Pearls from Dr. Mat Maurer
Diagnostic Pivot --> Syncope is different from fall given LOC
-Vasovagal --> elderly have less vagal tone/symptoms
-Seizure (post-ictal and lateral tongue laceration most specific sign/symptom)
Most important test for syncope --> orthostatics
-48 hours of tele is reasonable to catch arrhythmia (yield doubles from 24-48 hrs but diminishing returns after this)
Posted 06/03/16 01:58:28 PM by Adam Faye
4 Phases of valsalva (blow against higher pressure than CVP)
- Systolic pressure rises against increased intro-thoracic pressure
- Venous return declines
- Systolic pressure declines
- Venous return increases and BP increases (reflex brady, measure of barorecepter function). IF in chronic CHF (elevated CVP), no stage 2-4 (square root sign)
Posted 06/03/16 02:05:28 PM by Adam Faye
- Reduction in preload increases LVOT/murmur --> valsalva or squat to stand
- Increasing afterload (handgrip) decreases gradient and reduces murmur
SAM - Systolic anterior motion; MV presses against septum causing obstruction of LVOT during systole
(Venturi effect, dragging, or enlarged pappilary muscle/chordae that mechanically block LVOT)
Therapy (Gradient above 50 considered high)
-Disopyramide - initiate in hospital to monitor QTc; usually used to treat atrial arrhythmias; has negative inotropic effect to lower gradient
-Beta Blocker increases filling time in HOCM
Posted 06/03/16 02:09:16 PM by Adam Faye
Risk Stratification for HCM:
5 high risk features (if you have 2 or more, your risk of sudden death outweighs risk of AICD. 1/5 is 1-2% risk of sudden death)
- Family history of sudden death
- Septum > 3cm
- non-sustained VT on a holter (more predictive in younger patients)
- Drop in BP with exercise
Posted 06/03/16 02:17:17 PM by Adam Faye
For further reading...
Posted 06/03/16 02:23:20 PM by Adam Faye
- 7141 patients with acute heart failure; Nesiritide vs. Placebo
- Primary Endpoint- Change in dyspnea at 6 & 24hrs.
- 6hrs- 44.5% vs. 42.1% & 24hrs- 68.2% vs. 66.%1
- No difference in readmission/death/rate of worsening renal function at 30 days.
Posted 02/22/17 01:49:13 PM by Adam Faye
- Typically have high serum IgG4 levels
- On histopathology see IgG4-positive lymphoplasmacytic infiltration, fibrosis, and obliterative phlebitis or arteritis.
- Men:Women - 3:1 likelihood ratio, median age at diagnosis is 60 y/o.
- Responds to steroids- often have to put on Rituximab (B-cell depleting) if refractory disease/maintenance therapy
Posted 02/22/17 01:52:11 PM by Adam Faye
HFpEF- 80-90% MCC is HTN
- If someone with HFpEF does NOT have HTN (assessed on vital signs)- should prompt an immediate cardiology referral - has serious pathology and very difficult to treat
Posted 02/22/17 01:56:20 PM by Adam Faye
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.