Cardio Flashcards
MC cardiomyopathy
dilated
dilated cardiomyopathy causes
ETOH
pregnancy -> postpartum
viral myocarditisL enterovirus MC (coxsackie B)
dilated cardiomyopathy sx
dyspnea, JVD, edema, orthopnea, hepatosplenomegaly, frothy red sputum, pulses alternans
mitral or tricuspid valve regurgitation (holosystolic)
laterally displaced PMI
dilated cardiomyopathy test
BNP inc
EKG: tachycardia, LBBB, afib
echo: LV dilation and thickening
dec EF
dilated cardiomyopathy tx
low salt
short term: diuretics (furosemide)
long term: ACE (enalapril), BB (metoprolol), spironolactone
severe: LVAD or heart transplant
dilated cardiomyopathy complications
arrhythmias
CHF
hypertrophic cardiomyopathy type of HF
diastolic
dilated cardiomyopathy type of HF
systolic
hypertrophic cardiomyopathy MCC
genetic, autosomal dominant
hypertrophic cardiomyopathy sx
syncope, dyspnea on exertion, S4, bisfrens pulse (water hammer), sudden death
HOCM murmur sx
systolic crescendo decreascendo at LLSB
S4
worse w/ standing of valvalvs
dec w/ grip or swat
hypertrophic cardiomyopathy test
echo: asymmetrical wall thickness, LVH
hypertrophic cardiomyopathy tx
mainstay: BB (metoprolol), CCB (verapamil)
myomectomy for HOCM
hypertrophic cardiomyopathy tx CI
digoxin
ACE
nitrates
restrictive cardiomyopathy common causes
Amyloidosis
sarcoidosis
hemochromatosis
restrictive cardiomyopathy sx
inc JVP on inspiration (kussmaul sign)
S3, SOB, ascites
peripheral edema, hepatosplenomegaly
RHF sx
restrictive cardiomyopathy test
CXR: pulmonary congestion
EKG: low QRS, LBBB
echo: rapid diastolic filling, bilateral atrial enlargement
bx
restrictive cardiomyopathy tx
low salt diet
diuretics (furosemide), BB (carvedilol), CCB
tx underlying
heart transplant
takotsubo patho
inc sympathetic stimulation resulting in ventricular dilation
from increase of stress or acute stress event
takotsubo sx
CP, mimics STEMI w/ no true occlusion
takotsubo test
echo: apical ballooning
EKG: ST elevation
takotsubo tx
supportive care
anticoagulants
order of conduction system of the heart
SA node
AV node
bundle of his (L and R bundle)
purkinje fibers
indications for cardio version
afib
aflutter
VT w/ pulse
SVT
when to shock during cardioversion
do not shock on T wave
defibrillation indication
VTach w/o pulse
Vfib
when pharmacologic cardio version used
if electrocardioversion fails
pharmacologic cardioversion
IV ibutilide
procainamide
flecainide
Sotalol
amiodarone
sinus brady tx
1st line: atropine
definitive: pacemaker
sick sinus syndrome tx
permanent pacemaker
1st degree AV block tx
observation
2nd degree type I wenkenbach tx
atropine
epinephrine
sx: pacemaker
second degree type 2 Mobitz tx
permanent pacemaker
third degree heart block tx
permanent pacemaker
transcutaneous pacing 1st line
Wolff Parkinson white syndrome patho
bundle of Kent
delta wave, shortened PR, wide QRS
Wolff Parkinson white syndrome tx
vagal
wide: procainamide
definitive: radio frequency ablation
Wolff Parkinson white syndrome meds to avoid
ABCD
adenosine
BB
CCB
digoxin
Wolff Parkinson white syndrome complication
A. fib
Wolff Parkinson white syndrome w/ afib tx
U= ibutilide
causes of torsades
hypomagnesemia
hypocalcemia
hypokalemia
Torsades tx
stable: IV Mg bolus
unstable: defibrillation
PEA tx
CPR
epinephrine
bundle branch block patho
from bundle of his (damaged)
causes wide QRS
atrial flutter sx
pt will usually have COPD
inc fatigue, palpitations
can form emboli
atrial flutter tx
stable: rate control (CCB, BB, digoxin, vagal)
unstable: cardiovert (chemical: amiodarone, procainamide)
definitive: radio frequency ablasion
anticoagulants
holiday heart syndrome
drinking ETOH and afib
afib complication
emboli –> stroke
anticoagulation for afib
NOAC: dabigatran, riveroxiban, apixiban, edoxibam
warfarin
dual antiplt: ASA + clopidogrel
afib tx
stable: CCB (IV diltiazem), BB (metoprolol), digoxin, permanent pacemaker
unstable: synchronized cardio version
PSVT tx
stable: vagal, valsalva –> adenosine or CCB
unstable: cardio version
long term therapy: radio frequency catheter ablation
PAC tx
BB/CCB
stop causative agent
radiofrequency ablation
PAC causes
electrolyte imbalances
anxiety, cocaine use, ischemic damages
reentrant loop (scar tissue post MI)
PVC tx
reassurance
BB/CCB
radiofrequency ablation
what can cause PVC
anxiety, triggered activity
