Cardio Flashcards
MCC Torsades?
hypomagnesemia
hypokalemia
Tx for stable sustained VT
Amiodarone
(can also use lidocaine or procainamide)
Unstable VT with a pulse
Synchronized cardioversion
VT (no pulse) tx
Defib + CPR
Tx for Torsades de pointes
IV magnesium
Delta waves seen on EKG
Wolff-Parkinson-White
Tx for stable wolff parkinson white
Vagal maneuvers
_**Procainamide**_, Amiodarone, flecainide, Ibutilide
1st line tx for unstable wolff parkinson white
Synchronized cardioversion
Fixed split of S2 (doesnt vary with inspiration)
ASD, VSD
Pulmonary HTN
Mitral regurgitation
ejection click heard in systole
Mitral valve prolabse
Diastolic murmur:
Opening snap
Best heard where?
Opening snap= MS (also heard in TS but later)
MS- Best heard @ apex
Murmurs: Harsh/rumble= regurg or stenosis?
stenosis
Murmurs:
blowing= regurg or stenosis?
Regurg
which murmur radiates to carotid
AS
which murmur radiates to LUSB
AR
Which murmur radiates to the axilla
MR
Which murmur has no radiation
MS
Murmurs:
Carvallo’s sign (increased murmur intensity with inspiration
TR
(helps distinguish TR from MR)
Cheyne Stokes Breathing
Heart Failure
Pt comes to ER with dyspnea and has elevated BNP
Heart failure
Kerley B lines on CXR
heart failure
management for congestive (decompensated) heart failure
“LMNOP”
Lasix
Morphine
Nitro
Oxygen
Position (upright)
Pre HTN?
Stage 1?
Stage 2?
Pre= 120-139/80-89
Stage 1= 140-159/90-99
Stage 2= >160/100
What 5 drugs can be used to tx HTN urgency
Clonidine
Captopril
Furosemide
Labetolol
Nicardipine
What BP is HTN emergency
>180/120
3 meds used to tx HTN encephalopathy in HTN emergency
Nicrdipine or clevidipine
Labetalol, Fenoldopam
Sodium nitroprusside
2 meds used to tx hemorrhagic/ischemic stroke in HTN emergency
Note: decrease BP ONLY if >220/120 (not a thrombolytic candidate), >185/110 (if a thrombolytic candidate)
Nicardipine or Labetalol
tx for cardiogenic shock (4 + 1 if refractory)
O2 + Isotonic fluids (sm amounts) + dobutamine + epi
Refractory= + amrinone
What is Becks triad?
- Distant heart sounds
- Incr. JVP
- Systemic hypotension
= PERICARDIAL EFFUSION
Tx for acute pericarditis
Aspirin or NSAIDS (tx of choice)
2nd line= colchicine
Refractory (sxs >48h)= Steroids
What is Dresslers syndrome? how do you tx?
Acute pericarditis s/p MI
Tx: Aspirin or Colchicine
Tx for pericardial tamponade
pericardiocentesis
ECG findings:
Low voltage QRS complex
electrical alternans*
Pericardial effusion
MCC myocarditis
Enteroviruses (esp. Coxsackie B)
also SLE, Rheumatic fever
Tx for myocarditis
Supportive mainstay of tx, standard systolic HF tx:
- Diuretics, ACE, Inotropic drugs if severe- Dopamine, dobutamine, etc
- BB (not in peds)
- +/- IVIG
gold standard in dx myocarditis
endomyocardial bx
5 MAJOR jones criteria for rheumatic fever?
- Joint (migratory polyarthritis)
- Oh my heart (active carditis)
- Nodules (subcutaneous)
- _E_rythema marginatum
- _S_ydenham’s chorea
+ evidence of recent group A strep infection (pos throat culture or elevated ASO)
dx of rheumatic fever
jones criteria- 2 major or 1 major +2 minor
4 minor jones criteria for rheumatic fever
- Fever (>101.3)
- Arthralgia
- Incr. ESR, CRP or leukocytosis
- ECG: prolonged PR
+ evidence of recent group A strep infection (pos throat culture or elevated ASO)
Tx of rheumatic fever
- Aspirin (2-6wks w/ taper)
- +/- corticosteroids in severe cases w/ carditis
- _Penicillin G*_
MCC subacute bacterial endocarditis
strep viridans
(subacute= infection of abnormal valves)
MCC acute bacteroial endocarditis and IVDA
S. aureus
(acute= infection of normal valves)
MCC infective endocarditis in men 50y/o w/ h/o GI/GU procedures
Enterococci
MCC prosthetic valve endocarditis
Staph epidermidis
(early, w/in 60d)
- Janeway lesions (painless erythematous macules on palms/soles)
- Roth Spots (retinal hemorrhages)
- Oslers nodes (tender nodules on the pads of the digits)
- Splinter hemorrhages
infective endocarditis
Tx for acute (NV) infective endocarditis
Nafcillin + Gentamicin x4-6wks
OR
Vanco + gentamicin
Tx for subacute (NV) infective endocarditis
PCN or Ampicillin + Gentamicin
Vanco in IVDA
Tx for prosthetic valve infective endocarditis
Vanco + Gentamicin + Rifampin
Endocarditis prophylaxis tx
Amoxicillin 30-60 min prior to procedure
PCN allergic= Clindamycin
5 indications for endocarditis prophylaxis
1. Prosthetic (artificial) heart valves
2. Heart repairs using prosthetic material (not including stents)
3. H/o endocarditis
4. Congenital heart dz
- Cardiac valvulopathy in a transplanted heart
Management of AAA:
3-4cm
monitor- U/S every year
Management of AAA:
4-4.5cm
monitor by US q6mo
Management of AAA:
>4.5cm
Vascular surgeon referral
Management of AAA:
>5.5cm or >0.5cm expansion in 6mo
immediate surgical repair (even if asxs)
Initial Dx of choice for AAA?
Abdominal ultrasound
(esp if abd pain >60y/o)
Test of choice for thoracic aneurysms
CT scan
Dx gold standard for AAA
Angiography
most important predisposing factor for aortic dissection
hypertension
test of choic for aortic dissection
gold standard?
CT w/ contrast
Gold= MRI angiography
What is seen on CXR in aortic dissection
widening of mediastinum
Tx for aortic dissection
- acute proximal or acute distal w/ complications= surgery
- Descending w/o complications= medical (esmolol, labetolol 1st line)
Q wave/ST elevations in V1 through V4
(anterior wall) Left Anterior Descending
Q wave/ST elevations in I, aVL, V4, V6
Lateral wall (circumflex)
Q wave/ST elevations in I, aVL, V4 + V5 + V6
Anterolateral wall
mid LAD or CFX
Q wave/ST elevations in II, III, aVF
Inferior wall
Right coronary artery
ST depressions V1-V2
Posterior wall
RCA, CFX
