Cardiology Flashcards
Stable angina
-Predictable CP that occurs during exercise
-goes away with rest
-lasts less than 15 minutes
Describe unstable angina
-unpredicted CP that occurs at rest
-does not go away with rest
Management for stable angina
-low pretest likelihood: stress test
-high pretest likelihood: cath
-risk modification
-NTG
Management for unstable angina
NTG
Aspirin
Anticoag
Types of HF
-Systolic: Reduced EF (less than 40)
-Diastolic: Preserved EF (over 50)
symptoms of left sided HF
-DOE
-PND
-orthopnea
-crackles
symptoms of right sided HF
-JVD
-ascites
-peripheral edema
NYHA classifications (functional and structural)
1: no limitation of physical activity (asymptomatic)
2: slight limitation (symptoms with ordinary activity)
3: moderate limitation (asymptomatic only at rest)
4: symptoms at rest
Dx of HF
-CXR
-echo
Dx studies for acute decompensated HF
elevated BNP
chest XR: Kerley B lines, effusions
Echo is most helpful diagnostic tool
Tx for HF
-diuretics
-SGLT2 (flozins)
-ACE/ARB/ARNI
-BB
In HF, if EF is less than 35% what would you use
defibrillator
Management for acute decompensated HF
BiPAP: inc oxygenation, inc work of breathing, dec. preload/afterload
NTG: decrease preload/afterload
Furosemide: diuresis
Hypotension w/o signs of shock: dobutamine (may worsen hypotension)
Severe hypotension with signs of shock: norepinephrine (inc systemic vascular resistance, inc HR, inc BP, inc myocardial oxygen demand)
acute HF s/s
PICS
-Pink frothy sputum
-Inspiratory rales
-Cyanosis
-Severe dyspnea
management of acute HF
-oxygen
-IV loop diuretics
-NTG
CAD workup
EKG
STEMI management
-NTG and ASA
-cath
-PCI + plavix
-Tpa + UFH if PCI not available
etiology of endocarditis
-oral procedures
-IVDU
MC organisms for endocarditis
IVDU: staph aureus
Native valve: streptococci, S. aureus (mitral valve)
MC valve for IVDU endocarditis
tricuspid
s/s of endocarditis
from jane
-fever, chills
-SOB
-murmur
-petechiae
-splinter hemorrhages
-janeway lesions
-osler nodes
-roth spots
PE for endocarditis
(FROM JANE)
MC: Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Emboli
janeway lesions vs osler nodes
-janeway: painless patches on palms or soles
-osler: painful nodules on pads of fingers
(osler, OW!!)
diagnostic criteria of endocarditis
-positive blood culture
-evidence on echo
-symptoms present
management of endocarditis
IVDU
prosthetic valve
native valve
-native valve: gent +pen g (UTD: Vanc+Ceftriaxone)
-IVDU: gent+ vanc+ nafcillin
-prosthetic valve: gent + vanc+ rifampin
endocarditis prophylaxis
amoxicillin prior to dental or respiratory tract procedures
treatment for sinus arrhythmia
none
treatment for sinus bradycardia
pacemaker
What is sick sinus syndrome also known as?
tachy-brady syndrome
Tx for sick sinus syndrome
pacemaker
Tx for sinus tach
BB
treatment for 1st degree AV block or 2nd type 1
none
Tx for 1st degree AV block or 2nd type 1
none
treatment for 2nd degree type 2 or 3rd degree
pacemaker
tx of PAC
BB or CCB
Describe a PVC. + What is it most commonly caused by?
Early, wide, “bizarre” QRS, no P wave seen
Most commonly caused by SA node dysfunction (rosh)
Tx of PVC
Pacemaker and medication for rate control (BB)
Tx of PSVT
HR 120-200 beats per minute
Vagal maneuvers
adenosine
cardioversion if hemodynamically unstable
Tx of ectopic atrial arrhythmias
BB or CCB
What is the most common sustained dysrhythmia in adults?
