Cardio Flashcards
(82 cards)
1
Q
Stable Angina Presentation
A
Pain with exertion relieved by rest Neg troponins Negative ST Elevation ~70% occlusion
2
Q
Unstable Angina Presentation
A
Pain at rest Nothing relieves the pain Negative Troponins Negative ST Elevation ~90% occlusion
3
Q
NSTEMI presentation
A
Pain at rest Nothing relieves the pain Positive troponins Negative ST Elevvation ~90% occlusion
4
Q
STEMI
A
Pain at rest Nothing relieves the pain Positive troponins Positive ST Elevation 100% Occlusion
5
Q
Risk Factors for MI
A
Diabetes HTN HLD Obesity Family Hx Age >45M, >55 F
6
Q
MI Presentation
A
Associated Symptoms
SOB, Nausea/Vomiting, Presyncope
Non-pleuritic pain, Non-positional pain, Non-tender
7
Q
Angina Diagnostic Workup
A
- ECG
- Troponins
- Stress Test
8
Q
Angina
Normal ECG
Positive Troponins
What next
A
Urgent Cath
9
Q
Angina
ST Elevation
What Next
A
Emergent Cath
10
Q
Angina
Normal ECG
Negative Troponins
Positive Stress Test
A
Elective Cath
11
Q
MI 3 or more occluded Vessels
A
Perform CABG
12
Q
MI 1 or 2 occluded vessels
A
Place Stent
13
Q
Contraindicated in Right sided MI, (II, III, aVF)
A
Nitrates
Right sided infarcts are preload dependent, require preload support give IV fluids
14
Q
Medical management before Cath lab in angina/MI
A
MONA BASH Morphine Oxygen Nitrates Aspirin (ALWAYS GIVE FIRST) Beta Blockers ACEi Statin Heparin
15
Q
What medications should a patient receive on discharge post MI?
A
Aspirin
B-Blocker
ACEi
Statin
16
Q
Post MI, when do you add Nitrates to discharge medications
A
If patient has continuing chest pain
17
Q
When do you add clopidogrel? For how long?
A
When a stent is placed
DES-1 year
Bare Metal- 1 month
18
Q
When do you use tPa
A
When access to a cath lab is far away (60 Minutes)
19
Q
Sx of right sided heart failure
A
JVD Peripheral Edema HSM DOE Displaced PMI S3
20
Q
Sx Left sided Heart Failure
A
DOE-Crackles Orthopnea PND Abdominal pain Weight Gain Displaced PMI S3
21
Q
Diagnostic Tests in HF
A
BNP (released when RA stretches)
2D Echo
[Left Heart Cath-Ischemic or not]
22
Q
CHF Stage I Treatment
A
Beta- blockers, ACEi/ARB
23
Q
CHF Stage II Treatment
A
Stage I + Loop Diuretic (Furosemide)
24
Q
CHF Stage III Treatment
A
Stage I and II + Isosorbide Dinitrite and hydralazine
25
CHF Exacerabtion Work up
CXR
BNP
ECG
Troponins
26
CHF Exacerbation Treatment
```
Furosemide
Morphine
Nitrate
Oxygen
Position
```
27
What murmurs need a work-up?
Any systolic murmur grade 3+ and any diastolic murmur
28
Dx Test for Murmur
TTE, if not good then
| TEE
29
Mitral Stenosis
| Path, Dx, Tx
```
Pt-Younger (20-30), Rhuematic Disease
Sx: CHF, A-fib
Dx: Rumbling Diastolic, with an opening snap
best heard at the apex
Tx: Balloon Valvuloplasty
Valve Replacement
```
30
```
Aortic insufficiency (Regurgitation)
Path, Dx, Tx
```
```
Pt: Infection/Infarction
Aortic Dissection
Sx: Acute- Cardiogenic shock, Flash pulm Edema
Chronic-CHF, Chest Pain
Dx: base of heart (2 ICS RSB)
Rumbling Diastolic murmur
Tx: Valve replacement
```
31
Aortic Stenosis
| Path, Dx, Tx
```
Atherosclerosis, Ca Depostion
Pt: Older male
Sx: Chest pain, CHF, Syncope
Dx: Systolic, crescendo-decrescendo; Base of the heart
Tx: Replacement
```
32
```
Mitral Insufficiency (Regurg)
Path, Dx, Tx
```
Sx: Acute-cardiogenic shock, Flash Pulmonar Edema
Chronic: CHF, A-Fib
Dx: Apex, Holosystolic, high pitched blowing
33
Maneuvers to increase venous return to the heart
Squatting/ Leg Lift
34
Maneuver to decrease venous return to the heart
Valsalva
35
HOCM Pathology
Asymmetric septum hypertrophy causing left ventricular outlet obstruction
36
HOCM patient, Dx, Tx
Young athlete with SOB, syncope with exertion, Family history of sudden cardiac death
Dx: systolic murmur (Sounds like AS), more blood improves the murmur
Tx: B-Blockers, avoid dehydration
37
Mitral Valve Prolapse
| Dx, Tx
Patient is usual a young woman
Dx: like mitral regurg, but improves with more blood
Tx: Avoid dehydration
B-Blockers
38
Causes of Restrictive Cardiomyopathy
Amyloidosis, Sarcoid, Hemochromatosis
39
Restrictive Cardiomyopathy presentation
Sx of diastolic heart failure
| perform Echo
40
Dx of Restrictive cardiomyopathy
Amyloid-Myocardial biopsy
Sarcoid- Endomyocardial biopsy
Hemo-Ferritin increased, genetic test
41
Treatment restrictive cardiomyopathy
Beta blockers are equal to CCB
