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Cardiovascular Flashcards

1
Q

Guidelines for treating hyperlipidemia

A
  1. LDL > 190
  2. diabetic 40-75y/o.
  3. ASCVD risk >7.5%.
  4. history of ASCVD, AMI, stroke, TIA, peripheral artery disease.
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2
Q

Statins

A
  • Decrease cholesterol, inhibition of HMG-CoA reductase.
  • Best effect on LDL.
  • ADR: myositis, hepatotoxicity. Draw LFT as baseline before starting.
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3
Q

Ezetimibe

A
  • Impairs dietary and biliary cholesterol absorption at brush border of intestine.
  • Lowers LDL.
  • ADR: myalgia, LFT.
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4
Q

Fibrates

A
  • Primary effect on triglycerides and HDL.
  • Reduce hepatic secretion of VLDL.
  • ADR: myositis, LFT.
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5
Q

Bile Acid sequestrants (cholestyramine, colestipol)

A
  • Primary effect on LDL.
  • ADR: GI Upset.
  • Cholestyramine used as adjuvant to bind C.diff toxin.
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6
Q

Niacin

A
  • Primary effect on HDL.
  • ADR - flushing.
    • Prevent w/ NSAID or acetaminophen before use.
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7
Q

Omega - 3 fatty acids (fish oil)

A

Primary effect on triglycerides, Need super high dose.

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8
Q

Anterior wall MI

A

V2, V3, V4, V5. LAD

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9
Q

Septal wall

A

V1, V2, V3. LAD

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10
Q

Inferior wall

A

II, III, aVF. Posterior descending.

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11
Q

Lateral wall

A

I, aVL, V5, V6. LAD or circumflex.

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12
Q

Aspirin

A

Blocks COX-1/-2. Impairs platelet aggregation

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13
Q

Clopidogrel, Ticlopidine, Prasugrel, ticagrelor

A
  • ADP-receptor blockers:
    • prevent platelet aggregation
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14
Q

abciximab, eptifibatide, tirofiban

A
  • GpIIb/IIIa inhibitors:
    • block platelet aggregation
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15
Q

Heparin

A

Activates antithrombin.

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16
Q

LMWH (enoxaparin)

A

activates antithrombin

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17
Q

Warfarin

A
  1. Vit K antagonist.
    1. Blocks PrC, PrS, 10, 9, 7, 2 factors.
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18
Q

alteplase, reteplase, tenecteplase

A

Thrombolytics; increase plasmin. Which breaks down fibrin.

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19
Q

Treatment of Prinzmetal angina

A
  1. Smoking Cessation
  2. CCB (diltiazem)
  3. Nitrates

**Avoid B-blocker and triptans. Lease lead to vasonconstriction and worsen condition**

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20
Q

Benign cardiac sounds, IF patient is asymptomatic.

A
  • Split S2 with inspiration.
  • Split S1.
  • S3 < 40yo
  • early quiet systolic murmur < grade III.
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21
Q

Aortic Stenosis

A
  • Causes:
    • congenital bicuspid valve (Turner syndrome)
    • Elder age (senile calcifications)
  • Presentation
    • dyspnea, angina, syncope.
  • Dx
    • systolic ejection murmur at RUSB, radiates into carotids.
    • Valsalva decreases. Squatting increases.
    • Echo is definitive Diagnostic.
  • Tx
    • aortic valve replacement.
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22
Q

Mitral Regurgitation

A
  • Causes
    • MVP, rheumatic heart disease, infective endocarditis.
  • Pt
    • fatigue, DOE, A-fib
  • Dx:
    • holosystolic murmur at LLSB, with radiation into axilla.
  • Tx
    • vasodilators
    • anticoagulate if (+) A-fib.
    • mitral valve repair
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23
Q

Aortic Regurgitation

A
  • Cause
    • infective endocarditis, tertiary syphilis.
  • Pt
    • dyspnea, heart failure.
    • wide pulse pressure, rhythmic head bobbing.
    • diastolic murmur at RUSB.
  • Tx
    • ACEi, BBlock, spironolactone.
    • Aortic valve replacement.
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24
Q

