Cardio Flashcards
Indications for Diuretics
HF
Systolic HTN
CI for diuretics
Gout
SE diuretics
Hypokalemia
Hyponatremia
Hyperuricemia
Hypercalcemia (thiazides)
Hyperlipidemia
Beta Blockers
Indications
Angina HF Previous MI Tachydysrhythmias Migraine
Beta blockers
CI
Asthma
COPD
Heart Block
Beta blocker
SE
Bronchospasm Bradycardia HF Impaired Peripheral circulation Insomnia, fatigue Decreased, exercise tolerance hypertriglycreidemia
ACE inhibitors indications
HF LV dysfunction Previous MI Diabetic nephropathy Proteinuria
ACE inhibitors CI
Pregnancy
Bilateral renal artery stenosis
Hyperkalemia
ACE inhibitors SE
Cough Angioedema Hyperkalemia Rash Loss of taste Leukopenia
CCB indications
systolic hypertension
cyclosporine induced HTN
CCB CI
orthostatic hypotension
CCB SE
headache drowsiness fatigue weakness postural hypotension
Alpha blockers indications
Prostatic hypertrophy
Alpha blockers CI
orthostatic hypotension
Alpha blockers SE
HA drowsiness fatigue weakness postural hypotension
ARBs indications
ace inhibitor associated cough
diabetic nephropathy
proteinuria
HF
ARBs CI
pregnancy
bilateral renal artery stenosis
hyperkalemia
ARBs SE
angioedema (rare)
hyperkalemia
Which antihypertensive medications are associated with gingival hyperplasia
dihydropyridine and nondihydropyridine CCB
JNC 8 for HTN
Blood pressure goals
age < 60: 140/90
diabetic: 140/90
age>60 150/90
JNC 8 for HTN
first line tx
lifestyle modification
JNC 8 for HTN
non-African American
thiazide
ACE/ARB
CCB
alone or in combo
JNC 8 for HTN
African American
thiazide
CCB
alone or in combo
JNC 8 for HTN
CKD (with or w/o DM)
all races
ACE/ARB
alone or in combo with other drug classes
which antihypertensive is associate with peripheral edema?
amlodipine
A 60-year-old man with celiac disease presents with severe macrocytic anemia, jaundice, and glossitis. Laboratory testing reveals borderline levels of vitamin B12 and folate. Which additional laboratory test would most likely suggest a diagnosis of vitamin B12 deficiency anemia rather than folate deficiency anemia?
methylmalonic acid
What part of the spinal tract is damaged with B12 deficiency
posterior column (vibratory sense) lateral corticospinal tract (motor function of limbs)
The build up of methylmalonic acid impairs spinal cord mylenation and leads to…
poor propcioception
poor vibratory sense
N/V/D
spastic paresis
Causes of B12 anemia
MC pernicious anemia
veganism
fish tapeworm, Crohns, pancreatic insufficiency
Does folate or B12 deficiency have neurological sx
B12 has neurologic sx
Causes folate deficiency
alcoholism
pregnancy
cancer
folate antagonizing meds (METHOTREXATE)
What do PMNs look like macrocytic anemia
hypersegmented
Lab test elevated for both B12 and folate deficiency
homocysteine
Lab test elevated only B12, not folate, deficiency
methylmalonic acid
B12 clinical sx
psychologic: depression, irritability, psychosis
hematologic: megaloblastic anemia
neurologic: sensory & motor deficits (absent reflexes, paresthesias), dementia
GI: N/V/D
B12 tx
parenteral B12 if symptomatic and has impaired absorption
Oral B12 if dietary deficiency
What is ferritin
is a protein that binds to stored iron and acts as an indirect marker for it. It is the most useful test used to diagnose iron deficiency anemia
What is transferrin
Transferrin (D), like ferritin, is a useful biomarker used to investigate and diagnose iron deficiency anemia.
