Cardio Flashcards
which side of the heart shit increases with…..
inhalation
inhale you increase venous return to the right heart
*its venous return increases bc venous = blue & when your blue you inhale
Amyl Nitrate will —–to the heart/
decrease afterload
*vasodilator
guy comes in with ST elevation. hes already had MONA what do you do next?
Cath
tx of MS
diuretics then balloon valvuloplasty
what drug is uniquely used to tx PAD
cilostazol
what drug does a person need to be on with a 1. DES & 2. bare metal stent?
how long?
Clopidogrel
- DES = 12m
- Bare metal stent = 1m
tx of WPW
procainamide
what murmer?
water-hammer pulse, wide pulse pressure, Quinke Pulse, Hill Sign
AR!
quinke = pulse in nail bed hill = bp in leg 40 more than arm
dx of pericardial tamponade
ECG
MVP murmer
increase?
midsystolic click murmer
inc: valsalva + standing
Peripheral Arterial disease(PAD) sx
claudication, smooth, shiny skin, loss of hair and sweat glands and loss of pulses in the feet
what is the best initial test for pt with CHF
echo! = tells you if its systolic dysfunction or diastolic dysfunction
what 2 L sided murmers are increased by standing/valsalva but decreased by squating/leg raise
HOCM, MVP
Peripartum Cardiomyopathy
prego women makes Ab’s to her own heart. LV dysfunctionis short term and often reversable if not need transplant.
tx: ACE, BB, Diuretic, etc
pathogenesis of CHF?
infarction/ valvular heart disease/hypertension —> dilation —> regurgitation —> CHF
S4 means….
sound of atrial systole contracting against a stiff or noncompliant LV
well fuck…you
MR dx test?
TEE
MR murmer
increase? decrease?
pansystolic murmer caused by dilation of the heart that radiates to the axilla
.
inc:leg raise, squat, handgrop
dec: standing, valsalva and amyl nitrate
when do you give biventricular pacemaker?
EF <35% + QRS >120ms
tx of MVP
BB > valve repair
AS murmer
increases? decreases?
crescendo-decrescendo systolic murmer
inc: leg raising, squatting + amyl nitrate
dec: valsalva, standing, handgrip
if you see electrical alternans on ECG you shoudl be thinking….
pericardial tamponade, QRS height alternates between leads
causes of pleuritic pain
PE, pneumonia, pleuritis, pericarditis, pneumothorax
you do a nuc stress tests & see low uptake. what do you do next?
ANGIOGRAPHY to determine what vessels are involved.
how do you differentiate from 3rd degree block vs sinus brady?
3rd degree block will have “cannon a-waves” = atrial contracting againsted a closed tricuspid = ventricular diassociation
Squatting will —– to the heart.
increase venous return
*pushes blood from legs to heart via M contractions
lifting legs in the air with ——ot the heart.
increase venous return
*gravity
tx of bradycardia
atropine
MS sx
diastolic openign snap, dilated LA pushes on esophagus causing “horseness”, increased risk of Afib, elevates Left mainstem bronchus due to dilated atrium
What meds lower mortality in ACS?
BB(only one thats not time sensitive), Aspirin & Nitro
pt post MI, w/oxy sat in RV > RA. dx?
septal rupture!
when do you give a implantable cardioverter/defibulator
EF <35%
Which RF of CAD can you eliminate that will provide the greatest IMMEDIATE benefit?
smoking
Which cardiac marker can be used to assess 2nd MI?
CKMB
Constrictive pericarditis sx? path?
heart calcifies = can be seen on xray
sx: pericardial knock bc heart cant fill, edema, JVD, hepatosplenomegaly, ascites, kussmauls sign(increased JVD on inhalation)
sx of pericardial tamponade
SOB, hypotension, JVD, CLEAR LUNGS, pulsus paradoxus(>10mmhg on inhalation), ELECTRICAL ALTERNANS
What do you give for an NSTEMI?
heparin
tx of diastolic dysfunction in CHF
diastolic - normal EF
basic: ACE, BB(metoprolol, carvedilol), Spironolactone or hydralazine+nitrates
what are Rhonci?
Rhonci in the Bronchi = wheezing due to constriction/inflammation
who gets a statin?
