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NEJM cardio 1

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ismailalmokyad's version from 2017-10-30 03:53

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Question Answer
pt with prosthetic valve who present with symptom suggestive of infective endocarditis, wt is the work upfirst TTE if not revealing then do TEE if still not revealing and suspicion is still high to PET scan. ESR is so sensitive but not enough to diagnose bc its not specific
Wt is the first step in management of pt presented with new onset dizziness after recent hospital discharge?reconcile meds, identify any medication changes specially antihypertensive meds.
how to relive pain in aortic dissection pt?(first management?)if type B (ascending aorta is not involved)and stable then BB (never nitropresside before BB), if BB contraindicatied then CCB. if there are symptoms of decrease organ perfusion and blood supply compramization then go for stenting or surgery.
What is metabolic equivalent ? and how to use it for per-ob non cardiac risk stratification. is is a way to measure the functional capacity if the pt can go one flight of stairs without stoping or can walk 2 blocks without stoping bc of pain then he is >4, if the pt has hx of stable coronary artery disease and has ME >4 then no need for further testing prior to low to medium risk non-cardiac surgery.
What are the conditions that should delay medium risk non cardiac surgery in pt with hx of CAD?unstable angina, valve disease, concerning arrhythmia, decompensated heart failure. this conditions need further cardiac work up.
Who long should elective non-cardiac surgery get delayed after stent placement?30 days if bare metal stent and 6 months after drug-eluting stent.
how to adjust aspirin and P2Y12 inhibitor before elective surgery in pt who is still in duel anti-platelet post stent ?ASA to be continued if possible and P2Y12 (clopidogrel, ticagrelor or prasugrel) should be started as soon as possible post surgery.
How to deal with decompansated heart failure prior to elective and emergent surgery?if elective treat until the pt is euvolemic then surgery if emergent then just go for surgery.
do you need echo before surgery if the pt has early systolic murmur suggistive of aortic scelerosis no need unless there is symptom of decompensated heart failure.
wt is the next step to evaluate new onset HF with signs of CAD as wall motion abnormalities on Echo or abnormalities on EKG?angiography
Wt is next step in pt present with transient monocular vision loss ?this consist with TIA and will need carotid U/S bc this way more common than heart as source of emboli. MRA or CTA may be considered when doppler studies are unrevealing or not avalible
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