下壁梗塞においては時に迷走神経トーヌスが過剰に亢進することがあり,Bezold―Jarisch reflexとして知られる。迷走神経が緊張すると消化管の蠕動運動は亢進し,高じれば悪心や嘔吐,下痢などの消化器症状を呈することとなる。実際には下壁梗塞の約半数に消化器症状が認められるとする報告もある。 cardiology卒試国試 Oct 20, 2020, 4:25 AM HirotoShishido
心房細動への抗凝固療法弁膜症性心房細動における抗凝固療法の適応はワルファリンのみである一方,非弁膜症性心房細動では,ワルファリン以外にも直接経口抗凝固薬〔(DOAC)直接トロンビン阻害薬:ダビガトラン,第Xa因子阻害薬:リバーロキサバン,アピキサバン,エドキサバン〕が適応となる cardiologyhematology国試過去3回 Oct 12, 2020, 2:43 AM HirotoShishido
treatment for Torsades de pointes(TdP)★IV magnesium, temporary pacing, isoproterenol and correcting the underlying cause of prolonged QT, electrical cardioversion if hemodynamic compromise cardiologyUWorld step2CK Sep 21, 2020, 4:31 AM HirotoShishido
ABI 正常値●足関節上腕血圧比(ABI)は,足関節収縮期血圧(後脛骨動脈・足背動脈のいずれか高い方)を,左右のうち高い方の上肢収縮期血圧で除して算出される.ABIが0.90以下では下肢主幹動脈の狭窄や閉塞が,1.40より高値では動脈の高度石灰化が疑われる.最近のガイドラインでは,1.00〜1.40が標準値とされ,0.91〜0.99はボーダーラインとされている. 必修cardiology Jul 21, 2020, 11:45 PM HirotoShishido
ASの予後大動脈弁狭窄
aortic stenosis
●ASの予後としては,無治療の場合,平均余命は胸痛発症後5年,失神発作発症後3年,心不全発症後2年といわれる(2-3-5の法則) 必修cardiology Jul 19, 2020, 10:05 AM HirotoShishido
types of pericarditisfibrinous pericarditis
→ autoimmune disease(eg ☆SLE, RA), viral infection, uremia, MI
purulent pericarditis
→ active bacterial infection (eg S aureus, Streptococcus sepsis) in the pericardial space
hemorrhagic pericarditis (blood mixed with fibrinous exudate)
→ malignancy, TB, cardiac surgery cardiologyUWorld Jul 5, 2020, 2:57 AM HirotoShishido
drugs which has been shown to improve long-term survival in patients with HF due to left ventricular systolic dysfunctionβ-blocker(Bisoprolol, ☆Carvedilol, Metoprolol (β-blockers Curb Mortality)),
ACE inhibitors, ARB, aldosterone antagonists cardiologypharmacologyUWorld Jul 2, 2020, 10:07 AM HirotoShishido
native valve endocarditisHACEK organisms
Haemophilus,
Aggregatibacter [formerly Actinobacillus], Cardiobacterium,
Eikenella,
Kingella microbiologycardiology Jun 28, 2020, 6:05 AM HirotoShishido
Leriche syndromeThigh claudication is suggestive of occlusive disease of the ipsilateral external iliac artery or its more distal branches (ie, common femoral, superficial femoral, profunda femoris arteries).
Accompanying ☆★impotence and/or ☆gluteal claudication suggests ☆more proximal aortoiliac occlusion (so-called Leriche syndrome), which, in addition to affecting the external iliac artery, also diminishes blood flow to the internal pudendal and gluteal branches of the internal iliac artery. cardiologysurgeryUWorld step2CK Jun 27, 2020, 8:57 AM HirotoShishido
atheroembolic disease☆Invasive vascular procedures (eg,angiography, angioplasty, aortic surgery) can cause ☆cholesterol-containing debris from atherosclerotic plaques to become dislodged from large arteries (eg, the aorta during cardiac catheterization) and shower microemboli into the circulation.
Skin findings (eg, ☆livedo reticularis, blue toe syndrome) are the most common presenting signs.
kidney injury→ ☆needle-shaped clefts that partially or completely obstruct the arcuate or interlobular renal arteries. cardiologyUWorld Jun 27, 2020, 8:43 AM HirotoShishido
the strongest risk factor for coronary heart diseasehighest→ ☆diabetes mellitus, noncoronary atherosclerotic disease, CKD
other major risk factors→ HTN, hyperlipidemia, smoking, ↑age, obesity, physical inactivity
Several studies have shown that diabetes mellitus is one of the strongest risk factors for coronary heart disease.
The risk of dying from coronary heart disease exceeds the risk of dying from any of the other listed causes, even in the absence of other major risk factors forcoronary heart disease. cardiologyUWorld Jun 27, 2020, 8:35 AM HirotoShishido
histology of this“Pipestem” appearance on x-ray.
→
Monckeberg sclerosis
(Medial calcific sclerosis)
Calcification of internal elastic lamina and media of arteriesvascular stiffening without obstruction. Does not obstruct blood flow; intima not involved. cardiology Jun 27, 2020, 8:16 AM HirotoShishido
PictureLichtenberg figures= erythmatous cutaneous marks in a ☆fern-leaf pattern→ pathognomonic of lightning strike
Although lightning injuries are rare, they are associated with a 25% fatality rate, and more than 70% of survivors have long-lasting complications.
Two-thirds of lightning-related deaths occur within the first hour following injury; the most common causes are ☆fatal arrhythmias and respiratory failure cardiologydermatologyUWorld Jun 27, 2020, 7:25 AM HirotoShishido
holiday heart syndromeatrial fibrillation
Occasionally seen after binge drinking (“holiday heart syndrome”). Can lead to thromboembolic events, particularly stroke. cardiologyUWorld Jun 27, 2020, 6:01 AM HirotoShishido
what embryonic structures give rise to SVC/IVCRight common cardinal vein and right anterior cardinal vein→ SVC
Posterior, subcardinal, and supracardinal veins→ IVC cardiologyembryology Jun 27, 2020, 5:12 AM HirotoShishido