Master the Boards: Cardiology 1 Flashcards
Most common cause of death US
CAD
8 CAD risk factors
- DM- most dangerous
- HTN
- Tobacco
- HLD
- PAD
- Obesity
- Inactivity
- Family Hx (female <65, male <55)
Most common cause of chest pain
GERD
3 Q’s to rule out CAD (only need 1)
- pleuritic-lung stuff
- positional- pericarditis
- tenderness- costochondritis
Physiology behind S3
rapid ventricular refilling during diastole extra fluid
Physiology behind s4
sound of arrival systole pushing blood into non compliant ventricle
Most accurate test for ischemic type pain
Trop or CK-MB, but do EKG first
What does troponin c bind to
Calcium to activate actin myosin interaction
What does troponin T bind to
Tropomyosin
What does troponin I bind to
blocks or inhibits actin myosin interaction
When to do dipyriamole or adenosine or dobutamine echo
-when patient cannot exercise to 85% of Max HR, COPD, amputation, reconditioning, weakness from previous stroke, lower extremity ulcer, dementia, obesity
When to do exercise thallium test or stress echo
-when EKG is unreadable for ischemia: LBBB, digoxin use, pacemaker, LV hypertrophy, any baseline abnormality of ST segment
ACS tx
Aspirin clopidogrel prasugrel (if angioplasty is done) nitrates and morphine (don't lower mortality) 02 BB- lower mortality but timing is not critical Acei Statin
Thrombolytics MOA
they activate plasminogen to plasmin which chops up fibrin into d dimers, this is why clots elevate levels of D-Dimer
Most common cause of death in CHF and MI
Ventricular arrhythmia brought on by ischemia
MOA of BB in MI
Slow❤️ to increase reprofusion time
also means more filling time and better SV
What interventions always lower mortality in ACS(6)
Aspirin Thrombolytics Primary angioplasty metop statin clopidogrel
What meds lower mortality in ACS w low ejection fraction
ACEi/ARB
What med lowers mortality in ACS with ST depression
heparin
In ACS when should CCB be used instead of BB
intolerance of BB, severe asthma, cocaine induced, coronary vasospasms or peinzmetal angina
When to do pace maker for acute MI
3rd degree AV block Mobits 2 Bifasicular block New LBBB Symptomatic Bradycardia
lyte disturbance from ACEi/ARB
Hyper K
4 Indications for cabage
- Three Coronary vessels with >70% stenosis
- Left main coronary artery stenosis >50-70%
- Two Vessels in diabetics
- two or three vessels with low ejection fraction
What anti anginal can be added on if pain isn’t controlled
ranolazine
