Cardiology Flashcards
(50 cards)
1
Q
stress EKG
A
- confirms angina, evaluates response of tx, identifies pts with CAD with high risk of ACS
- if ST depression or if pt has CP, HoTN, or significant arrhythmias
- if +, send pt for cardiac catheterization
- if ST depression or if pt has CP, HoTN, or significant arrhythmias
2
Q
stress echo
A
- performed before and after exercise
- more sensitive than stress EKG for ischemia
- if +, cardiac cath
3
Q
cardiac catheterization
A
- most accurate method for specific cardiac diagnosis
- provides info on hemodynamics, intracardiac pressure, CO, O2 sat
- Indications:
- after + stress test
- pt w/ angina when noninvasive tests are nondiagnostic, angina occuring despite meds, angina soon after MI, dx dilemma
- severely sxatic pt needing urgent dx
- evaluation of valve dz
4
Q
Coronary CT angiography
A
- definitive test for CAD (GOLD STANDARD)
- most accurate method
- determines whether revasc is needed
- can perform PCI at same time with balloon or stent
- stenosis >70% is significant
- if severe (left main or 3-vessel), refer for CABG
5
Q
PCI vs CABG
A
- administer aspirin indefinitely and P2Y12 antag for 1-3mos after implantation of bare metal stent to reduce coronary thrombus formation
- administer aspirin indef + P2Y12 antag for at least 1 yr after implantation of drug-eluting stent
- defer noncardiac surg for at least 12mos
- use of drug-eluting stents that locally deliver antiproliferative drugs can reduce restenosis to less than 10%
- CABG: anastomosis of one or both internal mammary arteris or a radial artery to the coronary artery distal to obstructive lesion is preferred procedure; section of vein (usually saphenous) is used to form connection between aorta and coronary artery distal to obstructive lesion
6
Q
PCI indications, benefits, CI, and prognosis
A
- indications: symptom-limiting angina pectoris, despite medical tx, accompanied by evidence of ischemia during stress test
- tx stenoses in native coronary arteries as well as in bypass grafts in pts who have recurrent angina after CABG
- benefits: more effective than medical tx for relief of angina, improves outocmes in pts w/ unstable angina or early in MI w/ and w/out cardio shock, less invasive than CABG
- CI: left main coronary artery stenosis
- Prognosis: adequate dilation with relief of angina in >95% cases
- recurrent stenosis occurs in 20% cases w/in 6mos
- restenosis MC in pts w/ DM, small arteries, incomplete dilation of stenosis, long stents, occluded vessels, obstructed vein grafts, dilation of LAD, and stenoses containing thrombi
7
Q
CABG indications, benefits, CI, prognosis
A
- indications: L main coronary a. stenosis
- ideal candidate = male, <80yo, no other complicated dz, angina not controlled by medical tx or cant tolerate medical tx
- benefits: safe, mortality rates <1%, superior to PCI in preventing death, MI, and repeat revasc. in pts with DM and multivessel dz
- CI: none
- prognosis: angina abolished or greatly reduced in 90% pts
- w/in 3y, angina recurs in 25% pts but is rarely severe
8
Q
stable angina etiology, RF, sxs
A
- etiology: fixed atherosclerosis narrowing arteries
- O2 supply < )2 demand
- major RF: DM (worst), HLDL (high LDL), HTN (most common), smoking, age (m>45, w>55), FHx premature CAD or MI in 1st degree relative, low HDL
- minor RF: obesity, sedentary, stress, ETOH
- sxs: CP or substernal pressure (lasts <10-15m, heaviness, pressure, squeezing, tightness, rarely sharp), gradual onset pain, increases with exertion or emotion, relieved with rest or NTG
