FINAL Flashcards

Question

duke criteria

Answer 1

-2 major, 1 major with 3 minor, or 5 minor -possible dx- 1 major with 1 minor or 3 minor -MAJOR -2 + blood cultures -TTE echo- vegetations, abscess -auscultation of new regurgitation -MINOR -heart condition or IV drug use -fever -vascular- jane way, emboli, septic pulmonary infarct, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage -immune- osler, glomerulonephritis, roth, rheumatoid factor -1 + blood culture or serologic evidence

Answer 2

-dx- TEE -tx- -2 broad spectrum IV antibiotics -> until infectious cause identified -SURGERY INDICATIONS: -prosthetic valve -HF -pts refractory to medical therapy -abscess formation -conduction disturbance

Answer 3

-primary- viral -secondary- toxin, meds, drugs, chemo, radiation, inflammatory ds -HF/shock symptoms -pericardial friction rub -dx- echo, MRI, bx -tx- -aggressive support if shock -HF symptoms: ACE, beta blocker -treat underlying cause

Answer 4

-< 2 weeks -can lead to effusion -dx- EKG with ST elevations, sharp pain worse while supine, auscultation -kussmaul sign- increase JVD on inspiration -echo -CT or MRI if neoplasm -tx- -less activity -NSAIDS -colchicine -dresslers- ASA + colchicine -uremia- dialysis

Answer 5

-autoimmune- lupus, RA -uremia- dialysis -viral illness -lymes -dresslers syndrome -rheumatic fever -cardiac procedures -hemorrhage -constrictive- radiation, tb

Answer 6

-tamponde- >15mmHg -> RV collapse -JVD- collapse of IVC, SVC, RV -beck triad- muffled heart sounds, hypotension, JVD -tachycardia -pulsus paradoxus- decrease BP >10 during inhalation -dx- EKG (low voltage and electrical alternans) -US/echo- fluid, RV collaspe -tx -no hemodynamic compromise -> monitor (echo) and volume expansion -> bolus -procedural- percutaneous pericardiocentesis (tap) -surgical: trauma, purulent, pts with coagulopathy or need for bx -surgical with window- trauma with hole, chronic effusions, pts who decompensate

Answer 7

-PSVT: MC AV node reentry -atrial, multifocal, junctional -caffeine + alc -ischemic heart ds -post MI -bear down -> adenosine or amiodarone (wide) -> cardioversion if unstable -prevent with beta blockers and CCB -AFIB: -alc + withdrawl -ischemic heart ds -mitral stenosis -cardiomyopathy -AFLUTTER: -COPD* -cardiomyopathy -atrial septal defect -same tx as afib -Ablation can be done for all

Answer 8

-<48 hrs -> synchronized cardioversion ->48hrs -> anticoagulation + rate control for 3 weeks -beta blockers, CCB, digoxin -TEE- high risk -ablation -CHADSVASC: -CHF -Age 65-75 (1 point), >75 (2 points) -DM -prior stroke- 2 points -vascular disease- CAD, PAD -HTN -female- +1 -0- ASA, none -1- ASA or full anticoagulation ->2- full anticoagulation

Answer 9

Decreasing INR: -Leafy green vegetables: spinach, broccoli, brussels sprouts -Phenytoin, phenobarbitol -St. Jonhs wart- OTC -Increasing INR: -Alcohol -Antibiotics: quinolones, amoxicillin, metronidazole -Steroids -Amiodarone -if INR Is too high -> risk bleeding event

Answer 10

-HTN (uncontrolled) -abnormal liver or renal -stroke -bleeding (past major event) (labile INR) -elderly -drugs or alcohol

Answer 11

-pulseless tx- ACLS -stable sustained- synchronized cardioversion + antiarrhythmic -unstable sustained- synchronized cardioversion -nonsustained-beta blocker therapy -treating underlying cause: -myocardial ischemia- catheter -cardiomyopathy- echo -electrolytes -medication -torsades- magnesium -> synchronized cardioversion if there is pulse

Answer 12

-ischemic heart disease -defib -CPR -ACLS- defib -> epi -> defib -> epi -amiodarone IV- 24 - 28 hrs following conversion -ischemic eval -AICD placement

