Cardiology Flashcards
What condition?
a 50-year-old woman with a history of hyperlipidemia and diabetes type 2 complaining of “chest pain attacks.”
She says that these attacks tend to occur while walking up five flights of stairs to get to her apartment.
they last for 15-20 minutes and are relieved by rest.
She describes the pain as sharp and substernal.
A baseline EKG is unremarkable.
stress EKG and observe transient ST depressions in the anterolateral leads after significant exertion
Stable angina
Dx of stable/unstable angina…
EKG
Exercise stress test
Echo/stress echo
coronary angiography
Gold standard Dx of angina…
coronary angiography
Medical Tx of Stable angina… (6)
ASA, nitrates, Beta Blockers, CCBs, ACE Inhibitors, Statins
Invasive Tx for stable angina (2)
coronary angioplasty
CABG
What condition?
a 58-year-old man with a history of coronary artery disease, hypertension, and hyperlipidemia
dull left-sided chest discomfort while at rest at home that was not relieved with taking nitroglycerin.
His ECG shows no ST-segment changes; serum troponin is not elevated.
Unstable Angina
ST depression > 1mm indicates…
ischemia
Treatment for unstable angina…
antiplatelet drugs
Beta blockers
nitro/CCBs
Revascularization
ACE-I + Statins
Tx of prinzmetal angina
Nitrates
CCBs for prophylaxis
What is contraindicated for prinzmetal angina?
beta blockers
What is contraindicated for prinzmetal angina?
beta blockers
What arrythmia?
RFs: Elderly, excessive alcohol use
Symptoms range from syncope, dyspnea, palpitations
Irregularly irregular pulse
a fib/flutter
Tx for a-fib/flutter RATE
CCBs, Beta Blockers
diltiazem/verapamil or metoprolol
Tx for afib/flutter rhythm (2 categories)
< 48 hours: cardioversion, amiodarone)
> 48 hours: anticoags x 21 days then cardioversion
CHADS2VASc score > (x) = anticoagulation
2+
LBBB ECG findings…
bunny ears in V4-V6 (R and R’)
RBBB ECG findings…
bunny ears in V1-V3 (R and R’)
Medical tx progression for PSVTs…
valsalva –> adenosine –> radioablation
SVT with delta waves and longer QRS…
WPW
Etiology for torsades…
hypokalemia, hypomagnesemia
Tx for torsades…
IV magnesium sulfate
Stable wide complex VT Tx…
amiodarone, lidocaine,
8 DDx for CP
MI
Angina
Pericarditis
Aortic dissection
PE
Pulmonary HTN
Rheumatic fever
Costochondritis
CP relieved by sitting/leaning forward
CP worse supine and during inspiration
pericarditis
severe, tearing CP radiating to back…
aortic dissection
Dyspnea + pleuritic CP can’t miss DDx…
PE
Dyspnea on exertion
CP
Edema
Syncope
Loud S2/P2 + ejection click
Pulmonary HTN
Migratory joint pain knees, ankles, elbows
CP
(+) ASO Titers
Rheumatic fever
Pain with palpation of chest
Chest Pain with movement of the arm
costochondritis
What condition?
48 yo male hx of ESRD and DM.
Dyspnea, cough, CP worse with inspiration and laying flat
Relief leaning forward/sitting upright
CMP shows BUN > 60
pericarditis
pericardial friction rub
diffuse ST segment elevation
pericarditis
Dx of pericarditis
ECG
Echo
(+) Kussmaul’s sign (increased CVP during inspiration)
Tx of pericarditis
NSAIDs/ASA x 7-14 days
corticosteroids if sxs persist > 48 hours
Tx of pericardial effusion
pericardiocentesis/pericardial window
Dx of AAA
Ultrasound, CT
Angiography gold standard
Screening for AAA
ultrasound in men 65-75 who have ever smoked
Aortic dissection Dx (2)
MRI Angiography
CXR showing widened mediastinum
which tx for HTN?
concurrent angina pectoris…
CCBs
which tx for HTN?
