1. Cardiology Flashcards
Septic shock criteria 4 Criteria
SIRS criteria 2 or more positive
- Temp: 100.4<
- Heart rate: 90<
- WBC: 12000< or 4000> + 10% band
- Respiratory: 20
Obstructive shock disease
4 types/Tx
4 types
- Cardiac temponade
- Tension, Pnuemothorax
- Aortic dissection
- PE
Tx: underlying cause
General circulatory shock
Patho/Lab/Tx
Patho (lack of O2 in tissue and orgran )
- Autonomic - loss of O2 -> increase CO and SVR to maintain
- lack of O2 -> anareobic metabolic -> by product lactic acid
Lab: CBC, BMP, Lactate
Tx: ABCDE
Airway(intubation)
Breath (ventilation)
Circulation (IV fluid)
Delivary O2 check - lactate level
End (Urine output check 0.5ml/kg/hr)
Temp >38 (100.4), pulse >90, Respi >20, WBC >12000, <4000, lactate >4mmol/l
Name/Tx (+ anaphylatic)
Name: Distribution shock (spetic shock)
Tx: broad spectrum IV
if anyphylactic shock - 1:1000 epi 0.3mg IM
if cardiac arrest, IV 1:10000 epi 1mg
observe at least 4-6 hours
Significant loss of blood, pale cool dry skin/extremities, slow capillary refill >2sec
Name/def/Tx
Name: Hypovolumic shock
Patho: Loss of third space fluid
Tx: ABCDE
Most commonly caused by complications of acute MI
Name/Patho/Tx
Name: Cardiogenic shock
Path: lack of blood supply -> cardiac output low
Tx: O2, IV (not aggressive small amount) + Dobutamin/Epi
Dizziness occur when pt change position from siting to standing
Name/Dx/Tx
Name: Orthostatic hypotension
Dx: sitting vs standing BP change (sys - 20, Dia - 10 difference)
Tx: oral hydration preferred (fludrocortisone)
BP elevation 2 reading 2 different visit
Name/MC cause(2type)/Risk(3type)/PE/Tx
Name: Hypertension
MC cause
- Primary HTN - Idiopathic
- Secondary HTN - MC renal stenosis
Risk:
- General predisposition - age, black
- Environment - salt, obesity
- Exacerbating - smoking, ETOH, lack of exercising
PE:
- Funduscopic - AV nicking, arterial narrowing
- Cardiac check - bruit, PMI(vulvar dz) or BP arm/femoral check r/o coarctation (children)
- Abdomen - check for mass
- BMI check
Tx: Goal <140/90, diabetic 150/90 Life style (1st), meds (2nd) most successful tx - DASH diet
Syncope + healthy young man without any health problem + NO exp of post ictal status, bladder/bowel incontinence
Name/Patho/cause
Name: Vasovagal hypotension
Patho: due to systemic hypotension cause loss of conciousness
Cause: prolong standing, heat exhaust, fear, blood draw
Most of case not dangerous
- HTN + DM =
- HTN + AA =
- HTN + BPH =
- HTN + Gout =
- ACEI or ARB
- Thiazide, CCB
- Alpha blocker (zosin meds)
- CCB (No diuretic)
HTN grades 4 levels
Normal: 120/80
Elevated: 121-129/80
Stage 1: 130-139/80-90
Stage 2: 140/90 above
BP 180/120 + papilledema
Name/Tx
Name: HTN Emergency
Tx: BP decrease by Esmolol, labetalol IV (reduce 25% in 1 hour)
BP 160/100
Name/Tx
Name: HTN ugerncy
Tx: BP decrease by Clonidine (goal: 25% by 24-48 hr)
Every P wave followed by QRST, regular rhythm, 60-100 bpm, no abnormality Name
Name: Normal sinus
HR more than 100 bpm
Name/Cause/Tx
Name: Sinus tachycardia
Cause: infection, hemorrahge, anxiety, hypovolemia
Tx: underlying cause
HR less than 60 bpm
Name/Cause/Tx
Name: Sinus bradycardia
Cause: meds - beta blocker, CCB Some well controlled athlete (normal)
Tx: Atropine
HR changed by expiration and inspiration
Name/SC(3)/Tx
Name: Sinus arryhthmia
SC: Irregular rythm, heart rate increase = inspiration, heart rate decrease = expiration
Tx: none, watch
