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Clerkship > Cardio > Flashcards

Cardio Flashcards

1
Q

Timing of afib that is “paroxysmal”… vs persistent… vs permanent

A

Paroxysmal- within 7 days
Persistent - beyond seven days
Permanent- beyond a year

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2
Q

Possible symptoms of afib?

A 
Chest pain
SOB
Palpitations (probably “racing”)
Decreased exercise tolerance 
Fatigue
Dizziness
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3
Q

Two big buckets to categorize the etiology/cause of afib?

A

Cardiac

Non-cardiac

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4
Q

Cardiac causes of afib?

A

HTN, CHF, valvular (MR, MS), …CAD

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5
Q

Non-Cardiac causes of afib?

A

Hyperthyroidism (thyrotoxicosis)
OSA
?alcohol,cocaine

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6
Q

Most important complication of afib? And the second most important?

A

Stroke from atrial emboli

Heart failure

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7
Q

Investigations to consider for new onset afib?

A

Labs

  • CBC - anemia, infection
  • TSH, Cr, lytes, ALT, ALP
  • lipids, A1c - for risk stratification
  • coags (INR, baseline)
ECG - ?afib, hypertrophy
CXR - signs of heart failure, COPD
ECHO - valvular dysfunction, EF, thrombus, wall abnormalities
Stress test - ?CAD
Holter - capture afib
Sleep study - ?OSA
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8
Q

Treatment for afib - 2 major problems to deal with…

A

Rate/rhythm control - thought to be pretty equal

Anticoagulation

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9
Q

When considering starting antithrombotic for afib, what risk tools can you use to help you?

hint - why do you want to start the med and what makes you worried about starting the med

A

CHADS-65 - annual stroke risk

HASBLED or SPARC tool to assess bleeding risk

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10
Q

Patient goes into rapid afib… you ask “are they hemodynamically stable”… what symptoms and signs tell you about this?

A

hypotension
SOB
chest pain - ?coronary ischemia
decreased LOC

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11
Q

Is there a role for ASA in stroke prevention for a patient with (non-valvular) afib?
Bonus: Unless they have.. (2 things specifically in the CHADS65 algorithm)

A

No, not for run of the mill afib.

In CHADS65, ASA indicated for CAD and PAD

(CCS/CHRS 2020 Comprehensive Guideline Update: Atrial Fibrillation)

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12
Q

What antithrombotic should you use for afib if indicated?

A

DOAC.. any of them are reasonable choices.

eg. rivaroxaban (Xeralto) 20 mg PO daily
apixiban (Eliquis) 5 mg PO BID…
Always look up the drug for dosing and other considerations.

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13
Q

Patient asks you, “do I need to stop my DOAC to go to the dentist? Or to get my colonoscopy?” - where can you find a handy dandy algorithm for this???
Hint: when you stop a OAC, you worry about a clot… thrombosis…

A

Thrombosis Canada (http://thrombosiscanada.ca) Perioperative Anticoagulant Management Algorithm

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14
Q

What do you worry about when considering cardioverting someone with afib?

A

Inadvertently causing a stroke - atrial thrombus

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15
Q

Patient thinks they have been having chest pain, it sounds like stable angina on HPI.

What approach would curbsiders/cardionerds suggest you take to assess CVD risk?
Hint: 4+2

A

Assess CVD risk
1. qualitative - ask about RF (HTN, DM, smoking
2. quantitative - Risk tool (framingham)
3. Family history - father <55, mother <65 yo
4. Consider coronary artery calcification score
Escalate Management
1. lifestyle (diet, exercise, weight loss, smoking…)
2. risk modifying - ASA, statin - also manage the modifiable RF (DM, HTN, DLD)

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16
Q

What is stable angina?

A

TNotes: symptom complex resulting from an imbalance between oxygen supply and demand in the myocardium

Curbsiders: Stable angina occurs when coronary atherosclerosis builds up over time, and symptoms (nausea, dyspnea, chest pain, etc.) are unmasked by stress (physical, emotional)

17
Q

What are the three criteria for typical angina?

A
  1. Symptoms (chest tightness/discomfort… SOB, nausea, anxiety)
  2. predictably provoked by activity (3Es - exercise, eating, emotion)
  3. brief duration (<15 min) relieved by rest or nitrates
18
Q

Bonus: What is different about CVD in women…?

