Cardio Flashcards
What are the symptoms of beta blocker overdose?
Bradycardia Hypotension AV block Wheezing Hypoglycemia Delirium seizuer cardiogenic shock (from low HR and BP. cold and clammy extremities):
Management of beta blocker overdose
- 1st line: IV fluids and atropine
2. If refractory or profound low BP use Glucagon
Management of CAD based on pretest probability
- low risk: no diagnostic test
- intermediate: stress test based on EKG finding and ability to exercise
- high risK start on medical therapy and consider coronary angiography
Management of AF with rapid ventricular response
attempt rate control with b-blocker and CCB (such as diltiazem)
Managment of AF with hemodynamic instability
immediate synchronized electrical cardioversion
Common side effect of dihydropyridine calcium channel blocker
peripheral edema
How to reduce CCB-associated peripheral edema?
ACE inhibitor or angiotensin receptor blocker (ARB)
What type of patients get uremic pericarditis?
uremic pericarditis (UP) occurs in 6-10% of renal failure pts, typically thosw with urea nitrogen levels above 60 mg/dL
EKG difference between Uremic Pericarditis (UP) and classic pericarditis? why?
UP does not have diffuse ST elevation bc only visceral and parietal layers of pericardium are inflammed due to uremia. myocardium is not inflammed.
Treatment of uremic pericarditis
Hemodyalisis->fast chest pain resolution and reduce size of cardiac effusion
Advantage of dual antiplatelet therapy (aspirin with P2Y12 receptor blocker), compared to aspirin alone
- reduce reccurent MI
- reduce CV death in pt with NSTEMI
- reduce risk of stent thrombosis
- recommended for at least 12 months following drug eluting stent placement
Cause of Chagas disease
protozoan trypanosoma cruzi (endemic in latin america)
Sequelae of chagas disease
Chagas disease is a chronic disease that can cause megaesophagus, megacolon +/- cardiac dysfunction
Characteristic of AR
- early diastole murmur 2. hyperdynamic pulse
- wide pulse pressure, 4. bounding or water hammer peripheral pulse
- LV enlargement
common effect of left ventricular systolic/diastolic dysfunction on lungs
pulm htn
initial mgt of pulm htn
loop diuretidcs and ace inhibitors or ARBs.
Study of choice for diagnosis and f/u of AAA
-sensitivity and specificity
-abd US
100% sensitive
100% specific
Cause of vasospastic angina
hyper-reactivity of intimal smooth muscle-> intermittent coronary art. vasospasm
Preferred med for vasospastic angina
CCB bc they cause coronary art. vasodilation
Cause of MR in pt with acute MI
Papillary muscle displacement (2-3days post MI)
Effects of acute MR
Abrupt and excessive vol. overload->increased left atrial and ventricle filling pressure and acute pulm edema.
No effect on left atrial/ventricle size or compliance unlike chronic MR
Potential causes of 2ndary htn in young adults
- Coarctation of aorta
- Fibromuscular dysplasia
- Adrenal adenoma
- Cushing syndrome
- pheochormocytoma
Initial evalutation of pts with coarctation of aorta
- simultaneous palpation of brachial and femoral pulses to assess for brachial-femoral delay.
- bilat upper and lower ext. BP to assess BP differential
how to reduce risk of systemic thromboembolism in pt with AF and mod-high risk of thromboembolic events (CHA2DS2-VASc score>or=2
give warfarin or non vit-K antagonist oral anticoagulant like apixaban, dabigatran, rivaroxaban
define use dependence
def: enhanced pharm effect of a drug during fast HR
what drugs show use dependence?
