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330 Cards in this Set
- Front
- Back
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what group of pt needs prophylaxis for IE
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prosthetic valves
previous IE Congenital heart dz cardiac transpl with valvulopathy |
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WHAT PROCEDURES NEED ABX PROPHYLAXIS
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DENTAL PROCEDURES, RESPIRATORY TRACT, INFECTED SKIN, OR MSK STRUCTURES
NOT INDICATED FOR GI OR GU PROCEDURES |
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When do you order TTE
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Systolic murmur >3/6
or diastolic murmur |
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Antibiotics for prophylaxis for IE
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amoxicillin
Ampicillin IV/IM |
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What antibiotics to use if allergic to PCN or Ampicillin
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Keflex
Ceftriaxone IV Clindamycin PO or IV |
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Causes of Constrictive pericarditis
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viral
irradiation prior open heart surgery TB Neoplasm |
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What are Sx of Constrictive pericardtis
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Ascites
R sided failure Peripheral edema DOE Fatigue |
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Name physical exam findings of Constrictive pericarditis
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Inspiratory distention of neck veins
rapid X and Y desends pericardial knock |
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How do you diagnose constrictive pericarditis
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CT or MRI
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What do you expect on CT with constrictive pericarditis
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Thickened pericardium
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How do you treat constrictive pericarditis
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Thoracotomy to remove pericardium
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What rate is the atrial activity in a flutter
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240-320
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What is the ventricular rate in a flutter
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150 bpm
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What can you do to slow heart rate to reveal aflutter
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carotid massage
Adenosine |
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What can you do to slow heart rate to reveal aflutter
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carotid massage
Adenosine |
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What pharmacological meds can be used to control A flutter rate
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BB
CCB Digoxin |
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What is the long term tx for A flutter
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radiofrequency ablation success rate of 90%
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What are two EP options for A flutter
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1. radiofrequency ablation-Preffered
2. AV node ablation and pacemaker placement |
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Is Heparin indicated for STEMI
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Heparin is used to treat STEMI and should be administered 24 hr post thrombolytic therapy
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How does Heparin help in STEMI
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Prevents recurrent infarction
DVT Intracardiac thrombus formation |
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What drug can be given in STEMI if pt have allergy to ASA
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Plavix
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What is the role of Nitroglycerin in STEMI
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persistent Ischemia
Pulmonary edema uncontrolled HTN |
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In what type of MI that nitroglycerin is contraindicated
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Right ventricular infarction
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Name a IV thrombolytic
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tenecteplase
reteplase |
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In STEMI what drugs are used after intial IV thrombolytics
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Heparin gtt
TPA |
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What are the indications for PCI after thrombolytics
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spontaneous or inducible ischemia
Cradiogenic shock Pulmonary edema EF <40% and serious arrhythmias |
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What are the benefits for rotuine PCI/Angiography after thrombolytics
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None
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When is reperfusion therapy indicated in STEMI
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presenting within 12 hours of onset of pain
1mm ST elevation new LBBB ECG of a true posterior MI in the absence of ST elevation |
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What group of pts PCI is preferred over fibrinolytics even if transfer takes more than 2 hrs
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1. Contraindication to fibrinolytics
2. persistent ST elevation after 12 hr 3. prior CABG 4. Pt in cardiogenic shock |
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What are sx of pericarditis
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CP relieved with sitting up
low grade fever malaise |
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EKG findings of pericarditis
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diffuse concave ST elevation
depressed PR segment |
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What are the causes of percarditis
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viral pericarditis
idiopathic pericarditis autoimmune Collagen vascular disease radiation neoplasm Uremia TB |
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What type of neoplasm are associated with pericarditis
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Hodgkins lymphoma
Leukemia Lymphoma Breast Thyroid Lung |
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Signs of Temponade
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Low BP
Quite heart sounds Tachycardia elevated JVP RV collapse during diastole |
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What are the causes of cardiogenic shock after MI
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extensive LV dysfunction
Right ventricular infarct mechanical complication of MI |
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How do you diagnose RV infarct after MI
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Right sided failure
right side EKG V4R ST elevation |
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How do you treat RV infarct after MI
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IVF
Dobutamine Cardiac cath |
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In what group of pts CABG improves survival
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Left main coronary disease
3 vessel and moderately depressed LV function 3 vessel dz and severe sx of ischemia multi vessel disease with involvement of proximal LAD |
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With PTCA what group of pt have increased risk
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emergency procedure
elderly pt pt with severely reduced LV function ACS Diffuse coronary disease |
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What is the major problem with PTCA
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Restenosis
occurs in 30-40 % cases after 6 months |
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What is the risk associated with DES
