio*s r)+ai* 2*c&a*,).

. N.$. ;6. M)icatio*s to ?it&&o- (rior to cariac str)ss t)sti*,: $$ CC$ Nitrat)s.. N.$. ;J. M)icatio*s to co*ti*2) ACEIs AR$s Di,o>i* Stati*s Di2r)tics%.

. N.$. ;. /t )B r)c2rr)*t (2-+o*ar' i*f)ctio*s3 c&ro*ic co2,& 8 si,*ica*t s+oki*,H1O.. a*t)ro(ost)rior ia+)t)r 8 ?&))i*, o* /1E.. T&is is co*sist)*t ?it& CO/D.. T&) associat) c&ro*ic &'(o>)+ia co*strictio* of t&) (2-+o*ar' art)ria-s'st)+3. Co*strictio* /LMONARY ARTERY SYSTOLIC /RESSRE /LMONARYHTN.. /2-+o*ar' &'()rt)*sio* Rt 4)*tric2-ar &'()rtro(&' 8 Rt 4)*tric2-ar fai-2r).. R# /3 co*,)sti4) HSM3 H)(ato@2,2-ar r)2> 8 LL ))+a.

. N.$. ;. MASSIE /LMONARY EM$OLISM. is -ik)-' i* (osto()rati4) (t ?it& @2,2-ar 4)*o2s ist)*sio* 8 *)? o*s)t Rt $$$.

. N.$. . Diasto-ic 'sf2*ctio* = i+(air) 4)*tric2-ar --i*, ?it& (r)s)r4) E#3. D2) to (oor +'ocaria- r)-a>atio* or i+i*is&) 4)*tric2-ar co+(-ia*c).. s2a--' 2) to s'st)+ic &'()rt)*sio*.. T> Di2r)tics 8 a*ti&'()rt)*si4)s.. I* s)4)r) cas)s3 iasto-ic 'sf2*ctio* ca* ca2s) )co+()*sat) &)art fai-2r).


17/53

. N.$. ;. M)as2r)+)*t of s)r2+ $N/ ca* &)-( isti*,2is& 0)t. CH# 8 ot&)r's(*)a ca2s)s.. A 4a-2) ; (,1+- ia,*os)s CH# ?it&3. a s)*siti4it'3 s()cicit' 8 (r)icti4) acc2rac' of 3 J6 8 < U r)s()cti4)-' 999. N.$. . I* ot&)r?is) &)a-t&' (ts ?&o )4)-o( CH#3

. M'ocaritis s&o2- 0) co*si)r) &i,& o* D.D.. ira- i*f)ctio*3 )s()cia--' ?it& Co>sacki) $ 4ir2s is t&) +ost co++o* ca2s).

. N.$. CI%. ICREASED TOTAL /ERI/HERAL RESISTANCE T/R%. LE#T ENTRICLAR END DIASTOLIC OLME LED%.

. DI##ERENTIAL DIAGNOSIS O# DYS/NEA:____________________________________. /2-+o*ar' )+0o-is+ S2)* o*s)t 8 C-)ar -2*,s.

. $ro*c&ia- ast&+a S2)* o*s)t3 ?&))i*, 8 )>(irator' (&as).. /*)2+o*ia S-o?)r3 f)4)r3 s(2t2+3 NI-at)ra- ra-)s or ro*c&i.. /*)2+ot&ora> *i-at)ra- i* 0r)at& so2*s8 trac&)a- )4iatio*.. /a*ic attack Circ2+ora- *2+0*)ss3 ca)i*) 2s) 8 H1O of a*>i)t'.. A*)+ia /a--or3 ,ra2a- o4)r a's to ?))ks.. Ta+(o*a) /2-s2s (arao>2s3 fai*t &)art so2*s 8 D.. Arr&'t&+ia /a-(itatio*s 8 s'*co().. /-)2ra- )2sio* D2--*)ss to ()rc2ssio* at -2*, 0as)s.. CO/D Lo*, s+oki*, H1O 8 0arr)- c&)st.. M)t&)+o,-o0i*)+ia R)c)*t a*)st&)tic 2s)3 $RO!N 0-oo *ot i+(ro4) )B O8 c'a*osis.. CO (oiso*i*, $2r*i*, 02i-i*, or car3 !oo 02r*i*, sto4) i* ?i*t)r3 s2ici)att)+(t.. ALL of t&) (r)4io2s it)+s ?i-- -ack ort&o(*)a /ND S< Ga--o( 9

. ACTE CARDIOGENIC /LMONARY EDEMA:____________________________________. D2) to SEERE LE#T ENTRICLAR #AILRE.. ACTE ONSET SHORTNESS O# $REATH.. Ra-)s D S< ,a--o( E)+a Ort&o(*)a.. Ma' 0) ascit)s 8 HSM i* cas) of associat) R#.

. D> $rai* *atri2r)tic ()(ti) $N/.. $N/ is 2s) if t&) )tio-o,' of SO$ is *ot c-)ar 9. A *or+a- $N/ )>c-2)s (2-+o*ar' ))+a $N/ ; is ia,*ostic%.. CR asc2-ar co*,)stio* cario+),a-' (-)2ra- )2sio* 8 K)r-)' $ -i*)s.. A$G H'(o>ia 8 R)s(irator' a-ka-osis H'()r4)*ti--atio* ?it& )>c)ss COr)-)as)%.. EKG Af3 A# or .tac&'caria /)rfor+ s'*c&ro*i) cario4)rsio*.. Ec&o To )t)ct if t&)r) is s'sto-ic or iasto-ic 'sf2*ctio*.


18/53

. T&) $EST INITIAL TTT is LOO/ DIRETIC #ROSEMIDE%.. #2ros)+i) r)+o4)s a -ar,) 4o-2+) of 2i fro+ t&) 4asc2-ar s(ac).. It ca2s)s ENODILATATION so it )cr)as)s t&) (r)-oa.

. /RELOAD REDCTION LOO/ DIRETIC "#2ros)+i)" MOR/HINE NITRATES

OYGEN.. /OSITIE INOTRO/E DO$TAMINE.. A#TERLOAD REDCTION ACEIs 8 AR$s.. N.$. NITRATES "NITROGLYCERIN" THE MOST RA/IDLY ACTIE DRG TO RELIEESYM/TOMS%.

. N.$. Do02ta+i*) "4) i*otro()" is 2s) if t&)r) is *o r)s(o*s) to (r)-oar)2ctio*.

. N.$. A+ri*o*) 8 Mi-ri*o*) "/&os(&oi)st)ras) i*&i0itors" ar) a-so 4) i*otro()s.

. N.$. Nitro(r2ssi) 8 H'ra-ai*) ca* aft)r-oa i* ac2t) cas)s.

. N.$. $$ ar) 4) i*otro()s so t&)' ar) co*trai*icat) i* ac2t) (2-+o*ar' ))+a.. N.$. $$ ar) ,i4)* o*-' i* ttt of c&ro*ic &)art fai-2r).

. ALLAR HEART DISEASES:____________________________________________________

. IM/ORTANT CLES:___________________. Yo2*, f)+a-) M/.. H)a-t&' 'o2*, at&-)t) HOCM.. I++i,ra*t3 (r),*a*t MS.. T2r*)rBs 3 Aortic coarctatio* $ic2s(i Aortic 4a-4) AS%.. /a-(itatio*s3 At'(ica- c&)st (ai* *ot ?it& )>)rtio* M/.

. MRMRS:___________. SYSTOLIC AS MR M/ HOCM.. DIASTOLIC AR MS.

. E##ECT O# CHANGE IN ENOS RETRN:_____________________________________. a-42-ar -)sio* _____ R SF2atti*, 8 Raisi*, -),s% ____ R Sta*i*, 8a-sa-4a%__________________________________________________________________________________________. AS3AR3MS3MR3 SD ____ % ____ % Gi4) i2r)tics 9. HOCM 8 M/ __________ % ____ %

. E##ECT O# CHANGE IN A#TERLOAD:


19/53

_________________________________. a-42-ar -)sio* _____ A#TERLOAD HAND GRI/% ____ A#TERLOAD AMYLNITRATE%__________________________________________________________________________________________. AS __________________ % ____ %

. AR __________________ % ____ % Gi4) ACEIs 9. MR __________________ % ____ % Gi4) ACEIs 9. SD _________________ % ____ % Gi4) ACEIs 9. HOCM ________________ % ____ %. M/ _________________ % ____ %

. LOCATION 8 RADIATION O# MRMRS:___________________________________. AS H)ar 0)st at * Rt i*t)rcosta- s(ac) 8 raiat)s to t&) caroti art)ri)s.. AR3 TA3 TR3 SD H)ar 0)st at Lt -o?)r st)r*a- 0or)r.. MR H)ar 0)st at a()> 8 raiat)s i*to t&) a>i--a.

. DIANOSIS:____________. $)st i*itia- t)st ECHOCARDIOGRA/HY Tra*sT&oracic TTE Tra*sEso(&a,)a-

TEE%.. Most acc2rat) t)st L)ft &)art cat&)t)riatio*.

V;W AORTIC STENOSIS AS%:__________________________. C&)st (ai*.. O- (t ?it& H1O of HTN.. S'*co() 8 H# ar) -)ss co++o* (r)s)*tatio*s.. S'*co() 2) to -)ft 4)*tric2-ar o2t o? o0str2ctio*.. Associat) CAD.. AS 0)co+)s s'+(o+atic ?&)* it is s)4)r) a-4) ar)as 5 ; c+%.. CRESCENDO DECRESCENDO SYSTOLIC MRMR.. H)ar 0)st at * Rt i*t)rcosta- s(ac) 8 raiat)s to t&) caroti art)ri)s.. /LSS /ARS ET TARDS !))k 8 )-a') (2-s) strok)%.. EKG 8 CR Lt 4)*tric2-ar &'()rtro(&'.. T> $)st i*itia- ttt DIRETICS.. T> #ai-) AORTIC ALE RE/LACEMENT. Gi4) !arfari* ti-- INR ',)*.. +'ocaria- o>',)* )+a* A*,i*a- (ai*.

. N.$.. Aortic st)*osis i* o- i*i4i2a- is +ost-' 2) to AGE DE/ENDENT SCLEROCALCI#ICCHANGES


20/53

. T&)' +a' (r)s)*t ?it& )>)rtio*a- s'*co() 2) to r)strict) CO/ 2) to st)*oticaorta.. N.$.. I*icatio*s for aortic 4a-4) r)(-ac)+)*t: A-- s'+(to+atic (ts ?it& AS S'*co() A*,i*a D's(*)a%.

/ts ?it& s)4)r) AS 2*)r,oi*, CA$G or ot&)r 4a-42-ar s2r,)r'. As'+(to+atic (t ?it& )B AS 8 )it&)r (oor L s'sto-ic f2*ctio*3 L &'()rtro(&' ;7++.

. N.$.. T&) < +ost co++o* ca2s)s of aortic st)*osis i* t&) ,)*)ra- (o(2-atio* ar):. s)*i-) ca-cic aortic st)*osis 0ic2s(i aortic 4a-4) r&)2+atic &)art is)as).. A 0ic2s(i aortic 4a-4) is t&) ca2s) of aortic st)*osis i* t&) +a@orit' of (ts 5 J's.