Answer 13

-sick sinus syndrome -myocardial scarring -d/c med if its causing it -tx- pacemaker -BBB- 3 small boxes .12 -tx underlying cause -RBBB- right pressure -LBBB- myocardial scarring/ischemia- LAD* -tx- r/o underlying disease -AV block: -age -coronary artery disease MI -secondary diseases

Answer 14

-2ndary- renal, coarction of aorta, endocrine -goal- <140/90 -> DM <130/80 -diuretics -renal comorbid- ACE or ARB -CAD- beta blocker + ACE or ARB -HF- beta blocker, ACE or ARB, diuretic -dx- EKG (LV hypertrophy), labs, urine

Answer 15

-ACE (pril)- vasodilation, hyperkalemia, cough, angioedema, renal -ARB (sartan)- vasodilation, decrease preload/after load -beta blocker -CCB- peripheral edema, lightheadedness -DHP- vasodilate - amlodipine -nonDHP- contraction - verapamil -alpha blockers- vasodilate -> orthostatic hypotension* -diuretics- hypokalemia, hypotension

Answer 16

-urgency- >180/>120 without end organ damage -gradual decrease in MAP -> beta blocker, CCB, ACE -emergency- >220/>120 with end organ damage -papilledema, unstable angina, MI, CHF… -usually caused by 2ndary things or noncompliance -ASAP tx- reduce MAP by 25% in 1-2 hours -> can lead to ischemic CVA -IV: esmolol, labetalol, nitroglycerine

Answer 17

-<90/<60 -vasodilation? -> alpha blockers -cough to increase preload -orthostatic hypo- decrease 20/10 -med tx- fludrocortisone or midodrine

Answer 18

-systolic BP <90 with urine output <20ml/hr -caused by acute MI** and other cardiac emergency events -tx: ABCs (2 large bore needles, central line arterial line) -> vasopressors (dopamine, norepinephrine) -balloon pump, ecmo, underlying cause: -Acute MI- aspirin, heparin, nitrates -coronary angiogram -bypass, stent -cardiac tamponade- pericardiocentesis -arrythmia- ACLC

Answer 19

-high output- compensation -> anemia, hemochromatosis, pagets, pregnancy, thyrotoxicosis, AV fistula -MC- low output -> cardiomyopathy, valve stenosis -systolic- MC CAD - EF < 45% -diastolic- MC left hypertrophy from chronic HTN -> restrictive cardiomyopathy -diastolic preserves LVEF- impaired filling -left vs right

Answer 20

-BNP -imaging- cardiomegaly, B lines, effusions, echo*, stress test (ischemia), angiogram -> EKG not really -classify based on symps and tx based on EF -Class 1 (normal), 2 (slight limit), 3 (marked limit), 4 (symp at rest)

Answer 21

-diuretics -> loop, thiazide, aldosterone antagonist (add on) -ACE or ARB if ACE contraindicated* -beta blockers -digoxin- not first line -sacubitril vasartan (encresto) - neprilysin inhibitor -> increase BNP - for systolic HF -ICDs- <35% EF -LVADs- bridge to transplant

Answer 22

-MC- dilated: systolic -HF symptoms -alcohol -CAD* -S3 and S4 -sudden death -restrictive (diastolic): -collagen -> less relaxation -> bad filling -right HF symptoms -EKG low amplitude -endomyocardial bx -tx underlying cause -HF tx -defib- AICD -cardiac transplant

Answer 23

-systolic ejection murmur at lower left sternal border -> increase with valsalva and standing -> decrease with squatting and laying down -increase carotid pulse -echo- DX of choice -tx- avoid exercise -beta blockers or CCB -septal myomectomy -alcohol septal ablation -aicd

Answer 24

-tobacco, HTN, DM -metabolic syndrome: -3 of more of the following!!!: -Triglycerides > 150 mg/dL -HDL < 40 mg/dL men, <50 mg/dL women -Fasting blood glucose > 110mg/dL -Abdominal obesity -HTN -Family history of coronary artery disease -Obesity

Answer 25

-Mixed hyperlipidemia -Hypercholesterolemia- genetic -Hypertriglyceridemia- pancreatitis -asymptomatic -xanthoma

