Cardio Things I always Forget Flashcards
1
Q
FROM JANE
A
used to diagnose Bacterial Endocarditis
Fever
Roth Spots (fundoscopy)
Osler Nodes (Hands)
Murmur
Janeway lesions
Anemia
Nail bed hemorrhage
Emboli (CXR)
2
Q
Bacterial Endocarditis Diagnosis Criteria
A
DUKE Criteria:
2 Major
OR
1 Major + 3 Minor
OR
5 Minor
3
Q
Major Duke Criteria
A
Bacteremia: 2+ blood cultures
Vegetation: + echo (1st TTE, then TEE)
New murmur
4
Q
Minor Duke Criteria
A
FROM JANE - the murmur
Fever
Roth Spots (FUndocscopy)
Osler nodes (hands)
Janeway lesions
Anemia
Nail bed hemorrhage
Emboli (CXR)
5
Q
Unless mentioned otherwise, assume patient has native valve when presenting with Bacterial Endocarditis
That being said….What is the Tx for native valve bacterial endocarditis?
A
Native Valve: Nafcillin + Gentamicin (NG)
OR
VANCO + Gentamicin if IVDA
NG
VG (IVDA)
6
Q
Tx for prosthetic valve Bacterial Endocarditis
A
RGV:
Rifampin + Gentamicin + Vanco
7
Q
Bacterial Endocarditis PPX must be done for pts with what conditions?
A
- Prosthetic heart valves
- Heart repairs using artificial materials
- Hx of endocarditis
- Congenital Heart Disease
8
Q
What kind of procedures must you do PPX for (Bacterial Endocarditis)?
A
- Dental
- Respiratory
- Infected Skin/MSK tissue
9
Q
What is the PPX for Bacterial Endocarditis?
A
Amoxicillin 2G 1 hr prior
10
Q
Greatest Risk Factors for AAA
A
>60
athersclerosis
smoker
11
Q
Cpx for AAA
A
old male w/severe abd pain
syncope/HYPOtension
+ tender, pulsatile abd mass
12
Q
Dx of choice for AAA
A
Abd US
13
Q
Gold Standard DX for AAA
A
Angiographyq
14
Q
What will CXR of AAA show?
A
Calcified Wall
15
Q
Mgmt for AAA
A
≥5.5cm OR >05cm growth within 6 months = immediate surgical repair
>4.5cm = referral to vascular surgeon
4-4.5cm = US q 6 mos (CT or MRI is fine too)
3-4cm = US annually
16
Q
AAA Sx treatment
A
BB
17
Q
Bile Acid Sequestrants
A
- Cholestyramine
- Colestipol
- Colesevelam
18
Q
Fibrates
A
Gemfibrozil
Fenofibrate
19
Q
SES of Niacin (Vit B3)
A
Flushing, HA, warm sensation, pruritis
Hyperuricemia & Hyperglycemia (Avoid in gout & DM)
NSAIDS/ASA prior to dosing may decrease flushing
20
Q
Best drug to Increase HDL
A
Niacin (Vit B3)
21
Q
Best drug to decrease LDL
A
Statins (HMGcoA reductase inhibitors)
22
Q
SES of Statins
A
myositis/myalgias/rhabdomyolysis (esp in combo w/fibrates)
Hepatitis
23
Q
Best drug to decrease TGL
A
Fibrates
24
Q
SES of Fibrates
A
gallstones
25
SES of Bile Acid Sequestrants
Inc TGL
26
Main Goals of Lipid Control
LDL**\<100**
Total Cholesterol **\< 200**
HDL **\>60**
27
For which Heart Blocks would you implant a PPM?
