Cardiology Flashcards
Mechanism of S3 gallop
Rapid ventricular filling during diastole, a splash sound
Mechanism of S4
sound of atrial systole into a stiff or noncompliant left ventricle, the bang sound
If someone is having ischemic pain, what is the VERY FIRST thing that you do?
give aspirin, do the tx first
What is the main difference between CK MB and Troponin?
CKMB only stays elevated 1-2 days while troponin stays elevated for 1-2 weeks
What thing will rise first in an ischemic event?
myoglobin, rises 1-4 hrs after start of chest pain
What are the drugs we use to induce stress if pt cant exercise?
dipyridamole, adenosine, or dobutamine
What do you do if someone shows reversible ischemia on stress test?
angiography!
Mechanism of Thallium
gets picked up by Na/K ATPase of normal myocardium… it’s nuclear, we see it
What else besides aspirin needs to be given in ACS?
Nitrates and morphine… but they DO NOT lower mortality
What do you give with aspirin if pt is having acute MI?
Clopidogrel or ticagrelor (thienopyridine class)
What is given only when angioplasty is done?
Prasugrel (they are all P2Y12 antagonisits, keep platelets from sticking to each other)
What has the single greatest efficacy in lowering mortality in STEMI?
Urgent angioplasty (PCI)
When should PCI be done?
within 90 minutes of arrival in the ER
What happens if a person with MI is there for more than 90 minutes and no PCI has been done?
thrombolytics
When should someone receive thrombolytics?
chest pain for <12 hours and has ST elevation in 2 or more leads
Mechanism of thrombolytics?
activate plasminogen into plasmin, which chops up fresh or newly formed fibrin stands into D dimers… after several hours, the fibrin clot has been stabilized by factor XIII… then plasmin cannot cleave it
What is the most common cause of death in both CHF and MI?
ventricular arrhythmia brought on by ischemia
What are the things that always lower mortality in ACS?
Aspirin Thrombolytics Primary angioplasty Metoprolol Statins Clopidogrel, prasurgrel, or ticagrelor
How long does a guy have to wait to have sex after an MI?
2-6 weeks
What are some of the predominate differences in the management of NSTEMI’s as opposed to STEMI’s
no thrombolytic use
heparin is used routinely (LMWH>unfractionated)
Glycoptn 2b/3a inhibitors lower mortality, particularly in those undergoing angioplasty
Mechanism of heparin
heparin potentiates the effect of antithrombin. antithrombin inhibits almost every step of the clotting casade…. this is why it does not work with antithrombin deficiency… heparin only prevents new clots from forming
When are the GP2a/3b inhibitors really useful… in combination with….
angioplasty and stent placement
When is the only time thrombolytics are used?
if there is ST segment elevation or a new LBBB within 12 hrs of the onset of chest pain
What is a side effect of both ACEI’s and ARBs?
hyperkalemia
What drug do you use if a statin is not working and you’ve maxed out the dose?
PCSK9 inhibitors.. PCSK9 blocks the clearance of LDL by the liver from blood
What is the MOA of Carvediliol?
B1, 2, and alpha 1 antagonists… makes it anti-arrhythmic, anti-ischemic, and antihypertensive
Why do people with CHF have alkalosis?
hypoxia, hyperventilation, decreased PCO2, alkalosis
What are some inotropic drugs to be used in the ICU?
Dobutamine or milrinone
In general, how do you deal with pulmonary edema?
preload reduction
What are the 3 drugs that lower mortality in CHF?
Ace inhibitors, Beta blockers, spironolactone
-diuretics are purely symptomatic management
If the CHF patient is still dyspneic after using Ace inhibitors, beta blockers, and diuretics and everything else, what do we turn to?
Ivabradine or sacubitril/valsartan
What CHF med causes transient excess brightness of vision?
Ivabradine
When will biventricular pacemaker be good for CHF?
it decreases mortality in ppl with EF <35% and a QRS >120msec
What are the systolic murmurs?
Aortic stenosis, mitral regurge, mitral prolapse, HOCM
Which way of breathing increases the intesity of right sided murmurs?
inhalation… the opposite is true for left
What does aquatting and lifting legs in air do to venous return?
increase it
What does valsalva maneuver and standing up do?
decrase venous return to heart
what does the handgrip maneuver do?
increase afterload… opposite of ACe inhibitor
What does amyl nitrate do?
decreases afterload
Where will you hear aortic stenosis murmur the best?
second right intercostal space and radiates to the carotids… crescendo decrescendo
How are regurtitant lesion treated?
Vasodilator therapy
How are stenotic lesions treated?
anatomic repair
Mechanism of syncope and Angina in AS
a stiff valve just proximal to the entry point of the coronaries blocks the blood flo intob the vertberal and basilary ariteries and carotids….. no flow to the brain … passing out,,, thus. s causes LV hypertropby,…. LC phypertrophy equeals increased demand…..
AS… blocked fow ith increased demand…. chest pain
