Cardiology Flashcards
PCI within how many minutes of arriving in the ED with chest pain
90 minutes
Major bleeding
Recent surgery (within past two weeks)
Severe HTN (>180/110)
Nonhemorrhagic stroke within the last 6 months
Absolute contraindications to thrombolytics
Common complication of Acute MI
Sinus bradycardia
Complications of Acute MI
Third degree AV block
Cannon “a” waves
Treated first with atropine
Then place pacemaker if the atropine is not effective
Pace all permanent 3rd degree blocks
Symptomatic bradycardia
New inferior wall MI and clear lungs on auscultation
ST elevation in right lead 4
Treated with high volume fluid
Avoid nitroglycerin
RV infarction
Sudden loss of pulse Clear lungs Complication of acute MI/tachycardia Occurs several days after infarction Best test Echo Treated by pericardiocentesis
Tamponade/ Free wall rupture
New onset murmur and pulmonary congestion
Complication of acute MI/Tachycardia
Mitral regurgitation best heard at apex with radiation to the axilla
Ventricular septal rupture best heard at LL sternal border
Look for step up in oxygen sat as you go from RA to RV for septal rupture
Valve or Septal rupture
The following may be present in what cardiac event:
Recurrence of pain
New rales
Bump up in CK-MB
sudden onset pulmonary edema
Reinfarction
What is the next best step in management for re-infarction
Repeat EKG
Retreat with angioplasty or thrombolytics
Continue aspirin, metoprolol, nitrates, ACE, statin
Complication of acute MI
Bradycardia
Cannon A waves
Third degree AV block
Complication of acute MI
No cannon A wave
Sinus bradycardia
Complication of acute MI
Sudden loss of pulse, JV distension
Tamponade/wall rupture
complication of acute MI
IWMI in history, clear lungs
Tachycardia
Hypotension with nitroglycerin
RV infarction
Complication of acute MI
New murmur, rales/congestion
Valve rupture
Complication of acute MI
New murmur, increase in oxygen saturation on entering the RV
Septal rupture
Complication of acute MI
Loss of pulse, need EKG to answer question
Ventricular fibrillation
Dyspnea
Pulsus paradoxus
Decreased heart sounds
JVD
Tamponade
Dyspnea
Palpitations
Syncope
Arrhythmia
Dyspnea
Long smoking history
Barrel chest
COPD
Dyspnea Recent anesthetic use Brown blood not improved with oxygen Clear lungs on auscultation Cyanosis
Methemoglobinemia
Dyspnea
Burning building or car
Wood burning stove in winter
Suicide attempt
Carbon monoxide poisoning
Dyspnea
Sudden onset
Clear lungs
Pulmonary Embolus
Dyspnea
Sudden onset
Wheezing
Increased expiratory phase
Asthma
Dyspnea Slower Fever Sputum Unilateral rales/rhonci
Pneumonia
Dyspnea
Decreased breath sounds
Unilateral
Tracheal deviation
Pneumothorax
Dyspnea
Circumoral numbness
Caffeine use
History of anxiety
Panic attack
Dyspnea
Pallor
Gradual over days to weeks
Anemia
What is the best initial test in CHF
TTE
What’s the most accurate test in CHF
MUGA or multiple gated acquisition scan or nuclear ventriculography
When is BNP the most appropriate next step in management?
Acute SOB
Etiology unclear
CHF treatment in systolic dysfunction
ACEi or ARBs BB Spironolactone, Eplerenone Diuretics Digoxin
What is the next best step in management is a pt with CHF is still dyspneic after using an ACEi, BB, diuretic, digoxin and mineralcorticoid inhibitor?
Ivabradine
Sacubitril/valsartan
Hydralazine/nitrates
Drugs that provide mortality benefit in systolic dysfunction
ACEi BB Spironolactone Hydralazine/nitrates Implantable defibrillator
Most accurate test in Valvular heart disease
Catheterization
Best initial test for Valvular heart disease?
Echocardiogram TEE more sensitive and specific than TTE
SOB CHF Dysphasia Hoarseness A fib and stroke Hemoptysis
Mitral Stenosis
Murmur that increases with squatting and leg raises
Mitral stenosis
Best initial test in MS?
TTE
Most accurate test in MS?
Catherization
Triad of Aortic Stenosis
Angina
Syncope
CHF
Valsalva and standing decrease intensity of murmur
Hand grip soften murmur
Aortic Stenosis
Squatting and leg raising worsens murmur
MR
All left sided murmurs except - and - will increase with expiration
MVP
HOCM
Treatment of MR
ACEi or ARBs best
Handgrip worsens this murmur while valsalva and standing soften this murmur
AR
Wide pulse pressure Water hammer pulse Quincke pulse Hill sign (BP in legs as much as 40mmHg above arm BP) Head bobbing (de Musset sign)
AR
Atypical Chest
Palpitations
Panic attack
Most common presentation of MVP
Valsalva and standing worsen this murmur while squatting and handgrip improve
MVP
Treatment for MVP
B Blocker when symptomatic
QRS>120
Biventricular pacemaker
Automated implantable cardioverter/defibrillator has mortality benefit
Dilated cardiomyopathy treatment
Best initial therapy in both HOCM and HCM
B blockers
Most accurate test in diagnosing Restrictive Cardiomyopathy
Endomyocardial biopsy
What disease process causes equalization of pressures in diastole on R heart catheterization
Pericardial tamponade
Best initial test in constrictive pericarditis
Chest x Ray: calcification and fibrosis
