Cardiovascular Flashcards
What is the major criteria for dukes criteria?
- Positive blood cultures s. auerus, s. virdans, s. bovis or other cultures 12 hours apart.
- Vegetation shown on an echocardiogram.
- New regurgitant murmur
If they are IV drug users whats the main cause for enfective endocarditis? and if they are non iv drug users?
- staphylococcus
2. Streptococcus
for an IV drug user where would you first see vegetation for infective endocarditis? how bout non IV drug user?
for IV drug user it would be tricuspid valve for non iv it would be mitral valve
What is the minor criteria for the dukes criteria
- Risk factor
- Vascular phenomenon (splinter hemorrhages janeway lesions on palms and soles)
- osler nodes
- Roth spots
What is the empiric treatment for endocarditis? How bout if they have a prosthetic valve?
- IV Vancomycin or ampicillin/sulbactam plus an aminoglycoside
- Add rifampin
If a patient is high risk for endocarditis and they need a dental procedure, what do you prophylax with?
2g of amoxicillin taken one hour before
A person received a stress test because they have pain with exertion that is relieved with rest. What would the stress test show if they have stable angina?
Stress test demonstrates reversible wall motion abnormalities/ ST depression >1 mm
What is the definitive diagnoses/test for angina?
cardiac angiography
What is the treatment for stable angina?
beta blockers or nitrides
Previously stable and predictable symptoms of angina that are now more frequent, increasing or present at rest. This describes what kind of angina?
Unstable angina
a patient with perserved exercise capacity presents to the office with chest pain. EKG shows inverted U waves and t-wave abnormalities. They also have a history of smoking. What do they have?
Printzmetal angina
What is the treatment for printzmetal angina?
- Stress testing with myocardial perfusion imaging or coronary angiography
- Pharmacotherapy SL, topical, or IV nitrates (initial)
- Antiplatelet, thrombolytics, statins, BB
- Once diagnosis made—CCB and long-acting nitrates used for long-term prophylaxis (amlodipine)
How do you treat narrow ventricular complex tachycardias?
This can be slowed down with CCBs, beta blockers, adenosine, procainamide or cardioversion depending on the scenario
How do you treat wide complex tachycardias from the ventricles?
Cardioversion or antiarrythmics like amiodarone
What is becks triad?
- muffle heart sounds
- JVD
- hypotension
Treatment for pericardial effusion?
pericardiocentisis
What will the heart look like on cxr in someone with a pericardial effusion?
water bottle heart
What 5 things do you need to assess for in the acute setting of chest pain?
- Pneumothorax
- PE
- MI
- Aortic dissection
- Pericarditis or boorhaves esophagus (depends on who you talk to)
Typical workup for chest pain in the acute setting?
- EKG
- Troponin
- CXR
- BNP
- CMP/CBC
What cardiac marker is most sensitive? When does it appear? When does it peak? How long does it last?
Troponin, appears 2-4 hours, peaks at 12, last 7-10 days
When does CK/CK-MB appear, peak, and then return to normal?
appears at 4-6 hours, peaks 12-24, returns to normal around 48-72 hours
just foe fun even though it is less used. When does Myoglobin marker appear, peak and return to normal?
appears at 1-4 hours, peaks at 12, returns to normal at 24 hours
treatment for an nstemi includes what?
- beta blocker
- NTG
- Clopidogrel and aspirin
- statin
- ACEi
- heparin
- reprofusion
what leads will have ST elevation in a lateral infarct?
I, AVL, V5-V6
what leads will have ST segment elevation in a lateral wall infarct?
I, AvL, V5-V6
can have reciprocal T-wave inversion in inferior leads III and AvF
Within what time frame do you want to perform angiography with PCI?
within 90 minutes
If PCI is not available for 3 hours in someone having an MI what can you do?
thrombolytic therapy
What are absolute contraindications for thrombolytic therapy?
Prior intracranial hemorrhage (ICH)
Known structural cerebral vascular lesion.
Known malignant intracranial neoplasm.
Ischemic stroke within 3 months.
Suspected aortic dissection.
