Cardiology Flashcards
(75 cards)
1
Q
CK-MB timeline
A
present: 4-6hrs
peak: 12-24hrs
gone: 3-4 days
predict re-infarction
2
Q
CK-MB 1 vs 2
A
CK-MB 1: plasma
CK-MB 2: myocardial tissue (more specific)
3
Q
causes for elevated troponin
A
myocardial injury
renal disease
polymyositis/dermatomyositis
4
Q
aortic dissection, next test
A
CXR
confirmed by: TEE > CTA > MRA
5
Q
PE signs on EKG
A
S1 Q3 T3
lead 1 shows S wave
lead 3 shows Q wave
lead 3 shows inverted T wave
6
Q
confirm diagnosis PE
A
spiral CT
lung scan
pulmonary angiogram
7
Q
symptoms of pericarditis
A
sharp, positional, pleuritic
relieved by leaning forward
pericardial rub
8
Q
EKG signs pericarditis
A
diffuse ST elevation
NO elevation Q waves and CK levels normal
responds to NSAIDS
9
Q
Posterior: leads and artery involved
A
V1, V2: tall broad initial R wave ST depression Tall upright T wave usually occurs in a/w inferior or lateral MI artery: Posterior Descending
10
Q
anteroseptal infarction: leads and artery involved
A
V1, V2, V3
LAD
11
Q
anterior infarction: leads and artery involved
A
V2, V3, V4
LAD
12
Q
lateral infarction: leads and artery involved
A
I, aVL, V4, V5, V6
LAD or circumflex
13
Q
STEMI EKG
T wave inversion: onset, disappearance
A
onset: 6-24hrs
disappearance: months to years
14
Q
criteria for a positive stress test
A
> 2mm ST depression OR
>10mmHg decrease in systolic BP
15
Q
STEMI EKG
Q waves longer than 0.04sec: onset, disappearance
A
onset: one to several days
disappearance: years to never
16
Q
criteria for a positive stress test
A
> 2mm ST depression OR
>10mmHg decrease in systolic BP
17
Q
indications for CABG
A
- L main coronary dx
- 3 vessel dx and LV dysfunction
- 2 vessel dx with DM
- symptoms despite medical therapy or SE from therapy
18
Q
indications for PCI
A
-1 or 2 vessel disease
19
Q
what interventions lower mortality?
A
ASA BB Clopidogrel TPA Statins if LDL >100 angioplasty
20
Q
treatment for third degree HB
A
symptomatic = atropine asymptomatic = pacemaker
21
Q
treatment for first degree HB
A
nada
1st deg HB = PR > 0.12-0.20
22
Q
treatment for V-tach
A
stable = amniodarone, lidocaine unstable = shock
23
Q
treatment for V-fib
A
shock always
24
Q
Mitral Stenosis: who, long-term effects
A
MC 2/2 Rheumatic Fever (immigrants) Rarely genetic 2/3 Female (pregnant) Large LA --> A-fib --> strokes Large LA --> hoarseness, dysphagia
25
describe mitral stenosis murmur
opening snap following S2
| diastolic rumble
26
MR diagnosis: EKG, CXR, ECHO
EKG: LVH, LAE
CXR: Cardiac enlargement, vascular congestion
ECHO: LA and/or LV dilation
27
MR treatment medical/surgical
Medical: vasodilator, digitalis, diuretic, anticoag
Surgical: replace valve is still symptomatic with medical therapy
28
MVP: who gets it
MC congenital valvular lesion
| MC females, connective tissue disease
29
MVP murmur:
describe?
heard best?
Worse/better?
mid-to-late systolic click, late systolic murmur, heard best at apex
worse w/ valsalva (decreased preload, less blood more murmur)
better with squatting (increased afterload, more blood less murmur)
30
MVP: complications
serious arrhythmia and sudden death
31
SVT arrhythmias
Adenosine
BB
CCB: diltazem, verapamil
Digitalis
32
Multifocal Atrial Tachycardia: describe EKG findings
P wave morphology and PR interval varies from beat to beat (at least 3 to be diagnostic)
irregular supraventricular rhythm 100-200 bpm
each QRS is preceded by a p-wave
33
Multifocal Atrial Tachycardia: treatment
digoxin
| CCB
34
Multifocal Atrial Tachycardia: cause?
