tess
Forum Guru
Topics: 131
Posts: 368
|
1. a young person passed out and later died while exercising with family history of sudden death
2. A child became dizzy or dsypneic, passed out when playing, then recovered and had no toher symptoms; EKG shows delta wave.
What are the diagoses and treatments of the above two conditions?
|
| bobby
Forum Guru
Topics: 136
Posts: 569
|
1 OHSS ( or hypertrophic obstructive cardiomioparthy)
tx. surgery
2 absence (petit mal)
tx. ethosuximide
___________________
if you haven't any charity in your heart, you have the worst kind of heart trouble.
|
| tess
Forum Guru
Topics: 131
Posts: 368
|
1. Hypertrophic cardiomyopathy, treat with beta-blcokers and CCBs, avoid digoxin and beta-agonists,vasodilators; surgery in severe cases.
2. WPW syndrome, treat with procainamide or quinidine; avoid digoxin and verapamil.
|
| bobby
Forum Guru
Topics: 136
Posts: 569
|
i think question 1 is about Obstructive Hypertrophic Subaortic Stenosis (autosomal dominant) and not a typical hypertrophic cardiomegaly. if so, then your ans is correct :!:
beta blockers [as well as vasodilators and ACE inibitors] are contraindicated in patient with Aotic stenosis. (OHSS causes aortic stenosis).
in such pt, peripheral vasculature is maximally costricted to maintain BP, so administration of such agents will cause pt to go into shock.
___________________
if you haven't any charity in your heart, you have the worst kind of heart trouble.
|
| tess
Forum Guru
Topics: 131
Posts: 368
|
After reading ur post, I consulted kaplan and cmdt, when you have time please have a look at kaplan IM 2002 page 154 and 156, and cmdt 2004 page 387. I hope we can come to a consensus after this. Thanks.
|
| bobby
Forum Guru
Topics: 136
Posts: 569
|
hi tess, thanx for sharing your knowledge with everyone.
i have non of the books you mentioned. i am using Boards and Wards and The merck Manual. both mentioned that beta blockers are contraindicated in cases of OHSS.
regards
___________________
if you haven't any charity in your heart, you have the worst kind of heart trouble.
|
| tess
Forum Guru
Topics: 131
Posts: 368
|
Bobby, thanks. I am making mistakes during studies also; they often upset me; but I guess that's the way to improve. GL. :lol:
|
| bobby
Forum Guru
Topics: 136
Posts: 569
|
oh tess, you are not alone
we all have that same feeling.
cheers
___________________
if you haven't any charity in your heart, you have the worst kind of heart trouble.
|
| tess
Forum Guru
Topics: 131
Posts: 368
|
You are right in the patient 1 has OHSS. OHSS is about 60% of hypertrophic cardiomyopathy.
In case of nonobsrucitve, the goal is to improve LV relaxation, so use verapamil or beta-block.
In case of latent obstruction, the goal is to provent provocation of obstruction, so go for beta-blockers, then also calcium blockers; disopyramide, or go for surgery.
In case of resting obstruction, goal is to relife of obstruction, then disopyramide is the first choice, then calcium blockers, beta-blockers, and surgery (ventriculomyotomy or mitral valve replacement.)
(kaplan)
Cheers! 
|
|
| |
| | | | | | | | | |
