Cardiology Flashcards
symptoms of left-sided HF
- dyspnea, orthopnea, PND, nocturnal cough
- lower extremity edema
- cool extremities
signs of HF
- displaced PMI
- S3 gallop - best heard at apex with bell of stethoscope
Ken- tuck- Y - S4 best heard at left sternal border with bell of stethoscope
- atrial systole
TEN- nes - see - crackles/rales at lung bases
- increased intensity of S2
- peripheral HTN
Signs ands symptoms of right-sided HF
- peripheral pitting edema
- JVD
- ascites
- right ventricular heave
Right vs. Left-sided HF
Right-sided HF = peripheral edema AKA back up to body
Left-sided HF = back up to lungs
Dx of CHF
- CXR for cardiomegaly, pleural effusion
- echo - determine whether systolic or diastolic dysfunction + cause of CHF is due to pericardial, myocardial, or valvular process; estimates EF
EF <40% = HF - BNP levels - released from ventricles in response to ventricular volume/pressure overload
BNP >100 = decompensated CHF
Causes of CHF
- diet - sodium/fluid
- non-compliance with meds
- anemia
- uncontrolled HTN
- super-imposed illness
- new cardiac abnormality (MI, valve disorder, arrhythmia)
Tx of CHF
- restrict sodium intake
- diuretics
LOOP = most potent
HCTZ = moderately potent
Spironolactone - reduce hospitalizations for SEVERE cases of HF - ACEi - venous and arterial dilation, decrease preload + afterload
- ARBs - used in pts that cannot tolerate ACE due to cough
- B-blockers - decrease mortality in pts with post-MI HF, slow progression of HF (slows down tissue remodeling), given to STABLE pts with mild-moderate CHF
- ACE + diuretic = initial treatment *
When would you use digoxin?
Digoxin = positive inotropic agent
- reserved for pts resistant to ACEi + diuretic Tx
- useful if EF <30%, severe CHF, or severe AFib
- monitor levels to avoid toxicity (GI, anorexia, ectopic beats, AV block, AFib, visual disturbances, disorientation)
Beta-blockers
long term use of BB = improved LVEF and survival
__________ has been shown to have superior survival rates
carvedilol (alpha/beta)
Which patients are considered for anticoagulation therapy?
Patients with an EF <20%
5 Major Risk Factors for CAD
- Smoking
- Prior CAD
- Diabetes
- First degree relative before age 50 with a significant myocardial event
- Dyslipidemia
What is an absolute contraindication of the Bruce Protocol?
ACS or angina in the last 48 hrs, high grade AV block, high grade aortic stenosis, systolic BP >200, arrhythmias
What is the purpose of a thallium stress test?
Checks for ischemia
- want to see the donut where the walls are equidistant
- smaller wall = ischemic area
When would you want to do a dobutamine stress test?
People who have bronchospasm
Dobutamine is a positive inotrope - it only acts on the heart and does not interfere with the lungs
