cardiology - 3stepstomle

[ArchivalUser]

tuff Qs 3stepstomle! and wht a variety of answers..lemme add to tht

B
A
A

plz dont forget to gv us the ans

[ArchivalUser]

B
A
B

[ArchivalUser]

1. Can we do A in the CCU or should we give E 1st while awaiting to do A
= Pt ha s complete HB = hypotension n Bradycardia,
2. A (not B b/c u need asprin plus clopidrogel given after PTCA)
3. Pt has second degree HB Mobitz type 2 which als need pacemaker but not sure about the 2 answers?

[ArchivalUser]

C
D
A

[ArchivalUser]

1Feedback: The combination of hypotension and bradycardia suggests a vagal response in the setting of an acute myocardial infarction. Administration of the anticholinergic agent atropine is the treatment of choice. If the bradyarrhythmia and hypotension persist after 2.0 mg of atropine has been administered in divided doses, the insertion of a temporary pacemaker is indicated. Isoproterenol should be avoided in patients with acute myocardial infarction, since it may greatly increase myocardial oxygen consumption and thus intensify ischemia. Volume replacement or inotropic support may be required if hypotension persists after correction of the bradyarrhythmia, but they are not indicated as initial therapies.



PTCA to reduce one or more coronary stenoses in the treatment of chronic angina unresponsive to medical therapy, unstable angina, or acute myocardial infarction has been employed with increasing frequency. The risks and benefits of PTCA compare favorably with those of conventional surgery. Given the decreased cost and recovery and hospitalization time, PTCA is preferred whenever possible. While the current PTCA success rate exceeds 90%, a return of cardiac ischemia within 6 months strongly suggests restenosis of the dilated segment. Such restenosis appears to result from excessive local smooth-muscle cell hyperplasia triggered by platelet adhesion on the balloon-damaged surface. While the use of nitrates, calcium channel antagonists, heparin, and aspirin just before and up to 6 months after the procedure helps prevent an acute closure resulting from spasm and thrombus formation, no anatomic or pharmacologic strategy has substantially reduced the restenosis rate. When recurrent ischemia develops more than 6 months after a PTCA, progression of disease at another site is more likely than restenosis. However, repeat PTCA is quite successful in treating patients with restenosis; bypass surgery is required in 10% of such patients.




The electrocardiogram discloses sudden failure of atrial ventricular conduction without a preceding change in the PR interval, termed Mobitz type II second-degree AV block, which usually reflects significant disease of the conduction system. It may occur after a significant anterior myocardial infarction or in Lev's disease, which involves calcification and sclerosis of the fibrous cardiac skeleton (frequently involving the aortic and mitral valves), or Lenègre's disease, which involves only the conducting system. Mobitz type II block is inherently unstable and tends to progress to complete heart block with a slow, lower escape pacemaker. Therefore, pacemaker implantation is necessary in this condition, particularly if the patient is symptomatic, as in this case.

[ArchivalUser]

i thot i cud read English until i came across these ans-explns! ;o)

for the 3rd Q, plz help me understand wht the expln is saying. is the ans A or B??!

[ArchivalUser]

1-beat is too low regarding to age and position..could be D
2-Reocclusion could be seen after PTCA but it can be managed by warfarin for 6 months.D
3-He has AVBlock Mobitz 1 so probably he need to be taken a pacemaker VI for long time otherwise he has a potiential risk for suddenly death.so answer is A.

[ArchivalUser]

d--- heart rate is 40,atropine for less than this,dobutamine in iv fluid can treat cardiogenic shock
e--- ptca can cause restenosis
c ---- as discussed by alfred