PIMP Cardiology Flashcards
What are the toxicities of amiodarone?
BITCH Bradycardia/Blue man syndrome Interstitial lung disease Thyroid Corneal/Cutaneous Hepatic/Hypotension
*Check PFTs, TFTs, and LFTs for pulmonary, thyroid and liver function
What are the causes of atrial fibrillation?
PIRATES Pulmonary embollism, Pulmonary disease, Post-operative Ischemica heart disease, Idiopathic, IV central line Rheumatic valvular disease Anemia, alcohol, age, autonomic tone Thyroid disease Elevevated BP, Electrocution Sleep apnea, sepsis, surgery
What are the different types of shock and their treatment?
Hypovolemic shock : IV fluids
Cardiogenic shock : Inotropes revascularization
Distributive shock : Pressors IV fluids
Causes of congestive heart failure exacerbations?
1 cause of hospital admissions in the US - volume overload from CHF
- Medication non-compliance
- Fluid/sodium restriction non-compliance
- Acute worsening of cardiac output
- arrhythmia, ischemia or acute coronary syndrome, worsening/progression of cardiomyopathy
Which medications for systolic congestive heart failure reduce mortality?
Beta blockers ACE inhibitors Spironolactone ARBs *If ACE inhibitor and ARB intolerant, combine hydralazine and nitrates to reduce mortality (especially in African americans)
*Digoxin and diuretics DO NOT reduce mortality
Which beta blockers are FDA approved to treat systolic congestive heart failure?
Carvedilol (Coreg)
Bisoprolol
Metoprolol succinate (toprol)
Whati s the most common cause of right heart failure?
Left heart failure!
- ischemia, valve disease, cardiomyopathy, etc.
- LV pressure increases and transmits back to the lungs causing pulmonary hypertension that strains the right heart and eventually causes right heart failure
A patient comes in with chest pain, what are the 4 life threatening causes that should be excluded?
Acute coronary syndrome
Pulmonary embolism
Aortic dissection
Eosophageal rupture (boerhaave’s syndrome)
What are the signs/symptoms and issues with digoxin toxicity?
Nausea/vomiting/abdominal pain weakness/dizziness symptoms of arrhythmia altered mental status vision changes (xanthopsia)
- Digoxin causes every arrhtmia except rapidly conducted atrial rhythms
- EKG has reverse check sign
- Digoxin cause shyperkalemia, but is potentiaed by hypokalemia
What are the five life threatening complications of aortic dissection?
Coronary dissection, usually the right coronary artery causing inferior ST elevation MI
Carotid dissection causing stroke
Aortic rupture
Cardiac tamponade from rupture into pericardium
Acute aoritc valve regurgitation causing cardiogenic shock
Which atrial fibrilation patients can we use only aspirin for and who needs full anticoagulation to prevent stroke?
CHA2DS2 Vasc score
If 0-1 points then aspirin 81-325 mg
If >2 then full anticoagulation (warfarin, dabigatran, rivarxoiba, apixiban)
Congestive heart failure Hypertension Age (>65 = 1 point, >75= 2 pont) Diabetes STroke Vascular disease Female = 1 point
What are the different properties of beta blockers?
Cardioselectivity: Acts upon beta-1 receptors much more than beta-2 receptors. Safer to use in pateints with asthma or reactive airway disease
Lipid solubility: Lipid soluble (propranolol or metoprolol) can cross blood brain barrier easily and commonly used for migraine headaches, stage fright, and panic attacks
Intrinsic sympathomimetic activity: ISA only partially antagonize while causing a small degree of activation of hte beta receptors. Commonly used in younger patients or in athletes where heart rates need to elevate in order to compete in sports. Pindolol and acebutolol.
Membrane stabilization: Stabilizing membranes decreases the propagation of action potentials.
What are the side effects and other issues with ACE inhibitors?
CAPTOPRIL
Cough ANgioedema Potassium excess Taste changes Orthostatic hypotension Pregnancy contrainidcation/pressure drop Renal failure/Rash Indomethacin inhibition Leukopenia (rare)
What class of antiarrhythmic drug is _______ in?
Class 1A: “Queen Amy Proclaims Diso’s Pyramid” - Quinidine, AMiodarone, Procainamide, Disopyramid
Class 1B: Lidoacine, mexiletine
Class 1C: Flecainde, Propafenone
Class II: Beta blockers
Class III: Sotalol, amiodarone, dronedarone, dofeilide
Class IV: calcium channel blockers (diltiazem, verapamil)_
Class V: mechanism unknown
How do you diagnose and treat cardiac tamponade?
Beck’s Triad: Hypotension, muffled heart sounds, elevated neck veins
Pulsus paradoxus: Abnormal if > 12mmHG
Water bottle heart: chest xray finding - heart shaped like a canteen
*Clinical diagnosis, not echocardiographic one. Echo will show pericardial effusion and if right ventricle is collapsing in diastole, tamponade is thought to be present
Treat: IV fluids to increase preload and prevent right ventricular collapde. Pericardiocentesis is therapeutic
