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R2 - Family Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

stress EKG

A
  • confirms angina, evaluates response of tx, identifies pts with CAD with high risk of ACS
    • if ST depression or if pt has CP, HoTN, or significant arrhythmias
      • if +, send pt for cardiac catheterization
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2
Q

stress echo

A
  • performed before and after exercise
  • more sensitive than stress EKG for ischemia
  • if +, cardiac cath
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3
Q

cardiac catheterization

A
  • most accurate method for specific cardiac diagnosis
  • provides info on hemodynamics, intracardiac pressure, CO, O2 sat
  • Indications:
    • after + stress test
    • pt w/ angina when noninvasive tests are nondiagnostic, angina occuring despite meds, angina soon after MI, dx dilemma
    • severely sxatic pt needing urgent dx
    • evaluation of valve dz
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4
Q

Coronary CT angiography

A
  • definitive test for CAD (GOLD STANDARD)
  • most accurate method
  • determines whether revasc is needed
  • can perform PCI at same time with balloon or stent
  • stenosis >70% is significant
  • if severe (left main or 3-vessel), refer for CABG
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5
Q

PCI vs CABG

A
  • administer aspirin indefinitely and P2Y12 antag for 1-3mos after implantation of bare metal stent to reduce coronary thrombus formation
  • administer aspirin indef + P2Y12 antag for at least 1 yr after implantation of drug-eluting stent
  • defer noncardiac surg for at least 12mos
  • use of drug-eluting stents that locally deliver antiproliferative drugs can reduce restenosis to less than 10%
  • CABG: anastomosis of one or both internal mammary arteris or a radial artery to the coronary artery distal to obstructive lesion is preferred procedure; section of vein (usually saphenous) is used to form connection between aorta and coronary artery distal to obstructive lesion
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6
Q

PCI indications, benefits, CI, and prognosis

A
  • indications: symptom-limiting angina pectoris, despite medical tx, accompanied by evidence of ischemia during stress test
    • tx stenoses in native coronary arteries as well as in bypass grafts in pts who have recurrent angina after CABG
  • benefits: more effective than medical tx for relief of angina, improves outocmes in pts w/ unstable angina or early in MI w/ and w/out cardio shock, less invasive than CABG
  • CI: left main coronary artery stenosis
  • Prognosis: adequate dilation with relief of angina in >95% cases
    • recurrent stenosis occurs in 20% cases w/in 6mos
    • restenosis MC in pts w/ DM, small arteries, incomplete dilation of stenosis, long stents, occluded vessels, obstructed vein grafts, dilation of LAD, and stenoses containing thrombi
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7
Q

CABG indications, benefits, CI, prognosis

A
  • indications: L main coronary a. stenosis
    • ideal candidate = male, <80yo, no other complicated dz, angina not controlled by medical tx or cant tolerate medical tx
  • benefits: safe, mortality rates <1%, superior to PCI in preventing death, MI, and repeat revasc. in pts with DM and multivessel dz
  • CI: none
  • prognosis: angina abolished or greatly reduced in 90% pts
    • w/in 3y, angina recurs in 25% pts but is rarely severe
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8
Q

stable angina etiology, RF, sxs

A
  • etiology: fixed atherosclerosis narrowing arteries
    • O2 supply < )2 demand
  • major RF: DM (worst), HLDL (high LDL), HTN (most common), smoking, age (m>45, w>55), FHx premature CAD or MI in 1st degree relative, low HDL
    • minor RF: obesity, sedentary, stress, ETOH
  • sxs: CP or substernal pressure (lasts <10-15m, heaviness, pressure, squeezing, tightness, rarely sharp), gradual onset pain, increases with exertion or emotion, relieved with rest or NTG
    • Levine sign: clenched fist over sternum and clenched teeth when describing CP
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9
Q

stable angina dx and tx

A
  • dx: EKG - normal, Q-waves (prior MI)
    • cardiac stress test
  • tx: sublingual NTG - IV NTG
    • coronary angiography: if severely sxatic despite medical tx
  • prognosis: depends on LVEF: <50% = increased mortality
    • vessels involved: left main = poor prognosis, 2-3 vessels total = worst prognosis
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10
Q

congestive heart failure

A
  • decompensated: evidence on PE or chest radiograph of pulm edema, audible 3rd heart sound or increased JVP
  • Left ventricular failure: sxs of low cardiac output and congestion (SOB) dt systolic or diastolic dysfn
  • R ventricular failure: sxs of fluid overload almost always dt LVF
  • MCC systolif HF (reduced EF): ISCHEMIC CARDIOMYOPATHY (CAD with resultant MI an dloss of fning myocardium)
  • systolic dysfn: difficulty with ventricular contraction
  • diastolic dysfn: difficulty with ventricular relaxation; results from HTN and associated with aging; related to myocardial m. stiffness and LVH
    • HF with preserved EF
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11
Q

congestive heart failure etiology, RF, and sxs

A
  • MCC: CAD, HTN, DM
    • LV remodeling: dilation, thinning, mitral valve incompetence, RV remodeling
    • 75% have preexisting HTN
    • MCC of transudative (extravascular fluid) pleural effusions
    • mostly >65yo
  • sxs:
    • exertional dyspnea (SOB), then dyspnea with rest, chronic nonproductive cough, worse in recumbent position
    • fatigue, orthopnea, night cough, relieved by sitting up or sleeping with additional pillows, paroxysmal nocturnal dyspnea, nocturia
  • signs:
    • cheyne-stokes breathing, edema (ankles, pretibial (cardinal)), RALES, additional heart sounds:
      • S4 = diastolic HF (preserved EF)
      • S3 = systolic HF (reduced EF) with volume overload - tachycardia, tachypnea
    • jugular venous pressure >8cm
    • cold extremities, cyanosis, hepatomegaly (ascites, jaundice, peripheral edema)
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12
Q

congestive heart failure dx and tx

A
  • dx:
    • labs: CBC, CMP, UA +/- gluc, lipids, TSH
    • Serum BNP: increases with age and renal impairment, elevated in HF, differentiates SOB in HF from noncardiac issues
    • 12-lead EKG
    • CXR: kerley B lines
    • Echo: differentiates HF _/- preserved LV diastolic fn
    • Reduced pulse pressure and SVR
  • tx:
    • acute management: LMNOP
      • Lasix
      • Morphine (reduces preload)
      • Nitrates (reduces preload)
      • O2
      • Position
    • ACEi
    • CCB in diastolic HF
  • poor prognostic factors: CKD, DM, low LVEF, severe sxs, old
  • 5y mortality = 50%
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13
Q

New York Heart Association HF classification

A
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14
Q

when to refer HF vs admit

A
  • Refer: new sxs no explained by obvious cause, continued sxs and reduced LVEF (<35%)
  • Admit: unexplained new or worsening sxs or + biomarkers indicating acute MI, hypoxia, fluid overload, pulm edema not resolved as outpt
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15
Q

hypertension sxs, dx, and tx

A
  • sxs: >140/90 during at least 2 separate visits
    • mostly asx w/ nonsepcific HA
  • signs: BMI and waist circumference, BP in both arms, compare radial and femoral pulses
    • examine for abdominal aortic masses, PMI, murmurs, bruits, fundoscopic exam for eye changes
  • dx: EKG: LVH with strain
    • CXR
    • Labs: CBC, CMP, tox, preg, TSH
      • Hgb/Hct (decreased)
      • BUN, Cr, glucose (increased)
      • urinary gluc, prot, sediment: renal dz or DM
      • UA: hematuria or proteinuria
      • lipid profile
  • tx: Goal = <140/90 for gen pop, DM, and renal dz
    • older than 60 = <150/90
    • lifestyle modification = first line
      • DASH diet, weight loss, smoking cessation, limit ETOH and Na
    • Meds: ACEi (DM or renal dz), thiazide (AA), CCB, aldo antagonists (for refractory HTN, post MI, HF), alpha blockers (BPH), hydralazine (refractory HTN)
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16
Q

