Thanks to Nayiri for a great final AM report on atrial fibrillation!

Learning points:
– Etiology of atrial fib = PIRATES (Pulm, Ischemic, Rheumatic heart, Anemia/Atrial myxoma, Thyroid, Ethanol, Sepsis)
– Diamond-Forrester definition of typical angina = (1) substernal, (2) onset w/ exertion or emotional stress, (3) relieved w/ rest or nitrate
– AFFIRM (2002): rate control had equivalent outcomes to rhythm control w/ less adverse events
– RACE II (2010): lenient rate control (HR<110 at rest) as effective as strict (HR<80 at rest)

Thanks to Jason Bahk for a great presentation today!

Today’s learning points:
– Anti-synthetase syndrome: +Anti-synthetase Ab, ILD, inflammatory myopathy, inflammatory polyarthritis
– On exam: fever, “Mechanics’ hands’, non-erosive arthritis, myopathy
– Multiple cardiac manifestations: conduction, CHF, perimyocarditis
– Ddx for rhabdo causes include trauma, overexertion, metabolic, drug/toxin, inflammatory myopathies
– NEJM review on Inflammatory Muscle Diseases

Learning Points:
• Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability
• Etiology includes acute thrombosis, embolism from the heart, atherosclerosis, trauma and many more
• Assess the 6P’s: Pain, Pallor, Pulselessness, Parasthesia, Poikilothermia and Paralysis
• PROMPT diagnosis is necessary in an effort to salvage the limb
• Treatment options include anti-coagulation, endovascular revascularization vs surgical revascularization
• For more information, check out this article from NEJM.

Learning points

1) Keep autoimmune hepatitis on your differential for a patient presenting with jaundice and hepatitis.
2) There is a wide spectrum of presentations, from mild asymptomatic AST/ALT elevations to fulminant liver failure.
3) Autoimmune hepatitis is a type of chronic hepatitis, more commonly seen in women of any age, but dx is most commonly in the 40-50 age range.
4) Antibodies commonly associated with the dx: ANA, Anti-Smooth Muscle, Anti-Mitochondrial, Anti-SLA/LP (soluble liver antibody/liver pancreas), and elevated IgG levels.
5) Treatment = Prednisone +/- Azathioprine

Learning points:
1. Kussmaul’s sign refers to a jugular venous pulsation that rises with inspiration and is due to the constriction of pericardium

2. Ventricular interdependence is the classic echo finding of constrictive pericarditis where the volume in the left heart is dependent on the volume in the right heart

3. Constrictive cardiomyopathy often has both systolic and diastolic dysfunction with normal BNP while restrictive cardiomyopathy is pure diastolic dysfunction and elevation of BNP.

4. Click below for a great review from NEJM: