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Residency > Cardio > Flashcards

Cardio Flashcards

1
Q

echo findings of ie

A

oscillating mass on valve or adjacent structures, myocardial abscess, dehiscence of valves

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2
Q

risk of stent thrombosis duration of anticoagulation - bare metal stent/ des

A

bare metal stent - 1 month; drug eluting stent 1yr

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3
Q

prolonged qt definition and computation

A

bazzett’s formula - qt/sqrt of rr interval; male >0.45 sec female >0.46sec

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4
Q

Heparin dosing for mi vs vte

A

Mi - 60/12
Bolus: 60mg/kg then 12mg/kg/hr
Ptt 1.5-2 times of control

Vte - 80/18
Bolus: 80mg/kg then 18mg/kg/hr
Ptt 2-3 times control

Vte prophylaxis
5000units bid

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5
Q

2 most common autosomal dominant genetic mutations if vte

A
  1. Factor V leiden - activated protein c resistance

2. Prothrombin gene mutations

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6
Q

Most common cause of acquired thrombophilia

A

Antiphospholipid antibody syndrome

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7
Q

Each 2hr per day increment in watching tv increases risk of fatal pe by

A

40%

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8
Q

Most common gas exchange abnormalities in pe

A
  1. Hypoxemia

2. Increased a-a gradient

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9
Q

Causes of rise in pulmo artery pressure in pe

A
  1. Obstruction

2. Release of neurohormonal mediators - serotonin

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10
Q

Classification of pe

A

Massive pe (5-10%) - cardiogenic shock
*involves at least half of pulmo vasculature
Submassive pe (20-25%) - rv dysfunction but normal bp
Low risk pe (65-75%) - excellent prognosis

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11
Q

Most common symptom of pe

A

breathlessness

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12
Q

Most common symptom of dvt

A

Cramps

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13
Q

Diagnostic test for Low likelihood of vte

A

D dimer

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14
Q

High likelihood of vte diagnostic to request

A

Imaging (ctpa)

For wells score >4

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15
Q

Syndrome - Compression of the left proximal iliac by the right proximal iliac

A

May thurner syndrome

- presents with recurrent left thigh edema

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16
Q

Sensitivity of d dimer for pe and dvt

A

Dvt 80%
Pe 95%
D dimer less sensitive than pe because dvt thrombus size is smaller

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17
Q

Ecg abnormality pe

A

Sinus tachy - most common
S1q3t3 - specific
Rv strain and ischemia - most common abnormality t wave in version v1-v4

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18
Q

Cxr findings in pe

A

Hamptons hump - peripheral wedged shaped density
Westermarks sign - focal oligemia
Pallas sign - enlarged right descending pulmo artery

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19
Q

Ct scan finding associated with increased mortality in pe

A

Rv enlargement

*ct scan with iv contrast principal imaging test in pe

20
Q

Triple rule out ct

A

Ecg synchronized acquisition

Rules out 3 major cause of chest pain: pe, mi, acute aortic syndrome

21
Q

Lung scanning component andndiagnostic criteria

A
  • ventilation scan: xenon or krypton labeled gas
  • perfusion scan: particulate aggregates of albumin labeled with a gamma emitting radionuclide
    High probability scan for pe: 2 or more segmental perfusion defects in the presence of normal ventilation
22
Q

Pe sign in 2d echo

A

McConnells sign: hypokinetic rv free with hyperkinetic rv apex

23
Q

Pulmonary angiogram pe finding

A

Intraluminal filling defect in more than 1 projection

24
Q

Study which evaluates efficacy of anticoagulation vs catheter directed thrombolysis in preventing post thrombotic syndrome

A

ATTRACT

25
Q

graduated stocking appropriate pressure and duration of use for dvt

A

30-40mmhg

3 months - replace because garter loosens

26
Q

Risk strat of pe and treatment

A

Normotension with normal rv: anticoag, ivc filter
Normotension with rv hypokinesia: individualized
Hypotension: anticoag + thrombolysis, embolectomy

