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PANCE/EOC > Cardiology #2 > Flashcards

Cardiology #2 Flashcards

1
Q

Diagnostics for CAD

A

-ECG, Stress Testing, Coronary Angiography (gold)

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2
Q

Treatment for CAD

A
  • Aspirin, BB, Nitro, Statin

- Revascularization is definitive

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3
Q

Regarding revascularization, what are the two options?

A
  • (1 or 2 vessels): percutaneous transluminal coronary angioplasty
  • (left main coronary artery or 3 vessels or if the patient is diabetic): coronary artery bypass graft
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4
Q

Acute Coronary Syndrome is chest pain not relieved by rest of Nitro and lasts longer than 30 minutes. What three people have silent MI?

A

Diabetes, pregnancy, elderly

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5
Q

Treatment for ACS

A
  • ECG within 10 minutes
  • Door to thrombolytics within 30 minutes
  • Door to PCI within 90 minutes
  • MONA
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6
Q

If cocaine induced ACS, what medications should be avoided?

A

BB due to vasospasm

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7
Q

What is Prinzmetal Angina?

A

-Chest pain at rest (MC at midnight and early morning), not exertion. Transient ST elevations that resolve with CCB.

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8
Q

If a patient has gout, what medication should be used for hypertension?

A

CCB

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9
Q

If a patient is african american, what medications should be used for hypertension?

A

-Thiazides, CCB

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10
Q

If a patient has A-fib, what medications should be used for hypertension?

A

BB, CCB

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11
Q

Three Beta-1 selective drugs reduce mortality from HF. Name them.

A

Bisoprolol, Carvedilol, Metoprolol Succinate

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12
Q

Systolic vs Diastolic Heart Failure Symptoms

A

Systolic: S3 gallop, low EF
Diastolic: S4 gallop, preserved EF

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13
Q

What is a hypertensive Urgency and what is the treatment of choice?

A

> 180 and/or > 120 with no end-organ damage

-Clonidine

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14
Q

What is the rate of MAP reduction in a hypertensive urgency?

A

25% over 24-48 hours with oral medications

Treatment goal is < 160/100 mm Hg

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15
Q

What is a Hypertensive emergency and what is the treatment of choice?

A

> 180 and/or > 120 with end-organ damage

-IV Sodium Nitroprusside +/- BB (Esmolol, Labetolol)

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16
Q

What is the rate of reduction of MAP in a hypertensive emergency?

A

10-20% over the first hour, then 5-15% over next 23 hours

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17
Q

What is postural (orthostatic) hypotension and what is the treatment of choice?

A

> 20 mmHg and/or > 10 diastolic when standing

Fludricortisone

-Midodrine or Droxidopa if no response to Fludricortisone

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18
Q

Preventative maintenance of orthostatic hypotension

A
  • Increase salt and fluid intake
  • Gradual position changes
  • Compression stockings
  • Caffeine may be helpful
  • Discontinue offending medications
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19
Q

What ABG is present in shock and why

A

Metabolic acidosis due to cells producing lactic acid as a product instead

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20
Q

Hypovolemic shock symptoms and treatment

A
  • Pale cool skin, slow capillary refill, low skin turgor, dry mucous membranes, hypotension
  • Insert 2 large bore IV lines –> Crystalloid solution fluid
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21
Q

Treatment for cardiogenic shock

A

Small amounts of IVF, Dobutamine/Epinephrine

22
Q

What valves are MC affected in Endocarditis

A
  • Mitral

- Tricuspid if IVDU

23
Q

Organisms for Endocarditis

A
  • S. Aureus with normal valves and IVDU
  • S. Epidermidis with prosthetic valves
  • S. Viridans with abnormal valves
24
Q

Symptoms of Endocarditis

A

MRS FOJS

  • New onset Murmur
  • Roth Spots
  • Splenomegaly
  • Fever
  • Osler Nodes
  • Janeway Lesions
  • Splinter Hemorrhages
25
Q

Duke Criteria for Endocarditis (MAJOR AND MINOR). Need 2 Major or 1 Major and 3 Minor.

A

MAJOR: 2 positive blood cultures, Echo showing positive vegetation or new valvular regurgitation.

