Cardiology Flashcards
1
Q
What is the most common cause of death in the USA?
A
coronary artery disease
2
Q
What are some risk factors for coronary artery disease?
A
- diabetes
- hypertension
- tobacco use
- obesity
- hyperlipidemia
- PAD
- inactivity
- family hx; xx <65 and xy <55
3
Q
What is the most common cause of chest pain?
A
- GI
4
Q
What are characteristics of coronary artery disease?
A
- chest pain that does not change with body position or respiration
- dull pain
- pain lasting 15-30 minutes
- occurs on exertion
- substernal chest pain
- pain radiates to the jaw or left arm
- not associated with chest wall tenderness
5
Q
Differential diagnosis with a patient who has pleuritic chest pain (pain that changes with respiration)
A
- pneumonia
- PE
- pleuritis
- pericarditis
- pneumothorax
6
Q
Define costochondritis
A
- chest pain that occurs when palpating chest wall
7
Q
Patient is an alcoholic and comes to the ED with nausea, vomiting, chest pain, and epigastric tenderness. What should you check for initially?
A
- amylase and lipase levels as this patient is suspicious for pancreatitis
8
Q
Patient comes to the ED with chest pain, right upper quadrant tenderness, and a mild fever. What is the first step in management?
A
- get an abdominal U/S to check for gallstones; top dx with this info is acute cholecystitis
9
Q
If you hear an S3 gallop on physical exam, what does that indicate?
A
- a dilated left ventricle *rapid ventricular filling during diastole
10
Q
If you hear an S4 gallop, what does that indicate?
A
left ventricular hypertrophy
* atrial systole into a stiff or noncompliant left ventricle
11
Q
Rales heard on lung examination can be an indication to ?
A
CHF
12
Q
Holosystolic murmur is consistent with what defect?
A
- mitral regurgitation
13
Q
Best initial test for ischemic type chest pain is?
A
EKG
14
Q
What is the best thing to test for to detect reinfarction a few days after initial MI?
A
- CKMB
15
Q
Which cardiac enzyme rises first with ischemia?
A
- myoglobin
16
Q
What is the most accurate test for cardiac ischemia?
A
- cardiac enzymes: troponin or CKMB
17
Q
MOA of troponin C
A
- binds to calcium to activate actin:myosin interaction
18
Q
MOA of troponin T
A
- binds to tropomyosin
19
Q
MOA of troponin I
A
- inhibits actin:myosin interaction
20
Q
A patient has normal EKG and cardiac enzymes on visit to ED for chest pain. He comes back four days later with the same chest pain. What is the next step?
A
- do a cardiac stress test
21
Q
When is a chemical stress test needed?
A
- when the patient cannot exercise to reach the target heart rate
22
Q
WHen is it necessary to do a stress echocardiogram?
A
- left bundle branch block
- digoxin use
- pacemaker in place
- left ventricular hypertrophy
23
Q
A patient has an abnormal stress test that shows reversible ischemia. What is the next step in management?
A
- angiography
24
Q
What is the most accurate method of evaluating ejection fraction ?
A
- MUGA scan
25
When is sestamibi nuclear stress testing used?
- obese patients and those with large breasts because of its ability to penetrate tissue
26
What is the best initial treatment with a patient who has acute coronary syndrome?
- aspirin
27
What medications are given to those who are undergoing angioplasty and stent placement?
- block aggregation of platelets to each other by inhibiting ADP induced activation of the P2Y12 receptor, such as clopidogrel, ticagrelor, or prasugrel
28
What is the time frame for when angioplasty should be performed with a patient with a STEMI?
- w/i 90 minutes of ED arrival
29
When should a patient receive thrombolytics for an MI?
- w/i 30 minutes of ED arrival
30
ACE inhibitors only lower mortality if?
the patient has left ventricular dysfunction or systolic dysfunction
31
If the patient cannot have thrombolytics, what is the best way to lower mortality?
- urgent angioplasty or PCI
32
What is the most common cause of death in both CHF and MI?
