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OME > Cardiology > Flashcards

Cardiology Flashcards

1
Q

When stable angina becomes unstable angina, then NSTEMI

A

pain is worsening with less work
more pain with same work
refractory to nitroglycerine

NSTEMI with troponins

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2
Q

CAD RF

A

same as vascular disease:

Modifiable: 
DM
Smoking 
HTN
Dyslipidemia

Non modifiable:
Age (M>45 F>55)
FH

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3
Q

Diamond classification risk of CAD with symptoms

A

Substernal
Worse with exercise
relieved by Nitro

3/3 - typical
2/3 - atypical

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4
Q

CAD associated SXS

A

Dyspnea
NV
Diaphoresis

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5
Q

DX of CAD

A

ECG w/ ST Elevation or new LBBB

  • STEMI goes to Cath
  • R/O NSTEMI with triponin

If no, do STRESS TEST

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6
Q

STRESS TEST
Goal
Positive if:

A

85% maximum HR, have them sustain it
+ if CP or EKG or ECHO is positive
Nuclear stress test with perfusion can show reversibility

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7
Q

Cardiac cath

A

tells you extent

R/O prinzmetals

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8
Q

Pateint presents with Angina - Acute Therapy

A

Aspirin
Nitrates (can alleviate pain BUT avoid if right-sided: 2,3 AVF)
MONA BASH
Morphine, Oxygen, Nitrates, Aspirin, BB, Aspirin , Statin Heparin

tPA / heparin acutely only if within 12 hours and no Cath available

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9
Q

Chronic therapy for CAD risk factors

A

Statin (high potency)
DM - A1C <7 or 80-120 sugars
HTN 140/90

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10
Q

The four groups that should be on a high-intensity statin

A

Any vascular disease ( Stroke, CAD, PVD, Carotid stenosis)
LDL > 190

do ASCVD calculation, takes into account RF

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11
Q

What are the high intensity statins and their doses
-Caution if: _____ or ______. If either of those, then start on _____
If there is SA, then _____

A

Atorvastatin 40, 80
Rosuvastatin 20, 40

Liver or renal disease, go to moderate intensity
SA, stop, then start at lower

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12
Q

Statins: Baseline tests
SA tests
how often lipids

A

A1C, CK and LFTs
SA - Hepatits: LFTs , muscle: CK
Lipids every year
A1C q3mo

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13
Q

Myositis sxs

A

Sorness, weakness, muscle pain

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14
Q

Fibrates

A

LDL down, HDL up, second line to statins

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15
Q

In a pateint with an arrythmia, what makes them unstable?

A

CP
SOB
AMS
SBP<90

If unstable, pace slow shock fast

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16
Q

What arrythmias are fast, narrow and what do you give them if pt is stable?

A

Afib
Aflut
SVT

Can give Adenosine (rythem controll)
usually for Afib/ flut give Dilt (CCB). Can give B block (both for rate controll)

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17
Q

What arrythmias are fast, wide and what do you give them if pt is stable?

A

VT/VF
Torsods

Amiodarone

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18
Q

What arrythmias are slow, and what do you give them if pt is stable?

A

Heart BLocks 1 2a 2b 3
1 and 2a (wenky) get atropine
otherwise pace

19
Q

When to do CPR?

What to do in CPR?

A

In cardiac arrest: the heart has stopped (No BP / No pulse)

Shock? Drug, 2 min CPR, Drug, 2min CPR
Start with Epi. Shock only in Vtach, Vfib. If it is PEA / Asystoli, give nothing on first break.

