Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
Stable Angina Pectoris
|
Diagnosis:
- Resting ECG: usually normal - Stress ECG (exercise): subendocardial ischemia produces ST segment depression - Stress echocardiography: exercise-induced ischemia is evidenced by wall motion abnormalities not present at rest. - Pharmacologic stress test (if patient cannot exercise): IV adenosine, dipyramidole, dobutamine -Holter monitoring - Cardiac catheterization with coronary angiography (definitive test) Treatment: - Risk factor modification: smoking cessation, HTN, hyperlipidemia, DM, obesity, exercise, diet - Medical therapy: aspirin, beta-blockers, nitrates, CCBs, ACE inhibitors and/or diuretics (with comorbid CHF). - Revascularization: PTCA or CABG |
|
|
Unstable Angina Pectoris
|
Diagnosis:
- Perform diagnostic workup to exclude MI - Cardiac catheterization, before stress testing as patients with unstable angina have a higher risk of adverse events. - Tests of stable angina Treatments: - Hospital admission: IV access and supplemental oxygen, nitrates for pain - Aggressive medical management: Aspirin, beta-blockers, LMWH/UFH, nitrates, Gp IIb/IIIa inhibitors - Cardiac catheterization/revascularization - Risk factor reduction: (after acute treatment) smoking cessation, DM, HTN, hyperlipidemia |
|
|
Variant (Prinzmetal's) Angina
|
Diagnosis:
- transient ST segment elevation - Coronary angiography: definitive test; displays coronary vasospasm when patient is given IV ergonovine Treatment: - Vasodilators: CCB and nitrates |
|
|
Myocardial Infarction
|
Diagnosis:
- ECG: Peaked T waves, ST segment elevation, Q waves, T wave inversion, ST segment depression - Cardiac enzymes: CK-MB (increases within 4-8 hours, peaks at 24), Troponins (increases within 3-5 hours, peaks in 24-48 hours) Treatment (After Revascularization): - Admission: IV access, supplemental oxygen, analgesics (nitrates, morphine) - Medical therapy: Aspirin, beta-blockers, ACE inhibitors, statins, oxygen, nitrates, morphine sulfate, heparin - Revascularization: thrombolysis or PTCA - Rehabilitation: supervised regimen of exercise and risk factor reduction |
|
|
Congestive Heart Failure
|
Diagnosis:
- Chest X-ray: Cardiomegaly, Kerley B lines, interstitial markings, pleural effusion - Echocardiogram: tests ejection fraction (EF < 40% is indicative of systolic dysfunction), chamber dilation and/or hypertrophy - ECG: usually nonspecific, but can detect chamber enlargement and presence of IHD or prior MI - Radionuclide ventriculography using technetium-99m - Cardiac catheterization - Stress testing Treatment (Systolic dysfunction): - Sodium restriction - Diuretics (Loop > Thiazide > Spironolactone) - ACE Inhibitors - ARBs - Beta-blockers - Digitalis - Hydralazine |
|
|
Atrial Fibrillation
|
Diagnosis:
- ECG: "Irregularly irregular" rhythm (irregular RR intervals and excessively rapid series of tiny, erratic spikes on ECG with a wavy baseline and no identifiable P waves) Treatment: Acute AFib - In hemodynamically unstable patient: immediate electrical cardioversion to sinus rhythm. - Rate control (CCBs, beta-blockers) - Cardioversion to sinus rhythm: electrical, ibutilide, procainamide, flecainide, sotalol, amiodarone - Anticoagulation to prevent embolic CVA Treatment: Chronic AFib - Rate control: beta-blocker or CCB - Anticoagulation: warfarin |
|
|
Atrial Flutter
|
Diagnosis:
- ECG provides a saw-tooth baseline, with a QRS complex appearing after every second or third "tooth" (P wave). Saw-tooth flutter waves are best seen in the inferior leads (II, III, aVF) Treatment: - In hemodynamically unstable patient: immediate electrical cardioversion to sinus rhythm. - Rate control (CCBs, beta-blockers) - Cardioversion to sinus rhythm: electrical, ibutilide, procainamide, flecainide, sotalol, amiodarone - Anticoagulation to prevent embolic CVA |
|
|
Multifocal Atrial Tachycardia
|
Diagnosis:
- ECG: variable P-wave morphology and variable PR and RR intervals. At least three different P-wave morphologies and required to make an accurate diagnosis. - Vagal maneuvers or adenosine to show AV block without disrupting the atrial tachycardia Treatment: - Improving oxygenation and ventilation - CCBs, beta-blockers, digoxin, amiodarone, IV flecainide, IV propafenone |
|
|
Paroxysmal Supraventricular Tachycardia (PSVT)
|
Diagnosis:
- ECG: narrow QRS complexes with no discernible P waves (P waves are buried within the QRS complex) Treatment: - Maneuvers that stimulate the vagus delay AV conduction and thus block the reentry mechanism: Valsalva maneuver, carotid sinus massage, breath holding, head immersion in cold water - Pharmacologic treatment: IV adenosine, IV verapamil, IV esmolol, digoxin, DC cardioversion if drugs are not effective |
|
|
Wolff-Parkinson-White Syndrome