Answer 26

-PSK9 inibitors: mabs -> -lower LDL -familial hypercholesterolemia and CAD -headache, diarrhea, URI -niaotinic acid: -lower triglycerides and increase HDL -flushing, itch, N/V, skin on fire -fenofibrates: -gemfibrozil -lowers triglycerides -GI upset -bile acid binding resins: -cholestyramine -lowers LDL -> not triglyceride -last resort drug -GI side effect

Answer 27

-low perfusion of myocardium -MC- coronary artery disease -dissection, vasospasm (cocaine + prinzmetals) -typical (men) vs atypical (women, old, DM, immunocompromised): -jaw, back of right shoulder -radiates to right or both arms and back -stable vs unstable: -stable: -<3 mins -predictable -relieved with sublingual nitroglycerin -unstable: -grouped with acute coronary syndrome -indicated stenosis that has enlarged -less response to nitroglycerin -1 or more: -angina at rest -new onset of angina -increasing pain in stable pts

Answer 28

-MC in females -75% with atherosclerotic lesion -early morning -exercise capacity reserved -ST elevations with neg troponins -tx- CCB, nitro -> just a vasospasm -cocaine MI- ST elevation and + troponin => CCB, ASA and heparin until CAD is ruled out

Answer 29

-EKG- normal in 25% -> ST depressions (nonspecific) -stress test- at least 2 leads ST depression -> + test -stress test can be done with SPECT, nuclear, pharm use if unstable -echo- wall abnormalities, EF -cardiac catheterization (angiography) -> DEF DX (high timi/grace score)

Answer 30

-1. 1st line for stable angina- beta blocker (increase O2)-> DO NOT USE FOR PRINZMETAL -2. 2nd line- CCB non-DHP -> FIRST LINE FOR PRINZMETAL -3. nitrates- -angina persisting with monotherapy -nitroglycerin- episodic -isosorbide and hydralazine- long acting -SE- flushing, orthostatic hypotension -cant gives to pts with ED -balloon angioplasty -drug eluding stents -> 12 months need aspirin and clopidogrel (antiplatelet) -bare metal stents -> 1 month of dual antiplatelet therapy (DAPT) -bypass (CABG): -triple vessel ds with >70% stenosis of each vessel -left main coronary disease > 50% stenosis -YOU CAN NEVER PUT A STENT IN LEFT MAIN CORONARY unless the other option is death

Answer 31

-1. unstable angina- depressions and - troponins -2. NSTEMI -> partial thickness necrosis - depressions and + troponins -3. STEMI- full thickness necrosis - 2 elevations and + troponins -MC cause of MI- thrombosis -atypical chest pain -hyper or hypotension -dx: -EKG -3 sets of enzymes every 6 hours

Answer 32

-Morphine- pain -Oxygen -Nitroglycerine (NTG) -Aspirin -> use adenosine diphosphate inhibitor (antiplatelet) if allergic (clopidogrel, ticlopidine, prasugrel) -> caution if CABG in 7 days -Beta blocker -Statins- reduce further events (CAD) -Unfractionated heparin or low molecular weight heparin (LMWH) -unfractionated- less thrombus and fibrin -LMWH- inactive factor Xa ASAP REPERFUSION…

Answer 33

-PCI > thrombolysis -door to cath = 90 mins -DES (12 months) or BMS (1 month) -thrombolysis: -door to thrombolytic = 30 mins -TPA- ateplase, reteplase, teneceplase -absolute CI: Previous hemorrhagic CVA, CVA within the last year, Intracranial neoplasm, Active internal bleeding, Suspected aortic dissection, Suspected aortic dissection, Trauma or major surgery < 2 weeks, Active internal bleeding -relative CI- trauma within 2-4 weeks, surgery within 3 weeks, HTN, internal bleeding, pregnant, PUD

Answer 34

-TIMI scale – Thrombolysis In Myocardial Infarction -GRACE – Global Registry of Acute Coronary Events -Low score = conservative treatment -Antiplatelet therapy -Anticoagulation therapy -High score = invasive treatment -> Cardiac angiogram/angioplasty