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Internal Medicine > Heart Articles > Flashcards

Heart Articles Flashcards

1
Q

Hear failure is?

A

Common clinical syndrome characterized by :

  • dypsnea,
  • fatigue
  • signs of volume overload

Volume overload

  • peripheral edema
  • pulmonary rales
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2
Q

Diastolic heart failure w preserved left ventricle function accounts for how much HF?

A

40-50%

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3
Q

PE findings for heart failure?

A 
Displaced cardiac apex
3rd heart sound
Radiology findings
- venous congestion
- interstitial edema
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4
Q

Heart failure definition

A

Structural or functional cardiac d/o that impaires the ability of the ventricle to fill w or eject blood

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5
Q

Risk factors for progression from asymptomatic to symptomatic LV systolic disfunction?

A

HTN
Valve disease
DM

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6
Q

DM and Heart Failure?

A

DM = one of the strongest risk factors for HF in women w CAD

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7
Q

Framingham criteria value?

A

Systolic heart failure can be effectively r/o when framingham criteria are not met

SYSTOLIC HEART FAILURE

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8
Q

Framingham criteria?

A

2 major or 1 maj 2 minor

MAJOR

  • paroxysmal nocturnal dyspnea/orthopnea
  • neck vein distention
  • rales
  • cardiomegaly
  • acute pulmonary edema
  • S3 gallop
  • hepatojugular reflux

Minor criteria

  • ankle edema
  • night cough
  • dypsnea on exertion
  • pleural effusion
  • tachycardia rate >120 bpm
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9
Q

Common causes of heart failure

A

More common

  • Coronary Artery Disease
  • HTN
  • Idiopathic cardiomyopathy
  • Valvular disease

Less common

  • arrhythmia
  • collagen vascular disease (SLE, DM)
  • hypertrophic cardiomyopathy
  • myocarditis
  • pericarditis
  • postpartum cardiomyopathy
  • restrictive cardiomyopathies
  • toxic cardiomyopathy (ETOH, cocaine)
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10
Q

Most important consideration when categorizing heart failure?

A

If Left ventrical ejection fracture is preserved or reduced (<50%)

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11
Q

Classic diastolic HF pt?

A 
Woman
Older
HTN
Afib
LVH

No HX of CAD

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12
Q

Therapies for systolic vs diastolic HF?

A

Systolic - well validated therapies

Diastolic - no good EBM

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13
Q

Simplest and most widely used method to gauge heart failure symptom severity?

A

New york heart association functional classification of HF

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14
Q

New york heart association functional classification of HF

A

classes

I: no limitations of activity, no HF sx
II: mild limiation, HF sx w significant exertion
III: marked limitation, HF sx w mild exertion, comfortable at rest
IV: discomfort w any activity; HF sx at rest

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15
Q

Blood test for eval of HF?

A 
BNP
Calcium  and Magnesium
CBC 
Liver function
Serum electrolytes
TSH
UA

These will help r/o common causes of sx

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16
Q

This test is a strong predictor of mortality at 2-3 months post cardiovascular event

A

BNP
- if greater than 200 pg/mL

N-terminal pro BNP
- greater than 5,180 pg/mL

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17
Q

Value of framingham study?

A

Not so good at diagnosing HF but really good at r/o HF

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18
Q

How do you confirm HF diagnosis?

A

Echocardiography

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19
Q

Heart failure w angina?

A

coronary angiography - unless contraindication to revascularization

Improve sx and survival in pts w angina and reduced EF

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20
Q

How are acute MI’s categorized?

A

STEMI or NSTEMI

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21
Q

Classifications of acute MI?

A
  1. Coronary artherothrombosis
  2. Supply-demand mismatch
  3. Sudden death (no biomarker or ECG)
    4a. PCI related
    4b. thrombosis of stent
  4. CABGE related
22
Q

Usual cause of acute MI?

A

Rupture or erosion of plaque

23
Q

Thrombosis relationship to STEMI vs NSTEMI?