Active bleeding or bleeding diathesis (excluding menses)
Treatment for hypertensive emergency? hypertensive urgency? malignant hypertension?
- nitroprusside
- Clonidine
- Hydralazine
What is malignant hypertension?
blood pressure greater than 140 with papilledema, and either encephalopathy or nephropathy
Cardiac causes for DOE?
- CAD
- Heart failure
- myocarditis
- pericarditis
- MI
- ACS
pulmonary causes for DOE?
- asthma
- COPD
- pneumonia
- pulmonary hypertension
- interstitial lung disease
- obesity, kyphosis, scoliosis
What meds should you keep in mind about peripheral edema?
- CCBs
2. Alpha 1-blockers
What are the most common causes of heart failure?
- CAD
- MI
- HTN
- DM
LV remodeling: thinning, dilation, mitral valve incompetence,
An S4 is a sign of what kind of CHF?
diastolic heart failure, EF is usually preserved
an S3 is usually a sign of what kind of heart failure?
systolic heart failure.
What causes the S3 heard in systolic heart failure?
rapid filling of the ventricles during early diastole
Class 1 heart failure is (with or without) physical limitations?
without, 5% of patients
class II heart failure have slight limitation of physical activity, are the (comfortable or uncomfortable) at rest?
comfortable
Class III heart failure has a marked limitation of physical activity. Are they comfortable or uncomfortable at rest?
They are also comfortable
Then you have class IV heart failure. Are these patients capable of any physical activity? and do they have symptoms of anginal syndrome at rest?
They cant do any physical activity without issues and have symptoms even at rest
Tx for systolic heart failure?
Acei + beta blocker + loop diuretic
Tx for diastolic heart failure?
Acei + beta blocker or CCB
do not use diuretics in stable chronic diastolic heart failure
An ABI less than 0.9 is a sign of what?
peripheral vascular disease/ intermittent claudication
gold standard for diagnosing peripheral vascular disease?
arteriography
What is the Tx for PVD?
- anti-platlets
- cholesterol drugs
- cilostazole
medical definiton of syncope?
loss of postural tone/transient loss of consciousness secondary to an acute decrease of cerebral blood flow.
What are some red flags of syncope?
- syncope during exertion
- multiple recurrences in short time
- heart murmur / structural heart disease
- old age
- significant injury during syncope
- family hx of unexpected death/exertional/unexplained recurrent syncope
Aortic stenosis is heard where? is it systolic or holosystolic? does it radiate anywhere? how is it best heard?
- RUSB
- Systolic
- Radiates to the neck and apex
- With the patient leaning forward with expiration
aortic regurgitation is heard where? systolic? diastolic? holosystolic? soft or harsh? best heard how?
- at erbs point so left sternal border
- diastolic
- soft
- leaning forward after exhaling
Mitral stenosis is best heard where? systolic? diastolic? holosystolic? best heard how?
- at the apex
- Diastolic
- lateral decubitus position
Low pitched decrescendo murmur with opening snap
mitral regurg is best heard where? systolic? diastolic? holosystolic? radiate anywhere?
- at the apex
- holosystolic
- to the axilla with split S2
symptoms of abdominal aortic aneurysm?
flank pain, hypotension, pulsatile abdominal mass
what size abdominal aortic aneursym do you perform surgery on?
anything greater than 5.5cm or expands greater than 0.6cm per year
how often do you monitor an abdominal aortic aneurysm if its >3cm? and >4cm
annually for 3cm, every 6 months for 4cm
tx for abdominal aortic aneurysm
beta blockers
symptoms of aortic dissection?
sudden onset tearing chest pain, between scapulas diminished pulses
difference between tx if its on the ascending aorta vs the descending
if its ascending then immediate surgical repair
if descending then medical tx with beta blockers
what are two very common causes of thrombus formation?
a-fib and mitral stenosis
gold standard to diagnose arterial thrombus?
angiography
gold standard for dx phlebitis/thrombophlebitis?
Venous duplex ultrasound
tx for Phlebitis/thrombophlebitis?
supportive with NSAIDs warm compress
