First Aid Cardio Flashcards
(96 cards)
1
Q
5 managements for acute CHF (pulmonary congestion) management
A
LMNOP
Lasix Morphine Nitrates Oxygen Position (upright)
2
Q
what is the class I NYHA?
A
no limitation of activity, no symptoms with normal activity
3
Q
for CHF, echo will show what 2 things?
A
- dec EF
2. ventricular dilation
4
Q
lab abnormalities in CHF?
A
BNP > 500 pg/ml
inc creatinine
dec sodium in later stages
5
Q
beta blockers should not be used during
A
decompensated CHF, but should be started once the pt is euvolumic
6
Q
what are the 2 fast arrythmia with narrow QRS?
A
SVT, A fib
7
Q
what are the 2 fast arrythmia with wide QRS?
A
torsade, V tach
8
Q
2 treatment options for SVT?
A
adenosine, shock
9
Q
2 treatment options for A fib?
A
rate (hrythm) control using beta blockers, CCB
shock
10
Q
2 treatment options for Torsade?
A
Mg, shock
11
Q
2 treatments for V. tach?
A
amiodarone, shock
12
Q
in A fib, how do you assess for anticoagulant treatment?
A
using CHADSS score (if more than 2, needs anticoagulant)
CHF HTN Age DM Stroke Storke
13
Q
treatments for second degree (mobitz 1, wenkebach) AV block?
A
atropine (only works for 1st and 2nd degree AV block)
14
Q
why shouldn’t you give atropine for mobitz 2?
A
it can go into 3’ AV block
15
Q
in A fib, under what situation would you cardioconvert the pts?
A
in new onset (less than 48 hrs) or TEE shows no Lt. atrial clot or after 3-6 hrs wks of warfarin treatment with INR of 2,3
16
Q
gold standard for diagnosing aortic dissection?
A
CT angiography (MRA for contraindication)
17
Q
treatment for aortic regurge?
A
vasodilator therapy (dihydropyridines or ACEIs) for isolated aortic regurgitation until symptoms become severe enough to warrant valve replacement
18
Q
treatments for mitral valve stenosis?
A
antiarrhythmics (beta blockers, digoxin) for symptomatic relief
mitral balloon valvotomy and valve replacement are effective for severe cases
19
Q
clinical presentations of cardiac tamponade?
A
Beck’s triad: hypotension, distant heart sound, JVD
- fatigue
- dyspnea
- anxiety
- tachycardia
- tachypnea
20
Q
3 treatment options for cardiac tamponade?
A
- aggressive IV fluids
- urgent pericardiocentesis
- decompensation
21
Q
typical presentations of dilated cardiomyopathy?
A
often presents with gradual development of CHF symptoms
22
Q
clinical signs for dilated cardiomyopathy?
A
- displacement of Lt. ventricular impulse
- JVD
- S3/S4 gallop
- mitral/tricuspid regurge
- LBBB
23
Q
what drugs should be avoided for dilated cardiomyopathy caused by CHF?
A
CCBs
24
Q
definitions of dyslipidemia?
A
LDL > 130 mg/dl
HDL
25
how is hypertensive emergency diff from urgency?
end organ damage (altered mental state, retinal hemorrhage etc)
26
DOC for hypertensive emergency?
IV (nitroprusside, labetalol, nicardipine)
27
DOC for hypertensive urgency?
oral antihypertensive (beta blockers)
28
goal of lowering BP in hypertensive emergencies?
lowering mean arterial pressure by no more than 25% over the first 2 hours to prevent cerebral hypoperfusion or coronary insufficiency
29
how do you diagnose malignant hypertension?
on the basis of progressive renal failure and/or encephalopathy with papilledema
30
best next step management for abdominal pain in women who are in childbearing ages?
pregnancy test
31
dx for abdominal pain + syncope or shock in older pts?
abdominal aortic aneurysm (AAA)
32
dx for hypotension, abdominal pain radiating to the back, significant hx of HTN and DM?
AAA
33
best next step management for elderly female, and diabetic, acute coronary syndrome with abdominal pain?
