Cardiovascular Flashcards
What is medical management of hypertrophic cardiomyopathy?
Negative inotropic agents (e.g. beta blockers, verapamil)
What is the treatment for sustained ventricular tachycardia in a stable patient?
Antiarrhythmic drugs - usually IV amiodarone
What is alcoholic cardiomyopathy?
Diagnosis of exclusion: LV dysfunction (dilated) in pt with hx of alcohol abuse in whom no other potential causes of cardiomyopathy (e.g. coronary artery disease, valvular heart disease) are identified. Cessation of EtOH use can improve or even normalize LV function over time
What are symptoms of an ateriovenous fistula?
Widened pulse pressure, strong peripheral arterial pulsation (e.g. brisk carotid upstroke), systolic flow murmur, tachycardia, and often flushed extremities if fistula involves the extremity. PMI will be displaced to the left and ECG will show left ventricular hypertrophy
What kind of bundle branch block can severe right heart strain cause (e.g. massive PE)?
RBBB
What is Beck’s triad?
Hypotension, elevated JVP, and muffled heart sounds - signs of cardiac tamponade
What happens to the PMI in pts with large pericardial effusions?
Becomes nonpalpable
What is Dressler syndrome?
A secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (e.g. following MI). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion. Treated with NSAIDS
What is/are the most common location(s) for the ectopic foci that cause A-fib?
The pulmonary veins
What medication is preferred to manage aortic dissection?
IV beta blocker (e.g. labetalol, proranolol, esmolol) - reduces HR, SBP, and LV contractility putting less stress on the dissection
What EKG findings are associated with LVH?
High voltage QRS complexes, lateral ST segment depression, and lateral T wave inversion
What valvular disease may result from carcinoid syndrome?
Tricuspid regurgitation
What are features of a supravalvular aortic stenosis?
Systolic murmur similar to AS except is best heard at the first right intercostal space, unequal carotid pulses, differential blood pressure in upper extremities (high-pressure jet in ascending aorta), and a palpable thrill in the suprasternal notch
Why does left ventricular hypertrophy lead to increased myocardial oxygen demand with exertion?
Patients end up with coronary artery stenosis as an associated anomaly.
What is LV wall stress a measure of?
Preload
How does morphine reduce myocardial oxygen demand in ACS?
Morphine sulfate reduces sympathetic tone through a centrally mediated anxiolytic affect. Morphine also reduces myocardial oxygen demand by reducing pre-load and by a vagally mediated reduction in heart rate
What does a new onset holosystolic murmur 2-7 days after MI indicate (although could be sooner)?
MR due to papillary muscle rupture
How does the cardiac index change in hypovolemic shock?
Decreases
What pressure measurements represent preload?
RA pressure and PCWP
How does preload (RA pressure and PCWP) change in cardiogenic shock?
Increases
What is the first line intervention for a conscious and stable patient with torsades de pointes?
IV magnesium
What is atropine used for?
Symptomatic sinus bradycardia or atrioventricular nodal block
What precipitating factors should be avoided in patients with premature atrial complexes, even if they are asymptomatic?
Tobacco, alcohol, caffeine, and stress
What heart sound correlates with an elevated BNP?
S3 - indicates high LV pressure
What are symptoms of a RV infarction?
Hypotension, tachycardia, clear lungs, JVD, and NO pulsus paradoxus. DON’T give nitro. Tx w/ vigorous fluid resuscitation (need more preload)
What cardiac marker is the best test to get if you are concerned about a repeat MI within a short period of time?
Myoglobin - rises quickly and peaks in 2 hrs. Out of system by 24 hrs (troponin and CKMB will be in the system already from the previous MI because stick around for several days)
If cardiac enzymes are normal in a patient you suspect of NSTEMI, what should you do?
Get cardiac enzymes Q8hrs x 3 to make sure
In a patient with an MI, what meds should you give?
Morphine, oxygen, nitrates, beta-blocker, aspirin/clopidogrel
When would you do a CABG over PCI in a pt with an MI?
Three vessel disease (or 2 vessel in DM), left main disease, or post intervention angina
In a patient with unstable angina and has a LBBB or is on digoxin therapy, what kind of stress test is preferred?
ECHO stress test - very difficult to interpret the EKG
What are markers of a positive stress test?
CP is reproduced, ST depression, hypotension
What should you be thinking in a patient with persistent ST segment elevation and a MR murmur ~1 mo post MI?
Ventricular wall aneurysm
What are “Cannon A-waves” a sign of?
AV dissociation (e.g. 3rd degree block or V-fib)
In a patient with stable V-tach, how is it treated?
Amiodarone or lidocaine
What does the valsalva maneuver do to hemodynamics?
Decreases preload
What cardiac defect is associated with a wide, fixed S2?
ASD
What type of heart failure dose hemachromatosis cause?
Diastolic HF - reversible with phlebotomy