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Stent thrombosis
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What is the outcome of PCI for chronic stable angina
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clearly relieves sx
Does not reduce the risk of subsequent MI or Death |
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How long should ASA should continue after PCI with DES
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FOREVER
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How long Plavix should continue after bare metal stent
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1 month
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How long Plavix should continue after DES
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3 mos to one year
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EKG of AVNRT
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150-250 BPM
regular rhythm narrow QRS P waves buried waves in QRS |
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How can you terminate AVNRT
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Carotid massage
Adenosine |
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What is the best long term treatment for AVNRT
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Catheter ablation
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What maneuvers can increase right sided sounds
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Inspiration
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What maneuver can increase venous return and increase TS, PR, PS
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Inspiration
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What are the effects of Valsalva
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increases intrathoracic pressure
inhibits venous return decrease preload |
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What murmurs increase in intensity with Valsalva
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HOCM
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What murmurs decrease with valsalva
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Almost all
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What does squatting do
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increases peripheral resisitance
increase venous return |
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What murmur decrease in intesity with valsalva
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Aortic stenosis
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what are the predisposing factors for aortic dissection
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advanced age
Connective tissue disorder Aortitis-takayasu, GCA 3rd trimester pregnancy Trauma-blunt, IABP, cardiac, aortic surgery male HTN Marfans congenital aortic abnormalities |
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What to do when AAA is >5.0 cm
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surveillance in 3 months vs surgery
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what are some clinical features of aortic dissection
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sudden onset of ant chest, back or abdomen
HTN pulse defecits neurological changes |
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How can dissection be diagnosed
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ECHO
CT MRI Aortography |
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When is emergent surgery needed for aortic dissection
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proximal dissection
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What pharmacological treatment should begin after aortic dissection is suspected
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B Blocker
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what coronary artery is involved with aortic dissection
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RCA which leads to inferior MI
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how long do pt with secundum atrial septal defect live
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often survive to adulthood and may asx
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what arrhythmia is seen in secundum atrial defect
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a fib start around age 50
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why do we check for ECHO in CVA pt
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look for atrial septal defect may explain paradoxical embolism
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what are physical exam findings of secundum ASD
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FIXED SPLITTING S2
SEM in pul artery |
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where is the lesion in secundum ASD
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fossa ovalis
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what do you see on EKG for ASD secundum
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RBBB
RAD RS---RBBB, RAD---Secundum |
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where is the lesion in sinus venosus in ASD
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Vena cava with anomalous PV where PV eneters right atrium instead of left atrium
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where is the lesion in primum ASD
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lower part of septum where cleft MV and causes MR
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what EKG findings do you see with primum ASD
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RBBB
LAD 1st degree AV block LAE *** |
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what chamber of heart is enlarged in primum ASD
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LA
causes MR |
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what type of ASD is seen in Downs syndrome
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Primum ASD
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what are absolute contraindications to fibrinolytics in STEMI
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any prior ICH
Known structural cerebral vascular lesion ischemic stroke within 3 months suspected Aortic dissection closed head or facial trauma within 3 months |
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Constrictive percarditis
- What happens to LV size - What happens to LV pressure during insp - what happens to RV and LV pressure |
- ECHO doesn't show LVH
- drop in LV filling during inspiration - Equalized LV and RV diastolic pressure |
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Restrictive pericarditis
- What happens to LV size - What happens to LV pressure during insp - what happens to RV and LV pressure |
- ECHO shows LVH
- No drop in LV filling during inspiration - LV and RV diastolic pressure not equal |
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What are the causes of Aortic regurgitation
|
congenital bicuspid valve
Rheumatic fever Endocarditis Degenrative aortic valve Seronegative artritis Ankylosing spondylitis Rheumatoid arthritis Syphilis |
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What are sx of acute aortic regurgitation
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pulmonary edema
Shock Chest pain- w/ aortic dissection |
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What are sx of chronic aortic regurgitation
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fatigue
dyspnea palpatations exertional angina |
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Physical findings of Aortic regurgitation
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Bounding, rapidly collapsing pulse
diastolic decresendo murmur S2 may be split |
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What is the relationship b/w duration and severity of murmur of aortic regurgitation
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shorter the murmur more severe the regurgitation
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What is the Tx for acute aortic regurgitation
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SURGERY
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What meds can be used as a bridge to operation
