Cardiology Flashcards
1
Q
most common cause of death in US
A
CAD
2
Q
CAD risk factors (8)
A
- diabetes mellitus
- hypertension
- tobacco use
- hyperlipidemia
- peripheral arterial disease (PAD)
- obesity
- inactivity
- family history
3
Q
what is considered “significant” in the family history of CAD?
A
- females > 65 years of age
- males > 55 years of age
4
Q
chest pain that changes with RESPIRATION
A
pleuritic pain
5
Q
causes of PLEURITIC chest pain
A
- PE
- pneumonia
- pleuritis
- pericarditis
- pneumothorax
6
Q
cause of chest pain that is tender to palpation
A
costochondritis
7
Q
causes of POSITIONAL chest pain
A
pericarditis
8
Q
clues that chest pain is ISCHEMIC in nature
A
- dull pain
- last 15-30 minutes
- exertional
- substernal location
- radiates to jaw or left arm
9
Q
S3 gallop indicates
A
DILATED left ventricle
10
Q
mechanism of S3 gallop
A
rapid ventricular filling during diastole
11
Q
mechanism of S4 gallop
A
atrial systole into a stiff or noncompliant left ventricle
12
Q
S4 gallop indicates
A
left ventricular HYPERTROPHY
13
Q
best INITIAL step in presentation of chest pain
A
ASPIRIN
14
Q
which test is best to detect REINFARCTION a few days after initial infarction?
A
CK-MB
15
Q
which cardiac enzyme rises first?
A
myoglobin
16
Q
if initial EKG and/or enzymes do NOT establish diagnosis of CAD, next step
A
stress test
17
Q
when should you order a dipyridamole or adenosine thallium stress test, or dobutamine echocardiogram?
A
patient can’t exercise to target HR of > 85% of maximum
18
Q
situations where patient won’t be able to do an exercise stress test
A
- COPD
- amputation
- deconditioning
- weakness/previous stroke
- LE ulcer
- dementia
- obesity
19
Q
when should you answer exercise thallium testing, or stress echocardiography?
A
EKG is unreadable for ischemia
20
Q
situations where EKG may be unreadable for ischemia
A
- LBBB
- digoxin use
- pacemaker
- LVH
- baseline ST segment abnormality
21
Q
next diagnostic test to evaluate an abnormal stress test
A
angiography
22
Q
mechanism of thallium (nuclear isotope)
A
decreased uptake = damage
23
Q
- causes acute chest pain
- can occur with exertion or at rest
- ST segment elevation, depression, or normal EKG
- NOT based on enzyme levels, angiography, or stress test results
- BASED ON h/o chest pain with features suggestive of ischemic disease
A
definition of acute coronary syndrome (ACS)
24
Q
best initial therapy for all cases of ACS
A
ASPIRIN
25
benefit of using aspirin in ACS
instant effect of inhibiting platelets
26
can be given in ACS, but do NOT lower mortality
nitrates and morphine
27
added to aspirin for patients with ACUTE MI
clopidogrel or ticagrelor
28
only given when angioplasty is done
prasugrel
29
MOA of clopidoGREL, ticaGRELor, and prasuGREL
inhibit ADP activation of platelets
30
what LOWER MORTALITY in STEMI and are TIME DEPENDENT?
thrombolytics and PCI
31
PCI should be done within what timeframe of reaching the ER?
90 MINUTES
32
what if PCI cannot be done within 90 minutes?
thrombolytics
33
indications for thrombolytics
1. cannot perform PCI
| 2. chest pain for
34
thrombolytics should be done within what timeframe of reaching the ER?
