3⼀CARDIOLOGY Flashcards

Question

On EKG, What constitutes as *[**PROLONG*** **QT** interval*]* in peds \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Male \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FeMale

Answer 1

males \> 4**5**0 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Peds \> 4**6**0 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FEMALES \> 4**7**0 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | (ms) [peds = 1-15 yo]

Answer 2

**[vessel wall aneurysm]** *specifically 2/2 [vessel wall infection ^{*(i.e. from IE septic embolization)*}] ➜ vessel wall destruction ➜ vessel wall aneurysm* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {[vessel wall infection ^{*(i.e. from IE septic embolization)*}] ➜ vessel wall destruction ➜ vessel wall aneurysm*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [SubArachnoid Hemorrhage (from [vessel wall aneurysm] rupture) - *LOOK FOR NECK STIFFNESS*] ; | *🔎IE = Infective Endocarditis*

Answer 3

## Footnote *💡oral anticoag = warfarin / dabigatrin / rivaroXaban / apiXaban*

Answer 4

➜ SA node [➜ R marginal a ➜ RV] ➜ [**PDA** (in 70% popln)]

Answer 5

➜ **LATERAL** LV ➜ [**PDA** (in 10% of popln)]

Answer 6

➜ ***IVP***: I: ANT 2/3 V: ANT LV P: ANT LAT ## Footnote ✏️ IVP= Interventricular septum/ Vt Free Wall/ Papillary muscle

Answer 7

1. [RVMI]^{(= Preload dependent = no Nitrate/no Diuretic/no Opioid):*Tx = {IVF-nitrates*}} 2. [AV Block] 3. [Sinus Bradycardia]^{*Tx = {Atropine IV}*} | *severe = unresponsive/hypOtension/dizziness/HF/syncope* ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 💊[P⼀harm^{[(IVF*-nitrates)*+AtropineIV]}] 💊💊--(if severe)--\> [P⼀ace^transQ|V] 💊💊💊→ [P⼀erfuse_PCI revascularization]

Answer 8

## Footnote 1.Previous SBIE 2.Prosthetic heart valve 3 [Transplanted heart with valve structure❌] 4.[CHD-Congenital Heart Disease (with cyanosis or after repair)] *🔎SBIE = [[Subacute Bacterial Infective Endocarditis]*

Answer 9

"Bacteria **FROM JANE**" ## Footnote **F**ever [**R**etinal Roth Spots - *Immunologic phenomena*] [**O**sler "Ouch" Nodes- *Immunologic phenomena*] [**M**umur that's new] [**J**aneway's purplish nonpainful lesions of the palms&sole] **A**nemia [**N**ailbed Subungal _Splinter_ Hemorrhages] [**E**mboli from valvular (T\>A\>M) vegetations] ; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Enterococcus⼀[STAph **A**], [STAph **E**]⼀[strEP **B**] [strEP **V**]* ⼀[^{*and nonbacterial*}*maranti(C)*^{*with its misc (C)*}] ..^{" causes ^{[mitral>tricuspid\*]}IE ... *FROM JANE"*}.

Answer 10

[High Risk Cardiac Conditions] ; [SBIE abx px] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ A. [Surgery during (ACTIVE) GI infection] B. [Surgery during (ACTIVE) GU infection] c. [dental procedure^{*(involving gingiva or oral mucosa)*}] d. dental cleaning e. [respiratory tract procedure^{*involving incision or biopsy of mucosa*}] f. surgical placement of prosthetic cardiac material | *_ptsHRC must receive [SAP] prior to any [SRS]* ## Footnote [⚠️SBIE = strEP Viridans = 💊CefTriaxone|aPG] *🔎HRC = High Risk Cardiac* *🔎SAP = [SBIE abx px]}* *🔎SRS = [SBIE-Risk-Setting]* _{*"Enterococcus⼀[STAph **A**], [STAph **E**]⼀[strEP **B**] [strEP **V**]* ⼀[^{*and nonbacterial*}*maranti(C)*^{*with its misc (C)*}] ..^{" causes ^{[mitral>tricuspid\*]}IE ... *FROM JANE"*}.}

Answer 11

patient with previous structural heart disease has random Vtach arrhythmia ➜ [**RANDOM SYNCOPE WITH NO PRECEDING SX**] ➜ rapid spontaneous patient recovery within min and no residual sx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *this can ➜ SUDDEN CARDIAC DEATH eventually*

Answer 12

## Footnote 1. Sick Sinus Syndrome 2. AV Block 3. MMVT 4.{[PMVT_torsades des Pointes] *RF:(low K+, low Mg+, Long QT)*} 5. HOCM 6. Aortic Stenosis

Answer 13

a. 1. pulmonary❌^{(disease|exacerbation)} 2. electrolyte❌^(K+|Mg+) 3. sepsis (catecholamine surge) | c. [(*wap*) < 100bpm ≤ (*MAT*)] ## Footnote b. MAT etx: ^{*(PES) ➜ *}:random firing of multiple ectopic foci in the atria ➜ [***3 DIFFERENT P-wave MORPHOLOGIES***^{with **irregularly irregular R-R**} + **(rate ≥100bpm**)].

Answer 14

(dx = [EKG with P waves of 3 different morphologies] + [atrial rate \> 100]) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx =[treat *PES* cause^{*(Pulmonary/Electrolyte/Sepsis)❌*}] --(if fail)--\> [Verapamil_{nCCB (AV node blockade)}]

Answer 15

[infection (*peds*)] or [fat embolus (*ADULTS*)] ➜ life-threatening vasooclusioin of pulmonary vasculature in sickle cell patients \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [CXR New Pulmonary infiltrate] + ≥1 of : - WOB - Temp\>38.5C - Hypoxemia - chest pain

Answer 16

## Footnote ***CVC*** = {[**C**.**O**.**D**.**E**.] ➜ [**V^V.A.P.**]} ➜ [**C=A=R**]

Answer 17

[***CVC***_⼀ACLS] _{*START CHEST COMPRESSIONS!*} | *"C - V - C"* ## Footnote ***CVC***^③ = 1)[**C**.**O**.**D**.**E**.] ➜ 2)[_V.(**A**)._P.] 3)➜ [**C=A=R**]

Answer 18

[***CVC***_⼀ACLS] _{*START CHEST COMPRESSIONS!*} | *"C - V - C"* ## Footnote ***CVC***^③ = 1){[**C**.**O**.**D**.**E**.] ➜ 2)[_V.A.(**P**).] 3)➜ [**C=A=R**]

Answer 19

[***⚡CVC***_⼀ACLS]\* _{*START CHEST COMPRESSIONS!*} | *"{shock} C - V- C*" ## Footnote \* ***⚡CVC***^{④⼀*"{shock} C - V- C"*} = 1) [**C**.O.D.E.] → 2) {[⊕(**V**) _A.P.] = _*--give-->**3) {⊕[(V)oltage\_SH⚡CK\_Debrillation]}* 4) → [**C**=A=R]

Answer 20

[***⚡CVC***_⼀ACLS]\* _{*START CHEST COMPRESSIONS!*} | *"{shock} C - V- C*" ## Footnote \* ***⚡CVC***^{④⼀*"{shock} C - V- C"*} = 1) [**C**.O.D.E.] → 2) {[⊕(**V**) _A.P.] = _*--give-->**3) {⊕[(V)oltage\_SH⚡CK\_Debrillation]}* 4) → [**C**=A=R]

Answer 21

AORTIC INJURY ## Footnote *secondary to rapid deceleration with shearing along the aortic arch*

Answer 22

[**ABCQ** *"Takotsubo"*] 1. [stressor(s) ➜ catecholamine surge ➜ **A**NT MI presentation] *+* 2. [*^{**B**alloon❤️}*LV wall motion ∆] 2/2 3. [**C**oronary spasms transiently ^{(withOUT coronary occlusion on Cath!)]} and 4. [**Q**T prolongation] ## Footnote 🔎[*Balloon❤️* =_Echo[(apical hypOkinesis) + (BASILAR HYPERkinesis)]

Answer 23

**a-c-s** [**a**zithromycin (*mycoplasma pna*)] [**c**eftriaxone (*strep pneumo*)] [**s**aline IVF w analgesia]

Answer 24

beta blockers \> ([Verapamil_*NCCB*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ HOCM TX GOAL = **⇪ LV Volume to overcome outflow tract obstruction**. BB and nCCB achieve this 2 ways: Negative chronotropy ( ⬇︎HR) ➜ inc diastolic time to fill -> higher LV end-**diastolic** volume Negative inotropy ( ⬇︎contractility) ➜ decreases systolic ejection strength -> completes systole with higher LV end-**systolic** volume

Answer 25

▶**PULSELESS (No palpable pulse)** *with* ▶electrical activity (organized rhythm ⼀that's not VF/VTp) on cardiac monitor \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ { [CPR x 2 min] + [Epi q 3-5 min]} until cause is determined! | *Note: [pulseless VT/VF] DO require defibrillation*

Answer 26

mitral valve insufficiency 2/2 **intrinsic defect of mitral valve apparatus** (leaflets/chordae tendineae) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [normal EF for Chronic Primary MVR] \> 60% (*normally \> 50%*)

Answer 27

1. [Major Depressive Disorder] = independent risk factor for [⇪ morbidity and mortality] from CV disease . 2. CVD = [independent risk factor for developing MDD] ## Footnote *Treat with SSRI*

Answer 28

**CABG** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CABG has lower all-cause morTality, MI and repeat vascularization than PCI

Answer 29

dihydropyridine-CCB [Amlodipine | Nifedipine] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ACEK2 inhibitors

Answer 30

**PULMONARY** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** [DC amiodarone] ➜ [CTS if severe/life threatening]

Answer 31

RIGHT Ventricular MI ; {**[AGGRESSIVE IVF (BOLUS)] - [Nitrates]**} = ## Footnote ☞ RVMI tx = **PRELOAD DEPENDENT** = (need to INC preload with IVF and avoid Nitrates/diuretics/opioids that DEC preload) ☞ (add AtropineIV to treat associated AV Block and Sinus brady) 💊[P⼀harm^{[(IVF*-nitrates)*+AtropineIV]}] → P⼀ace → P⼀erfuse_PCI]

Answer 32

Men: [\> 60% occlusion and Symptomatic] or [\> 70% occlusion] Women: [\> 70% occlusion regardless of sx] ANY OF THESE --\> CAROTID ENDARTERECTOMY \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *ASA, antiHTN and Statin = medical mgmt*

Answer 33

ASA*,* antiHTN *and* Statin

Answer 34

[CARDIAC OUTPUT --corrected for *patient's size*^{(smaller people = smaller CO / Larger People = Larger CO)} = **standardized measure of pump functioning** | ^{[(⬇︎⬇︎ in cardiogenic shock) > (⬇︎ in hypOvolemic shock)]}

