Cardiovascular Flashcards
what is stable angina vs unstable angina
- stable = typical, predictable chest pain occuring during exercise that releives with rest or NTG
- unstable = unexpected, caused by sudded slowed or narrowed bloodvessels, does NOT go away w rest/NTG
what causes prinzmetal angina
vasospasms
what is the tx for prinzmetal angina
CCB and NTG
mimics STEMI on EKG and MC in middle aged women
what EKG changes would you see in the following timespans after an MI
* minutes/hours
* 1-2 days
* 7-10 days
* months
- minutes/hours - ST elevation
- 1-2 days - ST elevation, inverted T wave, Q wave
- 7-10 days - ST flattening, Q wave
- months - persistent Q wave
which cardiac biomarker would you use to identify a repeat MI in a patient who just suffered an MI 2 days ago
myoglobin (returns to normal after 36ish hours)
after undergoing a PCI what medications should be initiated
ASA + clopidegrol
what is the diagnostic study of choice for carotid artery stenosis
CT angiography (carotid angiography)
what is the treatment for carotid artery stenosis
revascularization via stenting or endarterectomy
mostly for patients >50% stenosis and symptomatic
what is the diagnostic of choice for ALL valvular heart diseases
echo
If you wanna learn about valve murmurs and treatments, do the surgery EOR valvular heart dz card set
okie dokie
what anticoagulation is used for mechanical valves
lifelong warfarin
what is the goal INR for warfarin
2.5-3.5
what is the anticoagulation for a tissue valve replacement
ASA for 10+ years
when you see aschoff body, what should you think of
rheumatic heart disease
which valve does rheumatic heart disease MC effect
mitral
followed by atrial
what is the major criteria for rheumatic heart disease
2 major OR 1 major and 2 minor
what is the treatment of rheumatic heart disease
PCN
How do you determine HR on EKG
Large box method:
3 boxes = 100bpm
4 boxes = 75 bpm
5 boxes = 60 bpm
6 boxes = 50 bpm
small box method:
1500 divided by number of small boxes
For IRREGULAR rhythms:
count R waves over 10 second period and multiply by 6
What is sinus arrhythmia
irregular rate with normal rhythm. P-P wave intervals are present but vary.
treatment of sinus bradycardia
none if asymptomatic, atropine can increase HR, but pacemaker is definitive
sick sinus syndrome
recurrent supraventricular arrhythmias and bradycardia
supraventricular = narrow QRS, tachy at 180-220, regular rhythm.
etiology of sick sinus syndrome
medications or autonomic malfunction
problems with the Sinoatrial (SA) node. (remember this is the pacemaker of the heart)
treatment of stable vs unstable sick sinus syndrome
stable + asymptomatic: observation
stable + symptomatic: pacemaker
Unstable: urgent atropine and cardiac pacing.
treatment of sinus tachycardia
beta blockers
heart blocks
-first degree: PR interval >0.2 seconds (5 lil box)
-second degree type 1: longer, longer, longer, drop
-second degree type 2: randomly dropped beats
-third degree: no correlation between atria and ventricles (p-p normal, not in line though)
treatment of heart blocks
-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)
what is a PAC
premature beat followed by normal QRS, P wave has different morphology
treatment of PAC
-beta blockers or CCB
what is a PVC
Premature beat with a wide QRS and a compensatory pause afterward
What is SVT
Rapid, narrow regular beats caused by irregular electrical impulses in the atria
treatment of SVT
-mechanical measures (valsalva)
-adenosine
-cardioversion if the patient is hemodynamically unstable
treatment of afib
-rate control (BB, CCB, digoxin)
-rhythm control (flecanide, amiodarone, sotolol)
-anticoagulation (ASA, Xinhibs, warfarin)
how to determine who needs anticoagulation with afib?
