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ER EOR > Cardio 1 > Flashcards

Cardio 1 Flashcards

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1
Q

what is the most common valve affected in endocarditis

+ name order of most to least common valves affected

A

mitral MC

M > A > T > P

tricuspid in drug users

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2
Q

what is the MC overall cause of endocarditis

A

strep viridans

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3
Q

MCC acute bacterial endocarditis and what valves are affected

A

staph aureus - normal valves

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4
Q

MCC subacute bacterial endocarditis and what valves are affected

A

S viridans - abnormal valves

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5
Q

MCC drug-related endocarditis

A

S aureus (especially MRSA)

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6
Q

MCC prosthetic valve endocarditis

A

early (within 60 days) = S aureus (including MRSA) and s. epidermidis

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7
Q

MCC endocarditis if recent GI or GU procedure

A

enterococcus

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8
Q

HACEK organisms + what type of organisms

A

haemophilus aphrophilus
actinobacillus
cardiobacterium hominis
eikenella corrodens
kingella kingae

these are gram negative organisms, hard to culture

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9
Q

sx endocarditis (FROM JANE)

A

fever
rosh spots
osler nodes
murmur
laneway lesions
anemia
spliNter hemorrhages
emboli

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10
Q

what are the 2 most important tests for suspected endocarditis

A

blood cultures and echo (obtain TTE first –> TEE)

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11
Q

what criteria is used to diagnose endocarditis

A

duke criteria

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12
Q

major duke criteria

A

sustained bacteremia - 2 + blood cultures by organism known to cause endocarditis

endocardial involvement documented by either echo (vegetation, abscess, valve perforation, prosthetic dehiscence) or clearly established new valvular regurgitation (aortic or mitral regurgitation)

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13
Q

minor duke criteria

A

predisposing conditions - abnormal valves, IVDA, indwelling catheters

fever (100.4F)

vascular and embolic phenomena

+ cultures not meeting major criteria

+ echo not meeting major criteria (worsening existing murmur)

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14
Q

how to diagnose endocarditis with duke criteria

A

2 major or 1 major + 3 minor or 5 minor

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15
Q

treatment for native valve (MSSA) endocarditis

native valve (MRSA) or unknown

prosthetic valve

fungal

A

native MSSA - nafcillin, oxacillin

native MRSA or unknown - vancomycin + cef or gentamicin

prosthetic valve - vancomycin + gentamicin + rifampin

fungal - parenteral anti fungal (amphotericin, can add flucytosine)

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16
Q

how long is therapy for endocarditis

A

4-6 weeks

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17
Q

what is the worst risk factor for angina

A

DM

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18
Q

diagnosing angina

A

EKG - initial test of choice, ST depression

Stress testing - most important noninvasive

coronary angiography - definitive; defines location and extent

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19
Q

what is used for definitive diagnosis of angina

A

coronary angiography

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20
Q

treatment for angina

A

outpatient - aspirin, beta blockers, nitroglycerin, statin

Revascularization with PCI or CABG = definitive

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21
Q

when to do PCI vs CABG for angina

A

PCI - 1 or 2 vessel disease in non diabetes NOT involving left main coronary artery

CABG - left main coronary artery stenosis, 3 vessel disease, decreased LVEF < 40%, 2 vessel disease in DM

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22
Q

unstable angina is characterized by what 3 things

A

1) sx suggestive of ACS
2) negative cardiac biomarkers (negative CK and troponin)
3) with or without EKG changes suggestive of ischemia (ST segment depressions or new T waves)

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23
Q

what is the MCC of unstable angina

A

plaque rupture

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24
Q

when is angina considered “unstable”

A

rest angina lasting > 20-30 minutes
new-onset angina
change in anginal pattern

not relieved with rest or nitroglycerin

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25
Q

treatment for unstable angina

A

aspirin, beta blockers, oxygen if hypoxic
aspirin + P2Y12 inhibitor
anticoagulant

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26
Q

what 3 things tend to trigger vasospastic angina

A

cold weather
alpha antagonists (pseudoephedrine, oxymetazoline, cocaine, amphetamines)
hyperventilation

27
Q

what 3 things are major risk factors for vasospastic angina

A

female
smoking
vasospastic disorders (migraine, raynauds)

28
Q

sx vasospastic angina

A

chest pain mainly at rest (esp at midnight to early morning)
usually does not pertain to activity

29
Q

dx vasospastic angina

A

EKG - transient ST elevation in the pattern of the affected artery == resolve with CCB and/or nitroglycerin and/or symptom resolution

angiography - may show coronary vasospasm with the use of Ergonovine, hyperventilation, or Acetylcholine

30
Q

what 3 things during angiography may induce a vasospasm if someone has vasospastic angina