hx of corrective cardiac surgery, brady-tachy heart rate
Name/Risk/Tx
SSS (sick sinus syndrome)
Risk: strong relationship with A Fib, corrective heart surgery
Tx: PPM
EKG: Constant prolonged PRI
Name/Tx
Name: 1st degree block
Tx: Observe
EKG: Progressive PRI lengthening, dropped QRS
Name/Patho/Tx
Name: 2nd degree block I (mobitz 1 = wenckerbach)
Patho: not all atria signal reach at ventricle
Tx
- sx - atropine
- Nonsx - observe
EKG: Constant/ prolong PRI, dropped QRS
Name/Patho/SC/Tx
Name: 2nd degree block II (mobitz II)
Patho: not all atria signal reach at ventricle
SC: always involve secondary organ disease
Tx: PPM
EKG: P wave no related with QRS
Name/Patho/Tx
Name: 3rd degree block
Patho: No communication with atria and ventricle
Tx: PPM
EKG: Flutter “saw tooth” wave, regular rhythm (3:1, or 4:1 ratio)
Name/Tx
Name: AV flutter
Tx
- Stable: vagal (1st), BB or CCB
- Unstable: DCC (50J),
- Definitive: radiofrequency ablation
hx of alcohol use, irregularly irregular rhythm with narrow QRS
Name/Tx
Name: AF
Tx
- Stable - BB, CCB, if pt with AF + CHF - better with digoxin
- Unstable: DCC
- anticoagulation: CHADS2 to check risk, 4-6 weeks of warfarin
CHADS2 list explain
CHF
HTN
Age75
DM
Stroke+TIA - 2< warfarin
hx of using macrolide, TCA, recurrent syncope, palpitation
Name/Tx
Long QT syndrome
Tx
- Disc med
- BB (control rate)
- AICD for congenital prolong QT
Tachycardia, regular NARROW complex QRS, no P morphology
Name/Patho/Tx
Name: Orthodromic PSVT
Patho: goes normal AV node
Tx:
- Stable: Vagal (1st), adenosine, (2nd), BB CCB (3rd)
- Unstable: DCC
- Definitive - Radiofrequency abalation
Tachycardia, regular WIDE complex QRS, no P morphology
Name/Patho/Tx
Name: Antidromic PSVT
Patho: goes accessory pathway
Tx:
- procainamide
- Unstable: DCC
- Definitive - Radiofrequency abalation
Delta wave + wide QRS + Short PRI
Name/patho/Tx
Name: WPW (AVRT)
Patho: AV send signal to bundle of kent = accesory pathway cause pre-exite venticle
Tx:
- Vagal (1st)
- Procainamide
- Unstable: DCC
- Definitive: ablation
Meds need to avoid WPW (4)
ABCD - adenocine, BB, CCB, digoxin
2 type of PSVT
AVNRT - 2 pathway in AV node (MC type)
AVRT - 1 pathway in AV node + 1 accessory pathway (WPW)
HR 100< + less 3 morpho P
Name/Tx
Name: WAP (wandering)
Tx: BB, CCB
HR 100< + more 3 Morpho P + COPD
Name/Risk/Tx
Name: MAT (multifocal)
Risk: strong associated with COPD
Tx: BB, CCB
P wave inverted + narrow QRS
Name
AV junctional dysrhythmias
Wide Bizarre QRS less than 3
Name/Tx
Name: PVC (premature ventricular complexes)
Tx: no tx need observe
Wide bizarre QRS more than 3, regular, tachy
Name/Tx
Name: VT
Tx:
- Stabe: BB, CCB
- Unstable: DCC
- Pulseless VT: defib + CPR
hypomag, tachy, twisted around baseline
Name/Risk/Tx
Name: Torsades de point
Risk: antipsychotic meds related
Tx: IV mag + stop medication, if offending Recurrent -> needs PPM
Coarse, fine, no visible PQRST
Name/Tx
Name: V Fib
Tx: Defib (1st) + CPR
Rhythm presents on machine but no palpable pulse
Name/Cause/Tx
Name: PEA (pulseless electrical activity)
Cause: MC hypovolemia
Tx: CPR (1st) + EPI(2nd) + Defib
- ST depression or horizon means
- Convex vs Concave
- pathological
- Convex(sad) - patho, Concave(smile) - benign
RBB pattern (bunny) + ST elevation w/ downsloping + Asian male
Name/Risk/Tx
Name: Brugada syndrome
Risk: asian male MC
Tx: AICD
- In CAD what is worst factor?
- In CAD what is most important modifiable risk factor?
- In CAD what is most common cause?
