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ROSH REVIEW > Cardiology > Flashcards

Cardiology Flashcards

1
Q

HTN

  1. Stage 1
  2. Stage 2
  3. Comorbidities & Tx
    1. CAD
    2. CHF
    3. Smoke/Kidney/LIver
A
  1. Stage 1: >140/90 => THZ/CCB/ACEi/ARB
  2. Stage 2: >160/100 => THZ + Comorbid conditions
  3. Comobrid tx
    1. CAD = BB + ACEi + Nitrate/CCB
    2. CHF = BB + ACEi + Isonitrite/Spiranolactone
    3. Smoke/kidney/liver = ACEi/ARB
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2
Q

HTN Tx

  1. Goals x 2
  2. Rules x 3
A

JNC 8 Treatment for HTN

  • BP goals:
    • Age < 60 or Diabetic/CKD: 140/90
    • Age > 60: 150/90
  • Treatment: #1 is always lifestyle modifications
    • Nonblack: THZ, CCB, ACE-i > ARB
    • Black or >75: THZ, CCB
    • CKD (+/- DM): ACEi/ARB (even if old/black)
  • Medications
    • THZ (Chlorthalidone)
    • CCB (-dipine)
    • ACEi (-pril)
    • ARB (-sartan)
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3
Q

torsades de pointes

A
  • ECG will show rhythm > 100 bpm + frequent QRS axis/morphology variation
  • Mcc acquired or congenital long QT interval syndrome (drugs or hypokalemia)
  • Treatment is
    • Unstable: defibrillation
    • Stable: intravenous magnesium sulfate and stopping the offending drug
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4
Q

Arrhythmia => palpitations, dizziness, syncope, SCD

  • Caused by: prolonged QT or Hypokalemia/Hypomagnesemia
A

torsades de pointes = form of polymorphic ventricular tachycardia. fluctuating amplitude of the QRS complexes which appear to twist around the isoelectric line => V.fib

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5
Q
A

Left Bundle Branch Block

  • ECG will show:
    • Wide QRS >.12 sec
    • Broad, slurred R in V4 and V6
    • Deep S in V1 and V2
    • ST elevations in V1 - V3
  • Comments: New LBBB + Chest Pain = MI until proven otherwise
  • Cause: Senile fibrosis of conduction system, chronic HTN/ischemia/CHF and valvular disease
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6
Q

Bundle Branch Blocks

Lt vs Rt

A

Bundle branch blocks are abnormal conduction abnormalities (not rhythm disturbances) in which the ventricles depolarize in sequence, rather than simultaneously, thus producing a wide QRS complex (> 120 msec) and a ST segment with a slope opposite that of the terminal half of the QRS complex.

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7
Q

Tetralogy of Fallot

A
  • Patient with a history of episodes of cyanosis (tet spells) and squatting for relief
  • PE will show pulmonic stenosis, right ventricular hypertrophy, overriding aorta, VSD
  • CXR will show “boot-shaped” heart
  • Comments: Most common cyanotic congenital heart disease
  • Mnemonic: PROVe:: Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
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8
Q
A

Supraventricular Tachycardia

  • All tachydysrhythmias that arise above the bifurcation of the bundle of His
  • Characteristics:
    • Atrial rate 120-200
    • Rhythm: regular
    • Narrow QRS
  • Causes
    • Pre-excitation syndromes (WPW)
    • Mitral disease
    • Digitalis toxicity
    • Drugs and toxins
    • Hyperthyroidism
  • Treatment:
    • Vagal maneuvers (Valsalva)
    • Adenosine (first-line medication), ßBs, CCBs
    • Unstable: synchronized cardioversion
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9
Q

Premature Atrial Contractions (PACS)

A
  • Pt = skipped beats/palpitations via psychological stress, stimulants (caffeine, tobacco, alcohol)
  • P = Extra beats that originate outside sinus node = ectopic atrial pacemaker
  • Dx = Holter monitor
    • Different morphology from sinus P waves
    • Appears interspersed throughout an underlying rhythm
  • Tx = most asx & benign
    • sxs = CCB or BB
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10
Q

When is bridgings indicated during interruption (surgery) of oral anticoagulation (warfarin) in patients with atrial fibrillation

A
  • CHA2DS2-VASc score 0-1 and duration of interruption < 1 week = no bridging
  • CHA2DS2-VASc score >1 or duration of interruption > 1 week = bridging needed (LMWH/unfractionated heparin).
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11
Q