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Nitroprusside to reduce afterload
inotropes to augment cardiac output |
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What is the role of IABP in Aortic regurgitation
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CONTRAINDICATED
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How can pts with chronic AI remain asx
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AI causes pressure and volume overload on LV
LV dilates and increases compliance |
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What is the medical mgmt of Chronic AI
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ACE-I
Nifedipine |
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How do ACE-I and Nifedipine delay operation for AI
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They help delay left ventricular dilatation
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What to do when Sx occur due to AI
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Surgery
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What are some guidelines for surgery for AI
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Systolic dimension of LV: 55mm
Diastolic dimension of LV: 75mm EF less the 50% |
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When to offer surgery to asymptomatic pt with AI
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1. If resting LV systolic dysfunction
2.progressive diastolic dysfunction 3. rapidly progressive LV dilatation |
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Coarctation is most frequently associated with kind of valve
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Bicuspid valve
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Coarctation of aorta
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Turner syndrome
Aneurysm of Circle of Willis Aortic disection Bicuspid aortic valve |
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5 major complication of Coarctation of aorta
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1. Cardiac failure
2. Aortic valve disease 3. Aortic rupture or dissection 4. endarteritis 5. Circle of willis aneurysm rupture |
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How do pt present with coarctation
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HTN
Pain/Fatigue in legs on exercise may present with claudication |
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Physical findings of coarctation of aorta
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palpable brachial pulse
weak/delayed femoral pulse difference in systolic pressure b/w UE and LE |
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What does CXR shows with coarctation
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rib notching
"3" configuration of aortic knob |
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Treatment for coarctation
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surgery
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3 anatomical abnormalities with MR
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1. leaflet
2. tensor apparatus 3. alteration in myocardium |
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what may lead to chronic leaflet problem in MR
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rheumatic disease
MVP Annular calcification Connective tissue disorder Congenital cleft like in ASD Drug related |
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What may lead to acute problem in MV leaflet which can cause MR
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IE
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What may cause acute problems in tensor apparatus which lead to MR
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MI
papillary muscle rupture Rupture of chordae |
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What may cause chronic problems with myocardium that lead to MR
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Ischemia
Dilated cardiomyopathy HCM |
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What are the most common causes of MR
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MVP
Myxomatous degenration ischemia IE |
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What are chronic sx of MR
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Volume overload
Reduced afterload Fatigue Dyspnea Pulmonary edema |
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What you may find on EKG with pt with MR
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Atrial Fib
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What are physical findings of MR
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S1 is usually not heard
Holosystolic murmur S2 is widely split |
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How should asymptomatic pt with MR with normal EF be treated
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Observation
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Pt with sx of MR and severe MR what is the correct treatment
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Surgery
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What are the indication for surgery in asx pt with MR
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EF < 60%
LVED dimension > 45mm |
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What are the indication for surgery in asx pt with MR
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EF < 60%
LVED dimension > 45mm |
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What meds may be used in MR to decrease afterlaod
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ACE-I
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What meds may be used in pt with MR to decrease preload
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Diuretics
Nitrates |
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What imaging modality can be ordered in men >65 who have smoked to screen for AAA
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U/S
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symptomatic without rupture AAA
complaint |
Abdominal pain
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Triad of AAA rupture
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Abdominal pain
Hypotension tender abd mass |
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Name some less common presentation of AAA rupture
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Obstructive uropathy
GI bleed due to rupture in GI High output cardiac failure due to aortocaval fistula DIC |
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How can AAA be diagnosed
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U/S
CT MRI MRA |
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What is the medical mgmt of AAA
|
B Blocker
D/C Smoking treatment of coronary and carotid dz |
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how often should AAA 5cm should be monitored
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every 3 months
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What should be the mgmt in good risk pts AAA 5cm
|
elective surgery
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Sx of Inflammatory AAA
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back pain
weight loss elevated ESR |
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Treatment of inflammatory AAA
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Surgical resection regardless of size
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large a waves on atrial pressure tracing
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tricuspid stenosis
RV hypertrophy Pulmonary HTN |
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Cannon wave
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atria contracting intermittently against a closed AV valve- AV dissociation
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Rapid x and y descent
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Constrictive pericarditis
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Kussmaul sign
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pericardial temponade
constrictive pericardtis |
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What is kussmaul sign
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paradoxical increase in venous pressure-- i.e. JVP rises with inspiration.
