UW Flashcards
acute coronary syndrome induced by cocaine - management
benzodiazepines (for anxiety and BP), aspiri, nitroglyc and CCB, no fibrinolytics (risk for intracranial hemorr), immediate cardiac catheterization with reperdusion when indicated(ST elevation or persistent)
indications for endarterctomy
- sympromatic with stenosis more than 70%
- asymptomatic more than 80%
(symptomatic means TIA or stroke in the distribution)
all treated medically with statin and antiplatelet
when to check for 2ry hypertension
refractory hypertension after use of 3 different drugs (of different classes), and in non-obese, nonblack patients under 30
causes of high outputHF
- severe asthma
- beriberi
- paget
- hyperthyroidism
- AV fistulas
AF is most commonly caused by ectopic focin within the (vs the atrial flatter)
pulmonary veins (and atrial flutter around Tricuspid annulus)
drugs that can cause bronchocostriction in patients with asthma
- b-blockers
2. aspirin
Cardiac index
cardiac output / body surface
initial management of GERD
- fewer than 2 episodes of symptoms per week: lifestyle changes and antihistamines as needed
- patients with more frequent or severe symptoms, evidence of erosive esophagitis, or laryngopharyngeal involvement should be managed with an 8-week course of a PPI
survivors of Hodgkin lympho,a are at increased risk for cardiac disease, which can preesnt …. (when) due to
- after 10-20 years or more
- due to mediastinal irradiation or anthracyclines
β-blockers intoxication - treatment
- IV fluids and atropine are the first line options
- if profound or refractory hypotension –> glucagon
Most suggestive test to diagnose myxoma
TEE (but TTE is usually adequate)
atheroembolism (cholesterol embolism) is a complications of cardiac catheterization and other vascular procedures - manifestations / treatment
- cutaneous findings: blue toe syndrome, livedo reticularis
- cerebral or intestinal ischemia
- acute kidney injury
- Hollenhorst plaques (retinal findings)
IT CAN BE IMMEDIATE OR DELAYED (30days or more)
treatment: statin
exertional syncope - DDX
- ventricular arrhythmias
2. outflow obstruction (AS, HOCM) `
developing AV block in a patient with endocarditis should raise the suspicion of
perivalvular abscess extending into the conduction tissue
increased risk with aortic valve endocarditis and IV drugs
persistent ST elevation post MI –>
ventricular aneurysm
MCC of sudden cardiac arrest in the immediate post-infraction period in patients with acute MI
Reentrant ventricular arrhythmias (eg. ventricular fibrillation)
hypertensive emergencies - target (if fast decreasing?)
target: lowering 10-20% in the first hour and by another 5-15% in the next 23 hours
excessive drop can cause cerebral iscemia (mental status + seizures)
cyanide toxicity - manifestations
mental status + seizures + lactic acid
HOCM - ECG
LV hypertrofy: tall R in aVL + Depp S in V3 (Cornell criteria)
2. Repolarization changes in anterolateral leads (I, aVL, V4, V5, V6)
difference between uremic pericarditis vs other type of pericarditisi
uremic doesn’t have diffused ST elevation because inflammation does not affect the myocardium
describe a benign murmur
midsystolic in otherwise young, asyymptomatic adults –> no further evaluation
Diastolic and continious murmurs detected in a routine examination –>
usually due to underlying pathologic case –> TTE
cardiac cathetirization in tamponade
elevated and equilibrium diastolic pressures
puslus paradoxus - definition / ddx
fall in SBP more than 10 during inspiration
frequent in cardiac tamponade but can also occur in conditions without pericardial effusion such as severe asthma or COPD
fibromuscular dysplasia?
systemic noninflammatory syndrome that affects renal + internal carotid arteries–> arterial stenosis, aneurysms, dissections
post-infraction pericarditis - treatment
supportive
avoid anti-inflammatory (NSAID, steroids) due t impairment of collagen deposition and possible increased risk of serious post-MI complications
a clinical differences in a post-MI papillary rapture vs VSD
VSD has a palpable thrill
tension pneumothorax - mechanism of shoch
obstruction of vena cava –> decreased venous return
patients with WPW should be treated with
cardioversion (if unstable) or antiarrhythymics (if stable) such as procainamide
after the diagnosis of hypertension - tests?