CHADS2-VASc
-CHF
-HTN
-over 75 (2)
-DM
-prior stroke (2)
-vascular disease
-between 65-74
-female
CHADS2-VASc score interpretation
VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation
what is the difference between a-fib and a-flutter
treatment of atrial flutter
-catheter based radiofrequency ablation
-anticoagulation same as afib
etiology of junctional arrhythmias
-digoxin toxicity
-electrolyte abnormalities
junctional = inverted p wave, no p wave, or post QRS p wave
treatment of junctional arrhythmias
treat underlying cause
sustained vs nonsustained Vtach
-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds
what is brugada syndrome
genetic heart disorder that impairs electrical system of the heart via faulty sodium channels. Increases risk of SCA
brugada syndrome EKG
incomplete right bundle branch block and ST-segment elevations
management of brugada
ICD
management of acute sustained VT
-if unstable: cardioversion
-stable: amiodarone
Treatment of nonsustained VT
-with heart disease: BB
-without heart disease: BB only if symptoms
treatment of vfib
immediate defibrillation
s/s of cardiac tamponade
-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus
kussmauls sign
increase in JVD on inspiration
pulsus paradoxus
inspiratory systolic fall in arterial pressure
EKG of tamponade
electrical alternans
chest xray of tamponade
waterbottle heart
angina pectoris
used to describe chest discomfort related to ischemia
most sensitive cardiac marker
Troponin I
most sensitive early marker for MI
myoglobin
initial management of all ACS
-chewable ASA
-NTG
-oxygen if needed (</= 94%)
-morphine if pain isn’t managed by NTG
(MONA)
if using TPA what anticoagulants and antiplatelets should be used
-plavix
-lovenox
if doing PCI what anticoagulants and antiplatelets should be used
-brilinta (ticagrelor)
-UFH
timeline for STEMI management
-30 minutes for fibrinolytics
-120 minutes for PCI
presentation of heart failure
-DOE
-PND
-orthopnea
-s3 heart sound
-JVD
-peripheral edema
-ascites
diagnosis of heart failure
-CXR: cardiomegaly, interstitial edema
-BNP
-echo
treatment of heart failure
-lasix
-ace/arb
-BB
-SGLT2
treatment of hypertensive heart failure
-NTG
-then lasix
treatment of cardiogenic shock
-oxygen
-250-500mL of IV fluids
-vasopressors
NYHA classification of heart failure
Class I: symptoms only occur with vigorous activities
II: symptoms with prolonged or moderate exertion, slight limitation of activities
III: symptoms occur during ADLs, markedly limiting
IV: symptoms occur at rest
ACC/AHA classification of heart failure
-A: high risk of heart failure
-B: structural heart defect but no symptoms
-C: structural changes and symptoms
-D: advanced disease causing hospitalization
management for HFpEF vs HFrEF
-HFpEF: lifestyle modifications and diuretics
-HFrEF: combination of multiple meds
s/s of acute decompensated HF
-pulmonary edema
-pink frothy sputum
-diaphoresis and cyanosis
-inspiratory rales
management of acute decompensated HF
-stabilize
-IV lasix
-NTG
presentation of cardiogenic shock
-cool, clammy skin
-tachycardia
-hypotension
what is endocarditis
an infection of the hearts inner lining (endocardium)
MC source of bacterial endocarditis
oral procedures
specifically oral infections like gingivitis
MC organism of native valve endocarditis
staph aureus
diseases that increase the risk of endocarditis
-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease
MC organism for prosthetic valve endocarditis
staph epidermis
MC valve affected by IVDU endocarditis
tricuspid
s/s of endocarditis
-FROM JANE
-Fever, chills, weakness, SOB
-Roth spots
-Osler nodes
-Murmur (new regurgitant)
-petechiae
-splinter hemorrhages
-janeway lesions
anemia, nail hemorrhages, emboli
what is the diagnostic criteria for endocarditis
2 major OR 1 major + 2 minor OR 5 minor
what are the major criteria for endocarditis
- 2 positive blood cultures
- echo showing valve disease
- new regurgitant murmur
what are the minor criteria for endocarditis
