Cardio Flashcards
1
Q
Treatment for child with coarctation of the aorta presenting in cardiogenic shock?
A
PGE1 (to keep ductus arteriosus open)
2
Q
Acute Aortic Dissection early Tx:
A
Esmolol (short acting B1 easily titratable)
3
Q
Prinzmetal’s angina.
d/t
EKG findings
Tx
Do not give ____? Why? What other related condition should you not give this med?
A
Substernal chest pressure at rest and during activity worse in the AM and with smoking.
Dx: Transient ST Elevations on EKG
Tx: CCB, Nitrates
Do not give Propranolol. Unopposed alpha vasoconstriction can cause death. Don’t give Propranolol in Intermittent Claudication (for the same reason).
4
Q
EKG findings of myocardial infarction.
A
Sustained ST elevations (transmural)
Transient or sustained ST depressions
Q waves (Old MI)
5
Q
Digoxin
MOA
What is it used for?
A
Blocks Na/K ATPase of cardiac myocytes to slow conduction through SA and AV nodes.
For A.Fib
6
Q
Digoxin Toxicity S&S.
Antidote?
A
Yellow vision
Abd pain
2º AV Node Type I (Wenckebach) Block.
Tx: Digoxin Immune Fab
7
Q
S&S of Left sided Heart Failure (weeks after Anterior MI.)
Most likely caused by?
A
Dyspnea, crackles
↑ PCWP (> 15) and ↑ RA pressure (>6)
d/t Ventricular Aneurysm (ST elevations in V1-V4)
8
Q
What is the 1st line med in all Acute Coronary Syndromes?
A
Aspirin. (Clopidogrel if unable to tolerate). Reduces morbidity and mortality.
9
Q
Management of Symptomatic A. Fib
Dx?
A
Dx: TEE to check for intracardiac thrombus OR
Anticoagulate for 3 wks before cardioversion
10
Q
LBBB
A
No R in V1
Tall R in V6
11
Q
RBBB
A
RSR1 “Rabbit ears”
12
Q
Hypo/Hypercalcemia EKG changes?
A
Hypocal = “po“longed QT.
Hypercalcemia is opposite (shortened QT)
13
Q
What is Kussmaul’s sign?
A
JVP Increased with Inspiration
[Norm JVP= 6-8]
14
Q
Aortic Stenosis keywords
A
Pulmonic Post (L 2 ICS)
Ejection
“Parvus”
Radiates to Carotids
Assoc: Turner’s Syn, Heyde’s angiodysplasia of colon
15
Q
Mitral Regurg keywords
A
@ Apex
Radiates to Axilla
Blowing
Marfan’s (also seen in Aortic Regurg)
Papillary mm. rupture
Weight loss meds
16
Q
Mitral Valve Prolapse keywords
A
@ Apex
Midsystolic (Think MVP of the mid-season)
Better w/ squat
Klinefelter
17
Q
Hypertrophic (Systolic) Cardiomyopathy keywords
A
LSB
S in V1 + R(V5/V6) > 35mm
Louder w/ Valsalva, standing, vasodilators, diuretics (anything that ↓ preload/afterload)
Tx: BB, CCB
18
Q
Aortic Regurg keywords
A
@ LSB/Pulmonic post (L 2 ICS)
High pitched blowing
Flash pulmonary edema
(Austin Flint, Duroziez, Corrigan, DeMusset, Quincke),
Marfan’s (also seen in Mitral Regurg)
Syphilis
Tx: Hydralazine, ACEi, CCB
Valve replace if Austin Flint
HAC V?
19
Q
What is Austin Flint? Significance?
A
backward flow of blood hitting mitral valve leaflet.
Time to REPLACE the AORTIC VALVE
20
Q
What is Duroziez sign?
A
Femoral bruit
21
Q
What is Corrigan’s Pulse?
A
Water hammer bounding pulse
22
Q
What is DeMusset’s sign?