Stroke risk

A
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12
Q
  • Child sxs all c/in hrs
    • Kernigs + –>
    • petechial rash head to toe –>
    • rapid necrotizing purpura –>
    • cardiac shock
A

Meningococcal meningitis

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13
Q

Orthostatic Hypotension

A
  • C/in 3 min of changing positions (sit => stand)
    • Decrease in SBP > 20 or DBP > 10
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14
Q
A
  • MI or infarct
  • EKG
    • >3 consecutive ectopic ventricular beats
    • AV dissociation = QRS >120, Rate >100
    • Wide complexes, Fusion beats, Capture beats
  • Tx
    • Pulseless: immediate defibrillation
    • Unstable: synchronized cardioversion
    • Stable: procainamide, amiodarone, synchronized cardioversion (refractory)
    • If unsure, manage all wide complex tachycardias as ventricular tachycardia
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15
Q

Valsalva/Squat/Leg elevation/Volume expansion/Alpha agonist

  1. Increase what murmur
  2. Decrease what murmur
A
  1. Aortic stenosis
  2. HOCM
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16
Q

Long QT syndrome

A
  • QT interval > 460 msec (W); > 440 msec (M)
  • Pt = palpiataions, syncope, SCD
  • P = meds, physical/emotional stress
  • Tx
    • Stable = metoprolol + cardiology referral
    • Unstable = torsades de pointe = Mg
17
Q

Mean Arterial Pressure

A
  • MAP = tissue perfusion
    • Nl adult = 70–100 mm Hg in adults.
    • 60 req to perfuse coronary arteries, brain, and kidneys.
  • MAP = (CO x SVR) + CVP
  • MAP = DBP + 1/3 (SBP-DBP) = [(2 x diastolic)+systolic] / 3
18
Q

Infective Endocarditis PE Findings

A
  • FROM JANE = Staph/Strep
  • Fever
  • Roth spots (eyes)
  • Osler nodes (ouch on fingers pads)
  • Murmurs (MOST COMMON)
  • Janeway lesions (painless red lesions on extremities)
  • Anemia
  • Nail bed hemorrhage
  • E mboli
19
Q
A

A. Flutter

  • EKG
    • Sawtooth pattern, Narrow QRS
    • Atrial rate: 250-300/minute
    • Ventricular rate: 150- +/-30
    • AV node conducts every 2 or 3 atrial impulses
  • Tx
    • Stable = Adenosine
    • Unstable = Syn cardiovert
20
Q
A

A. Fib

  • EKG
    • Irregularly irregular
    • No P waves
    • Narrow QRS unless conduction block or accessory pathway
    • Variable ventricular response rate
  • Tx
    • Stable = Adenosine
    • Unstable = Syn cardiovert
21
Q
A

Ventricular Fibrillation

  • EKG
    • Wide-complex, disorganized
    • No cardiac output or pulse
  • Pt = Incompatible with life => pulseless
  • Tx = Defibrillation, ACLS
22
Q
A

Normal sinus rhythm

  • Rate 60-100
  • Regular rhythm with P for every QRS
  • PR interval 120-200
  • QRS 60-100
23
Q
A
24
Q

Amiodarone Side effects

A
  • Tx = VT > SVT
    • Class 3 = inhibit K out => prolonged action potentional
    • Class 2 = beta blocker
    • Class 4 = CCB
  • Adverse
    • Hypotension > bradycardia, Heart block, prolonged QT
    • Interstitial lung dz
    • Hypothyroid/Hyperthryoid
    • Hepatitis, Epidiymitis
25
Q

Premature Ventricular Contractions (PVCs)

A
  • EKG
    • Earlier QRS -> compensatory pause
    • Wider bizarre QRS c/o preceding P wave
  • Path = MV prolapse
26
Q

Cocaine should not get what medication

A

beta-blocker can cause unopposed alpha effects leading to worsening symptoms and blood pressure.

27
Q

CCB Types & Fxn

A
  • Vascular disorders (HTN, raynauds, etc..)
    • Dihydropyridines “-pines”
      • Amlodipine (many side effects)
      • Nicardipine, Nifedipine, Felodipine
  • Rate Control = SVTs
    • Phenylalkylamines = Verapamil (most effect on AV node)
    • Benzothiazepines = Diltiazem
  • CCB Toxicity
    • SA/AV node slowing, vasodilation
    • Bradycardia, hypotension, hyperglycemia
28
Q
A

ROSH REVIEW (1 decks)

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