Cardiology Flashcards
(28 cards)
Management of premature atrial complexes (PACs)
Usually asymptomatic and do not require treatment.
Monitor for increased frequency and if symptomatic can give low dose beta-blockers.
Can be precipitated by: adrenergic excess, drugs, ETOH, tobacco, electrolyte imbalance, ischemia, infection
Systolic-diastolic abdominal bruit
Found in ~ 40% RAS patients, finding has very high specificity
AAA main risk factors
Large diameter
Rate of expansion
Current cigarette smoking
Indications for operative of endovascular repair for AAA
Size > 5.5 cm
Rapid rate of aneurysm expansion (>0.5 cm in 6 months, > 1cm per year)
Symptoms, regardless of size
Vasospastic angina (aka Prinzmetal angina)
Path: vascular smooth muscle hyperreactivity that leads to focal/diffuse spasm of coronary arteries, transient MI, and resulting angina –> recurrent episodes of chest discomfort during sleep
Dx: coronary angiography, can be provoked by IV ergonovine or acetylcholine
Tx: CCBs (preventative) and nitrates (abortive); risk factor modification with smoking cessation and lipid lowering drugs
Test used to differentiate cardiac or hepatic disease as cause of LE edema?
Hepatojugular reflux
Fusion beats
Seen in wide complex tachycardia. Those with wide complex tachycardia with 2 fusion beats essentially diagnostic for sustained monomorphic ventricular tachycardia (SMVT).
Clinically and hemodynamically stable patients can be treated with antiarrhythmics like amiodarone without the need to cardiovert.
Fusion beats are capture of electrical signal through both atrium and ventricle, leading to hybrid of normal and wide QRS complex (P waves precede fusion complex)
Digoxin
Used for rate control in supraventricular arrhythmias (eg atrial flutter, fibrillation, tachycardia) esp in those with hypotension and/or heart failure who cannot tolerate BB or CCBs.
Digoxin toxicity and EKG findings
Since digoxin directly stimulates vagus nerve, can cause AV block.
Digitalis can also increase ectopy in atria or ventricles, leading to atrial tachycardia (150-250 bpm).
Combination of ectopy + AV block would show up as atrial tachycardia and AV block on EKG (rare for both to show up together–specific for digitalis toxicity)!
Risk factors for aortic dissection
HTN, Marfan, cocaine use
Most frequent location of ectopic foci causing AF? Atrial flutter?
AF - Pulmonary veins
A flutter - tricuspid annulus
First line treatment for acute pericarditis 2/2 SLE?
NSAIDs like ibuprofen
Corticosteroids in those with contraindications to NSAIDs (eg renal insufficiency)
Mitral valve prolapse
Most common cause of chronic MR in developed countries.
Occurs due to myxomatous degeneration of MV leaflets and chordae and causes mid-systolic click followed by mid to late systolic murmur.
Uremic pericarditis
Occurs in the setting of advanced renal failure and BUN > 60 mg/dL –> pleuritic CP and pericardial friction rub.
HOWEVER, would not find classic ECG diffuse ST elevations due to lack of myocardial inflammation.
Most common cause of cardiac arrest in immediate post-infarct period in patients with acute MI?
Reentrant ventricular arrhythmias (eg vfib)
Definition of orthostatic hypotension
Drop is systolic BP > 20 mmHg when moving from supine to standing
Multifocal atrial tachycardia (MAT)
Etiology: pulmonary disease exacerbation (eg COPD), electrolyte disturbance (eg hypokalemia), catecholamine surge (eg sepsis)
Clinical findings: usually asx, rapid irregular pulse, ECG => P wave forms and atrial rate > 100 BPM
Treatment: correct underlying disease (eg COPD), AV nodal blockage (eg verapamil) if persistent
HOCM murmur
Crescendo decrescendo systolic murmur along LEFT STERNAL BORDER without carotid radiation
vs. aortic stenosis is crescendo decrescendo systolic along right 2nd intercostal than radiates to carotids
Mechanism of action of NG in CAD?
Direct vascular smooth muscle relaxation –> systemic vasodilation –> increased peripheral capacitance –> decreased cardiac preload –> decreased LVEDV/SV –> reduced LV systolic wall stress –> decrease in O2 demand
Most common causes of constrictive pericarditis in developing countries vs. U.S.?
Developing countries and endemic areas (eg Africa, India, China), TB is common cause.
In U.S., most common causes include idiopathic, viral, radiation, cardiac sx, and CTDs.
Kussmaul’s sign
Lack of inspiratory declines in CVP –> sharp X and Y descents on central venous tracing.
A/w pericardial knock, early heart sound after S2.
Dressler syndrome
Inflammatory condition seen after MI, causing pericarditis. Mainstay therapy is NSAIDs, corticosteroids for refractory cases or when NSAIDs contraindicated.
First steps in managing patient suspected to have infective endocarditis?
Collect x 3 blood cx within 1 hour from three different venipuncture sites before starting empiric abx. Cultures should be obtained before any type of cardiac imaging (eg TTE, TEE) to assess for vegetations.
See Duke’s major and minor criteria for diagnosis of IE.
Most common causes of out of hospital SCA (sudden cardiac arrest) in adults? Most important factors in improving patient survival?
Vtach/fib
Prompt effective resuscitation by CPR
Prompt rhythm analysis
Defib in those with shockable rhythm
