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Inpatient EOR > Cardio > Flashcards

Cardio Flashcards

1
Q

Diamond classification

A

substernal or L sided chest pain
worsened w/ exertion
relieved with NTG and rest

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2
Q

Typical angina

A

3/3 of diamond classification

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3
Q

Atypical angina

A

2/3 of diamond classification

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4
Q

Non-anginal

A

0-1 of diamond classification

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5
Q

Diagnostic studies for angina

A

R/O STEMI first β†’ 12 lead EKG

If STEMI β†’ 🚨 cath lab

If NO STEMI β†’ troponins

If ↑ trop β†’ 🚨cath

If no ST elev or ↑ trop β†’ stress testβ†’ if βŠ• electively go to cath

Eval stress test with:
EKG β†’ if nl baseline EKGβ†’ βŠ• if ST Ξ”

Echo β†’ baseline EKG abnl β†’ βŠ• if no mvt

Nuclear β†’ prev coronary artery bypass

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6
Q

Clinical intervention for angina

A

Cath β†’
if β‰₯3 vessels β†’ CABG

if 1-2 vessels β†’ stent

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7
Q

Clin therapeutics angina

A

Morphine
Oβ‚‚ β†’ NC
Nitrates β†’ if CAD + angina
*Aspirn β†’ 1st

*Ξ²-blocker β†’ next after aspirin
*ACE-I
*Statin
Heparin β†’ if high sus of CAD

Clopidogrel β†’ if stent

tPA if in rural setting and can’t get to cardiologist within 60 min

*everyone gets

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8
Q

What med ↑ mortality when used to control CP

A

morphine

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9
Q

Stable Angina

A

Substernal chest pain w/ exertion and relieved w/ rest and NTG

βˆ… Biomarkers
βˆ… ST Ξ”
βŠ• Stress test

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10
Q

Stable Angina tx

A

Med mgmt only

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11
Q

Unstable Angina

A

90% occlusion
demand ischemia

Chest pain at rest & nothing relieves pain

βˆ… Biomarkers
βˆ… ST Ξ”

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12
Q

UA treatment

A

Hosp admission & cath + meds

If not treated will progress to STEMI

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13
Q

NSTEMI

A

Heart is damaged β†’ 90% occlusion
demand ischemia

CP at rest
↑ troponin
βˆ… ST elevation

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14
Q

NSTEMI tx

A

Hosp admission & cath + meds

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15
Q

When should you AVOID giving nitrates when a pt has chest pain

A

II, III, avF (inferior) ST elevations β†’ RV infatcton β†’ NO NITRATES bc RV is preload dependent and will cause severe hypotension

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16
Q

A fib mgmt

A

Stable→ rate control
Ξ² blockers (Metoprolol), CCB (Diltiazem, Verapamil), Digoxin preferred for rate control in pts w/ hypotension or CHF

Unstable β†’ synchronized cardioversion
need to anticoag if >48h

Anticoagulation
NOACs β†’ Dabigatran, Rivaroxaban, Apixaban, Edoxaban
Warfarin-Preferred if severe CKD, HIV on PI, CYP450 antiepileptics (carbamazepine, phenytoin)
INR goal of 2-3
Aspirin + Clopidogrel (not as good)

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17
Q

Torsades mgmt

A

defib + IV magnesium

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18
Q

V tach mgmt

A

If stable β†’ Amiodarone 150 mg IV over 10 min; repeat as needed to maximum dose of 2.2 g in 24 hours

Unstable β†’ defibrillate

If pulseless β†’ CPR q 2 min, defib and alt epi and amio alt q 2 min

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19
Q

Med mgmt of sinus brady

A

Unstable β†’ pace

Atropine

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20
Q

Mgmt of 2nd deg heart block

A

Atropine or temporary pacing

If you give atropine it may push into 3rd deg and worsen

Progression to 3rd deg common so pacing is definitive tx*

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21
Q

PEA/asystole mgmt

A

CPR q 2 min with epi q 4 min

NO shock

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22
Q

What is CHADSVASC

A 
CHF
Hypertension
Age ( β‰₯ 65 = 1 point, β‰₯ 75 = 2 points)
Diabetes
Stroke/TIA (2 points)

