PPOM 2 Block 2 OMK

Causes of acute cough (less than 3 weeks)

Most common cause is

Viral Upper Respiratory

Infection

• Acute bronchitis

• Pneumonia

• Left-Sided heart failure • Asthma

• Foreign body

• Smoking

• ACE-I therapy

Hypertension + hypokalemia + metabolic alkalosis + virilization + HIGH 11-deoxycortisol =

11-beta-hydroxylase deficiency

These originate in the atria and typically produce an early, abnormal P wave followed by a narrow ventricular complex.

Premature atrial contractions

Every other heartbeat is a premature, wide ventricular complex without a preceding P wave.

Ventricular bigeminy

Drug to use in Hemodynamically stable monomorphic ventricular tachycardia

Amiodarone

“Thrombolysis is reserved for selected ST-elevation myocardial infarctions when timely percutaneous coronary intervention is unavailable” which drug to use?

Alteplase

Use aspirin and heparin for ST depression

Ventricular automaticity →

generally wide-complex ventricular tachycardia.

“Exercise-induced syncope + family history of sudden cardiac death + systolic murmur.”

Hypertrophic obstructive cardiomyopathy

Alcohol consumption + possible dehydration + postural changes → decreased cerebral perfusion.=

Orthostatic hypotension

“Classically associated with epiglottitis.”

Haemophilus influenzae type b

“Paroxysmal cough, inspiratory whoop, posttussive vomiting.”

Bordetella pertussis

“Impaired cholesterol release from lysosomes.”

Niemann-Pick type C

Forward through atrioventricular node → Narrow complex.

Orthodromic

Forward through accessory pathway → Wide complex.

Antidromic

“Involved in vascular constriction.”

Alpha 1

“Blockade decreases heart rate.”

Beta-1

Longer refractory period → Longer wavelength →

Less reentry.

24-year-old man with no known cardiovascular disease presents for routine preventive care. His last lipid panel was normal.

According to the lecture, how often should adults generally be screened for dyslipidemia?

Every 5 years.

LOW sodium + NORMAL serum osmolality + elevated lipids =

Pseudohyponatremia

→ Laboratory artifact caused by increased plasma lipids.

decreases high-density lipoprotein and increases very-low-density lipoprotein.“ which medication causes this

Beta blocker

Meds that can cause secondary hyperlipemdia

Retinoid And cyclosporine h

increases high-density lipoprotein and also increases very-low-density lipoprotein/triglycerides.“

Estrogen

“Causes atrioventricular dissociation, usually with a slow ventricular escape rhythm,”

Complete AV block

“Associated with atrioventricular canal defects.”

Endocardial cushion fusion

“Accessory pathway + retrograde P waves after QRS.“

Atrioventricular reentrant tachycardia

The QT prolongations

Type 1: Reduced slow potassium current (IKs)

Type 2: Reduced rapid potassium current (IKr)

Type 3: Increased inward sodium current

Decreased reflexes + hypotension + respiratory depression + heart block =

Hypermagnesemia

→ Excess magnesium suppresses neuromuscular and cardiac activity.

What is the most common underlying condition that leads to stable angina pectoris?

Atherosclerotic plaques on coronary artery intimal layer

The physical examination shows decreased brachial and radial pulses in the left arm, and his systolic blood pressure is 20 mm Hg lower in the left arm than the right arm.

Occlusion of which of the following vessels would most likely produce these symptoms?

Subclavian vein

Can fibrates be used for hypertriglyceridemia

Yes

Acute mesenteric ischemia is characterized by inadequate blood flow through the mesenteric arteries and can result in

bowel ischemia and necrosis.

Familial dysbetalipoproteinemia (Type III)

ApoE defect → Impaired remnant clearance → Chylomicrons/VLDL ↑

ABCA1 defect + HDL ↓ =

Tangier disease.

Continuous murmur + upper right chest + disappears supine

Venous hum → caused by abnormal venous return.

VLDL overproduction + ↑ triglycerides + glucose intolerance=

Familial hyperlipoproteinemia Type IV

Cholesterol trapped in lysosomes + impaired cholesterol release + nerve cell death =

Niemann-Pick type C

Accelerated catabolism of apolipoprotein A-I and apolipoprotein A-II + decreased high-density lipoprotein=

Hypoalphalipoproteinemia

Low calcium + HIGH parathyroid hormone + HIGH phosphate =

Parathyroid hormone resistance

→ Target organs fail to respond to parathyroid hormone.

Causes of SIADH

Aortic stenosis + coarctation + hypertension =

Left ventricular hypertrophy

Prolonged ST segment + unchanged T-wave duration =

Hypocalcemia

Lead V1 + backward tracing from T wave + turn right =

Right bundle branch block

Lead V1 + backward tracing from T wave + turn left =

Left bundle branch block

Preserved left-to-right septal depolarization + delayed right ventricular activation =

Right bundle branch block

Most common paroxysmal supraventricular tachycardia + 150–250 beats/minute + buried P waves =

Atrioventricular nodal reentrant tachycardia → Treatment: Ablation.