30 MINUTES
35
mechanism of thrombolytics
ACTIVATE plasminoGEN into PLASMIN
| chops up fibrin strands into D-dimers
(does nothing if already stabilized by factor XIII)
36
lower mortality in ACS, but is NOT time critical
beta blockers
37
should be given to ALL patients with ACS, but only lower mortality if there is LEFT VENTRICULAR DYSFUNCTION, or SYSTOLIC DYSFUNCTION
ACE inhibitors
38
should be given to ALL patients with ACS, regardless of EKG/enzyme levels
statins
39
ALWAYS lower mortality in ACS
1. aspirin
2. thrombolytics
3. angioplasty
4. metoprolol
5. statins
6. clopidoGREL/ticaGRELor/prasuGREL
40
lower mortality in ACS in CERTAIN CONDITIONS
1. ACE/ARBs inhibitors IF EF is LOW
41
do NOT lower mortality in ACS
1. oxygen
2. morphine
3. nitrates
4. calcium channel blockers (actually INCREASE; avoid!)
5. lidocaine
6. amiodarone
42
clopidoGREL or ticaGRELor is used in ACS when
- aspirin allergy
- patient undergoes angioplasty/stenting
- acute MI
43
calcium channel blockers are used in ACS when
- intolerance to beta blockers (e.g. asthma)
- cocaine-induced CP
- coronary vasospasm/Prinzmetal's angina
44
when do you use a pacemaker for AMI?
- 3rd degree AV block
- Mobitz II, second degree AV block
- bifasicular block
- NEW LBBB
- symptomatic bradycardia
45
when is lidocaine or amiodarone used for AMI?
- ONLY in Vtach, or Vfib
46
complications of myocardial infarction
1. cardiogenic shock
2. valve rupture
3. septal rupture
4. myocardial wall rupture
5. sinus bradycardia
6. third degree (complete) heart block
7. right ventricular infarction
47
diagnostic tests for cardiogenic shock
- echo
| - Swan-Ganz (right heart) catheter
48
treatment for cardiogenic shock
- ACE inhibitor
| - urgent revascularization
49
diagnostic test for valve rupture
echo
50
treatment for valve rupture
- ACE inhibitor
- nitroprusside
- intra-aortic balloon pump as bridge to surgery
51
diagnostic tests for septal rupture
- echo
| - right heart cath showing STEP UP IN SATURATION FROM RIGHT ATRIUM TO RIGHT VENTRICLE
52
treatment for septal rupture
- ACE inhibitor
- nitroprusside
- urgent surgery
53
diagnostic test for myocardial wall rupture
echo
54
treatment for myocardial wall rupture
- pericardiocentesis
| - urgent cardiac repair
55
diagnostic test for sinus bradycardia
EKG
56
treatment for sinus bradycardia
- atropine
| - pacemaker IF there are STILL symptoms
57
diagnostic test for third-degree (complete) heart block
- EKG
| - canon "a" waves
58
treatment for third-degree (complete) heart block
- atropine
| - pacemaker EVEN IF symptoms resolve
59
diagnostic test for RIGHT ventricular infarction
EKG showing right ventricular leads
60
treatment for RIGHT ventricular infarction
fluid loading
61
ALL post-MI patients should go home on
1. aspirin
2. clopidoGREL, or prasuGREL
3. beta blocker
4. statin
5. ACE inhibitor
62
CAD + LDL > 100
give statins
63
LDL goal in ACS patient with DIABETES
< 70
64
CAD equivalents
1. DM
2. PAD
3. aortic disease
4. carotid disease
65
MC adverse effect of statins
LIVER TOXICITY
66
MC of post-MI erectile dysfunction
anxiety
67
MC of post-MI erectile dysfunction d/t medication
beta blockers
68
contraindicated with sildenafil (PDI's)
nitrates
69
CHF presentation
* SOB, especially on exertion, and...
