Cardiology Flashcards
-same symptoms of angina but SOB instead of pain, what is ur dx?
(-ve troponin )
-angina equivalent
-pt with MI, after 2 hours starting ttt, HR 40 pb 80/50 what to give first???
IV atropine sulphate , even before IV fluid! repeat until HR corrected up to 3 times
ACS management?
Ideal time frame , for tpa in MI and stroke?
-PCI?
-MI (best after 30 min and CI after 12 hs)
-stroke (during the first 4 hs and 30 min after symptoms start)
PCI: 90 mins (best) to 120 min
Atrial fibrillation, wanted to stop anticoagulants due to what ever the reason, what is ur next step?
Chad score (cha2ds2-vasc)
PCI for MI, anticoagulants should be given, what types of anticoagulants u will give to this pt???
Clopidogrel for one year, aspirin for life!!!
In ACS when to use heparin??
See the pic
In ACS when to use heparin??
See the pic
-What medication in ischemic HD will reduce mortality??
-What medication in CHF will reduce mortality??
- note: all BB here is cardio selective*
First, IHD :
ABC,
-Aspirin and ACE inhibitors
-BB
-Stain(c)
حسب الافضلية: عباس ABAS
1- aspirin
2- BB
3-ACEI
4-statin
Second,CHF: effectivety arranged:
1- Acei, ARBs
2-BB
3-SGLT, Spironolactone
Most modifiable risk factor for MI???
-HTN (mc)
DM (most serious)
Smocking
BMI
Chad score more than 2 + valvular a fib (mc mitral stenosis) , which anticoagulants is preferred?
-warfarin
-DOAC
Warfarin , usually DOAC is preferred over warfarin except in valvular A fib or prosthetic valve!
-CHF presents with AFib , HR 140 bp normal, what to give next??
-stable pt ,hospitalized, u notice A fib on monitor (just developed) what is ur next step?
-BB ,best BB given is cardio selective (MBC) best one of them is Bisoprolol
-Cardioversion (see the pic)
HR more than 200 , narrow complex tachycardia , regular,dx??
-best next step in this case if patient is hypotensive?
-SVT
-cardioversion
SVT pt , stable, next step???
Vagal manoeuvre (carotid massage ,valsalva )
Valsalva better than massage
-CHF pt decompensated( pt has ascites ) on acei and furosemide, best next step??
-CHF pt NOT decompensated( pt has no ascites ) on acei and furosemide, present with hypotension , Labs :high creatinine and FeNa 0.6% best next step??
-iv diuretics then if failed therapeutic paracentesis .
-IV fluid carefully
FeNa:
Less than 1 is pre renal cause
More than 1 is renal cause
بيشنت متنفخ
ER, CHF ,SOB,Orthopnea, hepatomegaly, LL edema ,basel crackles , best medication to give?
وايد قوي
Furosemide
Best HTN ttt in
1 african:
2 Non african:
3 Old pt:
4 Young pt:
5 DM or CKD : (same medication)
6 CHF or CAD :
7 essential tremors or Hyperthyroidism or migraine +HTN?
1 -Thiazide type of diuretic, or CCB
2 -ACEIs and CCB
3 -CCB
4 -ACEi
5- ACEi
6- ACEi
7- BB
-Acei side effect?
-Pt on acei, creatinine increased, when to stop the drug?
-see the pic
- stop if pt basal creatinine increased more than 30%
Thiazide other names??
مصر والهند
-Best medication to prevent cardiovascular events???
-PAD initial and diagnostic tests??
-Aspirin
-initial > US doppler +ABI (< 0.5 severe ,need emergency intervention ttt)
Diagnostic >conventional angiography
Post MI , severe unilateral leg pain ,dx?
Acute arterial emboli, after MI or A fib, can cuz stroke or AKI
If bilateral (atherosclerosis)»_space;acute arterial thrombosis
MC organism in IE in:
1-prosthetic valve?
2- native valve
- IV drug abuser?