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Aortic pulse parvus and tardus
|
aortic stenosis
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pulsus paradoxus
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exaggerated inspiratory decrease >10mmhg in pulse pressure- Temponade
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Pulsus alternans
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severe LV dysfunction
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Opening snap
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Mitral stenosis
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Name 3 different type that may cause AS
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1. Congenital bicuspid
2. Degenrative aortic valve disease 3. Rheumatic |
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Describe the AS mumur in bicuspid valve
|
SEM
Ejection click before the murmur Closer to S1 more severe AS Paradoxical split of S2 in severe AS |
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In young pt with AS due to bicuspid vlave what needs to be ordered next
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U/S or CT to r/o coarctation of aorta
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What happens to A2 in degenerative AS
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when calcification in severe A2 is inaudible
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Name sx of Aortic stenosis
|
DOE
Syncope Angina Sudden cardiac death |
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Name PEX findings of AS
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1. Parvus and tardus- small/delayed
2. SEM becomes louder with inc severity 3. A2 is gone, delayed with worsening AS |
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What do you find on EKG with pt with AS
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LBBB
LVH |
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How do you tell AS apart from HCM
|
valsalva- inc mumrmur with HCM
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In severe AS what is teh doppler gradient and vlave area
|
40 mm Hg
1.0 cm2 |
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With onset of sx of CHF what is the survival with AS
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1 year
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Treatment for AS
|
Surgery
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Most common valvular heart disease
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MVP
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What septal defect MVP is associated with
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ASD Secundum
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Midsystolic click
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MVP
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What maneuver may cause MVP murmur to appear closer to S1
|
Squatting-increases LVEDV
|
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Treatment for MVP in asx pts
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Reassurance
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Treatment for pts with recurrent palpatations with MVP
|
B Blocker
CCB |
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How often asx pt with MVP need to be followed
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every 3-5 years
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What indications for surgery for MVP
|
If MR is present same indication as for severe MR
|
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What is the cause for Tricuspid stenosis
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Always rheumatic
|
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What is the murmur of VSD
|
long holosystolic murmur usually with a thrill
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What is the complication of VSD
|
Eisenmenger syndrome i.e pulmonary HTN
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Is prophylactic abx needed for IE for VSD
|
Yes
|
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What type of septal defect maternal rubella is associated with
|
patent ductus arteriosus
|
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Machinery murmur @ 2nd ICS
|
patent dustus arteriosus
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Is prophylaxis needed for IE for PDA
|
Yes
|
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Complication of PDA
|
Pulmonary HTN
|
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What are the causes of Eisenmenger Syndrome
|
Large VSD or PDA
|
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What is Eisenmenger syndrome
|
L->R shunt usually VSD reverses and becomes R->L shunt
Pulm HTN takes effect |
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Common presentation of eisenmenger syndrome
|
exercise induced syncope
arrhythmia Hemoptysis Stroke Cyanosis Erythrocytosis |
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Noonan Syndrome
|
Pulmonary valve stenosis
|
|
|
Prominent A wave in JVP
Ejection Click softer with inspiration |
Pulmonary stenosis
|
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Treatment for pulmonary stenosis
|
Baloon valvuloplasty
|
|
|
Maternal lithium ingestion
|
Ebstein anomaly
|
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Ebstein anomaly is associated with
|
ASD secundum
WPW syndrome |
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Cardiac conditions absolute contraindicated in pregnancy
|
1. Marfan- risk of aortic dissection
2. Eisenmenger syndrome 3. Primary pul HTN 4. Sx severe AS 5. Sx sever MS 6. Sx dilated cardiomyopathy |
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Can cardioversion be performed for afib in pregnancy
|
Yes
|
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What cardiac procedures may be performed in pregnant patients
|
1. Percutaneous aortic valvuloplasty
2. Percutaneous Mitral valvuloplasty 3. Percutaneous pulmonary valvuloplasty |
|
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What drugs are ok to give during pregnancy
|
quinidine procainamide B blocker Verapamil |
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Drugs to avoid in pregnancy
|
ACE-I
Dilantin Coumadin |
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What is the anticoagulation for preganant women with mechanical valves
|
Heparin atleast for 1st trimester
|
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What meds are used to control BP in pregnant women
|
Methyldopa
Hydralazine |
|
|
Cardiac findings of Hyperthyroidism
|
tachycardia
Bounding pulse Wide pulse pressure SEM |
|
|
Most common cardiac arrhythmia found in hyperthyroidism
|
A fib
|
|
|
Cardiac enlargement
reduced Myocardial contractility Pericardial effusion |
Hypothyroidism
|
|
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What causes physiological split of S2
