Cardio Flashcards
What are 3 alarm signs for ACS
Chest pain not ameliorated with nitro infusion
Heart failure sx
New brady, tachy or hypotension
AVR ST elevation
What are the indications to work someone up for secondary hypertension
Onset < age 30 or abrupt onset
(Newly) Drug-resistant
+++end organ damage out of proportion
HypoK+
New diastolic HTN in age >65
What is the duration of DAPT after a bare metal stent is inserted?
1 month
What is the duration of DAPT for a drug routine stent to treat ischemic heart disease?
6 months
What is the duration of DAPT for DES for NSTEMI
12months
What are the two most common congenital cardiac malformations in individuals with Turner syndrome
1.Bicuspid aortic valve
2.coarctation of the aorta
What are the characteristics of high-probablity cardiac ischemic chest pain?
central, pressure, squeezing/gripping tightness, heaviness, exertional, retrosternal
What are the high-risk features of angina that make you suspect ACS?
Angina at rest, or new onset, or increasing angina (more frequent, occurs with less exertion, or lasts longer).
If you have a normal ECG yet have a high suspicion of ACS, what can you try?
Order a 15 lead (V7-V9) and repeat the ECG if symptoms change/persist or trop positive.
In the office or home setting, if you have a patient c/o of suspiscious cardiac chest pain what should you tell them to do?
Call 9-1-1 (don’t get them to drive to the hospital)
What are the findings on ECG consistent with NSTEMI
new horizontal or down-slope ST depression or new T wave inversion
What is the localization of a STEMI with 2+ precordial leads?
anterior wall
What is the localization of a V1-V3 STEMI?
Anteroseptal
What is the localization of a I II AVL STEMI
Lateral
What is the localization of an ST elevation in III AVF?
Inferior wall MI
When you see an R in V1 V2 and S in V5 V6 what do you look for?
Right Bundle Branch Block
What are the signs of a left bundle?
You’ll see wide QRS everywhere with ST elevation in the V1-V3
What are the criteria for acute STEMI with LBBB?
ST elevation that is discordant (so with R wave you should have ST elevation) or ST elevation >5mm or ST depression in V1-V3
When you see a biphasic T wave in the precordial leads, what do you think?
This is Wellen syndrome -> you have proximal LAD and need cath.
What is the purpose of checking pulses in chest pain?
Look for aortic dissection! Check BP in both arms
What type of aortic dissection presents as STEMI
Type A (ascending aorta)
What is the initial management for ACS
Manage pain with morphine or nitrate (but caution if suspiscion for RV MI or inferior MI)
Give antiplatelet drugs (loading dose of aspirin 160mg). If sending for urgent cath do not have to give DAPT (in case they need CABG). They can give ticagrelor on the table.
GIve anticoagulation (LMWH or Fonda, UFH if renal dysfunction)
Move to monitored setting.
For patients with A fib, how should they be managed after PCI
Triple therapy for 1 week, then double therapy for 12 months then DOAC only. If at high risk of bleeding, you do 6 months double therapy (DOAC+Plavix). If at high risk of ischemia, continue to triple therapy for 1 month.
What are the contraindications for fibrinolytic therapy in STEMI
Piror ICH, known cerebral AVM or intracranial alignancy or ischemic stroke within 3 months (except acute stroke within window),
What diagnosis should you consider in a person who smokes cigarettes and comes in with retrosternal chest pain and ST elevation on EKG;; but has no evidence of coronary narrowing on cardiac Cath
Prinzmetal Angina
What is the first line treatment for prinzmetal angina?
CCB
What is first line therapy for RV infarction
Normal saline / ?RL
What is the treatment of choice for hemodynamically stable VTach in the setting of WPW
Procainamide (or ibutilide)
