Cardiology Flashcards
Presents post re-vascularization with cardiogenic shock, pulmonary edema, hyperdynamic precordium and a systolic murmur
Acute papillary muscle rupture with subsequent mitral regurgitation. Murmur may be very faint due to early equalization of pressures
EKG findings in hyperkalemia
peaked T waves, wide complex QRS without p waves
Murmur best heard by sitting up, leaning forward, holding breath in full expiration and using diapharagm of stethoscope with firm pressure
Aortic regurgitation
Affect on mitral valve prolapse murmur with standing or valsava
Earlier click with longer murmur
Affect on mitral valve prolapse murmur with squatting
Later click with shorter murmur
Murmur best heard in left lateral decubitus with bell of stethoscope
Mitral stenosis
DAPT management in CABG perioperative period
Stop clopidogrel 5-7 days prior to CABG as these are associated with increased bleeding risk. Continue aspirin through surgery as it has been shown to significantly reduce the risk of early graft occlusion
Periprocedural anticoagulation management in mechanical aortic valves
If high risk of bleed procedure - stop warfarin 5 days prior to procedure until INR < 1.5 , proceed with procedure and then restart warfarin the night of procedure. No need to bridge as high flow through the aortic valve
Periprocedural anticoagulation management in mechanical mitral valves
If high risk of bleed procedure - stop warfarin 5 days prior to procedure. Start heparin bridge when INR <2, hold the morning of the procedure and restart 24-48 hours post procedure in combination with warfarin. Low flow through mitral valve increases thrombotic risk
Late peaking systolic murmur with paradoxical S2 splitting
Aortic stenosis - typically severe. Paradoxical split due to delayed closure of aortic valve
Exercise EKG stress testing is non diagnostic in these patients:
Patients with LBBB, pacemakers, or inability to reach target heart rate 85% of 220-age
Cannot use pharmacologic stress testing in these patients:
With reactive airway disease, on dipyramidole or theophylline
Cannot use dobutamine stress echocardiography in these patients
with tachyarrhythmias
Anticoagulation in mitral stenosis
Should anticoagulate with warfarin (DOAcs not studied for this indications) if moderate to severe mitral stenosis + 1 of the following: atrial fibrillation, atrial thrombus, or prior embolic event
Kidney function cut off for DOAcs
CrCl >30 can use DOAcs, CrCl < 30 should use warfarin
General first line atrial flutter treatment preference
radiofrequency ablation over long term anti-arrhythmics
Follow up interval of mild aortic stenosis (mean gradient <20)
Every 3-5 years with TTE
Follow up interval of moderate aortic stenosis (mean gradient 20-39)
Every 1-2 years with TTE
Follow up interval of severe aortic stenosis (mean gradient >40)
Every 6-12 months with TTE
Severe mitral regurgitation that is asymptomatic next steps
Clinical follow up with echo every 6-12 months to monitor for symptom development or cardiac dysfunction leading to an indication for repair
Indications for repair (preferred)/replacement in severe mitral regurgitation
Symptomatic. New onset atrial fibrilllation, LVEF <60, end diastolic systolic dimension >40, PAP >50
Drug that interacts with statins making statin myopathy more likely
Verapamil
Initial tests to send when suspicious of statin myopathy
CK, vitamin D and thyroid function tests
Preferred antiarrhythmic agent in patients with atrial fibrillation without structural heart disease or ischemic heart disease
flecainide or propafenone