|
inspiration due to increased blood return to right side of the heart
|
|
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What happens to S2 in RBBB
|
S2 splits further during inspiration
|
|
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What happens to S2 in ASD
|
Fixed
|
|
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What happens to S2 in LBBB
|
S2 splits in expiration instead during inspiration
|
|
|
Apple green bifringence on congo red stain
|
Amyloidosis
|
|
|
Thickened ventricular walls
Granular myocardial appearence dilated atria |
Amyloidosis
|
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What are the indications for GIIb IIIa in NSTEMI
|
ongoing chest pain
Transient ST depression with angina at rest Increased in Trop with PCI likely |
|
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When is PCI indicated in NSTEMI
|
Age > 75
Accelerating Ischemic SX over 48 hrs Ongoing rest pain >20 min Recurrent ischemic pain during obs Hypotension Reduced EF Pulmonary edema Severe Arrhtyhmia ST depression >0.05mV Increased Trops |
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What two courses after NSTEMI
|
conservative approach
Early invasive |
|
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What are common associated conditions with Atrial fibrillation
|
HTN
Cardiomyopathy MS sick sinus WPW especially in young ETOH Thyrotoxicosis |
|
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Patients with A fib for more than 2 days- how long they need to be on coumadin before cardioversion
|
3 weeks
|
|
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Patients with A fib for more than 2 days- how long they need to be on coumadin after cardioversion
|
4 weeks
|
|
|
How is WPW defined
|
PR internal less than 0.12 sec
Prolonged QRS more than 0.12 sec Delta wave Symptomatic tachycardia |
|
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The most serious rhythm in WPW
|
Onset of A fib with RVR which may lead to V fib
|
|
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In preexcited, atrial fib , wide irregular RVR what drugs need to be avoided
|
B blocker
Digoxin CCB Adenosine May result in ever rapid ventricular response due to accessory pathway |
|
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What is the agent of choice for stable WPW/ afib pt
|
Procainamide
It slows the AV node and accessory pathway |
|
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In unstable pt with Afib/WPW what is the treatment
|
cardioversion
|
|
|
Treatment for ventricular ectopy and non sustained V tach in structurally normal heart
|
if no sx- no therapy
if Sx- BB, CCB |
|
|
What conditions may lead to exacerbation of diastolic dysfunction
|
exertional HTN
Ischemia Volume overload Atrial fib |
|
|
What is the most common cause of dialted cardiomyopathy
|
Ischemic heart disease
|
|
|
Name some causes of dilated cardiomyopathy
|
CAD
HTN ETOH Thyroid Postpartum cardiomyopathy Toxins/Drugs Infiltrative disease like Sarcoidosis and Hemochromotosis AIDS Pheochromocytoma |
|
|
Causes of Heart Failure
|
Myocardium-dilated,restrictive,hypertrophic
Pericardial- Temponade,constrictive Valvular HTN Pulmonary HTN High output as in Thyroid,paget disease |
|
|
What group of pt with prosthetic valve need Heparin gtt bridge while awaiting procedure
|
Prosthesis in mitral position
Atrial fib Prior hx of thromoembolism |
|
|
What prophylaxis is needed for IE in ASD
|
not rec unless other congenital heart defects present
|
|
|
When do we need to consider intervention in pt with ASD
|
Left to right shunt >30 %
Evidence of Right chamber enlargement |
|
|
What is the treatment for ASD repair
|
Percutaneous closure with occlusive device
|
|
|
Classic triad of hypertrophic cardiomyopathy
|
Syncope
Angina Dyspnea |
|
|
Please name 4 major abnormalities with Hypertrophic CM
|
1. Diastolic dysfunction
2. Hypertrophied Septum 3. Mitral regurgitation 4. Ventricular arrhythmias |
|
|
LV hypertrophy w/o any known cause
+/- septal hypertrophy +/- outflow obstruction |
HCM
|
|
|
How can arrhythmias be evaluated in HCM
|
Holter 48-72 hrs
|
|
|
What drugs need to be avoided in HCM
|
Afterload reduction-Nitrates
Preload reduction- Valsalva, diuretics Increased contractility- Digoxin |
|
|
Effective medications in symptomatic HCM
|
Beta Blocker
Cautious Diuretics if + volume overload Septal reduction in severe cases |
|
|
Describe sx of restrictive Cardiomyopathy
|
Bi Ventricular failure
Dyspnea Low output sx Atrial arrhythmias like afib Elevated JVP with rapid x and y descent |
|
|
Describe ECHO of restrictive cardiopmyopathy
|
Normal LV cavity size and function
Marked enlargment of atria |
|
|
What ABI indicates mild disease
|
0.8-0.9
|
|
|
ABI of 0.5-0.8 what grade of vascular disease
|
Moderate
|
|
|
What ABI indicated severe disease
|
ABI < 0.5
|
|
|
What is a penetrating aortic ulcer
|
atherosclerotic plaque undergoes ulceration and penetrates the internal elastic lamina
|
|
|
How do we differentiate b/w aortic dissection and penetrating aortic ulcer
|
pulse deficits, neurological signs, aortic regurgitation, MI pericardial effusion do not occur in aortic ulcer
|
|
|
Treatment for penetrating aortic ulcer
|
HTN control
usually non operative |
|
|
What are surgical indication for penetrating aortic ulcer
|
ascending aortic involvement
saccular aneurysm intramural hematoma with persistent sx, inc aortic diameter, uncontrolled HTN |
|
|
What is the complication of surgery for penetrating aoric ulcer
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Paraplegia
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Aortic intraluminal Hematoma
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Cystic medial Necrosis
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Management for Aortic intraluminal Hematoma
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same as aortic dissection
Surgery for type A medical tx for Type B |
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What causes incomplete rupture of aortic rupture-transection
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sudden deceleration injury as in MVA
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What is the treatment for Aortic transection
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Emergency surgery
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Mitral stenosis is associated with what disease
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Rheumatic heart dz
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What arrhythmia is associated with mitral stenosis
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A FIb
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What are late manifestations of Mitral stenosis
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Hemoptysis
Pulmonary HTN R heart failure |
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What are Sx of Mitral stenosis
