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55 y/o man complain of chest pain while he was resting. EKG find ST-segment depress >1 mm in lead I, aVl and V4. you are suspecting that this pt could develop arrhythmia and you are monitor with EKG at the hospital. what drug could prevent this person to develop the arrhythmia?
(A) digoxin
(B) lidocaine
© procainamide
(D) propranolol
you are suspecting that this pt's ischemia could get worse and you gave nitroglycerin, aspirin, heparin. what is the next step to prevent the clot formation to get worse for this person?
(A) increase dose of heparin
(B) add warfarin
© streptokinase
(D) abciximab
(E) clopidogrel
after medical treatment this person's chest pain go away. what is the next step for the management for this pt?
(A) advice to eat low salt food
(B) angiogram
© stress test
(D) warfarin to prevent development of the mural thrombus
(E) streptokinase
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no arrhythmia. don't give anti-arrhythmia drug. because itself can induce the arrhythmia.
answer is PROPRANOLOL.
if pt has high risk to form clot, add GpIIb/IIIa receptor blocker with aspirin and heparin to prevent the clot formation. if pt can't tolerate aspirin, give clopidogrel. answer is abciximab.
yes stress test if medical treatment respond before do the angiogram. base on stress test, decide to do the angiogram. if medical treatment don't respond, directly do the angiogram.
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what you would do if find LBBB at EKG in your office which is 3 hours away from the hospital?
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If the patient has new onset lbbb in ekg, its MI then emergent reperfusion is required via PCI or streptokinase
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@ gopal63108 .
If the patient has produced angina it literally means obstruction is greater than 70 % .. I think even if patients respond to treatment they would have to go through angiography to guide for angioplasty or CABG.
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angiogram is an invasive procedure. if medical treatment respond, do the stress test as long as can keep the pt on medical treatment and change the life style change. coloring use at the angiogram also have effect on kidney (if have kidney problem). if stress test positive, do the angiogram.
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i think propranolol is NOT used in angina since its not a cardioselective Bblocker.digoxin can be used instead?
every pt is given clopidogrel along with asprin to inc the antiplatelet effect.y abicimab?
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digoxin use only for atrial arrhythmia. and for CHF pt when diuretic, ACE-inhibitor and beta-blocker do not improve the cardiac output. Propanolol would decrease the vasoconstriction and decrease workload for the heart. and by blocking at the A-V node it would slow down the HR. so decrease the progression of the ischemia which would help to lower the chance to develop the arrhythmia. Dr. Hoque explain me this way in his note.
for nowckturn
probably clot size reduce after a few days. i am not sure. so no need for angiogram when medical treatment respond.
terss test