Cardiology 3 Flashcards by Denisse Tiangco

HF with reduced EF
<40%
Formerly systolic failure

HFrEF

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HF with EF >/= 50%

Formerly diastolic hf

HFpEF

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Causes of preserved EF

Pathologic hypertrophy
Aging
Endomyocardial disorder
Restrictive cardio
Fibrosis

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Causes of high output states

Metabolic Thyrotoxicosis
Nutritional disorder beri beri thiamine
Excess blood flow requirement
Systemic AV shunt
Chronic anemia

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Dec ventricular contraction
CAD, MI, myocarditis, dilated cardiomyopathy
Low EF

Systolic dysfunction

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Nonconpliant ventricle
Concentric LVH due to HTN
restrictive cardiomyopathy
LV overload due to AR, MR
Normal to high EF + S4 gallop

Diastolic dysfunction

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Cardiac disease without limitation of physical activity
Ordinary PA does not cause fatigue, palpitation, dyspnea or angina

No symptom with ordinary exertion

NYHA Class I

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Cardiac disease with SLIGHT limitation of PA
Comfortable at rest
Ordinary PA results in fatigue, palpitation, dyspnea or angina

Ordinary activity causes symptoms

NYHA Class II

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Cardiac disease resulting in MARKED limitation of PA
Comfortable at rest
Less than ordinary PA causes fatigue, palpitation, dyspnea or angina

Asymptomatic at rest

NYHA Class III

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Cardiac disease with INABILITY to carry on any PA without discomfort

Anginal symptom even at rest

NYHA Class IV

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Control of congestion
Stabilize HR and BP
-Candesartab (CHARM trial)
-Digoxin and Nebivolol trial (ineffective)
Improve exercise tolerance

HFpEF management

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DOC to stabilize HR and BP in HFpEF

Candesartan

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Cornerstone of therapy for HFrEF

RAAS blocker ACE/ARB

Beta blocker

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Beta blockers that have beneficial effects to HFrEF

Carvedilol
Bisoprolol
Metoprolol succinate

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HFrEF

Symptomatic NYHA II-IV give

ACEI or ARB + BB + Aldosterone antagonist (eple and spirono)

Avoid 4 drug tx

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HFrEF drugs

Hydralazine Nitrate
Ivabradine (Coralan) HR Na funny channels: Drug class Hyperpolarization Cyclic Activated Nucleotide-gated ch blockers
Valsartan + Sacubitril ARNI
Diuretics
Aspirin

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Endopeptidase inbitor

Angiotensin Receptor Neprilysin Inhibitor

Sacubitril

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Nerve that transmits pain on MI

intercostobrachial nerve

TI-T4

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Paroxysmal recurrent precordial or substernal chest pain causes by transient MI falls short of infarct

Angina pectoris

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Most stable type of angina

Narrowing of CA atherosclerosis >75%

Transient chest pain precipitated by exertion, emotion, relieved by rest and vasodilator

Stable angina

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Acute Pericarditis ECG

Stage 1 widespread ST elevation PR depression
Stage 2 ST segment normalization
Stage 3 T wave inversion
Stage 4 Normalization

Most common type of pericarditis

Fibrinous

Costochondritis of rib cartilage

Tietze syndrome

Most serious cardiac arrhythmia

Ventricular fibrillation

Mumur audible with steth partially off the chest

5/6

Most persistent sign of infective endocarditis

fever

Nitrate in CHF is for

venous vasodilation

Most prominent sign in acute infective endocarditis

Fever

Most common manifestation of rheumatic fever

Arthritis

Corrigans Water Hammer pulse

Aortic regurgitation

Metabolic syndrome

Impaired FG Central obesity HTN

Aortic stenosis pulse

Pulsus parvus et tardus

ECG in Wolf Parkinson White

Accessory pathway in atria and ventricles along AV ring Short PR interval with delta wave Prolonged QRS

Cornerstone of HFrEF tx

ACEI + BB

Major rf for MI

HTN DM Smoking Dyslipidemia Not Obesity

Most common primary heart tumor

Rhabdomyosarcoma

AD | Multiple cardiac, extra cardiac, myoma, skin pigmentation, endocrine overactivity

Carney’s syndrome

Most common sx in holiday heart syndrome

Palpitation fr atrial fibrillation

No heart failure No rales or S3 (congestion sign) Mortality rate

Killip Kimbal Class I 6%

Heart failure Rales <50% lunges S3 Venous hypertension Mortality rate

Killip Kimbal Class II 17%

Severe heart failure: frank pulmonary edema Rales >50% lungs Mortality rate

Killip Kimbal Class III 38%

Cardiogenic shock: hypotension SBP = 90, peripheral vasoconstriction (oliguria, cyanosis, diaphoresis) Heart failure often with pulmonary edema Mortality rate

Killip Kimball Class IV 81%

Patients with high Killip Kimbal class

Had severe angiographic CAD Higher incidence of ventricular dysfunction Larger myocardial infarction

Soft Heard in all positions No thrill

Murmur grade II

Moderately loud | No thrill

Mumur grade III

Loud and associated with | palpable thrill

Murmur Grade IV

Loudest with thrill

Murmur Grade VI

Very faint Only by expert Not heard in all positions No thrill

Mumur Grade I

Weakening of the heart muscle (cardiomyopathy) Myopathy Intellectual disability Retinal changes In Females Lysosomal storage X linked dominant Defect in the wall of the lysosome

Cardiac Danon disease | X linked Vacuolar cardiomyopathy and myopathy

Deficiency in enzyme alpha-galactosidase ``` Febrile Angiokeratoma Burning pain (peripheral neuropathy) Renal failure Youth death Ceramide trihexoside accumulation Cardiovascular disease ```

Fabry disease

``` Cerebellar ataxia (spinal cord, DRG, heart hypertrophy) Frequent diabetes Loss of sensation in the arms and legs Impaired speech Cardiomyopathy Scoliosis ```

Friedreich’s ataxia | Spinocerebellar degeneration