- edema
- rales
- ascites
- jugular venous distention
- S3 gallop
- orthopnea (SOB when lying flat)
- paroxysmal nocturnal dyspnea (SOB attacks at night)
- fatigue
70
standard of care for pulmonary edema
1. oxygen
2. furosemide (preload reduction)
3. nitrates
4. morphine
71
non-ST segment elevation myocardial infarction treatment
1. no thrombolytics
2. low molecular weight heparin
3. glycoprotein IIb/IIIa inhibitors (lower mortality)
72
MOA of heparin
potentiates effect of antithrombin
73
improve mortality of chronic angina
aspirin and metoprolol
74
which medications should only be used in congestive heart failure, systolic dysfunction, or low ejection fraction?
ACE inhibitors or ARBs
75
AE of ACEI and ARBs
- hyperkalemia with both
| - cough with ACEIs
76
when do you add ranolazine?
persistent chest pain
77
indications for CABG
1. THREE coronary vessels > 70% stenosis
2. left main coronary artery > 50-70% stenosis
3. TWO vessels in a DIABETIC
4. 2 or 3 vessels with LOW EF
78
mechanism of rales
increased HYDROSTATIC pressure in pulmonary capillaries --> transudation of liquid into alveoli --> "popping" sound during inhalation
79
MOA of carvedilol
antagonist of B1, B2, and a1 receptors
1. antiarrhythmic
2. anti-ischemic
3. antihypertensive
80
initial diagnostic tests for CHF patient
1. CXR
2. EKG
3. oximeter (maybe an ABG)
4. echo
81
what CXR shows in CHF patient
1. pulmonary vascular congestion
2. cephalization of flow
3. effusion
4. cardiomegaly
82
what EKG shows in CHF patient
1. sinus tachycardia
| 2. atrial and ventricular arrhythmia
83
what oximeter shows in CHF patient
1. hypoxia
| 2. respiratory alkalosis (from tachypnea)
84
what echo shows in CHF patient
distinguishes systolic vs diastolic dysfunction
85
possible causes of CHF
1. HTN
2. valvular heart disease
3. MI
86
MOA of imamRINONE and milRINONE
- PDE inhibitors
- increase contractility
- vasodilators= decrease AFTERload
87
MOA of dobutamine
- increase contractility
| - vasoconstriction= increases AFTERload
88
clinical diagnosis of acute pulmonary edema
1. SOB
2. rales
3. S3 (splash)
4. orthopnea
89
right heart catheter results in acute pulmonary edema
- CO = decreased
- SVR = increased
- wedge pressure = increased
- RA pressure = increased
(wedge pressure = indirect LA pressure measurement)
90
treatment for SYSTOLIC dysfunction (low EF)
1. ACEI or ARB
2. metoprolol/carvedilol/bisoprolol
3. spironolactone/eplerenone
4. diuretic
5. digoxin
91
treatment for DIASTOLIC dysfunction (normal EF)
1. metoprolol/carvedilol/bisoprolol
| 2. diuretic
92
decreases mortality in patients with
- EF 120ms
biventricular pacemaker
93
exertional SOB: young female, general population
MVP
94
exertional SOB: healthy young athlete
HCM
95
exertional SOB: immigrant, pregnant
MS
96
exertional SOB: Turner's syndrome, coarctation of aorta
BICUSPID aortic valve
97
exertional SOB: palpitations, atypical chest pain NOT with exertion
MVP
98
possible PE findings in valvular heart disease
- peripheral edema
- carotid pulse findings
- gallops
99
all RIGHT-sided murmurs increase in intensity with
INhalation
100
all LEFT-sided murmurs increase in intensity with
EXhalation
101
ONLY 2 murmurs that become SOFTER with SQUATTING/leg raise
1. MVP
| 2. HCM
102
ONLY 2 murmurs that LOUDER with STANDING/Valsalva
1. MVP
| 2. HCM
103
which maneuver increases afterload?
handgrip
104
which murmurs are LOUDER with handgrip maneuver?
1. AR
2. MR
3. VSD
105
which murmurs are SOFTER with handgrip?
1. MVP
| 2. HCM
106
which medications decrease afterload?