MINOR: Fever, Predisposing condition (IVDA, abnormal valves), Immunologic phenomena (Osler, Roth, RF), Vascular Phenomena (Janeway)

26
Q

What other diagnostics do you need for endocarditis?

A
  • 3 blood cultures 1 hour apart

- TEE more sensitive than TTE

27
Q

Treatment for Endocarditis

A
  • Native valve: Nafcillin/Oxacillin + Ceftriaxone/Gentamicin
  • Abnormal Valve: Vanco + Gent + Rifampin

Treatment is for 4-6 weeks

28
Q

Causes of Pericarditis

A
  • Idiopathic

- Viral (Coxsackievirus and Echovirus)

29
Q

Symptoms of Pericarditis (4P)

A

-Positional (worse with supine), Pericardial Friction Rub, Pleuritic, Persistent

30
Q

Diagnostics for Pericarditis

A

-ECG: Diffuse ST elevations in V1-V6 with PR depressions

31
Q

Treatment for Pericarditis

A

NSAID or Aspirin

32
Q

What is the diagnostic of choice for pericardial effusion

A

Echo
CXR: water bottle heart
-ECG: electrical alternans, low QRS voltage

33
Q

Treatment for pericardial effusion

A

Pericardiocentesis if large

34
Q

What are the symptoms of cardiac tamponade

A

Beck’s Triad: hypotension, JVD, muffled heart sounds

35
Q

Echo of cardiac tamponade show

A

-Pericardial effusion + diastolic collapse of cardiac chambers

36
Q

Treatment for cardiac tamponade

A

Pericardiocentesis to remove pressure

37
Q

Aortic Stenosis Murmur

A

Systolic crescendo-decrescendo murmur heard at RUSB radiating to carotid artery

38
Q

Treatment for aortic stenosis

A

Aortic valve replacement

39
Q

Aortic Regurgitation Murmur

A

Diastolic blowing decrescendo murmur best heard at LUSB, high-pitched

40
Q

Treatment for Aortic Regurgitation

A

Treatment: afterload reduction (ACE, ARB, Hydralazine)

-Surgical therapy is definitive

41
Q

Mitral Stenosis Murmur

A

Low-pitched, mid-diastolic rumbling murmur heard at apex with prominent S1 and opening snap

42
Q

MCC of mitral stenosis

A

Rheumatic Heart Disease

43
Q

Treatment for mitral stenosis

A

percutaneous balloon valvuloplasty

44
Q

Mitral Regurgitation

A

Blowing holosystolic murmur at apex with radiation to axilla

  • Echo and catheter
  • Treatment: ACE, ARB, surgical repair
45
Q

MVP

A

Mid-late systolic ejection click best heard at apex

  • Panic attacks, atypical chest pain, palpitations
  • Reassurance and BB for treatment
46
Q

Pulmonic Stenosis

A

Murmur increases with inspiration

  • Harsh mid-systolic ejection crescendo-decrescendo murmur radiates to neck
  • Balloon valvuloplasty
47
Q

Pulmonic Regurgitation

A

Graham-Steell murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration
-No treatment needed

48
Q

AAA

A

Smoking is the main modifiable risk factor, age > 60, Caucasians, males

  • Abdominal flank or back pain, flank ecchymosis if symptomatic
  • CT scan with IV contrast is best initial test
  • Abdominal US for asymptomatic patients to monitor progression
  • Treatment: Immediate surgical repair if > 5.5 cm or 0.5 cm expansion in 6 months
  • Screening: Abdominal US in men 65-75 years old who have ever smoked
49
Q

Aortic Dissection

A

CT angiogram used first

  • Unequal blood pressure in both arms
  • Treatment
    • Ascending: Surgical
    • Descending: BB (Labetolol) with Sodium Nitroprusside
50
Q

DVT

A

Virchow’s Triad

  • Anticoagulation is first-line treatment
  • IVC filter for recurrent, or if anticoagulation is contraindicated (pregnancy, malignancy)
51
Q

Chronic Venous Insufficiency

A

leg pain worsened with prolonged standing

  • leg pain improved with ambulation and leg elevation
  • Statis dermatitis (browning and purplish color of skin), medial malleolus MC location, depending pitting leg edema
  • Treatment: leg elevation, compression, exercise

PANCE/EOC (63 decks)

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