Cardiology Flashcards
When is family history significant in ischemic heart disease?
When the family member is young (female relatives < 65, male relatives < 55 yo)
What is the single worst/most dangerous risk factor for CAD?
DM
How does CAD present?
as chest pain that does NOT change with body position or respiration, NOT associated with chest wall tenderness
What diagnoses do you think of w/ pleuritic pain (changes with respiration)?
PE, PNA, pleuritis, pericarditis, PTX
What diagnosis do you think of with positional chest pain?
pericarditis
What diagnosis do you think of with chest wall tenderness?
costochondritis
A pt comes to ED w/ chest pain (epigastric), a/w sore throat, metallic taste, cough - what do you recommend?
PPIs
An alcoholic pt comes to ED w/ chest pain, N/V, epigastric tenderness. What do you recommend?
amylase and lipase levels
A patient comes to the ED with chest pain, RUQ tenderness, mild fever - what do you recommend?
abdominal U/S to look for gallstones
When CV exam shows S3 gallop, what do you think of?
dilated L ventricle; fluid overload states (CHF, mitral regurg); normal in patients <30
What CV exam shows S4 gallop, what do you think of?
L ventricular hypertrophy; HOCM
What is always the best first diagnostic test for ischemic CP?
EKG
If pt p/w ischemic CP and case gives you a choice b/w treatment first (ASA, nitrates, O2, morphine) and EKG, what do you choose first?
Tx!
What is the most accurate test for ischemic CP?
CK-MB or troponin (both rise 3-6 hrs after start of CP but CK-MB only stays elevated 1-2 days while troponin stays elevated for 1-2 weeks - therefore, CK-MB best test for reinfarction)
Which cardiac enzyme elevates first after MI?
myoglobin
When is stress testing the answer?
when the case is NOT acute and the initial EKG and/or enzyme tests are inconclusive
When are dipyridamole or adenosine thallium stress test or dobutamine ECHO ordered?
For patients who cannot exercise to a target heart rate of > 85% of maximum, complete LBBB, paced ventricular rhythm, preexcitation syndromes (WPW), > 1 mm ST segment depression at rest, LVH w/ repolarization changes, prior h/o revascularization
When is exercise thallium testing or stress ECHO ordered?
When EKG is unreadable for ischemia (L BBB, digoxin use, pacemaker in place, L ventricular hypertrophy, any baseline abnormality of the ST segment of the EKG)
What is the next best diagnostic test to evaluate for “reversible ischemia?”
angiography (note: “reversible ischemia” the most dangerous thing a stress test can show)
What is the best initial tx for all ACS cases?
ASA (lowers mortality) Note: nitrates and morphine do not
What therapies lower mortality in STEMI?
thrombolytics & primary angioplasty (but dependent on time)
In what time frame must angioplasty (a type of PCI) be done for a STEMI?
within 90 min of arrival at the ED
What if PCI cannot be performed within 90 min of arrival at the ED?
thrombolytics should be given (when CP < 12 hours, ST elevation in 2 or more leads, new LBBB) - need to be given w/i 30 min!
What other therapies should be given to ACS patients?
-beta blockers (lower mortality; timing of 1st dose not critical), ACE-Is or ARBs (lower mortality when there is L ventricle dysfunction or systolic dysfunction), statins