Cardiology Error List Flashcards
When is revascularization indicated for Coronary Artery Disease
Sx despite medical therapy
Left MAIN Coronary Artery Stenosis >50%
3-vessel disease with LV dysfunction (EF
What type of revascularization is indicated for Left MAIN coronary artery
CABG
When is a Percutaneous Transluminal Coronary Intervention used (PTCA)
1 or 2 vessels that are NOT the Left main coronary artery + normal or near normal left ventricular function
What intervention is used for Left Anterior Descending Artery
Beta Blockers
Ranolazine
CCB
Ivabradine
What is the gold standard to test for CAD
Coronary Angiongraphy (Cath)
What is Heart Failure
When the heart can’t pump sufficient blood to meet the metabolic demands of the body at normal filling pressure
What causes left sided HF
CAD and HTN
Sx for left sided HF
Think Pulmonary back-up
Dyspnea, Pulmonary Congestion/Edema, HTN
What causes right sided HF
Left sided HF
Sx for right sided HF
Peripheral Edema
JVD
GI/Hepatic Congestion
Dx for HF and what does it measure
Echo is most useful, measures EF and wall motility
CXR: See Cephalization of flow, Kerly B lines, Cardiomegaly, Pleaural Effusions
Increased BNP
Tx for HF
Ace-I are 1st line
Beta Blockers
Diuretics
Digoxin for short term use in pts. with A.Fib
Which Tx for HF reduce sx vs. improve mortality
Improve Mortality: Ace-I, Beta Blockers, Spironolactone (Potassium sparing diuretic)
Treat sx: Loop diuretics (Furosemide, Bumetanide, Torsemide)
If a patient with CHF can’t tolerate beta blocker or Ace-I what is an alternative
Hydralize + Nitrates
They do decrease mortality when used together
What valve is most commonly affected in Infective Endocarditis (normal valves)
Mitral Valve
What valve is most commonly affected in a person with IV drug use and infective endocarditis
Tricuspid Valve
What are the pathogens for Normal Valves, Abnormal Valves, Prosthetic Valves, IV Drug User
Normal: S. Aureus
Abnormal: S. Viridans
Prosthetic: Staph. Epidermis
IV Drug Use: MRSA, Pseudomonas, Candida
Sx for Infective Endocarditis
Fever, Anorexia, Weight Loss, Fatigue, EKG abnormalities, Regurgitant murmurs
Peripheral Manifestations: Janeway Lesions, Roth Spots, Petechia, Osler Nodes, Splinter Hemorrhages
What is the Duke Criteria for Infective Endocarditis (DX)
2 Major or 1 Major + 3 Minor, or 5 Minor
Major: 2 Positive blood cultures, Echo (Vegetations on Valves)
Minor: Predisposing factor like abnormal valves, indwelling catheter, fever, vascular and embolic phenomena (Janeway Lesions, Emboli), Immunologic Phenomena (Osler Nodes, Roth Spots, Positive RF, Acute Glomerulonephritis, Positive blood cultures not meeting major)
Tx for Infective Endocarditis based on valve (Native, Abnormal, Prosthetic, IV drug user, Fungal)
Native: Nafcillin + Gentamicin
Abnormal: Penicillin/Ampicillin + Gentamicin
Prosthetic: Vancomycin + Gentamycin + Rifampin
IV Drug Use: Penicillin/Ampicillin + Vancomycin
Fungal: Amphotericin B
Replace Vancomycin in any of those if pt has PCN allergy
What is prophylactic treatment for dental procedure in someone with infective endocarditis history
Amoxicillin 2g one hour before procedure. Clindamicin if PCN allergy
What is the reading for HTN
> 140/90
Dx for HTN
More than 2 abnormal readings on 2 different visits with elevated readings
What are complications of HTN
CAD, HF, MI, TIA, Stroke, Retinal Hemorrhages, Blindness, Retinopathy
Sx of HTN
Striae, Carotid Bruits, JVD, Pheochromocytoma, Polycystic Kidneys, Bruits over renal arteries
What are common findings in a person with HTN on a fundoscopic exam
Grades I: Arterial Narrowing II: A-V Nicking III: Hemorrhage, Soft Exudates IV: Papilledema (Malignant)
What is the goal for someone with HTN. Someone with Diabetes and HTN
What is the first line non-medical treatment for someone with HTN
Lifestyle modification, sodium restriction, dash diet, exercise
What is the first-line medication used in HTN
Hydrochlorothiazides (Diuretics)
What is the strongest diuretic
Loop Diuretic: Furosemide, Bumetadine
What do you want to use to treat HTN in someone with diabetes
Ace-I (Captopril, Enalapril, Ramipril, Benazepril)
If can’t tolerate Ace-I, use ARB
What do you use to treat HTN in someone with angina
CCB (Nifedipine, Amlodipine, Verapamil, Diltiazem)
What do you use to treat HTN in someone with hx of MI or Angina
Beta-Blockers (Atenolol, Metoprolol, Esmolol, Propranolol, Labetalol, Carvedilol)
What goes under the category of an MI and what do they mean
NSTEMI and STEMI
Complete occlusion of vessels that leads to infarction
Sx of MI
Pain, Dyspnea, Diaphoresis, Nausea, Weakness
Tachycardia, bradycardia, CHF, Hyoptension, new murmur
What is a physical exam finding that can be found 24 hours after an MI. What is it called when it happens 1-2 months after an MI
24 hours: Pericarditis with friction rub
Dressler’s Syndrome: Pericarditis 1-2 months after MI (autoimmune pathophysiology)
What EKG findings do you find with an MI
T-Wave Abnormalities
ST-Segment Depression: Ischemia
ST-Segment Elevation: Infarction
Q-Waves: Infarction (could be old or new)
