T1-Cardiology Flashcards
ACS is _____ or _____ of myocardial _____
Confirmation or suspicion
Ischemia
Unstable angina ______ symptoms without _____
Presence suggesting myocardial ischemia
ECG changes or elevated bio markers.
See ACS chart on safari
Reduce risk of MI in male patients with coronary risk factors by administering 81-325mg of aspirin starting at age 45-50.
Lowering BP in patients high risk for vascular events with _______ lowers risk of events by ____
ACE inhibitors
20-25%
Criteria for metabolic syndrome:
Abdominal obesity
Triglycerides 150 or over
HDL <40 (men) <50 (women)
Fasting glucose 110 or higher
Hypertension.
Primary and secondary prevention of CHD (coronary heart disease)
Smoking cessation
Treatment of dyslipidemia
Lower BP
Daily aspirin
Stage 1 C-K-M syndrome (cardiovascular kidney metabolic)
Excess adipose tissue, abdominal obesity and impaired glucose tolerance
Stage 2 CKMS
Metabolic risk factors and CKD
-HTN, metabolic syndrome, hypertriglyceridemia, T2DM, moderate to high-risk CKD (no metabolic etiology)
Stage 3 sub clinical CVD in CKM syndrome
Subclinical ASCVD, subclinical HF
-VERY high risk for CKD
-High risk for CVD
Stage 4 clinical CVD in CKM syndrome
- CHD, HF, PAD, Stroke and Afib
Signs of MI
Elevated BP (hypotension in posterior vessels)
Gallop, apical systolic murmur
Contributing or accompanying disease
______ murmurs are always abnormal
_____ murmurs can be normal.
Diastolic.
Systolic.
Stable angina is _______ and _______
Predictable
Reproducible
T/F: troponin is not helpful in determining re-infarction because elevated levels can last weeks after the event.
True
If hs-Tn is not an option, what other labs could you use for MI diagnositcs?
CK-MB, Myoglobin, LDH (lactate dehydrogenase)
Not as sensitive for cardiac muscle specifically.
When can CK-MB be used in relation to MIs?
If another cardiac event occurs during the few weeks after the first event and the troponin is still elevated.
Slide 40 - look over
Medications used for pharmacological stress tests
Adenosine, dipyridamole and dobutamine.
What criteria does a STEMI cause on an ECG?
ST segment elevation of 2mm for Men and 1.5 for women in V2 and V3
1mm in lead V1, V4-6, I, II, III, aVL and aVF
0.5mm for leads V3R, V4R and V7-9 (posterior)
New or presumed new LBB w/ CP and w/ elevated troops
T/F: New LBB w/out symp of ischemia is NOT considered MI.
True
ST segment depression, Symmetric T wave inversions and Q waves are ______
Increased risk for MI.
What abnormalities can conceal ischemia on ECG?
Ventricular hypertrophy, afib, pacing artifacts, BBB.
Anterior wall MI has ST elevations in _____ leads and is an occlusion of the ______
V1,2,3 and 4
LAD
Inferior MI is ST elevation in leads _____ and occlusion of ________
II, III and aVF
Right coronary, left circumflex
Ask about ______ prior to giving nitroglycerin. If used within past ______( or ______ for tadalafil) then nitro is contraindicated.
Phosphodiesterase-5 inhibitors
12hrs
36 for tadalafil
Medication post MI
ASA daily (75-162mg)
Clopidogrel 75mg if ASA contraindicated
BBlocker (metoprolol)
Consider ACE or ARB if pt also has DM, HTN, rLVEF, CKD.
Statin - need LDL <70-100
Use a _____ if BBlocker is contraindicated for symptom relief
Calcium channel blocer (diltiazem or verapamil)
What is isosorbide?
Long acting nitrate
If CP is unrelieved _____ after taking nitro then go to ER
15mins
You can repeat nitro every ____ mins, max is ____ doses in ____ mins.
5
3
15
T/F: endocarditis prophylaxis is recommended for patients with MVP
False. No longer recommended.
Www.mdcalc.com/duke-criteria-infective-endocarditis
Buttaro chart for s/s of CHF
What is the USPSTF rec for AAA screening?
One time screening for those over 65yo who smoke - abdominal ultrasound
AAA >=5cm - _______
AAA 4-4.9 _____
Repair
Watch annually.
What is Homan’s sign?
Associated with DVT.
Discomfort in the calf on forced dorsiflexion of the foot with knee straight.
R ventricular hypertrophy, ischemic heart disease, PE, atrial septal defect, rheumatic heart disease, myocarditis, cardiomyopathy and Brugada (long QT) are all associated with ______ bundle branch block
RBBB
Ischemia, MI, aortic stenosis or regurg, dilated cardiomyopathy and Lyme disease are associated with ______ bundle branch block.
LBBB
Non-pharmacological management of arrhythmias
Tachy?