ECG to rule out ischemia
34
1st intervention for pt with dyslipidemia with no known atherosclerotic vascular dz?
12 wk trial of diet and exercise
35
1st line therapy for viral/idiopathic pericarditis?
high dose NSAIDs
36
in what situation do you do pericardiocentesis with acute pericarditis with pericardial effusion?
pericardial effusions without symptoms can be monitored, but evidence of tamponade requires pericardiocentesis with continuous drainage as needed
37
which drug is contraindicated to dilated cardiomyopathy?
NSAIDs, b/c they worsen afterload by blocking prostaglandin synthesis and by counteracting the benefits of ACE inhibitors
38
Beck triad for cardiac tamponade?
hypotension, distant heart sound, distended neck veins
39
clinical signs for restrictive cardiomyopathy?
1. includes Rt sided more than Lt sided heart failure
2. JVD
3. hepatic congestion
4. ascites
5. peripheral edema
40
key tool to diagnose restrictive cardiomyopathy?
echocardiography
41
key findings of hypertrophic cardiomyopathy?
systolic ejection crescendo-decrescendo murmur that inc with dec preload (Valsalva maneuver or standing)
42
2 drugs that have mortality benefit in angina treatment?
ASA, beta blocker
43
what are the initial treatment for STEMI?
aspirin, oxygen therapy, nitrates for cardiac discomfort, morphine, and beta blockers
44
treatments for USA and Non STEMI?
1. ASA
2. O2
3. IV nitroglycerin
4. IV morphine
5. beta blockers as hemodynamics allow
45
once medical treatments are done for possible USA or Non STEMI pts, what is the best next step?
admit to the hospital and monitor until acute MI is ruled out by serial cardiac enzymes
46
for pts with chest pain refractory to medical therapy, a TIMI score of more than 3, a troponin elevation, or ST elevation more than 1 mm, next best step?
1. give IV heparin
2. schedule for angiography and possible revascularization (percutaneous coronary intervention, PCI or coronary artery bypass graft, CABG)
47
4 indications for CABG instead of PCI?
1. unable to perform PCI (diffuse dz)
2. Lt main coronary artery dz
3. triple vessel dz
4. depressed ventricular function
48
in cocaine induced chest pain what drug is contraindicated? why?
the etiologies of cocaine induced chest pain is from simple coronary vasospasm to MI, beta blockers decrease HR and cotractility thus lead to unopposed alpha mediated HTN which can exacerbate the coronary vasospasm
49
first best step for tension pneumothorax?
1. insert large bore needle (14 gauge IV angiocatheter) into the 2nd intercostal space at the midclavicular line to decompress
2. then place a chest tube
50
indications for fibrinolytic therapy?
1. acute persistent chest pain
| 2. time to therapy 2-3 mm in the chest leads and 1 mm in the limb leads
51
what is the diagnostic criteria for HTN?
1. three bp measurements (each at least 1 wk apart)
| 2. > 140 and > 90
52
COPD is associated with what type of dysrhtymia?
multifocal atrial tachycardia
53
what are the 2 causes of multifocal atrial tachycardia?
1. COPD
| 2. hypoxemia
54
DOC for heart failure refractory to therapy with an ACE inhibitor, diuretic, and b blocker?
digoxin
55
DOC for cardiogenic shock?
NE
56
what is pulsus paradoxus and in what path is this seen?
a fall in systolic bp more than 10 mmHg during inspiration
cardiac tamponade
57
what is the ejection fraction in restrictive cardiomyopathy?
normal 55% (diastolic dysfunction)
58
what would be the pul capillary wedge pressure in distributive shock secondary to sepsis?
low due to mild hypovolemia and capillary leak
59
two signs of acute MI that require immediate revascularization?
Lt BBB, ST elevation
60
gold standard for diagnosing aortic disruption?
CT angiography
61
pericarditis can be complicated by what 3 conditions if left untreated?
1. cardiac tamponade
2. recurrent pericarditis
3. pericardial constriction
62
what renal path can cause pericarditis?
uremia with chronic renal failure
63
what are the two of the 3 followings that can help diagnose pericarditis?
