Cardiology Flashcards

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1
Q

Door to balloon time (PCI=angioplasty=stent)

A

under 90 minutes

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2
Q

Door to needle time (tPA=thrombolytics)

A

under 30 minutes

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3
Q

Absolute C/Is to thrombolytics

A

1) Bleeding, major (into bowel or brain = melena or h/o hemorrhagic CVA)
2) Surgery, recent (w/in past 2 wks)
3) HTN, severe (>180/110)
4) Stroke, non-hemorrhagic (w/in last 6 mon)

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4
Q

ACS tx mnemonic

A
MONA BASH
Morphine 
O2 
NTG (UNLESS R-sided MI or CHF) 
*ASA (Clopidogrel instead if ASA-allergic, Clopidogrel in addition if h/o stent) 

Bb (CCB instead if asthmatic, cocaine-induced MI, or Prinzmetal angina)
ACEI/ARB
Statin
Heparin (after thrombolytics/PCI to prevent restenosis)

*BEST FOR MORTALITY REDUCTION

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5
Q

CP + Chest wall tenderness (give dx and test)

A

Dx: Costochondritis
Test: PE

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6
Q

CP + Radiation to back, unequal BP b/w arms (give dx and test)

A

Dx: Aortic dissection
Test: contrast CT, TEE

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7
Q

CP + Pain worse w/ lying flat, better w/ sitting up, young age (give dx and test)

A

Dx: Pericarditis
Test: EKG shows ST elevation everywhere, PR depression

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8
Q

CP + Epigastric discomfort, pain better when eating (give dx and test)

A

Dx: Duodenal ulcers
Test: Endoscopy

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9
Q

CP + Bad taste, hoarseness, dry cough (give dx and test)

A

Dx: GERD
Test: none, just give PPIs and see if sx resolve

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10
Q

CP + Productive cough, hoarseness, hemoptysis (give dx and test)

A

Dx: PNA
Test: CXR

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11
Q

CP + Sudden-onset SOB, tachycardia, hypoxia (give dx and test)

A

Dx: PE
Test: spiral CT, V/Q

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12
Q

CP + Sharp pleuritic pain, tracheal deviation (give dx and test)

A

Dx: PTX
Text: CXR

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13
Q

Cardiac CP sx; typical vs atypical vs non-cardiac

A

1) Substernal pressure (crushing, dull, sore)
2) Worse w/ exertion
3) Better w/ rest and NTG

3/3=typical
2/3=atypical
1/3=non-cardiac

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14
Q

Statins A/Es

A

Elevations of LFTs (AST/ALT) in 1%, myositis or CPK elevation in 0.1%

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15
Q

Grading murmurs, when to workup, how to workup

A

I S1S2 > murmur
II S1S2 = murmur
III S1S2

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16
Q

Murmurs: Mitral Stenosis (MS) (path, pt, dx, tx)

A

Path: rheumatic heart dz
Pt: young (usu 30s); LAD –> A-fib, dysphagia (esoph comp), hoarseness (laryngeal n comp); CHF
Dx: MS. Opening Snap, Dia (mitral area)
Tx: balloon valvuloplasty (pt young, wait to surgically replace bc you’ll have to re-replace eventually)

17
Q

Murmurs: Aortic Regurg (AR) (path, pt, dx, tx)

A

Path: infxn or infarction (endocarditis or MI), HTN, Aortic dissection
Pt: CP; Acute: cardiogenic shock and flash pulm edema, Chronic: CHF
Dx: Dia Decrescendo, Left Lower sternal border (AR in LL)
Tx: Valve replacement (consider CABG); ACEI/ARBs or CCBs delay progression bc vasodilators

18
Q

Murmurs: Aortic Stenosis (AS) (path, pt, dx, tx)

A

Path: atherosclerosis –> calcification w/ aging; bicuspid aortic valve accelerates process
Pt: old man w/ atherosclerosis, CHF, syncope
Dx: Sys Crescendo-decrescendo (aortic area)
Tx: Valve replacement (consider CABG)

19
Q

Murmurs: Mitral Regurg (MR) (path, pt, dx, tx)

A

Path: infxn or infarction (endocarditis or MI), HTN, Marfans, Anky spondy, Reiter synd, Syphilis
Pt: CP; Acute: cardiogenic shock and flash pulm edema, Chronic: CHF and A-fib
Dx: HoloSystolic, Headbobbing, Water-hammer pulse, Wide pulse pressure
Tx: Valve replacement

20
Q

Consider CABG w/ which valve replacements?

A

Aortic, bc ostea of coronary vessels is just superior to aortic valve at root of Ao

21
Q

Anything that dilates the heart (HTN, infxn, infarction) can lead to what kind of murmur?

A

Regurg (MR and AR)

22
Q

Increase venous return (and therefore preload) how?

A

Squatting or leg lift

23
Q

Decrease venous return (and therefore preload) how?

A

Valsalva maneuver (bearing down against closed airway; generates thoracic pressure, impeding venous return of blood to heart –> dec preload; may be used to tx SVT)

24
Q

Define preload

A

Max vol of blood in LV at end diastole; think more blood coming into heart –> more preload!

25
Q

Define afterload

A

Max resistance LV must overcome to circulate blood; higher BP = higher afterload

26
Q

Murmurs: Hypertrophic Cardiomyopathy (HCM) (path, pt, dx, tx)

A

Path: HCM 2/2 longstanding HTN; HOCM 2/2 sarcomere mutations, hypertrophic septum + SAM of mitral valve –> LVOTO (aortic outlet blocked)
Pt: young athlete w/ SOB or syncope on exertion (at risk for sudden death; may have FHx)
Dx: Sys murmur +/- S4; sounds like AS, EXCEPT more blood makes it BETTER (murmur get softer w/ squatting or leg lift)
Tx: Bbs and avoid dehydration

27
Q

Murmurs: Mitral Valve Prolapse (MVP) (path, pt, dx, tx)

A

Path: congenital; 2-5% of population; valves too big and floppy –> balloons/parachutes out during systole but still touch, better when ventricle widens)
Pt: young female
Dx: Sys sounds like MR, EXCEPT more blood makes it BETTER (murmur get softer w/ squatting or leg lift)
Tx: Bbs and avoid dehydration

28
Q

What does squatting or leg lifts do to preload? How does that affect murmurs?

A

Squatting or leg lifts INCREASE preload (think of SQUEEZING blood back to heart)

MORE blood makes MOST Murmurs LOUDER (MR, AS, AR, MS)
Weird ones go away (MVP, HCM)