Paragh Note Cardio

Front 1

Tiredness, Shortness of breath after PE, Edema in the legs, 50yrs old man

Back 1

Heart failure

Front 2

Left heart failure

Back 2

cardiac output ↓ ➜ blood backup ➜ pulmonary HTN ➜ Left ventricular hypertrophy.

Front 3

Left heart failure symptoms

Back 3

Dyspnea, Orthopnea

Paroxysmal nocturnal dyspnea

Nocturnal cough

sweating, cold limbs

Advanced - Confusion, memory impaired

Front 4

Left heart failure signs

Back 4

Displaced point of maximal intensity

S3, S4 gallops

Lung base - rales, crackles

Lower lung - Dull percussion, ↓ tactile fremitus

2nd ♡ sound - ↑ pulm component = pulm HTN

Front 5

Right heart failure

Back 5

↑ pulm vascular resistance ➜ RV hypertrophy

Due to left HF, pulmonary HTN, Valvulopathy, congenital defects

Front 6

Right heart failure Symptoms/Signs

Back 6

Peripheral edema

Nocturia

Ascites

Hepato-jugular reflux, Hepatomegaly

Jugular venous distension

Right ventricular heave

Front 7

Right heart failure risk factors

Back 7

Atherosclerosis

Valvular heart disease

CAD

cardiomyopathy

Front 8

Rheumatic heart disease

Back 8

Late result of Rheumatic fever.

Acute carditis (peri, myo, valvulitis) and chronic valve damage.

Front 9

Rheumatic heart disease pathogenesis

Back 9

5-15 yrs children ➜ GABHS infection (strep throat, scarlet fever) ➜ autoimmune HS-2 ➜ Abs to M protein ➜ cross react with valve tissue.

Mitral > Aortic > Tricuspid (order of pressure)

Front 10

Rheumatic heart disease associated with

Back 10

Aschoff bodies

Antiashkow's cells (activated histiocytes)

ASO titers

Front 11

ARF non-suppurative inflammatory lesions

Back 11

Polyarthritis - big joints (knee, ankle)

Carditis

Subcutaneous nodules

Erythema marginatum

Sydenham's chorea

Front 12

ARF Diagnostic criteria

Back 12

2 major / 1major+2minor = JONES PEACE

Major - Joints, Carditis, Nodules, Erythema, Sydenham's chorea

Minor: Previous rheumatic fever, ECG with PR prolonged, Arthralgia, ↑ CRP,ESR, Elevated temp

Front 13

ARF Treatment

Back 13

Bed rest, Corticosteroids, NSAIDs(Aspirin), Haloperidol, Diuretics, Antibiotics(penicillin)

Front 14

Headache, dizziness, palpitations

Back 14

Hypertension

Front 15

Hypertension bp levels

Back 15

>140/90 on 3 measurements

Optimal: 110/80

Ideal: 120/80

Pre: 120-139/80-89

Stage1: 140-159/90-99

Stage2: 160-179/100-119

Stage3(malignant): >180/120

Front 16

Primary HTN risk factors

Back 16

Family history

Tobacco

Obesity

High salt diet

Increased age

Blacks > whites

Front 17

Primary HTN complications

Back 17

Cotton wool spots, Retinal hemorrhage

Aneurism, stroke, ophthalmic disease,

aortic dissection, CAD, CHF, Renal failure

Front 18

Secondary HTN causes

Back 18

Renal artery stenosis

Endocrine: OCP, pheochromocytoma,

hyperparathyrodism (hyperCa),

Hyperthyroidism, conn, cushing, Acromegaly

Others: aorta coarctation, pregnancy, drugs (steroids, MAOi, mercury)

Front 19

Malignant HTN

Back 19

BP > 180/120 with end-organ damage.

-encephalopathy, papilledeam, aortic dissection, pulm edema, RF

Front 20

Malignant HTN labs

Back 20

Blood: electrolytes, cathecholamines

Urine: urinalysis, cethecholamines

ECG

Front 21

Hypertension treatment

Back 21

Goal bp < 140/90 (DM < 130/80)

Lifestyle modification

Drug (Diuretic, beta blockers, ACEi, CCB, nitrates)

*Stage2,3: combination therapy

➜ ACEi + diuretics

➜ ACEi + CCB

Front 22

1.Pain in legs after surgery, or

2.Rheumatic ♡ disease decades ago, and now

developed palpitation

Back 22

Thrombus from Endocarditis

Front 23

Endocarditis types

Back 23

Acute: S.aureus, S.pneumoniae, S.pyogens, N. gonorrhea. normal&prosthetic valves affected

Subacute: S.viridans (after dental), S.bovis,

Staph.epidermidis, fungi (candida, aspergillus).

