Cardiology Flashcards
Dobutamine contraindications for stress echo/ekg
Tachyarrhythmia, severe AS, HOCM, baseline severe HTN, unstable angina, large aortic aneurysm
Adenosine contraindications for stress echo/ekg
Bronchospastic airway disease, hypotension, SSS, high degree AV block
Radionuclide angiography imaging (MUGA)
Allows for accurate and seriate LVEF measurements; used to help assess cardiotoxicity from chemotherapy usually
Therapy for high risk bleeding patients who have afib AND a recent stent placement
Plavix + Xarelto/Eliquis
Do not need DAPT in these patients but can consider in patient’s with lower HASBLED scores
In CAD patients, when should you exercise caution when starting a BB?
If they are on nondihydropyridine CCVs (verapamil, diltiazem) as they may have additive negative chronotropic and inotropic effects
-Should also not use these meds w/ LV dysfunction
CCB to avoid in patients w/ refractory angina
Nifedipine; acute BP drops will cause reflex tachycardia increased myocardial O2 consumption
Med to use first when maximally dosed BB as not helped angina
CCB
Why are nitrates only used once a day?
To avoid tolerance
Drug interaction to consider when starting ranolazine
CYP inhibition (dilt and verapamil both exhibit mild inhibition)
What to monitor after administering thrombolytic for STEMI
EKG at 60 and 90 minutes
Want 50% reduction in ST segment elevation, although, 25% of patients do not achieve reperfusion
Indication for Effient
Prasugrel (P2Y inhibitor) ACS TREATED w/ PCI
-Is more potent and has quicker onset of action relative to plavix
CIs: Prior TIA or stroke (higher risk of bleeding than Plavix), age >75
Benefit of Brillinta
(Ticagrelor, P2Y inhibitor) studies have shown greater potency and faster onset of platelet inhibition
PLATO trial: Significantly lower mortality rates compared to Plavix
ADR: Dyspnea
Antiplatelet therapy for ACS
At least one year of DAPT if patient has low bleed risk
DM medication that has reduced risk of cardiovascular death
Trulicity (liraglutide) : GLP-1 agonist
Type of shock needed to treat afib w/ hemodynamic compromise
R-R wave synchronized shock
CHADS VASC score needed for valvular afib
0
You always anticoagulate valvular afib
Valvular afib refers to mitral stenosis, rheumatic mitral valve disease, or mechanical heart valve NOT MVR
Duration of anticoagulation needed prior to cardioversion for afib
At least 3 weeks (assuming they have been in afib for >48hrs)
Then receive anticoagulation for four weeks after procedure
Indications for permanent pacemaker in symptomatic bradycardia
- No reversible cause
- Significant pauses (>3 seconds)
- HR <40
- A fib w/ pause of >5 seconds
- Alternating bundle branch block
- Mobitz type II or complete heart block
Capabilities of implantable cardioverter-defibrillator
Monitors and treats ventricular arrhythmias
- Pacemaker present
- Can also do antitachycardia management and defibrillate
Subcutaneous implantable cardioverter-defibrillator capabilities
Monitors and treats ventricular arrhythmias ONLY
Inappropriate sinus tachycardia
Baseline tachycardia w/ exaggerated increases w/ minor physical activity; usually has normal HR during sleep
Commonly in female health professionals
Can treat symptoms w/ BB, CCBs, ivabradine if needed
Class 1A antiarrhythmics
Disopyramidine
Quinidine
Procainimide
- Decreases speed of depolarization and prolongs repolarization
- Used for preexcitable afib, Brugada syndrome, afib, SVT, ventricular arryhthmias
ADR: Drug induced lupus w/ procainamide
CIs to Class 1A antiarrhythmics
Ischemic Heart Disease Structural Heart Disease Third degree AV block w/o pacemaker Prolonged QT ESRD
**Associated w/ increased mortality in these patients
Class Ib antiarrhythmics
Lidocaine
Mexiletine