20
Q

What is and what are the causes of Dialated Cardiomyopathy

DX

How do you treat it

A 
Big heart, causes systolic failure. 
Ischemia
Valve dz
idiopathic
infectious 
metabolic 
alcoholic 
autoimmune

DX - CXR, US

Treat - HF medications

21
Q

HOCM

A

Teens , Big ventrical obstructs outflow, sudden death in teens, tx with B blockers

22
Q

Restrictive Cardiomyopathy

Causes

A

Sarcoid, Amyloid, hemachromatosis, cancer, fibrosis

TX - gentle diuresis, xplant

23
Q

What are Systolic and diastolic heart failure, and what are the causes

A

Systolic cant push blood forward
-Dialated cardiomyopathy, ischemic tissue, leaky valves

Diastolic cannot fill
-hypertrophy, infiltration, pericardial/deposition dizeases as well

24
Q

Pathogenisis of HTN induced HF

A

Heart gets big and beefy, eventually becomes floppy. Catecholamines initially help overcome the hypertension, but eventually leads to neural hormonal cardiac remodeling

25
Q

Symptoms of chronic CHF

Symptoms of acute CHF exacerbation

A 
CHRONIC 
(L sided failure)
Exertional dyspnia
Orthopnia - When lying flat
Paroxysmal nocturnal dyspnia - waking up at night

crackles / Rales

(R sided failure)
Leg swelling
Peripheral Edema
Hepatomegaly

ACUTE

  • JVD
  • S3
26
Q

DX of CHF

Under what % of EF is classified as Diastolic falure

A

BNP can help determine if the body is volume overloaded or not

TTE - tells you if if its systolic / diastolic.

under 55% is Systolic HF

27
Q

Treatment of CHF (non acute)

How to reduce preload
How to reduce Afterload

A

Everyone:
Cardiac Diet
Ace
Bblock

Consider adding: 
Furosimide
Nitrates
hydralizine (biDil?)
Spironilactone

Reduce Preload
<>Reduce fluid
-cardiac diet: <2g NaCl / day and <2l fluid/day
-Furosimide: Slight limitations (II) / Significant
-Isosorbide dinitrate (nitrates) : only comfortable at rest (III)

Reduce Afterload
<>
-Ace inhibitors (Lisinopril) (II)
-Spironilactone Hydralizine (III and up)
NOTE: Isosorbide dinitrate + Hydralizine = Bi Dil

Reduce risk of sudden cardiac death
-B-blocker

Reduce Sxs (not mortality) 
-Digoxin 
Conisder AICD if EF<35%
Consider Dobutamine (or other ionotrope) if need help to ventricular assist device
28
Q

Acute exacerbation of CHF

Causes:

SXS:

Tx:
(If ischemic?)

A

–Causes–
-Usually volume overload from:
medication noncompliance
dietary noncompliance
ischemia
arrythmia

SXS:

  • Crackles
  • JVD
  • edema (acute)
  • elevated BNP
  • Confirm with Echo

Make sure to rule out other causes of Dyspnia (PE, asthma, COPD, PNA, Anxiety)

Tx:
aggressive Furosemide
Afterload reduction (BP controll)
Preload reduction (diuresis and nitrates)
**Never start or increase Bblocker during exacerbation

if ischemic: Add ASA and Statin

29
Q

Acronym for all the actions to consider with CHF exacerbation

A 
Lasics 
Morphine? 
Nitrates 
Oxygen 
postion
30
Q

What is Hypertensive Urgency
-tx?

What is Hypertensive Emergency
-Tx?

How can you tell if there is end organ damage

A

Hypertensive Urgency:
>180/110 without evidence of end organ damage
-IV or orals

Hypertensive Emergency
>180/110 with evidence of end organ damage
-IV dilt or Nitrates to dec 25% in 6 hrs, then orals for 24 hours

End Organ Damage:
Retninal hemorrhage
HF - JVD, crackles, edema
CNS - AMS, visual fields

31
Q

What are some circumstances where BP is less strictly managed

A

Not long to live (institutionalized / elderly)
Pts on dialysis - may get hypotensive
Orthostatic hypotension

32
Q

ASCVD

A 
Gender 
Race 
Age
Total cholesterol 
HDL cholesterol 
Systolic BP 
BP medications?
DM?
Smoker?

