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CK - IM > SUM - CH1 - Cardiovascular > Flashcards

SUM - CH1 - Cardiovascular Flashcards

1
Q

High output heart failure:

A

Increase in CO because of increased peripheral oxygen demands

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2
Q

Systolic dysfunction;

A

Impaired contractility; Decreased EF

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3
Q

Systolic dysfunction: Causes

A

Ischemia, HTN –> Cardiomyopathy,

valvular heart disease,

myocarditis,

Alcohol,

radiation,

hemochromatosis,

thyroid disease

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4
Q

Diastolic dysfunction:

A

Impaired filling; Impaired relaxation or increased stiffness of ventricle or both

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5
Q

Diastolic dysfunction: Causes

A
  • HTN –> myocardial hypertrophy,
  • aortic stenosis,
  • mitral stenosis,
  • aortic regurg,
  • restrictive cardiomyopathy
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6
Q

PND:

A

Waking after 1-2 hours of sleep due to SOB

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7
Q

Pathologic S3:

A

rapid filling into non-compliant left ventricular chamber

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8
Q

S4 gallop:

A

Atrial systole as blood is ejected into non-compliant, stiff, left ventricular chamber; heard best at left sternal border

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9
Q

New York heart association classification

A
  1. Symptoms with vigorous activity
  2. Symptoms with mild activity
  3. Symptoms with regular daily activity
  4. Symptoms at rest. incapacitating
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10
Q

Tests to order for CHF:

A

CXR, ECG, Cardiac enzymes, CBC, ECHO

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11
Q

CHF: CXR findings

A
  • Cardiomegaly,
  • Kerley B lines (pulmonary congestion; secondary to dilation of pulmonary lymphatic vessels),
  • Prominent interstitial markings
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12
Q

Systolic dysfunction: Treatment options

(Diuretics, spirono, ACEi, B-blocker, Digitalis, Hydralazine)

A
  • Lifestyle modifications,
  • Diuretics (symptomatic relief)
    • Initial treatment for symptoms
  • Spironolactone
    • Effective in NYHA class 3/4
  • ACE inhibitor
    • Given to all Systolic heart failure pts
  • Beta-Blockers
    • Given to stable patients
  • Digitalis
    • EF <40 who have symptoms despite optimum treatment with all above
  • Hydralazine / isosorbide dinitrates
    • pts who cant tolerate ACEi
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13
Q

CHF: ACE inhibitors

A

Venous / Arterial dilation
Decrease Preload / afterload
Reduction in mortality
Alleviate symptoms

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14
Q

CHF: Spironolactone

A

prolong survival in NYHA 3/4;
monitor renal function and K+

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15
Q

CHF: beta blockers

A
  • Decrease mortality in pts post MI Heart failure
    • Slow progression of heart failure (inhibit tissue remodelling)
  • Improve symptoms
  • Anti-arrythmic and Antischemic effect
  • Carvedilol > metoprolol, bisoprolol >>>> all others
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16
Q

CHF: Digitalis

A
  • Short term symptomatic releif
  • No change in mortality
    *
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17
Q

CHF: Hydralazine

A

Reduce mortality (in place of ACEi)

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18
Q

CHF: Digitalis - signs of toxicity

A
  • GI: N/V
  • Cardiac:
    • ectopic ventricular beats,
    • AV block,
    • AFib
  • CNS:
    • Visual disturbances,
    • Disorientation
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19
Q

CHF: Systolic dysfunction - contraindications

A
  • Metformin: potentiallly lethal lactic acidosis
  • Thiazolidinediones: fluid retention
  • NSAIDS: increased risk of exacerbation
  • Antiarrythmics with negative ionotropic effects
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20
Q

Systolic dysfunction: Devices that reduce mortality

A
  • ICD: Prevent SCD
    • Indication:
      • 40 days post MI
      • EF <35
        • Class 2/3 symptoms
  • Cardiac resynchronization therapy
    • Biventricular pacemaker
    • Indications:
      • Same + QRS >120
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21
Q

CHF: Diastolic dysfunction - treatment

A
  • Beta blockers: clear benefit
  • Diuretics for symptoms
    • ACEi and ARBs possibly
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22
Q

CHF: Diastolic dysfxn - contraindications

A

Digoxin/spironolactone

23
Q

General principles of CHF treatment: NYHA classification

A

NYHA1

  • Loop if volume overload / pulm congestion
  • ACEi

NYHA 2/3

  • Add beta blocker

NYHA 3/4

  • Add Digoxin (can be added at any time)
  • possibly add spironoactone
24
Q

Acute Decompensated heart failure

A

Acute dyspnea associated with elevated left sided filling pressures, with or without pulmonary edema

25
Q

Acute Decompensated heart failure: Treatment

A
  • Oxygenation and ventilatory assistance
  • Diuretics for volume overload
  • Nitrates
  • Possibly inotropic agents if pulmonary edema is not cleared by above medication
26
Q

