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Adult Outpatient > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the expected max heart rate of a given adult? What HR should be achieved in stress test?

A

220 - age

Expected to reach 85% during stress test

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2
Q

Pharmacological Stress Test

A

Adenosine / Dipyridamole - causes coronary vasodilation; if already fully dilated at rest then when who system is dilated there will be relatively less flow

Dobutamine - inc myocardial oxygen demand (inc HR, contractility and BP)

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3
Q

Indications for CABG

A

1- three vessel disease (> 70% stenosis of ea)

2- LAD > 50% (supplies 2/3 heart)

3- LV dysfunction

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4
Q

CAD Mgt

A

Should all be on ASA

Beta blockers - reduce HR / oxygen demand of heart

Nitrates - vasodilation for symptomatic relief

Ca Channel Blockers - second line if not fully managed on beta and nitrates

If co-existing CHF - ACE and / or diuretic

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5
Q

Prinzmetal Angina

A

Transient coronary vasospasm

Transient ST elevation during chest pain episode

Diagnosis - definitively by coronary angiography; give ergonovine or acetylcholine to vasoconstrict –> spasm

Dec lipids, smoking cessation, Ca channel blockers, nitrates

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6
Q

Cardiac Enzymes

A

Always order if chest pain w/ cardiac suspicion

Troponin - inc in 3-5 hrs; peak at 24-48 hrs; inc for 5-14 days

CK-MB - inc in 4-8 hrs; peak at 24 hrs but returns to normal by 48-72 hrs so good for detecting recurrent MI

Serial - check q 8 hrs for 24 hrs

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7
Q

Std MI Tx

A

MONA + beta + statin + heparin

M - morphine (dec pain and venous dilation)

O - oxygen

N - nitrates (dilation for symptoms relief)

A - ASA (prevent platelet aggregation on top of existing thrombus) + ACE (dec mortality)

Beta - dec mortality; dec oxygen demand; dec remodeling after MI

Statin - (atorvastatin); take long term to reduce risk repeat event

Heparin - LMWH (enoxaparin)

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8
Q

When to use dual anti-platelet in CAD

A

30 days after bare metal stent

12 mo for drug-eluting stent

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9
Q

Dressler Syndrome

A

wks to months after MI

Immunologically based pericarditis (fever, malaise, leukocytosis, pleuritis)

Tx = ASA

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10
Q

Mgt of CHF Pts (long-term therapy and what to monitor)

A

Drugs (for systolic) -

  • ACE + diuretic (symptomatic relief of edema)
  • May add beta blocker (metoprolol, bisprolol, carvedilol); dec remodeling
  • Nitrates
  • Digoxin (inotrope - use if EF < 40%); must check level periodically

Monitor -

  • Wt gain at ea visit
  • Exercise intolerance
  • Amount of peripheral edema
  • Electrolytes, BUN, Cr, digoxin level if using
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11
Q

Digoxin Toxicity

A

GI - nausea and vomiting; dec appetite

Cardiac - ectopic beats, AV block, A fib

Neuro - disorientation, visual disturbances

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12
Q

PVCs

A

Conduction thru ventricular muscles; slower; wide QRS

Only concerning if also have underlying structural heart disease

Couplet = 2 PVCs in a row
Bigeminy = sinus then PVC
Trigeminy = 2 sinus then PVC
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13
Q

A Fib

A

No p waves

Irregularly irregular RR intervals (between QRS complexes)

If stable - rate control (beta or Ca channel blocker), then convert, anticoagulation w/ warfarin

Echo to check for mural thrombus before electrical conversion

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14
Q

Atrial Flutter

A

atrial rate 250-300 but refractory period of AV node means only 1 of every 2-3 p waves –> QRS

Sawtooth of p waves w/ QRS after every 2-3 p waves (esp in inferior leads - II, III, aVF)

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15
Q

WPW

A

Accessory path from atria to ventricles

Short PR interval & delta waves before QRS

AVOID DRUGS THAT DEC AV NODE BECAUSE THIS MAY ACCELERATE THRU ACCESSORY PATH (no digoxin, verapamil or beta blockers)

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16
Q

V Tach v. V Fib

A

V Tach - no p waves; wide back-to-back QRS complexes (sustained v non-sustained)