Answer 35

[LE claudication (butt/thigh pain or weakness)] diminshed femoral pulses Erectile Dysfunction \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ BL AortoiLiac PAD *PATIENTS WITH ED SHOULD BE SCREENED FOR CVD/PAD BEFORE TX!*

Answer 36

PAD; PAD ➜ ED and ED is a strong predictor of CAD ED patients should receive diagnostic testing (ABI/Stress testing) BEFORE INITIATING TREATMENT FOR SEXUAL DYSFUNCTION

Answer 37

**[REVERSIBLE** asx decline of LV EF (that may ➜ overt HF)] BUT AFTER DISCONTINUANCE ➜ COMPLETE REGAINMENT OF CARDIAC FUNCTION POSSIBLE | *Trastuzumab is used in Breast CA*

Answer 38

get a [**LOAN⼀aP**] to treat Coke! ## Footnote 1. [**L**orazepam\_ benzo (*HR/BP/psych control*)]^IV 2. [**O**pioid🟢\_Morphine]^IV 3. [**A**mlodipine\_dCCB] 4. [**N**TG^IV] --(if persist)--→ 5. → [**a**lpha1🟥\_Phentolamine (if *P*ersistent)] 6. ➜ ➜ **P**CI (for coronary revascularization if sx still not alleviated)

Answer 39

ironically, although [IVC filters] [⬇︎PE risk x 2], it actually [⇪DVT RISK x 2]

Answer 40

1. tall (T) 2. Loss of (P) 3. [Wide/sinusoidal QRS] 4. (U) wave absent \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {**1st** (*stabilizes cardiac membrane potential*): [IV Calcium Gluconate] or [IV Calcium Cl] } ➜ {-**2nd** *drive K+ into cells*: Beta agonist or [insulin-glucose]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Hyperkalemia sx = weakness + cardiac*

Answer 41

Patients with all 3: 1. **SINUS RHYTHM** + 2. [symptomatic HF EF<35%] 3. [LBBB with QRS\>150]

Answer 42

TTE = Evaluates [RV function], [**Pulmonary Artery Pressure**], [L valve function] and [LV function]

Answer 43

*{"with Cocaine [**L**orazepam_Benzo] targets [Psych / Pressure / Pain"]}* 1.[^*Psych:*⬇︎Psychomotor agitation] 2.[^*Pressure:*⬇︎sympathetic NS →⬇︎HTN] 3.[^*Pain:*⬇︎myoscardial ischemia] | *Cocaine OD_tx = [**LOAN-aP**]* ## Footnote ⚠*but do NOT give β🟥 (MAY ➜ UNOPPOSED ALPHA 1 ACTIVATION)*

Answer 44

acute *TAAAD* [Type A *ascending* Aorta Dissection] (severe HTN from cocaine can ➜ *TAAAD* = sharp ANT chest pain | and if *TAAAD* ascends into carotid artery ➜ [neuro weakness]) *dx = [Chest Spiral_CTA]*

Answer 45

1. [**TEE**- *unstable or renal CXD*] 2. [Chest Spiral CT Angio]- *Stable vitals*] 3. [MRI-*NonEmergency*] ## Footnote *TEE is great because it's used in renal pts*

Answer 46

1. [SEVERE SHARP TEARING (CHEST⼀*TAAAD*) OR (BACK⼀*tBDAD*) PAIN] 2. [BUE SBP discrepancy \> 20 mmHg] 3. [Aortic Regurgitation ➜ [pericardial effusion/tamponade/Hemothorax] 4. [LE paraplegia (*⼀spinal a*)] 5. [Horner's *MAP* (⼀*carotid sympathetic plexus*)] | * biggest RF = HTN* ## Footnote * TAAAD = [Type A Ascending Aorta Dissection] || tBDAD = [Type B Descending Aorta Dissection]*

Answer 47

[Rheumatic Mitral Stenosis]; [10-20 years after Rheumatic Fever] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote 1. **LOUD** S1 2. [mid-diastolic rumble @ apex] 3. DYSPENA 4. orthopnea 5. paroxysmal nocturnal dyspnea 6. hemoptysis

Answer 48

\<1% risk of CV events within the next year \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *NEGATIVE stress test = ≥85% of Max HR with no major EKG* ∆

Answer 49

Acute pericarditis ## Footnote *diffuse ST elevations with PR depression*

Answer 50

Cardiovascular events \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SLE is major risk factor for [**premature coronary atherosclerosis**] which ➜ fatal CV events

Answer 51

1. [ST_{8️⃣-9️⃣} **Depressions**] 2. [T_🔟 inversions] | *🔎{#️⃣} = MEGAN (McCalister ECG Graph Association Number]* ## Footnote _{💡[ST_{{8️⃣-9️⃣}*segment*} **Depressions**]
💡[T_🔟*wave* inversions}

Answer 52

1. ST **Depressions** 2. T Wave inversions ## Footnote *same EKG as **AanS** = [**A**CS⼀**a**cute **n****S**TEMMI]*

Answer 53

[ACS acute STEMI] R₄ criteria * * * * **R₀**_:Revascularize only if **[SX ≤ 12h]** * **R**1: [_iHP = PCI ≤90 min eDB] * **R**2: [_OHP ≤120m eDB TFR] = [PCI ≤120 min eDB] * **R**3: [_OHP \>120m eDB TFR] = [*ART*-tPA fibrinolysis^{within 30m}] ## Footnote * * * * _^iH/OHP: _{^{in/OUT House}}PCI Institute* * TFR: Transfer* * eDB: estimated Door→Balloon*

Answer 54

New [**\> 1 mm** ST-Elevation (J point to baseline)] in [≥2 contiguous leads (*except V2,V3\**)] \**V2,V3= [women ≥1.5mm]| [( ≥2.5)\<--m40--\> (≥2mm)]* \_\_\_\_\_\_OR\_\_\_\_\_\_\_ [New LBBB with ACS sx]

Answer 55

< **V1** [R1º (second R wave)] \> \_\_\_\_\_\_\_\_\_with\_\_\_\_\_\_\_\_ < **V6** [Fat *^(widened)* S wave] \>

Answer 56

- [(AVR^RF*) = warfarin^2.**⁵**^-3.**⁵**] - [(MVR) = warfarin^2.**⁵**^-3.**⁵**] - [(AVR) = warfarin^2-3] [+ ASA_L (if severe CAD\*)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ LIFELONG *RF = old-gen replacement valve, afib, LVHF, hypercoagulable, prior Thromboembolism // ASA_L = Low dose ASA*

Answer 57

**DAN** is always droppin' orthostatic ## Footnote • **D**iuretics **• A**lpha R blocker • **N**itrates

Answer 58

[**S**eptal endocardial cushion defect] ## Footnote {[**SHEEPPS**]^*traits* & [**SHALA** **H**as **D**own **S**yndrome]^*conditions*}

Answer 59

- [Sinus Bradycardia (+/- 1º AV Block)] -*2/2 heightened vagal tone* - [EKG LVH]*-* *responsive LV thickness will meet EKG LVH voltage criteria*

Answer 60

1. [fatal Vt Arrhythmia triggered by intense exertion io\ [structural heart❌^{(*HOCM, coronary a anomalous origin*)}] \> [conduction❌^{(*long QT, Brugada-Pokkuri*)}] 2. leading COD age < 35

Answer 61

[Systolic BP] ⬇︎more than 10 **during inspiration** ## Footnote "Pulsus for **CAPOT**"

Answer 62

**[10-20% in 1st hour] --\> [5-15% over next 23 hours]** * * * | Normal MAP: 65-110 ## Footnote Malignant HTN Emergency = [Hypertensive Urgency (BP\>180/120)] PLUS Papilledema/Retinal Hemorrhages

Answer 63

65-110 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 64

_{*(while investigating/treating underlying cause)*} 1st : [**Atropine IV + IVF**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2nd : [**Glucagon IV**(⇪intracell cAMP)**] *⼀BB toxicity* 3rd: [Epi^gtt |DOPAmine^gtt] 4th: [transQ/V pacing]

Answer 65

\> 2 Days after onset

Answer 66

*MA * VZ * A * D* ## Footnote 1st: {BB: [**M**etoprolol^{10 mg start}] | | [**A**tenolol] - *rCTD IN HF or hypOtension*} 2nd: {NCCB: [**V**erapamil] | [diltia**Z**em^{([0.25 mg/kg bolus] → [0.35 mg/kg DRIP])}]) -*rCTD IN HF or hypOtension*] 3rd: [**A**miodarone^{+ Cardio consult}] 4th: [**D**igoxin^{+ Cardio consult}]

Answer 67

**100J CARDIOVERSION** **\_\_\_\_\_\_\_\_(unless duration ≥48h) ________ ➜** [Clots on Echo?] ➜ No = [Heparin ➜ 100J Cardioversion STAT] YES = [Warfarin x 3 wks ➜ Cardioversion when Warfarin therapeutic]

Answer 68

1. Surgery for *TAAAD* 2. [Esmolol β🟥]^IV 3. Nitroprusside IV^{(if SBP >120)} 4. Pain

Answer 69

(primary arterial vasoDilator) ; arterial vasoDilation ➜ [reflex tachycardia ➜ ⇪ LV contractility] ➜ [⇪ aortic wall shear stress] ➜ [worsens aortic dissection] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Sodium Nitroprusside^{*(mixed vasoDilator/venoDilator)*}] should **only** be used to ⬇︎ [AD **SBP \> 120**] | *never use Hydralazine ⼀ only use Nitrop if SBP > 120*

Answer 70

BB allow for more time for LV to fill with blood ➜ more LV blood DEC outflow tract obstruction (and ⬇︎murmur) ➜ improves HOCM cardiac output

Answer 71

Exercise | Mediterranean diet | DASH diet

Answer 72

antiPsychotics / antiDepressants / antiFungals /[_antiBioticMacrolides] / [_antiBioticFluoroquinolones] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **B**radyarrhythmia (*sinus brady, AV block*) | "[HIS **B**EDS] gave me arrhythmia"

Answer 73

[PMVT Torsade de Pointes] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1.{[**MgSO₄^IV**]_{pharm cardioversion}} 2.{^{--(if persist)--\>}[Temporary transVenous pacing]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [MgSO₄^IV] | *give regardless of preexisting baseline Mg*

Answer 74

1. Sotalol^[3] 2. Dronedarone^[3]

Answer 75

1. Dronedarone^[3] 2. Amiodarone^[3]

Answer 76

1. Flecainide^[1C] 2. Propafenone^[1C]

Answer 77

1. **A**miodarone^[3] 2. do**F**etilide^[3]

Answer 78

self limited --(if persist)--\> [ASA^{650 TID}] | [acute pericarditis] ## Footnote *(NO NSAIDs or CTS as these impair myocardial healing and ➜ vt rupture)* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 79

