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SD- Hospital > Cardiac Lecture > Flashcards

Cardiac Lecture Flashcards

1
Q

Renal Disease
Myocarditis
Cardiac contusion
Recent cardiac surgery or cath

..what do they all have in common?

A

Can all cause false positives in elevated troponins

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2
Q

ST elevation or new LBBB
T wave inversion
ST depression

A

EKG signs of acute coronary syndrome

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3
Q

>1 mm elevation in 2 contiguous leads
New LBBB

A

STEMI

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4
Q

ST elevation or new LBBB

ST depression or T inversion

CP w/ hemodynamic instability

Dynamic EKG changes

Known CAD w/ reminiscent pain

High risk Hx +/- w/ positive troponin

A

high risk CAD

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5
Q

Atypical CP w/ CAD and normal or unchanged EKG

CP w/ nonspecific ST depression (dominant R leads)

Low risk Hx w/ normal EKG and + troponin

Angina Pt with rest angina w/ spont resolution or promptly after NTG SL

A

moderate CAD risk

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6
Q

Atypical CP is a ____ risk for CAD

A

LOW

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7
Q

Thrombotic =

A

NSTEMI

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8
Q

Embolic= ?

A

STEMI

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9
Q

what is MONA?

A

Morphine
Oxygen
Nitro
Aspirin

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10
Q

Patient dependent (Prior episodes, Prior work up, Abilty to exercise)

2 D Echo (TTE)

ETT

Stress Echo

Stress nuclear imaging (technetium 99mTc sestamibi)

Cardiac catheterization

A

Ways to R/O ACS

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11
Q

Aspirin/ antiplatlet agents
P2Y12 receptor blocker
beta blocker
heparin

..tx for?

A

NSTEMI/UA

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12
Q

What is dual anti-platelet therapy?

A

Aspirin/antiplatelet agents
P2Y12 receptor blocker

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13
Q

PRN: diuretics, NTG

Long term: beta blockers, statins

tx for?

A

Heart failure

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14
Q

Age ≥ 65

≥ 3 risk factors fpr CHD

Prior coronary stenosis ≥ 50%

ST segment deviation on admit EKG

≥ 2 anginal episodes in prior 24 hours

Elevated cardiac biomarkers

Use of aspirin in prior 7 days

A

TIMI score

(Thrombosis in MI Score)

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15
Q

2 week risk of death, new or recurrent MI, or severe recurrent ischemia requiring revascularization

A

TIMI

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16
Q

Verify rhythm

Verify hemodynamic stability

Ventricular rate control

Blood pressure management

A

A Fib

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17
Q

Test of choice when looking for…

Valvular disease

Atrial size

LV size and function

LVH

Peak RV/PA pressures.

Pericardial disease

A

TTE

18
Q

True or False…

You would use a TEE when looking for presence of a LA thrombus

A

True

19
Q

Benefit: Maintain sinus rhythm and optimal cardiac output.
Improved LV fcn over time.

Drugs: Flecainide, Propafenone, Sotalol, Dofetilide and Amiodarone

Problem: At best, 50-60% effective in maintaining SR long term.

A

A fib rhythm control

20
Q

Adverse effects include pro-arrhythmia (VT, Torsades, VF) which can be life threatening.

A

A fib rhythm control

21
Q

Which tx for a fib is “worse/not as effective”

*higher 4 year mortality rate
*more strokes
*more hospitalizations

RATE CONTROL or RHYTHM CONTROL

A

Rhythm control

(both groups have similiar bleeding and similar life score/fxn tho)

22
Q

Younger, more active patients who benefit from optimal CO or ↑risk of bleed, especially athletes, occupations with ↑risk of trauma.

Patients in whom anticoagulation is contraindicated or have adverse reactions to anticoagulants.

Patients in whom rate is uncontrollable or symptomatically can’t tolerate AF.

Patients who request it.

A

A fib rhythm control

23
Q

If pt is in A fib for >48 hours, must have out patient anticoagulation for ______ weeks before CV cardioversion can be tried

A

3-4 weeks

24
Q

Cardiology consult

DC cardioversion

Pharmacological cardioversion

Non pharmacological approaches( Maze procedure, Radiofrequency Catheter ablation)

A

Rhythm control options for A fib

25
Q

Drug therapy: Slow AV conduction, control rate at rest/exercise.

Drugs: Ca-Blocker (Diltiazem, Verapamil), B-blocker, Digoxin; often combination needed, e.g. Diltiazem plus Digoxin.

A

A fib rate control

26
Q

Risk factors
Age >65
Prior History of stroke
Diabetes mellitus
History of systemic hypertension

A

risk for stroke with chronic a fib

27
Q
  • LV dysfunction/CHF
  • ↑LA size
  • other aortic or mitral valve disease
A

HIGH stroke risk with a fib

28
Q

-age<60 years, heart disease (preserved LV function, Nl LA, no HTN) and no other risk factors

A

LOW risk of stroke with a fib

29
Q

With a fib, anticoagulation reduces incidence of stroke to __% per year

A

1%

30
Q

CHADS VAS score of:

0
1
>2

should the pt be anticoagulatd?

A 
0= generally no
1= consider
2+= generally yes
31
Q

*what should be used to anticoagulate to prevent stroke:

Decreased Stroke Risk

Decreased bleed risk

Increased cost

Increased frequency of dosing for some

Limitted by renal disease

Reversal available only for dabigatran (direct thrombin inhibitor)

A

Novel Oral AntiCoagulant (NOAC)

no bridging required

32
Q

Cardioversion is primary objective.

Rate control secondary option with Amiodarone

Ablation consideration.

A

WPW

33
Q

Anticoagulants should be held for how long before procedures?

A

3-4 days

(the resumed post-procedure)

34
Q

True or False…

You can use heparine or LMWH periprocedure for patients who are at very high risk of emboli (ie rheumatic mitral stenosis, mechanical hear valve, prior thromboembolism)

A

True

35
Q

Decreased pump function of the heart due to cardiomyopathy (dilated or hypertrophic) or wall motion abnormality

A

Heart failure

36
Q

an EF <40% is what type of HF?

A

Systolic

37
Q

Impaired relaxation of the heart is what type of HF?

A

Diastolic

38
Q

Systolic
Diastolic
L sided
R sided

A

types of HF

39
Q

IV diuretic
O2
NTG – SL, Transcutaneous
Morphine
Sodium restrict (2g/D)
Fluid restrict (1-1.5 l /D)
Avoid NSAIDS (helps avoid HyperK and Na retention as well as vasodilator prostaglandin inhibition)
Avoid empiric use of anti-arrhythmics
Correct aggravating or precipitating factors

A

Acute management of HF

40
Q

ACE inhibitor
Beta blocker (once stable)
Carvedilol vs metoprolol
Digoxin
ABG
Potassium replacement
Thiazide diuretic in addition to furosemide
Spirinolactone (25mg) for severe CHF in addition to loop diuretic and ACE-I (monitor K)

A

management for systolic HF

41
Q

IV or oral diuretics

Unless complicated by a precipitating factor (eg, recent MI) or a concurrent threatening condition (eg, electrolyte imbalance, azotemia, symptomatic arrhythmias) many do not require hospital admission beyond several hours observation in ED or as OutPt.

A

mild to moderate acute on chronic CHF

SD- Hospital (10 decks)

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