Decreases speed of depolarization
Used for ventricular arrhythmias ONLY
ADR: HA, dizziness
CI: Liver disease
Class IC antiarrhythmics
Fleicainide
Propafenone
Decreases speed of depolarization and repolarization
Used for afib, SVT, ventricular arrhythmias
ADRs: HA, dizziness, neurologic symptoms
Contraindications to Class IC antiarrhythmics
Ischemic Heart Disease Structural Heart Disease Sinus node dysfunction 2nd or higher AV block Bundle branch disease w/o pacemaker
Class III antiarrhythmics
Sotalol, dofetilide
Prolongs the action potential by blocking K channels
Used for rate control of atrial and ventricular arrhythmias
ADRs: HA, dizziness, bradycardia, dyspnea w/ sotalol, torsades w/ dofetilide
Amiodarone info
Works through multiple mechanisms although primarily works by extending repolarization
Used for atrial and ventricular arrhythmias
CIs: Advanced liver, lung, or thyroid disease
Monitor labs q6 months and consider PFTs
Primary use of Class II (BBs) and Class IV (CCBs) antiarrhythmics
Inhibit AV conduction in supraventricular tachyarrhythmias or atrial arrhythmias
Pradaxa
Dabigatran (direct thrombin inhibitor); advantage to this is Idaracuizumab exists and can reverse effects
CHADS VASC score needed for valvular afib
0
You always anticoagulate valvular afib
Duration of anticoagulation needed prior to cardioversion for afib
At least 3 weeks (assuming they have been in afib for >48hrs)
Pradaxa
Dabigatran (direct thrombin inhitibitor); advantage to this is Idaracuizumab exists and can reverse effects
What to examine w/ supraventricular tachycardias
RP interval
RP < PR = AVNRT, AVRT (WPW), junctional tachycardia
RP > PR = Sinus, atrial tachycardia
Atrial flutter physiology
Reentry tachycardia around the tricuspid annulus
Treatment for short QT syndrome or Brugada syndrome
ICD in ALL PATIENTS
What to examine w/ supraventricular tachycardias
RP interval
RP < PR = AVNRT, AVRT, junctional tachycardia
RP > PR = Sinus, atrial tachycardia
First line therapy for stable WPW
Catheter ablation
Treatment for short QT syndrome
ICD in ALL PATIENTS
Early Repolarization Syndrome
Characterized by J point elevation in the inferior and lateral leads; requires ICD placement in patients who have VF or cardiac arrest
Activities to avoid if you have an ICD
Weight lifting or upper body exertion; can lead to stress and fracture of device
Also avoid welding equipment, high voltage machinery
Patients to consider Watchman placement for
Thrombocytopenia Coagulation defects Recurrent bleeding Need for prolonged DAPT Poor oral anticoagulant compliance Fall risk
Pulses in aortic stenosis
Pulsus tardus et parvus
Delayed and late
Goal INR for mechanic aortic valve prosthesis with no other risk factors for thromboembolism
2.5
They also need to be on aspirin!
When is the goal INR 3.0?
High risk factors for thromboembolism
Order generation AV VALVE (ball in cage)
Any mitral prosthesis
Duke criteria
Major:
Positive blood culture (two separate, need to be 12hrs apart if atypical organism, or single culture if Coxiella)
Evidence of myocardial involvement (echo positive, can include new MVR if no discrete lesion seen)
Minor:
Predisposing risk factors
Fever
Vascular phenomena (emboli, ICH, Janeway lesions, conjunctival hemorrhages)
Immunologic phenomena (glomerulonephritis, Osler nodes,RF, Roth spots)
Microbiological evidence(positive blood culture not meeting above criteria)
When is dental prophylaxis appropriate
History of endocarditis
Cardiac transplant WITH valve regurgitation
Prosthetic valve
Prosthetics used for cardiac repair
Congenital heart disease
Duration of colchicine therapy for pericarditis
3 month, 0.5mg BID
Additionally, patients should avoid exercise/overexertion
What to check when your ABI is >1.4 indicating calcified arteries?
