Cardiology Flashcards
Individuals who should be on mod-high intensity statin
- Clinical ASCVD (ACS, MI, angina, CVA, TIA, PAD)
- LDL > 190
- Diabetes Mellitus AND age 40-75
- 10-year ASCVD risk 7.5% AND age 40-75
Beck Triad
Hypotension, distant heart sounds, and distended neck veins
Cardiac Tamponade –> urgent pericardiocentesis
Jones Criteria
Acute rheumatic fever (JONES PEACE)
MAJOR: Joints, Heart, Nodules, Erythema marginatum (painless rash), Syndenham chorea
MINOR: Prev RF. EKG w/ PR prolongation, Arthralgias, CRP/ESR elevated, Elevated temp
- hx of strep infxn + 2 major OR 1 major & 2 minor
Pulsus paradoxus
Fall in systolic BP > 10 mmHg with inspiration
*acute pericarditis
Stanford criteria
Aortic dissection
A: involves ascending aorta (emergent surgery)
B: distal to left subclavian artery (medical tx)
Endocarditis sx
- Osler nodes (tender nodes on finger and toe pads)
- Janeway lesions (peripheral petechiae)
- Splinter hemorrhages (subungual petechiae)
- Retinal hemorrhages (Roth spots)
Positive hepatojugular reflex
apply firm sustained pressure for 10-15 seconds over upper abdomen. + response = sustained elevation of jugular venous pressure >3cm during continued abdominal pressure
- reflection of failing right ventricle that can’t accommodate for incr venous return
- *constrictive pericarditis (post TB), right ventricular infarct, restrictive cardiomyopathy
malignant htn
> 180/120 associated with retinal hemorrhages, exudates, and/or papilledema
tx for prolonged QT
sodium bicarbonate - improves BP, narrows the QRS, and prevents and arrhythmia
Pt with fatigue, dizziness, bradycardia, episodes of 3-6 seconds with no sinus nodal activity
Sick sinus syndrome - age related degeneration of the cardiac conduction system with fibrosis to sinus node
Pt with WPW in a-fib with RVR, hemodynamically stable
Procainamide or ibutilide
11 month old with fever, rash, conjunctival injection, coronary artery problems
Kawasaki disease
Pt with COPD presents with SOB and wheezing. Pulse is 114 and irregular. ECG shows irregular narrow complex tachycardia with 3 different P wave morphologies.
Multifocal Atrial Tachycardia
- exacerbation of pulm dz, electrolyte disturbance (hypokalemia), catecholamine surge (sepsis)
- correct underlying disturbance & AV nodal blockade (verapamil) if it persists
Pt with a-fib and no palpable carotid or femoral pulses
Start chest compressions
- pulseless electrical activity
How to determine if a murmur is innocent in a 5 year old
Maneuvers that decrease blood return to the heart (standing, valsalva) typically reduce the intensity of the murmur
Side effects of amiodarone
Chronic interstitial pneumonitis sinus bradycardia, heart block Elevated transaminases, hepatits corneal microdeposits blue grey skin discoloration peripheral neuropathy
Treatment of acute pericarditis
NSAIDs and colchicine
Episodic flushing, secretory diarrhea, cutaneous telangictasias, brochospasm, niacin deficiency (dermatitis, diarrhea, dementia) and tricuspid regurgitation
carcinoid syndrome
tx: octreotide
Pt with high BP placed on nitroprusside develops AMS
Cyanide toxicity
how to rapidly reduce potassium
insulin and glucose
beta 2 agonist
sodium bicarb
(ca stabalizes cardiac membrane)
Retropharyngeal abscess can turn into…
acute necrotizing mediastinitis
- retropharyngeal space can drain into superior mediastinum the cross the alar fascia and enter the “danger space” and enter the posterior mediastinum
Causes of anterior mediastinal mass
4 T’s: thymoma, teratoma, thyroid neoplasm, terrible lymphoma
Pt with intermittent episodes of dizziness and left arm weakness/heaviness. BP is higher in higher in the right arm than the left.
subclavian artery occlusion
Pt passes out in the grocery store. Right before she passed out she felt an overwhelming sense of warmth and nausea. Her pulse was 40 bpm
Neurocardiogenic or vasovagal syncope
Pt develops right calf pain, swelling following embolectomy of right femoral artery. Extremity is cool and shiny. Distal pulses are palpable. Pt has loss of sensation and is unable to move his toes.
