Cardiology Flashcards
1
Q
Treatment of STEMI
A
1st line - PCTA
2nd line - fibrinolytic therapy
Adjunct therapy is - aspirin - Clopidogrel -LMWH - Enoxaprain - B blocker - IV glyceryl Trinitrate if severe lV dysfunction - ACEIs Statin glycoprotein 2b/3a inhibitors
2
Q
Treatment of acute limb ischemia ( reversible in <4 hrs)
A
- IV heparin + emergency embolectomy
OR - Stenting
- Arterial bypass - if acute thrombosis in chronically diseased artery
in selected cases - thrombolysis with streptokinase or urokinase
+ lifetime anticoagulation with warfarin
3
Q
Treatment of acute limb ischemia (irreversible)
A
Amputation
lifetime anticoagulation with warfarin
4
Q
Treatment of Paroxysmal supraventricular tachycardia
A
vagal maneuvers
1st line - verapamil or adenosine IV
2nd line - B-blockers and flecainide
5
Q
Prophylactic tx of PSVT
A
PO verapamil , B-blockers , flecainide , metoprolol , atenolol or Amiodarone
6
Q
Treatment of acute sinus bradycardia
A
IV atropine
7
Q
Treatment of intolerable premature ectopic atrial complexes
A
Atenolol or metoprolol or verapamil
8
Q
Treatment of double some symptoms of premature ventricular complexes
A
- metoprolol or atenolol
9
Q
When should verapamil be avoided in the treatment of PSVT
A
- in asthmatics - can cause bronchospasm
- where there in persistent tachycardia
or QRS>0.14s
10
Q
Treatment of Medical resistant PSVT
A
Radiofrequency catheter ablation
11
Q
Treatment of rapid rate control in A.fib and A.flutter
A
Verapamil or Metoprolol
If LV systolic dysfunction or clinical heart failure - use amiodarone
if fails - start digoxin
12
Q
Treatment of putting control in A fib or A flutter
A
verapamil or metoprolol or diltiazem
if fails - add digoxin
13
Q
Treatment of rhythm control in A fib or A flatter
A
flecainide , stall or amiodarone
if fails - AV ode ablation and a permanent pacemaker
14
Q
Treatment of failed medical cardioversion in A fib or A flutter
A
Electrical DC cardioversion
15
Q
Treatment of MAT
A
Diltiazem , Verapamil or Digoxin
16
Q
Treatment of 1st degree heart block
A
observation
17
Q
Treatment of Mobitz type 1
A
no treatment
might be ok to give atropine
18
Q
Treatment of third degree heart block
A
1st line - pacing
2nd line - adrenaline IV
19
Q
Treatment of Mobitz type 2
A
Pacing
20
Q
Definitive treatment of Wolf Parkinson white syndrome
A
Radiofrequency catheter ablation
21
Q
Treatment of patients with symptomatic bradycardia associated with AV block
A
pacemaker
22
Q
Treatment of LBBB or RBBB
A
cardiac resynchronization therapy or temporary pacemakers or permanent pacemakers
23
Q
complications of temporary pacemakers
A
pneumothorax
brachial plexus or subclavian artery injury
local infection or sepsis (usually with Staphylococcus aureus)
pericarditis
24
Q
early complications of permanent pacemaker
A
Pneumothorax
Cardiac tamponade
Infection
Lead displacement
25
late complications of permanent pacemaker
Infection
Erosion of the generator or lead
Chronic pain related to the implant site
Lead fracture due to mechanical fatigue
26
ACLS guidelines to Pulseless electrical activity
continuous CPR (100 compressions/min, 10 breaths/min, 30:2 ratio if unintubated)
intubation + ventilation, IV access
adrenaline 1mg IV immediately upon recognition of PEA then every 2nd cycle
Address underlying cause
27
Treatment of VSD
easy surgery by 6 months
| open heart or surgery done by a percutaneous cardiac catheter
28
Treatment of ASD
repair via direct surgical suture
or
