Cardiology COPY Flashcards
mechanism of syncope
ONLY BRAINSTEM stroke can cause syncope (controls sleep/wake in brain)
exertional SOB: immigrant, pregnant
MS
treatment for pericarditis if pain persists after NSAID
prednisone
diagnostic test for valve rupture
echo
is pregnancy a contraindication to do balloon valvuloplasty in MS?
NO
if cardiac exam is ABNORMAL, possible causes could be?
structural heart disease:
- aortic or mitral stenosis
- HCM
- mitral valve prolapse (rare)
mechanism of increased MS symptoms in pregnancy
- 50% increase in plasma volume
- more volume = more pressure, backflow, and symptoms
- ADH levels higher
best INITIAL treatment for WPW
procainamide
MC complaint in MR
exertional dyspnea
mechanism of S4 gallop
atrial systole into a stiff or noncompliant left ventricle
possible causes of RESTRICTIVE cardiomyopathy
- sarcoidosis
- amyloidosis
- hemochromatosis
- cancer
- myocardial fibrosis
- glycogen storage diseases
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
treatment for RIGHT ventricular infarction
fluid loading
decreases mortality in patients with
- EF 120ms
biventricular pacemaker
best INITIAL treatment for pericardial tamponade
pericardiocentesis
- exertional SOB
- S4 gallop
hypertrophic cardiomyopathy
PARADOXICAL splitting of S2 (P2 delayed) causes
- LBBB
- AS
- LVH
- HTN
benefit of using aspirin in ACS
instant effect of inhibiting platelets
what does EKG show in constrictive pericarditis?
low voltage
Hill’s sign
BP gradient much higher in LE’s
if etiology of syncope is STILL NOT clear
- tilt table test (to diagnose neurocardiogenic (vasovagal) syncope)
- EP testing
CXR findings for MS (mitral stenosis)
- straightening of left heart border
- elevation of left mainstem bronchus
moderate AS pressure gradient
30-70mmHg
BLS for VF
- continue CPR
- defibrillate (UNsynchronized cardioversion)
- IV epinephrine/vasopressin
- defibrillate (UNsynchronized cardioversion)
- IV amiodarone/lidocaine
- defibrillate (UNsynchronized cardioversion)
repeat CPR between each shock
exertional SOB: palpitations, atypical chest pain NOT with exertion
MVP
possible causes of CHF
- HTN
- valvular heart disease
- MI
best treatment for REGURGITANT lesions
VASODILATORS
ACEIs, ARBs, or nifedipine
diagnosis of loss of pulse/VF
EKG
when should you answer exercise thallium testing, or stress echocardiography?
EKG is unreadable for ischemia
if EKG does not detect VT then
telemetry monitoring
best INITIAL test for PAD
ankle-brachial index (ABI)
normal aortic valve pressure gradient
ZERO
- low-voltage EKG
- speckled pattern on echo
amyloidosis
management of syncope is based on 3 criteria
- was the loss of consciousness SUDDEN or GRADUAL?
- was the regaining of consciousness SUDDEN or GRADUAL?
- is the cardiac exam NORMAL or ABNORMAL?
MOST EFFECTIVE treatment for dissection of thoracic aorta
surgery
best INITIAL treatment for pericarditis
NSAID
severe AS pressure gradient
> 70mmHg
test for ASD
echo
which murmurs are LOUDER with handgrip maneuver?
- AR
- MR
- VSD
are beta blockers contraindicated with PAD?
NO
indications for thrombolytics
- cannot perform PCI
2. chest pain for
if cardiac exam is NORMAL, possible cause could be?
ventricular arrhythmia
exertional SOB: young female, general population
MVP
situations where EKG may be unreadable for ischemia
- LBBB
- digoxin use
- pacemaker
- LVH
- baseline ST segment abnormality
causes of MR
- HTN
- ischemic heart disease
- any condition leading to dilation of heart
- chest pain/syncope
- older
- h/o HTN
AS
all LEFT-sided murmurs increase in intensity with
EXhalation
Duroziez’s sign
murmur heard over femoral artery
treatment for myocardial wall rupture
- pericardiocentesis
- urgent cardiac repair
next best step in patient with a-fib, that’s rate controlled
warfarin with goal INR of 2-3
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
if return to consciousness onset was GRADUAL, possible causes could be?