Compartment syndrome
- ischemia-reperfusion syndrome
Man develops severe left sided chest pain 5 days after an LAD infarction. He develops PEA and shock
free wall rupture
- occurs 5 days - 2 weeks after
- LAD involved
- echo shows pericardial effusion with tamponade
3-5 days after MI, patient develops chest pain, new holosystolic murmur, biventricular failure, and shock
interventricular septum rupture
- LAD, RCA
- left to right ventricular shunt
3-5 days after MI patient develops severe pulmonary edema and new holosystolic murmur
Papillary muscle rupture
- RCA
- echo: severe mitral regurg with flail leaflet
Patient presenting with right-sided heart failure following pace-maker implantation is due to
Tricuspid regurgitation
- due to lead placement causing direct leaflet damage or inadequate leaflet coaptation
Effects of digoxin toxicity
nausea, vomiting, diarrhea, vision changes (yellow/green), and arrhythmias
Isolated systolic hypertension
systolic >140 and diastolic <90
- seen in old men
- due to increased stiffness and decreased elasticity in aortic and arterial walls
Initial management of left ventricular systolic or diastolic dysfunction
ACEi (or ARB) and loop diuretic
Cardiovascular changes in Turner syndrome
Bicuspid aortic valve, coarctation of the aorta, aortic root dilation –> can lead to dissection
Tx for person with DVT and elevated homocysteine
Folate and B6 (pyridoxine)
endocarditis after nosocomial UTIs
Enterococci
Most common valvular abnormality in IE
MVP with mitral regurgitation
arrhythmia associated with digoxin toxicity
Atrial tachycardia with AV block
- increased vagal tone slowing conduction to the AV node
3-5 days after LAD infarct pt develops complications
Interventricular septum rupture
Medications used to prevent thromboembolic events in a fib patient
Warfarin and non-vitamin-K antagonists (apixaban, dabigatran, rivaroxaban)
Pt with palpable purpura on the LE, peripheral neuropathy (hyporflexia), liver involvement, arthralgias, fatigue, glomerulonephritis, previous hep C infection
Mixed cyroglobulinemia
- IC deposition in small and medium sized vessels
- assay for cryoblogulins that classically contain RF
Long term amiodarone use can lead to
pulmonary toxicity
indication for MVP repair
LVEF less than or equal to 60 with or without sx
How to inhibit beta blockers in an overdose
Glucagon
When is an endarterectomy indicated
symptomatic pt with 70-99% stenosis
Pt ODs on a drug and EKG show wide QRS and prolonged QT. What do you do next?
Sodium bicarbonate
-TCA overdose
Ischemic eval testing for a patient with LBBB or paced rhythm
COPD: dobutamine perfusion imaging
no COPD: persantine/regadenoson myocardial perfusion imaging
MOA and SE of digoxin
slows the conduction through the SA and AV nodes by inhibiting the Na+/K+ ATPases of the cardiac myocytes
SE: abdominal pain, yellowing vision, heart block. *give immune Fab antibody
Restrictive cardiomyopathy with fibrosis and prominent eosinophilic infiltrate
Loffler syndrome
Debakey Classification
Type I involves the ascending aorta, arch, and descending thoracic aorta.
Type II is confined to the ascending aorta.
Type IIIa involves the descending thoracic aorta distal to the left subclavian artery and proximal to the celiac artery.
Type IIIb dissection involves the thoracic and abdominal aorta distal to the left subclavian artery.
Most common cause of aortic dissection
hypertension
Hypertensive crisis tx
nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam
Medication CI in WPW and A-fib
digoxin - blocks the AV node and shortens the pathway needed for depolarization down the accessory pathway increasing the risk of v-fib
chest pain with diaphoresis. ECG findings of ST elevation in leads V1-V3 and ST depression in leads II, III and aVF
Anteroseptal infact (see reciprocal changes in II, III and aVF)
Prinzmetal angina
transient narrowing of the coronary vessels by the contraction of the smooth muscle in the vessel
- EKG: transient ST elevations
- tx: CCB, sublingual NTG to relieve vasospasm
EKG in hypercalcemia
shortened QT interval
EKG in hypomagnesemia
nonspecific T wave changes and a prolonged QT interval. As the deficit progresses, Torsades de pointes, a polymorphic ventricular tachycardia, may result
- common in alcoholics
posterior MI EKG
a posterior STEMI presents as ST depression (reciprocal ST elevation) and R-waves (reciprocal Q-waves) in leads V1-V3.
Endocarditis and conduction abnormality on EKG
perivalvular abscess
Pt with recent URI develops increasing SOB. CXR shows enlarged cardiac silhouette and she has clear lung sounds on PE with jugular vein distension
Cardiac tamponade
- nonpalpable PMI on exam
pulsus paradoxus
cardiac tamponade, asthma, copd
synchronized cardioversion
a-fib, a flutter, VT with a pulse
defibrillation
v-fib and pulseless VT
meds shown to prolong survival in left ventricle dysfunction
ACEi, ARBs, BB, mineralcorticoid receptor antagonist (aldosterone), hydralazine and nitrates in AAs
Why do you give sodium bicarb in TCA overdose
increases serum pH and sodium level, alleviating the cardio-depressant action on sodium channels
Triptans and ergot derivatives are avoided in patients with
CAD - can cause vasospasm
Pt complains of transient, rapid, painless monocular vision loss. States it appears as if a curtain is being drawn down over his visual field
Amaurosis fugax - retinal ischemia due to atherosclerotic emboli from internal carotid
- get duplex US of neck
medication contraindicated in prinzmetal angina
propanolol - can exacerbate vasospasm
left main artery is occluded greater than or equal to 50%
bypass surgery
Brugada syndrome
- most common cause of sudden death among young men of Asian descent without known underlying cardiac disease (possible mutation with Na channels in myocytes)
- die in their 40s
- die from ventricular tachycardia (VT)/ventricular fibrillation.
- persistent ST elevations in the V1–V3 leads with a right bundle branch block appearance, with or without terminal S waves in the lateral leads
- tx: ICD
indications for valve replacement in endocarditis
- prosthetic valve endocarditis especially when associated with valve dysfunction or Staphylococcus aureus or Gram-negative rod bacteremia;
- uncontrolled infection leading to conduction abnormalities, periannular suppuration, and fistula despite appropriate antibiotic treatment for at least 1 week;
- repeated systemic embolizations despite appropriate antibiotic treatment;
- severe valvular disease resulting in refractory congestive heart failure.