Anyone over 10% gets orals
Everyone gets diet

33
Q

DASH diet

A 
Dietary approach to stop hypertension 
Low Na (<2300mg/day, High K and Mg) 
Portion sizing 
30min excercise / day 
Goal BMI < 25
34
Q

TX for HTN

TX for HTN with: 
CAD
CHF
CVA
Dm
CKD

African Amercians

A

HTN with no cormorbid:
Ace-I
Thiazide
CCB

CAD- BB / Ace-I …..Nitrates, CCB

CHF- BB / Ace-I …….Nitrates+ Hydralizine (Bidil),
Spironilactone

CVA- Thiazide, CCB

DM- Ace-i

CKD- Ace-i (avoid if CKD stage 4!!)

Dont give Ace-I to aftrican americns UNLESS there is DM

35
Q

What is acute pericarditis vs Chronic pericarditis?

What are some causes?

A

Acute Pericarditis (an inflamatory condition) that MAY cause an effusion - that COULD lead to tampanad.

Chronic Pericarditis can lead to fibrosis arund the heart - constriction (knock) (DX with echo, treat with pericardectomy)

Causes - autoimmune, cancers, trauma, infection

36
Q

Sxs of pericarditis

Tests for DX?

A 
Positional pain (lean forward, its better) 
reproducible

ECG (all you need)

  • Diffuse ST segment elevation
  • PR segment depression (PATHOPNEUMONIC)

Echo - will only show an effusion, not inflamation

37
Q

TX of pericarditis

A

NSAIDS and colchicine

38
Q

Sxs of tampanad due to effusion from pericarditis

TX

A

CHF sxs!

  • DOE, PND, Orthopnea
  • Findings: JVD, Crackles, Edema

TX

  • “treat the cause” - tons of things can cause it.
  • if refractory and recurrent, you can get a pericardial window
39
Q

SX, Exam findings and TX of Rapid effusion (due to trauma, pericarditis etc)

A

SXS:

Exam findings:
Becks Triad
-JVD, Distant Heart sounds, hypotension

can also see clear lungs* and pulses paradoxis ( more than 10mm differense in systolic BP during inspiration)

TX: Pericardiocentesis

40
Q

DDX of Syncope

Women 3-2-1 PE

A 
VasoVagal 
Orthostatic
-Nervous system broken (elderly, Diabetic) 
-Lack of sympathetic tone from Sepsis 
-Low Preload (Hypovolemia)

Mechanical Cardiac Dz

Arrythmia

Neuro

  • Vertebrobasilar Insuficiency -CTA
  • Seizure - look for post ichtal
  • Stroke - CT
  • Narcolepsy

PE

Electrolytes

41
Q

Causes of orthostatic hypotension

DX of orthostatic Hypotension

A

Orthostatic

  • Nervous system broken (elderly, Diabetic)
  • Lack of sympathetic tone (Sepsis, anaphalxis, addisons)
  • Low Preload (Hypovolemia) (Diuretics, Hemmorhage, dehyd)

BP Orthostatics (laying down, sitting, standing)

  • Systolic DECREASE by 20
  • Diastolic DECREASE by 10
  • HR INCREASe by 10

Very low percentage get DX
Can give IVF if severe

42
Q

Vasovagal Snycope
cause?
Dx?
Tx?

A

Vagus nerve activates way more than it should

Cuases include cough, defication, micturition, turning head, shaving

Tilt table diagnosis it!

Tx - usually trigger avoidance. Could give fludricortisone or do surgery if super serious.

43
Q

Mechanical Cardiac dz as a cause of Syncope

  • different causes
  • Dx
A

Obstruction - PE, AS, HOCM, Myxoma
Sxs may be exertional , may have a murmer

DX w/ Echo

44
Q

Arrythmia as a cause of Syncope

A

Will proly dx with holter

May need antiarrythmics or AICD (automatic implantable cardiac diffibrilator) to tx it if sever

OME (11 decks)

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