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Cardiology Flashcards

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1
Q

Tx CAD

A
  • Always: ASA, statin, beta-blocker, ACE-i
  • Nitrate: if continued chest pain
    • CONT if R-sided infarct (leads II, III, avF)
  • Clopidogrel: if stented
    • x 1 mo for bare metal
    • x 1 yr for drug-eluting (best)
  • Heparin + Clopidogrel Load if
    • NSTEMI
    • High pretest probability CAD
  • Other:
    • Morphine - CONT in R-sided infarct (venodilator)
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2
Q

Drugs CONT in R-sided infarct

A
  1. Nitrate
  2. Morphine

Both are venodilators, decreasing preload. R-sided infarct is preload-dependent

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3
Q

Next step in R-sided infarct

A

IVF

(b/c it is preload-dependent and this will increase preload. Don’t be tricked by JVD. IVF is okay if no signs of pulmonary congestion)

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4
Q

If recent onset of CP, NSTEMI suspected, cardiac enzymes negative, what is the next step?

A

Repeat cardiac enzymes at 6 hours

Considered negative after 2 sets of negative enzymes

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5
Q

Troponins vs CK-MB

A
  • Troponins
    • rise more immediately
    • declines slower
    • peaks at 18 hours
  • CK-MB
    • Declines more quickly
    • Measure to test for repeat infarct
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6
Q

Drugs used for Pharm Stress Testing

A
  1. Dobutamine
  2. Adenosine
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7
Q

When to use different types of stress testing?

EKG, ECHO, Nuclear

A
  • EKG
    • Test of choice, no baseline abnormality
  • ECHO
    • EKG abnormalities. No CABG
  • Nuclear:
    • CABG, Baseline wall motion defects, BBB
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8
Q

Tx: Chronic CHF

A
  • Always: beta-blocker and ACE-i
  • Stage II: Add Furosemide
  • Stage III: 1 and 2. Add Spironolactone or Hydralazine + Isosorbide Dinitrate
  • Stage IV: Inotrope: Dobutamine or Milrenone. VAD bridge to transplant
  • Stage I-III and EF < 35%: AICD
  • Ischemic: Add Aspirin and Statin
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9
Q

Dx: Possible Chronic CHF

A
  1. BNP
  2. ECHO
  3. Left Heart Cath
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10
Q

Dx: Acute CHF Exacerbation

A
  • CXR: volume overload?
  • BNP
  • ECG and troponins: r/o ischemia/arrhythmia as cause
  • ECHO: not necessary but often done
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11
Q

Tx: CHF Exacerbation

A

“LMNOP”

  • L = Lasix
  • M = Morphine
  • O = Oxygen
  • P = Position

Note: initiating a beta-blocker during acute exacerbation is CONTRA (acutely decreases EF). If already on it, may continue

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12
Q

Differentiating CHF vs ARDS?

A

CHF = cardiogenic pulm edema; PCWP > 12

ARDS = non-cardiogenic pulm edema; PCWP < 12

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13
Q

HTN recommendations (JNC-8)

A
  1. >/= 60 + No Dz = 150/90 goal
  2. Everyone else = 140/90 goal
  3. CCB, Thiazide, or ACE-i as first line
  4. (>75) or AA = No Ace-i
  5. CKD = ACE-i/ARB (overrules #4)
  6. Don’t use beta blockers alone for HTN (add for CAD/MI)
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14
Q

Tx Hypertensive Urgency

A

PO Meds (hydralazine)

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15
Q

Tx: Hypertensive Emergency

A

IV Meds (Labatalol, CCB, Nitrates)

Rule: IV meds to decrease BP by 25% in first 2-6 hours. Then switch to PO with goal to reduce to normal within 24 hours.

