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Flashcards in Cardio Deck (125):
1

Treatment for child with coarctation of the aorta presenting in cardiogenic shock?

PGE1 (to keep ductus arteriosus open)

2

Acute Aortic Dissection early Tx:

Esmolol (short acting B1 easily titratable)

3

Prinzmetal's angina.

d/t

EKG findings

Tx

Do not give ____? Why? What other related condition should you not give this med?

Substernal chest pressure at rest and during activity worse in the AM and with smoking.

Dx: Transient ST Elevations on EKG

Tx: CCB, Nitrates

Do not give Propranolol. Unopposed alpha vasoconstriction can cause death. Don't give Propranolol in Intermittent Claudication (for the same reason).

4

EKG findings of myocardial infarction.

Sustained ST elevations (transmural)

Transient or sustained ST depressions

Q waves (Old MI)

5

Digoxin

MOA

What is it used for?

Blocks Na/K ATPase of cardiac myocytes to slow conduction through SA and AV nodes.

For A.Fib

6

Digoxin Toxicity S&S.

 

Antidote?

Yellow vision

Abd pain

2º AV Node Type I (Wenckebach) Block.

 

Tx: Digoxin Immune Fab

7

S&S of Left sided Heart Failure (weeks after Anterior MI.)

 

Most likely caused by?

Dyspnea, crackles

↑ PCWP (> 15) and ↑ RA pressure (>6)

 

d/t Ventricular Aneurysm (ST elevations in V1-V4)

8

What is the 1st line med in all Acute Coronary Syndromes?

Aspirin. (Clopidogrel if unable to tolerate). Reduces morbidity and mortality.

9

Management of Symptomatic A. Fib

 

Dx?

Dx: TEE to check for intracardiac thrombus OR

Anticoagulate for 3 wks before cardioversion

10

LBBB

No R in V1

Tall R in V6

11

RBBB

RSR1 "Rabbit ears"

12

Hypo/Hypercalcemia EKG changes?

Hypocal = "po"longed QT.

Hypercalcemia is opposite (shortened QT)

13

What is Kussmaul's sign?

JVP Increased with Inspiration

[Norm JVP= 6-8]

14

Aortic Stenosis keywords

Pulmonic Post (L 2 ICS)

Ejection

"Parvus"

Radiates to Carotids

Assoc: Turner's SynHeyde's angiodysplasia of colon

15

Mitral Regurg keywords

@ Apex

Radiates to Axilla

Blowing

Marfan's (also seen in Aortic Regurg)

Papillary mm. rupture

Weight loss meds

16

Mitral Valve Prolapse keywords

@ Apex

Midsystolic (Think MVP of the mid-season)

Better w/ squat

Klinefelter

17

Hypertrophic (Systolic) Cardiomyopathy keywords

LSB

S in V1 + R(V5/V6) > 35mm

Louder w/ Valsalva, standing, vasodilators, diuretics (anything that ↓ preload/afterload)

Tx: BB, CCB

18

Aortic Regurg keywords

@ LSB/Pulmonic post (L 2 ICS)

High pitched blowing

Flash pulmonary edema

(Austin Flint, Duroziez, Corrigan, DeMusset, Quincke),

Marfan's (also seen in Mitral Regurg)

Syphilis

 

Tx: Hydralazine, ACEi, CCB

Valve replace if Austin Flint

HAC V?

19

What is Austin Flint? Significance?

backward flow of blood hitting mitral valve leaflet.

Time to REPLACE the AORTIC VALVE

20

What is Duroziez sign?

Femoral bruit

21

What is Corrigan's Pulse?

Water hammer bounding pulse

22

What is DeMusset's sign?

Head Bobbing

23

What is Quincke's Pulse?

Pulsating Nail Bed

24

Mitral Stenosis keywords

@ Apex

Hemoptysis

Mid-diastolic rumble with *Opening snap* 

Loud S1

Rheumatic FeverGroup A Strep.  

 

Tx: Balloon Valvotomy

25

What can cause 1st Degree AV Block?

Vagal tone

26

Wenckebach Tx.

Stop BB, CCB, or Digoxin 

Atropine

27

Tx. for Mobitz 2, 3rd Degree AV Block, and Sick Sinus Syndrome

Pacemaker (Transcutaneous pacing)

28

A. Fib Tx parameters

1) Anticoagulate if CHADS2 >=2.

2) If 48 hrs, Anticoagulate,

3) If 3-6 weeks of Warfarin (INR 2-3) can cardiovert

29

Multifocal Atrial Tachycardia Tx

BB or CCB for rate control

30

Tx. for AVNRT or AVRT

1) Carotid massage, Valsalva.