VW AORTIC REGRGITATION AR%:

_______________________________. SO$ 8 fati,2) ar) t&) +ost co++o* (r)s)*tatio*s.. H1O of HTN3 R&)2+atic &)art is)as)3 )*ocaritis.. Marfa*Bs 3 '(&i-is 8 r)acti4) art&ritis ar) rar) ca2s)s.. DIASTOLIC DECRESCENDO MRMR &)ar 0)st at -)ft st)r*a- 0or)r.. 2i*ck) (2-s) Art)ria- or ca(i--ar' (2-satio*s i* t&) *,)r *ai-s.. Corri,a*Bs (2-s) Hi,& 0o2*i*, (2-s)s "!at)r&a++)r (2-s)".. M2ss)tBs si,* H)a 0o00i*, 2( 8 o?* ?it& )ac& (2-s).. D2roi)Bs si,* M2r+2r &)ar o4)r t&) f)+ora- art)r'.. Hi-- si,* $-oo (r)ss2r) ,rai)*t +2c& &i,&)r i* t&) -o?)r -i+0s.. EKG 8 CR Lt 4)*tric2-ar &'()rtro(&'.. T> $)st i*itia- t&)ra(' ACEIs3 AR$s 8 Nif)i(i*).. T> A -oo( i2r)tic #2ros)+i)%.. T> S2r,)r' If E# 5 77U or LESD 77++%.

. N.$.. AR +2r+2r is 0)st &)ar a-o*, t&) -)ft st)r*a- 0or)r at t&) (iratio*.

. N.$.. I* DEELO/ED co2*tri)s3. Co*,)*ita- 0ic2s(i aortic 4a-4) is t&) +ost co++o* ca2s) of AR i* 'o2*, a2-ts.

. N.$.. I* DEELO/ING co2*tri)s3. R&)2+atic &)art is)as) is t&) +ost co++o* ca2s) of AR.

. N.$.


21/53

. AR ca2s)s ?i)*i*, of t&) (2-s) (r)ss2r)3 ?&ic& ca* 0) f)-t as "?at)r&a++)r"(2-s).. L'i*, o?* 8 t2r*i*, to t&) -)ft 0ri*,s t&) &)art c-os)r to t&) c&)st ?a--3. +aki*, t&) (t +or) a?ar) of t&) forc)f2- &)art 0)at.

V Most ))cti4) t&)ra(' $a--oo* 4a-42-o(-ast'.. /r),*a*c' is *ot a co*trai*icatio* to 4a-42-o(-ast'.

. N.$. MS +a' 0) ca2s) 0' INTRACARDIAC ATRIAL TMOR ATRIAL MYOMA%.. Atria- +'>o+a +a' o0str2ct t&) +itra- 4a-4).. Co*stit2tio*a- +a*if)statio*s of t&) t2+or Lo? ,ra) f)4)r 8 ?)i,&t -oss%.. /r)s)*ts as a +ass o* )c&ocario,ra(&'.. Ma' 0) assocaiat) )B *)2ro-o,ica- s'+(to+s "si) ?)ak*)ss" 2) to t2+or)+0o-iatio*.. Atria- +'>o+a is NOT )F2a- to M'>o+ato2s 4a-4) ),)*)ratio* COMMONMISTAKE% 999

VW MITRAL REGRGITATION MR%:_______________________________. D's(*)a o* )>)rtio* is t&) +ost co++o* co+(-ai*t.. A*' is)as) -)as to &)art i-atatio* ).,. H'()rt)*sio*3 isc&)+ic &)art is)as).. HOLOSYSTOLIC MRMR O$SCRING $OTH S 8 S.. S< GALLO/ 2) to 4o-2+) o4)r-oa.. T> $)st i*itia- t&)ra(' ACEIs3 AR$s 8 Nif)i(i*).. T> A -oo( i2r)tic #2ros)+i)%.. T> S2r,)r' If E# 5 6U or LESD ++%.

. N.$.. DIASTOLIC 8 co*ti*o2s +2r+2r as ?)-- as -o2 s'sto-ic +2r+2rs o* a2sc2-tatio*3


22/53

. s&o2- a-?a's 0) i*4)sti,at) 2si*, TTE Tra*st&oracic Do((-)rEc&ocario,ra(&'%.. Mis'sto-ic soft +2r+2rs i* a* as'+(to+atic 'o2*, (t ar) 2s2a--' 0)*i,*3. No f2rt&)r i*4)sti,atio*s ar) *))).

. N.$.. AORTIC STENOSIS Tra*sT&oracic TTE.. AORTIC DISSECTION Tra*sEso(&a,)a- TEE.

. N.$.. Ac2t) MR ca* occ2r 2) to (a(i--ar' +2sc-) 'sf2*ctio* i* (ts ?it& ac2t) MI.. Ac2t) MR c&aract)ristica--' ca2s)s a ris) i* LE#T ATRIAL /RESSRE.. NO CHANGE i* Lt atria- si) Lt 4)*tric2-ar si) Lt 4)*tric2-ar E#%.

. MITRAL ALE /ROLA/SE M/%:______________________________

. Most-' a 'o2*, f)+a-).. Most-' as'+(to+atic.. A0s)*t s'+(to+s of CH#.. Mis'sto-ic c-ick o4)r t&) cariac a()>.. A* acco+(a*'i*, s&ort s'sto-ic +2r+2r if +itra- r),2r,itatio* is (r)s)*t.. SF2atti*, R cariac (r)-oa or )-i+i*at)s t&) (ro-a(s).. At'(ica- c&)st (ai* Lasti*, 7 ; s)co*s%.. A*>i)t'3 (a-(itatio*s 8 &'()r4)*ti-atio* +a' 0) (r)s)*t.. D> Ec&ocario,ra(&' is t&) 0)st c&oic).. T> $$ ?&)* t&) (t is s'+(to+atic.. a-4) r)(air i* r)fractor' cas)s to $$.. A f)? stitc&)s i*to t&) 4a-4) ca* +ark)-' ti,&t)* 2( t&) -)a)ts.. E*ocaritis (ro(&'-a>is is NOT r)co++)*) )4)* i* t&) (r)s)*c) of a +2r+2rof MR 9

. N.$. M/ is 2) to MYOMATOS DEGENERATION O# THE MITRAL ALE LEA#LETS9

. IN#ECTIE ENDOCARDITIS:__________________________________________________. I*t)r+itt)*t f)4)r.. N)? +2r+2r.. 4) 0-oo c2-t2r).. T> E+(iric 4a*co+'ci* Co4)ri*, sta(&3 str)(t 8 )*t)rococci%.. IRIDANS ,ro2( str)(tococci Str)(. M2ta*s% ar) &i,&-' s2sc)(ti0-) to ()*ici--i*.. T> Str)(t 4iria*s 8 +2ta*s ?it& INTRAENOS AEOS /ENICILLIN G or ICE#TRIAONE.. I C)ftria>o*) is )asi)r to a+i*ist)r at &o+) 2) to o*c) ai-' osi*,.. Ora- a*ti0iotics ar) NOT r)co++)*).


23/53

. IN#ECTIE ENDOCARDITIS IN INTRAENOS DRG SERS:___________________________________________________. HI i*f)ctio* i*f)cti4) )*ocaritis risk i* I r2, a02s)rs.. STA/HYLOCOCCS ARES is t&) +ost co++o* ca2si*, or,a*is+.. TRICS/ID 4a-4) i*4o-4)+)*t RIGHTsi)% is +or) co++o* t&a* aortic 4a-4).. HOLOSYSTOLIC MRMR ?it& INS/IRATION i*icat)s tric2s(i i*4o-4)+)*t.

. AGMENTATION O# INTENSITY !ITH INS/IRATION IS ERY SENSITIE SIGN.. S)(tic (2-+o*ar' )+0o-i ar) co++o* Co2,&3 c&)st (ai* 8 &)+o(t'sis%.. S(-i*t)r &)+orr&a,)s 8 a*)?a' -)sio*s ar) co++o*.. H)art fai-2r) is +or) co++o* i* aortic 4a-4) is. 02t rar) i* tric2s(i 4a-4) is.. asc2-ar +a*if)statio*s i* i*f)cti4) )*ocaritis:____________________________________________________. S'st)+ic art)ria- )+0o-i #oca- *)2ro-o,ic )cits3 r)*a- or s(-)*ic i*farcts.. S)(tic (2-+o*ar' i*farcts.. M'cotic a*)2r's+.. Co*@2*cti4a- &)+orr&a,)s.. a*)?a' -)sio*s Mac2-ar )r't&)+ato2s *o* t)*)r -)sio*s o* t&) (a-+s 8

so-)s.

. I++2*o-o,ic +a*if)statio*s i* i*f)cti4) )*ocaritis:_______________________________________________________. Os-)rBs *o)s /ai*f2- 4io-ac)o2s *o2-)s s))* o* *,)r ti(s 8 to)s.. Rot& s(ots E)+ato2s 8 &)+orr&a,ic -)sio*s of t&) r)ti*a.. G-o+)r2-o*)(&ritis.. Art&ritis or (ositi4) r&)2+atoi factor.

. Micro0io-o,' of i*f)cti4) )*ocaritis:_________________________________________

X STA/HYLOCOCCS ARES:_________________________. /rost&)tic 4a-4)s.. I*tra4asc2-ar cat&)t)rs.. I+(-a*t) )4ic)s (ac)+ak)rs D)0ri--ators%.. I*@)ctio* r2, 2s)rs.

X STRE/TOCOCCS IRIDANS:__________________________. D)*ta- (roc)2r)s.. I*cisio* 8 0io(s' or r)s(irator' tract.

X COAGLASE NEGATIE STRE/TOCOCCI:___________________________________. I*tra4asc2-ar cat&)t)rs.. /rost&)tic 4a-4)s.. (ac)+ak)rs D)0ri--ators.X ENTEROCOCCI:

_______________


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. Nosoco+ia- 2ri*ar' tract i*f)ctio*s.X STRE/TOCOCCS $OIS:

_______________________. Co-o* carci*o+a.. I*a++ator' 0o?)- is)as).

X #NGI:_________. I++2*oco+(ro+i) &ost.. C&ro*ic i*?)--i*, cat&)t)rs.. /ro-o*,) a*ti0iotic t&)ra('.

. SE/TAL DE#ECTS:__________________________________

.;. ENTRICLAR SE/TAL DE#ECT SD%:_____________________________________. HOLOSYSTOLIC MRMR at t&) -o?)r -)ft st)r*a- 0or)r.. Most-' as'+(to+atic.. Lar,) )f)cts +a' ca2s) SO$.. D> ECHOCHARDIOGRA/HY.. D> Cat&)t)riatio* is 2s) to )t)r+i*) t&) ),r)) of Lt to Rt s&2*t.. T> Mi- )f)cts ca* 0) -)ft ?it&o2t +)c&a*ica- c-os2r).

.. ATRIAL SE/TAL DE#ECT ASD%:________________________________. Most-' as'+(to+atic.. Lar,) )f)cts +a' ca2s) si,*s of Rt 4)*tic2-ar fai-2r) SO$ (arast)r*a- &)a4)%.. #IED S/LITTING of S.. D> ECHOCARDIOGRA/HY.. T> $)st i*itia- /)rc2ta*)o2s or cat&)t)r )4ic)s.. T> R)(air if t&) s&2*t ratio )>c))s ;.7:;.

. ARTERIOENOS #ISTLA A#%:_______________________________. Co*,)*ita- /at)*t 2ct2s art)rios2s.. AcF2ir) #)+ora- tra2+a Iatro,)*ic "f)+ora- cat&)t)riatio*".. A0*or+a- co**)ctio* 0)t?))* t&) art)ria- 8 4)*o2s s'st)+s 0'(assi*, ca(i--ar'0)s.. S&2*ti*, of -ar,) a+o2*ts of 0-oo t&ro2,& t&) st2-a SR3 (r)-a 8 CO/.. A stat) of &i,& o2t (2t cariac fai-2r).

. !i)*) (2-s) (r)ss2r).


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. Stro*, ()ri(&)ra- art)ria- (2-satio* $risk caroti 2(strok)%.. S'sto-ic o? +2r+2r &)ar o4)r cariac a()> *ot a)ct) 0' a-sa-4a +a*)24)r.. Tac&'caria 8 2s&) )>tr)+iti)s.. H'()rtro(&i) -)ft 4)*tric-) Lt is(-ac)+)*t of t&) (oi*t of +a>i+a- i+(2-s).. D> Do((-)r 2-traso*o,ra(&'.

