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Step 2 CK > First Aid Cardio > Flashcards

First Aid Cardio Flashcards

1
Q

5 managements for acute CHF (pulmonary congestion) management

A

LMNOP

Lasix
Morphine
Nitrates
Oxygen
Position (upright)
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2
Q

what is the class I NYHA?

A

no limitation of activity, no symptoms with normal activity

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3
Q

for CHF, echo will show what 2 things?

A
  1. dec EF

2. ventricular dilation

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4
Q

lab abnormalities in CHF?

A

BNP > 500 pg/ml
inc creatinine
dec sodium in later stages

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5
Q

beta blockers should not be used during

A

decompensated CHF, but should be started once the pt is euvolumic

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6
Q

what are the 2 fast arrythmia with narrow QRS?

A

SVT, A fib

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7
Q

what are the 2 fast arrythmia with wide QRS?

A

torsade, V tach

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8
Q

2 treatment options for SVT?

A

adenosine, shock

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9
Q

2 treatment options for A fib?

A

rate (hrythm) control using beta blockers, CCB

shock

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10
Q

2 treatment options for Torsade?

A

Mg, shock

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11
Q

2 treatments for V. tach?

A

amiodarone, shock

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12
Q

in A fib, how do you assess for anticoagulant treatment?

A

using CHADSS score (if more than 2, needs anticoagulant)

CHF
HTN
Age
DM
Stroke
Storke
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13
Q

treatments for second degree (mobitz 1, wenkebach) AV block?

A

atropine (only works for 1st and 2nd degree AV block)

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14
Q

why shouldn’t you give atropine for mobitz 2?

A

it can go into 3’ AV block

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15
Q

in A fib, under what situation would you cardioconvert the pts?

A

in new onset (less than 48 hrs) or TEE shows no Lt. atrial clot or after 3-6 hrs wks of warfarin treatment with INR of 2,3

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16
Q

gold standard for diagnosing aortic dissection?

A

CT angiography (MRA for contraindication)

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17
Q

treatment for aortic regurge?

A

vasodilator therapy (dihydropyridines or ACEIs) for isolated aortic regurgitation until symptoms become severe enough to warrant valve replacement

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18
Q

treatments for mitral valve stenosis?

A

antiarrhythmics (beta blockers, digoxin) for symptomatic relief

mitral balloon valvotomy and valve replacement are effective for severe cases

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19
Q

clinical presentations of cardiac tamponade?

A

Beck’s triad: hypotension, distant heart sound, JVD

  1. fatigue
  2. dyspnea
  3. anxiety
  4. tachycardia
  5. tachypnea
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20
Q

3 treatment options for cardiac tamponade?

A
  1. aggressive IV fluids
  2. urgent pericardiocentesis
  3. decompensation
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21
Q

typical presentations of dilated cardiomyopathy?

A

often presents with gradual development of CHF symptoms

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22
Q

clinical signs for dilated cardiomyopathy?

A
  1. displacement of Lt. ventricular impulse
  2. JVD
  3. S3/S4 gallop
  4. mitral/tricuspid regurge
  5. LBBB
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23
Q

what drugs should be avoided for dilated cardiomyopathy caused by CHF?

A

CCBs

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24
Q

definitions of dyslipidemia?

A

LDL > 130 mg/dl

HDL

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25
Q

how is hypertensive emergency diff from urgency?

A

end organ damage (altered mental state, retinal hemorrhage etc)

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26
Q

DOC for hypertensive emergency?

A

IV (nitroprusside, labetalol, nicardipine)

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27
Q

DOC for hypertensive urgency?

A

oral antihypertensive (beta blockers)

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28
Q

goal of lowering BP in hypertensive emergencies?

A

lowering mean arterial pressure by no more than 25% over the first 2 hours to prevent cerebral hypoperfusion or coronary insufficiency

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29
Q

how do you diagnose malignant hypertension?

A

on the basis of progressive renal failure and/or encephalopathy with papilledema

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30
Q

best next step management for abdominal pain in women who are in childbearing ages?

A

pregnancy test

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31
Q

dx for abdominal pain + syncope or shock in older pts?

A

abdominal aortic aneurysm (AAA)

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32
Q

dx for hypotension, abdominal pain radiating to the back, significant hx of HTN and DM?

A

AAA

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33
Q

best next step management for elderly female, and diabetic, acute coronary syndrome with abdominal pain?

A

ECG to rule out ischemia

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34
Q

1st intervention for pt with dyslipidemia with no known atherosclerotic vascular dz?

