Cardiovascular Flashcards

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1
Q

ACS

Diagnosis criteria for STEMI

Diagnosis criteria for NSTEMI

A

STEMI

  • 2 or more contiguous leads with >1mm elevation at J-point
  • (V2-V3 must be 2mm)
  • New LBBB
  • Elevated Troponin

NSTEMI

  • ST depression and/or T-wave inversion
  • Elevated Troponin
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2
Q

MI localization based on ECG

A

Septal: V1-V2: Proximal LAD

Anterior: V3-V4: LAD

Apical: V5-V6: Distal LAD, LCx, RCA

Lateral: I, aVL: LCx

Inferior: II, III, aVF: RCA (85%), LCx (15%)

RV: V1-V2 and V4: Proximal RCA

Posterior: ST depression V1-V3: RCA, LCx

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3
Q

STEMI treatment

A
  • Time is Muscle
  • Once at hospital: PCI within 90mins or Fibrinolytic within 30 mins
    • Transfer for PCI if door to balloon <120mins, or patient has high risk factors (cardiogenic shock, >3h since symptoms, high risk for cerebral hemorrhage)
    • Fibrinolysis = TpA (activates plasmin)

Percutaneous Coronary Intervention

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4
Q

Immediate medical adjuncts for Untable Angina/NSTEMI/STEMI

A
  • Morphine: venodilation to decrease preload which decreases pulm effusion. Also treats pain/anxiety
  • Oxygen: maintain SpO2 >90%
  • Nitrates: relief symptoms (contraindications: hypovolemia, RV infarcts, Sildenafil)
  • ASA: Chew 325mg
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5
Q

Unstable Angina/NSTEMI treatment

A
  • Beta blocker: CI’s bronchospasm, HF, 2/3 degree block, shock, brady/hypoten
  • CCB: Only if Bb contraindicated for bronchospasm
  • ACE inhibitor: Esp for HF, EF <40%
  • Morphine: venodilation to decrease preload which decreases pulm edema. Also treats pain/anxiety
  • Oxygen: maintain SpO2 >90%
  • Nitrates: relief symptoms (contraindications: hypovolemia, RV infarcts, Sildenafil)
  • Antiplatelet
  • Anticoag
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6
Q

Effectiveness of Bb in decreasing progression of UA/NSTEMI to STEMI

A

13%

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7
Q

CHF

  • Systolic HF (can’t expel blood): EF, murmur, left ventricle
  • Diastolic HF (can’t relax and fill): EF, murmur, left ventricle
A

Systolic:

  • Reduced EF <40%
  • S3 murmur
  • Dilated LV

Diastolic

  • Preserved EF >50%
  • S4 murmur
  • Hypertrophoic LV
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8
Q

CHF stage and treatment

A: risk of HF

B: Asymptomatic but structural abnormalities

C: HF symptoms + structural abnormalities

D: HF symptoms at rest. (4yr mortality >50%)

A

A: Treat underlying condition

B: ACE inhibitor, Bb

C: ACE-I, Bb, diuretic, salt restriction

D: Above + mechanical support (VAD, transplant, end of life)

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9
Q

Valve sounds:

Crescendo-decrescendo systolic murmur

A

Aortic stenosis

Angina, syncope, HF

AVR if symptomatic

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10
Q

Valve sounds:

Decrescendo blowing diastolic murmur

A

Aortic regurg

Dyspnea on exertion, signs of HF

Decrease afterload with systemic vasodilatros and diuretics

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11
Q

Valve sounds:

Opening snap

A

Mitral stenosis

Gradual onset dyspnea on exertion, R HF, Pulm HTN

Rx, valvuloplasty, MVR

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12
Q

Holosystolic blowing murmur

A

Mitral regurg

Asymptomatic progressing to dyspnea on exertion and HF

EF <30% MVR

EF>30 Rx or left vent assist device

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13
Q

Midsystolic click

A

MVP

Asymptomatic

No treatment if asymptomatic

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14
Q

Midsystolic click

A

MVP syndrome

SVT, autonomic nerve dysfunction, CP, palpitations, sycope

Reassurance, stress reduction

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15
Q

Difference between Esmolol and Labetalol

  • receptors
  • rate of onset
  • duration
A

Receptors

  • Esmolol selective-beta-1 blocker
  • Labetalol non-selective beta blocker: beta-1, beta-2, alpha

