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Medicine Flashcards

1
Q

How do you pharmacologically stress a heart?(if can’t walk to do a stress test?)

A

Dobutamine
Adenosine
Dipyridamole

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2
Q

whatdo in a CABG?

A

connect LIMA to biggest coronaryarters, and also harvest the saphenous vein located in the legs (dual antiplatelet therapy also required)

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3
Q

Medical management of Angina

A

Aspiring, Statin, BB, ACE/ARB, DAPT (P2Y12 inhibititor)

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4
Q

what is critical stenosis v obstructive lesions in an artery

A

critical >70%, occluded is >50%

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5
Q

How do you medically manage CAD?

A

Aspirin, statin, BB/ARB, DAFT (P2Y12)

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6
Q

Names of 3 PY12 inhibitors for DAPT

A

clopidogrel, ticagrelor, prasugrel

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7
Q

What statins are used for CAD

A

high-potency statins like Rosuvastatin, atorvastin

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8
Q

what Beta blockers are used to treat CAD?

A

metoprolol (controls only HR, B1 antagonist) and carvedilol (controls B1 and a1 antagonist)

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9
Q

ARBS vs ACE inhibitors

A

do the same thing but ace inhibitors have side effect of angioedema and dry cough

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10
Q

when do you give anti-anginals

A

when cannot treat CAD and Beta blockers do not relieve symptoms, diff classes:
-nitrates
-dCCBs
-palliative

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11
Q

what are dCCBs used to treat CAD?

A

Amplodipine (also has antihypertensive effects)

Dihydropyridines are one of the different types of calcium channel blockers; they predominately act on blood vessels with less effect on the heart.

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12
Q

What palliative drug is given for CAD?

A

Ranolazine (Ranolazine inhibits persistent or late inward sodium current (INa) in heart muscle in a variety of voltage-gated sodium channels. Inhibiting that current leads to reductions in intracellular calcium levels.)

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13
Q

What nitrates are used for CAD?

A

ISMN and Nitroglycerin Prn

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14
Q

How do you medically manage a STEMI?

A

–Morphine sulfate 2 to 4 mg IV PRN for severe pain. May repeat dose of 2 to 8 mg at 5 to 15-minute intervals.
–Oxygen via nasal cannula to keep SaO2 > 92%
–Nitroglycerin (NTG) 0.3-0.6 mg SL q5min PRN chest pain. Max: 3 doses within 15 minutes.
–Aspirin. The first tab is 325 (chew), then 81mg QD after that. Avoid enteric coated Aspirin.
–Beta-blocker. Metoprolol tartrate 25mg po q6h
–ACE. Watch BP. May wait to see BB work if concerned about BP or start low dose, e.g. Lisinopril 5mg po BID
–Statin. High-intensity statin for all patients with ACS – atorvastatin 80mg po Qbedtime or rosuvastatin 20-40 mg daily.
–Heparin. For all patients with non-ST elevation ACS, start anticoagulation ASAP after you’ve made the diagnosis. Will start heparin instead of Lovenox. Heparin is easily reversible if needed. 60 U/kg IVB (max 4000 U); 12 U/kg/hr (max 1000 U/hr initially).

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15
Q

what drugs do you give first line with CHF?

A

ace/aARB and loop diuretic ( furosemide, bumetanide, and torsemide) then only if gets worse give spironolactone

*for an exacerbation of CHF give:
L(lasix)
M(morphine)
N(nitroglycerines)
O (oxygen)
P(position, sit up)

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16
Q

mitral valve stenosis
pathology:
symptoms:
treatment:

A

Patient: younger (bc pathology due to inflammation from rheumatic heart disease, not calcification like aortic stenosis), atria gets bigger and can lead to afib
Dx: diastolic murmur at the at apex opening snap is specific, rumbling
Tx: balloon valvuloplasty (only murmur for which you can do this bc not calcification)

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17
Q

aortic insufficiency
pathology:
symptoms:
treatment:

A

path: aotic dissection, infarction, infection
Patient: acute (cardiogenic shock), flash pulmonary edema, chest pain) or chronic (CHF-dyspnea on exertion, crackles, could also have chest pain)
Dx: diastole, rumbling murmur without opening span
Tx: replacement, either urgent or elective (still urgent)

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18
Q

aortic stenosis
pathology:
symptoms:
treatment:

A

Path: atherosclerosis-> calcium deposition (if bicuspid then makes calcium deposition faster), left ventricle dilates bc regurg, so has big, floppy heart
Patient: old man with atherosclerosis, presenting with chest pain, CHF, and syncope
Dx: systolic, crescendo, decrescendo murmur
Tx: replacement (no valvuloplasty bc it is calcium)

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19
Q

mitral insufficiency
pathology:
symptoms:
treatment:

A

causes blood to regurg into left atrium so can cause pulmonary edema, CHF, and afib
path: infection, infarction
Pt: acute (cardiogenic shock, pulmonary edema) or chronic (CHF, afib)
Dx: systolic, holosystolic (aka high, pitched and blowing and hear throughout systole)
Tx: replacement

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20
Q

where are aortic v mitral murmers?