- Levine sign: clenched fist over sternum and clenched teeth when describing CP
9
Q
stable angina dx and tx
A
- dx: EKG - normal, Q-waves (prior MI)
- cardiac stress test
- tx: sublingual NTG - IV NTG
- coronary angiography: if severely sxatic despite medical tx
- prognosis: depends on LVEF: <50% = increased mortality
- vessels involved: left main = poor prognosis, 2-3 vessels total = worst prognosis
10
Q
congestive heart failure
A
- decompensated: evidence on PE or chest radiograph of pulm edema, audible 3rd heart sound or increased JVP
- Left ventricular failure: sxs of low cardiac output and congestion (SOB) dt systolic or diastolic dysfn
- R ventricular failure: sxs of fluid overload almost always dt LVF
- MCC systolif HF (reduced EF): ISCHEMIC CARDIOMYOPATHY (CAD with resultant MI an dloss of fning myocardium)
- systolic dysfn: difficulty with ventricular contraction
- diastolic dysfn: difficulty with ventricular relaxation; results from HTN and associated with aging; related to myocardial m. stiffness and LVH
- HF with preserved EF
11
Q
congestive heart failure etiology, RF, and sxs
A
-
MCC: CAD, HTN, DM
- LV remodeling: dilation, thinning, mitral valve incompetence, RV remodeling
- 75% have preexisting HTN
- MCC of transudative (extravascular fluid) pleural effusions
- mostly >65yo
- sxs:
- exertional dyspnea (SOB), then dyspnea with rest, chronic nonproductive cough, worse in recumbent position
- fatigue, orthopnea, night cough, relieved by sitting up or sleeping with additional pillows, paroxysmal nocturnal dyspnea, nocturia
- signs:
- cheyne-stokes breathing, edema (ankles, pretibial (cardinal)), RALES, additional heart sounds:
- S4 = diastolic HF (preserved EF)
- S3 = systolic HF (reduced EF) with volume overload - tachycardia, tachypnea
- jugular venous pressure >8cm
- cold extremities, cyanosis, hepatomegaly (ascites, jaundice, peripheral edema)
- cheyne-stokes breathing, edema (ankles, pretibial (cardinal)), RALES, additional heart sounds:
12
Q
congestive heart failure dx and tx
A
- dx:
- labs: CBC, CMP, UA +/- gluc, lipids, TSH
- Serum BNP: increases with age and renal impairment, elevated in HF, differentiates SOB in HF from noncardiac issues
- 12-lead EKG
- CXR: kerley B lines
- Echo: differentiates HF _/- preserved LV diastolic fn
- Reduced pulse pressure and SVR
- tx:
- acute management: LMNOP
- Lasix
- Morphine (reduces preload)
- Nitrates (reduces preload)
- O2
- Position
- ACEi
- CCB in diastolic HF
- acute management: LMNOP
- poor prognostic factors: CKD, DM, low LVEF, severe sxs, old
- 5y mortality = 50%
13
Q
New York Heart Association HF classification
A
14
Q
when to refer HF vs admit
A
- Refer: new sxs no explained by obvious cause, continued sxs and reduced LVEF (<35%)
- Admit: unexplained new or worsening sxs or + biomarkers indicating acute MI, hypoxia, fluid overload, pulm edema not resolved as outpt
15
Q
hypertension sxs, dx, and tx
A
- sxs: >140/90 during at least 2 separate visits
- mostly asx w/ nonsepcific HA
- signs: BMI and waist circumference, BP in both arms, compare radial and femoral pulses
- examine for abdominal aortic masses, PMI, murmurs, bruits, fundoscopic exam for eye changes
- dx: EKG: LVH with strain
- CXR
- Labs: CBC, CMP, tox, preg, TSH
- Hgb/Hct (decreased)
- BUN, Cr, glucose (increased)
- urinary gluc, prot, sediment: renal dz or DM
- UA: hematuria or proteinuria
- lipid profile
- tx: Goal = <140/90 for gen pop, DM, and renal dz
- older than 60 = <150/90
-
lifestyle modification = first line
- DASH diet, weight loss, smoking cessation, limit ETOH and Na
