Cardiovascular Flashcards by Dana Chemali

What is the acute treatment of HF?

Lasix - frusemide 
Morphine 
Nitrates
Oxygen 
Position - upright

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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

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Which drug out of this has been shown to reduce mortality risk in HF? 
thiazide 
CCB 
spironolactone 
ACE

Spironolactone

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what are the symptoms of LHF?

L sided S3/S4 gallop 
Bilateral basically rales 
Pleural effusion 
Pulmonary edema 
PND

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what are the symptoms of RHF?

R sided S3/S4 gallop
JVD
Hepatojugular reflex
peripheral edema

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what is systolic dysfunction

EF is reduced

L ventricular end-diastolic volume is increased

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what is non-systolic dysfunction

reduced ventricular compliance with systolic function

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what are 4 side effects of loop diuretics (frusemide)?

HypoCalcemia 
HypoKalemia 
Ototoxicity 
Dehydration 
Gout

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what are side effects of thiazide?

HyperGLUC

glycemic
lipidemia
uricemia
calcemia

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what are side effects of K+ sparing?

Hyperkalemia
Gynecomastia
Sexual dysfunction

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what is the most common cardiomyopathy?

dilated

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What happens to left ventricular size at end of diastole and systole in dilated cardiomyopathy?

increase in size of both

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What happens to EF in dilated cardiomyopathy?

Decreases

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What happens to left ventricular size at end of diastole and systole in hypertrophic cardiomyopathy?

Decreases in size

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What happens to EF in hypertrophic cardiomyopathy?

Increases

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What is the most common cause of cardiomyopathy?

Idiopathic

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Which infections can cause a cardiomyopathy?

Cocksackievirus
Chagas
HIV
Parasites

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Which drugs can cause a cardiomyopathy?

doxorubicin
AZT
Cocaine

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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

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How is hypertrophic obstructive cardiomyopathy inherited?

Autosomal dominant

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How does hypertrophic cardiomyopathy present

Crescendo-Decrescendo increasing with reduced preload

reduced preload = standing, Valsalvs

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what is the treatment of stable angina?

ASA
B-blocker
NG

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U ain’t got enzymes with ….

Unstable Angina

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When your patient is MOANing from an MI remember

Morphine
Oxygen
Aspirin
Nitrogen

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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