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16
Q

Side effects of CCB

A

Peripheral edema

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17
Q

Side effects of ACE-i

A
  • Increase K
  • Increase Creat
  • Angioedema
  • Cough
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18
Q

Side effects of Thiazide diuretic

A
  • Decreased K
  • Gout
  • Urinary Freq
  • ***Stop if GFR decreased***
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19
Q

Side effects of Loop Diuretic

A
  • Decrease K
  • Urinary Frequency
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20
Q

Side effects of Beta Blocker

A

Decreased HR

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21
Q

Side effects of Arterial Dilators (ex Hydralazine)

A

Reflex tachycardia

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22
Q

Side effects of Aldosterone Ant (ex: spironolactone)

A
  • Increased K
  • Gynecomastia (switch to eplerenone)
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23
Q

HTN and Hypo-K

A

Hyperaldosteronism

  • Dx:
    • Aldo:Renin > 20
      • CT pelvis
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24
Q

HTN, renal bruit, hypo-K

A

Renovascular, 2ndary HTN

  • Dx
    • Creatinine Clearance
    • BMP
    • Aldo:Renin < 10
    • Renal artery U/S
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25
HTN, palpitations, perspiration, pallor, pain
Pheochromocytoma * Dx: * Urinary metanephrines * CT
26
HTN, diabetes, central obesity, moon facies
Cushing's * Dx: * Low dose dexamethasone suppression test * ACTH lvl * High dose dexamethasone
27
Name murmur & Tx | (Apex)
Mitral stenosis (Opening snap, diastolic decresc. murmur) Tx: Balloon Valvotomy
28
Name murmur & Tx | (R sternal border)
Aortic Stenosis (Cresc/Decresc murmur in systole) Tx: Valve replacement + CABG
29
Name Murmur & Tx | (Apex)
Mitral Valve Prolapse (mid-systolic click) Tx: beta blockers, avoid dehydration
30
Name Murmur & Tx | (Apex)
Mitral Regurg (holosystolic) Tx: Valve Replacement
31
Name murmur & Tx | (R sternal border)
Aortic Regurg (Insufficiency) Diastolic decresc murmur Tx: Valve Replacement + CABG
32
Cause of mitral stenosis?
Rheumatic fever | (Past strep infxn)
33
Murmurs that increase with squatting/leg lift
1. Mitral Stenosis 2. Aortic Stenosis 3. Mitral Regurg 4. Aortic Regurg (Squatting/Leg lift = Causes increased preload)
34
Murmurs that Increase with Valsalva
1. Mitral Valve Prolapse 2. Hypertrophic Obstructive Cardiomyopathy (Valsalva increases Preload)
35
Dx in any murmur
ECHO
36
Dx Cardiomyopathy
ECHO Possible Bx (Restrictive)
37
Tx: Syncope on exertion in young athlete w/ family hx of sudden cardiac death
Hypertrophic Obstructive Cardiomyopathy Tx: * Beta-blocker = CCB (diltiazem/virapamil) * EtOH ablation * Myectomy * All 1st degree relatives should be screened
38
Tx Hypertrophic Cardiomyopathy
(NOT HOCM) * Beta-blocker = CCB * BP control Note; Concentric hypertrophy on ECHO. HOCM has assymetric hypertrophy
39
Tx: Restrictive Cardiomyopathy
Beta-blocker = CCB Gentle Diuresis (Diastolic HF, so be careful)
40
Dx: CHF + Peripheral Neuropathy
Restrictive Cardiomyopathy 2ndary to Amyloidosis * Dx: * Fat Pad/Gingival Bx * if (-), Myocardial Bx Note: Assoc. w/ MM
