23-ddx of sudden falls + digoxin and aspirin toxicity + thiazide-like diuretics

pg 130- 174

vasovagal attack is usually due to ____________ or _____________ or ____________ e.g. _________. patient usually feels ______ and gets _________ before the attack

overwarm environment…prolonged standing…visual stimuli…seeing blood.

dizzy…tunnel visions

a condition in which you faint because of an abnormal heart rhythm

Stokes-Adams syndrome

ddx of sudden falls

drop attack →

stokes adam →

hypoglycemia →

vasovagal attack →

epilepsy →

digoxin toxicity : _______, _______, _______, ________

GIT, neurological, visual, arrythmias

digoxin toxicity

GIT : ________, ________, ________

Neurological : __________, __________

Visual : ________, ________, ________

arrythmias : ________, ________, ________

nausea, vomit, anorexia

confusion, hallucination

yellow haloes, blurred vision

bradycardia, V tach, premature contractions

management of digoxin toxicity

order digoxin level

digibind (digoxin immune FAB)

correct arrythmia

monitor potassium

aspirin toxicity earliest symptom is _______________ and __________. others may include ________, ________, ________, ________, ________, ________

ringing in the ears (tinnitus)… impaired hearing

rapid breathing, vomiting, dehydration, fever, double vision, feeling faint

thiazide like diuretics work by _____________ at the ____ of the ________ part of the ___________ by blocking the ___________________.

loop diuretics such as _________ and ________ inhibits the _____________ in the _______________

inhibiting Na reabsorption… beginning… proximal…distal convoluted tubule (DCT)…thiazide-sensitive Na-Cl symporter

furosemide…bumetanide…Na-K-Cl cotransporter…thick ascending limb of the loop of Henle

the main use of bendroflumethiazide was in the management of _____________ but NICE now recommend other thiazide-like diuretics such as ___________ and ____________.

hypertension

indapamide…chlortalidone

common adverse effects of thiazide like diuretics

• postural hypotension

• hypercalcemia and hypocalciuria

• hypokalemia and hyponatremia

• hyperuricemia

• dehydration

• impaired glucose tolerance

• impotence

a patient with hypertension on treatment + recurrent falls when trying to get up, explain.

postural hypotension due to thiazide used for hypertension

defib = asynchronized cardioversion

in 2 conditions 😀

vFib and pulseless ventricular tachycardia

cause of stable angina could be ________ and _________.

it is relieved by _________ and ___________.

exercise and emotional stress

rest and GTN(glyceryl trinitrates)

unstable angina occurs mostly at ________, ________ , _________.

rest, unpredictable, random

ecg shows - tall tented waves → hyperkalemia

(likely cause : use of ACEi)

causes of hyperkalemia : ACEi, ARB, spironolactone, NSAIDS

treatment : protect cardiac membrane with calcium gluconate then reduce potassium by giving insulin with dextrose

U wave in hypokalemia

(additional wave after T wave)

Tall tented T wave in hyperkalemia

hypothermia

delta wave in WPW syndrome

widespread saddled shape ST elevation with upward concavity + PR depression in pericarditis

antiplatelets guide for :

ACS-MI and PCI → __________ and ____________

TIA & ischaemic stroke → __________ then ____________

ischemic stroke + AF → __________ then start ____________

peripheral arterial disease → _________

aspirin (lifelong) + clopidogrel/ticagrelor 12months

aspirin 300mg (2w) + clopidogrel 75mg (lifelong)

aspirin 300mg (2w) + DOAC/warfarin

clopidogrel (lifelong)

when is the best time to take statins? why?

night, it is when the majority of the cholesterol synthesis takes place.

statin primary and secondary prevention

primary → atorvastatin 20mg OD

• 10 year cvs risk ≥ 10%

• type 1 DM

• CKD if eGFR<60

secondary → atorvastatin 80mg OD

• IHD (MI)

• cerebrovascular disease (stroke)

• peripheral arterial disease

important side effects of diuretics (loop, thiazide like, K sparing)

Na, K, Uric

secondary prevention (long-term) of ischemic stroke/TIA

control bp. if with DM, add ACEi

statins

anti platelets

• with AF → warfarin or DOAC

• without AF → clopidogrel 75mg OD

ABCD2 score is used to identify the _____________ in the following ____ days in patients who have had a suspected ______ .

risk of future stoke..7…TIA

hypertensive patient on treatment + ankle swelling/edema.

the likely cause is

amlodipine (CCB)

CCB cause ankle swelling as it causes vasodilation

2 important side effects of CCB (verapamil, diltiazem, amlodipine, nifedipine)

ankle swelling/edema

gingival hyperplasia

2 most important test to be done before initiating lithium are

-thyroid fn test

-kidney fn test

atropine

symptomatic bradycardia (norm pulse 60-100 bpm)

excessive alcohol → _________ (__________ on xray) → ___________

acute alcohol intake can lead to _____ or ____ (___________ syndrome)

alcoholic cardiomyopathy…cardiac enlargement…aFib

aFib…flutter…holiday heart syndrome

Triple Vessel Disease is

blood transfusion is indicated if

hb <80g/L + anemia symptoms or

hb <70 w or w/o symptoms

complications of MS

__________ → __________→ _________ → __________ →

left atrial enlargement

aFib

venous thromboembolism

cerebral infarction