Cardio Flashcards
Dx stable angina?
- EKG
- Stress test
- Angiography
When to measure cardiac enzymes in angina?
Acute chest pain > 1 HR
Drug contraindicated with quinidine?
Amiodrone
Decrease quinidine clearance by kidney resulting in fatal arrhythmia
Nitrate formulas and their rout of administration
- Isosorbide mononitrate = oral no 1st bypass metabolism (Tab)
- Isosorbide dinitrate = max effect in 6 min (sublingual)
- Glyceryl trinitrate = max effect in 4 min (sublingual)
- Erythrityl tetranitrate = mixed w/ lactose (sublingual)
MC SE of CCB? (Amlodipine)
Peripheral edema
Low BP
Cough
Lung edema
Due to vasodilation
Drugs improve mortality in MI?
BB
ACEI/ARB
Aspirin (time dependent)
Statins
Drug contraindicated in anaphylaxis?
Atropine if tachycardia
Lab monitoring with amiodrone
LFT
Thyroid (hypo > hyper)
Every 6 months
No need for CXR or slit lamp
SE of amiodrone
Liver + thyroid toxicity
Lung toxicity: cough and dyspnea + interstitial filtrates on CXR
ARDS
Corneal deposits don’t effect vision.
Drugs contraindicated with BB? Why?
CCB
Verapamil + diltiazem
Cause bradycardia and effect AV conduction.
MCC of drug induced angioedema?
ACEI = increase levels of bradykinin
ECG in inferior MI
ST elevation in II, III, aVF
What artery causes inferior MI
Rt coronary artery
Left circumflex artery
ECG findings of left circumflex artery MI?
- ST elevation in II = III and ST-depression in V1-3 or ST-elevation in I + aVF
ECG of Rt coronary artery MI
ST elevation in III > II
ST-Depression in I and aVF
ECG of left anterior descendant coronary artery?
ST elevation or Q wave in any leads V1-V6 + I and aVF
Drug worsen CHF? Why?
Vasopressin
Vasoconstricts arteries and veins causing fluid retention and worsen low Na
Mechanism of action of nitroglycerin
Dilates veins, arteries, and arterioles.
Reduce LV preload + after load
Reduce oxygen demand
What’s angina decubitus
Angina when lying down without cause.
Cause of angina decubitus
Gravity redistributes fluids and make the heart work harder.
Dose of aspirin given in acute MI?
162-325 mg uncoated aspirin. (Not enteric asa which has delayed effect).
What determines cardiac oxygen demand
Tension Preload After load Contractility HR
DM drugs contraindicated in CHF? Why?
Thiazolidinediones (pio/rosiglitazone)
Cause fluid retention
MVP murmur
Midsystilic click
Late systolic murmur
Effect of standing + valsalva on valvular disease
- MVP: Increased
2. AS: increased
AS murmur? Best heard?
Systolic crescendo-decrescendo ejection murmur
Rt 2nd ICS w/ patient leaning forward
Cardiac SE of sumatriptan
It’s a 5HT1D + 1B agonist
Causes vasoconstriction = angina.
What’s cilostazol?
Phosphodiestrase inhibitor for intermittent claudication
Contraindication to cilostazol
CHF
Bcz increases HR
Beneficial effects of cilostazol
Increases HDL
Rx 3rd degree block.
Gold standard for aortic dissection
MRI
What’s aortic dissection
Tear in aortic intima with separation of intima and media creating false lumen and hemorrhage within media
What other than ST elevation indicate MI in ECG?
New onset Lt BBB
Left anterior descending artery
IE prophylaxis in VHD
Prosthetic valve
Underwent repair
Hx IE
Cyanotic congenital disease even with repair (tetralogy of fallout, Transposition of great vessels) Not patent foramen ovale
Give oral amoxicillin 1 HR before procedure
If allergic to penicillin:
Clindamycin
Azithromycin
Effect of digitalis on heart
Reduce filling pressure
Increase contraction force
Increase CO
Decrease HR
How to measure the effects of warfarin, heparin, ASA
Warfarin = PT Heparin = PTT ASA = BT
Contraindication to ACEI
Angioedema
Rx of HTN
1. Age > 60 Start thiazide < 60 Start CCB
- No benefit combine:
Thiazide + CCB + BB + ACE/ARBs - Add:
- Central a-agonists:
a-methyl dopa
Clonidine
- Peripheral a-antagonists:
Prazosin
Terazosin
Doxazosin - vasodilator:
Minoxidil
Hydralazine
When to start combination HTN meds?
If > 160/100
HTN + co-morbidities Rx (6 conditions)
- Asthma / depression:
No BB - Black: CCB or thiazide
- DM: ARBs/ ACEI
- CAD: BB, ACEI/ARBs
- Hyperthyroid: BB
- Osteoporosis: thiazide
Benefit of ACEI/ARBs in CHF (systolic)
Improve mortality with low EF
Anti-HTN not used in sulfa allergy
Thiazides
BP control post stroke
Gradual reduction in SBP 10-20% it it’s > 220.
Anti-HTN contraindicated in gout?
Thiazide
Increase uric acid
Anti-HTN contraindicated in diabetic nephropathy
Alpha blockers
Dx VHD?