. T> S2r,)r' if -ar,) s'+(to+atic A#.

. Ot&)r ca2s)s of &i,& o2t(2t cariac fai-2r):. T&'roto>icosis /a,)t is)as) A*)+ia T&ia+i*) )f)ci)*c'.

. S/LITTING O# S:____________________________________. !IDE D)-a') /% R$$$ /S RH /HTN.. /ARADOICAL D)-a') A% L$$$ AS LH SHTN.. #IED ASD.

. CARDIOMYO/ATHY:__________________________________

V;W DILATED CARDIOMYO/ATHY:____________________________. (r)s)*ts 8 +a*a,) i* t&) sa+) ?a' as CH#.. Most co++o* ca2s)s Isc&)+ia ira- A-co&o- Aria+'ci* Raiatio* C&a,aBsis%.. D> $)st i*itia- t)st ECHOCARDIOGRA/HY to )t)ct E#.. D> Most acc2rat) t)st MGA or *2c-)ar 4)*tric2-o,ra(&'.. T> ACEIs3 AR$s 8 s(iro*o-acto*).. Di,o>i* s'+(to+s 02t o)s*Bt (ro-o*, s2r4i4a-.

VW HY/ERTRO/HIC CARDIOMYO/ATHY:_________________________________. SO$ o* )>)rtio*.. S Ga--o(.. D> ECHOCARDIOGRA/HY NORMAL E#.. T> $$ 8 Di2r)tics.. ACEIs +a' 0) 2s).. Di,o>i* 8 s(iro*o-acto*) o NOT 0)*it 9

V 8 ' )sc)*t.


26/53

. EKG Lo? 4o-ta,).. D> $)st i*itia- t)st ECHOCARDIOGRA/HY is t&) +ai* sta' of ia,*osis.. D> Most acc2rat) t)st E*o+'ocaria- 0io(s'.. T> Di2r)sis 8 corr)cti*, t&) 2*)r-'i*, ca2s).

VW HY/ERTRO/HIC O$STRCTIE CARDIOMYO/ATHY HOCM%:

____________________________________________________. ATOSOMAL DOMINANT i*&)rita*c).. Africa* A+)rica* +a-) c&i.. H1O of s2)* )at& i* t&) fa+i-'.

. D's(*)a 8 c&)st (ai*.. S'*co() 8 -i,&t &)a)*)ss.. S2)* )at&3 (artic2-ar-' i* &)a-t& at&-)ts.

. S'+(to+s ?ors)*) 0' a*'t&i*, t&at HR ).,. )>)rcis)3 )&'ratio* 8i2r)tics.. !ors)*) 0' a*'t&i*, t&at Lt 4)*tric2-ar c&a+0)r si) ).,. ACEIs.

. D> ECHOCARDIOGRA/HY T&) s)(t2+ is ;.7 ti+)s t&) t&ick*)ss of t&)(ost)rior ?a--%.

. T> $ETA $LOCKERS ARE THE $EST INITIAL THERA/Y for 0ot& HOCM 8 HCM.. DIRETICS ARE CONTRAINDICATED i* HOCM 02t t&)' ar) 2s)f2- i* ori*ar' HCM.

. N.$. S'sto-ic a*t)rior +otio* SAM% of t&) +itra- 4a-4) is c-assic for HOCM.

. N.$. Cat&)t)riatio* is t&) +ost acc2rat) t)st to )t)ct (r)cis) ,rai)*ts of(r)ss2r).

. N.$. EKG No*s()cic ST 8 T ?a4) c&a*,)s ar) co++o*.

. N.$. L)ft 4)*tric2-ar &'()rtro(&' is co++o*.

. N.$. S)(ta- ?a4)s i* t&) i*f)rior 8 -at)ra- -)as ar) co++o* i* HOCM A0s)*t i*MI%.

. N.$. Di,o>i* 8 s(iro*o-acto*) ar) )*it)-' a-?a's ?ro*, i* HOCM.

. N.$. S2r,ica- +'o+)cto+' is t&) t&)ra(' o*-' if a-- +)ica- ttt fai-s.. N.$. A H1O of 2(()r RTI fo--o?) 0' s22)* o*s)t cariac fai-2r) i* a &)a-t&' (t3. is s2,,)sti4) of i-at) cario+'o(at&'.. It is t&) )* r)s2-t of +'ocaria- a+a,) 2) to to>ic3 +)ta0o-ic or i*f)ctio2sa,)*ts.. ira- +'ocaritis is +ost co++o*-' s))* fo--o?i*, Co>sacki) 4ir2s $ i*f)ctio*.. ira- +'ocaritis +a' ca2s) i-at) cario+'o(at&' 4ia ir)ct 4ira- a+a,).. D> Ec&ocario,ra+ Di-at) 4)*tric-)s ?it& i2s) &'(oki*)sia.. Lo? E# S'sto-ic 'sf2*ctio*%.


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. N.$. E>c)ssi4) a-co&o- co*s2+(tio* -)as to DILATED cario+'o(at&'.. /r)s)r4) 4)*tric2-ar i+)*sio*s RLES OT i-at) cario+'o(at&' 9

. N.$. H)+oc&ro+atosis ca2s)s RESTRICTIE cario+'o(at&'.. C-assic *i*,s /a*cr)atic 'sf2*ctio* $ro*) ski* H)(ato+),a-'%.

. N.$. Sarcoiosis ca2s)s RESTRICTIE cario+'o(at&'.. Mor) co++o* i* Africa* A+)rica*s 0)t EKG ST s),+)*t )-)4atio* i* ALL -)as.. D> EKG /R s),+)*t is (at&o,*o+o*ic 02t is*Bt a-?a's (r)s)*t.. T> $)st i*itia- t&)ra(' NSAIDs I*o+)t&aci*%.. T> A ora- st)rois (r)*iso*)% i* r)fractor' cas)s.

. N.$.


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. REMIC /ERICARDITIS /% occ2rs i* ; U of r)*a- fai-2r) (ts.. T'(ica--' t&os) ?it& $N 6 +,1-.. Most (ts o NOT (r)s)*t ?it& t&) c-assic ECG c&a*,)s of ()ricaritis Di2s) ST)-)4.%. T> HEMODIALYSIS Ra(i r)so-2tio* of c&)st (ai* 8 si) of )2sio*.

. N.$. /)ricaria- )2sio*s a(()ar as a* )*-ar,)3 "?at)r 0ott-)" s&a() o* CR.. /1E of ()ricaria- )2sio* ?it&o2t a ta+(o*a) Di+i*is&) &)art so2*s 8. DiZc2-t' to (a-(at) t&) (oi*t of +a>i+a- i+(2-s).

VW /ERICARDIAL TAM/ONADE:___________________________. SO$ $)ckBs tria H'(ot)*sio* D M2[) &)art so2*s%.. Ma' fo--o? 4ira- ()ricaritis aft)r a* RT i*f)ctio*.. Ta+(o*a) is 2) to 2i acc2+2-atio* i* t&) ()ricaria- ca4it' -)ai*, to3. r)stricti*, 4)*o2s r)t2r* to &)art I+(air) 4)*tric2-ar --i*, L(r)-oa.XXX. 8 2) to )>a,,)rat) s&ift of i*t)r4)*tric2-ar s)(t2+ i*to t&) -)ft 4)*tric2-ar

ca4it'. C-)ar -2*,s.. /LSS /ARADOS i* $/ 5 ; ++H, o* i*&a-atio*.. D>: ECHOCARDIOGRA/HY MOST ACCRATE% Diasto-ic co--a(s) of t&) Rt atri2+8 4)*tric-).. D> EKG Lo? 4o-ta,) 8 ELECTRICAL ALTERNANS ariatio* i* t&) RSco+(-)>)s &)i,&t%. Rt &)art cat&)t)riatio* EF2a-iatio* of a-- t&) (r)ss2r)s i* &)art 2ri*, iasto-).. T> 0)st i*itia- t&)ra(' /ERICARDIOCENTESIS.. Most ))cti4) -o*, t)r+ t&)ra(' /)ricaria- ?i*o? (-ac)+)*t.. Most a*,)ro2s t&)ra(' Di2r)tics 9

. N.$. /2-s2s (arao>2s E>a,,)rat) fa-- i* 0-oo (r)ss2r) ; ++H, o*INS/IRATION.. It is a fr)F2)*t *i*, i* cariac ta+(o*a).. Ot&)r ca2s)s s)4)r) ast&+a 8 CO/D.

V


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. D> EKG Lo? 4o-ta,).. D> / traci*, /ro+i*)*t > 8 ' )sc)*ts.. D> CT 8 MRI T&ick)*i*, of ()ricari2+.. T> $)st i*itia- ttt Di2r)tics.. T> Most ))cti4) ttt S2r,ica- r)+o4a- of t&) ()ricari2+ "()ricari)cto+'".

. AORTIC DISEASES:____________________________________. AORTIC DISSECTION:

_____________________. Diss)ctio* of t&) THORACIC aorta.. Most co++o* ca2s) is SYSTEMIC HY/ETENSION.. Marfa*Bs 8 E&-)rsDa*-os '*ro+)s +a' ca2s) iss)ctio* i* YONG (o(2-atio*.

. T)ari*, c&)st (ai* raiati*, to t&) 0ack 0)t?))* t&) sca(2-a).. )r' s)4)r) "Ri((i*,".

. Diss)ctio* +a' )>t)* to:. caroti art)ri)s strok) 8 AMI.. r)*a- art)ri)s Ac2t) r)*a- fai-2r).. aortic 4a-4) Aortic r),2r,itatio*: Ear-' iasto-ic )cr)sc)*o +2r+2r at t&)st)r*2+. ()ricaria- ca4it' Ta+(o*a) H'(ot)*sio* / (2-s2s (arao>2s%.. (-)2ra- ca4it' H)+ot&ora>.. s2()rior c)r4ica- s'+(at&)tic ,a*,-io* Hor*)rBs .. s(i*a- or co++o* i-iac art)ri)s -o?)r )>tr)+it' ?)ak*)ss or isc&)+ia.. a0o+i*a- (ai* +)s)*t)ric art)r'.

. ++H, i)r)*c) 0)t. 0-oo (r)ss2r)s of t&) Rt 8 Lt ar+s.

. D> $)st i*itia- t)st CR !i)*) +)iasti*2+.. D> Most acc2rat) t)st CT ANGIOGRA/HY = Tra*sEso(&a,)a- ECHO TEE =MRA.. D> TEE NOT TTE COMMON MISTAKE%.

. T> $$ 8 Nitro(r2ssi).. T> IC ?it& s2r,ica- corr)ctio*.

. N.$. Aortic iss)ctio* is t&) +ost a*,)ro2s co+(-icatio* of Marfa*Bs .. Ta-- (t ?it& -o*, )>tr)+iti)s &i,& )>t)*si0i-it' of &a* @oi*ts ()ct2s cari*at2+.

. N.$. $$ is t&) +ost i+(orta*t i*itia- i*t)r4)*tio* for ac2t) aortic iss)ctio*.. T'() "A" iss)ctio*s i*4o-4) t&) asc)*i*, aorta T>: M)ica- t&)ra(' 8 s2r,)r'.. T'() " $" iss)ctio*s i*4o-4) o*-' t&) )sc)*i*, aorta T>: M)ica- t&)ra('a-o*).


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31/53

. /ERI/HERAL ARTERY DISEASE /AD%:__________________________________. CLADICATION /ai* i* t&) ca-fs o* )>)rtio*%.

. S+oot&3 s&i*' ski* ?it& -oss of &air 8 s?)at ,-a*s 8 -oss of (2-s)s i* t&) f))t.. /AIN /ALLOR /LSELESSNESS = ARTERIAL OCCLSION.