1- depend on time
See the pic
2-staph viridans
3 staph aureus
1-Least frequently congenital HD associated with infective endocarditis?
2-Most frequently congenital HD associated with infective endocarditis?
3-Most common congenital anomaly of heart??
1- ASD
2- VSD
3- VSD
IE prophylaxis, when to give?
Pt with tonsillectomy, valve prolapse, what antibiotics should be given?
1- see the pic
2- no need
Note**
Another indication for for antibiotics prophylaxis is , Cardiac transplant surgery with valve regurgitation!
Decresendo diastolic murmur, what might be the cause?
Aortic/Pulmonary regurgitation or Mitral/tricuspid stenosis
Early diastolic murmur,pistol sound in femoral artery , wide pulse pressure dx??
Aortic regurgitation
mc murmur with rheumatoc fever?
MR
note
MC cause of mitral stenosis is :
Rheumatic fever
MC murmur in rheumatic fever?
Mitral regurgitation
What is the Cardiac murmur that can decrease with valsalva manoeuvre with hand grip ?
AS
1-The best next step to confirm a diagnose of all valvular Heart diseases??
2- The most sensitive test for all valvular Heart diseases??
1- Transthoracic Echo
2- Transesophageal Echo
What are the indications for aortic valve replacement?
See the pic
What the the :
1-Best
2-next
Step in suspected Cardiac tamponade ?
1- ECHO
2- x ray
Cardiac tamponade beck triad ?
Kussmaul sign, what are the 2 diagnoses come to ur mind???
What are the differences between cardiac tamponade and cardiac pericarditis presentations?
Highest diagnostic value for constrictive pericarditis ?
Cardiac CT, (Ca around the heart)
1 -Syncope while coughing or micturition, ECG is normal, what is the next?
2-? Syncope proceeded by nausea , vomiting, and fear , ECG is normal, what is the next?
1 and 2 ,Education and reassurance
Pt hx of syncope, family hx of sudden cardiac death, pt has murmur ,norma ECG, what is the next step??
ECHO
note
If family hx or sudden cardiac death, do ECHO
Old age pt, persistent bradycardia with hypotension, what is ur approach?
1- atropin ,if not work:»
2- repeat atropin, up to 3 times»
3- transcutaneous pacing»
4- dopamine or epinephrine»_space;
5- transvenuos pacing
50 y o, coronary artery ca score is 45%, on atorvaastatin, vit d3 and aspirin, wjat u should stop?
-Aspirin, don’t give aspirin in pt less than 70 and ca score less than 100%
What is the difference between NSTMI and unstable angina?
Inferior MI pt suddenly hypotensive , what is the cause?
Next step?
-RV infarction, SA node and AV node infarction
Rt sided ECG
Hypotension post MI+ bradycardia+increased JVP+ clear lung, dx????
Initial Ttt??
How to confirm dx?
Rt ventricular MI
Ttt is IV Fluid +positive inotrops (dopamine, doputaime)
CI is nitrite
Rt sided ECG
Ttt used for rhythm control of atrial fib??
Amiodarone
Dilated cardiomyopathy, now he had A fib, best ttt?
BB!
Pt on warfarin ,high INR, developed subdural hemoatoma, what to give?
Answer: see pic
note normal INR = 0.9 -1
Gaol INR if pt take warfarin = 2-3
Goal of INR if pt have prosthetic valve=3-4
Pt , chest pain, diffuse ST elevation, “smily face” , dx and ttt??
Pericarditis
NSAID, and consider colchicine .
Infective Endocarditis ttt???
Native:
Vancomycin +(gentmicine or ceftriaxone)
Prosthetic :
Vancomycin +(gentmicine or rifampin)
Give me 2 conditions that will increase the mortality rate associated with Severe symptomatic AS
1- development of sympathetic HF
2- pumlonary HTN
Most preventable risk factor for:
1 dyslipidemia /MI
2 HTN
3 mostly all other diseases
1 smocking (can decrease risk after cessation in 1 year by 50%, decrease risk 100% by 2 years)
2 high BMI > best to control is»_space;weight loss
3 DM control -most serious-
Post MI , streptokinase was given, pt developed hemptysis , most appropriate next step??
