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PLE REVIEWER > IM Cardio > Flashcards

IM Cardio Flashcards

(59 cards)

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1
Q

Initial diagnostic tests for chronic coronary syndrome

A

Ecg

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2
Q

Pharmacologic agent for stress test used for Chronic coronary syndrome

A

DAD
Dobutamine
Adenosine
Dipyridamole

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3
Q

Definitive test for chronic coronary syndrome

A

Coronary angiography

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4
Q

First line and second line intervention for chronic coronary syndrome

A

1st line : BBB, CCB

2nd line: long acting nitrates, ivabradine, nicorandil, trimetazidine

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5
Q

Drugs for prevention of event in CCS and their MOA (4)

A

Aspirin - cox 1 inhi
Clopidogrel - p2y12 inhi
Statin - HMGcoA reductase inhi
ACEi /ARB - RAAS inhi

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6
Q

Drugs for relief of angina

A

Bb - decrease hr,
Ccb - vasodi, dec PVR, nodal inhi ( for nondihydropyrines)
Nitrate - venous vasodilator, coronary arteriolar dilator
Ivabradine - sinus node lf channel inhi
Nicorandril - stimulates k adenosine triphosphate
Trimetazidine - 3 ketoacyl coA inhi, anti ischemic metabolic modulator

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7
Q

Indicatios for CORONARY ARTERY BYPASS GRAFT SURGERY

A

left main coronary artery disease
3 vessel + LVEF <50% or diabetes
2 vessel including Left descending coronary artery

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8
Q

Indication for Percutaneous Coronary Intervention

A

Single vessel disease

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9
Q

Definitive management CCS

A

PCI percutaneous coronary intervention

Coronary Arteru Bypass Graft surgery

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10
Q

Sudden onset cheat pain, increasing in intensity , associated with diaphoresis, shortness of breath
Usually lasting for more than 30 mins and does not relieved with reat, nitroglycerin or meds

A

ACS acute coronary syndrome

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11
Q

Diagnostic procedure of choice for ACS

A

12L ECG

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12
Q

Heart wall affected when ecg findings are seen on

1) v1-v2
2) v3-v4
3) v5-v6
4) II, III AVF
5) I AVL

A

1) septal - LAD
2) anterior- LAD
3) Lateral - Lcx
4) Inferior wall - 80 RCA, 10 lcx, 10 both
5) high Lateral - Lcx

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13
Q

Effect of

1) james reflex
2) bezold jarish reflex

A
  1. James - high HR, BP

2. bezold Jarish - decrease HR. BP

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14
Q

Criteria for STE ACS

For NSTE ACS

A

STE ACS (infarct)
V1-V6 : 1mm elevation / 1 small box
I avL, II III avF : 5mm elevation /5 small box

NONSTE ACS -(ischemia)
ANY 2 contigous LEADS
ST DEPRESSION 1mm/1small box
T wave inversion 5mm/5small box

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15
Q

Antiplatelet therapy

A 
Aspirin 120-325
Clopidogrel 300-600 the 75 OD
Prasugrel 60mg then 10 0D /5mg OD
Ticagrelor 180 mg then 90mgBID
Cilostazol 100mg BID
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16
Q

Adjunctive therapy

A

Acei arbs : captopril 25mg thenn75 1/4 tab q8
Bb : metoprolol 50mg 1/2 tab q6
Statin : atorvastatin 40-80 mg OD / rosuvastatin 20-40mg OD
Heparin- target PTt 2x control / enoxaparin 1mg/kg q12
Nitrates : ISDN /NITROGLYCERIN
Lactulose
PPI

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17
Q

Management for
STE ACS
NSTE ACS

A

Ste acs
Urgernt revascularization
pci

nste acs
Primarily medical
Unless there are presence of riak factora
1) refrac chest pain
2) persistent ST Elevation
3) ventricular tachycardia
4) hemodynamic instability
5) signs of heart failure
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18
Q

Diagnostic to distinguish STE vs Nste

A

Cardiac biomarkers

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19
Q

Typical ECG of NSTE

A

ST depression, T wave inversion, transient ST elevation

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20
Q

1st cardiac marker to be elevated
Specific sensitive and preferred markers for myocardial necrosis
This only stays elevated foe 1-2days
1-2weeis elevation
Best to detect a reinfarction a few days after the initial infarction

A

1) myoglobin
2) troponin
3) ckmb
4) troponin
5) ck mb

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21
Q

TIMI RISK SCORE FOR NSTE ACS

A 
*1 point each category
Age more than or equal to 65 
More than or equal to 3CAD risk factors
Known CAD (50%stenosis)
Aspirin use within past 7 days
Severe angina in last 24hrs
Elevated cardiac markers
St deviation >0.5mm
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22
Q

High risk score for TIMI

Treatment for oatient having high risk TIMI

A

> / = 3 points (13% mortality)
Early invasive strategy followingbtreatment with anti ischemic and antithrombotic agents, angiography is carried out within 48 hours followed by PCI or CABG

