cardio Flashcards
Impact of CHF right
weight gain, edema, ascites
impact of CHF left
nocturnal cough, gasping at night, orthopnea, wheezes (pulmonary edema)
need to ask for differential diagnosis cause of CHF
MD
Medications
C - change
A additionals
R - regularly taking
D - dose changes/ digoxin
diet
c- change in diet
a- additional salt / additional fluids
r- regular monitoring of salt
nyha classification
class
1 - ordinary activity does not case chf
2 - comfortable at rest , ordinary acitivity causes symptoms
3 - marked limitation on ordinary activity
4 - inability to carry out ordinary activity
chest findings CHF
increased pulmonary vascular marking
kerley B lines
cardiomegaly
small bilateral pleural effusions
bilateral interstitial infiltrates
treatment acute CHF
L - lasix 40-500mg TIV - dec preload
M- morphine 2-4mg decrease anxiety
N - nitrates increase kidney perfusion
O - oxygen
P- positive airway pressure decrease preload
P - position with legs hanging
CHF long term treatment
A - ACEI / ARBS
B - beta blockers - titrate may initially worsen CHF
C -
D- digoxin
D - diuretics furosemide 80mg OD
Spironolactone class II B and IV CHF already on Loop and ACE
still uncompensated - implantable cardioverter defibillator
Anti arrythmic drugs - amiodarone, beta blocker, digoxin
anti coagulants - warfarin
Digoxin overdse
Nausea/ vomiting
E- yellow halos around objects
Bradycardia, dizziness, LOC
ECG - PVC heart block
CHF differential diagnosis if with fever
bacterial endocarditis
CHF case DD if sudden symptoms
cardiac tamponade / acs
Heart racing problem trigger factors
ACCCC SAD
anxiety
chocolate
coke
caffeine
coccaine
smoking
alcohol
medications causing heart racing problem
beta blockers
stimulants
pseudophedrines
Heart racing problem DD
hyperthyroidism
pheochromocytoma
heart racing case worrisome problems
CVA. heart failure, V fib
causes of AF
IHD
hypertension/ CHF
medications
electrolyte imbalance
too much alcohol - holiday heart
cardiomyopathy
causes of tachycardia
pregnancy
exercise
caffeine
anemia
hypovolemia
fever
stress
smoking
hyperthyroidism
pheochromocytoma
AF management <48 hrs
amiodarone / satolol
AF > 48 hrs mgt
rate control: BB CA blockers diltiazem, verapaml, digoxin
Rhythm structural amidarone
non structural flecainide, propofenone
anticoagulation after 3 weeks
Cardioversion of AF
electrical 150joules
Cardioversion A flutter
50 joules
Pharmacologic cardioversion
procainamide 1g/1hr infusion
CHADS 2 scoring
CHF 1
Hypertension 1
age >75 1
diabetes 1
stroke TIA 2
Long Term Management of Ischemic Heart
Disease
Pharmacological
Aspirin
Clopidogrel
Beta Blocker
Statin
In case of LVF:
ACEI/ARB
Spironolactone
Non-Pharmacological
* Control underlying disease
* Diet according to Canadian
Food guide (DASH if HTN)
* Exercise 30-35 minutes 3-5
times a week
* Quit smoking
* Weight reduction
* Cardiac Rehabilitation
Stable Angina diagnostics
ECG
Stress testing with ECG
or imaging (using
echocardiography,
radionuclide imaging, or
MRI)
Coronary angiography
for significant symptoms
or positive stress test
Unstable Angina investigations
ECG, cardiac enzymes, CXR
CBC-D, electrolytes, BUN/
CR, PTT/INR, Lipid profile,
FBS/RBS, HBA1C, Urine
analysis
Angiography
PCI (if needed)
ACE Inhibitors contraindication
Bilateral renal artery stenosis
Hx of angioedema
Pregnancy
CRB65 meaning and interpret
confusion
urea 7
RR >/= 30
BP <90/60
65 >/= 65 years old
0- opd
1 admit
3 icu