Acute Pericarditis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | *can → calcified+fibrous → cardiac decline = Constrictive pericardiits* ## Footnote *diffuse PR depression + diffuse ST elevation*

Answer 80

"give that **LAD** a *Statin^M/H*!" 1. [**L**DL ≥190] 2. [**A**SCVD^10y \> 7.5-10%] 3. [**D**M ≥40 year old] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *ASCVD^10y = AtheroSclerotic CVD 10 year estimated risk | Statin^M/H = Moderate/HIGH Intensity*

Answer 81

1. afib (L Vt hypertrophy ➜ LAE ➜ afib) = [EKG_amb ➜ [antiCoag + rate/rhythm control] 2. **VT (L Vt ischemia and fibrosis ➜ Vtach --****(if sustained)****--\>SCD (most common COD for HOCM) = [EKG_amb➜ ICD]** * * * *[AMBULATORY EKG (24H Holter)] to diagnose both*

Answer 82

1. [noncoronary Atherosclerosis (PAD, Carotid, AAA)] 2. CKD 3. [DM (*note: strict glycemic control only ⬇︎ **micro**vascular complication*)] ***these factors are AKA "CHD equivalents"*** ^{= carries same risk to of damaging CV health ... as having CHD itself}

Answer 83

* NYHF**4** * refractory angina * arrhythmias * valvular disease \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [low = sex ≥1 wk post ✔︎CRV] || [HIGH = requires assessment before sex]

Answer 84

1. Restrictive cardiomyopathy with diastolic dysfxn 2. constrictive pericarditis 3. valve damage 4. conduction damage 5. MI

Answer 85

mmVT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [***SLAP***_{pharm cardioversion}] ## Footnote -mmVT = monomorphic VT -***SLAP*** = Sotalol³ |Lidocaine^1B |Amiodarone³|Procainamide^1A

Answer 86

[PMVT Torsades de Pointes] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1.{[**MgSO₄^IV**]_{pharm cardioversion}} 2.{^{--(if persist)--\>}[Temporary transVenous pacing]} ## Footnote PMVT = POLYMORPHIC VT

Answer 87

mmVT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [***SLAP***_{pharm cardioversion}] ## Footnote -mmVT = monomorphic VT -***SLAP*** = Sotalol³ |Lidocaine^1B |Amiodarone³|Procainamide^1A

Answer 88

[atrial Tachycardia *(looks like aflutter THAT'S MISSING SAWTOOTH PATTERN)* ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***BB***|***nCCB*** rate control ## Footnote -[BB=Beta Blocker] / [NCCB=nonDihydropyridine Calcium Channel Blocker (Verapamil|Diltiazem)]

Answer 89

[AV**N**RT]^*PSVT* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ stable: -vagal maneuevers stable: -adenosine ⚠️unstable: DC Cardioverson ## Footnote [AVnRT = AtrioVentricular (nodal) Reentrant Tachycardia]

Answer 90

[atrial flutter *(look for sawtooth pattern)* ] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ***BB***|***nCCB*** rate control ## Footnote -[BB=Beta Blocker] / [nCCB=NonDihydropyridine Calcium Channel Blocker (Verapamil|Diltiazem)]

Answer 91

[AVRT orthodromic^{*retrograde P wave*} SVT] | *Look for **[retrograde P waves]**!*

Answer 92

[atrial fibrillation] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [*MA* * *VZ* * *A* * *D*]_{rate control} | [irregular R⼀R] / [no P wave] / [narrow QRS] ## Footnote [*MA* * *VZ* * *A* * *D*]_{rate control} **(M|A)*** **(V|Z)** * **A** * **D**

Answer 93

[⚡mmVT_{**pulseless**}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [***⚡CVC***_⼀ACLS]^{*START CHEST COMPRESSIONS!*} ## Footnote -mmVT = monomorphic VT -***⚡CVC*** = **C**ODE| **V**^⚡AP| **C**=A=R ^{(⚡= *give* [Voltage Defibrillation SHOCK])}

Answer 94

[⚡VF] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [***⚡CVC***_⼀ACLS]^{*START CHEST COMPRESSIONS!*} ## Footnote -VF: Ventricular Fibrillation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **⚡CVC** : **C**ODE| **V**AP| (**C**=A=R)] -{VF = [***⚡CVC***⼀ACLS] tx--regardless of pulse}

Answer 95

[⚡VF] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [***⚡CVC***_⼀ACLS]^{*START CHEST COMPRESSIONS!*} ## Footnote -VF: Ventricular Fibrillation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -[***⚡CVC** : **C**ODE| **V**AP| (**C**=A=R)] -{VF = [***⚡CVC***⼀ACLS] tx--regardless of pulse}

Answer 96

[ACS ⼀STEMI]⁽*^{anterolateral}*⁾

Answer 97

psychogenic etx (*Do Detailed Psychological assessment/counseling*)

Answer 98

1. {[Crescendo Decrescendo Systolic murmur ^{w/*delayed* carotid pulse} @ R 2nd ICS]} 2. [Pulsus Parvus et Tardus^{(*delayed* carotid pulse)}] 3. [S4^{(from LV hypertrophy)}]

Answer 99

**Aortic Stenosis** *[Crescendo-Descrescendo Systolic Ejection Murmur]* "**Lean forward**...& then **Squat** with that *As*s, that'll turn it up!" B: INC with... 1. Leaning Forward 2) Squatting C: DEC with...handgrip (*INC afterload*)

Answer 100

**M**itral **V**alve **P**rolapse *[**MidSystolic NON-Ejection Click** + Late Systolic Crescendo Murmur]*

Answer 101

**Mitral Stenosis** *[Diastolic delayed **Opening Snap** followed by Rumbling]* B: [Apex + **LLDP** (L Lateral Decubitus Position)] C: Maneuvers that [INC Afterload] (i.e. handgrip)

Answer 102

**Hypertrophic Cardiomyopathy** *[Holosystolic **Harsh** Blowing Murmur + palpable thrill] @ [L Sternal 2/3 ICS]*

Answer 103

**V**entricular **S**eptal **D**efect *[Holosystolic **Harsh** Blowing Murmur + palpable thrill] @ [tricuspid area]*

Answer 104

_N=none**[*****(Sx ^{*(😵‍|🫨)*} or Na < 120)*****?]**^{Y=Water restriction (c/s Tolvaptan if Na<120 + chronic HF)} ## Footnote *hypOnatremia sx (confusion😵‍, seizure🫨) ||* [**Tolvaptan** *(Vasopressin-2 ADH R blocker)*]

Answer 105

SIADH ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *NEVER give Oral salt tablets to edematous/volume overload CHFE*

Answer 106

inhibition of B1 R ➜ [⬇︎intracellular cAMP] in… ## Footnote ▶[cardiac **contractile** myocytes] ➜ DEC heart contractility ➜ DEC BP*^{(poor perfusion/confusion if OD)}* ▶[cardiac **pacemaker** myocytes] ➜ DEC [phase 4 depolarization slope] ➜ DEC HR*^{(arrest/AV block if OD)}* *_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* *BB_tox tx = IVF, atropine, glucagon*

Answer 107

1. IVF (if hypOtension) 2. atropine (symptomatic bradycardia) 3. **GLUCAGON** **= BB toxicity tx ⼀*****activates glucagon R ➜ directly INC intracellular cAMP = bypasses adrenergic blockade from BB and restores HR and contractility in setting of BB toxicity***

Answer 108

Calcium **gluconate** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *INC intracellular Ca+ ➜ restores arterial smooth m tone and cardiac contractility*

Answer 109

- [AUTO DOM *with incomplete penetrance*] or - sporadic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [screen 1st degree relatives for [bicuspid aortic valve] with echo]

Answer 110

5; 200; 0.5

Answer 111

1; 40; 0.1

Answer 112

“*K* [(*lifts up the* 🆃), (*sits on the* 🄿),*(widens 1st interval* **Q**) & *(suppresses the 🅄]*” ## Footnote = [⇪ K] ➜ [widening & flattening of *P*] ➜ [No *P*]

Answer 113

“*K* [(*lifts up the* 🆃), (*sits on the* 🄿),*(widens 1st interval* **Q**) & *(suppresses the 🅄]*” ## Footnote = ([⇪ K] ➜ [peaked *T*]) or ([⬇︎ K] ➜ [flat *T*])

Answer 114

“*K* [(*lifts up the* 🆃), (*sits on the* 🄿),*(widens 1st interval* **Q**) & *(suppresses the 🅄]*” ## Footnote = ([⇪ K] ➜ [wide *QRS*]) ([⇪⇪ K] ➜ [very wide *QRS*]) ([⇪⇪⇪ K] ➜ [sinusoidal vs Torsades *QRS*])

Answer 115

“*K* [(*lifts up the* 🆃), (*sits on the* 🄿),*(widens 1st interval* **Q**) & *(suppresses the 🅄]*” ## Footnote = ([⬇︎ K] ➜ [visible *U*]) ([⬇︎⬇︎ K] ➜ [prominent *U*])

Answer 116

## Footnote *🔎A**A**S = [AVRT **A**ntiDROMIC(delta wave) **S**VT]* *🔎BKAP ⼀Bundle of Kent accessory pathway* 💡delta wave = 2/2 fusion of both conduction ☞ [*early but slow* myocardial depolarization via *BKAP*] ..with the [normal AV node depolarization]

Answer 117

[Wolff Parkinson White] ## Footnote *🔎BKAP ⼀Bundle of Kent accessory pathway*

Answer 118

◮[*BKAP* **ABLATION**^{*via Catheter*}] Obliterates accessory pathway ## Footnote *🔎A**A**S = [AVRT **A**ntiDROMIC(delta wave) **S**VT]* *🔎BKAP ⼀Bundle of Kent accessory pathway*

Answer 119

✔︎ {DO✅SURGERY \<-- **[****(****0-1****pt (LR≤1%)**|***Revised Cardiac Risk Index***|**(****≥2****pt (HR\>1%)**|**]** --\> [DELAY❌SURGERY^{*(unless can concomitantly perform ≥4METS)*}]} ✔︎ Pts {[≥2pt (HR\>1%)] *but* can perform ≥4 METs} = DO✅SURGERY also ## Footnote * [Revised Cardiac Risk Index] has 6 scoring variables, each 1 pt* * \*Delay❌Surgery= to assess cardiac functional capacity* * METs = Metabolic Equivalent*

Answer 120

LV Ejection Fraction ; [High accuracy & reproducibility] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Radionuclide ventriculography (AKA Multigated Acquisition Scan)] is used clinically for [initial, ongoing and follow up monitoring of [LV EF] in patients receiving cardiotoxic chemo (like doxo/daunarubicin) = [a *DEC in EF by ≥10% during chemo➜ Discontinue chemo]*

