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ER EOR > Cardio 1 > Flashcards

Cardio 1 Flashcards

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1
Q

what is the most common valve affected in endocarditis

+ name order of most to least common valves affected

A

mitral MC

M > A > T > P

tricuspid in drug users

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2
Q

what is the MC overall cause of endocarditis

A

strep viridans

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3
Q

MCC acute bacterial endocarditis and what valves are affected

A

staph aureus - normal valves

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4
Q

MCC subacute bacterial endocarditis and what valves are affected

A

S viridans - abnormal valves

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5
Q

MCC drug-related endocarditis

A

S aureus (especially MRSA)

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6
Q

MCC prosthetic valve endocarditis

A

early (within 60 days) = S aureus (including MRSA) and s. epidermidis

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7
Q

MCC endocarditis if recent GI or GU procedure

A

enterococcus

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8
Q

HACEK organisms + what type of organisms

A

haemophilus aphrophilus
actinobacillus
cardiobacterium hominis
eikenella corrodens
kingella kingae

these are gram negative organisms, hard to culture

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9
Q

sx endocarditis (FROM JANE)

A

fever
rosh spots
osler nodes
murmur
laneway lesions
anemia
spliNter hemorrhages
emboli

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10
Q

what are the 2 most important tests for suspected endocarditis

A

blood cultures and echo (obtain TTE first –> TEE)

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11
Q

what criteria is used to diagnose endocarditis

A

duke criteria

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12
Q

major duke criteria

A

sustained bacteremia - 2 + blood cultures by organism known to cause endocarditis

endocardial involvement documented by either echo (vegetation, abscess, valve perforation, prosthetic dehiscence) or clearly established new valvular regurgitation (aortic or mitral regurgitation)

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13
Q

minor duke criteria

A

predisposing conditions - abnormal valves, IVDA, indwelling catheters

fever (100.4F)

vascular and embolic phenomena

+ cultures not meeting major criteria

+ echo not meeting major criteria (worsening existing murmur)

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14
Q

how to diagnose endocarditis with duke criteria

A

2 major or 1 major + 3 minor or 5 minor

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15
Q

treatment for native valve (MSSA) endocarditis

native valve (MRSA) or unknown

prosthetic valve

fungal

A

native MSSA - nafcillin, oxacillin

native MRSA or unknown - vancomycin + cef or gentamicin

prosthetic valve - vancomycin + gentamicin + rifampin

fungal - parenteral anti fungal (amphotericin, can add flucytosine)

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16
Q

how long is therapy for endocarditis

A

4-6 weeks

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17
Q

what is the worst risk factor for angina

A

DM

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18
Q

diagnosing angina

A

EKG - initial test of choice, ST depression

Stress testing - most important noninvasive

coronary angiography - definitive; defines location and extent

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19
Q

what is used for definitive diagnosis of angina

A

coronary angiography

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20
Q

treatment for angina

A

outpatient - aspirin, beta blockers, nitroglycerin, statin

Revascularization with PCI or CABG = definitive

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21
Q

when to do PCI vs CABG for angina

A

PCI - 1 or 2 vessel disease in non diabetes NOT involving left main coronary artery

CABG - left main coronary artery stenosis, 3 vessel disease, decreased LVEF < 40%, 2 vessel disease in DM

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22
Q

unstable angina is characterized by what 3 things

A

1) sx suggestive of ACS
2) negative cardiac biomarkers (negative CK and troponin)
3) with or without EKG changes suggestive of ischemia (ST segment depressions or new T waves)

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23
Q

what is the MCC of unstable angina

A

plaque rupture

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24
Q

when is angina considered “unstable”