. D> $)st i*itia- t)st ANKLE $RACHIAL INDE A$I% "Nor+a- A$I .".. LL $/ s&o2- 0) EAL to L $/ Di)r)*c) ; U = O0str2ctio*%.. D> Most acc2rat) t)st ANGIOGRA/HY.. T> $)st i*itia- ttt As(iri* ACEIs for $/ co*tro- E>)rcis) Ci-ostao-)%.. N.$. S/INAL STENOSIS is a* i+(. D.D. for /AD.. S(i*a- st)*osis ?i-- ,i4) (ai* t&at is ?ors) ?it& ?a-ki*, o?*&i-- 8. -)ss ?it& ?a-ki*, 2(&i--3 or ?&i-) c'c-i*, or sitti*,.. /2-s)s 8 ski* )>a+ ?i-- 0) NORMAL ?it& s(i*a- st)*osis.. Ac2t) art)ria- )+0o-2s is 4)r' s2)* i* o*s)t ?it& -oss of (2-s) 8 a co-

)>tr)+it'.. It is a-so F2it) (ai*f2-.. H1O of AS or Af is (r)s)*t.. $$ ar) *ot co*trai*icat) ?it& /AD.. If t&) (t *))s t&)+ for isc&)+ic is)as)3 t&)' s&B 0) 2s).

. ARRHYTHMIAS:______________________________. INITIAL MANAGEMENT O# CARDIAC ARREST:

________________________________________. T&) ;st st)( is to +ak) s2r) t&at t&) (t is tr2)-' 2*r)s(o*si4).. E>c-2) s-))(i*, or s'*co(a- )(iso) 99. O()* t&) air?a' H)a ti-t3 c&i* -ift 8 @a? t&r2st.. #i4) r)sc2) 0r)at&s if *ot 0r)at&i*,.. C&)ck (2-s) 8 start c&)st co+(r)ssio*s if (2-s)-)ss.. C/R o)s*Bt r)start t&) &)art\ it k))(s t&) (t a-i4) 2*ti- cario4)rsio* is()rfor+).. T&) +ost i(orta*t factors i* i+(ro4i*, s2r4i4a- i* (ts ?it& s2)* cariac arr)st: ADEATE $YSTANDER C/R. /ROM/T RHYTHM ANALYSIS. DE#I$RILLATION i* (ts fo2* to 0) i* 4)*tric2-ar 0ri--atio*.

. i.). T&) +ost i+(. it)+ is TIME TO RHYTHM ANALYSIS 8 DE#I$RILLATION.


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. /LSELESSNESS S2)* -oss of a (2-s) ca* 0) ca2s) 0' as'sto-)3 #3 T 8/EA:______________________________________________________________________________________________________________________________________________________________________

. ;% ASYSTOLE:

________________. $)si)s C/R3 t&)ra(' for as'sto-) is ?it& )(i*)(&ri*) 8 atro(i*).. aso(r)ssi* is a* a-t)r*ati4) to )(i*)(&ri*) $ot& co*strict 0-. 4s. i* tiss2)s%.. T&is s&2*ts 0-oo i*to critica- c)*tra- circ2-atio* ).,. &)art 8 0rai*.. Ma*a,a) ?it& 2*i*t)rr2(t) cario(2-+o*ar' r)s2scitatio* C/R 8 4aso(r)ssort&)ra('3. i* or)r to +ai*tai* a)F2at) c)r)0ra- 8 coro*ar' ()rf2sio*.. D)0ri--atio* or s'*c&ro*i) cario4)rsio* &as *o ro-) i* +a*a,)+)*t 9. % ENTRICLAR #I$RILLATION #%:

_____________________________________. O*) of t&) +ost a*,)ro2s MI co+(-icatio*s.

. $)st i*itia- ttt I++)iat) 2*s'*c&ro*i) cario4)rsio* = D)0ri--atio*.. /)rfor+ C/R if cario4)rsio* is *ot ))cti4).. T&) +ost i+(orta*t *)>t st)( aft)r cario4)rsio* is )(i*)(&ri*) or 4aso(r)ssi*.. T&)' o*Bt r)start t&) &)art. T&)' +ak) t&) *)>t att)+(t of )0ri--atio* s2cc)).. A+ioaro*) or -iocai*) is ,i4)* *)>t to tr' to ,)t s20s)F2)*t s&ocks s2cc)ssf2-.. MAGNESIM is +a*ator'.. # is +a*a,) 0' s&ock3 r2,s3 s&ock3 r2,s3 s&ock3 r2, 8 C/R at a-- ti+)si*0)t?))*.. tac&'caria ?it& a r),2-ar rat).. Ma*a,)+)*t is 0as) o* &)+o'*a+ic sta0i-it':. /2-s)-)ss T Sa+) as #.. H)+o'*a+ica--' STA$LE A+ioaro*) t&)* -iocai*) t&)* (rocai*a+i).. Cario4)rt t&) (t. if +)icatio*s fai-).. H)+o'*a+ica--' Nsta0-) E-)ctrica- cario4)rsio* s)4)rati+)s fo--o?) 0'r2,s.. N.$. H)+o'*a+ic i*sta0i-it' = C&)st (ai* D's(*)a CH# H'(ot)*sio* Co*f2sio*.. N.$. Dir)ct i*tracariac +)icatio* is a-?a's a ?ro*, a*s?)r.. % /LSELESS ELECTRICAL ACTIITY /EA%:

___________________________________________. /EA = E-)ctrica- +)c&a*ica- issociatio* EMD%.. T&) &)art is )-)ctrica--' NORMAL 02t t&)r) is NO +otor co*tractio*.. So+)ti+)s3 t&) &)art +a' sti-- 0) co*tracti*, 02t ?it&o2t 0-oo i*si) .. No CO/ 9. D> NORMAL EKG 8 NO /LSE 9999. T> Corr)ct t&) 2*)r-'i*, ca2s) Ta+(o*a)3 (*)2+ot&ora>3 Massi4) /E3 Kisor)rs%.. Ma*a,a) ?it& 2*i*t)rr2(t) cario(2-+o*ar' r)s2scitatio* C/R 8 4aso(r)ssort&)ra('3


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. i* or)r to +ai*tai* a)F2at) c)r)0ra- 8 coro*ar' ()rf2sio*.. D)0ri--atio* or s'*c&ro*i) cario4)rsio* &as *o ro-) i* +a*a,)+)*t 9. ATRIAL ARRHYTHMIAS:

____________________________________________

. Rar)-' associat) ?it& &)+o'*a+ic i*sta0i-it' 0)c. CO/ is )()*)*t 2(o*4)*tric-)s.. H1O of (a-(itatio*s3 ii*)ss or -i,&t&)a)*)ss.. H1O of )>)rcis) i*to-)ra*c) or 's(*)a.. H1O of )+0o-ic strok).

. N.$. A* irr),2-ar-' irr),2-ar r&'t&+ s2,,)sts Af )4)* 0)for) a* EKG is o*) 9. Af is t&) +ost co++o* arr&'t&+ia i* t&) S.

V;W 8 VW . ATRIAL #I$RILLATION Af% 8 ATRIAL #LTTER A#%:

____________________________________________________________

. $ot& &a4) i)*tica- +a*a,)+)*t .. O*-' i)r)*c)s:. ; #-2tt)r is a r),2-ar r&'t&+ ?&i-) 0ri--atio* is irr),2-ar.. #-2tt)r 2s2a--' ,o)s 0ack i*to si*2s r&'t+ or )t)riorat)s i*to 0ri--atio*.

V;W . Atria- 0ri--atio* Af%:________________________________. IRREGLAR (2-s) RR i*t)r4a-% ?it& A$SENT "/" ?a4)s 8 *arro? RS co+(-)>)s.. Af is a co++o* co+(-icatio* aft)r CA$G.. T&) +ost co++o* ca2s) of Af is HY/ERTHYROIDISM.. T> H)+o'*a+ica--' Nsta0-) S'*c&ro*i) DC cario4)rsio*.. S'*c&ro*iatio* &)-(s to (r)4)*t )t)rioratio* i*to T or #.. CHRONIC Af:

______________. Af -asti*, +or) t&a* a's.. It tak)s s)4)ra- a's to 0) a risk of c-ot for+atio*.. T&) +a@orit' of t&os) ?&o ar) co*4)rt) to si*2s r&'t&+ ?i-- *ot sta' i* si*2s.. Af 8 A# ar) +ost-' ca2s) 0' a*ato+ic a0*or+a-iti)s of t&) atria fro+ HTN or4a-4) is.. S&ocki*, t&) (t. i*to si*2s r&'t&+ o)s*Bt corr)ct a i-at) -)ft atri2+.. O4)r U ?i-- r)4)rt to 0ri--atio*.. SLO! THE RATE 8 COAGLATE "!AR#ARIN" ar) t&) STANDARD CARE for c&ro*icAf.

. T&) 0)st i*itia- t&)ra(' is to co*tro- t&) rat) ?it& $$3 CC$ or Di,o>i*.. O*c) t&) rat) is 2*)r ;1+i* Gi4) !AR#ARIN 2*ti- t&) INR is 0)t?))*


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. N.$. Co*tro--i*, t&) r&'t&+ or rat) i* (ts ?it& (ro-o*,) tac&'s'sto-ic Af3. 2s2a--' i+(ro4)s t&) L f2*ctio* si,*ica*t-'3 so+)ti+)s )4)* ra+atica--'.. Af CLASSI#ICATION:

_____________________

. #IRST DETECTED I*itia- ia,*osis3 i*)()*)*t of 2ratio*.. /AROYSMAL R)c2rr)*t )(iso)s t&at t)r+i*at) s(o*ta*)o2s-' i* 5 Ja's.. /ERSISTENT E(iso)s -asti*, Ja's.. LONGSTANDING /ERSISTENT /)rsist)*t ; ')ar 2ratio*.. /ERMANENT /)rsist)*t ?it& *o f2rt&)r (-a*s for r&'t&+ co*tro-.

. LONE Af:___________. LONE = (aro>'s+a-3 ()rsist)*t or ()r+a*)*t Af ?it& *o str2ct2ra- &)art is)as).. /ts )B -o? risk of strok) ca* saf)-' (r)4)*t it )B 2si*, AS/IRIN a-o*) )Bo2t ?arfari*.

. Crit)ria of -o? risk of strok) fro+ Af:

No cario+'o(at&'3 CH# or at&)rosc-)rosis. No &'()rt)*sio*. A,) J7 or 'o2*,)r. No DM. No (ast strok).

. !&)* a-- t&) (r)4io2s risk factors ar) a0s)*t3 t&is is ca--) "LONE Af".. T> of -o*) Af AS/IRIN 8 rat) co*tro- ?it& $$.

. CHADS SCORING:__________________. C Co*,)sti4) &)art fai-2r).. H H'()rt)*sio* $/ ;1 ++H,%.. A A,) J7 's.. D DM.. S /r)4io2s strok) or TIA.. ANTICAGLATION ttt i* Af accori*, to CHADS scor):

______________________________________________________. CHADS scor) Strok) risk A*tit&ro+0otic ttt.. Lo? No a*ticoa,2-atio* (r)f)rr)% or As(iri*.. ; I*t)r+)iat) A*ticoa,2-atio* (r)f)rr)% or As(iri*.. Hi,& A*tica,2-atio*.

. N.$.. A*tiarr&'t&+ic r2,s ar) r)s)r4) for (ts ?it& r)c2rr)*t s'+(to+atic Af )(iso)s3. or t&os) ?it& Lt 4)*tric2-ar s'sto-ic 'sf2*ctio* t&o2,&t to 0) r' to 2*co*to--)Af.. Lo*, t)r+ 2s) of a*tiarr&'t&+ic r2,s &as si,*ica*t si) ))cts.

. N.$.