Answer 121

**ECHO: early diastolic [R heart (atria & ventricle) collapse]** **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** 2. Echo: IVC plethora 3. EKG: electrical alternans 4. EKG: low voltage QRS 5. CXR: enlarged cardiac silhouette 6. CXR: clear lungs with HF-like sx

Answer 122

1. IVF^{( ⇪ R Heart preload)} 2. Drainage^{(via pericardiocentesis or pericardial window)}

Answer 123

1. [Beck's triad (hypOtension, JVD, muffled heart sounds)] 2. [Pulsus Paradoxus^{(SBP ⬇︎\> 10 during inspiration)}]

Answer 124

Jugular Venous Tracing ## Footnote 1. [**a**trial on RIGHT contracts⼀*RA contracts*] 2. [**c**ontraction of RV ➜ tricuspid bulge ⼀ *RV contracts*] 3. [rela**x**ation of RA ⼀*RA relaxes*] 4. [ **v**enous blood fills RA ⼀*RA fills*] 5. [ empt**y**ing of RA passively after tricuspid valve opens ⼀*RA emptys*]

Answer 125

severe Tricuspid Regurgitation ## Footnote 1. [**a**trial on RIGHT contracts⼀*RA contracts*] 2. [{**c**losure *(& bulge)* of tricuspid}⼀ *2/2 RV contracts -> tricuspid closure/bulge] 3. [rela**x**ation of RA ⼀*RA relaxes* and subsequently fills with {venous IVC blood}] 4. [{ **v**enous IVC blood cont to fill RA}] 5. [ empt**y**ing *(passively)* of RA into RV)]

Answer 126

[(Distal to L subclavian artery) & (Proximal to Ductus Arteriosus)]; Turner ; MALES

Answer 127

1. UE HTN 2. LE hypOtension 3. LE weak and delayed distal pulses 4. LE claudication 5. [CXR: “3” sign from aortic narrowing + rib notching from collateral vessels] -**dx** ***confirmed by echo*** 6. [+/- murmur (if [PDA-continuous] or [L sternal -turbulent flow] present)]

Answer 128

Cyanotic heart disease ; R-to-L shunting

Answer 129

1. SCD fam hx 2. Syncope 3. [holter nonSustained VT] 4. exertional hypOtension 5. [LVH \> 3 cm]

Answer 130

1. survivor of cardiac arrest 2. [holter Sustained ventricular arrhythmias]

Answer 131

## Footnote *Stable* CAD management = **stabLE** = **s**tatin, [**t**ighten Lifestyle(BP/Glucose/no smoking]), **a**SA, [**b**Blocker\>ccb + ACEK2i],[**L**ab_for_coronary angio revascularization in high risk/false neg], [**E**xercise stress = dx *unless ⊕baseline EKG❌ → Pharmacologic stress imaging*] *HIGH RISK= ST depression at min exertion, Vt arrhythmia, poor exericse capacity*

Answer 132

diagnoses [Syncope 2/2 carotid hypersensitivity (*found in elderly with Carotid atherosclerosis*)]

Answer 133

1. HR INC 2. dry mucous membrane 3. hemoconcentration 4. BUN/Cr ratio INC

Answer 134

1. Surgery_cardiac 2. idiopathic 3. TB 4. viral^*Coxsackie* 5. radiation 6. other^{[Uremia/CA/MI_Dressler]} "*Surgeons* are *viral* *idiots* to **constrict** my *TV*, *radio* and *More*"

Answer 135

1. Fatigue / DOE 2. R HF [Peripheral edema/ascites/INC JVP] 3. **Early diastole Pericardial knock** 4. **[JVD with ⊕Kussmaul** *(paradoxic INC JVP with inspiration)***]** 5. **Prominent** ***y*** **descent** 6. **CXR pericardial calcifications** 7. **TTE: biatrial enlargement with nml Vt wall** 8. EKG: low voltage QRS 9. {[acute pericarditis] {*C*an → [*C*alcified fibrous thickening of Pericardium] → [*C*ardiac compromise with decline] = ^{***C***onstrictive}Pericarditis]} ***T***x = {[anti-inflammatory R_x]--(*refractory)*--\>[pericardiectomy]}

Answer 136

1. [Neuro (ataxia, peripheral neuropathy)] 2. visual disturbance 3. thyroid 4. bradyarrhythmia 5. [chronic interstitial pneumonitis] 6. hepatotoxic 7. **blue gray skin**

Answer 137

*unexplained …* 1. [Echo: INC Vt wall thickness with nl LV cavity dimension] 2. [HFpEF diastolic] 3. EKG low voltage

Answer 138

Inferior MI often causes [R Vt wall and SA node ischemia] which → **INC Vagal Tone** → sinus bradycardia (+ R HF and L HF sx) = atropine tx (*blocks INC Vagal tone*)

Answer 139

1. [AV**N**RT]^*PSVT* 2. [A**O**S]\* 3. Sinus Tachycardia SVT 4. [atrial tachycardia SVT] 5. [atrial Flutter SVT] 6. [aFib SVT]^{*⚠️irregular*} 7. [A**A**S] \* 8. [aberrant SVT]^*⚠️WIDE* | *SVT are typically Regular and Narrow unless ⚠️* ## Footnote \* **AOS**: [**A**VRT **O**RTHOdromic^{*retrOgrade P wave*} **S**VT] **AAS**: [**A**VRT **A**ntidromic^{*deltA wave*} **S**VT]

Answer 140

(Adenosine^IV) * * * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [synchronized DC cardioversion]

Answer 141

[Adenosine^IV and/or vagal maneuvers]: 1. *_Dx*_: temporarily slows AV node conduction and unmask “hidden” P waves on EKG for dx. 2. *_Tx*_:also causes transient AV nodal block → terminates AV node-dependent arrhythmias (i.e. [AV**N**RT]^*PSVT* and [AOS-*AVRT orthodromic SVT*])

Answer 142

Aortic Regurgitation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Head bobbing with each heart beat = de Musset sign and is sign of widened pulse pressure*

Answer 143

Atrial Septic Defect

Answer 144

1. [Inguinal Ligament *Superiorly*] 2. Sartorius M. *Laterally* 3. [ADDuctor Longus M. *Medially*]

Answer 145

Pregnant Women *\> 20 weeks gestation* can experience hypOtension when [gravid uterus] (while **supine**) compresses IVC --\> [DEC Venous Return] --\> DEC CO

Answer 146

Pulmonary Veins *Myocardial sleeves extends around PVs and are supposed to be a sphincter to prevent reflux during atrial systole*

Answer 147

1. Give [**A**SA + ADP P2Y12 R Blocker]^{*alt: ( vs ASA vs Warfarin)*} *(unless)* 2.*#2nd stroke → Warfarin^⚠️* 3.*⊕aFib present → Warfarin^⚠️|NOAC* | B**A**LTIC ## Footnote *⚠️Cont ASA/ADP🟥 if Warfarin CXD* *Also make sure pt is on a Statin* ✏️START WARFARIN FOR SURE **after second stroke** (if warfarin contraindicated, use only ASA) ✏️Give WARFARIN vs NOAC if pt has **aFib** after ANY stroke

Answer 148

**Procainamide** ; the others are AV nodal blockers and may ⬆︎condution through the [BKAP] | *🔎BKAP = Bundle of Kent accessory pathway* ## Footnote *🔎A**A**S = [AVRT **A**ntiDROMIC(delta wave) **S**VT]*

Answer 149

***^{with EARLY DX & APPROPRIATE TX …}*** **[NORMAL]****^MAJORITY**\> \> [poor pgn 2/2 LV systolic dysfunction]^minority

Answer 150

**D**\>**W**\>**A\>S\>****E** * * * {[**_⬇︎**_{Sat/Total Fats}**D**ash diet ^{⇪Fruits/Vegetables}]*^{→ (⬇︎11mmHg)}*} [**W**eight loss^{⬇︎10kg = ⬇︎6mmHg}]*^{(if BMI ≥25)*}* [**A**erobic exercise^{30min/d x 5d/wk}] [**S**odium^{(<1.5g PO/d)}] [**E**TOH^{M≤2 | W ≤1 (drink/day)}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\*Use If BMI ≥25 | central obesity = greatest lifestyle RF for HTN*

Answer 151

*“call **TECNA*** *for [ACS_primary] = ALWAYS DO THIS FOR ANY ACS* [**T**roponin-iii^{q6H x ≥3}]⼀rises@4h, peaks 6-12h, falls@7-10d [**E**KG^{q30m x ≥3}] [**C**KMB] ⼀rises@6h, peaks@24h, falls@2d [**N**TG_{sublingual - prn active chest pain}]^{*C❌D{RV MI}*} [**A**SA 325 mg]^{(may trigger asthma)} ## Footnote *“1st [**TECNA**] 2nd ["**R**eally **A**lways **N**eeds **OBAMA**"]*

Answer 152

- compression stockings - leg elevation - wt loss

Answer 153

**Prior** MI \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *II/III/avF: contiguous TWI and Q waves are representative of previous MI* | "T wave *Inverts* my **MUNDO**, smh"

Answer 154

**ABCD** | *[**ABCD** 2º prevention of CV events]* ## Footnote **A**CE inhibitor/ARB **B**eta blocker [**C**holesterol lowering HIGH INTENSITY STATIN] [**D**ual anti-Platelet^{(ASA + ADP P2Y12 R Blocker)}]

Answer 155

"DigX Tox hurts *Brain^confusion* , *Eye^{yellow-green 👀∆}* , *Heart*^{DAD arrhythmia} *GI*^NV/anorexia ## Footnote “(**VAQS**) traps Digoxin” by preventing renal excretion → DigX Tox hurts ^{*[Brain, Eye, Heart, GI]*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 🔎***V**erapamil|**A**miodarone|**Q**uinidine|**S**pironolactone* *🔎DigX = [Digoxin | Digitalis]^{*(Cardiac Glycoside)*}

Answer 156

✔︎ {DO✅SURGERY \<-- **[****(****0-1****pt (LR≤1%)**|***Revised Cardiac Risk Index***|**(****≥2****pt (HR\>1%)**|**]** --\> DELAY❌SURGERY} ✔︎ Pts {[≥2pt (HR\>1%)] *but* can perform ≥4 METs} = DO✅SURGERY also \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 157

home environment; health literacy * * * [In-person (*at pt's home*) medication reconciliation/management/education] by RN case manager (in patient home \> clinical setting)

Answer 158

1.^{[Onset of Sx^{*(angina/syncope/DOE)*}]} *or* 2.**LVEF < 50%** *or* 3.**Undergoing other Cardiac Surgery** | *AV replacement* = [(Severe AS) + (1|2|3)]