2) Adenosine.

3) Cardiovert if hemodynamically unstable

31

Tx. Unstable supraventricular tachycardia

Synchronized Cardioversion (If conscious add sedation)

32

CHF acute exacerbation management

LMNOPA:

Lasix, Morphine, Nitrates, O2, Position upright, ACEi/ARB

33

Cilostazol MOA, indications, and contraindications

Phosphodiesterase inhibitor that decreases platelet aggregation and causes arterial vasodilation, that used for Intermittent Claudication and PVD.

Contraindicated in CHF

34

NYHA Class I

No limitations.

35

NYHA Class II

Slight activity limits. Comfortable at rest, but ordinary activity results in angina, dyspnea, fatigue, or palpitations. Tx: ACEi, BB, Loops for exacerbations

36

NYHA Class III

Comfortable ONLY at rest. Tx: ACEi, BB, Loops, Spironolactone

37

NYHA Class IV

Symptoms at rest. Can't carry out any physical activity without discomfort. Tx: ACEi, BB, Loops, Spironolactone

38

Tx of Ventricular Tachycardia

Cardioversion is your PAL (Procainamide, Amiodarone, Lidocaine)

39

What EKG abnormality is Brugada Syndrome associated with?

V. Fib

40

Torsades can be d/t taking what medications?

Haloperidol

Atypical antipsychotics

41

Torsades de Pointes tx

Mg

42

Chronic CHF Tx

Chronic CHF is BADS

BB

ACEi/ARB, ASA

Diuretics (Loops + Thiazide + Spironolactone)

Statin

43

Loop Diuretics [Lasix, Ethacrynic Acid, Torsemide]

MOA

AE

↓ Na/K/Cl/Ca reuptake.

Ototoxicity, HypO-K and Ca

44

Which Loop diuretic is not part of the Sulfa family?

Ethacrynic Acid

45

Thiazides [Chlorothiazide, Chlorthalidone]

MOA

AE?

↓ NaCl reuptake.

Cause HypO-K and alkaLOsis, HyperGLUC

46

Aldosterone antagonists/K sparing [Spironolactone, Triamterene, Amiloride]

MOA

AE

Spironolactone: aldosterone rec antagonist

Triamterene, Amiloride: block Na channels

HyPER-K, Gynecomastia

47

Carbonic Anhydrase Inhibitors MOA

AE

Decreased HCO3- retention

HyPER-Chloremia and aCidosis, Sulfa allergy

48

Wet Beriberi

B1 deficiency manifesting as: 

Tachycardia, vasodilation, ↓ SVR, ↑ JVP, DOE, Edema

49

What is the gold standard for diagnosing atherosclerosis or if there's unstable angina?

Coronary Angiography

50

Angina Pectoris Acute tx.

MONAB:

Morphine, O2, Nitrates, ASA + ACEi, BB

51

Angina Pectoris Chronic tx

"BAN"

BB

ACEi + ASA

Nitrates

 

52

NSTEMI tx

CASH CAB:

Cath,

ASA,

Statin,

Heparin

Clopidogrel,

ACEi,

BB

53

What does it mean if you see ST Elevations in II, III, aVF? What blood supply is affected?

What do you do?

Inferior MI (which will involve the RV 50% of the time), RCA/PDA and LCA.

- Right sided MI will usually have Hypotension and Bradycardia (RCA s> SA node)

 

Dx: Get Right-sided EKG

Tx: Give Fluid Bolus (because RV function will be 'preload' dependent)

54

What meds are contraindicated in RV infarction?

NITRATES contraindicated in RV infarction

55

If there's a Coronary A. Reocclusion after MI, what labs do you look at?

CK-MB

56

ST depression V1-V2 indicates what?

Acute Posterior Wall Transmural Infarct

57

If an MI pt. is in heart failure (hypoxia, S3, pulm edema) or Cardiogenic shock, DON'T give what?

NO BB. Gives ACEi

58

STEMI tx

Angiography.

PCI within 90 min.

>90 then do TPA

59

Most common cause of death following acute MI?

Tx?

Ventricular Arrhythmia

Tx: Immediate unsynchronized Cardioversion

60

Post MI complication Day 1

Heart failure

 

Arrhythmia is most common complication (within 24 hrs, and days 2-4) following MI. 

61

Post MI complications days 3-7 (or 5-10)

Intraventricular septal rupture: hemodynamic instability and new holosystolic murmur @ LSB

 

Ventricular free wall rupture: leads to hemopericardium/ cardiac tamponade with Beck's triad

 

Papillary mm. rupture: mitral regurg and left heart failure

62

Post MI complication Weeks-Mo. after

CHF, persistent ST Elevation, mitral regurg, ventricular aneurysm

63

Which lipid lowering agent causes angioedema?

