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Cardiology > cardio by treatment > Flashcards

cardio by treatment Flashcards

1
Q

Sinus Bradycardia

A

Usually none. If symptomatic: atropine

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2
Q

Sick Sinus Syndrome

A

Antiarrhythmic drug for tachy, pacemaker for brady

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3
Q

Junctional (Nodal) escape rhythm

A

Antiarrhythmic drug for tachy, pacemaker for brady

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4
Q

Ventricular escape rhythm

A

Antiarrhythmic drug for tachy, pacemaker for brady

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5
Q

1st deg AV block

A

Usually none

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6
Q

2nd deg AV block: Mobitz Type I

A

Usually none. If symptomatic, IV atropine/isoproterenol. If chronic, pacemaker.

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7
Q

2nd deg AV block: Mobitz Type II

A

Pacemaker, even if asymptomatic

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8
Q

3rd deg (complete) AV block

A

Pacemaker

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9
Q

Sinus tachy

A

Treat underlying cause or use beta-blockers

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10
Q

APBs

A

Avoid precipitants (caffeine, EtOH, stress). Can use BB if needed.

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11
Q

Afib (3)

A
  1. control rate: BB, CCB
  2. restore sinus rhythm in symptomatic pts:
    a. cardioversion via drugs (Class Ia, Ic, III antiarrhythmics)
    b. maze procedure: incisions in R/L atria to prevent reentry circuits
    c. percutaneous catheter ablation
    d. serious case: catheter ablation of AV node followed by pacemaker.
  3. Anticoagulation (using CHADS2) to prevent thrombus.
    0: none or aspirin
    1: aspirin or warfarin
    2 or higher: warfarin (regular blood tests to monitor INR) or dabigatran = direct thrombin inhibitor
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12
Q

AVNRT (4)

A
  1. Increase vagal tone via valsalva maneuver/carotid sinus massage
  2. IV adenosine, CCB, BB
  3. Catheter ablation
  4. Class Ia, Ic, III antiarrhythmic drugs
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13
Q

Atrial Flutter (4)

A
  1. Electrical cardioversion
  2. Temp/permanent pacemaker rapid atrial burst pacing
  3. BB/CCH/digoxin to slow ventricular depolarization, THEN use antiarrhtyhmias to slow conduction of atrial monocytes
  4. Catheter ablation for chronic therapy
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14
Q

AVRT/WPW (3)

A
  1. Na channel blockers (Class Ia and Ic, some class III)
    NOT beta blockers or digitalis which only slow AV node and can increase ventricular rate thru accessory pathway.
  2. Acute:
    a. Cardioversion (if hemodynamically unstable)
    b. IV procainamide (class Ia) or ibutilide (class III) if hemodynamically stable
  3. Chronic: catheter ablation of accessory pathway, chronic oral
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15
Q

Focal Atrial Tachy (3)

A
  1. Remove contributing factors (digitalis?)

2. BB, antiarrhythmics, catheter ablation

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16
Q

Multifocal Atrial Tachycardia

A

Tx aimed at causative disorder (severe pulm dz? Hypoxemia?)

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17
Q

VPBs

A

Reassurance. If needed, BB, If serious, ICD.

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18
Q

VT (2)

A
  1. Acute: electric cardioversion or IV antiarrhythmic drug

2. Chronic (e.g. structural aggravating factor): ICD

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19
Q

Torsades de Points (2)

A
  1. If drug or electrolyte induced: IV Mg2+ to suppress repeat episodes, beta-adrenergic stimulating agents (isoproterenol) to shorten QT interval, artificial pacemaker
  2. If congenital long QT: BBs and implantable defibrillator
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20
Q

Vfib (3)

A
  1. prompt electrical defibrillation
  2. IV antiarrhythmics, ICD
  3. Correct underlying source of arrhythmia
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21
Q

Dilated Cardiomyopathy

A

Treat any acute exacerbation (CHF) = LMNOP
L = Lasix (furosemide)
M = morphine
N = nitrates
O= oxygen
P = position upright/ pee out excess water

Long term control:
salt restriction and diuretics 
ACEi or ARB 
Beta-blocker 
Spironolactone, digoxin or home O2 if severe dz
Prevention of arrhythmias:
amiodarone = safest for AFib 2/2 DCM. 
ICD if LVEF < 35%.
Cardiac transplant if necessary.
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22
Q

Hypertrophic Cardiomyopathy (8)

A
  1. Beta-blockers
  2. If BB fail, CCB in caution (can reduce intravascular volume → dec LV size –> exacerbate outflow tract obstruction. Similarly, avoid vasodilators.
  3. Control AFib aggressively with antiarrhythmic drugs (amiodarone, disopyramide). Avoid digitalis b/c it’s + inotropic → can worsen outflow tract obstruction
  4. Anticoagulation if AFib
  5. Avoid strenuous exercise
  6. Pts at risk (i.e: FamHx of SCD, ventricular wall thickness >30mm, hx of syncope, hx of high-grade Vtach) should receive ICD.
  7. Surgery (myomectomy) or a percutaneous septal ablation in pts that don’t respond
  8. Genetic counseling
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23
Q

Restrictive Cardiomyopathy (2)

A
  1. Treat underlying dz (e.g. iron chelation for hemochromatosis)
  2. Treat symptoms: Salt restriction, cautious use of diuretics to improve congestion
24
Q

Chronic Heart Failure w reduced EF (systolic HF)

