View Full Version : Int Med chat: Cardiology 1

04-02-2005, 09:12 PM
dua_frank has joined the chat.
[achache] HI
[achache] RUHERE
[nasrin06] hi
[rose1212] hello
[rose1212] Any one doing Step 2 CK Prepration?
[rose1212] *)
[rose1212] any on here?
[img68] hi
[img68] anyone here?
[img68] nasrin06
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[dua_frank] hey all
[ash] hi dua
[dua_frank] hi ash
[dua_frank] how are you?
[ash] did you do neurology yesterday?
[samantha] hi dua ash
[dua_frank] yes we did
[ash] good dua how are u?
[dua_frank] good too, hi sammy
[ash] so today cardiology?
[dua_frank] yes
[samantha] yes
[ash] ok
[samantha] today and tommorow is cardio
[ash] and what are cardio part 1 and 2?
[dua_frank] no idea :)
[ash] :)
[samantha] getting exam jitters
[samantha] as the exam nears feel paralysed
[dua_frank] me too
[ash] when is it sammy?
[samantha] with fear
[samantha] probably end of this month
[ash] ouch!!!!all the best
[dua_frank] oh man
[dua_frank] all the best sammy
[dua_frank] ash you better stick with me on these chat sessions
[dua_frank] i know yours is in aug
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[ash] here!my fingers are crossed for u
[samantha] thanx '
[ash] sure dua
[dua_frank] ok good, lets start
[ash] but u will leave me dua.urs is in june right?
[dua_frank] july ash
[ash] ok
[ash] then we are in this together
[dua_frank] but i will still be here for you coz i will be taking cs in aug
[ash] thanks!!!
[dua_frank] i don't mind continuing step 2 ck until my cs exam
[ash] it sort of helps with the differential diagnosis
[dua_frank] welcome
[samantha] i don't know how to read this medicine
[dua_frank] exactly, so its a benefit for me too
[dua_frank] to stay here with you until aug
[ash] ok shall we begin?
[ash] gee dua
[dua_frank] sammy is there any way you can postpone your exam?
[samantha] there is so much
[dua_frank] if you can, do it
[dua_frank] for a couple of more months
[samantha] do you think i have to dua
[dua_frank] and stick with us here until you see improvements in your q bank scores
[dua_frank] depends on your scores on q banks sammy
[dua_frank] if you are scoring more than 70%, you're good to go i think
[samantha] kind of in 60's
[lanny] hi all
[dua_frank] hi lanny
[samantha] hi lanny
[ash] hi lanny dear
[samantha] it fluctuates
[dua_frank] lanny how much should we ideally score on q banks to say we're prepared enough to go for this exam?
[ash] sam is this score in usmle world?
[dua_frank] mine too sammy
[lanny] hi sammy and dua ash all my friends
[lanny] hey dua im not a guy of proprtions
[samantha] lanny when is your exam
[lanny] generally i was getting 50 %
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[ash] a score of 65 in usmle world is supposed to be really good
[samantha] ash UW 50'2 and 60's
[lanny] but hey guys lkapan is not as easy as others say
[dua_frank] yeah ash and more than 70 on kaplan q bank
[ash] well that score gets you through
[lanny] i am averaging 70 on kaplan
[dua_frank] you're ready then lanny
[lanny] but the q are not all easy???
[ash] dua yesterday i tried some questions from qbank.they are too easy
[dua_frank] no they are not, quite tricky some of them
[dua_frank] but familiar scenarios
[lanny] some are tough so dont take kaplan lightly
[samantha] yes kaplan q bank is tricky kind of stressful to do them
[lanny] yes dua
[ash] ok thanks lanny.i probably got lucky yesterday
[dua_frank] sammy when you do q banks, just revise the wrongs you got well
[lanny] lucky for what?
[ash] but thanks for the warning
[dua_frank] so you'll see your scores improving
[img68] is it possible to share the qbanks?
[ash] well yesterday's questions were easy
[dua_frank] but if you are not scoring 70 on q banks, postpone the exam sammy
[lanny] UW has good explanations too read them!!
[dua_frank] how much did you score ash?
[ash] 37 on 50
[dua_frank] yeah UW for learning and kaplan q to know how dirty and tricky they can be :an
[dua_frank] thats very good ash
[lanny] i will say so
[samantha] i am not getting 70's still dua
[ash] hey but that was only 1 test.