- DM
- stop Smoking
- atherosclerosis
Path plaque of CAD 3 steps
- fatty streak formation - lipid enter to WBC
- LDL enter endothelium bring macropage to ingest LDL becoming foam cell
- mature plaque
Chest pain less than 30 mins + relieved with nitro or rest
Name/PE/DX/TX
Name: Angina pectoris
PE: often normal
Dx: ECG(1st), stress test (2nd if ok ECG)
Tx: Nitro(acute), BB(chronic)
Classic outpatient: ASA + nitro (prn) + BB + statin
PTCA vs CABG
PTCA - used when 1-2 vessel involve w/o left main coronary artery
CABG - 3 vessel or main coronary artery involve, EF less than 40%
New onset of chest pain more than 30 mins + not relieved with nitro + troponin Negative + pain at rest
Name/Patho/Dx/Tx
Name: UA
Patho: partial occulsion
Dx: ECG - ST depression or T wave inverted
Tx:
- antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
- adjuctive therapy - BB(start in 24hr), NGT
New onset of chest pain more than 30 mins + not relieved with nitro + troponin positive + pain at rest + ECG ST depression/T wave inverted
Name/Patho/Dx/Tx
Name: NSTEMI
Patho: partial occlusion
Dx
- ECG - ST depression or T wave inverted
- cardiomarker - troponin +
Tx
- antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
- adjuctive therapy - BB(start in 24hr), NTG
New onset of chest pain more than 30 mins + not relieved with nitro + troponin positive + pain at rest + ECG ST elevation
Name/Patho/Dx/Tx
Name: STEMI
Patho: 100% occluision
Dx:
- ECG - ST elevation
- Cardiomarker - troponin +
Tx:
- PCI or thrombolytic (alteplase, tenectaplase, reteplase)
- antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
- adjuctive therapy - BB (start in 24hr), ACEI (start in 24hr) - slow progression on HF
Cardiomarker 3 type/ appear time/return time
1) myoglobin - 1-2 hr appear/ return in 24 hr
2) CK/CK-MB - 4-6 hr appear/ 3-4 day return to baseline
3) troponine - 4-8 hr appear/ 7-10day return to baseline (most specific/sensitive)
What are complication of MI?
V fib, dressler syndrome (pericarditis)
Emergency ACS protocol (3step)
- ECG in 10 min
- thrombolytics in 30 min or PCI in 90 min
- MONA
Recent hx of MI + chest pain
Dressler syndrome = pericarditis
ACS important 3 ‘NO’ meds
- cocain induced MI - NO BB (unopposed alpha 1 constriction)
- Right ventricular MI - NO nitrate or morphine due to preload decrease
- hx of use viagra - NO nitrate
Early morning chest pain + transient ST elevation on EKG
Name/Patho/Dx/Tx
Name: Variant (Prinzmetal) angina Patho: vasospasm in the morning (if emotional - takasubo)
Dx:
- ECG - transient ST elevation
- Echo - if takasubo - LV apical balloon
Tx: CCB
useful tool to assess the risk of death & ischemic event
TIMI score
Thrombolytic absolute vs relative contraindication
Absolute: active bleeding, hx of ICH, stroke in 6month, aortic dissection
Relative: BP 180, internal bleeding 2 week ago
- I, V5, V6, AVL
- II, III, AVF
- ST depression V1, V2
- V1-V4
- I, aVL, V4-6
- lateral - CFX
- inferior - RCA
- posterior - RCA, CFX
- anterior - LAD
- anterolateral - LAD or CFX
In heart failure,
- Right side MC/SS
2, Left side MC/SS
- Systolic vs diastolic
- left HF (Edema, JVD, hepatic congestion)
- CAD, HTN (congest pulmonary, cough, fatigue)
- systolic - thin wall + EF low + S3 Diastolic - thick wall + EF normal/high + S4
Dyspnea + rale + S3 gallop
Name/Dx/Tx
Name: HF (systolic)
Dx: Echo (1st), BNP
Tx: ACEI (1st) + diuretic (out patient)
Acute: LMNOP (lasix/morphine/nitrate/O2/postion)
CXR finding of CHF progress
cephalization -> kerley B line->butterfly pattern -> CHF sign -> pulmonary edema
diffuse ST elevation with PR depression, sharp & acute pleuritic chest pain (sharp), leaning forward feel better
Name/Cause/Dx/Tx
Name: Acute Pericarditis
Cause: MC idiopathic, virus (2nd, coxsackie), dresslar = hx of MI