VASc β†’ peripheral arterial disease, previous MI, aortic atheroma, female gender

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23
Q

Duke criteria for endocarditis

A

pt must have 2 major OR 1 major and 3 minor OR 5 minor

Major: 2 pos blood cx, ECHO evidence of endo involv or regurg

Minor: predisposing factor, fever >100.4, vascular phenomena (embolic dz, pulm infect), immunologic phenomena (glomerulopnephirtis, osler nodes, roth spots)

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24
Q

Dilated Cardiomyopathy pathophys

A

β™₯ chambers dilate β†’ floppy + thin walls

↓ contractility

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25
Q

Dilated Cardiomyopathy sx

A

Sx typical of systolic CHF β†’ orthopnea, PND, DOE, crackles, peripheral edema

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26
Q

Dilated Cardiomyopathy dx

A

Echo β†’ dilated chambers

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27
Q

Dilated Cardiomyopathy tx

A

βˆ…EtOH, βˆ… chemo

Transplant

Goal: target CHF sx

Ξ²-blocker
ACE-I
Diuretics β†’ furosemide

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28
Q

Hypertrophic Obstructive Cardiomyopathy pathophys

A

Unilateral septum hypertrophy β†’ covers aortic opening β†’ LV outlet obstruction

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29
Q

Hypertrophic Obstructive Cardiomyopathy sx

A

Young athlete*

Aortic stenosis murmur

DOE, syncope w/ exertion, sudden cardiac death

Systolic, heard best at 2nd ICS RSB (base), crescendo-decrescendo

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30
Q

Hypertrophic Obstructive Cardiomyopathy tx

A

Avoid dehydration β†’ do not get HR up, AVOID exercise

EtOH ablation, myectomy, AICD if at ↑ risk of death

Definitive tx β†’ transplant

Goal: keep ventricle filled

Ξ²-blockers
CCB→ verapamil, dilatazlam

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31
Q

Restrictive Cardiomyopathy pathophys

A

Stuff gets in way of ventricle wall other than myocytes β†’ β™₯ can’t relax

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32
Q

Restrictive Cardiomyopathy sx

A

Diastolic CHF

Amyloid β†’ peripheral neuropathy

Sarcoid β†’ pulmonary dz

Hemochromatosis β†’ cirrhosis or bronze diabetes

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33
Q

Restrictive Cardiomyopathy dx

A

Echo β†’ restrictive pattern

Amyloid β†’ fat pad or gingiva bx

Sarcoid β†’ cardiac MRI + endomyocardial bx

Hema β†’ screen w/ ferritin (will be ↑) + genetic test

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34
Q

Restrictive Cardiomyopathy tx

A

Manage underlying dz

Definitive tx = transplant

Goal: rate control + control HTN

Ξ²- blockers
CCB

Gentle diuresis

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35
Q

R sided HF

A

R sided β™₯ failure β†’ ↓ blood to lungs β†’ ↓ blood to LV and ↓ blood to periph

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36
Q

L sided HF

A

L sided β™₯ failure β†’ blood can’t get out of LV β†’ lungs drown with fluid bc RV still works

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37
Q

Diastolic dysfn

A

Diastolic Dysfn β†’ β™₯ gets big and beefyβ†’ thick ventricle β†’ can’t relax β†’ ↑ or nrml Ej frac

38
Q

Systolic dysfn

A

Systolic dysfnβ†’ LV weakβ†’ can’t get blood out of β™₯ β†’ ↓ ej frac < 50%*

39
Q

Congestive Heart Failure sx

A

DOE, orthopnea, PND

Lateral displaced PMI + S3

JVD, peripheral edema, hepatosplenomegaly

L-sided will have crackles

Wt gain d/t fluid retention

40
Q

Congestive Heart Failure dx

A

BNP β†’ released when R atrium stretches (will show ↑ vol but not specific)