- ventricular arrhythmia brought on by ischemia
33
When do you use prasugrel, clopidogrel, or ticagrelor?
- patient is undergoing angioplasty
- patient has an aspirin allergy
- patient with acute MI gets one of these + aspirin
34
When do you use verapmil or diltiazem?
- patient has intolerance to beta blockers (asthma, cocaine induced chest pain, or coronary vasospasm)
35
When do you use lidocaine or amiodarone?
- if patient has VTac or VFib
36
When does a patient need a pacemaker?
- 3rd degree heart block
- Mobitz II, second degree AV block
- Bifascicular block
- New LBBB
- Symptomatic bradycardia
37
Prasugrel has a higher efficacy that clopidogrel; however, it increases bleeding in those with which conditions?
- age >75
- weight < 60kg
- stroke victims
38
what is the diagnostic test for cardiogenic shock?
- echo
| - swan-ganz catheter
39
What is the tx for cardiogenic shock?
- ACEi
| - urgent revascularization
40
What is the diagnostic test for valve rupture?
- Echocardiogram
41
What is the treatment for valve rupture?
- ACEi
- nitroprusside
- intra-aortic balloon pump as a bridge to surgery
42
What is the diagnostic test for septal rupture?
- echocardiogram
| - Swan-ganz catheter
43
Tx for septal rupture
- ACEi
- nitroprusside
- urgent surgery
44
What is the diagnostic test for myocardial wall rupture?
- echocardiogram
45
Tx for myocardial wall rupture
- pericardiocentesis
| - urgent cardiac repair
46
What is the diagnostic test for sinus bradycardia?
EKG
47
Tx for sinus bradycardia
- atropine followed by a pacemaker if the patient is still having symptoms
48
How to diagnose third degree heart block?
- EKG
| - canon a waves present
49
Tx for third degree heart block
- atropine and a pacemaker even if the symptoms resolve
50
How to diagnose right ventricular infarction?
- EKG showing right ventricular leads with the ST segment elevation
51
Tx for right ventricular infarction
- fluid loading
52
Which way is the blood shunted in a septal rupture?
- left to right due to the higher pressure in the left ventricle
53
Post-MI, what medications should a patient be on when going home?
- statin
- ACEi
- beta-blocker
- aspirin
- clopidogrel
54
How long should a patient wait to have sex after having an MI?
- 2-6 weeks
55
What are the special differences when treating an NSTEMI compared to a STEMI?
- no thrombolytic use
- use low molecular weight heparin
- use of glycoprotein 2b/3a inhibitors
56
Name some GP2b/3a inhibitors
- eptifibatide
- tirofiban
- abciximab
57
When are thrombolytics used in MI cases?
- STEMIs
- new LBBB
* within 12 hours of the initial symptoms
58
In what case will heparin not work?
- antithrombin deficient patients
59
MOA of heparin
- prevents new clots from forming via potentiating antithrombin, which inhibits almost every step of the clotting cascade
60
When to use an ARB instead of an ACEi?
- patient has cough ADR from the ACEi
61
Main ADR of both ACEi and ARBs?
- hyperkalemia
62
What is used to determine who is a candidate for coronary artery bypass grafting?
- angiography
63
What are the four indications for coronary artery bypass grafting?
- three coronary vessels with >70% stenosis
- left main coronary artery stenosis > 50-70%
- 2 vessels >70% in a diabetic
- 2 or 3 vessels with low ejection fraction
64
You will see a reduced ejection fraction in which type of dysfunction?
- systolic
65
What is the main difference between saphenous vein graft and internal mammary artery graft?
- Internal mammary artery graft remains open for 10 years
66
When do most vein grafts start to become occluded?
- in five years
67
MOA of ranolazine
- inhibits late I(NA) channels, which prevents overload of sodium
68
When is ranolazine added to the Post-MI regimen?
- when the other medications do not control the pain
69
MOA of proprotein convertase subtilisin kexin type 9 PCSK9 inhibitors
- reduce LDL by blocking the clearance of LDL by the liver from the blood
70
What is the most common ADR of a statin?
