what are the three options for a flutter Tx - stable: - Unstable - definitive

- Stable: vagel, BB, CCB - Unstable: cardiovertion - Definative: ablation

Cardiology PANCE 2 6/9/20 Flashcards by sean husted

what artery for an anterior wall MI

LAD

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what artery for a lateral wall MI

circumflex

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what artery for an inferior wall MI

RCA

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what leads are anterior

V1 - V4

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what leads are lateral

I, AVL, V5, V6

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what leads are inferior

II, III, AVF

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what rates are sinus tach

100-150

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how do you tx sinus tach

nothing

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what rate is sinus brady

less than 60

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how do you tx sinus brady

atropine

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how do you tx sinus brady syndrome, sick sinus syndrome

pacemaker

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describe 1at degree heart block

long PR interval

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tx for 1st degree block

none

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describe type II A block

progressive block with dropped beats

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how do you tx II A block

atropine + Pace

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describe type III AV block

pacemaker

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what are the three options for a flutter Tx

stable:
Unstable
definitive

Stable: vagel, BB, CCB
Unstable: cardiovertion
Definative: ablation

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what are three medication classes that will control the rate in A fibb patients

BB: metoprolol
CCB: diltiazam
digioxin

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who with a fib can get cardioverted

AF < 48 hours

- 3/4 weeks of anticoag + TEE

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how do you tx unstable A fib:

cardiovertion

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what CHADs VAS gets anti coag

> 1

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what are all the elements of the CHADs VAS

CHF 
HTN 
Age > 75 
DM II 
Stroke: +2
Vascular disease 
age >65 
sex

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what are the three primary pathologies that can cause a prologed QT

macrolides
TCA
electrolight abnormalities

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How do you tx prolonged QT

AICD

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How do you tx stable SVT (2)

- vagal | - adenosine

How do you tx stable V tach

amiodrone

How do you tx unstable V tach or SVT

cardiovertion

what is the definitive dx of narrow or wide complex tachycardia

- ablation

what is wide complex SVT

V tach

what is multifocal atrial tachycardia (MAT) a compliaction of

COPD

what do you tx MAT with (2)

BB | CCB

what do you tx WPW with

procainimide

a prolonged QT can lead to what

torsades

how do you tx torsades

IV Mag

How do you manage PEA

CPR + EPI + defib

what is another name for D fiv

unsynchronized cardivertion

Diffuse ST elevation- "what pathology"

- acute pericarditis

LBB RsR in what leads

V5- V6

RBB RsR what leads

V1- v2

who cannot get a pharmacologic stress test

obstructive airway disease

who cannot get a tredmill stress test (2)

- cant walk | - baseline abnormalities

what is the MCC of CAD

athersclerosis

what are 5 RF for CAD

- DM - smoking - HTN - HLD - Family history

what is subsernal chest pain that is brought on by exertion

angina

how long can angina last for

< 30 min

what are the three anginal equivalents

- Dyspnea - epigastic - shoulder pain

what is the first line test for angina

- EKG

what is the medication used for a pharmachologic stress test

- dobutamine

what is the gold standard for CAD

Cath

what are the 4 indications for CABG over CAD

- > 3 vessles - > 70% - LAD - ED < 40%

what are the three groups that cannot get nitro

- SBP < 90 - RV infarct - Sildenophil

how do you tx prinzmental angina

CCB

what is the MC cause of MI

Atherosclerosis

Chest pain and brady may be what location MI

inferior wall

what are the three EKG progressions you will see in an MI

- peaked T waves - ST elevation - T wave invertion

what are the three timelines for troponin - appear - peak - last

- appear: 4-8 hours - peak:12-24 hours - last: 7-10 days

what type of medication is clopedogril (plavix)

antiplatelet

what low molecular weight hererin has a SE of thrombocytopenia

low molecular weight heperin

prinzmetal angina or cocaine MI's do NOT get what meds

- beta blockers

what is the most importnat part about an MI

PCI

alteplase is AKA

TPA

what does NSTEMI get in addition to MONA

heperin

what does STEMI get in addition to MONA

- hererin - ACE - PCI

what do you do for R ventricle (interior wall MI)