Answer 159

1. ^{during inspiration}[1 single soft second heart sound] 2. [**LATE** peaking systolic murmur] (early = mid/mod Aortic Stenosis) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(normally, inspiration ⇪ blood into right heart ➜ pulmonic valve closes after aortic valve -- but in SEVERE Aortic Stenosis, the stenotic Aortic valve will have delayed closure also ➜ single second heart sound)*

Answer 160

Obesity causes **FALSELY LOW** **BNP** levels --> **underestimates their HF** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Bigger people have Bigger BNP than you think"*

Answer 161

Sudden Cardiac Death \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [^**Sx**HOCM] + [≥1 SCD (^{1º vs 2º px}) risk factor]\* ## Footnote SCD (^{1º vs 2º px}) risk factors: 1º : SCD fhx/ syncope/ holter VT/ exertional hypOtension/LVH 2º: cardiac arrest survivor, sustained VT

Answer 162

aortic DISSECTION aortic ANEURYSM aortic DILATION \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *screen aortic root and proximal aorta*

Answer 163

[Coronary Artery Diseasse] ; stress test | coronary angiography ## Footnote *"the **PIGS© PAID** for Dilated Cardiomyopathy"*

Answer 164

Neprilysin normally degrades BNP ➜ ARNI ➜ falsely higher BNP/**over**States HF status

Answer 165

*"Enterococcus⼀[STAph **A**], [STAph **E**]⼀[strEP **B**] [strEP **V**]* ⼀[^{*and nonbacterial*}*maranti(C)*^{*with its misc (C)*}] ..^{" causes ^{[mitral>tricuspid\*]}IE ... *FROM JANE"*}. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [Enterococcus^{= 💊*amp-gent*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2. [STAph **A**ureus^{#ACUTE⼀HIGH virulence➜RAPID+LARGE on NML Valves = 💊*Vanc*}] 3. [STAph **E**pidermidis^{#prosthetic valves= 💊*Vanc*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4. [strEP **B**ovis ^{#present in colon CA}] 5. [strEP **V**iridans ^{#subACUTE⼀low virulence➜ gradual+small on dz valves #dental = 💊*[cefTriaxone|aPG]*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 6. [*maranti(C)*^{(misC (C)auses:*(C)A|(C)lotting/SLE) ***non***bacterial vegetations*}] | *(aPG = aqueous Pencillin G IV)* ## Footnote *✏️^tricuspidSBIE is a/w IVDU*

Answer 166

*"Enterococcus⼀[STAph **A**], [STAph **E**]⼀[strEP **B**] [strEP **V**]* ⼀[^{*and nonbacterial*}*maranti(C)*^{*with its misc (C)*}] ..^{" causes ^{[mitral>tricuspid\*]}IE ... *FROM JANE"*}. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [Enterococcus^{= 💊*amp-gent*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2. [STAph **A**ureus^{#ACUTE⼀HIGH virulence➜RAPID+LARGE on NML Valves = 💊*Vanc*}] 3. [STAph **E**pidermidis^{#prosthetic valves= 💊*Vanc*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 4. [strEP **B**ovis ^{#present in colon CA}] 5. [strEP **V**iridans ^{#subACUTE⼀low virulence➜ gradual+small on dz valves #dental = 💊*[cefTriaxone|aPG]*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 6. [*maranti(C)*^{(misC (C)auses:*(C)A|(C)lotting/SLE) ***non***bacterial vegetations*}] | *(aPG = aqueous Pencillin G IV)* ## Footnote *✏️^tricuspidIE is a/w IVDU*

Answer 167

Ventricular Enlargement (HF) ; **S3 = NORMAL FINDING IN YOUNG PTS\<40 y/o**

Answer 168

EDS = in addition to [Skin/Msk/GU] sx... EDS also cuases myxomatous degeneration (and ultimately RUPTURE) of the **chordae tendineae**

Answer 169

\>1000 ; [HTAP - HyperTriglyceridemia Associated **PANCREATITIS**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Insulin or Apheresis (to lower serum TAG acutely)] + [FIBRATES (for HTAP tx and px)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Pts with HTAP hx require long term Fibrates for acute tx and prevention*

Answer 170

**RAMILIES** 1. **R**adiation Fibrosis (includes coronaries and valves) 2. **A**myloidosis (heterogenous misfolded proteins) 3. **S**arcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen 4. **M**etastatic Tumor 5. **I**nborn metabolism errors 6. **E**ndomyocardial fibrosis= Common in [African/Tropic children] 7. [**L**oeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate]) 8. **I**diopathic ## Footnote Restrictive Cardiomyopathy = -AKA *infiltrative* cardiomyopathy. -Diastolic dysfunction -low voltage EKG

Answer 171

[*PR* and *QRS* are completely independent]

Answer 172

observation

Answer 173

[*PR* prolonged \> [1 LOX (200 ms)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *LOX = LARGE bOX*

Answer 174

[2nd degree AV Block: Mobitz Type 1 Wekenbach] where = AV Node EKG = [(^*Narrow*QRS Clusters) with ("*Wenke*" PR intervals)] until ➜ **Random Beat Drop** QRS is Narrow "*Wenke = gets longer and longer*

Answer 175

Bundle of His \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [(^{*wide vs narrow*}QRS clusters) +(constant PR)] ➜ [**RANDOM QRS Drop**] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (^{*wide vs narrow*}QRS groups | *[2nd degree AV Block: Mobitz Type 2] ("2 and 2")*

Answer 176

Marfan Syndrome (AUTO DOM) [Aortic Dissection] r/o

Answer 177

1.Homocystinuria = auto recessive / Marfan = AUTO DOM 2.Homocystinuria = [*TALL* Marfan Sx] [+ DVT] [- intelligence]

Answer 178

Intact ➜ delayed ➜ ABSENT

Answer 179

**SAVED** ## Footnote **S**ensory/Motor deficit **A**rterial doppler **V**enous doppler [**E**mpty-to-full (capillary refill)] [**D**olor (PAIN)]

Answer 180

* ^Viable[Catheter or Surgical Revascularization] * ^Threatened[Surgical Revascularization STAT] * ^NonViable[Amputation]

Answer 181

[_{dihydropyridine}CCB] *(ex: amlodipine, nifedipine)*

Answer 182

a. " b. ultrasound

Answer 183

1. COMMON occurring afib after cardiac surgery 2. caused by INC sympathethetic tone (from surgery itself) 3. spontaneously converts to sinus rhythm within few days 4. likely indicates underlying substrate ➜ recurrent afib ➜ subsequent complications (stroke, HF)

Answer 184

**LHEMM CHOP** makes *afib*! 1. [**L** atrial enlargement^{*(2/2 HF/HTN/Mitral dz)*}] 2. ⭐[**H**TN = MOST COMMON CAUSE]⭐ 3. **E**tOH 4. **M**itral/Rheumatic❤️ dz 5. **M**I/CAD 6. [**C**atecholamines^{*i.e. sympathetics*}] 7. **H**YPERthyroid 8. **O**bstructing PE 9. **P**ericarditis

Answer 185

▶*resolves spontaneously if rate is controlled with:* ▶HDS: (Beta Blockers vs Diltiazem vs Amiodarone³) ▶HDUS: DC Conversion | *This type of Afib is common*

Answer 186

**TALL** 1. {[**T**all/slender/flat feet] with [bone❌^{*breastbone∆ + (scoliosis vs kyposis)*} 2. {[**A**ortic root disease\*^{*(Aortic Dissection | Aortic Aneurysm)*} + MVP ➜ SCD 3. {**L**ens dislocation*^{(ectopia lentis)}* ➜ myopia} 4. {**L**ong [fingers*^{( = arachnodactyly ⼀Steinberg thumb/wrist),}*], [arms] and [LEGS] with [hypermobile joints]} ## Footnote 🧠 Aortic Root Disease 2/2 idiopathic cystic medial degeneration which → Aortic Dissection|Aortic Aneurysm

Answer 187

7.5 - **15** | *"GFR under fif-teen? then dia-lyze mee"*

Answer 188

[Hypertensive Urgency (BP\>180/110)] + Papilledema/Retinal Hemorrhages

Answer 189

## Footnote 1. [Coarctation of Aorta] 2. [THYROID❌^{*(HYPERthyroid)*}] 3. [THYROID❌^{*(hypOthyroid)*}] 4. HYPERParathyroid 5. Pheochromocytoma 6. Cushing Syndrome 7. [RENAL❌^{*(-vascular)*}] 8. [RENAL❌^{*(-parenchymal)*}]

Answer 190

FIRST 1A. AntiPlatelet 1B. [STATIN high intensity] 1C. [Lifestyle ∆ (EXERCISE PROGRAM, no smoking)] \_\_\_\_\_\_\_(THEN ⬇️)\_\_\_\_\_\_\_\_\_\_\_ 2. [Cilostazol PDE inhibitor] for sx \_\_\_\_\_\_(THEN ⬇️⬇️)\_\_\_\_\_\_\_\_\_ 3. [Surgical Revascularization]

Answer 191

*"the **PIGS© PAID** for Dilated Cardiomyopathy"* ## Footnote 1. **P**ost Viral Myocarditis (Coxsackie B) 2. **I**ron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with myocytes 3. **G**enetic (affects cytoskeleton) 4. {[**S**ad Broken Heart *ABCQ Takatsubo*] (apical ballooning octopus on echo)} 5. ⭐**©**AD = MOST COMMON CAUSE OF DILATED CARDIOMYOPATHY ⭐ 5. **P**eriPostpartum (late in pregnancy : 5 mo. post partum) 6. **A**lcohol related (direct toxicity vs. nutritional deficiency) 7. **I**diopathic 8. [**D**oxorubicin, Daunarubicin and Traztuzumab Chemo] (dose-dependent)

Answer 192

low ATP ➜ DEC ability to vasoconstrict peripheral arterioles ➜ VERY DILATED peripheral arterioles ➜ DEC afterload resistance ➜ HIGH CARDIAC OUTPUT ➜ chronic INC venous return ➜ Dilated Cardiomyopathy

Answer 193

1. Wet Beri Beri 2. chronic Anemia 3. Arteriovenous fistula 4. Paget's bone disease 5. HYPERthyroid

Answer 194

rate control failed\* | *(io\ [MA-VZ-A-D rate control rx] pt still unable to tolerate aFib sx)* ## Footnote *❤️ → Rhythm Rx* ▶Normal → F.P. ▶⊕CAD → S.D. ▶⊕LVH → A.D. ▶⊕HF → A.i. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Use Rhythm Chart (*see image*)

Answer 195

**RHYTHM** control^{(after Rate control failure 1st )} failed also\* | *symptomatic afib patients who can NOT tolerate antiarrhythmic agents*

