UW3 (09 CV) Flashcards
Stain Myopathy
- Stop indication? 2
- Restart indication?
- Symptomatic
- Asymptomatic + CK> x10n
• Repeat CK = n + Asymptomatic
- HoloSystolic murmur
- L 3-4 ICS
- Thrill
VSD
Acute PeriCarditis
- Specific PE finding?
- EKG findings?
- Treatment? 2
- Pericardial friction rub (specific)
- Diffuse ST elevation, PR depression
- NSAID + Colchicine (@ virus / idiopathic), Aspirin
STEMI bradycardia
Management? 3
- Atropine + IVF
- Pacing
- PCI
Constrictive Pericarditis
- PE findings? 5
- US findings?
- Treatment? 2
- JVP ↑
- Peripheral edema
- Clear lung
- Ascites
- Pericardial knock
- Pericardial thickening / calcification
- Atrial enlargement
- NSAID
- Pericardiectomy
AAA
• Treatment? 2
• Surgery indication? 2
- Stop smoking
- Aspirin / Statin
- Size > 5.5cm
- Growth > 0.5cm/6m
Cardiac Tamponade
- PE findings? 4
- EKG findings?
- XR findings?
- Echo findings?
- JVD + BP ↓ + Heart sound ↓ + sBP ↓ > 10 @ inspiration
- Low voltage amplitude
- Enlarged cardiac silhouette
- Clear lung
- RA & RV collapse
- IVC plethora
3 different P wave form
Atria > 100 bpm
- Diagnosis?
- Medical treatment?
- MultiFocal Atrial TachyCardia
* Verapamil / Esmolol
CABG indication? 2
- Multivessel
* DM2
Atrial fib
- Target HR?
- Treatment class? 2 each?
• Target HR < 110 bpm
- Metoprolol / Atenolol
- Diltiazem / Verapamil
Coronary vessel distribution
1) Anterior wall
2) Lateral wall
3) Anterior & Lateral
4) RV + inf post LV
1) LAD
2) Circulflex
3) Diagonal
4) RCA
Pulmonary Hypertension
Treatment?
Bosentan / Ambrisentan
HCM
- Initial medical therapy? 2
- ICD indications? 6
1) Beta blocker
2) Verapamil / Disopyramide
1) Cardiac arrest
2) Ventricular tachycardia
3) FH sudden cardiac death
4) Syncope
5) Hypotension
6) LV hypertrophy
Trastuzumab
1) Use?
2) Toxic effects?
1) Treatment @ Her2 breast cancer
2) Reversible cardiotoxicity (LV-EF ↓, CHF symptoms)
STEMI
EKG indications? 5
1) 1mm @ all except V2+V3
2) 1.5mm @ V2+V3 (female)
3) 2mm @ V2+V3 (male > 40y)
4) 2.5mm @ V2+V3 (male < 40y)
5) New LBBB + Symptoms
Aortic Dissection
Management? 4
1) Pain control
2) Esmolol IV
3) + NitroPrusside
4) Surgery
CCB edema
1) Medication cause:
2) Mechanism?
3) Management? 2
1) Cause: Amlodipine / Nifedipine
2) Mechanism: Arteriolar dilation
3) Change to different meds (verapamil) Or add ACE-I
EncoCarditis
• High risk indication? 5
Prophylaxis for:
• Gingival / Respiratory
• GU / GI
• Skin / Muscle / Prosthetic cardiac
- Prosthetic valve
- Prior infective endocarditis
- Valve abnormality @ transplanted heart
- Unrepaired cyanotic congenital heart disease
- Repaired congenital heart disease with residual defect
- Amoxicillin
- Ampicillin
- Vancomycin
Mitral Regurgitation
Surgery indication?
EF < 60
Cocaine OD
1) 2 conditions to r/o? What test?
2) Initial treatment?
3) Medication for chest pain?
4) Medication for HTN?
5) Management for MI?
6) Medication to avoid?
1) MI r/o = EKG & trop
Aortic dissection r/o = CTA / MRA / TEE
2) Benzo + Nitroglycerin
3) CCB @ chest pain
4) Phentolamine (alpha blocker) @ HTN
5) PCI @ MI
6) Avoid beta blocker
TCA OD
- Autonomic symptoms / PE?
- Management?
- Respiratory ↓
- HR ↑ / Arrhythmia
- BP ↓
- Urinary retention
- Flushing
- Pupil dilation
1) O2 / Intubation
2) IVF
3) Activated charcoal
4) HCO3 @
Wide QRS
Ventricular Arrhythmia
5) Mg / Lidocaine
A-fib (treatment)
1) No CAD/HD
2) LVH
3) CAD
4) HF
5) Recurrent / Refractory
1) Flecainide / Propafenone
2) Amiodarone / Dronedarone
3) Sotalol / Dronedarone
4) Amiodarone / Dofetilide
5) RFA
RV MI
1) Medications to avoid? 3
2) Medications to caution? 2
3) Main therapy?
1) Nitrate / Diuretics / Opioids
2) Beta blocker / CCB
3) IVF
HF w/o decomp or hypotension
1) Diuretic med?