1. amyl nitrate
| 2. ACEIs
107
which murmurs are LOUDER with amyl nitrate?
1. MVP
2. HCM
3. AS
108
effect of handgrip on aortic stenosis
SOFTENS murmur
| less blood travels from LV to aorta
109
effect of amyl nitrate on aortic stenosis
makes it LOUDER
| decreases afterload
110
AS is best heard where and radiates where?
- 2nd RIGHT intercostal space
| - carotid arteries
111
pulmonic valve murmurs are best heard where?
2nd LEFT intercostal space
112
AR, tricuspid murmurs, and VSD are best heard where?
LLSB
113
MR is best heard where and radiates where?
- apex (5th intercostal space)
| - axilla
114
best INITIAL test for valvular heart disease
ECHO
115
MOST ACCURATE test for valvular heart disease
left heart catheterization
116
best treatment for REGURGITANT lesions
VASODILATORS
| ACEIs, ARBs, or nifedipine
117
best treatment for STENOTIC lesions
anatomic repair
118
Valsalva improves murmur than ___ medicine is indicated
diuretics
119
handgrip makes it worse/amyl nitrate improves murmur
ACEI indicated
120
best treatment for mitral stenosis
balloon valvuloplasty
121
best treatment for severe aortic stenosis
aortic valve replacement
122
- chest pain/syncope
- older
- h/o HTN
AS
123
prognosis of AS
- CAD = 3-5-year average survival
- syncope = 2-3-year average survival
- CHF = 1.5-2-year average survival
124
mechanism of syncope/angina in AS
blocked flow with increased demand = chest pain
125
AS murmur description and location it's best heard
- crescendo-decrescendo
| - 2nd RIGHT intercostal space radiating to CAROTIDS
126
mechanism of crescendo-decrescendo murmur of AS
- isovolumetric contraction = no blood moving = no murmur
| - mid-systole = peak flow = peak noise
127
best INITIAL test for AS
TTE
128
MORE ACCURATE test for AS
TEE
129
MOST ACCURATE test for AS
left heart catheterization
130
normal aortic valve pressure gradient
ZERO
131
mild AS pressure gradient
< 30mmHg
132
moderate AS pressure gradient
30-70mmHg
133
severe AS pressure gradient
> 70mmHg
134
best INITIAL therapy for AS
diuretics
| don't improve long-term prognosis
OVERDIURESIS IS DANGEROUS
135
treatment of choice for AS
valve replacement
136
when do you balloon dilate AS?
ONLY when patient can't tolerate surgery
137
how long do bioprosthetic valves last?
about 10 years
138
how long do mechanical valves last?
15-20 years
need to be on warfarin with INR of 2-3
139
causes of AR
- HTN
- rheumatic heart disease
- endocarditis
- cystic medial necrosis
140
MC presentation of AR
1. SOB
| 2. FATIGUE
141
AR murmur description and location it's best heard
- diastolic decrescendo murmur
| - LEFT sternal border
142
Quincke pulse
arterial or capillary pulsations in FINGERNAILS
143
Corrigan's pulse
high bounding pulses
| "water-hammer" pulse
144
Musset's sign
head bobbing with pulse
145
Duroziez's sign
murmur heard over femoral artery
146
Hill's sign
BP gradient much higher in LE's
147
best INITIAL test for AR
TTE
148
MORE ACCURATE test for AR
TEE
149
MOST ACCURATE test for AR
left heart catheterization
150
best INITIAL therapy for AR
- ACEI/ARB, or nifedipine
| - and loop diuretic
151
when do you do SURGERY for AR?
| EVEN IF PATIENT IS ASYMPTOMATIC
- EF 55mm
152
why does high pressure dilate aortic valve?