A

aortic=base, or “right sternal border”

mitral= apex, 5th intercostal space, mid-clavicular line

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21
Q

hypertrophic cardiomyopathy murmur

A

pathology: sacromere mutation
Pt: young athelete, hx of syncopeSOB on exertion
Dx: systolic…more blood makes it better
Tx: avoid dehydration and BB to increase preloadand filling time

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22
Q

mitral valve prolapse

A

Pathology: congenital
Pt: young woman
Dx: mitral regurgitation that gets better with more blood
Tx: avoid dehydration and BB

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23
Q

how to treat dilated cardiomyopathy?

A

BB, Ace inhibitors, diuretics

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24
Q

how do you identify and treat hypertrophic obstructive cardiomyopathy (HOCM)?

A

murmur like AS, but in young athlete bc genetic (DOE, syncope, SCD)
Tx: avoid dehydration (keep heart rate down), BB, CCB
Can surgically treat with EtOH ablation and myectomy

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25
Q

how do you treat concentric hypertrophy?

A

Tx: diastolic CHF, avoid dehydration and BB or CCB, control HTN

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26
Q

how do you treat restrictive cardiomyopathy?

A

Path: amyloid, carcoid hemachromatosis (fibrosis and thickened)
Pt: DIA CHF
Amyloid->neuropathy
Sarcoid->pulm disease
Hema->cirrhosis, DM
Tx: diastolic CHF, avoid dehydration and BB or CCB, control HTN

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27
Q

what is the character of pericardial chest pain?

A

Pleuritic (hurts when you have to take a deep breath in) and positional (hurts when you arch your back and is better when you bend forward)

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28
Q

how do you diagnose pericarditis

A

EKG, NOT echo (but technically mRI is the best test, but not diagnosistic)

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29
Q

what is thetreatment of pericarditis

A

NSAIDS+colchicine (be careful of NSAIDS with CKD, thrombocytopenia or peptic ulcer disease also colchicine is dose-limited by diarrhea)

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30
Q

what are the contraindications for nsaids

A

CKD, thrombocytopenia, peptic ulcer disease

31
Q

what are the most common causes of pericarditis?

A

uremia and viral

32
Q

what does the ekg of pericarditis look like?

A

diffuse ST segment elevations, basically in all of the leads

33
Q

howdo you diagnose pericardial effusion (just the fluid part)

A

echo to detect the fluid (although it is important to note there is also usually percarditiswith effusion, but you detect pericarditis with ekg)

34
Q

how do you treat pericrdial effusion with pericarditis

A

threat the pericarditis, nsaids and colchicine, but if bad can also surgically cut a pericardialwindow for fluid drainage

35
Q

what triad do you use todiagnose cardiac tamponade?

A

Beck’s triad:
elevated JVP
muffled heart sounds
hypotension

also diagnosic in combo with triad: pulsis paradoxis (This exaggerated drop in systemic blood pressure during inspiration is termed pulsus paradoxus) greater than 10 cm
(and you find clear lungs)

36
Q

what is the treatment not cardiac tamponade

A

pericardiocentisis (NOT echo orpericardial window)

37
Q

How do you diagnose pericarditis?

A

diastolic CHF and a pericardial knock (is a high-pitched sound that occurs in early diastole, or sudden cessation of ventricular filling)

diagnostic test is echo, then you treat with pericardectomy

38
Q

what are the different types of stimulation for vaso-vagal syncope?

A
  1. visceral organ (valsala-type maneauvers)
  2. carotid body stimulation (too-tight tie or punched in the neck)
  3. psychogenic (bc vagal nerve in the brain) ex. sight of blood, fear, etc
39
Q

how to treat vaso-vagal syncope?

A

Beta blockers, prevents vasovagal discharge, aka maintains hr

40
Q

What are the diagnostic criteria for orthostatic hypotension?

A

change in:
systolic pressure >20
Diastolic>10
HR>15
(usually in older people and can be caused by diabetes mellitus, parkinsons, or age)

41
Q

treatment for orthostatic hypotentsion?

A

give fluids If resolves then know the issue was just volume depletion), if does not dissolve then consider rarer etiologies (ex. dysfunctional autonomic nervous system, like diabetes, parkinsons, and age)

42
Q

What are the criteria for giving statins?

A
  1. vascular disease
  2. CDL>190
  3. CDL 70-189, age 40-75, and diabetes or high calculated risk (HTN, smoking, obesity)

What do you give?
high intensity statin (atorvastatin 40,80 or rosuvastatin 20,40) and then moderate intensity statin (atorvastatin 10,20 or rosuvastatin 3,10) if the person is 75+, has statin intolerance, or has liver/renal failure

43
Q

What medications are used to treat high cholesterol?

A

Statin (myositis and incr LFTs)
Fibrates (myositis and incr LFTs)
Ezetimibe diarrhea)
Bile acid resins (diarrhea)
Niacin (flushing-treat with aspirin)

44
Q

which cholesterol is bad and which is good?

A

bad=LDL (should be <70)
good=HDL (should be >60)

45
Q

what is the most effective treatment for high cholesterol?

