Cardiology Error List Flashcards
When is revascularization indicated for Coronary Artery Disease
Sx despite medical therapy
Left MAIN Coronary Artery Stenosis >50%
3-vessel disease with LV dysfunction (EF
What type of revascularization is indicated for Left MAIN coronary artery
CABG
When is a Percutaneous Transluminal Coronary Intervention used (PTCA)
1 or 2 vessels that are NOT the Left main coronary artery + normal or near normal left ventricular function
What intervention is used for Left Anterior Descending Artery
Beta Blockers
Ranolazine
CCB
Ivabradine
What is the gold standard to test for CAD
Coronary Angiongraphy (Cath)
What is Heart Failure
When the heart can’t pump sufficient blood to meet the metabolic demands of the body at normal filling pressure
What causes left sided HF
CAD and HTN
Sx for left sided HF
Think Pulmonary back-up
Dyspnea, Pulmonary Congestion/Edema, HTN
What causes right sided HF
Left sided HF
Sx for right sided HF
Peripheral Edema
JVD
GI/Hepatic Congestion
Dx for HF and what does it measure
Echo is most useful, measures EF and wall motility
CXR: See Cephalization of flow, Kerly B lines, Cardiomegaly, Pleaural Effusions
Increased BNP
Tx for HF
Ace-I are 1st line
Beta Blockers
Diuretics
Digoxin for short term use in pts. with A.Fib
Which Tx for HF reduce sx vs. improve mortality
Improve Mortality: Ace-I, Beta Blockers, Spironolactone (Potassium sparing diuretic)
Treat sx: Loop diuretics (Furosemide, Bumetanide, Torsemide)
If a patient with CHF can’t tolerate beta blocker or Ace-I what is an alternative
Hydralize + Nitrates
They do decrease mortality when used together
What valve is most commonly affected in Infective Endocarditis (normal valves)
Mitral Valve
What valve is most commonly affected in a person with IV drug use and infective endocarditis
Tricuspid Valve
What are the pathogens for Normal Valves, Abnormal Valves, Prosthetic Valves, IV Drug User
Normal: S. Aureus
Abnormal: S. Viridans
Prosthetic: Staph. Epidermis
IV Drug Use: MRSA, Pseudomonas, Candida
Sx for Infective Endocarditis
Fever, Anorexia, Weight Loss, Fatigue, EKG abnormalities, Regurgitant murmurs
Peripheral Manifestations: Janeway Lesions, Roth Spots, Petechia, Osler Nodes, Splinter Hemorrhages
What is the Duke Criteria for Infective Endocarditis (DX)
2 Major or 1 Major + 3 Minor, or 5 Minor
Major: 2 Positive blood cultures, Echo (Vegetations on Valves)
Minor: Predisposing factor like abnormal valves, indwelling catheter, fever, vascular and embolic phenomena (Janeway Lesions, Emboli), Immunologic Phenomena (Osler Nodes, Roth Spots, Positive RF, Acute Glomerulonephritis, Positive blood cultures not meeting major)
Tx for Infective Endocarditis based on valve (Native, Abnormal, Prosthetic, IV drug user, Fungal)
Native: Nafcillin + Gentamicin
Abnormal: Penicillin/Ampicillin + Gentamicin
Prosthetic: Vancomycin + Gentamycin + Rifampin
IV Drug Use: Penicillin/Ampicillin + Vancomycin
Fungal: Amphotericin B
Replace Vancomycin in any of those if pt has PCN allergy
What is prophylactic treatment for dental procedure in someone with infective endocarditis history
Amoxicillin 2g one hour before procedure. Clindamicin if PCN allergy
What is the reading for HTN
> 140/90
Dx for HTN
More than 2 abnormal readings on 2 different visits with elevated readings
What are complications of HTN
CAD, HF, MI, TIA, Stroke, Retinal Hemorrhages, Blindness, Retinopathy
Sx of HTN
Striae, Carotid Bruits, JVD, Pheochromocytoma, Polycystic Kidneys, Bruits over renal arteries
What are common findings in a person with HTN on a fundoscopic exam
Grades I: Arterial Narrowing II: A-V Nicking III: Hemorrhage, Soft Exudates IV: Papilledema (Malignant)
What is the goal for someone with HTN. Someone with Diabetes and HTN
What is the first line non-medical treatment for someone with HTN
Lifestyle modification, sodium restriction, dash diet, exercise
What is the first-line medication used in HTN
Hydrochlorothiazides (Diuretics)
What is the strongest diuretic
Loop Diuretic: Furosemide, Bumetadine
What do you want to use to treat HTN in someone with diabetes
Ace-I (Captopril, Enalapril, Ramipril, Benazepril)
If can’t tolerate Ace-I, use ARB
What do you use to treat HTN in someone with angina
CCB (Nifedipine, Amlodipine, Verapamil, Diltiazem)