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0 [{"id":519961,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:45:10","updated_at":"2018-08-10 05:45:10","questionName":"The following are features particularly for stable angina","questionTimeSeconds":"40","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519970,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:51:12","updated_at":"2018-08-10 05:51:12","questionName":"Severe rheumatic heart disease usually only occurs after multiple episodes of acute rheumatic fever","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"Rheumatic heart disease occurs 10-20 years after original attack. This is why the peak incidence of rheumatic heart disease is 15 \u2013 30 years of age (since the peak age for acute rheumatic fever is at 4- 9 years of age). \nProbably develops in over 50% of patients with initial carditis due to acute rheumatic fever. \n\nSevere rheumatic heart disease usually only occurs after multiple episodes of acute rheumatic fever. \n\nRecurrent episodes of inflammation lead to chronic fibrosis and then calcification of the valves. \n\nThis is why antibiotic prophylaxis after a first episode of acute rheumatic fever is so important.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519969,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:50:20","updated_at":"2018-08-10 05:50:20","questionName":"sinus rate of less than 60 beats\/minute. Has normal P wave configuration consistent with origin in sinus node area. ","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"ARRHYTHMIAS (emphasis on Atrial Fibrillation) Definition: Abnormality in cardiac conduction that can manifest as either change in rate or rhythm\nTypes and etiologies Bradyarrhythmia: any rhythm that results in a ventricular rate of less than 60 beats per minute.\n\nSinus bradycardia: sinus rate of less than 60 beats\/minute. Has normal P wave configuration consistent with origin in sinus node area. Etiology: increased vagal tone, hypothyroidism, ischemia, medication such as digoxin, beta blockers, calcium channel blockers\nAV Block\n\uf0b7 1st degree: conduction delay within AV node, with prolonged PR interval on ECG > 200 msec. Etiology: medication, CHF, ischemia, electrolyte abnormalities. No therapy needed.\n\uf0b7 2nd degree Type I (Wenckebach): progressive PR interval prolongation before a blocked or dropped beat. Etiology: medication, electrolyte abnormalities, ischemia. If symptomatic, can give atropine.\n\uf0b7 2nd degree Type II: abrupt AV conduction block without evidence of PR prolongation. No change in PR interval and then sudden dropped beat. Etiology: ischemia, conduction system disease. Need pacemaker.\n\uf0b7 3rd degree: dissociation of atrial beats and ventricular beats. Atrial impulses fail to conduct to the ventricle. And ventricle is beating on its own with a slower rate. Etiology: medication toxicity, ischemia, infiltrative disease (sarcoid, amyloid), Lyme disease, Chagas disease. Need pacemaker.\nTachyarrhythmia: any rhythm with a rate in excess of 100 beats per minute\n\uf0b7 Narrow Complex Tachycardia or Supraventricular (narrow QRS < 120 msec) o Sinus Tachycardia. Etiology: pain, fever, hypovolemia, hypoxia, anemia, anxiety, thyroid disease; rate not greater than 220-age\no AV nodal reentrant tachycardia (AVNRT): reentrant circuit using AV node and accessory pathway, rate can be > 150.\no Atrial flutter: macro-reentry usually within right atrium (atrial rate is 300 and usually conducts 2:1 for HR = 150)\no Atrial fibrillation: see below for more\n\uf0b7 Wide Complex Tachycardia (wide QRS > 120 msec) o Ventricular tachycardia: monomorphic (QRS all the same size) or polymorphic Etiology: ischemia, cardiomyopathy, structurally abnormal heart, prior MI\nAtrial Fibrillation Definition: Most common arrhythmia for which patients seek treatment. This is an irregularly irregular rhythm in which the atria depolarize chaotically and are not able","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":521269,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-11 03:24:12","updated_at":"2018-08-11 03:24:12","questionName":"sinus rate of less than 60 beats\/minute. Has normal P wave configuration consistent with origin in sinus node area. ","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"ARRHYTHMIAS (emphasis on Atrial Fibrillation) Definition: Abnormality in cardiac conduction that can manifest as either change in rate or rhythm\nTypes and etiologies Bradyarrhythmia: any rhythm that results in a ventricular rate of less than 60 beats per minute.\n\nSinus bradycardia: sinus rate of less than 60 beats\/minute. Has normal P wave configuration consistent with origin in sinus node area. Etiology: increased vagal tone, hypothyroidism, ischemia, medication such as digoxin, beta blockers, calcium channel blockers\nAV Block\n\uf0b7 1st degree: conduction delay within AV node, with prolonged PR interval on ECG > 200 msec. Etiology: medication, CHF, ischemia, electrolyte abnormalities. No therapy needed.\n\uf0b7 2nd degree Type I (Wenckebach): progressive PR interval prolongation before a blocked or dropped beat. Etiology: medication, electrolyte abnormalities, ischemia. If symptomatic, can give atropine.\n\uf0b7 2nd degree Type II: abrupt AV conduction block without evidence of PR prolongation. No change in PR interval and then sudden dropped beat. Etiology: ischemia, conduction system disease. Need pacemaker.\n\uf0b7 3rd degree: dissociation of atrial beats and ventricular beats. Atrial impulses fail to conduct to the ventricle. And ventricle is beating on its own with a slower rate. Etiology: medication toxicity, ischemia, infiltrative disease (sarcoid, amyloid), Lyme disease, Chagas disease. Need pacemaker.