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ER EOR > Cardio 2 > Flashcards

Cardio 2 Flashcards

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1
Q

EKG premature atrial complexes

A

early P waves that differ in morphology from the normal sinus P wave

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2
Q

tx premature atrial complexes

A

usually asx - no treatment
symptomatic - beta blockers

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3
Q

are QRS complexes typically wide or narrow in premature ventricular complex

A

WIDE QRS - bc it is usually due to muscle contraction outside of the original pathway = slower contraction

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4
Q

EKG Afib

A

irregularly irregular rhythm (irregular RR intervals and excessively rapid series of tiny, erratic spikes on EKG with a waxy baseline and NO IDENTIFIABLE P WAVES)

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5
Q

tx Afib

A

unstable - cardioversion

stable - RATE control > rhythm control – BB > CCB
BUT if LVEF - use metoprolol, digoxin, or amiodarone

anticoagulation based on CHA2DS2VASc score (warfarin vs DOAC (apixaban, rivaroxaban, edoxaban)

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6
Q

goal INR range on warfarin

A

2-3

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7
Q

CHA2DS2VASc

A

CHF (1)

HTN (1)

Age >/= 75 (2)

DM (1)

Stroke, TIA (2)
Vascular dz (MI, aortic plaque) (1)

Age 65-74

Sex (female = 1)

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8
Q

what CHA2DS2VASc score for anticoagulation in afib

A

2 or more males
3 or more females

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9
Q

if Afib is present for > 48 hours (or unknown period of time), anticoagulant patients for ________

A

3 weeks before and at least 4 weeks after cardioversion

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10
Q

EKG Aflutter

A

saw-tooth baseline with a QRS complex appearing every second or third “tooth” (P wave)

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11
Q

tx for aflutter

A

same as for afib

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12
Q

multifocal atrial tachycardia is commonly see in people who have

A

COPD

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13
Q

EKG MAT

A

variable P wave morphology and variable PR and RR intervals

at least 3 different P wave morphologies are requires to make an accurate diagnosis

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14
Q

tx MAT

A

underlying cause

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15
Q

tx paroxysmal supraventricular tachycardia

A

IV adenosine

definitive - radio frequency catheter ablation

prevention: CCB or BB

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16
Q

EKG for Wolff-parkinson-white syndrome

A

wide complex tachycardia (can also be narrow), short PR interval (<0.12), delta wave (upward deflection seen before the QRS complex)

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17
Q

tx WPW

A

stable - procainamide

unstable - cardioverson
definitive - radio frequency ablation

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18
Q

what is sustained vtach

A

duration of at least 30 seconds or causes hemodynamic collapse in < 30 seconds

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19
Q

what electrolyte abnormalities can lead to vtach

A

hypomagnesemia
hypokalemia
hypocalcemia

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20
Q

what medication can lead to vtach

A

digoxin

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21
Q

tx vtach

A

stable - amiodarone or procainamide
unstable - cardioversion
pulseless - defibrillator + CPR

chronic - BB and ICD

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22
Q

tx torsades de pointes

A

IV mag sulfate

congenital - BB

unstable - cardioversion
pulseless - defibrillator + CPR

23
Q

tx Vfib

A

defibrillator + CPR
epinephrine and amiodarone per ACLS

24
Q

when is angina considered unstable

A

angina at rest, generally lasting longer than 20-30 minutes
new onset angina
change in angina pattern

25
Q

EKG for unstable angina

A

ST segment depression
new deep T wave inversions or flattening

26
Q

cardiac enzymes unstable angina

A

negative CK and troponin = ischemia without cell death

27
Q

tx unstable angina/NSTEMI

A

MONA BASH
morphine
oxygen
nitrates
aspirin + P2Y12 inhibitor

beta blockers
acei
statin
heparin (enoxaparin)

28
Q

what is the difference between NSTEMI and unstable angina

A

positive cardiac biomarkers in NSTEMI

29
Q

reperfusion therapy for STEMI

A

PCI > Fibrinolytics

PCI within 90 minutes

thrombolytics within 30 minutes if PCI is not possible

30
Q

triad of right ventricular infarction

A

increased JVP
clear lungs
positive kussmaul sign (increase in JVP during inspiration)

31
Q

the treatment for right ventricular MI (inferior or posterior wall MI) is treated the same as a STEMI except for what meds should be avoided?

