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IM > AF, IE, Brugada, PAD, VTE > Flashcards

AF, IE, Brugada, PAD, VTE Flashcards

1
Q

ECG findings in AF

A

Irregularly irregular rhythm

no discernable P-Waves

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2
Q

CHADSVAS Scoring

A 
CHF
Hypertension
Age >=75
DM
Stroke 
Vascular Disease
Age 65-75
Sex - Female

1 point each except for Stroke and Age >=75 given a score of 2

1pt - 1.3
2pt - 2.2
3pt - 3.2
4pt - 4.0
5pt - 6.7
6-9pt - >9

1pt - aspirin
>=2pt - anticoagulation

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3
Q

AF Treatment: Pharmacologic Cardioversion

A

Amiodarone - if with structural heart dse

Flecainide, Ibutilide, Propafenone - if without structural heart disease

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4
Q

AF Treatment: Rate Control

A

Beta Blockers, Verapamil, Diltiazem, Digoxin, Amiodarone

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5
Q

AF Treatment: Electrical Cardioversion

A

For recent onset AF (<48h) with hemodynamic instability

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6
Q

AF Treatment: Anticoagulation

A

Warfarin - Vit K Antagonism
Dabigatran - oral direct thrombin inh.
Rivaroxaban, Apixaban - oral direct factor Xa inh.

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7
Q

Most Important Step in diagnosing IE

A

Serial Blood Cultures

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8
Q

Risk Factors IE

A

Structural Heart Disease (RHD, VHD)
IV Drug Use
Prosthetic Heart Valves

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9
Q

Duke’s Criteria

A

02/13/05
2 major or 1 major+3minors or 5 minors

MAJOR

  • sustained bacteremia
  • endocardial involvement documented by echocardiogram or established new valvular regurgitation

MINOR

  • Predisposing condition (abnormal valve or abnormal risk of bacteremia)
  • Fever
  • Vascular Phenomena (septic arterial or pulmonary emboli, mycotic aneurysms, intracranial hemorrhage, janeway lesions)
  • Immune Phenomena (GN, osler nodes, roth spots, Rheumatoid Factor)
  • positive blood culture not meeting major criteria
  • positive echocardiogram not meeting major criteria
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10
Q

Etiology for

  1. Acute IE
  2. Subacute IE
A

Acute - s. aureus

Subacute - s. viridans

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11
Q

Best Empiric Therapy for IE

A

Vancomycin + Gentamycin

- will cover most common organisms such as s. aureus, MRSA, s. viridans

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12
Q

Most common cause of Sudden Cardiac Death

A

Brugada Syndrome

Ventricular Fibrillation that is ischemic in nature (secondary to ACS)

Take note of patient profile - young, male, Asian, with family history

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13
Q

Brugada Syndrome pathophysiology

A

loss of function mutation in SCN5A gene causing decrease in sodium channel that affect the Phase 0 and Phase 1 of the cardiac action potential

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14
Q

ECG findings in Brugada

A

pseudo RBBB and persistent ST segment elevation in V1-V2

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15
Q

Brugada Pattern Types

A

Type 1: Coved
Type 2: Saddle-back
Type 3: Saddle-back (?)

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16
Q

Diagnosis of Brugada

A

ECG - Type 1 Pattern in at least one right precordial lead plus one of the ff:

  • documented vfib
  • polymorphic VT
  • family hx of sudden cardiac death age<45
  • family hx of type 1 pattern on ECG
  • inducivle vtach during EP study
  • unexplained syncope
  • nocturnal agonal respiration
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17
Q

MEDICATIONS TO AVOID IN BRUGADA

A

Class I anti-arrhythmic drugs (ajmaline, flecainide, ranolazine)

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18
Q

Management: Brugada

A

ICD implantation or Amiodarone 200mg once daily after initial loading dose of 400mg 2-3x daily for 1-2 weeks

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19
Q

65/M, heavy smoker, with pain on both calves after walking a few blocks, and resolves with rest. Femoral and dorsalis pedis pulses are diminished bilaterally. Skin on legs are cool to touch and appears shiny with very little hair growth. DIAGNOSIS?

A

PAD

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20
Q

Best initial test for PAD

A 
Ankle Brachial Index
(Duplex Ultrasonography)
>1 normal
<0.9 PAD
<0.5 Severe Ischemia
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21
Q

Most accurate test for PAD

A

Arteriography

22
Q

Leading cause of PAD

A

Atherosclerosis

23
Q

Primary site of involvement in PAD

A

90% Femoral and Popliteal Arteries

24
Q

Most common symptom of PAD

A

Intermittent Claudication

25
Q

6Ps of Acute Limb Ischemia (PAD)

A 
Pain
Pallor
Paresthesia
Paralysis 
Pulselessness
Poikilothermia
26
Q

True of False. Calcium Channel Blockers can be used in management of PAD.

A

FALSE.

WHY?

27
Q

Management: PAD

A

smoking cessation, BP control, exercise

Cilostazol - first line
Pentoxifylline - second line
Antiplatelets - Aspirin
ACEi, BB, Statins

28
Q

First Line Therapy for PAD

A

Cilostazol

29
Q

Virchow’s Triad

A

Endothelial Injury
Venous Stasis
Hypercoagulable state

30
Q

Most common symptom of Pulmonary Embolism

A

Sudden onset unexplained breathlessness (dyspnea) in a patient with risk factors

31
Q

Rule Out test for DVT

A

D-Dimer

  • if normal, not DVT
32
Q

Most common symptom in DVT

A

Leg cramps or charley horse

33
Q

ECG findings in VTE

A

Sinus tachycardia
S1Q3T3
T-wave inversion V1-V4

34
Q

Ultrasound finding in DVT

A

Loss of vein compressibility - primary criterion for DVT

35
Q

Diagnostic Test of Choice for DVT

A

Chest CT with Contrast

36
Q

Primary Therapy for DVT

A

Clot dissolution

37
Q

Secondary therapy for DVT

A

Anticoagulation
IVC filter
Compression stockings

38
Q

Only NOAC with a reversing agent

A

Dabigatran

reversing agent: Idarucimab

39
Q

Warfarin reversing agent

A

Prothrombin complex

40
Q

Protamine reverses effect of

A

Heparin, Enoxaparin, Dalteparin, Fondaparinux

41
Q

CPR rate

A

100-120 compressions per minute

42
Q

CPR depth

A

2-2.4 inches deep

43
Q

When to stop CPR

A

Patient is revived
You are too tired to continue
Help arrives

44
Q

Wide QRS

A

VTach, Vfib

45
Q

Narrow QRS

A

ST, AF, SVT, MAT

46
Q

Patient in pulseless VTach or VFib, what will you do?

A

SCREAM

47
Q

Patient in VT with pulse but unstable. What will you do?

A

Sedate then cardiovert starting 100j

48
Q

Patient in VT with pulse and stable. What will you do?

A

Manage medically.

Give Amiodarone 150mg slow IV push…

49
Q

Patient in SVT, unstable. What will you do?

A

Sedate. Cardiovert starting 50j

50
Q

Patient in SVT, stable. What will you do?

A

Vagal maneuver
Adenosine
CCB (Verapamil)

IM (9 decks)

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