Hypertension definitions per JNC and ACC

A
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17
Q

Metabolic Syndrome

A
    1. truncal obesity
    1. hyperinsulinemia
    1. hypertriglyceridemia
    1. HTN
  • Associated with DM and increased CV complications
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18
Q

Primary (essential) HTN

A
  • 90-95% of cases
  • Multifactorial: genetic predisp (old age, AA), environmental (high Na, obese), sympathetic NS, abnl cardio or renal development, imbalance in RAAS, deficit in sodium secretion, abnl Na-K exchange
  • Exacerbating facotrs: excessive ETOH, tobacco, sedentary, polycythemia, NSAIDs, low K intake
  • tx: Goal = <140/90 for gen pop, DM, and renal dz
    • older than 60 = <150/90
    • lifestyle modification = first line
    • DASH diet, weight loss, smoking cessation, limit ETOH and Na
    • Meds: ACEi (DM or renal dz), thiazide (AA), CCB, aldo antagonists (for refractory HTN, post MI, HF), alpha blockers (BPH), hydralazine (refractory HTN)
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19
Q

secondary HTN

A
  • parenchymal dz, renal artery stenosis, coarctation of aorta, pheochromocytoma, Cushings syndrome (excess cortisol), hyperthyroidism, primary hyperaldosteronism, chronic steroid use, estrogen use, NSAID use, sleep apnea
  • tx: treat underlying dz
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20
Q

hypertensive urgency

A
  • BP needs to be reduced within hours
  • Persistently elevated higher than 220 systolic or 125 diastolic or accompanied complications without end-organ damage
  • tx: oral agents: clonidine, captopril, nifedipine, labetolol
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21
Q

Hypertensive emergency (malignant hypertension)

A
  • elevated BP with papilledema or retinal hemorrhage and either encephalopathy or nephropathy, confusion, left ventricular failure, intravascular coagulation
  • Difference: HTN emergency always has retinal papilledema and flame-shaped hemorrhages and exudates
  • must be reduced within 1 h to prevent progression to end organ damage or death
  • diagnostic criteria: persistently elevated higher than 220 systolic, diastolic >130
  • Complications: encephalopathy, nephropathy, ICH, aortic dissection, pulmonary edema, unstable angina, MI, stroke
    • ​on fundoscopic: retinal hemorrhages, exudates, papilledema
  • Hallmark complication: fibrinoid necrosis of the arterioles in the kidney
  • Tx: DONT REDUCE TOO RAPIDLY - can cause ischemia
    • sodium nitroprusside (short acting, titratable, potential for thiocyanate and cyanide tox with prolonged use or renal/hep fail)
    • labetalol (alpha and beta blocker) - preferred in dissection and ESRD
    • Neuro emergencies:
      • encephalopathy, stroke, ICH, SAH: labetalol, nicardipine, esmolol. AVOID nitroprusside and hydralazine
        • reduce MAP 25% over 8h
        • for MI us NTG or BB
      • aortic dissection: use nitroprusside and BB
      • Hydralazine during preg
      • lower BP within first 24-48h by 25%
        • 90% will die after 1-2y
22
Q

endocarditis etiology, RF, and sxs

A
  • MC native valve infection (strep viridans, staph aureus, enterococci)
  • IVDU: staph aureus, tricuspid
  • Prosthetic valve: staph aureus, gram neg or fungi
  • most pts have underlying regurgitant defect providing a nidus
  • sxs: fever, nonspecific sxs (dyspnea, cough, CP, arthralgias, back or flank pain, GI complaints)
  • signs: stable murmur (90%), palatal, conjunctival, or subungal petechiae, splinter hemorrhages, pallor, splenomegaly
  • diagnostic signs:
    • osler nodes (painful, violaceous, raised lesions on fingers, toes, feet)
    • janeway lesions (painless red lesions on palms/soles of feet)
    • roth spots (exudative lesions in retina)
23
Q