- Meds: ACEi (DM or renal dz), thiazide (AA), CCB, aldo antagonists (for refractory HTN, post MI, HF), alpha blockers (BPH), hydralazine (refractory HTN)
16
Q
Hypertension definitions per JNC and ACC
A
17
Q
Metabolic Syndrome
A
- truncal obesity
- hyperinsulinemia
- hypertriglyceridemia
- HTN
- Associated with DM and increased CV complications
18
Q
Primary (essential) HTN
A
- 90-95% of cases
- Multifactorial: genetic predisp (old age, AA), environmental (high Na, obese), sympathetic NS, abnl cardio or renal development, imbalance in RAAS, deficit in sodium secretion, abnl Na-K exchange
- Exacerbating facotrs: excessive ETOH, tobacco, sedentary, polycythemia, NSAIDs, low K intake
- tx: Goal = <140/90 for gen pop, DM, and renal dz
- older than 60 = <150/90
- lifestyle modification = first line
- DASH diet, weight loss, smoking cessation, limit ETOH and Na
- Meds: ACEi (DM or renal dz), thiazide (AA), CCB, aldo antagonists (for refractory HTN, post MI, HF), alpha blockers (BPH), hydralazine (refractory HTN)
19
Q
secondary HTN
A
- parenchymal dz, renal artery stenosis, coarctation of aorta, pheochromocytoma, Cushings syndrome (excess cortisol), hyperthyroidism, primary hyperaldosteronism, chronic steroid use, estrogen use, NSAID use, sleep apnea
- tx: treat underlying dz
20
Q
hypertensive urgency
A
- BP needs to be reduced within hours
- Persistently elevated higher than 220 systolic or 125 diastolic or accompanied complications without end-organ damage
- tx: oral agents: clonidine, captopril, nifedipine, labetolol
21
Q
Hypertensive emergency (malignant hypertension)
A
- elevated BP with papilledema or retinal hemorrhage and either encephalopathy or nephropathy, confusion, left ventricular failure, intravascular coagulation
- Difference: HTN emergency always has retinal papilledema and flame-shaped hemorrhages and exudates
- must be reduced within 1 h to prevent progression to end organ damage or death
- diagnostic criteria: persistently elevated higher than 220 systolic, diastolic >130
- Complications: encephalopathy, nephropathy, ICH, aortic dissection, pulmonary edema, unstable angina, MI, stroke
- on fundoscopic: retinal hemorrhages, exudates, papilledema
- Hallmark complication: fibrinoid necrosis of the arterioles in the kidney
- Tx: DONT REDUCE TOO RAPIDLY - can cause ischemia
- sodium nitroprusside (short acting, titratable, potential for thiocyanate and cyanide tox with prolonged use or renal/hep fail)
- labetalol (alpha and beta blocker) - preferred in dissection and ESRD
- Neuro emergencies:
- encephalopathy, stroke, ICH, SAH: labetalol, nicardipine, esmolol. AVOID nitroprusside and hydralazine
- reduce MAP 25% over 8h
- for MI us NTG or BB
- aortic dissection: use nitroprusside and BB
- Hydralazine during preg
- lower BP within first 24-48h by 25%
- 90% will die after 1-2y
- encephalopathy, stroke, ICH, SAH: labetalol, nicardipine, esmolol. AVOID nitroprusside and hydralazine
22
Q
endocarditis etiology, RF, and sxs
A
- MC native valve infection (strep viridans, staph aureus, enterococci)
- IVDU: staph aureus, tricuspid
- Prosthetic valve: staph aureus, gram neg or fungi
- most pts have underlying regurgitant defect providing a nidus
- sxs: fever, nonspecific sxs (dyspnea, cough, CP, arthralgias, back or flank pain, GI complaints)
- signs: stable murmur (90%), palatal, conjunctival, or subungal petechiae, splinter hemorrhages, pallor, splenomegaly
- diagnostic signs:
- osler nodes (painful, violaceous, raised lesions on fingers, toes, feet)
- janeway lesions (painless red lesions on palms/soles of feet)