Prosthetic valves affected

Front 24

SLE patients with non-infective endocarditis

Back 24

Libman-Sacks endocarditis

Front 25

Endocarditis clinical features

Back 25

Infection: fever, malaise, night sweats, weight loss, anemia, splenomegaly

Cardiac: new murmur, aortic root abscess, LVF, PR prolongation

Immune: vasculitis, GN, roth spot, osler node, janeway lesion, splinter hemorrhage

Vacular: abscess in brain/heart/kidney/spleen.

If right sided - pulmonary abscess

Front 26

Fever + new murmur

Back 26

Endocarditis

Front 27

Endocarditis diagnosis

Back 27

DUKE criteria

-2major, or 1major + 3 minor, or 5minor

OR

-Direct histologic evidence

-Positive gram stain / Positive culture

Front 28

DUKE criteria - major

Back 28

Blood culture: typical organisms in 2 cultures

Endocardium involvement: Echocardiogram showing abscess/vegetation/dehiscence of prosthetic valve, new valvular regurgitation.

Front 29

DUKE criteria - minor

Back 29

Predisposing heart condition, IV drug use, dental surgery

Fever

Vascular phenomenon/ immunological sign

Blood culture that doesn't meet major

Echo that doesn't meet major

Front 30

Endocarditis treatment

Back 30

Penicillin + gentamycin iv

MRSA: vancomycin + gentamycin

Valve replacement

Front 31

Palpitation, shortness of breath that began with standing up from a chair

Back 31

Myocarditis

Front 32

Myocarditis causes

Back 32

Virus: Parvovirus b19, Coxsackie

Bacteria: Clostridia, Diphtheria

Spiro: Leptospirosis, Lyme, Syphilis

Protozoa: T.cruzi ➜ chagas disease

Drugs: chemo, alcohol

Autoimmune

Front 33

Myocarditis signs

Back 33

Low PE ➜ tachycardia, shortness of breath

Fever

Chest pain (changes with position)

Edema, rales, crackles

Front 34

Myocarditis diagnosis

Back 34

ECG: ST elevate, PQ prolong, T inversion

Labs: ↑ CK, ↑ troponin, ↑ ESR/CRP

CXR: cardiomegaly

Front 35

Myocarditis treatment

Back 35

Treat cause, stop offending meds

Avoid PE

Beta blockers ( carvedilol, metoprolol)

NSAIDs

Anticoagulants (LMWH ➜ 2days ➜ warfarin)

*monitor APTT and PT

Front 36

Old

History of thromboembolic complication

Abdominal pain

Back 36

Abdominal aortic aneurism

Front 37

Abdominal aortic aneurism risk factors

Back 37

Family history

Age > 55

HTN

Atherosclerosis

Smoking

Collagen disease: marfan, EDS

Front 38

Abdominal aortic aneurism Diagnosis

Back 38

Abdominal CT/US

Front 39

Abdominal aortic aneurism Treatment

Back 39

2-4cm: no growth or symptom - watchful waiting

4-6cm: anticoag, anti-HTN, elective operation

>6cm: Urgent operation

Front 40

Aortic dissection

Back 40

intimal layer tear ➜ blood burrow under ➜ risk of aneurism, rupture, hemopericardium

Front 41

Aortic dissection risk factors

Back 41

HTN!!!!

CT disoder: marfan, EDS

Trauma

Pregnancy

Front 42

Aortic dissection symptoms and signs

Back 42

Sudden tearing pain ➜ radiates to the back

dysphagia

new diastolic murmur

unequal radial pulses

Front 43

Aortic dissection classification

Back 43

Stanford

A-involve asc. aorta, B-not involve asc. aorta

De bakey

I- start in asc. ➜ reach at least aortic arch

II- start and confined to asc.

III- Start in desc ➜ extend distally, may involve asc.

Front 44

Aortic dissection treatment

Back 44

ABC

beta blockers IV

Analgesia

Surgical repair

Front 45

Syncope cause

Back 45

cardiac dysfunction (aortic stenosis, brady, ↓ SV)

vasovagal response

hypotension

hypoglycemia

seizure

cerebrovascular ischemia

Front 46

Syncope features

Back 46

prodrome: lightheadedness, nausea, weakness

generalized spasms

quickly regain consciousness

Postdrome: hypotension, arrhythmia, neurologic deficit

Front 47

Pacemaker indications

Back 47

Bradycardia

AV block

SSS

Frequent short run VT

Cardiomyopathies

Long QT

Front 48

Oppression chest pain after PE

Back 48

Stable angina pectoris

Front 49

Chest pain PQRST

Back 49

Provoking factor

Quality

Region

Severity

Time

Front 50

Approaching patient with chest pain

Back 50

Initial impression

Vitals: BP, HR, RR

Breath sounds: +pain(pleuritic), asymmetrical(PE, PTX)