MC anemia in hospitalized pts with chronic ds
anemia of chronic ds
What B vitamin is folate
B9
Irregularly irregular rhythm
atrial fibrillation (quivering)
MC disorders associated with Afib
HTN CAD DM OSA COPD Hyperthyroidism rheumatic heart ds
what can provoke afib
anxiety
alcohol consumption
exercise
PE of afib
irregularly irregular HR
tachycardia (often)
Dx confirmation
ECG
irregularly irregular
no P waves
varying ventricular rate
What sx someone with afib have
palpitations dizziness syncope HA fatigue dyspnea chest pain
What are the complications of afib
HF
peripheral embolism
stroke
secondary thrombus formation in the atrium
tx afib techniques
cardio version
cardiac ablation
pacemaker
What two things try to control with afib
rate and rhythm
Acute Afib that is hemodynamically unstable… what do you do?
electrical cardioversion
Acute Afib and hemodynamically STABLE… what do you do?
ventricular rate control with beta blockers or calcium channel blocker and cardioversion to sinus rhythm after rate control is achieved
What if pt presents with AFib >48 hours or unknown period of time…
3 weeks of anticoagulation, then cardiovert, then 4 more weeks of anticoagulation
AFib: how do you evaluate the left atrium for thrombus prior to cardioversion?
TEE - transesophageal echocardiogram
What meds used to control rate in chronic AFib
BB (metoprolol) and CCBs (diltiazem)
What is the CHA2DS2 VASc score
is a tool used to calculate the risk of a patient with atrial fibrillation developing a stroke or thromboembolism over one year and is used to guide the decision to start long term anticoagulation.
Does AFib have P waves
no
Describe Atrial Flutter
is an atrial tachycardia characterized by regular atrial contractions originating outside of the sinoatrial node. Atrial flutter is most common in individuals with underlying pulmonary disease or heart conditions such as valvular disorders, recent or remote heart surgery, and pericardial disease. Symptoms are similar to atrial fibrillation including dizziness, headache, fatigue, chest pain, and shortness of breath. Physical exam may show tachycardia with or without an irregular heart rate noted. Diagnosis is made with electrocardiogram revealing classic flutter waves described as a “sawtooth” pattern. The most common ventricular rate in a patient presenting with atrial flutter is 150 beats per minute. Similar to atrial fibrillation, treatment should address heart rate versus rhythm control as well as anticoagulation.
Describe Sinus tachycardia
Sinus tachycardia (C) is a normal physiologic response to increased oxygen demands in the body such as with exercise, fever, or infection. Patients are typically asymptomatic but may complain of palpitations. Physical exam reveals a regular, rapid heart rate. Diagnosis is confirmed with an electrocardiogram showing a narrow-complex tachycardia with normal p-waves prior to each QRS. Treatment is generally aimed at addressing the underlying condition.
Describe Ventricular Fibrillation
Ventricular fibrillation (D) is a ventricular arrhythmia that results in rapid, unorganized ventricular contractions with no substantial cardiac output. Left untreated, this condition is fatal within minutes. Ventricular fibrillation most commonly occurs in patients with underlying heart disease. Patients have sudden collapse into an unresponsive state with no pulse or respirations. Telemetry or electrocardiogram reveals the presence of irregular fibrillatory waves of varying amplitude and morphology with no p-waves or QRS complexes. Treatment requires emergent cardiopulmonary resuscitation and defibrillation.
Question: What is an early, wide QRS complex with no associated p-wave followed by a brief pause and return to normal sinus rhythm known as?
premature ventricular contraction
Afib RR
Rate will be irregular
Rhythm will be irregular
Notable feature: No defined P waves
Treatment
Unstable: cardioversion
Stable: rate control is mainstay
Comments:
> 48 hours - anticoagulate for 21 days prior to cardioversion
Determine the need for anticoagulation by using CHA2DS2-vasc score
Most common sustained dysrhythmia in adults
