CV: Ischemic, Myocardia, Pericardial, and Valvular Heart Dz Flashcards
Management of stable angina?
EKG
- if nml, do stress test and then cath (if stress test is positive)
- if ST/T abn = unstable angina (no need for stress test)
A positive stress test =
chest pain, ST depression, hypotension, or significant arrhythmias
Coronary steal during stress test:
dipyridamole causes blood flow redistribution to nondiseased veins in stress test
Management of angina:
- Mild angina (1 vein)
- Moderate (2 veins)
- Severe (3 veins)
- mild (1 vx) → Tx β-blocker + aspirin + nitrates
- moderate (2 vx) → Tx (above) vs. PTCA/CABG
- severe (3 vx) → Tx CABG
Unstable angina + biomarkers =
treatment?
NSTEMI
medical management
NSTEMI + EKG changes =
treatment?
STEMI
cath lab for PTCA or CABG
Tx of Acute coronary syndrome?
*Which reduce mortality?
- Morphine (analgesia)
- O2
- Nitrates (analgesia)
- Aspirin* ± clopidogrel
- β-blockers*
- ACE inhibitor* (remodeling)
- Statins
- Heparin vs. enoxaparin
EKG leads: Lateral = Inferior = Anterior = Posterior =
Lateral: I, aVL
Inferior: II, III, aVF
Anterior: V1-V4
Posterior: V1-V2
Prinzmetal (variant) angina:
dx?
inducible by?
EKG (ST-elevation during episode)
inducible by IV ergonovine
Defn and Management of CHF:
Class I?
Class II/III?
Class IV?
- class I sx only w/ vigorous activity → Tx loop diuretic + ACE inhibitor
- class II-III (II= sx with mod activity and III sx w/ ADLs)→ add β-blocker
- class IV (sx at rest) → add digoxin
Adenosine toxicity sx:
Nitrate toxicity:
Digoxin toxicity:
Adenosine toxicity: HA, flushing, nausea, SOB, chest pressure
Nitrate toxicity: headache, orthostatic hypotension, tolerance, syncope
Digoxin toxicity: atrial tachycardia w/ AV block
What enhances the murmur in HCM?
Symptoms?
Management?
Etiology?
↓preload (e.g. handgrip, Valsalva)
exertional dyspnea, angina,
syncope, sudden death in young athlete
dx with ECHO; if symptomatic, B blockers vs myomectomy vs pacemaker
Autosomal dominant, few are sporadic
How soes dialted cardiomyopathy presnet?
Dx o?
Tx?
Etiology?
presents as decr contractility with CHF symptoms
Dx: echo+CXR
Tx for CHF + heart txp (MC indication)
MI (MCC), infx, alcohol, doxorubicin (Adriamycin), etc.
Presentation of restrictive cardiomyopathy?
Dx
Tx?
Etiology?
presents as infiltration of myocardium → ↓compliance → CHF sx
Dx echo + endomyocardial bx to find cause
Tx underlying cause
Etiology: CASHES – carcinoid syndrome, amyloid, sarcoid, hemochromatosis, endocardial fibroelastosis (kids), scleroderma
Presentation of mycarditis?
dx?
etiology?
usually asx, can present w/ fever, chest pain, pericarditis
Dx ↑cardiac enzymes, ↑ESR
Etiology: coxsackie B virus (MCC)
*tx underlying cause
Acute pericarditis: EKG findings? tx? MCC? Other etiologies? complications?
diffuse ST elevation + PR dePRession
Tx NSAIDs
coxsackie B virus > Dressler
pericardial effusion and tamponade
Tx of pericarditis + uremia?
hemodialysis
Dressler syndrome =
tx?
post-MI pericarditis, “feels like a second heart attack”
Tx NSAIDs
Constrictive pericarditis:
a/w increased…
s/s?
↑systemic venous pressure (due to fibous pericardial scarring)
edema, ascites, hepatic congestion, JVD, pericardial knock, Kussmaul sign
Constrictive pericarditis:
dx?
tx?
- EKG shows AFib
- cardiac cath shows “square root sign”
pericardiectomy
Constrictive pericarditis vs. tamponade?
pericarditis fills rapidly then stops suddenly, tamponade fills slowly through-out diastole
muffled heart sounds, soft PMI,
±pericardial friction rub
dx?
management?
mcc?
Pericardial Effusion
echo (gold standard)
CXR shows “water bottle” silhouette
small/asx → repeat echo in 1-2 wks
rapidly developing → pericardiocentesis
acute pericarditis
pulsus paradoxus + Beck’s triad (hypotension, JVD, muffled heart sounds)
dx?
etiology?
Cardiac tamponade
echo (gold standard)
EKG shows electrical alternans
trauma, pericarditis, post-MI w/ free wall rupture
Cardiac tamponade:
management of hemorrhagic vs non-hemorrhagic?
**most important factor in determing severity/how quick to act?
nonhemorrhagic, stable → close monitoring
nonhemorrhagic, unstable → pericardiocentesis
hemorrhagic → ER thoracotomy
Rate vs. amount: rate is more
important than amount b/c
pericardium has ability to stretch
All vavular diseases require..
warfarin (anticoagulate) + amoxicillin (SBE ppx)
loud S1, opening snap w/ late diastolic rumble
Mitral stenosis (rheumatic heart dz)
holosystolic blowing murmur
Mitral regurgitation (think MVP, ischemic heart dz)
Tricuspid regurgitation (+ pulsatile liver, think IV drug user)
systolic crescendo-decrescendo murmur following opening snap
Aortic stenosis
high-pitched blowing diastolic murmur
Aortic regurgitation (Etiology: bicuspid aortic valve, syphilitic aortitis, rheumatic fever)
midsystolic click, late systolic crescendo murmur
Mitral valve prolapse
What are the MI biomarkers? When do they appear and how long do they last?
CK-MB: peaks in 24 hrs and lasts 2-3 days (therefore good to detect reoccurance)
Troponin 1: peaks un 24 hrs and lasts 1-2 weeks (most specific)
EKG changes seen with MI
peaked T waves ST-elevation ST-depression Q waves T wave inversion
Complications of MI
CHF, arrhythmias, recurrent infarction, free wall rupture, papillary muscle rupture, acute pericarditis, tamponade, Dressler syndrome
transient coronary vasospasm
→ episodic angina at rest
prinzmetal angina
suspect CHF, next steps?
EKG + cardiac enzymes (r/o MI) + ↑BNP + echo (best test, estimates EF)
what kind of CHF does MI cause? HTN?
MI: systolic
HTN: diastolic (LVH impairs filling)