27
Q

Treatment for heparin induced thrombocytopenia

A

Direct thrombin inhibitors: argatroban and bivalirudin

28
Q

Enoxaparin dose for mi and pe

A

Same for both 1mg/kg bid

29
Q

Warfarin moa

A

Inhibits vitamin k epoxide reductase and prevents carboxylation activation of vit k dependent factors (2, 7, 9,10)

30
Q

Warfarin pharmacogenomics associated genetics

A

Cyp2c9 impair hydroxylation and metab of s-warfarin and lpwers requirments
Gene: vkorc1 (vitamin k epoxide reductase complex 1)

31
Q

Warfarin dosing

A

Requires 5 days overlap with either ufh, lmwh, fondaparinux or iv direct thrombin inhibitors even if already on target inr (2-3)
May d/c overlap once 2 consecutive inr witjin target
Usual starting dose 5mg

32
Q

Fondaparinux moa

A

Anti-Xa pentasaccharide

Synthesized and not derived from animal products - does not cause heparin induced thrombocytopenia

33
Q

Noacs dose for treatment of vte

A

No bridge with parenteral

  • rivaroxaban 15mg bid x 3 wks then 20mg od
  • apixaban 10mg bid x 1 wk then 5mg bid
34
Q

Reversal agents in treatment of vte
Ufh/lmwh
Dabigatran
Universal reversal agent for anti xa agents

A

Ufh/lmwh - protamine sulfate
Dabigatran - idarucizumab
Universal reversal agent for anti xa agents - andexanet

35
Q

Duration of therapy and target inr pe

A

Target inr = 2-3
Upper extremity dvt or provoked lower extremity (calf) dvt - 3 months
Proximal leg dvt - 3-6 months
Cancer and vte - indefinitely or until on remission
Unprovoked - indefinite duration
**note: vte during long air haul travelnis considered unprovoked
Apas - indefinite

36
Q

Study which showed provoked vte derived greater risk reduction with extended anticoagulation

A

EINSTEIN CHOICE

37
Q

2 principal indications for ivc

A
  1. Active bleeding which precludes anticoagulation

2. Recurrent venous thrombosis despite anticoagulation

38
Q

Common complication of ivc filter

A

Recurrent dvt or caval thrombosis

39
Q

Volume to infuse for massive pe with hypotension, and first line pressors to use if nonresponsive

A

500cc nss

Dopamine and dobutamine

40
Q

Fibrinolysis indications in pe and dose

A

Massive pe only

Tpa 100mg iv over 2hrs

41
Q

Types of respiratory failure

A

Type 1: hypoxemic
Type 2: hypercarbic
Type 3: perioperative
Type 4: hypoperfusion of respi muscles in shock

42
Q

Ards treatment:
Tidal volume
Shown to improve survival
Decrease days on mv

A

Tidal volume - 6cc/kg
Shown to improve survival - 1. Prone positioning 2. Neuromuscular blockade
Decrease days on mv - fluid conservative over fluid liberal strategy

43
Q

Screening test for spontaneous breathing trials in mv patients

A
  • pao2/fio2 >200 and peep <5
  • off sedatives
  • off pressors
44
Q

Spontaneous breathing trial method

A

Cpap 5 cmh20 and open t piece x 30-120min

45
Q

Failed sbt

A
  • rr >35 x >5min
  • hr >140 or >20% increase from baseline
  • sbp <90 or >180
  • o2 sat <90
  • diaphoresis or anxiety
46
Q

Rsbi (rapid shallow breathing index)

A

Rsbi = Rr/tv in ml

<105 : higher likelihood of successful extubation

47
Q

Normal ef
Normal end diastolic volume
Normal end systolic volume

A

Normal ef 67 +/-8%
Normal end diastolic volume 75 +/- 20cc
Normal end systolic volume 25 +/- 7

Residency (6 decks)

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