- Aspirin, BB, Nitro, Statin - Revascularization is definitive

- ECG within 10 minutes - Door to thrombolytics within 30 minutes - Door to PCI within 90 minutes - MONA

Cardiology #2 Flashcards by Tyler Cichowski

Diagnostics for CAD

-ECG, Stress Testing, Coronary Angiography (gold)

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Treatment for CAD

Aspirin, BB, Nitro, Statin

- Revascularization is definitive

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Regarding revascularization, what are the two options?

(1 or 2 vessels): percutaneous transluminal coronary angioplasty
(left main coronary artery or 3 vessels or if the patient is diabetic): coronary artery bypass graft

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Acute Coronary Syndrome is chest pain not relieved by rest of Nitro and lasts longer than 30 minutes. What three people have silent MI?

Diabetes, pregnancy, elderly

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Treatment for ACS

ECG within 10 minutes
Door to thrombolytics within 30 minutes
Door to PCI within 90 minutes
MONA

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If cocaine induced ACS, what medications should be avoided?

BB due to vasospasm

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What is Prinzmetal Angina?

-Chest pain at rest (MC at midnight and early morning), not exertion. Transient ST elevations that resolve with CCB.

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If a patient has gout, what medication should be used for hypertension?

CCB

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If a patient is african american, what medications should be used for hypertension?

-Thiazides, CCB

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If a patient has A-fib, what medications should be used for hypertension?

BB, CCB

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Three Beta-1 selective drugs reduce mortality from HF. Name them.

Bisoprolol, Carvedilol, Metoprolol Succinate

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Systolic vs Diastolic Heart Failure Symptoms

Systolic: S3 gallop, low EF
Diastolic: S4 gallop, preserved EF

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What is a hypertensive Urgency and what is the treatment of choice?

> 180 and/or > 120 with no end-organ damage

-Clonidine

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What is the rate of MAP reduction in a hypertensive urgency?

25% over 24-48 hours with oral medications

Treatment goal is < 160/100 mm Hg

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What is a Hypertensive emergency and what is the treatment of choice?

> 180 and/or > 120 with end-organ damage

-IV Sodium Nitroprusside +/- BB (Esmolol, Labetolol)

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What is the rate of reduction of MAP in a hypertensive emergency?

10-20% over the first hour, then 5-15% over next 23 hours

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What is postural (orthostatic) hypotension and what is the treatment of choice?

> 20 mmHg and/or > 10 diastolic when standing

Fludricortisone

-Midodrine or Droxidopa if no response to Fludricortisone

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Preventative maintenance of orthostatic hypotension

Increase salt and fluid intake
Gradual position changes
Compression stockings
Caffeine may be helpful
Discontinue offending medications

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What ABG is present in shock and why

Metabolic acidosis due to cells producing lactic acid as a product instead

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Hypovolemic shock symptoms and treatment

Pale cool skin, slow capillary refill, low skin turgor, dry mucous membranes, hypotension
Insert 2 large bore IV lines –> Crystalloid solution fluid

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Treatment for cardiogenic shock

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Small amounts of IVF, Dobutamine/Epinephrine

What valves are MC affected in Endocarditis

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Mitral

- Tricuspid if IVDU

Organisms for Endocarditis

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S. Aureus with normal valves and IVDU
S. Epidermidis with prosthetic valves
S. Viridans with abnormal valves

Symptoms of Endocarditis

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MRS FOJS

New onset Murmur
Roth Spots
Splenomegaly
Fever
Osler Nodes
Janeway Lesions
Splinter Hemorrhages

Duke Criteria for Endocarditis (MAJOR AND MINOR). Need 2 Major or 1 Major and 3 Minor.

MAJOR: 2 positive blood cultures, Echo showing positive vegetation or new valvular regurgitation. MINOR: Fever, Predisposing condition (IVDA, abnormal valves), Immunologic phenomena (Osler, Roth, RF), Vascular Phenomena (Janeway)

What other diagnostics do you need for endocarditis?

- 3 blood cultures 1 hour apart | - TEE more sensitive than TTE

Treatment for Endocarditis

- Native valve: Nafcillin/Oxacillin + Ceftriaxone/Gentamicin - Abnormal Valve: Vanco + Gent + Rifampin Treatment is for 4-6 weeks

Causes of Pericarditis

- Idiopathic | - Viral (Coxsackievirus and Echovirus)

Symptoms of Pericarditis (4P)

-Positional (worse with supine), Pericardial Friction Rub, Pleuritic, Persistent

Diagnostics for Pericarditis

-ECG: Diffuse ST elevations in V1-V6 with PR depressions

Treatment for Pericarditis

NSAID or Aspirin

What is the diagnostic of choice for pericardial effusion

Echo CXR: water bottle heart -ECG: electrical alternans, low QRS voltage

Treatment for pericardial effusion

Pericardiocentesis if large

What are the symptoms of cardiac tamponade

Beck's Triad: hypotension, JVD, muffled heart sounds

Echo of cardiac tamponade show

-Pericardial effusion + diastolic collapse of cardiac chambers

Treatment for cardiac tamponade

Pericardiocentesis to remove pressure

Aortic Stenosis Murmur

Systolic crescendo-decrescendo murmur heard at RUSB radiating to carotid artery

Treatment for aortic stenosis

Aortic valve replacement

Aortic Regurgitation Murmur

Diastolic blowing decrescendo murmur best heard at LUSB, high-pitched

Treatment for Aortic Regurgitation

Treatment: afterload reduction (ACE, ARB, Hydralazine) | -Surgical therapy is definitive

Mitral Stenosis Murmur

Low-pitched, mid-diastolic rumbling murmur heard at apex with prominent S1 and opening snap

MCC of mitral stenosis

Rheumatic Heart Disease

Treatment for mitral stenosis

percutaneous balloon valvuloplasty

Mitral Regurgitation

Blowing holosystolic murmur at apex with radiation to axilla - Echo and catheter - Treatment: ACE, ARB, surgical repair

MVP

Mid-late systolic ejection click best heard at apex - Panic attacks, atypical chest pain, palpitations - Reassurance and BB for treatment

Pulmonic Stenosis

Murmur increases with inspiration - Harsh mid-systolic ejection crescendo-decrescendo murmur radiates to neck - Balloon valvuloplasty

Pulmonic Regurgitation

Graham-Steell murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration -No treatment needed

AAA

Smoking is the main modifiable risk factor, age > 60, Caucasians, males - Abdominal flank or back pain, flank ecchymosis if symptomatic - CT scan with IV contrast is best initial test - Abdominal US for asymptomatic patients to monitor progression - Treatment: Immediate surgical repair if > 5.5 cm or 0.5 cm expansion in 6 months - Screening: Abdominal US in men 65-75 years old who have ever smoked

Aortic Dissection

CT angiogram used first - Unequal blood pressure in both arms - Treatment - Ascending: Surgical - Descending: BB (Labetolol) with Sodium Nitroprusside

DVT

Virchow’s Triad - Anticoagulation is first-line treatment - IVC filter for recurrent, or if anticoagulation is contraindicated (pregnancy, malignancy)

Chronic Venous Insufficiency

leg pain worsened with prolonged standing - leg pain improved with ambulation and leg elevation - Statis dermatitis (browning and purplish color of skin), medial malleolus MC location, depending pitting leg edema - Treatment: leg elevation, compression, exercise

Cardiology #2 Flashcards

(51 cards)