2D Echo β†’ ej frac, pulm arterial press, diastolic vs systolic

Lβ™₯ cath angiogram β†’ determine ischemic vs not

41
Q

Congestive Heart Failure tx

A

Smoking cessation

<2 L fluid/day

<2 gm NaCl/ day (bc water follows salt)

Ξ²-blocker + ACE-I (or ARB)

+ loop diuretic if class II

+ Spironolactone or Bidil if class III

+ Inotropes if class IV

42
Q

CHF Exacerbation dx

A

CXR β†’ βœ“ for vol overload

EKG β†’ βœ“ for STEMI or arrhythmia causing CHF

BNP β†’ βœ“ for vol overload

Troponin β†’ βœ“ for NSTEMI

43
Q

CHF Exacerbation tx

A

Lasix→ get rid of excess fluid

Morphine β†’ dyspnea + vasodilate pool fluid away from lungs

Nitrates β†’ vasodilate pool fluid away from lungs

Oxygen

Position β†’ sit up to prevent orthopnea

44
Q

Atherosclerosis tx

A

Smoking cessation, control HRN, treat DM, + dyslipidemia

BMI <25, <40 in WC

Aerobic exercise

Low sat far, low trans fat and low cholesterol diet high in fiber and rich in veggies, fruti and hwole grains

45
Q

Endocarditis etiology

A

S. aureus = MC
2nd MC = Strep viridans
Enterococci

IV drug users β†’ S. aureus MC

46
Q

Endocarditis pathophys

A

Infection d/t direct intracascular contamination

Vegetations, fibrin, inflammation, organisms

47
Q

Endocarditis sx

A

New regurgitation murmur, HF, evidence of embolic events, peripheral lesions (petechiae, splinter hemorrhages, orth spots), fever

Osler nodes + Janeway lesions

48
Q

Endocarditis dx

A

Blood cx x 3 at least 1 hr apart

EKG

ECHO→ vegetation + ID affected valves

Duke criteria β†’ determine criteria

49
Q

Endocarditis tx

A

Empiric therapy β†’ IV vanc (or ceftriaxone) + gentamicin + cefepime or carbapenem x 6 wks

Ppx for HIGH risk groups prior to procedures that have high risk for bacteremia β†’ prosthetic valves, cyanotic congenital heart defet

Amoxicillin 2 g 30-60 min before procedure

50
Q

Mitral Stenosis etiology

A

Rheumatic β™₯ dz

Inflam of mitral valve

51
Q

Mitral Stenosis sx

A

Atrial stretch + fluid in lungs drive the sx

CHF sx β†’ β†’DOE, PND, crackles

Afib

Rumbling diastolic murmur heard best at apex 5th ICS MCL, opening snap

52
Q

Mitral Stenosis tx

A

Balloon valvuloplasty β†’ opens up valve so blood flows normally again

Replacement

↓ volume

Afterload reduction + diuresis

53
Q

Aortic Stenosis etiology

A

Atherosclerosis β†’ calcium deposits

54
Q

Aortic Stenosis sx

A

Heart failure sx, CP, syncope

Systolic, 2nd ICS RSB (base of β™₯), crescendo-decrescendo

55
Q

Aortic Stenosis tx

A

Valve replacement

↓ volume

Afterload reduction + diuresis

56
Q

Lipid lowering drugs

A

Statins (HMGcoA Reductase Inhibitors) β†’ only one that ↓ MI/Strokes

High Intensity = Atorvastatin, Rosuvastatin

Niacin/Nicotinic Acid (Vit B3)

Fibrates β†’ Gemfibrozil, Fenofibrate

Bile Acid Sequestrants β†’ Cholestyramine, Colestipol, Colesevelam (↑ TGs)