hypoxia, CAD, hypokalemia
Vtach criteria
3+ PVC
V tach complication
V fib
V tach tx
stable: amiodarone
unstable w/ pulse: sync cardioversion
unstable w/o pulse: defibrillator w/ CPR
v fib tx
defibrillation
lidocaine or procainamide
CPR, epinephrine
MC ASD
osmium secundum
MC congenital heart defect in adults
ASD
osteum premum RF
1st septum
downs
fetal alcohol syndrome
often related to mitral/tricuspid valve clefts and VSD
ASD shunt
left to right
ASD sx
cyanotic
fixed split S2, systolic crescendo decrescendo in 2nd and 3rd LUSB
parasternal heave
ASD test
CXR: cardiomegaly
EKG: RAD, RVH, RBBB
echo (diagnostic): RA, RV overload, ASD
ASD tx
spontaneous closure in 1st year if small
surgery
ASD complications
paradoxical emboli -> cryptogenic stroke
HF
eisenmengers
coarctation of aorta seen in which condition
turners syndrome
coarctation of aorta infant type
MC: preductal
coarctation of aorta adult type
post ductal: distal to ductus arteriosum
coarctation of aorta sx
HF in infant
systemic HTN, BP UE>LE
cyanosis of LE, ayanosis of UE
LV failure, delayed/weak femoral pulse
harsh systolic murmur head on back
coarctation of aorta test
CXR: rib notching, figure 3 sign
EKG: LVH
echo: diagnostic
CT/MRI: coarctation
coarctation of aorta tx
prostaglandin E1 preop
diuretics: HF sx
surgery: balloon angioplasty stent
PDA sx
cyanotic, pulmonary HTN, L to R shunt
continuous (Gibson’s) machine like murmur, thrill
wide pulse pressure: bounding pulses (water hammer)
hyper dynamic precordium
PDA sx later in life
pulmonary HTN, inc pressure -> R to L shunt =
eisenmengers syndrome –> cyanotic
PDA test
EKG: LVH
CXR
Echo: best
MRI/CT
inc BNP
PDA tx
indomethacin
surgical correction
usually close w/in 1st week of life
tetralogy of fallot abnormalities
pulmonary stenosis
RV hypertrophy
VSD
overriding aorta
tet spells
in tetralogy of fallot
acute extreme hypoxia, cyanosis, syncope, and hyperpnea
worse w/ crying/feeding
MC cyanotic heart defect
tetralogy of fallot
tetralogy of fallot patho
chromosome 22 deletion
digeorge syndrome
maternal retinoid acid exposure
tetralogy of fallot murmur
crescendo decreascendo holosystolic along LLSB
radiating to back
tetralogy of fallot sx
cyanotic
clubbing
failure to develop
tetralogy of fallot test
CXR: boot shaped heart, no interstitial lung markings
echo: gold standard
EKG: RAD
tetralogy of fallot tx
squatting during tet spell
calming, O2, IV fluids
IV prostaglandin E1 (keep PDA open for PE perfusion)
definitive: surgery, can play sports w/ R vent pressure <50
IV prostaglandin E1 AE
apnea
MC baby heart defect of membrane
MC congenital heart disease
VSD
VSD seen in which conditions
downs syndrome
VSD sx
small: cyanotic, SOB
large: pulmonary HTN –> R to L shunt –> eisenmenger –> cyanotic
VSD murmur
loud high pitch harsh pan/holosystolic murmur @ LLSB
VSD test
echo: definitive
VSD tx
may spontaneously close in 10y
larger VSD: diuretics
+/- digoxin or surgical closure (sx of HF)
MC coronary artery to occlude
LAD
tx unstable angina
antithrombotic therapy: ASA, UF heparin, LMWH
adjunct: BB (metoprolol), nitrates, morphine, CCB
BB first line
AE LMWH
thrombocytopenia
RCA occlusion sx
affects SA and AV node –> bradycardia
hypertension meds safe in pregnancy
hydralazine
methyldopa
labetalol
nifedipine
hypertensive urgency tx
clonidine
captopril
nifedipine
labetalol
hypertensive emergency tx
sodium nitroprusside
labetalol
hydralazine
sodium nitroprusside AE
potential thiocyanate and cyanid toxicity w. prolonged use or if renal/hepatic failure
hypotension tx
fludrocortisone
pyridostigmine
dopamine
cardiogenic shock tx
ABC
IV dobutamin, milrinone
orthostatic hypotension tx
fludrocortisone
fibric acid derivative CI
gemefibrozin, clofibrate
CI in biliary disease
acute endocarditis MCC
S aureus
subacute endocarditis MCC
strep viridian’s
acute endocarditis tx
nafcillin + gent or
vanco + gent
subacute endocarditis tx
penicillin/ ampicillin + gent
ceftriaxone/ vanco + gent
endocarditis IVDU MCC
pseudomonas
candida
IVDU endocarditis tx
vanco
prosthetic endocarditis MCC
Staph epidermis
prosthetic endocarditis tx
vanco + gent + rifampin
MCC myocarditis
viral (coxsackie)
myocarditis sx
dyspnea, cough, chest fullness,
fatigue, palpitations, edema, S3 murmur
viral prodrome
myocarditis test
BIT: EKG
cardiac enzymes (may be elevated)