Gentle Diuresis
Transplant
Treat underlying cause
42
Pericarditis Presentation
Viral, Uremia
| Pt: Pleuritic chest pain, and positional
43
Pericarditis Dx and Tx
Best MRI, First ECG ( Diffuse ST Elevations and Depressed PR segments)
Tx: NSAIDs and colchicine the best
44
Contraindications for NSAIDs Pericarditis treatment
CKD, Thrombocytopenia, PUD
45
Pericardial Effusion Path, Dx, Tx
caused by Pericarditis
Dx: Echo
Treat the pericarditis, if continues perform pericardial window
46
Cardiac Tamponade Presentation
CHF Sx
Becks Triad (JVD, Hypotension, Muffled Heart sounds)
Pulsus Paradoxus >10mmHg
Clear Lungs
47
Tamponade Treatment
Pericardiocentesis
| if cant reach OR quickly give IV fluids
48
Constrictive Pericarditis Path, Presentation, Dx, Tx
```
Due to chronic pericarditis
Sx: Diastolic CHF
Pericardial Knock
Dx: Echo
Tx: Pericardiectomy
```
49
Vasovagal Syncope Presentation, Tx
Situational and reproducible with a prodrome
Vasovagal organ stimulation, carotid body stimulation (micturation, defecation, coughing)
Tx: Beta blockers
50
Orthostatic Syncope Presentation, Tx
```
Standing up get dizzy
Dx: Systolic change 20
Diastolic change 10
HR change 15
Tx: Fluids
```
51
Orthostatic Syncope causes
Diarrhea, Dehydration, Diuresis, Hemorrhage
| Diabetes, Parkinsons, Age
52
Syncope caused by valvular lesions
exertional syncope (AS or HOCM)
Dx: Echo
TX; Depends on lesion
53
Syncope due to Arrhythmia
Sudden loss of consciousness without prodrome
| Tx: Depends on the arrhythmia
54
Syncope Due to Arrhythmia workup
ECG
24 hour Holter monitor
Event Recorder
55
Who should receive Statin Therapy
1. Anyone with Valvular disease
2. if LDL >190
3. if LDL is 70-189 aged 40-75 with diabetes
4. LDL 70-189 aged 40-75 with calculated 10 year risk for MI
56
What are the Statins used for therapy and dosages for high and moderate
```
High -
Atorvastatin 40, 80
Rosuvastatin 20, 40
Moderate-
Atorvastatin 20, 40
Rosuvastatin 10, 20
```
57
When should you use moderate statin therapy
age >75, statin intolerance, liver or renal disease
58
What tests should you run before statin therapy
HbA1c, CK, LFTs, Lipids
Recheck Lipids in one year
recheck HbA1c if patient has DM
59
If muscle soreness or weakness develop after starting statin therapy what should you do
perform CK and UA
LFTs if with hepatitis
discontinue Statin until symptoms resolve and then restart at lower dose
60
Hypertension treatment for Elevated Stage
<130/<80
| Lifestyle modifications and f/u in 6 months
61
Hypertension treatment for Stage 1
<140/<90
Lifestyle modifications f/u 3 months or
lifestyle modifications and 1 medication follow up in 1 month
62
Hypertension treatment for stage 2
>140/>90
| 2 medications follow up in 1 month
63
Hypertension treatment for patients with comorbid conditions
HF: Beta blockers, ACEi
Stroke: ACEi, HCTZ
CKD: ACE/ARB unless stage IV
DM: ACE
64
CCB Side Effects and uses
SE: Peripheral edema
| Antianginal DO NOT USE IN HF
65
ACEi/ARB Side effects
Increase creatinine and potassium
| Use ARBs for ACE angioedema
66
Thiazides Side Effects
Decrease potassium and calcium
| Can be used for kidney stones
67
Fast Narrow Arrhythmias
SVT, A-fib/flutter
68
Fast Wide Arrhythmias
V-tach, Torsades
69
Slow Wide Arrhythmias
3rd degree AV block, Idioventricular
70
Slow Narrow Arrhythmias
Sinus Brady, 1st and 2nd (type i and ii) heart block
71
SVT Tx
1. Adenosine-stable
| 2. shock
72
A-Fib/flutter Tx
1. Beta-blocker=CCB
| 2. Shock
73
V-tach Tx
Amiodarone
74
Torsades Tx
Magnesium
75
A-fib workup, stable, old, and cardiovert
1. Rate control, CCB= Beta blockers
2. old, >48 hr or unknown
3. TTE-valvular or non-valvular
4. Anti-coagulate for 3 weeks with warfarin
5. TEE and cardioversion
6. Anti-coagulate for 1 month
76
A-fib workup, unstable
Cardiovert, shock
77
when should you anti-coagulate in A-fib
if CHADSS score is greater than 2
78
CHADSS SCORE
```
CHF
HTN
Age >75
DM
Stroke
Stroke
0-none
1- ASA or anticoag
>2 anticoagulate
```
79
When there is a valvular lesion what changes for anticoagulation
bridge with LMWH if going for a procedure, give warfarin
80
if patient has a slow rhythm and is unstable what do you do
PACE
81
What rhythms can you give atropine
Sinus Brady, 1st degree AV block, 2nd degree type 1
82
What drugs are used for a pharmacologic stress test
Adenosine/dobutamine
