Cardiology Flashcards by Victor Roy

What are the key buckets for pericarditis?

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

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What is classic presentation of pericarditis?

chest pain, relieved by sitting forward; pericardial friction rub

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What is the Beck’s triad?

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

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What is pulsus paradoxus?

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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What are pericardial EKG findings?

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

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when should a patient be admitted for pericarditis?

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

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What are the treatments for pericarditis?

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

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How long is colchicine used in pericarditis?

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

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What tx should be added in treatment for pericarditis?

PPI for gastric protection given NSAID use

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

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

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What is a complication of pericarditis?

Constrictive pericarditis / fibrous scar

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What is electrical alternans?

when qrs amplitude swings, can happen cardiac tamponade

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

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

ARNI
SGLT2

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What do you need to do to transition to ARNI

break patient for 36 hours on ACE and then start ARNI

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What is the main clinical trial for ARNI?

PARADIGM-HF in 2014

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SGLT2 benefits in both HFpEF and HFrEF

YES!

in HFrEF - DAPA-HF and EMPEROR REDUCED studies

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When to use IV Fe in HFrEF?

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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JVP - how high is it if pulsation is at clavicle

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

How should we dose diuresis in ADHF?

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

What is the primary goal of hospitalization in HF?

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

What defines angina? Three criteria?

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

EKG findings for STEMI

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

When to think about getting a posterior EKG?

when ST depression or normal EKG but concerning s/s

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

High sensitivty troponin - when to check

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

What are the major classes of meds for ACS?

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

Which anti-thrombotic treatment beyond aspirin has best evidence?

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

Is there an age cut off in Afib?

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

HAS-BLED score - do you use it?

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

Dilt vs verapamil in Afib?

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

What is considered to be valvular Afib?

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

When are DOACs contraindicated?

MECH valves, and also with moderate to severe MS

What is management with bioprosthetic valves?

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

What are the rate control options for Afib?

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

What are contraindications for TEE?

neutropenia esophagitis recent esophageal surgery recent radiation with ongoing dysphagia Relative contraindications: TCP < 50, unevaluated dysphagia, strictures, varices

When might some one use cardiac CT in Afib management?

Increasing used for non-invasive evaluation for L atrial appendage

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

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

What trials are critical for rhythm control mgmt?

AFFIRM trial - no benefit to rhythm vs rate control CASTLE-AF trial - showing that ablation is beneficial in HFrEF

When to consider LAA occlusion device?

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

Counseling re: driving from syncope

Can have driving restriction for a few months

What are imposters of syncope?

hypoglycemia; seizures; hypoxia; TIA/stroke

what is orthostatic hypotension defined by?

SBP drops by 20 DBP drops by 10

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

STRESS TEST

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

PE!