1st: Echo
Dx: catheterization
Triad of AS
Syncope
Exertional angina
CHF
AS murmur
Ejection systolic murmur at 2nd ICS
Rt to sternum
Radiates to clavicle
Anti-HTN contraindicated in DM
Thiazide
Increases glucose
Hypertrophic obstructive cardiomyopathy classic
Young 20-40
Healthy
PMO displaced laterally
Mid-systolic harsh murmur at left Lowe sternal
Reduced by squatting
Enhanced by standing
SE of ASA
Tinnitus / ringing in ears
Rx of Raynaud’s phenomenon
CCB
Contraindicated in Raynaud’s phenomenon
BB
Ergotamine
Methysergide
Appropriate BP cuff size
Cuff width: 40% of limbs circumference
Cuff length: bladder at 80% limbs circumference
Placement of BP cuff
3 cm above elbow
Bladder on brachial artery
At heart level
How to measure pressure manually
- Place cuff 3 cm above elbow
- Bladder on brachial artery
- Patient rest seated for 5 min
- Arm bare and at heart level
- Inc pressure to 30 mmHg rapidly above level radial pulse is extinguished.
- Place bell/diaphragm on brachial artery
- Open valve at deflation rate 2 mmHg/HR
- Read systolic at 1st tap
- Read diastolic at point sound disappear.
How to avoid venous congestion with manual pressure reading
Allow >1 min between readings
Clinical signs of AR
Wide pulse pressure
Quinckes pulse
Musset sign
When is bifid pulse found
Hypertrophic cardiomyopathy
When is low amplitude pulse found
Peripheral arteriosclerosis
When is pulsus alternans found
CHF
When is pulsus paradoxus found
Constrictive or restrictive cardiomyopathy
What’s 5-HIAA when is it found
Break down of serotonin in urine
GI tumor in carcinoid tumors
Define resistant HTN
> 140/90 if no DM or CDK
> 130/80 if DM/CKD
While adherent to 3 Rx including diuretics
Diuretic of choice of GFR <30 ml/Min?
Loop > thiazide
Drugs contraindicated in cocaine-induced chest pain
BB
When is BB contraindicated in chest pain/STEMI?
In Cocaine, amphetamine or stimulant overdose
Why BB contraindicated in cocaine overdose
BB = block B2 vasodilator receptor
And cocaine activates a-1 and cause vasoconstriction
So worsening of MI
Rx of cocaine induced chest pain
CCB
Hydralazine
ASA
Common drug interacts with ACEI?
NSAID’s
- NSAIDs lead to Na retention
- Decrease PG which have a vasodilatory effect on kidney
What decreases mortality in hypertrophic cardiomyopathy?
Defibrillator
Effect of BB / CCB in hypertrophic cardiomyopathy
Sx control
Hypocalcemia ass arrhythmia
QT prolongation
Rx of STEMI (time dependent)
ASA + P2Y12 receptor blacker (clopidogrel, prasugrel, ticarogrelor)
NSAIDs in STEMI?
Contraindicated
Weaken muscle = rupture.
Sx of subaortic stenosis
Young
Systolic murmur at Rt sternal
Increased with valsalva
Decreased with hand grip
What valvaular disease in endocarditis from IV drug use?
Tricuspid regurge
Systolic murmur
Increase with inspiration = inc heart filling
Guide lines for HTN in stroke?
Keep SBP < 220
DBP < 120
Why maintain BP at < 220/120 in stroke
Protective mechanism to increase cerebral profusion
Replacement of ACE/ARBs in HTN of CHF?
Nitrates/ hydralazine
HTN drug causes rebound if stopped?
Alpha-blockers:
- Clonidine
- Guanfacin
T/F: BNP differentiates systolic from diastolic CHF
F
When to replace in aortic stenosis?
Aortic area < 1 cm
What worsen prognosis of AS?
If asymptomatic survival is same as normal
If symptomatic:
Angina 50% 5Yr survival
Syncope 50% 3Yr survival
CHF 50% 2Yr survival
T/F: digoxin improve mortality in CHF
F
T/F: Digoxin decreases hospital admission from CHF
T
What’s diastolic HF?
Stiff ventricle = increased EDLV pressure
MCC of diastolic HF?
HTN
T/F: optima Rx of systolic HF necessary for diastolic HF
F
Worsen diastolic HF
T/F: CCB reduce mortality in diastolic HF
F
T/F: BB improve mortality in diastolic HF
T
Control rate allow for enough filling
When to admit DVT?
- Massive DVT (iliofemoral)
- PE
- Risk of bleeding on anticoagulant
- Co-morbid conditions
Outpatient Rx of DVT
LMWH + warfarin
Compression stockings for 1 years
HTN + LV hypertrophy Rx
ACEI
Pathophysiology of cocaine-chest pain
Dopamine-depleted state = vasospasm
Receptors mediate cocaine induced chest pain
Alpha receptor
Thus BB worsen Sx
Rx of superventricular tachy
Adenosine
Amiodrone is used in what arrhythmia
Sustained VT regardless of hemodynamic stability
AFib ONLY in symptomatic w/ LV heart failure
Facts about digoxin
- Not used in AV block unless Rx with pacemaker.
- Loading dose not necessary
- Serum levels are not necessary
Period of anticoagulation after drug-eluting stent in MI?
12 months of
ASA 162-325
Clopidogrel 75 or prasugrel 10 mg
DOC for SVT?
Adenosine
Other non-pharm: carotid massage
Pain Drugs contraindicated in CHF
NSAIDs
Effect of high-dose ASA in CHF?
Decrease mortality benefit by ACEI!
Use low-dose if must
Benefit of exercise in peripheral vascular disease?
As beneficial as bypass or angioplasty!
Needs to be rigorous training!
LDL level in any artery disease
MI, PVD or else?
< 100 or < 2.6
If diabetic < 70
How to describe SVT?
Narrow QRS
SVT resistant to adenosine?
Narrow QRS + No P
Verapamil
Or
BB
Ventricular tachycardia
Rx
Epi + amiodrone
No improvement = lidocaine