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. A+ioaro*) ca2s) (2-+o*ar' to>icit' 8 s&B 0) a4oi) i* (ts ?it& (r))>isti*,-2*, is.. So .. RESTRICTIE -2*, is)as) (ts ca* NOT 0) ,i4)* A+ioaro*).. A+ioaro*) is A$SOLTELY CONTRAINDICATED.

. N.$.

. $$s ca2s)s 0ro*c&oco*strictio*.. So .. O$STRCTIE -2*, is)as) Ast&+a CO/D% (ts ca* NOT 0) ,i4)* $$s.. $$s ar) RELATIELY CONTRAINDICATED i* o0str2cti4) -2*, is)as)s.. $$s ca* 0) 2s) SA#ELY i* RESTRICTIE -2*, is)as)s.

. N.$.. Af (ts ?it& (ast H1O of !o-f/arki*so*!&it) '*ro+)3. S&o2- 0) tr)at) ?it& cario4)rsio* or a*tiarr&'t&+ics -ik) (rocai*a+i).. A *oa- 0-ock)rs $$ CC$ Di,o>i* A)*osi*)% s&o2- 0) AOIDED3. 0)ca2s) t&)' co*2cta*c) t&ro2,& t&) acc)ssor' (at&?a' aft)r AN0-ocka,).

. N.$.. /ts )B *)?o*s)t Af s&BB4) TSH 8 fr)) T -)4)-s +)as2r) to r2-) o2t&'()rt&'roiis+.Vi* if a)*osi*) is *ot ))cti4).. If &)+o'*a+ica--' NSTA$LE DC CARDIOERSION.

. N.$. 'o2 s&B i)r)*tiat) 0)t ST 8 si*2s tac&'caria 2) to (a*ic attacks3. Si*2s tac&'caria &as *or+a- / ?a4) +or(&o-o,' 8 r)-atio*s&i( ?it& RSco+(-)>.. T> of si*2s tac&'caria 2) to a*>i)t A-(rao-a+.

. N.$. Yo2 s&B i)r)*tiat) 0)t ST 8 4)*tric2-ar tac&'caria T%3. )*tric2-ar tac&'caria &as !IDE RS COM/LEES3. ?&i-) ST &a4) NARRO! RS co+(-)>)s.. T> of T if &)+o'*a+ica--' sta0-) A+ioaro*).


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. N.$. Yo2 s&B i)r)*tiat) 0)t ST 8 Af ?it& ra(i 4)*tric2-ar r)s(o*s) A# ?it&RR%3. ST (r)s)*ts as s2)* o*s)t3 REGLAR3 *arro? co+(-)> tac&'carias.. ST HR ;6 0)ats1+i*.. Ca* 0) +a*a,) 0' 4a,a- +a*)24)rs as caroti +assa,) or A)*osi*).

. $2t Af ?it& RR &as IRREGLARLY IRREGLAR RHYTHM ?it& *arro? co+(-)>tac&'caria3. i* aitio* to a0s)*c) of / ?a4)s.. Af ?it& RR is +a*a,) 0' rat) co*tro- $$ +)to(ro-o or CC$ Di-tia)+%3. if &)+o'*a+ica--' sta0-) No &'(ot)*sio*%.

VW . !OL## /ARKINSON !HITE YNDROME !/!%:________________________________________________. A*ato+ic a0*or+ai-' i* t&) co*2ctio* (at&?a'.. S2(ra4)*tric2-ar tac&'caria a-t)r*ati*, ?it& 4)*tric2-ar tac&'caria.. S2(ra4)*tric2-ar tac&'caria t&at ,)ts ?ors) aft)r i-tia)+ or i,o>i*.. DELTA ?a4)s o* EKG.

. D> Most acc2rat) t)st Cariac )-)ctro(&'sio-o,' E/% st2i)s.. T> Ac2t) t&)ra(' /rocai*a+i) or A+ioaro*). O*-' if t&)r) is c2rr)*t!/!%.. T> C&ro*ic t&)ra(' Raiofr)F2)*c' cat&)t)r a0-atio* is c2rati4).. Di,o>i* 8 CC$ ar) DANGEROS "t&)' 0-ock t&) *or+a- (at&?a' forci*, a0*or+a-co*2ctio*"

. N.$. /ts ?it& !o-f/arki*so*!&it) '*ro+) ?&o )4)-o( Atria- 0ri--atio* ?it&RR3. S&o2- 0) tr)at) ?it& cario4)rsio* or a*tiarr&'t&+ics -ik) (rocai*a+i).. A *oa- 0-ock)rs $$ CC$ Di,o>i* A)*osi*)% s&o2- 0) AOIDED3. 0)ca2s) t&)' co*2cta*c) t&ro2,& t&) acc)ssor' (at&?a' aft)r AN0-ocka,).

V7W MLTI#OCAL ATRIAL TACHYCARDIA MAT%:__________________________________________. Associat) ?it& c&ro*ic -2*, is)as) ).,. CO/D.. Tr)at t&) 2*)r-'i*, -2*, is)as).. Tr)at MAT as Af $2t a4oi $$ 0)ca2s) of t&) -2*, is)as)%.. N.$.. AMIODARONE SIDE E##ECTS (2-+o*ar' 0rosis H)(atoto>icit' H'(ot&'roiis+.. A-?a's o (2-+o*ar'3 -i4)r 8 t&'roi f2*ctio* t)sts.. N.$.. A+ioaro*)i*2c) &'(ot&'roiis+:. (ro,r)ssi4)-' ?ors)*i*, fati,2) iZc2-t' co*c)*trati*, 8 for,)tf2-*)ss.. *i*t)*sio*a- ?)i,&t ,ai* 8 r' ski*.. N.$.. /r)+at2r) atria- 0)ats ar) 0)*i,*.


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. N)it&)r r)F2ir) fo--o? 2( *or tr)at+)*t.. Ma' 0) 2) to a*>i)t'3 CH#3 &'(o>ia3 Ca)i*) or )-)ctro-'t) i+0a-a*c).

. N.$.. Do*Bt ONLY r)ass2r) t&) (t ?it&o2t a4isi*, &i+ 99. To0acco 8 a-co&o- ar) r)4)rsi0-) risk factors for /ACs.

. $$s ar) &)-(f2- i* t&os) ?&o ar) s'+(to+atic.. N.$.. H)riitar' &)+oc&ro+atosis A0*or+a- iro* )(ositio* M2-tis'st)+ )*or,a* a+a,).. Iro* )(ositio* ?it&i* t&) +'ocari2+ ca* -)a to Di-at) cario+'o(at&'3 &)artfai-2r). Ma' -)a to co*2ctio* a0*or+a-iti)s ).,. Sick si*2s '*ro+).. Ma*if)statio*s of &)+oc&ro+atosis DM3 -i0io3 &)(ato+),a-' 8 t)stic2-aratro(&'%.. Sick si*2s = Tac&'caria$ra'caria = $2rsts of atria- tac&' t&)*0ra'arr&'t&+ias

. N.$.. M2-ti(-) (r)+at2r) 4)*tric2-ar co+(-)>)s /Cs%. I)*ti) 0' a ?i) RS ; +s)c.. $iarr) +or(&o-o,'.. Co+()*sator' (a2s).. /Cs ca* 0) s))* i* *or+a- i*i4i2a-s.. T&)' +a' fo--o? a +'ocaria- i*f)ctio*s.. No ttt i*icat) if (t is as'+(to+atic.. $$ ar) t&) ;st -i*) of ttt i* s'+(to+atic (ts.

. N.$.. Gra4)Bs is)as) i*so+*ia fati,a0i-it' ?)i,&t -oss -i -a, tr)+or%.. Atria- 0ri--atio* is a co++o* co+(-icatio* of &'()rt&'roiis+.. $)st i*itia- ttt is $$ "(ro(ra*o-o-".. $$ *ot o*-' co*tro- Af3 02t a-soi+i*is&)s &'()rt&'rois+ s'+(to+s.

. N.$.. )*tric2-ar (r)+at2r) 0)ats /$s%. If associat) ?it& Ac2t) coro*ar' 3. Yo2 s&B *Bt ,i4) LIDOCAINE C-ass ;$ a*tiarr&'t&+ic%99. A-t&o2,& Liocai*) 2s) )c)as)s t&) risk of 4)*tric2a-ar 0ri--atio*3. It +a' risk of as'sto-) 99. Loiocai*) is *ot 2s) (ro(&'-actica--' i* (ts ?it& AC.. O4)ra-- (ro,*osis is *ot a)ct).

. N.$.. A0s)*c) of / ?a4)s is c&aract)ristic for Af.. /LMONARY EINS ar) t&) +ost co++o* fr)F2)*t ori,i* of )cto(ic foci t&atca2s) Af.. N.$.


38/53

. DELTA ?a4)s ar) c&aract)ristic for !/! .. N.$.. #LTTER ?a4)s ar) c&aract)ristic for A#.. TRICS/ID ANNLS is t&) +ost co++o* fr)F2)*t of )cto(ic foci ca2si*, A#.

. N.$.. HIGH RATE REGLAR RHYTHM NARRO! RS COM/LEES TACHYCARDIA = /ST.. It +ost-' i*4o-4)s for+atio* of a r))*tr' circ2it ?it&i* A *o) or acc)ssor'(at&?a'.

. $RADYCARDIA 8 A $LOCK:____________________________________________________. HR 5 61+i*.. EKG is +a*ator' to )t)ct t&) ca2s) of 0ra'caria.

. V;W SINS $RADYCARDIA:_________________________. HR 5 61+i* ?it& REGLAR r&'t&+ 8 co*sta*t /R i*t)r4a-.. Ma' 0) associat) ?it& )>a,,)rat) 4a,a- acti4it'3 &'(o,-'c)+ia 8 sick si*2s'*ro+).. Ma' 0) i*2c) 0' so+) +)icatio*s Di,ita-is3 $$ 8 CC$%.. Most-' as'+(to+atic.. Ma' 0) ii*)ss -i,&t&)a)*)ss s'*co() fati,2) 8 ?ors)*) a*,i*a.. No ttt if as'+(to+atic *o +att)r &o? -o? t&) &)art rat) is.. If s'+(to+atic Atro(i*) is 0)st i*itia- ttt 8 /ACE MAKER is t&) +ost ))cti4)ttt.. Atro(i*) HR 0' 4a,a- i*(2t.

. VW #IRST DEGREE A $LOCK:_____________________________. D)-a') i+(2-s) tra*s+issio* fro+ atria to 4)*tric-)s.. /ro-o*,) /R i*t)r4a- . s)co*s i.). 7 s+a-- sF2ar)s i.). ; 0i, sF2ar).. T&) /R i*t)r4a- r)+ai*s co*sta*t.. T&)r) is a RS co+(-)> (r)s)*t for )4)r' / ?a4).. Sa+) +a*a,)+)*t.. V)s fo--o?) 0' ro(() co+(-)>.. Lo? risk for co+(-)t) &)art 0-ock.. Nor+a- si,* i* a,i*, (o(2-atio*.


39/53

. No ttt )it&)r s'+(to+atic or as'+(to+atic 99

. V0W MO$IT "":__________________. $2*-) 0-ock 0)-o? t&) A *o).. No /R i*t)r4a- (ro-o*,atio*.

. Dro(s a 0)at ?it&OT t&) (ro,r)ssi4) -)*,&t&)*i*, of t&) /R i*t)r4a-.. i.). /R i*t)r4a- is co*sta*t 2*ti- ro(() RS co+(-)>.. / ?a4)s ar) )(isoic 8 2*(r)icta0-) ro(() RS co+(-)>.. Hi,& risk of (ro,r)ssio* to /ac)+ak)r )4)* if as'+(to+atic.

. VW THIRD DEGREE A $LOCK:_____________________________. T&) atria 8 4)*tric-)s 0)at s)(arat)-'.. Co+(-)t) fai-2r) of i+(2-s) co*2ctio* fro+ atria to 4)*tric-)s.. // ?a4)s i*t)r4a-s ar) co*sta*t So+) / ?a4)s +a' 0) 02rri) i*si) RSco+(-)>)s%.

