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PANCE > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

Modifiable Risk Factors of Ischemic Heart Disease

A 
Dyslipidemia 
Smoking (2x the risk)
HTN
Obesity
DM
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2
Q

Uncontrollable Risk Factors of Ischemic Heart Disease

A

Age (W>65, M>55)
Males greater risk than females
Family History

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3
Q

MI Clinical Features

A 
Chest pain (retrosternal, may radiate to arm, neck or jaw, crushing, constricting)
Prolonged (>20 mins to hours)
N/V
Weakness, Dizziness, Palpitations
Cold Sweat, impending doom
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4
Q

MI Physical Exam

A

No real findings typically

May have elevated BP, JVD, presence of S4, displaced PMI

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5
Q

MI Ddx

A

Pericarditis, PE, aortic dissection, costochondritis, esophageal rupture

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6
Q

MI Diagnostic Factors

A

Labs: leukocytosis
Echo: wall motion abnormalities

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7
Q

Cardiac Markers: CK

A

appears 3-6 hrs, lasts 2-4 days, peaks at 24 hrs

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8
Q

Cardiac Markers: Troponin

A

appears 2-4 hrs, lasts 5-12 days, peaks at 10-24 hrs

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9
Q

Cardiac Markers: Myoglobin

A

appears 1-2 hrs, lasts

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10
Q

MI EKG Findings

A

ST elevation (transmural) and Q waves, ST depression (subendocardial)

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11
Q

Inferior Wall

A

II, III, aVF - RCA

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12
Q

Lateral Wall

A

I, aVL, V5, V6- Circumflex

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13
Q

Anterior Wall

A

V2-V4, I, aVL-LCA

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14
Q

Posterior Wall

A

V1, V2 (ST dep) - RCA, Circumflex

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15
Q

MI Treatment

A 
MONA-Hep-B
Morphine
Oxygen
Nitrates
Aspirin
Heparin
Beta-Blockers
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16
Q

MI Treatment: Antiplatelet Tx

A

Aspirin, Clopidogrel, thienopyridine, abciximab (glycoprotein inhibitors)

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17
Q

MI Treatment: ACEi

A

Cardioprotective, start in all patients with AMI, continue if LVH, or HF develops

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18
Q

MI Treatment: Heparin (indications)

A

Antithrombin Tx: inactivates thrombin and factor X

Indications: those not receiving thrombolytics, those with ST depression, those getting TPA

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19
Q

MI Treatment: Recanalization

A

PCI
PCTA
Fibrinolytics: need within 12 hrs (streptokinase)

20
Q

ABSOLUTE Contraindications for Thrombolysis

A

active internal bleeding
recent head trauma or known intracranial neoplasm
Hx of hemorrhagic CVA
major surgery/trauma

21
Q

Stable Angina Pectoris

A

Chest pain (lasts 5-15 mins, builds up rapidly)
worse with activity, relieved by rest
PE: normal or S4
Labs: cardiac enzymes negative
EKG: may show ST depression and T waves during pain
Dx: positive stress test
Tx: anti-platelets, BB, ACEi, revascularization with PTCA, CABG

22
Q

Unstable Angina Pectoris

A 
Chest pain not relieved by rest
S/S: DOE, palpitations, fatigue, SOB, diaphoresis
PE: normal or S4
Labs: cardiac enzymes normal
EKG: non-specific changes
Tx: ASA, BB, ACEi, revascularization
23
Q

Acute Pericarditis

A

Chest pain (better with leaning forward), pericardial friction rub
Viral pericarditis: Coxsackie B virus is MCC
EKG: diffuse ST elevations with upright T waves
Tx: NSAIDs, ASA for pain, steroids if not better, usually self-limiting

24
Q

Cardiac Tamponade Definition

A

Fluid builds up in pericardial sac, unable to fill cardiac chambers in diastoles leads to reduction of stroke volume and cardiac output which leads to hypotension which leads to shock and death.