endocarditis dx and tx

A
  • dx: 3 sets of blood cultures at least 1h apart, before starting abx
    • echo: required to make dx and identify involved valves (vegetation)
  • tx: empiric abx cover staph, strep, enterococci
    • native valve: vanco alone or + cefazolin
    • Ill pts w/ HF: gentamicin plus cefepime and vanco
    • aortic valve replacement if refractory or abscess (funcal infxn)
  • prophylaxis: abx recommended before invasive dental work or surgical procedures: prosthetic valves, previous IE, some congenital heart dzs (transposition, tetrology), acquired valve disorders, HCM, cardiac transplant pts with valvulopathy
    • ALL OF THE ABOVE GET AMOX 1 hr before procedure (clarith or azith if PCN allergy)
24
Q

Modified duke criteria

A
  • For detecting endocarditis
  • must have one of the following criteria:
    • 2 major
    • 1 major and 3 minor
    • 5 minor
  • Major:
      1. two pos blood cultures of typical causative microorganism
      1. echo showing new valve regurg
  • Minor:
      1. predisposing factor
      1. fever >100.4
      1. vascular phenomena (embolic dz or pulm infarct)
      1. immunologic phenomena (glomeruloneph, osler nodes, roth spots)
        • blood cuture not meeting major criteria
25
Q

hyperlipidemia etiology, RF and sxs

A
  • elevated LDLs increase risk of CAD; higher HDLs = protective; elevated TGs are risk factor for atherosclerosis; severe elevations can cause pancreatitis
    • Recommended screening for pts with no evidence of CVD and NO RISK FACTORS - 35yo
    • NCEP recommends screening at age 20 regardless of risk factors
  • genetic: primary HLD, familial hypercholesterolemia; secondary to DM, ETOH, hypothyroid, obesity, sedentary lifestyle, renal or liver dz, drugs
  • RF: DM (CAD risk equivalent), smoking, HTN, HDL <40, age (>45 men, >55 women), HIV (CAD risk equivalent
  • sxs: eruptive or tendinous xanthomas
    • 2/3 ppl with xanthelasmas affecting eyelids have normal lipid profiles
    • severe: premature arcus senilis; lipemia retnalis (cream-colored retinal vessels) seen with TG levels >2000mg/dL
26
Q

hyperlipidemia dx and tx

A
  • dx: without RF, order total cholesterol
  • tx: lifestyle changes = first line: reduce total fat intake, saturated fat, dietary cholesterol <200, 30 min aerobic exercise daily, increase antioxidants from fruits and veggies, soluble fiber may reduce LDL
    • CAD prophylaxis (81mg aspirin) unless CI
    • smoking cessation
    • statin tx
  • health maintenance: pts with any evidence of CVD or CAD risk equivalent (DM, HIV should be screened with fasting complete lipid profile)
27
Q

Statins

A
  • HMG-CoA reductase inhibitors
  • reduce cholesterol production in liver and increase ability of liver to remove LDL from blood
  • BEST AT DECREASING LDL, moderate decrease in TGs and increase in HDL
  • Adverse effects: myalgias, mild GI upset; severe = myositis, liver tox, rhabdo
  • monitoring: LFTs and creatinine-phosphokinase if myalgias develop, monitor lipids every 6wk until goals met
28
Q

Niacin

A
  • Reduces long-term risk of CAD by reducing production of VLDL, lowering LDL and increasing HDL; may also reduce TG
  • moderate decrease in LDL, TG; best at elevating HDL
  • adverse effects: prostaglandin-induced NIACIN FLUSHING (may be reduced by taking ASA 30 min prior or a daily NSAID)
  • Monitoring: baseline LFTs, LFTs q6-12wks first year, then q6mo; lipid panel, blood sugar (DM) or platelets and PT (if on anticoagulants), uric acid (gout)
29
Q

