PANCE Cardiology 8/12 Flashcards
what artery for an anterior wall MI
LAD
what artery for a lateral wall MI
circumflex
what artery for an inferior wall MI
RCA
what leads are anterior
V1 - V4
what leads are lateral
I, AVL, V5, V6
what leads are inferior
II, III, AVF
what rates are sinus tach
100-150
how do you tx sinus tach
nothing
what rate is sinus brady
less than 60
how do you tx sinus brady
atropine
how do you tx sinus brady syndrome, sick sinus syndrome
pacemaker
describe 1at degree heart block
long PR interval
tx for 1st degree block
none
describe type II A block
progressive block with dropped beats
how do you tx II A block
atropine + Pace
describe type III AV block
pacemaker
what are the three options for a flutter Tx
- stable:
- Unstable
- definitive
- Stable: vagel, BB, CCB
- Unstable: cardiovertion
- Definative: ablation
what are three medication classes that will control the rate in A fibb patients
BB: metoprolol
CCB: diltiazam
digioxin
who with a fib can get cardioverted
AF < 48 hours
- 3/4 weeks of anticoag + TEE
how do you tx unstable A fib:
cardiovertion
what CHADs VAS gets anti coag
> 1
what are all the elements of the CHADs VAS
CHF HTN Age > 75 DM II Stroke: +2 Vascular disease age >65 sex
what are the three primary pathologies that can cause a prologed QT
macrolides
TCA
electrolight abnormalities
How do you tx prolonged QT
AICD
How do you tx stable SVT (2)
- vagal
- adenosine
How do you tx stable V tach
amiodrone
How do you tx unstable V tach or SVT
cardiovertion
what is the definitive tx of narrow or wide complex tachycardia
- ablation
what is wide complex SVT
V tach
what is multifocal atrial tachycardia (MAT) a compliaction of
COPD
what do you tx MAT with (2)
BB
CCB
what do you tx WPW with
procainimide
a prolonged QT can lead to what
torsades
how do you tx torsades
IV Mag
How do you manage PEA
CPR + EPI + defib
what is another name for Dfibrillation
unsynchronized cardivertion
Diffuse ST elevation- “what pathology”
- acute pericarditis
LBB RsR in what leads
V5- V6
RBB RsR what leads
V1- v2
who cannot get a pharmacologic stress test
obstructive airway disease
who cannot get a tredmill stress test (2)
- cant walk
- baseline abnormalities
what is the MCC of CAD
athersclerosis
what are 5 RF for CAD
- DM
- smoking
- HTN
- HLD
- Family history
what is subsernal chest pain that is brought on by exertion
angina
how long can angina last for
< 30 min
what are the three anginal equivalents
- Dyspnea
- epigastic
- shoulder pain
what is the first line test for angina
- EKG
what is the medication used for a pharmachologic stress test
- dobutamine
what is the gold standard for CAD
Cath
what are the 4 indications for CABG over CAD
- > 3 vessles
- > 70%
- LAD
- ED < 40%
what are the three groups that cannot get nitro
- SBP < 90
- RV infarct
- Sildenophil
how do you tx prinzmental angina
CCB
what is the MC cause of MI
Atherosclerosis
Chest pain and brady may be what location MI
inferior wall
what are the three EKG progressions you will see in an MI
- peaked T waves
- ST elevation
- T wave invertion
what are the three timelines for troponin
- appear
- peak
- last
- appear: 4-8 hours
- peak:12-24 hours
- last: 7-10 days
what type of medication is clopedogril (plavix)
antiplatelet
what low molecular weight hererin has a SE of thrombocytopenia
low molecular weight heperin
prinzmetal angina or cocaine MI’s do NOT get what meds
- beta blockers
what is the most importnat part about an MI
PCI
alteplase is AKA
TPA
what does NSTEMI get in addition to MONA
heperin
what does STEMI get in addition to MONA
- hererin
- ACE
- PCI
what do you do for R ventricle (interior wall MI)
- No nito
- give fluids
what clinical decision rule is used in a MI
- TIMI
what TIMI is high risk
> 3
what are three contrainidcatrions to TPA
- hemorrhagic stroke 6 months
- facial trauma 3 months
- previous intracranial hemorrhage
what is the MC cause of CHF
CAD
what heart sound is best heard on diastolic HF
S4
what type of breathing do you see with CHF
Chayne stokes breathing
what is the MC symptom of L sided CHF
dyspnea
what type of HF has a good EF
diastolic
what are the 3 imaging / lab values in CHF
- ECHO: best
- CXR:
- BNP: > 100
what are the 3 best medications for CHF
- Ace
- BB
- Diuretic
what metabolic distribution is caused by an ACE
- hyperkalemia
where are ace metabolized
kidney
what HF medication causes gout
Lopp diurtics (furosimide)
what EF for defibrillator
< 35%
what pathology is kerly B lines associated with
CHF
