Cardiology/Cardiovascular Sx/CCU Flashcards
What are causes of increased Troponin?
ACS Myocarditis Pericarditis PE Severe Sepsis Renal failure cardiomyopathy Cirrhosis, hypertensive crisis, connective tissues disease, cardiac contusion, cardioversion, electrical injury
When does Troponin rise and peak?
Should rise within 3-12 hours and peak at 24 hours
Is troponin elevation in CRF patients correlated with creatinine clearance
No
What is the purpose of the TIMI risk score?
It is for risk stratification of composite end point of death, MI or need for urgent revascularization within 14 days.
What are some indications for PCI? (aside from STEMI)
- Cardiogenic shock (proven by shock trial)
- Contraindication to lytic
- Failure of thrombolytic (ongoing pain/ecg changes)
- Large anterior MIs (debatable if not in shock)
- Post lytic (within 24-48 hours should get cath)
Which interventions for ACS have a mortality benefit?
- ASA (NNT 43, NNH 167)
- BB
- Ace-i (decreases remodeling)
- PCI
(Nitro and CCBs do not decr mortality)
What are contraindications for BB?
Bradycardia Hypotension AV Blocks Bronchospasm:COPD/asthma Acute HF
What are 7 complications of Acute MI
Mechanical
- LV aneurysm
- VSD
- Acute MR from papillary m. rupture
- Free wall/ventricular wall rupture, acute tamponade
Electrical
- Arrythmias - tachy
- Bradycardia/Heart blocks
- Reperfusion arrythmias
Hemodynamic
- Acute CHF
- Cardiogenic shock
- VTE
- Post MI pericarditis (Dresslers syndrome)
What is the treatment for pericarditis?
what about after an MI?
Naproxen 600 mg BID for week (add PPI)
Colchicine 0.6mg BID (can cause diarrhea)
Post MI - ASA 3-4 weeks
Whats the pathophysiology of myocarditis?
Viruses gets into myocardium, immune system attacks viruses, creates antigens and there is some crossreactivity with myosin and beta receptors – ends up attacking own heart - causing inflammation in myocardial tissue.
How does digoxin work?
1) Blocks Na/K ATPase
- This increases intra-cellular Na
- The Na/Ca anti-porter then is not as active and more calcium accumulates in the cell
- This leads to incr inotropy and contractility
2) increases vagal tone which results in decr conduction thru SA and AV nodes
Why doesn’t digoxin not work for Afib in younger patients?
The younger patient’s sympathetic system can overdrive the drugs effect on increasing the vagal tone. In elderly the sympathetic system is not as ‘robust’ and therefore is more likely to work
DDX VT (4)
- ACS
- Scarring (old infarct)
- Electrolytes (K, Ca, Mg)
- Hypoxia
- AbN tissues (myocarditis, rheumatic fever, HCM, ARVD)
What are the hemodynamic goals in a patient with aortic dissection?
100/60 rule
Use Labetalol to achieve HR
What clinical risk factors increase the likelihood that a WCT on ecg is VT?
- Age > 35 (positive predictive value of 85%)
- Structural heart disease
- Ischaemic heart disease
- Previous MI
- Congestive heart failure
- Cardiomyopathy
- Family history of sudden cardiac death (suggesting conditions such as HOCM, congenital long QT syndrome, Brugada syndrome or arrhythmogenic right ventricular dysplasia that are associated with episodes of VT)
What are the Class I anti-dysrhymics? (A,B,C)
Class IA Double Quarter pounder Disopyramide Quinidine Procainamide
Class IB Mayo, Lettuce, tomato, Pickles Mexilitine Lidocaine Tocainamide Phenytoin
Class IC
Fries Please
Flecanide
Propafenone