CARDIOLOGY Flashcards
Modifiable Risk Factors of Ischemic Heart Disease
Dyslipidemia Smoking (2x the risk) HTN Obesity DM
Uncontrollable Risk Factors of Ischemic Heart Disease
Age (W>65, M>55)
Males greater risk than females
Family History
MI Clinical Features
Chest pain (retrosternal, may radiate to arm, neck or jaw, crushing, constricting) Prolonged (>20 mins to hours) N/V Weakness, Dizziness, Palpitations Cold Sweat, impending doom
MI Physical Exam
No real findings typically
May have elevated BP, JVD, presence of S4, displaced PMI
MI Ddx
Pericarditis, PE, aortic dissection, costochondritis, esophageal rupture
MI Diagnostic Factors
Labs: leukocytosis
Echo: wall motion abnormalities
Cardiac Markers: CK
appears 3-6 hrs, lasts 2-4 days, peaks at 24 hrs
Cardiac Markers: Troponin
appears 2-4 hrs, lasts 5-12 days, peaks at 10-24 hrs
Cardiac Markers: Myoglobin
appears 1-2 hrs, lasts
MI EKG Findings
ST elevation (transmural) and Q waves, ST depression (subendocardial)
Inferior Wall
II, III, aVF - RCA
Lateral Wall
I, aVL, V5, V6- Circumflex
Anterior Wall
V2-V4, I, aVL-LCA
Posterior Wall
V1, V2 (ST dep) - RCA, Circumflex
MI Treatment
MONA-Hep-B Morphine Oxygen Nitrates Aspirin Heparin Beta-Blockers
MI Treatment: Antiplatelet Tx
Aspirin, Clopidogrel, thienopyridine, abciximab (glycoprotein inhibitors)
MI Treatment: ACEi
Cardioprotective, start in all patients with AMI, continue if LVH, or HF develops
MI Treatment: Heparin (indications)
Antithrombin Tx: inactivates thrombin and factor X
Indications: those not receiving thrombolytics, those with ST depression, those getting TPA
MI Treatment: Recanalization
PCI
PCTA
Fibrinolytics: need within 12 hrs (streptokinase)
ABSOLUTE Contraindications for Thrombolysis
active internal bleeding
recent head trauma or known intracranial neoplasm
Hx of hemorrhagic CVA
major surgery/trauma
Stable Angina Pectoris
Chest pain (lasts 5-15 mins, builds up rapidly)
worse with activity, relieved by rest
PE: normal or S4
Labs: cardiac enzymes negative
EKG: may show ST depression and T waves during pain
Dx: positive stress test
Tx: anti-platelets, BB, ACEi, revascularization with PTCA, CABG
Unstable Angina Pectoris
Chest pain not relieved by rest S/S: DOE, palpitations, fatigue, SOB, diaphoresis PE: normal or S4 Labs: cardiac enzymes normal EKG: non-specific changes Tx: ASA, BB, ACEi, revascularization
Acute Pericarditis
Chest pain (better with leaning forward), pericardial friction rub
Viral pericarditis: Coxsackie B virus is MCC
EKG: diffuse ST elevations with upright T waves
Tx: NSAIDs, ASA for pain, steroids if not better, usually self-limiting
Cardiac Tamponade Definition
Fluid builds up in pericardial sac, unable to fill cardiac chambers in diastoles leads to reduction of stroke volume and cardiac output which leads to hypotension which leads to shock and death.
Cardiac Tamponade
S/S: DOE, orthopnea, JVD, hypotension, muffled heart sounds, pulsus paradoxus
Dx: Echo: RA and ventricular collapse during diastole
Tx: drain fluid, tx pericarditis, pericardiotomy or windowplacement possible
Pericardial Effusion
Large effusions can show signs of cardiac tamponade, small effusions can by asymptomatic
S/S: diminished heart sounds, poss friction rub
Dx: CXR, EKG, echo
Tx: pericardiocentesis, maintain BP
Heart Failure
Inability of heart to pump sufficient blood to meet metabolic demands
MC Cause of CHF
CAD
R-Sided Heart Failure Causes
L-sided HF (90%), Pulmonary disease
THINK SYSTEMIC SX! JVD, edema, ascites
L-Sided Heart Failure Causes
MCC is HTN and CAD
THINK PULMONARY SX! dyspnea, orthopnea, rales
S/S of L-Sided HF
THINK PULMONARY SX! dyspnea, orthopnea, rales
MC sx is Dyspnea (orthopnea, paroxysmal nocturnal dyspnea)
rales, rhonchichronic nonproductive cough w/ pink frothy sputum
PE: HTN, cheyne stokes breathing, tachycardia, cool extremities
S/S of R-Sided HF
THINK SYSTEMIC SX! JVD, edema, ascites Systemic fluid retention peripheral edema JVD GI/hepatic congestion
Dx of HF
Best test-Echo (decreased EF, systolic-thin wall or diastolic-thick wall dysfunction
CXR-Kerley B Lines, cardiomegaliy, pleural effusions
BNP >100 means CHF is likely
Long Term Management of Heart Failure
Unless CI, all pts should be on an ACEi and Diuretic
Na restriction-
Acute Pericarditis
acute inflammation of the pericardium
MCC is viral (esp enteroviruses like coxsackie and echovirus)
Dresslers syndrome
autoimmune, idiopatic, systemic
Acute Pericarditis S/S
pleuritic chest pain (sharp & worse with inspiration)
Postural CP-relieved by leaning forward and worse lying down
Pericardial Friction rub-best heard at end of expiration
P’s of Pericarditis
Persistent
Pleuritic
Postural
Pericardial Friction Rub
Dx of Pericarditis
EKG: diffuse ST elevation in precordial leads, associated PR depressions in those leads
Echo: check for effusion or tamponade
Tx of Pericarditis
1st Line-Aspirin or NSAIDs x 7-14 days
2nd Line-Colchicine
Add corticosteroids if not responding to other management or sx>48 hrs
Tx of Dressler’s Syndrome
Aspirin or Colchicine
Pericardial Effusion (sx,dx,tx)
increased fluid in pericardial space
pericarditis is a common cause
s/s: distant heart sounds
Dx: echo shows increased pericardial fluid
CXR: cardiomegaly
EKG: low voltage QRS complexes, electric alterans (cyclic beat shift in QRS b/c heart is swinging in fluid)
Tx: small effusion-tx underlying cause, pericardiocentesis if tamponade or large effusion
Beck’s Triad
Muffled Heart Sounds
Hypotension
Increased JVP
Pericardial (cardiac) tamponade
pericardial effusion causes lo of pressure on the heart causing restriction of cardiac ventricular filling which leads to dec. cardiac output
-small rapidly evolving effusions are more dangerous than chronic ones
Pericardial (cardiac) tamponade (s/s, dx, tx)
S/S: becks triad (hypotension, muffled heart sounds, inc. JVP) pulsus paradoxus (a decreases in systolic BP >10mmHg)
Dx: echo-effusion and diastolic collapse of cardiac chambers
Tx: pericardiocentesis, add pericardial window if recurrent
Constrictive Pericarditis
thickened fibrotic calcified pericardium
S/S: MC is dyspnea
r-sided heart failure sx-JVD, edema, NV
Kussmauls Sign- Increased JVD during inspiration
Pericardial knock- high pitched 3rd heart sound
Dx: echo-pericardial thickening
CXR- pericardial calcification
Tx: pericardiotomy definitive, diuretics for sx
What is Pericardial Knock
high pitched 3rd heart sound because of sudden cessation of ventricular filling in early diastole from thickened inelastic pericardium (mistaken for S3 often)
