Cardiovascular- First Aid Flashcards
Treatment of STABLE angina (ABCDE)
A- aspirin and antianginals B- beta blocker and control of BP C- cigarretes and cholesterol reduction D- diet and diabetes E- education
Prinzmetal angina (Definition, Causes, Findings)
- coronary artery spasm with complete coronary artery occlusion
- tobacco, cocaine, triptans
- ST elevation due to transmural ischemia
Left circumflex coronary artery supply
lateral and posterior walls of left ventricle
Left anterior descending coronary artery
anterior 2/3 of interventricular septum, anterior papillary muscle, and anterior surface of left ventricle
Posterior descending artery
supplies posterior 1/3 of interventricular septum and posterior walls of ventricles
Microscopic changes in MI
coagulative necrosis (no nuclei)–> neutrophils–> macrophages–> granulation tissue (heart is permanent tissue)–> fibrosis
Pathophysiology of Hemosiderin laden macrophages in the lungs
- secondary to left sided heart failure
- increased hydrostatic pressure in the pulmonary vasculature leads to rupture of pulmonary capillaries
- blood leaks into alveolar space
- alveolar macrophages consumes the blood
Features of Eisenmenger’s syndrome
- RVH
- Polycythemia (hypoxemia-induced erythropoietin release)
- Clubbing (cyanosis)
Paradoxical Embolus
- Seen in ASD that has reversed (R–>L) shunt
- DVT enters into right heart, gets shunted to the left, and enters the systemic circulation
- embolus either in brain or lower extremities
Jones criteria for Rheumatic fever
- migratory polyarthritis
- valvular damage (mitral>mitral+aortic»tricuspid)
- subcutaneous nodules
- erythema marginatum
- sydenham chorea
Pathophysiology behind and findings for WIDENED PULSE PRESSURE in aortic regurgitation
- increased stroke volume and decreased cardiac output secondary to regurg increases SP and decreases DP respectively
- bounding pulses, head bobbing, pulsating nail bed
Complications of atherosclerosis (thickened intima of medium/large vessels)
- PVD (popliteal artery)
- Angina/MI (coronary)
- Ischemic bowel disease (mesenteric artery)
- Stroke (middle cerebral)
- Atherosclerotic emboli
- aneurysm (abdominal aorta)
Class 1A Antiarrhythmics
- Quinidine, Procainamide, Disopyramide
- increase AP duration, increase effective refractory period
- increase QT interval
- use for both atrial and ventricular arrhythmias, especially re-entrant and ectopic SVT and VT
- cinchonism (quinidine), reversible SLE-syndrome (procainamide), heart failure (disopyramide), thrombocytopenia, torsades de pointes due to increased QT inerval
Class 1B Antiarrhythmics
- lidocaine, mexiletine
- decrease AP duration, preferentially affect ischemic or depolarized tissue
- use for both acute ventricular arrhythmias (post-MI) and digitalis-induced arrhythmias
- CNS stimulation/depression, cv depression
Class 1C Antiarrhythmics
- flecainide, propafenone
- significantly prolongs refractory period in AV node, minimal effect on AP duration, negative inotropy
- use for SVT’s, atrial fibrillation, refractory VT
- proarrhythmic, contraindicated in structural and ischemic heart disease
Class 2 Beta blockers
- metoprolol, propranolol, esmolol, atenolol, timolol, carvedilol
- decrease SA and AV nodal activity by decreasing cAMP, Ca currents, decrease slope of phase 4 (Na funny channels)
- use for SVT
- impotence, bronchospasm, bradycardia, AV block, CHF,sedation, sleep alterations, hypoglycemia, dyslipidemia (metoprolol), vasopasm in Prinzmetal angina
Class 3 K channel blockers
- amiodarone, ibutilide, dofetilide, sotalol
- increase AP duration, increased ERP, increased QT interval
- Afib, atrial flutter, v-tach
- torsades, excessive beta blockade (sotalol), torsades (ibutilide), pulmonary fibrosis, hepatotoxicity, hypothyroidism, hyperthyroidism, corneal deposits, skin deposits–> photodermatitis, neurologic effects, constipation, bradycardia, heart block, CHF (amiodarone)
Class 4 Calcium Channel Blockers
- verapamil, diltiazem
- decreased conduction velocity, increased ERP, increased PR interval, prolong phase 4 in AVN, SAN
- Prevention of nodal arrhythmias (SVT), rate control
- constipation, flushing, edema, CHF, AV block, sinus node depression