- predisposing condition
- fever
- vascular/embolic symptoms
- immunologic signs
- 1 positive blood culture
janeway lesions
painless patched on palms or soles caused by emboli
osler nodes
painful lesions on pads of fingers or toes caused by vasculitis
diagnosis of endocarditis
-CBC
-blood cultures
-echo
tx of endocarditis
-native valve
-IVDU
-prosthetic valve
-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin
patients who get endocarditis prophylaxis
-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant
procedures that require endocarditis prophylaxis
-dental procedures
-respiratory trat procedures
-I&D
antibiotic for endocarditis prophylaxis
amoxicillin
What is the definition of dyslipidemia
Defined as elevated levels of LDL-C and triglycerides, as well as low levels of HDL-C
what is the clinical presentation of dyslipidemia
- most are asymptomatic
- eruptive xanthomas (extreme high TG or VLDL)
- tendinous xanthomas (high LDL)
- lipemia retinalis (Extreme high TG)
- Serum changes (milky serum, high TG)
What is the screening reccomendation for dyslipidemia
- all adults 20+ Q 5 years
- children screen 1 time at ages 9-11
- start screening at 2 if fmhx of early CVD or significant primary hypercholesterolemia
Q 3 yrs if close to warranting treatment
what is the screening test for dyslipidemia
- start with total TG and HDL (fasting preferred but not mandatory, if abnormal confirm w fasting)
- Fasting full lipid panel is needed if TC > 250 or HDL-C is < 40
What are indications for statin therapy in hyperlipidemia patients
- Clinical ASCVD (hx of ACS, CVA, PAD, or arterial revascularization)
- Type 2 DM
- LDL >/= 190
- ASCVD risk >/= 7.5%
- TG >1000
what is the MOA of statins
enhances LDL catabolism
what should be checked prior to starting a statin
- LFTs (hepatotoxic)
- pregnancy test (CI in preggo or breast feeding)
what are SE of statins
- myalgias
- rhabdomyolysis
- hyperglycemia?
- hepatotoxicity/liver failure
what are the blood pressure classifications
Normal: <120/<80
Elevated: 120-129/<80
Stage 1: 130-139 Or 80-89
Stage 2: >140 Or >90
what is the difference between primary and secondary hypertension
- primary = no underlying cause
- secondary = underlying cause
What are the treatment reccomendations based on classifications of HTN
- elevated: non-pharm therapy, re evaluate in 3-6 months
- stage 1 + ASCVD>10%: pharm + non pharm tx
- stage 1 w/o ASCVD: non pharm only
- Stage 2: pharm + non pharm
What is the anti-HTN of choice
non AA: ACE/ARB, CCB, thiazides
AA: CCB or thiazides
hypertensive urgency
-no symptoms
-225/125
-no evidence of end organ damage
idk UTD says >180/120 mmHg
Hypertensive Emergency
(>220/130) WITH end organ damage.
idk UTD says >180/120 mmHg
treatment of hypertensive urgency
-clonidine
-captopril
-nifedipine
goal of therapy for hypertensive emergency
reduce bp to 160/100 over the next 2-6 hours
Tx Hypertensive emergency
BP decreased no more than 25% in first 2 HOURS→ goal BP of 160/100 over next 2-6hrs
BB 1st Line
strongest risk factors for PAD
-diabetes
-smoking
presentation of PAD
-claudication
-relieved with rest
-decreased pulses
-cool skin
-distal hair loss
-shiny skin
pseudoclaudication
painful cramps that are not caused by peripheral artery disease, but rather, by spinal, neurologic, or orthopedic disorders such as spinal stenosis, diabetic neuropathy, or arthritis
-occurs with standing and can last up to 30 minute
diagnosis of PAD
-ABI < 0.9
-angiography gold standard
treatment of PAD
-lifestyle modifications
-ASA or plavix
-statins
Mcc of embolus occlusion
afib
S/S of Arterial Occlusion
-pain
-pallor
-pulselessness
-paralysis
-poikilothermia
-parasthesias
management of arterial occlusion
immediate revascularization and IV heparin
thromboangiitis obliterans etiology
thrombotic processes
MC in male smokers <40
s/s of thromboangiitis obliterans
-distal ischemic rest pain or ischemic ulcerations
management of thromboangiitis obliterans
tobacco cessation
