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Flashcards in Cardiology Deck (50):
1

Stable Angina

Chest discomfort due to myocardial ischemia. Occurs with exacerbation, relieved by rest.

2

What determines myocardial demand for O2?

HR, SBP, contractility, LV wall stress

3

Why does subendocardium get ischemic during tachycardia?

Because it receives its blood during diastole, so when tachycardia occurs, diastole preferentially shortens

4

Most common cause of stable angina

Vasospasm, AS, HOCM, HTN

5

How to treat asymptomatic patients with moderate framingham risk?

Daily aspirin

6

Is it recommended to treat women with hormone replacement to prevent heart disease?

No

7

Is it recommended to test homocysteine?

No

8

How to screen for CAD?

Dont do it.

9

How to determine typical vs atypical vs nonanginal cp?

Retrosternal
Relieved by rest/nitro
Exacerbated by activity or stress

1 is nonanginal
2 is atypical
3 is typical

10

How to use stress testing to diagnose angina?

Patients with low probability don't require stress test, patients with high probability should be started immediately on medical management. Patients with intermediate pretest probability should receive stress test.

11

How to choose a stress test?

Patients with baseline changes in EKG shouldn't get EKG stress, patient's who can't exercise need chemical stress.

Dipyridamole for nuclear perfusion, dobutamine for echo

12

Contraindications for EKG exercise stress

LBBB, ST depressions, WPW, LVH or on digoxin

13

Contraindications for echo

LVOT obstruction
Wall motion abnormalities
Obese

14

Contraindications for nuc perfusion

Asthma
hypotension
conduction disease

15

Goal of exercise or chemical stress

To achieve 80% of max heart rate.

16

Coronary angiography

Goal standard for patients at high risk or abnormal stress tests. Though patients with abnormal stress tests can be managed medically.

17

Therapy for chronic stable angina

1) lifestyle modifications
2) Antianginal meds + vascular protective meds

18

Initial medication regimen for chronic stable angina

Beta blocker, aspirin, long acting nitrate, statin (high intensity for >75, moderate intensity for

19

How to manage chronic stable angina if symptoms persist on first pass?

Increase B blocker dose, increase nitrate dose, add CCB.

20

How to manage chronic stable angina if symptoms persist on second pass?

consider ranolazine, refer for angio

21

Should antiplatelet agents besides aspirin be used in chronic stable angina?

No, only if contraindication to aspirin

22

Is PCI effective in chronic stable angina?

Not effective in reducing mortality, but effective in controlling symptoms and increasing quality of life.

23

How to follow up patients with stable angina?

Repeat EKG's not recommended if there hasn't been a change in symptoms or meds.
Repeat stress test contraindicated unless there is a change in symptoms

24

How to work up a patient with anginal chest pain

Get an ekg, if positive, stemi, then cath or TPA
If negative, then get biomarkers, if those are positive, then NSTEMI, cath if TIMI 3-7. If negative then eventually get a stress test.

If biomarkers are negative, then UA. Geta stress test eventually.

25

How to treat ACS patients

MONA BASH
Morphine
O2
Nitro
Aspirin + clop

Beta blocker
Acei
Statin
Heparin

26

Sinus arrest

2 or more seconds of pause on EKG

27

Sick sinus syndrome

AKA brady tachy. SA nodal disease where bradycardia or pauses are followed by SVT or Afib

28

Indications for pacing

Symptomatic bradycardia (5sec
Alternating bundle branch blocks

29

How to treat AV blocks with bradycardia?

Atropine

30

First degree heart block

PR>200ms. Usually asymptomatic but associated with heart failure and death.

31

Second Degree heart blocks

Mobitz I - wenchybach

Mobitz II - Dropped beats without Pr elongation, defect is within ventricular conduction system
Pace

32

Third degree heart block

Complete P and Q dissociation. QRS can be wide or narrow. Pace.

33

SV arrhythmias

Can be regular (SVT) or irregular (Afib/aflutter/mat)

34

SVT

Patient has palps, syncope, dyspnea, fatigue
HR usually >150, no P or T waves.
Tx: adenosine or shock

35

Afib

No p waves
If unstable: shock
If stable: rhythm control = rate control
For rhythm: if Afib for cardiovert
If afib >48 hours, TTE ->TEE, cardiovert if no LA thrombus

36

Torsades

Wide complex, give mag

37

Vtach

Wide complex, treat with shock or amio

38

How to work up heart failure

EKG, Echo, BNP, LH cath if new and acute

39

How to treat CHF (everybody)

H2O

40

How to treat NYHA class III or IV

Add spironolactone, add furosemide, add ISDN or hydralazine

41

How to treat CHF if EF

Defibrillator placement

42

How to treat CHF if in ICU?

Dobutamine

43

How to work up CHF exacerbation

Get EKG, Echo, BNP, Trop
If stemi, LH cath +MONABASH
If negative, not CHF
If positive, its a true exacerbation and treat with LMNOP
Lasix, morphine, O2, Nitro, Position

44

How to conduct ACLS if patient has a pulse?

Arrhythmia (everything but sinus tach or NSR)? Symptomatic? No? Give IVF, O2 and Tele. If symptomatic, check if stable. If SBP>90 and no AMS or CP, then stable. Give drugs: Amiodarone for wide and fast, adenosine for narrow and fast, atropine for slow.
If not stable, then shock or pace.

45

Diastolic murmurs

Mitral stenosis, aortic regurgitation

46

Mitral stenosis (Path, sxs, murmur, tx)

Path: Rheumatic heart disease
Sxs: CHF, Afib
Murmur: Diastolic rumble with opening snap
Tx: Balloon valvuloplasty, then replace

47

Aortic regurgitation

Path: Infection, infarction, aortic dissection.
Acute presentation: Cardiogenic shock, flash pulm
Chronic: CHF, Chest pain
Murmur: Diastolic at base
Tx: Acute: Emergent replacement
Chronic: Urgent replacement

48

Systolic murmurs

Mitral insufficiency, aortic stenosis

49

How to treat carotid stenosis if asymptomatic?

Surgery or stent if stenosis >70%

50

How to treat carotid stenosis?

Surgery or stent if stenosis >50%