Cardiology #2 Flashcards
Diagnostics for CAD
-ECG, Stress Testing, Coronary Angiography (gold)
Treatment for CAD
- Aspirin, BB, Nitro, Statin
- Revascularization is definitive
Regarding revascularization, what are the two options?
- (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
Acute Coronary Syndrome is chest pain not relieved by rest of Nitro and lasts longer than 30 minutes. What three people have silent MI?
Diabetes, pregnancy, elderly
Treatment for ACS
- ECG within 10 minutes
- Door to thrombolytics within 30 minutes
- Door to PCI within 90 minutes
- MONA
If cocaine induced ACS, what medications should be avoided?
BB due to vasospasm
What is Prinzmetal Angina?
-Chest pain at rest (MC at midnight and early morning), not exertion. Transient ST elevations that resolve with CCB.
If a patient has gout, what medication should be used for hypertension?
CCB
If a patient is african american, what medications should be used for hypertension?
-Thiazides, CCB
If a patient has A-fib, what medications should be used for hypertension?
BB, CCB
Three Beta-1 selective drugs reduce mortality from HF. Name them.
Bisoprolol, Carvedilol, Metoprolol Succinate
Systolic vs Diastolic Heart Failure Symptoms
Systolic: S3 gallop, low EF
Diastolic: S4 gallop, preserved EF
What is a hypertensive Urgency and what is the treatment of choice?
> 180 and/or > 120 with no end-organ damage
-Clonidine
What is the rate of MAP reduction in a hypertensive urgency?
25% over 24-48 hours with oral medications
Treatment goal is < 160/100 mm Hg
What is a Hypertensive emergency and what is the treatment of choice?
> 180 and/or > 120 with end-organ damage
-IV Sodium Nitroprusside +/- BB (Esmolol, Labetolol)
What is the rate of reduction of MAP in a hypertensive emergency?
10-20% over the first hour, then 5-15% over next 23 hours
What is postural (orthostatic) hypotension and what is the treatment of choice?
> 20 mmHg and/or > 10 diastolic when standing
Fludricortisone
-Midodrine or Droxidopa if no response to Fludricortisone
Preventative maintenance of orthostatic hypotension
- Increase salt and fluid intake
- Gradual position changes
- Compression stockings
- Caffeine may be helpful
- Discontinue offending medications
What ABG is present in shock and why
Metabolic acidosis due to cells producing lactic acid as a product instead
Hypovolemic shock symptoms and treatment
- Pale cool skin, slow capillary refill, low skin turgor, dry mucous membranes, hypotension
- Insert 2 large bore IV lines –> Crystalloid solution fluid
Treatment for cardiogenic shock
Small amounts of IVF, Dobutamine/Epinephrine
What valves are MC affected in Endocarditis
- Mitral
- Tricuspid if IVDU
Organisms for Endocarditis
- S. Aureus with normal valves and IVDU
- S. Epidermidis with prosthetic valves
- S. Viridans with abnormal valves
Symptoms of Endocarditis
MRS FOJS
- New onset Murmur
- Roth Spots
- Splenomegaly
- Fever
- Osler Nodes
- Janeway Lesions
- Splinter Hemorrhages
Duke Criteria for Endocarditis (MAJOR AND MINOR). Need 2 Major or 1 Major and 3 Minor.
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)
What other diagnostics do you need for endocarditis?
- 3 blood cultures 1 hour apart
- TEE more sensitive than TTE
Treatment for Endocarditis
- Native valve: Nafcillin/Oxacillin + Ceftriaxone/Gentamicin
- Abnormal Valve: Vanco + Gent + Rifampin
Treatment is for 4-6 weeks
Causes of Pericarditis
- Idiopathic
- Viral (Coxsackievirus and Echovirus)
Symptoms of Pericarditis (4P)
-Positional (worse with supine), Pericardial Friction Rub, Pleuritic, Persistent
Diagnostics for Pericarditis
-ECG: Diffuse ST elevations in V1-V6 with PR depressions
Treatment for Pericarditis
NSAID or Aspirin
What is the diagnostic of choice for pericardial effusion
Echo
CXR: water bottle heart
-ECG: electrical alternans, low QRS voltage
Treatment for pericardial effusion
Pericardiocentesis if large
What are the symptoms of cardiac tamponade
Beck’s Triad: hypotension, JVD, muffled heart sounds
Echo of cardiac tamponade show
-Pericardial effusion + diastolic collapse of cardiac chambers
Treatment for cardiac tamponade
Pericardiocentesis to remove pressure
Aortic Stenosis Murmur
Systolic crescendo-decrescendo murmur heard at RUSB radiating to carotid artery
Treatment for aortic stenosis
Aortic valve replacement
Aortic Regurgitation Murmur
Diastolic blowing decrescendo murmur best heard at LUSB, high-pitched
Treatment for Aortic Regurgitation
Treatment: afterload reduction (ACE, ARB, Hydralazine)
-Surgical therapy is definitive
Mitral Stenosis Murmur
Low-pitched, mid-diastolic rumbling murmur heard at apex with prominent S1 and opening snap
MCC of mitral stenosis
Rheumatic Heart Disease
Treatment for mitral stenosis
percutaneous balloon valvuloplasty
Mitral Regurgitation
Blowing holosystolic murmur at apex with radiation to axilla
- Echo and catheter
- Treatment: ACE, ARB, surgical repair
MVP
Mid-late systolic ejection click best heard at apex
- Panic attacks, atypical chest pain, palpitations
- Reassurance and BB for treatment
Pulmonic Stenosis
Murmur increases with inspiration
- Harsh mid-systolic ejection crescendo-decrescendo murmur radiates to neck
- Balloon valvuloplasty
Pulmonic Regurgitation
Graham-Steell murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration
-No treatment needed
AAA
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
Aortic Dissection
CT angiogram used first
- Unequal blood pressure in both arms
- Treatment
- Ascending: Surgical
- Descending: BB (Labetolol) with Sodium Nitroprusside
DVT
Virchow’s Triad
- Anticoagulation is first-line treatment
- IVC filter for recurrent, or if anticoagulation is contraindicated (pregnancy, malignancy)
Chronic Venous Insufficiency
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
