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Cardiology

Question
60 out of 67
 

Pulmonary edema, systolic BP >90 indicate which class of Killipe’s classification in acute MI?



A Class I
B Class II

C Class III
D Class IV

Ans. C

Class III

Left ventricular failure (LVF)

Killip’s classification (for assessing the prognosis of a case of MI. It is based on degree of LV dysfunction)

Class

Feature

Mortality

Class I –

No sign of pulmonary or venous congestion

5-10%

Class II –

Crepts at lung bases, S3, tachypnea

20- 25%

Class III –

Severe heart failure, Pulmonary edema, systolic BP >90

50 – 60%

Class IV –

Cardiogenic shock, systolic BP < 90 mental confusion, cyanosis

80- 90%

(Note: With the recent advancement in treatment of MI, the above mentioned mortality percentage is much reduced now)

Cardiogenic shock – By definition

1. Systolic arterial pressure < 90 mmHg

2. Cardiac index < 1.8 L/min/m2

3. Pulm capillary wedge pressure >18 mm Hg

Treatment –

1. Vasopressor – Dopamine, Dobutamine, Amrinone Milrinone

2. Intra-aortic balloon pumping (IABP)

3. PTCA (It is the treatment of choice) MCQ(AIPG 2009)

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

Pericarditis: Central chest pain, relieved by sitting forwards. ECG: saddle-shaped ST elevation Q

Treatment-: NSAIDS. Echo to check for effusion.

DVT & PE: Patients are at risk of developing DVT & PE and should be prophylactically heparinizedQ (enoxaparin) until fully mobile.

Systemic embolism: May arise from a LV mural thrombus. After large anterior MI, consider anticoagulation with warfarin Q for 3 months.

Cardiology Flashcard List

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