- urinaysis for occult hematuria + urine protein/creatinine ratio
- chemistry panel
- lipid profile
- baseline electrocardiogram
the strongest predictor of AAA expansion and rupture are
- large aneurysm diameter
- rapid rate of expansion
- current cigarette smoking
AAA - current indications for endovascular repair include
- aneurysm size more than 5.5
- more than 0.5 cm in 6 moths or 1 cm per year expansion
- symptoms
all patients with new AF should have
thyroid function test
constrictive pericarditis manifestations
RHF
initial treatment of Pulmonary hypertension due to problem in LV
loop diuretics and ACEi
torsades de points - treatment
stable: magnesium sulfate
unstable: defibrillation
Sick sinus syndrome
due to degeneration and/or fibrosis of the SA node and surrounding atrial myocardium
- fatigue, lightheartedness, palpitations, presencope, syncope
ecg: sinus pauses, /arrest, bradycardia, SA exit block, alternating bradycardia and atrial tachyarrhythmias
inferior wall MI - when put temporary pacemaker
transient bradyxardia or AV block
Tachycardia-mediated cardiomyopathy
- AF, atrial flatter, ventricular tachycardia, etc
- chronic tachycardia can cause structural changes like LV dilation and Myocardial dysfunction
isolated systolic hypertension in elederly patients
by increased stiffness or decreased elasticity of the arterial wall
(similar management to that of 1ry hypertension)
the major cause of morbidity and mortality in people with PAD
MI
clinical mainifestation of SEVERE aortic stenosis
- soft and single S2
- pulsus purvus et turdus
- mid-to-late peaking systolic murmur (if early: not severe)
PAD - when cilostazol
patients with symptoms despite antiplatelets and adequate supervised exercise programs
the strongest predictor of stent thrombosis after intracoronary stent implantation
premature discontinuation of antiplatelet therapy
AAA - screening
active or former smokers 65-75 with 1 time U/S
acute limp arterial occlusion - next step
heparin
treatment of hypertension in patients with PKD
ACEi
which arrhythia is most specific for Digitalis toxicity
Atrial tachycardia with AV block
current guidelines for PCI using
within 90 mins in the hospital or 120 if must transferred to other hospital
heart failure - hyponatremia
indication of severe HF
acute AF due to hyperthyroidism - best initial therapy
b-blockers
a unique symptom of coartraction
epistaxis
initial treatment of chronic venous insufficiency
conservative measures with leg elevation, exercise and compression therapy
special characteristic of the murmur due to congenital AS
- right but in the first intercostal (higher than normal)
- palpable thrill
- differential BP in the upper extremities
- unequal carotid pulses
- may be carotid artery stenosis as associated anomaly
- angina during exercise
indications for using sychronised cardioversion (direct current cardioversion)
all patients WITH a pulse who have persistent tachyarrhythmia (narrow or wide complex) causing clinical or hemodytnamic instability)
most important predisposing factor for thoracic dissection
HTN (not the atherosclerosis)
manifestation of sarcoidosis in heart
- complete AV block (MC)
- restrictive cardiomyopathy (early)
dilated cardiomyopathy (late) - valvular dysfunction
- HF
- sudden cardiac death due to AV block or ventricular arrhythmia
treatment of symptomatic sinus bradycardia
initially with IV atropine (0.5 mg every 3-5 mins, max: 3mg) –> if inadequate response –> iv epinephrine or dopamine or transcuteneous pacing –> expert consultation or transvenous pacing
the most effective non-pharmacologic way to decrease BP in overweight people
Weight loss (better than exercise, smoking, alcohol etc)
increased incidence of orthostatic hypertension in elderly
progressively decreasing baroreeptor sensitivity and defects in the myocardial response to this reflex
(other: arterial stiffness, decreeased norepinephrine content of sympathetic nerve endigs, reduced sensitivity to of the mocardium to sympathetic stimulation)
complete AV block how are the QRS - wide or narrow
they can be either wide or narrow
what to suspect in patients presenting with RHF following implantable pacemaker or cardioverter defibrillator placement
transvenous lead placement through the tricuspid valve can cause severe TR due to direct valve leaflet damage or inadequate leaflet coaptation
situational syncope is a form of reflex or neurally mediated syncope associated with specific triggers (eg. cough, micturation. These triggers cause n alternation in the autonomic response and can precipitate a predominant
cardioihnibitory, vasodepressor or mixed response
squatting - effects on afterload and preload
increases both
cocaine complications
- MI 2. aortic dissection 3. intracranial hemorrhage
aortic stenosis heart failure -EF
normal
cor pulmonale - diagnostic tests
ECG: partial or complete RBBB, right axis
echo: pulm hypertension, dilated RV, TR
Right heart catheterization: gold standarrd
viral myocarditis - echo / biopsy / mri / ecg
echo: 4 chamber dilation
ecg: non-specific
biopsy: lymphocytic infiltration
mri: late enchancement of the epicardium
viral myocarditis - treatment
- medication (diuretics, ACEi, b blockers
- temporary ventricular assist device if needed
- heart transplant if no recovery
Alcohol withdrawal syndrome - manifestations and time
6-24 h: anxiety insomniia, tremor, palpitations, GI
12-48: single or multiple generalized tonic-clonic
12-48: hallucinations (visual, auditorym tactile)
48-96: confusion, tachycarda, hypertension, fever
diagnostic approach of aortic dissection
chest x-ray or ECG
- suggests something other –> evaluate + treat
- suggests dissection –> normal serum creatinine + no contrast allergy?
