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Hyperlipidemia
Lipid lowering Criteria Any person >35 y should get fasting lipids and repeat every 5 years Hyperlipidemia Total Cholesterol >200 LDL >130 HDL <40 Guidelines No atherosclerosis risk → First 12-week trial of diet and exercise! High risk and DM → High-dose statin (Atorvastatin 80mg) Medium risk and DM →...
Read moreArrhythmia
Bradycardia, AV Block Bradycardia (HR <60) → ECG Sinus Bradycardia Treatment Asymptomatic → No treatment Symptomatic Best initial → Atropin Most accurate → Pacemaker First-Degree AV Block Presentation Fixed PR lengthening Treatment Asymptomatic → No treatment Symptomatic Best initial → Atropin Most accurate → Pacemaker Second-Degree AV Block Mobitz I (Wenckebach) Presentation...
Read moreSyncope
WOMAN 3-2-1 PE History Physical Diagnosis VV (Vaso Vagal) Visceral Organs (micturition, defecation, cough) Carotid Stimulation (turning head, shaving) Psychogenic (site of blood) Situational Often reproducible Positive prodrome Vagal stimulation produces asystole or a ↓ SYS BP of 50 mmHg Tilt Table Orthostatic Volume Down Autonomic Nervous Dysfunction Orthostatic...
Read moreManeuvers
Valsalva → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Standing → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Diuretic → ⬇︎ Preload → ↓ All murmurs, ↑MVP/HOCM Squatting → ⬆︎ Preload → ↑ All murmurs, ↓MVP/HOCM Leg raising → ⬆︎ Preload → ↑ All murmurs, ↓MVP/HOCM Handgrip → ⬆︎ Afterload → ↑MR/AR, ↓AS/MVP/HOCM, MS not changed Amyl Nitrate → ⬇︎ Afterload → ↓MR/AR,...
Read moreHypertension
SBP >140 DBP >90 Most common disease in US Most common risk factor for MI Etiology 90% → Essential hypertension Other causes Renal artery stenosis Glomerulonephritis Coarctation of aorta Acromegaly Obstructive sleep apnea Pheo Hyperaldosteronism Cushing syndrome Congenital adrenal hyperplasia Presentation Majority asymptomatic → Found on screening Renal artery stenosis → Continuous...
Read moreMI Complications
MI Complications Hypotension → Seen in all complications, not specific Bradycardia Sinus bradycardia Vascular insufficiency to SA node Presentation Bradycardia NO cannon A wave Treatment Atropin Pacemaker 3rd degree AV block Presentation Bradycardia Cannon A wave Bounding jugular wave bouncing up into neck Atrial systole against closed tricuspid valve Treatment...
Read moreHeart Disease in Pregnancy
Peripartum Cardiomyopathy Worst heart disease in pregnancy Etiology Antibody against pericardium Presentation LV dysfunction → Often reversible Mostly develops after pregnancy Next pregnancy → More Ab → Worse Treatment ACEi/ARB Beta blocker Spironolactone Diuretic Digoxin Transplant Eisenmenger Syndrome Second worst heart disease in pregnancy Etiology VSD → L to R shunt → Pulmonary hypertension →...
Read moreAortic Disease
Aortic Dissection Etiology Hypertension Smoking Presentation Chest pain Sudden Shearing Radiate to scapula Different blood pressure between arms History of smoking Hypertension Diagnosis Best initial → CXR → Mediastinum widening Most accurate → Angiography CT Angio = MRA = TEE Renal failure → TEE Treatment Best initial → Control blood pressure Beta...
Read morePeripheral Vascular Disease
Peripheral Vascular Disease Etiology DM Hyperlipidemia Hypertension Smoking Presentation Leg pain (calves) on exertion → Intermittent claudication Both walking UP and DOWN hill Spinal stenosis is worse walking DOWN hill Smooth shiny skin Loss of Hair follicle Sweat gland Sebaceous gland Diagnosis Best initial → Ankle-brachial index (ABI) → <0.9...
Read morePericardial Disease
Pericarditis Etiology Infectious Viral → Coxackie B Staph Strep Fungi Autoimmune SLE Wegener Goodpasture RA PAN Uremia Post-MI Peri-infarction pericarditis Dressler Syndrome 🔗 Aortic dissection Radiation Cancer Drugs Presentation Sharp chest pain Change intensity with respiration, position Worsen by lying down Improved by sitting up Diagnosis Best initial → ECG...
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