\nTachyarrhythmia: any rhythm with a rate in excess of 100 beats per minute\n\uf0b7 Narrow Complex Tachycardia or Supraventricular (narrow QRS < 120 msec) o Sinus Tachycardia. Etiology: pain, fever, hypovolemia, hypoxia, anemia, anxiety, thyroid disease; rate not greater than 220-age\no AV nodal reentrant tachycardia (AVNRT): reentrant circuit using AV node and accessory pathway, rate can be > 150.\no Atrial flutter: macro-reentry usually within right atrium (atrial rate is 300 and usually conducts 2:1 for HR = 150)\no Atrial fibrillation: see below for more\n\uf0b7 Wide Complex Tachycardia (wide QRS > 120 msec) o Ventricular tachycardia: monomorphic (QRS all the same size) or polymorphic Etiology: ischemia, cardiomyopathy, structurally abnormal heart, prior MI\nAtrial Fibrillation Definition: Most common arrhythmia for which patients seek treatment. This is an irregularly irregular rhythm in which the atria depolarize chaotically and are not able","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519962,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:45:47","updated_at":"2018-08-10 05:45:47","questionName":"The clinical diagnosis of Acute rheumatic fever is made by","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"Clinical diagnosis: Jones Criteria: 2 major criteria OR one major + 2 minor criteria AND evidence of recent streptococcal infection. Major Criteria \n\uf0b7 Carditis: Occurs in about 50% of the cases and is the most serious manifestation of RF. It may affect only the endocardium, or it can affect all layers of the heart (pericardium to the endocardium). This acute presentation is different from the later sequelae of rheumatic heart disease (mitral stenosis). Congestive heart failure symptoms tend to represent advance disease.\n\uf0b7 Arthritis: Occurs in 80% of the cases. Migratory polyarthritis usually of large joints. each affected joint inflamed for less than one week and typically over 6 joints involved\n\uf0b7 Chorea: also called Sydenham chorea or St. Vitus dance is seen in 10% of the patients. It\u2019s abrupt, purposeless, nonrhythmic, involuntary movements, usually worse on one side. Chorea can occur up to 8 months after strep infection\n\uf0b7 Subcutaneous nodules: Firm, painless, non-inflamed, variable in size, symmetric when multiple and located over bony surfaces or near tendons, appear earlier in course of ARF and usually only in patients with carditis. This presentation is rare.\n\uf0b7 Erythema marginatum: pink, evanescent, non-itchy rash on trunk and limbs, but not on face. Heat brings lesions out. Seen in < 5% of the cases.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519971,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:52:10","updated_at":"2018-08-10 05:52:10","questionName":"secondary to another illness (hyperthyroidism, PNA, PE, etc.)","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"Types \n\n\uf0b7 Valvular atrial fibrillation: usually associated with rheumatic heart disease due to MS or MR with left atrial enlargement; *the most common type in our setting*\n\uf0b7 Isolated atrial fibrillation: secondary to another illness (hyperthyroidism, PNA, PE, etc.)\n\uf0b7 Lone atrial fibrillation: age < 65, no history of stroke or HTN, no structural heart disease\n\uf0b7 Paroxysmal atrial fibrillation: intermittent (less than 24 hours) \uf0b7 Persistent atrial fibrillation: lasts > 7 days or requires cardioversion \uf0b7 Chronic atrial fibrillation: atrial fibrillation is the predominant rhythm \uf0b7\n*paroxysmal, persistent, and chronic afib have the same risk of stroke","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519966,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:48:47","updated_at":"2018-08-10 05:48:47","questionName":"Some studies suggested that over 50% of MS is caused by RHD","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"Mitral stenosis is most common finding, followed by aortic stenosis. Some studies suggest that over 70% of MS is caused by RHD. Even though stenosis occurs 10-20 years after infection symptoms may be delayed as late as 40 years. If antibiotic treatment is not adequate in ARF (not available vs. more virulent strains causing earlier adhesion of leaflets), onset of symptoms often occurs earlier.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519965,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:48:19","updated_at":"2018-08-10 05:48:19","questionName":"Symptoms and signs develop only with complications of HTN or in cases of secondary HTN","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"Symptoms\/Signs Most patients with HTN are asymptomatic! Symptoms and signs develop only with complications of HTN or in cases of secondary HTN. The only reliable sign of HTN is the blood pressure.\nMeasuring the BP \u2013 The blood pressure cuff must be large enough so that the bladder of the cuff encircles the arm + 30%! If the cuff is too small the blood pressure will be falsely elevated.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519963,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:46:27","updated_at":"2018-08-10 05:46:27","questionName":"The cardiomyopathies are a group of diseases that primarily effect the heart muscles and are the result of congenital, acquired valvular, hypertensive, coronary arterial, or pericardial abnormalities.","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"The cardiomyopathies are a group of diseases that primarily effect the heart muscles and are not the result of congenital, acquired valvular, hypertensive, coronary arterial, or pericardial abnormalities.