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166 Cards in this Set
- Front
- Back
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elevated homocysteine
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stable angina
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Q waves
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prior MI
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ST segment depression
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subendocardial ischemia
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wall motion abnormalities on stress echo
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exercise induced ischemia
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rx for pharmacologic stress test
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adenosine or dipyridamole (which vasodilate coronaries, and therefore makes little difference in diseased ones)
or dobutamine (which increases O2 demand by increasing HR, BP, contractility) |
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ACS means
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atherosclerotic plaque rupture and coronary occlusion
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beware of stress testing a patient with...
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unstable angina
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how to differentiate USA and non-STEMI
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cardiac enzymes
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ESSENCE trial
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Enoxaparin led to better outcomes than heparan in USA and non-STEMI
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tx for unstable angina
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aspirin
beta blocker LMWH heparin (enoxaparin) nitrates GPIIb/IIIa inibitors as adjunct |
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TIMI score
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age >=65
more than three CAD risk factors known CAD (stenosis >50%) 2 episodes of severen angina in past 24 hrs apsirin use in past 7 days elevated cardiac enzymes ST changes >= .5mm Risk is about 4-5 per point |
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CARE trial
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statins
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transient ST elevations during exertion
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Prinzmetal
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substernal chest pain > 30 minutes
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MI
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inferior ECG changes
hypotension elevated JVP hepatomegaly clear lungs |
RV infarct
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Peaked Ts
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early ischemia
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ST elevation
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transmural injury
ST is TS |
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elevated troponins, no heart issues
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renal failure
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CAPRICORN trial
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beta blocker carvedilol reduces risk of death in patients with post-MI LV dysfunction
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ST elevations V1-V4
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anterior MI
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Q waves in V1-V4
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Anterior MI
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R wave in V1 V2
ST depression in V1V2 T elevation in V1V2 |
Posterior
P is RST for Vs |
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Q waves in I, aVL
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Lateral MI
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Q waves in II, III, aVF
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Inferior MI
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HOPE trial
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ACEi, ramipril, reduces mortality in MI, stroke and renal disease in high-risk CAD pts
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GUSTO trial
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tPA and Heparin is the best thrombolytic regime
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tx for VT
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IV amiodarone
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rx to correct severe/symptomatic bradycardia
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atropine
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tx for 1st and 2nd degree (type I) AV block
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none
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what is CK useful for
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an early subsequent MI (because they are shorter duration)
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incomplete free wall rupture...
what is it called? what is tx? |
ventricular pseudoaneurysm
surgery |
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dyspnea
orthopnea PND nocturnal cough confusion and memory impairment diaphoresis and cool extremities at rest |
Left sided HF
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S3
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ventricular gallop
left sided heart failure S3 follows S2 |
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tx for mild CHF
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ACEi
loop if volume overload |
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tx for moderate CHF
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ACE, loop
add beta blocker |
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tx for sever CHF
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loop, ACE
add digoxin add spironolactone if needed |
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where to hear S3
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apex
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where to hear S4
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base
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peripheral pitting edema
nocturia JVD hepatomegaly/mepatojugular reflex ascites RV heave |
Right sided heart failure
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RV heave
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right sided heart failure
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BNP >100
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CHF vs. COPD
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Kerley B lines
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on CXR
pulmonary congestion secondary to dilatation of pulmonary lymphatic vessels |
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RALES trial
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spiRonolactone Reduces Rigor moRtis in patients with class thRee or fouR heaRt failuRe
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When to use digitalis
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EF <30%, but doesn't reduce mortality
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nausea/vomiting, anorexia
ectopic ventricular beats AV block A Fib visual disturbances, disorientation |
digoxin toxicity
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wide QRS
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PVCs
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PVCs increase risk for?
