CR IV MEDI Cardio Flashcards
What are causes of hypertonic hyponatremia?
Hyperglycemia or hypertonic infusion
How is isotonic hyponatremia similar to hypertonic hyponatremia
Similar to hypertonic hyponatremia but slow onset time so body has time to adjust
What are non-renal and renal causes of hypovolemic hypotonic hyponatremia?
Non-renal - GI (UNa <20)
Renal - Thiazide diuretics, low aldosterone (UNa >20)
What are two causes of euvolemic hypotonic hyponatremia? How can you tell them apart?
SIADH and Psychogenic polydipsia
SIADH - Urine concentrated
Psychogenic polydipsia - urine dilute
If Na is increased too quickly, what is caused?
Osmotic Demylination Syndrome
What three labs are needed for hyponatremia?
Urine Na
Urine Osmolarity
Plasma osmolarity
How is the water deprivation test performed? What does each point tell you?
Restrict water - if urine osm improves = polydipsia
Give ADH - if urine osm improves = neurogenic
If ADH does not improve = nephrogenic
What diuretics do you use to treat hypervolemic hyponatremia? Hypervolemia hypernatremia?
Loop diuretics - hyponatremia
Thiazide diuretics - hypernatremia
What should be ordered immediately when K >5.5?
EKG
What ECG abnormalities can be seen with hyperkalemia?
High T-wave, widened QRS
What should be given immediately to stabilize a patient with hyperkalemia if symptomatic?
IV calcium gluconate
What should be given to treat someone with hyperkalemia?
Insulin and glucose
If a patient is hyperkalemic and in metabolic acidosis, what should be given?
IV bicarb
What should be checked when a person is truly hypokalemic?
Magnesium
What is the most common cause of hypercalcemia?
Hyperparathyroidism
What three things should be given to treat hypercalcemia?
Saline
Loop diuretics
IV bisphosphanates
What is the treatment for hyperphosphatemia?
Oral phosphate binders
What regulates the movement of calcium into SMC?
MAgnesium
What helps stabilize hypermagnesia? What is the treatment of choice?
Stabilize - IV calcium gluconate
Hemodialysis - treatment of choice
What test is good at showing myocardial viability, better than eCHO and stress EKG?
Nuclear scintigraphy - MPI
What test is still used in oncology and is useful for identifying EF?
MUGA scan
What is the best test for congenital heart disease?
MRI with gadolinium contrast
What is the most popular drug for cardiac stress testing? What can be used if BMI > 50?
Lexiscan
Adenosine - if BMI > 50
What is the first goal of treatment for Afib? Second goal? Long term use?
Rate
Rhythm
Amiodarone - lone term use
What is the most common symptom of LHF?
Orthopnea
What is a major cause for Afib, not procedure related?
Obstructive Sleep Apnea
What is hypokensis? Akinesis? Diskinesis?
Hypokenesis - ischemia, low oxygen, can be reversed
Akinesis - dead tissue thins wall
Dyskinesis - anneurysm
What is the angiographic hallmark of prinzmetal’s angina?
Coronary spasm w/ ST elevating during chest pain, goes away when pain goes away
What is the treatment order for angina?
Aspirin 1st BB 2nd long-acting nitrate CCB Statin
What should be used for IHD in a hypotensive patient?
Ranolazine
What did the Courage trial show?
Medical treatment vs PCI no different in long term for asymptomatic patient
PCI still wins when symptoms present
What does 3rd heart sound indicate? 4th heart sound?
3rd - dilation because of ischemia
4th - diastolic dysfunction because of ischemia
What is the cornerstone of treatment for a person with Acute coronary syndrome?
BB and Nitrates
What score is used to evaluate chest pain in the ER?
HEART score
What is the gold standard enzyme for diagnosing MI?
Troponin
What is mandatory treatment after PCI?
P2Y12 inhibitor/ASA dual treatment
Is treatment for STEMI and nonSTEMI different?
No
What complication has occured if you hear a loud harsh systolic murmur?
Interventricular septal rupture
If a person keels over after lifting or straining after an MI, what most likely has happened?
Free wall rupture
What should be done if Right ventricular infarction occurs?
Volume expansion
What should not be given in Dressler’s Syndome?
Steroids
What is the most important diagnostic measure for HF?
ECHO
What is the corner stone of treatment for HF? What should be added if EF <35?
ACEI or ARB
Spironolactone
What BB is great for HF, particular diabetes?
Carvedilol
What is an a-wave mean? V-wave? Cannon a-waves? Large V-waves?
A-wave - pressure in atria during atrial contraction
V-wave - pressure in atria during ventricular systole
Cannon a-wave - atrial contraction against closed tricuspid (v.tach, junctional rhythms)
Large v-waves (tricuspid regurg)
What two things are required for diagnosis of pulmonary hypertension?
Righ heart cath
PA resting pressure > 25 mmhg
What calculator is used for risk of serious complication before/after surgery?
NSQIP calculator
What is 1 MET? 4 MET? >10 MET?
1 MET - eat, dress, use toilet
4 MET - can walk up 1 flight of stiars
>10 - can do physical exercise
When is resynchronization therapy (biventricular pacer used)?
QRS >120
Symptomatic (NYHA III or IV)
EF < 35
What is a defibrilator used?
Class II or III with reduced EF
Already on max therapy