- No nito | - give fluids

what clinical decision rule is used in a MI

- TIMI

what TIMI is high risk

> 3

what are three contrainidcatrions to TPA

- hemorrhagic stroke 6 months - facial trauma 3 months - previous intracranial hemorrhage

what is the MC cause of CHF

CAD

what heart sound is best heard on diastolic HF

what type of breathing do you see with CHF

Chayne stokes breathing

what is the MC symptom of L sided CHF

dyspnea

what type of HF has a good EF

diastolic

what are the 3 imaging / lab values in CHF

- ECHO: best - CXR: - BNP: > 100

what are the 3 best medications for CHF

1. Ace 2. BB 3. Diuretic

what metabolic distribution is caused by an ACE

- hyperkalemia

where are ace metabolized

kidney

what HF medication causes gout

Lopp diurtics (furosimide)

what EF for defibrillator

< 35%

what pathology is kerly B lines associated with

CHF

what are the 2 main causes of acute pericarditis

- Idiopathic | - (viral)coxackie

do individuals with perdicaditis have fever

most often yes

what position for pericarditis is better

fetal

what might you hear on ascultation with pericarditis ina FORWARD position

friction rub

low voltage EKG and muffles heart sounds think what

pericardial effusion

what is the MC cause of a pericardial effusion

pericarditis

what will you see on an EKG for pericardial effusion

- Low voltage | - electrical alternates

what will you see on CXR for pericardial effusion

cardiomegaly

what is becks triad

- muffled heart sounds - JVD - hypotesion

what pathology is pulses paradoxus associated with

cardiac tampanode

how do you tx cardiac tampanode

pericardiocentesis

what is thickened pericardium that decreases filling

- constrictive pericarditis

what is Kussmals sign and what pathology is it associated with

- Kussmals sign: increased JVD with inspiration | - constrictive pericarditis

what is a "high pitched 3rd heart sound" and what is it associated with

high pitched 3rd heart sound: pericardial knock | Pathology: constrictive pericarditis

what is the cause of rheumatic fever

-GABHS (strep pyogenys)

what valve for rehumatic fever - 70% - 30%

mitral (70%) | aortic (30%)

what labs for rheumatic fever

ESR | CRP

what is the jones criteria associated with

rheumatic fever

how do you tx rheumatic fever

aspirin | Pen G

Harsh / rumble sound stenosis or regurg

stenosis

Blowing sound stenosis or regurg

regurg

aortic regurg radiated where

L upper sternal boarder

aortic stenosis radiates where

carotids

Mitral regurg radiates where

axilla

sitting up and leading forward makes what murmurs louder

aortic stenosis and aortic regurg

what type of murmur is louder if you are lying on the left side

mitral regurg

squatting supine leg raises increases what murmurs

all but hypertrophic cardiomyopathy

what 2 movements decrease the venous return

- valsalva | - standing

how does decreasing venous return AKA | Valsalva and standing influence murmurs

it decreases all murmurs with teh exception of HCOM

how do you increase HCOM 2

valsalva and standing

what are the three aortic stenosis complications

angina syncope CHF

systolic crescendo de crescendo murmur that radiates to the neck

aortic stenosis

treatment for severe Aortic stenosis

AVR

RHD and endocarditis cause what type of murmur

aortic regurg

"diastolic decrescendo blowing murmur" | bounding pulses

aortic regurg

what murmur has a narrow pulse pressure

- aortic stenosis

what Murmur has a mise pulse pressure

- aortic regurg

How so you tx aoritc regurg

afterload reduction

what is the MC cause of mitral stenosis

- reheumatic heart disease

"fish mouth valve"

- mitral stenosis

Diatolic rumble with opening snap

mitral stenosis

"boundng pulse murmur"

aortic regurg

"blowing holosystolic murmur"

Mitral regurg

mitral regurg tx

Ace

"mid to late ejection click"

Mitral vale prolapse

how do you tx mitral valve prolapse

- reassurance | - beta blockers

what is the MCC of secondary HTN

renal artery stenosis

what is the MCC of end stage renal disease in the US

1. DM | 2. HTN

what are the 4 grades if HTN retinopatht

1. arterial narrowing 2. A-V nicking 3. hemmorages + soft excudated 4. papilledema

JNC 8 what is the goal HTN

1. <140/90 | 2. If > 60 yo: 150> 90

with HCTZ what are the only 3 things that increase

- Hypercalcemia - Hyperurecemia (Gout) - Hyperglycemia (DM)

what is the only Duirertc that causes HYPERkalemia

- K sparing (spironolactone)

what is the main metabolic chnage that is involved with Ace

Hyperkalemia

ace and arbs are containdicated in what population

pregnancy

what is the one non cardioselective beta blocker

propanolol

what 2 beta blockers are both cardioselective and non cardioselective

labetalol and carvedilol

what CCB are non dihydropyidines and this are NON cardioselective 2

- verapamil | - Diltiazem

how much should you lower the BP by in an emergency

- 25% in 48 hours hours

what are the two primary medications used in HTN urgency

- clonidine | - captopril

what is a compliaction to clonidine

rebound HTN (will look liek pheo)