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23
Q

Standard anti ischemic therapy

A 
Bed rest
Supplemental o2 if o2 sat is less than 94
Nirtates and sublingual IV *
Beta blockers *
CCB * 
Ace arb*
Morphine 2-5 mg IV
HIGH intensity statins : atorvastatin 40 - 80mg or rosuvastatin 20-40 mg

*contraindicated if ot has SBp of less than 90mmhg or more than 30mmgh from. Baseline

Bb and CCB are contraindicated if patient have pr interval of more than 0.24 sec or with high gradeAV BLOCK IN THE ABSENCE of pacemaker

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24
Q

Pathophy of STEMI

Study These Flashcards
A

Rupture of plaque

25
Txt for v. Fib
SCREAM Shock Asynchronous cardioversion or defib 360j monophasic Biphasic 200j Cpr Epinephrine 1mg every 3 - 5 mins AMiodarone 200 mg IV bolus
26
Most common arrhythmia associated with STEMI
V. Fib
27
1) Most common cause of OUT HOSPITAL death from STEMI 2) most common cause of IN HOSPITAL death from STEMI 2) what will you suspect if the patient develops or presents with new murmur 4) if the the patient develops pain radiating to either trapezius muscle, what does disease entity the patient have
1) Vfib 2) pump failure 3) free or septal wall rupture and acute mitral regurgitation 4) pericarditis
28
Scoring used for ST SEGMENT ELEVATION MI
Killip Scoring Class 1 - no rales or signs of pulmo congestion Normal bp Class 2 - moderate heart failure, bibasal rales Normal BP S3 gallop Tachypnea or signs of right sided CHF ( venous and hepatic congestion Class 3 - severe heart failure, mid basal rales and pulmo edema Normal BP S3 and S4 Class 4 - shock with SBP < 90 mmhg and evidence of peripheral vasoconstriction Peripheral cyanosis Mental confusion and oliguria
29
Management for STEMI
General approach for STEMI 1) referfusion therapy ( primary goal of management) via thrombolysis or PCI within 12 hours 2) pharmacologic approach same with NSTEMI For inferiror wall STEMI IN THE ABSENSES OF RV INFARCTION : BB are contraindicated If with RV INFARCTION : BB and nitrates are contraindicated
30
How to determine the presence of RV INFARCT
right ECG V3-V6R
31
First Medical Contact time to device attachment in patients seen in PCI CAPABLE HOSPITAL FMC- Device time for patients seen in NON Pci capable hospital If the FMC - Device time for the patient above cannot be meet, what is the best next step
32
This is the preferred therapy for patients with EARLY PRESENTATION < 3 HRS of ONSET of symptoms, invasive therapy is not available, and if there is delay to invasive therapy (prolonged transport and fmc-d > 120 mins IF FMC-D time is = 120 mins, high riak STEMI ( cardiogenic ahock killip >/= 3), contraindications with fibrinolytic, late presentation (symptom onset >3 hours), diagnosis of STEMI is in doubt
FIBRINOLYSIS / THROMBOLYSIS | INVASIVE THERAPY
32
This is the preferred therapy for patients with EARLY PRESENTATION < 3 HRS of ONSET of symptoms, invasive therapy is not available, and if there is delay to invasive therapy (prolonged transport and fmc-d > 120 mins IF FMC-D time is = 120 mins, high riak STEMI ( cardiogenic ahock killip >/= 3), contraindications with fibrinolytic, late presentation (symptom onset >3 hours), diagnosis of STEMI is in doubt
FIBRINOLYSIS / THROMBOLYSIS | INVASIVE THERAPY
33
Clear contraindications for Thrombolysis
MANS C ``` MARKED Hypertension SBP >180 mmhg and or DBP >110 mmhg Activw internal bleeding Non hemorrhagic stroke Suspicion of Aortic Dissection Cerebrovascular hemorrhage anytime ```
34
Clear contraindications for Thrombolysis
MANS C ``` MARKED Hypertension SBP >180 mmhg and or DBP >110 mmhg Activw internal bleeding Non hemorrhagic stroke Suspicion of Aortic Dissection Cerebrovascular hemorrhage anytime ```
35
Relative contraindicationa for thrombosis
CR PP HHF KA Current use of anticoagulants Recent (<2 weeks) invasive or surgical procedure ``` Pregancy Prolonged (> 10 min) invasive or surgical procedure ``` Hemorrhagic ophthalmic conditiona Hx of severe hypertension that is currently adequately controlled For streptokinas : if agent had been recieved within the preceeding 5 days to 2 years Known bleeding diasthesis Active PUD
36
Lab parameters/procedue that will direct the management of ACS
12 L ECG
37
Feature that will lead you to proceed with urgent coronary angiogram possible angioplasty
Hypotension reuiring vasopressor support
38
Contraindicated in Patients with inferior wall STEMI W/O RV INFARCT WITH RV INFRACT
BB metoprolol BB + nitroglycerin
39
Mc cause of in hospital death after STEMI
Pump failure
40
Heard when AV VALVE CLOSES (mitral and tricuspid valve) Heard when SEMILUNAR VALVE CLOSES Heard heart sound that is due rapid flow of blood from atria into ventricles Due to late systolic filling of ventricle due to atrial contraction Patholgic in ADULT , normal in children Heardvin ventricular hypertrophy