. RR ?a4)s ar) co*sta*t.. /ACEMAKER is +a*ator'.

. N.$.. T&) +ost co++o* ca2s) of )at& i* t&) J &o2rs (ost AMI is ENTRICLARARRHYTHMIA.. Ma*a,) arr&'t&+ia fro+ isc&)+ia 0' corr)cti*, t&) isc&)+ia.. Do*Bt (2t i* a* i+(-a*ta0-) )0ri--ator for a* arr&'t&+ia 2 ca* > t&) its ca2s) 9

. N.$.. To )t)r+i*) t&) risk of r)c2rr)*c) of arr&'t&+ia3 o ECHOCARDIOGRA/HY.. If t&) )c&o s&o?s a *or+a- E#3 t&) risk of r)c2rr*c) of arr&'t&+ia is s+a--.. N.$.. I* (ts ?it& r)c2rr)*t s'*co()s 2) to arr&'t&+ia3 /2t a* i+(-a*ta0-) )0ri--ator.. A* i+(-a*ta0-) )0ri--ator ?i-- (r)4)*t t&) *)>t )(iso) of s'*co() or s2)*)at&.. N.$.. Torsa)s ) (oi*t)s = (o-'+or(&ic 4)*tric2-ar tac&'caria (ro-o*,) Ti*t)r4a-.. H1O of a-co&o-is+ R)c)*t 2co*ao-) or Mo>io>aci* ttt.. T> M, So A-co&o- is associat) ?it& M,%.

. N.$.. Loo( i2r)tics "#2ros)+i)" ca2s) &'(oka-)+ia 8 &'(o+a,*)s)+ia.. T&)s) )-)ctro-'t) a0*or+a-iti)s ca* ca2s) 4)*tric2-ar taac&'caria.. so .. Yo2 s&o2- +)as2r) s)r2+ )-)ctro-'t)s 0)for) tr)ati*, 4)*tric2-ararr&'t&+ia.. N.$.. A*tiarr&'t&+ic +)icatio*s ?it& t&) (ro()rt' of 2s))()*)*c)3


40/53

. ar) +or) ))cti4) at &i,&)r rat)s 0)ca2s)3. t&)r) is *o ti+) 0)t?))* &)art 0)ats for t&) +)icatio* to issociat) fro+ itsr)c)(tor. T&is (&)*o+)*o* is s))* ?it& c-ass ;C a*tiarr&'t&+ics )., "#LECAINIDE" 8 c-ass.. C-ass ;C (ro-o*, t&) RS co+(-)> ?&)r)as c-ass o*Bt.

. N.$. A//ROACH TO !IDECOM/LE TACHYCARDIA:_____________________________________________

A DISSOCIATION Q ___________________ #SION1CA/TRE $EATSQ _______________________ P ______YES_____________NO________ P P ENTRICLAR TACHYCARDIA S/RAENTRICLAR TACHYCARDIA !it&

A$ERRANCY _________________________ _____________________________________________P P _________________________ _____________________________ P P P P STA$LE NSTA$LE STA$LE ________ ___________ _________ P P P . I AMIODARONE . HY/OTENSION . AGAL MAEERS Caroti+assa,)% . A-t)r) +)*tatio* . A)*osi* $$ CC$ Di,o>i*. . R)s(irator' istr)ss P . SYNCHRONIED CARDIOERSION

. SYNCO/E MANAGEMENT:____________________________________________. Ma*a,)+)*t of s'*co() is 0as) o* < crit)ria:________________________________________________. !as t&) -oss of co*scio2s*)ss s2)* or ,ra2a- Q. !as t&) r),ai*i*, of co*scio2s*)ss s2)* or ,ra2a- Q. Cariac )>a+i*atio* *or+a- or a0*or+a- Q

V;W !as t&) -oss of co*scio2s*)ss s2)* or ,ra2a- Q______________________________________________________. S2)* Cariac or *)2ro-o,ic )tio-o,' "s)i2r)s".. Gra2a- To>ic +)ta0o-ic (ro0-)+ Dr2, to>icit' H'(o>ia A*)+ia H'(o,-'c)+ia.

VW !as t&) r),ai*i*, of co*scio2s*)ss s2)* or ,ra2a- Q___________________________________________________________


41/53

. S2)* Cariac )tio-o,' R&'&t+ isor)r or str2ct2ra- &)art is)as)%.. Gra2a- N)2oro-o,ic "Si)2r)s".Va+i*atio* *or+a- or a0*or+a- Q

_____________________________________________. Nor+a- )*tric2-ar arr&'t&+ia.

. A0*or+a- Str2ct2ra- &)art is)as) AS HOCM MS M/%.

. DI##ERENTIAL DIAGNOSIS O# SYNCO/E:_____________________________________.;. ASOAGAL = NERALLY MEDIATED SYNCO/E = NEROCARDIOGENICSYNCO/E:_______________________________________________________________________. Most co++o* t'() of s'*co().. D2) to )>c)ssi4) 4a,a- sti+2-atio* /rofo2* &'(ot)*sio* 8 0ra'caria.. Tri,,)rs /ro-o*,) sta*i*, )+otio*a- str)ss (ai*f2- sti+2-i.

. Sit2atio*s -ik) +)ica- *))-)s 8 2ri*atio* ca* (r)ci(iatat) it.. /roro+a- s'+(to+s Na2s)a ?ar+t& Dia(&or)sis.. s'+(to+s i+(ro4) ?it& s2(i*) (ositio*.. D> /RIGHT TILT TA$LE TESTING i* 2*c)rtai* cas)s%.

.. ORTHOSTATIC HY/OTENSION:_____________________________. /ost2ra- c&a*,)s i* &)art rat) or 0-oo (r)ss2r) aft)r sta*i*, s2)*-'.. ++H, i)r)*c) i* $/ 0)t sta*i*, 8 s2(i*) (ositio*s.. DE TO DECREASED $ARORECE/TORS RES/ONSIENESS 9

.


42/53

.. SITATIONAL SYNCO/E:_________________________. Mi-) a,) or o-)r +a-) ?it& (rostatic &'()rtro(&'3. ?&o -ost &is co*scio2s*)ss aft)r a?ak)*i*, 8 4oii*, at *i,&t.. /at&o(&'sio-o,' A2to*o+ic 'sr),2-atio*.

. Tr)at+)*t of s'*co() is 0as) o* )tio-o,'.. Ma@orit' of cas)s *)4)r ,)t a s()cic ia,*osis.. T&) +ost i+(orta*t is to ECLDE cariac )tio-o,' ).,. arr&'t&+ia.. T&) +a@orit' U% of +orta-it' fro+ s'*co() i*4o-4)s a cariac )tio-o,'.. If a 4)*tric2-ar 'srr&t&+ia is ia,*os) I+(-a*ta0-) cario4)rt)r1)0ri--ator.

. N.$. E-)r-' (ts ar) 4)r' s)*siti4) to 2i -oss.. E4)* +i- &'(o4o-)+ia +a' (r)is(os) t&)+ to ort&ostatic &'(ot)*sio* 8s'*co().. A r)c)*t )(iso) of iarr&)a ?it& 2i i*tak) 2) to a(()tit) is a risk factor.. /ati)*ts o* i2r)tics t&)ra(' ar) -ia0-) to s'*co() 2) to &'(o4o-)+ia.

. M2cosa- r'*)ss is a si,* of &'(o4o-)+ia.. Most-' *otic) 2(o* ,)tti*, 2( i* t&) +or*i*,.. $N1Cr)ati*i*) ratio is t&) 0)st i*icator of )&'ratio*.

. N.$. S'*co() +a' 0) 2) to ()ricaia- ta+(o*a).. Ta+(o*a) is 2) to 4ira- ()ricaritis fo--o?i*, a* RT 4ira- i*f)ctio*.. H'(ot)*sio*3 @2,2-ar 4)*o2s ist)*sio* 8 ista*t &)art so2*s.. E-)ctrica- a-t)r*a*s ar'i*, RS a+(-it2)s o* EKG%.. CR Cariac si-&o2)tt) )*-ar,)+)*t.

. COM/ARISON $ET!EEN SEIRES 8 SYNCO/E:_________________________________________

. /.O.C. _______ SEIRES _______ SYNCO/EX Circ2+sta*c)s: . S-))( -oss. . (ri,&t (ositio*.

. E+otio*s. . E+otio*s. . A-co&o- ?it&ra?a-. . H)at. . #-as&i*, -i,&t. . Cro?) (-ac)s.X C-2)s: . A2ra O-factor' &a--2ci*atio*s%. . /r)s'*co() -i,&t&)a)*)ss. . occ2r ?it& s-))(i*, or sitti*, (ositio*.. NO

. H)a )4iatio*s. . /a--or 8 ia(&or)sis. . To*,2) 0iti*, 8 -ac)ratio*. . !)ak 8 s-o? (2-s). . Ra(i stro*, (2-s). . *2s2a- 0o' (ost2ri*,.

X S)F2)-a) . D)-a') r)t2r* to 0as)-i*). . /ost icta- stat) s-))(' co*f2s)%. . IMMEDIATE S/ONTANEOSRETRN.


43/53

. N.$.. C-o*ic @)rks +a' occ2r 2ri*, a*' s'*co() if it is (ro-o*,) 2) to 0rai* &'(o>ia.. A0s)*c) of (r)4io2s H1O of s)i2r) 8 (r)s)*c) of str2ct2ra- &)art is)as)3. )>c-2)s s)i2r) 8 +ak)s a ia,*osis of s'*co() 2) to arr&'t&+ia +or) r)-ia0-).

. SYSTEMIC HY/ERTENSION:________________________________________________. S'sto-ic 0-oo (r)ss2r) ; ++H,.. Diasto-ic 0-oo (r)ss2r) ++H,.. A ia0)tic (t or c&ro*ic r)*a- is)as) (t ;tr)+it' $/ Lo?)r )>tr)+it' $/". Acro+),a-'. /&)oc&ro+oc'to+a "E(isoic HTN 2s&i*, /a-(itatio*s H)aac&) /art ofMEN ". H'()ra-ost)ro*is+ "Na3K3 !)ak*)ss3 M)ta0o-ic a-ka-osis3 R)*i*3A-ost)ro*)". C2s&i*, C)*tra- o0)sit' A0o+i*a- stria) #acia- (-)t&ora%. E>o,)*o2s t&)ra()2tic ,-2cocorticois. Co*,)*ita- ar)*a- &'()r(-asia. H'()r(arat&'roiis+ HTN H'()rca-c)+ia r)*a- sto*)s N)2ro(s'c&iatrics'+(to+s%. Ora- co*trac)(ti4) (i--s "Sto((a,) of OC/s i*tak) +a' corr)ct t&) (ro0-)+".

. D> ROTINE O##ICE TESTS ri*a-'sis Li(i (ro-) G-2cos) -)4)- EKG.. T> $)st i*itia- t&)ra(' LI#E STYLE MODI#ICATION:

_________________________________________________________ O0)s) (ts !)i,&t -oss Most ))cti4)%. T&i* (ts fr2it 8 4),)ta0-)s = DASH DIET. Soi2+ r)strictio*. Di)tar' +oicatio* L)ss fat 8 r) +)at3 Mor) s& 8 4),)ta0-)s%. E>)rcis). To0acco c)ssatio* o)s NOT sto( HTN 02t i+(orta*t to (r)4)*t cario4asc2-aris)as)s.


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Co2*c)- for r)2ctio* of a-co&o- i*tak).. T> DRG THERA/Y:

______________________. T&) 0)st i*itia- r2, t&)ra(' is THIAIDE DIRETICS.

. If $/ is 4)r' &i,& o* (r)s)*tatio* a0o4) ;61;%3 +)icatio*s s&o2- 0) ,i4)*.