V fib - no discernible p waves or QRS complexes (firing from multiple ventricular foci); IMMEDIATE DEFIBRILLATOR

17
Q

Types of AV Block (tx for ea)

A

1st Degree - prolonged PR interval (> 200 ms)

2nd Degree Type 1 - prolonged PR interval then dropped QRS

2nd Degree Type 2 - NO prolonged PR interval; just dropped QRS

3rd Degree - p waves and QRS ea have own rate (AV dissociation)

**Pacemaker indicated for 2nd degree type 2 and 3rd degree

18
Q

Acute Pericarditis ECG

A

Diffuse ST elevation (tomb stones) and PR depression

ST then returns to normal in 1 wk

T wave inversion (in some); also returns to normal

19
Q

Constrictive Pericarditis Findings

A

Sx - fluid overload OR dec CO / syncope picture OR both

  • Elevated JVD (x and y descent both prominent)
  • Kussmaul sign (no dec in JVD w/ inspiration - normally happens due to dec intra-thoracic pressure of inspiration)
  • Pericardial knock (cessation of filling of ventricle)
  • Ascites / dependent edema
20
Q

Pericardial Effusion Findings

A
  • Echo showing pericardial fluid
  • CXR shows cardiomegaly w/o pulmonary vascular congestion
  • ECG may show flat t waves and low amp QRS; may also have electrical alternans (alternating amp or axis in successive QRS complexes)
21
Q

What should be order in pericardial fluid analysis?

A

Protein and glucose content

Cell count and differential

Cytology

Specific gravity

Gram stain + acid -fast stain

Fungal smear

Cx

LDH content

22
Q

Cardiac Tamponade Findings

A

Refers to fast rate of pericardial fluid accumulation (more so than volume of fluid); no time for compensation

  • Equal pressure in all 4 chambers (equals pulmonary artery and pericardium too)
  • BECK’s Triad = muffled heart tones, JVD, hypotension
  • Prominent x descent but no y descent (no huge rush of blood from R atrium to R ventricle w/ tricuspid opening)
  • Pulsus paradoxus - BP dec by > 10 mmHg during inspiration
  • Electrical alternans
23
Q

Rheumatic Fever Diagnostic Criteria

A

2 major OR 1 major + 2 minor

MAJOR (JONES)

  • migratory polyarthritis
  • heart manifestations (valve disease, pericarditis, CHF)
  • subQ nodules
  • erythema marginatum
  • St. Vitus chorea

MINOR

  • Elevated ESR
  • Fever
  • Polyarthralgias
  • Prior hx rheumatic fever
  • Known strep infection beforehand
  • Prolonged PR interval
24
Q

Duke Criteria for Infective Endocarditis

A

2 major OR 1 major + 2 minor OR 5 minor

MAJOR

  • sustained bacteremia by organism known to cause endocarditic (staph, strep, enterococcus, HACEK)
  • Endocardial involvement documents on echo (vegetations, abscess valve perforation) or new valvular regurg

MINOR

  • Fever
  • Abnormal valve or predisposing condition
  • Vascular signs (PE, intracranial hemorrhage, Janeway lesions)
  • Immune signs (glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor)
  • Pos blood cx (other organism)
  • Pos echo (otherwise)
25
Q

When to use abc prophlyaxis for valve disease

A

Cardiac Indication + Procedural Indication (must have both)

CARDIAC

  • Prosthetic valve
  • Hx infective endocarditis
  • Cong heart disease that was not repaired or has been repaired in last 6 months w/ prosthetic material
  • Cardiac transplant w/ valvuloplasty

PROCEDURE

  • dental w/ involving gingival mucosa or peri-apical region (extractions, implants, surgery, cleaning w/ bleeding)
  • biopsy or incision into respiratory mucosa
  • procedures involving infected skin or MSK tissue
26
Q

Cilostazol

A

PDE inhibitor used for PVD / claudication symptoms

MOA: suppression of platelet aggregation and arteriole dilation

27
Q

Normal ABI’s & Symptomatic ABI’s

A

Normal: .9-1.3

Claudication once < .7

Rest pain once 1.3 then severe because means cannot compress arteries due to calcification; cannot measure

Adult Outpatient (11 decks)

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