CARDIOLOGY Flashcards
BP HAS DROPPED DRAMATICALLY
PMH: RECENT MI
PE: CANNON a WAVES
DZ X
HYPOVOLEMIA CARDIOGENIC SHOCK VALVULAR OR CORDAE TENDINOSA RUPTURED PAPILLARY MUSCLE JARISCH BEZOLD COMPLETE HEART BLOCK VENTRICULAR TACHYCARDIA SINUS BRADYCARDIA VENTRICULAR RUPTURE VENTRICULAR SEPTAL DEFECT
ISOPROTERENOL ES B INESPEC AGO PERO WRONG ANSWER IN BRADI + HYPO»_space; MIO O2 CONSUMPTION
RIGHT VENT SAME VASCULATURE OF THE INFERIOR WALL
IWU:
EKG
COMPLETE AV BLOCK
FM: ATROPINE DOPAMINE IVF BRIDGE TO
PACEMAKER*
END OF THE CASE
RIGHT VENTRICLE TREATED WITH FLUIDS
SIMPLE HYPO TENSION TREATED W FLUIDS AND DOPAMINE
VENTRICULAR TACHYCARDIA AND HYPOTENSION SYNCHRONIZED CARDIOVERSION
WALL AND VALVE RUPTURE IMMEDIATE OPERATIVE REPAIR
SEVERE CP
DZ X
1-2-3 MI UA DISSECTION TIETZE GERD DES PE PNEUMOTHORAX
REMEMBER ABSOLUTE CI Tpa
REMEMBER NEEDLE DOOR TIME 30 ‘
IWU:
RX FIRST
OXYGEN
ASPIRIN
THEN: EKG* CK MB* CXR ABG
MORPHINE SL OR IV NITROGLYCERIN ADMIT TO THE CRITICAL CARE UNIT THROMBOLYTIC THERAPY Tpa OR STREPTOKINASE BETA BLOCKERS PCI 90 ' ACE/ARB IF EF < 50% OR LARGE ANTERIOR MI STOP 6 WK AFTER IF NORMAL VENTRICULAR FUNCTION
I HAVE A FUNNY SENSATION IN MY CHEST
DZ X
V TACK SVT - WPW A FIB AF MI UA
UNA TKC SVT CON CONDUCTION ABERRANT O UN WPW SE PUEDE CONFUNDIR
V TACK ALWAYS NEED TX »_space;> DETERIORATES IN V. FIB
TORSADES DE POINT Y RECORDAR NIELSEN JIERWEL BRUGADA QT LARGO E HYPOMAGNESEMIA.
AMIODARONE LONG TERM L. FIBROSIS THYROID DISORDERS
IWU:
LYTES
ABG
DC CARDIOVERSION
LIDOCAINE
TREAT UNDERLYING ABNORMALITY
OXYGEN
EVEN IF UNSTABLE PREMEDICATION IS PREFERABLE
AMIODARONE* DOC IN EF<40%
LIDOCAINE
PROCAINAMIDE
IF UNSTABLE: SBP<90 CHF CP AMS SYNCHRONIZED CARDIOVERSION IV MIDAZOLAN / DIAZEPAN FIRST THEN 100>>200>>360>>360 J IF PERSISTS: THEN LIDOCAINE FOLLOWED BY PROCAINAMIDE OR AMIODARONE
PULSELESS VENTRICULAR TACHYCARDIA IS MANAGED THE SAME AS VENTRICULAR FIBRILLATION
HIGH YIELD *
I HAVE A WEIRD FEELING IN MY CHEST
A FIB W/ RAPID VENT RESPONSE
PT STABLE
HTN DILATION ATRIUM
TSH
DZ X
MULTI FOCAL ATRIAL TACHYCARDIA CARDIOMYOPATHY PULMONARY EMBOLISM' THYROTOXICOSIS SINUS TACHYCARDIA WITH ECTOPY HYPOGLYCEMIA
UNSTABLE= AMS or SBP<90 or CHF.