what are the 2 main causes of acute pericarditis
- Idiopathic
- (viral)coxackie
do individuals with perdicaditis have fever
most often yes
what position for pericarditis is better
fetal
what might you hear on ascultation with pericarditis ina FORWARD position
friction rub
low voltage EKG and muffles heart sounds think what
pericardial effusion
what is the MC cause of a pericardial effusion
pericarditis
what will you see on an EKG for pericardial effusion
- Low voltage
- electrical alternates
what will you see on CXR for pericardial effusion
cardiomegaly
what is becks triad
- muffled heart sounds
- JVD
- hypotesion
what pathology is pulses paradoxus associated with
cardiac tampanode
how do you tx cardiac tampanode
pericardiocentesis
what is thickened pericardium that decreases filling
- constrictive pericarditis
what is Kussmals sign and what pathology is it associated with
- Kussmals sign: increased JVD with inspiration
- constrictive pericarditis
what is a “high pitched 3rd heart sound” and what is it associated with
high pitched 3rd heart sound: pericardial knock
Pathology: constrictive pericarditis
what is the cause of rheumatic fever
-GABHS (strep pyogenys)
what valve for rehumatic fever
- 70%
- 30%
mitral (70%)
aortic (30%)
what labs for rheumatic fever
ESR
CRP
what is the jones criteria associated with
rheumatic fever
how do you tx rheumatic fever
aspirin
Pen G
Harsh / rumble sound
stenosis or regurg
stenosis
Blowing sound
stenosis or regurg
regurg
aortic regurg radiated where
L upper sternal boarder
aortic stenosis radiates where
carotids
Mitral regurg radiates where
axilla
sitting up and leading forward makes what murmurs louder
aortic stenosis and aortic regurg
what type of murmur is louder if you are lying on the left side
mitral regurg
squatting
supine
leg raises
increases what murmurs
all but hypertrophic cardiomyopathy
what 2 movements decrease the venous return
- valsalva
- standing
how does decreasing venous return AKA
Valsalva and standing influence murmurs
it decreases all murmurs with the exception of HCOM
how do you increase HCOM 2
valsalva and standing
what are the three aortic stenosis complications
angina
syncope
CHF
systolic crescendo de crescendo murmur that radiates to the neck
aortic stenosis
treatment for severe Aortic stenosis
AVR
RHD and endocarditis cause what type of murmur
aortic regurg
“diastolic decrescendo blowing murmur”
bounding pulses
aortic regurg
what murmur has a narrow pulse pressure
- aortic stenosis
what Murmur has a wide pulse pressure
- aortic regurg
How so you tx aoritc regurg
afterload reduction
what is the MC cause of mitral stenosis
- reheumatic heart disease
“fish mouth valve”
- mitral stenosis
Diatolic rumble with opening snap
mitral stenosis
“boundng pulse murmur”
aortic regurg
“blowing holosystolic murmur”
Mitral regurg
mitral regurg tx
Ace
“mid to late ejection click”
Mitral vale prolapse
how do you tx mitral valve prolapse
- reassurance
- beta blockers
what is the MCC of secondary HTN
renal artery stenosis
what is the MCC of end stage renal disease in the US
- DM
2. HTN
what are the 4 grades if HTN retinopatht
- arterial narrowing
- A-V nicking
- hemmorages + soft excudated
- papilledema
JNC 8 what is the goal HTN
- <140/90
2. If > 60 yo: 150> 90
with HCTZ what are the only 3 things that increase
- Hypercalcemia
- Hyperurecemia (Gout)
- Hyperglycemia (DM)
what is the only Duirertc that causes HYPERkalemia
- K sparing (spironolactone)
what is the main metabolic chnage that is involved with Ace
Hyperkalemia
ace and arbs are containdicated in what population
pregnancy
what is the one non cardioselective beta blocker
propanolol
what 2 beta blockers are both cardioselective and non cardioselective
labetalol and carvedilol
what CCB are non dihydropyidines and this are NON cardioselective 2
- verapamil
- Diltiazem
how much should you lower the BP by in an emergency
- 25% in 48 hours hours
what are the two primary medications used in HTN urgency
- clonidine
- captopril
what is a compliaction to clonidine
rebound HTN (will look liek pheo)
Grade IV HTN retininopathy may presnet with what
blurred vision
when someone is having an ishemic stroke at what level do you lower their BP
> 185/ 110
what what age do you start checkling lipids
- w/o FH
- w/ FH
- w/o: 35M, 45F
- with: 25M, 35F
who are the 4 statin benifit groups
- DM 40-75
- 40-75 with 10 year risk > 7.5
- > 21 yo with LDL > 190
- CAD
what meds lower TG
fibrates
what meds inc HDL
niacin
niacin is also B?