It’s a complication of thrompolytic , give transexamic acid and aminocaprioc acid
HTN ttt in less than 55 what?
ACEi
Black people HTN ttt?
Thiazide CCB
What are the acute complications of MI (within 24 h) ?
Complication of MI after 24 h??
ECG!!!
Types of heart block difference between each other?
Al has PR interval prolongation!
Nyha classification of HF??
Pt with TIA , admission decision will be based on what???
More than 3 , admit .
Ischemic stroke , high blood pressure, , what is the target for bp control?
180/105
What is the goal of hypertension ttt in patient with
Ischemic stroke with no TPA ttt
Ischemic stroke with TPA
hemorrhagic stroke
بكون سعيده جدا واموت بسلام لو جاوبتوها كلها صم
schemic stroke with no TPA
(Permissive HTN> 220/110(
Ischemic stroke with TPA
(<180/ 105)
hemorrhagic stroke
Systolic 160-140
Angina pain, decrease pain after nitroglycerin, what contributed to pain relief???
Decrease afterload
Young woman , transient angina symptoms,dx?
Ttt?
Variant angina
CCB
LDL goal in DM pt with IHD??
Less than 70
Criteria to diagnose Rheumatic heart disease?
V5,v6 , l
Have ST elevation, which cardiac wall had infarcted ?
Lateral wall
Difference between early and late MI induced pericarditis?
Management??
Difference between SA ,UA,NSTEMI,STEMI??
Difference between SA ,UA,NSTEMI,STEMI??
HF , asymptomatic,A fib on ECG, what to give?
HF , acute , symptomatic , A fib, what to give?
1- BB
2- BB is contra indicated! Give digoxin.
-Early diastolic murmur?
-Mid diastolic murmur?
-Both together in the same pt?
-Aortic/polu regurgitation
-Tricuspid or mitral stenosis
-aortic regurgitation
Type of valvular disease that have the worst prognosis in pregnancy due to high complications ?
A. AS
B. MS
C. AR
D. AS
Mitral stenosis
Q
Mention 2 high intensity statin
And 1 low intensity
Q: what class of statin you will give for
- diabetic alone
- diabetic + LDL 170
- anyone with LDL 200
- TIA patient
Q
TPA (alteplase )
Indication
Mention 4
STEMI
massive PE
Stroke in first 4.5 hr
PAD
Q: The 2 indication of using defibrillation ?
A:
Pulseless VT
VF
Q: what is the antiplatelet of choice in patient
Going to PCI
glinting to fibrinolytic ?
A:
Patient treated by PCI, or not treated by any reperfusion therapy > Ticagrelol
Patient treated by fibrinolytics > clopidogrel
Q: what is the anticoagulant of choice in patient
Going to PCI
glinting to fibrinolytic ?
A:
Patient treated by PCI > UFH
Patient treated by fibrinolytics > LMWH (enoxaprin)
Q: complete the blank
In patient with chest discomfort
Ideally 12 lead ECG should be done within ……. and if not diagnostic with high clinical suspicion should be repeated every …….
A:
In patient with chest discomfort
Ideally 12 lead ECG should be done within ….10 min… and if not diagnostic with high clinical suspicion should be repeated every …15 min….
To dx u need 2 out of 3: (acute stemi)
Typical hx
ECG finding
Cardiac enz
Answer is :C
To dx u need 2 out of 3: (acute stemi)
Typical hx
ECG finding
Cardiac enz
Answer is :C
When discharging patient after MI what to give medication?
The combination of fever and new murmur
Suggest ?
IE
Systolic ejection murmur ddx???
Aortic stenosis
Hypertrophic cardiomyopathy > (increase with standing and valsalva)
