Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sam: Hospital Medicine > Cardiac Issues > Flashcards

Cardiac Issues Flashcards

1
Q

Three examples of bad heart things that present with chest pain that are life threatening

A

ACS, aortic dissection, pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What three populations typically present with “atypical” symptoms? (but as Emily Downs astutely noticed maybe its men that are the “atypical” patients).

A

Women, elderly, diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How soon do we want to get an ECG within when a patient presents with chest pain

A

10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What criteria must be met to a diagnose a STEMI?

A

Greater than or equal to 1 mm elevation in two contiguous leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Time delay for Troponin?

A

6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some causes of high troponins that false positives?

A

Renal disease, myocarditis, cardiac contusion, recent cardiac surgery or cath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ST elevation, ST depression or T wave inversion, chest pain with hemodynamic instability are all high, moderate, or low risk signs?

A

High

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What electrolytes are important to monitor when someone presents with chest pain? (or which ones were mentioned)

A

Potassium and manegsium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the gold standard to rule out ACS?

A

Cardiac catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NSTEMI – how do we treat?

A

Aspirin/anti-platelet agents

(dual anti-platelet therapy), beta blocker, heparin, statin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the TIMI score?

A

Thrombolysis in Myocardial Infarction Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the TIMI used for?

A

to determine the likelihood of ischemic events or mortality in patients with unstable angina or non-ST segment elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Age greater than or equal to 65, 3 or more risk factors for CHD, prior coronary stenosis of 50 percent or more, ST segment deviation on admit EKG, 2 or more anginal episodes in 24 hours, elevated cardiac biomarkers, and use of aspirin in prior 7 days are all part of what scoring system?

A

TIMI score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If you have a TIMI score of 6, what is your percent risk?

A

50 percent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If you have a TIMI score of 2, what is your percent risk?

A

8.3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If we believe someone is in atrial fibrillation, what 4 actions must we take immediately?

A

Verify rhythm, verify hemodynamic stability, ventricular rate control, blood pressure management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

After we have taken care of the first 4 immediate actions, we have to do these 3 things – the “post immediate issues”

A

Identification of precipitating factor(s), consideration of cardioversion (rhythm vs rate), and anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Minimize symptoms related to a fib, prevent thromboembolic complications, minimize side effects of adverse reactions, minimize risk of bleeding, and decrease mortality are all????

A

Management goals of a fib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Besides and ECG and an echo for evaluating a fib, what other test should we order?

A

Thyroid function tests, chest x-ray looking for pulmonary disease, and possibly ambulatory monitoring and/or exercise testing for rate control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should we hospitalize patients with a fib?

A
  1. Cardioversion
  2. Initiation of anti-arrhythmics
  3. Rate management
  4. Treatment of associated medical conditions
  5. elderly patients more safely treated in hospital
  6. Patient with risk of complications from A fib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the benefits of rhythm control?

A

Maintain sinus rhythm and optimal cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What chamber of the heart has improved function over time with rhythm control?

A

Left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Percentage wise, how effective is rhythm control effective in maintaining sinus rhythm long term?

A

50-60%

24
Q

What are some adverse effects of rhythm control?

A

Pro-arrhythmias (VT, Torsades, VF) which can be life threatening

25
Q

Hospitalizations are higher for the rhythm or the rate group?

A

Rhythm

26
Q

Who gets rhythm control?

A
  1. Younger, more active patients who benefit from optimal cardiac output
  2. Those at risk of bleed, especially athletes, occupations with risk of trauma
  3. Patient in whom anticoagulaton is contraindicated
  4. Patients in whom rate in uncontrollable or symptomatically can’t tolerated A fib
  5. Patients who request it
27
Q

Risk of stroke greatly increases after how many hours of being in A fib?

A

48 hours

28
Q

If someone has been in a fib for more than 48 hours (or we don’t know how long), how long do we fully anticoagulate?

A

3-4 weeks

29
Q

If someone has been in a fib for less than 24 hours can we attempt a cardioversion?

A

YUP

30
Q

If someone has been in a fib for more than 48 hours, we cannot attempt a cardioversion, so what do we do?

A

Fully anti-coagulate for 3-4 weeks

31
Q

When preparing for a cardiology consult what two things must you know? (this is a stupid question)

A

Know what you want

Know information about the patient

32
Q

What are the goals of a surgical approach to a fib?

A
  1. Isolate pulmonary veins for LA
  2. Remove LA appendage
  3. Interrupt re-entrant pathways
33
Q

Percentage wise, how effective is a surgical approach in maintaining sinus rhythm long term?

A

90%

34
Q

Is rate control or rhythm control more common?

A

Rate control

35
Q

What are the two steps to rate control?

A
  1. Control the rate – symptom monitoring, blood pressure management
  2. Prevent stroke (anticoagulation)
36
Q

When we use the rate control approach, and we use drug therapy, we are trying to slow ______ conduction.

A

AV

slows the number of impulses making it to the ventricle

37
Q

What drugs do we commonly use for rate control?

A

Calcium channel blockers – mainly Diltiazem.

Beta-blockers, digoxin.

38
Q

When using the rate control approach, is one drug usually enough?

A

No – often need a combination of medications

39
Q

If rate control is not obtained with medications, what is our next step?

A

Ablate AV node with radiofrequency, then pacemaker

40
Q

What are risk factors of chronic a fib and stroke?

A

Age greater than 65, prior history of stroke, diabetes mellitus, history of systemic hypertension

41
Q

If a patient has increased LA size, LV dysfunction, and aortic valve disease, are they at a high, low, or very low risk for a stroke?

A

High

42
Q

If someone has a CHAD2ds2 score of 1, do we anticoagulate?

A

we consider it!

score of 0, generally not
score of 2, generally yes

43
Q

Can we use aspirin as an anti-coagulant?

A

No!

44
Q

What are NOAC’s?

A

Novel Oral Anticoagulants (Dabigatran)

45
Q

Do we have to use bridging therapy when starting someone on an NOAC?

A

no!

46
Q

When do we not have to bridge to warfarin?

A

If there is no history of thromboembolism

47
Q

For WPW, what is our primary objective in terms of treatment?

A

Cardioversion

48
Q

If someone is being anticoagulated and needs to have a procedure, when do we start holding their medication?

A

3-4 days preprocedure, and then resume postprocedure

49
Q

Decreased pump function of the heart due to cardiomyopathy or wall motion abnormality

A

Heart failure

50
Q

Thickened walls of the heart describes hypertrophic or dilated cardiomyopathy?

A

hypertrophic

51
Q

What are some things that can cause dilated cardiomyopathy?

A

Toxins, diseases, alcoholism

52
Q

An ejection fraction less than _____ percent is systolic heart failure

A

40

53
Q

Is left or right heart failure more common?

A

Left

54
Q

What will you see on chest x-ray of someone with heart failure?

A

Increased vascular markings toward the apices, cephalization of the vessels, Kerley B lines, enhancement of hilum, pleural effusions

55
Q

How do we acutely manage heart failure?

A

IV diuretics, oxygen, sodium restriction (2g/d), and fluid restriction (1-1.5 l/d)

Sam: Hospital Medicine (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions