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Medicine Clerkship > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Stable Angina

A

Chest discomfort due to myocardial ischemia. Occurs with exacerbation, relieved by rest.

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2
Q

What determines myocardial demand for O2?

A

HR, SBP, contractility, LV wall stress

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3
Q

Why does subendocardium get ischemic during tachycardia?

A

Because it receives its blood during diastole, so when tachycardia occurs, diastole preferentially shortens

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4
Q

Most common cause of stable angina

A

Vasospasm, AS, HOCM, HTN

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5
Q

How to treat asymptomatic patients with moderate framingham risk?

A

Daily aspirin

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6
Q

Is it recommended to treat women with hormone replacement to prevent heart disease?

A

No

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7
Q

Is it recommended to test homocysteine?

A

No

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8
Q

How to screen for CAD?

A

Dont do it.

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9
Q

How to determine typical vs atypical vs nonanginal cp?

A

Retrosternal
Relieved by rest/nitro
Exacerbated by activity or stress

1 is nonanginal
2 is atypical
3 is typical

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10
Q

How to use stress testing to diagnose angina?

A

Patients with low probability don’t require stress test, patients with high probability should be started immediately on medical management. Patients with intermediate pretest probability should receive stress test.

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11
Q

How to choose a stress test?

A

Patients with baseline changes in EKG shouldn’t get EKG stress, patient’s who can’t exercise need chemical stress.

Dipyridamole for nuclear perfusion, dobutamine for echo

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12
Q

Contraindications for EKG exercise stress

A

LBBB, ST depressions, WPW, LVH or on digoxin

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13
Q

Contraindications for echo

A

LVOT obstruction
Wall motion abnormalities
Obese

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14
Q

Contraindications for nuc perfusion

A

Asthma
hypotension
conduction disease

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15
Q

Goal of exercise or chemical stress

A

To achieve 80% of max heart rate.

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16
Q

Coronary angiography

A

Goal standard for patients at high risk or abnormal stress tests. Though patients with abnormal stress tests can be managed medically.

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17
Q

Therapy for chronic stable angina

A

1) lifestyle modifications

2) Antianginal meds + vascular protective meds

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18
Q

Initial medication regimen for chronic stable angina

A

Beta blocker, aspirin, long acting nitrate, statin (high intensity for >75, moderate intensity for

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19
Q

How to manage chronic stable angina if symptoms persist on first pass?

A

Increase B blocker dose, increase nitrate dose, add CCB.

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20
Q

How to manage chronic stable angina if symptoms persist on second pass?

A

consider ranolazine, refer for angio

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21
Q

Should antiplatelet agents besides aspirin be used in chronic stable angina?

A

No, only if contraindication to aspirin

22
Q

Is PCI effective in chronic stable angina?

A

Not effective in reducing mortality, but effective in controlling symptoms and increasing quality of life.

23
Q

How to follow up patients with stable angina?

A

Repeat EKG’s not recommended if there hasn’t been a change in symptoms or meds.
Repeat stress test contraindicated unless there is a change in symptoms

24
Q

How to work up a patient with anginal chest pain

A

Get an ekg, if positive, stemi, then cath or TPA
If negative, then get biomarkers, if those are positive, then NSTEMI, cath if TIMI 3-7. If negative then eventually get a stress test.

If biomarkers are negative, then UA. Geta stress test eventually.

25
Q

How to treat ACS patients

A 
MONA BASH
Morphine
O2
Nitro
Aspirin + clop

Beta blocker
Acei
Statin
Heparin

26
Q

Sinus arrest

A

2 or more seconds of pause on EKG

27
Q

Sick sinus syndrome

A

AKA brady tachy. SA nodal disease where bradycardia or pauses are followed by SVT or Afib

28
Q

Indications for pacing

A 
Symptomatic bradycardia (5sec
Alternating bundle branch blocks
29
Q

How to treat AV blocks with bradycardia?

A

Atropine

30
Q

First degree heart block

A

PR>200ms. Usually asymptomatic but associated with heart failure and death.

31
Q

Second Degree heart blocks

A

Mobitz I - wenchybach

Mobitz II - Dropped beats without Pr elongation, defect is within ventricular conduction system
Pace

32
Q

Third degree heart block

A

Complete P and Q dissociation. QRS can be wide or narrow. Pace.

33
Q

SV arrhythmias

A

Can be regular (SVT) or irregular (Afib/aflutter/mat)

34
Q

SVT

A

Patient has palps, syncope, dyspnea, fatigue
HR usually >150, no P or T waves.
Tx: adenosine or shock

35
Q

Afib

A 
No p waves
If unstable: shock
If stable: rhythm control = rate control
For rhythm: if Afib for  cardiovert
If afib >48 hours, TTE ->TEE, cardiovert if no LA thrombus
36
Q

Torsades

A

Wide complex, give mag

37
Q

Vtach

A

Wide complex, treat with shock or amio

38
Q

How to work up heart failure

A

EKG, Echo, BNP, LH cath if new and acute

39
Q

How to treat CHF (everybody)

A

H2O

40
Q

How to treat NYHA class III or IV

A

Add spironolactone, add furosemide, add ISDN or hydralazine

41
Q

How to treat CHF if EF

A

Defibrillator placement

42
Q

How to treat CHF if in ICU?

A

Dobutamine

43
Q

How to work up CHF exacerbation

A 
Get EKG, Echo, BNP, Trop
If stemi, LH cath +MONABASH
If negative, not CHF 
If positive, its a true exacerbation and treat with LMNOP
Lasix, morphine, O2, Nitro, Position
44
Q

How to conduct ACLS if patient has a pulse?

A

Arrhythmia (everything but sinus tach or NSR)? Symptomatic? No? Give IVF, O2 and Tele. If symptomatic, check if stable. If SBP>90 and no AMS or CP, then stable. Give drugs: Amiodarone for wide and fast, adenosine for narrow and fast, atropine for slow.
If not stable, then shock or pace.

45
Q

Diastolic murmurs

A

Mitral stenosis, aortic regurgitation

46
Q

Mitral stenosis (Path, sxs, murmur, tx)

A

Path: Rheumatic heart disease
Sxs: CHF, Afib
Murmur: Diastolic rumble with opening snap
Tx: Balloon valvuloplasty, then replace

47
Q

Aortic regurgitation

A

Path: Infection, infarction, aortic dissection.
Acute presentation: Cardiogenic shock, flash pulm
Chronic: CHF, Chest pain
Murmur: Diastolic at base
Tx: Acute: Emergent replacement
Chronic: Urgent replacement

48
Q

Systolic murmurs

A

Mitral insufficiency, aortic stenosis

49
Q

How to treat carotid stenosis if asymptomatic?

A

Surgery or stent if stenosis >70%

50
Q

How to treat carotid stenosis?

A

Surgery or stent if stenosis >50%

Medicine Clerkship (12 decks)

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