hammer18 Flashcards
What are key features of third degree AV block?
Bradycardia, cannon A waves
What are key features of tamponade/free wall rupture?
Sudden loss of pulse, JVD
What are key features of RV infarction?
Inferior wall MI in history, clear lungs, tachycardia, hypotension with nitroglycerin
What are key features of valve rupture?
New murmur, rales/congestion
What are key features of septal rupture?
new murmur, increase in O2 saturation on entering the right ventricle
What are key features of ventricular fibrillation?
Loss of pulse
What 6 post infarction medications should everyone go home with?
Apirin, betablockers, statins, ACE inhibitors, clopidogrel or prasugrel or ticagrelor if they are intolerant of aspirin, ARBs if they have cough on ACE inhibitor
What medications are good for anterior wall MI? What medications cause erectile dysfunction commonly?
ACEi. Betablockers.
What is the essential feature of CHF? What are CI, SVR and LVEDV values? What are other features of CHF? What is one test that is essential for CHF?
Dyspnea. CI is decreased, SVR and LVEDV is increased. Orthopnea, rales, JVD, paroxysmal nocturnal dyspnea, S3 gallop rhythm. Echocardiography.
What is the most accurate test for ejection fraction? WHen do you use it?
Nuclear ventriculography or Meultiple gated acquisition scan to check for cardiotoxicity during doxyrubicine treatment
What is the management of a patietn with severe CHF who develops gynecomastia?
Switch spirnolactone to eplerenone since it doesnt have antiandrogenic effects
What devices do you use for CHF treatment and what are the indications?
Implantable defibrillator - Ischemic cardiomyopathy and EF below 35%.
Biventricular pacemaker - EF below 35% and wide QRD above 120 milliseconds with persistent symptoms
What medications provide mortality benefit in Systolic dysfunction?
ACEi/ARBS, betablockers, spirnolactone or eplerenone, Hydraliazine/nitrates, implantable defibrilator
What medications are beneficial for CHF with preserved EF (diastolic dysfunction)?
Beta blockers and diuretics. Don’t use diuretics in HOCM.
What is the most important test to do in acute Pulmonary edema?
EKG because it can lead to cardio version if the cause of the pulmonary edema is afib, aflutter or ventricular tachycardia.
What are the symptoms of acute pulmonary edema dn what is the first initial step?
Acute onset of shortenss of breath plus rales, JVD, S3 gallop, edema, orthopnae
What is the treatmetn of patients with acute pulmonary edema?
Oxygen, loop diuretics, morphine, nitrates. Dobutamine, amrinone and milrinone can be used in an acute setting as they increase contractablity and decrease afterload.
What causes increase in murmurs on teh right side? left side?
Right side inhalation which brings back blood through the right heart. Left side exhalation which releases blood into the left side.
What is the best initial test in valvular heart disease? Most accurate test?
Echocardiogram. Catherization
What are unique presentations of Mitral stenosis?
Dysphagia from LA compressing esophagus
Hoarseness from LA pressing laryngeal nerve
Atrial fibrillation and stroke from enormous LA
Hemoptysis. Opening snap murmur
What are EKG findings in Mitrial stenosis?
Biphasic pwaves in V1 and V2
What are CXR findings in mitral stenosis?
Straightening of the left heart border, elevation of the left main-stem bronchus, second “bubble” behind the heart
What is the treatment for Mitral stenosis?
- Diuretics and sodium restriction 2. Balloon valvuloplasty 3. Valve replacement only when a catheter procedure cannot be done, or fails 4. Warfarin for atrial fibrillation to an INR of 2 to 3 5. Rate control of afib with digoxin, BB or CCBs
What is the presentation of aortic stenosis? Diagnostic tests?
Angina, syncope ,CHF - poorest prognosis. TTE, then TEE, then catherization
What are EKG findings in aortic stenosis? Treatment?
LVH. S wave in V1 plus an R wave in V5 greater than 35 mm . Valve replacement
What is the murmur in mitral regurgitation and treatment?
Pansystolic murmur. ACEIs or ARBs are best. Can add Digoxin and diuretics.
What are unique presentations of aortic regurgitation?
Wide pulse pressure, water hammer (wide-bounding) pulse, Quincke pulse (pulsations in nail bed), Hill sign (BP in legs as much as 40mm Hg above arm BP), head bobbing (de Musset sign)
What is the treatment for aortic regurgitation?
ACEi/ARBs or nifedipine as vasodilators will increase forward flow of blood and delay progression
What is the presentation of MVP? What is the best initial treatment?
Atypical chest pain, palpitations, panic attack. Beta blockers.
What murmurs do not increase with expiration?
MVP and HOCM
What medications lower mortality in dilated cardiomyopathy?
ACEi, ARBs and BB
What makes hypertrophic obstructive cardiomyopathy worse? Best initial test?
Anything that decreases left ventricular chamber size (e.g. ACEi, ARBs, digoxin, hydralazine, Valsalva and udeenly standing. Echo
What is the treatment for HOCM?
Beta blockers, Negative inotropes like Verapamil and disopyramide. NO DIURETICS.NO SPIRNOLACTONE Implantable defibriallotrs if syncope and ablation of septum. Surgical myomectomy if therapy fails.
What contributes to obstruction i HOCM?
Systolic anterior motion of mitral valve
What does valsalva do for MVP and HOCM? handgrip?
Increases the murmurs. Decreases murmurs.
What is the difference between handgrip and amyl nitrate?
Handgrip increaseas afterload thereby decreasing ventricular emptying. Amylnitrate increases emptying making HOCM and MVP worse.
What is a specific finding on EKG for pericarditis? What drug decreases recurrence?
PR depression. St is elevated in all leads.Colchicine
What are EKG and echo findings in pericardial tamponade?
Electrical alterans (different heights of QRS complexes between beats). Echo shows right atrial and ventricular diastolic collapse.
Which findings are associated with constricitve pericarditis and what is best initial test? Treatment?
Kussmaul sign - increase in JVD on inhalaition and pericardial knock. CXR. Diuretics and surgical removal.
What is the diagnostic test for Peripheral artery disease?
ABI less than 0.9. Aspirin, smoking cessation, cilostazol is most effective medication.
What is the best initial test for acute aortic dissection? What is the most accurate?
CXR. CT angiogram.
What is the management of aortic dissection?
Control BP. Give BB first, then nitroprusside then surgical correction.
What is the worst cardiac defect in pregrnant women?
Peripartum cardiomyopathy.
What organisms does Amoxicillin cover?
H. influenza, E. coli, listeria, proteus, salmonella
What are some penicilinase resistant penicillins and what do they treat?
Oxacillin, cloxacillin, dicloxacillin. Skin infections like impetigo, erysipelas, endocarditis, meningitis, bacteremia f, osteomyelitis and septic arthritis
What are pip tazo used to treat?
Cholecystitis, ascending cholangitis, pyelonephritis, bacteremia, Hospital acquired and Ventilator associated PNA, Neutropenia and fever
Which cephalosporins cover anerobes? What do they treat and what is the contraindication?
Only cefotetan and cefoxitin. PID combined with doxycycline. Increase risk of bleeding and disulfram reaction with alcohol.
Which cephalosporin covers MRSA? Pseudomonas?
Ceftaroline. Ceftazidime
What is the adverse effect of cephalosporins?
Cefoxitin and cefotetan deplete prothrombin and increase risk of bleeding. Ceftriaxone has inadequate biliary metabolism.
What is the purpose of aztreonam?
Monobactam that only treats gram negative bacilli including pseudomonas and has no cross reaction with penicillin