[dua_frank] esp since you are just starting your prep and your exam is in aug
[dua_frank] sammy good idea to postpone
[lanny] i dont believe in correlations sammy
[samantha] i will see if i can postpone some more
[ash] yeah sammy agree with dua
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[lanny] read and do q as much as possoble,
[dua_frank] i'm planning on doing only q banks after this months' chat
[samantha] did you take nbme lanny?
[ash] lanny what do you think is the best source of questions?
[lanny] thats a good aproach dua
[dua_frank] so if we are all together in this, we can plan a strategy on revising and reading everything
[ash] and dua and sammy what do you think?
[lanny] not yet sammmy
[megs] hi all
[lanny] hi megs
[dua_frank] ash i think all q banks that give clinical scenarios are good
[ash] hi megs
[dua_frank] it keeps you stimulated
[ash] thanks dua
[lanny] ash UW and kaplan so far are the best sources
[dua_frank] welcome
[ash] thanks lanny
[megs] so cardio today
[lanny] i dont find q book very good
[samantha] hi megs you all cannot keep away for long lol
[megs] lol sammy
[dua_frank] megs you ditched us yesterday :an
[megs] dua lol
[lanny] me too dua how ws y day...
[dua_frank] you said you and i will give this exam together, jhooti *)
[lanny] i didnt see post
[dua_frank] lanny i lost yesterdays post
[dua_frank] i'll make doc post it
[lanny] ok dua i found the IM sched though tthanks!!
[megs] we will do that dua
[ash] hey people should we start now?
[lanny] ok guys shoot...
[dua_frank] ok
[dua_frank] substernal chest pain with a bad taste in the mouth with no significant history
[dua_frank] dx?
[lanny] zenkers
[ash] a 47 y/o woman with LDL 191 and c/o chest pain and ecg is abnormal.what next in mgt?
[ash] dua gerd
[lanny] total choesterol
[dua_frank] thrombolyse
[dua_frank] yes ash
[megs] agrre zenkers
[dua_frank] not halitosis, just a bad taste in mouth due to regurgitation and belching
[lanny] oh i t
[megs] ohh got it
[lanny] hought bad breath youmean
[dua_frank] and zenkers has dysphagia not chest pain
[ash] right lanny .now raised total cholesterol.what next?
[lanny] thrombolysis
[ash] ok ecg abnormal but not m.i.
[dua_frank] whats initial test for GERD?
[ash] what next?
[dua_frank] heparin?
[samantha] treat hypercholesterol
[samantha] ash
[ash] dua manometry
[lanny] aspirinendoscopy
[samantha] agree ash
[dua_frank] ph monitorin
[dua_frank] or upper GI endo
[ash] right sammy.so what do you do?
[lanny] prescribe statins
[ash] yes lanny
[samantha] give nitrites
[samantha] and beta blockers
[ash] what if her ldl was 150 and ecg was normal?
[dua_frank] controlling what risk factor improves immediate survival rates in a CAD patient?
[ash] no sammy give statins
[lanny] prescribe dietary modify
[samantha] for angina ash?
[ash] nice lanny
[ash] sammy ok
[ash] yeah if she has angina then right sammy
[dua_frank] smoking
[dua_frank] CP with dyspnea where dyspnea is more serious than cp dx?
[ash] now this lady has stress test positive then what next diagnostic method?
[ash] dua what is the full form of CP?
[dua_frank] chest pain
[megs] angiography ash
[samantha] pulmonary emoboli dua?
[dua_frank] yes sammy also pnemothorax
[ash] yes megs.why?
[lanny] angiograohy
[ash] thnx dua
[megs] to visualise arterial defect ash
[dua_frank] CP with chest tenderness dx?
[megs] chostochondritis
[dua_frank] yes
[ash] yes megs.now on arteriography left main a. involved.what next
[ash] ?
[dua_frank] cp with positional variation?
[dua_frank] bypass
[megs] then coronery bypass surg ash
[megs] pericarditis dua
lanny has left the chat.
[dua_frank] right
[samantha] plueritis
[ash] right dua and megs.what if 2 vessels involved excluding lt.main a?
[megs] which substance produses pain in angina???
[dua_frank] why is there fever in pneumothorax?
[lanny] severe wind here in NY power just went off and back
[dua_frank] PTCA
[ash] megs substance p
[megs] nope ash
[megs] agree ptca
[lanny] PTCA
[ash] both right
[megs] ita adenosin
[dua_frank] oh thanks megs
[megs] adenosin...cause anginal pain
[megs] what is syndrome x???
