Cardiology Flashcards
What is the most common cardiac complication in Hemachromatosis?
arrhythmia; paroxysmal A fib
Carcinoid syndrome affects which heart valve?
pulmonic; pulmonary stenosis
Pts with a subclavian or jugular CRBSI MUST be treated w/ what AB(s)?
VANCOMYCIN (MRSA protective)
Pts with a femoral CRBSI MUST be treated w/ what AB(s)?
- VANC
- cefepime (pseudomonas)
- caspofungin (candida)
Methadone, Ondasteron, and Amiodarone cause what change in the EKG> deadly arrhythmia?
== QT prolongation»_space; torsades de pointes (TdP)
- norm = <440
Citrate toxicity from recurrent blood transfusions depletes what 2 electrolytes?
Calcium & Magnesium
what is the most common post-op arrhythmia?
how is it identified on EKG?
premature ventricular complex
EKG = bigeminy = finding in which every normal complex is followed by a premature complex
**also see trigeminy
what are some causes of post op arrhythmias (PVCs) ??
high levels of catecholamines (endogenously due to the perioperative stress state; exogenous in the case of cardiovascular support)
***electrolyte or acid-base imbalances (e.g., hypokalemia, hypomagnesemia)
reduced ventilation
certain drugs
what treatment reduces the risk of SCD in pts with HOCM?
SCD is caused by Vfib / Vtach
SOOO
Placement of an automated, implantable cardioverter defibrillator (AICD) is the best method to prevent sudden cardiac death (SCD) in patients with HOCM
AICD averts fibrillation = no death
what kind of murmur continuously radiates to the neck but disappears when pt flexes the neck?
venous hum (veins are easy to compress)
how can pts on hemodialysis with a created AV fistula end up with HFpEF?
AV fistulas send blood from systemic circulation to pulm circulation > dec in SVR> increased HR w/ decreased filling pressures triggers RAAS activation
what dx test is performed prior to anticoag therapy or cardioversion in a pt with AFib?
why?
alway visualize the heart w/ TEE prior to giving anticoags/cardioversion bc you want to see if there is an active thrombus sitting in the heart waiting to be thrown around
(anticoags & cardioversion will loosen a thrombus from a heart wall/valve)
what is the difference between synchronized cardioversion and defibrillation?
synchronized cardioversion waits for a R wave before admin a shock === SOOO there must be a PULSE in order to shock!
defibrillation is given when there is NO PULSE & you are trying to bring pt back
which arrhythmias receive synchronized cardioversion?
arrhythmias with a PULSE:
- A fib
- A flutter
- AVNRT
- Pulsing Vtach
which arrhythmias receive defibrillation?
arrhythmias with NO PULSE:
- ventricular fibrillation
- Pulseless VTach
BP for hypertensive emergency?
> 180 / >120
either one is an emergency
which patients are recommended evaluation/screening for AAA?
65-75 yo w/ PMHx smoking & ATHEROSCLEROTIC diseases (claudication/PAD/HLD/HTN)
Afib is almost always likely to occur in pts with what
- arrhythmia
- valve disease
pre-excitation WPW > Afib in 20% of pts
Mitral stenosis; hx of rheumatic fever enlarges the L.atria> excites the Pulm VEIN > Afib in 2/3 of pts
Pts with new onset Afib should always be evaluated for what valve disease?
Mitral valve stenosis!
Pts with UNSTABLE Afib/AFib w/ RVR need to be treated with what ASAP (aka this takes priority over any med!!)
EMERGENCY synchronized cardioversion (controls RHYTHM)!!
what are the 2 complications of AFib?
- Afib w/ RVR
2. emboli
Dx criteria for AFib w/ RVR
drug Management of AFib w/ RVR
AFib w/ HR >100 pt can be stable or unstable
1st= Bblockers
2nd= CCB Nondihydropyridines (verapamil & diltiazem)
3rd (if cant tolerate above)= Digoxin or Amiodarone
what is the PARASITE mnemonic for the etiology of AFib ?
THIS IS VERY IMPORTANT
P- Pulm dx (COPD, PE, PNA) A- Anemia R- Rheumatic heart disease/Mitral Stenosis A- Atrial Myxoma S- Sepsis or Hypovolemia (dehydration) I- Ischemia T- Thyroid dx (Hyperthyroidism or Thyrotoxicosis) E- Ethanol
when is the ONLY time SVR is decreased?
when shock is SEPTIC/distributive or NEUROGENIC shock!
when is the ONLY time CO index (how MUCH blood is pumped out) is high?
CO index is increased SEPTIC/Distrubutive shock only (bc SVR is low so CO is high)
CO pump function is dec in:
- cardiogenic (heart not pumping= less blood leaves heart)
- hypovolemic (less blood passing through heart)
- neurogenic (dead heart = no blood passing)
why would you perform a exercise or adenosine stress test ?
what pt characteristics (CC, PMHx, FHx, etc) would make you consider a stress test?
to evaluate if a pt has obstructive coronary artery disease
do a stress test in pts who you worry may have a MI soon:
new onset SOB on exertion, PMH HLD/DM/HTN, FHx MI in 1st degree relatives, etc
sound and location of Aortic regurg vs MV regurg
Aortic regurg= a DECRESCENDO murmur heard after S2 (= DIASTOLE); located at either side of the sternal border (BUT best heard at the right 2ND intercostal space where the aorta starts)
Mitral regurg= HOLO-SYSTOLIC apical murmur (bc normally the MV is closed during systole, but in MR blood regurges back into LA during systole); located at left 4th/5th intercostal space @ mid clavicular line & radiates to axilla
what is a common brain complication of coarctation of the aorta & what is the pathophys?
intracranial hemorrhage!!
- pts w/ Coarctation of the aorta are GENETICALLY predisposed to berry aneurysms.
- the coarctation> secondary HTN> aneurysm rupture> ICH
myxomatous valve degeneration is associated with what valve defects?
MVP that worsens to become MR
what valve defect is known for causing ANXIETY?
MVP!!
what is the order of drugs/protocol for management of CHF?
- Lasix (diuretic will give pt comfort)
- ACEi (#1 for CHF for controlling BP)
- Add beta blocker after the pt is stable on the ACEi
ACEi is ALWAYS b4 Bblocker bc blockers take longer to kick in
an IE pt with a new conduction finding (ex. heart block) is a sign that the IE has spread to what part of the heart?
VALVE involvement in IE causes conduction problems
