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Cardio Flashcards

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1
Q

Diamond classification

A

substernal or L sided chest pain
worsened w/ exertion
relieved with NTG and rest

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2
Q

Typical angina

A

3/3 of diamond classification

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3
Q

Atypical angina

A

2/3 of diamond classification

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4
Q

Non-anginal

A

0-1 of diamond classification

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5
Q

Diagnostic studies for angina

A

R/O STEMI first β†’ 12 lead EKG

If STEMI β†’ 🚨 cath lab

If NO STEMI β†’ troponins

If ↑ trop β†’ 🚨cath

If no ST elev or ↑ trop β†’ stress testβ†’ if βŠ• electively go to cath

Eval stress test with:
EKG β†’ if nl baseline EKGβ†’ βŠ• if ST Ξ”

Echo β†’ baseline EKG abnl β†’ βŠ• if no mvt

Nuclear β†’ prev coronary artery bypass

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6
Q

Clinical intervention for angina

A

Cath β†’
if β‰₯3 vessels β†’ CABG

if 1-2 vessels β†’ stent

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7
Q

Clin therapeutics angina

A

Morphine
Oβ‚‚ β†’ NC
Nitrates β†’ if CAD + angina
*Aspirn β†’ 1st

*Ξ²-blocker β†’ next after aspirin
*ACE-I
*Statin
Heparin β†’ if high sus of CAD

Clopidogrel β†’ if stent

tPA if in rural setting and can’t get to cardiologist within 60 min

*everyone gets

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8
Q

What med ↑ mortality when used to control CP

A

morphine

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9
Q

Stable Angina

A

Substernal chest pain w/ exertion and relieved w/ rest and NTG

βˆ… Biomarkers
βˆ… ST Ξ”
βŠ• Stress test

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10
Q

Stable Angina tx

A

Med mgmt only

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11
Q

Unstable Angina

A

90% occlusion
demand ischemia

Chest pain at rest & nothing relieves pain

βˆ… Biomarkers
βˆ… ST Ξ”

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12
Q

UA treatment

A

Hosp admission & cath + meds

If not treated will progress to STEMI

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13
Q

NSTEMI

A

Heart is damaged β†’ 90% occlusion
demand ischemia

CP at rest
↑ troponin
βˆ… ST elevation

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14
Q

NSTEMI tx

A

Hosp admission & cath + meds

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15
Q

When should you AVOID giving nitrates when a pt has chest pain

A

II, III, avF (inferior) ST elevations β†’ RV infatcton β†’ NO NITRATES bc RV is preload dependent and will cause severe hypotension

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16
Q

A fib mgmt

A

Stable→ rate control
Ξ² blockers (Metoprolol), CCB (Diltiazem, Verapamil), Digoxin preferred for rate control in pts w/ hypotension or CHF

Unstable β†’ synchronized cardioversion
need to anticoag if >48h

Anticoagulation
NOACs β†’ Dabigatran, Rivaroxaban, Apixaban, Edoxaban
Warfarin-Preferred if severe CKD, HIV on PI, CYP450 antiepileptics (carbamazepine, phenytoin)
INR goal of 2-3
Aspirin + Clopidogrel (not as good)

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17
Q

Torsades mgmt

A

defib + IV magnesium

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18
Q

V tach mgmt

A

If stable β†’ Amiodarone 150 mg IV over 10 min; repeat as needed to maximum dose of 2.2 g in 24 hours

Unstable β†’ defibrillate

If pulseless β†’ CPR q 2 min, defib and alt epi and amio alt q 2 min

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19
Q

Med mgmt of sinus brady

A

Unstable β†’ pace

Atropine

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20
Q

Mgmt of 2nd deg heart block

A

Atropine or temporary pacing

If you give atropine it may push into 3rd deg and worsen

Progression to 3rd deg common so pacing is definitive tx*

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21
Q

PEA/asystole mgmt

A

CPR q 2 min with epi q 4 min

NO shock

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22
Q

What is CHADSVASC

A 
CHF
Hypertension
Age ( β‰₯ 65 = 1 point, β‰₯ 75 = 2 points)
Diabetes
Stroke/TIA (2 points)

VASc β†’ peripheral arterial disease, previous MI, aortic atheroma, female gender

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23
Q

Duke criteria for endocarditis

A

pt must have 2 major OR 1 major and 3 minor OR 5 minor

Major: 2 pos blood cx, ECHO evidence of endo involv or regurg

Minor: predisposing factor, fever >100.4, vascular phenomena (embolic dz, pulm infect), immunologic phenomena (glomerulopnephirtis, osler nodes, roth spots)

