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CONT. g. abstinence from EtOH ❏ treat CHF ( see Heart Failure Section) ❏ anticoagulation to prevent thromboembolism • absolute - AF, history of thromboembolism or documented thrombus • clinical practice is to anticoagulate if EF < 20% ❏ treat symptomatic or serious arrhythmias ❏ immunize against influenza and pneumococcus ❏ surgical therapy • cardiac transplant - established therapy • volume reduction surgery (role remains unclear) • cardiomyoplasty (latissimus dorsi wrap) • LVAD HYPERTROPHIC CARDIOMYOPATHY ❏ also known as hypertrophic obstructive cardiomyopathy (HOCM) and idiopathic hypertrophic subaortic stenosis (IHSS) ❏ issues are obstruction, arrhythmia, diastolic dysfunction Pathophysiology ❏ symmetrical or asymmetrical hypertrophy of the myocardium either: ❏ non-obstructive • symptoms secondary to decreased compliance and impaired diastolic filling ❏ obstructive (latent [brought on by provocative testing] or resting) • symptoms secondary to dynamic ventricular outflow obstruction diminishing cardiac output ❏ clinical manifestations • asymptomatic • dyspnea (90%) - secondary to diastolic dysfunction • cardiac ischemia • presyncope, syncope - obstruction or arrhythmic • CHF • arrhythmias • sudden death (may be first manifestation) Hallmark Signs of HCM ❏ pulses • rapid upstroke pulse • bifid or bisferiens pulse ❏ precordial palpation • localized, sustained, double/triple impulse apex beat MCCQE 2000 Review Notes and Lecture Series Cardiology 35 CARDIOMYOPATHIES Notes .

G. antihypertensives), venous pooling (postural, pregnancy), autonomic neuropathy (1º: Shy-Drager, 2º: DM), hypovolemia (blood loss, diuresis pheochromocytoma) • neurological: vertebrobasilar TIA/stroke, SAH, cervical spondylosis, seizure, subclavian steal • metabolic: hypoxia, hypoglycemia, hypocapnia Clinical Manifestations ❏ history and physical examination are critical - reflect underlying pathology in 40-50% (attention to cardiac and neurological exams) Table 13. Differentiation of Seizure vs.

G. hypokalemia, acute MI, acute/chronic myocarditis, frequent PVCs, WPW with anterograde conduction down bypass tract, acute hypoxemia, chronic cor pulmonale , diastolic dysfunction in the absense of systolic dysfunction) • risk of complete AV block/ bradycardia • sick sinus syndrome • incomplete AV block • HCM Absolute • high degree AV block • hypersensitivity • hypersensitivity • active peptic ulcer • severe hypokalemia • severe hypovolemia • severe hypotension • hypersensitivity to furosemide or sulfonamide • pregnancy CONTRA-INDICATIONS COMMONLY USED CARDIAC THERAPEUTICS .

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