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米国にて内科修行中。何ができるか模索している過程を記録していく

Cardiology (memo from NEJM knowledge plus and MKSAP)

・dual antiplatelet Tx for STEMI

    avoid prasugrel for patient with h/o stroke, >75 yo, body weight < 60kg

 

・Tx for HTN in HFpEF patient

ARB (candesartan) reduce hospitalization in patient with HFpEF

 

・first-line monotherapy for hypertensive african-american patient

thiazide or CCB

 

・indication of echocardiography for patient with heart murmur

3/6 or louder SM or any diastolic or continuous murmur

 

・management of NSTEMI with high TIMI score (5-7)

anticoagulation (TIMI 3-7) and glycoprotein IIb/IIIa (eptifibatide) in addition to ASA, clopidogrel, BB, nitrate, statin

 

・complete heart block secondary to Lyme disease

    reversible

 

・management of recurrent pericarditis

colchicine and aspirin

 

・management of perioperative (total hip replacement) anticoagulation for patient with mechanical aortic valve on warfarin

discontinue warfarin 3 days prior to surgery and restart on evening of surgery (no heparin bridge if no risk factor: afib, LVEF<30, hypercoagulable state, h/o thromboembolic event)

 

・intermittent claudication and borderline ABI

    -> ABI after exercise increase sensitivity 

 

・management of patient with suspected peripheral artery disease whose ABI is above 1.4

great toe pressure measurement

 

・diagnosis of type A aortic dissection 

transesophageal echocardiography

 

・cocaine-induced chest pain

   NTG + benzodiazepine

 

・widespread deeply inverted T waves

   sign of severe brain injury

 

・new onset of widened QRS and QT interval secondary to TCA overdose

    sodium bicarbonate

 

・patient with ACS managed with non-invasive fashion

    LMWH has better outcome than unfractionated heparin

 

・indication for surgical intervention to aortic aneurysm

   diameter > 5.5 cm or expand 0.5 cm/year

 

・indication for aortic valve replacement for AS

    symptomatic or LVEF <50%

 

・initial management of congenital long-QT syndrome

    beta blocker

 

・patient with severely depressed systolic function and fluid overload who responds poorly to IV diuretics or has worsening renal function

   -> inotropic agent (milrinone)

 

・narrow-complex tachycardia in patient with h/o heart transplant

   low dose of adenosine (3mg)

 

・atrial tachycardia with atrioventricular 2:1 block 

    digoxin toxicity

 

・ST-segment elevation more prominent in aVR than V1

 obstruction of left main coronary artery

 

・patient with mechanical valves on warfarin

    addition of low-dose ASA reduce the risk of thromboembolism

 

・ABX for endocarditis prophylaxis prior to dental procedure 

   amoxicillin 2 gram po once 1 hour prior to procedure

 

・6 months of intermittent fever, orthopnea, progressive SOB, chest pain

    cardiac myxoma

 

・management of asymptomatic myxoma

surgical removal (risk for systemic embolic event)

 

・late cardiac complication of Hodgkin disease treatment

coronary artery disease, (valve disorder, restrictive cardiomyopathy, diastolic dysfunction)

 

・fixed splitting of the S2

ASD

 

・management of patient with pacemaker whose corner is eroding through skin without sign of systemic infection

extraction of pacemaker and leads

 

・management of severe pulmonary valve stenosis with peak gradient of 70

percutaneous pulmonary balloon valvuloplasty

 

・diagnosis of patient who has newly developed holosystolic murmur at left sternal border associated with palpable thrill 3 days after myocardial infarction

postinfarction VSD

 

・cardiovascular risk scoring system preferable for young female

Raynolds risk score (Framingham risk score underestimate risk of young female)

 

・cannon a wave

atrial contraction against closed tricuspid valve -> AV dissociation 

 

・management of patient with ACS who is contraindicated to beta blocker

diltiazem

 

・clopidogrel Tx for patient with unstable angina or NSTEMI who is treated medically without stent placement

clopidogrel for at least 1 month, ideally up to 1 year

 

・management of patient with chronic stable angina who remains symptomatic despite optimal dose of beta blocker, cacium channel blocker and long-actign nitrate

ranolazine

 

・management of patient with ICD placement and pacemaker dependence who is about to undergo surgery

turn off shock therapy and change to asynchronous mode (ventricular pacing continue regardless of any native electrical activity)

 

・time window of thrombolytic Tx for STEMI

within 12 hours

 

・follow up aortic coarctation repair

MRI or CT for aort (to evaluate recurrent coarctation and aneurysm)

 

・biventricular pacing

QRS > 120

 

・complication of previous radiation to thorax

aortic regurgitation,  ・・・

 

・ejection click that diminish in intensity during inspiration 

pulmonary valve stenosis

 

・evaluation of newly diagnosed left ventricular systolic dysfunction 

coronary angiography 

 

・management of limb ischemia with dense anesthesia, severe motor impairment, lack of doppler vascular signal 

prompt amputation (consistent with nonviable limb)

 

・DDx of patient with newly developed heart failure 5 years after heart transplant

cardiac allograft vasoculopathy

 

・ST change in myocarditis and pericarditis

myocarditis: nonspecific ST-T change (ST elevation, TWI)

pericarditis: concave ST elevation 

 

・management of patient with cyanotic congenital heart disease who present with dyspnea on exertion, Hb 15, Hct 52, ferritin 10, transferrin saturation 13%

iron therapy

(normal Hb and Hct are 18-20 and 60-65% for cyanotic heart disease patient)

 

・management of severe MR

mitral valve repair or replacement?

 

・management of patient with STEMI brought to the facility without cardiac cath lab and the other facility with cardiac cath is in 1.5 hour drive

thromolytic Tx if not contraindicated (door-to-balloon time should be 90 minutes or less)