Ezetimibe (cholesterol absorp inhibitor)

64

How to diagnose and tx. Renal A. stenosis?

MRA or Renal A. Doppler US. Tx: Angioplasty, stenting, ACEis ONLY if unilateral

65

Conn's syndrome Triad

HTN, HypO-K and AlkaLOsis. Increased Aldo v Renin

66

Malignant HTN

S&S

Tx?

>180/120.

Retinal hemorrhages, exudates, encephalopathy, papilledema (NOT Renal failure)

 

Tx: IV Sodium Nitroprusside (1st line), HydralazineLabetolol (if no COPD), Enalapril

67

Mean Arterial Pressure

[SBP + 2(DBP)] / 3

68

ACEi Adverse Effects

HyPER-K, Angioedema, Cough

69

MOA of Methyldopa

centrally acting adrenergic agonist

70

Constrictive Pericarditis keywords

pericardial knock

71

Aortic Dissection keywords

Spiral CT angiography, Between media & adventitia, diastolic decrescendo @ aortic post

72

Stanford A of Aortic Dissection

Left Subclavian, Proximal. Surgical emergency

73

Stanford B of Aortic Dissection

Left Subclavian, Distal. Medically manage

74

Debakey I

Ascending & Descending

75

Debakey II

Ascending

76

Debakey III

Descending

77

Leriche Syndrome

Butt claudication, v femoral pulses, impotence

78

What drains to Right lymphatic Duct

R Head and Neck, R upper extremity, Heart, Lungs

79

Vasovagal syncope

excess parasympathetics. Tilt-table test. Tx BB

80

Brugada Syn keywords

Na chan mutation in myocytes. ST elevation V1-V3 + RBBB + S waves in lateral leads.

81

Goal LDL for CAD/equivalents i.e. DM, PAD, Symptomatic Carotid a. dz, abdominal aortic aneurysm

82

Goal LDL for 0-1 risk factors

83

Goal LDL for 2+ risk factors

84

When is measuring PCWP (~Left Atrial pressure) helpful?

for checking severity of LV HF, quantifying degree of mitral stenosis, inc. in tamponade, restrictive cardiomyopathy, hypertrophy, for checking for pulmonary HTN

85

Loud holosystolic murmur @ LSB that is non-cyanotic

Ventricular Septal Defect

86

What would an Atrial Septal Defect sound like?

wide, fixed split S2

87

Tx. of Asymptomatic Sustained Monomorphic Vtach

Procainamide

88

Tx. of Symptomatic Sustained Monomorphic Vtach

Cardioversion

89

Tx. of Narrow QRS SVT

Adenosine

90

Tx. of Severe Bradyarrhythmias causing hemodynamic collapse

Transvenous pacing

91

What is the most appropriate next step in management in a patient with Intermittent Claudication?

Check Ankle-Brachial Index (ABI)

92

Venous hum

systolic/diastolic @ RSB quiets with pressure to jugular vein

93

Still murmur

early systolic, @ LSB, normal split S2

94

Peripheral pulmonary a. stenosis of the newborn

mid systolic, radiates to back and axilla, resolves in 3-6 mo.

95

Tx. for Atrial Flutter (hemodynamically stable pt)

Verapamil Metoprolol

96

What is the leading cause of isolated mitral regurgitation requiring surgery?

mitral valve prolapse

97

Tx. for 2nd Degree AV block (Wenckebach)?

Atropine, BB, CCB, Digoxin

98

Tx. for Mobitz II?

Q image thumb

Pacemaker

99

Tx. for 3rd Degree AV Block?

Q image thumb

Pacemaker

100

What is the most common indication for pacemaker placement?

Sick Sinus syndrome

101

Tx. Atrial Fib?

Q image thumb

Anticoagulate if >48 hrs

BB, CCB, Dig Cardioversion

102

Tx. for AVNRT and AVRT?

 

Q image thumb

If unstable: Cardioversion

Stable: carotid massage, valsalva, Adenosine

103

Tx: Unstable Supraventricular Tachycardia

Circulation, Airway, Breathing

Synchronized Cardioversion

104

Defibrillation (not in synchrony with QRS) is Tx for what?

V. Fib

V. Tach no pulse

105

Cardioversion (in synchrony with QRS) is tx for what?

A. Fib/ A. Flutter

SVT

VT w/ pulse

106

CHF Dx?

Labs?

Tx?

Dx: Clinical diagnosis. Check EKG, BNP, 2D Echo. 