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A Fib
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what cardiac trouble can be caused by hyper/hypo thyroidism
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A Fib
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what cardiac trouble can be caused by excessive alcohol drinking (holiday heart)
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A fib
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sequela of A fib
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embolic stroke
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preferred tx for rate control for acute A Fib in a stable patient
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Calcium blockers
B blocer alternative vs either for chronic AFib |
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first step in A fib tx
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rate control with calcium blocker
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next step after rate control in A Fib
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cardioversion (electrical > pharm)
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INR range to prevent CVA
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2-3
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AFFIRM trial
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better in A Fib tx to controle Rate
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tx for chronic AFib
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rate control with beta blocker or Ca channel blocker (vs just CCB in chronic A Fib)
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atrial rate > 400
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A fib
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atrial rate of 250-350
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A flutter
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causes of A flutter
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COPD
RHD, CAD, CHF ASD |
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cardiac sequelae of COPD
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Flutter
multifocal atrial tachycardia |
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multifocal atrial tachycardia tx
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oxygenation and ventilation
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what does multifocal tachycardia indicate
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severe pulmonary disease
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variable P waves and variable PR and RR intervals (at least 3 different)
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multifocal atrial tachycardia
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narrow QRS
P waves burried inside the QRS |
PSVT, generally due to AV nodal reentrant tachycardia
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causes of PSVT (narrow QRS, possibly with no visible Ps)
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ischemia
digoxin toxicity (2:1 block) AV node reentry excessive caffeine or alcohol consumption |
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tx for PSVT
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IV adenosine preferred
also can use IV verapamil, esmolol |
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PSVT prevention rx
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digoxin (verapamil or bb as alternatives)
ablation of AV node or accessory tract |
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difference in tx of PSVT and WPW
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avoid digoxin (because it acts on AV node) in WPW; just use ablation
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difference in location of PSVT and WPW
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PSVT is either in AV node or between A and V
WPW is only between the A and V |
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tachycardia
short PR delta wave |
WPW
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tx for torsades
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IV magnesium
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acute Canon A wave
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VT
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wide QRS tachycardia
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suspect VT
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VT tx
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first, ICD
second, amiodarone |
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no atrial P waves
no QRS identified |
VFib
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tx for pulseless electrical activity
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AMIodarone (in our AMI with VFib)
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P and Q waves unrelated
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3rd degree AV block
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p waves lengthen progressively until a beat dropped
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2nd degree block type I
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heart d/o causedby doxorubicin
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dilated cardiomyopathy
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heart d/o caused by thiamine deficiency
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dilated cardiomyopathy
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heart deficiency caused by Chagas disease
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dilated cardiomyopathy
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heart irregularity caused by pheochromocytoma
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dilated cardiomyopathy
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S3 and S4 murmurs
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dilated cardiomyopathy
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inheritance of HCM
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AD
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loud S4
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HCM
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intensity of a murmur increases with valsalva and standing, but decreases with handgrip
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HCM
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bisferious pulse (rapidly increasing carotid pulse with two upstrokes)
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HCM
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tx for HCM
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beta blockers are first choice
also CCBs diuretics for fluid retention mymectomy MV replacement |
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viral causes of pericarditis
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echovirus
coxsackie |
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Dressler syndrome
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Percarditis post MI (weeks to months)
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drugs that cause lupus pericarditis
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procainamide
hydralazine |
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chest pain with breathing
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pericarditis
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pericardial friction rub
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pericarditis
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scratching, high pitched, 3 component sound heard during expiration
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pericardial rub
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PR depression
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pericarditis
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tx for pericarditis
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NSAIDS
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when is ventricular filling impeded..