- roth spots (exudative lesions in retina)
23
Q
endocarditis dx and tx
A
- dx: 3 sets of blood cultures at least 1h apart, before starting abx
- echo: required to make dx and identify involved valves (vegetation)
- tx: empiric abx cover staph, strep, enterococci
- native valve: vanco alone or + cefazolin
- Ill pts w/ HF: gentamicin plus cefepime and vanco
- aortic valve replacement if refractory or abscess (funcal infxn)
- prophylaxis: abx recommended before invasive dental work or surgical procedures: prosthetic valves, previous IE, some congenital heart dzs (transposition, tetrology), acquired valve disorders, HCM, cardiac transplant pts with valvulopathy
- ALL OF THE ABOVE GET AMOX 1 hr before procedure (clarith or azith if PCN allergy)
24
Q
Modified duke criteria
A
- For detecting endocarditis
- must have one of the following criteria:
- 2 major
- 1 major and 3 minor
- 5 minor
- Major:
- two pos blood cultures of typical causative microorganism
- echo showing new valve regurg
- Minor:
- predisposing factor
- fever >100.4
- vascular phenomena (embolic dz or pulm infarct)
- immunologic phenomena (glomeruloneph, osler nodes, roth spots)
- blood cuture not meeting major criteria
25
hyperlipidemia etiology, RF and sxs
* elevated LDLs increase risk of CAD; higher HDLs = protective; elevated TGs are risk factor for atherosclerosis; severe elevations can cause pancreatitis
* Recommended screening for pts with no evidence of CVD and **NO RISK FACTORS** - **35yo**
* NCEP recommends screening at **age 20** regardless of risk factors
* genetic: primary HLD, familial hypercholesterolemia; secondary to DM, ETOH, hypothyroid, obesity, sedentary lifestyle, renal or liver dz, drugs
* RF: DM (CAD risk equivalent), smoking, HTN, HDL \<40, age (\>45 men, \>55 women), HIV (CAD risk equivalent
* sxs: eruptive or tendinous xanthomas
* 2/3 ppl with **xanthelasmas affecting eyelids** have normal lipid profiles
* severe: premature arcus senilis; lipemia retnalis (cream-colored retinal vessels) seen with TG levels \>2000mg/dL
26
hyperlipidemia dx and tx
* dx: without RF, order total cholesterol
* tx: **lifestyle changes = first line**: reduce total fat intake, saturated fat, dietary cholesterol \<200, 30 min aerobic exercise daily, increase antioxidants from fruits and veggies, soluble fiber may reduce LDL
* CAD prophylaxis (81mg aspirin) unless CI
* smoking cessation
* **statin tx**
* health maintenance: pts with any evidence of CVD or CAD risk equivalent (DM, HIV should be screened with fasting complete lipid profile)
27
Statins
* HMG-CoA reductase inhibitors
* reduce cholesterol production in liver and increase ability of liver to remove LDL from blood
* **BEST AT DECREASING LDL**, moderate decrease in TGs and increase in HDL
* Adverse effects: **myalgias**, mild GI upset; severe = myositis, liver tox, rhabdo
* monitoring: LFTs and creatinine-phosphokinase if myalgias develop, monitor lipids every 6wk until goals met
28
Niacin
* Reduces long-term risk of CAD by reducing production of VLDL, lowering LDL and increasing HDL; may also reduce TG
* moderate decrease in LDL, TG; **best at elevating HDL**
* adverse effects: prostaglandin-induced **NIACIN FLUSHING** (may be reduced by taking ASA 30 min prior or a daily NSAID)
* Monitoring: baseline LFTs, LFTs q6-12wks first year, then q6mo; lipid panel, blood sugar (DM) or platelets and PT (if on anticoagulants), uric acid (gout)
29
Bile-acid sequestrants
* cholestyramine, colesevelam, colestipol
* bind bile acids in the intestine; resins reduce the incidence of coronary events in middle aged men; no effect on mortality