. If i2r)tics o*Bt co*tro- $/3 t&) +ost i+(orta*t *)>t st)( i* +a*a,)+)*t is:. ACEI AR$ $$ CC$.

. M)icatio*s t&at ar) *ot co*si)r) as ;st or * -i*) t&)ra(' ar): C)*tra- acti*, a-(&a a,o*ists A-(&a +)t&'- o(a C-o*ii*)%. /)ri(&)ra- acti*, a-(&a a*ta,o*ists /raosi* t)raosi* o>aosi*%. Dir)ct acti*, 4asoi-ator H'ra-ai*) Mi*o>ii-%.

. Co+()--i*, i*icatio*s for s()cic r2,s:_____________________________________________

Coro*ar' art)r' is)as) $$ ACEI AR$. Dia0)t)s +)--it2s ACE AR$. $)*i,* (rostatic &'()r(-asia A-(&a 0-ock)rs /raoci*%. D)(r)ssio* 8 Ast&+a A4oi $$. H'()rt&'roiis+ $$ ;st. Ost)o(orosis T&iai)s. Ess)*tia- tr)+ors $$.

. N.$.. $)*i,* )ss)*tia- tr)+or ar) tr)+ors occ2ri*, ?it& (ost2r) "+o4)+)*t".. T&)' ar) 2*-ik) /arki*so*Bs is)as) ?&ic& is c&aract)ri) 0' r)sti*, tr)+ors.. It 2s2a--' ist2r0s t&) *) +otor tasks ).,. &a*-i*, a *)?s(a()r or (o2ri*, t)a.. I*&i0itio* of t&) tr)+or 0' a s+a-- a+o2*t of a-co&o- is t'(ica-.. T> /ro(ra*o-o-.

. N.$.. Iso-at) s'sto-ic &'()rt)*sio* ISH% is a* i+(orta*t ca2s) of &'()rt)*sio* i*)-)r-'3. it is 2) to DECREASED ELASTICITY O# THE ARTERIAL !ALL.. It s&B 0) ttt 2) to stro*, associatio* ?it& risk of cario4asc2-ar )4)*ts.. I*itia- ttt Mo*ot&)ra(' ?it& a -o? os) t&iai)3 a* ACEI or -o*, acti*, CC$.

. N.$. r' &'()rt)*sio* 2) to C2s&i*,Bs 3. cortiso- 4asoco*strictio*3 i*s2-i* r)sista*c) 8 +i*)ra-ocorticoi acti4it'.. asoco*strictio* H'()rt)*sio*.. i*s2-i* r)sista*c) H'()r,-'c)+ia 8 ?)i,&t ,ai*.. +i*)ra-ocorticoi acti4it' H'(oka-)+ia.. /ro>i+a- +s ?)ak*)ss3 c)*tra- a)(osit'3 t&i**i*, of ski*3 ?)i,&t ,ai* ar)co++o*.. /s'c&iatric (ro0-)+s S-))( ist2r0a*c)s3 )(r)ssio* 8 (s'c&osis% ar) a-soco++o*.. C2s&i*,Bs +a' 0) 2) to ADRENAL CORTICAL Not +)2--ar'% HY/ER/LASIA3


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. ACTH (ro2ci*, (it2itar' a)*o+a C2s&i*,Bs is)as)%3 )cto(ic ACTH (ro2ctio*3. or )>o,)*o2s st)rois.

. N.$.. R)*o4asc2-ar &'()rt)*sio*. s&B 0) s2s()ct) i* a-- (ts ?it& r)sisa*t &'()rt)*sio* i* aitio* to

. i2s) at&)rosc-)rosis as'++)tric ki*)' si) r)c2rr)*t as& (2-+o*ar'))+a.. or )-)4atio* i* s)r2+ cr)ati*i*) A0o+i*a- 1.

. HY/ERTENSIE CRISIS:______________________. H'()rt)*si4) crisis is *ot )*) as a s()cic -)4)- of 0-oo (r)ss2r) 9. It is )*) as &'()rt)*sio* associat) ?it& ENDORGAN DAMAGE.. E* or,a* a+a,) = CON#SION $LRRY ISION DYS/NEA CHEST /AIN.

V;W HY/ERTENSIE RGENCY:__________________________. S)4)r) &'()rt)*sio* ;1; ++H,% .. $T .. No s'+(to+s or ac2t) )*or,a* a+a,).VW HY/ERTENSIE EMERGENCY:

____________________________. S)4)r) &'()rt)*sio* ;1; ++H,% Ac2t)3 -if) t&r)at)*i*, )* or,a*co+(-icatio*s.. Ma-i,*a*t &'()rt)*sio* S)4)r) HTN R)ti*a- &)+orr&a,)s )>2at)s /a(i--))+a.. H'()rt)*si4) )*c)(&a-o(at&' S)4)r) HTN c)r)0ra- ))+a No* -oca-ii*,*)2ro si,*s

. T&) 0)st i*itia- t&)ra(' for &'()rt)*si4) crisis is LA$ETALOL or NITRO/RSSIDE.. INTRAENOS LA$ETALOL is (r)f)rr) to Nitro(r2ssi) N))s +o*itori*,%.. Do NOT -o?)r 0-oo (r)ss2r) i* HTN crisis to NORMAL3 or 'o2 +a' /ROOKE ASTROKE.


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. N.$. ANTIHY/ERTENSIE DRGS SIDE E##ECTS:____________________________________________

. THIAIDE DIRETICS "HYDROCHLOROTHIAIDE":____________________________________________

. M)ta0o-ic si) ))cts H'()r,-'c)+ia3 tri,-'c)ri)s 8 LDL c&o-)st)ro-.. E-)ctro-'t) si) ))cts H'(o*atr)+ia3 &'(oka-)+ia 8 &'()rca-c)+ia.

. DIRECT RENIN INHI$ITOR:__________________________. E*&a*c)s *atri2r)sis.. s)r2+ a*,iot)*si* co*c)*tratio*.. A-ost)ro*) (ro2ctio*.

. N.$. CLES #OR CASES O# SECONDARY HY/ERTENSION:

__________________________________________________

X RENAL /ARENCHYMAL DISEASE:_____________________________. s)r2+ cr)ati*i*).. A0*or+a- 2ri*a-'sis (rot)i*2ria 8 R$Cs casts%.X RENOASCLAR DISEASE:

_________________________. S)4)r) &'()rt)*sio* ; ++H, s'sto-ic 8 ; ++H, iasto-ic% aft)r a,) 77.. /ossi0-) r)c2rr)*t as& (2-+o*ar' ))+a or r)sista*t &)art fai-2r).. *)>(-ai*) ris) i* s)r2+ cr)ati*i*).. A0o+i*a- 0r2it.

X /RIMARY HY/ERALDOSTERONISM = CONNBs :_________________________________________. D2) to ar)*a- a)*o+a or 0i-at)ra- ar)*a- &'()r(-asia.. Easi-' (ro4ok) &'(oka-)+ia.. S-i,&t &'()r*atr)+ia.. M)ta0o-ic a-ka-osis Hi,& s)r2+ $ICAR$ONATE HCO


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. /ro>i+a- +2sc-) ?)ak*)ss.. Ecc&'+osis3 a+)*orr&)a 8 )r)cti-) 'sf2*ctio*.. H'()rt)*sio* ?it& ar)*a- i*ci)*ta-o+a.X HY/OTHYROIDISM:

__________________

. #ati,2)3 r' ski* 8 co- i*to-)ra*c).. Co*sti(atio*3 ?)i,&t ,ai* 8 0ra'caria.

X /RIMARY HY/ER/ARATHYROIDISM:_______________________________. H'()rca-c)+ia /o-'2ria 8 (o-'i(sia%.. R)*a- sto*)s.. N)2ro(s'c&iatric Co*f2sio*3 )(r)ssio* 8 (s'c&osis%.X AORTIC COARCTATION:

______________________. Di)r)*tia- &'()rt)*sio* ?it& 0rac&ia- f)+ora- (2-s) )-a'.

. MISCELLANEOS TO/ICS:______________________________________________

. NORE/INE/HRINE INDCED ASOS/ASM:___________________________________. Ca2s) 0' 4aso(r)ssors 2s) i* )+)r,)*c' 0-))i*, )(iso)s.. Nor)(i*)(&ri*) is a* a-(&a ; a,o*ist ca2si*, 4asoco*strictio*.. Nor)(i*)(&ri*) ca2s)s isc&)+ia of t&) ista- *,)rs 8 to)s r' to 4asos(as+.. SYMMETRICAL 2ski*)ss 8 coo-*)ss of a-- *,)rti(s.. A si+i-ar co*itio* +a' occ2r i* i*t)sti*)s M)s)*t)ric isc&)+ia% or ki*)'s R#%.

. $LE TOE YNDROME:____________________. D2) to c&o-)st)ro- )+0o-i i* (ts ?it& at&)rosc-)rosis.. A)ct t&) ista- (ortio*s of t&) i,its.. A$SENCE of s'++)tr' of i,ita- i*4o-4)+)*t.. S$CLAIAN EIN THROM$OSIS:_____________________________. s) for tota- (ar)*t)ra- *2tritio*.. Co*ti*o2s irritati*, &'()ros+o-ar 2i ca* tra2+ati) t&) 4)i*s -)ai*, tot&ro+0osis.. /ro-o*,) (-ac)+)*t of c)*tra- -i*)s ca* -)a to s20c-a4ia* 4)i* t&ro+0osis.. It r)s2-ts i* ar+ s?)--i*, 8 (a--or.. CATHETER REMOAL IS MANDATORY.. D2(-)> is or)r) to oc2+)*t t&ro+02s 8 t&) *)) for a*ticoa,2-atio*.


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. HEAT STROKE:______________. T)+()rat2r) a0o4) .7 c ;7 #%.. E>)rtio*a- &)at strok) occ2rs i* &)a-t&' i*i4i2a-s )>)rcisi*, i* )>tr)+) &)at.. D)&'ratio*3 &'(ot)*sio*3 tac&'caria 8 tac&'(*)a ar) co++o*.. S'st)+ic ))cts -ik) s)i2r)s3 ARD3 DIC 8 &)(atic or r)*a- fai-2r) +a' occ2r.

. COCAINE SE:______________. Atro(&ic *asa- +2cosa.. S'+(at&)tic &'()racti4it' Tac&'caria3 &'()rt)*sio*3 i-at) (2(i-s%.. C&)st (ai* 2) to coro*ar' 4asos(as+.. /s'c&o+otor a,itatio* 8 si)2r)s.. Co+(-icatio*s Ac2t) MI Aortic iss)ctio* I*tracra*ia- &)+orr&a,)%.. Ma*a,)+)*t of c&)st (ai*: I $ENODIAE/INES for 0-oo (r)ss2r) 8 a*>i)t'. As(iri*. Nitro,-'c)ri* 8 CC$s for (ai*.

$$s ar) CONTRAINDICATED. #i0ri*o-'tics ar) NOT /RE#ERRED 2) to risk of i*tracra*ia- &)+orr&a,). I++)iat) cariac cat&)t)riatio* ?it& r)()rf2sio* ?&)* i*icat).

. LATE ANA/HYLACTIC SHOCK:___________________________. E>(os2r) to -at)>co*tai*i*, (ro2cts s2c& as s2r,ica- ,-o4)s 8 co*o+s.. D)4)-o(+)*t of &i4)s aft)r (rot)ct) s)> 2) to s)*sitiatio* to -at)> co*o+s.. Lat)> ,-o4)s 2s) 0' s2r,)o*s(ro4ok)s a*a(&'-actic r)actio* ?it& &'(ot)*sio* 8ras&.. H)a-t& car) ?ork)rs 8 (ts ?it& ato(ic is)as) ar) at &i,& risk of -at)> a--)r,'.