[ash] oh thanks megs
[dua_frank] obesity, DM and CAD
[dua_frank] atelectasis
[ash] that is in step 1 right megs
[megs] ARE U SURE DUA???
[dua_frank] i think so megs :(
[megs] CAD WIthout any positive finding on angioghraphy
[dua_frank] that is syndrome x?
lanny has left the chat.
[megs] means there will be ischemia...angina...but no positive fi ndings on angiography is syndrome x
[lanny] happened again severe winds
[ash] this woman comes with M.I and also history of malena recently.what treatment?
[dua_frank] http://www.mayoclinic.com/invoke.cfm?id=AN00404
[lanny] agree megs
[megs] wb lanny
[dua_frank] PTCA ash?
[lanny] ash have no clue.. trt the MI thromboltics??
[ash] right angioplasty and stent
[dua_frank] when do you stop tread mill testing?
[megs] can u explain ash
[samantha] no thrombolytics megs
[lanny] ok i dont have the original q ash
[megs] when there is chest pain
[lanny] EKG changes
[dua_frank] thats abnormally yes
[dua_frank] all those are right
[lanny] ST depress
[dua_frank] but when 85% of max heart rate is reached
[samantha] yup'
[dua_frank] can a person taking digoxin get on a TMT test?
[megs] what is thallium treadmill???
[samantha] when there is melena
[samantha] no thrombolytics
[ash] megs this pt has a history of recent malena and has come with m.i.so we cant give her heparin as it is contraindicated in case of malena.instead you perform angioplasty and put a stent to keep the artery patent
[lanny] dua please post todays in case i dont get back in thankyou there is off and on power outages here
[dua_frank] thallium is injected to record where the ischemia is
[dua_frank] its a tracer
[dua_frank] sure lanny
[megs] ok ash
[ash] thallium free area is the ischemic area
[dua_frank] yeah
[megs] right both
[dua_frank] hypoperfused areas are less thallium lit
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[dua_frank] patient on dig cannot take TMT
[ash] for how long after m.i. do you give thrombolytics?
[lanny] om back
[lanny] 6 wks
[ash] welcome back lanny
[dua_frank] for this patient, stress echo and stress thallium are appropriate
[lanny] thakns
[samantha] wblanny
[dua_frank] wb lanny
[lanny] dua whats TMT
[samantha] 4 hours ash
[ash] 12 hours
[dua_frank] tread mill testing
[samantha] for TPA?
[lanny] oh ok
[dua_frank] what does stress echo show?
[ash] and for how long after a stroke can you give thrombolytics?
[dua_frank] 3 hours
[lanny] 3 hrs
[ash] dua it shows a wall that is moving slower than the rest of the heart
[samantha] for streptokinase?
[dua_frank] right
[ash] right dua and lanny
[samantha] it is a little longer for streptoo
[ash] what if a patient has come with m.i. and had a previous episode of m.i. for which he was given streptokinase?
[samantha] it is different for MI and stroke also
[samantha] rt
[ash] oh ok thanks sammy
[ash] ghar pe aaj biryani he?
[samantha] yea ash have to check it out
[dua_frank] you don't give stk again
[dua_frank] right ash?
[ash] right dua
[dua_frank] bbq tha :)
[ash] so what do you give?
[dua_frank] tandoori chicken
[dua_frank] tpa?
[samantha] only heparin ash?
[ash] oh yaar i have to learn this stuff from u
[lanny] i think strp has dev of antibodies to it or allergies???
[ash] dua right
[ash] yes lanny
[dua_frank] lots of time after our exams until we get into residencies
[lanny] what about TPA
[ash] sammy we can still give tpa
[lanny] wont you give it
[ash] yes lanny dua said it
[lanny] yes we can
[samantha] ok ash
[lanny] oh ok
[dua_frank] when do you give ticlopidine?
[lanny] within 1 hr of chest pain
[samantha] when you have allergy to aspirin dua
[ash] to prevent further ischemia
[dua_frank] right sammy
[dua_frank] what drugs do you give typically for IHD?
[ash] yeah
[lanny] nitrates
[dua_frank] and?