- liver toxicity
71
What should be checked routinely in a patient with a statin?
- LFTs since statins increase transaminases
72
Besides raising the transaminases, what other ADR is less common when using a statin?
- rhabdomyolysis
73
What is the most important reason why we use statin drugs?
- They have the greatest effect on lowering mortality than any other medication.
74
What is the risk of the Framingham scale to prescribe a statin?
>7.5% in 10 years
75
Which two diseases should the LDL be controlled to be under 70 mg/dL?
- those with diabetes and or coronary disease
76
When do you use PSCK9 inhibitors?
- When patient is on max dose of a statin and still needs their LDL to be lower
77
Give two examples of a PSCK9 inhibitor
- evolocumab
| - alirocumab
78
What is the most common cause of erectile dysfunction post MI?
- anxiety
79
What class of medications are contraindicated when a patient is on a medication such as sildenafil?
- nitrates
80
What are some common characteristics of presenting CHF?
- SOB on exertion
- edema
- rales on lung exam
- ascites
- JVD
- S3 gallop
- orthopnea
- paroxysmal nocturnal dyspnea
- fatigue
81
What causes rales in the lungs?
- Increased hydrostatic pressure develops in the pulmonary capillaries from left heart pressure overload. This causes transudation of liquid into the alveoli.
During inhalation, the alveoli open with a popping sound--> rales
82
What is the worst manifestation of CHF?
- pulmonary edema--> can make clinical diagnosis from this
83
MOA of carvedilol
- same as labetalol: both beta 1 and 2 blocker and alpha-1 receptor
84
What are four basic things that should be ordered when suspecting CHF?
- CXR
- EKG
- oximeter
- echocardiogram
85
What is the first line tx for acute pulmonary edema?
- oxygen
- furosemide
- nitrates
- morphine
86
MOA of inamrinone and milrinone
- phosphodiesterase inhibitors that increase contractility and decrease afterload due to vasodilation
87
MOA of dobutamine
- beta-1 agonist leading to increased contractility and decreased afterload due to vasodilation
88
MOA of dopamine
- increases contractility but acts on alpha 1 receptors, leading to vasoconstriction
89
What can cause respiratory alkalosis in CHF?
- fluid overload causes patient to be hypoxic--> patient then hyperventilates--> decreases PCO2
90
Tx for those with systolic CHF dysfunction
- ACEi or ARBS
- beta blockers
* hydralazine + nitrates if the above three are contraindicated
- digoxin to decrease symptoms
- mineralocorticoid receptor antagonists (spironolactone, eplerenone)
91
Most common ADR of mineralocorticoid receptor antagonists?
- hyperkalemia
92
ADRs of spironolactone
- gynecomastia
| - erectile dysfunction
93
If a patient is on an ACEi, beta blocker, MRA, digoxin, and diuretic but is still symptomatic, what should you add to their tx?
- hydralazine and nitrates
94
What is the main treatment management for diastolic CHF dysfunction?
- MRAs (mineralocorticoid receptor antagonists)
95
A patient with pulmonary edema has V tac. What is the best therapy?
- synchronized cardioversion
96
A patient with pulmonary edema can have v tac, a fib, a flutter, or SVT, what is the best therapy?
- synchronized cardioversion
97
When is unsynchronized cardioversion used?
- v fib, v tac without a pulse
98
When do you use nesiritide?
- when dobutamine, inamrinone, milrinone fail
99
MOA of nesiritide?
- synthetic version of atrial natriutretic peptide
100
If BNP levels are normal, it excludes ____ as the diagnosis.
- CHF
101
A patient with pulmonary edema has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?
- cardiac output= decreased
- systemic vascular resistance = increased
- wedge pressure= increased
- right atrial pressure = increased
102
A patient with hypovolemic shock has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?
- cardiac output= decreased
- systemic vascular resistance = increased
- wedge pressure = decreased
- right atrial pressure = decreased
103
A patient with septic shock has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?
- cardiac output= increased
- systemic vascular resistance = decreased
- wedge pressure = decreased
- right atrial pressure = decreased
104
A patient with pulmonary hypertension has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?
