Cardio 2 Flashcards
How does the auscultory findings of an IV septal rupture differ from papillary muscle rupture?
IV septal rupture = harsh holosystolic murmur at L sternal border (with palpable thrill)
Papillary muscle = severe mitral regurg. Soft systolic murmur (no palpable thrill found)
What is the primary treatment for prinzmetal’s angina?
CCB (diltiazem - potent coronary dilator/weak systemic arterial dilator)
Dihydropyridines (amlodipine, felodipine) can also be used.
Sublingual Nitro = abortive therapy
What drug class should be avoided in Vasospastic angina?
B-blockers - can worsen coronary vasospasm.
Adrenergic stimulation of B2 R dilates coronary arteries and alpha 1 R stimulation constricts them.
What medication should be used to treat SVT (supraventricular tachycardia)?
Adenosine - slows conduction through AV node.
SVT = narrow QRS and no regular P wave
Sinus Tachy = normal P wave and relationship to QRS
What is the mechanism of viral induced dilated cardiomyopathy?
DCM likely due to viral myocarditis (HHV 6, HIV, coxsackie, adeno). Virus invades cardiac myocytes»_space; cytotoxicity + impaired contractile function»_space; ventricular dilation (tends to present as decompensated HF).
** Tends to affect young adults and can cause 4 chambered dilation.
What Rx would you give to prevent uric acid stone formation?
Uric acid stones are seen in Pt with abnormally low pH (possible defect in ammonia excretion) and hyperuricosuria. Rx = alkalinization with potassium citrate.
** Added effect of citrate»_space; stone inhibition and reduces crystallization
What side effect should you look out for when using high dose nitroprusside for a hypertensive emergency?
Look out for cyanide toxicity. Nitroprusside can be metabolized to NO and CN-. This can especially happen in Pt with renal insufficiency. Characterized by AMS, lactic acidosis, seizures, and coma.
What electrolyte abnormality is associated with trimethoprim use?
Trimethoprim can cause hyperkalemia due to interaction with ENaC channel in the collecting tubule, and functions similarly to the action of a potassium sparring diuretic. TMP also inhibits renal tubule creatinine secretion. Maintains GFR though and can cause an artificial rise in GFR.
If a patient presents with palpable purpura, proteinuria, and hematuria in addition to hepatosplenomegaly, arthralgias, and hypcomplementemia then you should consider:
Mixed cryoglobinemia
If you have a patient with palpable purpura of the buttocks, abdominal pain, arthralgias, proteinuria and hematuria with RBC casts on urinalysis and Normal complement level then you should consider:
HSP (Henoch Schonlein purpura)
What is the initial treatment for a patient with symptomatic sinus bradycardia?
Atropine (antimuscarinic) – increases cardiac output via increasing SA and AV node activity. Can also be used for different types of heart block.
How would you replete hyponatremia?
Should give 3% saline (hypertonic) but correction should not exceed .5 mEq/L/hr because you want to prevent irreversible brain damage from osmotic demyelination/central pontine myelinolysis.
How does treatment differ in complicated vs uncomplicated cystitis?
Uncomplicated : TMP/SMX (3 days), Nitrofurantoin (5 day), or fosfomycin (single dose)
Complicated: fluoroquinolones (levofloxacin)