\n\uf0b7 The term cardiomyopathy should be restricted to the conditions which primarily affect the myocardium.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519960,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:44:06","updated_at":"2018-08-10 05:44:06","questionName":"The most common cause of Valvular heart disease in Tanzania is","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519972,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:54:09","updated_at":"2018-08-10 05:54:09","questionName":"search for source & start empiric antibiotics based on likely type of infection. Give IV fluids","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"\uf0b7 Intubation if in respiratory distress \uf0b7 Stop any antihypertensives or diuretics. If pressors (dopamine, epinephrine, neosynephrine, etc), if shock is present despite aggressive fluid resuscitation and pressors are available\n\uf0b7 If septic: search for source & start empiric antibiotics based on likely type of infection. Give IV fluids\n\uf0b7 If hypovolemic: IV fluids, check electrolytes, fix underlying condition (e.g. diabetic ketoacidosis), send for type & crossmatch for urgent transfusion if hemorrhage (hemorrhage is the most common cause of hypovolemic shock).\n\uf0b7 If cardiogenic: IV fluids may be harmful, IV lasix and or dopamine may help, fix the underlying problem (e.g. valve replacement).\n\uf0b7 If outflow obstruction suspected: IV fluids, urgent ECG, CXR to confirm, thrombolysis for PE, chest tube for tension pneumothorax, percardiocentesis for tamponade.\n\uf0b7 If anaphylactic: IV fluids, subcutaneous epinephrine 0.3ml 1:1000 solution if severe, antihistamines, & corticosteroids may help.\n\uf0b7 If adrenal insufficiency: give hydrocortisone 100mg TDS x 5\/7","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519964,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:47:00","updated_at":"2018-08-10 05:47:00","questionName":"Tamponade can occur as a result of any type of pericarditis","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519959,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:43:05","updated_at":"2018-08-10 05:43:05","questionName":"The most common causes of Diastolic dysfunction CHF in our setting are","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519968,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:49:36","updated_at":"2018-08-10 05:49:36","questionName":"sinus rate of less than 60 beats\/minute. Has normal P wave configuration consistent with origin in sinus node area. ","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"ARRHYTHMIAS (emphasis on Atrial Fibrillation) Definition: Abnormality in cardiac conduction that can manifest as either change in rate or rhythm\nTypes and etiologies Bradyarrhythmia: any rhythm that results in a ventricular rate of less than 60 beats per minute.\n\nSinus bradycardia: sinus rate of less than 60 beats\/minute. Has normal P wave configuration consistent with origin in sinus node area. Etiology: increased vagal tone, hypothyroidism, ischemia, medication such as digoxin, beta blockers, calcium channel blockers\nAV Block\n\uf0b7 1st degree: conduction delay within AV node, with prolonged PR interval on ECG > 200 msec. Etiology: medication, CHF, ischemia, electrolyte abnormalities. No therapy needed.\n\uf0b7 2nd degree Type I (Wenckebach): progressive PR interval prolongation before a blocked or dropped beat. Etiology: medication, electrolyte abnormalities, ischemia. If symptomatic, can give atropine.\n\uf0b7 2nd degree Type II: abrupt AV conduction block without evidence of PR prolongation. No change in PR interval and then sudden dropped beat. Etiology: ischemia, conduction system disease. Need pacemaker.\n\uf0b7 3rd degree: dissociation of atrial beats and ventricular beats. Atrial impulses fail to conduct to the ventricle. And ventricle is beating on its own with a slower rate. Etiology: medication toxicity, ischemia, infiltrative disease (sarcoid, amyloid), Lyme disease, Chagas disease. Need pacemaker.\nTachyarrhythmia: any rhythm with a rate in excess of 100 beats per minute\n\uf0b7 Narrow Complex Tachycardia or Supraventricular (narrow QRS < 120 msec) o Sinus Tachycardia. Etiology: pain, fever, hypovolemia, hypoxia, anemia, anxiety, thyroid disease; rate not greater than 220-age\no AV nodal reentrant tachycardia (AVNRT): reentrant circuit using AV node and accessory pathway, rate can be > 150.\no Atrial flutter: macro-reentry usually within right atrium (atrial rate is 300 and usually conducts 2:1 for HR = 150)\no Atrial fibrillation: see below for more\n\uf0b7 Wide Complex Tachycardia (wide QRS > 120 msec) o Ventricular tachycardia: monomorphic (QRS all the same size) or polymorphic Etiology: ischemia, cardiomyopathy, structurally abnormal heart, prior MI\nAtrial Fibrillation Definition: Most common arrhythmia for which patients seek treatment. This is an irregularly irregular rhythm in which the atria depolarize chaotically and are not able","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":519958,"quiz_id":"26312","answer_id":null,"answerType_id":"0","created_at":"2018-08-10 05:41:52","updated_at":"2018-08-10 05:41:52","questionName":"The most common condition occuring in secondary hypertension is","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null}]
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The following are features particularly for stable angina

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