Mitral Stenosis

A
  • Cause
    • rheumatic heart disease
  • Pt
    • dyspnea, CHF, A-fib
  • Dx:
    • Diastolic at apex, w/ opening snap.
  • Tx
    • balloon valvuloplasty.
      • diuretics for symptom relief.
      • anticoagulate if A-fib(+)
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25
Systolic Heart Failure (HFrEF)
* Chronic HTN * high afterload * high preload * Reduced contractility. * High output conditions * poor O2 circulation. * high metabolic demand.
26
Diastolic HF (HFpEF)
* LV hypertrophy * Hypertrophic cardiomyopathy * restrictive cardiomyopathy.
27
Tx for acute decompensated CHF?
* NOLIP * Nitrates, O2, Loop diuretics, Inotropics, Position.
28
Which drugs are proven to reduce mortality in CHF patients?
* ACEi/ARBs * reduce afterload/preload, increase cardiac output. * B-blocker * Carvedilol, bisoprolol. Do not start during an acute event. * Aldosterone antagonists * spironolactone, eplerenone.
29
Dobutamine
* B1 agonist. * increase HR and contractility * Use for cardiogenic shock
30
Norepinephrine
* A1, B1 agonist. * use for septic shock
31
Epinephrine
* a1, a2, b1,b2 agonist. * a1 at high dose. * b1 at low dose. * Use for anaphylactic shock. * 2nd line for septic shock
32
Vasopressin
* weak vasoconstrictor * use as 2nd line for septic or anaphylactic shock.
33
Phenylephrine
* a1 agonist. * Use 2nd line septic shock
34
Dopamine
* b1 agonist (low dose) * a1 agonist (high dose) 2nd line for cardiogenic shock.
35
Treatment of myocarditis.
1. Supportive (majority are viral cause) 2. If bacterial --\> antibiotics. 3. Stop any offending Rx. 4. Tx any arrhythmias. 5. Immunosuppresion if immunocompromised.
36
Diagnosis of acute rheumatic fever.
* Typically occurs 2-4wk s/p strep throat infection. Ab attack heart valves. * Requires **2 major or 1 major and 2** minor JONES criteria. * Major: * polymigratory arthritis. * pancarditis. * subcutaneous nodules (wrist, elbow, knee) * erythema marginatum * syndeham chorea. * Minor: *PEACE* * previous h/o * ECG w/ prolonged PR. * Arthralgias * CRP/ESR elevated. * Elevated temp.
37
Treatment for acute rheumatic fever
* NSAIDs * corticosteroids * penicillin *if strep throat is still ongoing or recurring.*
38
Dental procedure ppx.
* Indicated for H/o * prosthetic valve. * infective endocarditis. * congenital heart disease. * heart transplant. * Rx * amoxicillin 2g IV 30-60 min prior.
39
Endocarditis
* Etiology * M \>60. * poor dentition. * IV drug use. * Pt * Janeway lesions, Osler nodes, Splinter hemorrhages, Roth spots. * fever, malaise, weight loss, New murmur.
40
DUKE criteria
Used to diagnose Endocarditis Consist of 2 Major, 1 Major + 3 minor, or 5 minor criteria. * **Major:** * (+) serial blood Cx. * (+) valvular vegetations or abscess. * New valve regurgitation * (+) Coxeilla burnetii. * **Minor:** * IV drug use. * Fever \>38.0. * arterial emboli, conjunctival hemorrhages, janewaylesion. * immunologic disease.
41
Treatment of bacterial endocarditis
1. 2-3 blood Cx before therapy to confirm 2. Empiric Vancomycin 4-6wk. Taper based on Cx.
42
Kussmaul Sign
JVD during inspiration * Seen with Constrictive pericarditis. * restrictive cardiomyopathy * RV infarction * Tricuspid stenosis * Massive PE * Rt CHF
43
Treatment for Wenckebach?
Adjust current medications. Pacemaker if bradycardic
44
Treatment for Mobitz type II block
Requires pacemaker
45
3rd Degree heart block treatment
Pacemaker
46
Causes and treatment for **Paroxysmal supraventricular tachycardia**
* Causes * AV nodal reentry * WPW (accessory nerve conduction pathway) * Treatment 1. Carotid massage, Valsalva 2. **IV adenosine** 3. Bblock, CCB, cardioversion.
47
Tx for multifocal atrial tachycardia
Non-dihydropyradine CCB (verapamil, diltiazem) Bblock. Coorect K\>4.0. Mg \> 2.0.
48
Management of A-fib
* Acute (\<48hr onset) * electric cardioversion * \> 48 hours 1. TEE 2. heparin + warfarin 3. Rhythm control (*sotalol, amiodarone)* 4. Rate control (*b-block, NDHP-CCB, digoxin)*
49
Sodium Channel Blockers
* IA * quinidine, procainamide, disopyramide * IB * lidocaine, mexiletine, tocainide * IC * flecainide, propafenone
50
Potassium channel blockers
Class III * sotalol * amiodarone * ibutilide
51
