Cardiology Flashcards
MC diagnosis of chest discomfort at the ER
GI causes
pleuritic, KNIFE-LIKE pain radiation to trapezius
pain in acute pericarditis
severe sudden TEARING pain radiating to the INTERSCAPULAR AREA
Aortic Dissection
MC presentation of pulmonary embolism
dyspnea
clenching of FIST held against the sternum
Levine sign
50/M, smoker, HTN, heavy complaining substernal chest pain during exertion lasting 5 minutes and relieve by rest
Chronic stable angina pectoris
first line of treatment to reduce angina (Chronic CS)
Beta blocker/CCB
Canadian CVS FC of Angina: Emotional stress in cold, few hours from after awakening, slight limitation
CCS II
CCS FC of angina: MARKED limitation
CCS III
I - ordinary physical activity
IV - inability to carry on any physical activity without discomfort
Definitive test for CAD
Coronary angiography
Drugs rescued for patient who cannot stress test
Dobutamine
Adenosine
Dipyridamole
Goal LDL for proven CAD:
LDL: <100mg/dl
if with DM: <70mg/dl
most important determinant of Pulse pressure
Stroke volume
Indications for CABG`
Left main coronary artery disease
3 vessels dse + LVEF <50% or DM
2 vessel dse that includes proximal left descending coronary artery
what is MCC of IN-HOSPITAL death among patients suffering from ACS
Pump failure
Classification of MI: MI related to percutaneous Coronary Intervention
Type 4a
Classification of MI: MI resulting in death when biomarkers are unavailable
type 3
Classification of MI: MI related to CABG
Type 5
Class of MI: spontaneous MI, Severe CAD but on occasion non obstructive CAD
Type 1
Classification of MI: MI secondary to an ischemic balance, coronary artery spasm, arrhythmia, anemia, respiratory failure, hypotension and hypertension with or without left ventricular hypertrophy
type 2
Classification of MI: related to Stent thrombosis
type 4b
Reflex: Anterior wall involvement, tachycardia, hypertensive
James-Reflex
Reflex: inferior wall affected, bradycardia, hypotension
Bezold- Jarisch Reflex
first cardiomarker to rise in N-STEMI ACS
Myoglobin
best test to detect a REINFARCTION a few days after the initial infarction
CK-MB - rise in 3-6hrs, sustain till 1-2 days
cardio marker that rise 3-6 hrs and sustain till 1-2 weeks
Troponin
Kilip scoring with Severe heart failure, mid basal rales and pulmonary edema, S3 and S4, Normal BP
Class III
Kilip scoring of Mod HF, bibasal rales, Normal BP, S3 gallop, tachypnea
Kilip score of 2
MCC of OUT-hospital death from STEMI
Vfib
Compromise the first heart sound
mitral and tricuspid valve closure
Compromised by the 2nd heart sound
Aortic and pulmonic valve closure
ECG changes of Hypokalema
Flat/inverted T waves
prominent U wave
ST depression
QT prolongation
ECG changes of Hyperkalemia
Low p waves
Tall T wave
ECG changes in HypoCalcemia
Prolong QT – associated with long QT syndrome, Torsade de pointes
Hypercalcemica - shortened QT interval
Drug that can cause Torsades de pointes (prolong QT)
Macrolides
Associated condition with Opening snap at Diastole
Mitral stenosis
Associated condition with Tumor Plop at Diastole
Atrial Myxoma
Associated condition with Pericardial Knock at Diastole
Constrictive pericarditis
sign where the murmur heard over femoral artery
Duroziez sign
Sign of jarring of the entire body and bobbing motion of the head, due to AR
De musset sign
sign: bounding and forceful pulse, rapidly increasing and subsequently collpasing
Water-hammer/Corigan pulse - AR
capillary pulsation at the root of the nail due AR
Quinke’s pulse
Booming “pistol shot” sound over femoral arteries due to AR
Traube sign
Treatment of choice for acute AR:
Surgery and usually necessary within 24hrs of diagnosis
best initial treatment for symptomatic mitral stenosis
Diuretics - relieved of dyspnea from pulmonary congestion
most effective treatment for MS
Percutaneous mitral balloon valvotomy or valvuloplasty
Cardinal sx of HF
fatigue and shortness of breath
MC systolic HF or HFrEF?
HFrEF: depressed <40%
MC: CAD
MC diastolic HF or HF with preserved EF?
preserved >40-50%
MC: HTN
In ACS, time period if NOT re-perfused –> IRREVERSIBLE INJURY
20 minutes
Medical Management you can give to Chronic HF, but NOT in acute HF?
Chronic HF: Beta blockers (Bisoprolol, Carvedilol, Metoprolol)
if given in ACS –> depresses everything
MCC of chronic cosntrictive pericardutis in develiping nations
TB
Becks triad
Hypotension
Soft or absent heart sounds
Jugulae venous distention
Fluid to consider acute or chronic tamponade?
Acute - 200mL
Chronic - >2000mL
Decrease in at least 10mmhg os systolic blood pressure
Pulsus paradoxus
BP ,190/80, taken Enalapril 50mg OD, Creatinine 2.1mg/dL. Consider
Dx if there is detoriation of renal function assoc wit ACEI
Renal artery stenosis
Differentiate Urgency from emergency
Presence of target organ damage
Drug that raises the HDL cholesterol
Niacin
First line tx for severe hypertriglyceridemia
Fibrates
This prevets pancreatitis in px with severe hypertruglyceredemia
Omega 3 FA (fish oils)
Decreases LDL, and safe for pregnant and lactating women
Bile acid sequestrants
MC A/E of statin
Liver toxicity
How to diagnose Infective Endocarditis
2 major
1 major & 3 minor
5 minor
Best emperic therapy for IE
Vancomycin and Gentamicin
What is the caused of Brugada syndrome
Loss of function mutation in SCN5a – decrease sodium channel that affect the Phase 0 and Phase 1 of cardiac AP
ECG findings in Brugada syndrome
Pseudo Right bundle branch block
Persistemt ST segment elevation in leads V1 to V2
Medication to avoid in Brugada syndrome
Class I antiarrhythmic drugs
ABI ratio diagnostic
N - 1-1.40
ABI <0.9
Noncompressible arteries due to vasculad calcification >1.40
6P’s of Acute Limb ischemia
pain
Pallor
Paresthesia
Paralysis
Pulseleness
Poikilothermia
First line for symptom improvement for PAD
Cilostazol
CI: CHF
Most appropriate diagnostic exam in Pulmonary embolism
Chest CT with contrast
Virchows Triad
Endothelial injury
Venous statis
Hypercoagulable stats
Gold standard exam for pulmonary embolism
Invasive pulmonary angiogram
Known as the great masquerader
Pulmonary embolism
MC ECG abnormality in PE
T wave inversion