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24
Q

Dilated Cardiomyopathy pathophys

A

β™₯ chambers dilate β†’ floppy + thin walls

↓ contractility

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25
Dilated Cardiomyopathy sx
Sx typical of systolic CHF β†’ orthopnea, PND, DOE, crackles, peripheral edema
26
Dilated Cardiomyopathy dx
Echo β†’ dilated chambers
27
Dilated Cardiomyopathy tx
βˆ…EtOH, βˆ… chemo Transplant Goal: target CHF sx Ξ²-blocker ACE-I Diuretics β†’ furosemide
28
Hypertrophic Obstructive Cardiomyopathy pathophys
Unilateral septum hypertrophy β†’ covers aortic opening β†’ LV outlet obstruction
29
Hypertrophic Obstructive Cardiomyopathy sx
Young athlete* Aortic stenosis murmur DOE, syncope w/ exertion, sudden cardiac death Systolic, heard best at 2nd ICS RSB (base), crescendo-decrescendo
30
Hypertrophic Obstructive Cardiomyopathy tx
Avoid dehydration β†’ do not get HR up, AVOID exercise EtOH ablation, myectomy, AICD if at ↑ risk of death Definitive tx β†’ transplant Goal: keep ventricle filled Ξ²-blockers CCBβ†’ verapamil, dilatazlam
31
Restrictive Cardiomyopathy pathophys
Stuff gets in way of ventricle wall other than myocytes β†’ β™₯ can't relax
32
Restrictive Cardiomyopathy sx
Diastolic CHF Amyloid β†’ peripheral neuropathy Sarcoid β†’ pulmonary dz Hemochromatosis β†’ cirrhosis or bronze diabetes
33
Restrictive Cardiomyopathy dx
Echo β†’ restrictive pattern Amyloid β†’ fat pad or gingiva bx Sarcoid β†’ cardiac MRI + endomyocardial bx Hema β†’ screen w/ ferritin (will be ↑) + genetic test
34
Restrictive Cardiomyopathy tx
Manage underlying dz Definitive tx = transplant Goal: rate control + control HTN Ξ²- blockers CCB Gentle diuresis
35
R sided HF
R sided β™₯ failure β†’ ↓ blood to lungs β†’ ↓ blood to LV and ↓ blood to periph
36
L sided HF
L sided β™₯ failure β†’ blood can't get out of LV β†’ lungs drown with fluid bc RV still works
37
Diastolic dysfn
Diastolic Dysfn β†’ β™₯ gets big and beefyβ†’ thick ventricle β†’ can't relax β†’ ↑ or nrml Ej frac
38
Systolic dysfn
Systolic dysfnβ†’ LV weakβ†’ can't get blood out of β™₯ β†’ ↓ ej frac < 50%*
39
Congestive Heart Failure sx
DOE, orthopnea, PND Lateral displaced PMI + S3 JVD, peripheral edema, hepatosplenomegaly L-sided will have crackles Wt gain d/t fluid retention
40
Congestive Heart Failure dx
BNP β†’ released when R atrium stretches (will show ↑ vol but not specific) 2D Echo β†’ ej frac, pulm arterial press, diastolic vs systolic Lβ™₯ cath angiogram β†’ determine ischemic vs not
41
Congestive Heart Failure tx
Smoking cessation <2 L fluid/day <2 gm NaCl/ day (bc water follows salt) Ξ²-blocker + ACE-I (or ARB) + loop diuretic if class II + Spironolactone or Bidil if class III + Inotropes if class IV
42
CHF Exacerbation dx
CXR β†’ βœ“ for vol overload EKG β†’ βœ“ for STEMI or arrhythmia causing CHF BNP β†’ βœ“ for vol overload Troponin β†’ βœ“ for NSTEMI
43
CHF Exacerbation tx
Lasix→ get rid of excess fluid Morphine → dyspnea + vasodilate pool fluid away from lungs Nitrates → vasodilate pool fluid away from lungs Oxygen Position → sit up to prevent orthopnea
44
Atherosclerosis tx
Smoking cessation, control HRN, treat DM, + dyslipidemia BMI <25, <40 in WC Aerobic exercise Low sat far, low trans fat and low cholesterol diet high in fiber and rich in veggies, fruti and hwole grains
45
Endocarditis etiology
S. aureus = MC 2nd MC = Strep viridans Enterococci IV drug users β†’ S. aureus MC
46
Endocarditis pathophys
Infection d/t direct intracascular contamination Vegetations, fibrin, inflammation, organisms
47
Endocarditis sx
New regurgitation murmur, HF, evidence of embolic events, peripheral lesions (petechiae, splinter hemorrhages, orth spots), fever Osler nodes + Janeway lesions
48
Endocarditis dx
Blood cx x 3 at least 1 hr apart EKG ECHO→ vegetation + ID affected valves Duke criteria → determine criteria
49
Endocarditis tx
Empiric therapy β†’ IV vanc (or ceftriaxone) + gentamicin + cefepime or carbapenem x 6 wks Ppx for HIGH risk groups prior to procedures that have high risk for bacteremia β†’ prosthetic valves, cyanotic congenital heart defet Amoxicillin 2 g 30-60 min before procedure