Exercise + fever + thyrotoxicosis = Sinus tachycardia → Treatment:

Treat underlying cause.

Short refractory period + short wavelength =

Increased reentry risk

Premature beat + one-way block + slow conduction =

Reentry circuit

Unidirectional block + slow conduction + recovered proximal tissue =

Reentry

Reperfusion + calcium overload + fast heart rate =

Delayed after polarization

Buried P waves + dual nodal pathways + regular narrow QRS =

Atrioventricular nodal reentrant tachycardia → Treatment: Slow pathway ablation.

A total anomalous pulmonary vein return is associated with which shape

Snowman shaped heart

Jatene arterial switch operation Is the definitive treatment for

Transposition of the great arteries

Heart rate below 60 + decreased automaticity/conduction block = Bradyarrhythmia → Treatment:

Atropine if unstable; pacemaker if recurrent and severely symptomatic.

Heart rate above 100 + increased automaticity/triggered activity/reentry =

Tachyarrhythmia

Origin at His bundle or above + narrow QRS =

Supraventricular arrhythmia

Reentry requirements:

Unidirectional block + slow conduction + recovered proximal tissuE

Dual pathways + slow pathway forward + fast pathway backward = Atrioventricular nodal reentrant tachycardia → Treatment:

Slow pathway ablation.

Advanced age + sinoatrial node degeneration + recurrent syncope =

Sick sinus syndrome → Treatment: Pacemaker.

Epsilon wave + sudden death + fibrofatty replacement =

Arrhythmogenic cardiomyopathy caused by a desmosomal defect

Arrhythmogenic cardiomyopathy + thickened palms and soles = Naxos syndrome →

Desmosomal protein defect

Dilated ventricles + reduced ejection fraction + systolic dysfunction =

Dilated cardiomyopathy caused by a Titin mutation

Young male + dilated ventricles + X-linked inheritance =

X linked dilated cardiomyopathy caused by a dystrophin mutation

Stiff ventricles + impaired filling + diastolic dysfunction =

Restrictive cardiomyopathy → Increased myocardial stiffness (multiple possible causes).

“Associated with atrioventricular septal defects and tetralogy of Fallot.”

Down syndrome

What aspirin dose is used during acute Kawasaki disease?

Hugh dose and switch to low when it resolves

Rashkind balloon atrial septostomy Function

Temporarily improves mixing between the two circulations but does not correct the anatomy.

Asymmetric septal hypertrophy + exertional syncope + sudden cardiac death?

Hypertrophic cardiomyopathy → Sarcomere mutation.

What needed for survival in tricuspid atresia

Atrial septal defect and ventricular septal defect

Why do dihydropyridine calcium channel blockers cause reflex tachycardia?

Reflex sympathetic activation

Which drugs control heart rate versus heart rhythm in atrial fibrillation?

Rate: Metoprolol, diltiazem, digoxin. Rhythm: Amiodarone, flecainide, sotalol.

Young athlete + syncope + epsilon wave + inverted T waves in V1–V3?

Arrhythmogenic right ventricular cardiomyopathy → fibrofatty replacement.

Why does slow conduction sustain reentry around ventricular scar?

Scar + slow conduction + recovered tissue. The impulse returns after the myocardium has recovered and reexcites it.

“Reexcitation of myocardium that has recovered” is the mechanism of

Reentry

Verapamil increases ____ levels

Digoxin

“Can contribute to conduction block”

Slowing atrioventricular conduction

Vascular tumor associated with von Hippel-Lindau disease.

Hemangioblastoma

How to treat stable A fib

Rate control with metoprolol or diktiazem

When is coronary artery bypass grafting preferred vs percutaneous coronary intervention

Coronary artery bypass grafting: Generally favored for high-risk multivessel disease, particularly with diabetes or reduced ventricular function.

Percutaneous coronary intervention: Generally favored for persistent angina with single- or two-vessel disease and preserved ventricular function.

“Wide complexes with atrioventricular dissociation”

Ventricular tachycardia

Regular narrow complexes, terminates with adenosine“

Atrioventricular nodal reentrant tachycardia

“Chronic lung disease, multiple P-wave shapes”

Multifocal atrial tachycardia

A 6-year-old develops fever, swollen hands, bilateral conjunctival injection, and a strawberry tongue. Two weeks later, her fever resolves, but she develops peeling around her fingertips.

Which laboratory finding is most likely at this stage?

Increased platelet count

How can Kawasaki disease cause myocardial infarction?

Coronary aneurysm → blood stasis → thrombosis.

Why does dilated cardiomyopathy cause mitral regurgitation?

Ventricular dilation distorts the mitral valve apparatus, causing functional regurgitation.

A 63-year-old man with heart failure and type 2 diabetes needs a beta blocker after a myocardial infarction. His physician wants to avoid masking hypoglycemia and excessive beta-2 blockade.

Which drug is the best choice?

Metoprolol

A 76-year-old man has recurrent syncope. Electrocardiography shows regular P-P intervals and regular R-R intervals, but there is no consistent relationship between P waves and QRS complexes.

Which additional finding is most likely?

Atrial rate greater than ventricular rate (3rd degree heart block)