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Medicine

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Cardiology

Question
53 out of 67
 

A patient had an inferior wall myocardial infarction and was in shock. The reason for the patient being in shock is :- (AIIMS May 10)



A Mitral regurgitation

B Infarction causing septal defect

C Right ventricular infarction

D Decreased ejection fraction from left ventricle

Ans. C

Right ventricular infarction

RV infarct

Features:

1. Usually associated with inferior wall MI

2. JVP is raised Q

3. Kussmaul sign is positive Q

4. Catheterization of the right side of the heart often reveals a distinctive hemodynamic pattern resembling constrictive pericarditis (steep right atrial "y" descent and an early diastolic dip and plateau in RV waveforms) (Ref. Hari-18th ed., Pg- 2032)

5. Patient may or may not have hypotension Q

6. Right ventricular failure (RVF)/infarction: Presents with low cardiac out and JVP raised. Do a Swan-Ganz catheter to measure right -sided pressures a guide fluid replacement Q

7. Give IV fluid for hypotension Q

Unstable angina: Manage along standard lines but thrombolysis is not done.

Mortality 50% of deaths occur within 24h of onset of symptom. (MCQ)

Important Points: - CABG

Indications for CABG (to improve survival)

1. Left mainstem disease

2. Triple vessel disease involving proximal part of the left anterior descending

To relieve symptoms

a. Angina unresponsive to drugs

b. Unstable angina (sometimes)

c. If angioplasty is unsuccessful

NB: When CABG and PTCA are both clinically valid options, PTCA is preferred.

Artery used for bypass graft

1. Internal mammary artery (Right + Left)

2. Radial artery

Vein used for bypass graft

Long saphenous vein

Cardiology Flashcard List

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