A

rest angina lasting > 20-30 minutes
new-onset angina
change in anginal pattern

not relieved with rest or nitroglycerin

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25
treatment for unstable angina
aspirin, beta blockers, oxygen if hypoxic aspirin + P2Y12 inhibitor anticoagulant
26
what 3 things tend to trigger vasospastic angina
cold weather alpha antagonists (pseudoephedrine, oxymetazoline, cocaine, amphetamines) hyperventilation
27
what 3 things are major risk factors for vasospastic angina
female smoking vasospastic disorders (migraine, raynauds)
28
sx vasospastic angina
chest pain mainly at rest (esp at midnight to early morning) usually does not pertain to activity
29
dx vasospastic angina
EKG - transient ST elevation in the pattern of the affected artery == resolve with CCB and/or nitroglycerin and/or symptom resolution angiography - may show coronary vasospasm with the use of Ergonovine, hyperventilation, or Acetylcholine
30
what 3 things during angiography may induce a vasospasm if someone has vasospastic angina
acetylcholine ergonovine hyperventilation
31
tx vasospastic angina
smoking cessation CCB (mainstay of therapy) nitroglycerin
32
what meds should be avoided in people with vasospastic angina
beta blockers
33
definition of sinus tachycardia
HR > 100 BPM
34
tx for persistent sinus tachycardia
beta blockers
35
definition of sinus bradycardia
HR < 60 BPM
36
tx sinus bradycardia
symptomatic: atropine epinephrine or subq pacing (2nd line) asymptomatic observation
37
sinus node dysfunction is also called
sick sinus syndrome
38
tx sick sinus syndrome
unstable: atropine (first line) dopamine epinephrine temporary pacing (transq or trans venous pacing) stable/asymptomatic: observation symptomatic: pacemaker
39
definition of first degree AV block
prolonged AV conduction -- prolonged PR interval > 0.20 seconds
40
2 most common causes of first degree AV block
increased vagal tone (highly conditioned endurance athletes) AV node-blocking meds (beta blockers, non-DHP CCB, digoxin)
41
what meds can cause first degree AV block
BB Non-DHP CCB Digoxin
42
EKG for first degree AV block
prolonged PR interval > 0.2 seconds + all P waves are followed by QRS complexes
43
tx first degree AV block
asymptomatic - observation symptomatic - atropine definitive - permanent pacemaker
44
what will EKG show for mobitz 1 second degree AV block (Wenckebach)
progressive lengthening of PR node until an occasional non-conducted atrial impulse (dropped QRS complex)
45
tx mobitz 1 (Wenckebach)
asymptomatic - no treatment symptomatic - atropine first line definitive - permanent pacemaker
46
what will EKG show for mobitz 2 second degree AV block
constant PR interval before and after the non-conducted atrial beat (dropped QRS complexes)
47
tx mobitz 2 second degree AV block
symptomatic - transq pacing and/or atropine unstable - atropine, temporary cardiac pacing definitive - permanent pacemaker
48
EKG for third degree AV block
AV dissociation - evidence of P waves and QRS complexes (atrial and ventricular activity) -- regular P-P intervals and regular R-R intervals independent of each other
49
tx third degree AV block
symptomatic and stable - atropine unstable - atropine and temporary pacing definitive - permanent pacemaker
50
what is cardiac tamponade
accumulation of pericardial fluid
51
what is more important in cardiac tamponade: the rate or the amount of fluid
THE RATE
52
what is impaired during cardiac tamponade: diastolic filling or systolic pumping
diastolic filling
53
decreased diastolic filling in cardiac tamponade leads to
decreased stroke volume and decreased cardiac output
54
cardiac output equation
CO = HR + SV
55
common causes of cardiac tamponade
penetrating or blunt trauma iatrogenic - central line placement, pacemaker insertion, etc. pericarditis post-MI free wall rupture aortic dissection
56
key findings to diagnose cardiac tamponade is this a clinical diagnosis?
THIS IS A CLINICAL DIAGNOSIS key findings: beck's triad and pulsus paradoxus
57
beck's triad
hypotension muffled heart sounds elevated JVP (distended neck veins)
58
pulsus paradoxus
exaggerated decrease in arterial pressure during INSPIRATION > 10 mmHg drop decrease in amplitude of carotid or femoral pulses during INSPIRATION (pulse is strong during expiration and weak during inspiration)
59
dx cardiac tamponade
echo - most sensitive & specific CXR - enlargement of cardiac silhouette when > 250 mL has accumulated; clear lung fields EKG - electrical alternans (altering QRS amplitudes) cardiac Cath
60
tx cardiac tamponade
nonhemorrhagic + stable - observe; can do dialysis if renal failure non hemorrhagic + unstable - pericardiocentesis hemorrhagic - emergent surgery; pericardiocentesis is only a temporizing measure
61
what is the difference between pericardial effusion and cardiac tamponade
Pericardial effusion = fluid in the pericardial space. Cardiac tamponade = when pericardial effusion leads to increased pressure, impairing ventricular filling and resulting in decreased cardiac output.
62
an enlarged heart without pulmonary vascular congestion suggests
pericardial effusion
63
tx pericardial effusion
pericardiocentesis is not indicated unless there is evidence of tamponade; analysis of pericardial fluid can be useful if the cause of effusion is unknown if the effusion is small and clinically insignificant, a repeat echo in 1-2 weeks is appropriate
64

ER EOR (28 decks)

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