LaPlace's law
tension = radius x pressure
153
MCC of MS
rheumatic fever
154
special features of MS
1. dysphagia (LA pressing on esophagus)
2. hoarseness (pressure on recurrent laryngeal nerve)
3. a-fib (stroke)
155
mechanism of increased MS symptoms in pregnancy
- 50% increase in plasma volume
- more volume = more pressure, backflow, and symptoms
- ADH levels higher
156
MS murmur description
diastolic RUMBLE after OPENING SNAP
| opening snap moves closer to S2 as mitral stenosis worsens
157
mechanism of opening snap earlier in worsening MS
worse MS = higher LA pressure = mitral valve opens earlier
| mitral valve opens when LA pressure > LV pressure
158
best INITIAL test for MS
TTE
159
MORE ACCURATE test for MS
TEE
160
MOST ACCURATE test for MS
left heart catheterization
161
CXR findings for MS (mitral stenosis)
- straightening of left heart border
| - elevation of left mainstem bronchus
162
best INITIAL therapy for MS
diuretics
163
most effective therapy for MS
balloon valvuloplasty
164
is pregnancy a contraindication to do balloon valvuloplasty in MS?
NO
165
causes of MR
1. HTN
2. ischemic heart disease
3. any condition leading to dilation of heart
166
S3 gallop can be normal in which patients?
age
167
MC complaint in MR
exertional dyspnea
168
MR murmur description and location it's best heard
- holosystolic murmur that obscures S1 and S2
| - apex radiating to axilla
169
best INITIAL test for MR
TTE
170
MORE ACCURATE test for MR
TEE
171
best INITIAL treatment for MR
- ACEI/ARB, or nifedipine
172
when do you do SURGERY for MR?
| EVEN IF PATIENT IS ASYMPTOMATIC
- LVEF 40mm
173
VSD murmur description
- holosystolic murmur
| - LLSB
174
complaint in VSD
SOB
175
diagnostic test for VSD
echo
176
used to determine degree of left-to-right shunting
catheterization
177
VSD treatment
mechanical closure if severe
178
- holosystolic murmur at LLSB
- SOB
- parasternal heave
VSD
179
- FIXED splitting of S2
- SOB
- parasternal heave
ASD
180
mechanism of fixed splitting of S2 in ASD
equal pressure between LA and RA = no change in splitting
181
test for ASD
echo
182
treatment for ASD
percutaneous or catheter repair
183
when is ASD repair most often indicated?
if shunt ratio exceeds 1.5:1
184
WIDE splitting of S2 (P2 delayed) causes
- RBBB
- pulmonic stenosis
- RVH
- pulmonary HTN
185
PARADOXICAL splitting of S2 (P2 delayed) causes
- LBBB
- AS
- LVH
- HTN
186
FIXED splitting of S2
ASD
187
best INITIAL test for DILATED cardiomyopathy
echo
| check EF and wall motion abnormality
188
MC causes of dilated CMP
- ischemia (MOST COMMON)
- alcohol
- adriamycin
- radiation
- Chagas' disease
189
treatment for DCMP
1. ACEI/ARB
2. BB
3. spironolactone/eplerenone (decrease work of heart)
190
- exertional SOB
| - S4 gallop
hypertrophic cardiomyopathy
191
best INITIAL test for HYPERTROPHIC cardiomyopathy
echo
| shows normal EF
192
treatment for HCMP
1. BB
| 2. diuretics
193
possible causes of RESTRICTIVE cardiomyopathy
- sarcoidosis
- amyloidosis
- hemochromatosis
- cancer
- myocardial fibrosis
- glycogen storage diseases
194
- exertional SOB
| - Kussmaul's sign (increase in jugular venous pressure on inhalation)
restrictive cardiomyopathy
195
- low-voltage EKG
| - speckled pattern on echo
amyloidosis
196
what does cardiac catheterization show in RCMP?
rapid x and y descent
197
what does EKG show in RCMP?
