cardio5 gd morning..simple - showman

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First on eis MI due to COCAINE ABUSE !!

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b, c, ?, e, e

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The correct answer is B. The main differential diagnoses for ST-segment elevations on the electrocardiogram include: acute myocardial infarction, ventricular aneurysm, pericarditis, and normal variants (secondary to J-point elevation). In a young patient with a presentation similar to those described in patients having a myocardial infarction, a high index of suspicion for drugs of abuse should be entertained, particularly amphetamines and cocaine. These drugs can precipitate acute myocardial infarction in healthy patients secondary to coronary vasospasm. In this case, the patient had taken too many amphetamines at the party, which precipitated the current event.

A cardiac contusion (choice A) can also cause ST-segment abnormalities. However, the contusion is usually attributed to blunt trauma, which is absent in this case.

Headache, profuse sweating, palpitations, and apprehension, often with the sense of impending doom, are common in patients with a pheochromocytoma (choice C). The blood pressure is elevated, often to alarming levels, and the elevation is usually accompanied by tachycardia. The paroxysm may be precipitated by any activity that displaces the abdominal contents. Although anxiety may accompany the attacks, mental or psychological stress does not usually provoke a crisis.

Plaque rupture (choice D) is more characteristic in patients who have risk factors for coronary artery disease, which appear to be absent in this healthy, athletic man.

Valvular incompetence (choice E) changes the blood pressure. In patients with aortic regurgitation the pulse pressure is increased and the diastolic pressure is decreased. In mitral regurgitation the systolic blood pressure is decreased because of a decrease in stroke volume.

[ArchivalUser]

The correct answer is C. The patient is status post a large myocardial infarction and at risk for left ventricular dilation and aneurysm formation. Addition of an angiotensin-converting enzyme inhibitor will be beneficial in preventing remodeling. Thus, lisinopril will be useful in preventing”or at least minimizing”the formation of an aneurysm.

Amiodarone (choice A) is useful in the setting of an arrhythmia such as atrial fibrillation, supraventricular tachycardia, or ventricular tachycardia. However, in the absence of such a disorder it is not indicated.

A calcium channel blocker such as diltiazem (choice B) is not strongly indicated in patients with heart failure or in patients who have recently suffered a myocardial infarction. In fact, short-acting housing calcium channel blockers have been shown to increase mortality.

Angiotensin receptor blockers such as losartan (choice D) have not been as intensively studied as angiotensin-converting enzyme inhibitors. Thus, there is little to support the use of losartan over lisinopril. However, if a patient is allergic to lisinopril then losartan should be considered.

Procainamide and other and other antiarrhythmics (choice E) are not automatically indicated in patients after a myocardial infarction. Indeed, these patients are at risk for malignant arrhythmias. However, a beta-blocker would be preferable. Recent studies have supported the use of a defibrillator if there is evidence of malignant arrhythmias, even after an ischemic episode is reversed.

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The correct answer is D. There is a clear indication for intervention, with progressive angina. With multiple vessels involved, the surgical option is better than angioplasty. The most critical graft should be done with the best available conduit, which is the internal mammary artery.

Angioplasty and stenting (choice A) is better suited for isolated vessels rather than multiple ones.

Seventy percent occlusion already is an indication for intervention, and it should be done before ventricular function deteriorates. Continued medical management until occlusion levels exceed 90% or ejection fraction becomes less than 35% (choice B) delays treatment until occlusion becomes more critical, or until ventricular damage precludes surgery.

The patient described has a normal ejection fraction. It could never become 85%, as suggested in choice C.

Using the saphenous vein (choice E) is the next best answer, which would be appropriate if for some reason the internal mammary artery were not available

[ArchivalUser]

The correct answer is D. It is important to know the indication for coronary artery bypass graft (CABG). These are 1. Significant left main coronary stenosis, 2. Left main equivalent: significant (>70%) stenosis of proximal LAD and proximal left circumflex artery, 3. Three-vessel disease (survival benefit is greater when LVEF is

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showman can we have answer of Q number 4.

[ArchivalUser]

The correct answer is D. It is important to know the indication for coronary artery bypass graft (CABG). These are 1. Significant left main coronary stenosis, 2. Left main equivalent: significant (greater than70%) stenosis of proximal LAD and proximal left circumflex artery, 3. Three-vessel disease (survival benefit is greater when LVEF is less than0.50), 4. Two-vessel disease with a significant proximal LAD stenosis and either ,0.50 or demonstrable ischemia on noninvasive testing, 5. One- or 2-vessel coronary artery disease without significant proximal LAD stenosis, but with a large area of viable myocardium and high-risk criteria on noninvasive testing, 6. Disabling angina despite maximal medical therapy, when surgery can be performed with acceptable risk.

Choices A and E are inappropriate because immediate intervention is required.

Reexamination in 6 months (choice B)”or sooner if symptoms worsen”is totally inappropriate because this patient has significant occlusion to one of the most vital arteries to the heart. Immediate intervention is necessary.

Percutaneous coronary intervention (choice C) is widely employed in patients with symptoms and evidence of ischemia due to stenoses of one or two vessels, exclusive of the left main coronary artery, and even selected patients with three-vessel disease.

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hello vanco..not seen much on forum these days?

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answer to last q showman that is the only one i was a bit disy rest all i was sure what is it