Bile-acid sequestrants

A
  • cholestyramine, colesevelam, colestipol
  • bind bile acids in the intestine; resins reduce the incidence of coronary events in middle aged men; no effect on mortality
  • second best at decreasing LDL, mild decrease in TGs, mild elevation HDL
  • Adverse effects: constipation, gas
  • monitoring: fasting lipid profile prior to treatment, then 3 mo after initiation, then 6-12mo thereafter
30
Q

Fibric acid derivatives

A
  • gemfibrozil, clofibrate
  • peroxisome proliferator-activated receptor alpha (PPAR alpha) agonists - most important meds for lowering of TG levels and raising HDL
  • best at lowering TGs, second best at increasing HDL
  • adverse effects: may induce gallstones, hepatitis, myositis
  • monitoring: periodic LFT, CBC, cholesterol in the first year
31
Q

hyperlipidemia goals

A
  • HDL: >40 men, >50 women
  • LDL: <100
  • TG: <150
  • Total cholesterol: <200
32
Q

Coronary artery disease

A
  • risk factor mod: SMOKING CESSATION - cuts risk by 50%
  • Medical tx: ASA + BB
    • Sublingual NTG (for angina)
    • ASA (decreases morbidity and mortality)
    • BB (atenolol and metoprolol are first-line)
    • ACEi (for pts with heart failure)
    • Morphine (venodilation, decreases preload and O2 demand)
    • Nitrates (long acting - need 8 to 10 hr nitrate free interval to prevent tolerance; dilates coronary arteries, reduces preload and myocardial O2 demand; adverse effects = HA, ortho HoTN, tolerance, syncope)
    • CCB - coronary vasodilation, afterload reduction, reduces contractility; secondary tx when BB or NTG not fully effective or maxed out
    • Statins (stabilizes plaques and lower cholesterol)
  • revascularization - does NOT REDUCE RISK OF MI, but improves sxs
    • PCI, CABG, antiplatelet tx
  • Thrombolytic tx (alteplase): first line tx
    • pts who present late and PCI contraindicated, administer ASAP upt to 24hrs after onset of CP, best if given in first 6hrs
33
Q

Peripheral vascular dz or peripheral arterial dz

A
  • in absence of limb-threatening ischemia, sxs of PAD tend to remain stable with med tx
  • if revascularization is needed, percutaneous revasc first, reserve surgery for when arterial anatomy is unfavorable
  • clinical features used to determine if thrombolytic therapy or surg revasc is most appropriate:
    • presumed etiology (embolus vs thrombus)
    • location
    • duration of sxs
    • availability of autologous vein for bypass grafting
    • suitability of pt for surg
  • proximal embolus at bifurcation of common fem artery is ideal lesion for embolectomy
    • embolus to distal vessel Ii.e. tibial a.) may be tx with thrombolytic agent
    • major use of percutaneous transluminal angioplasty (PTA) is in the tx of underlying lesion after clot has been lysed with thrombolytic tx
  • Leriche syndrome: triad of 1) claudication, 2) absent or diminished femoral pulses, and 3) erectile dysfunction
34
Q

intermittent claudication

A
  • occurs distal to level of stenosis or occlusion (calf pain with walking 10-35% of ppl with PAD)
  • sxs: reproducible pain aggravated by sustained exercies, relieved with rest, aching, dull pain, leg pain occurs after certainwalking distances, resolving within 10min, cramping, numbess, weakness, giving way
    • Physical: hair loss on bilateral lower extremities, thinning of skin, diminished pulses
  • dx: treadmill testing using ABIs at rest and after exercise - <0.9 = diagnostic
  • tx: stop smoking (first line), graduated exercise, foot care, control HLD, HTN, weight, DM, avoid extremes of temp, ASA + ticlopidine or clopidogrel (sx relief), cilostazol (PDE inhibitors)
    • surgery: angioplasty, bypass grafting
35
Q

Asx PAD

A
  • screen in pts with abnormal/absent pedal pulses, age >70, age 50-69y with hx of smoking or DM
  • sxs: none
  • dx: ABI - if <0.9 is dx; if 0.91-1.3 normal and no further testing; if >1.3 doppler ankle waveforms and toe pressures
  • tx: preventative = ASA, lipid lowering, blood pressure control
36
Q