neurological etiology (seizures)
MORE ACCURATE test for AS
TEE
INITIAL treatment for dissection of thoracic aorta
beta blocker, and get EKG/CXR
S3 gallop indicates
DILATED left ventricle
sudden death
ventricular fibrillation (VF)
heart failure is primarily a clinical diagnosis:
name the MAJOR criteria
need either, 2 major criteria, or 1 major and 2 minor
- paroxysmal nocturnal dyspnea (PND)
- orthopnea
- raised jugular venous pressure (JVP)
- third heart sound
- increased cardiac silhouette on CXR
- pulmonary vascular congestion on CXR
lower mortality in ACS, but is NOT time critical
beta blockers
best long-term management
radiofrequency catheter ablation
- SVT that can alternate with ventricular tachycardia
- WORSENING of SVT after use of CCB or digoxin
Wolff-Parkinson-White syndrome (WPW)
MOST ACCURATE test for MS
left heart catheterization
best treatment for mitral stenosis
balloon valvuloplasty
best INITIAL test for AR
TTE
MOST ACCURATE test for PAD
angiography
when is lidocaine or amiodarone used for AMI?
- ONLY in Vtach, or Vfib
diagnostic tests for MAT
- EKG first
- if EKG is negative, Holter monitor or telemetry
MOA of imamRINONE and milRINONE
- PDE inhibitors
- increase contractility
- vasodilators= decrease AFTERload
- pleuritic chest pain (changes with respiration)
- positional chest pain (better when sitting up/leaning forward)
- pain is SHARP, and BRIEF
pericarditis
- 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
PCI should be done within what timeframe of reaching the ER?
90 MINUTES
diagnostic test for VSD
echo
only given when angioplasty is done
prasugrel
AS is best heard where and radiates where?
- 2nd RIGHT intercostal space
- carotid arteries
ALWAYS lower mortality in ACS
- aspirin
- thrombolytics
- angioplasty
- metoprolol
- statins
- clopidoGREL/ticaGRELor/prasuGREL
best INITIAL test for HYPERTROPHIC cardiomyopathy
echo
shows normal EF
treatment for RCMP
- diuretics
2. correct underlying cause
diagnostic test for sinus bradycardia
EKG
complications of myocardial infarction
- cardiogenic shock
- valve rupture
- septal rupture
- myocardial wall rupture
- sinus bradycardia
- third degree (complete) heart block
- right ventricular infarction
- palpitations
- REGULAR rhythm
atrial flutter
treatment for VF
ALWAYS UNsynchronized cardioversion first
VSD murmur description
- holosystolic murmur
- LLSB
what does CXR show in constrictive pericarditis?
calcification
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
if syncope onset was SUDDEN, next question is?
was the regaining of consciousness SUDDEN or GRADUAL?
what does CT and MRI show in constrictive pericarditis?
thickening of pericardium
diagnostic test for RIGHT ventricular infarction
EKG showing right ventricular leads
treatment for syncope
based on etiology
but most cases lack specific diagnosis
calcium channel blockers are used in ACS when
- intolerance to beta blockers (e.g. asthma)
- cocaine-induced CP
- coronary vasospasm/Prinzmetal’s angina
mechanism of rales
increased HYDROSTATIC pressure in pulmonary capillaries –> transudation of liquid into alveoli –> “popping” sound during inhalation
how long do bioprosthetic valves last?
about 10 years
what EKG shows in CHF patient
- sinus tachycardia
2. atrial and ventricular arrhythmia
if syncope onset was GRADUAL, possible causes could be?
- toxic-metabolic
- hypoglycemia
- anemia
- hypoxia
treatment for VT in patient that hemodynamically STABLE
- amiodarone
- lidocaine
- procainamide
- magnesium
what echo shows in CHF patient
distinguishes systolic vs diastolic dysfunction
treatment for cardiogenic shock
- ACE inhibitor
- urgent revascularization
treatment for VT in patient that hemodynamically UNSTABLE
synchronized cardioversion
standard of care for pulmonary edema
- oxygen
- furosemide (preload reduction)
- nitrates
- morphine
- SUDDEN onset loss of pulse and COLD extremity
- painful
- can have h/o AS or atrial fibrillation
acute arterial embolus
best INITIAL therapy for MS
diuretics
special features of MS
- dysphagia (LA pressing on esophagus)
- hoarseness (pressure on recurrent laryngeal nerve)
- a-fib (stroke)
MOST ACCURATE test for valvular heart disease
left heart catheterization
mainstay of diagnosis of RCMP
echo
treatment of choice for AS
valve replacement
ALL post-MI patients should go home on
- aspirin
- clopidoGREL, or prasuGREL
- beta blocker
- statin
- ACE inhibitor
effect of handgrip on aortic stenosis
SOFTENS murmur
less blood travels from LV to aorta
AR, tricuspid murmurs, and VSD are best heard where?