50
Mitral Stenosis etiology
Rheumatic β™₯ dz Inflam of mitral valve
51
Mitral Stenosis sx
Atrial stretch + fluid in lungs drive the sx CHF sx β†’ β†’DOE, PND, crackles Afib Rumbling diastolic murmur heard best at apex 5th ICS MCL, opening snap
52
Mitral Stenosis tx
Balloon valvuloplasty β†’ opens up valve so blood flows normally again Replacement ↓ volume Afterload reduction + diuresis
53
Aortic Stenosis etiology
Atherosclerosis β†’ calcium deposits
54
Aortic Stenosis sx
Heart failure sx, CP, syncope Systolic, 2nd ICS RSB (base of β™₯), crescendo-decrescendo
55
Aortic Stenosis tx
Valve replacement ↓ volume Afterload reduction + diuresis
56
Lipid lowering drugs
Statins (HMGcoA Reductase Inhibitors) β†’ only one that ↓ MI/Strokes High Intensity = Atorvastatin, Rosuvastatin Niacin/Nicotinic Acid (Vit B3) Fibrates β†’ Gemfibrozil, Fenofibrate Bile Acid Sequestrants β†’ Cholestyramine, Colestipol, Colesevelam (↑ TGs) Ezetimibe/Zetia PCSK9 Inhibitors (-mabs)
57
Pericarditis tx
NSAIDs + colchicine Avoid NSAIDs in CKD, thrombocytopenia, PUD Colchicine β†’ dose lim by diarrhea Can go to steroids if refractory but ↑ risk of recurrence w/ steroids (esp if d/t viral etiology)
58
Rheumatic fever tx
Anti-inflam β†’ ASA w/ taper (+/- CCS if carditis/severe) ABX β†’ PCN G for Strep (Erythro if PCN allergy) acute phase & AFTER (prevention = imp)
59
Short PR and widened QRS
WPW
60
secondary pphx for GAS after pt has acute rheumatic fever
needs to be for 10 yrs or until 40 yo Pen G IM q 21-29d Pen V 250 mg po BID If PCN all then Azithromycin 250 mg po BID
61
ststins that dec size of atheromas
rosuvastatin and atorvastatin
62
non statin lipid lowering agent with additive prevention of CV adverse events
Ezetimibe
63
Dx TOC for ID valvular vegetations in at risk pts
TEE
64
GS to locate PVD
angiography
65
Mc cause of exacerbation of PVD
emboli
66
split S2, clubbing, cyanosis, tricupsid regurg and inc HVP
Pulm HTN
67
Becks Triad
hypotension, JVD, muffeled heart sounds assoc w/ cardiac tamponade
68
V1 and V2
septal (prox LAD)
69
V1-V4
Anterior (LAD)
70
I, avL, v5 and v6
Lateral (circumflex)
71
I, avL, v4, v5. v6
Anterior lat (mid LAD or CFX)
72
II, III, aVF
inferior (RCA)
73
II, III, aVF
inferior (RCA)
74
Which beta-blockers have a proven mortality benefit in the treatment of heart failure?
Carvedilol, metoprolol succinate and bisoprolol
75
Which beta-blockers have a proven mortality benefit in the treatment of heart failure?
Carvedilol, metoprolol succinate and bisoprolol
76
hat cardiac complication is associated with hyperthyroidism?
Atrial dysrhythmias and high cardiac output failure
77
hat cardiac complication is associated with hyperthyroidism?
Atrial dysrhythmias and high cardiac output failure
78
Which virus is the most common cause of acute viral pericarditis?
coxsackie virus
79
Which virus is the most common cause of acute viral pericarditis?
coxsackie virus
80
s3
restrictive cardiomyopathy
81
pericardial knock
constrictive pericarditis
82
pericardial knock
constrictive pericarditis
83
What are the components of the San Francisco syncope rule
History of CHF, hematocrit <30%, abnormal ECG, dyspnea, systolic BP <90β€”defines high-risk criteria for patients with syncope
84
What are the components of the San Francisco syncope rule
History of CHF, hematocrit <30%, abnormal ECG, dyspnea, systolic BP <90β€”defines high-risk criteria for patients with syncope
85
egg shaped heart
transposition of the great arteries
86
egg shaped heart
transposition of the great arteries
87
snowman heart
total anomalous pulmonary venous return
88
What coronary artery supplies the AV node?
RCA
89
chest pain early in the AM
Prinzmetal angina (variant angina)
90
In patients with a myocardial infarction, which three drugs have been shown to decrease mortality?
Aspirin, beta-blockers, and ACE-inhibitors

Inpatient EOR (12 decks)

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