PAD or PVD etiology, RF, and sxs

A
  • occlusive atherosclerotic dz of lower extremities
    • superficial femoral artery is MC, popliteal, aortoiliac
  • RF: smoking HLD, DM, HTN
    • Men >40y, AA
  • MCC: atherosclerosis
    • Considered to be a coronary artery disease risk equivalent
    • Common in pts with ESRD
    • 20-50% are asx and 40-50% present with atypical leg pain
  • Sxs: pain in one or more lower extremity muscle groups (cramping thigh, calf, or buttock pain’ intermittent claudication; worse with elevation (reclining))
    • Rest pain felt over distal metatarsals, prominent at night (wakes pt up from sleep), hangs foot over side of bed or stands to relieve pain
  • signs: diminished/absent pulses, muscular atrophy, hair loss distal to obstruction, thick toenails, decreased skin temp, localized skin necrosis (toes), nonhealing, infarction, or gangrene, pallor of elevation and rubor of dependency
37
Q

PAD or PVD dx and tx

A
  • dx: hypercholesterolemia >240, hypertTG >250
    • ABI testing - if <0.9 = dx
    • doppler - reduced or interrupted flow
    • Arteriography (gold standard)
  • tx: prevention of atherosclerosis (control HLD, HTN, weight, DM
    • manage primary HLD: statins, diet exercise (walk to point of claudication, rest, then continue walking), foot care
    • reduce BP, STOP SMOKING (most important)
    • Medical intervention: ASA and ticlopidine or clopidogrel (sx relief), cilostazol (PDE inhib)
    • Surgery: angioplasty (preferred), adjunctive stenting, bypass grafting
38
Q

aortoiliac dz

A
  • inflow dz
  • sxs: buttock or thich claudication = more disabling
  • tx: percutaneous transluminal angioplasty (PTA) - iliac artery and stenting
    • aortoiliac bypass
    • aortofemoral bypass
39
Q

femoropopliteal dz

A
  • disease below inguinal ligament = outflow dz
  • tx: balloon angio/stenting of femoral or superficial femoral artery
    • surgical bypass (femoral to above-knee popliteal bypass, femoral to below-knee bypass
40
Q

phlebitis

A
  • inflammation at entry site due to needle or catheter insertion
  • MCC of fever after postop day 3
  • MC in lower extremity veins
  • sxs: induration, edema, tenderness, visible signs are minimal but include redness
  • tx: remove catheters at earliest signs
  • prevention: aseptic technique during insertion, frequent change of tubing (48-72h), rotation of insertion sites q4d
    • use silastic catheters (least reactive) and hypertonic solutions in veins with substantial flow
41
Q

suppurative phlebitis

A
  • MC bug: STAPH
  • presence of infected thrombus around indwelling catheter
  • sxs: locla signs of inflammation + pus from venupuncture site, high fever
  • dx: + blood cultures
  • tx: excise affected vein, extend incision proximally to first open collateral, leave wound open
42
Q

coronary artery vasospasm (Prinzmetal variant) etiology, RF, sxs

A
  • etiology: smooth muscle constriction (spasm) of the coronary artery w/out obstruction - leads to MI, ventricular arrhythmias, sudden death
  • known triggers: hyperventilation, cocaine, tobacco use, provocative agents (acetylcholine, ergonovine, histamine, serotonin)
  • Nitric oxide deficiency: increased activity of potent vasoconstrictors and stimulators of smooth muscle proliferation
  • 50yo, females
  • sxs: nonexertional chest pain similar to unstable angina
    • normal exercise tolerance
    • pain is cyclical (most occur in morning hours, no correlaiton to cardiac workload)
43
Q

Prinzmetal angina dx and tx

A
  • dx: EKG (ST segment or Twave abnormalities)
    • Cardiac enzyme: normal troponin, CK-MB
    • Check Mg level, CBC, CMP, lipid panel
  • tx: stress testing with myocardial perfusion imaging or coronary angiography
    • pharmacotherapy (SL, topical, or IV nitrates (initial), antiplatelet, thrombolytics, statins, BB
    • once dx made, CCB and long-acting nitrates used for long term prophylaxis (amlodipine)
44
Q

pharm tx of ACS/chest pain (angina)