25
Q

Cardiac Tamponade

A

S/S: DOE, orthopnea, JVD, hypotension, muffled heart sounds, pulsus paradoxus
Dx: Echo: RA and ventricular collapse during diastole
Tx: drain fluid, tx pericarditis, pericardiotomy or windowplacement possible

26
Q

Pericardial Effusion

A

Large effusions can show signs of cardiac tamponade, small effusions can by asymptomatic
S/S: diminished heart sounds, poss friction rub
Dx: CXR, EKG, echo
Tx: pericardiocentesis, maintain BP

27
Q

Heart Failure

A

Inability of heart to pump sufficient blood to meet metabolic demands

28
Q

MC Cause of CHF

A

CAD

29
Q

R-Sided Heart Failure Causes

A

L-sided HF (90%), Pulmonary disease

THINK SYSTEMIC SX! JVD, edema, ascites

30
Q

L-Sided Heart Failure Causes

A

MCC is HTN and CAD

THINK PULMONARY SX! dyspnea, orthopnea, rales

31
Q

S/S of L-Sided HF

A

THINK PULMONARY SX! dyspnea, orthopnea, rales
MC sx is Dyspnea (orthopnea, paroxysmal nocturnal dyspnea)
rales, rhonchichronic nonproductive cough w/ pink frothy sputum
PE: HTN, cheyne stokes breathing, tachycardia, cool extremities

32
Q

S/S of R-Sided HF

A 
THINK SYSTEMIC SX! JVD, edema, ascites
Systemic fluid retention
peripheral edema
JVD
GI/hepatic congestion
33
Q

Dx of HF

A

Best test-Echo (decreased EF, systolic-thin wall or diastolic-thick wall dysfunction
CXR-Kerley B Lines, cardiomegaliy, pleural effusions
BNP >100 means CHF is likely

34
Q

Long Term Management of Heart Failure

A

Unless CI, all pts should be on an ACEi and Diuretic

Na restriction-

35
Q

Acute Pericarditis

A

acute inflammation of the pericardium
MCC is viral (esp enteroviruses like coxsackie and echovirus)
Dresslers syndrome
autoimmune, idiopatic, systemic

36
Q

Acute Pericarditis S/S

A

pleuritic chest pain (sharp & worse with inspiration)
Postural CP-relieved by leaning forward and worse lying down
Pericardial Friction rub-best heard at end of expiration

37
Q

P’s of Pericarditis

A

Persistent
Pleuritic
Postural
Pericardial Friction Rub

38
Q

Dx of Pericarditis

A

EKG: diffuse ST elevation in precordial leads, associated PR depressions in those leads
Echo: check for effusion or tamponade

39
Q

Tx of Pericarditis

A

1st Line-Aspirin or NSAIDs x 7-14 days
2nd Line-Colchicine
Add corticosteroids if not responding to other management or sx>48 hrs

40
Q

Tx of Dressler’s Syndrome

A

Aspirin or Colchicine

41
Q

Pericardial Effusion (sx,dx,tx)

A

increased fluid in pericardial space
pericarditis is a common cause
s/s: distant heart sounds
Dx: echo shows increased pericardial fluid
CXR: cardiomegaly
EKG: low voltage QRS complexes, electric alterans (cyclic beat shift in QRS b/c heart is swinging in fluid)
Tx: small effusion-tx underlying cause, pericardiocentesis if tamponade or large effusion

42
Q

Beck’s Triad

A

Muffled Heart Sounds
Hypotension
Increased JVP

43
Q

Pericardial (cardiac) tamponade

A

pericardial effusion causes lo of pressure on the heart causing restriction of cardiac ventricular filling which leads to dec. cardiac output
-small rapidly evolving effusions are more dangerous than chronic ones

44
Q

Pericardial (cardiac) tamponade (s/s, dx, tx)

A 
S/S: becks triad (hypotension, muffled heart sounds, inc. JVP)
pulsus paradoxus (a decreases in systolic BP >10mmHg)

Dx: echo-effusion and diastolic collapse of cardiac chambers

Tx: pericardiocentesis, add pericardial window if recurrent

45
Q

Constrictive Pericarditis

A

thickened fibrotic calcified pericardium
S/S: MC is dyspnea
r-sided heart failure sx-JVD, edema, NV
Kussmauls Sign- Increased JVD during inspiration
Pericardial knock- high pitched 3rd heart sound

Dx: echo-pericardial thickening
CXR- pericardial calcification

Tx: pericardiotomy definitive, diuretics for sx

46
Q

What is Pericardial Knock

A

high pitched 3rd heart sound because of sudden cessation of ventricular filling in early diastole from thickened inelastic pericardium (mistaken for S3 often)

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