no –> TEE (and in instability)
yes: TEE or chest CT with contrast, MRI (if non-emergency) (has to be stable)
neurological symptoms of amiodarone
- peripheral neuropathy
2. optic neuropathy
maniodarone cardiac SE
sinus bradycardia, heart block
risk of proarrhythmias, QT prolongation
VSD, vs free wall rupture vs aneurysm vs papillary muscle rupture - regarding time + artery
papillary muscle: acute or 3-5d (RCA)
VSD: acute or 3-5D (RCA or LAD)
free wall: 5-14d (LAD)
aneyrysm: up to several months (LAD)
normal MvO2 and variations in shocks
normal: 60-80%
hypovolemic: decreased
cardiogenic: decreased
septic: INCREASED
CO variations in shoocks
ypovolemic: decreased
cardiogenic: highly decreaesd
septic: increased
conditions associated with AF
cardiac: hypertensive heart disease (MC), CAD etc
pulmonary: pulm embolsim, COPD etc
other: obesity, endocrine, alcohol, drugs
MC cardiac cause for AF
hypertensive heart disease
S4 - normal in
healthy older adults
Mobitz 1 vs 2 - vagal maneuvers
worsen type 1
improves type 2
Mobitz 1 vs 2 - exersise or atropine
Improves type 1
Worsens type 2
types of amyloidosis
AL: clonal plasma cells
AA: chronic inflammation
ATTR: age or familial related
AB2M: hemodialysis
amiodarone vs digoxin
amidarone can increase serum levels of digoxin –> toxicity
decrease digoxin dose 25-50% when start amiodarone
digoxin SE are divided to
acute: GI
chronic: neurologic and visual (less GI)
combination of nitrates hydralazine in patients with LV systolic dysfunction - survival
increases survival in african american
MCC of isolated aortic regurgitation in young adults in developed countries
bicuspid valve
early decrescendo diastolic murmur, best heard with the diaphragm of the stethoscope along the left sternal border at the the 3rd and 4th intercostal spaces while the patient is sitting u, leaning forward, and holding breath
prinzmental angina - treatment (preventive and abortive)
preventive: CCBs
abortive: sublingual nitroglycerin
B blockers can worsen it
AAA - study of choice for (a) diagnosis and (b) follow up
U/S
pulsus bisferines (or biphasic pulse)?
2 strong systolic peaks of the aortic pulse from LV ejection sepetated by midsystolic click
palpable in patients with significant AR, HOCM, large PDA
antiarrhythmis that causes long QT
III
I (esp IC in fast HR)
Pulmonic valve stenosis? / treatment
- congenital defect, asymptomatic until adulthood, crescendo-decresento murmur
- Percutaneous balloon valvulotoy (preferred)
surgical repair in some cases
exercise ECG - best for / not for
best for patients able to reach HR
Not for LBBB, pacemaker, unable to reach HR
Pharmacologic stress test with …. (medication and mechanism of action)
adenosine or dipyridamole:
nonselective adenosine agonist / dilates coronary arteries without altering HR or BP
Pharmacologic stress test - best for / not for
best for LBBB, pacemaker, unable to reach HR
not for reactive airway disease, patients on dipyrodamole or theophylline
stress echo - mechanism of action of drug
dobutamine: b1 agonist –> increase HR +/- bp
stress echo - best for / not for
best for reactive airway disease, unable to reach HR
not for tachyarrhythmias
LV aneurysm - artery?
LAD
