Cardiology Flashcards
How does digoxin work and when is it indicated
NA+K+Pump inhibition
Rate control through slowed AV node conduction
2nd line treatment for AFIB and CHF
Peri infarction pericarditis occurs when
Less than 4 days from procedure
Mechanism of action of fibrates
Inhibit bile acid synthesis ; best for hypertriglyceridemia .
PPARA goes in and actives MORE LPL —> decreased availability of fatty acids ==> VLDL can’t activate.[decrease in triglycerides]
This PROMOTES gallstones, avoid in gallbladder disease patients
MOA of fish oil in hypertry.
Fish oil increases bile acid synthesis ; decreasing cholesterol saturation
MOA of ezetimibe
Block cholesterol absorption decreasing liver liver cholesterol stores and reducing biliary cholesterol content
2 side effects of statin therapy
Myopathy
And
Hepatic dysfunction
What is the drug of choice for hemodynamically good ; Vtach?
Amiodarone
Adverse affects of Amiodarone
Bradycardia
QT prolongation
When do you give fibrates
If severe triglyceridemia over 500
What is the peripheral resistance in hypovolemic patients
High due to stress, fluids decreases this.
1st line medical management of AFIB
Beta blocker
If an arrythmia originates below the average node think what type of QRS complex
Wide
Hemodynamics of :
Cardiac
Hypovolemic
Distributive
Obstructive
Cardiac = high preload,, low cardiac output, high vascular resistance
Hypovolemic = low preload, low cardiac output, high vascular resistance
Distributive = high right sided preload, low left sided ventricular output, high cardiac ouptut, low vascular resistance
Obstructive = low preload, high cardiac output, low vascular resistance
Explain the murmur of mitral stenosis
Best heard at the cardiac APEx = OPENING SNAP
Mid diastolic murmur
MC due to RHDz
Echo = Increased left atrial size with normal LV ejection fraction
Most important risk factor for aortic dissection
Hypertension
Describe the physiologic murmur of pregnancy
Increased blood production @ 6 weeks leads to ventricular dilation and increased CO
-Pulmonic flow murmur = increased w/ inspiration @ the left upper/mid sternal boarder
-S3 = increased FILL of an enlarged LV
-Venous Hum = continuous brisk blood flow through JVD
Atrial thrombi associated with AFIB are most commonly associated with what anatomic part
The left atrial appendage
Best way to determine SVT vs V tach
SVT = narrow complex tach
VT = WIDE complex tach!
AFIB mechanical intervention
Synchronized CARDIOVERSION
Vfib and Vtach can get what mechanical intervention
DEFIBRILLATOR!
MOA of ezetimibe
Decreases intestinal choleserol absorption leading to decreased liver cholesterol, requiring the liver to to increase LDL receptor expression = pulling cholesterol from the bodies circulation
STOMACH
MOA of PCK9 inhibitor
Increases LDL receptors on the liver hepatocyte increasing removal from circulation
Aortic rupture causes what findings
Immediate DEATH
Flat neck veins and mediastinal widening
Cardiac Tamponade causes
Becks triad : HYPOTN / Venous Distention / Dimensioned Heart Sounds
Distended neck veins and slightly enlarged cardiac contour
Narrow pulse pressure
Indomethacin vs PGE1 for PDA.
PDA = closes around day 3 of birth, patient would present with EARLY PULM DECLINE
Indomethacin = CLOSES ; inhibits prostaglandins synthesis which would close the PDA.. HELPS PDA
PGE1= OPENS ; vasodilator that prevents PDA closure= so blood can still bypass the lungs! In Tetrology of Fallot
Calcium scoring is only good when
No symptoms [ZERO]
But suspicious risk
Levels of triglycerides elevated but less than 500 get what
Statin therapy!
Normal ejection fraction is around what?
Usually greater than 60%
What does the heart look like in HFreF vs HFpeF
HFreF = thin non compliant weak ventricles
HFpeF = dialted and stiff ventricles
Classifications of heart failure based on ventricle structure
HFReF = thin non compliant weak ventricle = S3 SOUNDS
HFPeF = dilated large stiff ventricles = S4 SOUNDS!
