UWORLD Cardio Flashcards
New-onset A fib in hemodynamically stable patient emergency surgery
IV Bb or ND-CCB
Goal: 100-110/MIn
Anticoagulant not needed becuase risk of Afib related thromboembolic even in surgery is low
CHA2D-VAS2
Thromboembolic risk
C: CHF
H: HTN
A2: ≥75yo (2 points)
D: DM
V: Vascular disease
A: 65-74yo
S2: Stroke or TIA (2 points)
CHADS-VASc Score
Max: 9
Score =
1 moderate risk- possible anticoag
≥ 2 high- oral anticoagulant
Mechanical heart valve antithrombotic TX
Life long Warfarin (ONLY). Evidence does not support other anti-coag or anti-platelet.
Add LDaspirin if severe CAD
Therapeutic range for warfarin in pt with mechanical heart valves
Aortic Valve not risks= 2-3
Mirtal Valve or Aortic with risks= 2.5-3.5
Goal of using diuretics in acute decompensated heart failure
Pulmonary Edema results from ^ PCWP due to ^ cardia preload.
Diuretics decrease cardiac preload.
Decompensated Heart failure and Beta blockers
Avoid. Blockade of sympathetic activity inhibits compensatory mechanisms that maintain CO and organ perfusion.
Use only if cause is A-Fib
Heart failure exacerbation and inotropic agents (dobutamine, milrinone)
Improving contractility only in patents with cardiogenic shock
CHF without cardiogenic shock do not administer: ^ hypotension, arrhythmia, death
Clinical features of acute pericarditis
pleuritic chest pain (worsens with deep breaths, decreases with sitting) ± fever
pericardial friction rub (highly specific)
ECG: diffuse ST segment elevation & PR segment depression
Peri- infarction pericarditis
acute pericarditis <4 days post MI.
reperfusion >3 hrs onset sxs increases risk.
MI complication ventricular aneurysm
ECG: persistent ST elevation with deep Q waves same leadsa
Progressive left ventricular enlargement: HF, refractory anginia, ventricular arrhythmia, mural thrombus
peri-infarction pericarditis TX
usually send limited.
High does aspirin (650mg Tid) for symptomatic relief
Avoid other NSAIDs and glucocorticoids, impair myocardial healing
VIdopathic or viral acute pericarditis Tx
naproxen with colchicine
Discontinue statin therapy post MI?
elevated CK with myopathy.
asymptomatic patient with a CK>10 times normal.
Medications that increase warfarin effect ( ^ INR)
Metronidazole, quinolones
Azoles, amiodarone
Acetaminophen
Medications that decrease warfarin effect (decrease INR)
Rifampin, phenytoin, St. johns wart
OCP
Green leafy veggies
Aldosterone antagonists indicated for what patient populations?
NYHA class II, III, IV and LVEF < 35%
STEMI with LVEF <40 and wither Heart failure sxs or DM
Optimal therapy for Heart Failure with reduced EF (HFrEF)
Initial: ACE/ ARB, BB, Diuretic
Step 2: Aldosterone antagonist
step 3: SGLT-2 inhibitor
Avoid aldosterone antagonist in PT with
underlying Hyper K
advance renal failure
New York Heart Association (NYHA) heart failure classification
1- no symptomatic limits
2-slight limits with physical activity
3- marked limits
4- inability to perform physical activity
Pathophysiology of Compartment Syndrome
Increases pressure within a facial compartment that compromises blood flow.
Typically due to trama.
Can also occur with ischemia & reperfusion (^radical oxygen, interstitial edema and possible intracellular swelling)
Diagnosis of acute compartment
Based clinical findings
delta pressure (diastolic- compartment pressure) <30 indicates acute compartment syndrome
Continue or discontinue aspirin for cardiac cath
Aspirin is safe to continue during cath. Discontinued aspirin the patients risk for myocardial infarction
MS and pregnancy
Risk for atrial fibrillation and pulmonary edema due to physiologic hypervolemia and increased left atrial and pulmonary venous pressure.
MS ECG
- P mitrale ( broad notched waves)
-Atrial tachyarrythmias
-RVH (tall R waves in V1 &V2)
Noonan Syndrome
AD. short stature, facial dysmorphism, and a spectrum of congenital heart defects.
cardiac involvement 90%- pulmonic stenosis, ASD, hypertrophic cardiomyopathy
aortic dissection and nitro
mono therapy contraindicated. can add to BB
Mobitz II ECG
normal PR…. dropped QRS….
ecg is diagnostic showing intermittent nonconducted P waves and a regular PR interval;
mangement of Mobtiz 2
high rate of progression to 3rd degree (complete block).
treat reversible cause or permanent pacemaker
MCC of sudden death in steering wheel injusry
Aortic injury: shearing force along the aortic arch where the aorta is firmly attached. It is usually observed in the area of the ligamentum arteriosum, the aortic root, and the diaphragmatic hiatus.
can cardiac contussion caue suden death?
yes but not common.
Cardiac contusion produces sudden death when the injury involves the cardiac chambers or vessels.
acute limb ischemia sxs
pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis
management of acut limb ischemia
All patients with clinical signs and symptoms of ALI should receive anticoagulation (ie, intravenous heparin bolus followed by continuous heparin infusion) immediately while awaiting further i
Anticoagulation prevents thrombus propagation and formation of new distal thrombus due to stasis.
Risk for irreversible myonecrosis within 4–6 hours and should have emergency surgical revascularization.
Acute mirtal valve regurgitation
Rapid onset of pulmonary edema
Acute LV failure (also causing acute RV failure)
Hypotension, cardiogenic shock
Jugular venous distension, pulmonary crackles
Hyperdynamic cardiac impulse
Apical systolic murmur (often absent)
Diaphoresis, cool extremities (if shock is present)