* **second best at decreasing LDL**, mild decrease in TGs, mild elevation HDL
* Adverse effects: constipation, gas
* monitoring: fasting lipid profile prior to treatment, then 3 mo after initiation, then 6-12mo thereafter
30
Fibric acid derivatives
* gemfibrozil, clofibrate
* peroxisome proliferator-activated receptor alpha (PPAR alpha) agonists - most important meds for lowering of TG levels and raising HDL
* **best at lowering TGs, second best at increasing HDL**
* adverse effects: may induce gallstones, hepatitis, myositis
* monitoring: periodic LFT, CBC, cholesterol in the first year
31
hyperlipidemia goals
* HDL: \>40 men, \>50 women
* LDL: \<100
* TG: \<150
* Total cholesterol: \<200
32
Coronary artery disease
* risk factor mod: **SMOKING CESSATION -** cuts risk by 50%
* Medical tx: **ASA + BB**
* **Sublingual NTG** (for angina)
* **ASA** (decreases morbidity and mortality)
* **BB** (atenolol and metoprolol are first-line)
* ACEi (for pts with heart failure)
* **Morphine** (venodilation, decreases preload and O2 demand)
* **Nitrates** (long acting - need 8 to 10 hr nitrate free interval to prevent tolerance; dilates coronary arteries, reduces preload and myocardial O2 demand; **adverse effects = HA, ortho HoTN, tolerance, syncope)**
* CCB - coronary vasodilation, afterload reduction, reduces contractility; secondary tx when BB or NTG not fully effective or maxed out
* **Statins** (stabilizes plaques and lower cholesterol)
* revascularization - does NOT REDUCE RISK OF MI, but improves sxs
* PCI, CABG, antiplatelet tx
* **Thrombolytic tx (alteplase):** first line tx
* pts who present late and PCI contraindicated, administer ASAP upt to 24hrs after onset of CP, best if given in first 6hrs
33
Peripheral vascular dz or peripheral arterial dz
* in absence of limb-threatening ischemia, sxs of PAD tend to remain stable with med tx
* if revascularization is needed, percutaneous revasc first, reserve surgery for when arterial anatomy is unfavorable
* clinical features used to determine if thrombolytic therapy or surg revasc is most appropriate:
* presumed etiology (embolus vs thrombus)
* location
* duration of sxs
* availability of autologous vein for bypass grafting
* suitability of pt for surg
* proximal embolus at bifurcation of common fem artery is ideal lesion for **embolectomy**
* embolus to distal vessel Ii.e. tibial a.) may be tx with thrombolytic agent
* major use of **percutaneous transluminal angioplasty (PTA)** is in the tx of underlying lesion after clot has been lysed with thrombolytic tx
* **Leriche syndrome:** triad of 1) claudication, 2) absent or diminished femoral pulses, and 3) erectile dysfunction
34
intermittent claudication
* occurs distal to level of stenosis or occlusion (calf pain with walking 10-35% of ppl with PAD)
* sxs: reproducible pain aggravated by sustained exercies, relieved with rest, aching, dull pain, leg pain occurs after certainwalking distances, resolving within 10min, cramping, numbess, weakness, giving way
* Physical: **hair loss** on bilateral lower extremities, thinning of skin, diminished pulses
* dx: treadmill testing using ABIs at rest and after exercise - \<0.9 = diagnostic
* tx: **stop smoking (first line)**, graduated exercise, foot care, control HLD, HTN, weight, DM, avoid extremes of temp, **ASA + ticlopidine** or clopidogrel (sx relief), cilostazol (PDE inhibitors)
* surgery: **angioplasty**, bypass grafting
35
Asx PAD
* screen in pts with abnormal/absent pedal pulses, age \>70, age 50-69y with hx of smoking or DM
* sxs: none
