Cardiology Flashcards
LBBB
- describe
- Wide QRS > 0.12 sec
- Broad, slurred R V6
- Deep S V1 and V2
LBBB
- newly diagnosed, what step is next
- Echo
- Cardiac stress test
Medication s/p PCI
- ASA
- Clopidogrel, prasugrel, ticagrelor (P2Y12 receptor inhibitors)
- BB in stable patients
- Heparin during procedure
Length of Dual antiplatelet treatment after PCI
Min 6 to 12 months
Sick Sinus Syndrome
- sx
- dizziness
- fatigue
- dyspnea
- palpitations
- pre- and syncope
Sick Sinus Syndrome
- R/O
- MI
- AV node dysfunction such as heart blocks
- other causes of syncope
- Hypothyroidism (causes bradycardia)
CHF
- pathophys behind edema
- CO down = blood backed up = increased venous pressure
- Renal perfusion decreases = compensatory renal sodium retention
CHF
- Edema types (left vs. right)
- Left HF = pulmonary edema
- Right HF = lower extremity edema/ascites
CHF
- mgmt
- tx underlying condition
- restrict sodium and fluid intake
- daily monitoring of weight
- lose weight
- ACE i, ARB, BB, diuretics
Abdominal aortic aneurysm
- definition
- MC locations
- Aorta dilated > 50% normal size
- peri-renal arteries, iliac bifurcation MC locations
Abdominal aortic aneurysm
- RF
- Smoking (MC preventable factor)
- male
- age
- caucasion
- fam hx
- atherosclerosis
Ruptured Abdominal aortic aneurysm
- sx
Triad
- abd pain
- hypotension
- palpable pulsatile abdominal mass
Abdominal aortic aneurysm
- imaging
US
Abdominal aortic aneurysm
- Screening
- men with smoking history
- One time US between 65 and 75, US f/u based on results
Abdominal aortic aneurysm
- mgmt
<4.5 cm: annual US
>4.5 cm with expansion: US every 6 months
- >5.5 cm or >0.5 cm growth in 6 months: surgery
Aortic dissection
- HTN treatment
- correct promptly
- IV esmolol, IV labetalol, IV sodium nitroprusside
Ductus arteriosus
- Fetal circulation
- Pulmonary artery to aorta
- Kept open via prostaglandins and low O2
Ductus arteriosus at birth
Fetal changes: increased pulmonary pressure, lung expansion
- changes from right ot left to left to right shunt = closure of ductus arteriosus and foramen ovale
Ductus arteriosus
- shunt if doesn’t properly close
Left to right shunt from aorta to pulmonary artery bc now aorta is higher pressure
PDA
- effects
- volume overload
- pulmonary HTN
- right-sided HF
PDA
- RF
prematurity
low birth weight
PDA
- clinical presentation
- murmur: harsh, machine-like continuous at pulmonic position
- respiratory sx: tachypnea, apnea, hypercapnia
- heart failure
- bounding peripheral pulses
- widened pulse pressure
PDA
- murmur
- continuous “machinery-like” murmur
- left second intercostal space
PDA
- imaging
Echo
PDA
- mgmt
- watchful waiting
- Pharm: indomethacin, ibuprofen
- sx
Hypertriglyceridemia
- mgmt at diff levels
- 150-199: lifestyle
- 200-499: consider pharm for high risk pts
- > 500: pharm
Dressler Syndrome
- timing
- presentation
- 2-10 weeks s/p MI
- persistent low-grade fever, pleuritic chest pain, pericarditis
Dressler Syndrome
- mgmt
- ibuprofen/ASA
- steroids
- colchicine
Unstable Angina
- length of chest pain
> 20 minutes at rest
Varicose Veins
- mgmt
- Compression stockings and lifestyle (smoking cessation, exercise, elevation of limb) X 3 months
- Sclerotherapy
- Thermal vein ablation
- Surgical excision of veins
What tick borne disease is most likely to be associated with AV heart block
Lyme
- consider Lyme carditis in any patient presenting with new-onset AV block