2nd Degree Mobitz Type II & 3rd degree block
28
CPx for DVT
* unilateral swelling/edema of calf: \>3cm = most specific sign
* calf pain/tenderness
29
1st line imaging of choice for DVT
**venous duplex US**
30
Most sensitive test for DVT
D-dimer: r/o DVT in low risk pt
31
Gold Standard Diagnostic test for DVT
**Venography**
32
Anticoag will be lifelong in pt w/
**Protein C/S def or Factor V Leiden Mutation**
**1st DVT w/ unreversible Risk Factors**
33
You do not need to monitor PTT in
LMWH
34
Unfractionated Heparin PTT should be titrated to
1.5-2.5 x nml
35
Antidote for Heparin Toxicity
**Protamine Sulfate**
36
Antidote for Warfarin Toxicity
Vit K
37
How long should you take anticoag agents for if pt has **1st DVT w/ reversible Risk Factors**
3 mos
38
Anticoag of choice in pregnancy
LMWH (does not cross placenta)
39
This type of Heparin has an increased chance of **HIT**
**Unfractionated Heparin**
40
**Well's Criteria** for DVT
Active Cancer
Immobilization of lower extremity
Bedridden \> 3 days due to surgery
Localized tenderness
Swelling of entire leg
Unilateral calf swelling \>3cm
Unilateral Pitting edema
Collaterol SF veins
Alt dx more likely (-2)
41
**Kussmaul's sign + Pericardial Knock**
Kussmaul's sign = increased JVD during inspiration
**Constrictive Pericarditis**
42
What is Pulsus Paradoxus?
**Decreased strength of radial pulse during inspiration**
**Constrictive Pericarditis**
43
Which laboratory test helps define a cardiac versus a pulmonary cause of dyspnea?
**Brain Ntriuretic Peptide**
44
6 Ps of Arterial Occlusion
**P**ain
**P**allor
**P**ulselessness
**P**aresthesia
**P**oikilothermia
**P**aralysis
45
MC site of thromboembolism
**femoral artery bifurcation**
46
Flow of electricity through heart
SA node
AV node
Bundle of His
Bundle Branches
Purkinje Fibers
47
Temporal (Giant Cell) Arteritis can lead to what complications?
Aortic involvement can lead to **valvular insufficiency, aortic arch syndrome, and dissection.**
48
Tx of Temporal Arteritis if no vision loss
**Prednisone**
49
Tx of Temporal Arteritis w/ **vision loss**
**Methylprednisone IV**
50
**Capture beats and fusion beats** confirm the diagnosis of which cardiac dysrhythmia?
V tach
51
CPx of Kawasaki Disease
CRASH + Burn
## Footnote
**C**onjunctivitis
**R**ash (polymorphous)
**A**denopathy (cervical)
**S**trawberry tongue
**H**ands and feet edema
Fever must be present **\> 5 days**
52
Main complication of Kawasaki Dz
coronary vessel arteritis: **coronary artery aneurysm, MI**
53
What will UA show for Kawasaki?
**Sterile Pyuria**
54
Tx for Kawasaki Dz
**IVIG + High dose ASA**
55
Most imp predisposing factor for **Aortic Dissection**
**HTN**
56
Most **commonly seen symptom** in Aortic Dissection
**chest pain**
57
Is syncope/HYPOtension a presentation for AAA or Aortic Dissection?
**AAA**
58
CPx for **Aortic Dissection**
Chest pain: **sudden onset severe, tearing upper back pain**
**Decreased peripheral pulses**
**HYPERtension**
**acute new onset aortic regurgitation**
59
Test of choice for **Aortic Dissection**
**CT scan w/contrast**
OR
**TEE**
60
Gold Standard Aortic Dissection Dx
MRI Angio
61
Medical Tx for **Aortic Dissection**
**Esmolol, Labetolol**
62
**Transudate** causes of **Pleural Effusion**
**Heart Failure**
**Cirrhosis**
**Nephrotic Syndrome**
**Pulmonary Embolism**
63
**Exudative** causes of **Pleural Effusion**
**Malignancy**
**Bacterial/Viral Pneumonia**
**TB**
**Pancreatitis**
64
**Major Criteria** for **Rheumatic Fever**
**JONES:**
## Footnote
**J**oints (migratory polyarthritis)
**O**h no, Carditis!
**N**odules (subcutaneous)
**E**rythema Marginatum
**S**ydenham Chorea
65
**Minor Criteria** for Rheumatic Fever
Fever
arthralgias
**Increased ESR + CRP**
66
Diagnostic Criteria for Rheumatic Fever
**2 Major**
OR
**1 Major + 2 Minor**
**Jones Criteria**
67
What 3 BB are approved for tx of heart failure?
