Cardiology PANCE Flashcards by Patrick M

Dilated cardiomyopathy

Etoh, idio, viral, chemo, cocaine, pregnancy
systolic HF
Weak floppy heart
S3 systolic
Low EF
BASD = BB, ACE, Spiron, Diuretics

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Restrictive Cardiomyopathy

Right sided HF
Filling problem, Diastolic
Kussmaul’s sign (jvd on inspiration)
Normal ventricle walls with dysmotility
Speckled on echo
Echo, biopsy for definitive
Treat underlying cause, sarcoid, amyloid, etc

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Takasubo cardiomyopathy

Transient ST elevation
Stress, depression, sad
Transient Systolic failure
water bottle shape heart

Treat initial like ACS
Then symptomatic tx

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Hypertrophic cardiomyopathy

Autosomal dominant Genetic
Outflow tract obstruction
Dyspnea on exertion, angina, CP
Sudden cardiac death
Harsh systolic murmur
S4
THick septum
NO dig, no nitro, no diuretics
Give BB to keep Cardiac demand low

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Myocarditis

Inflammation of heart muscle (young adults)
Viral - coxsackie, SLE, RA, Meds
Fever sick for few days, then systolic Dysfunction
(dilated cardiomyopathy, S3, HF)
Cardiomegaly, tachy, Diffuse st elevation
Biopsy is gold standard
Supportive, treat HF - BASD

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Constrictive cardiomyopathy (pericarditis)

Pericardial effusion
Tamponade
Becks triad ect.

Thick Pericardium

Knock
Kussmaul
Pulsus paradoxus (pulse decreases on inspiration)

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Unstable patient equals (symptomatic)

AMS
CP
Hypotension
HF with a low pulse

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First degree block

BB,Dig, CCB
MI, Lyme
R far from P
Symptomatic Atropine pacemaker

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Mobitz 1 (wenke)

BB,Dig, CCB
MI, Lyme
longer longer drop
Asymptomatic no treatment
Symptomatic Atropine
pacemaker

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Mobitz 2

Structural heart disease
Some p’s dont get through
Symptomatic Brady Atropine
Trans pace
Permanent pacemaker

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3rd degree block

AV Dissociation
P’S and Q’s Don’t agree
Trans pacing
Permanent Pacemaker

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AFlutter

CHA2DS2 VASc
(anticoagulation same as non valve afib)
Stable - vagal, BB, CCB
Cardiovert (sync) if unstable)
Ablation definition

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Afib

Paroxysmal, persistent, permanent, Lone
Holter or loop if not all the time
GIve BB, CCB (Dilt etc), can use dig
unstable = cardio vert
—TEE first
afib over 48 hours
—DOACs for 3 weeks then cardiovert, then doac for 4 weeks

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CP Meds

ASA
BB or CCB
Statin
Nitro

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angina meds

BANS

BB
ASA
Nitro
Statin

MONA

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STEMI Leads and Vessel and Heart Region
- Anterior Wall

V1-V4
LAD

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STEMI Leads and Vessel and Heart Region
-V1-V4

Anterior wall
LAD

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STEMI Leads and Vessel and Heart Region
- LAD

Anterior wall
V1-V4

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STEMI Leads and Vessel and Heart Region
-Septal

V1-V2
Proximal LAD

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STEMI Leads and Vessel and Heart Region
-V1-V2

Septal
Proximal LAD

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STEMI Leads and Vessel and Heart Region
- Proximal LAD

V1-V2
Septal

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STEMI Leads and Vessel and Heart Region
- Lateral Wall

I, AVL, V5-V6
Left Circumflex

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STEMI Leads and Vessel and Heart Region
- I, AVL, V5-V6`

Left Circumflex
Lateral Wall

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STEMI Leads and Vessel and Heart Region
- Left Circumflex

I, AVL, V5-V6
Lateral wall

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STEMI Leads and Vessel and Heart Region - Inferior Wall

II, III, AVF RCA

STEMI Leads and Vessel and Heart Region - II, III, AVF

RCA Inferior

STEMI Leads and Vessel and Heart Region - RCA

II, III, AVF Inferior

CHA2DS2VASc

CHF =1 HTN =1 AGE >75 =2 DM = 1 Stroke = 2 Vascular disease = 1 Age 65-74 = 1 Sex - female = 1 2 or more gerts anticogs NOAC

Pericardial knock

Constrictive pericarditis

Aortic stenosis

Pulsus Parvus and tardus (low and slow) Preload dependent Give fluids if symptomatic

Positive ECG finding in Stress test

ST depression

Aortic dissection greatest risk factor

HTN

Prinzmetal

Transient ST Elevation Angina gets better with nitro

Hypertensive emergency Med

Labetalol

Test for LBBB in setting of CAD

Adenosine radionucleotide test

Long standing HTN can cause what heart sound

S4 (stiff ventricle)