A

MI’s tend to present atypically.. consider getting an ECG when a woman with risk factors complains of “reflux”..

Stable angina may occur in the absence of a discrete obstruction, especially in women

  • Stress testing and EKG may be positive, but focal large artery stenosis is absent on angiography
  • Treatment consists of aggressive risk factor modification (treatment of comorbid conditions, exercise, smoking cessation, etc.), and antianginal therapy (bb, nitro)
19
Q

Separate the medication treatment for stable angina into risk modifying (2) and symptom modifying (3-4)…

A

Risk modifying for stable angina
- ASA, statin

Symptom modifying
- BB, CCB, nitrates, PCI (if STABLE angina, stenting does not change outcomes, but it can help with symptoms)

20
Q

What is a Coronary Artery Calcium scan/score?
What imaging modality does it use? (US, xray, CT, MRI)
What does it show?

Bonus: should you show it to your patients?

A
  • CT scan
  • detects calcium deposits in the coronary arteries
  • CAC score is an independent marker of risk for cardiac events, cardiac mortality, and all-cause mortality and can help guide lifestyle and pharmacological risk factor modification
  • Yes, just showing patients the plaque on CT imaging can improve outcomes :)
21
Q

You’re running a code, ECG shows bradycardia, no pulse. What is a likely culprit and what do you give immediately?

ie. bradycardia PEA arrest

A

Any patient who has had a bradycardia PEA arrest has hyperkalaemia until proven otherwise

calcium carbonate 2g IV to stabilize myocardium

22
Q

ECG changes of pericarditis?

A

diffuse ST elevation (+/- depressed PR segment) and reciprocal changes in aVR

after 2-5 days, may progress to T-wave changes, flattening then inversion

23
Q

Most common cause of pericarditis?

Bonus: other common cause, hint metabolic

A

idopathic, presumed to be viral

uremia

24
Q

“Diagnostic triad” of pericarditis?

A

chest pain, friction rub, ECG changes

25
Q

Common treatment for idiopathic pericarditis?

A

high dose NSAIDS

bonus - colchicine can decrease rate of recurrent pericarditis (NEJM 2013)

26
Q

Symptoms (1 major) and signs (vitals, exam) of cardiac tamponade?

A

Symptoms
- SOB/dyspneic
Signs
- vitals - hypotensive, tachycardic, tachypneic
- exam - incr JVP, muffled heart sounds, (pulsus paradoxus in theory)

27
Q

Pathognomonic ECG change of tamponade?

A

Electrical alternans (alternating height of R-wave)

bonus: also low voltage

28
Q

What medication should you definitely NOT give if you suspect tamponade?

A

diuretics and vasodilators
- these would decrease preload, decrease venous return to an already under-filled RV, which would decrease LV preload, decrease CO… make things worse

29
Q

How should you monitor mild pericardial effusion?

A

Serial echos

30
Q

What procedure to treat moderate/severe pericardial effusion/tamponade?

A

Pericardiocentesis

31
Q

Acute complication of rheumatic fever?

A

Acute “carditis”

  • myocarditis (DCM/
  • conduction abnormalities (sinus tach, Afib)
  • valvulitis (acute MR)
  • acute pericarditis
32
Q

What imaging should you get if you suspect a aortic dissection?

A

CTA

33
Q

Precipitants of CHF?

Hint, mnemonic… (7 letters)

A

FAILURE - mnemonic for cause of decompensation
Forgetting medication (or new meds - recent beta blocker increase, NSAIDs, methamphetamine, or cocaine)
Arrhythmia, Anemia
Ischemia, Infarction
Lifestyle - fluids, salt
Upregulation of cardiac demand - pregnancy or hyperthyroidism
Renal failure - progression of kidney disease or insufficient dialysis?
Embolus - pulmonary embolism

34
Q

You suspect CHF and get a CXR.
What are do you look for? (7)

If you can only order one thing to get your answer (Does this patient have CHF), what do you order?

A 
Edema
- alveolar edema, bilateral infiltrates, bat wing sign
- interstitial edema, Kerley B lines
Peribronchial cuffing
Pleural effusion, blunting of the CPA
Fluid in the fissure
Cardiomegaly
Vascular redistribution to upper lobes

Order an ECHO

35
Q

Fabulous five medications post stent?

A

dual antiplatelet (ASA + ticegrelor/clopidogrel)
ACEi
Beta blocker
Statin

Clerkship (21 decks)

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