low voltage
198
mainstay of diagnosis of RCMP
echo
199
MOST ACCURATE test for RCMP
endomyocardial biopsy
200
treatment for RCMP
1. diuretics
| 2. correct underlying cause
201
- pleuritic chest pain (changes with respiration)
- positional chest pain (better when sitting up/leaning forward)
- pain is SHARP, and BRIEF
pericarditis
202
only pertinent positive PE finding for pericarditis
FRICTION RUB
203
best INITIAL diagnostic test for pericarditis
EKG
| GLOBAL ST elevation
(PR segment depression in lead II is pathognomonic)
204
best INITIAL treatment for pericarditis
NSAID
205
treatment for pericarditis if pain persists after NSAID
prednisone
206
- SOB
- hypOtension
- jugular venous distention
- lungs CTA
- PULSUS PARADOXUS (BP decrease > 10mmHg on INhalation)
- ELECTRICAL ALTERNANS (alternating QRS complex heights)
pericardial tamponade
207
mechanism of pulsus paradoxus
inhale = big RV = smaller LV = BP drop > 10mmHg
208
MOST ACCURATE test for pericardial tamponade
echo
209
finding on echo in pericardial tamponade
diastolic collapse of RA and RV
210
right heart catheterization findings of pericardial tamponade
EQUALIZATION of ALL pressures in heart during systole
211
best INITIAL treatment for pericardial tamponade
pericardiocentesis
212
MOST EFFECTIVE treatment for pericardial tamponade
pericardial window placement
213
MOST DANGEROUS thing to give a patient with pericardial tamponade
diuretics
214
- SOB
- signs of chronic right heart failure (edema, JVD, hepatosplenomegaly, ascites)
- Kussmaul's sign (increase in JVD on INhalation)
- PERICARDIAL KNOCK (extra diastolic sound from heart hitting calcified thickened pericardium)
constrictive pericarditis
215
what does CXR show in constrictive pericarditis?
calcification
216
what does EKG show in constrictive pericarditis?
low voltage
217
what does CT and MRI show in constrictive pericarditis?
thickening of pericardium
218
best INITIAL treatment for constrictive pericarditis
diuretic
219
MOST EFFECTIVE treatment for constrictive pericarditis
surgical removal of pericardium
220
- chest pain radiating to back between scapula
- CP is INITIALLY very severe and "ripping"
- difference in BP between RIGHT and LEFT arms
dissection of thoracic aorta
221
best INITIAL test for dissection of thoracic aorta
CXR showing WIDENED MEDIASTINUM
222
MOST ACCURATE for dissection of thoracic aorta
CTA
223
INITIAL treatment for dissection of thoracic aorta
beta blocker, and get EKG/CXR
224
further management of dissection of thoracic aorta
1. order CTA = TEE = MRA
| 2. start nitroprusside
225
MOST EFFECTIVE treatment for dissection of thoracic aorta
surgery
226
screening US of abdominal aorta should be done in?
MEN OVER 65 who are current or were former SMOKERS
227
when do you repair AAA?
> 5cm
228
- claudication (pain in calves on exertion)
- "smooth, shiny skin" with loss of HAIR and SWEAT GLANDS
- loss of pulses in feet
PAD
229
best INITIAL test for PAD
ankle-brachial index (ABI)
230
what is a NORMAL ankle-brachial index (ABI)?
greater than or equal to 0.9
> 10% difference = OBSTRUCTION
231
MOST ACCURATE test for PAD
angiography
232
best INITIAL treatment for PAD
1. aspirin
2. BP control with ACEI
3. exercise as tolerated
4. cilostazol
5. statin with LDL goal
233
PAIN + PALLOR + PULSELESS =
ARTERIAL OCCLUSION
234
- SUDDEN onset loss of pulse and COLD extremity
- painful
- can have h/o AS or atrial fibrillation
acute arterial embolus
235
are beta blockers contraindicated with PAD?
