Cardiology #3 Flashcards
(50 cards)
Mitral Valve Prolapse Murmur
Mid-late systolic ejection click best heard at apex.
- Standing and Valsalva make click earlier
- Squatting and supine make click delayed
Mitral Regurgitation Murmur
Blowing holosystolic murmur heard at apex with radiation to axilla
MCC of mitral regurgitation in the US
Mitral Valve Prolapse
What are some common complications of cardiac catheterization?
- Hematoma/Retroperitoneal Bleeding
- AV Fistula
- Dissection
- Myocardial Infarction
- Infection
- Allergic Reaction to Contrast Dye
Treatment for anterior and lateral wall MI
- MONA
- Heparin, BB, Clopidogrel
Treatment for Inferior or Posterior Wall MI
- Aspirin/Heparin, IVF, Oxygen, Clopidogrel
- Avoid Nitroglycerin and Morphine in these types
What is Dressler Syndrome?
-Post-MI Pericarditis
MCC of Heart Failure
CAD
Mechanism of action of Ace Inhibitors
- Decreased preload, decreased afterload, decreased aldosterone production
- Decreases ventricular remodeling
What do all Ace Inhibitors end with?
- Pril
- Lisinopril, Captopril, Enalapril, Quinapril
Ace inhibitors are first-line therapy for heart failure. (Most effective singular medication for mortality benefit.) What are the common adverse effects of Ace Inhibitors?
- Hyperkalemia
- Angioedema
- Cough
HAC
True or False: Ace Inhibitors are not safe in pregnancy?
True
They should be avoided in pregnancy, hypotension, renal insufficiency, and bilateral renal artery stenosis.
What medications should be used first in African Americans with hypertension?
-Hydralazine + Nitrates
Diuretics and CCB
Regarding lipid medications:
- Best meds to lower elevated LDL levels: ______
- Best meds to lower elevated triglycerides: _____
- Best meds to increase HDL: ______
- With type II DM: ______, ______
Statins
Fibrates
Niacin
Statins, Fibrates
What are five times a statin should be started?
1) Patients with DM between 40-75
2) People > 21 with LDL > 190
3) Any patient with any form of atherosclerotic CVD
4) Patients < 19 with familial hypercholesterolemia
5) Patients 40-75 with no CVD but 7.5% risk for stroke within 10 years
Mechanism of action of statins
-Inhibit the rate-limiting step in hepatic cholesterol synthesis via inhibition of enzyme HMG-CoA reductase
Adverse effects of statins
- Muscle damage (myalgias, rhabdomyolysis)
- Increased liver function tests
- Hepatitis (MC)
- GI symptoms
- Diabetes mellitus
Side effects of Niacin
- Flushing, warm sensation, pruritus (give NSAIDs or Aspirin beforehand)
- Hyperglycemia (take with meals)
What are 4 cardiac conditions that are indications for endocarditis prophylaxis?
- Prosthetic heart valves
- Heart repairs using prosthetic material (not including stents)
- Prior history of endocarditis
- Congenital heart disease
What is given as prophylaxis for dental or respiratory procedures against endocarditis?
- Amoxicillin 2g 30-60 min before procedure
- Clindamycin 600 mg if PCN allergy
What is the treatment for Dressler Syndrome?
Aspirin or Colchicine
Amyl Nitrate ________ and, therefore, murmurs like AR and MR are decreased with amyl nitrate
Decreases afterload
Describe the murmur for Aortic Regurgitation
Diastolic blowing decrescendo murmur best heard at the LUSB
Unique symptoms/signs of widened pulse pressure in AR/AI
- Water Hammer Pulse: swift upstroke and rapid fall of radial pulse accentuated with wrist elevation
- Hill’s Sign: Popliteal artery systolic pressure > brachial artery by 60 mmHg (MOST SENSITIVE)
- De Mussett’s Sign: Head bobbing with each heartbeat
- Quincke’s Pulse: Visible fingernail bed pulsations with light compression of fingernail bed