Answer 196

Class… [1*^(a/b/c)*: **Na⁺**Channel blocker] [2: **Beta** blocker] [3: **K⁺**Channel blocker] [4: **Ca⁺**Channel blocker]

Answer 197

*360 J* 1.VF 2.mmVT*p* 3.[PMVT⼀TDP)]*p* ## Footnote 1. VF = VFib 2. [mmVT]p = [monomorphic VT *pulseless*] 3. [PMVT⼀TDP]p = [POLYMORPHIC VT⼀TORSADES DE POINTES *pulseless*]

Answer 198

STEMI R₄ criteria * * * * **R₀**_:Revascularize only if **[SX ≤ 12h]** * **R**1: [_iHP = PCI ≤90 min eDB] * **R**2: [_OHP ≤120m eDB TFR] = [PCI ≤120 min eDB] * **R**3: [_OHP \>120m eDB TFR] = [*ART*-tPA fibrinolysis^{within 30m}] ## Footnote * * * ▶* _^iH/OHP: _{^{in/OUT House}}PCI Institute* ▶ TFR: Transfer ▶ eDB: estimated Door→Balloon

Answer 199

(if HDS) [BB/^NCCB Rate Control] to [100-110 bpm] *[beta blocker/nondihydropyridine Calcium Channel Blocker]*

Answer 200

"[_AV🅽🆁🆃 _{(subtype of)}🅿︎_SVT]" \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **🅽arrow QRS** 2. **🆁egular rhythm** 3. _PSV**🆃achycardia>100 bpm** 4. **🅿︎ wave❌**: ⭐4A) ["hidden" burried within QRS = MOST COMMON] _and/or 4b) _{*V1* lead}[pseudo R'^{(tiny blip 2/2 retrograde P wave)} ] ✏️ _and/or 4c) _{*"Southern"* lead}[pseudo S'^{2/2 retrograde P wave}] ✏️ | "AV... **NRT** -(suptype of ) **P** SVT" ## Footnote ✏️ [*AV****NRT***^***P****SVT*] *Retrograde P waves possibly appear as spikes at beginning/end of QRS or as inverted P waves* *Southern lead = inferior leads (II, III, avF)*

Answer 201

**HIS BEDS** *gave me arrhythmia* 1. [**H**ypoxia & ishchemia] 2. **I**nflammation 3. **S**ympathetic stimulation 4. **B**radycardia 5. [**E**lectrolyte❌ (K/Ca+/Mg)] 6. **D**rugs 7. [**S**tretched chambers (enlarged/hypertrophied atria/Vt ➜ arrhythmia)]

Answer 202

A: Blocks [Na+ Phase 0] and K+ channels B: - [Slow upstroke of AP and AP conduction → ⇪ AP duration] - [Prolongs QRS complex → ⇪ *Effective Refractory Period*] - Direct depressant actions on [SA/AV nodes] - use/state-dependent C: [Class 1A]

Answer 203

bundle of his; purkinje fibers ## Footnote Phase 0: [Na+VGC] open ➜[Na+ influx] =**rapid upstroke and depolarization** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phase 1: eventually, [K+ VGC] *begin* to open ➜ [K+ efflux] = **initial repolarization** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phase 2: -but soon thereafter, [Ca+ VGC] also open ➜ allows [Ca+ influx] to balance [K+ Efflux] and this causes PLATEAU. -,[Ca+ influx] also triggers Ca+ release from Sarcoplamic reticulum which ultimately ➜ **MYOCYTE CONTRACTION** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phase 3: -[Ca+VGC] close -[*slow* K +VGC] open ➜ MASSIVE [K+ EFFLUX] = **RAPID REPOLARIZATION** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phase 4: high K+ permeability ➜ **resting potential** until Phase 0 again

Answer 204

[SA node] and [AV node] ## Footnote Phase **0**: ⚡ ▶at -40 mV📈: [Ca+ _LVGC] Open^{*(while [Ca+ T-VGC] close)*} ➜ _MAJOR[Ca+ iNflux] ➜ [*SUAD*] {🚧} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phase **3**: 🪫 ▶at 0 mV: [Ca+ _LVGC] closE ▶[K+ VGC] Open ➜ [K+ Efflux] ➜ *repolarization* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phase **4**: 🔌 ▶at -60 mV: 🔌[Na+ iNflux] via [Na+ i(funny) channels] ➜[^INITIAL*ssDD*] ➜ ▶🔋causes ... [Ca+ _**T**VGC] open ➜_minor[Ca+ iNflux] ➜ [^END*ssDD*] _{until -40mV} _{✏️Phase 4 *slope* determines [SA node HR] =*responsible for SA/AV node automaticity*
✏️
-( *ACh/adenosine ⬇︎ rate/speed of *ssDD* which ➜ ⬇︎[node HR])
-(catecholamines ⇪ diastolic depolarization)
-(sympathetic stimulation ⇪ chance that i(funny) channels are open →⇪rate/speed of *ssDD* thus ➜ ⇪ HR)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{*🔎ssDD = *slow spontaneous Diastolic Depolarization*
*🔎SUAD = [*slow upstroke _AP_ depolarization*]*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {🚧}:_{✏️[*fast* Na+ VGC] are permanently inactivated 2/2 negative resting voltage (-60mV) of SA/AV nodes = slows conduction velocity in both SA and AV node... BUT! AV node uses this to prolong transmission from atria to ventricles}

Answer 205

A: \*[Atrial Arrhythmias] \*[2nd choice for Ventricle Arrhythmias after acute MI] B: PO / IV / IM C: Metabolized into **NAPA** and eliminated via **RENAL**

Answer 206

- Torsades des pointes, - hypOtension - Anticholinergic effects - SLE-like syndrome B: Similar to Procainamide AND SAME CLASS but with stronger anticholinergic effects. _Rarely used due to cardiac and other (HA/tinnitus) adverse effects._

Answer 207

A: Similar to Procainamide but anticholinergic effects \>\> Procainamide and Quinidine, B: Its Anti-cholinergic effects INC [sinus rate and AV conduction] but requires co-administration of drugs that slow AV conduction. C: \*Negative inotropic effects, \*may induce heart failure. \*extra-cardiac side effects from atropine-like actions. D: Approved only for *ventricular arrhythmias*, Not drug of 1st or 2nd choice

Answer 208

A: Class 1 Antiarrhythmic Drugs are [*dFUSt^{(AKA "state")} dependent* Phase 0 Na+ Channel Blockers] that have a [local anesthetic] action ## Footnote B: 3 Subtypes 1A: **Intermediate** kinetics and [prolongs action potential *duration*] 1B: **FAST** kinetics and [DEC action potential *duration*] 1C: **Slow** kinetics and [NO EFFECT ON ACTION POTENTIAL* duration *] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ {*🔎**dFUSt**-dependent = ⛔[**d**epolarizing (**F**REQUENT **U**SE-**S**TATE) **t**issue]** ( = ⛔tachycardic and ischemic tissue)}

Answer 209

A: [***dFUSt** dependent* Phase 0 Na+ Channel Blocker] B: - Generally no effect on _overall conduction_ *(since recovery from block occurs between action potential*). - Selective depression of conduction in [**depolarized** ischemic purkinje and ventricular cells] *(binds and blocks phase 0 Na+ channels that are active/in depolarized state)* C: [Class 1B] ## Footnote *🔎**dFUSt** = [**d**epolarized (**F**REQUENT **U**SE-**S**TATE) **t**issue]*

Answer 210

A: - [ventricular arrhythmias after MI]. - [_1st choice - [Vtach and fib]_ after cardioversion in the setting of ischemia/infarction] B: **IV ONLY** in Arrhythmias C: First Pass-**Hepatic** metabolism D: (x) Least cardiotoxic in Class 1 (x) Neurological SE from local anesthetic properties (x) hypOtension with large doses

Answer 211

A: Orally Active Lidocaine analog! *(is also Class 1B)* B: SE similar to Lidocaine C: - Chronic Pain - Diabetic Neuropathy - Nerve Injury

Answer 212

A: [Na+ and K+ channel] blockade B: -[prolongs ERP in AV node and accessory bypass tracts (but no ERP ∆ to Purkinje and Vt tissue)] -K+ blocker but has NO EFFECT ON ACTION POTENTIAL DURATION -No Anticholinergic Effects C: 1. [SVT (***especially aFib***) in pt with normal hearts] 2. Maintains NSR

Answer 213

A: Liver and Kidney B: patients with.. * ventricular tachyarrhythmias, * ventricular ectopy * previous MI C: [Class 1C]

Answer 214

A: [Class 1C] Potent blocker of Na+ channels, / may also block K+ channels. B: Structural similarity to propanolol with weak β-blocking activity. C: Used for [supraventricular arrhythmias] in patients with otherwise normal hearts. D: Adverse effects/toxicity: - sinus bradycardia (from β-blockade). - bronchospasm (from β-blockade). - Metallic taste - constipation.

Answer 215

A: [**Class 2** General β-blocker] B: - inhibits sympathetic influences on cardiac electrical activity. - DEC heart rate by DEC pacemaker currents (SA node automaticity) - reduces conduction - decreases [catecholamine induced DAD] and [EAD mediated arrhythmias]

Answer 216

B: (x) Bradycardia (x) DEC excercise capacity (x) Heart Failure (x) hypOtension (x) AV Block C: pts with: \*Pulmonary Dz \*bradycardia \*AV Block D: May mask tachycardia associated with hypOglycemia in diabetic patients

Answer 217

A: "Amy BLOCKED the **NBC-K** channel" [Blocks **N**a+ / **B**eta *receptors* / **C**a+ / **K**+ channels] B: * Prolongation of action potential duration (QT interval) by prolonging refractoriness * slows conduction (prolongs QRS)--\> suppresses abnormal automaticity * can slow normal sinus automaticity. C: [Class 3]

Answer 218

A: Oral: - [Recurrent VTach resistant to other drugs] - [Recurrent VF resistant to other drugs] - aFib *IV*: ▶ [1st choice-out of hospital Cardiac Arrest] ▶VT termination ▶VF termination

Answer 219

B: * Highly lipophilic--\> accumulation in several organs (heart, lung, liver, cornea). * Bradycardia in SA/AV node disease * heart block in patients with SA/AV node disease. * Pulmonary toxicity * hepatic toxicity, * photodermatitis, * cornea microdeposits. C: -Structural analogue of thyroid hormone--\>blocks conversion of T4 to T3, -source of inorganic iodine: Hypo- and hyperthyroidisms

Answer 220

" **N**ervous **B**arry **K**illed **C**arrie " Class 1: **N**a+ channel Blockers (A vs. B vs. C) Class 2: **B**eta Blockers Class 3: [**K**+ channel blocker^{(* = prolongs action potential duration*)}] Class 4: [**C**a+ L-type channel blockers - *Non-Dihydropyridine*] [Vascular smooth m. / cardiac myocytes / SA node / AV Node]

Answer 221

A: Structural analogue of amiodarone but **without iodine atoms**,. Designed to eliminate effects on thyroxine metabolism. B: Indications: atrial fibrillation/flutter. Contraindicated in severe or recently decompensated symptomatic heart failure.

