Cardiology Flashcards
Takotsubo Cardiomyopathy
Acute myocardial damage in post-menopausal women following a stressful event
Ballooning of LV, LV dyskinesia
Tx = beta blockers and ACE
Indication for Stress Test
Acute CP when EKG is not diagnostic and etiology still unclear
What meds do you use for CAD when ACE causes hyperkalemia?
No ARB (also hyperkalemia)
Hydralazine + nitrates
Hydralazine dilates arteries so must also dilate coronary vessels w/ nitrates so blood is not stolen away from coronary vessels
What meds lower mortality in chronic angina?
ASA + beta blocker
Indications for Statin
Any arterial disease (carotids, PAD, CAD. stroke, MI)
MI / stenting
10 yr risk > 7.5%
DM
LDL > 190
Niacin Use & Side Effects
Use = add to statin to further dec LDL, inc HDL
Glucose intolerance
Elevated uric acid
Itching
Gemfibrozil Use & Side Effects
Use = dec TGs
Side effect = inc risk myositis
Tx of Cocaine-Induced Chest Pain
Ca channel blocker (verapamil or diltiazem)
Beta blockers contraindicated
Indications for CABG
3 vessels 70% stenosis or greater
2 vessels + DM
L main occlusion
Steps in Acute STEMI
1 - EKG (diagnosis ST elevations)
2- ASA (more important than morphine, O2 or nitrates)
3 - cath lab
4- later start statin, beta blocker and ACE
Contraindications to Thrombolytics (5)
Major bowel bleed
Major brain bleed
Severe HTN > 180/110
Non-hemorrhagic stroke in last 6 mo
Surgery in last 2 wks
What drugs should be given in acute NSTEMI?
ASA, plavix
Low molecular weight heparin (enoxaparin) to prevent further clot formation
What is the most common physical exam finding in new 3rd degree AV block?
Cannon A waves (atrial systole against closed tricuspid valve)
What does it suggest when blood in RV is more oxygenated than blood in R atrium?
Septal wall rupture (post-MI)
What is the best initial test in CHF?
TTE - measure ejection fraction
Which meds have mortality benefit in HFrEF?
- ACE/ARB
- Beta blocker
- Spironolactone or eplerenone
- Hydralazine w/ nitrates
- implantable defibrillator
- Sacubitril (can be used to replace ACE if cough)
Which beta blockers should be used in heart failure?
Metoprolol
Carvedilol
Bisprolol
Indication for Bi-ventricular Pacemaker
EF < 35% and QRS > 140
When should you order a BNP?
If pt has SOB w/ unclear etiology
Elevated in heart failure and pulmonary edema
What is the relationship between inhalation and murmurs?
Inhalation = inc venous return to R side of hear (more intense tricuspid or pulmonic valve sounds)
Exhalation = squeezes blood out of lungs to L side of heart (inc intensity in mitral and aortic valve sounds)
4 Unique Presenting Sx of Mitral Stenosis + 2 Populations to Think Of
1- dysphagia (L atrium is full and presses on esophagus)
2- Hoarse (L atrium presses on laryngeal nerve
3- atrial fibrillation from enormous LA
4- Hemoptysis
POPULATIONS = pregnant women & immigrants
Tx of Aortic v Mitral Stenosis
Aortic - replace valve
Mitral - balloon valvuloplasty first
TAVR v. Open Aortic Valve Surgery Risks
TAVR = higher risk aortic regurgitation and pacemaker placement
Surg = higher risk of AKI and atrial fibrillation
MV Prolapse Tx
Beta blockers if symptomatic (CP, palpitations)