A
Head Bobbing
23
Q
What is Quincke’s Pulse?
A
Pulsating Nail Bed
24
Q
Mitral Stenosis keywords
A
@ Apex
Hemoptysis
Mid-diastolic rumble with *Opening snap*
Loud S1
Rheumatic Fever, Group A Strep.
Tx: Balloon Valvotomy
25
What can cause 1st Degree AV Block?
Vagal tone
26
Wenckebach Tx.
Stop BB, CCB, or Digoxin
Atropine
27
Tx. for Mobitz 2, 3rd Degree AV Block, and Sick Sinus Syndrome
Pacemaker (Transcutaneous pacing)
28
A. Fib Tx parameters
1) Anticoagulate if CHADS2 \>=2.
2) If 48 hrs, Anticoagulate,
3) If 3-6 weeks of Warfarin (INR 2-3) can cardiovert
29
Multifocal Atrial Tachycardia Tx
BB or CCB for rate control
30
Tx. for AVNRT or AVRT
1) Carotid massage, Valsalva.
2) Adenosine.
3) Cardiovert if hemodynamically unstable
31
Tx. Unstable supraventricular tachycardia
Synchronized Cardioversion (If conscious add sedation)
32
CHF acute exacerbation management
LMNOPA:
Lasix, Morphine, Nitrates, O2, Position upright, ACEi/ARB
33
Cilostazol MOA, indications, and contraindications
Phosphodiesterase inhibitor that decreases platelet aggregation and causes arterial vasodilation, that used for *Intermittent Claudication* and *PVD*.
## Footnote
***Contraindicated in CHF***
34
NYHA Class I
No limitations.
35
NYHA Class II
Slight activity limits. Comfortable at rest, but ordinary activity results in angina, dyspnea, fatigue, or palpitations. Tx: ACEi, BB, Loops for exacerbations
36
NYHA Class III
Comfortable ONLY at rest. Tx: ACEi, BB, Loops, Spironolactone
37
NYHA Class IV
Symptoms at rest. Can't carry out any physical activity without discomfort. Tx: ACEi, BB, Loops, Spironolactone
38
Tx of Ventricular Tachycardia
**Cardioversion** is your PAL (**P**rocainamide, **A**miodarone, **L**idocaine)
39
What EKG abnormality is **Brugada Syndrome** associated with?
***V. Fib***
40
Torsades can be d/t taking what medications?
Haloperidol
Atypical antipsychotics
41
Torsades de Pointes tx
Mg
42
Chronic CHF Tx
Chronic CHF is **BADS**
**B**B
**A**CEi/**A**RB, **A**SA
**D**iuretics (Loops + Thiazide + Spironolactone)
**S**tatin
43
Loop Diuretics [Lasix, Ethacrynic Acid, Torsemide]
MOA
AE
↓ Na/K/Cl/Ca reuptake.
*Ototoxicity, HypO-K* and *Ca*
44
Which Loop diuretic is not part of the Sulfa family?
Ethacrynic Acid
45
Thiazides [Chlorothiazide, Chlorthalidone]
MOA
AE?
↓ NaCl reuptake.
Cause HypO-K and alkaLOsis, HyperGLUC
46
Aldosterone antagonists/K sparing [Spironolactone, Triamterene, Amiloride]
MOA
AE
Spironolactone: aldosterone rec antagonist
Triamterene, Amiloride: block Na channels
*HyPER-K, Gynecomastia*
47
Carbonic Anhydrase Inhibitors MOA
AE
Decreased HCO3- retention
*HyPER-Chloremia* and *aCidosis, Sulfa allergy*
48
Wet Beriberi
B1 deficiency manifesting as:
Tachycardia, vasodilation, ↓ SVR, ↑ JVP, DOE, Edema
49
What is the gold standard for diagnosing atherosclerosis or if there's unstable angina?
Coronary Angiography
50
Angina Pectoris A*cute* tx.