41
Dx: CHF + Lung Dz
Restrictive Cardiomyopathy 2ndary to Sarcoidosis * Dx: * Cardiac MRI * Endomyocardial Bx
42
Dx: CHF + Cirrhosis
Restrictive Cardiomyopathy * Dx: * Ferritin * Cardiac MRI * Endomyocardial Bx
43
Dx: CHF + MM
Restrictive Cardiomyopathy 2ndary to Amyloidosis * Dx: * Fat Pad/Gingival Bx * if (-), myocardial bx
44
Dx: CHF + Bronze DM
Restrictive Cardiomyopathy 2ndary to Sarcoidosis * Dx: * Cardiac MRI * Myocardial biopsy
45
Pt w/ positional CP that is Pleuritic and a Multiphasic Friction Rub. Dx and Tx?
Pericarditis * Dx: * EKG (first test) * PR segment depression (pathog) * Diffuse ST segment elevation * Best: MRI * Tx: * Best: NSAIDS + Colchicine * Colchicine only in CKD, Thrombocytopenia, PUD (anything that can't have NSAID) * NSAID only if diarrhea with colchicine * Steroids if all else fails (High rate relapse). BAD in viral.
46
Pt w/ positional CP + SOB. Dx and Tx?
Pericardial Effusion * Dx * ECHO * Tx: * Treat pericarditis (NSAIDS +/- Colchicine) b/c this is most likely etiology * Refractory: Pericardial window (allows to drain to thoracic cavity)
47
Pt w/ JVD, Muffled Heart Sounds, Clear Lungs. Dx and Tx?
Pericardial Tamponade * Dx: * DON'T TAKE TIME FOR THIS * Tx: * Emergency Pericardiocentesis
48
Pt w/ knocking on cardiac auscultation
Constrictive Pericarditis (Pericardial Knock) * Dx: ECHO * Tx: Pericardiectomy
49
Pt. w/ Syncope of sudden onset (no prodrome)
Arrhythmia * Dx: * EKG
50
Pt w/ Syncope of sudden onset and Focal Neuro Deficit
Neurogenic: Vertebrobasilar Insufficiency * Dx: * CT angiogram * Tx: * Medical Management * Stenting
51
Pt. w/ Sycope on Exertion
Mechanical Cardiac * Etiology * Aortic Stenosis * HOCM * LA Myxoma * Saddle Embolus * Dx: * ECHO * Tx: * Tx underlying dz
52
Tx: Vasovagal Syncope
Beta-blockers
53
Tx: Orthostatic Syncope
Rehydrate/Transfuse Steroids if that fails
54
Who needs a Statin?
1. Vascular Dz = MI, CVA, PVD, CS 2. LDL \>/= 190 3. LDL 70-189 * + Age 40-75 * + DM 4. LDL 70-189 * + Age 40-75 * + Calculated Risk = 2 or more Risk Factors * Smoking * HTN * Obesity * Age \>55 for women, \>45 for men * DM * Dyslipidemia \*\*\*Start High-Intensity Statin (Atorvastatin, Rosuvastatin)
55
Baseline Labs to Start Statins
* HbA1c = q3mo * Lipids = annually * CK = at beginning and if symptoms * LFTs = at beginning and if symptoms
56
Dx: Pt on statins and begins having muscle pain
Statin-Myositis? * Dx: * CK * U/A
57
Who should get a moderate-intensity statin?
* Liver Dz * Kidney Dz * Age \> 75 * Statin-Intolerance
58
2nd Line Tx if can't use Statin?
Fibrates | (Same side effect profile, same labs)
59
SVT distinguished from Sinus Tachy by HR \> 150 and no p-waves Tx: Adenosine
60
V-tach Tx: Amiodarone / Lidocaine
61
Afib Tx: beta-blocker = CCB (verapamil/diltiazem)
62
Sinus Brady Tx: Atropine
63
1st Degree AV Block Tx: Atropine
64
2nd Degree AV Block Type 1 Tx: Atropine
65
2nd Degree AV Block Type 2 Tx: Shock! (pace) (Atropine no longer works)
66
3rd Degree AV Block Tx: SHOCK (pace)
67
Idioventricular Rhythm Tx: SHOCK (pace)
68
Torsades de pointes Tx: Mg
69
Tx: Valvular Afib
Warfarin + LMWH bridge
70
Tx: Non-valvular Afib
Warfarin or NOAC, No LMWH bridge
71
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