HFReF stage A treatment
Lifestyle changes
HFrEF stage B treatment is likely
ACEI or ARB
B Beta Blocker
HFrEF stage C think what meds
Diuretics for sxs
ACE/ARB/ARNI/SGLT2
*ARNI =1st line
HFrEF stage D think what treatment
Inotropes
Loop diuretics 4 main points
Sxs control ONLY
Decrease total body water; removing heart fluid; relieving sxs
Decreases NA and Chloride absorption in loop of henle
Hypovolemic; increase in sCr; Ototoxic
CONTRA = Sulfa Allergy
What kind of diuretic can you use in sulfa allergy
Ethacrynic acid
ARNI FOUR MAIN POINTS
Sacubitril and Valsartan
Prevents the breakdown of BNP
Promotes diueresis, natiruesis, and vasodilation
Could cause hypotension, sCr increase, hyperK+, if angioedema/36hr of ACE rxn/use
ACEI four main points
Blocks production of AT2 ; which increases bradykinin
Decreases ventricular remodeling and fibrosis
Prevents progression of heart failure
Increased sCr, hyperK, dont use in prior angioedema
Beta blockers 4 main points
Inhibits beta adrenergic receptors and decreases catacholamines
Decreases heart rate and constriction
Can correct abnormal arrythmias ; heart selectives - BMAE ; best in asthmatics
Contra if bad lung disease
Aldosterone antagonists [4]
Blocks aldosterone in the kidney heart and vasculature
CrCl greater than 30mL/min
K less than 5 in order to use
Class 2-4 HF mainstay
Epileronone > Spironolactone for gynecomastia
SLGT2 four main points
Diuretic and hemodynamic effects to decrease mortailty
Mainstay effect with good kidney, glucose function
GFR greater than 20-30 to use
Causes UTIs cause you pee the sugar
Bidil four main points
Vasodilates arterial and venous vasodilation
HF benefit only in AA
Can cause HA ; Drug induced Lupus
Dont use with sildenfil = hypotension
Ivabradine four main points
Inhibits NA + channels in SA node reducing heart rate
NO MORTALITY BENEFIT
Must also be on a B blocker, HR above 70, and normal sinus rhythm,
Can cause AFIB = discontinue the agent ; hypertension can occur
Not used in ADHF
Digoxin four main points
Inhibits Na+ and K+ pump increases heart contractility
Improves exercise tolerance not mortality
Causes bradycardia, heart blocks, N/V, anorexia
Less than 0.5-2 levels in the serum for HF, monitor electrolytes and renal function
Anything over 2 can be considered toxicity
HFpEF treatment algorithm
Diuretics as needed
SGLT2
ARNI
MRA
ARB
ADHF stages 1-4
1 = normal ; warm and normal
2 = fluid overload over 18 PWP ; pulmonary congestion ; warm and wet
3 = hypoperfusion ; warm and dry
4 = pulm congestion and hypoperfusion; cold and dry
3 step treatment steps for ADHF
1.Diuretics
2.Inotropes
3.Inotropes and Diuretics
_Vasodilators prn.
Half life of dobutamine
2 mins
*It’s. A beta 1 agonist
Cardiac conduction cycle
SA —> AV —> Bundle of His —> Purkinje Fibers
Two main types of cells in cardiac conduction
NA + = atria; ventricular ; purkinje cells
CA 2+ = SA and AV node
Pacemaker cell phases
4 to 0 to 3
Na + Ca 2+ + decrease in K+
2 main goals of antarrythmics
Decrease automaticity
Prolong refractory signals
1234 agents for antiarrythmics
Class 1 = NA+ blockers;
Class 2 = K+ channel blockers
Class 3
Class 4 = CCBs
Class 1 anti arrhythmic agents pnuemonic
Double Quarter Pounder = Vtach ; WPW = procainamide IV
Lettuce mayo = Vtach ; lidocaine = IV, causes seizures ; crosses the BLOOD BRAIN BARRIER
Fries please = SVTs ; contra in HF ; visual taste disturbance
Amiodarone affects where
B blocker, Na+ , K+ blockers
Good in HF
Half life of 60 days
Loading dose required
Need annual labs, eye exams, LFTs
Dronerdarone is contraindicated in
HF and AFIB
K+ antiarrythmics have what warning
QT prolongation
Initiation of what two drugs requires hospitalization
Sotalol
Dofetilide
What med can pharmacologically get a patient out of AFIB
Ibutilide
What type of CCBs are used in arrythmias
Non dihydrperidine
Verapimil and Dilitiezem