``` S1 S2 S3 S4 S3 ```
41
Increased intensity of S1 is due to what condition Softer S1 is due to what conditions S2 increases during S2 decreases during S2 is best heard when
Increased s1 : early stage of MS, hyperkinetic states Softer s1: late stage MS, cobtractile dysfunction S2 increases during inspiration S2 decreases during expiration Best heard in supine condition 2nd LICS
42
Murmur that increases with inspiration Murmur that increases with expiration Murmur that increases with valsalva maneuver Murmur that decreases with valsalva maneuver Murmur that increases with squatting Decreases with squatting Increases with standing Decreases with standing
Respiration Increased IN INSPIRATION : RIGHT SIDED MURMUR TS, TR, PS, PR (TPRI) LOUDER IN EXPIRATION. : LEFT SIDED MURMUR AS, AR, MS, MR (MALE) Valsalva Increased : HOCM, MVP Decreased : SQUATTING (passive leg raising) increased: Decreased : HOCM, VMVP Standing Increased : Hocm, mvp Decreased: as, ar, ms, mr, vsd
43
Manifestation : syncope angina dyspnea, heart failure PE: diamond shaped crescendo descresendo midsystolic murmur at 2nd ICS R sternal border, weak and delayed pulse (pulsus parvus et tardus) Best initial test TOC
Aortic stenosis Transthoracic echocardiogram Aortic valve replacement surgery
44
Principal causes of AS
Congenital bicuspid valve with superimposed calcification Calci of normal trileaflet valve Rheumatic disease
45
Murmur transmitted downward confusing with MR | Weak and delayed heart contraction
Galliverdin effect | Pulsus parvus et tardus
46
Prognosis in pts with AS based on clin mani
Syncope : 3 years Anginsa : 3 years Dyspnea : 2 years CHF : 1.5-2 years
47
Mangement for AS
``` Medical txt Avoid strenous physical activity Avoid dehydration and hypovolemia Tx comormid Statins may slow down progessiob of leaflet calci ``` Surg tx Conventional surgical AVR :toc for low or intermediate risk TAVI : for severe
48
Clin mani : fatigue, hx of htn, dyspnea Pe: high pitched blowing diastolic descrecendo murmur on the L STERNAL. BORDER AND widened pulse pressure, murmur that ia also heard in the femoral artery Best initial test Tx to be avoided
Aortic regurgitation Transthoracic echocardiogram Beta blockers
49
Murmur that is heard over femoral artery when compressed Murmur in severe AR Jarring of entire body and bobbing motion of head Bounding and forceful pulse rapidly increasing and subsequently collapsing Capillary pulsation of root of nail Booming pistol shot sound over femoral arteries
Duroziez sign Austin flint murmur - rumbling sound De musset sign Water hammer or corrigans pulse Quincke's pulse Traube sign
50
Etiology of AR Cln mani of acute AR Chronic AR
Primary valve disease and aortic root disease Acute AR : PULMO EDEMA and cardiogenic shock Chronic AR: palpitations tachycardia exertional dyspnea, PND, cheat pain High pitched diastolic murmur at left parasternal border Austin flint murmur Widened pulse
51
Treatment of AR
Acute Diuretics vasodilators Avoid betablockers Surgery : TOC necessary within 24hrs of diagnosis ``` Chronic AR Ace inhi or ARB Diuretics Dihydropyridine CCB/BB Surgery : aortic valve replacement ```
52
Clin mani : hx of RF, dyspnea, palpitation, female Pe : opening snap low pitched tumbling diastolic murmur at the apex Most common cause Earliest chest xray findings Toc
Mitral stenosis Rheumatic fever Strajghtening of upper left border of cardiac silhouette Percutaneous transmitral commissurotomy PTMC if there is no contraindications
53
Hemodynamic hallmark of mitral stenosis Most common presenting symptoms of MS Functional tricuspid murmur Manifestation in ECG
Abnormally elevated left av pressure gradient on 2d echo Decreased exercise tolerance fatigue dyspnea Carvallo sign ECG : LA enlargement, RAD, RVH CXR: straightening of the upper border of the cardiac silhoutte
54
Most accurate approach to diagnosis and evaluation of MS
2d echo with doppler studies
55
Characteristic anatomy seen inn2decho in MS
Leaflet thickening and restriction of opening caused by assymetric fusion of commisures resulting in DOMING of leaflets in diastole (hockey stick sign)
56
Level of mitral stenosis
Normal 4-6cm2 Mild >1.5 Mod 1-1.5 Severe <1
57
Management for ms
Diuretics Slow hr : bb, digoxin, NDPH ca channel. Blocker (verapamil /diltiazem) Warfarin if with onset of AF percutaneous mitral valvr ballon valvotomy Mitral valvr replacement surgery Penicilline prophylaxis
58
Beat initial tx for symptomatic patients with ms Prophylacis given in patients with MS Most effective treatment
Diuretics Penicillin prophylaxis for group A B hemolytic streptococcal infection Percutaneous mitral balloon valvotomy or vulvuloplasty

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