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- Marked exertional dyspnea, echo moderate AR, proceed with cardiac catheterization with aortography to confirm AR severity and to assess coronaries
- In cardiac catheterization, calculation of mitral valve area typically relies on substitution of PCWP for LA pressure
- Nausea, diaphoresis during argument & with physical exertion, resolves with rest - atypical angina. Typical angina - substernal discomfort, aggravated by exertion or emotional distress, relieved by rest or nitroglycerin. Atypical angina - two of three features
- Typical angina+single vessel CAD+optimal therapy - PCI will reduce angina if moderate-to-severe ischemia in stress SPECT but not risk of death, MI, or other major CV events
- Patients with unstable angina due to coronary microvascular dysfunction have poor short-term prognosis
- Age above 50 yr, substernal pain provoked by activity or emotional stress, obesity, hypertension, hyperlipidemia - coronary CT angiography or stress testing for diagnosis
- PFO associations: migraine, platypnea-orthodeoxia, decompression sickness, paradoxical embolism & stroke
- In most patients with WPW syndrome, accessory pathway conducts more rapidly than normal AV node but takes longer to recover excitability
- Systolic ejection murmur at right upper sternal border without radiation, increases in intensity with Valsalva manoeuvre, decreases in intensity with handgrip, S4 gallop - asymmetric septal hypertrophy
- URTI, elevated WBCs, ESR, CRP & troponin normal. Acute pericarditis most appropriate therapy for acute episode and maintain remission is Ibuprofen 600 TID for 2 weeks followed by taper and colchicine 0.5 mg BID for 3 months