Stain Myopathy Stop indication? 2 Restart indication?

Symptomatic Asymptomatic + CK> x10n • Repeat CK = n + Asymptomatic

Acute PeriCarditis Specific PE finding? EKG findings? Treatment? 2

Pericardial friction rub (specific) Diffuse ST elevation, PR depression NSAID + Colchicine (@ virus / idiopathic), Aspirin

Constrictive Pericarditis PE findings? 5 US findings? Treatment? 2

JVP ↑ Peripheral edema Clear lung Ascites Pericardial knock Pericardial thickening / calcification Atrial enlargement NSAID Pericardiectomy

Cardiac Tamponade PE findings? 4 EKG findings? XR findings? Echo findings?

JVD + BP ↓ + Heart sound ↓ + sBP ↓ > 10 @ inspiration Low voltage amplitude Enlarged cardiac silhouette Clear lung RA & RV collapse IVC plethora

3 different P wave form Atria > 100 bpm Diagnosis? Medical treatment?

MultiFocal Atrial TachyCardia Verapamil / Esmolol

Atrial fib Target HR? Treatment class? 2 each?

• Target HR < 110 bpm Metoprolol / Atenolol Diltiazem / Verapamil

UW3 (09 CV) Flashcards by M S

Stain Myopathy

Stop indication? 2
Restart indication?

Symptomatic
Asymptomatic + CK> x10n

• Repeat CK = n + Asymptomatic

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HoloSystolic murmur
L 3-4 ICS
Thrill

VSD

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Acute PeriCarditis

Specific PE finding?
EKG findings?
Treatment? 2

Pericardial friction rub (specific)
Diffuse ST elevation, PR depression
NSAID + Colchicine (@ virus / idiopathic), Aspirin

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STEMI bradycardia

Management? 3

Atropine + IVF
Pacing
PCI

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Constrictive Pericarditis

PE findings? 5
US findings?
Treatment? 2

JVP ↑
Peripheral edema
Clear lung
Ascites
Pericardial knock
Pericardial thickening / calcification
Atrial enlargement
NSAID
Pericardiectomy

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AAA
• Treatment? 2
• Surgery indication? 2

Stop smoking
Aspirin / Statin
Size > 5.5cm
Growth > 0.5cm/6m

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Cardiac Tamponade

PE findings? 4
EKG findings?
XR findings?
Echo findings?

JVD + BP ↓ + Heart sound ↓ + sBP ↓ > 10 @ inspiration
Low voltage amplitude
Enlarged cardiac silhouette
Clear lung
RA & RV collapse
IVC plethora

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3 different P wave form
Atria > 100 bpm

Diagnosis?
Medical treatment?

MultiFocal Atrial TachyCardia

* Verapamil / Esmolol

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CABG indication? 2

Multivessel

* DM2

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Atrial fib

Target HR?
Treatment class? 2 each?

• Target HR < 110 bpm

Metoprolol / Atenolol
Diltiazem / Verapamil

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Coronary vessel distribution

1) Anterior wall
2) Lateral wall
3) Anterior & Lateral
4) RV + inf post LV

1) LAD
2) Circulflex
3) Diagonal
4) RCA

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Pulmonary Hypertension

Treatment?

Bosentan / Ambrisentan

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HCM

Initial medical therapy? 2
ICD indications? 6

1) Beta blocker
2) Verapamil / Disopyramide

1) Cardiac arrest
2) Ventricular tachycardia
3) FH sudden cardiac death
4) Syncope
5) Hypotension
6) LV hypertrophy

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Trastuzumab

1) Use?
2) Toxic effects?

1) Treatment @ Her2 breast cancer

2) Reversible cardiotoxicity (LV-EF ↓, CHF symptoms)

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STEMI

EKG indications? 5

1) 1mm @ all except V2+V3
2) 1.5mm @ V2+V3 (female)
3) 2mm @ V2+V3 (male > 40y)
4) 2.5mm @ V2+V3 (male < 40y)
5) New LBBB + Symptoms

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Aortic Dissection

Management? 4

1) Pain control
2) Esmolol IV
3) + NitroPrusside
4) Surgery

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CCB edema

1) Medication cause:
2) Mechanism?
3) Management? 2

1) Cause: Amlodipine / Nifedipine
2) Mechanism: Arteriolar dilation
3) Change to different meds (verapamil) Or add ACE-I

EncoCarditis

• High risk indication? 5

Prophylaxis for:
• Gingival / Respiratory
• GU / GI
• Skin / Muscle / Prosthetic cardiac

Prosthetic valve
Prior infective endocarditis
Valve abnormality @ transplanted heart
Unrepaired cyanotic congenital heart disease
Repaired congenital heart disease with residual defect
Amoxicillin
Ampicillin
Vancomycin

Mitral Regurgitation

Surgery indication?

EF < 60

Cocaine OD

1) 2 conditions to r/o? What test?
2) Initial treatment?
3) Medication for chest pain?
4) Medication for HTN?
5) Management for MI?
6) Medication to avoid?

1) MI r/o = EKG & trop
Aortic dissection r/o = CTA / MRA / TEE

2) Benzo + Nitroglycerin
3) CCB @ chest pain
4) Phentolamine (alpha blocker) @ HTN
5) PCI @ MI
6) Avoid beta blocker

TCA OD

Autonomic symptoms / PE?
Management?