[samantha] Beta blockers
[lanny] b blockers?/
[ash] beta blockers
[dua_frank] right and aspirin
[ash] morphine
[ash] heparin
[samantha] and oxygen
[dua_frank] what if an IHD pt also has LVF or HTN or DM?
[ash] thrombolytics
[ash] oxygen
[samantha] ACE in hibitors
[dua_frank] right
[dua_frank] what if a person is CI to taking b blockers?
[dua_frank] like asthmatic or DM
[samantha] ace inhibitors
[dua_frank] CCBs
[samantha] in diabetes ace dua
[dua_frank] or ace too yes but remember CCBs is an option too if b blockers are contraindicated
[dua_frank] you can give both sammy
[samantha] ok dua
[dua_frank] you have to put the patient on at least 3-4 drugs
[dua_frank] aspirin, nitratse, bbl/ccb, ace inhi
[samantha] is diuretics contra indicated in diabetics?
[ash] no sammy
[dua_frank] no
[ash] if chf and diabetic the diuretics are given
[samantha] ok
[dua_frank] which statin decs TGs the most?
[ash] or if an african american with diabetes and hypertension then again diuretics are given
[ash] no idea dua
[samantha] alright ash
[dua_frank] gembibrozil
[dua_frank] which statin inc HDL the most?
[ash] dua thats not a statin
[dua_frank] oops
[ash] oh u mean anti lipidemic
[dua_frank] i shoud have said cholesterol controling drugs
[dua_frank] right
[ash] got it
[samantha] niacin dua
[ash] dua niacin
[dua_frank] right
[ash] bad sideeffect of statins?
[ash] esp. when given with gemfibrosil?
[dua_frank] pancreatitis?
[samantha] rhabdomyolysis
[ash] rhabdomyolysis
[ash] right sammy
[dua_frank] oh
[ash] i think only gemfibrosil causes pancreatitis
[ash] not statins
[dua_frank] oh ok
[dua_frank] thanks
[samantha] have to remember step 1
[ash] yeah i dont remember it anymore.
[ash] :(
[dua_frank] :(
[ash] raat gayi baat gayi
[dua_frank] lol
[samantha] lol
lanny has left the chat.
[dua_frank] what drugs lower mortality?
[samantha] beta blockers dua
[dua_frank] and?
[samantha] and ace also
[dua_frank] aspirin too
[dua_frank] statins
[samantha] yup
[dua_frank] heparin too
[ash] 65 y/o man in CCU in your care with M.I. YEsterday.he got all emergency medicines .c/o confusion,b.p.-70/40,pulse-40 and clear chest.cannon a waves and murmur.ddiagnosis?
[dua_frank] rupture
[dua_frank] tamponade
[dua_frank] oh yseterday
[dua_frank] papillary ms tear?
[ash] dua see the pulse rate
[dua_frank] :(
[samantha] ccf ash?
[ash] this is a tricky question.try
[samantha] block
[samantha] complete heart block
[ash] sammy.yippie!!!
[dua_frank] nice
[samantha] cannon a waves!!!
[samantha] rt?
[ash] it is third degree heart block.cannon a waves,bradycardia,syncope,low b.p.
[ash] ye ssammy
[dua_frank] yes i remeber now, thanks
[ash] if this same patient had tachycardia and rest all same then ?
[samantha] good q ash
[ash] thanks sam
[ash] good ans sam
[samantha] wc
[dua_frank] inferior wall MI?
[dua_frank] RV infarct
[ash] right dua right ventricular infarct
[ash] also it could be tamponade
[dua_frank] ok
[ash] if the chest had rales
[ash] +tachycardia?
[samantha] good dua
[dua_frank] oh man
[dua_frank] cardiogenic shock?
[ash] dua she has murmur
[dua_frank] v tach?
[dua_frank] dunno
[ash] cardiogenic shock would be right if the pt. had no mur mur
[samantha] papillart muscle rupture ash
[dua_frank] ok
[ash] right sammy
[ash] valve rupture
[dua_frank] good q
[samantha] yes
[dua_frank] when do you not shock a patient?
[samantha] asystole dua
[ash] hey girls i will be back in a moment
[dua_frank] yes also EMD and bradycardia
[dua_frank] CHB
[dua_frank] cardiac arrest scenarios
[dua_frank] rx for brady?
[samantha] atropine
[dua_frank] right
[samantha] epi?
[dua_frank] SE of adriamycin?
