Cardio Flashcards
LAD, LCx, RCA vascular territories?
LAD: anterior and septum
LCx: lateral
RCA: inferior and right ventricle
Unstable angina, NSTEMI, STEMI are what kind of coronary syndromes?
acute
Risk factor for athero syndromes? (5)
Age (M>45, F>55) Hypertension Hyperlipidemia Diabetes Tobacco Family history (M
If pt gets chest pain during procedure and some risk factors what steps to take?
- stop procedure
- sublingual nitroglycerin
- aspirin
- emergency dept
place what with catheterization?
stents
Difference between bare metal and drug-eluting stents?
Drug eluting stents last longer, have to give dual anti- platelet therapy for 1 month with bare metal, 1 year for drug-eluting.
If pt has stent, what considerations for tooth extraction?
Postpone for amt time theyre on antiplatelet therapy
Aspirin or other drugs with “grel” are?
antiplatelet
type of drugs are.. statins? "olol" "pril/sartan" nitro
lipid-lowering
beta blockers
Ace-inhibitors
nitrates
Cardiomyopathies defined as due to what? Manifest as what?
Abnormal muscle function, abnormal contraction/relaxation, CHF
Etiology of Ischemic cardiomyopathy?
coronary disease
Etiology of non-ischemic cardiomyopathy?
Htn
Valve Disease
Infiltrative disease
Arrythmia
ALcohol
Chemo
Viral infection
Treatment for cardiomyopathy:
symptoms?
prevent remodeling?
devices?
diuretics for symptoms
beta-blockers, ace inhibitors for remodeling
defibrillators, “resynch” therapy
Patients in decompensated heart failure should get procedures?
Should not undergo nonemergent procedures
Conduction system components?
SA, AV, His, bundles
P, QRS, T waves are?
P - atria activation
QRS - ventricle activation
T - recovery
Tachycardia BPM?
> 100
Bradycardia BPM?
Rate = ?
60/R-R interval
Normal sinus rhythm means?
Each P followed by one QRS
Atrial Fib rhythm?
no P wave, ventricle contracts at random intervals
Atrial flutter rhythm?
saw-tooth P wave, QRS after several flutter waves
narrow vs wide complex tachycardia
wide has big smooth QRS, suspect ventricular
QRS interval should be how long?
Syncope in young athlete can mean…
underlying cardiac condition, avoid epinephrine
Sinus pause sinus arrest will cause patient to?
black out
If any pauses are greater than what or HR less than what, stop procedure? This could be?
pauses > 3seconds
HR
Implantable Cardioverter Defibrillators need Abx prophylaxis?
nooo
What can affect ICDs programming?
electrocautery
Magnet does what to ICD? How strong is safe?
disables ICD shocks, >30s disables
10 Gauss/1mTelsa
Lub and Dub sounds are wut?
lub = atrioventricular valves close dub = semilunar valves close
Cardiac murmur from?
turbulent blood flow from stenotic or regurgitant valve
Mechanical and bioprosthetic pros cons
Mechanical: lasts longer but needs lifelong anticoagulation
Bioprosthetic: doesn’t last as long but doesn’t need lifelong anticoag
Prosthetic valve complications?
thrombosis
Endocarditis
Leak
Hemolysis
INR goal for all mechanical valves is?
2.5 - 3.5 (0r 2.0 if bileaflet/mechanical aortic valve with no history of stroke, afib, left ventricular dysfunction, or hypercoag state)
Low risk valve patients?
Bi-leaflet aortic valve AND no history of stroke, atrial fibrillation, left ventricular dysfunction or hypercoagulable state
High Risk valve patients?
Mitral or tricuspid valve
Multiple valves
Older valves
History of previous event
Left ventricular dysfunction
Atrial fibrillation
Hypercoagulable state
Treatment considerations for low risk patients?
Warfarin withheld 48-72h before procedure so INR can fall below 1.5
Warfarin started 24h after
Heparin not cessary
High risk patients treatment procedure?
“Heparin Bridge”
- stop warfarin >72h before
- IV unfractionated herparin started when INR below 2 (usually 48h prior)
- Heparin stopped 6h before
- Heparin/Warfarin restarted after surgery/bleeding stops
- Heparin discontinued when INR reaches therapeutic levels
Endocarditis risk factors?
Structural Heart DiseaseTypic Prosthetic heart valves IV drug abuse HIV+ Hospital-Acquired Hemodialysis Pacemakers Poor dental hygiene Prior history of endocarditis
Typical Endocarditis organisms
Staph. aureus Strep. viridans Strep. bovis Enterococcus HACEK group
Endocarditis Major criteria
Positive blood culture with common microorganism
Evidence of Endocardial envolvement (vegetation/murmur)
Endocarditis Minor criteria
Fever Single positive blood culture Predisposing condition (IV drug use, cardiac abnormality) Embolic event (embolic stroke, pulmonary infarcts, renal infacts, conjuctival hemorrhages, Janeway lesions) Immunologic phenomenon (Glomerulonephritis, Osler’s node, Roth’s spot)
Dental prophylaxis needed when? (4)
Prosthetic valve
Previous infective endocarditis
CHD (unrepaired, repaired within 6mo, repaired but defects)
Cardiac transplant with valvulopathy
What kind of dental procedures require prophylaxis?
minupulation of gingival tissue, periapical region, perforation of oral mucosa (but not anesthetic)
Abx Chart
yeah
