Cardiology Flashcards
Aflutter leads best seen in
II, III, aVF
Takusoba
Nonexertional cp, with apical ballooning, often with ST elevations
Role of anti platelet in PAD
single anti platelet recommended in symptomatic pad, or asymptomatic to reduce risk of MI
indication for open vs. enxovascular repair of AAA
Infra renal - often EVAR
supra or juxta - often open
CVD risk enhancers
Risk enhancers include family history of premature atherosclerotic CVD (men aged ≤55 years, women aged ≤65 years), LDL cholesterol level of 160 mg/dL (4.14 mmol/L) or higher, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, history of premature menopause or previous history of preeclampsia, South Asian ancestry, or triglyceride level of 175 mg/dL (1.98 mmol/L) or higher.
Indications for cardiac surgery for IE
- infection persisting longer than 5-7 days while on appropriate abx
- symptomatic heart failure
- left sided involvement w s/ aureus, fungi, or highly resistant bugs
- heart block, abscess, penetrating lesion
- prosthetic valve
Increase in CAD risk in HIV pts
1.5-2x fold increase
Components of ASCVD calc
- age
- sex
- race
- total and HDL cholesterol
- systolic BP
- use of anti-hypertensives
- DM
- Smoking status
when to use exercise stres
if baseline normal EKG and can exercise - it is initial test of choice
paradoxical split s2
- can hear split in expiration
2. indicates pathology - later S2 (severe aortic stenosis, HCM, LBBB)
Indications for CRT
EF <35%
QRS >150s w/ LBBB
on goal directed therapy
sinus rhythm
Restrictive vs. Constrictive CM
- Elevated BNP
2. concordant rise and fall of left and right systolic pressures with respiration
Inspiration and preload
causes increased preload due to pumped of intraabdominal veins (increases pressure), decreased pressure of Pulm veins
Delayed enhancement of gad on MRI
c.w myocardial fibrosis
Constrictive CM
Due to external pericardial constraint (ventricular interdependence)
Restrictive CM
reduced compliance of elastic properties of the myocardium. usually has elevated BNP
Fabry’s disease
lysosomal storage disease, manifestations by 40
BP goal for aortic dissection
=120 in the first hour (first with BB, then nitroprusside)
Temporizing measure in cardiac tampoade
IV normal saline, esp if sap <100
Young kids w HCM and sports
can participate in low intesnitys sports (golfing)
first line tx of symptomatic pats with HCM
Nonvasodilating BB
Treatment of HCM for mod-severe symptoms
Catheter based alcohol septal ablation or open myomectomy in those that have s/s despite max medical therapy
ICD indications in HCM
- wall thickness massive (>30=mm)
- prior cardiac arrest
- hypotension during exercise
- syncope
- NSVT
- FH of SCD 2/2 HCM
Risk factors for ventricular free wall rupture
- older women
- anterior MI
- receiving anti-inflammatory agents
- delay in reperfusion
symptoms of free wall rupture
quick tamponade–>PEA
in stent re-stenosis symptoms
s/s ischemia
timing of in stent re-stenossi
months to years
cornerstone of HFpEF tx
diuretic therapy to maintain euvolemia
two causes of murmurs
- increased flow anemia, thyrotoxicosis, pregnancy)
2. turbulent flow
benign murmur intensity with standing
usually decrease
murmurs that require evaluation
- diastolic
- continuous
- symptoms
- or abnormalities on exam (clicks, )
preload with standing and valsalva
decreases (HCM murmur increases)
murmurs that increase with handgrip (increased co and peripheral R)
VSD
mitral and aortic regurgitation
fixed split s2 during I and E
ASD
DAPT length for DES for stable angina
6 months
P2Y12 inhibitors
clopidegrol, ticragrelor, prasugrel –> does not allow platelet activation
DAPT length for DES in ACS
at least 12 months
atrial myxoma presentation
Can present with obstruction, emboli or constitutional s/s 2/2 IL-6 (fatigue, fever, arthralgia) and early diastolic sound (tumor plop)
presentation of cardiac lymphoma
usually Right atrial mass and immunocompromised
Cards finding of Noonan syndrome
pulmonary stenosis, usually dysplastic (can have asd, vsd, hcm)
Noonan syndrome features
Pulm stenosis short stature, hypertelorism neck webbing intellectual impairment
cards s/s a/w Downs
ASD, specifically ostium premium asd
ICD indication in nonischemic CM
EF <35% + symptoms;
2. or NICM w/ unexplained syncope and LV dysfunction
screening interval for bicuspid + TAA
q6 months for aneurysm >4.5cm or faster than 0.5cm per year, if smaller q12 months
Surgical indication for AI
EF <50%, LV dilation >50mm
AC in HCM + afib
Warfarin (even if low chads2vasc)
CABG indications
- multi vessel + lvd
- DM _+ multivessel
- Left main dz
Management of PVC
- first line if BB
2. ablation if not resolved or develop left ventricular dysfunction
CI to cardiac transplant
- malignancy w/in 5 years
- renal dysfunction
- older than 70years
- other dz that decrease survival
Mechanical valve AC + pregnancy
IF dose <5mg in first trimester - warfarin is preferred over other ac
- warfarin»_space; all other AC in 2nd and 3rd trimesters
- IV UFH heparin around time of delivery
- if greater than 5mg in 1st trimester –> UFH
Screening for HCM
- genetic counseling and testing is recommended for patients with HC for all first degree fam members regardless of symptoms. (AD disorder of B myosin gene)
risk of CVD in RA
increases it 1.5-2 fold (like HIV). Risk of CVD increases with duration of underlying inflammatory condition.