A fib
Describe A fib
No discernable p waves
irregularly irregular
uncoordinated atrial activity
MC sustained dysrhythmia in adults
Variable ventricular response rate
Tx of stable afib
Rate control (diltiazem, metoprolol)
rhythm control
anticoag (if condition persists >48 hrs, patient should be anti coagulated for 21 days prior to cardioversion)
Tx of unstable A fib
synchronized cardioversion
CHADS2VASc score
0: no anticoagulant
1: ASA
2: oral anticoagulation
Tx of atrial flutter
same as a fib
treatment of junctional arrhythmia
tx underlying cause
Tx of accelerated idioventricular rhythm
none
Tx of nonsustained Vtach
BB
Tx of sustained vtach
HR >100 bpm
stable
unstable
pulseless
Stable: amiodraone
Unstable: cardioversion
Pulseless: defibrillation``
Brugada
RBBB + ST elevation
Management of brugada
ICD implantation
If a patient is hemodynamically unstable….
cardioversion
(rosh said: a fib, a flutter, WPW syndrome, PSVT, V tach)
tx of v fib
defibrillation
tx of LBB
none
Tx of RBB
none
Elevated lipid levels
total: >200
triglycerides: >150
LDL: >100
HDL: <60
Tx for HLD in ASCVD patients
high intensity statin
treatment of HLD for patients with LDL >190
high intensity statin
treatment of HLD for patients 40-75 without DM and LDL is 70-189
-calculate ASCVD risk
-probably moderate intensity
-lifestyle management if low risk
treatment of HLD for patients 40-75 with DM and LDL>70
moderate intensity statin
indications for hypertriglyceridemia management
-triglycerides between 175-499: lifestyle modifications
->500 or ASCVD risk: statin therapy
HTN classifications
-normal: <120 /and <80
-elevated: 120-129/<80
-stage 1: 130-139/80-89
-stage 2: >140/>90
s/s of PAD
-claudication
-limb ischemia
-ulcers
-diminished pulses
dx of PAD
ABI
<0.9 indicates >50% stenosis
<0.4 indicates ischemia
interpretation of ABI
-1.4: noncompressible and atherosclerosis
-1.4-1: normal
-.99-.91: borderline
-.9-.7: PAD
gold standard peripheral vascular imaging
digital subtraction angiography
tx of PAD
-lifestyle modifications
-ASA or plavix
Cilostazol
s/s of acute arterial occlusion
-pallor
-pain
-pulseless
-paralysis
-poikilothermia
-paraesthesia
management of acute occlusion
immediate revascularization (within 3 hrs of symptoms) and IV heparin
irreversible tissue damage at 6 hrs
s/s of buergers disease
digital ischemic pain
ischemic ulcers
MC plantar and digital vessels of foot/leg
Buergers disease typical presentation
Male, cigarette smokers, <40 yo
involves distal extremeties causing severe ischemia, progressing to tissue loss
tx of buergers dx
tobacco cessation
tx of varicose veins
compression stockings
s/s of chronic venous insufficiency
-pitting edema
-taut, shiny skin at the ankle (d/t edema)
-stasis dermatitis
-ulcers
tx of chronic venous insufficiency
compression stockings
s/s of superficial venous thromphlebitis
-redness and tenderness along superficial vein
-palpable cord
treatment of superficial venous thrombophlebitis
-NSAIDs
-elevation and warm compress
-if over 5cm, anticoagulation
Cram the pance Diastolic murmurs
s/s of aortic stenosis
-harsh systolic murmur
-radiates to carotids
treatment of aortic stenosis
-surgery if symptomatic
s/s of aortic regurg
-rumbling diastolic murmur
-radiates to apex
treatment of aortic regurg
-surgery if symptomatic
-vasodilators
MCC of mitral stenosis
rheumatic fever
s/s of mitral stenosis
-diastolic murmur at apex
-opening snap
treatment of mitral stenosis
BB and diuretics
sign of mitral regurgitation
-systolic murmur that radiates to the axilla and back
treatment of mitral regurg
-vasodilators
-diuretics
sign of MVP
-midsystolic click followed by late systolic murmur
treatment of MVP
-mild: none
-severe: repair or replacement
MCC of tricuspid stenosis
rheumatic heart disease
signs of tricuspid stenosis
-diastolic murmur on the left sternal border
-increases with inspiration
murmers on R side of heart increase w RINspiration
treatment of tricuspid stenosis
diuretics
s/s of tricuspid regurg
-systolic murmur at left sternal boarder
treatment of tricuspid regurg
treat underlying cause
s/s of pulmonic stenosis
-systolic murmur at pulmonic post
-opening click
treatment of pulmonic stenosis
-mild: asymptomatic
-moderate: surgery
s/s pulmonic regurgitation
-diastolic murmur pulmonic post
treatment of pulmonic regurg
-treat pulmonary HTN