INITIAL DIAGNOSTIC PLAN:
EKG
FM:
DILTIAZEM
ADMIT TO TELEMETRY UNIT
ORDER: TSH FT4 CARDIAC ENZYMES ECHO CARDIOGRAM VENTILATION PERFUSION SCAN V/Q SCAN ABG
MGMT OPTIONS:
CONTROL RATE:
VERAPAMIL CRONO /DROMO / INO NEG CI:
IF CHF OR BUNDLE /AV CONDUCTION PATHOLOGY
SYNCHRO CARDIOVERSION IF UNSTABLE*
DIGOXIN IF VENTRICULAR DYSFUNCTION «_space;EF ATENOLOL
ANTI COAGULATE:
WARFARIN IF MORE THAN 2 DYS
ALTERNATIVE: DABIGATRAN RIBAROXABAN* NO INR NEEDED
FU: INR
FU: CARDIOLOGY CONSULT ELECTIVE CARDIO-VERSION AFTER SOME WEEKS OF ANTI COAGULATION W/ MEDICATIONS AMIODARONE DOC IN CHF OR ELECTRICAL
IM HAVING PALPITATIONS
PE WHILE:
BECOME UNRESPONSIVE AND LOST PULSES
DZ X
V TACK
V FIB
ASYSTOLE
ELECTROMECHANICAL DISSOCIATION
PE
W/O EKG IT IS IMPOSSIBLE TO DIFFERENTIATE BETWEEN:
V TACK
V FIB
A SYSTOLE
ELECTRO /MECHANICAL DISSOCIATION
IM:
DEFIBRILATE ANY V. FIB
PLAN:
CPR
DEFIBILATE 200 DEFIBRILATE 300 DEFIBRILATE 360 J IV A INTUBATE EPINEPHRINE OR VASOPRESSINE IV EVERY 5 MINS DEFIBRILATE 360 J LIDOCAINE OR AMIODARONE CONSIDER BICARBONATE DEFIBRILATE 360 J PROCAINAMIDE DEFIBRILATE 360 J
USE AMIODARONE LIDOCAINE OR PROCAINAMIDE WITH DEFIBRILLATION IN BETWEEN
ASYSTOLE
EPI ALTERNATES WITH ATROPINE
IF POSSIBLE OF VERY SLOW BRADI PACEMAKER IT
PULSELESS ELECTRICAL ACTIVITY MAY HAVE SOME SPONTANEOUS RESPIRATIONS
TREAT HYPOVOLEMIA TAMPONADE PNEUMOTHORAX PE OR THE CAUSE ALWAYS FIRST
MY CHEST HURTS WHEN I WALK UP STAIRS
TYPICAL PAIN STABLE FEATURES*
DZ X ANGINA PECTORIS STABLE UNSTABLE ANGINA MI GERD DES PNEUMOTHORAX
IWU: EKG FM: RESTART USUAL MEDICATION ATENOLOL AND NTG START ON ASPIRIN OUTPATIENT CARDIAC CATHETERIZATION
CABG BENEFIT MORTALITY ONLY IF LCA PROX ,LOW EF Or 3 VESSELS DISEASE/ 2 VESSESLS + DM
WHY NOT CK MB-TROPONIN I NO UNSTABLE FEATURES WHY NOT STRESS/EXCERCISE TEST: 3 MAIN INDICATION DXZ ATYPICAL CP FROM ANGINA SEE RESPONSE TO TREATMENT EVALUATE ARRHYTHMIA ON EXERCISE ECHOCARDIOGRAM COULD HELP IF EF<<< ADD ACE INHIBITOR TO TX
MY CHEST HURTS WHILE I WAS EATING
THIS IS UNSTABLE* THIS IS AN NST NON CKMB MI*
EKG: ST DEPRESSION ZUCKERMAN Ts
DZ X
EMI*
UA
MI DISSECTING AORTIC ANEURYSM PERICARDITIS PUD GERD
IWU: EKG TELEMETRY UNIT (MONITORING) CKMB - TROPONIN I CXR OXYMETRY / 2h (MONITORING)
FM:
EKG c/6h
CK MB-TROPONIN c/6h (MONITORING)
IM:
CRITICAL CARE UNIT ADMIT NTG SL IV NTG IF PAIN PERSISTS AFTER SL NTG MORPHINE SULFATE METOPROLOL
PE: CHEST/ CV EXAM UPDATE NOTE (MONITORING)
MAIN FORM OF THERAPY:
ASPIRIN*
LMWH*
FM:
CARDIAC CATHETHERIZACION
GLICOPROTEIN IIa /IIIb INHIBITOR TIROFIBAN EPIFIRBITIDE IN HIGH RISK PTS
ARTORVASTATIN
FU
STATINS-LFTS (MONITORING)
CKMM
HYPERLIPIDEMIA MANAGEMENT
FRAMINGHAM
MULTIPLES OF 30
-/1 RF 160 190
2 RF 130 160
CAD or CAD EQ 100 130
HDL< 40 + 1 HDL > 60 -1 PREMATURE CAD 1D REL 55/65 YO TOBACCO HTN