testing done prior to dx of inappropriate sinus tachycardia
EKG, tte to r/o structural abnormalities, ambulatory EEG for remote findings,
hyperthyroid, anemia, pheo
Ticragrelor vs. clopidogrel vs. prasugrel
ticragrelor > clopidogrel for ACS
prasugrel only good when stents placed and no superiority found
If patient has infective endocarditis per Duke criteria, straight to TEE
otherwise if less and probable, TTE first
Increased risk of CVD 2/2 DM
2-4 x increase
Statins in DM
Any patient with DM , 40-75 should be on moderate intensity statin
if increased risk factors calculate ASCVD and if >20% should be on high intensity statin
Interaction between ranolazine and dilt/verapamil
Diltiazem and verapamil are moderate CYP3A inhibitors, which increase ranolazine (thus, decrease this dosage in pts if adding the above CCBs)
Indications for device closure of osmium secundum ASD
- Right heart enlargement and symptomatic disease
- asymptomatic patients w/ shunt related hemodynamics
- orthorexia, platypnea syndrome (dyspnea/hypoxemai when sitting, fixed when lying down)
Surgical closure of ASD indicatinos
- non secudnum ASD
large
Utility of balloon aortic valvuloplasty
Bridge to trans catheter or surgical aortic valve replacement
GDMT for heart failure
STEMI pts with LVEF <40, bb, ace-I and aldosterone antagonist
first line tx for pericarditis
high dose aspirin (750-1000mg) OR NSAIDS ( 600mg) q8 hours for 102 weeks and adjuvant colchicine (0.5mg/day) for 3 months
Most common etiologies if EI
staph and strep
culture negative IE
2.2 fastidious IE
or partially treated
Duke criteria Major (2) = clinical dx of IE
- blood cultures
2. evidence a valve is involved (tte, new regurgitant murmur)
Minor duke criteria
- predisposing valve (as, ms)
- fever
- other vascular phenomona
- immunological phenomena
vascular phenomenon on IE
septic Pulm emboli
mycotic aneurysm
IC hemorrhage
Janeway lesions
Immunological phenomenon of IE
- GN
- osler nodes (raised painful bumps)
- roth spots (retinal hemorrhages)
Indications for sx for IE
HF access/annular involvement fungal abx resistance (+ cx for >7 days) veg > 10mm severe MR, AR obstruction
prosthetic valve IE org based on timing
early (< 2 months): S. epi
late (>2) normal IE bugs
ppx for IE
previous IE
prosthetic valve
congenital HD (cyanotic)
cardiac transplant w valvular dz
ppx for IE abx for dental procedures
- amoxicillin 2g prior to procedure or
2. azithro of penicillin allergic
Jones criteria is for?
Rheumatic fever
5 major jones criteria
carditis
polyarthritis
chroea
erythema marginatum
5 major jones criteria
carditis polyarthritis chroea erythema marginatum (painless, kind of looks like drug rash?) subcutaneous nodules
4 minor criteria of Jones
arthralgia
increased sed rate, abc, crp
prolonged PR
Percentage of pts with significant AS by 45 years
50%
bicuspid valve management
monitor aortic aneurysm + valve
AS murmur
crescendo-decrecendo (ejection murmur)
class I indication for AS sx
- symptoms
Severe AS sounds
paradox split S2 (quiet A2, loud P2)
AR
decrescendo blowing murmur, diastolic (sounds same as PR)
