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Cardiology Flashcards

1
Q

Drugs in Hypertensive crisis

A

1.Glyceryl trinitrate: 0.6 - 1.2 mg/hr infusion
2.Sodium nitroprusside: 0.3-10 ug/kg/min infusion
3.Hydralazine: 1.5-5 ug/kg/min infusion
4.Labetolol: 20mg/m max 200-300mg infusion

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2
Q

Goal of hypertensive crisis

A

Reduce BP within 24-36 hrs to 150/90

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3
Q

Goal for hypertensive emergency and define

A

BP >200/120 with TOD

Reduce BP by 20-25% within 1-2hrs using IV agents

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4
Q

Goal of hypertensive urgency and define

A

Reduce BP within 24-48hrs usually using oral drugs

BP >200/120 with no TOD

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5
Q

Heart failure treatment

A
  1. Bed rest: renal perfusion and diuresis
  2. Salt and fluid restriction
  3. Diuretics
  4. ACE-I (vasodilators)
  5. BB (start low and go slow)
  6. Digitalis
  7. Potent inotropic (dopamine, dobutamine, PDE-I amrinone)
  8. CRT
  9. Treat precipitating factors
  10. Treat complications (arrhythmias/ thrombosis)
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6
Q

Digitalis indication

A

Chronic heart failure on left systolic dysfuntion
Showing signs and symptoms while receiving standard therapy or AF pts

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7
Q

PCWP at 20 and 25mmHg?

A

@20= Interstitial edema (kerly B lines on CXR)
@25= alveolar edema (bat’s wing on CXR)

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8
Q

Causes of AHF

A
  1. Acute LVF - infraction/ myocarditis
  2. MS and aggravating factors as AF
  3. Acute MR
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9
Q

Frothy pink sputum

A

Pulmonary edema

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10
Q

Causes of high COP failure

A
  1. Wet beriberi
  2. Chronic severe anemia
  3. Thyroxtoxicosis
  4. Pregnancy
  5. AV fistula
  6. AR and MR
  7. Paget’s ds of bone

Note: increased tissue demand with semi diseased heart

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11
Q

Managment of acute LHF

A
  1. Bed rest, oxygenation and hospitalization
  2. Frusemide 40-80mg IV max 200mg
  3. Morphone 2-5mg/IV with metaclopramide 10mg/IV
  4. Venous venodilators: nitroglycerin 5-10ug/m
  5. Na Nitropruside max 20-30ug/min if HTN not less than 100mmhg Bp
  6. Dobutamine or dopamine
  7. IV digitalis if AF
  8. Aminophylline 5mg/kg IV infusion over 10min
  9. Tracheobronchial aspiration
  10. Ultrafiltration, rotating tourniquets, intra aortic balloon
  11. Treat precipitating factors
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12
Q

NYHA classification system of the heart failure symptoms

A

Class 1: no limitation of ordinary physical activity
Class 2: slight limitation with ordinary physical activity
Class 3: marked limitation less than ordinary activity lead to marked symptoms
Class 4: symptoms present at rest; cant carry out any physical activity without discomfort

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13
Q

Angina equivalent

A

Myocardial ischemia not presenting with anginal pain but with dyspnea, fatigue, faintness

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14
Q

Angina never to be

A
  1. Localized
  2. Stitching or throbbing
  3. <30sec or >30min (except unstable angina)
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15
Q

Anginal pain precipitated by

A
  1. Cold
  2. Exertion
  3. Heavy meal
  4. Vivid dreams (nocturnal angina)
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16
Q

Angina signs

A

S4
MR murmur
Xanthelasma or signs of anemia

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17
Q

Digoxin tox ECG

A

Sagging ST segment
Bigeminy
Ventricular tachy
Heart block
Extrasystoles

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18
Q

First symptom of digitalis tox

A

Anorexia

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19
Q

Treatment of digitalis tox

A

Stop drug
Give K
Digitalis Ab
Stop diuretics
Treat arrhythmias
Hemoperfusion

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20
Q

Coronary angiography

A

Diagnostic and theraputic
Stenosis > 70% significant

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21
Q

Cardiac scan

A

Assess coronary perfusion using thalium or technitium IV

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22
Q

Echocardiography in angina investigation

A

For ventirular function EF and wall motion abnormalities

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23
Q

Which vessels used in CABG

A
  1. Saphenous v.: right coronary and LCX
  2. Left Internal mammary artery : left main and LAD
  3. Right internal mammary artery: right CA
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24
Q

BB contraindicated in?

