Cardiology

Front 1

Tx of PSVT

Back 1

Mechanical Valsalva or
carotid massage
if unsuccessful then IV Adenosine or IV Verapamil or IV Esmolol
If still unsuccessful: Cardioversion (hemodynamic unstable)
Prevention: Digoxin &/or Verapamil or BB

Front 2

Tx of A. Fib

Back 2

ACUTE
1. If hemodynamic unstable: cardioversion
2. If hemodynamic stable:
a. Rate control: IV BB or CCB
or Digoxin
b. Rhythm control :
Elective Cardioversion:
-electrically
- chemically: IV ibutelide or PO
amiodarone,or propapefone, or
soltalol

CHRONIC A fib:
a. rate control:
-BB (HTN, HF, Coronary DZ)
-CCB (HTN)
-digoxin
b. cardioversion: IV ibutilide or PO amiodarone

c. Anticoagulation w/ Warfarin (maintained for 3 wks before cardioversion)
-TEE necessary r/o emboli before cardioversion

Front 3

Tx of PVC

Back 3

-BB if symptomatic
-Class I & III used w/ caution only if symptomatic

Front 4

Tx of V tachycardia

Back 4

If UNSTABLE (hypotension, HF, or MI): synchronized cardioversion

If patient tolerating rhythm:
a) lidocaine,
b) If reocurs: amiodarone
c) once stable: procainamide

CHRONIC/RECURRENT
1. Sustained V-Tach:
-pts w/ significant LV dysfuction: ICD
- pts w/ preserved LV fuction: amiodarone + B blocker
soltalol

2. Nonsustained V tach:
B blocker
amiodarone

Front 5

Contricted Pericarditis (CP)
vs.
Restricted Cardiomyopathy (RCM)

Back 5

CP
-ventricular interaction is affected (accentuated w/ resp)
-pulmonary pressure is not affected (pressure in all 4 chambers the same)
RCM
-ventricular interaction is not affected or normal ( preserved fxn)
-pulmonary pressure is affected ( elevated in LA, LV)

Front 6

DCM murmur

Back 6

mitral regurgitation that decreases with valsalva (less LV filling)

Front 7

HOCM murmur

Back 7

systolic murmur @ LSB that increases w/ valsalva (less LV filling accentuates obstruction)

Front 8

Diagnostic tools for Angina?

Back 8

1. ECG: down slopping ST segment depression ; T wave flattening may occur
2. Excercise Stress test :ST seg depression of 1mm
3. Myocardial perfusion scinitgraphy
4. Radionuclide angiography
5. positive-emission tomography
6. Echo
7. Ultrafast or cine CT & Cardiac MRI
8. Cornonary angiography (DEFINITIVE DIAGNOSTIC) but used selective b/c costly

Front 9

Txt of Stable Angina

Back 9

nitroglycerine (SL/ spray) acute
Beta Blockers with or without
long acting nitrate or
Calcium Channel Blocker
Statin
ASA
consider clopidrogel or LMWH

Front 10

Risk factors for ischemic heart disease (stable Angina/ACS)

Back 10

male sex, increased age, low estrogen state, cigarette smoking, family history, HTN, DM, obesity, inactivity, dyslipidemia, consumption too few fluits/veg, elevated ETOH consumption

Front 11

Metabolic syndrome

Back 11

a major contributor to coronary heart dz:
abdominal obesity, Triglycerides >/= 150, HDL < 40 men, <50 women, fasting glucose >/= 110, HTN

Front 12

Can cocaine cause MI or ischemia

Back 12

True

Front 13

Prinzmetal Angina
what? who? when? EKG?

Back 13

Chest pain without precipitating factors; associated w/ ST-seg elevation; common in females </=50 yo w/ sxs early AM awakening from sleep

Front 14

Prinzmetal Angina
Diagnosis:

Back 14

EKG ST elevation
Diagnosed coronary angiography using ergonovine challenge.

