CV 5 Flashcards
A patient is diagnosed with Afib.. in deciding wether they need to be anticoagulant or not you look at their
CHA2DS2-VASc Score..
What are the individual components?
CHF ( 1 point) HTN ( 1 point) Age > 75 (2 points) DM (1 point) Stoke (2 points)
Vascular disease (1 point) Age 65-74 (1 point) Sex category (F) (1 point)
What CHA2DS2-VASc score should prompt Anticoagulation?
Score 0 -> ASA
Score 1 -> ASA
Score 2 or more –> oral AC (Warfarin, Dabigatran or Rivaroxaban)
When a patient presents to the ED with Afib, what is the first thing you want to determine?
Are they hemodynamically stable –> IF NO –> Emergency Cardioversion.
They do not need Rate control, or continue to have Afib after rate control is provided…what is the next step in management?
IV/PO BB (Metoprolol)
OR
Non-Diydropyridine CCB
- Verapamil
- Diltiazam
(If Rate control kicks them out of Afib, then AC according to CHA2DS-VASc)
IF AF < 48 hours —> Cardiovert
IF AF > 48 or unknown
- -> TEE + Cardiovert OR
- -> AC x 3 weeks then Cardiovert
All patients with a coronary stent require dual anti platelet tharapy to prevent stent thrombosis.
What are the two drugs you use?
How long do you have to do dual AC for bare metal stent vs Drug elluding?
ASA + Clopidogrel (Plavix)
Drug elluding stent = 1 yr
bare metal stent = 1 month
What are the two known cardiac complications of maternal DM/Hyperglycemia?
What is prognosis?
HOCM and CHF due to excessive glycogen deposition in cardiac tissue.
Typically spontaneously resolves after birth.
Classic triad of Cardiac Tamponade is Beck Triad. What is it?
What is the classic PE finding?
What is the classic EKG finding in Cardiac tamponade?
DX?
TRX?
- JVD
- HYPOtn
- Distant heart sounds
Pulsus Paradoxus - decrease in SBP 10 mmHg on inspiration.
EKG = electrical alterans (changing voltage of QRS) and low voltage QRS
DX = Echo
TRX = Pericardiocentesis vs window
MI can cause bradycardia via what mechanism?
TRX?
SA node and RV wall ischemia causing INCREASED VAGAL TONE.
TRX: If HD significant Bradycardia –> IV ATROPINE
– IF not IV Atropine responsive then TRANSCUTANEOUS PACING.
Small atrial septal defects are usually asymptomatic…but large ASDs can present how?
What PE finding clues you into the presence of ASD
L->R shunting causing RHF and dyspnea
PE–> wide and fixed splitting of S2
+/- Mid-diastolic rumble due to increased flow across Tricuspid
+/- Mid systolic murmur due to increased flow across pulmonic valve.
What are the 5 non-pharmacologic life style modifications for HTN? Put them in order of effectiveness in decreasing BP?
- Weight loss (BMI < 25)
- 5-20 SBP/10 kg loss - DASH Diet (increased fruit/veg, decreased fat)
- 8-14 SBP - Exercise (30 min/day; 5-6 day/wk)
- 4-9 SBP - Decrease Na intake (<3g/day)
- 2-8 SBP - Alcohol (2 drinks/day(M); 1 drink/day (W)
Out of life style modifications for HTN, what is most effective? What is second most effective?
#1 Weight loss #2 DASH diet
What are the preferred Anti-arrhythmic for AFIB with the following comorbidities:
No CAD or Heart disease?
LV hypertrophy or HF?
CAD but no CHF?
NO CAD/Heart disease:
- Flecainide
LV hypertrophy or HF
- Amiodarone
CAD, NO CHF:
- Sotalol
In treatment of Afib Rate control (metoprolol, Diltiazem, Verapamil) is better than Rhythm Contol…
In what 2 situations would you consider rhythm control?
- Unable to get adequate HR control on rate control
2. Persistent symptomatic episodes on rate contol.
What are the 5 indications to implant a Cardioverter/Defibrillator in HOCM?
- Hx of cardiac arrest or VT (In HOCM)
- Fam hx of sudden cardiac death ( in HOCM)
- Recurrent or exertional syncope ( in HOCM)
- HYPOtn with exercise ( in HOCM)
- LV hypertrophy with septal wall > 3 cm (In HOCM)