A

12 wk trial of diet and exercise

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35
Q

1st line therapy for viral/idiopathic pericarditis?

A

high dose NSAIDs

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36
Q

in what situation do you do pericardiocentesis with acute pericarditis with pericardial effusion?

A

pericardial effusions without symptoms can be monitored, but evidence of tamponade requires pericardiocentesis with continuous drainage as needed

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37
Q

which drug is contraindicated to dilated cardiomyopathy?

A

NSAIDs, b/c they worsen afterload by blocking prostaglandin synthesis and by counteracting the benefits of ACE inhibitors

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38
Q

Beck triad for cardiac tamponade?

A

hypotension, distant heart sound, distended neck veins

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39
Q

clinical signs for restrictive cardiomyopathy?

A
  1. includes Rt sided more than Lt sided heart failure
  2. JVD
  3. hepatic congestion
  4. ascites
  5. peripheral edema
40
Q

key tool to diagnose restrictive cardiomyopathy?

A

echocardiography

41
Q

key findings of hypertrophic cardiomyopathy?

A

systolic ejection crescendo-decrescendo murmur that inc with dec preload (Valsalva maneuver or standing)

42
Q

2 drugs that have mortality benefit in angina treatment?

A

ASA, beta blocker

43
Q

what are the initial treatment for STEMI?

A

aspirin, oxygen therapy, nitrates for cardiac discomfort, morphine, and beta blockers

44
Q

treatments for USA and Non STEMI?

A
  1. ASA
  2. O2
  3. IV nitroglycerin
  4. IV morphine
  5. beta blockers as hemodynamics allow
45
Q

once medical treatments are done for possible USA or Non STEMI pts, what is the best next step?

A

admit to the hospital and monitor until acute MI is ruled out by serial cardiac enzymes

46
Q

for pts with chest pain refractory to medical therapy, a TIMI score of more than 3, a troponin elevation, or ST elevation more than 1 mm, next best step?

A
  1. give IV heparin
  2. schedule for angiography and possible revascularization (percutaneous coronary intervention, PCI or coronary artery bypass graft, CABG)
47
Q

4 indications for CABG instead of PCI?

A
  1. unable to perform PCI (diffuse dz)
  2. Lt main coronary artery dz
  3. triple vessel dz
  4. depressed ventricular function
48
Q

in cocaine induced chest pain what drug is contraindicated? why?

A

the etiologies of cocaine induced chest pain is from simple coronary vasospasm to MI, beta blockers decrease HR and cotractility thus lead to unopposed alpha mediated HTN which can exacerbate the coronary vasospasm

49
Q

first best step for tension pneumothorax?

A
  1. insert large bore needle (14 gauge IV angiocatheter) into the 2nd intercostal space at the midclavicular line to decompress
  2. then place a chest tube
50
Q

indications for fibrinolytic therapy?

A
  1. acute persistent chest pain

2. time to therapy 2-3 mm in the chest leads and 1 mm in the limb leads

51
Q

what is the diagnostic criteria for HTN?

A
  1. three bp measurements (each at least 1 wk apart)

2. > 140 and > 90

52
Q

COPD is associated with what type of dysrhtymia?

A

multifocal atrial tachycardia

53
Q

what are the 2 causes of multifocal atrial tachycardia?

A
  1. COPD

2. hypoxemia

54
Q

DOC for heart failure refractory to therapy with an ACE inhibitor, diuretic, and b blocker?

55
Q

DOC for cardiogenic shock?

56
Q

what is pulsus paradoxus and in what path is this seen?

A

a fall in systolic bp more than 10 mmHg during inspiration

cardiac tamponade

57
Q

what is the ejection fraction in restrictive cardiomyopathy?

A

normal 55% (diastolic dysfunction)

58
Q

what would be the pul capillary wedge pressure in distributive shock secondary to sepsis?

A

low due to mild hypovolemia and capillary leak

59
Q

two signs of acute MI that require immediate revascularization?

A

Lt BBB, ST elevation

60
Q

gold standard for diagnosing aortic disruption?

A

CT angiography

61
Q

pericarditis can be complicated by what 3 conditions if left untreated?

A
  1. cardiac tamponade
  2. recurrent pericarditis
  3. pericardial constriction
62
Q

what renal path can cause pericarditis?

A

uremia with chronic renal failure

63
Q

what are the two of the 3 followings that can help diagnose pericarditis?

A
  1. pleuritic chest pain
  2. pericardial friction rub
  3. widespread ST segment elevation of ECG
64
Q

treatment of pericarditis caused by uremia?