insertion of a patch or a devise closure by cardiac catheterization
29
prophylactic treatment of A fib
Beta blockers
30
Treatment of PDA
```
Indomethacin
or surgery ( ONLY if pulmonary vascular disease is ABSENT)
```
31
Treatment of Tetralogy of Fallot
```
A)Of spells:
O2 and keep them calm
Knee-chest position
Fluid bolus
Morphine sulfate
Propranolol
B) Surgical repair at 4-6 mo of age; earlier if marked cyanosis or “tet” spells
```
32
Treatment for transposition of great arteries
1)For symptomatic neonates
Prostaglandin E1 infusion to keep ductus open until balloon atrial septostomy
2)Surgical repair
Arterial switch performed in the first two weeks in those without a VSD while LV muscle is still strong
33
Treatment of Systolic LV failure
ACEis/ ARBs + Diuretic + Beta Blocker + Aldosterone receptor blocker + Digoxin + vasodilator
34
Treatment of Severe Systolic CHF
ACEi + furosemide + Spirinolactone + heparin (if in bed ) + consider thiazide + digoxin + Beta - blocker
35
Treatment of Diastolic CHF
Diuretics + Spirinolactone +/- ACEi / ARB
36
which drugs improve surgical in CHF
ACEi , Beta blockers ad spirinolactone
37
Medical treatment of mitral valve regurgitation
- Treat heart failure if present
- vasodilating drugs - for all patients
a) angiotensin receptor blockers
b) angiotensin-converting enzyme inhibitors
c) hydralazine
- diuretics - for patients with heart failure
- β-blocker - for patients with heart failure
38
Indications for surgery in mitral valve regurgitation
ejection fraction ≤ 60%
left ventricular end systolic diameter ≥ 40 mm
refractory to medical therapy
39
Treatment of mitral valve stenosis
- standard therapy for atrial fibrillation in patients with the arrhythmia
Conservative - salt restriction
Diuretics - patients with heart failure
β-blockers - patients with exercise intolerance
40
indications for surgery in mitral valve stenosis
balloon valvuloplasty or valve replacement
- patients refractory to medical therapy
severe stenosis
41
Treatment for aortic stenosis
Diuretics for all with pulmonary congestion
42
Indications for surgery in aortic stenosis
```
1) aortic valve replacement
indication
- definitive treatment
- if patients are symptomatic
- if aortic valve area is < 0.8 cm2 (normal 2.5-3 cm2)
- if ejection fraction < 50%
```
2) balloon valvuloplasty
indication
- in patients too ill for surgery
43
Treatment of aortic regurgitation
- Salt restriction for all patients
1) vasodilating agents - patients with AR and hypertension
- bridge to surgery
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin-II receptor blockers (ARBs)
- nifedipine
Patients with AR + Heart failure
- β-blockers
- mineralocorticoid antagonists - spironolactone
- loop diuretics
- digoxin
44
Indication for aortic valve surgery in aortic regurgitation
symptomatic patients regardless of LV function
| asymptomatic patients with ejection fraction < 50%
45
Acute rheumatic fever
Benzathine penicillin
46
acute pericarditis
- NSAIDs + Cholchicine +/- PPi
47
chronic constrictive pericarditis
Loop Diuretics and Aldosterone Antagonists - Spironolactone - For the resulting diastolic heart failure
- Surgical Resection
48
cardiac tamponade
Percutaneous pericardiocentesis is the most effective therapy.
49
Infective endocarditis
- bennzylpenicillin + Flucloxacillin / dicloxacillin + grntamicin
50
prophylaxis of endocarditis
amoxycillin or ampicillin
51
Treatment of Variant or prinzmetal angina
Treatment with calcium channel blockers or nitrates eliminates spasm in most of patients.
