EM - Cardio Flashcards
t/f there has to be some type of prior damage to the tissue for bacterial endocarditis to occur
T
MC source of bacterial endocarditis
oral procedures
MC organism of native valve endocarditis
staph aureus
diseases that increase the risk of endocarditis
-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease
MC organism for prosthetic valve endocarditis
staph epidermis
MC valve affected by IVDU endocarditis
tricuspid
s/s of endocarditis
-fever, chills, weakness, SOB
-murmur
-petechiae
-splinter hemorrhages
-janeway lesions
-osler nodes
-roth spots
janeway lesions
-painless patched on palms or soles caused by emboli
osler nodes
painful lesions on pads of fingers or toes caused by vasculitis
diagnosis of endocarditis
-CBC
-blood cultures
-echo
major criteria for endocarditis
-2+ positive cultures
-evidence on echo
-new regurg murmur
minor criteria for endocarditis
-predisposing heart condition or IVDU
-fever
-vascular or embolic sx
-immunologic sx
-1 positive culture
tx of endocarditis
-native valve
-IVDU
-prosthetic valve
-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin
patients who get endocarditis prophylaxis
-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant
procedures that require endocarditis prophylaxis
-dental procedures
-respiratory trat procedures
-I&D
antibiotic for endocarditis prophylaxis
-amoxicillin
stable vs unstable angina
-stable: typical and predictable that goes away with rest and NTG
-unstable: unexpected and goes not go away with rest and NTG
prinzmetal angina
vasospasm resulting in angina that is treated with NTG and CCB
treatment of sinus bradycardia
none if asymptomatic, atropine can increase HR, but pacemaker is definitive
sick sinus syndrome
recurrent supraventricular arrhythmias and bradycardia
etiology of sick sinus syndrome
medications
treatment of sick sinus syndrome
pacemaker
treatment of sinus tachycardia
beta blockers
heart blocks
-first degree: PR interval >0.2 seconds
-second degree type 1: longer, longer, longer, drop
-second degree type 2: randomly dropped beats
-third degree: no correlation between atria and ventricles
treatment of heart blocks
-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)
treatment of PAC
-beta blockers or CCB
treatment of PVC
-BB
treatment of SVT
-mechanical measures
-adenosine
-cardioversion if the patient is hemodynamically unstable
treatment of afib
-rate control
-rhythm control
-anticoagulation
how to determine who needs anticoagulation with afib?
CHADS2-VASc
-CHF
-HTN
-over 75
-DM
-prior stroke
-vascular disease
-between 65-74
-female
CHADS2-VASc score interpretation
VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation
afib treatment for patients who cannot have long-term anticoagulation
watchman procedure
treatment of atrial flutter
-catheter based radiofrequency ablation
-anticoagulation same as afib
etiology of junctional arrhythmias
-digoxin toxicity
-electrolyte abnormalities
sustained vs nonsustained Vtach
-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds
brugada
incomplete right bundle branch block and ST-segment elevations
management of brugada
ICD
management of acute sustained VT
-if unstable: cardioversion
-stable: amiodarone
Treatment of nonsustained VT
-with heart disease: BB
-without heart disease: BB if symptoms
treatment of vfib
immediate defibrillation
etiologies of LBBB and RBBB
structural heart disease
treatment of LBBB, treatment of RBBB
No Specific Tx
s/s of cardiac tamponade
-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus
kussmauls sign
increase in JVD on inspiration
pulsus paradoxus
inspiratory systolic fall in arterial pressure
EKG of tamponade
electrical alternans
CXR of tamponade
water bottle heart
diagnosis of tamponade
echo
treatment of tamponade
pericardiocentesis
which arteries feed which parts of the heart?
-right coronary: inferior wall and RV
-LAD: septum and anterior wall
-left circumflex: lateral wall
angina pectoris
used to describe chest discomfort related to ischemia
most sensitive cardiac marker
Troponin I
most sensitive early marker for MI
myoglobin