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DOE
Orthopnea PND |
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PEX findings of Mitral stenosis
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Loud S1
short interval from S1 to A2 DIASTOLIC LOW PITCHED RUMBLE MURMUR |
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EKG findings of Mitral stenosis
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P mitrale
RVH |
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what does CXR shows for Mitral stenosis
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Straightening of L heart border
Large left atrial shadow Dilated pulmonary veins |
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Name meds that may help with mitral stenosis
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BB
diuretics anticoag if Afib present |
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what are the indications for intervention for mitral stenosis
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DOE
Pulmonary edema moderate pul HTN |
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What is the surgical option for mitral stenosis
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Percutaneous balloon valvuloplasty
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What conditions include sick sinus syndrome
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sinus bradycardia
sinus pauses tachybrady syndrome sinus arrest |
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what is the treatment for asx sick sinus syndrome
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none
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What is the tx for sx sick sinus syndrome
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pacemaker
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What valve lesions are better tolerated in pregnancy
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regurgitation due to pregnancy related increased volume and decreased peripheral resistance
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What is pericardial knock
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early diastolic sound heard in constrictive pericarditis
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What to do when AAA is increasing 0.5cm per year
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Elective surgery
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What tyoe of heart valves are more thrombogenic
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Mechanical valves
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Do tissue valve require anticoagulation
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Most pt with tissue valve and in sinus rythym do not require anticoagulation
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What are the compliaction of mechanical valve
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Thrombosis
Hemolysis Endocarditis |
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What causes hemolysis in pt with mechanical heart valve
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perivalvular leak
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What diagnostic test can be done after cardiogenic shock after MI
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Pulmonary artery catherization
ECHO |
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What are the mechanical complication of MI
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Myocardial free wall rupture
papillary muscle rupture Ventricular septal defects |
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Describe free wall rupture after MI
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85% of all ruptures
occurs 2-14 days after MI May present as temponade Requires SURGERY |
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Describe papillary muscle rupture after MI
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5% of all ruptures
occurs 2-10 days after MI Associated with inferior MI Presents as dyspnea and hypotension Murmur +/- Needs ECHO and PA catheter |
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Describe Ventricular septal defects after MI
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occurs in 10% of cases of rupture
1-20 days after MI associated with inferior and ant MI Presents with dyspnea and hypotension Loud murmur and systolic thrill Need ECHO and PA catheter |
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In Ventricular septal rupture after MI what is the emergent treatment
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IABP
Surgery |
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What is the drug that can be used for sx HCM
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B Blocker
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What is the tx for severely symptomatic pt with HCM who are not responding to BB
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Septal reduction
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What treatment reduces the mortality in HCM due to sudden cardiac arrest
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ICD
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Classic features of Marfans
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Tall stature
high arched palate Scoliosis Hypermobile joint Aortic regurgitation |
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Most common primary cardiac tumor
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Myxoma
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What chamber has cardiac myxomas
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Left Atrium 80%
Right Atrium 20% |
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What are clinical features of cardiac myxomas
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obstruction to blood flow
embolization-brain,LE systemic effects-fatigue,fever,wt loss |
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What are systemic sideeffects of cardiac myxomas
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fatigue
wt loss Fevers Elevated ESR Leukocytosis Anemia |
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What is paradoxical embolism
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Stroke from clot from right side to left side due to ASD
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What diagnostic test we need with someone with paradoxical embolism
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TEE with bubble study
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What factors other than CHF can raise BNP
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ARF
MI Volume loss |
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What is the aortic valve area in moderate AS and gradient in AS
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0.5-0.8
30-40mmhg |
