Cards Flashcards by Kelly MacWhorter

fatigue, anorexia, nausea, blurred vision, disturbed color perception, cardiac arrhythmia

digoxin toxicity - give digoxin Fab for antidote

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bradycardia, AV block, hypotension, diffuse wheezing, hypoglycemia, bronchospasm, neuro dysfunction

BB overdose -> give fluid, atropine, and glucagon (increase cAMP)

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lungs, liver, eyes, skin, thyroid, nerves

AMIODARONE; monitor LFTs and Thyroid; if lung sx, think pneumonitis

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retinal hemorrhange + papilledema + HTN

malignant HTN

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STEMI tx

DAPT (ASA + clopidogrel)
BB
Statin 
Oxygen 
Nitrates
PCI
Anticoag (heparin, LMWH, bivalirudin)

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What can happen with RV MI?

profound hypotension due to inadequate RV preload – provide NS bolus

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electrical alternaans/varying amplitude of QRS + tachycardia + syncope + muffled heart sounds

pericardial effusion

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SENSITIVITY in diagnosing HF?

BNP; physical exam findings are specific (crackles, S3, edema, JVD)

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What 10 yr risk % indicates statin initiation?

> 7.5%

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Causes of acute limb ischemia 2/2 arterial insufficiency?

cardiac emboli, thrombosis, trauma

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Sources of cardiac emboli causing arterial insufficiency?

L ventricle, Thrombus due to afib, aortic atherosclerosis

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*** crescendo-decrescendo murmur, increase inspiration, systolic ejection click, widened split of S2

Pulmonic valve stenosis

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from what do you get pulmonic valve stenosis

congenital defect

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*** ejection click followed by crescendo-decrescendo systolic murmur over second intercostal space, and widened splitting of S2

Pulmonic valve stenosis

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Diffuse ST elevations, chest pain worse with breathing relieved with leaning forward, MI one week ago

pericarditis in Dressler syndrome, give NSAIDS

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4th heart sound

LVH - can be 2/2 HTN

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inferior notching of ribs, HTN, 4th heart sound, continuous murmur

coarctation of the aorta - continuous murmur when there is collateral blood flow

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episode of AF but found to have no cardiopulmonary or structural heart disease

Lone AF, commonly < 60 and requires no therapy

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if AF with mod-severe risk of thromboembolic events by CHADVASC

anticoagulate with WARFARIN or Xaban

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*** pruritus and flushing on hyperlipidemia control

niacin - prostaglandin mediated vasodilation, can be lessened by concomitant aspirin

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antiarrhthmic drugs used in rhythm management of paroxysmal a fib

amiodarone and flecainide

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types of cardioversion

electrical or chemical (ibutilide)

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Lab panel for new diagnosis of HTN

CMP, CBC, UA, TSH, Lipid panel, A1C and EKG

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*** two types of mineralcorticoid receptor antagonists (MRAs) that confer longtime survival benefit to patients with LV dysfunction

eplerenone, spironolactone

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*** Groups of drugs that provide survival benefit to patients with LV dysfunction

ARBs, ACEis, BB, MRAs and in African American, Hydralazine + Nitrates

tx for acute decompensated HF with adequate perfusion to end organs

supp O2, diuresis (furosemide), vasodilation (nitrates)

Types of nitrates

nitroglycerin and nitroprusside

muffled heart sounds, pulsus paradoxus, hypotension, pericardiocentesis

tamponande

persistent afib, pneumonitis, blue/grey discoloration of skin, thyroid and liver issues

amiodarone (antiarrhythmic; should monitor with LFTs and thyroid labs)

**** life prolonging in African Americans with LV dysfunction, SE of salt and fluid retention + edema + palpitations + hypotension + drug induced LUPUS

hydralazine

*** two common heart medications that can trigger broncho-constriction and pulmonary symptoms in someone with asthma

aspirin and b-blockers

when do you get ACEi SE cough?

immediately or months following, depends on individual thresholds for reaction to bradykinin

Becks triad

3 symptoms of TAMPONADE - hypotension + distended neck veins + muffled heart sounds

pulsus paradoxus

drop > 10 mm hg in BP with inspiration; seen in tamponade

Why does inspiration worsen tamponade?

lowers intrathoracic pressure thus increases blood return to RV

***Signs of left HF

crackles and S3

Signs of right HF

BEFORE heart - JVD and peripheral edema

What increases in the heart during tamponade?