Dx: ECG - diffuse ST elevation, PR depression, Echo (find 2nd problem like effusion)
Tx: ASA or NSAID, 2nd colchicine
Muffled heart sound + low voltage QRS complex + electran alternan + waterbottle heart
Name/Dx/Tx
Name: Pericardia effusion
Dx: ECG (low voltage QRS/alternan), Echo
Tx: Obsevation
Muffled heart sound, JVD, hypotension
Name/Dx/Tx
Name: Cardiac temponade (WORST Form effusion)
Dx: Echo
Tx: Pericardiocentesis
Dypsnea + pericardial knock (high pitched 3rd heart sound) + kassumaul’s sign
Name/Patho/Dx/Tx
Name: Constrictive pericarditis
Patho: stiff or thickened pericardium
Dx: Echo
Tx: pericardiectomy
Dyspnea + fever + myalgia + chest pain + rales + S3
Name/Patho/Cause/Risk/Dx/Tx
Name: Myocarditis
Patho: heart musle inflammed
Cause: MC coxsakie B
Risk: MC children
Dx: Echo, biopsy is gold
Tx: Supportive tx (same as HF)
hx of alcohol use + pregnancy + dyspnea
Name/Cause/Dx/Tx
Name: DCM (systolic)
Cause: MC idiopathic, alcohol, pregnancy
Dx: echo - thin ventricle, dilated heart, EF low
Tx: HF tx
hx of amyloidosis + kussmaul sign
Name/Risk/Dx/Tx
Name: RCM (diastole)
Risk: hx of amyloidosis(1st), sarcoidosis
Dx: Echo - normal/large ventricle, atria dialated
Tx: no specific tx
Sudden cardiac death during sports + fm hx of sudden death in young age
Name/Patho/PE/Dx/Tx
Name: HCM
Patho: septum is enlarged
PE: squatting, lying supine - murmur decreased, standing & valsalva - murmur increase
Dx: Echo - thick septum
Tx: Early detection and ICD placement is key BB (1st),
Definitive: Myodectomy
Avoid extreme sport and dehydration
Join pain + chest pain + erythema marginatum
Name/SC/Risk/Cause/Dx/Tx
Name: Rheumatic fever
SC: MC mitral valve involve
Risk: children *(5-15)
Cause: GAS bacteria
Dx: Jones major, fever minor (joint/oh my carditis/nodule/erythema marginatum/sydeham’s chorea)
Tx: ASA + PEN G (if allergic - erythro)
Trigriceride 200< + LDL 100
Name/Cause/Dx/Screen/Tx
Name: Hyperlipidemia
Cause: Hypercholestrolemia, hypertriglyceridemia
Dx: 10year CVD risk screening
Screen: initial normal person age 35 male, 45 female
- Statin guideline -
- DM
- LDL >190, >21 yo,
- ASCVD score >7.5,
- hx of CVD
Tx: LDL lower - statins, HDL higher - niacin, Trigly lower - fibrates *Weight loss/exercise*
fever + roth spot + osler node + murmur + Janeway + anemia + nail hemorrage
Name/Cause/SC/Dx/Tx
Name: Infective endocarditis
Cause: Acute - staph A, subacute - strep viridin (relate with dental disease), Enterococci - Man in 50y with hx of GI/GU procedures
SC: MC valve - mitral (Staphy A, strep viridin), IV drug - tricuspid (staphy A)
Dx: 3 sets of blood draw before abx 1 hr apart, ECHO(TTE)
- DUKE criteria - Blood 2 set +, Echo (major), Fever (minor)
Tx:
- acute: Naf + genta
- subacute: pen/amx + genta,
- IF IVDA - VANCO
Dental procedure prophylaxis of infective endocarditis meds
3 case/Tx
Only recommended for
- prosthetic heart valves
- previous bacterial endocarditis
- congenital heart defects
Tx: 2g amox 30-60 min (clinda if allergy)
Uni-vision impairment + temporal pain
Name/Related dx/Dx/Tx
Name: Giant cell arthritis
Related Dz: Polymyalgia rheumatica
Dx: ESR first/biopsy definitive
Tx: before diagnosis must start prednisone (no vision loss)
If vision loss - methylprednisolone
Decreased/absent pulse + atropic skin change + worse with walking/better with rest + pale, dusky red
Name/Dx/Tx
Name: PAD
Dx: ABI (1st) - <0.9, Arteriography (gold)
Tx: Cilostazol + ASA + clopidogrel, Surgical: PTA
hx of smoking, atherosclerosis, pulsatile abd mass, bruit heard on abd, hypotension/syncope
Name/Cause/Dx/Tx/Screen
Name: AAA
Cause: MC risk factor Artherosclerosis, Strongest factor SMOKING
Dx: US (1st), test of choice CT scan w/ contrast
Tx:
- surgical repair - >5.5cm or 0.5 cm every in 6month
- 4.5cm - referral for surgery
- 4-4.5cm - Q6Mo monitor
- 3-4cm Q1yr monitor