Acute pulmonary edema 1st line meds

Lasix Nitro O2 Morphine Levophed (norepi) ACE if those fail

Hypertrophic Cardio myopathy First line

Arrhythmia seen in MVP

PVC's

ACE effects

Reduce preload and afterload does not affect inotropic activity (contraction)

Coarctation findings

3 sign on CXR Murmur heard in back BP different in upper/lower extremities

What does IABP do for BP and CWP

maintains SBP reduces Cap Wedge pressure

Most common S/S of MI

Substernal CP diaphoresis

MC S/S of constrictive pericarditis

JVD

Syndrome X

CP with exertion but clean cath

Most common site of acute arterial occlusion

Common femoral Artery

Anti coag for new onset afib over 48 hrs (non valvular)

Anti coags for 3 weeks TEE Cardiovert Anticoag for additional 4 weeks

Common sign in cardiogenic shock

Distended neck veins

Valve problem commonly associated with STEMI

Mitral Regurg

What happens with verapamil in CHF

can worsen CHF

Gold standard for DVT

Venography

What STD is risk factor for aortic aneurysm

Syphilis

Carvallo sign

Tricuspid regurg increases with inspiration

Med contraindicated with peripheral claudication

what is seen on echo in amyloidosis

Speckled pattern

Things linked to Multi focal atrial tachycardia

COPD Hypoxia Pulmonary HTN

First sign in mitral stenosis

dyspnea

Most common valve in AFIB

Mitral Valve

Digoxin Side effects

Yellow/blue vision changes

Digoxin ECG changes

ST Depression PVC's

Valve problem with hemoptysis

mitral stenosis

Best diuretic for CHF and kidney issue

Loop

Ebstein anomaly Valve

Tricuspid Abnormally located or shaped tricuspid valve

Stable WPW first line

Vagal

Orthodromic

Orthodromic Narrow Adenosine

Antidromic

Antidromic Wide Procainamide Avoid Adenosine, BB, CCB, AV node blockers

Med to keep PDA open

Prostaglandin

most common cause of syncope

vagal

HTN Urgency treatment inpatient or out patient?

outpatient (no benefit shown for rapid BP lowering)

How to confirm Inferior MI

Right sided ECG (no nitro or morphine) Preload dependant

Heart issue that can be caused by kawaski

Aortic aneurysm

most common Congenital heart defect

VSD

to ways to stratify ACS

Heart Score TIMI

Bacteria of non IVDU without valve replacement With poor dental

Strep Viridians

Bacteria of non IVDU without valve replacement no dental issues

Staph aureus

Rubella is associated with what valve issue

Pulmonic stenosis

PAD tx

stop smoking exercise ASA pletal (reeval in 3 months) ABI to diagnose <0.9 bad (normal 1.2-1.0) NO BB

MCC of aortic regurg

bicuspid aortic valve

MCC of mitral valve disease

myxomatous degeneration (MVP)

Myocarditis MCC

MCC Viral - coxsackie

Myocarditis S/S

Fever Viral prodrome Cardiomegaly S3 URI s/s

Long standing pericarditis can lead to?

Afib

what does a tetralogy of fallot patient need

PDA

Aortic regurg sound

Paradoxical splitting of S2 All Weird named murmurs

Pericardial effusion heart shape

water bottle

What can be seen in neck of tricuspid stenosis

Large A wave

ECG finding of tricuspid stenosis / regurg

Peaked P wave (P Pulmonale)

Key finding in carotid stenosis

Delayed carotid upstroke

What sound is decreased in mitral stenosis

Decreased S1 intensity

Tx for new onset AFIb with mitral stenosis

balloon valve commissurotomy

What is seen in aortic regurg in pulse pressure

Wide pulse pressure

What will atria look like in afib with chf

large left atrium

Kawasaki tx

ASA IVIG Steroids (IVIG first with high dose ASA) Goal is to prevent coronary artery aneurysm

MCC of kawasaki

Strep Pyogenes (GAS)

What is ivabrandine

SA node inhibitor used in CHF with HR over 90

CHF exacerbation first line

Diuretics Nitro

Eisenmenger

VSD L to R shunt That later becomes R to L shunt Cyanosis, Hypoxia, Fatigue Usually shows up in adolescence

Key finding of SSS or SND

Tachy brady

WHat can chagas lead to

Biventricular HF

What is conn syndrome

Primary Hyperaldosteronism (adrenal aldosteronoma) HTN Metabolic alkalosis Hypokalemia MANAGEMENT OF CONN SYNDROME • Surgical excision + Spironolactone (blocks aldosterone).