antiarrythmic agents in class 1 (especially 1C) and class IV (CCBs) Class 1C antiarrythmics: Encainide Flecainide Propafenone Moricizine Class IV antiarrythmics = slow CCBs (nondihydro) like Verapamil, Diltiazem
use dependence effect of Class IC antiarrythmic on EKG
progressive decrease in impulse conduction with faster HR->increased QRS complex duration
Mainstay of therapy in pt with alcoholic cardiomyopathy and its effect on fxn
- complete cessation of alcohol consumption
- improved or normalized left ventricular function over time
recommended tx for acute pulm edema from acute MI
Diuretics
is standard therapy in MI but should be avoided in pt with decompensated CHF or bradycardia
b-blockers
meds that trigger bronchoconstriction in asthma pts
aspirin, b-blocker
definition of hypertensive emergency
marked severe htn associated with malignant htn or hypertensive encephalopathy
define maligant hypertension
bp: >or=180/120
retinal hemorrhage
retinal exudates
+/- papilledema
WPW EKG pattern
- short PR (<120msec)
- slurred inital upstroke of QRS complex (delta wave)
- wide QRS complex with ST/T wave changes
Cause of WPW
accessory pathway that bypasses the AV node and directly connect atria to ventricles
Definition of fibromuscular dysplasia
-pt demographic
noninflammatory and nonatherosclerotic condition that causes abnml cell development in arterial wall->stenosis, aneurysm, dissection. primaryly affects renal arteries
-pt demographic: female 15-50yo
Different Presentations of fibromuscular dysplasia and why.
htn: renal artery involvment
Cerebrovascular arteries: TIA, amaurosis fugax, stoke
HA, pulsatile tinnitus, dizziness
Digoxin adverse effect
NVD, vision changes, arrythmias
Electric alternans definition and diagnosis
amplitude of QRS complex vary from beat to beat
dx=pericardial effusion
Electric alternans is specific for
pericardial effusion
Diagnosis of pericardial effusion
- electric alternans on EKG
- enlarged cardiac silhouette on CXR
- Echocardiogram (more definite)
murmurs that are usually pathologic
diastolic murmurs
continuous murmurs
how to evaluate murmurs
transthoracic echocardiogram
Ventricular aneurysm and MI
Vent aneurysm=late complication of acute STEMI or transmural MI.
EKG findings in Post MI Ventricular aneurysm
persistent ST elevation along with deep Q waves
complications of Post MI ventricular aneurysm
progressive L. Vent enlargment->HF, refractory angina, ventricular arrythmia, functional MR, or mural thrombus
How long after MI do the following occur?
- reinfarct
- vent septal rupture
- free wall rupture
- postinfarct angina
- papillary muscle rupture
- pericarditis (dressler)
- left ventricular aneurysm
- reinfarct: hrs to 2 days
- vent septal rupture: hrs to 1 week
- free wall rupture: hrs-2 wks
- postinfarct angina: hrs to 1 month
- papillary muscle rupture: 2 days-1 week
- pericarditis: 1 day to 3 months
- left vent aneurysm: 5 days-3 months
Use of amiodarone
- ventricular arrythmia
2. rhythm control in afib with left ventricular systolic dysfunction
Amiodorone adverse effect
hypo/hyperthyroid hepatotoxic bradycardia/heart block pneumonitis neurologic symptoms visual disturbance
Post MI Papillary muscle rupture leads to
acute MR and cardiogenic shock
Presentation of aortic stenosis
decreased exercise tolerance, exertional dyspnea, angina, syncope
AS phys exam findings
- delayed/diminished carotid pulse
- soft heart sound
- mid to late peaking systolic murmur with max intensity at 2nd right intercostal space and radiation to carotids
Treatment of choice for dressler’s syndrome
NSAIDS
Should pts with dressler syndrome be anticoagulated?
No! Anticoagulation might lead to hemorrhagic pericardial effusion
When to perform PCI
within 90 minutes for acute STEMI
When to perform fibrinolysis in acute STEMI pts?
within 12 hrs of symptoms onset for pts who cannot undergo PCI
Drug interaction: loop diuretics and digoxin
loop diuretics enhance side effects of digoxin, they casue low K+ and low Mg->vent tach
most common benign primary cardiac tumor
myxoma
80% of myxomas are located in…
left atrium
Presentation of myxoma
- constitutional symptoms: fatigue, low fever, weight loss
- systemic emboli: TIA, ischemic stroke, acute embolic arterial occlusion
- CVS: ~mitral valve disease (dysnea, orthopnea, pulm edema, hemoptysis
hypotension, distended neck veins, muffled heart sounds
beck’s triad for cardiac tamponae
cause of cardiac tamponade classic triad
exaggerated shift of intervent. septum to left vent cavity-> decreased L. vent preload, stroke volume and CO.
Presentation of latex allergy
hypotension, tachycardia, urticarial rash, wheezing
may have life threatening upper airway edema
