this
DESCRIPTION
is. This. Your. With. Host. Dr.Krim. EKG ID. Cardiac Murmurs. Physical Signs. Anti- arrhythmics. JEOPARDY. Cardiac murmurs. Physical signs. Anti- arrhythmics. EKG ID. 100. 100. 100. 100. 200. 200. 200. 200. 300. 300. 300. 300. 400. 400. 400. 400. 500. 500. 500. - PowerPoint PPT PresentationTRANSCRIPT
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This
is
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With
Host...
Your
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EKG ID
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CardiacMurmurs
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PhysicalSigns
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Anti-arrhythmics
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100
200
300
400
500
EKG ID Physicalsigns
Anti-arrhythmics
Cardiacmurmurs
100
200
300
400
500
100
200
100
200
300300
400400
500500
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What is a normal ECG?
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What is anterior wall MI?
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What is ventricular tachycardia?
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What is Wolf-Parkinson-White
Syndrome (WPW) ?
![Page 18: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/18.jpg)
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What is atrial flutter?
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With a slow carotid upstroke,
this murmur is best heard in the 2nd L ICS and occurs in mid-systole, though a late-peaking
one may indicate worse disease
![Page 21: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/21.jpg)
What is aortic stenosis?
![Page 22: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/22.jpg)
Best heard at the apex and with
the patients in left lateral decubitus, it is holo-diastolic
and low-pitched—rare now with reduction in RHD cases
![Page 23: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/23.jpg)
What is mitral stenosis?
![Page 24: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/24.jpg)
A blowing, decrescendo, diastolic murmur, it is associated
with many conditions such as Marfan syndrome and ankylosing spondylitis
![Page 25: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/25.jpg)
What is aortic regurgitation?
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Named after a 19th century American MD, this diastolic murmur is best heard in the
apex; it suggests severe AR and is thought to be related to early
closure of the mitral valve
![Page 27: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/27.jpg)
What is Austin Flint murmur?
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In AS, the murmur may radiate to the apical area mimicking
MR presumed to be due to high frequency vibrations from a
calcific aortic valve to the apex
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What is Gallavardin phenomenon?
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This finding is defined by a greater than 10 mm Hg
inspiratory decline in systolic arterial pressure
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What is pulsus paradoxus?
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Inspiratory rise in jugular venous pressure commonly seen in cardiac tamponade
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What is Kussmaul’s sign?
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Performed by attempting to forcibly exhale while keeping
the mouth and nose closed, this maneuver can terminate supraventricular tachycardias
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What is Valsalva maneuver?
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Increase in the intensity of tricuspid regurgitation murmur
during inspiration
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What is Carvallo’s sign?
![Page 38: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/38.jpg)
Systolic and diastolic two-phase murmur that can be
heard over the femoral artery in severe aortic regurgitation
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What is Duroziez’s sign or murmur?
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Class Ia antiarrhythmic agent known to cause “cinchonism”
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What is Quinidine?
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Class II antiarrhythmic agents known to improve survival in
CAD and HF patients
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What are beta blockers?
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Class III antiarrhythmic agent with a half life of 45days
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What is amiodarone?
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A very effective pure class III antiarrhytmic agent for the
conversion of atrial flutter; it may however prolong the QT interval and promote torsades
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What is Dofetilide(or Ibutilide)?
![Page 48: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/48.jpg)
Class Ia antiarrhythmic agent often used to treat atrial fibrillation in the
setting of WPW
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What is procainamide(Pronestyl)?
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ACS 911
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Images in Cardiology
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BloodMarkers
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Heart Failure
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200
400
600
800
1000
ACS 911Blood
markersHeartFailure
Images inCardiology
200
400
600
800
1000
200
400
200
400
600600
800800
10001000
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According to the TIMI score, the minimum patient
age that merits 1 point indicating high risk
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What is 65 years?
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Killip class consistent with (+) rales, S3, JVD but no acute pulmonary edema
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What is Killip class II?
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Among patients who receive DES, the minimum duration (in months) of aspirin therapy 162-325 mg/d before switching to
75-162 mg/d indefinitely
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What is 3 months?
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While recommended PCI DTB time is <90 minutes, this is the maximum Door-to-Needle time
(in minutes) to treat STEMI patients with fibrinolytics in
non-PCI hospitals
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What is 30 minutes?
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Regardless of reperfusion therapy, STEMI patients should
take clopidogrel 75 mg/d in addition to aspirin for at least
this this number of days
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What is 14 days?
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What is infective endocarditis
(Janeway lesions)?
![Page 68: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/68.jpg)
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What is aortic dissection(widened mediastinum)?
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What is infective endocarditis (splinter
hemorrhage)?
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What is a prosthetic (metallic) mitral valve?
![Page 74: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/74.jpg)
![Page 75: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/75.jpg)
What is hypothermia (Osborne waves)?
![Page 76: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/76.jpg)
These biomarkers are highly sensitive and specific for acute
myocardial injury and offer equivalent, robust prognostic
information; make sure to note kidney function
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What are troponins I and T?
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This biologically active hormone from the ventricles is
secreted in response to LV wall stress; its clinical use is accepted in HF and emerging
in ACS
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What is BNP?
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Synthesized by the liver, this readily available acute phase reactant is an independent but
non-specific marker of inflammation, and mediator of
endothelial function
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What is CRP?
![Page 83: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/83.jpg)
This molecule is present in IDL, VLDL, LDL and chylomicrons;
thus, it represents the total burden of lipoprotein particles
that are most atherogenic
![Page 84: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/84.jpg)
What is ApoB-100?
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Made by the hypothalamus and stored in the post. pituitary,
excess of this hormone leads to worse HF and blockade of its receptor (i.e. tolvaptan) results
in relief of acute symptoms
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What is arginine vasopressin?
![Page 87: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/87.jpg)
In the DIG trial, although this drug did not reduce mortality of
patients with systolic HF, it reduced the rate of readmissions
![Page 88: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/88.jpg)
What is Digoxin?
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![Page 90: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/90.jpg)
As shown by the RALES trial, this drug improved mortality in patients with stage II-IV HF and
low EF (<30%)
![Page 91: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/91.jpg)
What is spironolactone (Aldactone)?
![Page 92: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/92.jpg)
In the A-HEFT trial, African American HF patients responded better to this combination therapy
![Page 93: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/93.jpg)
What are hydralazine and isosorbide dinitrate
(BiDil)?
![Page 94: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/94.jpg)
In the COMET trial, this closely related drug proved to be
superior to metoprolol in the treatment of HF patients
![Page 95: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/95.jpg)
What is carvedilol (Coreg)?
![Page 96: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/96.jpg)
In the CHARM trial, the addition of this class of drugs to ACE-I
therapy proved to be superior to ACE therapy alone in systolic
HF patients
![Page 97: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/97.jpg)
What are ARBs? (Angiotensin receptor
blockers)
![Page 98: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/98.jpg)
Late breaking Trials
![Page 99: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/99.jpg)
This recently published trial (NEJM) showed that patients with normal LDL levels and high CRP were at higher risk for death and would benefit from statin therapy as primary prevention for CVD
![Page 100: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/100.jpg)
What is the JUPITER trial?(The Justification for the Use of statins in Primary Prevention: an
Intervention Trial Evaluating Rosuvastatin)
![Page 101: This](https://reader036.vdocuments.us/reader036/viewer/2022062517/56813000550346895d957528/html5/thumbnails/101.jpg)
Thank you for playing