- cardiac output= decreased
- systemic vascular resistance= increased
- wedge pressure = decreased
- right atrial pressure = increased
105
Wedge pressure is a measure of which heart chamber?
- left atrial pressure
106
A patient on spironolactone or eplerenone develops hyperkalemia but still needs to stay on these medications. What can you add to the tx regimen?
- patiromer or zirconium
107
ADR of ivabradine?
- transient excess brightness of vision
108
If a patient cannot be on ACEi, what is the next step?
- use sacubitril/valsartan (neprilysin inhibitor + ARB)--> helps to lower mortality in this combo
109
MOA of ivabradine
- SA nodal inhibitor of funny channels that slows the heart rate
110
When is ivabradine used?
- if you cannot use a beta blocker in a patient with systolic dysfunction CHF
- if the patient's HR is > 70 with systolic dysfunction CHF
111
When is an implantable cardioverter/defibrillator indicated?
- dilated cardiomyopathy
| - those with an ejection fraction <35%
112
When is a biventricular pacemaker indicated?
- ejection fraction <35% AND QRS >120 msec
113
When is warfarin used in a CHF patient?
- if the patient has a metal valve or mitral stenosis
114
What is an ABSOLUTE contraindication for beta blockers?
- symptomatic bradycardia
115
A patient who is young, female, and in the general population most likely has what heart valve abnormality?
- mitral valve prolapse
116
A healthy young athlete most likely has what heart valve abnormality?
- hypertrophic obstructive cardiomyopathy
117
A patient who is an immigrant and pregnant most likely has what heart valve abnormality?
- mitral stenosis
118
Patient with turner syndrome or coarctation of the aorta most likely has what heart valve abnormality?
- bicuspid aortic valve
119
A patient with palpations, atypical chest pain that does not occur during exertion most likely has what heart valve abnormality?
- mitral valve prolapse
120
What are the most common systolic heart murmurs?
- AS
- MR
- MVP
- HOCM
121
WHat are the most common diastolic murmurs?
- AR
| - MS
122
All right sided murmurs increase in intensity with?
- inhalation
123
All left sided murmurs increase with intensity with?
- exhalation
124
Why does squatting and lifting the legs increase venous return?
- all the blood from the legs are rushing up into the heart
125
- Why does valsalva maneuver and standing up decrease venous return?
- it increases intrathoracic pressure, which decreases blood return to the heart
126
Which murmurs increase during a squat with leg raise?
- AS
- AR
- MS
- MR
- VSD
127
Which murmurs decrease with standing and valsalva?
- AS
- AR
- MS
- MR
- VSD
128
Which murmurs decrease with squat and then leg raise?
- HOCM
| - MVP
129
Which murmurs increase with stand and then valsalva?
- HOCM
| - MVP
130
Aortic regurg and mitral regurg are treated with?
- ACEi
131
Name some loop diuretics
- furosemide
- bumetanide
- torsemide
- ethacrynic acid
132
MOA of loop diuretics
- inhibit the Na/K/2Cl pump in the thick ascending limb of the loop of Henle
133
Where does spironolactone act at?
- late distal tubule and early collecting duct
134
MOA of conivaptan and tolvaptan
- block water reabsorption by blocking ADH
135
What test will determine change in care when a patient comes in with chest pain?
- EKG
136
What causes the cough with ACEi?
- ACEi increases bradykinin, which causes cough
137
MOA of ACEi
- inhibits angiotensin converting enzyme, which then blocks aldosterone release
- this causes increase in potassium
138
If a patient has hyperkalemia due to being on an ACEi or ARB, what is the next step in management?
- take the patient off the acei or arb and add hydralazine and nitrates
139
What is unique about digoxin compared to other cardiac drugs?
- it only decreases symptoms and DOES NOT decrease mortality
140
Which patients should have two anticoagulation drugs on their regimen?