Answer 222

A: 1. [General β-blocker] *(L-isomer only)* 2. inhibits delayed rectifyer and possibly other K+ currents B: Indications: - [Ventricular and supraventricular arrhythmias]. - [Maintenance of sinus rhythm in patients with afib] C: Class 3

Answer 223

A: {**NCCB** blocks activated and inactivated [L-Type Ca+ channels] in the heart} B: * [Directly slows AV node conduction] and [increases AV node refractoriness]^{*( →⇪ PR interval)*} , * slows SA node automaticity.--\> Lowers heart rate * Use/state-dependent action. B2: Major effects in slow- response tissues- (i.e. SA/AV node). C: 1. [**1st choice**- Supraventricular arrhythmias] 2. Re-entry arrhythmias/tachycardias involving AV node. 3. Slows ventricular rate in atrial flutter/fib ## Footnote *🔎NCCB = Nondihydropyridine Calcium Channel Blocker*

Answer 224

A: Class 4^{*(NCCB: Blocks [Calcium L-VGC] in Heart)*} B: Extensive Hepatic --\> can cause Liver Dysfunction | *🔎L-VGC = L-type Voltage Gated Channels* ## Footnote Verapamil side effects = "even **CHAPELS** hurt from CCB!"

Answer 225

Similar to Verapamil but with _lower cardioselectivity_, B: used also for - HTN - Angina - Exercise Tolerability **INCREASE** by [decreasing angina freq. and myocardial demand] C: Class 4

Answer 226

A: Inhibits [Na+,K+-ATPase] and [Na+/ K+/ Ca+ channels]---\> alters membrane surface charge B: **NO CLASS**

Answer 227

A: * Hyperkalemia; depolarizes resting membrane potential * Hypokalemia; decreases K+ permeability B: **NO CLASS**

Answer 228

A. DGC\* inhibits [(ShOUT PIN) Na+/K+ ATPase] which ➜ [⇪ intracell Na+] ➜ prevents [(COUnT SIN) Na+/Ca+ exchanger] (since there will be already too much [intracell Na+] for "SIN") and this leaves more intracell Ca+ = [⇪ cardiac contractility] B: **NO CLASS** C. {[DiGoxin | DiGitalis]_{Cardiac Glycoside}}^{= DGC} | "*ShOUT PIN ⼀COUnT SIN*" ## Footnote **S**hOUT **P**IN ⼀**C**OUT **S**IN ▶ [Na+/K+ ATPase pump] = 3 Na+ OUT, 2 K+ in ▶[Na+/Ca+ exchange] = 2 Ca+ OUT, 3 Na+in \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ShOUT = Sodium Out PIN = Potassium IN - - - - COUnT = Calcium Out SIN = Sodium IN

Answer 229

❌flushing ❌hypOtension ❌chest pain ❌impending doom ❌**bronchospasm** = **CXD IN PTS WITH BRONCOSPASTIC DISEASE** ## Footnote ✏️similar to ACh. ✏️acts on Atrial and AV node primarily

Answer 230

* Anti-arrhythmic effects^{*[PMVT Torsades de Pointes]*} in some patients with normal Mg+ levels. * May inhibit afterdepolarizations. ## Footnote *🧠MOA = Inhibits [Na+,K+-ATPase] and [Na+/ K+/ Ca+ channels]---\> alters membrane surface charge*

Answer 231

* Hyperkalemia--\> slows conduction (may lead to re-entrant arrhythmias and AV nodal block). * hypOkalemia---\>enhances ectopic automaticity, lengthens action potential duration which can lead to EADs (torsades de pointes).

Answer 232

* Positive inotropic actions (used widely in heart failure) * Parasympathomimetic effects: increase AV nodal refractoriness and slow AV node conduction.^{(treats RVR from afib/aflutter)}

Answer 233

-[(CardiacGlycoside-induced arrhythmia) in the setting of hypOmagnesemia] -[PMVT Torsades de Pointes] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ IV ## Footnote PMVT = POLYMORPHIC Ventricular Tachycardia

Answer 234

* Maintain normal plasma K+ B: IV or PO

Answer 235

* HF * [aFib^{*(slows RVR)*}] * [aFlutter^{*(slows RVR)*}] ## Footnote 💡In (atrial flutter/afib) CG parasympathomimetic effects slow AV nodal conduction,----\>slows [afib/aflutter associated_Rapid Ventricular Rates]

Answer 236

A: kidney ; **Narrow**. B: Many drug interactions (amiodarone, verapamil, flecainide)!!! B2: Hypokalemia/magnesemia enhance toxic effects. C: "DigX Tox hurts ^{*[Brain, Eye, Heart, GI]*}" D: Severe digitalis toxicity can be reversed by digoxin antibodies.

Answer 237

Action Potential Duration (Phase 2) (QT)

Answer 238

A: **Disturb Impulse Formation** and cause premature stimulation --\> INC HR B: EAD (*early afterdepolarization)* usually occurs at SLOW HR from the [Phase 2 Plateau] C: DAD (Delayed afterdepolarization) usually occurs at FAST HR from the Resting Potential

Answer 239

1. Reduction of phase 4 slope 2. Increase [max. Resting Potential] 3. Increase of threshold potential 4. Increase of action potential duration

Answer 240

A. antiarrhythmic rx selectively depresses _cardiac**dFUSt** = [**d**epolarizing & (**F**REQUENTLY-**U**SED-**S**TATE) **t**issue ] - *tissue frequently* used *[ AKA in a depolarized state with M-Lid up^{(tachycardia/ischemic)}]! * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ B: e.g. - during fast tachycardia (many channel *depolarizations frequently*) - [ischemic/infarcted tissue have more positive resting potential = will reach action potential threshold sooner = will reach (be in) [depolarized used/inactive state] = more likely to interact with [use/state^**"dFUSt"** dependent antiarrhythmic]] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ C: Antiarrhythmics CAN STILL ACT ON NORMAL Cells with "RESTING" Na+ channel M-Lids! ---\> Drug induced Arrhythmia! ## Footnote * "Antiarrhythmics are better acting when the **M-Lid** is up frequently"*

Answer 241

*Class 1* * Reduce Conduction Velocity^{*(in especially [**DAUST** {= tachycardic & ischemic tissue}])*} * ...by blocking [Phase 0 Fast AP Na+ VGC] → DEC rate and magnitude of [Phase 0 Fast Action Potential Upstroke] → alters ERP \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * Some Class 1 affect K+ channels ---\> Prolonged Repolarization ---\> Prolonged Action Potential Duration | *🔎DAUST = [Depolarized⼀ACTIVELY USED-STATE TISSUE]* ## Footnote B: Procainamide^1A / Quinidine^1A / Disopyramide^1A

Answer 242

A: Metabolite from [Procainamide^1A] B: Is actually Class 3! and C: eliminated via Liver and Kidney(requires dose reduction in renal failure ) D: - hypOtension - Torsade De pointes - Lupus Erythematosus with long term usage! | *Procainamide^1A --(breaks down into)--> NAPA³*

Answer 243

A./B.: **CLASS 3** - Antiarrhythmics --\> Prolongs Action Potential Duration as a K+ channel Blocker C: _WORKS BETTER WITH SLOW HR_ (even tho this may cause Torsades De Pointes) ## Footnote ADIDaS rx: Amiodarone⼀Dronedarone / ibutilide / Dofetilide / and Sotalol

Answer 244

B: interrupts^{*reentrant | accessory*} pathway C:[^**Nonpharm** rhythm control] s/p {[rate control *failure*] and [^{*pharmacologic*}rhythm control *failure*]} | frequently **replaces** [^*pharm*rhythm control]

Answer 245

- [^*HD**U**S* atrial fibrillation] - [Ventricular Fibrillation] - [Ventricular Tachycardia_*pulseless*]

Answer 246

Vagal maneuvers A: carotid sinus message, [diving reflex (cold water on face)], [Valsalva maneuver]. B: slows conduction through AV node. C: Acute treatment for paroxysmal supraventricular tachycardia (PSVT)

Answer 247

"_Adele_ and _Ami_ *converted* me to _Flex_" Adenosine / Amiodarone/ Flecainide

Answer 248

"Maintain ur **F**-**PPAD** man" Flecainide Propafenone Propranolol Amiodarone Dronedarone

Answer 249

" **V EDP**" Diltiazem/**V**erapamil / Propranolol/Esmolol

Answer 250

"Ur having VTach *without* Heart Dz..? Go to **LA**" **L**idocaine **A**miodarone

Answer 251

Atropine Pacemaker

Answer 252

1st:⭐-{Debrillation (_plus **Epinephrine***])} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2nd/Alt: -{Debrillation (+/- [Amiodarone^*3*])} OR -{Debrillation (+/- [Lidocaine^*1B*])} | Amiodarone 3 or Lidocaine 1B in place of epinephrine

Answer 253

" Propranolol uses **VARAMA** cream " 1. **V**t Rate Control 2. **A**trial arr 3. **R**einfarct POST MI tx 4. **A**fterDepolarization (*EAD/DAD)* tx 5. **M**aintains Sinus Rhythm 6. **A**V Nodal Re-entry tx

Answer 254

[Ca+ Channel & BB Blockers] have **NEGATIVE INOTROPIC EFFECTS!**

Answer 255

1. CHF 2. [RVR^{*(in aFib RVR/aFlutter RVR )*}] | *(since DigX slows ventricular rate)*

Answer 256

Reflex Tachycardia _\_\_\_\_\ *(in addition to **CHAPELS**)*

Answer 257

A: 1. [CHF exacerbation] in hospitalized patients 2. HTN B: 1. **[Human BNP recombinant]** that... 2. [**renal BNP🟢]** → DCT _Natriuresis_ 3. [**vascular smooth muscle NPR1/2🟢]** → [renal Afferent arteriole]*vasoDilation*--\> INC GFR 4. INC cGMP in [**vascular smooth muscle**] --\> [peripheral arteriole] *vasoDilation* | 🧠[Nesiritide = *artificial* BNP] = [Nesiritide BNP]

Answer 258

anti**ABCDEKG** -[anti**A**rrhythmics (class 1A, 3)] -[anti**B**iotics (macrolide)] -[anti"**C**"ychotics (haloperidol)] -[anti**D**epressants (TCA)] -[anti**E**metics (ondansetron)] -[anti-**K** = ⬇︎K+] -[anti-M**g** = ⬇︎M**g**] | *both low K+ and low Mg+ can prolong QT*