- anyone with CAD
- LDL>190
- LDL 70-189 w/DM + 40-75yoa
- LDL 70-189 + 40-75 yoa w/calculated risk
pt on ACE/ARB develops hyperkalemia. what do you do?
switch them to hydralazine + nitrates
valsalva will ——to the heart.
decrease blood return = increases intrathroasic pressure = flattens IVC = decreasing flow into heart
VSD murmer
increases ?
holosytolic murmer at the LLstearnal boarder, SOB
inc: exhalation, squat, leg raise
pulsus paradoxus is classic for…
(>10mmhg on inhalation) = pericardial tamponade
guy comes in with ST depression hes has MONA what do you do next?
thrombolytics! = depression = he hasnt clotted yet = bust up that clot and save the myocardium
AR murmer
increases? decreases?
blowing diastolic murmer = diastolic decrescendo murmer @ LLboarder
inc: leg raiseing, squatting, handgrip
stent vs bypass
stent = 1-2vessels bypass = 3 + vessel or main vessel dz
causes of postional chest pain
pericarditis = worse when lying dwn but better when sitting up
tx of SVT
adenosine
dx of VSD
echo then cathe
What would you give an asthmatic instead of a BB for CAD?
CCB like Vermpamil or Diltalazam
*risk fo reflex tachy
RF of Ischemic heart dz?
DM, HTN, Tobacco, Hyperlipidemia, PAD, Obesity, Inactivity & family History
MS murmer increases with…
leg raise, squat and expiration
ECG of pericarditis
global ST elevation and PR segment depression
mechanism of Thallium in stress tests?
picked up by NaK ATPase = decrease uptake = dmg myocardium
best test for PAD
ABI with >10% differ then angiography
tx of hypertropic cardiomyopathy
BB & diuretics
tx of MR?
ACE ARB, Nifedipine; if EF<60 then do surgery
tx of AS?
diuretics > valve replacement
screening for AAA
65-75 smokers w/U/S
tx of pericarditis
NSAIDs + Colchicine
if a patient cannot get PCI within 90 min what do you need to do for them?
thrombolytics
tx for aortic dissection
1.ence BB 2. Nitroprusside 3. Surgical Consultation
whats the single worst/most dangerous factor for CAD?
diabetes
restrictive cardiomyopathy sx
SOB, Kussmauls Sign(increased JVP with inhalation), low voltage ECG
tx of PAD
ASA, BP control with ACE, exercise, lipid control and CILOSTAZOL(unique)
which nuclear stress test should be used wiht obese pt? why?
sestamibi bc it has greater ability to penetrate tissue in fattys
do u need to ppx pt for dental surgery if they have MVP
no
MCC of death after MI?
Vtach or Vfib
tx of restrictive cardiomyopathy
diuretics + tx underlying cause +/- pericardiocentesis
handgrip will ——to the heart.
increases blood in the heart/afterload
- compressing arteries in arm pushing blood back into heart
other not so common causes of CHF
alcohol, post viral myocarditis, radiation, adraymycin, doxorubicin, chagus + others, hemochromatosis, thyroid dz, peripartum cardiomyopathy, thiamine deficiency
tx of AR
ACE, ARB, Nifedipine to decrease afterload = push blood out
then surgery if EF <55
takotsubo cardiomyopathy tx
ACE, diuretics and BB
Tx of dialated cardiomyopathy
ACE/ARB, BB, Spironolactone
tx of pericardial tamponade
pericardiocentesis and if chronic pericardial windown placement
what are rales?
Rales in the Tails = bubbling/crackling in the aveoli due to fluid
ASD auscultation shit
fixed splitting of S2
which side of the heart shit increases with…..
expiration
exhale you evict blood from your lungs & into the LV
RV infarction is likely to cause what complication?
3rd degree block!
Which stress test drug shouldn’t be used in asthmatics?
Dipyridamole = can provoke bronchospams
Complications of MI
shock, valve ruptures, septal rupture, myocardial wall rupture, sinus brady, 3rd degree block, RV infarction
S3 means….
rapid ventricular filling during diastole
fuck…your screwed
what should you NOT do with pericardial tamponade?
give diuretics
sx of pericarditis
pleuritic chest pain that is positional, sharp & breif, friction rub, GLOBAL ST ELEVATION & PR depression
what bb do you give for MI? why?
metoprolol or esmolol = B1 selective!
MS what might you see on ECG?
biphasic Pwaves
tx of constrictive pericarditis
diuretics then surgical removal of the pericardium
standing up will ——to the heart.
decreases blood return
*gravity!
tx of systolic dysfunction in CHF
systolic = decreased EF
basic: ACE, BB(metoprolol, carvedilol), Spironolactone or hydralazine+nitrates
unique: DIGOXIN
