Review - Clinical VIII (Cardiology)

Experimental dark pop, avant-garde trip-hop, trip-hop

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V5.5

[Block 1: Ethereal Whispers. The beat drags heavily. The Kemane weeps in the background.]

Jervell and Lange Nielsen syndrome “bilateral sensorineural hearing loss and prolonged Q.T.” Jervell Jervell Jervell

Mitral valve prolapse  prolapse yeah prolapse and Hypertropic C.M., C.M., C.M. C.M. INCREASE during Valsalva and standing “less venous return”. DECREASE in leg raise, squat, hand grip

AORTIC STENOSIS A.R., M.R., V.S.D. “less venous return” less murmur. Hand grip decreases A.S., increases A.R., M.R., V.S.D.

Large Bounding Pulses “A.R., fever, anemia, hyperthyroidism, A.V. fistulas, P.D.A., bradycardia and complete heart block”

Bisferiens Pulse “A.R., H.C.M.”. Pulsus alternans “severe left ventricular failure”.

Paradoxical pulse “pericardial tamponade, asthma and C.O.P.D. exacerbations, constrictive pericarditis”

[Block 2: Choral Dissonance. The reverb tightens. Multiple vocal takes overlap, creating a dizzying, claustrophobic chorus. The synths grow abrasive.]

Atrial Fibrillation A.F. TREAT
ACUTE
If less than 48 forty forty 8 hours; unstable  “cardiovert”.
If more than 48; T.E. echo if no thrombus; cardiovert then anticoagulation 
If thrombus; anticoagulation  then cardiovert
CHRONIC/STABLE; rate control (C.C.Bs or β-blockers). Anticoagulation “CHADS VASC wasc was wasc score of 2 or more”

[Block 3: The Transition. The sub-bass distorts and glitches wildly. The vocals shift from choral whispers into a cold, gritty spoken word.]

Reserved E.F. heart failure, S.G.L.T.2 inhibitors reduce the hospitalization and improve symptoms

Reduced E.F. H.F., Reduce mortality with A.C.E. I/A.R.B, A.R.N.Is , β-blockers, spironolactone, hydralazine+isosorbide dinitrate

Exercise E.C.G. “preferred test for patients suspected angina, diagnosis and prognosis of C.A.D.”. If not interpretable exercise M.P.I. or Echo
If exercise not possible, pharmacologic (dobutamine) stress with radionuclide imaging, M.R. and echocardiography

[Block 4: Gritty, Defiant Delivery. The Kemane bows violently, screeching in the high register. The vocalist pushes into a harsh, powerful, almost shouted rhythm.]

Anterior/anteroseptal M.I. “L.A.D.”, inferior “R.C.A.”, anterolateral “circumflex”

Posterior M.I. “left circumflex, R.C.A.”, frequently occurs with inferior or lateral M.I., examine in any patient with both
A.C.S. TREAT
A.S.A., heparin, clopidogrel, morphine, oxygen, sublingual nitroglycerin, beta-blockers.
C.C.B. for persisting or recurrent symptoms, despite beta-blockers and nitroglycerin.
A.C.E. inhibitors for (within 24 hr of A.C.S.) decreased E.F. <40%).
Discontinue N.S.A.I.D.
Bradycardia Brady Brady   is a relative contraindication for nitrates, particularly in inferior M.I. Atropine useful for symptomatic bradycardia
Post-A.C.S. therapy “aspirin, statin, beta-blocker, clopidogrel . A.C.E.I. for H.F.,

[Block 5: Climax of the Dark Pop Nightmare. Heavy, distorted drum crashes. The vocalist sounds entirely unhinged, commanding the track.]
POST-M.I.
Pump failure Pump Pump Pump  “the primary cause of in-hospital death”.
V.T./V.F. can occur within 24 hour. After 48h - increased mortality (I.C.D.)
Thromboembolism, sinus bradycardia, A.F.
Left Ventricular Aneurysm, “cause C.H.F., embolism, and ventricular arrhythmias weeks later”
Acute pericarditis on days 2 to 4
Dressler Dressler Dressler es es es syndrome “2 to 10 weeks”, immune mediated. Treat with aspirin avoid glucocorticoids and N.S.A.I.Ds
Mechanical complications “acute mitral regurgitation regurgitation regurgitation regurgitation 
, V.S.D., and ventricular free wall rupture. May occur throughout the hospital course

[Outro: The beat cuts off instantly. All that remains is the deep, throbbing sub-bass and a final, sickening scrape of the Kemane bow. A heavy, reverberated breath. Total silence.]