NO
236
mechanism of why CCB don't work in PAD
CCB dilate muscular layer EXterior to atherosclerotic clot which is INterior
237
perform surgical bypass in PAD when
signs of ischemia:
- gangrene
- pain at REST
238
- palpitations
- IRREGULAR pulse
- h/o HTN, ischemia, or CMP
a-fib
239
initial test for atrial fibrillation
- telemetry monitoring as INpatient
| - Holter monitoring as OUTpatient
240
other tests to order once atrial fibrillation is diagnosed
1. echo: looking for clots, valve function, LA size
2. TFT: TSH, T4
3. electrolytes: K+, Mag2+, Ca2+
4. troponin/CK
241
UNSTABLE patient with atrial fibrillation
(unstable = SBP
SYNCHRONIZED electrical cardioversion
242
STABLE patient with atrial fibrillation
slow ventricular HR if > 100-110
243
which medications can be given for atrial fibrillation to control the rate?
- beta blockers (metoprolol/esmolol)
- calcium channel blockers (diltiazem)
- digoxin
should be given IV
244
next best step in patient with a-fib, that's rate controlled
warfarin with goal INR of 2-3
245
other PO AC's for a-fib besides warfarin
- dabigatran (direct THROMBIN inhibitor)
- rivaroxaban (factor Xa inhibitor)
- apixaban (factor Xa inhibitor)
246
CHADS2Vasc
| indicates need for warfarin
```
CHF +1
HTN +1
Age
≥ 75 +2
DM +1
Stroke/TIA/Thromboembolism +2
Vascular Disease +1
Age
> 65-74 +1
Female +1
```
247
- palpitations
| - REGULAR rhythm
atrial flutter
248
atrial fibrillation/atrial flutter WITH:
- ischemic heart disease
- migraines
- Graves disease
- pheochromocytoma
beta blockers (metoprolol)
249
atrial fibrillation/atrial flutter WITH:
- asthma
- migrains
calcium channel blockers (diltiazem)
250
atrial fibrillation/atrial flutter WITH:
- borderline hypOtension
digoxin
251
- atrial arrhythmia IN ASSOCIATION WITH COPD/EMPHYSEMA
| - tachycardia (HR > 100)
multifocal atrial tachycardia (MAT)
252
MAT EKG finding
POLYMORPHIC P waves
253
treatment for MAT
1. oxygen FIRST
| 2. THEN diltiazem
254
do NOT use what in MAT?
beta blockers
255
- palpitations and tachycardia
- occasionally syncope
- NOT associated with ischemic heart disease
- REGULAR RHYTHM WITH VENTRICULAR RATE OF 160-180
supraventricular tachycardia (SVT)
256
diagnostic tests for MAT
- EKG first
| - if EKG is negative, Holter monitor or telemetry
257
best INITIAL management for UNSTABLE patients
synchronized cardioversion
258
best INITIAL management for STABLE patients
vagal maneuvers
- carotid sinus massage
- ice immersion of the face
- Valsalva
259
NEXT BEST step in management if vagal maneuvers do NOT work
IV adenosine
| most frequently asked SVT question
260
best long-term management
radiofrequency catheter ablation
261
- SVT that can alternate with ventricular tachycardia
| - WORSENING of SVT after use of CCB or digoxin
Wolff-Parkinson-White syndrome (WPW)
262
diagnosis of WPW
DELTA WAVE on EKG
263
MOST ACCURATE test for WPW
electrophysiologic studies
264
best INITIAL treatment for WPW
procainamide
265
best long-term treatment for WPW
radiofrequency catheter ablation
266
mechanism of WPW
neutralized cardiac muscle going around AV node creating aberrant pathway
267
- palpitations
- syncope
- chest pain
- sudden death
ventricular tachycardia (VT)
268
if EKG does not detect VT then
telemetry monitoring
269
MOST ACCURATE diagnostic test for VT
electrophysiologic studies
270
treatment for VT in patient that hemodynamically STABLE
- amiodarone
- lidocaine
- procainamide
- magnesium
271
treatment for VT in patient that hemodynamically UNSTABLE
synchronized cardioversion
272
sudden death
ventricular fibrillation (VF)
273
diagnosis of loss of pulse/VF
EKG
274
treatment for VF
ALWAYS UNsynchronized cardioversion first
275
mechanism for need of synchronization
- T-wave represents refractory period
| - electrical shock delivered during the T-wave can set off a WORSE rhythm; VF, and ASYSTOLE
276
BLS for VF
1. continue CPR
2. defibrillate (UNsynchronized cardioversion)
3. IV epinephrine/vasopressin
4. defibrillate (UNsynchronized cardioversion)
5. IV amiodarone/lidocaine
6. defibrillate (UNsynchronized cardioversion)
repeat CPR between each shock
277
management of syncope is based on 3 criteria
1. was the loss of consciousness SUDDEN or GRADUAL?