- patients who have had an acute MI--> right after post hospitalization
- patients who have acute coronary syndrome
- patients who have unstable angina
141
MOA of CCB
- inhibits the receptor of dihydropyridine
142
Name some thrombin inhibitor drugs
- argatroban
| - lepirudin
143
Which chest pain patients should receive TPA?
- STEMI
| - new left bundle branch block
144
What happens to the size of the LV chamber if there is increased afterload?
- LV chamber will not empty and thus it will be larger
| - a larger LV chamber relieves or lessens the obstruction in HOCM
145
MOA of amyl nitrate
- vasodilator that decreases afterload by dilating peripheral arteries
146
Amyl nitrate worsens which murmurs?
- it decreases the afterload, so HOCM and MVP, AS will WORSEN because afterload is decreased
147
What makes the murmur worse in Aortic stenosis? *what makes the degree of it worse or better
- the gradient between the LV and aorta
- If the LV pressure exceeds the aorta, then there will be a high gradient
- the higher the gradient, the louder the murmur
148
Hand grip will increase which murmurs?
- MR
| - VSD
149
Where is AS best heard?
- second right intercostal space and radiates to the carotid arteries
150
AS is classically described as?
- crescendo-decrescendo murmur
151
Pulmonic valve murmurs are best heard
- at the second left intercostal space
152
Where are AR, tricuspid, and VSD murmurs best heard
- lower left sternal border
153
MR is best heard?
- at the apex and radiates into the axilla
| - the apex is the level of the 5th intercostal space below the left nipple
154
A grade 4/6 murmur indicates?
- a thrill is present
155
best initial test for a valvular lesion?
- echocardiogram
156
Most accurate test for valve lesions?
- left heart catheterization
157
Which echo should be ordered first when assessing valvular lesions?
- transthoracic echocardiogram
158
What causes syncope in those with AS?
- a stiff valve proximal to the entry point of coronaries blocks blood flow into the vertebral and basilar arteries and carotids
* no blood flow to the brain = passing out
159
Delayed carotid upstroke is associated with which murmur?
- AS
160
Normal aortic valve gradient is?
- zero
161
Best initial treatment for AS?
- diuretics
162
What are the two most common symptoms of AR?
- SOB
| - fatigue
163
What are some causes of aortic regurg?
- hypertension
- rheumatic heart disease
- endocarditis
- cystic medial necrosis
- Marfan syndrome
- ankylosing spondylitis
- syphilis
164
What is the indication to repair a bicuspid aortic valve?
- when it is >5cm
165
What is the sound of an AR?
- diastolic decrescendo murmur
166
Define quincke pulse
- arterial or capillary pulsations in the fingernails
167
define corrigan pulse
- high bounding pulse "water hammer pulse"
168
define musset sign
- head bobbing up and down with each pulse
169
Define duroziez sign
murmur heard over the femoral artery
170
define hill sign
- blood pressure gradient much higher in lower extremities
171
When is surgery indicated for AR?
- EF is <55%
| - Left ventricular end systolic diameter >55mm
172
What is the most common cause of mitral stenosis?
- rheumatic fever
173
How does mitral stenosis cause dysphagia?
- large left atrium presses on the esophagus
174
How does mitral stenosis cause hoarseness>
- pressure on the recurrent laryngeal nerve
175
How would you describe the sound of mitral stenosis?
- diastolic rumble with an opening snap
176
What makes mitral stenosis worse?
- the higher the left atrial pressure
177
Best initial therapy for mitral stenosis?
- diuretics
178
Best effective therapy for mitral stenosis?
- balloon valvuloplasty
179
Why does balloon valvuloplasty work in mitral stenosis but not in aortic stenosis?
- Mitral stenosis is most often caused by fibrosis of the valve,which can stretch with a balloon insertion.
- Aortic stenosis is caused by calcification of the valve, and it will not stretch when a balloon is inserted.
180
When a patient has metal valves, what should be prescribed?
- aspirin and warfarin to prevent clotting
181
Operative criteria for mitral regurgitation
- left ventricular ejection fraction <60%
- or left ventricular and systolic diameter >40 mm
* even if the patients are asymptomatic
182
A holosystolic murmur at the lower left sternal border is consistent with?