A

lifestyle modification (then statins)

46
Q

What is normal BP

A

120/80 or less, follow up every yr with pcp

47
Q

WHat are the 3 levels of abnormal BP

A
  1. elevated BP<130/<80 (lifestyle modification (LSM))
    2.stage 1 <140/<90 (if comorbidities, LSM and +1 medication
  2. stage 2 (>140/>90 LSM and 2 medications)

ALSO
urgency=220/120 and Emergency (ICU)=signs of end organ damage, SOB, chest pain, troponin, creatinine

48
Q

What are the lifestyle recommendations to keep BP down?

A

<2.4mg NaCl/day
DASH diet
K-supplementation (in the form of citrus fruits and avoid if you have CKD)
stop alcohol
exercise 30 mins a day, 2 hrs a week

49
Q

what medications do you give for high BP for people with the following comorbid conditions?
heart failure
stroke
CKD

A

If no chronic issues you can choose: ACE/ARB, CCB, or hydrocholorthiazide

heart failure-BB, ACE/ARB
stroke-ACE/ARB, and thiazide
CKD-ACE/ARB except if stage 4
diabetes-ACE/ARB

50
Q

what are side effects of DCCBs? (dihydropyridine calcium channel blockers)

A

peripheral edema
side note: they are also anti-anginal although they do not help with HFrEF

51
Q

What are side effects of ACE/ARBs?

A

increase creatinine (20% ok), increase potassium (only ace cause dry cough and angioedema bc they work on bradykinin which causes vasodilation)

52
Q

what are side effects of thiazides?

A

decreased potassium and urinary calcium, can cause kidney stones

53
Q

What is a side effect of beta blockers?

A

decreased heart rate

54
Q

WHat are side effects of angrogen antagonists? (spironolactone and eplerenone)

A

hyperkalemeia, (spironolactonecauses gynecomastia, so then you should choose eplerenone),

55
Q

what are the side effects of vasodilators? (hydralazine-artery dilator, ISDN-vasodilator)

A

(hydralazine-artery dilator)-reflex tachicardia, drug-induced lupus

(ISDN-vasodilator)-should not be used with nitrates or phosphodiesterase 5 inhibitors

56
Q

What are side effects for alpha antagonists?

A

they dont decrease hypertension but just cause orthostatic hypotension

57
Q

Do not use which type of CCBs with hypertension?

A

regular CCbs (those are used for afib and have a rate control element), while you SHOULD use dCCBs which are specific for the heart for hypertension

58
Q

how long is a normal qrs interval?

A

less than three little boxes (.12)

59
Q

What are the fast rythms with narrow qrs and which are the fast rythms with a wide qrs?

A

narrow: afib and superventricular tachycardia

wide: toursads and ventricular tachycardia

60
Q

how do you treat super-ventricular tachycardia?

A

adenosine, or shock back into rhythm

61
Q

How do you treat afib?

A

BB, CCB if stable, if unstable shock

62
Q

how do you treat torsades?

A

magnesium and shock

63
Q

what is the treatment for v tach?

A

amiodarone and shock

64
Q

ekg for super ventricular tachycardia

A

no p waves, regular, HR >150, narrow qrs <3 little boxes

65
Q

ekg for afib

A

no p waves, irregularly irregular, HR not >150, narrow qrs <3 little boxeschaotic background and flutter sawtooth

66
Q

ekg for torsads

A

see bigger and smaller amplitudes, wide qrs >3 little boxes

67
Q

ekg for ventricular tachycardia

A

monomorphic, wide qrs >3 little boxes

68
Q

how do you medically manage afib?

A

shock if unstable, if not then give CCB ex verapamil, diltiazam (not dCCB aka amlodipine) or BB,

then we ask if it is old or new afib (<48hrs is new onset and goal is cardioversion), if you dont know or know it is older cannot cardiovert, need TTE (echo) to determine if it is valvular (warfarin and bridge with low molecular weigh heparin) or not (NOAC or warfarin)

if have to cardiovert bc unstable we anticoag (usually warfarin), do a transesophagealTEE, then cardiovert, then anticoagulate

69
Q

What is the CHA2DS2-VASc score tell you?

A

The CHA2DS2-VASc score is a point-based system used to stratify the risk of stroke in AF patients. The acronym CHA2DS2-VASc stands for congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female).

score 0=aspirin
1=ASA or anticoag
2+=anticoag

anticoag (warfarin 2-3 or NOAC-then and in ban, apixaban, also irreversible)

70
Q

How do you treat nonvlavular afib?

A

verapamil and diltiazem (non dCCBs)-if they do not have CHF give these, if they do have CHF then give Digoxin and amio

71
Q

Simple way to treat acute arrythmias:
fast/wide:
fast/narrow:
slow:

A

fast/wide: Amio
fast/narrow: Adenosine
slow: Atrapine

72
Q

What is the correct answer for when they ask what you do in a code?

A

CPR

73
Q

In a code, which is the only type of arrythmia that can be shocked?

A

VT/VF (NOT PEA/Asystole)

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