LLSB
treatment for valve rupture
- ACE inhibitor
- nitroprusside
- intra-aortic balloon pump as bridge to surgery
MOST ACCURATE for dissection of thoracic aorta
CTA
NEXT BEST step in management if vagal maneuvers do NOT work
IV adenosine
most frequently asked SVT question
treatment for ASD
percutaneous or catheter repair
do NOT use what in MAT?
beta blockers
CAD equivalents
- DM
- PAD
- aortic disease
- carotid disease
exertional SOB: healthy young athlete
HCM
MOST EFFECTIVE treatment for constrictive pericarditis
surgical removal of pericardium
screening US of abdominal aorta should be done in?
MEN OVER 65 who are current or were former SMOKERS
which murmurs are LOUDER with amyl nitrate?
- MVP
2. HCM
in evaluation of syncope, if the neuro exam is FOCAL, or there’s h/o head trauma
order CTH
Corrigan’s pulse
high bounding pulses
“water-hammer” pulse
mechanism of fixed splitting of S2 in ASD
equal pressure between LA and RA = no change in splitting
which maneuver increases afterload?
handgrip
ONLY 2 murmurs that LOUDER with STANDING/Valsalva
- MVP
2. HCM
in evaluation of syncope, if headache is described
order CTH
best INITIAL management for STABLE patients
vagal maneuvers
- carotid sinus massage
- ice immersion of the face
- Valsalva
diagnostic test for myocardial wall rupture
echo
what if PCI cannot be done within 90 minutes?
thrombolytics
lower mortality in ACS in CERTAIN CONDITIONS
- ACE/ARBs inhibitors IF EF is LOW
should be given to ALL patients with ACS, but only lower mortality if there is LEFT VENTRICULAR DYSFUNCTION, or SYSTOLIC DYSFUNCTION
ACE inhibitors
right heart catheterization findings of pericardial tamponade
EQUALIZATION of ALL pressures in heart during systole
treatment for DCMP
- ACEI/ARB
- BB
- spironolactone/eplerenone (decrease work of heart)
only pertinent positive PE finding for pericarditis
FRICTION RUB
UNSTABLE patient with atrial fibrillation
(unstable = SBP
SYNCHRONIZED electrical cardioversion
Musset’s sign
head bobbing with pulse
best INITIAL therapy for AS
diuretics
don’t improve long-term prognosis
OVERDIURESIS IS DANGEROUS
when do you add ranolazine?
persistent chest pain
when do you use a pacemaker for AMI?
- 3rd degree AV block
- Mobitz II, second degree AV block
- bifasicular block
- NEW LBBB
- symptomatic bradycardia
non-ST segment elevation myocardial infarction treatment
- no thrombolytics
- low molecular weight heparin
- glycoprotein IIb/IIIa inhibitors (lower mortality)
MS murmur description
diastolic RUMBLE after OPENING SNAP
opening snap moves closer to S2 as mitral stenosis worsens
all RIGHT-sided murmurs increase in intensity with
INhalation
best initial therapy for all cases of ACS
ASPIRIN
complaint in VSD
SOB
when do you do SURGERY for MR?
EVEN IF PATIENT IS ASYMPTOMATIC
- LVEF 40mm
best INITIAL management for UNSTABLE patients
synchronized cardioversion
diagnostic tests for syncope evaluation
- cardiac/neurological exam
- EKG
- chemistries (looking at glucose, and electrolytes)
- oximeter
- CBC (looking for anemia)
- cardiac enzymes
MR murmur description and location it’s best heard
- holosystolic murmur that obscures S1 and S2
- apex radiating to axilla
MOST ACCURATE test for RCMP
endomyocardial biopsy
possible PE findings in valvular heart disease
- peripheral edema
- carotid pulse findings
- gallops
atrial fibrillation/atrial flutter WITH:
- borderline hypOtension
digoxin
best long-term treatment for WPW
radiofrequency catheter ablation
MOST ACCURATE test for pericardial tamponade
echo
- claudication (pain in calves on exertion)
- “smooth, shiny skin” with loss of HAIR and SWEAT GLANDS
- loss of pulses in feet
PAD
best treatment for STENOTIC lesions
anatomic repair
atrial fibrillation/atrial flutter WITH:
- asthma
- migrains
calcium channel blockers (diltiazem)
MOA of heparin
potentiates effect of antithrombin
handgrip makes it worse/amyl nitrate improves murmur
ACEI indicated
which murmurs are SOFTER with handgrip?