. CHAGAS DISEASE:_________________. A (otooa- is)as) ca2s) 0' Tr'(a*oso+a cr2i.. It is )*)+ic to Lati* A+)rica "$rai-".. T?o (ri+ar' +a*if)statio*s MEGACOLON1MEGAESO/HAGS 8 CARDIACDISEASE.. M),aco-o* or +),a)so(&a,2s foca- GI i-atatio*% is r' t )str2ctio* of t&)*)r4)s3. co*tro--oi*, t&) ,astroi*t)sti*a- s+oot& +2sc-)s -)ai*, ia-atatio*.. Co*,)sti4) &)art fai-2r) occ2rs /)a- ))+a D S< ,a--o( cario+),a-'%.

. ACTE LIM$ ISCHEMIA:______________________. /ai* /2-s)-)ss*)ss /ar)st&)sia /oiki-ot&)r+ia "Co-*)ss" 8 /a--or.. A*,io,ra(&' A0r2(t c2to of art)ria- 0-oo o?.. I H)(ari* s&B 0) start) i++)iat)-' 2(o* s2s(icio*.. D)*iti4) ttt S2r,ica- )+0o-)cto+'3. or I*traart)ria- 0ri*o-'sis 8 +)c&a*ica- )+0o-)cto+'.


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. ARD:_______. Ac2t) o*s)t.. $i-at)ra- (atc&' airsa(c) is)as) o* CR.. /C!/ 5 ;.. No i* LED/.

. /aO1#iO 5 .

. GASTROESO/HAGEAL MRAL INRY CHARACTERISTICS:__________________________________________________________________________________________________A% MALLORY !EISS YNDROME:

____________________________. (()r ,astroi*t)sti*a- MCOSAL TEAR.. Ca2s) 0' forc)f2- r)tc&i*, (r)ss2r)%.. S20+2cosa- art)ria- or 4)*2-) (-)>2s 0-))i*,.. o+iti*,3 r)tc&i*,3 &)+at)+)sis 8 )(i,astric (ai*.

. D> EGD co*r+s ia,*osis.. Most t)ars &)a- s(o*ta*)o2s-'.. E*osco(ic t&)ra(' for co*ti*o2s 0-))i*,.

$% $OERHAAE YNDROME:________________________. Eso(&a,)a- TANSMRAL t)ar.. Ca2s) 0' forc)f2- r)tc&i*, (r)ss2r)%.. ESO/HAGEAL AIR1#LID LEAKAGE i*to *)ar0' ar)as ).,. (-)2ra.. o+iti*,3 r)tc&i*,3 c&)st 8 2(()r a0o+i*a- (ai*.. O'*o(&a,ia3 f)4)r3 's(*)a 8 s)(tic s&ock +a' occ2r.. S20c2ta*)o2s )+(&'s)+a +a' 0) s))*.. D> CT or CONTRAST ESO/HAGOGRA/HY ?it& GASTROGRA#IN co*r+sia,*osis.. CR /*)2+o+)iasti*2+ 8 (-)2ra- )2sio*.. /-)2ra- 2i a*a-'sis EDATIE3 LO! (H3 ERY HIGH AMYLASE 7 I.. T> S2r,)r' for t&oracic ()rforatio*s.. Co*s)r4ati4) +)as2r)s ).,. a*ti0iotics for c)r4ica- ()rforatio*.. IM/ORTANT ASCLTATORY MEDIA s:____________________________________________________________________. Straso2* &)ar) @2st aft)r S.. k)*t2c"KY"% !it& S< corr)s(o*i*, to t&) -ast s'--a02s.. R)s2-t ?&)* i*o? fro+ Lt atri2+ strik)s 0-oo a-r)a' i* Lt 4)*tric-).. It is a si,* of Lt 4)*tric2-ar fai-2r).. $)st i*itia- ttt of L# is I i2r)tics.. S. Aitio*a- iasto-ic so2* @2st (rior to S;.


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. "TEN"*)ss))% !it& S corr)s(o*i*, to t&) rst s'--a02s.. It is i*icator of a sti -)ft 4)*tric-).. Ca2s)s: (ro-o*,) s'st)+ic &'()rt)*sio* or r)stricti4) cario+'o(at&'.. AR MRMR. Ear-' iasto-ic +2r+2r.

. Associat) c-i*ica- *i*, !at)r &a++)r (2-s) = $o2*i*, (2-s).. MR MRMR. Ho-os'sto-ic +2r+2r.. H)ar 0)st o4)r t&) a()> ?it& raiatio* to t&) a>i--a.

. IM/ORTANT KEY !ORDS:______________________. #IED S/LITTING o S = ASD.. /LSS /ARADOS #a-- i* $/ ; ++H, ?it& i*s(iratio*% = CARDIACTAM/ONADE.

. /LSS /ARS ET TARDS !))k 8 )-a') (2-s) strok)% = Aortic st)*osis.. O/ENING SNA/ ?it& -o2 S; = MS.. CA/ILLARY /LSATIONS i* *,)rs 8 -i(s = AR.

. /ERI/HERAL EDEMA DI##ERENTIAL DIAGNOSIS:____________________________________________________________________________________

V;W CARDIAC:_____________. $i-at)ra-.. Co*,)sti4) &)art fai-2r).. D's(*)a 8 ort&o(*)a.. 2,2-ar 4)*o2s ist)*sio* 8 &)(ato+),a-'.

VW HE/ATIC:_____________. $i-at)ra-.. H)(atic c)-- fai-2r).. Ascit)s o+i*at)s o4)r LL ))+a.. A0*or+a- -i4)r f2*ctio* t)sts ALT 8 AST%. H'(oa-02*i+)a 8 &'()r0i-ir20i*)+ia.. S(i)r *)4i3 ,'*)co+astia3 (a-+)r )r't&)+a.

V


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VW NTRITIONAL:_________________. $i-at)ra-.. H1O of +)ta0o-ic (ro0-)+s.. Rar) i* a2-ts.

V7W MEDICATIONS SIDE E##ECTS:______________________________. $i-at)ra-.. E>. Di&'ro('rii*) Ca c&a**)- a*ta,o*ists A+-oi(i*)%.. A+-oi(i*) i-at) ()ri(&)ra- 0-oo 4)ss)-s.

V6W ENOS INS##ECIENCY:__________________________. *i-at)ra-.. aricos) 4)i*s.. Ski* c&a*,)s 8 2-c)rs.

. N.$. TRICKY CASE:___________________. 7< 's o- (t a's H1O of Rt ca-f (ai* 8 s?)--i*,.. Co*sta*t (ai* )>ac)r0at) 0' k*)) )>io*.. H1O of (ast I r2, a02s)3 )*ocaritis 8 strok).. H) is c2rr)*t-' ?&))-c&air 0o2* r' to strok) r)-at) Lt si) &)+i(ar)sis.. $/ ;1 HR ;1+o*.. No D No &)(ato@2,2-ar r)2>.. C-)ar c&)st o* a2sc2-atatio*.. E*-ar,) a0o+)* ?it& s&ifti*, 2--*)ss 8 2i ?a4) s2,,)sti4) of ascit)s.. /a-(a0-) -i4)r < c+ 0)-o? t&) Rt. costa- +ar,i* s(-)*o+),a-'.. Rt si) ca-f s?)--i*, 8 t)*r*)ss.. !&at is t&) ca2s) of ascit)s QQ. /2-+o*ar' )+0o-is+1(arao>ica- )+0o-is+1Rt si) H#1C&ro*ic -i4)ris)as)1N)(&rotic Q. T&) a*s?)r is CHRONIC LIER DISEASE.

. T&) (tBs H1O of I r2, a02s) risk for cirr&osis r' to i*f)ctio* )B H$ 8 HC.. T&) *i*,s of &)(atos(-)*o+),a-' 8 ascit)s (oi*t to?ar t&) ia,*osis.. Most co++o* ca2s) of ascit)s is &)(atic cirr&osis.. T&) (tBs -), s?)--i*, +a' 0) 2) to DT r)s2-ti*, fro+ i+(air) +o0i-it'.. ASCITES is NOT r)-at) to DT 99

. N.$. H)(ato@2,2-ar r)2>:. A 2s)f2- c-i*ica- too- t&at ca* i)r)*tiat) 0)t. cariac 8 -i4)r ca2s)s of LL ))+a.. Cariac ca2s) H)art fai-2r)% 2,2-ar 4)*o2s (r)ss2r) 8 4) H)(ato@2,2-arr)2>.. H)(atic ca2s) Li4)r cirr&osis% or Nor+a- / 8 4) H)(ato@2,2-ar r))>.

. N.$.


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. C&ro*ic 4)*o2s i*s2)ci)*c' is a co++o* ca2s) of ()ri(&)ra- ))+a.. S&B 0) s2s()ct) i* (ts ?it& iso-at) -o?)r -i+0 ))+a 8 or i-at) 4)i*s3. ?it& ot&)r?is) *or+a- (&'sica- )>a+i*atio*.. I*itia- ttt Co*s)r4ati4) +)as2r)s ?it& -), )-)4atio*3 )>)rcis) 8 co+(r)ssio*t&)ra('

. /ATHO/HYSIOLOGY of CASES of /ERI/HERAL EDEMA:_________________________________________________. CA/ILLARY HYDROSTATIC /RSSRE:

____________________________________. H)art fai-2r) Lt 4)*tric2-ar 8 cor (2-+o*a-)%.. /ri+ar' r)*a- Na r)t)*tio* R)*a- is)as)s 8 r2,s%.. )*o2s o0str2ctio* Cirr&osis 8 4)*o2s i*s2)ci)*c'%.

. CA/ILLARY ONCOTIC /RESSRE = HY/OAL$MINEMIA:___________________________________________________

. /rot)i* -oss N)(&rotic %.. A-02+i* s'*t&)sis Cirr&osis 8 Ma-*2tritio*%.

. CA/ILLARY /ERMEA$ILITY:_____________________________. $2r*s3 tra2+a 8 s)(sis.. A--)r,ic r)actio*s.. ARD.. Ma-i,*a*t ascit)s.

. INTERSTITIAL ONCOTIC /RESSRE = LYM/HATIC O$STRCTION:____________________________________________________________. Ma-i,*a*t ascit)s.. H'(ot&'roiis+.. L'+(& *o) iss)ctio*.

. /ARAMETERS O# DI##ERENT TY/ES O# SHOCKS:____________________________________________________________________________________

. TY/E O# SCOCK __ CO/ __ SR __ $/ __ HR __ /C!/C/% __ T>

. CARDIOGENIC __ __ __ __ __ __ TTT cariac (ro0-)+

. HY/OOLEMIC __ __ __ __ __ __ #2is 8 (r)ssors

. SE/TIC __ __ __ __ __ __ #-2is3 (r)ssors 8 A*ti0iotics

. NEROGENIC __ __ __ __ __ __ #-2is 8 (r)ssors


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. $/ i* a-- t'()s of s&ock.. HR i* a-- t'()s of s&ock.

. /C!/ o*-' i* cario,)*ic s&ock.

. CO/ o*-' i* s)(tic s&ock.. SR i* &'(o4o-)+ic 8 cario,)*ic s&ocks.

. Ski* is (a-) 8 coo- i* &'(o4o-)+ic 8 cario,)*ic s&ocks.. Ski* is ?ar+ 8 fai*t i* s)(tic s&ock.

. T&) +ost co++o* ca2s) of cario,)*ic s&ock is +'ocaria- i*farctio*.. T&) +ost co++o* ca2s) of &'(o4o-)+ic s&ock is +assi4) &)+orr&a,).. T&) +ost co++o* ca2s) of s)(tic s&ock is Eco-i 8 sta(&'-ococca- i*f)ctio*.. T&) +ost co++o* ca2s) of *)ro,)*ic s&ock is c)r4ica- or t&oracic s(i*a- cori*@2r'.

Dr. !a)- Ta?c Mo&a+)

_________________________

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