DM with proteinuria
ACE/ARB
ACE-I contraindicated in…
pregnancy
which tx for HTN? (2)
a/w hyperkalemia
ACE-I, spironolactone
_______ HTN meds are contraindicated in asthma and may cause impotence
beta blockers
____ HTN meds may cause leg edema
CCBs
Which CCBs are for rate control?
verapamil, diltiazem
_____ HTN meds treat HTN and BPH
alpha blockers
____ HTN med may cause lupus-like syndrome or pericarditis
hydralazine
DOC for hypertensive urgency
clonidine
DOC for hypertensive emergency
sodium nitroprusside
DOC for malignant hypertension
clevidipine/sodium nitroprusside
Pt. p/w:
heart murmur with one week increasing fatigue/low fever
hx of dental cleaning/surgery
Grade III holosystolic murmur at apex
infectious endocarditis
Roth spots
janeway lesions
splinter hemorrhages
painful osler nodes
digital clubbing
infectious endocarditis
Stroke + fever… can’t miss DDx…
infectious endocarditis
MC pathogen for endocarditis…
strep. viridans
Dx of endocarditis (4)
Blood Cx x 3 1 hour apart
EKG
CBC/ESR/RF
TEE
Tx of endocarditis with no IVDU and native heart valves…
ampicillin 500mg/hr IV
Nafcillin 2g IV q 4 hours
Gentamicin 1 mg/kg IV q 8 hours
Tx of endocarditis with prosthetic valve
vancomycin 15mg/kg IV q 12 hours
nafcillin 2g IV q 4 hours
Gentamycin 1 mg/kg IV q 8 hours
Tx of endocarditis for IVDU
nafcillin 2 g IV q 4 hours (covers MSSA)
endocarditidis abx prophylaxis
2g amoxicillin 30-60 min before procedure
Labs for CHF
BNP (low in obese)
EKG
CXR showing kerley B lines
Echocardiogram (most useful)
NY Heart Failure Classifications: 4
1: no limitation
2: slight limitation of activity, comfortable at rest
3: marked limitation of activity, comfortable at rest
4: no physical activity, angina at rest
Tx for systolic left heart failure…
Loop Diuretic + ACE-I + beta blocker
Tx for diastolic HF
ACE + Beta Blocker or CCB
3 meds for intermittent claudication
ASA + clopidogrel
cilostazol (PDE inhibitor)
High intensity statin therapy
Atorvastatin 40-80 mg
Rosuvastatin 20mg
Which HLD drug class?
TGs: down 20-40%
LDL: down 18-55%
HDL: 5-15 pt increase
SFx: myopathy, rhabdo, increased LFTs
Statins
Which HLD drug class?
TGs: 40-60%
LDL: 5-30% increase
HDL: 15-25
SFx: rhabdo
Fibrates
Which HLD drug class?
TGs: 30-50%
LDL: 5-10% increase
HDL: 5-10
SFx: flushing, poor glycemic control increased LFTs
niacin
Which HLD drug class?
TGs: 30-50%
LDL: 5-10 increase
HDL: 5-10
SFx: GI upset
fish oil
gold standard for PVD
angiography
surgical interventions for PAD/PVD
angioplasty
bypass graft
MC site for PAD/PVD
superficial femoral artery
Pt. p/w:
pain in one or more LE muscle groups
diminished/absent distal pulses
hair loss
thick toenails
pallor
PAD/PVD
Diastolic murmur usually indicates…
heart disease
Which murmur?
Soft HIGH PITCHED, BLOWING DIASTOLIC murmur along LSB with the patient sitting, leaning forward after exhaling
Aortic regurgitation
Which murmur?
DIASTOLIC low-pitched DECRESCENDO and rumbling with OPENING SNAP at the APEX
best heart at apex
mitral stenosis
Which murmur?
High pitch, decrescendo murmur at LUSB, increases with inspiration
Best heard at LUSB
pulmonary regurgitation
Which murmur?
MID DIASTOLIC RUMBLING at LLSB with OPENING SNAP
tricuspid stenosis
Which murmur?
Systolic ejection crescendo-decrescendo RUSB
Best heard when sitting
aortic stenosis
Which murmur?
HARSH MIDSYSTOLIC EJECTION CRESCENDO-DECRESCENDO murmur with WIDELY SPLIT S2 at LSB that RADIATES TO THE LEFT SHOULDER & NECK
best heard supine
pulmonic stenosis
Which murmur?
Medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining
S4 gallop and apical lift with a thick, stiff left ventricle
hypertrophic cardiomyopathy
Which murmur?
MIDSYSTOLIC EJECTION CLICK at APEX
mitral valve prolapse
Which murmur?
best heard supine
BLOWING HOLOSYSTOLIC murmur at APEX with a SPLIT S2
Mitral regurgitation
Which murmur?
HIGH PITCHED HOLOSYSTOLIC murmur at mid LSB
tricuspid regurgitation
Which murmur?
HARSH HOLOSYSTOLIC murmur heard best at the LLSB with WIDE RADIATION and a fixed, split S2
VSD
