Cardio Flashcards
RE-LY - 2009
Noninferiority trial
Dabigatran vs Warfarin
Warfarin reduces stroke risk by
~55%
AFFIRM - 2002
Pts w non-valvular AF
Rate vs rhythm control non-inferior,
Rhythm control shows trends towards increased mortality
RACE II -2010
Lenient (HR <80/min) in preventing cardiovascular events
Antiarrythmic drugs - Class I
NaCB
1a - procainamide, quinidine
1b - lidocaine
1c - flecanaide, propafenone
Anti arrhythmic drugs - Class II
BBs
Anti arrhythmic drugs - Class III
KCBs
Amiodarone, sotalol, dofetilide
Anti arrhythmic drugs - Class IV
CCBs
Digoxin
Na-K ATPase inhibitor: increases contractility (IC Na increases, resulting in Ca influx)
AV node blockade - increases effective refractory period, slows heartrate
Inotropic effect
+ increases myocardium contractility
- decreases myocardium contractility
Chronotropic effect
+ increases HR
- decreases HR
Dromotropic effect
+ increases AV node conduction speed
- decreases Av node conduction speed
Maintenance of Sinus rythtm if no Heart disease (and HTN without LVH)
1st choice: flecanaide, propafenone, sotalol
2nd line: amio, dofetilide, cath ablation
Maintenance of sinus rhythm if HTN & LVH
1st line: amio
2nd line: cath ablation
Maintenance of sinus rhythm if CAD
1st line: dofetilide, sotalol
2nd line: amio or cath ablation
Maintenance of sinus rhythm if CHF
1st line: amio, dofetilide
2nd line: cath ablation
Dronedorone
Amio derivate
Not in CHF
Causes GI upset
Causes incr of creatinine 2ry to decreased tubular secretion
Complications of AF ablation
Stroke
PV stenosis
LA tachycardias
SCT-HEFT
Pts w NYHA II/III and EF<35% mortality benefit of Prophylactic ICD
MADIT II.
Post-MI w EF=< 30% mortality benefit from prophylactic ICD
Biventricikar device Tx
NYHA III/IV w EF120-130 ms
NYHA I/II w LBBB QRS>130 and EF=<30%
When to Echo a murmur?
All diastolic
=< 2/6 if symptoms
=> 3/6 all
When to intervene? - MS
Valvuloplasty, if
Symptoms; AF; increased PAP on exercise
(Severe, if VA 60 or PAP >30 mmHg on exercise)
When to intervene! - AS
AVR - if symptomatic; if asymptomatic but EF4.0m/s, mean gr >40 mmHg)
When to intervene? - MR
MV repair or MVR, if symptomatic, or if LV dysfunction (ESD >= 40, EF60 cc, regurg orifice area: >= 0.4 cm2, vena contracta >= 0.7 cm)
When to intervene? -AR
AVR, if symptomatic, or LV dysfunction (ESD >= 55 mm, EF0.6 mm, regurg volume >60 cc, regurg orifice area >0.3 cm2)
Electrical alterans
Dg for pericardial fluid
Electrical alterans + hemodynamical instability
Pericardial Tamponade
Pericarditis
Rub= 2 systolic, 1 diastolic
Relieved by leaning forward
Diffuse ST-elevation & PR depression
Constructive pericarditis
Kussmaul’s sign
HOCM - incidence 1/500; no vigorous sports!!
ICD recommendations
Symptomatic (syncope or sudden cardiac death)
Asymptomatic high risk (family Hx of sudden cardiac death, septum >30 mm)
A/C in pregnancy
1st trimester - UFH or LMWH
Then - warfarin until wk 36
At the end cont UFH drip until delivery
Coarctation aortae
Distal to L subclavian
50-80% a/w bicuspid aortic valve
UE HTN
CXR: 3-sign, rib-notching
Smoking cessation and all cause mortality in pts w IHD
36%
Anti-platelet in U/A - NSTEMI if medical therapy only
Asa 81 mg indefinitely
Plavix 75 mg x 1/12, ideally for 1yr
Dual antiplatelet in pt w DES
Asa 81 mg x indefinitely
Plavix 75 mg x min 1yr, or
Prasugrel 10 mg, or ticagrelor 90 mg bid
Dual antiplatelet Tx for U/A or NSTEMI w BMS
Asa 81 mg indefinitely
Plavix 75 mg x 1/12, ideally x1yr, or
prasugrel 10 mg daily or ticagrelor 90 mg bid
Acute MR on PA catheter
PCWP 25 (elevated) & v waves to 40 mmHg
Cardiogenic shock on PA catheter
PCWP 25 (elevated), w CI 1.5 (decreased)
Tamponade on PA catheter
Equalization of pressures:
RA 20 mmHg, PAP 40/20, PCWP 20
VSD on PA catheter
Sat 88% in PA
Pulmonary embolism on PA catheter
PAP 50/30,PCWP 4