B3
Gemfibrozil
fenofibrate
these are examples of
Fibrates to lower TG
what is the MC value effected in endocarditis
mitral valve unless IVDU then tricuspid
what is the difference between acute bacterial and subacute endocarditis
subacute is in abnormal valves
what organism for acute bacterial endocarditis
staph aurues
what organism for subacute endocarditis
step virdands
what organisms for endocarditis in IVD
MRSA
what is the Tx for subacute endocarditis
ampcillin + gent
what is the Tx for acute endocarditis
nafcillin + gent
what is the Tx for PV endocarditis
Vanc + Rifampin + Gent
what murmur for infective endocarditis
new regueg murmur
what are the 4 clnical manifestations ABE
Janeway lesions
roth sports
osler nodes
splinter hemorrhages
what are the 4 endocarditis prophalaxis indications
- Prosthetic valve
- heart repairs with prosthetic material
- prior endocarditis
- congenital heart disease
what are the two options for endocarditis prophalaxis
amoxicillin
clindamycin
Pain
pallor
pulselessness
These are associated with what pathology
- PAD
what location for PAD ulcers
- lateral malleolar
how do you dx PAD
ABI < .9
what are the three tx for PAD
- cliostazole
- aspirin
- clopedogrel
what are the 2 MC risk factors for AAA
- athersclerosis
- smoking
- Syncope
- hpotension
- pulsitile mass
what pathology
AAA
what is the qualification for a low dose CT of the chest
- 15 pack years within the last 30 years
annual low dose CT
what do you do with a AAA
- 3.0cm - 4.0 cm
- 4.0 -4.5 cm
- > 4.5cm
- 3.0cm - 4.0 cm: monitor every year
- 4.0 -4.5 cm: monitor every 6 months
- > 4.5cm: surgery
what medication is included in the mamangemnt of a AAA because it lowers the sheering forces
beta blocker
where is the worst location to have a aortic dissection
ascending
what is the most importnat risk factor for an aortic dissection
hypertension
sudden ripping tearing chest pain:
- aortic dissection
what is the classic finding on X ray for an aortic disection
widened mediastimum
what is the gold standard DX for aortic dissection
MRI
how do you manage aortic dissection
- ascending:
- Descending:
- ascending: surgery
- Descending:labetalol
what is burgers disease
non athersclerotic inflammatory disease of the small to medium vessels
what is burgers disease associated with (RF)
smoking
what is trousseau’s sign of malignancy
- migratory thrombophilibitis associated with malignancy
for superficial thrombophilibitis what do you see on ultrasound
non compressable vein
superficial thrombophilibitis what is the MC cause
factor V leiden difficenecy
superficial thrombophilibitis tx (3)
warm compress
elevation
NSAIDs
how long for DVT treatment
3 months for inital life long after that
what pathology “inadequate perfusion and tissue oxygenation”
shock
what are the 4 types of shock and a little infor about each
- hypovolemic: reduced blood volume
- cardiogenic: reduced cardiac output
- obstructive: Obstruction to circulation
- disributive: maldistribution of blood flow
what is the SVR and CO with hypovolemic shock
- SVR: increased
2. CO: decreased
what is the SVR and CO with cardiogenic shock
- SVR: increased
- CO: decreased
- pulmonary capilary wedge pressure: increased
what is the one type of shock you do not give fluids
- cardiogenic
what type of shock
- CO: decreased
- SVR: decreased
- PCWP: decreased
distributive
what are the 4 qualifications for SIRS
- Temp: > 100.3
- Pulse: > 90 BPM
- respiratory rate: >20
- WBC: >12,000
what is the only type of shock that has
CO: increased
Skin: warm
septic
