Cardio Flashcards
What is the number one cause of death world wide?
Ischemic Heart Disease
Tx for Printzmetal Angina
MC Females
CCB - amlodipine / nifedipine
Absolute contraindications for use of TPA in a STEMI (<70 mins)
1) Any prior ICH
2) Any known structural cerebral vascular lesion (AVM)
3) Known CA
4) Hx of ischemic stroke
5) significant closed head/ facial trauma w/in 3 months
TPA timeframe for
1) PCI
2) Ischemic Stroke
1) < 90 min
2) <3 hrs
STEMI the big 5
BB ACE Statin ASA Plavix (clopidogrel) or Xa inhibitor - no if murmur/valve dz)
ST segment
1) Elevation
2) Depression
1) Injury
2) Ischemia
Pharmacologic stress testing vs exercise stress test
1) unable to perform exercise
2) AS
3) LBBB
4) Pacemaker
5) Recent MI
6) Severe HTN
Listening to murmurs
Start with Diaphragm
S3 (Ventral) + S4 (atrial) are low pitched - BELL, best heard in left lateral decubitus position
Murmur Intensity Scale
I- VI 3= mod loud, no Thrill 4= Thrill 5= Thrill palpable 6= Thrill visible
Symptoms of AS
“SAD” Syncope, Angina, Dyspnea (on exertion)
-Once symptomatic need surgical referral
AR
Corrigans
Water-Hammer
Quincke’s pulsation
Etiology of Mitral Stenosis
Rheumatic Fever
Opening Snap
Etiology of Mitral Reg
Acute: Dyspnea/ PND
IE
Chorda tendinae rupture
Papillary m. ischemia/infarct
Chronic: Fatigue, A-fib
RF, calcification, MVP (MC cx)
S3
CHF
Dialated Cardiomyopathy
S4
Hypertrophic CM
HCM
Sustained/ hyperdynamic PMI
High voltage on ECG
Nml heart size
S4
Restrictive Cardiomyopathy
Hemochromatosis Wilson's dz Amyloidosis Scleroderma Sarcoidosis
Restrictive Cardiomyopathy
S/S’s
RHF
Kussmaul’s sign
Low voltage on EKG
Nml heart size
Stroke a/w A-Fib MC where?
SMA (Superior mesenteric artery)
Anticoagulants approved for A-Fib
1) Warfarin Those w/out valve dz: 2) Dabigatran- Pradaxa-DTI 3) Rivaroxaban- Xarelto-Xa 4) Apixaban- Eliquis-Xa
Drugs for cardioversion
Flecainide
Amiodarone
Quinidine
(prophylaxis 3 wks before and 4 wks after)
Etiology of Acute vs Chronic Pericardial Effusion
Acute: infectious, inflammatory, trauma, drug induced, AMI
Chronic: malignancy, uremia, radiation
CHF or Low CO
Beta sympathetic tone
1) Inc HR (+ chronotropy)
2) Inc BP ( sm m constriction)
3) Inc contraction (+ inotropy)
CHF or Low CO
Alpha sympathetic tone
1) Inc sm m. contriction
2) Increase BP (afterload)
Parasymptathetic tone
counteracts beta + alpha
1) Dec HR
2) Dec BP
DOE, echo perserved
+40%
Diastolic dysfunction
MC HTN
DOE, echo perserved
+40%
Diastolic dysfunction
MC HTN
Tx: BB
*no role for + inotropes like digoxin
Abn EF (<40%)
Systolic dysfunction
MC MI
Precipitating Factors of CHF
1) Inc metabolic demands
2) Inc circulating volume
3) Conditions that inc afterload
4) Conditions that impair contractility
HF Classes
I- Risk, no symptoms
II- Symptoms w/ activity
III- Symptoms w/ ADL
IV- Symptoms at rest
+ Inotrope
Digoxin
Does not prolong life, only improves QOL, can reach toxic levels
Aneurysm size and surgery
Abdominal >5.0 cm
Thoracic >6.0 cm (Surgery at >5cm if Marfan’s)
Tx: BB
Dx of thoracic aneursyms
MC found incidentally on CXR or PE
GS- Aortography
Diagnosis for pt with Pain, LE pallor, paralysis, paresthesia, pulselessness, poikilothermia
ARTERIAL U/S
PAD vs PVD
PAD- gangrene (no O2)
Dx for PAD
Tx
Ankle-brachial Index
>0.9
Exercise, RF modification, ASA/ Plavix
PVD (Venous Insufficiency)
Increased sxs w/ standing
Heaviness, fatigue of legs
Swelling, warmth, brawny discoloration, ulceration around malleoli
PE Syncope
Always includes VS w/ orthostatics, cardiac & complete neuro exam
-Vasodepressor/motor only if PE and Hx are nml