* dx: ABI - if \<0.9 is dx; if 0.91-1.3 normal and no further testing; if \>1.3 doppler ankle waveforms and toe pressures
* tx: preventative = ASA, lipid lowering, blood pressure control
36
PAD or PVD etiology, RF, and sxs
* occlusive atherosclerotic dz of lower extremities
* **superficial femoral artery is MC,** popliteal, aortoiliac
* RF: **smoking** HLD, DM, HTN
* Men \>40y, AA
* MCC: **atherosclerosis**
* Considered to be a **coronary artery disease risk equivalent**
* Common in pts with ESRD
* 20-50% are asx and 40-50% present with atypical leg pain
* Sxs: **pain in one or more lower extremity muscle groups** (cramping thigh, calf, or buttock pain' intermittent claudication; worse with elevation (reclining))
* **Rest pain** felt over distal metatarsals, **prominent at night** (wakes pt up from sleep), **hangs foot over side of bed** or stands to relieve pain
* signs: **diminished**/absent pulses, muscular atrophy, **hair loss** distal to obstruction, **thick toenails**, decreased skin temp, localized skin necrosis (toes), nonhealing, infarction, or gangrene, **pallor** of elevation and rubor of dependency
37
PAD or PVD dx and tx
* dx: hypercholesterolemia \>240, hypertTG \>250
* **ABI testing - if \<0.9 = dx**
* doppler - reduced or interrupted flow
* **Arteriography** (gold standard)
* tx: prevention of atherosclerosis (control HLD, HTN, weight, DM
* manage primary HLD: statins, diet exercise (walk to point of claudication, rest, then continue walking), foot care
* reduce BP, **STOP SMOKING (most important)**
* Medical intervention: **ASA and ticlopidine** or clopidogrel (sx relief), cilostazol (PDE inhib)
* Surgery: angioplasty (preferred), adjunctive stenting, bypass grafting
38
aortoiliac dz
* inflow dz
* sxs: buttock or thich claudication = more disabling
* tx: percutaneous transluminal angioplasty (PTA) - iliac artery and stenting
* aortoiliac bypass
* aortofemoral bypass
39
femoropopliteal dz
* disease below inguinal ligament = outflow dz
* tx: balloon angio/stenting of femoral or superficial femoral artery
* surgical bypass (femoral to above-knee popliteal bypass, femoral to below-knee bypass
40
phlebitis
* inflammation at entry site due to needle or catheter insertion
* MCC of fever after postop day 3
* MC in lower extremity veins
* sxs: induration, edema, tenderness, visible signs are minimal but include redness
* tx: remove catheters at earliest signs
* prevention: aseptic technique during insertion, frequent change of tubing (48-72h), rotation of insertion sites q4d
* use silastic catheters (least reactive) and hypertonic solutions in veins with substantial flow
41
suppurative phlebitis
* MC bug: **STAPH**
* presence of infected thrombus around indwelling catheter
* sxs: locla signs of inflammation + pus from venupuncture site, high fever
* dx: + blood cultures
* tx: excise affected vein, extend incision proximally to first open collateral, leave wound open
42
coronary artery vasospasm (Prinzmetal variant) etiology, RF, sxs
* etiology: **smooth muscle constriction (spasm) of the coronary artery w/out obstruction** - leads to MI, ventricular arrhythmias, sudden death
* known triggers: hyperventilation, cocaine, tobacco use, provocative agents (acetylcholine, ergonovine, histamine, serotonin)
* Nitric oxide deficiency: increased activity of potent vasoconstrictors and stimulators of smooth muscle proliferation
* 50yo, females
* sxs: **nonexertional chest pain similar to unstable angina**
* normal exercise tolerance
* pain is **cyclical (most occur in morning hours, no correlaiton to cardiac workload)**