1. pleuritic chest pain
2. pericardial friction rub
3. widespread ST segment elevation of ECG
64
treatment of pericarditis caused by uremia?
dialysis
65
what type of statin treatment should you be using for pts with hx of CAD, CVA (cardiovascular accident), PAD (peripheral artery dz)
high intensity statin
66
1st intervention for dyslipidemia?
12 wk trial of diet and exercise
67
what are the LDL and HDL values for dyslipidemia?
LDL > 130 mg/dl
| HDL
68
side effects of lidocaine?
slurred speech, confusion, tremor, personality, and mood changes, and hallucinations
69
characteristics of ECG of pulmonary embolus?
1. nonspecific sinus tachycardia
| 2. Rt. ventricular strain pattern of S1Q3T3
70
what is the definitive therapy for STEMI?
PCI or thrombolytic agent
71
2 ECG changes in STEMI?
LBBB, ST elevation
72
describe the sequence of ECG changes in STEMI?
peaked T waves --> ST elevation --> Q waves --> T wave inversion --> ST segment normalization --> T wave normalization over several hrs to days
73
4 pt groups that will have atypical or clinically silent MI?
women, diabetes, the elderly, and post heart transplant pts
74
treatments for A fib?
1. for hemodynamically stable pts --> rate control with a b blocker or CCB
2. for hemodynamically unstable pts --> immediate cardioversion and give anticoagulation for thromboembolic risk
75
what is non-systolic dysfunction?
dec ventricular compliance with normal systolic function (normal EF)
76
DOC for CHF due to non-systolic dysfunction (normal EF)?
1. diuretics --> 1st line of therapy
| 2. b blockers --> to maintain rate and BP
77
Is digoxin useful for CHF pts with non-systolic dysfunction (normal EF)?
No
78
manifestations of digitalis toxicity?
1. cardiac dysrhythmias
2. GI distress
3. dizziness
4. weakness
5. headache
6. change in mental status
79
what is the end diastolic volume in the diastolic heart failure?
normal or decreased end diastolic volume, due to the inability of ventricle to relax and properly fill during diastole
80
def of nonsystolic (diastolic) HF?
dec ventricular compliance with normal systolic function (dec end-diastolic volume or high end-diastolic pressure)
81
4 indications for surgery in pts with peripheral vascular dz?
1. lifestyle interference
2. rest pain
3. nonhealing ulcers
4. disabling claudication
82
most important risk factor for coronary artery dz?
smoking
83
what is the def of shock?
inadequate tissue level oxygenation to maintain vital organ function
84
4 types of shocks?
1. hypovolemic
2. cardiogenic
3. obstructive
4. distributive (septic, anaphylactic, SIRS, neurogenic)
85
5 causes for hypovolemic shocks
1. trauma
2. blood loss
3. dehydration with inadequate fluid repletion
4. third spacing
5. burn
86
4 causes for cardiogenic shock
1. CHF
2. arrhythmia
3. structural heart dz (severe mitral regurge, VSD)
4. MI
87
3 causes for obstructive shock?
1. cardiac tamponade
2. tension pneumothorax
3. massive pulmonary emoblism
88
name 4 types of distributive shocks
1. septic
2. anaphylactic
3. SIRS
4. neurogenic
89
etiologies for acute AF?
PIRATES
```
Pulmonary dz
Ischemia
Rheumatic heart dz
Anemia/atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
```
90
characteristics of septic shock?
1. dec systemic vascular resistance
2. inc cardiac output (b/c septic shock = high output shock)
3. inc mixed venous oxygen content due to high flow state
91
characteristics of cardiogenic shock?
1. high systemic vascular resistance
| 2. high pulmonary capillary wedge pressure
92
major causes for distributive septic shock
bacteremia, especially gram -
93
treatments for distributive septic shock?
1. broad spectrum antibiotics
| 2. pressors (norepinephrine or dopamine)
94
what is the goal of central venous pressure in distributive septic shock?
give fluid until CVP of 8
95
what is the cutoff of PCWP for cardiogenic pulmonary edema?
more than 12
96
most effective DVT prophylaxis?
early ambulation
