Cardiology Flashcards
Door to balloon time (PCI=angioplasty=stent)
under 90 minutes
Door to needle time (tPA=thrombolytics)
under 30 minutes
Absolute C/Is to thrombolytics
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)
ACS tx mnemonic
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
CP + Chest wall tenderness (give dx and test)
Dx: Costochondritis
Test: PE
CP + Radiation to back, unequal BP b/w arms (give dx and test)
Dx: Aortic dissection
Test: contrast CT, TEE
CP + Pain worse w/ lying flat, better w/ sitting up, young age (give dx and test)
Dx: Pericarditis
Test: EKG shows ST elevation everywhere, PR depression
CP + Epigastric discomfort, pain better when eating (give dx and test)
Dx: Duodenal ulcers
Test: Endoscopy
CP + Bad taste, hoarseness, dry cough (give dx and test)
Dx: GERD
Test: none, just give PPIs and see if sx resolve
CP + Productive cough, hoarseness, hemoptysis (give dx and test)
Dx: PNA
Test: CXR
CP + Sudden-onset SOB, tachycardia, hypoxia (give dx and test)
Dx: PE
Test: spiral CT, V/Q
CP + Sharp pleuritic pain, tracheal deviation (give dx and test)
Dx: PTX
Text: CXR
Cardiac CP sx; typical vs atypical vs non-cardiac
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
Statins A/Es
Elevations of LFTs (AST/ALT) in 1%, myositis or CPK elevation in 0.1%
Grading murmurs, when to workup, how to workup
I S1S2 > murmur
II S1S2 = murmur
III S1S2
Murmurs: Mitral Stenosis (MS) (path, pt, dx, tx)
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)
Murmurs: Aortic Regurg (AR) (path, pt, dx, tx)
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
Murmurs: Aortic Stenosis (AS) (path, pt, dx, tx)
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)
Murmurs: Mitral Regurg (MR) (path, pt, dx, tx)
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
Consider CABG w/ which valve replacements?
Aortic, bc ostea of coronary vessels is just superior to aortic valve at root of Ao
Anything that dilates the heart (HTN, infxn, infarction) can lead to what kind of murmur?
Regurg (MR and AR)
Increase venous return (and therefore preload) how?
Squatting or leg lift
Decrease venous return (and therefore preload) how?
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)
Define preload
Max vol of blood in LV at end diastole; think more blood coming into heart –> more preload!
Define afterload
Max resistance LV must overcome to circulate blood; higher BP = higher afterload
Murmurs: Hypertrophic Cardiomyopathy (HCM) (path, pt, dx, tx)
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
Murmurs: Mitral Valve Prolapse (MVP) (path, pt, dx, tx)
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
What does squatting or leg lifts do to preload? How does that affect murmurs?
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)
