high yield Flashcards
H influ pne associated with
COPD
Staph Aureus pne associated with
post viral
tx for CAP
3rd gen cephlasporin + macrolide
OR
moxifloxin
tx for HAP
Pip/Tazo + Vanc
tx for lung absecess
3rd gen cehp + clinda
tx for PCP, TB or fungal PNE
Bactrim
+/- steroids
worst risk factor for CAD
DM
MONA BASHC
tx for CAD
Morphine, O2, Nitro, ASA, BB, ACE-i, statin, heparin, clopidogrel
ACE-i benifits in CAD
- stops remodeling
2. reduces afterload
drug that reduces mortality MOST in CAD
ACE-i
tx of CAD long-term
- BB &ACE-i
- Dual anti-platlet therapy: ASA (81mg) + Clopidogrel (75mg)
- statin- atorvastatin, rosuvatatin
when in tPA used in CAD
when transport time is >60 min away for PCI (per cutaneous cath intervention_
how much time does a hospital have to stent STEMI
door–>90 min balloon inflation
pt has increase ACE-i
sarcoidosis
normal ejection fraction of heart
55%
diuretics used for CHF
hydralazine OR spironolactone
EF <35%, HF NOT class VI tx
AICD
tx of CHF
ACEi + BB
tx CHF exacerbation
LMNOP L-lasix (forosemide) M-morphine N-nitrates O- O2 P-position
murmur grade
1: S1, S2 > murmur
2: S1, S2= murmur
3: S1, S2 < murmur
4: palpable thrill
5: hear murmur w/ stethscope half of chest
6: hear murmur w/o stethoscope
1st step after hearing mumur
echo
rheumatic heart disease is associated w/ which mumur
mitral stenosis
younger pt with
afib (atrial stretch)
CHF
rheumatic heart dz
mitral stenosis
mitral stenosis murmur location & time
diastolic
Apex
rumbling diastolic murmur w/ an opening snap
mitral stenosis
tx for mitral stenosis
balloon valvuloplasty
** different from other murmurs b/c vegitations
what causes valve insufficiency
infection or infarction
major complication of aortic valve insufficiency
aortic dissection
aortic insufficiency murmur
location & time
diastole
blowing
decresendo
L upper sternal border
tx of aortic insufficiency
replacement
Aortic Stenosis causes
Calcium buildup OR bicuspid valve
old man with CP, CHF syncope + systolic cresendo decresendo murmur at base
aortic stenosis
aortic stenosis
location & time
systolic
R upper sternal border
cresendo-decresendo
radiates to cartoid artery
mitral insufficiency
tx
replacement
mumur that radiates to carotid artery
aortic stenosis
mumur that has bounding pulses and increased pulse pressure due to increased stroke volume
aortic insufficiency
signs associated w/ wide pule pressure in chronic aortic regurg
water hammer pulse: radial pulse upstroke
corrigan’s pulse: carotid upstroke
hill’s sign: popliteal atery pressure > brachial artery by >60 *MOST sensitive
de mussets: head bobbing
qunickes: fingernail bed pulse
mitral facies
ruddy (flushed cheeks w/ facial palor
MC cause of mitral regurg
MVP- US
rheumatic fever- developing
marfan syndrome is related to which mumur
mitral regurg
blowing hollosystolic mumur best heard at apex
mitral regurg
murmur radiates to axilla
mitral regurg
left lateral decubits increases this murmur
mitral stenosis
MC systemic vasculitis
Giant Cell Arteritis
Valsalva increase or decrease blood flow
decrease
HCOM tx
avoid dehydration
BB
MVP tx
avoid dehydration
BB
moves that increase venous return
supine
leg lift
squat
moves that decrease venous return
Valsalva
standing
inspiration increases sound of which mumurs
right sided
diastolic murmurs
AR MS rest
causes of dilated cardiomyopathy
- ETOH
- virus
- ischemia
causes of restrictive cardiomyopathy
- sarcoidosis- pulm dz
- amyloid- neuropathy
- hemachomatosis- cirrhosis or DM bronze dz
Restrictive Cardiomyopathy dx AFTER echo
- sacoidosis=
- amyloidsis
- hemachromatosis=
- sacoidosis= cardia MRI, endo cardio biopsy
- amyloidsis= fat pad biopsy/gingiva
- hemachromatosis= elevated ferritin + genetic test
electrical alternans
pericardial effusion
pericarditis
1st test
best test
1st test: ECG
best: MRI
pericarditis tx
NSAIDS + colchicine
when can NSAIDs not be used
- CKD
- PUD
- low platelets
tx for uremic pericarditis
dialysis
MC cause of pericarditis
- VIRAL
2, uremia
pericardial effusion
-cause
pericarditis
pericardial effusion
dx
echo
pericardial effusion
tx
pericardial window
Becks triad
pericardial tamponade
- decreased heart sound
- JVD
- hypotension
pericardial knock
constrictive pericarditis
constrictive pericarditis
tx
pericardectomy
MAP
COx SVR
CO= HR X SV
SV= contractility & preload
S1
S2
S1= tri & bicuspid valves S2= aortic & pulmonic
vasovagal causes
- stimulate visceral organs
- carotid bodies
- psych
vasovagal
tx
BB
+ orthostatics
systolic 20
diastolic 10
HR 15
cardiac causes of syncope
- valve– AS-old person over exert OR HOCM -young athlete
2. arrhythmia (no prodrome)
base line labs before starting statins
- lipids (yearly)
- A1C 1x (unless DM)
- CK –> rhabdo (sxs)
- LFT–> hepatitis (sxs)
Niacin
-bad effect
flushing
–> tx w/ ASA
ezetimibe
decrease LDL
causes diarrhea
fibrates
decrease Trigs
increase HDL
hypertension classes
normal <120/ <80 (lifestyle)
elevated >120/>80 (lifestyle)
stage I <130/ <90 (1 MED)
stage II >140/>90 (2 MEDS)
HTN tx
comorbid: HF or CAD
ACEi and BB
BB= metropolol, carvadilol
HTN tx
comorbid: stroke
ACEi & thiazide
HTN tx
comorbid: CKD
ACEi
EXCEPT STAGE 4
HTN tx
comorbid: DM
ACEi
ONLY HTN tx
choose one:
ACEi, CCB (dihydropyridine), thiazide
dCCB
S/E
notes
“dipines”
S/E: peripheral edema
notes: anti-anginal (CAD)
NOT useful in HFrEF
ACEi & ARB
S/E
S/E: increase Cr & K (work collecting duct via aldosterone)
ACEi only: angioedema, dry cough
thiazides
S/E
Note:
distal collecting duct
decreased K & urinary Ca
Note: help with kidney stone from decrease urinary Ca
BB
S/E
Hypotension
Aldosterone antagonists spironolactone epleronone S/E notes
hyperkalemia
only spiro: gynecomastia
notes: hyperladosterone or CHF
hydralazine
S/E
dilator
reflex tachy
drug induced Lupus
alpha- antagonist
S/E
Doxazosin, Prazosin
othrostatic hypo
for BPH
clonidine
S/E
rebound HTN
non dyhydropyridine CCB
RATE CONTROL in afib
diltiazam & verapamil
HTN urgency
> 220/120