Screen: Task force: recommanded screen who ever smoked before 65 year old
hx of HTN, severe tearing (ripping knife-like) chest pain (10/10), R/L arm BP different 20 or more
Name/Dx/Tx/Caution
Name: Aortic dissection (intimal wall tearing)
Dx: CT, CXR - widening of the mediastinum
Tx:
- Surgical - standford A/debakey I/II
- Medical - Esmolo, labetalol (1st) + nitroprusside (negative inotrope)
Caution: vasodilator will cause tachycardia rebound
IV catherization has done, redness, swollen
Name/Cause/Dx/Tx
Name: Superficial thrombophlebitis
Cause: MC IV cath, trauma, pregnancy
Dx: duplex US
Tx: supportive
Long Smoking hx + finger toes claudication
Name/Cause/PE/Dx/Tx
Name: Thromboangiitis obliterans (buerger’s disease)
Cause: strong relationship with smoking
PE: allen test
Dx: Aortography
Tx: Stop smoking definitive tx, CCB for raynaud
PVD vs PAD explain
PAD - better with rest, lateral malleolus, atrophic
PVD - worse with rest, medial malleolus, brownish hyperpigment
Unilateral calf pain + homan sign
Name/Risk/MC site/Dx/Tx
Name: DVT
Risk: car ride/plan flight >4 hours, OCP, pregnancy, malignancy
MC site: calf MC -> lung PE
Dx: duplex US (1s), venography (gold)
Tx: LMWH -> warfarin for 3month (1st), IV filter if failed coagulation
LMWH is initial tx for pregnancy and malignancy
2 or more thrombophillic warfarin for 12 month (deficiencies of antithrombin, protein C, or protein S; factor V Leiden; prothrombin; hyperhomocysteinemia; or high factor VIII)
Obesity, Dilated tortuous vein, worsening with long standing
Name/Dx/Tx
Name: Varicouse vein
Dx: Clinical, duplex US
Tx: stocking, leg elevation
Brownish pigmentation/medial malleoulus + pain/color improves with leg evelation
Name/Cause/Dx/Tx
Name: Chronic Venous Insufficiency
Cause: MC occurs after superficial thrombophlebitis or after DVT
Dx: trendelenburg test, US
Tx: stocking, leg elevation If ulcer tx - wet to dry dressing, Unna boot
MC cardiac tumor in adults
Name/Patho/Dx/Tx
Name: Atrial Myxoma,
Patho: ball valve obstruction at mitral valve (atria 40-50%, Benign)
Dx: Echo
Tx: Surgical remove
Harsh holosystolic murmur at lower left sternal border
Name/SC/Dx/Tx
Name: VSD
SC: MC type of congenital murmur, MC type membrane
Dx: Echo
Tx: close its own in 10 year, Growth disruptive or sx - surgical correction
Rib notching, BP difference top and bottom
Name/Dx/Tx
Name: Coarctation of the arota
Dx: Echo
Tx: balloon angioplasty (open up the narrow spot)
Machinery murmur (continue murmur)
Name/Patho/Dx/Tx
Name: PDA
Patho: bradykin increase and PGE1 decrease to close
Dx: Echo
Tx: indomethacin
Sometimes requires PGE1 to keep it open due to other congenital effect
“Boot-shaped” heart on x-ray, tet-spells
Name/Patho/SC/Dx/Tx
Name: Tetralogy of Fallot
Patho: PROV - pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
SC: Cyanotic
Dx: Echo
Tx: initially squatting knee to chest, ultimately surgical correction, May requires PDA continue open
Wide fixed split S2
Name/MC site/Dx/Tx
Name: ASD
MC site: ostium secundum
Dx: Echo
Tx: close its own before 1 year, sx - surgical repair (2-4 yrs)
headache + siezure + bleeding
Name/MC site/Patho/Dx/Tx
Name: Arteriovenous malformation
MC site: MC brain, spine
Patho: tangled aterior + venos
Dx: CT
Tx: Surgery
metabolic syndrome criteria (5)
3 out of 5
1) waistline (>35 inches for women, >40 inches for men)
2) triglyceride levels (>150 mg/dL)
3) low HDL cholesterol level (<50 mg/dL for women, <40 mg/dL for men)
4) hypertension (>130/85 mmHg)
5) hyperglycemia (fasting blood glucose >100 mg/dL)
dyspnea, non-exertional CP + fatigue + Mid systolic Click
Name/Related dz/PE/Dx/Tx
Name: MVP
Related Dz: Marfan, ehler-danlos
PE: midsystolic click + later systolic murmur
- Murmur louder = preload low (standing), Murmur sound decrease = preload high (squatting)
Dx: Echo
Tx: Observation
