Whats the best treatment for this messed up heart? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-20-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 642 Times in 407 Posts
Reputation: 652
Drug Whats the best treatment for this messed up heart?

NOTE: this is a USMLE Consult-"inspired" question, so look away if you plan on using USMLE Consult as a measure of your progress.

----------------------------------------------------------
An 80 year old man is hospitalized after having an MI. He has pulmonary congestion, ventricular tacky-arrythmia, episodes of ventricular fibrillation requiring cardioversion, and myocardial ejection fraction of 28%. Which of the following drugs is most effective in treating the refractory life-threatening ventricular arrhythmia?

A. Adenosine
B. Amiodarone
C. Amlodipine
D. Esmolol
E. Quinidine
F. Procainamide

(please explain your choice).
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message



  #2  
Old 03-20-2012
bunny's Avatar
Banned
 
Steps History: Not yet
Posts: 176
Threads: 34
Thanked 117 Times in 69 Posts
Reputation: 127
Default

i may be wrong but i think its amiodarone
Reply With Quote Quick reply to this message
  #3  
Old 03-20-2012
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 452
Threads: 11
Thanked 354 Times in 197 Posts
Reputation: 364
Default

Quote:
Originally Posted by bunny View Post
i may be wrong but i think its amiodarone
Definitely not amiodarone as the patient already has pulmonary fibrosis!

My guess would be quinidine as its post mi
Reply With Quote Quick reply to this message
  #4  
Old 03-20-2012
doxy's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 38
Threads: 8
Thanked 9 Times in 5 Posts
Reputation: 19
Default it can b esmolol

-Adenosine is indicated mostly in SVT

-procainamide Quinidine Amiodarone increase QT leading to precipitation of ventricular arrhythmias

-Amlodipine used mostly in SHT

- i think it can b esmolol...

plz correct me if I'm wrong
Reply With Quote Quick reply to this message
  #5  
Old 03-20-2012
doxy's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 38
Threads: 8
Thanked 9 Times in 5 Posts
Reputation: 19
Default

Quote:
Originally Posted by DefeatTheBeast View Post
Definitely not amiodarone as the patient already has pul fibrosis!

My guess would be quinidine as its post mi
for post MI ventricular arrhythmias ..class IB drugs are indicated like lidocaine flexetine etc
Reply With Quote Quick reply to this message
The above post was thanked by:
DefeatTheBeast (03-20-2012)
  #6  
Old 03-20-2012
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 452
Threads: 11
Thanked 354 Times in 197 Posts
Reputation: 364
Default

Quote:
Originally Posted by doxy View Post
for post MI vent.arrthymias ..class IB drugs r indicated like lidocaine flexetine etc
Yea...noticed i made that mistake after i hit enter...i would probably go with esmolol also
Reply With Quote Quick reply to this message
  #7  
Old 03-20-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 642 Times in 407 Posts
Reputation: 652
Default Answer = Amiodarone

Answer is Amiodarone.

Bunny you sly dog, you got it again.

care to explain how?
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message
The above post was thanked by:
bunny (03-20-2012)
  #8  
Old 03-20-2012
bunny's Avatar
Banned
 
Steps History: Not yet
Posts: 176
Threads: 34
Thanked 117 Times in 69 Posts
Reputation: 127
Default

I only remember goljan words no matter what
Always amiodarone alway amiodarone
It was a blind guess and i was blank
Reply With Quote Quick reply to this message
  #9  
Old 03-20-2012
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 452
Threads: 11
Thanked 354 Times in 197 Posts
Reputation: 364
Default

Hey dr. nick what was the explanation in the qbank
Reply With Quote Quick reply to this message
  #10  
Old 03-20-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Ans is in FA ........

Amiodarone.
is used when all drugs fail .............

the Qs says refractory life-threatening ventricular arrhythmia?

so the ans B
Reply With Quote Quick reply to this message
The above post was thanked by:
DefeatTheBeast (03-21-2012), whatsupdoc7 (03-20-2012)
  #11  
Old 03-21-2012
mdsoon's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 259
Threads: 8
Thanked 115 Times in 78 Posts
Reputation: 125
Default

why not adenosine?
Reply With Quote Quick reply to this message
  #12  
Old 03-21-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

Quote:
Originally Posted by mdsoon View Post
why not adenosine?
they said refractory , means the first line drugs like adenosine failed ..
Reply With Quote Quick reply to this message
  #13  
Old 03-21-2012
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 303
Threads: 57
Thanked 105 Times in 67 Posts
Reputation: 115
Send a message via Skype™ to usmlemydream
Default

amiodarone because in FA it says that is is a Class 1,class2 and class 3 antiarrythymic....and we know that post MI we give class 2 and no other choice matches
Reply With Quote Quick reply to this message
  #14  
Old 03-21-2012
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 452
Threads: 11
Thanked 354 Times in 197 Posts
Reputation: 364
Default

Quote:
Originally Posted by Hitman View Post
Ans is in FA ........

Amiodarone.
is used when all drugs fail .............

the Qs says refractory life-threatening ventricular arrhythmia?

so the ans B
Yea makes sense...the pulm fibrosis part confused me a bit but obv correcting the life threatening arrhythmia is more important then worrying about the fibrosis
Reply With Quote Quick reply to this message
  #15  
Old 03-21-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 105
Threads: 35
Thanked 26 Times in 21 Posts
Reputation: 36
Default

All I know is Flecainide and Amiodarone are preferred agents. However, flecainide is a very strong negative inotrope, so if there is structural heart disease, stick with amiodarone.

A couple of the books I've read merely mention the other anti-arrhythmics by name and just instead say something along the lines of 'amiodarone is recommended/most effective.' etc. so yea, just remember Amiodarone. When not sure, definitely amiodarone.
Reply With Quote Quick reply to this message



  #16  
Old 05-16-2013
USMLE Forums Addict
 
Steps History: ---
Posts: 123
Threads: 28
Thanked 45 Times in 29 Posts
Reputation: 55
Default

the patient has pulmonary congestion(edema)(due to heart failure secondary to MI)..... ...........not fibrosis........so amiodarone can be used......
Reply With Quote Quick reply to this message



Reply

Tags
Cardiovascular-, Pharmacology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
messed up patient note guesswhat USMLE Step 2 CS Forum 0 02-12-2012 10:48 PM
whats an omm add-on for dit? medicineman1 USMLE Step 1 Forum 1 01-12-2012 03:58 PM
Exam is near and am messed up! nerves USMLE Step 1 Forum 10 07-02-2011 03:01 AM
Whats the way go to cardiology? usmle2011 IMG Residency Match Forum 1 12-11-2010 08:53 PM
neurohormonal changes in heart failure and relation to treatment DrSeddik USMLE Step 1 Bits & Pieces 0 02-05-2010 11:06 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)