- MVP
2. HCM
if return to consciousness onset was SUDDEN, next question is?
is the cardiac exam NORMAL or ABNORMAL?
MC adverse effect of statins
LIVER TOXICITY
treatment for SYSTOLIC dysfunction (low EF)
- ACEI or ARB
- metoprolol/carvedilol/bisoprolol
- spironolactone/eplerenone
- diuretic
- digoxin
other PO AC’s for a-fib besides warfarin
- dabigatran (direct THROMBIN inhibitor)
- rivaroxaban (factor Xa inhibitor)
- apixaban (factor Xa inhibitor)
most common cause of death in US
CAD
Valsalva improves murmur
diuretics indicated
what is a NORMAL ankle-brachial index (ABI)?
greater than or equal to 0.9
> 10% difference = OBSTRUCTION
WIDE splitting of S2 (P2 delayed) causes
- RBBB
- pulmonic stenosis
- RVH
- pulmonary HTN
MR is best heard where and radiates where?
- apex (5th intercostal space)
- axilla
diagnosis of WPW
DELTA WAVE on EKG
MCC of MS
rheumatic fever
best INITIAL test for valvular heart disease
ECHO
initial test for atrial fibrillation
- telemetry monitoring as INpatient
- Holter monitoring as OUTpatient
in evaluation of syncope, if murmur is present
order an echo
in evaluation of syncope, if seizure is described, OR SUSPECTED
order CTH and EEG
MC causes of dilated CMP
- ischemia (MOST COMMON)
- alcohol
- adriamycin
- radiation
- Chagas’ disease
PAIN + PALLOR + PULSELESS =
ARTERIAL OCCLUSION
best INITIAL step in presentation of chest pain
ASPIRIN
mechanism of WPW
neutralized cardiac muscle going around AV node creating aberrant pathway
Quincke pulse
arterial or capillary pulsations in FINGERNAILS
why does high pressure dilate aortic valve?
LaPlace’s law
tension = radius x pressure
treatment for third-degree (complete) heart block
- atropine
- pacemaker EVEN IF symptoms resolve
MOST EFFECTIVE treatment for pericardial tamponade
pericardial window placement
mechanism of thrombolytics
ACTIVATE plasminoGEN into PLASMIN
chops up fibrin strands into D-dimers
(does nothing if already stabilized by factor XIII)
CAD risk factors (8)
- diabetes mellitus
- hypertension
- tobacco use
- hyperlipidemia
- peripheral arterial disease (PAD)
- obesity
- inactivity
- family history
prognosis of AS
- CAD = 3-5-year average survival
- syncope = 2-3-year average survival
- CHF = 1.5-2-year average survival
mechanism of S3 gallop
rapid ventricular filling during diastole
mechanism of thallium (nuclear isotope)
decreased uptake = damage
causes of PLEURITIC chest pain
- PE
- pneumonia
- pleuritis
- pericarditis
- pneumothorax
right heart catheter results in acute pulmonary edema
- CO = decreased
- SVR = increased
- wedge pressure = increased
- RA pressure = increased
(wedge pressure = indirect LA pressure measurement)
atrial fibrillation/atrial flutter WITH:
- ischemic heart disease
- migraines
- Graves disease
- pheochromocytoma
beta blockers (metoprolol)
- palpitations
- IRREGULAR pulse
- h/o HTN, ischemia, or CMP
a-fib
CAD + LDL > 100
give statins
when do you do SURGERY for AR?
EVEN IF PATIENT IS ASYMPTOMATIC
- EF 55mm
chest pain that changes with RESPIRATION
pleuritic pain
MC of post-MI erectile dysfunction d/t medication
beta blockers
which medications should only be used in congestive heart failure, systolic dysfunction, or low ejection fraction?
ACE inhibitors or ARBs
MOST ACCURATE test for WPW
electrophysiologic studies
what is considered “significant” in the family history of CAD?
- females > 65 years of age
- males > 55 years of age
LDL goal in ACS patient with DIABETES
< 70
what oximeter shows in CHF patient
- hypoxia
2. respiratory alkalosis (from tachypnea)
mechanism of why CCB don’t work in PAD
CCB dilate muscular layer EXterior to atherosclerotic clot which is INterior
MC presentation of AR
- SOB
2. FATIGUE
clopidoGREL or ticaGRELor is used in ACS when
- aspirin allergy
- patient undergoes angioplasty/stenting
- acute MI
which test is best to detect REINFARCTION a few days after initial infarction?