MONAB:
**M**orphine, **O**2, **N**itrates, **A**SA + **A**CEi, **B**B
51
Angina Pectoris Chronic tx
**"BAN"**
**B**B
**A**CEi + **A**SA
**N**itrates
52
NSTEMI tx
**CASH CAB:**
**C**ath,
**A**SA,
**S**tatin,
**H**eparin
**C**lopidogrel,
**A**CEi,
**B**B
53
What does it mean if you see **ST Elevations in II, III, aVF**? What blood supply is affected?
What do you do?
**Inferior** MI (which will **involve the RV** 50% of the time), ***RCA/PDA*** and ***LCA***.
- **_Right sided MI_** will usually have **Hypotension** and **Bradycardia** *(RCA s\> SA node)*
Dx: Get Right-sided **EKG**
Tx: Give **Fluid Bolus** (because RV function will be 'preload' dependent)
54
What meds are *contraindicated in RV infarction*?
***NITRATES*** contraindicated in RV infarction
55
If there's a Coronary A. Reocclusion after MI, what labs do you look at?
CK-MB
56
**ST depression** **V1-V2** indicates what?
Acute **Posterior Wall** Transmural Infarct
57
If an **MI pt. is in heart failure** (hypoxia, S3, pulm edema) or Cardiogenic shock, **DON'T** **give** what?
**NO** **BB**. Gives ACEi
58
STEMI tx
**Angiography**.
**PCI** within 90 min.
\>90 then do **TPA**
59
Most common cause of death following acute MI?
Tx?
Ventricular Arrhythmia
Tx: Immediate unsynchronized Cardioversion
60
Post MI complication Day 1
Heart failure
Arrhythmia is most common complication (within 24 hrs, and days 2-4) following MI.
61
Post MI complications days 3-7 (or 5-10)
**Intraventricular septal rupture**: hemodynamic instability and new holosystolic murmur @ LSB
**Ventricular free wall rupture**: leads to hemopericardium/ cardiac tamponade with Beck's triad
**Papillary mm. rupture**: mitral regurg and left heart failure
62
Post MI complication Weeks-Mo. after
CHF, persistent ST Elevation, mitral regurg, ventricular aneurysm
63
Which lipid lowering agent causes angioedema?
Ezetimibe (cholesterol absorp inhibitor)
64
How to diagnose and tx. Renal A. stenosis?
MRA or Renal A. Doppler US. Tx: Angioplasty, stenting, ACEis ONLY if unilateral
65
Conn's syndrome Triad
HTN, HypO-K and AlkaLOsis. Increased Aldo v Renin
66
Malignant HTN
S&S
Tx?
\>180/120.
Retinal hemorrhages, exudates, encephalopathy, papilledema (NOT Renal failure)
Tx: IV **Sodium Nitroprusside** (1st line), **Hydralazine**, **Labetolol** *(_if no COPD_)*, Enalapril
67
Mean Arterial Pressure
[SBP + 2(DBP)] / 3
68
ACEi Adverse Effects
HyPER-K, Angioedema, Cough
69
MOA of Methyldopa
centrally acting adrenergic agonist
70
Constrictive Pericarditis keywords
pericardial knock
71
Aortic Dissection keywords
Spiral CT angiography, Between media & adventitia, diastolic decrescendo @ aortic post
72
Stanford A of Aortic Dissection
Left Subclavian, Proximal. Surgical emergency
73
Stanford B of Aortic Dissection
Left Subclavian, Distal. Medically manage
74
Debakey I
Ascending & Descending
75
Debakey II
Ascending
76
Debakey III
Descending
77
Leriche Syndrome
Butt claudication, v femoral pulses, impotence
78
What drains to Right lymphatic Duct
R Head and Neck, R upper extremity, Heart, Lungs
79
Vasovagal syncope
excess parasympathetics. Tilt-table test. Tx BB
80
Brugada Syn keywords
Na chan mutation in myocytes. ST elevation V1-V3 + RBBB + S waves in lateral leads.