[dua_frank] yeah that too
[dua_frank] atro epi or PM
[samantha] what is PM dua
[dua_frank] pace maker
[samantha] ok
[dua_frank] CCF
[megs] adriamycin..cardiomyopathy is side ffect
[dua_frank] rx?
[dua_frank] yes leading to CHF eventually
[megs] rx of what dua??
[dua_frank] CHF
[megs] i.v furosemide,a ce inhibitors
[samantha] is it an chemo drug?
[megs] digoxin
[samantha] diuretics
[megs] adriamycin is doxorubicin
[dua_frank] right also aspirin and morphine
[samantha] oh...now i know
[megs] why aspirin in CHF DUA???
[dua_frank] oops
[megs] how it help??
[dua_frank] oxygen not aspirin :(
[megs] ok lol
[dua_frank] need to wake up
[dua_frank] patient with high BP and CHF, dobutamine or dopamine?
[samantha] dopamin
[dua_frank] also ace inhibs
[megs] dua dint get u r q??
[dua_frank] dobutamine
[megs] do we give dopa in CHF??
[lanny] just got power back..
[samantha] but dobutamine inc the BP dua
[dua_frank] its an ionotroph
[dua_frank] sammy dobutamine has effect only on heart
[lanny] right dua
[dua_frank] what do patients with CHF die of?
[lanny] MI
[samantha] oh...
[dua_frank] PE
[dua_frank] pulmonary edema that is
[megs] V FIBR
[dua_frank] whats the best test to measure EF?
[samantha] MUGA...
[megs] AGREE SAM
[lanny] some scan dua
[dua_frank] right
[dua_frank] i like the name muga
[dua_frank] :)
[dua_frank] nuclear ventriculogram
[samantha] nuclear ventriculogram megs
[dua_frank] funny how that doesnt' corelate to MUGA
[samantha] multigated ventriculograam
[lanny] whats noormal EF
[dua_frank] do you give b blockers to a patient who is on CHF?
[lanny] yes dua
[lanny] nowadays yes
[dua_frank] yes
[lanny] esp in non acute setting b block is giving
[samantha] ok..
[lanny] dua i thought 60 % normal EF
[dua_frank] yeah 60% is normal
[megs] OK
[dua_frank] 40% is determine to whether they can be taken for cardiac surgery or not
[dua_frank] generally less than 40% surgeons don't take the patient
[dua_frank] high risk
[lanny] yes thats abnormal
[lanny] well yes risk
[lanny] rather than abnormal
[dua_frank] yeah
[dua_frank] yes
[lanny] is prophyl for rheumatic fever ?given to MVP
[dua_frank] no
[lanny] right
[lanny] what about for endocard?
[dua_frank] yes
[lanny] right dua
[lanny] so whats the diff in trtments??
[dua_frank] hehe good q lanny, megs you answer :P
[lanny] mean why dont we give for r fever but give for endo?
[dua_frank] endo affects any damaged valve lanny
[dua_frank] even scared ones by surgery
[dua_frank] not just only after RF
[lanny] right dua and R fever in stenotic lesions
[dua_frank] yes
[dua_frank] rx for CHF in AS?
[lanny] remember they wont say MVP they will bring sms of MR
[dua_frank] right lanny
[lanny] valve replacememt
[dua_frank] heart replacement lanny
[dua_frank] you have to do AVR before CMP sets in
[lanny] thsts what i meant valve replacement
[megs] what is CMP DUA??
[lanny] cardiomyoapthy
[dua_frank] cardiomyopathy
[dua_frank] hypertrophic kind
[dua_frank] due to AS
[lanny] dua why did you say heart replacement
[dua_frank] once the CMP has set in, its irreversible lanny, even AVR will not help anymore nor any drug
[lanny] yes CMP is trminal but you do valve replacement first
[lanny] before transplant or to avoid it
[dua_frank] huh?
[dua_frank] you're replacing the whole heart then whats the point of doing AVR?
[megs] never heard heart transplant for AS directly
[dua_frank] AS with CMP megs, no surgeon will again touch such a case of AVR, won't help
[samantha] causes of sudden cardiac death?
[dua_frank] that is why EF is so important in cardiac surgeries
[megs] if CMP Is already there then yes i agree with u dua
[dua_frank] that was my q wasn't it?