Contracitility and HR in attempt to increase CO

Causes of LV outflow obstruction

Severe AS or hypertrophic obstructive cardiomyopathy (HOCM)

orthostatic hypotension is ___ change in systolic and ___ in diastolic between laying and standing

20 systolic, 10 diastolic

*** When may you hear S4

S4 indicates DECREASED LV compliance (hypertensive heart disease, AS, hypertrophic cardiomyopathy, acute phase of MI)

fixed splitting for second heart sound

ASD

opening snap, LA enlargement

severe mitral stenosis

*** recent URI, maximal apical impulse difficult to palpate, dyspnea, JVD, "water bottle" enlarged heart on CXR

Pericardial perfusion, before tamponade

risk factors for aortic dissection

HTN, marfan, cocaine use

*** IV drug use, holosystolic murmur that increase with inspiration

tricuspid regurgitation

diffuse ST elevation, PR depression

pericarditis

coronary artery re-occlusion

acute stent thrombosis

3 or more anti-hypertensive medications with inadequate control

resistant HTN, think of secondary causes

risk factors for AAA

age > 60, cigarettes, family history, race, atherosclerosis

risk for expansion and rupture of AAA

currently smoke, rapid rate of enlargement, large diameter

*** when to do defibrillation/unsynchronized shock

ventricular fib or pulseless ventricular tachy

*** treatment of persistent tachycardia with signs of heart instability/failure (hypotension, cardiogenic shock, signs of ischemia, acute heart failure)

immediate synchronized cardioversion

*** ST elevation II III and aVF

Inferior MI, RCA or Left circumflex

*** ST elevation in some/all of anterior leads V1-V6

Anterior MI, LAD

delayed impulse transmission from atria to ventricles

first degree AV block

testing for symptomatic patients (dizziness/syncope) suspected to have arrhythmia

24 hour holter (constant EKG)

*** PR interval > 0.2 seconds/greater than 5 small boxes

first degree heart block; delay in conduction from atria to ventricle

electrical alternans, recent viral illness, muffled heart sounds, JVD, hypotension

pericardial effusion from pericarditis, resultant tamponade

patient is asymptomatic but found to have prolonged PR interval on EKG (> 5 small boxes). Is this typical?

YES - first degree heart block is typically asymptomatic

risk factors for AAA

smoking, male, age > 65

*** screening recs for AAA

one time screening in man who has EVER smoked age 65-75, abdominal US

Is AAA screening dependant on pack years and number of years since cessation?

use of digoxin

rate control in tachy of afib and symptom control of CHF

are BB contraindicated in setting of pulmonary edema?

YES

weak diuretic and mortality benefit in CHF

spironolactone

*** laboratory findings which indicate poor prognosis with systolic heart failure

HYPONATREMIA, elevated pro-BNP levels, renal insufficiency

hyponatremia is an independent predictor of clinical outcome in CHF - T/F?

TRUE

*** what is responsible for mediating hyponatremia

renin, NE, ADH

*** 3 rate control meds for afib

digoxin, bb (metoprolol), ccb (diltiazem, verapamil)

choices of anticoagulation for pt with a fib and elevated CHADVASC score

warfarin, dabigatraban, rivaroxaban, apixaban

sudden onset, regular and narrow-complex tachycardia

paroxysmal supraventricular tachycardia

digitalis toxicity arrhythmia

atrial tachycardia with AV block - digitalis increases ectopy and vagal tone

*** serum BUN > 60

UREMIA - often in setting of renal failure, can cause pericarditis

4 types of NSAIDs

aspirin, naproxen, indomethacin, ibuprofen

tx of idiopathic or acute viral pericarditis

NSAID + colchicine

3 components of typical angina

sub-sternal location + provoked by exercise or emotional stress + relieved with rest or nitroglycerin

*** widened pulse pressure, brisk carotid artery upstroke, systolic flow murmur, tachycardia, flushed extremities, LVH, lateralized apical impulse

AVF - arteriovenour formation, often secondary to trauma

Types of AVF

trauma, iatrogenic, cancer, congenital (pulmonary, CNS, angiomas, PDA)