Pulmonary edema gets what med

ACE

ACE side effects

Hyperkalemia Hyperuricemia Cough Angioedema

HCTZ causes what in gout

increased uric acid

What med is contraindicated in Cocaine use

HTN Stages Normal

less than 120 / 80

HTN Stages Elevated

120-129 less than 80

HTN Stages High (stage 1)

130-139 80-89

HTN Stages High Stage 2

140 and up and/or 99 and up

HTN Stages Crisis

over 180 and/or over 120

HTN emergency

over 180 over 120 with EOD Brain, Eye, Heart, Kidney

HTN Urgency

Over 180 Over 120 No EOD

Post stent meds

SABA Statin Antiplatelet (DAPT) BB Ace

AAA screening

Abdominal US 65 and up Once

LBBB Ekg

L axis LVH (mitral regurg) Big floppy heart, S3

HOCM first line

BB (keep heart calm and slow) Then CCB, Then Dig S4 seen in hocm

Non dihydropyridine CCB

DI-VER cardio selective CCB Diltiazem Verapamil

dihydropyridine CCB

not cardio selective -dipines ie amlodipine

Murmurs that are blowing

Mitral and aortic regurg

most common ASD

ostium secundum

Ostium primum is linked to what

Fetal alcohol syndrome Downs

ASD sound

Split S2

Describe R to L shunt

Too much blood in atrium leads to R HF arrhythmia Pulmonary HTN

What is it if you give BB or Digoxin and the HR increases

Accessory pathway such as WPW

Amiodarone Side effects

Optic Neuritis THyroid Hepatitis Pulmonary Fibrosis

Afib tx with valve replacement

Warfarin

Afib Anti coag tx

DOAC Rivaroxaban Edoxaban Apixaban Dabigatran

Anti arrythmic meds Class 1 and 3

Used for Rhytm control

Anti arrythmic meds Class 2 and 4

Rate control

Anti arrythmic meds 1A

PDQ SE - Torsades, Drug incuced Lupus Used for WPW

Anti arrythmic meds 1b

Lidocaine Can be used for stable VT dont give with narrow complex SVT

Anti arrythmic meds 1C

Flecanaide, Propafenone last line for VT Used in AFib without stuctural heart disease

Anti arrythmic meds class 3

Amiodarone Eye, thyroid, pulm fibrosis, hepatitis Blue green skin

Anti arrythmic meds Class 4

non dihydrapyridien DI-VEr

Post Mi meds

BB ASA ACE Nitro Statin

Best BB for ACS

metoprolol

Entresto

Saccubatril and Valsartan Neprolysin Breaks down BNP ARB

What increase with Loops

Uric acid Hyperglycemia Na and K go down

Spironalactone Adverse effects

Potassium sparring met Acid Gynecomastia Hyper K

Acute exacerbation of CHF

LMNOP Lasix Morphine Nitro O2 Position and CPAP

HCTZ electrolyte

NA and k go down Uric acid, sugar go up

Why ar BB given carefully in DM

BB can mask Hyperglycemia

What meds dont you give for HTN and asthma

BB and ACE

Potassium goes and up and down with what electrolyte

Magnesium

Torsades refractory to mag

Overdrive pacing

Brugada can lead to what

V Fib

First sign of STEMI is STEMI Wave progression

Hyperacute t waves J point elevation ST elevation Q wave formation (loss of R) T wave inversion

pulmonary htn shows what axis

Right axis deviation

Major side effect of prostaglandin E1 (used to keep open PDA)

Apnea

Treatment for SSS

Pacemaker

MC sign of congenital heart defect

Basilar crackles peripheral edema

Holiday Heart

AFIB after drinking

MC s/s of ACS in the elderly

Dyspnea

Common drug contraindicated in HF

NSAIDS

Most common stemi vessel

RCA

Is coarctation of the aorta ductal dependent

Yes

Early morning chest pain is most likely what?

Prinzmetal

WHat EKG changes are seen in dilated cardiomyopathy

low voltage QRS

What can an extra cervical rib be an indicator of

Thoracic outlet syndrome

What medication for chronic stable angina increases coronary mortality

Short acting CCB

Hyperkalemia Progression in Ecg

Peaked T wave Widening QRS Flattening and then dropped p wave Sine wave - stretched out T wave

Fastest Cardiac biomarker

Myoglobin

PCI timeline

90 minutes If not give thrombolytics (up to 12 hours)

STEMI / NSTEMI Anticoag

Heparin

What Common med don't we use in ACS with COPD

Heart Score

History (none, suspicious, yes) ECG (none, nonspecific, significant) AGE (<45, 45-64, >65) Risk factors (none, 1-2, 3 or more) Troponin (normal, 1-3x normal, >3 times normal)

Cardiogenic shock pressor

Dobutamine Norepi Milrinone

Pulmonic stenosis Murmur

Wide split S2 (anyone other than infant)

Aortic valve fix

Not repaired always replaced TAVR

Lovenox, fondaparinux, rivaroxaban are excreted where

Kidney

Kidney disease anticoag

Heparin Warfarin

Liver disease anticoag

Lovenox

Pregnancy anticoag

Lovenox

Rheumatic fever tx

1.2 benzathine penicillin Q month until 21

Diagnostic of aortic dissection

Unstable TEE, TTE Stable CTA MRA

Cardiology PANCE Flashcards

(174 cards)