Cards Flashcards
WPW increases the risk of converting into what rhythm?
Parasoxymal Supraventricular Tachycardia
A pt on chronic anticoagulation (warfarin) is started on amiodarone. Do you need to make any changes?
Reduce warfarin dose by 25%
Amiodarone is a CYP inhibitor, so there will be more warfarin available in the blood stream
A cane dependent pt needs a stress test. What is his best option?
adenosine myocardial perfusion imaging
What is the management of a pt with DM and multivessel CAD?
CABG
This is preferred over PCI w/ drug eluting stents because they are less likely to have a MI s/p intervention
What heart murmur would you expect in a VSD?
Holosystolic murmur at LSB
Which heart defect has a fixed splitting of S2
ASD
What should be considered in all patients with DM ages 40-75
Starting a statin
Especially if LDL is >190
Heart score w/ 10 year risk determines if they need high or medium intensity statin
Initial management for Hypertrophic cardiomyopathy
Beta Blocker
Verapamil or disopyramide can be added if symptoms are persitent
Pt with pleuritic chest pain 3 days s/p PCI
Acute pericarditis
Tx for peri-infarction pericarditis?
High dose Aspirin
Avoid NSAIDS/colchicine/steroids because they impair cardiac healing and increase risk for ventricular wall rupture
Its with compartment syndrome are at high risk of developing?
Rhabdo
What would you do for a pt with new syncope w/o a prodrome but negative ER workup
admit
Tele
ECHO
This was most likely cariogenic shock d/t Vtach and could lead to sudden cardiac death if not well managed
May eventually need medication, ablation, and/or pacemaker
Syncope at rest w/o prodrome be concerned for?
Cardiogenic syncope 2/2 VTACH
At risk for sudden cardiac death
Admit for obs on tele
What increases risk of VTACH?
H/o MI
Treatment for NSTEMI?
antiplatelets x 2 (ASA, clopi) Metoprolol AC (heparin) High dose statin PCI within 24 hours
If a pt has NSTEMI + JVD, what medicine would you hold?
Metoprolol
Further exacerbates the decompensated HF
Pt with acute inferior MI develops bradycardia and hypotension. How do you manage?
Give atropine - if no improvement give cardiac pacing
Cardiac shock can occur after inferior MI’s (symptomatic brady’s). It tends to be transient but they do need help in the interim
Best way to improve blood pressure w/o medication?
Weight loss
AA male with HFrEF <40% w/o great control on ACEI and Beta blockade. Consider adding which medication?
Isosorbide nitrate + hydralazine
Improved mortality benefit in AA
Consider this in CHF patients that cant tolerate lisinopril
Patients with connective tissue disease are at risk for what acute cardiac event?
MVR d/t chordae tendinae rupture
Present with SOB, hypotension, Tachy, JVD. Acutely cannot move blood forward
Young healthy guy, weight loss x 2 months, now coming in with a small artery occlusion. Concerning for?
Cardiac myxoma
1st line therapy for Afib with RVR
Beta blocker or CCB
Why do athletes have sinus bradycardia?
Increased vagal tone
“athletes heart”
Criteria for Bi-ventricular pacing in CHF
EF < 35%
LBB with QRS >160ms
presence of syx (ie SOB, peripheral edema)
Whats a good idea for an antihypertensive in a guy with BPH?
Doxazosin
Improvement in urinary syx and decrease his BP
An infant’s mom has GDM and the infant is born with tachypnea and RDS but lungs look ok. Why
Transient hypertrophic cardiomyopathy
Temporarily these babies can have CHF d/t intraventricular thickening d/t the increased glycogen in their muscle.
Stress test with reversible perfusion defect in the lateral wall of the LV. Which artery is occluded?
L circumflex coronary a.
EKG criteria to dx a STEMI
> 1 mm ST elevation in two anatomically contingent leads (excluding V2, V3)
Treatment for cocaine related chest pain?
IV benzo
Decrease sympthametic tone
Pt with recent cocaine use now has chest pain and focal neuro findings. Negative head CT. What do you do next?
Chest CT
Be suspicious of aortic dissection
Down syndrome baby turns blue with feeds and has a holosystolic murmur. What are you suspicous for?
endocardial cushion defect
Most common cardiac defect in Down’s syndrome
ECHO will reveal defect
Which antihypertensives tend to cause lower extremity edema?
CCB’s
How do you distinguish SVT from Sinus tach on EKG
SVT has wide QRS, no p waves
Sinus tach narrow QRS and p waves if not burried