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What is the plan for pt with mod AS
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monitor for sx
ECHO 1-2 yrs |
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Plan for severe AS
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Sx--> operate
ASX---> ECHo every 6-12 months |
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What is severe AS
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Area less than 0.1 and gradient across valve greater than 40mmHg
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Diabetes
Liver disease Skin hyperpigmentation CHF |
Hemochromotosis
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What labs to order to check for hemochromatosis
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Transferrin
Ferritin |
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What are the effects of digoxin toxicity
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atrial tachycardia
heart block |
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Eisenmenger Syndrome
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Large shunt L->R causes pulmonary HTN and pulmonary vascular disease
Shunt reverses so blood flows from R->L |
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What causes death in patients with Eisenmenger syndrome
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Exercise induced Syncope
Arrhythmias Hemoptysis CVA |
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What causes erythrocytosis in pt with Eisenmenger
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Cyanosis
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What happens in Eisenmenger with repeated phelobotomy
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Fe def anemia
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Treatment for coronary vasospasm
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Short term Nitrates
Long term CCB |
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Treatment for sx WPW
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EP study and catheter ablation
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what are the best predictors that WCT is VT
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prior MI
CHF LV dysfunction |
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what are the ECG features that favor VT
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AV dissacoiation-independent p waves
very wide QRS extreme axis deviation concordance- all p waves in one direction |
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what are the meds to control VT in stable pt
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amio and BB
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what baseline EKG changes lowers the specificty for exercise stress test
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Non specific ST changes
Digoxin RBBB LVH WPW |
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ST depression during stress test shows lead I, aVL, V5-V6 --where is the lesion
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Left circumflex
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what lead you would expect to depression ST depression during stress test for LAD lesion
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V1-V2
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RCA lesion where do you the ST depression during stress test
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II, III, aVF
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what factors increase PCWP
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LVH
LV failure MR AR Temponade constrictive pericarditis |
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Patient with hypotension
swan ganz cath performed RA pressure elevated 18 diastolic PA pressure also 18 and PCWP i.e. LA pressure also 18 what is the diagnosis |
Temponade
tension pneumothorax might give you same numbers |
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CVP or RA pressure is >> than PCWP think of
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RV infarct
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elevated RA pressure and PA pressure with normal PCWP and normal BP
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pulmonary venous HTN
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where do you see pulsus pardoxus
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Pericardial temponade
Asthma Tension PNTX |
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what is pulsus paradoxus
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decrease in BP by greater than 10 during inspiration
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Bi Fid arterial pulse
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2 aortic peaks
AR HCM |
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where do you see large a waves
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TS
Severe pulmonic stenosis RVH MS |
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cannon a waves
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look out for VT
occurs in AV dissociation |
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what is the txt for HCM
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1. BB, Verapamil
2. Alcohol septal balation 3. Surgical myotomy 4. pacing |
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name 4 catastrophies post MI
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free wall rupture
papillary muscle dysfunction or rupture VSD Cardiogenic shock |
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what type of MI generally give you free wall ruprute
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ant MI- due to large size of infarct
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how do free wall rupture post MI present
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temponade
hypotension sudden syncope |
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what type of MI give you papillary muscle dysfunction
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inferior MI
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what are sx of papillary dysfunction
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severe MR
Pul edema get a stat echo and call surgery for surgical repair of MR |
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what lesion gives you ventricular septal wall rupture
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ant MI--LAD lesion
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how does heparin works
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it binds antithrombin and activates its function..Thrombin is involved with forming a clot
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what are the reason for heparin resisitance
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antithrombin deficiency