Respiratory ↓
HR ↑ / Arrhythmia
BP ↓
Urinary retention
Flushing
Pupil dilation

1) O2 / Intubation
2) IVF
3) Activated charcoal
4) HCO3 @
Wide QRS
Ventricular Arrhythmia
5) Mg / Lidocaine

A-fib (treatment)

1) No CAD/HD
2) LVH
3) CAD
4) HF
5) Recurrent / Refractory

1) Flecainide / Propafenone
2) Amiodarone / Dronedarone
3) Sotalol / Dronedarone
4) Amiodarone / Dofetilide
5) RFA

RV MI

1) Medications to avoid? 3
2) Medications to caution? 2
3) Main therapy?

1) Nitrate / Diuretics / Opioids
2) Beta blocker / CCB
3) IVF

HF w/o decomp or hypotension

1) Diuretic med?
2) Vasodilator med?

1) Furosemide

2) Nitroglycerin / Nitroprusside / Nesiritide

Bicuspid Aortic Valve * XR findings? 3 * Complications? 3 * Follow up? 2 * Balloon Valvuloplasty indication? 4 * Valve replacement indication? 3

* AV calcification * Aortic enlargement * Rib notching * Aneurysm * EndoCarditis * Regurgitation / Stenosis * screen @ family * FU echo q1-2y * Symptomatic * Asymptomatic * + Aortic stenosis * + No significant calcification * + Gradient < 50 * Severe symptoms * Aortic regurgitation * LV dysfunction

Acute Limb Ischemia 1) Immediate complication? 2) Treatment? 2

1) Irreversible MyoNecorsis @ 4-6h | 2) Heparin / Surgery

Digoxin Toxicity Synergic meds? 4

* Quinine * Amiodarone * Spironolactone * Verapamil

Hypertension BP reduction impact? 5

1) Weight 2) DASH diet 3) Exercise 4) Na restriction 5) Alcohol reduction

Varicose Vein Management? 4

1) Leg elevation 2) Compression stocking (avoid @ PAD) 3) Weight ↓ 4) Sclerotherapy (failed treatment 3-6m)

Tachycardia + Palpitation EKG: Narrow QRS * Diagnosis? * Management? 2

• SVT * Valsalva * Adenosine

Cardiac risk for these surgery types? * Aortic * Major vessel * Vascular * Carotid * Head & Neck * Abdominal * Thoracic * Orthopedic * Prostate * Ambulatory * Endoscope * Breast • When to do stress test prior to surgery?

* High cardiac risk surgery * Intermediate cardiac risk surgery * Low cardiac risk surgery * High & Intermediate risk = cardiac eval (stress test)

Unstable angina / NSTEMI * EKG finding? * Medical management? 5

• EKG: ST ↓ @ 2 + aVF + V3-V6 1) Aspirin + Clopidogrel / Prasugrel / Ticagrelor 2) Nitrates 3) Beta blocker 4) Statin 5) Heparin / Enoxaparin / Bivalirudin / Fondaparinux

VTE @ post menopausal HRT Management? 2

1) Stop: HRT | 2) Start: SSRI / Escitalopram (symptom treatment)

Cardiogenic Syncope Types? 1) Exertional syncope / Systolic murmur 2) No prodromal symptom / Cardiomyopathy / Prior MI 3) Prodromal (fatigue / dizziness) / Sinus pause 4) Bifasicular block / ↑ PR + QRS drop 5) No prodromal symptom / QT ↑ / K↓ / Mg ↓

1) Aortic Stenosis / HOCM 2) Ventricular tachycardia 3) Sick sinus 4) AV block 5) Torsades

Mechanical Valve * Targe INR 2-3? 2 * Target INR 2.5-3.5? 5

* AV valve replacement * No other risk Mitral valve replacement * fib * EF < 30% * Prior VTE * HyperCoag state

Bi-Vent | Pacing indication? 3

* EF < 25% * HF symptoms * QRS > 150ms + LBBB

Peri-Op med Complications? 1) Beta blocker 2) Alpha 2 blocker 3) CCB 4) Statin 5) Diuretics 6) ACE-I 7) SERM (Raloxifene, Tamoxifen)

1) Hypertension @ withdrawal 2) Hypertension @ withdrawal 3) ↑ Bleed 4) Myopathy 5) BP ↓ (stop @ AM surgery) 6) BP ↓ / Continue @ HF (stop @ PM before surgery) 7) Stop for 4 weeks

Rheumatic Heart Disease 1) PE finding? Consistent with? 2) Complication at pregnancy?

1) Low pitch, Diastolic murmur, Loud S1 = mitral stenosis | 2) Atrial fibrillation

Aortic Coarctation Xray finding? 2

* Rib notch | * 3 sign @ aortic narrowing

Warfarin interaction * Increases warfarin? 5 * Decreases warfarin? * No changes to warfarin effect?

* Metronidazole * Quinine * Antifungal – azoles * Amiodarone * Acetaminophen * Rifampin * Phenytoin * OCP * Green leaf veggie * NSAID * Clopidogrel * Ginko

Aortic Stenosis * Severe indication? 3 * Replacement indication? 3

* Velocity > 4m/s * Press Grad > 40mmHg * Valve opening < 1cm2 * Severe AS * + symptom * + EF < 50% * + Future cardiac surgery

Nitroprusside 1) Mechanism? 2) Indication? 2 3) Complication? S/s? 4) Increased risk? 5) Management?

1) Vasodilation @ artery & vein 2) Aortic dissection / Hypertensive emergency 3) Cyanide toxicity = flushing, cyanosis / headache / AMS seizure / Arrhythmia / metabolic acidosis 4) Nitroprusside @ kidney problem 5) ↓ infusion rate / Short term use Stop use Sodium ThioSulfate