81
Goal LDL for CAD/equivalents i.e. DM, PAD, Symptomatic Carotid a. dz, abdominal aortic aneurysm
82
Goal LDL for 0-1 risk factors
83
Goal LDL for 2+ risk factors
84
When is measuring PCWP (~Left Atrial pressure) helpful?
for checking severity of LV HF, quantifying degree of mitral stenosis, inc. in tamponade, restrictive cardiomyopathy, hypertrophy, for checking for pulmonary HTN
85
Loud holosystolic murmur @ LSB that is non-cyanotic
Ventricular Septal Defect
86
What would an Atrial Septal Defect sound like?
wide, fixed split S2
87
Tx. of **_A_**symptomatic Sustained Monomorphic Vtach
**Procainamide**
88
Tx. of _Symptomatic_ Sustained Monomorphic Vtach
**Cardioversion**
89
Tx. of Narrow QRS SVT
**Adenosine**
90
Tx. of Severe Bradyarrhythmias causing hemodynamic collapse
**Transvenous pacing**
91
What is the most appropriate next step in management in a patient with Intermittent Claudication?
Check Ankle-Brachial Index (ABI)
92
Venous hum
systolic/diastolic @ RSB quiets with pressure to jugular vein
93
Still murmur
early systolic, @ LSB, normal split S2
94
Peripheral pulmonary a. stenosis of the newborn
mid systolic, radiates to back and axilla, resolves in 3-6 mo.
95
Tx. for Atrial Flutter (hemodynamically stable pt)
Verapamil Metoprolol
96
What is the leading cause of isolated mitral regurgitation requiring surgery?
**mitral valve prolapse**
97
Tx. for 2nd Degree AV block (Wenckebach)?
Atropine, BB, CCB, Digoxin
98
Tx. for Mobitz II?
Pacemaker
99
Tx. for 3rd Degree AV Block?
Pacemaker
100
What is the most common indication for pacemaker placement?
Sick Sinus syndrome
101
Tx. Atrial Fib?
Anticoagulate if \>48 hrs
BB, CCB, Dig Cardioversion
102
Tx. for AVNRT and AVRT?
If unstable: **Cardioversion**
Stable: carotid massage, valsalva, **Adenosine**
103
Tx: Unstable Supraventricular Tachycardia
Circulation, Airway, Breathing
Synchronized Cardioversion
104
Defibrillation (not in synchrony with QRS) is Tx for what?
V. Fib
V. Tach no pulse
105
Cardioversion (in synchrony with QRS) is tx for what?
A. Fib/ A. Flutter
SVT
VT w/ pulse
106
CHF Dx?
Labs?
Tx?
Dx: Clinical diagnosis. Check EKG, BNP, 2D Echo.
Labs: ↓ Cardiac Index, ↑ SVR and LVEDV
Tx:
Restrict fluid and salt (H2O \<2L/d, Na \<2g/d), **A**CEi/ARB, **B**B, **L**asix, **S**pironolactone, **I**mdur, **H**ydralazine
**AICD** for Ejection Fraction \<35.
**Dobutamine** for cardiogenic shock.
107
Tx. HOCM
BB, CCB, avoid dehydration
108
Tx. of Acute Angina
**MONAB** (Morphine, O2, Nitrates, ASA/ACEi, BB)
109
Tx. Chronic Angina
**N**itrates, **A**SA/**A**CEi, **B**B
110
How do Nitrates work?
Dilate capacitance vessels (veins) and ↓ ventricular preload
111
NSTEMI
Dx?
Tx?
Myocardial infarction marked by elevated Troponin I and CK-MB without ST elevations
Tx: Stable: **Clopidogrel**, **Heparin**
Unstable: **Cardiac Cath**eterization/PCI
112
STEMI
Dx?
Tx?
Goals after hospitalization?
