Cardio Block 2 Cram Flashcards
UA/NSTEMI Medical Therapies
BB- beneficial in acute MI O2- <90% Nitro- sublingual then IV, avoid in inf MI and Sev AS, c/i in PDE5 inhib in past 24hrs Statin- all PTs w/ ACS @ high intensity Anti-platelet- ASA for all Morphine- caution Anti-coag- UFH or LMWH
Acute Decompensated HF
S/Sxs: Exertional dyspnea, orthopnea
Dx: BNP +500
CXR: Kerley Bs, Effusion, Cardiomegaly
Tx: BiPap, Nitro, Furosemide, HOTN w/ no shock- Doubtamine/HOTN w/ shock- NorEpi
College of Cardio Staging categories
A- high risk, no Sxs/Dz
B- structure Dz w/out Sxs
C- structure Dz w/ Sxs
D- refractory HF
Why are NSAIDs avoided in HF?
Na retention Negative ionootropic effects Direct cardiotoxicity Impaired ACEI/Diuretic response Inc renal dysfunction
NYHA HF Classifications
1- ASx
2- Sxs w/ ordinary activity
3- ASx only at rest
4- Sx at rest
Nitroprusside contains cyanide ligands which can accumulate and cause toxicity which manifests as ?
N/V
Anorexia
AMS
What is the most common vasculitis in the US?
GCA
S/Sxs- monocular vision loss, unilateral HA, jaw claudication
ESR >50 but Biopsy= Dx
Tx high dose NSAID, No vision loss= prednisone PO, + Vision loss= IV Methylprednisolone
Assoicated w/ Polymyalgia Rheumatica
What maneuvers increases HCM
What maneuver decreases it?
Valsalva and Standing due to decreased venous return
Squatting- increased venous return
What are the top two most common Sxs of HCM?
First- death
Common- dyspnea, chest pain
Peripheral Artery Dz
Caused by atherosclerosis
Presents w/ intermittent claudication, cool/shiny skin and dec hair
PE: cool to touch and decreased pulses
Dx: ankle brachial index (<0.9= stenosis, <0.4= ischemia)
THESE PTS ARE REQ’D TO BE ON STATINS
What is the classic presentation of Conn Syndrome?
Primary Hyperaldosteronism- common cause of 2* HTN
HTN, Unexplained HypoK, Metabolic alkalosis
Rheumatic Fever
Hx of GAS- Strep Pyogens Infxn S/Sxs: Fever, Red lesions on trunk/extremities, Non-tender joint lumps JONES Criteria Tx: PCN/Macrolide, ASA 2 Major, 1 Major 2 Minor; 5 minor
All PTs w/ Systolic HF need to be on what 2 meds?
ACEI/ARB
BB- Metoprolol Succinate is DOC
CHADS2VASC use and score method
Estimates risk of stroke in PTs w/ A-fib
CHF, HTN, Age (75 or more=2), DM, Stroke/Clot (2), Vascular Dz, Age, Sex (F-1)
Aortic Stenosis
Old PT- calcification of trileaflet valve
Young PT- bicuspid
NARROW Pulse Press, syncope, dyspnea
Crec/Decrec Systol murmur w/ S4, can radiate to carotid
Dec w/ Valsalva
Tx w/ Valve replacement
Associations w/ endocarditis and colonic neoplasms are most closely linked to ?
Strep Gallolyticus
S. Bovis Biotype I
Aortic Regurgitation
Abnormal leaflet on proximal root
S/Sxs: CHF, Dyspnea, Fatigue
PE: WIDE pulse pressure, 5 Sign Names
Dx w/ Echo
Tx- Diuretics, Digoxin, ACEI, Na restriction
Surgery if EF <55% or end diastolic >55mm
Regardless of etiology, what med is beneficial for Sx and ASx PTs w/ reduced LV systolic function?
ACEI
Mitral Stenosis
Exertional dyspnea, Hemoptysis
Loud S1, Open Snap, Low diastolic rumble at apex
Prophylaxis if undergoing procedures prone to bacteremia
What two meds can be used in the presence of heart block to increase HR?
Atropine
Isoproterenol
A 10yr atherosclerotic CV Dz score of __% is an indication to start a statin
> 7.5%
Mitral Regurg
Dyspnea
Blowing holosystolic mrmur heard at apex to axilla
Manage: Nitroprusside, Dobutamine, Intra Aorta Bolloon, Surgery
Mitral Valve Prolapse
Non-exertional chest pain, dyspnea
Mid-systolic click w/ late systolic murmur
Dx w/ Echo
What are the first two drugs usually utilized in HF and why?
What is the only diuretic proven to improve survival in HF?
ACEI- anti-HTN, dec AL, Inhib RAAS, Prevent remodel
BB- anti-HTN, dec O2 consumption, anti-arrhythmic effect
Spirinolactone