Cardio/renal Flashcards
Dx/tx hypertrophic cardiomopathy
murmur that increases with valsalva
beta blockers
high intensity statin
rosuvastatin 20-40
atorvastatin 40-80
mod inten: simvastatin 40
Indications for Primary Prevention of ASCVD with HIGH intensity statin
- LDL >190
- DM 40-75 w/ ASCVD >7.5%
- Age 40-75 with ASCVD > 20%
- CAC >300
Secondary preventation indications
Known CVD
Tx options for high risk ASCVD patients
1st- high int statin
2nd- ezetimibe + mod int statin
3rd- PCSK9 if intolerant to statins or unable to lower LDL
mortality benefit with spiro in….
HFrEF
Mgmt of PAD
First line: walking program, smoking cessation, healthy diet, statins (regardless of LDL)
Single anti-PLT like ASA or clopidogrel. Only need DAPT after revasc
meds that increase survival after ACS
ASA
Statin
ACE
BB
confirmation of nephrotic syndrome
Spot urine prot/cr ratio instead oof 24hr urine
topomax risk of kidney stones?
inhib CAH > met acidosis > hypercalciuria -> calc-phos stones
tx for WPW
catheter ablation (96% success) risk of procedure is permanent AV block. Esp recommended if patient has pAfib
Can do “pill in pocket” as next tx
(dilt, metop are node blocking agents, should not be used long term in WPW due to risk of Vfib)
carotid artery disease tx
Statin= first line
> 70% stenosis and sx can consider stenting or CEA
ppx for dental procedures?
Patients w/ prosthetic heart valves
orgs: staph, strep, enterococcus, strep bovis, mitans, viridans
Abx: amoxicillin > keflex –> can do clinda or azithro if PCN allergy
Dx of vit D deficiency
dx= 25-OH
monitoring 1,25 di-OH vit d
HAS-BLED
> 3 = high risk of bleeding
Age > 65
Uncontrolled HTN
Hx stroke
Hx prior bleed
ASA, antiplat, NSAID
Labile INR
>8 etoh drinks
tx of pericarditis
colchicine > nsaids
t/f: STEMI patiehts with afib need DAPT plus AC?
Yes, clopidegral, ASA and warf or doac. INR goal 2-3
BB that have mortality benefit in HFrEF
carvedilol
bisoprolol
metoprolol
Non-shockable ryhtm
Asystole, PEA
Asystole–> EPI only!!
5Ts and 6Hs
toxins, tamponade, tension pneumoo, thrombosis caridac or PE
H+, hypothermia, hypokalemia, hyperkalemia, hypovolemia, hypoxia
shockable rythm
Vfib/Vtach
defibrilate the dead –> CPR –> epic –> CPR –> amio
sepsis classifications
sepsis- SIRS + source
severe sepsis= sepsis + lactate >2 or organ dysfunction
Septic shock = severe sepsis + lactate >4 or hypotension
indications for AV replacement
sx, transthoracic velocity >4, AV area <1
T/f: statin therapy can decrease periop mortality for high risk procedures (including joint replacement)
True
when to use bidil (isosorbide mononitrate + hydral)
AA patients, NYHA III-VI already on all other meds
ARNI
ARB+ neprilysin inhibitor
-Replace with ACE for NYHAII-III who are still symptomatic despite medical optimization
- wait 36 hours for ACE to washout
Drugs to avoid in HFrEF
-NDHP-CCB (dilt, verapamil) –> potent negative inotropic effect and are associated with worsening heart failure
(Amlodipine ok)
- anti-arrythmics
- NSAIDs
- Thiazolidinediones
HFpEF treatment
-little evidence base but MAYBE ALDOSTERONE CAN prevent hospitalizations
-careful with prelooad reduction (impaired ventricular relaxtion limits diastolic filling -> decreases SV > dec CO)
- careful w/ heart rate reduction (inc diastolic filling time > inc SV > in CO
Most common underlying cause of HFpEF
HTN –> stiff and thick ventricle that cannot fill well during diastole
Indications for ICD in CHF
LVEF <35%
NYHA II-III
Symptomatic
Life expectanty > 1 yr
Indications for LVAD in CHF
-bridge for patients with 1 year survival <50% before heart transplant
treatment for mobitz I v mobitz II
Mobitz I (wanke) = no tx needed (in acute settings can be inf MI). Abnormality is above AV node
Mobitz II= needs permanent pacemaker –> indicats disease below AV node (his-purkinje sys aka ventricle). Can progress to 3rd degree
RCA is associated with _______ MI and may effect ______ node
inferior, AV
LAD is associated with _____ MI and may effect ______ conducting system
anterior, distal
Acute SVT tx (after vagal manuevers fail)
- adenosine: 6mg, then 12mg
- next: metop 5mg IV x2
- next: dilt 5-20mg q15 min
SVT long term
- pill in pocket
- daily med that converted rythem in ER
- catheter ablation (5% inadvertent heart block)
disease associated with MAT
COPD
tx: AV nodal blockers (verapamil, dilt, metop)
t/f etoh associated with a fib
true, >1 drink per day
CHADVASC scoring an AC
0 men, 1 women= no AC
1 men, 2 women= shared decision making
2 men, 3 women= anticoagulation
remaining indications for warfarin over doac
severe mitral stenosis or mechanical valve
AC before electrical cardioversion
4 weeks, or if ECHO shows no LA clot
(if unstable then do emergently obvs)
catheter ablation of afib
-target destruction of pulm vein ostea in LA
- primary predictor of success is size of LA
- 20% of patients need repeating
SSRI associated with long QT
citalopram
WPW syndrome: what is it, what can’t you treat with
- pt with delta wave who then develops tachyarrythmia
- Accessory pathway that bypasses AV node
- can’t give AV nodal blocking agents because will cause electrical impulses to exclusively go down accessory pathway and cause tachyarrythmia
WPW syndrome tx
AVRT: tx like SVT with cardioversion available
Afib: ibutilide or procainimide
tx of long QT
> 470= bb
500 = ICD
benefit of bidil in CHF
improves mortality in people who cannot tolerate BB or ACE
SGLT2 approved for HFrEF
Dapagliflozin
extra renal cysts in ADPCKD
liver, then intracranial aneurysm
PVC burden > ______, risk for _______
10% –> cardiomyopathy, warrants tx
Order echo for patients with palpitations and >10% PVC
Dx of renal artery stenosis
Cr inc >50% after starting ACE –> get CT scan
(uses renin/aldo to diagnose hyperaldosteronism)
