Page 360 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat
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316 SECTION III CARDIOvASCuLAR ``CARdIOvASCulAR—PHARMACOlOGY CARDIOvASCuLAR ``CARdIOvASCulAR—PHARMACOlOGY
Cardiac tumors Most common heart tumor is a metastasis (eg, melanoma).
Myxomas Most common 1° cardiac tumor in adults (arrows in A ). 90% occur in the atria (mostly left
atrium). Myxomas are usually described as a “ball valve” obstruction in the left atrium (associated
A
RV with multiple syncopal episodes). IL-6 production by tumor constitutional symptoms (eg, fever,
RA LV weight loss). May auscultate early diastolic “tumor plop” sound. Histology: gelatinous material,
LA myxoma cells immersed in glycosaminoglycans.
Adults make myxed drinks.
Ao
Rhabdomyomas Most frequent 1° cardiac tumor in children (associated with tuberous sclerosis). Histology:
hamartomatous growths.
Kussmaul sign in JVP on inspiration instead of a normal .
Inspiration negative intrathoracic pressure not transmitted to heart impaired filling of right
ventricle blood backs up into vena cava JVD. May be seen with constrictive pericarditis,
restrictive cardiomyopathies, right heart failure, massive pulmonary embolism, right atrial or
ventricular tumors.
Hereditary Also called Osler-Weber-Rendu syndrome. Autosomal dominant disorder of blood vessels. Findings:
hemorrhagic blanching lesions (telangiectasias) on skin and mucous membranes, recurrent epistaxis, skin
telangiectasia discolorations, arteriovenous malformations (AVMs), GI bleeding, hematuria.
` `CARdIOvASCulAR—PHARMACOlOGY
Hypertension treatment
Primary (essential) Thiazide diuretics, ACE inhibitors, angiotensin
hypertension II receptor blockers (ARBs), dihydropyridine
2+
Ca channel blockers.
Hypertension with Diuretics, ACE inhibitors/ARBs, β-blockers β-blockers must be used cautiously in
heart failure (compensated HF), aldosterone antagonists. decompensated HF and are contraindicated in
cardiogenic shock.
In HF, ARBs may be combined with the
neprilysin inhibitor sacubitril.
Hypertension with ACE inhibitors/ARBs, Ca channel blockers, ACE inhibitors/ARBs are protective against
2+
diabetes mellitus thiazide diuretics, β-blockers. diabetic nephropathy.
β-blockers can mask hypoglycemia symptoms.
2+
Hypertension in ARBs, Ca channel blockers, thiazide diuretics, Avoid nonselective β-blockers to prevent
asthma cardioselective β-blockers. β 2 -receptor–induced bronchoconstriction.
Avoid ACE inhibitors to prevent confusion
between drug or asthma-related cough.
Hypertension in Hydralazine, labetalol, methyldopa, nifedipine. “He likes my neonate.”
pregnancy
FAS1_2019_07-Cardio.indd 316 11/7/19 4:24 PM