Identify possible toxin or trigger and eliminate
Ensure adequate hydration, oxygenation and electrolyte balance
Reduce stress
Tachy: caffeine, tobacco, alcohol, stimulants,
4 treatment components of A-fib
- Anticoagulant
- Rate control
- Rhythm control
- Ribs factor modification (OSA, obesity, HTN, DM, alcohol and physical inactivity)
Afib anticoagulation pharmacological management
Factor Xa inhibitor - rivaroxaban, Endo a ban and Apixaban
Warfarin
What HR is the target for “lenient” control for Afib? Strict? Which is better?
<110
60-75
Lenient was noninferior to strict.
Best meds for Afib rate control?
Betablockers and nondihydropyridine CCBs are drug of choice for rate control alone.
CCB should be avoided in patients with EF <______ and use _____ and ______ instead.
40%
BB and digoxin instead.
1st line diagnostic tool for CS (Carotid stenosis = >60% occlusion)
Duplex US.
Amaurosis Fugax (transient Ipsilateral blindness) or Hollenhorst plaques seen on retinal exam are signs of?
Carotid stenosis.
Goal for general statin therapy vs aggressive statin therapy with Carotid stenosis?
General = LDL <100
Aggressive = LDL <70
Goal for HTN
If renal insufficiency or HF?
<140/90
<130/80
Goal for triglycerides?
<200
For a patient with chest pain, ask these questions:
What brings it on? What were you doing when it happens? (Exertion, meals, cold, stress)
What does it feel like? (Pressure, squeeze, burning, stabbing
Radiates? (Jaw, arm, wrist, neck, shoulders, back)
Relief? (Nitro, rest, food?)
Severity (1-10)
Timing (activity, bedtime, meals)
Duration (how long does it last)
Associated symptoms. (SOB, SOB sleeping (how many pillows), sweating, nausea, vomiting, diarrhea, fatigue)
Daily dose of high intensity statin therapy (eg____________) has an expected LDL-C lowering rate of ________.
Daily dose of mod-intensity statin therapy (eg _______________) has an expected LDL-c lowering rate of _____
Daily dose low-intensity statin therapy (eg __________) has expected LDL-c lowering rate of _______
Atorvastatin 40-80mg/rosuvastatin 20-40mg/. >50%
Atorvastatin 10-20/Rosuv 5-10/simvastatin 20-40/pravastatin 40-80/Lovastatin 40/Fluvastatin 40bid/ 30-50%
Simvastatin 10/pravastatin 10-20/lovastatin 20/. Up to 30%
Explain the New York Heart Association Heart Failure functional classification (I-IV)
I = No limitations, ordinary physical activity
II = Slight limitations
III = Marked physical activity limitation (comfortable at rest, but less than ordinary activity leads to fatigue)
IV = inability for any activity without discomfort - symptoms present at rest
ACC/AHA Heart Failure Stages
A - at risk, no structural abnormalities
B - Structural heart disease but no s/s
C - Symptomatic HF
D - advanced disease with marked HF s/s at rest WITH maximal medical therapy
Treating a patient who is stage A (ACC/AHA) - manage HTN w/ ACE or ARB (<130mmHg), tx lipid disorders.
Tx for ACC/AHA stage B HF
ACE (or ARB if ACE not tolerated), B blockers.
Tx for patient stage C HF
Daily weights, Na restriction, diuretic, ACE, ARB or ARNI, Bblocer and aldosterone agonist.
Digoxin, hydralazine and nitrates PRN,
ICDs or pacemakers,
These 4 groups of people should be treated with mod or high intensity statin
Clinical ASCVD risk
LDL-C level of 190 or higher
DM 40-75 with LDL-c 70-189
40-75yo with estimated 10-year risk of ASCVD 7.5% or higher
We want HDL-C levels above _____
60
When would you hear a “splitting of S1 or S2/
Usually in setting of a BBB or ASD
Physiological S3 is normally heard in this patient population and results from:
Children, young adults, pregnant patients
Rapid Early Ventricular Filling.
Low pitch
Pathological S3 or “Ventricular Gallup” is heart with decreased myocardial contractility, HF, volume overload and mitral or tricuspid regurg. Very soft and difficult to hear. Right after S2.
Possible causes of S4 - due to increased resistance to filling of the ventricle.
HTN, CVD, aortic stenosis, pulmonic stenosis or pulmonary HTN. Right before S1
A crescendo-decrescendo systolic ejection murmur is associated with ________
Pulmonic stenosis.
Pansystolic, high-pitched, blowing murmur associated with _________
Mitral regurg
Systolic murmurs associated with :
Aortic/pulmonic stenosis, Hypertrophic cardiomyopathy, mitral/tricuspid regurg and mitral valve prolapse
Diastolic murmurs associated with :
Mitral/tricuspid stenosis, aortic/pulmonic insufficiency/regurg, ventricular/atrial septal defect.