[lanny] but dua the q you asked did not say CMP set in
[megs] ok ...dua nice one
[lanny] i agree with your point though
[megs] didnt get the q only
[dua_frank] i did ask that lanny
[dua_frank] rx for CHF in AS
[lanny] ok i didnt see it
[lanny] the AS is causing the CHF right dua
[dua_frank] yes right
[samantha] hypertrophic cardiomyopathy AS and MVP
[dua_frank] AS too sammy?
[dua_frank] oh yes
[samantha] yes dua
[dua_frank] HOCM too
[dua_frank] thats IHSS
[megs] as with chf...diuretics and digoxin ...medical treatment
[dua_frank] yes megs
[dua_frank] and anticoagulants right?
[lanny] MVP causes sudden death?
[samantha] yes lanny
[lanny] thx sam
[samantha] wc
[dua_frank] rx for IHSS and MVP?
[lanny] large septal q waves ? coronary artery ok whats dx??
[megs] ihss..surical recection of septum
[dua_frank] IHSS lanny?
[samantha] surgery for IHSS
[dua_frank] medical rx please
[lanny] right dua
[lanny] oh dua you wanna get us???lol lol
[dua_frank] usmle is out to get you lanny not me :lolup: :scared:
[lanny] digoxin is contra
[lanny] all inotropes too
[dua_frank] CI in what lanny?
[lanny] IHSS
[megs] IHSS DUA
[dua_frank] its the main stay of rx lanny
[dua_frank] b blockers and digoxin
[samantha] he he
[lanny] yes megs
[samantha] it can aggravate it rt
[megs] b blocker can be given
[lanny] you are not going to overwork the heart
[lanny] when there is little place for blod to pas
[megs] yes lanny
[lanny] we did this in last chat megs
[megs] yes lanny
[dua_frank] but digoxin does increase HR
[dua_frank] it only incs force of contraction
[dua_frank] also gives time for heart to relax between each contraction
[dua_frank] so then why is it CI?
[lanny] no dua digoxin is usu not given in IHSS
[megs] there is obstruction dua
[lanny] b blockers calcium ch blocks are given
[megs] so we can not give it
[dua_frank] ok
[lanny] dua imagine you are going to put more force in a blocked heary
[samantha] the septum is hypertrophied so ionotropes will make it worse
[lanny] no place for outflow
[lanny] right sam
[samantha] it will close the valve more am i rt?
[samantha] ok lanny
[samantha] it can cause syncope
[dua_frank] right got it
[dua_frank] it increases force of contraction which is bad for HOCM
[dua_frank] good point
[dua_frank] stupid kaplan had digoxin listed as drug for hocm
[lanny] sammy it will make the heart be contracing forcefully with no where for the blood to flow casuing more congestion and dilation and back up
[lanny] dua in my kaplan it is not listed as DOC
[samantha] agree lanny
[ash] wow!!!did i miss a lot!!!sorry was on the phone with my folks
[dua_frank] lanny can you believe conrad ****** the great himself said this in the audio lectures?
[dua_frank] wb ash
[samantha] there is so much in cardio
[lanny] oh yea
[lanny] never give diuretics too in IHSS
[dua_frank] yeah thats understandable
[samantha] wb ash
[dua_frank] in fact all BP lowering drugs should be avoided
[dua_frank] rx of pericarditis?
[lanny] right
[lanny] also what should be avoided??
[samantha] steroids?
[dua_frank] dig
[lanny] n think think young athlete......
[dua_frank] thunk thunk thunk, dunno
[lanny] thunk thunk thunk....
[dua_frank] lol
[lanny] LOL LOL LOL
[dua_frank] ahhhhhhhh i was thinking of some drug
ash has left the chat.
[dua_frank] imagine telling an athelete not to exercise lol
[lanny] right
[dua_frank] he would look at you like youve gone nuts lol
[lanny] well theyy usu prst with IHSS
[samantha] steroids dua
[dua_frank] i would agree about anabolic steroids too but i don't know why
[lanny] he can do soft sports...
[dua_frank] can you give an explaination sammy?
[megs] how do we reduce pressure gradient across left ventrical???
[lanny] oh megs it just came off my head...
[dua_frank] give drugs to reduce preload
[dua_frank] and afterload
[lanny] calcium chanlle???
[megs] actually b blockers
[dua_frank] :O
[samantha] try ibupropen 600 mgms PO or aspirin or indo can be used if all fails pericardectomy
[dua_frank] b blockers alone?
