0071643192.pdf

CARDIOVASCULAR EMERGENCIES

b-Blockers and/or calcium

channel blockers are the

mainstay of therapy for

hypertrophic cardiomyopathy.

Unlike other

cardiomyopathies, the

physical exam is typically

normal in arrhythmogenic

right ventricular dysplasia.

■ β-Blockers and calcium channel blockers to decrease obstruction

■ Treat atrial fibrillation (consider anticoagulation).

■ Avoid:Positive inotropes or nitrates, which will worsen obstruction.

■ Admit for monitoring if syncope, near-syncope, or presence of dysrhythmia.

■ Surgery

COMPLICATIONS

■ Dysrhythmias (atrial fibrillation, PVCs most common)

■ Exertional syncope

■ Sudden cardiac death

Arrythmogenic Right Ventricular Dysplasia

As the name implies, this cardiomyopathy is characterized by right ventricular

dysplasia and ventricular dysrhythmias. It is an autosomal dominant disorder

common in regions of Italy.

PATHOPHYSIOLOGY

■ Replacement of right ventricle myocardium with fibrofatty tissue

■ Overall cardiac function is normal.

SYMPTOMS/EXAM

■ Sudden cardiac death or ventricular dysrhythmias

■ Normal examination

DIAGNOSIS

■ ECG: May see RBBB pattern

■ CXR: Normal

■ Echo: Right ventricular enlargement and dysfunction

■ Biopsy is confirmatory.

TREATMENT

■ Antidysrhythmics and/or AICD to prevent sudden death

A 24-year-old female with a history of injection drug use presents with

complaint of fever and chills with generalized malaise over the last 2 days.

On examination, she is afebrile, but you find tender nodules on the tip of

her second and third fingers. What is the most appropriate management for this

patient?

This patient likely has Staphylococcus aureusinfective endocarditis. Her fin-

gertip lesions are referred to as Osler’s nodes, one of the immunologic manifes-

tations of endocarditis. The most appropriate management is to obtain blood

cultures, administer vancomycin, and admit the patient.

INFECTIVE ENDOCARDITIS

Infective endocarditis is an infection of the endocardium that typically in-

volves the valves and adjacent structure. A wide range of infecting organisms

has been identified. Of the organisms, Staphylococcus aureusis considered to

be the most virulent, with a rapid destruction of affected valves.