A

Prinzmetal angina
Bronchial asthma
DM
Peripheral artery ds

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25
Q

Good drug combination for IHD

A

BB + Nitrates
BB + amlodipine
Verapamil + nitrate
Deltiazem + nitrate

26
Q

Verapamil contraindicated

A

HF

27
Q

IHD bad drug combo

A

Nifedipine and nitrates
Verapamil and BB

28
Q

Nemodipine

A

CCB used in subarachnoid hemorrhage 30mg tab1-2times per day

29
Q

Verapamil side effects

A

Gingival hyperplasia
Constipation
HF
Heart block

30
Q

Intractable angina

A

Transmyocardial laser revascularization
TMR

31
Q

Non cardiovascular BB uses

A

Thyrotoxicosis
Migraine
Glaucoma (timolol)
Familial tremor
Parkinsonism
Anxiety
Portal hypertension

32
Q

Cardiovascular BB uses

A

Angina
Arrhythmias
HTN
MVP
Cyanotic spells

33
Q

BB side effects

A

Bronchospasm
HF
Heart block
Depression
Fatigue
Nightmares
Impotence
Sudden withdrawal : angina

34
Q

Types of MI

A

Transmural MI (with superimposed thrombus)

Subendocardial MI (without superimposed thrombus- ppt by hypoxia or hypotension)

35
Q

Causes of painless infarction

A

Diabetic neuropathy
Infarction in comatose
Infarction during anesthesia
Infarction with pulmonary edema
Elderly
Transplanted heart (denervated)

36
Q

Contra indications of anticoagulants

A

Pericarditis after MI may lead to hemoperocardium

37
Q

Down syndrome CVS

A

CAVC
ASD
VSD

38
Q

Rubella on heart

A

PDA
PS
ASD

39
Q

Most common congenital heart ds

A

VSD

40
Q

Pulmonary plethora

A

Increase of blood flow in the p. Arteries due to ASD VSD or so

41
Q

Pulmonary congestion

A

Increase of pressure in the pulmonary veins due to left side problem mostly

42
Q

Most common congenital cyanotic heart ds

A

Tetralogy of fallot

43
Q

Types of aortic dissection

A

Stanford Type A 75% ( DeBakey 1(60%) and DeBakey 2 (10-15%)

Stanford Type B 25% (DeBekey 3: 25-30%)

44
Q

Most common type of aortic dissection

A

Standford type A - DeBekey 1 / proximal type

45
Q

Causes/ risk factors of aortic dissection

A

HTN (most common cause
Atherosclerosis: causing intimal ulcer
Connective tissue ds (marfan and ehler danlos
Bicuspid aortic valve
Coarctation of aorta and aneurysm
Obestity, Smoking, Hypercholestrolemia
3rd trimester Pregnancy
High intensity weightlifting
Trauma

46
Q

Complications of Aortic dissection

A
  1. Aortic rupture and internal bleeding
  2. AR
  3. Unequal UL pressure /pulse
  4. Ischemic manifestation:
    - stroke, dizziness, syncope
    - acute MI
    - renal failure
    - paraplegia
    -mesenteric occlusion
47
Q

Differential diagnosis of chest pain and shock

A
  1. Extensive MI
  2. Massive pulmonary emblosim
  3. Tension oneumothorax
  4. Cardiac tamponade
  5. Aortic dissection
48
Q

Gold standard investigation for Aortic dissection

A

CT aortography

CT/MRI usually when pt is stable

49
Q

When to use TEE in aoric dissection

A

Pt very unstable/ CT & MRI contraindicated

50
Q

CXR of aortic disection

A

Loss of aortic knob
Wide mediastinum
Pleural effusion?

51
Q

Fatal medication with aortic disection

A

Thrombolytic therapy when thinking its MI

52
Q

Treatment of aortic dissection

A

Type A: Emergency Open heart surgery
Type B:
Complicated: TEVAR (thoracic endovascular aortic repair) / EVAR
Uncomplicated: medical conservative therapy

53
Q

Conservative therapy for aortic dissection

A

In acute/chronic Type B can be treated by these if uncomplicated:

  1. IV BB (esmolol) Lower BP <120 and HR 60
  2. Morphine for pain relief
  3. CCB if BB is contraindicated (diltiazam)
  4. CVD risk modification
  5. Close survelliance with imaging
54
Q

Aortic disection investigation

A

Stable pt: CT/MRI
Unstable pt: bedside echo w/wo TEE

55
Q

First thing to do in managment of A disection

A

Lower blood pressure

56
Q

What do you see on JVP curve in complete heart block? Why?

A

Cannon a wave due to atria and ventricles contracting together sometimes causing atrial contraction against closed valves

57
Q

Gaint a wave

A

Irregular cannon wave : atrio-ventricular dissociation (complete heart block)

Regular cannon wave: junction rhythm such as ventricular and supraventricular tachy

58
Q

CV wave fusion on jvp

A

Large systolic wave due to TR

59
Q

Prominent a wave

A

Delayed or restricted right ventricular filling, example, pulmonary hypertension, or tricuspid stenosis

60
Q

Kussmal’s sign

A

Paradoxical rise of JVP on inspiration seen in :
pericardial construction
tamponade
Severe right ventricular failure
restrictive cardiomyopathy

IM Flashcards (5 decks)

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