Cardiology

Question 1

Indications for defribillator

Answer 1

1. Recent MI (40 days) and LVEF < 30%

2. Cardiomyopathy, NYHA 2-3, LVEF <35%

Question 2

When should you start Isordil for mgmt of heart failure?

Answer 2

First would start ACE-I; then Diuretic, BB, Spironolactone, Defribillator; then Isordil/Hydralazine if black

The combination of hydralazine plus nitrate therapy provides symptomatic and mortality benefit in African American patients with LV systolic dysfunction (left ventricular ejection fraction [LVEF] <40%) and NYHA class III or IV heart failure symptoms despite optimal therapy. It is also recommended in patients with heart failure and low LVEF who cannot tolerate ACE inhibitors or angiotensin receptor blockers (ARBs) due to hypotension, renal failure, or hyperkalemia and/or have persistent symptoms despite optimal therapy with a beta blocker, ACE inhibitor, aldosterone antagonist, and diuretic.

Question 3

Metolazone is a _______ diuretic

Answer 3

Thiazide

Question 4

Additional agent with lasix for flash pulmonary edema secondary to hypertensive urgency

Answer 4

Need nitrate…IV Nitroglycerin should be started for these decompensated HF (esp when inadequate diuretic response)/flash pulm edema patients

Question 5

Effect of Milrinone

Answer 5

Positive inotrope, also reduces preload and afterload. risk of hypotension and arrythmia

Question 6

mechanism of milrinone

Answer 6

selective PDE 3 inhibitor; use for decomp HF due to LV dysfunction

Question 7

when do you defibrillate patients with asystole?

Answer 7

you don’t, it doesn’t work for asystole or PEA. continue compressions.