Heart sounds

Extremities: calf swelling (PE), ↓ pedal pulse (dissection)

Front 51

Chest pain differential diagnosis

Back 51

GI: GERD, PUD, cholecystitis, Esophageal spasm

Musculoskeletal: costochondritis

Psychiatric

Respiratory: PE, PTX, pleuritis, pneumonia

Cardiac: Stable angina, MI, myocarditis, pericarditis, aortic dissection, mitral valve prolapse

Front 52

Angina types

Back 52

Stable: pain with exertion, relieved with rest

Unstable: not relieved with rest

Prinzmetal: cyclic pain. Due to vasospasm.

Front 53

Prinzmetal angina

Back 53

patho: vasospasm ➜ cyclic chest pain, migrane

Dx: angiogram, ergonovine challenge

Tx: CCB

Front 54

Prinzmetal ST vs Stable angina ST

Back 54

Prinzmetal: Vasospasm of large and medium vessel ➜ subepicardial myocardium affected➜ ST elevation

Stable: Exertion ➜ subendocardial myocardium ➜ ST depression

Front 55

Angina risk factors

Back 55

Modifiable: Cholesterol levels, smoking, obesity, HTN, lazy lifestyle

Non-modifiable: Age>60, Male, Genes

Front 56

Cardiac stress test

Back 56

Screen to see if CAD patient needs invasive treatment.

Exercise: ECG until 80% max HR (220-age)

-ischemia >2mm ST depression

-Hypotension ↓ systolic bp >10mmHg

Chemical: obese or bedridden patients

-Dobutamine: positive if ↓ ♡ wall movement

-Thallium schintigraphy: positive if ↓ uptake

Front 57

Angiogram interpretation

Back 57

Involvement of .....

3 vessels or LMA: CABG

single vessel: angioplasty with stenting

Front 58

Unstable angina diagnostic tests

Back 58

ECG: ST depression + T inversion

Enzymes: CK-MB (4-12hrs, new infarctions),

Troponin (stay high for long, MI)

Front 59

Unstable angina treatment

Back 59

Aspirin/clopidogrel

Beta blocker

Nitrate

LMWH

Morphine

Oxygen

Front 60

STEMI vs NSTEMI

Back 60

STEMI: severe occlusion ➜ transmural ischemia ➜ ST elevation ➜ within 3hrs ➜ fibrinolytics ➜ increase survival by 50%

NSTEMI: occlusion ➜ superficial ischemia ➜ ST depression (not always) ➜ Heparin

Front 61

Pain in chest that starts rapidly

Back 61

Pulmonary embolism

Front 62

Pulmonary embolism risk factors

Back 62

7Hs:

Hereditary (FV leiden, protein C/S deficit)

History (DVT, PE)

Hypomobility (fracture, surgery, obesity)

Hypovolemia

Hypercoagulability (cancer, smoking)

Hormones (pregnancy, OCP)

Hyperchromocysteinemia

Front 63

Pulmonary embolism signs and symptoms

Back 63

Dyspnea, Fever, Pleuritic chest pain, Cough, Hemoptysis, Impending doom, Shock

Disney Found Prince Charming Hiding In School

Cyanosis, JVP ↑, Tachycardia, Tachypnea, S2 loudness, Decreased breath sounds at effusion region

Charming was Just Trying To Study Dvt

Front 64

Pulmonary embolism Diagnosis

Back 64

Labs: Pulmonary wedge pressure, ↑ D-dimer, ABG (O2 <80mmHg, ↑ pH ➜ resp. alkalosis)

ECG: Tachycardia, lead I s wave, lead III T inversion)

CXR: Plural effusion, wedge infarct

spiral CT: Proximal PE

US: lower extremity

V/Q scan: mismatch areas

Front 65

Pulmonary embolism Treatment

Back 65

Oxygen

Fluids or cardiac pressors

Anticoagulant (LMWH ➜ warfarin)

Thrombolysis (streptokinase)

Front 66

DVT cause

Back 66

Virchow's triad

Endothelial injury

Venous stasis (postop, bedridden, obesity)

Hypercoagulability (OCP, FV leiden, C/S deficit)