[megs] in HOCM i mean dua
[dua_frank] oh ofcourse
[dua_frank] i thought you were asking in general
[lanny] me too dua
[megs] then in generall u said right dua
[dua_frank] when do you pericardial window or strip pericardium in pericardial effusion?
[megs] in recurrent pericardial effusion dua???
[dua_frank] right
[dua_frank] recurrance is the key word
[lanny] agree
[samantha] in pericardial effucition dua
[lanny] what do you do first before considering window??
[dua_frank] what will you do a patient with asymptomatic bradycardia?
[dua_frank] pericardiocentesis
[megs] pericardiocentesis
[lanny] right
[megs] nothing dua...
[megs] if asymtomatic
[dua_frank] right
[dua_frank] if symptomatic?
[megs] atropine...
[lanny] atrpine
[dua_frank] yes
[samantha] epi atropine
[dua_frank] do you rx first degree AVB?
[lanny] no
[samantha] no
[megs] no
[samantha] 2nd degree if sympto
[dua_frank] do not be hasty friends :P its an open ended q. you must reply, yes if its symptomatic
[megs] what type of chf u see in IHSS high output or low output???
[dua_frank] low output
[lanny] low output
[megs] what are pther ex 'of low output failure
[dua_frank] cardiogenic shock
[samantha] hypovolumia
[lanny] dehydration
[megs] lol yes
[samantha] hypothyroi?
[dua_frank] good sammy
[lanny] so megs whatis low outputfailure???
[dua_frank] cardiomegaly with bradycardia
[dua_frank] very good, never thought about that
[lanny] or megs how is high output failure be explained in CHF>???
[samantha] thanx dua
[megs] if much fluid in circulation ..high output failure
[samantha] what is the most imp cause of aortic dissection?
[lanny] HTN
[samantha] yes megs
[samantha] rt lanny
[lanny] ok megs
[samantha] causes of aortic dissec?
[dua_frank] marfans
[lanny] HTN
[dua_frank] Atherosclerosis
[dua_frank] HTN
[samantha] ehlerl danlos preg coarctation aortic stenosis
[samantha] relapsing polychonditie
[samantha] correct all
[samantha] what is the radiographic finding?
[lanny] what sm is worse prognosis in AS??
[dua_frank] double something
[dua_frank] dyspnea lanny?
[samantha] widening of mediastinum
[lanny] CHF dua but youre right too
[dua_frank] due to CHF
[lanny] ok dua you goit
[dua_frank] AF in graves disease with pt stable
[dua_frank] rx?
[samantha] beta blockers
[dua_frank] adenosine first sammy then b blocker
[lanny] agree sam
[dua_frank] same patient but with AF last for one week
[dua_frank] what other drug do you add?
[lanny] epi??
[samantha] valpro?
[dua_frank] coumadin
[dua_frank] to prevent embolization
[dua_frank] same patient with confusion, what do you do first?
[samantha] rt... :p
[dua_frank] :P
[samantha] deffribrilate
[samantha] dua
[dua_frank] correct
[samantha] or is it lido?
[dua_frank] rx of torsades pointes?
[dua_frank] no shock first always
[lanny] adenosine
[samantha] ok
[dua_frank] adnenosine or magnesium lanny?
[dua_frank] mag i think
[samantha] yes megnesium
[lanny] oh mag adenosine can cause it..
[lanny] sorry
[dua_frank] adenosine can cause it?
[dua_frank] or amiodarone?
[lanny] now you got me thinking...
[dua_frank] its amiodarone lanny
[lanny] oh ok thanks
[lanny] yes youre right
[lanny] adenosine is toc for SVT
[dua_frank] right
[dua_frank] most short acting so with least side effects
[lanny] is adenosine used nowadays??
[dua_frank] lasts for only like 8 seconds
[dua_frank] yeah it is
[dua_frank] MC arythmia in dig tox?
[lanny] most short acting of the antiarrythmics??
[dua_frank] adenosine :P
[lanny] yes dua i mean adenosine
[dua_frank] SVT with block
[samantha] is it heart block dua
[lanny] atrial fib dua
[dua_frank] supraventricular tach with variable blocks
[dua_frank] yes lanny
[dua_frank] shall we call it a day today?
[samantha] alright
[lanny] ok dua plz post todays ...thankyou
[dua_frank] will do
[dua_frank] bye all and thanks
[samantha] thanx all
[lanny] see you all tom for cardio and rheuma
[samantha] yes bye lanny dua megs

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