Labs: ↓ Cardiac Index, ↑ SVR and LVEDV

 

Tx:

Restrict fluid and salt (H2O <2L/d, Na <2g/d), ACEi/ARB, BB, Lasix, Spironolactone, Imdur, Hydralazine

AICD for Ejection Fraction <35.

Dobutamine for cardiogenic shock. 

 

107

Tx. HOCM

BB, CCB, avoid dehydration

108

Tx. of Acute Angina

MONAB (Morphine, O2, Nitrates, ASA/ACEi, BB)

109

Tx. Chronic Angina

Nitrates, ASA/ACEi, BB

110

How do Nitrates work?

Dilate capacitance vessels (veins) and ↓ ventricular preload

111

NSTEMI 

Dx?

Tx?

Myocardial infarction marked by elevated Troponin I and CK-MB without ST elevations

Tx: Stable: Clopidogrel, Heparin

     Unstable: Cardiac Catheterization/PCI

 

112

STEMI

Dx?

Tx?

Goals after hospitalization?

EKG, Troponins

Tx:

Angiography and PCI w/in 90 min

If no PCI, then TPA for thrombolysis

PMONAB: Plavix, Morphine, O2, Nitrates, ASA/ACEi, BB (but not if heart failure or cardiogenic shock. Just give ACEi)

On d/c: BASH --> BB, ACEi/ARB, Statin, Heparin

Goal: <130/80, A1C<7, LDL<70

113

Fibrates (Gemfibrozil)

MOA

Effects on lipid profile

Adverse SE?

↑ LPL

↓ TGs and ↑ HDL

! LFTs, myositis

114

Ezetimibe (Cholesterol absorption Inhibitors)

MOA

Effects on Lipid Profile

Adverse SE

↓ absorption at brush border to ↓ LDL

 

! diarrhea, angioedema

115

Niacin

MOA

Effects on Lipid Profile

Adverse SE

↓ LDL synthesis and thus ↑ HDL

 

! skin flushing, LFTs

116

Cholestyramine (Bile Acid resin)

Effects on Lipid Profile

Adverse SE

↓ LDL

! diarrhea, LFTs

117

Vasovagal syncope

d/t?

dx?

Tx?

excess parasympathetic stimulation (i.e. carotid stim, coughing, micturition, defecation)

Dx: Tilt-Table Test

Tx: BB

118

Neurogenic Shock

d/t?

Dx?

Tx?

hypotension, bradycardia, and hypothermia with + focal neurological deficit 

unopposed vagal tone causes vasodilation which then ↓ SVR, which is why ↓ PCWP. In addition, vagal tone promotes ↓ HR, which then ↓ CO and ↓ BP

"warm and dry extremities" (also seen in septic shock)

 

Dx: CT angio, MR angio, US of Carotids

Tx: DA, Vasopressin, Atropine for bradycardia

119

What is the tx. for acute decompensated Systolic Heart Failure refractory to medical management?

Milrinone: PDE inhibitor that increases cAMP and therefore increases cardiac contractility.

Dobutamine

Dopamine

120

What is a feared complication of Carotid Endarterectomy (CEA)?

Hyperperfusion Syndrome:

Increased blood flow after stenosis is released that causes headache, seizure, hemorrhage in pts. who have a high degree of stenosis or recently suffered a stroke

121

Cardiogenic Shock 

d/t?

Dx?

Tx?

heart failure causes ↓ CO, ↓ BP so the body tries to compensate by ↑ SVR,  ↑ HR and when blood comes back to left atrium, ↑ PCWP

 

"pale cool skin", JVP

d/t heart failure e.g. MI

Dx: EKG, Troponins

Tx: Fluids, Dobutamine, inotropes, anti-arrhythmics (Adenosine, Amiodarone, BB), Intra-aortic balloon pump

122

Septic Shock

d/t

Dx?

Tx?

↓ SVR (~↓ BP) which then leads to 

↓ PCWP (~Left Arterial Pressure: too little fluid in)

↑ HR ↑ CO

"warm and dry" extremities

suspect in pts. with penetrating abdominal wounds and GI contamination

Tx: Fluids, Broad spectrum ABX (? GI: Cipro, Metronidazole, Vanco), Norepinephrine to vasoconstrict peripheral arterioles

 

123

Anaphylactic Shock

 

↓ SVR (~↓ BP) which then leads to 

↓ PCWP (~Left Arterial Pressure: too little fluid in)

↑ HR ↑ CO (heart wants to raise the system's volume and flush out allergen?)

124

Tx: DVT

SQ Heparin x 5d then Coumadin x 6 mo. [INR 2.0-3.0]

125

Post MI complication 3-7 days

Intraventricular septal rupture: hemodynamic instability and new holosystolic murmur @ LSB