Front 15

Prinzmetal Angina Txt

Back 15

Nitrates & Ca Channel Blockers ( acute & prophylactic)

Front 16

Acute Coronary Syndrome

Back 16

Unstable Angina
NSTEMI
STEMI

Front 17

Txt of ACS

Back 17

1. IV fluids, O2, nitroglycerin, Morphine
2. Antiplatelet: ASA + Clopidogrel
3. Anticoag: Heparin/LMWH
4. GP IIb/IIIa inhibitor
5. Beta Blockers (limits the extent of infarction)
6. CCB only in pt who can't tolerate BB or nitrates
7 Coronary Reperfusion:
a) Throbolytic w/in first 3 hrs: ateplase, retaplase, & tenecteplase
b) immed coronary angiography + primary percutaneous coronary intervention (angioplasty w/ stenting)

Front 18

Cyanotic Congenital Heart Anomalies

Back 18

Tetralogy of Fallot
Pulmonary Atresia
Hypoplastic left heart syndrome
Transposition of great vessels

Front 19

Cyanotic Congenital Heart Anomalies
Tetralogy of Fallot

Back 19

1. subaortic septal defect (VSD)
2. Pulmonary Stenosis / right ventricular outflow obstruction (from infundibular stenosis)
3. overiding aorta
4. right ventricular hypertrophy

Front 20

Cyanotic Congenital Heart Anomalies
Pulmonary Atresia

Back 20

Most often occurs w/ an intact ventricular septum.
1. Pulmonary valve is closed
2. An atrial septal opening and PDA are present

Front 21

Cyanotic Congenital Heart Anomalies
Hypoplastic Left Heart Syndrome

Back 21

Defects with small left ventricle and normally placed great vessels

Front 22

Cyanotic Congenital Heart Anomalies
Transposition of great vessels

Back 22

Complete transposition of aorta and pulmonary artery

Front 23

NONcyanotic Congenital Anomalies

Back 23

ASD
VSD
PDA
Coarctation of Aorta

Front 24

Indications for thrombolysis in acute MI

Back 24

1. Clinical hx & presentation stronly suggestive of MI w/i 6 hours plus one or more of :
a) >1mm ST elevation in 2 or more limb leads.
b) new LBBB
c) >2mm ST depression in V1 to V4 suggestive of true posterior MI

2. symptoms 7-12 hrous of onset w/ persisting chest pain and ST seg elevations
3. younger pts than 75 yrs presenting w/i 6 hrs of anterior wall MI consider for recombinant t-PA

Front 25

Contraidications of thrombolysis

Back 25

1. aortic dissection
2. h/o cerebral hemorrhage
3. cerebral aneurysm
4. AV malformation
5. intracranial neoplasm
6. recent thromboembolic stroke (6 mo)
7. active internal bleeding
pts previously treated w/ streptokinase should receive a recombinant t-PA

Front 26

indications for CABG

Back 26

1. Severe left main stem coronary disease.
2. three vessel disease
3. two vessel disease with severly affected proximal left anterior descending (LAD) artery
4. diabetics with multivessel disease

Front 27

TXT of A. flutter

Back 27

ACUTE: chemical cardioversion with ibutilide or electric cardioversion
CHRONIC: amiodarone
refractory: radiofrequency ablation

Front 28

First Degree AV Block

Back 28

1. PR interval >0.2 with all atrial impulses conducted
2. may occur in
-normal indiv. w/vheightened vagal tone
- drug effect (dig, CCB, BB or tother sympatholytic agents)
-ischemia, infarction, inflammatory processes, fibrosis, calcification or infiltration
- prognosis good
-txt: observe

Front 29

Second degree AV block:
Mobitz type I

Back 29

Wenckeback:
1. AV condxn PR interval progressively lengthens with RR interval shortening, before the blocked beat;
2. due to abnl condxn w/i AV node
3. Observe

Front 30

Second degree AV block
Mobitz type II

Back 30

1. are intermittently nonconducted atrial beats not preceded by lengthening AV condxn.
2. usu. due to block within the bundle of his syst./organic dz
3. Prophylactic ventricular pacing is required

Front 31

Third degree AV block

Back 31

1. Transmission of atrial impulses through the AV node is completely blocked and ventricular pacemaker maintains a slow regualr rate .
2. P and QRS are independent of each other but P-P and R-R intervals are equal
2. rate is usually slower < 50 bpm
3. permanent pacing required

Front 32

pulseless V tachycardia & V fibrillation TXT

Back 32

CPR and Unsynchronize defibrillation