- VSD
183
In a VSD, what test will determine the degree of left to right shunting most precisely?
- catheterization
184
____ is associated with fixed splitting of S2
- ASD
185
What causes the S2 splitting in an atrial septal defect?
- different pressures on different sides of the heart
186
A wide P2 delayed sound is associated with ?
- RBBB - Pulmonic stenosis - Right ventricular hypertrophy - Pulmonary hypertension
.
187
What are some common causes of dilated cardiomyopathy??
- ischemia
- alcohol
- doxorubicin
- radiation
- Chagas disease
188
Tx for dilated cardiomyopathy?
- ACEi or ARBs
- beta blockers
- spironolactone
189
What is the main difference between spironolactone and eplerenone?
- spironolactone inhibits testosterone producing an anti-androgenic effect; eplereonone does not inhibit testosterone
190
Common causes of restrictive cardiomyopathy
- sarcoidosis
- amyloidosis
- hemochromatosis
- cancer
- myocardial fibrosis
- glycogen storage diseases
191
Define Kussmaul sign
- increase in JVP on inhalation
192
What is the most accurate diagnostic test for restrictive cardiomyopathy?
- endomyocardial biopsy
193
Define takotsubo cardiomyopathy
- rare, sudden systolic dysfunction brought on by extreme emotions
* sudden psychological stress
- presents like an acute MI with ventricular dysfunction
- coronary arteries are normal
194
What is the only pertinent positive finding for pericardial disease?
- friction rub
195
What does an EKG show in a patient with pericarditis?
- ST segment elevation in all leads
196
Tx for pericarditis
- NSAIDs
197
What will be found on EKG in a patient with pericardial tamponade?
- electrical alternans
198
Triad for cardiac tamponade
- Beck's triad
| - hypotension, jvd, muffled heart sounds
199
Right heart catheterization will show what in cardiac tamponade?
- equalization of all the pressures in the heart during diastole
200
Tx for cardiac tamponade
- short term: pericardiocentesis
| - long term: pericardial window placement
201
Constrictive pericarditis will involve signs of right heart failure. Name some signs of right heart failure
- edema
- JVD
- hepatosplenomegaly
- ascites
202
Define a pericardial knock
- extra diastolic sound from the heart hitting a calcified, thickened pericardium
203
If a pericardial knock is present, what is the diagnosis?
- constrictive pericarditis
204
Tx for constrictive pericarditis
- short term: diuretics
| - long term: surgical removal of the pericardium aka pericardial stripping
205
Name some characteristics of aortic dissection
- chest pain radiating to the back
- difference in blood pressure between the right and left arms
- sudden and severe pain
206
Best initial test for aortic dissection
- CXR
207
Most accurate test for aortic dissection
- CT angiogram
208
Most effective therapy for aortic dissection
- surgical correction
209
Who should be screened for an abdominal aortic aneurysm?
- men age 65-75 who are current or former smokers
210
When are abdominal aortic aneurysms repaired?
- >5cm in size
211
Presentation of peripheral arterial disease
- claudication aka pain in the calves on exertion
- smooth, shiny skin due to hair loss
- loss of pulses in feet
212
Best initial test for PAD
- ABI
213
Most accurate test for PAD
- angiogram
214
Pain, pallor, and pulseless is associated with?
- arterial occlusion
215
Tx for PAD
- aspirin
- ACEi
- exercise as tolerated
- cilostazol
- statins
- vorapaxar to add to aspirin or clopidogrel
- beta blockers if needed for ischemic disease
216
Hemodynamically stable patients who may have a fib should undergo?
- 24 hour holter monitoring
217
What are some other tests to order once a fib is found on ekg?
- echo
- TSH
- CMP
- troponins and or CKMB
218
Tx for hemodynamically unstable individuals with a fib *first line?
- synchronized electrical cardioversion
219
Stable patients who have a fib tx?
- beta blockers, CCBs, or digoxin
220
After a patient goes back into normal rhythm from a fib, what other medication should they be placed on?