4064/7500

[Intro: 75 BPM. A low, vibrating sub-bass shakes the speakers. A single, screeching note from the Turkish Kemane cries out in the darkness. The beat is a glitchy, skipping heartbeat. The vocalist begins with an ethereal, breathy whisper covered in oceanic reverb.] [Block 1: Ethereal Whispers. The beat drags heavily. The Kemane weeps in the background.] Jervell and Lange Nielsen syndrome “bilateral sensorineural hearing loss and prolonged Q.T.” Jervell Jervell Jervell Mitral valve prolapse prolapse yeah prolapse and Hypertropic C.M., C.M., C.M. C.M. INCREASE during Valsalva and standing “less venous return”. DECREASE in leg raise, squat, hand grip AORTIC STENOSIS A.R., M.R., V.S.D. “less venous return” less murmur. Hand grip decreases A.S., increases A.R., M.R., V.S.D. Large Bounding Pulses “A.R., fever, anemia, hyperthyroidism, A.V. fistulas, P.D.A., bradycardia and complete heart block” Bisferiens Pulse “A.R., H.C.M.”. Pulsus alternans “severe left ventricular failure”. Paradoxical pulse “pericardial tamponade, asthma and C.O.P.D. exacerbations, constrictive pericarditis” [Block 2: Choral Dissonance. The reverb tightens. Multiple vocal takes overlap, creating a dizzying, claustrophobic chorus. The synths grow abrasive.] Atrial Fibrillation A.F. TREAT ACUTE If less than 48 forty forty 8 hours; unstable “cardiovert”. If more than 48; T.E. echo if no thrombus; cardiovert then anticoagulation If thrombus; anticoagulation then cardiovert CHRONIC/STABLE; rate control (C.C.Bs or β-blockers). Anticoagulation “CHADS VASC wasc was wasc score of 2 or more” [Block 3: The Transition. The sub-bass distorts and glitches wildly. The vocals shift from choral whispers into a cold, gritty spoken word.] Reserved E.F. heart failure, S.G.L.T.2 inhibitors reduce the hospitalization and improve symptoms Reduced E.F. H.F., Reduce mortality with A.C.E. I/A.R.B, A.R.N.Is , β-blockers, spironolactone, hydralazine+isosorbide dinitrate Exercise E.C.G. “preferred test for patients suspected angina, diagnosis and prognosis of C.A.D.”. If not interpretable exercise M.P.I. or Echo If exercise not possible, pharmacologic (dobutamine) stress with radionuclide imaging, M.R. and echocardiography [Block 4: Gritty, Defiant Delivery. The Kemane bows violently, screeching in the high register. The vocalist pushes into a harsh, powerful, almost shouted rhythm.] Anterior/anteroseptal M.I. “L.A.D.”, inferior “R.C.A.”, anterolateral “circumflex” Posterior M.I. “left circumflex, R.C.A.”, frequently occurs with inferior or lateral M.I., examine in any patient with both A.C.S. TREAT A.S.A., heparin, clopidogrel, morphine, oxygen, sublingual nitroglycerin, beta-blockers. C.C.B. for persisting or recurrent symptoms, despite beta-blockers and nitroglycerin. A.C.E. inhibitors for (within 24 hr of A.C.S.) decreased E.F. <40%). Discontinue N.S.A.I.D. Bradycardia Brady Brady is a relative contraindication for nitrates, particularly in inferior M.I. Atropine useful for symptomatic bradycardia Post-A.C.S. therapy “aspirin, statin, beta-blocker, clopidogrel . A.C.E.I. for H.F., [Block 5: Climax of the Dark Pop Nightmare. Heavy, distorted drum crashes. The vocalist sounds entirely unhinged, commanding the track.] POST-M.I. Pump failure Pump Pump Pump “the primary cause of in-hospital death”. V.T./V.F. can occur within 24 hour. After 48h - increased mortality (I.C.D.) Thromboembolism, sinus bradycardia, A.F. Left Ventricular Aneurysm, “cause C.H.F., embolism, and ventricular arrhythmias weeks later” Acute pericarditis on days 2 to 4 Dressler Dressler Dressler es es es syndrome “2 to 10 weeks”, immune mediated. Treat with aspirin avoid glucocorticoids and N.S.A.I.Ds Mechanical complications “acute mitral regurgitation regurgitation regurgitation regurgitation , V.S.D., and ventricular free wall rupture. May occur throughout the hospital course [Outro: The beat cuts off instantly. All that remains is the deep, throbbing sub-bass and a final, sickening scrape of the Kemane bow. A heavy, reverberated breath. Total silence.]

0/500