**Carvedilol**
**Bisoprolol**
**Metoprolol**
68
Area of claudication in **buttock, hip, groin**
**Aortic bifurcation/common iliac**
69
**Leriche's syndrome**
1. **claudication** (buttock, thigh pain)
2. **impotence**
3. **decreases femoral pulses**
## Footnote
**aortic bifurcation/common iliac**
70
Area of claudication in **thigh, upper calf**
**femoral artery/branches**
71
Area of claudication in **lower calf, ankle, foot**
**Popliteal artery**
72
**pale on elevation**
dusky red w/ dependency **(dependent rubor)**
**lateral malleolar ulcers**
PAD
73
Most useful screening tool for PAD
Ankle-Brachial Index: **+PAD if \<0.90**
74
Gold Standard for PAD
**Arteriography**
75
1st line Tx for PAD
**Cliostazol**
76
Sxs of **Left Sided Heart Failure**
Think _Pulmonary Circulation Disruption_
## Footnote
**DOE**
**Tachypnea**
**Pulmonary Crackles/Rales**
**Cough**
**Paroxysmal Nocturnal Dyspnea**
77
Sxs of **Right Sided Heart Failure**
Think _Systemic Circulation Disruption:_
## Footnote
**Fatigue**
**Distended Jugular Veins**
**Lower Extremity Edema**
**Weight Gain**
**Hepatosplenomegaly**
78
Characteristics of **Diastolic Heart Failure**
**nml/Increased EF**
**Thich Ventricular Walls**
**Small LV chamber**
**+S4**
79
Characteristics of **Systolic Heart Failure**
**Decreased EF**
**Think Ventricular Walls**
**Dilated LV chamber**
**+S3**
80
What causes acute HF?
**systolic** causes: acute MI, HTN crisis
81
What causes chronic heart failure?
**dilated cardiomyopathy**
**valvular dz**
82
Dx of HF
**Echo: shows EF**
**CXR: cardiomegaly, Kerley B lines**
**Increased BNP**
83
Outpatient HF regimen
1st**: ACE + Diuretic**
Then: **BB +/- Hydralazine**
84
Diet/Exercise regarding HF
**Na+ restriction \<2G/day**
**Fluid restriction \<2L/day**
**smoking cessation**
85
1st line Tx of HF
ACE-I
86
HF pt not able to tolerate ACE-I
ARB
87
What med do you add after ACE-I in HF pt?
BB
\*\*stop or reduce BB dose during decompensated CHF\*\*
88
HF pt unable to tolerate ACE-I or BB
**Hydralazine + Nitrates**
89
Best symptomatic Tx for mild-mod CHF
**Diuretics:** Loops, K+ sparin
90
What meds can be used short term in acute CHF?
**Digoxin, Dobutamine, Dopamine**
91
If EF\<35% in HF
**implantable cardioverter defibrillator**
92
Mgmt of **Acute Pulmonary Edema/CHF**
LMNOP:
## Footnote
**L**asix (Furosemide)
**M**orphine
**N**itrates
**O**xygen (BIPAP)
**P**osition (upright to decrease venous return)
93
4 types of shock
1. **Hypovolemic**
2. **Cardiogenic**
3. **Obstructive**
4. **Distributive**
94
Causes of Hypovolemic Shock
**hemorrhage, GI bleed**
95
**CO, PCWP and SVR** in Hypovolemic Shock
**↓CO, ↑SVR**
**↓PCWP**
96
All shocks have decreased ____ and increased \_\_\_\_.
Except...
All shocks have decreased **_CO_** and increased **_SVR_**.
Except Septic Shock: early septick Shock has **Increased CO**
97
All shocks have Increased PCWP except...
**Hypovolemic Shock: Decreased PCWP**
98
Cpx of hypovolemic shock
**pale, cool mottled skin**
**prolonged cap refill**
**decreased skin turgor, dry mucous membranes**
_**NO resp distress\*\*\***_
99
Cpx of Cardiogenic Shock
_**Severe Resp Distress\*\***_
**_cool clammy skin_**
100
CPx of Obstructive Shock
**_Severe Respiratory Distress_**
**_Cool, clammy skin_**
101
Tx for cardiogenic shock
**dopamine, dobutamine, PDE-I, Norepinephrine**
102
Must have 2/4 following to Dx with **SIRS (septic shock)**
1. **\>38 degrees Celsius Fever or \<36 hypothermia**
2. **\>90 bpm**
3. **RR\>20 or PaCO2\<32**
4. **WBC \> 12,000**
103
Sepsis
SIRS + focus of infection
## Footnote
**Lactate \> 4**
104
Gen Mgmt of Shock
**ABCDE:**
## Footnote
**A**irway: intubation
**B**reathing: Mechanical ventilation
**C**irculation: isotonic crystalloids
**D**elivery of O2
**E**ndpoint of resuscitation
105
