Cardiology Flashcards
Chest pain on normal coronaries
Microvascular dysfunction
Treatment of severe mitral regurgitation
Reduce left ventricular volume:
Ace(arb), beta blocker, aldosterone inhibitors
Ascending aorta aneurysm requires repair
5.5 cm
SVT terminated by vagal maneuvers
Atrioventricular nodal reentrant tachycardia
Cannon a waves
Dissociation of AV conduction
Widened QRS due to
- SVT with aberrancy
- Pre-excited tachycardia
- VT
Ventricular Tachycardia
- Positive in aVR
- QRS morphology concordant (all predominantly positive or negative) in precordial leads
- Exhibit extreme axis deviation
Severe mitral stenosis
Valva area < 1.5 cm2
Mitral gradient > 5-10 mmHg at normal heart rate
PASP > 50 mmHg
Beta blockers with mortality effects
Bisoprolol
Carvedilol
Metoprolol succinate
Acute limb ischemia
Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia (coolness)
Paralysis
HFpEF pathophysiology
- LV hypertrophy
2, LV fibrosis - Chronotropic incompetence
- Microvascular dysfunction
- Inflammation
HFpEF
Elevated filling press
Structural abnormalities LVH, LAE
elevated BNP
DDX from HFpEF
- Restrictive CMP
- Hypertrophic CMP
- Storage disease
- Pericardial disease
- Valvular heart disease
- Primary RV failure
Causes of restrictive heart disease
- Amyloid
- Hemochromatosis
- Sarcoidosis
- Endomyocardial fibrosis
- Radiation/chemotherapy
Comorbidities in HFpEF
- Htn
- Obesity
- DM/prediabtes
- Chronic kidney disease
- Afib
- Chronotropic incompetence (left ventricular strain)
- Decrease oxygen uptake
Chronotropic incompetence
the inability of the heart to increase its rate commensurate with increased activity or demand
Treatment HFpEF
- Diuretic (1)
- SGLT2 inhibitors (2a)
- ARNI (2b)
- MRA (2b)
- ARB (2b)
Heart Failure
Goal of diuretic
> 100-150 ml/hr
CHF
Diuretic combination
Loop diuretic -double dose (2-2.5 x home diuretic divided into twice day(titrate q12-24hrs(max960mg/d)
Metalazone (low K, increamortality)
Acetazolamide (500 mg iv daily)
SGLT2 inhibitors
Increase in creatinine and congestion improved
Metra M et al Circ Heart Failure 2012; 5:54
Cardiac sarcoidosis
FDG, PET, cMRI, endometrial biopsy