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This is With Your Host... EKG ID Cardiac Murmurs Physical Signs Antiarrhythmics EKG ID Cardiac murmurs Physical signs Antiarrhythmics 100 100 100 100 200 200 200 200 300 300 300 300 400 400 400 400 500 500 500 500 What is a normal ECG? What is anterior wall MI? What is ventricular tachycardia? What is Wolf-Parkinson-White Syndrome (WPW) ? What is atrial flutter? With a slow carotid upstroke, this murmur is best heard in the 2nd L ICS and occurs in midsystole, though a late-peaking one may indicate worse disease What is aortic stenosis? Best heard at the apex and with the patients in left lateral decubitus, it is holo-diastolic and low-pitched—rare now with reduction in RHD cases What is mitral stenosis? A blowing, decrescendo, diastolic murmur, it is associated with many conditions such as Marfan syndrome and ankylosing spondylitis What is aortic regurgitation? th 19 Named after a century American MD, this diastolic murmur is best heard in the apex; it suggests severe AR and is thought to be related to early closure of the mitral valve What is Austin Flint murmur? In AS, the murmur may radiate to the apical area mimicking MR presumed to be due to high frequency vibrations from a calcific aortic valve to the apex What is Gallavardin phenomenon? This finding is defined by a greater than 10 mm Hg inspiratory decline in systolic arterial pressure What is pulsus paradoxus? Inspiratory rise in jugular venous pressure commonly seen in cardiac tamponade What is Kussmaul’s sign? Performed by attempting to forcibly exhale while keeping the mouth and nose closed, this maneuver can terminate supraventricular tachycardias What is Valsalva maneuver? Increase in the intensity of tricuspid regurgitation murmur during inspiration What is Carvallo’s sign? Systolic and diastolic twophase murmur that can be heard over the femoral artery in severe aortic regurgitation What is Duroziez’s sign or murmur? Class Ia antiarrhythmic agent known to cause “cinchonism” What is Quinidine? Class II antiarrhythmic agents known to improve survival in CAD and HF patients What are beta blockers? Class III antiarrhythmic agent with a half life of 45days What is amiodarone? A very effective pure class III antiarrhytmic agent for the conversion of atrial flutter; it may however prolong the QT interval and promote torsades What is Dofetilide (or Ibutilide)? Class Ia antiarrhythmic agent often used to treat atrial fibrillation in the setting of WPW What is procainamide (Pronestyl)? ACS 911 Images in Cardiology Blood Markers Heart Failure ACS 911 Images in Cardiology Blood markers Heart Failure 200 200 200 200 400 400 400 400 600 600 600 600 800 800 800 800 1000 1000 1000 1000 According to the TIMI score, the minimum patient age that merits 1 point indicating high risk What is 65 years? Killip class consistent with (+) rales, S3, JVD but no acute pulmonary edema What is Killip class II? Among patients who receive DES, the minimum duration (in months) of aspirin therapy 162325 mg/d before switching to 75-162 mg/d indefinitely What is 3 months? While recommended PCI DTB time is <90 minutes, this is the maximum Door-to-Needle time (in minutes) to treat STEMI patients with fibrinolytics in non-PCI hospitals What is 30 minutes? Regardless of reperfusion therapy, STEMI patients should take clopidogrel 75 mg/d in addition to aspirin for at least this this number of days What is 14 days? What is infective endocarditis (Janeway lesions)? What is aortic dissection (widened mediastinum)? What is infective endocarditis (splinter hemorrhage)? What is a prosthetic (metallic) mitral valve? What is hypothermia (Osborne waves)? These biomarkers are highly sensitive and specific for acute myocardial injury and offer equivalent, robust prognostic information; make sure to note kidney function What are troponins I and T? This biologically active hormone from the ventricles is secreted in response to LV wall stress; its clinical use is accepted in HF and emerging in ACS What is BNP? Synthesized by the liver, this readily available acute phase reactant is an independent but non-specific marker of inflammation, and mediator of endothelial function What is CRP? This molecule is present in IDL, VLDL, LDL and chylomicrons; thus, it represents the total burden of lipoprotein particles that are most atherogenic What is ApoB-100? Made by the hypothalamus and stored in the post. pituitary, excess of this hormone leads to worse HF and blockade of its receptor (i.e. tolvaptan) results in relief of acute symptoms What is arginine vasopressin? In the DIG trial, although this drug did not reduce mortality of patients with systolic HF, it reduced the rate of readmissions What is Digoxin? As shown by the RALES trial, this drug improved mortality in patients with stage II-IV HF and low EF (<30%) What is spironolactone (Aldactone)? In the A-HEFT trial, African American HF patients responded better to this combination therapy What are hydralazine and isosorbide dinitrate (BiDil)? In the COMET trial, this closely related drug proved to be superior to metoprolol in the treatment of HF patients What is carvedilol (Coreg)? In the CHARM trial, the addition of this class of drugs to ACE-I therapy proved to be superior to ACE therapy alone in systolic HF patients What are ARBs? (Angiotensin receptor blockers) Late breaking Trials This recently published trial (NEJM) showed that patients with normal LDL levels and high CRP were at higher risk for death and would benefit from statin therapy as primary prevention for CVD What is the JUPITER trial? (The Justification for the Use of statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin) Thank you for playing