Primary aldosteronism
- best initial test
Aldosterone to renin ratio
* aldosterone is usually elevated and renin suppressed
Pulsus bisferiens
- describe
- seen with what heart condition
- two distinct peaks of arterial pulse during systole
- hypertrophic cardiomyopathy
Infective endocarditis
- empiric abx
vancomycin
- covers staph (MSSA and MRSA), strep, enterococci
Infective endocarditis
abx for
- MSSA
S- trep viridans
- nafcillin or oxacillin
- penicillin or ceftriaxone
Hypertensive emergency
- def
- mgmt
- elevated bp (>180/120) AND signs of end organ damage
- lower bp 10-20% first hour
- then 5-15% over next 23 hours
- Use IV agents (hydralazine, esmolol, nitroprusside, labetalol, nitroglycerine)
PEA
- mgmt
- CPR + epi q 3-5 min
- manage underlying condition
Infective endocarditis
- MC clinical manifestation
Fever
Acute rheumatic fever
- complication of what
Group A strep infection (about 1%)
Acute rheumatic fever
- patho
- multisystem autoimmune response: ab vs. strep bacteria cross react with host tissue
Acute rheumatic fever
- timing and age
- children 5-15
- 2-4 weeks after step pharyngitis
Acute rheumatic fever
- sx
- arthritis
- pancarditis
- sydenham chorea
- erythema marginatum
- subcutaneous nodules
- fever
Acute rheumatic fever
- heart issues
carditis
- damages endocardial layer: impacts valves
- Mitral stenosis MC
Acute rheumatic fever
- diagnostic criteria
Jones Criteria
- Joints
- Oh no, carditis
- Nodules
- Erythema marginatum
- Sydenham chorea
Acute rheumatic fever
- labs
evidence of preceding GAS infection:
- throat culture
- rapid antigen detection test
- elevated anti streptococcal ab titer (antistreptolysic O) *most sensitive
Acute rheumatic fever
- mgmt
- NSAIDS for arthritis
- Abx (PCN or erythromycin) for strep
Restrictive Cardiomyopathy
- patho
- fibrotic processes
- reduced ventricular filling
- increased diastolic pressure / decreased diastolic volume
- restricted ventricular filling
Restrictive Cardiomyopathy
- common casues
- Amyloidosis
- Sarcoidosis
- Hemochromatosis
- Tropical endomyocardial fibrosis
Restrictive Cardiomyopathy
- clinical
- R sided HF symptoms
- Dyspnea, fatigue, LE swelling
- Rales, JVD, hepatomegaly
- Kussmaul’s Sign (incr JVP during inspiration)
Constrictive Cardiomyopathy
- pathophys
scarring and loss of elasticity of the pericardial sac (vs. restrictive with is fibrotic process)
Constrictive Cardiomyopathy
- causes
- infection
- post-cardiac surgery
- post-radiation therapy
- connective tissue disorder
- idiopathic
Wandering atrial pacemaker
- overview
atrial dysrhythmia caused by 3+ ectopic atrial foci
Wandering atrial pacemaker
- disease MC at increased risk
COPD
Wandering atrial pacemaker
- EKG
- variable P wave morphology
- variable PR interval duration
- Irregularly irregular rhythm
Wandering atrial pacemaker
- mgmt
- no specific tx required
- focus on treating underlying condition
Coarctation of the aorta
- MC location
Distal to left subclavian artery, at insertion of ductus arteriosus
Coarctation of the aorta
- RF
- Fam history
- Turner syndrome
Coarctation of the aorta
- MC sign
HTN
Coarctation of the aorta
- diagnosis
- Systolic HTN in arms
- Delayed or decreased femoral pulses
- low or undecteable arterial BP in legs
- Echo: definitive dx
Coarctation of the aorta
- CXR
- notching of ribs
- Figure “3” appearance due to indentation of aorta at site of coarctation
Coarctation of the aorta
- mgmt
- sx repair
