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UWorld Step 2 CK Notes - 2015

This document contains summaries of several patient cases involving cardiology issues. One case discusses a recent immigrant from China presenting with fatigue, dyspnea, and abdominal distention who was diagnosed with constrictive pericarditis after examination found signs of venous overload. Another case involves distinguishing between renal artery stenosis and abdominal aortic aneurysm based on differences in blood pressure readings in the arms and auscultated bruits. A third case reviews the presentation of aortic stenosis.

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Ernesto Prado
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6K views

UWorld Step 2 CK Notes - 2015

This document contains summaries of several patient cases involving cardiology issues. One case discusses a recent immigrant from China presenting with fatigue, dyspnea, and abdominal distention who was diagnosed with constrictive pericarditis after examination found signs of venous overload. Another case involves distinguishing between renal artery stenosis and abdominal aortic aneurysm based on differences in blood pressure readings in the arms and auscultated bruits. A third case reviews the presentation of aortic stenosis.

Uploaded by

Ernesto Prado
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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CARDIOLOGY

Qid 3635
Recent Immigrant from China Endemic Areas (Africa, India &
China)
CC:
Fatigue and Dyspnea on Exertion = decrease Cardiac Output
Abdominal distention for the Past 2 months =
Hepatosplenomegaly
SHx: Farmer his entire life
VS: wnl
PE: (Signs of Venous Overload)
Pedal Edema
Increase abdominal girth with free fluid = Ascities
Elevated JVP without Inspiratory decline = KUSSMAUL SIGN
Chest Ausculation = decrease heart sounds & Accentuated sound
directly after the S2 in Early Diastole = KNOCK OF S3 GALLOP
CXR = ring of calcification around the heart Pericardial Fibrosis
JVP Tracing: Prominent X & Y DESCENTS
Q: Most likely cause of symptoms? TB ***
Dx: Constrictive Pericarditis
In US, MCC of Constrictive Pericarditis include:
Idiopathic or Viral Pericarditis (>40%)
Radiation Therapy (~30%)
Cardiac Surgery (~10%)
Connective Tissue Disorders
Tachypnea & Dyspnea occurs when CO becomes compromised
Qid: 4682
Renal Artery Stenosis vs. Abdominal Aortic Anerysm
Differenial in BP b/w the Pxs Arm secondary to Subclavian
Atherosclerotic dz
o Aortic Dissection = Greater RIGHT ARM BP +
SMOKING HX
SYSTOLIC BRUIT
o RAS = Greater LEFT ARM BP
SYSTOLIC-DIASTOLIC BRUIT
QID: 3768
Adenosine inhibits L-type Ca channels, decreasing conduction
velocity in the AV node

Qid: 4592
Normal Juguglar Venous Pressure ( <3 cm above the Sternal
Angle) = suggest NL Central Venous Pressure = makes Right & Left HF
Less Likely.
Peripheral Edema due to Venous Insufficiency:
Leg discomfort, Pain or Swelling
o Worsens: Prolonged Standing
o Improves: After Walking or Limb Elevation
Depending on the severity.
o Venous Dilation (Telangiectasia, Varicose Veins)
o Pitting Edema
o Skin discoloration
o Dermatitis/Eczema
o Lipodermatosclerosis
o Skin Ulceration Px Medial Ankle Ulcer
Initial Tx of Chronic Venous Dz:
o Frequent Leg Elevation
o Exercise
o Compression Stocking
Px NOT responding to Initial Conservative
measurement require
VENOUS DUPLEX
ULTRASOUND to Identify Venous Reflux or
Insufficiency
Px w/ Persistent symptoms & Documented
Reflux should be referred for ENDOVENOUS
ABLATION
Qid: 2153
Aortic Stenosis:
Exertional Symptoms Chest Pain, Dyspnea, Dizziness, &
Syncope
Delayed & Diminished Carotid Pulse (PULSUS PARVUS ET
TARDUS)
Single and Soft S2, audible S4
Harsh Ejection (Crescendo-Decrescendo) Systolic Murmur in
Second Right Intercostal Space with Radiation to Carotids
Echocardiogram should be obtained in ALL Px with SYNCOPE due
to suspected structural Heart Dz.
Qid: 4705
Large VSD Failure to Thrive, Easy Fatigability & Heart Failure.
Pansystolic Murmur Loudest at Lt Lower Sternal Border
(LLSB)

o DDx: Tetralogy of Fallot from Pulmonic Stenosis


Harsh, Systolic Ejection Murmur over Lt Upper
Sternal Border (LUSB)
Diastolic Rumble at the Apex due to increased flow across the
Mitral Valve
Small VSD Asymptomatic
Large VSD Quieter due to LESS TURBULENCE through a Large
Orifice.
o Significant Left to Right Shunting
Dx: Echocardiogram Evaluate the location & size of the defect.
DDx: Eisenmenger X Cyanosis & Dyspnea secondary to Right to
Left Shunting
Qid: 8927
Peripheral Artery Dz (PAD):
Claudication ex: Cramping Pain in Rt thigh after walking 2
blocks (Limp)
Claudication or Pain in Leg Muscle brought on by a
predicable amount of walking (or other form of exercise)
and relieved by rest.
Intermittent Claudication + Diminished Pulses + (<1) Ankle
Brachial Index
Intermittent Claudication = Strong Predictor of Future Risk of
Cardiovascular Morbidity & Mortality
o 20% 5 year risk of Nonfatal Myocardial Infarction & Stroke
o 15% to 30% 5 year risk of death due to Cardiovascular
causes
Qid: 3881
Syncopal Episode:
Most probable explanation of Episode is:
ARRHYTHMIA:
o Sudden Onset of Syncope without warning sings
o Presence of Structural Heart Dz (Post-infarction Scar &
Probable Mitral Regurgitation = mild holosystolic Apical
Murmur)
o Frequent Ectopic Beats
o Thiazide diuretic = Electrolyte disturbance predisposing
to Ventricular Arrhythmia
VASOVAGAL SYNCOPE:
o Common Fainting Spell
o Precipitated by Emotional Reaction
o Preceded by: Presyncopal Dizziness, Weakness & Nausea

AUTONOMIC DYSFUNCTION OR DRUG-INDUCED POSTURAL


HYPOTENSION:
o Orthostatic in Nature
o Occurs on Standing when blood is redistributed
SEIZURE:
o Hx of Seizure

Premature Ventricular Complexes (PVCs):


Wide QRS (>120 msec)
Bizarre morphology
Compensatory pause
MC in Px with Cardiac Pathology following MI
Multiple PVCs may indicate a worse prognosis
Tx with antiarrhythmic medications has actually been shown to
worse survival OBSERVATION**
o No Tx indicated if Px is Asymptomatic
o Beta-blockers are DOC for Symptomatic Px.

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