2. was the regaining of consciousness SUDDEN or GRADUAL?
3. is the cardiac exam NORMAL or ABNORMAL?
278
if syncope onset was GRADUAL, possible causes could be?
- toxic-metabolic
- hypoglycemia
- anemia
- hypoxia
279
if syncope onset was SUDDEN, next question is?
was the regaining of consciousness SUDDEN or GRADUAL?
280
if return to consciousness onset was GRADUAL, possible causes could be?
neurological etiology (seizures)
281
if return to consciousness onset was SUDDEN, next question is?
is the cardiac exam NORMAL or ABNORMAL?
282
if cardiac exam is ABNORMAL, possible causes could be?
structural heart disease:
- aortic or mitral stenosis
- HCM
- mitral valve prolapse (rare)
283
if cardiac exam is NORMAL, possible cause could be?
ventricular arrhythmia
284
diagnostic tests for syncope evaluation
- cardiac/neurological exam
- EKG
- chemistries (looking at glucose, and electrolytes)
- oximeter
- CBC (looking for anemia)
- cardiac enzymes
285
in evaluation of syncope, if murmur is present
order an echo
286
in evaluation of syncope, if the neuro exam is FOCAL, or there's h/o head trauma
order CTH
287
in evaluation of syncope, if headache is described
order CTH
288
in evaluation of syncope, if seizure is described, OR SUSPECTED
order CTH and EEG
289
mechanism of syncope
ONLY BRAINSTEM stroke can cause syncope (controls sleep/wake in brain)
290
further evaluation of syncope if diagnosis is still unclear after INITIAL tests
- Holter monitor as outpatient
- telemetry monitor as inpatient
- repeat cardiac enzymes
- urine/blood toxicology
291
if etiology of syncope is STILL NOT clear
- tilt table test (to diagnose neurocardiogenic (vasovagal) syncope)
- EP testing
292
treatment for syncope
based on etiology
| but most cases lack specific diagnosis
293
if ventricular dysrhythmia is diagnosed as etiology of syncope, what is indicated?
implantable cardioverter/defibrillator
294
role of colchicine in pericarditis
adds efficacy to NSAIDs and prevents recurrent episodes
295
at what CHADS2Vasc score should a pt be started on warfarin, and should the pt be bridged on heparin?
- 2, or more points
| - NO!
296
heart failure is primarily a clinical diagnosis:
name the MAJOR criteria
need either, 2 major criteria, or 1 major and 2 minor
1. paroxysmal nocturnal dyspnea (PND)
2. orthopnea
3. raised jugular venous pressure (JVP)
4. third heart sound
5. increased cardiac silhouette on CXR
6. pulmonary vascular congestion on CXR
297
heart failure is primarily a clinical diagnosis:
name the MINOR criteria
need either, 2 major criteria, or 1 major and 2 minor
1. B/L LE edema
2. nocturnal cough
3. exertional dyspnea
4. tachycardia
5. presence of pleural effusion
6. hepatomegaly
