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Flashcards in Cardio Deck (58)
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Pain characteristics that make ischemia less likely

Sharp, knife like, last for a few seconds
Changes with respiration, position, touch of the chest wall (tenderness)


How to calculate maximum heart rate

220 minus age, so for me it's 194


Alternatives to exercise stress test

Persantine (dipyridamole, avoid in asthmatics) or adenosine in combo with nuclear isotopes such as Thallium or sestamibi
Or Dobutamine with echo


Nitro and ministration in chronic versus acute angina

Chronic: oral or transdermal patch
Acute: sublingual, paste, IV


Antiplatelet agents that should be given in ACS

Aspirin plus clopidogrl, prasugrel, or ticagrelor (P2Y12 Receptor inhibitors)
Clopidogrel commonly used if aspirin allergy
Prasugrel Best if undergoing angioplasty and stenting but increases risk of hemorrhagic stroke in patients over 75


Best mortality benefit in chronic angina

Aspirin and beta blockers


Target LDL in coronary artery disease (or PAD, carotid disease, aortic disease, stroke, diabetes)

Less than 100 mg/dL
If diabetes, less than 70 mg/dL


Most common side effect of statins

Liver dysfunction, myositis/rhabdo is rare
Measure LFTs not CPK


Why are statins so great for Improving mortality

They have an antioxidant effect on the endothelial lining of the coronary arteries in addition to lowering the LDL


Use fibrates with caution why?
Why is cholestyramine not used as much?
Side effects of Niacin?

Fibrates: If used in combo with statins have increased risk of myositis
cholestyramine: blocks absorption of other medications and has G.I. side effects
Niacin: elevation in glucose in uric acid level, pruritis


Why not to use Dihydropyridine CCB's in CAD?

They raise the heart rate, reflex tachycardia
Especially Nifedipine
Can use verapamil and diltiazem, which do not increase the heart rate, when beta blockers are contraindicated: severe asthma, Prinzmetal angina, cocaine induced chest pain


When to do CABG instead of standing in CAD

If at least three vessels are involved, or the left main is involved, or two vessels in diabetic


Mortality is highest with what type of STEMI

Anterior wall, ST elevation in leads V2-V4


Order of therapy and STEMI patient

Aspirin first, then angioplasty
Cardiac markers will be normal in the first four hours
Morphine, oxygen, nitrates should be given immediately but do not clearly lower mortality
Beta blockers, statins, ACE inhibitors do lower mortality but are not dependent on time, should be given before discharge


Cardiac marker timeline

Myoglobin: shows up at 1 to 4 hours, stays elevated 1 to 2 days
CK – MB: 4-6 hours; 1 to 2 days
Troponin: 4 to 6 hours; 10 to 14 days
Renal insufficiency he can result in false positive troponins


Best for decreasing the risk of restenosis in coronary arteries after PCI

Placement of drug eluting stents
Warfarin is not used here, useful in DVT/PE
Heparin is used during the procedure but not long-term


Absolute contraindications to thrombolytics

Major bleeding: G.I. or brain
Recent surgery in the last two weeks
Severe hypertension above 180/110
Non-hemorrhagic stroke within the last six months


ACE inhibitors have the most benefit in what patients?

In those with systolic dysfunction, ejection fraction below 40%


When to give heparin in MI

If ST depression but no ST elevation or in unstable angina
Heparin will prevent a clot from forming
If there is no ST elevation, there is no benefit of TPA


Meds useful when undergoing angioplasty and Stenting or if non-ST elevation MI

Glycoprotein IIb/IIIa inhibitors: abciximab, tirofiban, eptifibatide


TPA is only good for?

ST – elevation MI
If PC I not available, use within 12 hours of start of chest pain


Which is better in terms of mortality: LMWH or unfractionated heparin?



3rd° AV block will have what waves?

Cannon A waves
Produced by atrial systole against a closed tricuspid valve


How to find the right ventricular infarct
How to treat?

Flip the EKG leads to the right side, will have ST elevation in RV4
Treat with high-volume fluid replacement, avoid nitro


Diagnosis/treatment of tamponade/free wall rupture

Emergency echo, emergency pericardiocentesis on the way to the OR
Elevated JVD but lungs are clear, sudden loss of pulse


Post MI complications that present with new onset murmur and pulmonary congestion

Both valve rupture and septal rupture, echocardiogram is the best test
Septal rupture will also present with a step up in oxygen saturation as oxygen blood from the LV mixes with blood in the RV


How to treat acute pump failure

IABP: intra-erotic balloon pump helps push blood forward, serves as a bridge to surgery for valve replacement or transplant for 1 to 2 days


Signs of a second infarct

Recurrence of pain, new rails on exam, bump in CKMB, sudden onset of pulmonary edema


All postinfarction patients should go home on?

Aspirin, beta blockers – metoprolol, statins, ACE inhibitors ace: best for anterior wall infarctions because of high likelihood of developing systolic dysfunction


How myocardial infarction leads to CHF
Other causes of CHF (systolic dysfunction) besides infarction

Infarction leads to dilation which leads to regurgitation leading to CHF
Others: cardiomyopathy and valve disease