2) Vasodilator med?
1) Furosemide
2) Nitroglycerin / Nitroprusside / Nesiritide
Bicuspid Aortic Valve
- XR findings? 3
- Complications? 3
- Follow up? 2
- Balloon Valvuloplasty indication? 4
- Valve replacement indication? 3
- AV calcification
- Aortic enlargement
- Rib notching
- Aneurysm
- EndoCarditis
- Regurgitation / Stenosis
- screen @ family
- FU echo q1-2y
- Symptomatic
- Asymptomatic
- Aortic stenosis
- No significant calcification
- Gradient < 50
- Severe symptoms
- Aortic regurgitation
- LV dysfunction
Acute Limb Ischemia
1) Immediate complication?
2) Treatment? 2
1) Irreversible MyoNecorsis @ 4-6h
2) Heparin / Surgery
Digoxin Toxicity
Synergic meds? 4
- Quinine
- Amiodarone
- Spironolactone
- Verapamil
Hypertension
BP reduction impact? 5
1) Weight
2) DASH diet
3) Exercise
4) Na restriction
5) Alcohol reduction
Varicose Vein
Management? 4
1) Leg elevation
2) Compression stocking (avoid @ PAD)
3) Weight ↓
4) Sclerotherapy (failed treatment 3-6m)
Tachycardia + Palpitation
EKG: Narrow QRS
- Diagnosis?
- Management? 2
• SVT
- Valsalva
- Adenosine
Cardiac risk for these surgery types?
- Aortic
- Major vessel
- Vascular
- Carotid
- Head & Neck
- Abdominal
- Thoracic
- Orthopedic
- Prostate
- Ambulatory
- Endoscope
- Breast
• When to do stress test prior to surgery?
- High cardiac risk surgery
- Intermediate cardiac risk surgery
- Low cardiac risk surgery
- High & Intermediate risk = cardiac eval (stress test)
Unstable angina / NSTEMI
- EKG finding?
- Medical management? 5
• EKG: ST ↓ @ 2 + aVF + V3-V6
1) Aspirin + Clopidogrel / Prasugrel / Ticagrelor
2) Nitrates
3) Beta blocker
4) Statin
5) Heparin / Enoxaparin / Bivalirudin / Fondaparinux
VTE @ post menopausal HRT
Management? 2
1) Stop: HRT
2) Start: SSRI / Escitalopram (symptom treatment)
Cardiogenic Syncope
Types?
1) Exertional syncope / Systolic murmur
2) No prodromal symptom / Cardiomyopathy / Prior MI
3) Prodromal (fatigue / dizziness) / Sinus pause
4) Bifasicular block / ↑ PR + QRS drop
5) No prodromal symptom / QT ↑ / K↓ / Mg ↓
1) Aortic Stenosis / HOCM
2) Ventricular tachycardia
3) Sick sinus
4) AV block
5) Torsades
Mechanical Valve
- Targe INR 2-3? 2
- Target INR 2.5-3.5? 5
- AV valve replacement
- No other risk Mitral valve replacement
- fib
- EF < 30%
- Prior VTE
- HyperCoag state
Bi-Vent
Pacing indication? 3
- EF < 25%
- HF symptoms
- QRS > 150ms + LBBB
Peri-Op med
Complications?
1) Beta blocker
2) Alpha 2 blocker
3) CCB
4) Statin
5) Diuretics
6) ACE-I
7) SERM (Raloxifene, Tamoxifen)
1) Hypertension @ withdrawal
2) Hypertension @ withdrawal
3) ↑ Bleed
4) Myopathy
5) BP ↓ (stop @ AM surgery)
6) BP ↓ / Continue @ HF (stop @ PM before surgery)
7) Stop for 4 weeks
Rheumatic Heart Disease
1) PE finding? Consistent with?
2) Complication at pregnancy?
1) Low pitch, Diastolic murmur, Loud S1 = mitral stenosis
2) Atrial fibrillation
Aortic Coarctation
Xray finding? 2
- Rib notch
* 3 sign @ aortic narrowing
Warfarin interaction
- Increases warfarin? 5
- Decreases warfarin?
- No changes to warfarin effect?
- Metronidazole
- Quinine
- Antifungal – azoles
- Amiodarone
- Acetaminophen
- Rifampin
- Phenytoin
- OCP
- Green leaf veggie
- NSAID
- Clopidogrel
- Ginko
Aortic Stenosis
- Severe indication? 3
- Replacement indication? 3
- Velocity > 4m/s
- Press Grad > 40mmHg
- Valve opening < 1cm2
- Severe AS
- symptom
- EF < 50%
- Future cardiac surgery
Nitroprusside
1) Mechanism?
2) Indication? 2
3) Complication? S/s?
4) Increased risk?
5) Management?
1) Vasodilation @ artery & vein
2) Aortic dissection / Hypertensive emergency
3) Cyanide toxicity = flushing, cyanosis / headache / AMS seizure / Arrhythmia / metabolic acidosis
4) Nitroprusside @ kidney problem
5) ↓ infusion rate / Short term use
Stop use
Sodium ThioSulfate