What do the locations of the abnormalities tell you about the MI (leads)
V1-V2: Septal or Posterior V3-V4: Anterior V5-V6, I, aVL: Lateral II, III, aVF: Inferior V1-V2 with DEPRESSION: Posterior
What is t gold standard for dx of MI
Angiogram
What are some biomarkers seen with MI
Myglobin rise
CPK-MB
TROPONIN, TROPONIN, TROPONIN (but only after 4 hours)
When does Troponin rise, peak, and normalize
Rise: 4-6 hours
Peak: 18-24 hours
Normalizes: 7-10 days
What are some other imaging/tests you could use to work-up a patient with an MI
CXR: Look for CHF or aortic dissection
Echo: Identify wall abnormalities
Stress Test: Low-risk chest pain
Tx for MI
MONABASH M:Morphine O: Oxygen N: Nitroglycerin (1st line) A: ASA (for everyone) B: Beta-Blocker A: Ace-I S: Statin H: Heparin
What tx for MI improve mortality
ASA, Beta-Blocker, Ace-I, Statin
What is Sick Sinus Syndrome
Applied to patients with sinus arrest, sinoatrial exit block, or persistent sinus bradycardia
What are the arrhythmias seen with sick sinus syndrome
Supraventricular Arrhythmia and Bradyarrhythmia
Sx of sick sinus syndrome
Most asymptomatic
Syncope, Dizziness, Confusion, Palpitations, HF, or Angina
What patient do you see with sick sinus syndrome
Elderly with hx of A.Fib
Tx for sick sinus syndrome
Permanent pacing with dual-chamber pacemaker
What is Stable Angina and what causes it
A regular pattern of angina exacerbated by physical or emotional stress
Relieved with rest or NTG within minutes
Caused by Fixed Coronary Artery Stenosis
Sx of Stable Angina
Substernal Chest Pain, Poorly Localized, nonpleuritic, exertional
Radiates to arm, lower jaw, back, shoulder
Lasts
Non-Med Tx for Stable Angina
Modify RF, low fat, low cholesterol diet
Medication Tx for Stable Angina
Nitrates are 1st line for acute management
Beta-Blockers are 1st line for chronic management
CCB used in patients not able to tolerate beta-blockers (NOT Nifedipine because it causes reflex tachycardia)
What is Unstable Angina
New onset of angina
Increased intensity of stable angina
Increased frequency of stable angina
Sx of Unstable Angina
Retrosternal chest pain not relieved by rest or NTG, radiates to arms, neck, back, shoulders, epigastrum, lower jaw
Pain at rest usually means >90% occlusion
Anxiety, diaphoresis, tachycardia, N/V, palpitations, dizziness
Dx for Unstable Angina
EKG: T-wave Inversion/ST Depression
Tx for Unstable Angina
MONABASH (same as MI) Nitrates for all Antiplatelets: ASA, Clopidogren (Plavix) Beta-Blockers for all Anticoagulants: Heparin Statins if elevated LDL
What is Coarctation of the Aorta
Narrowing of the descending aorta
What is Coarctation of the Aorta associated with
Bicuspid valve
Sx of Coarctation of Aorta
Different blood pressures between upper and lower extremities
Weak and delayed femoral pulses
Systolic murmur that radiates to back or scapula
Dx of Coarctation of Aorta
Angiogram is gold standard
CXR: see Rib notching
EKG: LVH
Echo
Tx of Coarctation of Aorta
Balloon Angioplasty or surgical correction, PGE
What causes a Venous Stasis Ulcer
Vascular Incompetence of either deep or superficial veins
Usually after DVT, trauma, or thrombophlebitis
Sx of Venous Stasis Ulcer
Leg pain, worse with prolonged sitting, improved with walking or leg elevation
Edema, Stasis Dermatitis
Where you see a Venous Stasis Ulcer
Medial Malleolus
Tx of Venous Stasis Ulcer
Compression: Leg elevation, stockings, exercise
Ulcer: Wet to dry dressings, skin grafting, hyperbaric O2
Venous valve transplant
What is Left Ventricular Hypertrophy
Thickened ventricles with components of both systolic and diastolic dysfunction
Septum is big and thick, portion under the aortic valve is big and thick
Sx of Left Ventricular Hypertrophy
Exercise induced syncope, SOB, Murmurs
How do you decrease the sound of a murmur in ventricular hypertrophy
Squatting, Laying Down, Fist Clench, Inspiration
To decrease the sound, you increase the venous flow to the heart
This is because the septum covers the aortic outlet as blood enters the heart chambers
How do you increase the sound of a murmur in ventricular hypertrophy
Valsalva and Standing
To increase the sound, you decrease the venous flow to the heart
This allows the septum to relax and move away from aortic outlet, allowing flow through and the murmur to be heard
What is the first choice for Dx ventricular hypertrophy
Echo
What are other imaging/tests you can do for ventricular hypertrophy
CXR: Normal Heart Size
EKG: LVH, Large QRS, Non-Specific T-waves
Angiography
Tx for Ventricular Hypertrophy
Beta Blockers
Avoid strenuous exercise
No Inotropes
What is Aortic Regurgitation
Backflow from aorta to LV
It leads to LV volume overload
Sx of Aortic Regurgitation
Left Sided HF
What murmur is heard with Aortic Regurgitation
Diastolic Descrescendo BLOWING murmur heard best at LUSB
How can you increase the sound an Aortic Regurgitation murmur
Handgrip
It increases backward flow
How can you decrease the sound of an Aortic Regurgitation murmur
Amyl Nitrate
Where does an Aortic Regurgitation murmur radiate to
Left Sternal Border
Tx of Aortic Regurgitation
Vasodilators, Surgery