Cardio Flashcards
(81 cards)
Pt has atypical chest pain and mid systolic click on physical exam. Dx? What’s found on physical exam? Test? Rx?
Mitral valve prolapse. On physical exam murmur will be worse with standing and valsava. Improves with squatting. Do echo to confirm. Give beta blockers to reduce palpitations and chest pain.
Management of heart failure? Acute? Chronic?
EKG (need to rule out mi)and CXR (Evaluated fluid Overload.)
Then Rx with Oxygen, Diuretics, Nitrates, Morphine.
Give Dobutamine if pt fails O2, diuretics, nitrates, morphine.
Chronic give Ace and BB. Spiranolactone for class II and IV.
How to manage unstable angina and NSTEMI (medical and invasive)? Acute and chronic.
Treatment same as MI except no TPA.
Give O2, nitrates, morphine, Aspirin, Clopidegrol ( not before cabg and wait 5 days if given), beta blockers, unfractionated heparin or Enoxparin (drug of choice.)
Adjunct Eptifibatide (gp2b3a blocker) if pt is getting stent.
If patient fails to improve with medical therapy or if ichemia on EKG persist for more than 48 hrs then Invasive: Cath lab for coronary angiography and revascularization. Don’t do anything if pt has many severe comorbidities.
Chronic Rx: Aspirin, Clopidegrol (DAPT 6 months), Beta blockers, Statins, Nitrates.
(Warfarin if high risk for thromboembolism)
Manage HTN, DM, HLD, Smoking Cessation.
How to manage unstable angina and NSTEMI (medical and invasive)? Acute and chronic.
Treatment same as MI except no TPA.
Give O2, nitrates, morphine, Aspirin, Plavix ( not before CABG and wait 5 days if given), beta blockers, unfractionated heparin or Enoxparin (drug of choice.)
Adjunct Eptifibatide (gp2b3a blocker) if pt is getting stent.
If patient fails to improve with medical therapy or if ichemia on EKG persist for more than 48 hrs then Invasive: Cath lab for coronary angiography and revascularization. Don’t do anything if pt has many severe comorbidities.
Chronic Rx: Aspirin, Plavix (DAPT 6 months), Beta blockers, Statins, Nitrates.
(Warfarin if high risk for thromboembolism)
Manage HTN, DM, HLD, Smoking Cessation.
How to manage unstable angina and NSTEMI (medical and invasive)? Acute and chronic.
Treatment same as MI except no TPA.
Give O2, nitrates, morphine, Aspirin, Plavix ( not before CABG and wait 5 days if given), beta blockers, unfractionated heparin or Enoxparin (drug of choice.)
Adjunct Eptifibatide (gp2b3a blocker) if pt is getting stent.
If patient fails to improve with medical therapy or if ichemia on EKG persist for more than 48 hrs then Invasive: Cath lab for coronary angiography and revascularization. Don’t do anything if pt has many severe comorbidities.
Chronic Rx: Aspirin, Plavix, Beta blockers, Statins, Nitrates.
(Warfarin if high risk for thromboembolism)
Manage HTN, DM, HLD, Smoking Cessation.
Treatment for aortic stenosis? Treatment for mitral and aortic regurg, rx for mitral stenosis?
Aortic stenosis is surgical dz need to replace valve. Regurgitation rx is to reduce preload give diuretics, ace or arbs. For mitral stenosis- ballon valvuloplasty.
Seen in pregnant pts after they had viral illness as a child, Pt has hoarseness, dysphagia. Dx? Test? Rx?
Mitral stenosis caused by rheumatic fever. TEE is the best test. EKG will show biphasic p waves. CXR will show double bubble due to straightening of the left sternal border and pushing of the left main stem bronchus. All this due to the enlargement of the left atrium. Left heart cath is the most accurate. Rx: ballon valvuloplasty.
Hypotension, JVP, pulsus paradoxus. Dx? Cause? Test? Rx?
Pericardial tamponade. Cancer, infection, viral, SLE. Do echo. EKG will show electrical alternans ( variation in height of the QRS) ct will be quicker then echo sometimes and will show obvious fluid. rx: pericardiocentesis or pericardial window.
Hypotension, edema, ascities, JVP, pericardial knock( why?) cause? Test? Rx?
Constrictive pericarditis. Chronic infection and inflammation or post radiation of the pericardium leads to thickening and fibrosis. “Knock” is 3rd heart sound from filling of the ventricle hitting the fibrotic pericardium. CT or MRI shows thickened pericardium with calcifications
What is the management of symptomatic bradycardia?
IV atropine if fails then transcutaneous pacing if fails then pacemaker
When is IV adenosine given?
Supraventricular tachycardias
Pt presents with palpitations and dizziness, BP is 60/30, hr is 240. EKG shows narrow complex tachycardia. Next step in management ?
Supra ventricular tachycardias. D&C cardioversion (givens when there is unstable vitals and refractory chest pain)
The drug of choice for paroxysmal ventricular tachycardia. How does it work?
Adenosine decreases the conduction through the av node. Vagal maneuvers should be attempted before medications.
Syncope with exertion or exercise . Dx? (2)
Aortic Stenosis, Hypertrophic cardiomyopathy
Syncope with prior hx of MI, Cardiomyopathy, CAD or reduced ejection fraction. Dx?
Ventricular arrythymias
Hyperkalemia, Hypomagneiusm or medications that prolong QT interval and cause syncope. Dx?
Tordes De Pointes
Family Hx of sudden death, prolong QT with triggers such as emotion, stress, exercise causing syncope. Dx?
Congenital long QT syndrome
Emotion, stress, prolong standing (due to autnomic dysfunction) causing syncope? Dx?
Vasovagal syncope
Sinus pauses, prolonged PR interval and prolong ORS interval causing syncope. Dx? (2)
Sick sinus syndrome, AV block
Pt post CABG and valve replacement c/o weakness, chest tightness. Crackles are heard on lung exam. EKG shows absent P waves, irregularly irregular rhythm and narrow QRS complex. Next step in management
DC Cardioconversion
Which heart sound is associated with MI?
S4. ischemia causes stiff ventricle
Name 3 organisms that can cause subacute bacterial endocarditis? How is this acquired?
Viridians Streptococci, Enteroccoci and Staph epidermidis ( coagulase negative staph) Remember Staph aureus causes Acute endocarditis. You can get this from bacteremia possible if a patient had a procedure done.
How to treat and MI that occurs in leads II, III, and AVF?
This is a R ventricular wall MI. When this is infarcted it leads to decrease cardiac output and hypotension. for this MI never give Nitro. Give fluid bolus so you can treat the hypotension.
No p waves, Narrow QRS complexes conducted at irregular intervals. Rx ?
A. Fib. Due chads - anti coagulation. Manage cause. Mechanical cardioconversion - no help. Pharmocologic cardioconversion - amiaderone, dofetilide, flecainide, ibutilide, propafenone. Ablation is definitive rx.
