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A-fib (100 cards)

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1
Q

EKG of A-fib

A

narrow QRS complex

no P wave

chaotic activity of atria

irregular R-R intervals

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2
Q

4 types of a-fib

A
  1. Paroxysmal: <7days
  2. Persistent: >7days, requires termination
  3. Permanent: AF > 1 yr
  4. Lone: any of the above w/o evidence of hrt dz
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3
Q

Mgmt of stable a-fib rate control

A

B-Blockers: metoprolol

CCB: Diltiazem

Digoxin: pts w/hypotension or CHF

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4
Q

Options for A-fib rhythm control

A

DCC: direct current cardioversion (synchronized cardioversion)

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5
Q

When would you use DCC over pharm tx?

A

AF <48hrs

OR

post 3-4 wks of anticoag & TEE showing no atrial thrombi

OR

If you dont want to use DCC: **start IV Heparin, cardiovert w/in 24hrs & anticoag for 4 wks**

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6
Q

Pharma rhythm control meds

IFSA

A

Ibutilide

Flecainide

Sotalol

Amiodarone

“IFSA”

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7
Q

Main focus of A-fib meds

A

control Heart rate

reduce clotting

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8
Q

Other tx options for a-fib

A

Pacemaker

RF ablation(Av node ablation): maze–> need pacemaker with this

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9
Q

CHA2DS2-VASc Criteria topics

A

Congestive Hrt failure

HTN

Age >75y/o

DM

Stroke, TIA, Thrombosis

Vascular Dz: prior MI, aortic plaque, peripheral art dz

Age 65-74

Sex F

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10
Q

Which 2 categories of CHA2DS2-VASc Criteria have 2 points?

A

Age >75 y/old

Stroke, TIA, thrombus

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11
Q

tx for greater than or equal to 2 on CHAD2DS2-VASc criteria

A

mod-high risk = chronic anticoag

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12
Q

anti-coag agents used for a-fib

A

NOAC: lower rates of major bleeding, dec. risk of ischemic stroke, do not need to check INR

Ex: Dabigatran, “abans”

Warfarin indications: severe CKD, CI to NOAC (HIV pts), monitor INR goal of 2-3

Dual A-platelet therapy: ASA + clopidogrel –> only ise if pts annot be tx with anti-coag.

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13
Q

Class I Angina Pectoris

A

angina with unusually strenuous activity

no limitations on activity

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14
Q

Class II Angina Pectoris

A

W/prolonged/rigorous activity

slight limitation of physical activity

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15
Q

Class II Angina Pectoris

A

angina with usual daily activity

Marked limitation of Phys. activity

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16
Q

Class IV Angina Pectoris

A

angina at rest

unable to carry out any physical activity

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17
Q

stable angina

A

relieved by rest /nitroglycerine

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18
Q

unstable angina

A

more frequent sxs, increasing sxs, present at rest

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19
Q

Any new onset murmur w/fever is…

A

infective endocarditis

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20
Q

IVDA w/endocarditis will affect which valve and what bacteria?

A

staph aureus tricuspid

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21
Q

non IVDAs will affect which valve and what bacteria is it?

A

strep viridans and mitral valve

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22
Q

What 3 things do you see in infective endocarditis?

A
  1. Roths spots: hemorrhage in the retina with a white center
  2. Janeway lesions: arise from infected microemboli
  3. Osler Nodes: small tender subcutaneous nodules on digits
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23
Q

what is the INITIAL study for infective endocarditis?

A

TTE

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24
Q

what is the diagnostic method of choice for infective endocarditis?