in constrictive pericarditis? in tamponade? |
early and late diastole
vs all diastole |
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JVD fails to decrease during inspiration
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Kussmaul's sign for constrictive pericarditis
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how to image for pericardial effusion and tamponade
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echo
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enlarged heart without pulmonary vascular congestion
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pericardial effusion
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narrowed pulse pressure
pulsus paradoxus |
cardiac tamponade
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hypotension
muffled heart sounds JVD |
cardiac tamponade (Beck's triad)
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loud S1
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mitral stenosis
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LA enlargmenet
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MS
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LV hypertrophy, leading to dilation, dysfunciton, MR
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AS
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LV enlargement and hypertrophy
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AR
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LA/LR dilatation
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MR
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crescendo decrescendo systolic murmur
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AS
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S4
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AS
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parvus et tardus
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AS
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precordial thrill
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AS
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widened pulse pressure
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AR
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holosystolic murmur at apex
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MR
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tx for MR
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timely surgery
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blowing holosystolic murmur at LLSB
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TR
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A fib usually present with this murmur
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TR
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midsystolic clicks
mid to late systolic murmur |
MVP
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click:
increased by valsalva and handgrip decreased by squatting |
MVP
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migratory polyarthritis
erythema marginatum chorea subcutaneous nodules |
RH disease
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Acute endocarditis usually caused by
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staph aureus
Acute Aureus |
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organisms for native valve endocarditis:
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viridans
aureus, epidermidis enterococci HACEK (hemophilus, actinobacillus, cardioabacteium, Eikenella, Kingella) |
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endocarditis on both sides of aortic valve
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Libman Sacks
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thrombotic endocarditis
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Marantic
associated with metastases |
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Duke's criteria
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for endocarditis
major: bacteremia sustained endocardial involvement, esp by echo or new regurg minor: predisposing condition fever vascular phenomena immune phenomna positive blood cultures positive echo |
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wide fixed splitting of S2
low rumble murmur |
ASD
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harsh blowing holosystolic murmur
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VSD
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heart defect associated with congenital rubella
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PDA
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machinery murmur
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PDA
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mid systolic murmur heard over back
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coarctation of aorta
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coarctation of aorta in short woman
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turners
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hypertensive emergency
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systolic >200 and/or diastolic >120
AND end organ damage |
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tx plan for HTN emergency
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25% decrease in 1-2 hours and then gradually by IV nitroprusside, labetalol or NG
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tx plan for HTN urgency
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oral agents over 24 hours
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widened mediastinum on CXR
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aortic dissection
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diagnostic tools for aortic dissection
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CXR and TTE
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tx for aortic dissection
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IV beta blockers (to slow)
and IV sodium nitroprusside to lower BP type a proximal - surgery medical for type b |
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pain in back or lower abdomen radiating to groin, buttocks, leg
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Grey Turners Sign for AAA
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echymoses around umbilicus
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Cullen's sign for AAA
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abdominal pain
HTN palpable uplsatile abdominal mass |
ruptured AAA
tx = emergent laparotomy |
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size indication for surgery on AAA
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> 5cm
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cramping leg pain reliably reproduced by same walking distance
relieved at rest, or by hanging leg over bed |
PVD - chronic arterial insufficiency
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systolic BP at ankle/arm
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claudication is <0.7
resta pain <0.4 |
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first treatment for claudication
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stop smoking
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diagnostic tool for PVD? Acute arterial occlusion?
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both are by arteriogram
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pallor
pain pulselessness paresthesias paralysis polar (cold) |
Acute arterial occlusion
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risk with arteriograms
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cholesterol embolization
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what should you not anticoagulate for?
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cholesterol emboli!
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how to treat syphyllitic aortitis/leutic heart
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IV penicillin and surgical repair
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endothelial injury
venous stasis hypercoagulability |
Virchow's triad for DVT
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PTT target for DVT
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1.5-2 x
(vs 2-3 for Afib) |
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brawny induration of leg
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CVI (chronic venous insufficiency/venous stasis disease)
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migratory superficial thrombophlebitis
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malignancy, often of pancreas
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throbmobplebitis at IV site on arm or with LE varicostiy
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superficial thrombophlebitis
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tx for thrombophlebitis
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no tx unless painful
with pain and cellultis: be rest, elevation, hot compresses |
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swelling
redness indurated vein |
superficial thrombophlebitis
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cardiac output up means what kind of shock?
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septic
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PCWP up means what kind of shock?
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cardiogenic
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SVR up and PCWP down means
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hypovolemic shock
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CO down and SVR down means
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neurogenic shock
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severe peripheral vasodilatation
flushing warm skin |
septic shock
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peripheral vasoconstriction
cool skin |
hypovolemic shock
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two or more of:
fever hyperventilation tachycardia Increased WBCs |
SIRS
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SIRS plus positive blood cultures (2 sets from 2 different sites)
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sepsis
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hypotensin induced by sepsis
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septic shock
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peripheral vasodilation with decreased SVR
warm, well-perfused skin bradycardia and hypotension |
neurogenic shock
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diastolic murmur that changes character with changing body positions
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atrial myxoma
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