Tx for V-fib or PEA?
* shock, CPR x 2min (30:2) * check rhythm * Shock, CPR x 2min, Epinephrine 1mg Q3-5min * Check rhythm * Shock, CPRx2min, Amiodarone 300mg. 150mg. Repeat check rhythm.
52
What are you doing while you are running through the checklist of ACLS?
Checking your H's and T's. * Hypovolemia, hypoxemia, acidosis, hyperkalemia, hypokalemia, hypoglycemia, hypothermia. * Tamponade, tension pneumothorax, thrombosis, trauma, toxin overdose.
53
Casuses of secondary HTN
* ESRD * Drugs: OCP's in females. Especially over 35yo. * Hypercortisolism * Pheochromocytoma * Hypo/Hyperthyroidism * Hyperparathyroidism * Aortic coarctation * OSA
54
HTN urgency and emergency
* HTN Urgency: \>180/ 120 without end organ damage * HTN emergency: \>180/120 WITH end organ damage. * Tx * Goal BP of 160/100. However only reduce MAP by max of 25% in 2-3 hours. * MAP = DBP - 1/3(SBP - DBP) * Rx to use * nitroprusside * Labetalol * nicardipine * clonidine * captopril * enalapril
55
Captopril, enalapril, fosinopril
* ACE-I * Inhibit angiotensin converting enzyme. less Angiotensin, less aldosterone. Less fluid resorption and less vasoconstriction. * Used * post-MI, CHF, CKD, diabetes to prevent diabetic renal failure. * ADR: * dry cough. * angioedema
56
Candesartan, Losartan, Valsartan
* ARBs * inhibit angiotensin receptors (therefore do not increase bradykinin) * Uses * post-MI, CHF, CKD. * ADR * renal insufficiency * hyperkalemia.
57
Dihydropyridine CCB
* amlodipine, felodipine, nifedipine. * Block Ca channels in smooth muscle. * Use * prinzmetal angina. * esophageal spasm. Migraine prophylaxis. * ADR: * peripheral edema, HA, constipation, GERD.
58
Diltiazem, Verapamil
* Non-dihydropyridine CCB * Block Ca channels in the heart causing reduced cardiac output. * Use * A-fib, SVT. * Migraine prophylaxis. * ADR * peripheral edema, HA, constipation, GERD, bradycardia.
59
Thiazide diuretics
* Chlorthalidone, HCTZ. * reduce intravascular volume and vasodilation. Reduce Ca excretion. * Use * CHF, CKD * ADR * hyperkalemia * hypercalcemia * hyponatremia * Sulfa allergy
60
A1 blocker
* Doxazosin, prazosin, terazosin * block a1 adrenergic --\> vasodilation * Use * BPH, HTN * ADR * orthostatic HoTN * rebound HTN.
61
Arterial vasodilators for HTN
* Hydralazine, minoxidil * relax vascular smooth muscle. * Use * HTN. male pattern baldness. * ADR * reflex tachycardia * drug-induced lupus (hydralazine)
62
Indications for repair of abdominal aortic aneurysm
* Males \>5.5 cm * Females \> 5.0cm * Increase in size \>0.5cm in 6months. * symptomatic (back pain, tenderness)
63
Peripheral artery disease
* Pt * intermittent claudication. Non-healing foot ulcers, erectile dysfunction. * Dx: * Ankle-Brachial Index. * ABI \< 0.9 = abnormal. ABI \> 0.9 is normal. * start w/ US or CTA. Follow up with Arteriogram. * Tx * Medical: *smoking cessation, glucose/BP control. exercise, **Cilostazol** - improve bloodflow. daily ASA +/- statin.* * *Failure of medical management --\> progress to angioplasty, bypass grafting, amputation.* *\*\*consider coronary artery disease also\*\**
64
Diagnostic criteria for Kawasaki Disease
* **CRASH and Burn** * Requires a high grade fever for at least 5 days, 4/5 sxms: * **C**onjunctivitis (bilateral, non-exudative, painless) * **R**ash (trunk) * **A**denopathy (cervical LN) * **S**trawberry tongue and diffuse erythema * **H**and/feet desquamation Risk of coronary artery aneurysm within weeks on disease onset. * Tx * IVIG (1st 10 days of illness) * Aspirin (high-dose) * F/U echocardiogram 6-8 wk later.
65
Polyarteritis Nodosa
Lung sparing. *kidney, GI tract.* ## Footnote * Association w/ HCV, HBV.* * (-) ANCA.* * angiography shows multiple aneurysms.*
66
Wegener's Granulomatosis Granulomatosis with polyangiitis
* Granuloma formation in: * upper airway * Lungs * Kidney * (+) c-ANCA. * Tissue Bx is required to definitively confirm the diagnosis.
67
Mixed Cryoglobulinemia Syndrome
* Polyclonal IgG and IgM antibodies associated with HCV. * **Melzer's Triad:** * palpable purpura. * peirpheral neuropathy * arthralgias. Majority also have renal failure w/ hematuria and proteinuria

Boards 2 (10 decks)

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