Cardiology Mksap

Front 1

Stable Angina Medical Guidelines

Back 1

1) ASA, Statin, B-blocker (Goal HR 55-60), long acting nitrate, PRN sublingual nitrate

if still having symptoms

2) increase dse of beta blocker and long acting nitrate, add CCB

if still having symptoms --> cath

Front 2

Diabetes w/CAD guidelines with regards to stress test

Back 2

They will need a stress test if

1) Symptomatic

2) About to undergo excercise program

3) Have known CAD and haven't had stress test in > 2 years

Front 3

Causes of HFrEF

Back 3

Ischemia/CAD

Drugs (EtOH, cocaine, amphetamines)

HTN

SLE,HIV

Hyper/Hypothyroidism

Front 4

Causes of HFpEF

Back 4

HTN

CAD

Front 5

Drugs that reduce mortality in heart failure

Back 5

Beta blocker (Coreg, Metoprolol, Bisoprolol), Ace Inhibitor, Aldosterone receptor antagonist, Bidil (In blacks

Coreg corrects mortality

Front 6

ICD Indications

Back 6

1) Patient's with MI > 40 days ago and an EF less than or equal to 30%

2) NICM w/EF < 35% on max medical therapy for 3 months

3) Hx of Vfib arrest

Front 7

BivICD Indications (Cardiac Resynchronization Therapy)

Back 7

1) NYHA Class III-IV HF sx

2) EF less than or equal to 35% on guideline medical therapy

3) Ventricular Dysynchrony

***Need all 3

Front 8

Constrictive Pericarditis vs restrictive cardiomopthay

Back 8

Restrictive cardiomyopathy primarily affects LV, so you will see increased LV End Diastolic pressure which can lead to pulm HTN

CP affects all of pericardium so you will see equalization of pressures in all heart chambers on echo

Front 9

Pacemaker indications

Back 9

1) Symptomatic bradycardia

2) HR <40

3) A fib w/5 second pauses

4) SSS

5) Mobitz type 2 or 3rd degree

Front 10

Screening for PAD w/ ABI

Back 10

1) exertional leg pain, non healing wounds, age >50 w/smoking and DM hxx

Normal ABI 1-1.4, if > 1.4 it's from non compressible vessel 2/2 calcification, need to do toe brachial index, if <.7 it's PAD

Front 11

Premature CAD age definitition

Back 11

Men < 45

Women < 55

Front 12

Stress Echo

Back 12

Used when excercise EKG not an option (baseline EKG abnormalities ie. LVH)

Front 13

Nuclear SPECT Perfusion Stress Test

Back 13

Type of excercise stress test (Single Photon Emission CT) that uses technetium 99 to evaluate function of heart muscles

Front 14

length of time patients should excercise for during stress test

Back 14

goal of 6-12 minutes but ideally for as long as they can until they get symptoms

Front 15

Cardiac Meds and stress test

Back 15

If the diagnosis of CAD is trying to be established, B-blockers and nitrates should be held for 24 hours

If stress test is being performed to evaluate sx in ptnt with known CAD, medications should not be held

Front 16

Class IA anti-arrthmics

Back 16

Procainamide/Quinidine. Block Na channels to decrease speed depolarizations.

Not used very often except in specific arrythmias (WPW)

Front 17

Class 1B anti-arrythmics

Back 17

Lidocaine. Blocks Na channels to delay depolarizations.

Used in Ventricular arrythmias. Only anti-arrythmic that does not prolong QTc

Front 18

Class 1C anti-arrythmics

Back 18

Flecanide/Propafenone.

Cannot be used in patients with CAD/structural heart disease.

Used in Afib/SVT/Ventricular arrythmias

Front 19

Class II anti-arrythmics

Back 19

Beta Blockers

Front 20

Class III anti-arrythmics

Back 20

Potassium channel blockers which prolongs action potential

Sotalol/Dofetilide. Used in in Afib/Ventricular administers

**Usually initiated in hospital setting as they can prolong QTc, contraindicated in renal ds.

Front 21

Class IV anti-arrythmics

Back 21

Calcium channel blockers

Front 22

Typical AVNRT

Back 22

(Slow to Fast) or short RP tachycardia

Occurs when a PAC occurs and normal fast pathway is in refractory period so it gets conducted down slow pathway (Which has shorter refractory time). Because of this, the PR interval will be longer since impulse is being conducted down slow pathway. By the time the impulse gets conducted down slow pathway, the fast pathway is available for conduction, and the impulse travels retrograde up fast pathway, initiating a tachycardia.

P waves are are within QRS

Front 23

Atypical AVnRT

Back 23

(Fast to slow) long RP tachycardia

anterograde down fast, retrograde up slow pathway

Conduction goes down fast pathway and comes back up slow pathway which creates normal PR, long RP

Front 24

Orthodromic AVRT

Back 24

Orthodromic indicates impulse is conducted through normal fibers (ie. down AV node)

Initiated by PACs or PVCs.

When there is a PAC, accessory pathway is usually blocked, so it travels anterograde through AV node. Once it reaches ventricle, it travels retrograde back to atria via accessory pathway.

When there is a PVC, AV node is blocked but PVC can travel retrograde up accessory pathway to Atria, and then anterograde to ventricle via AV node.

ECG Findings: inverted P wave with short RP and narrow QRS.

**You get short RP because impulse travels faster through accessory pathway, activating atria right after QRS

Front 25

Antidromic AVRT

Back 25

Impulse gets conducted up AV node (retrograde) and down accessory pathway(anterograde)

Can be initiated via PAC or PVC

If PAC initiates conduction, impulse first gets conducted through accessory pathway to ventricles. If PVC initiates impulse, it gets conducted retrograde through AV node, and then gets continued from atria to ventricle via accessory pathway.

Will have wide QRS with short PR and long RP RP interval > 1/2 RR

Adenosine and AV nodal agents are contraindicated here because they can create ventricular arrythmias

***WPW is only seen in antidromic AVRT where accessory pathway gets anterograde conduction

Front 26

TOC for mitral stenosis

Back 26

balloon valvotomy is preferred TOC, if unsuccessful --> valve replacement

Front 27

Duke Criteria for endocarditis

Back 27

Major: positive blood cultures of organism known to cause endocarditis, vegetations seen on echo

Minor: Fever, positive blood cx of organism not known to cause endocarditis, embolic phenomenon, immune phenomenon (glomerulonephritis), hx IV drug use

Need 2 major or 1 major with 3 minor

Front 28

ASD murmur

Back 28

Ostium Secundum are most common type and are isolated

Ostium Primum are associated with VSD, endocardial cushion defects

***Will hear fixed splitting of S2, JVD and systolic flow murmur

Front 29

Patent Ductus Arteriosus

Back 29

Abnormal connection between aorta and pulmonary artery that creates a continues machine like murmur under left clavicle.