increased heparin clearnce increased heparin binding proteins |
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what labs do we montor if PTT cannot be used for montoring heparin
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anti Xa
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when PA catherter numbers shows equalization of diastolic pressure in right and left side of heart what is the dx
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Cardiac temponade
constrictive pericarditis |
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PA diastolic pressure greater than 20 compared to PCWP what is the dx
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Pulmonary HTN
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what are the indications for surgery for asx MR
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severe MR
EF less than 55 % LV diastolic diameter >45-50mm AFIB PHT |
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what are possible reason for acute decompensation of MR
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Infective endocarditis
ISchemia |
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what drugs may be used for acute MR untill the surgery in unstable pt
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Sodium nitroprusside
IABP dobutamine ALL TO DECREASE AFTERLOAD |
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what is the workup needed for VT
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ECHO for LV fxn
cath or stress test to r/o ischemia EP study for induciblity |
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what are the indication for ICD
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VF
Sx VT non sust VT + CAD + Low EF + Induciblity non ischemic DCMP with EF less than 35% or unexplained syncope congenital QT Brugada syndrome |
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what is the medical mgmt for acute AR
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IV afterload reduction with nitroprusside, inotropic support
Endocarditis ppx |
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what is the best drug to maintain SR after cardioversion
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Amiodarone
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what is acute bacterial endocarditis
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infection of normal valve with virulent organism-s. aureus
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what is SBE
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indolent infection of abnormal vlaves with less virulent organism
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what are 3 major criteria of endocarditis
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1. sustained bactremia from organism known to cause IE
2. Vegetation on ECHO 3. New regurgitation murmur |
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roth spot
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retinal hem with pale center
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janeway lesions
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septic emboli - non tender on soles and palms
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osler node
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tender nodules on pads of digits
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what are the indications for getting TEE for IE
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intermediate possiblity of IE
prosthetic valve TTE non diagnostic persistent bacremia |
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what is the role of anticoagulation in endocarditis
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embolic emboli may convert to hemorrgahic. if cerebral emboli r/o may do anticoag for prior condition
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what is the contraindication to surgery in case of IE
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Cerebral emboli due to conversion to hemorrghic on bypass machine
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what are the indication to surgery for IE
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refrectory CHF
persisitent or refrectory infection invasive infxn-ring abscess, conduction prob prothetic valve hard to eradicate infections-fungi, psuedomonads |
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what are predisposing conditions for bacterial endocarditis
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abnormal valve
abnormal risk for bactremia |
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what are some risk of abnormal valves--risk for IE
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prior endocarditis
RHD Aortic valve dz complex cyanotic lesions MVP with MR HCM |
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what is the duration of therapy for endocarditis
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4-6 weeks
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what is the exception to 4-6 weeks of abx therapy for endocarditis
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uncompliacted right sided endocarditis- 2 weeks should be ok
---usually found in IVDU |
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what is the txt for native valve ABE
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naf with gen...if MRSA then add vanco
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what is the txt for SBE
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amp and gent
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what is the txt for prosthetic valve endocarditis
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vancomycin + Gentamycin+ Rifampin
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tall R wave in V1-V3
ST elevation |
Right ventrucle
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name indications for placing IABP
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Cardiogenic shock
acute mitral regurgitation ventricular septal defect intractable ventricular tachycardia refrectory angina |
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relative and abs contraindication for thromobolytic therpay
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need to know
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when is valvuloplasty indicated for MS
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if TEE confirms no e/o artial appendage thrombus
valve area is less than 1cm2 |
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sick sinus syndrome and AFIB pt what is the txt
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AV nodal ablation and PM place,ent
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txt for aflutter
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RADIOFREQUENCY CATHETR ABLAION
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