|
Diagnosis:
- ECG: narrow complex tachycardia, a short P-R interval, and a delta wave Treatment: - Radiofrequency catheter ablation of one arm of the reentrant loop |
|
|
Ventricular Tachycardia
|
Diagnosis:
- ECG: Wide and bizarre QRS complexes - Unlike PSVT, VT does not respond to vagal maneuvers or adenosine Treatment: - Identify and treat reversible cause - Sustained VT: IV amiodarone, IV procainamide, or IV sotalol (for hemodynamically stable patients); DC cardioversion, followed by IV amiodarone (for hemodynamically unstable patients) - Nonsustained VT: if there is no underlying heart disease, do not treat. Otherwise, ICD placement is appropriate. |
|
|
Ventricular Fibrillation
|
Diagnosis:
- ECG: No atrial P waves can be identified; no QRS complexes can be identified; very irregular rhythm. Treatment: - Medical emergency! - Immediate defibrillation and CPR are indicated. - Initiate DC cardioversion immediately. It the equipment is not ready, start CPR until it is. - Intubate if necessary (VF persists), epinephrine, IV amiodarone (followed by shock) |
|
|
Acute Pericarditis
|
Diagnosis:
ECG shows four changes in sequence: - Diffuse S-T elevation and PR depression - S-T segment returns to normal - T wave inverts - T wave returns to normal Echocardiogram if pericarditis with effusion is suspected, but echocardiogram is often normal Treatment: - Most cases are self-limited, resolve in 2 to 6 weeks - Treat underlying cause if known - NSAIDs are mainstay of therapy (for pain and other systemic symptoms) - Glucocorticoids if pain does not respond to NSAIDs, but should be avoided if possible |
|
|
Constrictive Pericarditis
|
Diagnosis:
ECG: - Low QRS voltages, generalized T wave flattening or inversion, left atrial abnormalities - Atrial fibrillation occurs in less than half of patients Echocardiogram: shows thickened pericardium CT scan and MRI show pericardial thickening (more accurate than echocardiogram) Cardiac catheterization: - Elevated and equal diastolic pressures in all chambers - Ventricular pressure tracing shows a rapid y descent, which is described as a dip and plateau or a "square root sign" Treatment: Surgical: Complete resection of the pericardium is definitive therapy. Significant mortality rate, however. |
|
|
Pericardial Effusion
|
Diagnosis:
Echocardiogram: - Imaging procedure of choice - Most sensitive and specific method of determining presence of pericardial fluid, can show as little as 20 mL of fluid. CXR: - CXR shows enlargement of cardiac silhouette when >250 mL of fluid has accumulated. ECG: - Shows low QRS voltage and T wave flattening - Electrical alternans suggests a massive pericardial effusion and tamponade CT scan or MRI: very accurate Pericardial fluid analysis: - May clarify the cause of the effusion - Order protein and glucose content, cell count and differential, cytology, specific gravity, hematocrit, gram stain, acid-fast stains, fungal smears, cultures, LDH content Treatment: Depends on patient's hemodynamic stability Pericardiocentesis is not indicated unless there is evidence of cardiac tamponade. Analysis of pericardial effusion can be useful to determine cause. If the effusion is small and clinically insignificant, a repeat echocardiogram in 1 to 2 weeks is appropriate. |
|
|
Cardiac Tamponade
|
Diagnosis:
Echocardiogram: - Must be performed if suspicion of tamponade exists based on history/examination - Usually diagnostic; the most sensitive and specific noninvasive test CXR: - Enlargement of cardiac silhouette when >250 mL has accumulated - Clear lung fields ECG: - Electrical alternans (alternate beat variation in the direction of the ECG wave-forms) - due to pendular swinging of the heart - Should not be used to diagnose Cardiac catheterization: - Shows equalization of pressures in all chambers of the heart - Shows elevated right atrial pressure with loss of the y decent Treatment: For Nonhemorrhagic tamponade: - If patient is hemodynamically stable: monitor closely with echocardiogram, CXR, ECG; if patient has known renal failure, dialysis is more helpful than pericardiocentesis - if patient is not hemodynamically stable: pericardiocentesis is indicated; if no improvement is noted, fluid challenge may improve symptoms For Hemorrhagic tamponade secondary to trauma: - Emergent surgery is indicated to repair the injury - Pericardiocentesis is only a temporizing measure and is not definitive treatment. Surgery should not be delayed to perform pericardiocentesis |
|
|
Mitral Stenosis
|
Diagnosis:
