Cardio 4 Flashcards
Recent myocardial infarction (MI), pleuritic chest pain (pain worse with deep inspiration) with radiation to the shoulder, and a pericardial friction rub.
Dx?
Rx?
What medications to avoid? When can you use these medications?
Peri-infarction Pericarditis
Increase Aspirin dose up to 1000mg TID and AVOID steroids + NSAIDS (can cause scarring of the heart and thinning of muscle),
blood thinners (risk of pericardial effusion).
Can use NSAIDs/Steroids in Dresslers Syndrome post cardiac injury syndrome that occurs WEEKS to MONTHS after MI.
Management of Cocaine induced chest pain and why?
- Aspirin, Nitro, CCB and Benzo (help reduce Anxiety and Lower BP)
- Next step is Cath because cocaine increases thrombogenicity (Release Pro-Coagulants).
Beta blockers are contraindicated due to UNopposed Alpha activity.
After a patient is taking Asa, Carvedilol, Lisinopril, Furosemide and Spironolactone. What can be added to the regime if a patient is having continued symptoms?
Isosorbide Dinitrate (Imdur)
Name 2 hypertensives that are safe to use in Gout?
Amlodipine and Losartan. (Avoid Thiazides)
Hypotension, tachycardia and rapid x descent in neck veins. Dx?
Pericardial tamponade rapid x descent is elevated jugular venous pressure and pulsus paradoxous.
Pt s/p Acute inferior ST MI. He did not undergo revascularization due to time frame. He suddenly develops SOB, Hypotension. The Apical Impulse becomes Hyperdynamic with faint Systolic Murmur heard at the apex. Dx?
Mitral Regurgitation due Papillary Wall Rupture. This occurs (Days to 1 week)
- Which procedures DO NOT need abx prophylaxis ?
- Which procedures do the required patients NEED abx prophylaxis?
Low risk Procedures: GI Endoscopy, Vaginal/C-section and GU procedures.
High risk procedures: Cardiac, Manipulation of Gingival tissue, Respiratory Tract procedures with Incision and Biopsy, Procedures with ongoing infection.
i.e Abx is not recommended for patients with Mechanical Heart Valves or Prior Endocarditis undergoing LOW RISK procedures.
Pt presents with Hypotension, Tachycardia, Pulsus Paradoxus , Distant Heart Sounds and Low Voltage QRS. Dx?
Pericardial Tamponade
Management of patients with Stage B Heart Failure (Asymptomatic + LV dysfunction) ?
ACE and Beta blockers.
This Delays onset of Symptoms. (Reduces Events and Improves Survival)
- What is indicative of an ABI < 0.9 ?
- ABI 0.9-1.3 ?
- ABI > 1.3 ?
- Diagnostic of PAD
- Normal
- Noncompressible calcified vessels seen in DM and CKD patients.
A patient that undergoes Radionuclide Stress test and the ECG test shows ST segment Depression but the Myocardial Perfusion images show NO Ischemia?
What is the next step?
This is Balanced Ischemia
The next step is Cardiac Catherization
What are the 4 Key Management Decisions for HFpEF?
- Control of Systolic and Diastolic BPs.
- Control of Ventricular Rate
- Management of Fluid Volume
- Coronary Revascularization in patients with documented Ischemia
Management of Aspirin and Plavix in a patient undergoing CABG?
- Stop Plavix 5-7 days before procedure to decrease bleeding risk.
- Aspirin needs to be continued because it Decreases Rate of Graft Occlusion.
- Treatment for patients with Prolong QTc Male > 450 and Women > 470?
- Who gets ICD?
- Beta blockers ( to reduce arrhythmias and sudden cardiac death)
- Patients with Syncope
- When does Dig Toxicity occur?
- What are signs of Acute Dig Toxicity?
- What rare signs of Chronic Dig toxicity?
- During volume depletion (gastroenteritis) or Electrolyte Disturbance.
- GI symptoms (nausea, vomiting, fatigue)
- Weakness, Lethargy, Confusion, Visual symptoms (Neurological Symptoms.)
Management of patients with Rheumatic mitral Stenosis and Atrial fibrillation?
Life long Coumadin with goal INR of 2.5
AC recommended in pt with Afib, Prior Embolic Event or Left Atrial Thrombus.
What does Prolonged PR interval in patients with Aortic Valve Endocarditis suggest?
Perivalvular Abscess causing Heart Block.
The treatment is surgery.
Pt presents with fatigue, frequent headaches, systemic hypertension and obesity with palpitations are night?
OSA - OSA can cause nocturnal cardiac arrhythmias.
Diagnosis is made with sleep study + ECG monitoring.
Treat the OSA to suppress the arrhythmias.
Women with Chest pain, Ischemic appearing EKG changes and absence of coronary artery disease. Dx? Prognosis?
Takotsubo Cardiomyopathy
Recovery of left ventricular systolic function occurs in 8-12 weeks.
Pt presents with Syncope or Sudden Cardiac Death. He has 2mm ST elevation in the right precordial leads with T wave inversions and RBBB. Dx?
Brugada Syndrome
ICD placement for syncopal patients.
- Which Valve Replacements need an INR 2.0-3.0?
- Which Valve Replacements need INR 2.5-3.5?
- Aortic Valve Replacement with no risk factors
- Mitral and Aortic Valve replacement with high risk features ( Afib, LVEF < 30%, Previous thrombus, hyper coagulable state)
Pt presents 2 day hx of Chest pain, Shoulder pain, Back Pain, Fatigue, Sweating, Low grade Fever. He underwent CABG 4 weeks ago. EKG shows unchanged LBBB he had 4 weeks ago? Dx? Rx? What can be given to prevent this?
Post-Cardiac Injury Syndrome (PCIS): Acute pericarditis. Rx: NSAIDs or Steroids. Prophylatic colchicine helps decrease incidence.
Fever, tachycardia, chest pain, sternal wound infection 2 weeks after CABG. Dx?
Post Mediastinitis
Pt is s/p 3 days Cardiac Cauterization. A Tender Mass is Palpated right below the Right Inguinal Ligament near the puncture site.
Dx?
Psuedoaneurysm.
Conduct Doppler Us
- What is the Proper Treatment for Viral or Idiopathic Pericarditis?
- Which treatment is associated with higher recurrence rates?
- NSAID + Colchicine
- Steroids ( Use only in refractory cases)
Elderly patient passes out 2 hours after eating. Dx?
Management?
Postprandial Hypotension
Decreased portion size , increase salter water intake, low carb meals, avoid ETOH
Octreotide given in severe patients
What electrolyte abnormality is associated with a wide complex rhythm and no P waves?
Hyperkalemia
Give IV calcium gluconate
