Cardiology Flashcards
what medication lower mortality in systolic dysfunction
ACE inhibitors/ARBs
Beta blockers
spironolactone/eplerenone
sytolic dysfunction treatment
ACE inhibitors/ ARBS beta blockers spironolactone diuretics Digoxin
What medications can be used instead of ACE - and ARBS that lowers mortality in patients with systolic dysfunction
Hydralazine/nitrates
Device for CHF that lowers mortality in systolic dysfunction
implantable defibrillator
Medications used in treatment of diastolic heart failure
Beta blocker
Diuretics
treatment of stable angina
Aspirin
bet blockers
nitrates
treatment for unstable angina/ non-ST elevation MI
aspirin beta blockers nitrates heparin GP IIb/IIIa inhibitors
Treatment for STEMI
aspirin beta blockers nitrates Thrombolytics heparin (only after thrombolytics)
Indiacations for using thrombolytics
STEMI or new LBBB
Start within 12 hours of onset of chest pain and within 30 minutes after arriving to the ER
indications for using clopidogrel or prasugrel
- Aspirin allergy
2. Acute MI
positive ionotropic agents used in patients with CHF
Dobutamine
Amrinone
Milrinone
indications for using implantable defibrillator
used in patients whose EF <35%
indications for biventricular pacemaker
Used when EF< 35% and QRS above 120msec.
maneuvers that work on preload (venous return)
Squatting & leg raise- increases venous return, therefore increases the intensity of murmur
Valsalva and standing up- decreases venous return therefore decreases intensity of the murmurs
maneuvers that work on Afterload
Handgrip
Amyl Nitrate
Effect of handgrip on afterload
Afterload functions as the opposite of ACE inhibitor (used to treat AR and MR)
-Handgrip increases afterload making AR and MR murmurs worse by pushing blood backward into the heart (increases intensity)
what murmurs increase in intensity with handgrip
AR, MR and VSD
effect on amyl nitrate on afterload
amyl nitrate causes vasodilation therefore decreases the intensity of AR, MR and VSD
had opposite affect of handgrip
Maneuvers that increase/ decrease HOCM and MVP
increased intensity with valsalva, standing and Amyl nitrate
decreased intensity with squatting, leg raise, handgrip
effect of handgrip on AS mumur
softens the murmur of aortic stenosis
Handgrip increases afterload therefore the ventricle cannot empty out. If the ventricle cannot empty, there wont be a murmur
effect of amyl nitrate on AS
increases intensity of AS
-amyl nitrate decreases afterload and decreases the pressure in the aorta, thus increasing blood flow from the ventricle to the aorta cause an increase in intensity
Treatment for regurgitant murmurs
ACE-, ARBs, nifedipine
Diuretics can also be used
Management of stenotic murmurs
Best initial: Diuretics
anatomic defect therefore balloon valvuloplasty or valve replacement should be performed eventually
when is surgery indicated in asymptomatic patients with AR
EF 55mm
when is surgery indicated in patients with MR
EF 40mm
best therapy for ASD
percutaneous or cath devices
murmur associated with pregnancy and immigrants (rheumatic fever)
Mitral stenosis
Therapy for PAD
Aspirin
Ace inhibitors
CILOSTAZOL
