By Aaron B. Caughey
Situations & strategies Step 1: Pathophysiology evaluate is helping clinical scholars arrange for USMLE Step 1 via combining easy technological know-how subject matters with medical facts. operating via 88 scientific instances, the reader profits adventure interpreting circumstances, learns vintage displays of universal ailments and syndromes, and integrates simple technological know-how techniques with medical functions. Sections conceal cardiovascular, pulmonary, renal, gastrointestinal, hematology, oncology, endocrinology, rheumatology, copy, and neuroscience. circumstances are via USMLE-style questions with solutions and rationales. Thumbnail and Key idea packing containers spotlight key evidence. A spouse web site bargains totally searchable textual content on-line.
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Extra info for Cases & Concepts Step 1: Pathophysiology Review
While the atria depolarize at the intrinsic SA node rate (60–80 beats/min), the ventricles independently depolarize at the ventricular escape rate of 30 to 40 beats/minute. Because third-degree AV block can severely compromise heart rate and cardiac output, emergent pacemaker therapy is necessary. CASE CONCLUSION JS is experiencing an AV nodal-dependent SVT precipitated by her hyperthyroidism (low-grade fever, baseline sinus tachycardia, hyperreflexia, and thyroid nodule) and caffeine intake. The termination of the tachycardia by vagal stimulation (cold water stimulus) suggests that the tachycardia involves the AV node.
Mobitz type II block is more serious and more likely to occur distal to the AV node in the His bundle. Since Mobitz type II block is much more likely to progress to third-degree AV block, the treatment of choice is electronic pacemaker implantation. Third-degree AV block is complete absence of conduction between the atria and ventricles with no fixed relationship between the P waves and QRS complexes. While the atria depolarize at the intrinsic SA node rate (60–80 beats/min), the ventricles independently depolarize at the ventricular escape rate of 30 to 40 beats/minute.
Mitral valve prolapse with MR B. Bicuspid aortic valve C. Mitral valve prolapse without MR D. PDA E. qxd 11/14/08 CASE 1-5 5:24 PM Page 20 Arrhythmias HPI: JS is a 48-year-old woman with no significant past medical history who notes 3 months of palpitations, weight loss, and heat intolerance. The palpitations occur once or twice per week, last several minutes before self-terminating, and are not associated with chest pain or presyncope. A Holter monitor records several episodes of a regular narrow complex tachycardia at 160 beats/min.