EKG, Troponins
Tx:
**Angiography** and PCI w/in 90 min
If no PCI, then **TPA** for thrombolysis
**PMONAB**: Plavix, Morphine, O2, Nitrates, ASA/ACEi, BB (but not if heart failure or cardiogenic shock. Just give ACEi)
On d/c: **BASH** --\> BB, ACEi/ARB, Statin, Heparin
Goal: **\<130/80**, **A1C\<7**, **LDL\<70**
113
**Fibrates** (Gemfibrozil)
MOA
Effects on lipid profile
Adverse SE?
↑ LPL
↓ TGs and ↑ HDL
! LFTs, myositis
114
**Ezetimibe** (Cholesterol absorption Inhibitors)
MOA
Effects on Lipid Profile
Adverse SE
↓ absorption at brush border to ↓ LDL
! diarrhea, **angioedema**
115
**Niacin**
MOA
Effects on Lipid Profile
Adverse SE
↓ LDL synthesis and thus ↑ HDL
! skin flushing, LFTs
116
**Cholestyramine** (Bile Acid resin)
Effects on Lipid Profile
Adverse SE
↓ LDL
! diarrhea, LFTs
117
Vasovagal syncope
d/t?
dx?
Tx?
excess parasympathetic stimulation (i.e. carotid stim, coughing, micturition, defecation)
Dx: *Tilt-Table Test*
Tx: BB
118
Neurogenic Shock
d/t?
Dx?
Tx?
hypotension, bradycardia, and hypothermia with **+ focal neurological deficit**
**unopposed vagal tone** causes vasodilation which then ↓ **SVR,** which is why ↓ **PCWP**. In addition, vagal tone promotes ↓ **HR**, which then ↓ **CO** and ↓ **BP**
**"warm** and **dry** extremities" (also seen in septic shock)
Dx: CT angio, MR angio, US of Carotids
Tx: **DA**, Vasopressin, Atropine for bradycardia
119
What is the tx. for *acute decompensated* Systolic Heart Failure refractory to medical management?
**Milrinone**: PDE inhibitor that increases cAMP and therefore increases cardiac contractility.
## Footnote
**Dobutamine**
**Dopamine**
120
What is a feared complication of Carotid Endarterectomy (CEA)?
Hyperperfusion Syndrome:
Increased blood flow after stenosis is released that causes headache, seizure, hemorrhage in pts. who have a high degree of stenosis or recently suffered a stroke
121
Cardiogenic Shock
d/t?
Dx?
Tx?
heart failure causes **↓ CO, ↓ BP** so the body tries to compensate by ↑ **SVR**, ↑ **HR** and when blood comes back to left atrium, ↑ **PCWP**
**"pale cool skin", JVP**
d/t heart failure e.g. MI
Dx: EKG, Troponins
Tx: Fluids, **Dobutamine**, inotropes, anti-arrhythmics (Adenosine, Amiodarone, BB), Intra-aortic balloon pump
122
Septic Shock
d/t
Dx?
Tx?
↓ **SVR** (~↓ **BP**) which then leads to
↓ **PCWP** (~Left Arterial Pressure: too little fluid in)
↑ **HR** ↑ **CO**
**"warm and dry"** extremities
suspect in pts. with penetrating abdominal wounds and GI contamination
Tx: Fluids, Broad spectrum **ABX** (? GI: Cipro, Metronidazole, Vanco), **Norepinephrine** to vasoconstrict peripheral arterioles
123
Anaphylactic Shock
↓ **SVR** (~↓ **BP**) which then leads to
↓ **PCWP** (~Left Arterial Pressure: too little fluid in)
↑ **HR ↑ CO** (heart wants to raise the system's volume and flush out allergen?)
124
Tx: DVT
SQ Heparin x 5d then Coumadin x 6 mo. [INR 2.0-3.0]
125
Post MI complication **3-7 days**
**Intraventricular septal rupture**: hemodynamic instability and new holosystolic murmur @ LSB