Toe-brachial index
HOCM therapies for symptoms
BBs that do NOT cause systemic vasodilation (metoprolol or bisoprolol)
Nondihydropyridine CCBs
Last: Disopyramide - has significant negative inotropic activity
What to offer HOCM patients who still have symptoms despite maximal therapy?`
Open septal myectomy or catheter-based alcohol septal ablation
Can also give w/ provocable LVOT gradient >50mmHg or in patients w/ syncope unrelated to arrhythmia
Patients w/ HOCM and afib
Needs warfarin
Echo findings consistent w/ restrictive cardiomyopathy
Biatrial enlargement, severe diastolic dysfunction in the setting of normal ventricular size, wall thickness, and systolic function
If low voltage EKG also present, consider amyloidosis instead as RCM is an inheritable defect in sarcomeric unit
Carney Complex
Mutation of PRKAR1A TSG
Lentigines (liver spots)
Atrial
Myxoma
Blue nevi
Most common primary malignant cardiac tumor
Angiosarcoma; highly vascular and appear that way on CT or MR
Survival rate even w/ successful resection is <2 years
Duration of colchicine therapy for pericarditis
3 months with .5mg BID
Also tell patients to avoid exercise for this time period
Platypnea-orthodexia syndrome
Right-left cardiac shunting through a PFO due to transient increase in right atrial pressure
Requires PFO closure
Ostium secondum ASD findings
EKG: Incomplete RBBB, P pulmonale, RAD
CXR: RAE, prominent pulmonary arteries
Associated abnormalities w/ ostium primum defect
MVR due to mitral valve cleft, LVOT
Associated abnormalities w/ sinus venosus ASD
Afib, anomalous pulmonary vein connection
Repaired tetrology of Fallot abnormalities
EKG: RBB, QRS prolongation
CXR: Cardiomegaly w/ pulmonary or tricuspid valve regurgitation, Right sided aortic arch in 25%
ASD and cardiac pacemaker placement
Higher risk of thromboembolism; reasonable to consider closure prior to placement
Main indications for ASD closure
Right sided cardiac chamber enlargement
Dyspnea
Atrial arrhythmias
Crypotogenic stroke is a relative indication
Noonan syndrome
Pulmonary stenosis Mental retardation Short stature Webbed neck Ocular hypertelorism
Pulmonary Stenosis repair indications
Balloon valvulotomy is performed for asymptomatic patients w/ a PA gradient >60 and pulmonary valve regurgitation that is less than moderate or symptomatic patients with appropriate valve morphology
-Severe pulmonary regurgitation can occur following repair
What genetic syndrome is associated w/ TOF?
DiGeorge syndrome
Complication associated w/ TOF repair
VSD patch closure and transannular patch placement of PS leads to pulmonary regurgitation
Hematologic complication in patients w/ TOF or Eisenmenger syndromes
Erythrocytosis; therapeutic phlebotomy is indicated up to 3x/yearly if symptomatic w/ HA, HTN, visual disturbance, fatigue and if Hgb >20
Additional measures need w/ congenital cyanotic heart disease prior to procedures
Abx prophylaxis for nonsterile procedures
IV filters to prevent paradoxical air embolism
Early ambulation, SCDs, and anticoagulation
Pseudoclaudication
Mimics PAD, however, discomfort also includes neuropathies and does not always worsen w/ exercise
What to do when ABI is 1.0 but still highly suspect PAD
Do an exercise ABI
Black box warning and contraindication on cilostazol
Increased mortality in patients w/ heart failure
Size for DESCENDING thoracic aortic aneurysm repair
> 6.0 cm
Medication that can lower risk for cardiotoxicity w/ doxorubicin
Dexrazoxane
Chemotherapy class that will cause REVERSIBLE cardiotoxicity (unlike the anthracyclines)
Trastuzumab
You may actually even restart therapy once the EF has returned to normal
Risk calculator to use for pregnancy in cardiac patients
ZAHARA
