Flashcards in 2 Cardiology + Vasc surg Deck (34)
Chest pain in ED, concerning for ACS: What drugs to give
morphine, O2, nitro, aspirin
B-Blocker, ace-i, statin, heparin
Add: Plavix and/or abciximab/ebtifibitide
Maybe remove: O2, B-blocker
If hypotensive and RCA infarct, give IVF instead of Nitro or morphine
-how to dx
Either old man with atherosclerosis of renal arteries, or young woman with fibromuscular dysplasia.
Get Renal Artery Doppler, confirm with arteriogram if necessary. (can also get Ace-i scan instead of renal art doppler)
Pt with hx of CHF comes in ED with AFib with RVR, causing CHF exacerbation. Vitals stable. How to tx?
CANNOT use CCB or BB for rate control.
Use Digoxin or amiodarone (amio can do both rate and rhythm control)
mitral valve prolapse
-murmur, louder with what
-systolic murmur, louder with valsalva
-tx just like HOCM: avoid dehydration (keep preload up) and B-block (increase filling time)
-what to do with points
CHF (LV systolic dysfunction) 1
Age >75 1
Vascular dz 1
Age 65-74 1
Sex category--female 1
Restrictive cardiomyopathy: think what 3 important causes?
-what hx clues for each
-how to confirm dx?
1. hemochromatosis--cirrhosis, bronze diabetes. High ferritin. Get genetic test.
2. amyloidosis--Neuropathy, multiple myeloma. Do fat pad biopsy, myocardial bx if negative.
3. Sarcoidosis--pulmonary disease/sxs. Do MRI.
Restrictive cardiomyopathy tx:
what to be careful about in treating overload sxs?
Gentle diuresis for overload, since heart is also preload dependent. Difficultly filling.
Pt with syncope, has structural heart disease and/or CAD. Do what?
Automatic admission for 24h telemetry
Primary hyperaldosteronism: get what test, what are you looking for
Renin/Aldo level >20
Possible aldosterone adenoma. Get CT and resect.
Suspect primary hyperaldosteronism in pt with HTN and Hypokalemia
PVD: What is difference betwen CLI and ALI?
Critical limb ischemia: chronic, severe progression of PVD
Acute limb ischemia: usu single thrombus, do immediate revascularization (eg thrombectomy)
Pt with syncope and focal neuro deficit: Think what, and what test to do?
Vertebrobasilar insuff. (decreased flow to posterior circulation)
-Do CTA, look at vertebrobasilar arteries
STEMI door-balloon time?
-if facility is __min away, do tpa
-what to give before transferring to cath facility? (4 according to onlinemeded)
90min. If facility is >60min away, do TPA. (onlinemeded)
-CC book says do TPA if unable to do PCI withint 120 min of arrival
-Heparin, then BBlocker, Ace-I, statin
Pericardial disease overview: How to think about 3 main problems and their tx?
Etiology not important. Think about how pericardium is responding to dz. Big 3:
1. Pericarditis--inflammation, so anti-inflammatories
2. Effusion/Tamponade--Hemodynamic intervention required
3. Constrictive--Anatomic solution required
You suspect Cushing's syndrome. What test to start?
"low Then high"
1. 24h urinary cortisol, or low dose dexamethasone suppression test. This is to confirm Cushing's syndrome.
3. High dose DST
Main side effects:
1. Statins (2)
2. Fibrates (2)
3. Ezetimibe (1)
4. Niacin (1)
5. Cholestyramine (1)
1. myositis, hepatotox
2. (same) myositis, hepatotox
4. flushing (tx with ASA)
Stress test types (3)
who gets what
1. Treadmill--normal EKG, can exercise
2. Dobutamine+echo--Abnormal EKG, or can't exercise
3. Nuclear--reserved for ppl with BBB, poor echo image, previous bypass
Pt with tamponade. Do what as you set up for emergent pericardiocentesis?
Start IVF to increase preload.
Preload-dependent state! Absolutely do not do positive pressure ventilation
Effects on LDL, HDL, TG?
1. fibrates: decrease TG
2. niacin: incease HDL
Orthostatic hypotension definition
Within 3 minutes of standing:
SBP up by 20, or
DBP up by 10.
Also, HR up 10
Pheo 5 Ps
Subclavian steal syndrome
arm claudication and posterior CN sxs (vertigo, presyncope). Bypass the arm stenosis.
Surgery for which AAA's? (3)
AAA >5.5cm, >0.5 cm/year, or tender
Coronary stents: drug eluting vs bare metal.
-When to use one over other?
-what meds required after each stent
-Always drug eluting, unless homeless or unreliable and cannot guarantee clopidogrel
-Drug eluting: 1 year plavix
-bare metal: 1 month plavix
BNP in diagnosing CHF: what pts is test less reliable
Obese. BNP can 'hide in fat' so artificially lower BNP value
PVD: what vessels get stented vs bypassed?
Lesion in femoral a. and <3cm gets stent.
Everything else: bypass
Pt with Orthostatic hypotension. IVF does not help. You should think of what rare causes? (4)
Failure of reflex sympathetics:
1. Broken autonomics: eldery/DM
2. Sepsis (vasodilation)
4. Addision's disease
Arterial embolization to extremity:
-treatment time window
-what to watch out for with treatment
5 P's of embolism
6h to fix until ischemia (same for tourniquets). Embolectomy or TPA or heparin
-watch out for compartment syndrome with return of blood
Difference btwn NSTEMI and UA.
-how to tell apart?
NSTEMI causes elevated cardiac enzymes (however may take a few hours to elevate).
Cardiac enzymes can take up to 18h to peak. So, to r/o NSTEMI, must have 2 negative Trops 6h apart, or negative after 18h ongoing chest pain.
CHF acute exacerbation drugs
LMNOP: lasix, morphine, nitrates, O2, position
REDUCE PRELOAD. Nitro and BIPAP most important! BIPAP also helps to reduce preload