Cardiology Flashcards
STEMI
Symptoms: Chest pain, diaphoresis, n/v, arm/jaw pain, sob
Diagnosis: EKG with ST elevations (leads determine location), serial troponins elevated
Management: Reperfusion with pci or fibrinolysis. Heparin, aspirin, statin, morphine, nitro immediately. Ultimately add 2nd antiplatelet, beta blocker, and ACE inhibitor
Complications: Chronologically: Arrhythmias, pericarditis, papillary muscle rupture, ventricular septal reupture, ventricular aneurysm, ventricular free wall rupture, dressler syndrome, LV failure with pulmonary edema
Specialist and role: Cardiology for PCI
NSTEMI
Symptoms: Chest pain, diaphoresis, n/v, arm/jaw pain, sob
Diagnosis: EKG with absence of elevations, serial troponins
Management: If true NSTEMI, Heparin, aspirin, statin, morphine, nitro. Ultimately add 2nd antiplatelet, beta blocker, and ACE inhibitor
Complications: STEMIs, arrhythmias
Specialist and role: Cardiology for stress test or invasive angiography
Unstable Angina
Symptoms: Chest pain at rest, diaphoresis, n/v, arm/jaw pain, sob
Diagnosis: EKG with absence of elevations, serial troponins normal
Management: At least do aspirin, statin on presentation. Depending on severity can add MONA BASH
Complications: MI, Arrhythmias
Specialist and role: Cardiology for stress test or invasive angiography
Chronic CAD
Symptoms: Asymptomatic or may have occasional anginal pain
Diagnosis: Invasive angiography, coronary CT,
Management: Betablockers, Ace inhibitors, CCB’s, nitrates, ranexa, antiplatelets
Complications: MI, CHF, arrhythmia
Specialist and role: Cardiology if stress test or angiography is necessary
Heart Failure with preserved EF
Symptoms: Asx, SOB, fatigue
Diagnosis: Echo
Management: If symptomatic, diuretics, SGLT2, spironolactone
Complications: CHF exac
Specialist and role: Cardiology for med management
CHF Exacerbation
Symptoms: SOB, PND, orthopnea, JVD, pitting edema, weight gain
Diagnosis: Rales on exam, BNP, CXR, TTE
Management: Oxygen, IV diuretics. No beta blockers in acute phase unless they are already on it. Send with some combo of ACE/ARB, beta blockers, spironolactone, hydralazine with nitrates, and diuretics depending on severity and only if it is reduced EF. Newer drugs like entresto (Sacubitril/valsartan) and SGLT2 like jardiance (empagliflozin) may be used by cards. Also may need ICD/pacer, LVAD, or heart transplant
Complications: Pulmonary edema, pulmonary effusions, valvular disorders, arrhythmias, cardiogenic shock
Specialist and role: Cardiology if new onset to assess for underlying ischemic heart disease and to start chronic medications if not already on it. Or if need for ICD/pacer, LVAD, or heart transplant
Aortic stenosis
Symptoms: Syncope, SOB/heart failure symptoms, Chest pain
Diagnosis: Systolic murmur at right upper sternal border. EKG with LVH. Echo with valve area < 1cm squared and jet velocity > 4 m/s if severe. May need cath if other studies inconclusive
Management: Diuretics for volume overload, antihypertensives if HTN. May need IABP if severe HF. TAVR and surgical management is more definitive management
Complications: Heart failure
Specialist and role: Cardiology if severe HF and for evaluation of balloon angioplasty, TAVR, surgical management
Aortic regurgitation
Symptoms: SOB/CHF symptoms, pulmonary edema, cardiogenic shock, chest pain
Diagnosis: Diastolic murmur at RUSB, EKG with LVH, Echo for valve evaluation (may show endocarditis as cause). May need cath if other studies inconclusive
Management: Antihypertensives if HTN, Aortic valve replacement
Complications: Heart failure, cardiogenic shock
Specialist and role: Cardiology/CT surgery if acute severe AR with aortic valve replacement
Mitral stenosis
Symptoms: SOB/CHF symptoms, A fib due to atrial stretch
Diagnosis: Diastolic murmur with opening snap at cardiac apex, ekg with left atrial englargement or A fib, echo. Cath if other studies are inconclusive
Management: Diuretics and low salt diet for heart failure symptoms. Balloon valvuloplasty if severe (<1.5 cm squared) as it is usually rheumatic heart disease. Replacement in rare instances
Complications: CHF
Specialist and role: Cardiology if severe for evaluation of valvuloplasty or surgery
Mitral regurg
Symptoms: CHF exac, pulmonary edema, cardiogenic shock
Diagnosis: Systolic apex murmur. Echo. Look for infection/infarction for all insufficiency murmurs
Management: Chronic can be managed with ACE/BB whereas more acute will need IV nitro and IABP and mitral valve replacement
Complications: A fib, CHF exac
Specialist and role: Cardiology/CT surgery if severe for mitral valve replacement
Hypertrophic cardiomyopathy
Symptoms:
Diagnosis:
Management:
Complications:
Specialist and role:
Mitral valve prolapse
Symptoms:
Diagnosis:
Management:
Complications:
Specialist and role:
Pericarditis
Symptoms: Chest pain leaning forward, pleuritic
Diagnosis: Pericardial rub, EKG with diffuse ST elevations, Echo may show pericardial effusion. Consider viral, ACS, uremia, or rheumatic causes
Management: Rule out ACS, then aspirin or NSAID’s with colchicine
Complications:
Specialist and role: Cardiology to ensure not ACS
Pericardial effusion
Symptoms:
Diagnosis:
Management:
Complications: Tamponade
Specialist and role:
Cardiac tamponade
Symptoms: Vague but may include SOB/CHF from reduced cardiac output as well as syncope
Diagnosis: Becks triad (JVD, distant heart sounds, hypotension), EKG with electrical alternans, TTE shows pericardial effusion
Management:
Complications: Cardiogenic shock
Specialist and role: Pericardiocentesis or pericardial window for recurrent effusions
Constrictive pericarditis
Symptoms: SOB/CHF symptoms
Diagnosis: TTE will show findings suggestive
Management: Diuretics and low sodium diet help but pericardiectomy is definitive treatment
Complications: CHF exac
Specialist and role: Cardiology to determine need for pericardiectomy
Syncope
Symptoms: Lightheaded, dizzy
Diagnosis: EKG, echo, carotid dopplers if concern
Management: Treatment of underlying cause if cardiac etiology identified. Review meds
Complications:
Specialist and role: Cards/neuro if etiology found
Hyperlipidemia
Symptoms: Asx
Diagnosis: Lipid levels and ASCVD calculation
Management: Statins and pcsk9 (evolocumab or repatha and alirocumab or praluent) lower LDL the most. Fibrates lower TG the most
Complications: Cardiovascular disease; ACS/stroke
Specialist and role: None
Hypertriglyceridemia
Symptoms: Asx
Diagnosis: Lipid levels
Management: Fibrates
Complications: Pancreatitis
Specialist and role: None
Primary Hypertension
Symptoms: Asx, headaches, n/v if very high
Diagnosis: BP
Management: ACE/ARB, calcium channel blocker, thiazides, beta blockers, hydralazine for short term
Complications: Stroke, dissection
Specialist and role: None
Hypertensive Urgency
Symptoms: Asx, headache, n/v
Diagnosis: BP > 180/120 without end organ damage
Management: BP reduction over several hours with hydralazine/labetalol and oral agents
Complications: Stroke, dissection
Specialist and role:
Hypertensive Emergency
Symptoms: Asx, headache, n/v
Diagnosis: BP > 180/120 with signs of end organ damage (MI, stroke, encephalopathy, dissection, renal failure)
Management: Cardene drip to lower BP by 20% within the first hour, then oral agents to lower it by additional 10% over next 24 hours. Rapid lowering in patients with dissection/hemorrhagic stroke. Labetalol for pregnant patients. Do not lower in ischemic stroke
Complications: Stroke, dissection
Specialist and role: ICU
A fib
Symptoms: Chest pain, palpitations, syncope, pulmonary edema
Diagnosis: EKG with irregularly irregular and absent p waves, TTE to check valvular or nonvalvular
Management: Unstable tachyarrhythmia = cardioversion. Rate control preferred with beta blockers IV, cardizem push, cardizem drip. Make sure not hypotensive, otherwise amio drip. Digoxin if concurrent CHF. Rhythm control with pharmacologic cardioversion (amiodarone, sotalol, etc.), or DCCV, or catheter ablation. May need TEE to rule out clot before DCCV. Anticoagulation if CHADs2Vasc indicates and no contraindication (consider HASBLED) otherwise watchman. If valvular will need warfarin
Complications: Cardiac arrest, MI, stroke
Specialist and role: Cardiology if starting new medications (anticoagulants or rate/rhythm) or if RVR for adjusting medications, or if need for cardioversion/ablation
SVT/AVNRT
Symptoms: Chest pain, palpitations, syncope, pulmonary edema
Diagnosis: EKG showing regular tachycardia, usually > 150
Management: Unstable tachyarrhythmia = cardioversion. Vagal maneuvers. Adenosine. May need radiofrequency ablation following
Complications: Cardiac arrest
Specialist and role: Cardiology for medication management and possible ablation
V Tach
Symptoms: Asx, chest pain, palpitations, syncope, cardiac arrest
Diagnosis: Make sure no PPM/ICD as cause, bundle branch blocks at baseline. NSVT if 3 or more PVC’s that terminate within 30 seconds. Monormorphic or Polymorphic or Torsades. Echo to check for structural heart disease as cause
Management: Unstable tachyarrhythmia = synchronized cardioversion. Unless pulseless, in which case it is defibrillation (unsynchronized). IV amio. Mag if torsades. NSVT can receive beta blockers if symptomatic then amio if additional required and possible ablation/ICD. Review meds for QT prolonging agents
Complications: Cardiac arrest
Specialist and role: Cardiology for medication management and evaluation for ICD or ablation
V Fib
Symptoms: Cardiac arrest
Diagnosis: EKG showing
Management: Defibrillation
Complications:
Specialist and role: Cardiology post acute management for ICD or ablation
Asystole
Symptoms: Cardiac arrest
Diagnosis:
Management: ACLS
Complications:
Specialist and role:
Sinus bradycardia
Symptoms: Syncope, confusion, hypotension
Diagnosis: EKG, TSH, examination for cyanosis
Management: Rate < 50 with poor perfusion and AMS or chest pain = Atropine then transcutaneous pacing. Give oxygen. Check for medications that can be reversed like digoxin, BB, CCB
Complications: Cardiac arrest, end organ damage
Specialist and role: Cardiology for determination of medications and PPM placement need. May need loop recorder outpatient
1st degree heart block
Symptoms: Syncope, confusion, hypotension
Diagnosis: EKG with PR > 200ms, TSH
Management: Rate < 50 with poor perfusion and AMS or chest pain = Atropine then transcutaneous pacing. Give oxygen. Check for medications that can be reversed like digoxin, BB, CCB
Complications: Cardiac arrest
Specialist and role: Cardiology for determination of medications and PPM placement need. May need loop recorder outpatient
2nd degree heart block type 1
Symptoms: Syncope, confusion, hypotension
Diagnosis: EKG with progressively prolonged PR then dropped beat, TSH
Management: Asymptomatic look for reversible causes and treat accordingly. If unstable with rate < 50 with poor perfusion and AMS or chest pain = Atropine then transcutaneous pacing. Can also do dopamine drip. Give oxygen
Complications: Cardiac arrest
Specialist and role: Cardiology for determination of medications and PPM placement need. May need loop recorder outpatient
2nd degree heart block type 2
Symptoms: Syncope, confusion, hypotension
Diagnosis: EGK with fixed PR then dropped beat, TSH
Management: If stable, monitor with transcutaneous pacing pads in place. Review meds. If unstable with Rate < 50 with poor perfusion and AMS or chest pain = Atropine then transcutaneous pacing. Can also do dopamine drip. Give oxygen.
Complications: Cardiac arrest
Specialist and role: Cardiology for determination of medications and PPM placement need. May need loop recorder outpatient
3rd degree av block
Symptoms: Syncope, confusion, hypotension
Diagnosis: EKG with disassociation of p waves and qrs complexes, TSH
Management: If stable, monitor with transcutaneous pacing pads in place. Review meds. If unstable with Rate < 50 with poor perfusion and AMS or chest pain = Atropine then transcutaneous pacing. Can also do dopamine drip. Give oxygen.
Complications: Cardiac arrest, end organ ischemia
Specialist and role: Cardiology for determination of medications and PPM placement need. May need loop recorder outpatient
Aortic Dissection
Symptoms: Chest pain, abdominal pain, CHF exac if involves aortic valve
Diagnosis: CTA or US
Management: Maintain BP control systolic < 120 and heart rate < 60 with labetalol drip. CT surgery if type A. Vascular surgery if type B and signs of malperfusion (renal failure, shock liver, elevated lactate suggesting mesenteric or tissue ischemia) or expanding hematoma/aneurysm. Medical management if asymptomatic type B with BP control and heart rate control as above
Complications: Aortic regurg with acute CHF/pulmonary edema, Tamponade, MI
Specialist and role: Cardiology, CT surgery, or vascular surgery depending on location
Thoracic aortic Aneurysm
Symptoms: Chest/abdominal/back pain
Diagnosis: CTA
Management: Symptomatic is endovascular repair/surgery. Asymptomatic is BP control with beta blocker preferably and surgical consultation to determine need for repair
Complications: Dissection, MI
Specialist and role: CT surgery
Atrial Flutter
Symptoms: Chest pain, palpitations, syncope
Diagnosis: EKG showing regular sawtooth with rate of 150 exactly usually
Management: Treat like A fib
Complications: Cardiac arrest
Specialist and role: Cardiology for medication management and cardioversion/ablation if necessary
Sinus pauses
Symptoms: Asx, syncope
Diagnosis: EKG showing prolonged pauses
Management: If asx no treatment required but discontinue offending medications. PPM if symptomatic
Complications: Cardiac arrest
Specialist and role: Cardiology for evaluation of PPM
Prosthetic heart valves
Things to know:
Continue warfarin. Do not use any vitamin K reversals without cardiology approval
Infective Endocarditis
Symptoms:
Diagnosis:
Management:
Complications:
Specialist and role:
Abdominal Aortic aneurysm
Symptoms: Abdominal/back pain, hypotension if ruptured
Diagnosis: Pulsatile abdominal mass, ultrasound for asymptomatic detection or during FAST exam, otherwise CTA
Management: If ruptured or nonruptured but symptomatic, surgery; if asymptomatic smoking cessation or if large, elective surgery. Endovascular repair is an alternative to surgery
Complications: Ruptured AAA, end organ ischemia
Specialist and role: Vascular surgery if necessary
