Cardiology Flashcards by Viviana Castaneda

Stable angina

-Predictable CP that occurs during exercise
-goes away with rest
-lasts less than 15 minutes

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Describe unstable angina

-unpredicted CP that occurs at rest
-does not go away with rest

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Management for stable angina

-low pretest likelihood: stress test
-high pretest likelihood: cath
-risk modification
-NTG

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Management for unstable angina

NTG
Aspirin
Anticoag

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Types of HF

-Systolic: Reduced EF (less than 40)
-Diastolic: Preserved EF (over 50)

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symptoms of left sided HF

-DOE
-PND
-orthopnea
-crackles

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symptoms of right sided HF

-JVD
-ascites
-peripheral edema

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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

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Dx of HF

-CXR
-echo

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Dx studies for acute decompensated HF

elevated BNP
chest XR: Kerley B lines, effusions
Echo is most helpful diagnostic tool

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Tx for HF

-diuretics
-SGLT2 (flozins)
-ACE/ARB/ARNI
-BB

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In HF, if EF is less than 35% what would you use

defibrillator

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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)

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acute HF s/s

PICS

-Pink frothy sputum
-Inspiratory rales
-Cyanosis
-Severe dyspnea

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management of acute HF

-oxygen
-IV loop diuretics
-NTG

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CAD workup

EKG

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STEMI management

-NTG and ASA
-cath
-PCI + plavix
-Tpa + UFH if PCI not available

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etiology of endocarditis

-oral procedures
-IVDU

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MC organisms for endocarditis

IVDU: staph aureus
Native valve: streptococci, S. aureus (mitral valve)

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MC valve for IVDU endocarditis

tricuspid

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s/s of endocarditis

from jane

-fever, chills
-SOB
-murmur
-petechiae
-splinter hemorrhages
-janeway lesions
-osler nodes
-roth spots

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PE for endocarditis
(FROM JANE)

MC: Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Emboli

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janeway lesions vs osler nodes

-janeway: painless patches on palms or soles
-osler: painful nodules on pads of fingers

(osler, OW!!)

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diagnostic criteria of endocarditis

-positive blood culture
-evidence on echo
-symptoms present

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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

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 ## Footnote 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

Tx of sustained vtach | HR >100 bpm ## Footnote 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