CK-MB
which cardiac enzyme rises first?
myoglobin
best INITIAL test for MS
TTE
mechanism of syncope/angina in AS
blocked flow with increased demand = chest pain
added to aspirin for patients with ACUTE MI
clopidogrel or ticagrelor
mild AS pressure gradient
< 30mmHg
MOA of carvedilol
antagonist of B1, B2, and a1 receptors
- antiarrhythmic
- anti-ischemic
- antihypertensive
perform surgical bypass in PAD when
signs of ischemia:
- gangrene
- pain at REST
MORE ACCURATE test for MR
TEE
effect of amyl nitrate on aortic stenosis
makes it LOUDER
decreases afterload
MOST ACCURATE diagnostic test for VT
electrophysiologic studies
used to determine degree of left-to-right shunting
catheterization
most effective therapy for MS
balloon valvuloplasty
best INITIAL treatment for MR
- ACEI/ARB, or nifedipine
heart failure is primarily a clinical diagnosis:
name the MINOR criteria
need either, 2 major criteria, or 1 major and 2 minor
- B/L LE edema
- nocturnal cough
- exertional dyspnea
- tachycardia
- presence of pleural effusion
- hepatomegaly
- exertional SOB
- Kussmaul’s sign (increase in jugular venous pressure on inhalation)
restrictive cardiomyopathy
role of colchicine in pericarditis
adds efficacy to NSAIDs and prevents recurrent episodes
- atrial arrhythmia IN ASSOCIATION WITH COPD/EMPHYSEMA
- tachycardia (HR > 100)
multifocal atrial tachycardia (MAT)
can be given in ACS, but do NOT lower mortality
nitrates and morphine
should be given to ALL patients with ACS, regardless of EKG/enzyme levels
statins
when is ASD repair most often indicated?
if shunt ratio exceeds 1.5:1
causes of AR
- HTN
- rheumatic heart disease
- endocarditis
- cystic medial necrosis
clues that chest pain is ISCHEMIC in nature
- dull pain
- last 15-30 minutes
- exertional
- substernal location
- radiates to jaw or left arm
treatment for HCMP
- BB
2. diuretics
if ventricular dysrhythmia is diagnosed as etiology of syncope, what is indicated?
implantable cardioverter/defibrillator
MOST ACCURATE test for AR
left heart catheterization
AE of ACEI and ARBs
- hyperkalemia with both
- cough with ACEIs
when do you repair AAA?
> 5cm
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
STABLE patient with atrial fibrillation
slow ventricular HR if > 100-110
do NOT lower mortality in ACS
- oxygen
- morphine
- nitrates
- calcium channel blockers (actually INCREASE; avoid!)
- lidocaine
- amiodarone
next diagnostic test to evaluate an abnormal stress test
angiography
MOA of clopidoGREL, ticaGRELor, and prasuGREL
inhibit ADP activation of platelets
- 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
diagnostic tests for septal rupture
- echo
- right heart cath showing STEP UP IN SATURATION FROM RIGHT ATRIUM TO RIGHT VENTRICLE
FIXED splitting of S2
ASD
what does cardiac catheterization show in RCMP?
rapid x and y descent
ONLY 2 murmurs that become SOFTER with SQUATTING/leg raise
- MVP
2. HCM
treatment for DIASTOLIC dysfunction (normal EF)
- metoprolol/carvedilol/bisoprolol
2. diuretic
- FIXED splitting of S2
- SOB
- parasternal heave
ASD
treatment for sinus bradycardia
- atropine
- pacemaker IF there are STILL symptoms
MORE ACCURATE test for AR
TEE
initial diagnostic tests for CHF patient
- CXR
- EKG
- oximeter (maybe an ABG)
- echo
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
diagnostic test for third-degree (complete) heart block
- EKG
- canon “a” waves
further management of dissection of thoracic aorta
- order CTA = TEE = MRA
2. start nitroprusside
best treatment for severe aortic stenosis
aortic valve replacement
at what CHADS2Vasc score should a pt be started on warfarin, and should the pt be bridged on heparin?