A

STEMI - total occluding thrombus

NSTEMI - partial occlusion or occlusion w collateral circulation

Unstable angina - same as NSTEMI

24
Q

What do MI’s need w/in 10 min?

A

ECG

Troponin levels

25
Q

How long do you need to r/o MI w troponin?

A

1-2 hrs of serial troponin

26
Q

Causes of troponin rise?

A
  1. MI
  2. Other cardiac
  3. Renal failure
  4. Respiratory failure
  5. Stroke
  6. intracranial hemorrhage
  7. Septic shock
  8. Chronic heart disease
27
Q

O2 recommendation for pts with acute MI?

A

Only when SPO2 <90

28
Q

Sublingual nitroglycerine is used for?

A

Relief of ischemic discomfort

29
Q

Meds for myocardial supply-demand mismatch?

A 
O2
Analgesics (morphine 1-5mg)
Nitrates (NO2 0.3-0.4 mg q 5 min)
B-blocker
CCB - for persisten ischema
30
Q

Meds for coronary thrombus?

A

Antiplatelet therapy

  • ASA
  • P2Y inhibitor

Anticoagulant

31
Q

Meds for unstable atheroma or disease progression?

A

Statin therapy

ACEI

32
Q

Primary therapy for STEMI?

A

PCI (if w/in 90-120 min)
- sx w/in 12 hrs

Fibrinolytics

33
Q

PCI for STEMI uses what for therapy?

A

Stent

  • Bare metal
  • Drug eluding (preferred)
34
Q

NSTEMI and fibrinolytic therapy?

A

May be harmful in pts w/o ST elevation

35
Q

Antithrombotic therapy?

A

ASA - 162-325mg
- then 81-325 q day

P2Y inhibitor (high risk pts)

  • clopidogrel
  • prasugrel
  • ticagrelor
36
Q

Preferred P2Y for fibrinolytics?

A

Clopidogrel

37
Q

Anticoagulation agents?

A

Heparin
Enoxaparin
Bivalirudin
Fondaparinux

38
Q

Words used by pts to describe palpitations?

A

Flip-flopping in chest
Rapid fluttering in chest
Pounding in neck

39
Q

Palpitations that have an abrupt onset and termination are often?

A

SVT

V-tach

40
Q

Ways for pts to terminate their own palpitations?

A 
Carotid-sinus massage
Vagal maneuvers (valsalva)
41
Q

Midsystolic click?

A

Mitral-valve prolapse

42
Q

Harsh holosystolic murmur along LSB increasing w valsalva?

A

Hypertrophic obstructive cardiomyopathy

43
Q

Palpitations are determined to be high risk or low risk for arrhythmia. How is this determined?

A

High risk

  • organic heart disease
  • myocaridal abnormality
  • previous MI (scar)
  • idiopatic dilated cardiomyopathy
  • valvular regur
  • stenotic lesion
  • hypertrophic cardiymopathies
  • fam/personal hx

Low risk
- no potential substrate for arrhythmias

44
Q

Ambulatory Heart monitoring devices

A

Holter - 24hr continuous recording

Continuous-loop even recorder
- saves previous 2 min when pt pushes button

45
Q

Preferred heart monitor for palpitations? Why?

A

Continuous loop recorder
- worn for longer so more likely to catch the events

Typically worn for 2 weeks but can be up to 1 month

46
Q

Indications for treadmill exercise testing?

A

Sx during/following exercise

can be:

  • SVT
  • A- fib
  • Idiopathic VTac
  • premature depol
47
Q

Indications for electrophysiologic testing:

A

Documented rapid pulse w/o ECG findings
- any tachyarrhythmia

Palpitations preceeding syncopal episode

  • v-tach
  • SVT
48
Q

How are sustained supra-ventricular or ventricular arrhythmias causing palpitations managed?

A

Pharmacologic

Invasive electrophysiologic management
- radio-frequency ablation

49
Q

Premature contractions and non-sustained vtach in structurally normal heart?

A

Benign diagnosis - non life threatening

50
Q

The majority of outpatient palpitations are?

A

Benign - extensive investigation not warranted

Internal Medicine (5 decks)

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