A

beta blockers
nitrates
ccb
opioids
NSAIDs

so still can use - oxygen, aspirin + P2Y12 inhibitor, acei, statin, anticoagulant

32
Q

indications for PCI

A

patients with coronary artery disease and resultant angina involving one or two vessels but not involving the left main coronary artery and in those with normal ventricular function
diabetics with single vessel disease

33
Q

indications for CABG

A

left main coronary artery involvement with > 50% stenosis, > 70% stenosis three-vessel disease, or decreased left ventricular ejection fraction < 40%
diabetics with multi vessel disease

34
Q

tell me about HFrEF

A

most common type
post MI MCC
systolic dysfunction
decreased ejection fraction < 40%
S3 gallop

35
Q

tell me about HFpEF

A

diastolic dysfunction
normal ejection fraction
S4 gallop

36
Q

NYHA functional classes

A

I = no sx, no limitations during normal activity
II = mild symptoms (dyspnea, angina), slight limitation during normal activity
III = sx cause marked limitation in activity (even with minimal exertion); comfortable only at rest
IV = sx even at rest, severe limitations, inability to carry out physical activity

37
Q

Long-term management of HF

A

ACEI/ARB/ARNI
diuretic
beta blocker (reduces mortality) - metoprolol, carvedilol, bisoprolol

can add spironolactone or eplerenone as well as an SGLT2 inhibitor (dapagliflozin, empagliflozin)

if AA - can add hydralazine plus nitrate if persistent sx

38
Q

what is hypertensive emergency

A

SBP >/= 180 and/or DBP >/= 120 in addition to end-organ damage

39
Q

tx hypertensive emergency

A

reduce mean arterial pressure by 10-20% in the first hour, then gradually by another 10% over the remaining 23 hours

meds - IV nicardipine, clevidipine, labetolol

40
Q

tx for hypertensive urgency

A

BP should be lowered within 24 hours with oral meds (Clonidine or Captopril) by 25%

41
Q

define cardiogenic shock

A

SBP < 90 with urine output < 20 mL/hour and adequate left ventricular filling pressure

decreased cardiac output and increased systemic vascular resistance (vasoconstriction) and increased pulmonary capillary wedge pressure

42
Q

MCC cardiogenic shock

A

acute MI

43
Q

what is generally the measure of the PCWP in cardiogenic shock

what are the goals if you need to use a swan-ganz catheter

A

> 15 mmHg

goals with swan-ganz - keep cardiac output > 4 L/min, Cardiac index (CI) > 2.2, PCWP < 18

44
Q

tx cardiogenic shock

A

no fluids
NE generally preferred
dobutamine instead if borderline low BP

45
Q

definition of orthostatic hypotension

A

decrease in SBP of at least 20 and/or decrease in DBP of at least 10 mmHg

46
Q

what physical exam test can you do for orthostatic hypotension

A

tilt table test — BP reduction at a 60 degree angle

47
Q

tx orthostatic hypotension

A

increase salt and fluids
gradual postural change
compression stockings
exercise
d/c affection meds

fludrocortisone (mineralocorticoid) or midodrine (alpha 1 adrenergic agonist) if sx continue

Fludrocortisone > Midodrine

48
Q

vessel involvement and area of claudication for peripheral arterial disease

A

aortic bifurcation/common iliac = buttock, hip, groin

femoral artery/branches = thigh, upper 2/3 of the calf

popliteal artery = lower 1/3 of the calf, ankle, foot

tibial and peroneal arteries = foot

49
Q

sx peripheral arterial disease

A

LE pain with ambulation, exercise, movement; relieved with rest

decreased, weak, absent pulses

atrophic skin changes - shiny, dry skin; hair loss, thickened nails, cool limbs

wound on lateral malleolus

foot and leg pallor on elevation; dependent rubor

50
Q

dx peripheral arterial disease

A

ABI = most useful screening
Duplex ultrasonography - evaluate further extent
Arteriography = gold standard; usually only performed if revascularization is planned

51
Q

ABI ranges peripheral arterial disease

A

normal = 0.9 - 1.3

ABI > 1.3 is due to non compressible vessels and indicates severe dz

claudication when ABI < 0.7

rest pain when ABI < 0.4

52
Q

sx of chronic venous insufficiency

A

leg pain worsened with prolonged standing and sitting with feet dependent

leg pain improved with ambulation and leg elevation

stasis dermatitis - eczematous rash and brownish/purple rash (hemosiderin deposition)

ulcers on medial malleolus

PITTING leg edema

53
Q

what vein most commonly affected in chronic venous insufficiency

A

greater saphenous vein

54
Q
A

ER EOR (28 decks)

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