Cardiovascular Flashcards
What is the acute treatment of HF?
Lasix - frusemide Morphine Nitrates Oxygen Position - upright
Chronic treatment of CHF
Lifestyle: limit Na and fluid intake
Drugs
- beta blocks and ACE/ARB for class II-IV
- Loop diuretic
- low dose spironolactone
- daily ASA and statin if the cause is prior history of MI
Which drug out of this has been shown to reduce mortality risk in HF? thiazide CCB spironolactone ACE
Spironolactone
what are the symptoms of LHF?
L sided S3/S4 gallop Bilateral basically rales Pleural effusion Pulmonary edema PND
what are the symptoms of RHF?
R sided S3/S4 gallop
JVD
Hepatojugular reflex
peripheral edema
what is systolic dysfunction
EF is reduced
L ventricular end-diastolic volume is increased
what is non-systolic dysfunction
reduced ventricular compliance with systolic function
what are 4 side effects of loop diuretics (frusemide)?
HypoCalcemia HypoKalemia Ototoxicity Dehydration Gout
what are side effects of thiazide?
HyperGLUC
- glycemic
- lipidemia
- uricemia
- calcemia
what are side effects of K+ sparing?
Hyperkalemia
Gynecomastia
Sexual dysfunction
what is the most common cardiomyopathy?
dilated
What happens to left ventricular size at end of diastole and systole in dilated cardiomyopathy?
increase in size of both
What happens to EF in dilated cardiomyopathy?
Decreases
What happens to left ventricular size at end of diastole and systole in hypertrophic cardiomyopathy?
Decreases in size
What happens to EF in hypertrophic cardiomyopathy?
Increases
What is the most common cause of cardiomyopathy?
Idiopathic
Which infections can cause a cardiomyopathy?
Cocksackievirus
Chagas
HIV
Parasites
Which drugs can cause a cardiomyopathy?
doxorubicin
AZT
Cocaine
What does S4 suggest?
Hypertrophic cardiomyopathy
Aortic stenosis
Systemic HTN
Idiopathic hypertrophic sub aortic stenosis
atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle
How is hypertrophic obstructive cardiomyopathy inherited?
Autosomal dominant
How does hypertrophic cardiomyopathy present
Crescendo-Decrescendo increasing with reduced preload
reduced preload = standing, Valsalvs
what is the treatment of stable angina?
ASA
B-blocker
NG
U ain’t got enzymes with ….
Unstable Angina
When your patient is MOANing from an MI remember
Morphine
Oxygen
Aspirin
Nitrogen
What patients have atypical MI’s?
Diabetics
Women
Post-heart transplant
What is the mainstay treatment of a STEMI?
Emergency angiography and PCI if within 90 minutes
what is the treatment of STEMI if it is after 90mn of symptoms?
thrombolysis but has to be within the 3 hours of presentation
What is the long-term treatment of STEMI?
ASA ACE B-blocker High dose statin Clopidogrel (if PCI was performed)
What are the side effects of statin medication?
Raised LFT
Myositis
Warfarin potentiation
What are SE of fibrates?
GI upsets
Cholelithiasis
Myositis
Raised LFT
What are the side effects of niacin?
Skin flushing Parasthesia Pruritus GI upset RaisedLFT
What is the definition of HTN
BP >140 and/or > 90 on 3 occasions
what is the treatment goal for HTN in a patient who is over 60?
150/90
what is the treatment goal for HTN in a patient who is less 60?
140/90
What is the treatment of a hypertensive emergency?
IV labetalol/nitroprusside/nicardipine
Don’t lower BP more than 25% over the first 2 hours to prevent hypo perfusion
What is the Conn’s disease triad?
HTN
HypoK
Metabolic alkalosis
What is Conn’s Disease ?
Hyperaldosteronism
What are the causes of pericardial disease?
CARDIAC RIND
Collagen vascular disease Aortic dissection Radiation Drugs Infections Acute renal failure Cardiac MI
Rheumatic fever
Injury
Neoplasm
Dressler syndrome
What are the symptoms of pericarditis
Pleuritic chest pain
Cough
SOB
Fever
What is the treatment of pericardial tamponade?
Volume expansion with IV fluids
Urgent pericardiocentesis
May need to do a pericardial window
Commonest sites of aortic dissection
Aortic valve
Distal to L subclavian artery
What are the symptoms of aortic dissection?
Hypertension
Asymmetric pulse and BP measurements
What is the gold standard for imaging of aortic dissection?
CT angiography
What is the treatment of aortic dissection?
manage BP
give beta-blocker before vasodilators
What is a type A aortic dissection?
proximal to L subclavian artery
What are the SE of ACE inhibitors?
ANGIOEDEMA
Cough
Rash
HyPERkalemia
What are the side effects of Dihydropyridines
Headache
Flushing
Peripheral edema
What drugs are dihydropyridine
Nifedipine
Felodipine
Amlodipine
What drugs are nonDihydropyridines
diltiazem
verapamil
Which one of these nitrates is not administered sublingual? Isosorbide dinitrate Isosorbide monodinitrate Glyceryl trinitrate Erythrityl tetranitrate
isosorbide mononitrate
Which one of these nitrates needs to be dilated? Isosorbide dinitrate Isosorbide monodinitrate Glyceryl trinitrate Erythrityl tetranitrate
Erythrityl tetranitrate
What is the name of angina that occurs lying down?
Angina decubitus
What are the side effects of nonDihydropyridines
bradycardia
What is the main side effect of amiodarone?
Thyroid dysfunction
In what patients should PDE be avoided? (cilostazol)
CHF``
What effect does Digoxin have on the heart?
Reduces filling pressure
Increases contractility
Increases CO
Decreases HR
Fixed splitting of S2 suggests
ASD
What is the commonest SE of aspirin
rigning in the ears
What is the presentation of aortic regurgitation?
Blowing/descrendo diastolic murmur
Widened pulse pressure
3rd intercostal space on the L
What is the presentation of aortic stenosis?
Ejection systolic murmur
split S2
Plusus parvus et tardus
What is the presentation of mitral stenosis?
Mid-diastolic murmur at the apex
What is the presentation of mitral regurgitation?
Holosystolic murmur radiating to the axilla
This presentation suggest:
- Genital ulceration
- Oral ulceration
- Ocular involvement
- Skin lesions
Behcet’s Syndrome
Which disease has painless ulcers?
Syphilis
What is the cause of axillosubclavian vein thrombus?
Repeated use of arm in a raised position.
Which drugs reduce preload and after load?
ACE inhibitors
AngII
Nitroprusside
Prazocin
Why should NSAID’s be avoided in HF?
Cause fluid retention
What is a normal ABI?
0.9-1.2
What is the ABI of someone with claudication?
0.7- 0.4
What is the ABI of someone with claudication at rest?
< 0.4
What is a normal EF?
55-75%
Symptoms of digoxin toxicity?
AV-block Thrombocytopenia Delirium Severe bradycardia Ventricular arythmie
Which drugs are Beta 1 selective blockers?
Atenolol
Acembutol
Metoprolol
Esmolol (IV)
What is the treatment of HTN in a patient who is having a stroke?
Monitor if < 220/120