Ezetimibe/Zetia

PCSK9 Inhibitors (-mabs)

57
Q

Pericarditis tx

A

NSAIDs + colchicine

Avoid NSAIDs in CKD, thrombocytopenia, PUD

Colchicine β†’ dose lim by diarrhea

Can go to steroids if refractory but ↑ risk of recurrence w/ steroids (esp if d/t viral etiology)

58
Q

Rheumatic fever tx

A

Anti-inflam β†’ ASA w/ taper (+/- CCS if carditis/severe)

ABX β†’ PCN G for Strep (Erythro if PCN allergy) acute phase & AFTER (prevention = imp)

59
Q

Short PR and widened QRS

A

WPW

60
Q

secondary pphx for GAS after pt has acute rheumatic fever

A

needs to be for 10 yrs or until 40 yo

Pen G IM q 21-29d
Pen V 250 mg po BID
If PCN all then Azithromycin 250 mg po BID

61
Q

ststins that dec size of atheromas

A

rosuvastatin and atorvastatin

62
Q

non statin lipid lowering agent with additive prevention of CV adverse events

A

Ezetimibe

63
Q

Dx TOC for ID valvular vegetations in at risk pts

A

TEE

64
Q

GS to locate PVD

A

angiography

65
Q

Mc cause of exacerbation of PVD

A

emboli

66
Q

split S2, clubbing, cyanosis, tricupsid regurg and inc HVP

A

Pulm HTN

67
Q

Becks Triad

A

hypotension, JVD, muffeled heart sounds

assoc w/ cardiac tamponade

68
Q

V1 and V2

A

septal (prox LAD)

69
Q

V1-V4

A

Anterior (LAD)

70
Q

I, avL, v5 and v6

A

Lateral (circumflex)

71
Q

I, avL, v4, v5. v6

A

Anterior lat (mid LAD or CFX)

72
Q

II, III, aVF

A

inferior (RCA)

73
Q

II, III, aVF

A

inferior (RCA)

74
Q

Which beta-blockers have a proven mortality benefit in the treatment of heart failure?

A

Carvedilol, metoprolol succinate and bisoprolol

75
Q

Which beta-blockers have a proven mortality benefit in the treatment of heart failure?

A

Carvedilol, metoprolol succinate and bisoprolol

76
Q

hat cardiac complication is associated with hyperthyroidism?

A

Atrial dysrhythmias and high cardiac output failure

77
Q

hat cardiac complication is associated with hyperthyroidism?

A

Atrial dysrhythmias and high cardiac output failure

78
Q

Which virus is the most common cause of acute viral pericarditis?

A

coxsackie virus

79
Q

Which virus is the most common cause of acute viral pericarditis?

A

coxsackie virus

80
Q

s3

A

restrictive cardiomyopathy

81
Q

pericardial knock

A

constrictive pericarditis

82
Q

pericardial knock

A

constrictive pericarditis

83
Q

What are the components of the San Francisco syncope rule

A

History of CHF, hematocrit <30%, abnormal ECG, dyspnea, systolic BP <90β€”defines high-risk criteria for patients with syncope

84
Q

What are the components of the San Francisco syncope rule

A

History of CHF, hematocrit <30%, abnormal ECG, dyspnea, systolic BP <90β€”defines high-risk criteria for patients with syncope

85
Q

egg shaped heart

A

transposition of the great arteries

86
Q

egg shaped heart

A

transposition of the great arteries

87
Q

snowman heart

A

total anomalous pulmonary venous return

88
Q

What coronary artery supplies the AV node?

A

RCA

89
Q

chest pain early in the AM

A

Prinzmetal angina (variant angina)

90
Q

In patients with a myocardial infarction, which three drugs have been shown to decrease mortality?

A

Aspirin, beta-blockers, and ACE-inhibitors

Inpatient EOR (12 decks)

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