DM /PAD/CAROTID ARE CAD EQUIVALENTS
IWU:
LP
FM:
DIET LIMIT SATURATED FAT
EXCERCISE
FM:
HMG CoA REDUCTASE INHIBIT ATORVASTATINA SIMVASTATIN PRAVASTATIN
FU:
LIVER FUNCTION LFT’s
MYOSITIS CK MM
MY BREATH IS SHORT MY VISION IS BLURRY I CANT THINK STRAIGHT BP 230/150
HTN CRISIS
DZX
MI
SAH
HEM STROKE
ACCELERATED MICROANGIOPATHIC HEMOLYTIC ANEMIA DIC SV2 +RV5>35 >>> HOCM EYE EXAM BUN/CREA*
USMLE FAVORITE
FENOLDOPAM IN ASMATHICS AVOID BB
IWU:
EKG: SV2 +RV5>35
BUN/CREA*
CBC* SCHISTOCYTES PLAT<150
FM:
NON CON HEAD CT
CXR
FU:
LABETALOL BLOCK B 1-2 ALPHA AGO CENTRAL SAFE USE EMERG NITROPRUSIADE* ICU X ART LINE ART/VENOUS METAHEMOGLOBINE NTG VENOUS MAINLY ENAPRILAT (IV ACEI) NICARDIPINO ESMOLOL HYDRALAZINE DIAZOXIDE TRIMETAPHAN
RED BP 1/3 NOT BELLOW DBP 95
MY LEGS ARE SWOLLEN
DCM ALCOHOL
IWU:
FM:
FU:
I FAINTED IN BALLET CLASS
SEIZURE DISORDER ARRHYTHMIA VASOVAGAL SYNCOPE HOCM* ELECTROLYTE DISORDER HYPOGLYCEMIA PULMONARY HTN
USMLE FAVORITE STEP 2 CK
AVOID!
DIGOXIN ACEI/ARB DIURETICS NITRATES
DO NOT TOUCH PRE OR AFTERLOAD TOUCH AV CONDUCTION TO DELAY IT AS MUCH TO RAISE DIASTOLIC VENTRICULAR FULFILLING
IWU:
EKG LVH SMALL Q DI AVL ST-T CHANGES
FM:
ECHO CARDIOGRAM*
DIASTOLIC DYSFUNCTION ANTERIOR DISPLACEMENT OF THE MITRAL VALVE APPARATUS IN SYSTOLE
SEPTUM THICKENED COMPARED TO POST VENT WALL
FU: B BLOCKER THERAPY* AVOID STRENUOUS EXERCISE IMPLANTABLE DEFIBRILATOR VERAPAMIL IF BB DOESN'T WORK MYOMECTOMY SURGICAL IF NO RESPONSE TO MEDICATIONS
IM HAVING A HARD TIME BREATHING
MS
IWU:
FM:
FU:
MY LEFT LOWER LEG IS PAINFUL AND HAS A SWOLLEN ANKLE
DVT
IWU:
FM:
FU:
MY LEGS ARE SWELLING
CHF
DZ X
DILATED CARDIOMYOPATHY ALCOHOL* HOCM COR PULMONALE CIRRHOSIS IDIOPATHIC CARDIOMYOPATHY VIRAL CHAGAS THIAMINE.....
IWU:
CXR
EKG
FM:
ECHOCARDIOGRAM
FU:
DISCONTINUE ALCOHOL AFTERLOAD AGENT ACEI* BB CARVEDILOL METOPROLOL* DIURETICS^ DIGITALIS^ SPIRONOLACTONE* ARB IF ACEI NO TOLERATED*
DOBUTAMINE^ HOLIDAY IN SEVERES
TRASPLANT
- MORTALITY BENEFIT
^ SXs Tx
FDM: CKMB TROPONIN I CONSIDER (ARRYTHMIA/ISCHEMIA) AS IN ANY CHF: Tpa OR ANGIOPLASTY EMERGENT CARDIOVERTION
I CAN’T BREATH
ACUTE PULMONARY EDEMA ARRHYTHMIA* ACUTE ISCHEMIA* ACUTE MI VALVULAR O PAPILLARY MUSCLE RUPTURED
IWU:
EKG
CXR
ABG
CK MB
ECHO-CARDIOGRAM WHEN STABLE* EF 32%
IM
SIT UP RIGHT
OXYGEN
ALL PRELOAD FIRST: DIURESIS IV FUROSEMIDE ETACHRINIC ACID BUMETHANIDE MORPHINE SULFATE NITRATES
ADMIT TO CRITICAL CARE UNIT
INOTROP AGENTS DOBUTAMINE 3PDE INHIB. IMRINONE MILRINONE AFTERLOAD AGENTS NITROPRUSSIATE ENAPRILAT ACEI
SWAN GANZ CATHETER WEDGE P MEAS
B BLOCKERS AND POSSIBLY SPIRONOLACTONE AFTER STABILIZATION
DIGOXIN AFTER STABILIZATION
CHECK FOR
A FLUTTER - FIB / V TACK
EMERGENT CARDIO-VERSION
CHECK FOR ISCHEMIA TREAT AS CAS GUIDELINES