52
Treatment of acute attacks of stable angina
- Glyceryl trinitrate or Isosorbide denitrate
( if nitrates can't be given - nifedipine )
- aspirin
53
Treatment of mild stable angina
Aspirin
if aspirin is not tolerated -
Clopidogrel and glyceryl trinitrate
consider a beta blocker or long acting nitrate or nicorandil
54
Treatment of Moderate stable angina
aspirin / clopidogrel + glyceryl trinitirate
+
beta blocker / metoprolol + nitrates ( if BB is contraindicated - use diltiazem or verapamil))
55
Treatment of persistent angina
aspirin / clopidogrel + glyceryl trinitirate
+
beta blocker / metoprolol + nitrates ( if BB is contraindicated use diltiazem or verapamil)
+
nifedipine / amlodipine + nitrates
56
Treatment of Isolated systolic hypertension
- first is none-pharmacological measures
| - thiazide diuretics , Dihydropyridine Ca antagonists and ACEI
57
Contraindication of Non dihydropyridine CCBs( Calcium channel blockers)
- reduced ejection fraction
| - 2nd ad 3rd degree heart block
58
1st line treatment for Hypertension
- ACEis or ARBS
- thiazide diuretics
- CCBs
59
Which drug can be used instead of diuretics or B- blockers in HTN
Prazosin
60
most prominent Side effect of ACEIs
Angioedema
| cough
61
When are loop diuretics used in HTN
- if they have kidney function disorder
- cardiac failure
- resistant HTN
62
treatment of HTN in pregnancy
1st line
- methyldopa - if mild to moderate
- labetalol (but not in late term) - if severe
- nifedipine
- hydralazine
2nd line
- thiazide diuretics
- clonidine
63
what drugs are contraindicated in the treatment of HTN in pregnancy
- ACEis/ARBs
| - renin inhibitors
64
Treatment of HTN in asthma/COPD
Diuretics , ACEI/ARB, cab
65
treatment of HTN in cardiac failure
Diuretics , ACEI/ARB, CCB
66
Treatment of HTN in diabetics
ARB/ACEI , CCB
67
treatment Hyperuricemina/gout
ACEI/ARB, CCB
68
Treatment of Hypertensive emergencies
- Dihydropyridine CC and/ or ACE inhibitor
69
Treatment of hypertensive emergencies in ICU
sodium nitroprusside IV
70
Treatment of HTN in adolescents and children
- ACEI or CCB
2nd agent can be diuretics
AVOID ACEI IN POSTPUBERTAL GIRLS
71
Treatment of HTN in elderly
First line - indapaminde or thiazide
if hypokalemia develops in 2-4 weeks - add a K sparing diuretic
Second line- ACEI
72
Treatment of HTN urgency
Nifedipine
or Captopril
or clonidine
or Prazosin
73
Treatment of HTN caused by renal artery stenosis
- If bilateral - loop or thiazide diuretics
| if unilateral - ACEI
74
Treatment of recurrent varicose veins post surgery
Ultrasound guided sclerotherapy
75
Treatment of DVT
```
LMW heparin - eg - enoxaparin
OR
Unfractionated Heparin (UFH)
OR
UFH and then Normal Saline
```
depending on risk - PO warfarin can be given
76
Prevention measures in lymphedema
- Protection of leg
- Rest leg while recovering
- avoid heat on leg / or ice
- elevate leg
- avoid tight clothing
- keep the leg clean
77
management of lymphedema
- Hygiene and skin care
- physical therapy and compression - First line
- conservative measures like loosing weight
- palliative surgery
78
Pharmacologic measures in lymphedema
for cellulitis - Antifungals or antimicrobial
For Filariasis - diethylcarbamazine + albendazole
for Wucheria Bancrofti - 2 week doxycycline with rifampicin
benzopyrones - reduces secondary infections
Retinoids - to help normalize keratinization
Topical ammonium lactate , urea and salicylic acids
or other emollients and keratolytics to improve secondary epithelial changes
79
Treatment of Type A Stanford Aortic dissection
Surgery
80
Treatment of type B Stanford Aortic dissection
inn the absence of malperfusion syndrome - manage medically
- B-clockers
- Nitroprusside
or surgical correction
Always start B blockers first to protect against reflex tachycardia caused by nitroprusside
81
Best initial therapy for hypertrophic cardiomyopathy (HCM)
Beta blockers
| if BB is not tolerated well - Calcium channel blockers
82
Pharmacologic contraindications in HCM
- Digoxin
avoid - nitrates , diuretics and ACEI
(all increased left ventricular outflow tract obstruction)
83
Treatment of patients refractory to medical treatment in HCM
- surgical myectomy
- alcohol septal ablation
if high risk of sudden death - ICD
84
Treatment of HTN + essential tremor
Beta blocker
