Cardio Rosh Flashcards
MCC Vfib
severe ischemic cardiac disease
does hyperkalemia or hypokalemia cause Vfib
hyperkalemia
Tx Vfib
chest compressions and administration of epinephrine 1 mg IV every 3–5 minutes
chest compressions 100-120/min
in SVT, if vagal maneuvers are ineffective, what tx should you do next
Adenosine 6 mg then 12 mg
In what patient population should you use adenosine with extreme caution?
Those with heart transplants due to prolonged drug effect.
Nontraumatic causes of cardiac tamponade include
malignancy, acute pericarditis, uremia, bacterial pericarditis, chronic pericarditis, spontaneous hemorrhage, systemic lupus, post-radiation, and myxedema.
PE for cardiac tamponade
tachycardia
low systolic blood pressure
narrow pulse pressure
JVD
distant heart sounds
hypotension
tx for pericardial effusion / tamponade
The initial treatment should involve volume expansion with a 500–1,000 mL fluid bolus. However, this is only a temporizing measure, and pericardiocentesis is necessary for definitive therapy. In the setting of hemodynamic instability, pericardiocentesis should be performed in the emergency department
What is the most common cause of atraumatic pericardial effusion with tamponade?
malignancy
CXR for HF
cardiomegaly
Kerley B lines
pulmonary venous congestion
pulmonary edema
Interstitial perihilar infiltrates, also known as “bat winging,
Pleural effusions, typically right-sided
What causes Kerley B lines on chest X-ray?
engorgement of lymphatic vessels
A hypertensive emergency is defined as
systolic > 180 mm Hg or diastolic > 120 mm Hg with concomitant end-organ damage
Examples of hypertensive emergencies include
acute aortic dissection, acute pulmonary edema, acute myocardial infarction, acute coronary syndrome, acute kidney injury, severe preeclampsia or eclampsia, hypertensive retinopathy, hypertensive encephalopathy, subarachnoid hemorrhage, intracranial hemorrhage, acute ischemic stroke, or a sympathetic crisis
initial antihypertensive of choice for patients presenting with aortic dissection
esmolol
add nicardipine if needed
Anterior wall ST elevation in leads
v1-v4
inferior wall ST elevation in leads
II, III, and aVF
Lateral wall ST elevation in leads
I, aVL, V5, and V6
Posterior wall ST depressions in leads
V1 through V3 and elevations in leads V8 and V9
what artery affected in anterior STEMI
LAD
what artery affected in inferior STEMI
RCA and/or LCx
what artery affected in lateral STEMI
Lcx or diagonal of LAD
what artery affected in posterior STEMI
RCA-posterior descending
What antiplatelet agent should be given to patients with acute coronary syndrome who have a true aspirin allergy?
clopidogrel
what should be given for NSTEMI and STEMI when PCI is considered
Ticagrelor
MCC mitral stenosis
rheumatic fever
murmur for mitral stenosis
mid-diastolic rumbling murmur. A loud opening snap after S2 may also be heard
After rheumatic heart disease, what is the next most common cause of mitral stenosis?
Mitral annular calcification.
important finding in aortic regurgitation
wide pulse pressure
murmur of aortic regurgitation
blowing diastolic murmur that is best heard in the second or third intercostal space at the left sternal border
MCC of infective endocarditis
staph aureus
gram positive cocci in clusters
tx vasospastic angina
smoking cessation, calcium channel blockers (diltiazem is preferred) for prophylaxis, and nitroglycerin as needed during acute episodes
Which is the more common finding in volume-depleted adults: hypokalemia or hyperkalemia?
hypokalemia
EKG findings for pericarditis
ECG findings of diffuse ST elevation with reciprocal ST depression in leads aVR and V1
What viruses commonly cause pericarditis?
Coxsackie viruses A and B, echovirus, adenovirus, HIV, Epstein-Barr virus, influenza, and hepatitis B
tx for pericarditis
NSAIDs, colchicine
tx cardiogenic shock
dobutamine
NE
if failure –> intraaortic balloon pump
most common cause of acute arterial occlusion
Afib
murmur of mitral regurgitation
holosystolic murmur at the apex that radiates to the axilla
What is the most common location for a AAA?
Below the level of the renal arteries (infrarenal).
The midsystolic click is moved earlier in systole by maneuvers that decrease preload, such as
valsalva and standing
midsystolic click is moved later in systole by maneuvers that increase preload, such as
squatting
handgrip
murmur for aortic stenosis
crescendo-decrescendo systolic murmur that radiates to the carotids
first line tx for hypertensive encephalopathy
nicardipine
tx for WPW
procainamide
Ventricular free wall rupture presents with signs of
cardiac tamponade and shock
papillary muscle rupture commonly presents with
new murmur of mitral regurgitation
post MI
Which of the following patient history elements is most indicative of cardiac syncope?
absence of a postdrome