Almost all cases of Mitral Stenosis are due to rheumatic heart disease CXR: Left atrial enlargement Echocardiogram: (most important test in confirming diagnosis) - Left atrial enlargement - Thick, calcified mitral valve - Narrow, "fish-mouthed"- shaped orifice - Signs of RVF if advanced disease Treatment: Medical: - Diuretics: for pulmonary congestion and edema - Infective endocarditis prophylaxis - Chronic anticoagulation with warfarin is indicated (especially with A Fib) Surgical (for severe disease) - Percutaneous balloon valvuloplasty (excellent results) - Open commissurotomy and mitral valve replacement (if valvuloplasty is contraindicated) Management: - No therapy for asymptomatic patients - Diuretics can be used if patient has mild symptoms - Surgical treatment for more severe symptoms |
|
|
Aortic Stenosis
|
Diagnosis:
CXR: Calcific aortic valve, enlarged LV/LA ECG: LVH, LA abnormality Echocardiogram: - Diagnostic in most cases - LVH - Thickened, immobile aortic valve - Dilated aortic root Cardiac catheterization: - Definitive diagnostic test - Can measure valve gradient and calculate valve area- <0.8 cm^2 indicates severe stenosis; normal aortic valve is 3-4 cm^2 Treatment: - Surgical Therapy: Aortic valve replacement is treatment of choice. Indicated in all symptomatic patients. |
|
|
Aortic Regurgitation
|
Diagnosis:
CXR: LVH, dilated aorta ECG: LVH Echocardiogram: - Assess LV size and function - Look for dilated aortic root and reversal of blood flow in aorta - In acute aortic regurgitation, look for early closure of mitral valve Cardiac catheterization: to assess severity of aortic regurgitation and degree of LV dysfunction. Treatment: - Conservative if stable and asymptomatic: salt restriction, diuretics, vasodilators, digoxin, afterload reduction, restriction on strenuous activity - Definitive treatment is surgery (aortic valve replacement). Considered in symptomatic patients, or in those with significant LV dysfunction on echocardiogram. - Acute AR (e.g. post-MI): Medical emergency - perform emergent aortic valve replacement! - Endocarditis prophylaxis before dental and GI/GU procedures |
|
|
Mitral Regurgitation
|
Diagnosis:
CXR: dilated LV, pulmonary edema Echocardiogram: - MR - Dilated LA and LV - Decreased LV function Treatment: Medical: - Afterload reduction with vasodilators; salt reduction, diuretics, digoxin, and antiarrhythmics - Chronic anticoagulation if patient has A Fib. - IABP as bridge to surgery for acute MR Surgical: - Mitral valve repair or replacement - Must be performed before LV function is too severely compromised. |
|
|
Tricuspid Regurgitation
|
Diagnosis:
Echocardiogram: - Quantifies amount of TR - Identifies prolapse/flail of tricuspid valve leaflets - Measures pulmonary pressures ECG: RV and RA enlargement Treatment: Treat left-sided heart failure, endocarditis, or pulmonary HTN Severe regurgitation may be surgically corrected if pulmonary HTN is not present: - Native valve repair surgery - Valvuloplasty of tricuspid ring - Valve replacement surgery (rarely performed) |
|
|
Mitral Valve Prolapse
|
Diagnosis:
Echocardiogram Treatment: - If patient is asymptomatic: reassurance - If patient has systolic murmur or thickened valve: antibiotic prophylaxis for dental procedures to prevent infective endocarditis - For chest pain, beta-blockers have been useful, but unlikely to be required - Surgery is rarely required |
|
|
Rheumatic Heart Disease
|
Diagnosis: requires two major criteria or one major and two minor criteria
Major criteria: - Migratory polyarthritis - Erythema marginatum - Cardiac involvement (e.g. pericarditis, CHF, valve disease) - Chorea - Subcutaneous nodules Minor criteria: - Fever - Elevated ESR - Polyarthralgias - Prior history of rheumatic fever - Prolonged PR interval - Evidence of preceding streptococcal infection Treatment: - Treat streptococcal pharyngitis with penicillin or erythromycin to prevent rheumatic fever - Acute rheumatic fever is treated with NSAIDs. C-reactive protein is used to monitor treatment - Patients with a history of rheumatic fever should receive antibiotic prophylaxis with erythromycin or amoxicillin for dental/GI/GU procedures - Treat the valvular pathology of rheumatic heart disease |
|
|
Infective Endocarditis
|
Diagnosis:
Duke's clinical criteria: Two major criteria, one major and three minor criteria, or five minor criteria Major criteria: - Sustained bacteremia - Endocardial involvement (documented by echocardiogram) Minor criteria: - Predisposing condition (e.g. abnormal valve) - Fever - Vascular phenomena (e.g. septic arterial or pulmonary emboli) - Immune phenomena (GN, Osler's nodes, Roth's spots, rheumatoid factor) - Positive blood cultures - Positive echocardiogram Treatment: - Parenteral antibiotics based on culture results for extended periods (4 to 6 weeks) - If cultures are negative but there is high clinical suspicion, treat empirically with a penicillin (or vancomycin) plus an aminoglycoside until the organism can be isolated. |
