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Step3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Tx that lowers mortality with acs

A

Aspirin, beta blockers (lower hr so more time for CA perfusion), statin, p2y12antag

Acei or arb if low EF
Heparin if nstemi

Thrombolytics only for stemi or new lbbb

Glycoprotein IIb/IIIa inhib

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2
Q

Mortality lowering treatment in stemi

A

Angioplasty (pci, within 90 min of arrival at ed) or if not possible, thrombolytics (within 30 min of arrival, and CP<12 hours)

Also beta blockers, asa, Acei or arb, statin

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3
Q

Both ACEI and ARBs can cause

A

Hyperkalemia

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4
Q

Chronic CaD mortality benefiting meds outpt

A

Aspirin and metop
Acei or arb only if CHF/other EF issue

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5
Q

Indications for cabg

A
  • 3 vessels >70% stenosis
  • left main stenosis 50-70%
  • 2 vessels + dm
  • 2 vessels with low EF
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6
Q

Ranolazine

A

Med for anginal pain, decreases o2 demand in heart muscle

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7
Q

Saphenous vein vs internal mammary artery graft for cabg

A

Artery patent 10 yrs, vein only 5

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8
Q

Give statin if…

A
  • stroke or CAD (goal ldl<70)
  • usually with DM
  • ascvd>7.5%
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9
Q

Most common statin AE

A

Liver tox - check lfts periodically

Rhabdo less common - don’t need to check cpk routinely

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10
Q

CHF initial tx and tests

A

Tx: O2, furosemide, nitrates, morphine
Tests: cxr, ekg (expect tachy, maybe arrhythmia), pulse ox (hypoxia and resp alk), echo (systolic vs diastolic)

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11
Q

Chronic CHF tx

A
  • systolic: acei, arb, beta blocker (or hydral + nitrates if CI), digoxin to decrease sx but no mortality benefit, MRA (eg spirono, eplerenone - give with patiromer to bind k if Hyperkalemia), plus minus diur (no mortality benefit)
  • diastolic: MRA (don’t overuse diur)

Beta blocker, ace and arb, MRA, and sglt2 all have mortality benefit

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12
Q

When to order bnp?

A

To figure out if sob is cardiac (elevated in CHF) vs reapiratory

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13
Q

Ivabradine

A

Blocks sa node so slows HR, only works if in sinus, add to chronic CHF tx if all other meds not working

Causes transient bright vision

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14
Q

When do you need bivent pacemaker?

A

HFrEF and wide qrs

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15
Q

Murmurs that get louder with decreased venous return (eg valsalva, standing)

A

HOCM, MVP

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16
Q

Murmur ausc

A
  • AS - second right intercostal, rádiate to carotids, louder with increased preload or decreased after load, cresc-decreased systolic, carotid upstroke
  • pulm valve at second left intercostal
  • tricuspid and AR and vsd at llsb
  • ar: diastolic decresc
  • vsd: holosystolic, worse with increased flow, no tx if mild
  • asd: fixed splitting
  • mr at apex and radiate to axilla, holosystolic, louder with increased flow, often s3, tx = Acei/arb, nifed, loop, surgical repair if bad
  • ms (think RF or pregnancy) - sx = dysphagia and hoarseness from enlarged la compressing esoph and recurrent laryngeal, diastolic rumble with OS, louder with increased flow, tx diuretics and balloon
17
Q

Valve lesions best initial and other tests

A

Best initial = echo
Most accurate = left heart cath to measure pressures
Add ekg and cxr

18
Q

Valve replacement

A

AS: Tavr > surgery > balloon
Can’t do tavr for regurgitation
Bioprosthetic lasts 10 yrs but no ac needed, mechanical lasts longer but need warfarin to get to inr 2-3

MS do balloon valvuloplasty (stretch fibrosis that causes ms vs doesn’t work for as bc that’s caused by calcification)

19
Q

Pericarditis dx test and tx

A

Test = ekg (st elev in all leads, pr dep in lead 2)
Tx = nsaid and colchicine, if pain persists add oral pred

20
Q

Repair AAA when

A

Over 5cm

21
Q

Pericardial disease - give diur for __ but not __

A

Constrictive pericarditis, not tamponade

22
Q

Meds in afib

A

If chadsvasc 0-1, just asa, else:

Rate control with beta blockers, calcium channel blockers, or digoxin - ccb if asthma or migraine, dig if hypotn

Then anticoagulant - DOAC unless metallic heart valve or MS then warfarin

If can’t control hr with rate control agents alone or sx, Antiarrhythmics:
- no cad or struc heart dz, do flecainide or propafenone
- lvh - class 3 dronedarone or amio
- cad - sotalol or droned
- CHF - amio or dofetilide

23
Q

Worsening of svt with ccb or dig?

A

WPW

Tx: procain, sotalol or amio

Long term: radiofreq ablation

24
Q

Syncope work up

A

Ekg, trop/ckmb, echó, head ct

25
Q

MAT vs afib vs sinus tachycardia vs svt on ekg

A

MAt is irregular, narrow complex, variable p wave morphology bc multiple ectopic atrial foci usu iso copd or other acute illness

Afib irreg irreg wo p waves

Svt regular, p usu inverted and often buried in qrs, usu dt reentrant circuit

26
Q

Axis deviation

A

RAD is 90-180 deg (neg in I and pos in avf) - rvh or strain (pe), lateral stemi, copd
Lad is pos in I, neg in II, neg in avf - lvh, lbbb, inferior mi
Normal is pos qrs in I and avf

27
Q

Ebstein’s anomaly

A

Downward displacement of tv—> regurg

28
Q

When you stop ac prior to surgery, when do you have to bridge?

A

If on warfarin and chadsvasc high risk
- not necessary on DOAC because of quick onset of action once you restart

29
Q

Takotsubo cause and dx findings

A

Catecholamine aurge with stress —> myocardial stunning, causing increased basilar contraction and decreased mid and apical contraction, troponin leak, normal Cath

Self resolves

30
Q

Aortic dissection management

A

Pain control, iv beta blockers, sodium nitroprusside for persistent htn, emergency surgical repair for ascending

31
Q

How does CKD affect anemia and the heart?

A
  • Hypertension causes concentric hypertrophy
  • Anemia causes eccentric hypertrophy Because tissues have unmeet, oxygen demand, causing vasodilation, which drops systemic, vascular resistance, and increases volume overload, causing LV dilation. Myocardial hypoxia with anemia can also directly injure the heart, decreasing contractile function, and causing compensatory LV dilation.
  • Anemia occurs by various mechanisms. First, less erythropoietin and inflammation (high ferritin, low iron) causes decreased red blood cell production. Second, uremia causes platelet dysfunction (bleeding) and red blood cell fragility, both increasing red blood cell loss.
32
Q

What do we do for patients with MI and bradycardia?

A

Atropine. Pacing if no response to atropine. Epinephrine contraindicated, because it increases myocardial oxygen demand.

33
Q

AC and inr goal for patients with prosthetic aortic vs mitral valve

A

Warfarin
Aorta with no risk fx - inr 2-3
Risk fx (af, low ef, hypercoag etc) or mitral - 2.5-3.5

34
Q

EKG findings in stemi

A

1mm in 2 contig leads except more in v2 and v3 or new lbbb and sx

Do pci within 2 hours or fibrinolytics

Step3 (21 decks)

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