2-uWorld Flashcards
(28 cards)
what is eisenmenger syndrome?
when Pulm BP>systemic BP in an ASD/VSC–> so blood bypasses lungs and ends up on systemic circ
complications of VSD
LV dilation, volume overload
eisenmenger syndr
endocarditis!
describe unopposed alpha antagonism with Beta blockade when BB taken with Cocaine?
cocaine make coronary vasoconstrictict
and
BB make HR go down so coronaries not perfusing
2 obvious precautions to take labs/med wise when you see prolonged QTc
Meds: abx, antipsych, antiemetic-zofran, antiarrhythmics, SSRI, opioid
Electrolyte derangement
murmur at the 2nd and 3rd L intercostal space
vs
murmur at the 3rd and 4th L intercostal space
TR
vs
VSD
prognosis of VSD
closes spontaneously in 10%
typically stays asymptomatic
murmur sound VSD
holosystolic murmur L lower sternal border 3or4 intercostal space
THRILL
should cocaine user with ST changes be taken to cath lab?
yes, cocaine can make platelets aggregate therefore forms clots!
murmury sound MR
apex systolic murmur
rads to ARMPIT
what happens to following electrolytes that causes QTc prolongation
-K
-Mg
-Ca
-Low
-Low
-Low
Isosorbide Dinitrate-Hydralazine (BiDil) indications
-Blacks with HFrEF: mortality&hospitalization benefit…not considered GDMT tho
-HFrEF who cannot take ACE/ARNI/ARB bcs kidney/K/RAstenosis: so give Bidil as substitute
FIRST LINE agents in patient with chest pain and cocaine use
-ASA
-ng for pain,
-Benzo good for BP/anxiety
-CCB if need for BP/CCB also good for pain!
DONT give BB
ASD is in ??? intercostal space
2nd
ventricular ectopy commonly expected ____ hrs after MI
by up to 48hrs
how does tachycardia induce cardiomyopathy?
> 120 HR for weeks or months–> myocardial CELLULAR CHANGES –> LV dilation –> impaired LV function
afib for ____ timeline can develop L atrial appendage thrombus and as a results requires ____ before electrical cardioversion or ___
> 48hrs
TEE
pharmacological cardioversion
patient comes in with afib, TEE has ruled out thrombus—>he gets cardioverted and successful and now NSR, are we worried about thrombus still and a need for AC? if yes why?
yes, for 4wks bcs thrombus can form due to mycoardial stunning–which can also pool blood causing thrombus formation
(risk of stroke highest first 2-7–which is how long stunning can last— days post cardioversion)
what meds will reduce hospitalization in HFpEF
and also possibly reduce mortality
MRA 2nd line
SGLT 1st line
when is BB recommended in HFpEF…..and WHY
when there is afib….bcs if Afib not controlled it will elevate LV pressure or Angina symptoms
what do you substitute for ACE/ARB/ARNI in a HfrEF who cannot take those meds
give them Isosorbide Dinitrate-Hydralazine AKA BiDil
which 2 meds that are mortality benefit for HFrEF do NOT help in HFpEF (unless certain circumstances)
ACE/ARB/ARNI
BB (unless angina* or afib* in hfPef)
when should you NOT repair/replace MR?
EF>60% and NOT symptomatic (do echo Q6/12 months)
def consider intervene if EF<60% (when reaches <30% likely surgery is futile at this point)
what is preferred for MR….repair or replace? why?
Repair
bcs replaced MR may require AC (mechanical) or will need repeat Replace in 15y(bioprosthetic)
when is surgery/repair absolutely needed for MR?
EF<30%
