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PGY1 > Section 4 - Cardiovascular Diseases > Flashcards

Section 4 - Cardiovascular Diseases Flashcards

1
Q

unstable angina

A

anginal symptoms increasing in frequency or severity, or occur at rest

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2
Q

most reliable tool in assessing chest pain?

A

EKG

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3
Q

Peak and wane of CK-MB in MI? Trop?

A

CKMB - 1d, 2d

trop - 2d, 5d

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4
Q

angina sx?

A

episodic chest pain that lasts 5-15 min, precipitated by exertion, relieved by rest or sublingual nitrogen

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5
Q

prinzmetal angina

A

spasm of epicardial vessels wiht normal coronary arteries (1/3) or in patients with underlying atherosclerotic disease (2/3)
- precipitated by tobacco or cocaine

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6
Q

sx of acute pericardial tamponade?

A

positional or pleuritic chest pain, dyspnea, and palpitations
- tachy, hypotensive, jvd,distant heart sounds

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7
Q

NSTEMI definition

A

cardiac markers elevation, not STEMI

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8
Q

tx of chest pain

A

IV, O2, monitor, aspirin 160-325 mg chewed, NTG sublingual (total 3 tabs) 2-5 min intervals, morphine (caution with hypotension), consider clopidogrel, UFH, PCI/thrombolytics, consider beta blockers

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9
Q

disadvantages of UFH?

A

need for IV, frequent monitoring of aPTT, unpredictable response, HIT, increased bleeding
- reversible with protamine

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10
Q

LMWH advantage?

A

greater bioavailabliity, lower protein binding, longer half life, safer, more reliable, more risk of ICH in elderly, bad if CABG is planned

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11
Q

sx of cardiogenic shock

A

hypoperfusion (hypotension) and tachycardia, cool/mottle skin, oliguria, AMS
- possible pulmonary edema, JVD

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12
Q

dx of cardiogenic shock?

A

step 1: EKG, rule out bleeding, infectious causes, focal neuro deficits
step 2: CXR

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13
Q

tx of cardiogenic shock

A

airway management, IV access, monitor, PCI, give NTG or morphine cautiously, no beta blockers, pressors:

  • norepi for severe hypotension
  • dobutamine with dopamine for hypotension no hypovolemia
  • sodium nitroprusside for afterlooad reduction
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14
Q

tx of ACS

A

aspirin 160-325, nitroglycerin, beta blockers (metoprolol), clopidogrel, heparin or enoxaparin

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15
Q

diagnosis of syncope work up?

A

history, physical, EKG, pregnancy test, consider electrolytes

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16
Q

tx of acute pulmonary edema

A

oxygen to get sat up to 95% or CPAP or BiPAP if necessary, intubation if patient is tiring

NTG sublingually, drip, nitroprusside may be used if pt still HTN

furosemide 40-80 mg IV or bumetanide 0.5 -1 mg IV or torsemide 10 mg IV, monitor BMP

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17
Q

tx of mitral stenosis?

A

furosemide 40 mg IV, tx of afib, and anticoag

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18
Q

tx of mitral incompetence?

A

with pulm edema give: O2, noninvasive ventilation, furosemide 40 mg IV, nitrates

nitroprusside 5 mcg/kg/min IV if normotensive

hypotensive 2.5 mcg/kg/min in addition to nitroprusside

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19
Q

sx of aortic stenosis?

A

dyspnea, CP, syncope

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20
Q

tx of aortic stenosis?

A

pulm edema: furosemide 40 mg IV, no nitrates because you need preload

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21
Q

sx of aortic insufficiency? Acute vs chronic?

A

acute: dyspnea
chronic: widened pulse pressure (head bobbing), water hammer pulse, pulsus bisferiens, duroziez sign (to and fro femoral murmur) and quincke pulse (capillary pulsations visible at prox nailbed while pressure applied at tip

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22
Q

dx of aortic insufficiency?

A

EKG and echo

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23
Q

tx of aortic insufficiency?

A

pulm edema: oxygen and noninvasive ventilation

nitroprusside and dobutamine or dopamine can be started

chronic: ACEI or nifedipine

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24
Q

Most common cause of dilated cardiomyopathy?

A

idiopathic

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25
Q

sx of dilated cardiomyopathy?

A

DOE, orthopnea, and PND

- CP due to limited coronary vascular reserve

26
Q

tx of dilated cardiomyopathy?

A

IV, O2, monitoring

  • IV furosemide and dig 0.5 mg IV
  • ACEI, beta blocker carvedilol
  • amiodarone
  • anticoag
27
Q

sx of hypertrophic cardiomyopathy?

A

DOE, angina CP, palpitations, syncope

28
Q

tx of hypertrophic cardiomyopathY?

A

beta blockers, avoid exercise, monitored

29
Q

sx of restrictive cardiomyopathy?

A

dyspnea, orthopnea, and pedal edema

30
Q

tx of restrictive cardiomyopathy?

A
  • diuretics and ACEI
  • corticosteroids for sarcoidosis
  • chelation for hemochromotosis
31
Q

causes of myocarditis?

A

coxsackie B, echovirus, influenza, parainfluenza, EBV, HIV

- diphtheriae, meningitis, m pneumonia, beta hemolytic strep

32
Q

sx of myocarditis?

A

myalgias, headache, rigors, fevers, heart rate elevated disproportionate to temperature elevation

33
Q

cause of acute pericarditis?

A
  • virus: coxsackie virus, echovirus, HIV
  • bacteria: staph, strep, m tb
  • fungus: histoplasmosis
  • CA: leukemia, lymph, melanoma, mets
  • drugs: procainamide and hydralazine
  • radiation, CT disease, uremia, myxedema, post MI
34
Q

sx of acute pericarditis?

A

sharp stabbing CP that radiates to back, neck, left shoulder or arm, worse with movement and deep breathing, worse by lying supine and lessened by sitting up and leaning forward
- assoc with fever, dyspnea, and dysphagia

35
Q

best diagnostic test for acute pericarditis?

A

echo

36
Q

tx of acute pericarditis?

A

ibuprofen, tx cause, monitored

37
Q

sx of cardiac tamponade?

A

dyspnea, weight loss, pedal edema, ascites, tachycardic low SBP, narrowed pulse pressure. Pulsus paradoxus, neck vein distention, distant heart sounds, RUQ pain

38
Q

diagnostic test of choice for tamponade?

A

echo

39
Q

tx of tamponade?

A

IV, O2, monitor, IVF bolus, pericardiocentesis, ICU admission

40
Q

sx of DVT/PE?

A

hypoxemia, tachypnea, tachycardia, hemoptysis, diaphoresis, low grade fever

41
Q

dx of DVT/PE?

A

low or intermediate risk start with d dimer
next step US BLE
CT Chest angio

42
Q

tx of DVT/PE?

A
  • O2
  • IV crystalloid to increase preload and hypotension
  • UFH/LMWH
  • fondaparineux or lepirudin if can’t have heparin
  • also coumadin
  • some need thrombolytics
43
Q

tx of aortic dissection?

A

esmolol or labetalol

  • verapamil, dilt if can’t do beta blockers
  • nicardipine or nitroprusside if beta/CCB not working
44
Q

tx of acute hypertensive pulmonary edema?

A

NG SL, paste or IV infusion

- enalapril, nicardipine, nitroprusside

45
Q

tx of hypertensive ACS?

A

NTG or metoprolol

46
Q

tx of acute sympathetic crisis?

A

benzos, NTG or phentolamine

47
Q

tx of acute renal failure?

A

labetalol, nicardipine, fenoldopam

48
Q

tx of preeclampsia?

A

labetalol, hydralazine

49
Q

tx of HTN encephalopathy?

A

nicardipine or labetalol or fenoldopam or nitroprusside

50
Q

tx of hypertensive SAH?

A

nicardipine, labetalol, or esmolol

51
Q

tx of ICH?

A

nicardipine, labetalol, esmolol

52
Q

ischemic stroke from HTN?

A

labetalol, nicardipine, NTG

53
Q

most common cause of child with HTN?

A

renovascular lesions and pheochromocytoma

54
Q

tx of child with hTN?

A

labetalol, nicardipine, nitroprusside

55
Q

size for diagnosis of AAA?

A

> 5 cm

56
Q

tx of unstable patient with AAA?

A

bedside US, early consult to vascular, large bore IV, type and cross, pain control

57
Q

tx of stable patient with AAA?

A

ICU and early consult with vascular

58
Q

tx of aortic dissection?

A

large bore IV, type and cross, esmolol or labetalol, nitroprsside

59
Q

definition of PAD?

A

ABI of

60
Q

sx of PAD?

A

pain, pallor, poikilothermia, pulselessness, paresthesias, and paralysis

61
Q

tx of PAD?

A

IV bore, EKG, echo, ufractionated heparin, vascular consult

PGY1 (33 decks)

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