COPD
| elderly with respiratory failure
35
atrial flutter: formation
p-waves always look the same
| multiple P waves before QRS
36
atrial flutter: treatment
BB
CCB: diltazem, verapamil
Digitalis
37
when do you use adenosine
ONLY with SVT
38
A fib: treatment
- anti-coagulate! INR 2-3
- symptomatic/unstable (rhythm control)= shock
- asymptomatic/stable (rate control)= BB, CCB (verapamil, diltiazem), digoxin, pulse
39
WPW: treatment
acute:
- unstable: shock
- stable: procainamide
chronic:
- ablation
40
V-tach: definition
- 3+ consecutive ventricular beats at >120bpm
| - wide, bizarre QRS complexes
41
V-tach: etiology
- ischemia, post-MI
- cardiomyopathies
- metabolic (hyperkalemia)
42
CHA2DS2-VASc Score
```
CHF +1
HTN 140/90 +1
Age 75+ +2
DM +1
Stroke/TIA/thromboembolism +2
Vascular disease: MI, PAD, aortic plaque +1
Age 65-74 +1
Sex: female +1
```
coagulation if
>1 males
>2 females
43
Secondary causes of HTN
- Renal parenchymal disease
- Renovascular disease
- Primary aldosteronism
- Pheochromocytoma
- Cushing's syndrome
- Hypothyroid
- Primary hyperparathyroidism
- Coarctation of the aorta
44
Initial workup for HTN
- UA
- Chemistry panel
- Lipid panel
- Baseline EKG
45
Request further workup for HTN if
- Severe or malignant HTN
- Need 3+ drugs
- sudden rise in BP
- started before 30yo w/o h/o HTN
46
PVC: cause, definition, treatment
cause: normal people, MC following MI
definition: wide QRS (>120msec), bizarre morphology, compensatory pause
symptomatic Rx: BB
asymptomatic Rx: observation, treatment with arrhythmic may worsen survival
47
indications for urgent dialysis
AEIOU
A = metabolic acidosis 6.5, EKG abn
I = ingestion: methanol, ethylene glycol, salicylate, lithium, sodium valproate, carbamazepine
O = volume overload s/p diuretics
U = uremia, symptomatic: encephalopathy, pericarditis, bleeding
48
Thiazide S/E
```
HyperGLUC
Glycemia
Lipidemia
Uric Acid
Calcium
```
electrolyte abn = low Na, low K, high Ca
49
hypertrophic cardiomyopathy: EKG findings
aVL: tall R
V3: deep S
inverted T/repolarization changes in: I, aVL, V4-V6
50
hypertrophic cardiomyopathy: murmur
- Harsh crescendo-decrescendo systolic murmur heard best at the apex and lower left sternal border
- increases with less preload: valsalva, standing
- louder with more preload: passive leg raise
- louder with more afterload: handgrip, squatting
51
hypertrophic cardiomyopathy: mutation, cause of outflow obstruction
cardiac myosin binding C gene
cardiac beta-myosin heavy chain gene
hypertrophied interventricular septum
abnormal motion of mitral valve leaflets = systolic anterior motion (SAM)
52
when do you do carotid endarterecomy (CEA)?
Men
asym: 60+%
sym: 70+% (face-neuro symp w/i 6mo)
Women
both asym/sym: 70+% stenosis
53
PAC: treatment
asym: stop tobacco and alcohol
sym: Beta blocker
54
pulsus paradoxus: definition, when do you see it
Cardiac Tamponade
COPD
Asthma
drop in systolic BP >10mmHg during inspiration.
Cardiac tamponade --> increased pressure in pericardium --> RV and LV compete for space --> on inspiration RV fills and shifts LV over making it smaller --> less SV --> decreased BP on inspiration of >10
55
Beck's triad
hypotension
distended neck veins
muffled heart sounds
cardiac tamponade
56
RF for CAD
- worst?
- MC?
- correcting which RF has the most immediate benefit?
- DM (worst RF)
- smoking (most immediate benefit for stopping)
- HTN (MC RF)
- HLD: LDL is the most dangerous
- FH premature CAD: M45, F>55
57
what S/S exclude cardiac ischema as a D/D?
positional
pleuritic
tender
58
When do you do a ETT?
chest pain, unknown etiology
| EKG not diagnostic
59
ETT, pt can't exercise?
- Dipyradamole/adenosine + Thalium/sestambi
- Dobutamine + ECHO
specificity/sensitivity equal for
dipyradamole thallium = dobutamine echo
60
ETT, pt has EKG baseline abn
Exercise with...
- Nuclear isotope: thallium or sestambi
- ECHO
specificity/sensitivity equal for
Exercise thallium = exercise ECHO
61
when can you NOT use dipyradamole for ETT?
can't use with asthma
62
Treatment for lower mortality for chronic angina
ASA
BB (B1 specific)
Nitroglycerin
63
Nitroglycerin treatments for acute vs. chronic angina
Chronic: oral, transdermal
Acute: sublingual, paste, IV
64
Antiplatelet therapy for ACS patient
1) ASA
2) P2Y12 receptor: clopidogrel, prasugrel, ticagrelor
-NOTE: when angioplasty and stenting are planned DO NOT USE Clopidogrel
65
When to use Clopidogrel
- Combo with ASA for ACS
- ASA intolerence like an allergy
- Recent angioplasty with stenting
66
Prasugrel: when to use and not use
use: antiplatelet med, before angio/stenting
| don't: can cause hemorrhagic stroke in 75yo+
67
Ticlopidine: when to use and not use
use: anti-platelet Rx in rare pt where both ASA and clopidogrel not indicated
can't use if ASA and clopidogrel are not indicated because of bleeding. Ticlopidine will inhibit platelets too
S/E: neutropenia, TTP
68
ACE/ARB:
when to use them
when do you switch to diff class?
- low EF% in systolic dysfunction
- Regurgitant valvular disease
-switch to hydralazine + nitrates if cough, elevation in K+
69
what's the MC adverse effect of statin meds?
```
Liver dysfunction (1% have elevated transaminases)
must get LFTs at start and during treatment
```
other S/E: myositis, rhabdomyolysis
70
Niacin: effect and S/E
raise HDL
| S/E: elevate glucose and UA, pruritus
71
Gemfibrozil: effect and S/E
lower TG
| S/E: myositis when combined with statin
72
Cholestyramine: effect and S/E
binds bile acid
| S/E: flatus and abd cramping
73
Ezetimbe: effect and S/E
lowers LDL, no evidence of benefit to pt
| S/E: well tolerated and nearly useless
74
Use CCB verapamil/diltiazem in CAD only in pts with:
- Severe asthma preventing use of BB
- Prinzmetal variant angina
- Cocaine-induced chest pain (can't use BB)
- Can't control pain with max medical therapy
NOTE: verapamil/diltiazem are CCB which do NOT increase HR
75
CCB: adverse effects
- Edema
- Constipation (MC verapamil)
- Heart block (rare)