A

acetylcholine
ergonovine
hyperventilation

31
Q

tx vasospastic angina

A

smoking cessation
CCB (mainstay of therapy)
nitroglycerin

32
Q

what meds should be avoided in people with vasospastic angina

A

beta blockers

33
Q

definition of sinus tachycardia

A

HR > 100 BPM

34
Q

tx for persistent sinus tachycardia

A

beta blockers

35
Q

definition of sinus bradycardia

A

HR < 60 BPM

36
Q

tx sinus bradycardia

A

symptomatic:
atropine
epinephrine or subq pacing (2nd line)

asymptomatic
observation

37
Q

sinus node dysfunction is also called

A

sick sinus syndrome

38
Q

tx sick sinus syndrome

A

unstable:
atropine (first line)
dopamine
epinephrine
temporary pacing (transq or trans venous pacing)

stable/asymptomatic:
observation

symptomatic:
pacemaker

39
Q

definition of first degree AV block

A

prolonged AV conduction – prolonged PR interval > 0.20 seconds

40
Q

2 most common causes of first degree AV block

A

increased vagal tone (highly conditioned endurance athletes)
AV node-blocking meds (beta blockers, non-DHP CCB, digoxin)

41
Q

what meds can cause first degree AV block

A

BB
Non-DHP CCB
Digoxin

42
Q

EKG for first degree AV block

A

prolonged PR interval > 0.2 seconds + all P waves are followed by QRS complexes

43
Q

tx first degree AV block

A

asymptomatic - observation
symptomatic - atropine
definitive - permanent pacemaker

44
Q

what will EKG show for mobitz 1 second degree AV block (Wenckebach)

A

progressive lengthening of PR node until an occasional non-conducted atrial impulse (dropped QRS complex)

45
Q

tx mobitz 1 (Wenckebach)

A

asymptomatic - no treatment
symptomatic - atropine first line
definitive - permanent pacemaker

46
Q

what will EKG show for mobitz 2 second degree AV block

A

constant PR interval before and after the non-conducted atrial beat (dropped QRS complexes)

47
Q

tx mobitz 2 second degree AV block

A

symptomatic - transq pacing and/or atropine
unstable - atropine, temporary cardiac pacing
definitive - permanent pacemaker

48
Q

EKG for third degree AV block

A

AV dissociation - evidence of P waves and QRS complexes (atrial and ventricular activity) – regular P-P intervals and regular R-R intervals independent of each other

49
Q

tx third degree AV block

A

symptomatic and stable - atropine
unstable - atropine and temporary pacing
definitive - permanent pacemaker

50
Q

what is cardiac tamponade

A

accumulation of pericardial fluid

51
Q

what is more important in cardiac tamponade: the rate or the amount of fluid

A

THE RATE

52
Q

what is impaired during cardiac tamponade: diastolic filling or systolic pumping

A

diastolic filling

53
Q

decreased diastolic filling in cardiac tamponade leads to

A

decreased stroke volume and decreased cardiac output

54
Q

cardiac output equation

A

CO = HR + SV

55
Q

common causes of cardiac tamponade

A

penetrating or blunt trauma
iatrogenic - central line placement, pacemaker insertion, etc.
pericarditis
post-MI free wall rupture
aortic dissection

56
Q

key findings to diagnose cardiac tamponade

is this a clinical diagnosis?

A

THIS IS A CLINICAL DIAGNOSIS

key findings: beck’s triad and pulsus paradoxus

57
Q

beck’s triad

A

hypotension
muffled heart sounds
elevated JVP (distended neck veins)

58
Q

pulsus paradoxus

A

exaggerated decrease in arterial pressure during INSPIRATION > 10 mmHg drop

decrease in amplitude of carotid or femoral pulses during INSPIRATION (pulse is strong during expiration and weak during inspiration)

59
Q

dx cardiac tamponade

A

echo - most sensitive & specific
CXR - enlargement of cardiac silhouette when > 250 mL has accumulated; clear lung fields
EKG - electrical alternans (altering QRS amplitudes)
cardiac Cath

60
Q

tx cardiac tamponade

A

nonhemorrhagic + stable - observe; can do dialysis if renal failure

non hemorrhagic + unstable - pericardiocentesis

hemorrhagic - emergent surgery; pericardiocentesis is only a temporizing measure

61
Q

what is the difference between pericardial effusion and cardiac tamponade

A

Pericardial effusion = fluid in the pericardial space. Cardiac tamponade = when pericardial effusion leads to increased pressure, impairing ventricular filling and resulting in decreased cardiac output.

62
Q

an enlarged heart without pulmonary vascular congestion suggests

A

pericardial effusion

63
Q

tx pericardial effusion

A

pericardiocentesis is not indicated unless there is evidence of tamponade; analysis of pericardial fluid can be useful if the cause of effusion is unknown

if the effusion is small and clinically insignificant, a repeat echo in 1-2 weeks is appropriate

64
Q
A

ER EOR (28 decks)

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