A

ID and correction of underlying condition causing HF
Elimination of precipitating factors (arrhythmias, acute infxn, drugs)
DO NOT use CCBs (verapamil or diltiazem as they are neg inotropes)
Management of HF:
ACC/AHA treatment guidelines:
Class A: High Risk:
lifestyle, ASA, ACEi, statin, BB
Class B: asymptomatic HF:
all of the above + ICD if poor LV func
Class C: symptomatic HF:
all of above + ICD if LV systolic dysfunc (prev VTach, brady); CRT if LVEF < 35% and QRS wide
Class D: end-stage HF
all of above + inotropes, ICD as bridge to transplant, CRT as needed, LVAD/other
“Accepted sequence of therapy”-Lilly:
start w an ACEi (or H/T) + diuretic if congestive
If no ACEi, use ARB
For pts w/o recent clinical deterioration, volume overload, or other contraindication: add beta blocker

25
Q

Acute Heart Failure w preserved EF (diastolic) (4)

A
  1. Warm and dry: they’re fine, do nothing, maybe diet changes
  2. Cold and dry: inotropes
  3. Warm and wet (LHF): diuretics + ACEi/ARB prior to goal weight, then beta blockers once not acute
  4. Cold and wet (R and LHF): vasodilators, then diuretics
26
Q

Acute Pulm Edema

A 
LMNOP
L = Lasix
M = morphine
N = nitrates
O = oxygen
P = position upright
27
Q

stable angina

A

sublingual nitrate (nitroglycerin?) with “drug holiday” to prevent tolerance

28
Q

unstable angina/NSTEMI (3)

A
  1. aspirin and/or clopidogrel or heparin, BB, CCB, nitrates.
  2. If advanced: stent/bypass/angioplasty
  3. Assess TIMI to decide PCI or CABG vs conservative
29
Q

STEMI (7)

A

FIRST: chewed aspirin

  1. platelet inhibitor (clopidogrel or ticagrelor)
  2. heparin
  3. nitroglycerin (except in inferior MI-why??)
  4. morphine
  5. ideally, emergent PCI within 90 minutes
  6. Long term: beta blocker (metoprolol, carvedilol), aspirin, ACEi, statin
30
Q

pheochromocytoma

A

phentolamine, phenoxybenzamine (alpha blockers)

31
Q

Valvular Heart Dz (4)

A

Structural → surgery
Types of valves: St Jude mechanical bileaflet valve (trap door), bioprosthetic valve (eg hancock pig valve), Starr-Edwards (ball in socket), Bjork-Shiley (“toilet seat”)

32
Q

Familial Hypercholesterolemia

A

Most commonly statins + diet low in cholesterol and sat fat

33
Q

Defective ApoB

A

Niacin, statin, or ezetimibe.

34
Q

AD/AR hypercholesterolemia

A

AR: Most commonly statins + diet low in cholesterol and sat fat
AD: usually doesn’t respond to statins; can offer LDL apheresis (removal of LDL similar to dialysis) or liver transplant.

35
Q

Familial combined hyperlipidemia

A

Lifestyle change, statin

36
Q

Type III hyperlipoproteinemia

A

Low fat diet, niacin and/or fibrates

37
Q

Familial hypertriglyceridemia

A

Low fat diet, niacin or fibrates

38
Q

LPL deficiency

A

Low fat diet, niacin, fibrates, omega-3

39
Q

Long QT 1

A

Beta blocker, avoid increase in HR

40
Q

Long QT 2

A

Avoid hypokalemia, avoid sudden intense situations (difficult), lifestyle changes to avoid loud alarming sound, quiet areas

41
Q

Long QT 3

A

Mexiletine, flecanide

42
Q

Brugada syndrome

A

Possibly ICD

43
Q

VSD (2)

A

Medical: digoxin/furosemide, optimize nutrition, monitor
Surgical: If persistent or if develop CHF/PVR/valvular issue, repair in cath lab

44
Q

PDA (2)

A

Medical: intomethacin, ibuprofen (NSAID) to close PDA in premature
Surgical: closure if develop CHF/Failure to thrive/pulmonary HTN. Cath easy.

45
Q

ASD (2)

A

Usually asymptomatic.

Surgical: closure if RV too overloaded or if pulm HTN/thromboembolism risk develops. Cath easy.

46
Q

AV canal defect

A

Always surgical, by 3-6 mo of age

47
Q

Eisenmenger’s syndrome (2)

A

Medical: Pulm vasodilators (sildenafil, etc), birth control, AVOID systemic vasodilators and exercise.
Surgical: transplant

48
Q

Pulmonary atresia (2)

A
  1. PGE to maintain PDA!

2. Surgical: open PV if possible. If RV dependent coronary sinusoids, AVOID opening pulm valve- can cause MI

49
Q

Tricuspid atresia

A

Fontan surgery (bypass RV)

50
Q

Tetralogy of Fallot

A

Surgical repair of VSD and PS

51
Q

Truncus arteriosus

A

“surgical repair in infancy”

52
Q

TAPVR

A

NO PROSTAGLANDINS.

53
Q

TGA (2)

A 
Balloon atrial septostopy (maximize atrial mixing)
Surgical repair (arterial swtich)
54
Q

Hypoplastic left heart syndrome

A

Surgical repair: 3 procedures  heart transplant curative.

55
Q

Pericarditis

A

NSAIDs + colchicine

56
Q

Cardiac tamponade (4)

A

Pericardiocentesis, pericardial window surgery. Fluids given to maintain normal BP until pericardiocentesis can be performed. O2 to reduce workload on the heart.
Treat cause of tamponade.

Cardiology (8 decks)

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