Cardiology 3 Flashcards
HF with reduced EF
<40%
Formerly systolic failure
HFrEF
HF with EF >/= 50%
Formerly diastolic hf
HFpEF
Causes of preserved EF
Pathologic hypertrophy Aging Endomyocardial disorder Restrictive cardio Fibrosis
Causes of high output states
Metabolic Thyrotoxicosis Nutritional disorder beri beri thiamine Excess blood flow requirement Systemic AV shunt Chronic anemia
Dec ventricular contraction
CAD, MI, myocarditis, dilated cardiomyopathy
Low EF
Systolic dysfunction
Nonconpliant ventricle Concentric LVH due to HTN restrictive cardiomyopathy LV overload due to AR, MR Normal to high EF + S4 gallop
Diastolic dysfunction
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
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
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
Cardiac disease with INABILITY to carry on any PA without discomfort
Anginal symptom even at rest
NYHA Class IV
Control of congestion Stabilize HR and BP -Candesartab (CHARM trial) -Digoxin and Nebivolol trial (ineffective) Improve exercise tolerance
HFpEF management
DOC to stabilize HR and BP in HFpEF
Candesartan
Cornerstone of therapy for HFrEF
RAAS blocker ACE/ARB
Beta blocker
Beta blockers that have beneficial effects to HFrEF
Carvedilol
Bisoprolol
Metoprolol succinate
HFrEF
Symptomatic NYHA II-IV give
ACEI or ARB + BB + Aldosterone antagonist (eple and spirono)
Avoid 4 drug tx
HFrEF drugs
Hydralazine Nitrate Ivabradine (Coralan) HR Na funny channels: Drug class Hyperpolarization Cyclic Activated Nucleotide-gated ch blockers Valsartan + Sacubitril ARNI Diuretics Aspirin
Endopeptidase inbitor
Angiotensin Receptor Neprilysin Inhibitor
Sacubitril
Nerve that transmits pain on MI
intercostobrachial nerve
TI-T4
Paroxysmal recurrent precordial or substernal chest pain causes by transient MI falls short of infarct
Angina pectoris
Most stable type of angina
Narrowing of CA atherosclerosis >75%
Transient chest pain precipitated by exertion, emotion, relieved by rest and vasodilator
Stable angina
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