Acute Afib in hemodynamically unstable pt: Treatment

A

Immediate electrical cardioversion to sinus rhythm

27
Q

Acute AFib in hemodynamically stable pt: Treatment

A
  1. Rate control - beta blockers (CCB alternative)
    • LV Systolic Dfxn consider digoxin or amiodarone
  2. AFib > 48h?
    1. NO: Cardioversion
      • Electric prefered over pharmacologic
    2. YES: Anticoagulation
      1. Anticoagulate 3 weeks before cardioversion
      2. Or order TEE:
        1. no thrombus –> begin IV heparin and perform cardioversion
        2. Thrombus –> anticoagulate 3 weeks before cardioversion
28
Q

CHronic AFib: treatment

A
  • Rate control
    • Beta-blocker
    • CCB
  • Anticoag
    • Lone Afib:
      • <60: aspirin
      • >60: warfarin
29
Q

Multifocal Atrial Tachycardia: Associated with

A

Severe pulmonary disease

30
Q

Multifocal Atrial Tachycardia: Diagnosis

A

EKG:

  • Variable P wave morphology
  • Variable PR interval
  • Variable RR interval
31
Q

Multifocal atrial Tachycardia: vs Wandering atrial pacemaker

A

Wandering pacemaker has HR 60-100

32
Q

Multifocal atrial tachycardia: Treatment

A
  • Oxygenation and ventilation
  • If LV function is preserved:
    • CCBs
    • Beta blockers
    • Digoxin
    • Amiodarone
33
Q

Paroxysmal Supraventricular tachycardia: AV nodal reentrant tachy

A
  • Two pathways within AV node (re-entrant circuit within AV node)
  • ECG: narrow QRS with no discernable P waves (buried by QRS)
34
Q

Orthodromic AV reentrant tachycardia:

A
  • Accesory pathway between ventricles and atria conducts retrograde
  • EKG: Narrow QRS with P waves which may or may not be discernable
35
Q

Paroxysmal SVT: treatment

A
  • Vagus stimulation (carotid sinus massage, valsalva, breath holding, submersion in water)
  • IV Adenosine: DOC
  • Alternatives: IV verapamil / IV esmolol / Digoxin
    • Also DC cardioversion if drugs dont work
36
Q

Adenosine: Side effects

A
  • Headache
  • Flushing
  • SOB
  • Chest pressure
  • Nausea
37
Q

Paroxysmal SVT: Prevention

A
  • Drugs
    • Digoxin (DOC)
    • Alternatives: verapamil, beta blockers
  • Radiofrequency catheter ablation
38
Q

Wolf-Parkinson-White syndrome: Orthodromic reciprocating tachycardia

A
  • Atria –> ventricles –> bundle of kent –> atria –> repolarization circuit
39
Q

Wolf-Parkinson-White syndrome: Supraventricular tachycardias

A
  • Atria –> many impulses –> AV node –> only certian ones get through
  • Atria –> many impulses –> bundle of kent –> skips AV node –> Ventricles
40
Q

Wolf-Parkinson-White syndrome: ECG

A

Narrow QRS complex tachycardia

Short PR interval

Delta wave

41
Q

Wolf-Parkinson-White syndrome: Treatment

A
  • Radiofrequency cathetor ablation
  • Avoid drugs that work on AV node
    • May accelerate alternate conduction pathway
      • (Verapamil, digoxin)
42
Q

Torsades de pointes: Treatment

A

IV magnesium

43
Q

Ventricular Tachycardia: ECG

A

Wide and bizarre QRS complexes

44
Q

Ventricular Tach: Treatment of sustained VT

A

Sustained VT

  • Hemo stable:
    • Amiodarone, procainamide, sotolol
  • Hemo unstable:
    • DC cardioversion
    • Follow with amiodarone
  • Placement of ICD
45
Q

Ventricular Tach: Treatment of non-sustained VT

A

Non-sustained

  • No underlying heart disease:
    • Do not treat (no increased risk of SCD)
  • Underlying heart disease, MI, LV dysfxn:
    • Order elecrophysiologic study
      • Inducible sustained VT: ICD implant
46
Q

VFib: Prognosis

A
  • Associated with MI: good prognosis (rare recurrance)
  • No association: Recurrance is common
47
Q

VFib: diagnosis

A
  • absent heart sounds, pulse
  • Pt. unconscious
  • EKG:
    • No P waves,
    • No QRS
48
Q

Vfib: treatment

A
  • Immediate Defibrillation
  • If persists. IV epinephrine (increases myocardial and cerebral blood flow and decreases the defibrillation threshold)
    • Defibrillate 30-60 seconds after
49
Q

CAD: Stress tests: Stress EKG

A
  • Excercise induced ischemia of heart shows on EKG as ST depression.
  • Pts. positive should go for catheterization
50
Q

CAD: Stress tests: Stress Echo

A
  • Excercise induced ischemia noted for wall movement abnormalities
  • Abnormalities should –> catheterization
51
Q

CAD: Stress tests: Stress Perfusion imaging

A
  • Viable myocardial cells extract the dye
  • Reversible ischemic areas can be rescued by PCI or CABG
52
Q

CAD: Stress tests: Pharmacologic stress: Adenosine / Dipyridamole:

A
  • Cause cardiac perfusion stealing
53
Q

CAD: Stress tests: Pharmacologic stress: Dobutamine

A

Increase myocardial O2 requirement

CK - IM (7 decks)

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