Cardiology #4 Flashcards
Best initial test for AAA
CT scan with IV contrast
(For those who are symptomatic, hemodynamically stable) to get size, presence, and extent
What is the recommendation for screening for AAA?
One-time screening via abdominal US in men 65-75 years of age who have ever smoked
What is the pathophysiology of AAA?
Proteolytic degeneration of aortic wall and connective tissue inflammation
Risk Factors for AAA
- Smoking
- Age > 60
- Men
- Caucasians
- Connective tissue disorder (Marfan)
- Hypertension
- Syphilis
If a patient has DM or CKD and hypertension, what medications are recommended?
ACEi, ARB
Hypertensive medications to use in AA?
Thiazides, CCB
Name some CCBs
- Amlodipine
- Diltiazem
- Verapamil
- Nicardipine
- Nifedipine
Name some ARBs
- Losartan
- Olmesartan
- Valsartan
- Telmisartan
With gout, what medications should be used in hypertension?
CCB
-Losartan is the only ARB that doesn’t cause hyperuricemia
If a patient has Raynaud’s, what hypertensive medication should also be used?
CCB
What hypertensive medications are likely to help A-fib?
BB, CCB
If a patient has hypertension and depression, what medications should be avoided?
BB
What is the treatment for a hypertensive urgency?
Clonidine
Captopril
However, with Clonidine, what is an adverse effect?
Rebound hypertension if discontinued abruptly (mimics Pheochromocytoma)
What are some examples of end-organ damage with hypertensive emergency?
- General: headache, dyspnea, AMS, n/v
- Neurologic: stroke, seizure
- Cardiac: Aortic dissection, acute heart failure
- Renal: acute kidney injury, hematuria
- Retinal: malignant hypertension, retinopathy
Adenosine MOA
-Slows AV node conduction time and blocks AV nodal reentry pathways
Amiodarone MOA
- Class III anti arrhythmic (K+ channel blocker) with class I through IV properties
- Prolongs action potential
Common side effect of Loop Diuretics (Furosemide)
Ototoxicity
What loop diuretic do you use in sulfa allergy or history of gout?
Ethacrynic Acid
What is one common side effect of Spironolactone?
Gynecomastia
What two drug classes should you NOT use in pregnancy?
ACE and ARB
Regarding CCB, what three endings should you look for to determine if a medication belongs to this class?
ZEM, PINE, MIL
Regarding CCB, what two drugs are NON-dihydropyridines and what is the MOA?
Verapamil, Diltiazem
Vasodilation and slow conduction through AV node leading to decreased cardiac conduction and contractility
Two major adverse reactions to CCB
Peripheral edema
Constipation
Headache
When should you NOT use CCB?
- Patients with LV dysfunction and CHF
- Patients with 2nd or 3rd degree heart block
- Patients taking BB (do not double up on decreasing contractility of the heart)
What are the cardio selective BB? (They only affect Beta-1 receptors)
BEAM
Bispoprolol
Esmolol
Atenolol
Metoprolol
What is true about Nonselective BB?
They affect Beta-2 receptors in the lungs and should be avoided in patients with COPD, asthma, etc.
Side effects of BB
- Can make the symptoms of hyperglycemia
- Fatigue, Impotence, Depression
What is Eisenmenger Syndrome?
Pulmonary HTN and cyanotic heart disease occurring when a left-to-right shunt switches and becomes a right-to-left shunt (cyanotic).
-Patients develop cyanotic lower extremities, cyanosis and clubbing of the feet
What is the MC innocent physiologic murmur?
Still Murmur
Describe a Still Murmur
Musical, vibratory, noisy, twanging best heard in inferior aspect of the LLSB and apex
What is Tricuspid Atresia?
Absence of tricuspid valve leads to hypoplastic right ventricle
-A PDA or VSD is necessary for pulmonary blood flow and survival
What does a CXR show with tricuspid atresia?
Normal or enlarged cardiac silhouette with DECREASED pulmonary flow
Treatment for Tricuspid Atresia
- Maintain patency of ductus arteriosus (prostaglandin E1 Alprostadil) to stabilize initially
- Surgical repair is definitive
MCC of subacute endocarditis
Strep Viridans
