5080 - Heart Failure, Arrhythmias & Angina Flashcards
HTN in children is define as __ percentile for child’s age, height and gender on at least __ occasions. What is main indicator:
95th, 3, obesity
Percentage of children with hypertension:
3.9-4.5%
Percentage of children with hypertension that are not diagnosed:
75%
Stable angina is __ induced and is relieved by __ & __:
Exercise/exertionally induced; rest; nitroglycerin
With angina it’s important to note:
Quality of pain; region and radiation of pain; severity of pain; time/duration of pain
Stable angina is described as:
Squeezing pressure with radiation to arms, jaw, back or neck and is about 5-7/10 pain which lasts 20 minutes
Stable angina has a __ EKG and is caused by:
Normal; atherosclerotic plaques blocking 70%
Treatment for stable angina:
75-162mg of ASA daily and pain control. ACE or AERB is typically first-line
Unstable angina/NSTEMI/STEMI symptoms:
Pain at rest without provocation; not relieved with rest or nitro; described as crushing chest tightness with substernal pain with radiation; abnormal EKG; 50-60% of vessel is occluded but can rupture easily
Unstable angina/NSTEMI/STEMI pain:
Severity of pain is 8-10/10 and lasts more than 20 minutes.
Immediate therapy for unstable angina/NSTEMI/STEMI:
MONA B: Morphine, oxygen, SL nitro, Aspirin 325mg, beta blocker
Long-term therapy for unstable angina/NSTEMI/STEMI:
Aspirin 81mg, ACE/ARB, Statins, Oral nitrate, bowel regimen to prevent straining
2 Antiplatelet therapy agents:
Aspiring & Clopidrogel
Aspirin as an anti platelet therapy:
Inhibits thrombaxine, can cause GI upset, bleeding and tinnitus
Clopidrogel as an anti platelet therapy:
P2Y 12 inhibitors which reduce platelet aggregation, prevents ADP-mediated activation of the GPIIb/IIIa receptor; adverse reaction is bleeding
Anticoagulants include:
Heparin, Lovenox, Arixtra, direct thrombin inhibitor: Bivalirudin
How do nitrates work:
increase nitric oxide which causes vasodilation; creates improved exercise tolerance and time til angina onset; may cause tachycardia - needs beta blocker at the same time to prevent
Adverse effects of nitrates:
Tachycardia, headache, flushing, hypotension
Patient education for nitrates:
SL tab for acute angina only; call 911 is no relief in five minutes; replace supply every 6 months
How do first-line treatment beta blockers help angina/NSTEMI/STEMI:
Decrease heart rate and contractility
What is second-line treatment needed for unstable angina/NSTEMI/STEMI:
Calcium channel blockers which decrease heart rate and contractility
What does Ranolazine do and what is it used for:
Decreases oxygen demand of the heart without reducing HR or BP through reduction of ventricular tension; adjunct only for post-MI
Of Clopidrogel, Prasugrel and Ticagrelor antiplatelet therapies, which has reversible inhibition of P2Y12:
Ticagrelor
What is a side-effect of Ticagrelor that is not with other anti-platelets:
dyspnea
What is the classification of: Abciximab, Tirofiban, Eptifibatide:
Glycoprotein IIb/IIIa inhibitors - anti-platelet agents IV
What do beta blockers do in angina and ischemic heart disease:
Decrease myocardial oxygen demand by reducing heart rate and contractility
Which beta blocker agents are preferred in angina and ischemic heart disease, and are first-line for stable angina:
Beta-1 agents: Metoprolol, Atenolol, Nebivolol, Bisoprolol
Side-effects of beta blocker agents Metoprolol, Atenolol, Nebivolol and Bisoprolol:
Bradycardia, sexual dysfunction, masked hypoglycemia, fluid retention, depression, bronchospasm, patients may initially feel worse so need a slow titration
What are the adverse side-effects of Ranolazine:
Dizziness, nausea, palpitations, QTc prolongation
Ischemic stroke is:
Abrupt onset focal neurological deficit >24 hrs; occlusion of an artery
TIA is:
abrupt onset neurological deficit that lasts <24 hours - usually <30 minutes
Treatment for ischemic stroke:
Early repercussion therapy - thrombolytic therapy; tissue plasminogen activator - Alteplase
Alteplase helpfulness outweighs risk of hemorrhage only in the first:
4.5 hours
Secondary prophylaxis in ischemic stroke:
Antiplatelet therapy; initiate no sooner than 24 hours but no later than 48 hours after Alteplase (tPA therapy): Aspirin, Clopidogrel, Aggrenox; Blood pressure control to initiate 2-7 days after stroke: usually ACE inhibitor; Statin therapy to initiate in all patients post-stroke: Atorvastatin
Heart rhythm: Phase 0 =
Rapid depolarization
Heart rhythm: Phase 1 =
Brief period of repolarization
Heart rhythm: Phase 2 =
Plateau phase, slow depolarization
Heart rhythm: Phase 3 =
cellular repolarization
Heart rhythm: Phase 4 =
Gradual repolarization
Heart rhythm phase 0-3 is called:
The refractory period
Line of impulses through the heart:
SA node > Atrial conducting system > AV node > Bundle of His > Purkinje Fibers
Supraventricular type of arrhythmia:
PSVT, SVNRT, Atrial fib
Ventricular type of arrhythmia:
Ventricular tachycardia/fib, torsades de pointe
Antiarrhythmic medications - Class 1:
Sodium channel blockers; 1a - intermediate; 1b - fast-acting; 1c - slow-acting. Do not use in heart failure!
Antiarrhythmic medications - Class 2:
Sympathetic nervous system blockers - beta blockers
Antiarrhythmic medications - Class 3:
Primary potassium channel blockers
Antiarrhythmic medications - Class 4:
Calcium channel blockers