- anticoagulation with NOACs, such as dabigatran, rivaroxaban, edoxaban, apixaban
* similar or better efficacy to warfarin but do not need to monitor INR
221
If bleeding occurs with warfarin, it is reversible by giving?
- prothrombin complex concentrate
222
Bleeding with dabigatran is reversible with?
- idarucizumab
223
If bleeding occurs with Xa inhibitors, it is reversible with?
- andexanet
224
What is the scoring system used to indicate if a patient needs anticoagulation?
- CHA2DS2-VASc
225
What does CHA2DS2-VASc check for ?
- CHF
- Hypertension
- >75 y/o
- Diabetes
- S2- stroke or TIA
- Vascular disease
- 65-74 y/o
- sex category
* age >75 is 2 points
* stroke or TIA is 2 points
226
What is the score for CHAD2S2VASc?
- score 0 or 1 use aspirin or nothing
| - score >2: use apixaban, dabigatran, edoxaban, or rivaroxaban
227
define multifocal atrial tachycardia
- atrial arrhythmia in association with COPD
- EKG will show polymorphic P wave
- reveals different atrial foci for the QRS complexes
0 >100 HR
228
Tx for multifocal atrial tachycardia
- oxygen and then diltiazem
229
Best management for unstable patients with SVT
- synchronized cardioversion
230
Best initial tx for stable patients with SVT
- vagal maneuvers
231
If vagal maneuvers do not work in a stable patient with SVT, what is the next step?
- give adenosine 6 mg
232
Best long term management for SVT
- radiofrequency catheter ablation
233
A delta wave will be found on EKG in patients with?
- Wolff-Parkinson-White syndrome
234
Most accurate test for WPW syndrome
- electrophyisological study
235
Patients with WPW syndrome with SVT or VT, should be given?
- either procainamide, sotalol, or amiodarone
236
Long term therapy for WPW syndrome
- radiofrequency catheter ablation
237
Why do CCBs or digoxin worsen WPW syndrome?
- CCBs and digoxin block conduction more in the normal AV node- forcing the conduction down the abnormal conduction tract in those with WPW syndrome
238
Tx for hemodynamically unstable individual with VT?
- synchronized cardioversion
239
Tx for hemodynamically stable patients with VT
- amiodarone, lidocaine, procainamide, or magnesium
240
First line tx for v fib?
- unsynchronized cardioversion
241
Why should you not deliver a shock during the T wave or refractory period?
- Doing it during this time can set off a worse rhythm, such as asystole or v fib.
242
Those with sudden loss of conscious should be placed on a holter monitor for how long?
24-72 hours
243
If a patient presents with syncope what should be ordered?
- EKG
- CMP
- glucose
- troponins/CKMB
- echo
- head CT
244
What is the mechanism of rate control in a fib or a flutter?
- inhibition of conduction of the AV node
245
What causes the majority of SVTs?
- abnormal conduction pathway at the AV node
246
Define Brugada syndrome
- genetic disorder leading to syncope and sudden death in association with right bundle branch block; common in Asians
247
What is important to note about the accessory bundle of Kent seen in WPW syndrome?
- It conducts faster than the AV node, so the PR interval is less than 120 msec
248
A patient decompensating from cardiogenic shock should have what intervention tried first to increase blood pressure?
- normal saline boluses
249
If normal saline boluses do not increase the patient's blood pressure who has cardiogenic shock, then what do you try to bring it up?
- pressors
250
An inferior wall MI is associated with?
- AV nodal block and symptomatic bradycardia
251
Which artery supplies the AV node?
- right coronary artery
252
What causes wide QRS complexes in a patient with a pacemaker?
- Pacer impulses do not go down the normal HIS-Purkinje fiber pathway. They travel slow from myocyte to myocyte
253
30-40% of patients with an inferior MI will experience a ?
- right ventricular infarction (due to the same blood supply=right coronary artery)
254
MOA of cilostazol
- phodiesterase inhibition; increases cAMP
| - prevents platelet aggregation and has vasodilating effects