65
Q

what type of statin treatment should you be using for pts with hx of CAD, CVA (cardiovascular accident), PAD (peripheral artery dz)

A

high intensity statin

66
Q

1st intervention for dyslipidemia?

A

12 wk trial of diet and exercise

67
Q

what are the LDL and HDL values for dyslipidemia?

A

LDL > 130 mg/dl

HDL

68
Q

side effects of lidocaine?

A

slurred speech, confusion, tremor, personality, and mood changes, and hallucinations

69
Q

characteristics of ECG of pulmonary embolus?

A
  1. nonspecific sinus tachycardia

2. Rt. ventricular strain pattern of S1Q3T3

70
Q

what is the definitive therapy for STEMI?

A

PCI or thrombolytic agent

71
Q

2 ECG changes in STEMI?

A

LBBB, ST elevation

72
Q

describe the sequence of ECG changes in STEMI?

A

peaked T waves –> ST elevation –> Q waves –> T wave inversion –> ST segment normalization –> T wave normalization over several hrs to days

73
Q

4 pt groups that will have atypical or clinically silent MI?

A

women, diabetes, the elderly, and post heart transplant pts

74
Q

treatments for A fib?

A
  1. for hemodynamically stable pts –> rate control with a b blocker or CCB
  2. for hemodynamically unstable pts –> immediate cardioversion and give anticoagulation for thromboembolic risk
75
Q

what is non-systolic dysfunction?

A

dec ventricular compliance with normal systolic function (normal EF)

76
Q

DOC for CHF due to non-systolic dysfunction (normal EF)?

A
  1. diuretics –> 1st line of therapy

2. b blockers –> to maintain rate and BP

77
Q

Is digoxin useful for CHF pts with non-systolic dysfunction (normal EF)?

78
Q

manifestations of digitalis toxicity?

A
  1. cardiac dysrhythmias
  2. GI distress
  3. dizziness
  4. weakness
  5. headache
  6. change in mental status
79
Q

what is the end diastolic volume in the diastolic heart failure?

A

normal or decreased end diastolic volume, due to the inability of ventricle to relax and properly fill during diastole

80
Q

def of nonsystolic (diastolic) HF?

A

dec ventricular compliance with normal systolic function (dec end-diastolic volume or high end-diastolic pressure)

81
Q

4 indications for surgery in pts with peripheral vascular dz?

A
  1. lifestyle interference
  2. rest pain
  3. nonhealing ulcers
  4. disabling claudication
82
Q

most important risk factor for coronary artery dz?

83
Q

what is the def of shock?

A

inadequate tissue level oxygenation to maintain vital organ function

84
Q

4 types of shocks?

A
  1. hypovolemic
  2. cardiogenic
  3. obstructive
  4. distributive (septic, anaphylactic, SIRS, neurogenic)
85
Q

5 causes for hypovolemic shocks

A
  1. trauma
  2. blood loss
  3. dehydration with inadequate fluid repletion
  4. third spacing
  5. burn
86
Q

4 causes for cardiogenic shock

A
  1. CHF
  2. arrhythmia
  3. structural heart dz (severe mitral regurge, VSD)
  4. MI
87
Q

3 causes for obstructive shock?

A
  1. cardiac tamponade
  2. tension pneumothorax
  3. massive pulmonary emoblism
88
Q

name 4 types of distributive shocks

A
  1. septic
  2. anaphylactic
  3. SIRS
  4. neurogenic
89
Q

etiologies for acute AF?

A

PIRATES

Pulmonary dz
Ischemia
Rheumatic heart dz
Anemia/atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
90
Q

characteristics of septic shock?

A
  1. dec systemic vascular resistance
  2. inc cardiac output (b/c septic shock = high output shock)
  3. inc mixed venous oxygen content due to high flow state
91
Q

characteristics of cardiogenic shock?

A
  1. high systemic vascular resistance

2. high pulmonary capillary wedge pressure

92
Q

major causes for distributive septic shock

A

bacteremia, especially gram -

93
Q

treatments for distributive septic shock?

A
  1. broad spectrum antibiotics

2. pressors (norepinephrine or dopamine)

94
Q

what is the goal of central venous pressure in distributive septic shock?

A

give fluid until CVP of 8

95
Q

what is the cutoff of PCWP for cardiogenic pulmonary edema?

A

more than 12

96
Q

most effective DVT prophylaxis?

A

early ambulation

Step 2 CK (20 decks)

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