cardiology Flashcards
when do you need to do urgent cath in unstable angina
hemodynamic instability • HF • recurrent rest angina despite therapy • new or worsening MR murmur • sustained VT
initial tx of someone with unstable angina/nstemi and tini score of 0-2
Low risk. Begin aspirin, β-blocker, nitrates, heparin, statin, clopidogrel. Predischarge stress testing and angiography if testing reveals significant myocardial ischemia
initial tx of someone with unstable angina/nstemi and timi score of 3-7
Intermediate to high risk. Begin aspirin, β-blocker, nitrates, heparin, statin, clopidogrel, and early angiography followed by revascularization
other causes of st elevation
Consider acute pericarditis, LV aneurysm, takotsubo (stress)
cardiomyopathy, coronary vasospasm (Prinzmetal angina), acute stroke, or normal variant.
door to balloon time
90 min
transfer to pci capable hospital within how many minutes
120min
when should you start spironolactone after stemi
3-14 days after if LVEF does not improve over 40% and clinical HF or DM
when to give thrombolytics in stemi
Administer thrombolytic agents when PCI is not available and cannot be achieved within 120 minutes
with transfer
contraindications to thrombolytic tx in stemi
The most commonly encountered contraindications include active bleeding or high risk for bleeding (recent
major surgery). BP >180/110 mm Hg on presentation is a relative contraindication.
when do you do cabg in acute stemi setting
CABG is indicated acutely for STEMI in the presence of thrombolytic PCI failure or mechanical complications
(papillary muscle rupture, VSD, free wall rupture).
indications for pacing in acute mi
asystole
• symptomatic bradycardia (including complete heart block)
• alternating LBBB and RBBB
• new or indeterminate-age bifascicular block with first-degree AV block
criteria for icd post mi
> 40 days since MI
• LVEF ≤35% and NYHA functional class II or III or LVEF ≤30% and NYHA functional class I
• >3 months since PCI or CABG
signs of post mi VSD or papillary wall rupture
Patients with VSD or papillary muscle rupture develop abrupt pulmonary edema or hypotension and a loud holosystolic murmur and thrill.
signs of free wall rupture after mi
LV free wall rupture causes sudden hypotension or
cardiac death associated with pulseless electrical activity
when should you give pregnant pt with cardiomyopathy anticoagulation
Anticoagulation with warfarin is recommended for women with peripartum cardiomyopathy with LVEF <35%.
recommendation for future pregnancy once pt suffered peripartum cardiomyopathy
avoid future pregnancy
giant cell myocarditis
form of dilated cardiomyopathy with biventricular enlargement, refractory ventricular arrhythmias, and rapid progression to cardiogenic shock in young to middle-aged adults
first line tx for hocm
beta blocker
how to tx afib and hocm
warfarin regardless of chadsvasc score. noacs 2nd line
indication for hocm surgery/ablation
outflow tract gradient of >50 mm Hg and continuing symptoms despite maximal drug therapy.
indications for icd in hocm
Previous cardiac arrest
Spontaneous sustained VT
Family history of sudden death (first-degree relative)
Unexplained syncope
LV wall thickness ≥30 mm
Blunted increase or decrease in SBP with exercise
Nonsustained spontaneous VT ≥3 beats
who should be screened for hocm
All first-degree relatives of patients with HCM should have genetic counseling and, in the absence of a documented genetic mutation in the proband, echocardiographic screening. Ongoing screening is recommended throughout adulthood starting at
age 12 years because of the possibility of disease expression at any age
who should be screened for hocm
All first-degree relatives of patients with HCM should have genetic counseling and, in the absence of a documented genetic mutation in the proband, echocardiographic screening. Ongoing screening is recommended throughout adulthood starting at
age 12 years because of the possibility of disease expression at any age
clues that patient may have amyloid cardiomyopathy
Neuropathy, proteinuria, hepatomegaly, periorbital ecchymosis, bruising, low-voltage ECG. Diagnosis can be confirmed with abdominal fat pad aspiration.
clues that patient may have sarcoid cardiomyopathy
Bilateral hilar lymphadenopathy; possible pulmonary reticular opacities; and skin, joint, or eye lesions.
Cardiac involvement is suggested by the presence of arrhythmias, conduction blocks, or HF. Diagnosis is
supported by CMR imaging with gadolinium.
clues that patient may have hemochromotosis
Abnormal aminotransferase levels, OA, diabetes, erectile dysfunction, and HF; elevated serum ferritin and transferrin saturation level.
utility of ambulatory ecg
Indicated for frequent (at least
daily) arrhythmias
exercise ecg indication in arrhythmias
Indicated for arrhythmias
provoked by exercise
utility of event monitor
Indicated for infrequent
arrhythmias >1-2 min in
duration
small recorder held on chest when symptomatic
loop recorder utility
Indicated for infrequent
symptomatic brief arrhythmias
Saves previous 30 s to 2 min
ECG signal when patient
activates the recorder
inplanted loop recorder utility
Indicated for very infrequent
arrhythmias
chads2vasc
1 point each is given for:
• HF
• hypertension
• diabetes
• vascular disease (previous MI, PAD, aortic plaque)
• female sex
• age 65 to 74 years
2 points each are given for:
• previous stroke, TIA, or thromboembolic disease
• age ≥75 years
Provide anticoagulation for a score ≥1 in men and ≥2 in women.
what agent can you use for valvular afib meaning mechanical valve or mod to severe rheumatic mitral stenosis
only warfarin
likely cause of svt that is terminated with adenosine
AVNRT and AVRT
tx of MAT
address underlying dx
pulmonary and cardiac disease, hypokalemia, and hypomagnesemia.
Metoprolol is the drug of choice followed by verapamil
Aortic stenosis
Mid-systolic;
crescendo decrescendo
severe as: high pitched, late-peaking murmur; diminished and delayed carotid upstroke
bicuspid valve without calcification will have systolic ejection click followed by murmur
Aortic regurgitation
Diastolic; decrescendo
murmur is heard over LLSB over the valve, but RLSB (dilated aorta) is heard best when leaning forward
mitral stenosis
Diastolic; low pitched,
decrescendo
best heard apex in left lateral decubitus
Loud S1; tapping apex beat;
opening snap after S2
Mitral
regurgitation
Systolic; holo-,
mid-, or late
systolic
apex; radiates to underarm or back
systolic click with prolapse
tricuspid regurgitation
Holosystolic
LLSB radiates to LUSB
tricuspid stenosis
Diastolic; low pitched, decrescendo;
increased intensity during inspiration
pulmonary regurgitation
Diastolic; decrescendo
LLSB
pulmonary stenosis
Systolic; crescendo-decrescendo LUSB Pulmonic ejection click after S1 (diminishes with inspiration)
radiates to clavicle
HOCM murmur
Systolic;
crescendo decrescendo
LLSB
ASD
Systolic; crescendo decrescendo RUSB Fixed split S2; right ventricular heave;
