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Residency > Cardio > Flashcards

Cardio Flashcards

1
Q

defribrillator shock dosages

A

2J/kg then 4J/kg max 10J/kg for peds)

resume CPR after shock

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2
Q

epi doses during code

A

1mg IV/IO (0.01mg/kg) Q3-5min

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3
Q

amio doses during code

A

1) 300mg

2) 150mg

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4
Q

reversible causes of Cardiac arrest H’s

A 
Hypovolemia 
hypoxia
hyperkalemia
hydrogen ion(acidosis) 
hypoglycemia 
hypothermia
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5
Q

reversible causes of cardiac arrest T’s

A

tension pneumo
tamponade
thrombosis (PE,MI)
toxins

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6
Q

range for therapeutic hypothermia

A

32-36degrees celsius for >24hrs

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7
Q

post arrest managment

A

therapeutic hypothermia
bolus fluids
vasopressors/inotropes to maintain MAP>65
electrolyte goals K>4 and Mg >2

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8
Q

brugada syndrome

A

inherited myocardial ion channel disorder –> malignant ventricular arrhythmias and sudden cardiac death

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9
Q

dx of brugada syndrome

A

ekg ST segment elevation in V1-V3 followed by negative T wave

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10
Q

management of brugada syndrome

A

ICD

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11
Q

congenital long QT syndrome

A

inherited mutations in myocardial ion channels –> prolonged QT

increased risk of torsades de pointes and sudden cardiac death

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12
Q

presentation of congenital long QT syndrome

A

syncope
torsades de pointes
sudden cardiac death
risk of dysrhythmias highest when QTc >500

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13
Q

management of WPW

A

procainamide or synchronized electrical cardioversion

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14
Q

management of AVRT (narrow complex tachy)

can also be wide at times

A

vagal maneuvers
adenosine
CCBs or BBs
DC cardioversion if unstable

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15
Q

VSD

A

mc congenital heart dz
L–> R shunt
holosystolic murmur 2-6wks og age

poor feeding, failure to thrive, hepatomegaly

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16
Q

ASD

A

fixed split S2

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17
Q

PDA

A

continuous machine like murmur
L –> R shunt

tx indomethacin or sx

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18
Q

left sided ductal dependent lesions

A

prostaglandin E1 to increased flow thru ductus arteriosus

ADR: apnea

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19
Q

TOF

A

VSD
overriding aorta
pulm stenosis
RVH

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20
Q

management of ruptured AAA

A

permissive hypotension 80-100

emergent Sx consult

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21
Q

types of aortic dissections

A

standford A: ascending aorta, emergent sx

standford B: descending aorta (less severe)

esmolol HR 60s BP 100-120

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22
Q

ABI for thromboembolism

A

<0.9 indicates impaired blood flow

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23
Q

management of mesenteric ischemia

A 
broad spec (metro, etc) 
emegenct sux resection of necrotic bowel
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24
Q

wells criteria DVT

A 
active cancer (1) 
bedridden or sx <4wks (1) 
calf swelling >3 (1) 
collateral superficial veins (1) 
entire leg swollen (1) 
localized tenderness (1) 
pitting edema (1) 
paralsysis (1) 
previous DVT (1)
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25
Q

wells score interpretation and tx

A

1-2 mod risk
>2 high risk

anticoagulation - LMWH or unfractionated heparin or NOAC

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26
Q

most common physical exam finding in PE pts

A

tachycardia

tachypnea also common

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27
Q

Wells criteria PE

A 
clinical signs and symptoms of DVT (3) 
PE #1 dx (3) 
HR >100 (1.5)
immobilization >3 days or sx w/in 4wks (1.5)
previous DVT or PE (1.5) 
hemoptysis (1) 
malignancy w/ tx <6mnths (1)
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28
Q

wells PE Criteria interpretation

A

<5 = PE unlikely

> 4 = PE likely

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29
Q

PERC def

A

if no criteria are (+) then < 2% chance of PE so r/o basically

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30
Q

PERC criteria

A 
age >50
HR >100 
SaO on RA <95% 
unilateral leg swelling 
hemoptysis 
recent sx or trauma (w/in wks) 
Prior DVT or PE 
hormone use
31
Q

most common sign on EKG for PE

A

sinus tachycardia

non specific ST-T changes

32
Q

EKG signs for PE

A

sinus tachy
non specific ST-T changes
new RBBB
S1Q3T3

33
Q

S1Q3T3

A

means PE

S wave in lead I
Q wave in lead III
T wave inversion in III

34
Q

CXR of PE patient

A

mc - NML

hamptons hump - wedge shaped density indicated infarcted lung

westermakrs - paucity of vessel markings

35
Q

echo findings of a massive PE

A

RV dilation
RV hypokinesis
Dilated IVC

36
Q

tx of PE

A

anticoagulation w/ unfractionated hep or LMWH or NOACs

tPA for massive PE
embolectomy

37
Q

junctional tachycardia

A

junctional escape
100-130
nopreceeding p waves

38
Q

SVT (AVnRT)