A

echocardiography

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25
infective endo tx
IV PCN and ceftriaxone
26
leading cause of mitral valve stenosis and valve replacement
rheumatic heart dz
27
Major Jones criteria
carditis polyarthritis chorea, subcutaneous nodules, erythema marginatum
28
minor jones criteria
fever arthralgia elevated ESR ASO titer test
29
pts with rheumatic heart may develop what?
a fib
30
cpx of aortic stenosis
right 2nd ICS radiates to carotids and down to border of apex syncope dyspnea angina on exertion CHF
31
dx of PAD
A-B Index doppler US angiography (if surg required)
32
what is ABI?
ratio of **systolic ankle BP/brachial systolic BP** **if \<0.9 = PAD**
33
tx of PAD
anti-platelets if severe: stent placement
34
ABI \<0.9 indicates what? ABI \< 0.4 indicates what?
\< 0.9 = **\> 50% stenosis** \<0.4 = **ischemia**
35
can present with **lower extremity edema, varicosities, increased pigmentation, and venous stasis ulcers**
**Venous Insuff**
36
normal range of ABI
**0.91–1.3**
37
MCC of PAD
atherosclerotic disease
38
gold standard for PAD
If limb is threatened - contrast arteriography
39
**PE:** cool extremity with absent or diminished pulses What dz
PAD
40
classic triad of AS
chest pain, dyspnea, and syncope
41
**crescendo descrescendo** **systolic** ejection murmur delayed/**diminished carotid pulses** **paaradoxically split S2** **narrow pulse pressure** **Associated with what dz?**
Aortic Stenosis
42
Complaining of sudden **"ripping" or "tearing"** CP radiating to back CXR will show **widened mediastinum** Diagnosis is made by **CT or transesophageal echocardiogram (TEE)** Treatment is **reduce BP, surgery** **What dz?**
aortic dissection
43
What populations are recommended to start screening for Lipid disorders?
Men greater than or equal to 35 Men 20-35 yrs at inc. risk for coronary heart dz women greater than or equal to 45 at inc. risk for CAD women 20-45 yrs old at inc, risk for CAD
44
Causes of **mitral stenosis**
**rheumatic heart dz** atrial myxoma
45
**mitral stenosis** murmur
low pitched, rumbling diastolic apical murmur **(LRDA)** ## Footnote **Loud S1 & opening snap**
46
acute mitral regurg causes
endocarditis, myocardial infartion, trauma
47
**chronic mitral regurg** causes
rheumatic heart dz
48
mitral regurg murmur
**loud holosystolic** heard best at **apex**, with radiation to **base**
49
mitral valve prolapse cause
congenital
50
mitral valve prolapse murmur
**early to mid systolic click** with l**ate systolic mumur** heard best at l**eft lateral heart border**
51
aortic stenosis cause
**calcific valve** degeneration ## Footnote **bicuspid aortic valve**
52
aortic stenosis murmur
crescendo-decrescendo systolic murmur radiating to neck
53
acute aortic regurg cause
endocarditits, aortic dissection
54
chronic aortic regurg cause
rheumatic heart disease, bicuspid aortic valve
55
aortic regurg murmur
high pitched, blowing, diastolic murmur heard best at left sternal border **(HBD)**
56
what is the most commonly associated complication of mitral valve stenosis?
A FIB
57
What meds lower TGLs the best?
FIBRATES: **gemfibrozil, fenofibrate**
58
Can you use gemfibrozil in pts with biliary dz?
NO
59
**Xanthomas** **Tendinous xanthomas** **Corneal arcus** CPx of what dz?
hypertriglyceridemia
60
What are the 1st line antihyeprtensives for AA?
thiazide type diuretics
61
Dx of HTN
**elevated BP greater on 2 or more reading on 2 or more different visits** greater or equal to **140/90**
62
When should you suspect **2ry hypertension?**
if BP is **refreactory to anti-HTN drugs** or **severely elevated**
63
what signifiies an adv stage of malignant HTN?
papilledema
64
Grades of Retinopathy
1. arterial narrowing 2. A-V nicking 3. 1 + 2 and hemorrhages + soft exudates 4. papilledema
65
main side effects of HCTZ
hypercalcemia hyperuricemia hyperglycemia **\*\*avoid in pts with gout & DM\*\***
66
main SES of loop diuretics (furosemide, bumetanide)
**hypokalemia** **hyperglycemia** **metabolic alkalosis** **ototoxicity** _**\*\* avoid in pts with sulfa allergy\*\***_
67
main SES of **K+ sparing diuretics** (spironolactone, amiloride, eplerenone)
hyperkalemia gynecomastia with spironolcatone
68
SES of **ACE-I (prils)**
**1st dose hypotensio, azotemia/renal insuff** **hyperkalemia** **cough & angioedema (inc bradykinin)** **hyperuricemia** _**\*\*avoid in preggo pts\*\***_
69
Hypertensive **Urgency**
Inc. BP + **NO acute end organ damage**
70
Hypertensive Urgency Mgmt
Captopril Clonidine (short term use)
71
Hypertensive Emergency
inc. BP + **acute end organ damage\*\*** ## Footnote **\>180/\>120**
72
HTN emergency Mgmt
**use IV agents** When to not use IV agents: - **_acute phase of an ischemic stroke_** - **_acute aortic dissection_**
73
**Neurologic hypertensive emergency**
**nicardipine/clevidipine/labetolol**
74
CV hypertensive emergency
Esmolol/Labetolol Nitroglycerin/BB (ACS) Nitro/Furosemide (acute heart failure)
75
Four groups that benefit from statins
1. patients with **ASCVD,** 2. patients with LDL levels greater than or equal to **190** mg/dL, 3. patients aged **40-75 years with DM** and an **LDL level of 70-189** mg/dL, 4. patients with an **LDL level of 70-189** mg/dL and a **10-year ASCVD risk of greater than or equal to 7.5%**
76
What 2 choices are 1st line tx for AA for HTN?
HCTZ & CCB
77
Indications for ARB for HTN
pts **not able to tolerate BB/ACEI**
78
indication for non-dihydropyridine (verapamil,diltiazem) use in HTN
HTN w/a-fib
79
What should you use for a pt with HTN + **BPH?**
alpha 1 blockers **(zosins)**
80
What is the main SES of Alpha 1 blockers?
1st dose syncope
81
Best HTN med for a fib
BB or CCB (non-D)
82
best med for HTN + angina
BB, CCB
83
Best meds for **HTN + post-MI**
BB, ACE
84
HTN + systolic HF best HTN meds?
**ACE, ARB,** BB, diuretics
85
Best HTN meds ? HTN + DM/CKD
**ACE, ARB**
86
Best HTN for pt w/isolated systolic HTN in elderly
Diuretics
87
best HTN med for pt w/OP
Thiazides
88
Best HTN med for pts with BPH
A-blockers (zosins)
89
Best HTN meds for young, caucasian males
thiazides --\> ACE/ARB --\> BB
90
Best HTN med for pt w/gout
CCB or Losartan (only ARB allowed)
91
What is considered HTN in pregnancy?
**acute onset of BP _160/110 for \> 15 mins_**
92
Best meds to increase HDL
Niacin
93
Which Hyperlipidemia meds should be used in T2DM?
fibrates, statins
94
What hyperlipidemia med should be avoided in T2DM?
Niacin
95
Optimal cholesterol levels
LDL \<100 Total chol \<200 HDL \>60
96
Main SES of niacin
flushing HA warm sensation pruiritis hyperuricemia hyperglycemia
97
main SE of statins
hepatitis
98
Which cholesterol meds are safe in pregnancy?
bile acid sequestrants: **Chole**styramine **Cole**stipol **Cole**sevelam
99
SES of bile acid sequestrants
GI: inc. LFTs inc. TGL
100

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