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24 Cards in this Set
- Front
- Back
treatment of ARVC/D
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avoid exercise, ICD; no medical therapy to delay progression; B blockers, sotalol, amio and cath ablation can reduce ICD shocks
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treatment of symptomatic bradycardia (4)
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atropine, if ineffective, dopamine and epinephrine, until transcutaneous or transvenous pacing is initiated (ADEPt)
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NOTE: In infections of cardiac devices,
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it is important to not attempt aspiration of the device site because this can damage the leads.
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x most common cause of acute pericarditis
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viral infection
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How is diagnosis of pericarditis confirmed?
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2 of 3 classic findings: CP, pleuritic; friction rub; diffuse ST segment elevation; if (+) unexplained pericard effusion on echo, only 1 of 3 necessary
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unique feature of chest pain in acute pericarditis
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worsens in recumbent position
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pericardial friction rub is best auscultated at
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left lower sternal border during suspended respiration while leaning forward
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EKG in myopericarditis
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concave downward ST segment elevation like MI
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likely etiology of recurrent pericarditis
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autoimmune
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primary treatment for acute pericarditis
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antiinflammatory meds - (high dose ASA or NSAIDs), tapered weekly over 3-4 weeks [caution with NSAIDs in MI]
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NOTE: The COPE trial
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supports colchicine as an adjunctive agent for acute pericarditis; recurrence rate at 18 months decreased from 32% to 10.7% with 3 months of colchicine.
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when is corticosteroids indicated in acute pericarditis
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refractory cases or C/I to asa, nsaids and colchicine
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can anticoagulation be started in patients with acute MI who develop acute pericarditis?
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permitted provided pericard effusion does not develop or if present, does not increase in size
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pericardiectomy in pericarditis?
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Pericardiectomy is not effective for acute pericarditis or recurrent pericarditis.
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work-up for pericardial effusion (5)
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CBC, BUN Crea + [TAT-PB] TSH, ANA, tuberculin skin response; pericardiocentesis (culture, cytology, ADA activity, -- and rarely helpful, cell counts, LDH, total protein, glucose); surgical pericardial biopsy (for malig and sys inflammatory disease)
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treatment of malignant pericardial effusion
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prolonged catheter drainage, pericardial sclerosis, surgical decompression, and percutaneous balloon pericardiotomy.
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treatment of early or subacute tamponade
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serial monitoring, volume resuscitation, treat cause
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preferred method of drainage for malignant pericardial effusions or tamponade caused by aortic dissection
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surgical rather than pericardiocentesis
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NOTE: Caution with tamponade and mech ventilation and deep sedation
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may potentiate hemodynamic compromise (high PEEP reduces venous return, deep sedation reduces compensatory sympathetic drive)
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common causes of constrictive pericarditis in the US (4)
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viruses, surgery, irradiation, CTD
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diagnostic modality to differentiate constrictive pericarditis from restrictive CMP
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echo
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the only effective treatment for chronic constrictive pericarditis
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pericardiectomy
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when is pericardiectomy indicated?
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NYHA class II or III HF
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prognosis of constrictive pericarditis in TB
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resolves within 6 months of anti-TB treatment
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