Front 67

DVT clinical features

Back 67

Pain, swelling, Fever

Palpable cord

Homan's sign

Lowenberg sign

Trendelenburg test 1&2 positive

Perthes test positive

Front 68

DVT diagnosis

Back 68

Doppler and Duplex US

Venography

Impedence plethysmography

D-dimer

Perthes test

Front 69

DVT treatment

Back 69

Anticoagulation (LMWH ➜ 2days ➜ warfarin)

Fibrinolysis (if DVT close to iliac vein)

Bedrest (if DVT close to knee)

Front 70

Claudication classification

Back 70

Fontana classification

stage 1: Sx after severe PE

stage 2: Sx after moderate PE

stage 3: Sx at rest

stage 4: Trophic changes, ulcers, gangrene

Front 71

Buerger's disease pathogenesis

Back 71

Thromboangitis obliterance.

smoking ➜ vessel occlusion ➜ inflammation ➜ autoamputation

Front 72

Buerger's disease symptoms

Back 72

↑ sensitivity to cold

↓ peripheral pulse

skin color change (blue to reddish)

skin thinning, shiny, ↓ hair growth

ulcer, gangrene

Forefoot pain

Front 73

Buerger's disease diagnosis

Back 73

Ankle-brachial index

Normal >1

Moderate: 0.7-0.9

Severe < 0.4

Front 74

Buerger's disease treatment

Back 74

Quit smoking

pentoxifylline

cilostazol

prostacyclin

Front 75

Chest pain, Enlarged LN, had flu-like symptoms

Back 75

Pericarditis

Front 76

Pericarditis cause

Back 76

Idiopathic

Infections

Acute MI, Dressler's syndrome

Uremia

Collagen vascular disease

Neoplasm

Drug (INH, hydralazine, cyclosporin)

Recent ♡ surgery

Amyloidosis

Radiation

Trauma

Front 77

Pericarditis signs

Back 77

Chest pain (worse: lying supine, cough, deep breathing, better: sitting up, leaning forward)

Palpitation

Dyspnea

Fever, leukocytosis

Percardial friction rub

Pulsus paradoxus

Front 78

Pericarditis diagnosis

Back 78

ECG: diffuse ST ↑ , PR ↓, T invert

ECHO: if effusion suspected. usually normal

Front 79

Pericarditis treatment

Back 79

Mostly self-limiting, resolve in 2-6wks

Treat underlying cause

NSAID

Colchicine

Front 80

Palpitation and arrhythmia on ECG

Back 80

Atrial fibrillation

Front 81

Atrial fibrillation pathomechanism

Back 81

2nd atrial focus ➜ rapid firing ➜ >400bpm ➜ blocked at AV node ➜ vent rate 75-175bpm

Front 82

Atrial fibrillation risk factors

Back 82

❤️: CAD, MI, HTN, Mitral disease, pericarditis

Pulmonary disease: PE

Thyroid: Hyper &Hypo

Systemic: sepsis, malignancy, DM

Stress: post-op

Alcohol: holiday heart syndrome

Sick Sinus Syndrome

pheochromocytoma

Front 83

Atrial fibrillation signs and symptoms

Back 83

Possibly asymptomatic

Fatigue, exerted dyspnea, dizziness

Chest pain

Palpitations

syncope

Irregularly irregular rapid pulse

Front 84

Atrial fibrillation treatment

Back 84

Anticoagulation ➜ INR 2-3

Beta blockers, CCB, Digoxin

Cardioversion: electrical, chemical(antiarrhythmic)

AV nodal ablation

Front 85

Atrial fibrillation diagnosis

Back 85

ECG: no P wave, F wave, irregular QRS, short RR

Arrhythmia absoluta

Pulse deficit

Front 86

Atrial flutter pathomechanism

Back 86

Atrial ectopic focus ➜ fire 250-350bpm ➜ regular atrial contraction ➜ 1/2 - 1/3 to ventricle

P wave = sawtooth

Front 87

Atrial flutter cause

Back 87

♡: rheumatic heart disease, atrial septal defect, HF, CAD

COPD

Front 88

Old female, scleroderma, bradycardia

Back 88

Sick Sinus Syndrome

Front 89

Sick Sinus Syndrome types

Back 89

Sinus brady

SA arrest

SA exit block

Tachy-brady syndrome

Front 90

Sick Sinus Syndrome diagnosis

Back 90

1.PE ➜ tachycardia ➜ not SSS

2.Atropine ➜ tachycardia ➜ not SSS

3.Give atropine ➜ propranolol ➜ Intrinsic HR

4.Electrophysiological studies

Front 91

Patient collapsed during shaving

Back 91

Carotid sinus hypersensitivity

Front 92

Carotid sinus hypersensitivity types

Back 92

Cardio-inhibitory

Vasodepressor

Combined

Treat with pacemaker implantation