MAT: myocardial bx
myocarditis tx
tx like CHF until resolve
do not give steroids
acute pericarditis MCC
viral: coxackie B
acute pericarditis sx
positional sharp pleuritic CP
worse w/ inspiration or laying down
Bette when sitting up or leaning forward
friction rub
conductive: pericardial knock, S3, RHF sx
acute pericarditis test
diffuse ST elevation
PR segment depression
echo: definitive
inc ESR/CRP
acute pericarditis tx
NSAIDS (indomethacin, colchicine) w/ or w/o steroids
surgical: pericardiocentesis
pericardectomy definitive
AE colchicine
diarrhea
cardiac tamponade tx
ASAP pericardiocentesis
cardiac tamponade patho
heart does not stretch fully between contractions
build up fluid in pericardium puts pressure on outside of the heart
cardiac tamponade test
echo: diagnostic
EKG: low voltage QRS + pulsus alternans
pericardial effusion tx
colchicine
pericardiocentesis for severe effusion
acute rheumatic fever MCC
GABHS (S. pyogenes)
acute rheumatic fever patho
inflammatory dz that can damage heart tissue
hx of strep infection
develops after strep pharyngitis
acute rheumatic fever tx
rest
PCN or macrolide
NSAIDs/ASA
cardiac tamponade complication
PANDAS syndrome
MC valve in rheumatic heart disease
mitral valve
rheumatic heart disease h/o
repeated episodes of acute rheumatic fever
rheumatic heart disease sx
mitral stenosis or mitral regurgitation
palpitation, fatigue, CP, dyspnea
rheumatic heart disease test
echo: confirm
histology: Aschoff bodies (granulomas)
previous strep infx
inc ESR/ASO
rheumatic heart disease tx
prevent strep infection
prolonged abx tx until 21yo (IM penicillin G or sulfadiazine)
valve repair or replacement
kawasaki complication
CAD
coronary artery aneurisms
MI
harsh systolic creasendo decrescendo rad to neck/carotids
dec w/ valsalva
S2 split
aortic stenosis
aortic stenosis tx
IV fluids
valve replacement definitive
early diastolic blowing decrescendo 3rd ICS
water hammer pulse
aortic regurgitation
de musset sign
in aortic regurgitation
head bobbing
quinck’s sign
aortic regurgitation
fingers pulsing and nail bed change to pale color
aortic regurgitation tx
low Na diet
furosemide
valve replacement
prophylactic abx
MCC mitral stenosis
rheumatic fever
opening snap followed by S2
diastolic rumble
low pitched murmur at apex
mitral stenosis
mitral stenosis tx
low Na diet
pulmonary congestion -> lasix
afib: digoxin and warfarin
surgery: balloon valvuloplasty or replacement
holosystolic blowing murmur at apex
radiating to axilla, loud S3
mitral regurgitation
mid systolic click rad to axilla w/ palpitations
MVP
mitral regurgitation tx
tx afib: cardiovert, warfarin
pulmonary congestion: diuretic and vasodilators
surgery: valve repair for prolapse, replacement
BB for palpitation (propranolol)
ejection click
harsh mid systolic crescendo decrescendo @ LUSB, wide split S2
pulmonary stenosis
pulmonary stenosis tx
balloon valvuloplasty
graham steele murmur
brief decrescendo best @ LUSB
wide split S2
pulmonary regurgitation
graham steel murmur
pulmonary regurgitation tx
none, usually well tolerated
valve replacement
tricuspid regurgitation MCC
carcinoid heart disease
rheumatic heart disease
mid diastolic rumble @ LLSB
opening snap
tricuspid stenosis
tricuspid stenosis tx
diuretics
sodium restriction
valve repair or replacement
LLSB holosystolic blowing
radiates to R sternum and xiphoid
inc w/ inspiration
tricuspid regurgitation
tricuspid regurgitation tx
diuretics
salt restriction
valve repair/replacement
Aortic aneurism tx
<3cm none
3-4cm US Q2-3y
<4.5cm US Q6mo
4.5-5cm Q3-6mo
>5.5cm surgery
thoracic aneurism tx
BB prevent growth
>5cm repair if bicuspid aortic valve/ morfan
aortic dissection tx
IV BB
nitroprusside
definitive repair
crystalloids for hypoTN
most important RF for aortic dissection
HTN
Diseases from coxsackie A
hand foot and mouth
herpangina
diseases from coxsackie B
pericarditis
myocarditis
pleurodynia
pediatric functional murmurs
stills (MC)
venous hum
pulmonary ejection
congenital cyanotic heart diseases
truncus arteriosis
transposition of great arteries
tricuspid atresia
Tetralogy
total anomalous pulmonary venous return
ototoxic drugs
abx: aminoglycosides, vanco, macrolides
loop: furosemide, ethacrynic acid
chemotherapeutic: platinum agents, cytarabine
temp: NSAIDs, aspirin, quinine