Grade IV HTN retininopathy may presnet with what

blurred vision

when someone is having an ishemic stroke at what level do you lower their BP

>185/ 110

what what age do you start checkling lipids - w/o FH - w/ FH

- w/o: 35M, 45F | - with: 25M, 35F

who are the 4 statin benifit groups

- DM 40-75 - 40-75 with 10 year risk > 7.5 - > 21 yo with LDL > 190 - CAD

what meds lower TG

fibrates

what meds inc HDL

niacin

niacin is also B?

Gemfibrozil fenofibrate these are examples of

Fibrates to lower TG

what is the MC value effected in endocarditis

mitral valve unless IVDU then tricuspid

what is the difference between acute bacterial and subacute endocarditis

subacute is in abnormal valves

what organism for acute bacterial endocarditis

staph aurues

what organism for subacute endocarditis

step virdands

what organisms for endocarditis in IVD

MRSA

what is the Tx for subacute endocarditis

ampcillin + gent

what is the Tx for acute endocarditis

nafcillin + gent

what is the Tx for PV endocarditis

Vanc + Rifampin + Gent

what murmur for infective endocarditis

new regueg murmur

what are the 4 clnical manifestations ABE

Janeway lesions roth sports osler nodes splinter hemorrhages

what are the 4 endocarditis prophalaxis indications

- Prosthetic valve - heart repairs with prosthetic material - prior endocarditis - congenital heart disease

what are the two options for endocarditis prophalaxis

amoxicillin | clindamycin

Pain pallor pulselessness These are associated with what pathology

- PAD

what location for PAD ulcers

- lateral malleolar

how do you dx PAD

ABI < .9

what are the three tx for PAD

- cliostazole - aspirin - clopedogrel

what are the 2 MC risk factors for AAA

- athersclerosis | - smoking

- Syncope - hpotension - pulsitile mass what pathology

AAA

what is the qualification for a low dose CT of the chest

- 15 pack years within the last 30 years | annual low dose CT

what do you do with a AAA - 3.0cm - 4.0 cm - 4.0 -4.5 cm - > 4.5cm

- 3.0cm - 4.0 cm: monitor every year - 4.0 -4.5 cm: monitor every 6 months - > 4.5cm: surgery

what medication is included in the mamangemnt of a AAA because it lowers the sheering forces

beta blocker

where is the worst location to have a aortic dissection

ascending

what is the most importnat risk factor for an aortic dissection

hypertension

sudden ripping tearing chest pain:

- aortic dissection

what is the classic finding on X ray for an aortic disection

widened mediastimum

what is the gold standard for aortic dissection

MRI

how do you manage aortic dissection - ascending: - Descending:

- ascending: surgery | - Descending:labetalol

what is burgers disease

non athersclerotic inflammatory disease of the small to medium vessels

what is burgers disease associated with (RF)

smoking

what is trousseau's sign of malignancy

- migratory thrombophilibitis associated with malignancy

for superficial thrombophilibitis what do you see on ultrasound

non compressable vein

superficial thrombophilibitis what is the MC cause

factor V leiden difficenecy

superficial thrombophilibitis tx (3)

warm compress elevation NSAIDs

how long for DVT treatment

3 months for inital life long after that

what pathology "inadequate perfusion and tissue oxygenation"

shock

what are the 4 types of shock and a little infor about each

1. hypovolemic: reduced blood volume 2. cardiogenic: reduced cardiac output 3. obstructive: Obstruction to circulation 4. disributive: maldistribution of blood flow

what is the SVR and CO with hypovolemic shock

1. SVR: increased | 2. CO: decreased

what is the SVR and CO with cardiogenic shock

1. SVR: increased 2. CO: decreased 3. pulmonary capilary wedge pressure: increased

what is the one type of shock you do not give fluids

- cardiogenic

what type of shock - CO: decreased - SVR: decreased - PCWP: decreased

distributive

what are the 4 qualifications for SIRS

- Temp: > 100.3 - Pulse: > 90 BPM - respiratory rate: >20 - WBC: >12,000

what is the only type of shock that has CO: increased Skin: warm

septic

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Cardiology PANCE 2 6/9/20 Flashcards

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