- 2, or more points
- NO!
best INITIAL diagnostic test for pericarditis
EKG
GLOBAL ST elevation
(PR segment depression in lead II is pathognomonic)
MOA of dobutamine
- increase contractility
- vasoconstriction= increases AFTERload
S3 gallop can be normal in which patients?
age
improve mortality of chronic angina
aspirin and metoprolol
- palpitations and tachycardia
- occasionally syncope
- NOT associated with ischemic heart disease
- REGULAR RHYTHM WITH VENTRICULAR RATE OF 160-180
supraventricular tachycardia (SVT)
- palpitations
- syncope
- chest pain
- sudden death
ventricular tachycardia (VT)
VSD treatment
mechanical closure if severe
thrombolytics should be done within what timeframe of reaching the ER?
30 MINUTES
indications for CABG
- THREE coronary vessels > 70% stenosis
- left main coronary artery > 50-70% stenosis
- TWO vessels in a DIABETIC
- 2 or 3 vessels with LOW EF
if initial EKG and/or enzymes do NOT establish diagnosis of CAD, next step
stress test
treatment for septal rupture
- ACE inhibitor
- nitroprusside
- urgent surgery
best INITIAL treatment for constrictive pericarditis
diuretic
- 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
definition of acute coronary syndrome (ACS)
what CXR shows in CHF patient
- pulmonary vascular congestion
- cephalization of flow
- effusion
- cardiomegaly
AR murmur description and location it’s best heard
- diastolic decrescendo murmur
- LEFT sternal border
when do you balloon dilate AS?
ONLY when patient can’t tolerate surgery
how long do mechanical valves last?
15-20 years
need to be on warfarin with INR of 2-3
what does EKG show in RCMP?
low voltage
best INITIAL test for AS
TTE
diagnostic tests for cardiogenic shock
- echo
- Swan-Ganz (right heart) catheter
best INITIAL test for MR
TTE
situations where patient won’t be able to do an exercise stress test
- COPD
- amputation
- deconditioning
- weakness/previous stroke
- LE ulcer
- dementia
- obesity
exertional SOB: Turner’s syndrome, coarctation of aorta
BICUSPID aortic valve
treatment for MAT
- oxygen FIRST
2. THEN diltiazem
contraindicated with sildenafil (PDI’s)
nitrates
cause of chest pain that is tender to palpation
costochondritis
causes of POSITIONAL chest pain
pericarditis
MOST DANGEROUS thing to give a patient with pericardial tamponade
diuretics
when should you order a dipyridamole or adenosine thallium stress test, or dobutamine echocardiogram?
patient can’t exercise to target HR of > 85% of maximum
best INITIAL treatment for PAD
- aspirin
- BP control with ACEI
- exercise as tolerated
- cilostazol
- statin with LDL goal
mechanism of crescendo-decrescendo murmur of AS
- isovolumetric contraction = no blood moving = no murmur
- mid-systole = peak flow = peak noise
clinical diagnosis of acute pulmonary edema
- SOB
- rales
- S3 (splash)
- orthopnea
- SOB
- hypOtension
- jugular venous distention
- lungs CTA
- PULSUS PARADOXUS (BP decrease > 10mmHg on INhalation)
- ELECTRICAL ALTERNANS (alternating QRS complex heights)
pericardial tamponade
pulmonic valve murmurs are best heard where?
2nd LEFT intercostal space
AS murmur description and location it’s best heard
- crescendo-decrescendo
- 2nd RIGHT intercostal space radiating to CAROTIDS
S4 gallop indicates
left ventricular HYPERTROPHY
- holosystolic murmur at LLSB
- SOB
- parasternal heave
VSD
best INITIAL therapy for AR
- ACEI/ARB, or nifedipine
- and loop diuretic
MAT EKG finding
POLYMORPHIC P waves
MORE ACCURATE test for MS
TEE
best INITIAL test for DILATED cardiomyopathy
echo
check EF and wall motion abnormality
best INITIAL test for dissection of thoracic aorta
CXR showing WIDENED MEDIASTINUM
other tests to order once atrial fibrillation is diagnosed
- echo: looking for clots, valve function, LA size
- TFT: TSH, T4
- electrolytes: K+, Mag2+, Ca2+
- troponin/CK
which medications decrease afterload?
- amyl nitrate
2. ACEIs
MC of post-MI erectile dysfunction
anxiety
mechanism of pulsus paradoxus
inhale = big RV = smaller LV = BP drop > 10mmHg
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
finding on echo in pericardial tamponade
diastolic collapse of RA and RV
MOST ACCURATE test for AS
left heart catheterization
what LOWER MORTALITY in STEMI and are TIME DEPENDENT?
thrombolytics and PCI