Rate of onset

  • Esmolol 2 mins
  • Labetalol 5 mins

Duration

  • Esmolol 30 mins
  • Labetalol 8 hours
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16
Q

Why is ACE inhib + diuretic 1st line for CHF

A

Why is ACE inhib + diuretic 1st line for CHF

  • Decrease afterload (ACE) and preload (Diuretic)
17
Q

Heart Sounds

  • S1
  • S2
  • Split S2: which valve is delayed in closing and why?
  • Which heart sounds are pathologic if present?
A

Heart Sounds

  • S1 = End of diastole (TcV and MtV closed)
  • S2 = End of systole (PmV and AoV closed)
  • Split S2 = PmV delayed closing bc inspiration brings extra blood into R ventricle. More blood to push out of ventricle means valve stays open a little longer
  • Pathologic = fixed S2, S3 (gallop volume overload or CHF), S4 (stiff ventricle in HTN, Aortic Stenosis, Cardiomyopathy)
18
Q

Renin-Aldosterone System

  • Sympathetic or Parasympathetic mediated
  • What organ releases Renin?
  • What organ converts Angiotensin I into Angiotensin II?
  • What structure releases ADH (Vasopressin)
  • What structure releases Aldosterone
  • Action of ADH
  • Action of Aldosterone
  • Action of Angiotensin II
A

Renin-Aldosterone System

  • Sympathetic mediated
  • Kidney releases Renin if perfussion/serum Na low
  • Lung converts Angiotensin I into Angiotensin II?
  • Pituitary releases ADH (Vasopressin)
  • Adrenal gland Aldosterone
  • Action of ADH - renal retention of sodium leading to fluid retention
  • Action of Aldosterone - retention of sodium in kidney, colon, sweat glands
  • Action of Angiotensin II - see photo
19
Q

RCA occlusion manifests how clinically?

LCA/LAD occlusion manifests how clinically?

A

RCA supplies SA node, AV node, R ventricle

  • Occlusion causes arrythmias, heart block

LCA/LAD supplies septum, L ventricle

  • Occlusion causes decreased myocardial function
20
Q

Which ECG lead is most sensitive to ischemia?

Which ECG lead monitors RCA and conduction disturbances?

A

Lead V5 most sensitive to ischemia

Lead II monitors RCA and conduction disturbances

21
Q

List 3 calcium channel blockers

  • Uses
  • Mechanism
  • Side effects
A

List 3 calcium channel blockers

  • Verapamil, Diltiazem, Amlodipine
  • Uses: Vasodilation, angina
  • Mechanism: Smooth muscle relaxation in vessels, decreased contractility of myocardium (negative ionotrope)
  • Side effects: Reflex tachycardia, HA, flushing
22
Q

Does aldosterone waste or retain K+?

Side effects of ACE-I

A

Aldosterone wastes K+

Side effects of ACE-I

  • Hyperkalemia, cough, angioedema from increased bradykynin, teratogen
23
Q

Infective Endocarditis

Organism(s) for each:

  • IV drug use
  • Native valve
  • Prothestic valve
  • Culture negative
A

IV drug use

  • Staph aureus

Native valve

  • Staph aureus, Strep virridans, enterococci

Prothestic valve

  • Staph epidermidis, aureus

Culture negative

  • HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella corrodens, Kingella),
  • Candida, Aspergillus
24
Q

WPW

  • EKG signs
  • Pathophys
  • Treatment
  • Medications to avoid
A

WPW

  • Delta wave = slurred P wave + QRS
  • Atrial contraction + Ventricle contraction almost simeoutaneously because of an accessory pathway
  • Tx = Procainamid (Na channel blocker anti-arrhythmic )
  • Don’t use = Adenosine, Amiodarone. Will cause V-fib