Answer 259

[solitary nucleus of medulla] ← [Vagus CN10]

Answer 260

[solitary nucleus of medulla] ← [Glossopharyngeal CN9]

Answer 261

1. released from atrial myocytes when [blood volume ⇪] or [atrial pressure ⇪] 2. [⇪GFR (promotes diuresis)] - via dilates Afferent arteriole /constricting efferent arteriole 3. vasoDilation 4. ⬇︎Na+ ReAbsorption at CD

Answer 262

1. from Vt myocytes in response to ⇪ pressure 2. similar to ANP but longer 1/2 life 3. good NPV for HF dx 4. available to treat HF as *Nesiritide* ## Footnote NPV = Negative Predictive Value

Answer 263

"[PG**E** Prostaglandin] -- *ke**E**ps a PDA*" | *🔎PDA = patent ductus arteriosus * ## Footnote [Indomethacin/NSAIDs inhibit [PGE Prostaglandin] synthesis! ➜ Closes ductus arteriosus

Answer 264

a. [**E**KG (STEMI/ST Depression/hyperacute T/TWI/new LBBB/Q/poor R progression)] = gold standard Hours 1-6 post MI b. [**T**roponin-iii] rises@4h, peaks@6-12h, falls@7-10d c. [**C**KMB (also released from sk muscle)] rises@6h, peaks@24h, falls@2d (returns to baseline 48h post MI = useful for diagnosing reinfarction) ## Footnote *“1st [**TECNA**] 2nd ["**R**eally **A**lways **N**eeds **OBAMA**"]*

Answer 265

a. ⬇︎TAG ## Footnote b. -[upregulates (LPL)] ➜ [ ⇪VLDL to IDL]➜ [ ⇪ TAG clearance via HDL] -[activates PPARα ➜ ⇪ HDL ➜ [ ⇪ TAG clearance via ⇪ HDL] c. 📝gemFIBrozil 📝cloFIBrate 📝bezaFIBrate 📝FenoFIBrate d. ❌Cholesterol Gallstones ❌[Myopathy *(⇪ with Statins)*]

Answer 266

a. ⬇︎⬇︎⬇︎LDL Cholesterol ## Footnote b. *[HMG-CoA reductase inhibitor]* -Inhibits conversion of [HMG-CoA ➜ mevalonate (*necessary for (LDL Cholesterol) synthesis*)] ❗️⬇︎Mortality in CAD patients c. 📝Atorvastatin 📝Simvastatin 📝Pravastatin 📝Rosuvastatin 📝Lovastatin d. ❌HEPATOTOX (*⇪ with F.N.*) ❌MYOPATHY ( *⇪ with F.N.*)

Answer 267

a1. [⬇︎VLDL^{*(by blocking [DGA2] which is needed in VLDL synthesis)*}] a2. [ ⇪ HDL] ## Footnote b. -[VLDL synthesis requires DGA2]. Niacin blocks DGA2 ➜ [⬇︎VLDL] c. 📝Niacin B3 d. ❌Flushing (px = NSAIDs) ❌HYPERUricemia ❌HYPERGlycemia

Answer 268

a. ⬇︎LDL Cholesterol ## Footnote b. -Prevent [Cholesterol] absorption at small intestine brush border ➜ body uses internal [LDL Cholesterol] ➜ [⬇︎ LDL Cholesterol] c. 📝Ezetimibe d. ❌Diarrhea ❌rare ⇪ LFTs

Answer 269

a. ⬇︎LDL Cholesterol ## Footnote b. [prevents intestinal Bile ReAbsorption ➜ forces liver to replace Bile using LDL Cholesterol = ⬇︎LDL Cholesterol c. 📝Cholestyramine 📝 Colestipol 📝 Colesevelam d. ❌Fat Malabsorption

Answer 270

A. 1.given as [6 mg rapid IV bolus]^{(similar to ACh. Atrial tissue affected more)} 2.[**slows AV node conduction**^{*(causes 15 second AV node depolarization delay by ⬇︎Ca+ influx)*}]^{produces transient cardiac arrest} 3.[**prolongs AV node refractory**^{*(by causing AV node hyperpolarization via activating K+ efflux]^{produces transient cardiac arrest}

4.blunted by theophylline (Adenosine R Blocker)

5.blunted by caffeinee (Adenosine R Blocker)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
b.
✅SVT diagnostics
✅SVT abolishment

## Footnote

✏️Increases K+ conductance (hyperpolarization) and inhibits [camp-Ca+ currents] both via purinergic receptors}

Answer 271

a. [blocks Calcium L-VGC] ➜ _*dCCB*[⬇︎muscle contractility] /_*NCCB*[⬇︎AV node conduction] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. heart c. Verapamil>Diltiazem | "even **CHAPELS** hurt from CCB!"^{*= side effect*}

Answer 272

"even **CHAPELS** hurt from CCB!" ❌**C**onstipation ❌[**H**yperprolactinemia^{*(Verapamil)*}] ❌[**A**V Block^{*= nCCB = ^{(in pts: high dose | nodal dz | on β🟥) - treat with atropine}]*}] ❌[**P**eripheral Edema^*(DCCB)*] ❌[**E**verything's Spinning ⼀Dizziness/hypOtension] ❌[**L**arge gums⼀gingival hyperplasia] ❌[**S**kin Flushing^{*(and skin Rxn = Verapamil IV)*}] ## Footnote *[blocks Calcium L-VGC] ➜ _*DCCB*[⬇︎muscle contractility] /_*nCCB*[⬇︎AV node conduction]*

Answer 273

[Giant Cell Temporal Arteritis] and [Takayasu Pulseless arteritis] ## Footnote 1. elderly female 2. uL temporal artery *(from Carotid a)* HA 3. jaw claudication 4. ophthalmic artery *(from Carotid a)* occlusion may ➜ irreversible blind 5. a/w PolyMyalgia Rheumatica 6. ⇪ ESR with Focal granulomatous inflammation 7. tx (prevent blindness) = [(CTS⼀HD) f/b Temporal artery bx]

Answer 274

[Giant Cell Temporal Arteritis] and [Takayasu Pulseless arteritis] ## Footnote 1. asian young <40 yof 2. "pulseless" = [granulomatous thickening (⇪ ESR) ➜ narrowing of aortic arch & proximal great vessels] ➜ weak UE pulses 3. fv, night sweats, skin ∆, ocular ∆ 4. tx = CTS

Answer 275

Medium vessel vasculitis are [Polyarteritis Nodosa], [Kawasaki disease], [Buerger Thromboangiitis Obliterans] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote 1. Young adults 2. HBV in 30% of patients 3. -Const: Fever, wt loss, malaise -Cardiac: HTN -GI: abd pain, melena 4. [Immune complex mediated ⼀renal and visceral vessels (renal microaneurysms) ⼀arterial wall transmural inflammation with fibrinoid necrosis] 5. tx = cyclophosphamide and CTS

Answer 276

Medium vessel vasculitis are [Polyarteritis Nodosa], [Kawasaki disease], [Buerger Thromboangiitis Obliterans] ## Footnote 1. <40 yom Smokers 2. etx = [Segmental thrombosing vasculitis] ➜ Intermittent Claudication ➜ gangrene/digital autoamputation 3. ⊕Raynaud phenomenon 4. tx = smoking cessation

Answer 277

-[MP ⼀microscopic polyangiitis] -[WGP ⼀Wegener Granulomatosis with polyangiitis] -[CEGP ⼀Churg strauss Eosinophilic Granulamtosis with Polyangiitis] -[BrIAN-hSP ⼀Berger IgA Nephropathy (*Henoch Schonlein purpura*)] ## Footnote **WGP** 1. {[**c**-ANCA] binds to [PR3 antigen] = antiproteinase 3} ➜ [WGP Triad] 2. [⛔ASTHMA⼀✅Granulomas ] *a/w* 3. [WGP Triad]: WGP-1.[Focal necrotizing vasculitis] WGP-2.[Necrotizing granulomas in ELK], WGP-3.[Necrotizing Glomerulonephritis] 4. tx = [cyclophosphamide and CTS] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *🔎ELK = ENT/Liver/Kidney* ENT\LK: -E:Otitis media -N:nasal septum perforation, chronic sinusitis -T: hemoptysis, dyspnea -L: CXR large nodular densities -K: hematuria, RBC cast, [Necrotizing Glomerulonephritis]

Answer 278

-[MP ⼀microscopic polyangiitis] -[WGP ⼀Wegener Granulomatosis with polyangiitis] -[CEGP ⼀Churg strauss Eosinophilic Granulamtosis with Polyangiitis] -[BrIAN-hSP ⼀Berger IgA Nephropathy (*Henoch Schonlein purpura*)] | **CEGP** = *"**pPAGING** churg-strauss"* ## Footnote *"**pPAGING** churg-strauss"* 1. {[**p**-ANCA]^{(binds to [MPO neutrophil antigen] = antiMyeloPerOxidase}} ➜ 2. **P**olyps in Nose with rhinitis, sinusitis and skin nodules 3. ⊕[**A**sthma ( ⇪ IgE)] 4. ⊕[**G**ranulomas on necrotizing vasculitis with eosinophilia] 5. **i**mmune-pauci glomerulonephritis 6. [**N**europathy (wrist/foot drop) +/- GI or heart involvement] 7. ⊕[**G**ranulomas on necrotizing vasculitis with eosinophilia]

Answer 279

-[MP ⼀microscopic polyangiitis] -[WGP ⼀Wegener Granulomatosis with polyangiitis] -[CEGP ⼀Churg strauss Eosinophilic Granulamtosis with Polyangiitis] -[BrIAN-hSP ⼀Berger IgA Nephropathy (*Henoch Schonlein purpura*)] ## Footnote **MP** 1.{[**p**-ANCA]^{(binds to [MPO neutrophil antigen] = antiMyeloPerOxidase}} ➜ 2.[⛔ASTHMA ⼀ ⛔GRANULOMAS] *but will →* 3.^{*necrotizing vasculitis of*} LKS -Lung: Hemoptysis -Kidney: [pauci-immune glomerulonephritis] -Skin: palpable purpura 4.[tx= cyclophosphamide and CTS]

Answer 280

-[MP ⼀microscopic polyangiitis] -[WGP ⼀Wegener Granulomatosis with polyangiitis] -[CEGP ⼀Churg strauss Eosinophilic Granulamtosis with Polyangiitis] -[BrIAN-hSP ⼀Berger IgA Nephropathy (*Henoch Schonlein purpura*)] ## Footnote **BrIAN-hSP** 1. TRIAD: [GI Pain / Palpable Purpura on Butt-Legs/ Arthralgias] 2. Vasculitis 2/2 IgA immune complex deposition 3. occurs Post-URI 4. most common childhood systemic vasculitis

Answer 281