A
  • Clopidogrel: reduces incidence of MI in pts with USA compared with ASA alone
  • LMWH: continue for at least 2d; PTT not followed
  • UFH: PTT 2-2.5x normal if using UFH
  • start pt with USA or NSTEMI with high LDL on statin
45
Q

Unstable angina

A
  • O2 demand unchanged, supply decreased, secondary to low resting coronary flow
  • sxs: chronic angina increasing in frequency, duration, or intensity of pain OR
    • new onset angina that is severe and worsening OR
    • angina at rest
  • dx: EKG shows ST segment or Twave abnl
    • cardiac enzymes show normal troponin and CK-MB
  • tx: admit to unit with continuous cardiac monitoring, establish IV access, O2, pain control with NTG and morphine
    • ASA, clopidogrel, BB (first line), LMWH, replace electrolytes, if response to med tx - stress test to determine if catheterization/revascularization necessary
    • reduce RF: stop smoking, weight loss, tx DM/HTN/HLD
    • heparin
  • NOT BENEFICIAL: thrombolytics and CCB
46
Q

NSTEMI and STEMI etiology, RF, sxs

A
  • NSTEMI: caused by severely narrowed artery that is not 100% blocked
  • STEMI: caused by 100% blockage of a coronary artery, necrosis of myocardium (thrombotic occlusion), asx in 1/3 of pts
  • sxs: CP (intense, substernal, crushing), radiation to neck, jaw, arms, back, left side, similar to angina pectoris but more severe and lasts longer, pain doesnt respond to NTG, epigastric, SOB, sweating, nausea, vomiting, weakness fatigue, syncope
47
Q

NSTEMI and STEMI dx and tx

A
  • dx:
    • NSTEMI: EKG shows pathologic Q waves, elevated trop and CK-MB
    • STEMI: EKG shows peaked T-waves, ST elevation, Q waves, T wave inversion
    • in both, monitor BP/HR, cardiac enzymes
  • tx: admit to ccu, establish IV access, O2, NTG/morphine
    • MONA: morphine, O2, nitrates, ASA
    • BB, ACE, heparin, statin
  • prognosis: 30% mortality rate
48
Q

dressler syndrome

A
  • post-MI syndrome occurs 1-2 wk post-MI
  • sxs: fever, malaise
  • complications: pericarditis, pleuritis
  • dx: CBC shows leukocytosis
  • tx: ASA (first line), ibuprofen
49
Q

hypertriglyceridemia

A
  • often caused or exacerbated by uncontrolled DM, obesity, sedentary habitus
  • RF: CAD, usually asymptomatic until TG >1000-2000 mg/dl
  • sxs: GI: midepigastric pain, but can occur in chest or back areas; nausea or vomiting
  • signs: TTP over midepigastric, RUQ/LUQ, hepatomegaly, dyspnea, xanthomas, corneal arcus, xanthelasmas, memory loss, dmentia, depression
  • dx: decreased pedal pulses or ABI index in presence of PAD, lipid panel, chylomicron determination, FBG, TSH, UA, LFTs
  • tx: lifestly mod (diet exercise, weight loss, smoking cessation, limit ETOH)
    • pharm: fibric acid derivatives, niacin, omega 3 FAs, statins
    • plasmapheresis in setting of severe hyperTG
50
Q

cardioversion vs defib

A
  • Cardioversion indicated for A-fib, A-flutter, VT WITH PULSE, SVT
  • Defibrillation indicated for VT WITHOUT PULSE, V-fib
  • Automatic implanted defib: VT not controlled by med tx, V-fib
  • Pharm cardioversion (ibutilide, procainamide, flecainide, sotalol, amiodarone): if pharm cardioversion fails

R2 - Family Medicine (14 decks)

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