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Adult medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the key buckets for pericarditis?

A

viral infection, malignancy, autoimmune hx, TB, prior MI (Dressler)

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2
Q

What is classic presentation of pericarditis?

A

chest pain, relieved by sitting forward; pericardial friction rub

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3
Q

What is the Beck’s triad?

A

1) muffled heart sounds, 2) JVD distension, 3) low blood pressure

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4
Q

What is pulsus paradoxus?

A

Cardiac tamponade - right ventricle can’t expand due to fluid restricting during inspiration, so interventricular septum bulges to the left, this leads to less LV stroke volume&raquo_space; leads to drop in blood pressure.

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5
Q

What are pericardial EKG findings?

A

diffuse ST elevation; PR elevation in aVR, inversion in V5/6

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6
Q

when should a patient be admitted for pericarditis?

A

1) elevation in troponin, 2) large effusion, 3) fever, 4) pt with immunosuppression

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7
Q

What are the treatments for pericarditis?

A

NSAID / aspirin / ibuprofen; taper for 2-4 weeks

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8
Q

How long is colchicine used in pericarditis?

A

up to 3 months - can help with prevention of recurrent pericarditis ; GI side effects are common

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9
Q

What tx should be added in treatment for pericarditis?

A

PPI for gastric protection given NSAID use

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10
Q

What is the work up for pericarditis if no obvious culprit?

A

ANA, dsDNA, TB work-up, complements, age appropriate cancer screening

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11
Q

What is a complication of pericarditis?

A

Constrictive pericarditis / fibrous scar

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12
Q

What is electrical alternans?

A

when qrs amplitude swings, can happen cardiac tamponade

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13
Q

In addition to BB, ACE/ARB, what are two other additional meds that are now part of GDMT?

A

BB - B/M/C
ACE/ARB
+++

ARNI
SGLT2

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14
Q

What do you need to do to transition to ARNI

A

break patient for 36 hours on ACE and then start ARNI

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15
Q

What is the main clinical trial for ARNI?

A

PARADIGM-HF in 2014

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16
Q

SGLT2 benefits in both HFpEF and HFrEF

A

YES!

in HFrEF - DAPA-HF and EMPEROR REDUCED studies

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17
Q

When to use IV Fe in HFrEF?

A

When Tsat < 20%
- reduced hospitalizations, no mortality benefit
- should get atleast 3 doses – can get them IV infusions as outpaitent if only get them 1-2 while inpatient

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18
Q

JVP - how high is it if pulsation is at clavicle

A

have pt sit up, if pulsation at clavicle - its 10 cm

1:2 relationship with wedge pressure - means at clavicle/10cm RA pressure is 20cm

19
Q

How should we dose diuresis in ADHF?

A

Can be 2x or do 2.5x home dose –> leads to symptom benefit and weight loss in hospitalization at 72 hours, but not in terms of re-hospitalization or mortality benefit at 60d

20
Q

What is the primary goal of hospitalization in HF?

A

Reduce filling pressures (not improve cardiac index)! NEed to get JVP < 10, equivalent with right sided pressures of < 20

21
Q

What defines angina? Three criteria?

A

1_ substernal chest pain
2_ provoked by exertion/stress
3_relieved by rest or NTG

22
Q

EKG findings for STEMI

A

STE
LBBB new
ST depression >- .5mm
TWI > 1mm

23
Q

When to think about getting a posterior EKG?

A

when ST depression or normal EKG but concerning s/s

get posterior leads v7-v9 - potenital L Cx occlusion/posterior MI

24
Q

High sensitivty troponin - when to check

A

can get it 1-3 hours later, instead of 3-6

25
Q

What are the major classes of meds for ACS?

A

antithrombotic: aspirin immediately
AC w/ heparin with plan for potential invasive strategy (can think about lovenox too in conservative management)

BB
Statin

26
Q

Which anti-thrombotic treatment beyond aspirin has best evidence?

A

NOT clopidigrel
now ticagrelor or prasugrel (prasugrel when you know lesion and undergoing PCI)

27
Q

Is there an age cut off in Afib?

A

No age cutoff really - net clinical benefit for warfarin upwards of 87, with apixiban 92….and if healthy, than still benefit to prolonging AC

28
Q

HAS-BLED score - do you use it?

A

Use CHADS-VAsc more, more priority of reducing stroke risk (so devastating) vs reducing bleeding risk (we can manage a bleed)

29
Q

Dilt vs verapamil in Afib?

A

often easier to start on dilt given there is IV infusion version

30
Q

What is considered to be valvular Afib?

A

Afib with moderate to severe MS, valve replacement, or valve repair

31
Q

When are DOACs contraindicated?

A

MECH valves, and also with moderate to severe MS

32
Q

What is management with bioprosthetic valves?

A

warfarin preferred in first 3-6 months; after 3-6 months, DOACs among patients with bioprosthetic valves or valve repair and Afib

33
Q

What are the rate control options for Afib?

A

1st line - BB
2nd line - dilt or verap BUT in heart failure patients with LV dysfunction - no CCB or verap
Amio - last resort, if hemodynamically unstable NOT from Afib

Remember to replete lyres, get fluid balance right
110 is a good HR tagert

34
Q

What are contraindications for TEE?

A

neutropenia
esophagitis
recent esophageal surgery
recent radiation with ongoing dysphagia

Relative contraindications: TCP < 50, unevaluated dysphagia, strictures, varices

35
Q

When might some one use cardiac CT in Afib management?

A

Increasing used for non-invasive evaluation for L atrial appendage

36
Q

Rhythm control is being considered in which two situations more and more?

A

In HFrEF with ICD in place, also in early new-onset Afib

37
Q

What trials are critical for rhythm control mgmt?

A

AFFIRM trial - no benefit to rhythm vs rate control

CASTLE-AF trial - showing that ablation is beneficial in HFrEF

38
Q

When to consider LAA occlusion device?

A

CHADSVASC > 2, good reason foregoing AC, if possible 6 weeks of AC is possible ideally (but can probalby do it without)

39
Q

Counseling re: driving from syncope

A

Can have driving restriction for a few months

40
Q

What are imposters of syncope?

A

hypoglycemia; seizures; hypoxia; TIA/stroke

41
Q

what is orthostatic hypotension defined by?

A

SBP drops by 20
DBP drops by 10

42
Q

What test do you need to do for those with exertional syncope?

A

STRESS TEST

43
Q

What’s a can’t miss diagnosis with syncope?

A

PE!

Adult medicine (14 decks)

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