CV 7 Flashcards
A patient who had CKD is getting an infusion of nitroprusside for HTN emergency…and later develops metabolic acidosis/lactic acidosis + AMS…what should you suspect?
CYANIDE poising due to decreased renal clearance of metabolized byproduct of Nitroprusside.
Revascularization of an ischemic limb can cause this catastrophic syndrome.
Compartment syndrome.
What is the goal INR for Mechanical Aortic Valve Replacement?
What is the goal INR for Mechanical Mitral Valve Replacement?
What are the two medications that individuals with a mechanical valve should be placed on for life?
Aortic –> INR 2-3
Mitral –> INR 2.5-3.5
ASA (75-100) + Warfarin
The L Coronary Artery Gives rise to what three cardiac arteries? And what are of the heart do they supply?
The R Coronary Artery gives rise to what three cardiac arteries? And what are of the heart do they supply?
LCA:
- -> L. Ant Descending (LAD) –> LV anterior wall
- -> Septal branch of LAD –> Ant 2/3 of inter ventricular septum
- -> Circumflex –> L. Atrium, L Ventricle lateral and posterior wall.
RCA:
- -> R. Acute Marginal Branch –> RA, RV
- -> Posterior Descending –> LV inferior wall, post 1/3 IV septum.
- -> Nodal branch –> SA/AV node
What EKG leads correspond to:
- LAD (Ant wall MI)?
- Septal Branch (Septal MI)?
- Circumflex Branch (Lateral wall MI)?
- Post Descending Branch of RCA (inferior wall MI)?
- V2, V3, V4
- V1, V2, V3
- AVL, V5, V6
- AVF, II, III
What is the time frame in which you define Peripartum Cardiomyopathy? What is the definition?
What are the three main RFs?
What is the management of Permpartum Cardiomyopathy?
Prognosis?
Peripartum Cardiomyopathy = HF that occurs btw 36 wks pregnancy to 5 months post partum.
Definition = LVEF < 45 during 36 wks to 5 months post partum + no other etiology of HF (dx of exclusion)
RFs:
- Maternal age > 30
- Multiparity
- Pre-Eclampsia
Management:
- Deliver baby if mom is HD unstable
- Standard HF medications
- Follow with serial echo for few years.
Prognosis:
- Some will have spontaneous resolution. IF LVEF dysfunction persists, no future pregnancy is banned.
For a woman who has experienced peripartum cardiomyopathy…what are the two conditions that would make another pregnancy contraindicated.
- LVEF < 20 % at time of dx
OR
- Continued HF (no resolution)
What are the three CHD “Equivalents” ?
DM
CKD
Non coronary atherosclerosis (PAD, stroke, AAA)
What are the 7 CHD risk factors?
- Age (M>45, F> 55)
- Male gender
- Fam Hx (M<50, F<60)
- HTN
- HLD
6 Smoking
6 Obesity
In Second degree Heart Block…
What is the difference between Mobitz type I and Moritz type II:
- In location of block?
- EKG finding?
- Affected by Exercise or Atropine?
- Affected by Vagal maneuvers?
- Need for pacemaker?
- LOCATION OF BLOCK
Type 1: @ AV node
Type 2: Below AV node/bundle of His - EKG:
Type 1: Progressive increase in PR until QRS is dropped (non-conducting P)
Type 2: PR interval prolonged but consistent, with intermittent non-conducting P in a set ratio (2:1, 3: 1 ext) - EXERCISE/ATROPINE
Type 1: Improves
Type 2: Worsens - VAGAL MANEUVERS
Type 1: Worsens
Type 2: Paradoxically improves - PACEMAKER
Type 1: NO
Type 2: Yes
What is the treatment of COCAINE INDUCED CP?
What is contraindicated?
IV BZDs.
BB contraindicated (unopposed alpha effect causing vasoconstriction).
In what scenario can you see neurological problems in the setting of an Aortic Dissection?
Stanford Type A Dissection (involving asc Aorta) that involves the Carotid Arteries
A patient comes in with COCAINE intoxication and has acute onset neurologic deficits…what two mechanisms should be on your differential?
- Cerebral Artery Vasoconstriction
2. Aortic dissection extending into Carotid Arteries
In what type of MI can you develop cardiogenic shock from standard MI trx meds of NTG and Morphine?
How do you treat if HYPOTN develops?
RV MI (Inferior wall MI AVF, II, III)
–> Decrease in Preload can precipitate cariogenic shock.
TRX: IVF + stop NTG, Morphine, Diuretics.
After successful PCI after MI, without any evidence of further ischemia, how many weeks should you wait before having sex?
2 weeks
