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Step 2 CK > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Tx CAD

A
  • Always: ASA, statin, beta-blocker, ACE-i
  • Nitrate: if continued chest pain
    • CONT if R-sided infarct (leads II, III, avF)
  • Clopidogrel: if stented
    • x 1 mo for bare metal
    • x 1 yr for drug-eluting (best)
  • Heparin + Clopidogrel Load if
    • NSTEMI
    • High pretest probability CAD
  • Other:
    • Morphine - CONT in R-sided infarct (venodilator)
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2
Q

Drugs CONT in R-sided infarct

A
  1. Nitrate
  2. Morphine

Both are venodilators, decreasing preload. R-sided infarct is preload-dependent

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3
Q

Next step in R-sided infarct

A

IVF

(b/c it is preload-dependent and this will increase preload. Don’t be tricked by JVD. IVF is okay if no signs of pulmonary congestion)

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4
Q

If recent onset of CP, NSTEMI suspected, cardiac enzymes negative, what is the next step?

A

Repeat cardiac enzymes at 6 hours

Considered negative after 2 sets of negative enzymes

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5
Q

Troponins vs CK-MB

A
  • Troponins
    • rise more immediately
    • declines slower
    • peaks at 18 hours
  • CK-MB
    • Declines more quickly
    • Measure to test for repeat infarct
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6
Q

Drugs used for Pharm Stress Testing

A
  1. Dobutamine
  2. Adenosine
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7
Q

When to use different types of stress testing?

EKG, ECHO, Nuclear

A
  • EKG
    • Test of choice, no baseline abnormality
  • ECHO
    • EKG abnormalities. No CABG
  • Nuclear:
    • CABG, Baseline wall motion defects, BBB
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8
Q

Tx: Chronic CHF

A
  • Always: beta-blocker and ACE-i
  • Stage II: Add Furosemide
  • Stage III: 1 and 2. Add Spironolactone or Hydralazine + Isosorbide Dinitrate
  • Stage IV: Inotrope: Dobutamine or Milrenone. VAD bridge to transplant
  • Stage I-III and EF < 35%: AICD
  • Ischemic: Add Aspirin and Statin
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9
Q

Dx: Possible Chronic CHF

A
  1. BNP
  2. ECHO
  3. Left Heart Cath
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10
Q

Dx: Acute CHF Exacerbation

A
  • CXR: volume overload?
  • BNP
  • ECG and troponins: r/o ischemia/arrhythmia as cause
  • ECHO: not necessary but often done
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11
Q

Tx: CHF Exacerbation

A

“LMNOP”

  • L = Lasix
  • M = Morphine
  • O = Oxygen
  • P = Position

Note: initiating a beta-blocker during acute exacerbation is CONTRA (acutely decreases EF). If already on it, may continue

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12
Q

Differentiating CHF vs ARDS?

A

CHF = cardiogenic pulm edema; PCWP > 12

ARDS = non-cardiogenic pulm edema; PCWP < 12

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13
Q

HTN recommendations (JNC-8)

A
  1. >/= 60 + No Dz = 150/90 goal
  2. Everyone else = 140/90 goal
  3. CCB, Thiazide, or ACE-i as first line
  4. (>75) or AA = No Ace-i
  5. CKD = ACE-i/ARB (overrules #4)
  6. Don’t use beta blockers alone for HTN (add for CAD/MI)
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14
Q

Tx Hypertensive Urgency

A

PO Meds (hydralazine)

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15
Q

Tx: Hypertensive Emergency

A

IV Meds (Labatalol, CCB, Nitrates)

Rule: IV meds to decrease BP by 25% in first 2-6 hours. Then switch to PO with goal to reduce to normal within 24 hours.

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16
Q

Side effects of CCB

A

Peripheral edema

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17
Q

Side effects of ACE-i

A
  • Increase K
  • Increase Creat
  • Angioedema
  • Cough
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18
Q

Side effects of Thiazide diuretic

A
  • Decreased K
  • Gout
  • Urinary Freq
  • ***Stop if GFR decreased***
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19
Q

Side effects of Loop Diuretic

A
  • Decrease K
  • Urinary Frequency
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20
Q

Side effects of Beta Blocker

A

Decreased HR

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21
Q

Side effects of Arterial Dilators (ex Hydralazine)

A

Reflex tachycardia

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22
Q

Side effects of Aldosterone Ant (ex: spironolactone)

A
  • Increased K
  • Gynecomastia (switch to eplerenone)
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23
Q

HTN and Hypo-K

A

Hyperaldosteronism

  • Dx:
    • Aldo:Renin > 20
      • CT pelvis
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24
Q

HTN, renal bruit, hypo-K

A

Renovascular, 2ndary HTN

  • Dx
    • Creatinine Clearance
    • BMP
    • Aldo:Renin < 10
    • Renal artery U/S
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25
Q

HTN, palpitations, perspiration, pallor, pain

A

Pheochromocytoma

  • Dx:
    • Urinary metanephrines
    • CT
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26
Q

HTN, diabetes, central obesity, moon facies

A

Cushing’s

  • Dx:
    • Low dose dexamethasone suppression test
    • ACTH lvl
    • High dose dexamethasone
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27
Q

Name murmur & Tx

(Apex)

A

Mitral stenosis

(Opening snap, diastolic decresc. murmur)

Tx: Balloon Valvotomy

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28
Q

Name murmur & Tx

(R sternal border)

A

Aortic Stenosis

(Cresc/Decresc murmur in systole)

Tx: Valve replacement + CABG

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29
Q

Name Murmur & Tx

(Apex)

A

Mitral Valve Prolapse

(mid-systolic click)

Tx: beta blockers, avoid dehydration

30
Q

Name Murmur & Tx

(Apex)

A

Mitral Regurg

(holosystolic)

Tx: Valve Replacement

31
Q

Name murmur & Tx

(R sternal border)

A

Aortic Regurg (Insufficiency)

Diastolic decresc murmur

Tx: Valve Replacement + CABG

32
Q

Cause of mitral stenosis?

A

Rheumatic fever

(Past strep infxn)

33
Q

Murmurs that increase with squatting/leg lift

A
  1. Mitral Stenosis
  2. Aortic Stenosis
  3. Mitral Regurg
  4. Aortic Regurg

(Squatting/Leg lift = Causes increased preload)

34
Q

Murmurs that Increase with Valsalva

A
  1. Mitral Valve Prolapse
  2. Hypertrophic Obstructive Cardiomyopathy

(Valsalva increases Preload)

35
Q

Dx in any murmur

A

ECHO

36
Q

Dx Cardiomyopathy

A

ECHO

Possible Bx (Restrictive)

37
Q

Tx: Syncope on exertion in young athlete w/ family hx of sudden cardiac death

A

Hypertrophic Obstructive Cardiomyopathy

Tx:

  • Beta-blocker = CCB (diltiazem/virapamil)
  • EtOH ablation
  • Myectomy
  • All 1st degree relatives should be screened
38
Q

Tx Hypertrophic Cardiomyopathy

A

(NOT HOCM)

  • Beta-blocker = CCB
  • BP control

Note; Concentric hypertrophy on ECHO. HOCM has assymetric hypertrophy

39
Q

Tx: Restrictive Cardiomyopathy

A

Beta-blocker = CCB

Gentle Diuresis (Diastolic HF, so be careful)

40
Q

Dx: CHF + Peripheral Neuropathy

A

Restrictive Cardiomyopathy 2ndary to Amyloidosis

  • Dx:
    • Fat Pad/Gingival Bx
    • if (-), Myocardial Bx

Note: Assoc. w/ MM

41
Q

Dx: CHF + Lung Dz

A

Restrictive Cardiomyopathy 2ndary to Sarcoidosis

  • Dx:
    • Cardiac MRI
    • Endomyocardial Bx
42
Q

Dx: CHF + Cirrhosis

A

Restrictive Cardiomyopathy

  • Dx:
    • Ferritin
    • Cardiac MRI
    • Endomyocardial Bx
43
Q

Dx: CHF + MM

A

Restrictive Cardiomyopathy 2ndary to Amyloidosis

  • Dx:
    • Fat Pad/Gingival Bx
    • if (-), myocardial bx
44
Q

Dx: CHF + Bronze DM

A

Restrictive Cardiomyopathy 2ndary to Sarcoidosis

  • Dx:
    • Cardiac MRI
    • Myocardial biopsy
45
Q

Pt w/ positional CP that is Pleuritic and a Multiphasic Friction Rub. Dx and Tx?

A

Pericarditis

  • Dx:
    • EKG (first test)
      • PR segment depression (pathog)
      • Diffuse ST segment elevation
    • Best: MRI
  • Tx:
    • Best: NSAIDS + Colchicine
    • Colchicine only in CKD, Thrombocytopenia, PUD (anything that can’t have NSAID)
    • NSAID only if diarrhea with colchicine
    • Steroids if all else fails (High rate relapse). BAD in viral.
46
Q

Pt w/ positional CP + SOB. Dx and Tx?

A

Pericardial Effusion

  • Dx
    • ECHO
  • Tx:
    • Treat pericarditis (NSAIDS +/- Colchicine) b/c this is most likely etiology
    • Refractory: Pericardial window (allows to drain to thoracic cavity)
47
Q

Pt w/ JVD, Muffled Heart Sounds, Clear Lungs. Dx and Tx?

A

Pericardial Tamponade

  • Dx:
    • DON’T TAKE TIME FOR THIS
  • Tx:
    • Emergency Pericardiocentesis
48
Q

Pt w/ knocking on cardiac auscultation

A

Constrictive Pericarditis

(Pericardial Knock)

  • Dx: ECHO
  • Tx: Pericardiectomy
49
Q

Pt. w/ Syncope of sudden onset (no prodrome)

A

Arrhythmia

  • Dx:
    • EKG
50
Q

Pt w/ Syncope of sudden onset and Focal Neuro Deficit

A

Neurogenic: Vertebrobasilar Insufficiency

  • Dx:
    • CT angiogram
  • Tx:
    • Medical Management
    • Stenting
51
Q

Pt. w/ Sycope on Exertion

A

Mechanical Cardiac

  • Etiology
    • Aortic Stenosis
    • HOCM
    • LA Myxoma
    • Saddle Embolus
  • Dx:
    • ECHO
  • Tx:
    • Tx underlying dz
52
Q

Tx: Vasovagal Syncope

A

Beta-blockers

53
Q

Tx: Orthostatic Syncope

A

Rehydrate/Transfuse

Steroids if that fails

54
Q

Who needs a Statin?

A
  1. Vascular Dz = MI, CVA, PVD, CS
  2. LDL >/= 190
  3. LDL 70-189
      • Age 40-75
      • DM
  4. LDL 70-189
      • Age 40-75
      • Calculated Risk = 2 or more Risk Factors
        • Smoking
        • HTN
        • Obesity
        • Age >55 for women, >45 for men
        • DM
        • Dyslipidemia

***Start High-Intensity Statin (Atorvastatin, Rosuvastatin)

55
Q

Baseline Labs to Start Statins

A
  • HbA1c = q3mo
  • Lipids = annually
  • CK = at beginning and if symptoms
  • LFTs = at beginning and if symptoms
56
Q

Dx: Pt on statins and begins having muscle pain

A

Statin-Myositis?

  • Dx:
    • CK
    • U/A
57
Q

Who should get a moderate-intensity statin?

A
  • Liver Dz
  • Kidney Dz
  • Age > 75
  • Statin-Intolerance
58
Q

2nd Line Tx if can’t use Statin?

A

Fibrates

(Same side effect profile, same labs)

59
Q
A

SVT

distinguished from Sinus Tachy by HR > 150 and no p-waves

Tx: Adenosine

60
Q
A

V-tach

Tx: Amiodarone / Lidocaine

61
Q
A

Afib

Tx: beta-blocker = CCB (verapamil/diltiazem)

62
Q
A

Sinus Brady

Tx: Atropine

63
Q
A

1st Degree AV Block

Tx: Atropine

64
Q
A

2nd Degree AV Block Type 1

Tx: Atropine

65
Q
A

2nd Degree AV Block Type 2

Tx: Shock! (pace) (Atropine no longer works)

66
Q
A

3rd Degree AV Block

Tx: SHOCK (pace)

67
Q
A

Idioventricular Rhythm

Tx: SHOCK (pace)

68
Q
A

Torsades de pointes

Tx: Mg

69
Q

Tx: Valvular Afib

A

Warfarin + LMWH bridge

70
Q

Tx: Non-valvular Afib

A

Warfarin or NOAC, No LMWH bridge

71
Q
A

Step 2 CK (9 decks)

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