43
Prinzmetal angina dx and tx
* dx: EKG (ST segment or Twave abnormalities)
* Cardiac enzyme: **normal troponin,** CK-MB
* Check Mg level, CBC, CMP, lipid panel
* tx: stress testing with myocardial perfusion imaging or coronary angiography
* pharmacotherapy (SL, topical, or IV **nitrates** (initial), antiplatelet, thrombolytics, statins, BB
* once dx made, **CCB** and long-acting nitrates used for long term prophylaxis (**amlodipine)**
44
pharm tx of ACS/chest pain (angina)
* Clopidogrel: reduces incidence of MI in pts with USA compared with ASA alone
* LMWH: continue for at least 2d; PTT not followed
* UFH: PTT 2-2.5x normal if using UFH
* **start pt with USA or NSTEMI with high LDL on statin**
45
Unstable angina
* **O2 demand unchanged**, supply decreased, secondary to low resting coronary flow
* sxs: **chronic angina** increasing in frequency, duration, or intensity of pain OR
* **new onset** angina that is severe and worsening OR
* **angina at rest**
* dx: EKG shows ST segment or Twave abnl
* cardiac enzymes show **normal troponin** and CK-MB
* tx: admit to unit with continuous cardiac monitoring, establish IV access, **O2,** pain control with **NTG and morphine**
* **ASA,** clopidogrel, **BB** (first line), LMWH, replace electrolytes, if response to med tx - stress test to determine if catheterization/revascularization necessary
* reduce RF: stop smoking, weight loss, tx DM/HTN/HLD
* heparin
* NOT BENEFICIAL: thrombolytics and CCB
46
NSTEMI and STEMI etiology, RF, sxs
* NSTEMI: caused by severely narrowed artery that is not 100% blocked
* STEMI: caused by 100% blockage of a coronary artery, necrosis of myocardium (thrombotic occlusion), asx in 1/3 of pts
* sxs: **CP** (intense, substernal, crushing), **radiation** to neck, jaw, arms, back, **left side**, similar to angina pectoris but more severe and lasts longer, pain doesnt respond to NTG, epigastric, **SOB, sweating, nausea, vomiting,** weakness fatigue, syncope
47
NSTEMI and STEMI dx and tx
* dx:
* NSTEMI: EKG shows pathologic Q waves, **elevated trop and CK-MB**
* STEMI: EKG shows peaked T-waves, ST elevation, Q waves, T wave inversion
* in both, monitor BP/HR, cardiac enzymes
* tx: admit to ccu, establish IV access, O2, NTG/morphine
* MONA: morphine, O2, nitrates, ASA
* BB, ACE, heparin, statin
* prognosis: 30% mortality rate
48
dressler syndrome
* **post-MI** syndrome occurs 1-2 wk post-MI
* sxs: fever, malaise
* complications: pericarditis, pleuritis
* dx: CBC shows leukocytosis
* tx: **ASA** (first line), ibuprofen
49
hypertriglyceridemia
* often caused or exacerbated by uncontrolled DM, obesity, sedentary habitus
* RF: CAD, usually asymptomatic until TG \>1000-2000 mg/dl
* sxs: GI: midepigastric pain, but can occur in chest or back areas; nausea or vomiting
* signs: TTP over midepigastric, RUQ/LUQ, hepatomegaly, dyspnea, xanthomas, corneal arcus, xanthelasmas, memory loss, dmentia, depression
* dx: decreased pedal pulses or ABI index in presence of PAD, lipid panel, chylomicron determination, FBG, TSH, UA, LFTs
* tx: lifestly mod (diet exercise, weight loss, smoking cessation, limit ETOH)
* pharm: fibric acid derivatives, niacin, omega 3 FAs, statins
* plasmapheresis in setting of severe hyperTG
50
cardioversion vs defib
* Cardioversion indicated for **A-fib, A-flutter, VT WITH PULSE, SVT**
* Defibrillation indicated for **VT WITHOUT PULSE, V-fib**
* Automatic implanted defib: **VT not controlled by med tx, V-fib**
* Pharm cardioversion (ibutilide, procainamide, flecainide, sotalol, amiodarone): if pharm cardioversion fails