A

150-250
regular
no discernable pwaves

39
Q

management of SVT (AVnRT)

A

stable pts = (1)vagal maneuvers –> (2)
adenosine 6-12mg bolus IV –> (3)
CCBs (dil, verap) or
Beta Blockers

40
Q

SVT (WPW, LGL)

A

narrow = orthodromic

wide-complex = antidromic

41
Q

AVnRT vs Afib

A

AVnRT = regular, very faster

Afib = irregular, fast or nml

42
Q

synchronized cardioversion is performed at what voltage

A

120-200 and can if needed go to 360J

43
Q

causes of atrial flutter

A 
idiopathic 
valvular heart dz
cardiomyopathy 
hyperthyroidism 
PE 
chronic lung disease `
44
Q

? aflutter vs SVT next step

A

use adenosine to block AV node and visualize the saw tooth waves

45
Q

tx of atrial flutter

A

unstable - synchronized cardioversion (25-50J) sensitive to low voltages

stable - diltiazem or beta blockers

46
Q

causes of V tach

A 
structural heart dz
trauma 
hypothermia 
hypoxia 
severe electrolyte issues 
brugada 
congenital long GT 
QT prolonging meds
47
Q

tx of VTach

A

pulseless - defib CPR
unstable - syn cardiovert start at 100J (sedate if time)

stable- (1) procainamide 100mg IV over 2min Q5min or continuous infusion

(2) amio 150mg IV over 10min then infusion
(3) lido 1mg/kg IV over 5min then infusion

48
Q

causes of Pulseless electrical activity

A

H’s and T’s

tx - CPR, IV epi

49
Q

NIPPV for CHF

A

decreases preload and afterload
improves work of breathing

PEEP = most important, decreases preload and stents open airways

50
Q

when should you be weary of CHF without fluid overload

A

in new onset afib with RVR since patient is not fluid overloaded

51
Q

pressors for CHF with hypotension

A

NE - reduced risk for arrhythmias but increases afterload

Dopamine w/ dobutamine has greater inotropy than NE (but will initially decrease BP so no use if sys <70)

52
Q

initial management of ACS

A

aspirin (162-324mg)
nitro
oxygen (only if hypoxemic)
pain control (morphine watch BP)

53
Q

wellens syndrome

A
  • biphasic T waves
  • deep symmetric T wave inversions in anterior precordial leads

= proximal LAD occlusion HIGH irsk for progression to anterior MI

54
Q

inferior STEMI

A

ST elevation in II, III and aVF

55
Q

anterior MI

A

ST elevation in V2-4

56
Q

septal MI

A

ST elevation V1-2

57
Q

lateral MI

A

ST elevation in I, aVL, V5, V6

58
Q

posterior MI

A

ST depression in V1-V4

59
Q

earliest finding on EKG for STEMI

A

HYPER acute T waves

60
Q

sgarbossa criteria for STEMI with preexisting LBBB

A

concordant ST Elevation >1mm in leads with (+) QRS complex (5pts)

ST depression >1mm in V1-3 (3pts)

Excessive discordant ST elevation >5mm in leads with (-) QRS (2pts)

61
Q

sgarbossa score interpretation

A

score >2 = 90% specificity for dx of MI

62
Q

complications of STEMI

A
  • cardiogenic shock from LV failure
  • Heart Block

Tachydysrhythmias (Vfib mc complication)

LV wall rupture

papillary muscle rupture

ventricular aneury

63
Q

echo of myocarditis

A

dilated chambers
hypokinesis

myocardial biopsy is gold standard

64
Q

tx of refractory pericarditis

A

steroids

65
Q

physical exam finding of aortic stenosis

A

crescendo decresendo systolic murmur radiating to carotids

66
Q

aortic stenosis on EKG

A

LVH with strain

LBBB

67
Q

management of aortic stenosis

A
  • avoid nitrates
  • give gentle fluids if hypotensive
  • diuresis if CHF
68
Q

valves affected by infective endocarditis

A

mitral regurg —> mitral stenosis with time

69
Q

mcc of chronic mitral regurgitation

A

afib

70
Q

causes of narrow QRS PEA arrest

A
  • hypovolemia
  • pericardial effusion leading to tamponade
  • PE
  • pneumo
71
Q

management of TOF

A
  • flex knees to chest
  • morphine/ intranasal fentanyl to decrease pulm vasc resistance
  • phenylepi/ NE to increase SVR
  • IVF for volume expansion
72
Q

mc tachydysrthmia in WPW patients

A

SVT

followed by afib and then atrial flutter 3rd

73
Q

what is targeted temp for post ROSC following cardiac arrest

A

32-34

89.6-96.8

Residency (19 decks)

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