Cards Flashcards
fatigue, anorexia, nausea, blurred vision, disturbed color perception, cardiac arrhythmia
digoxin toxicity - give digoxin Fab for antidote
bradycardia, AV block, hypotension, diffuse wheezing, hypoglycemia, bronchospasm, neuro dysfunction
BB overdose -> give fluid, atropine, and glucagon (increase cAMP)
lungs, liver, eyes, skin, thyroid, nerves
AMIODARONE; monitor LFTs and Thyroid; if lung sx, think pneumonitis
retinal hemorrhange + papilledema + HTN
malignant HTN
STEMI tx
DAPT (ASA + clopidogrel) BB Statin Oxygen Nitrates PCI Anticoag (heparin, LMWH, bivalirudin)
What can happen with RV MI?
profound hypotension due to inadequate RV preload – provide NS bolus
electrical alternaans/varying amplitude of QRS + tachycardia + syncope + muffled heart sounds
pericardial effusion
SENSITIVITY in diagnosing HF?
BNP; physical exam findings are specific (crackles, S3, edema, JVD)
What 10 yr risk % indicates statin initiation?
> 7.5%
Causes of acute limb ischemia 2/2 arterial insufficiency?
cardiac emboli, thrombosis, trauma
Sources of cardiac emboli causing arterial insufficiency?
L ventricle, Thrombus due to afib, aortic atherosclerosis
*** crescendo-decrescendo murmur, increase inspiration, systolic ejection click, widened split of S2
Pulmonic valve stenosis
from what do you get pulmonic valve stenosis
congenital defect
*** ejection click followed by crescendo-decrescendo systolic murmur over second intercostal space, and widened splitting of S2
Pulmonic valve stenosis
Diffuse ST elevations, chest pain worse with breathing relieved with leaning forward, MI one week ago
pericarditis in Dressler syndrome, give NSAIDS
4th heart sound
LVH - can be 2/2 HTN
inferior notching of ribs, HTN, 4th heart sound, continuous murmur
coarctation of the aorta - continuous murmur when there is collateral blood flow
episode of AF but found to have no cardiopulmonary or structural heart disease
Lone AF, commonly < 60 and requires no therapy
if AF with mod-severe risk of thromboembolic events by CHADVASC
anticoagulate with WARFARIN or Xaban
*** pruritus and flushing on hyperlipidemia control
niacin - prostaglandin mediated vasodilation, can be lessened by concomitant aspirin
antiarrhthmic drugs used in rhythm management of paroxysmal a fib
amiodarone and flecainide
types of cardioversion
electrical or chemical (ibutilide)
Lab panel for new diagnosis of HTN
CMP, CBC, UA, TSH, Lipid panel, A1C and EKG
*** two types of mineralcorticoid receptor antagonists (MRAs) that confer longtime survival benefit to patients with LV dysfunction
eplerenone, spironolactone
*** 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?
NO
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)
