Cardio - IM Quick Notes

arold001's version from 2015-12-31 01:21

Section 1

Question Answer
What are the 4 acute coronary syndromesstable angina, unstable angina, NSTEMI, STEMI
chest pain that lasts 10-15 min, occurs after exertion, relieved with rest or nitroglycerinstable angina
chest pain that is new onset, crescendo, or at rest, typically lasts <30 min; subtotal coronary thrombosis; +/- ECG changes (ST depression, T wave inversion); troponin/CK-MB (-)unstable angina
whats the difference btw unstable angina and NSTEMI?unstable angina: NEGATIVE troponin/CK-MB
NSTEMI: + troponin/CK-MB
MI location: anteroseptalV1-V4
MI location: apicalV5-V6
MI location: lateralI, aVL
MI location: inferiorII, III, aVF
MI location: posteriorST depression V1-V3
MI location: RV infarctV1-V2, V4R (reverse leads)
whats the treatment for ALL acute coronary syndromes?MONA: morphine, oxygen, nitroglycerin, aspirin.
ACEI, heparin, beta-blockers
whats the treatment for NSTEMI and STEMI?PCI within 90 minutes or fibrinolytics within 30 minutes
what are 3 instances where CABG may be considered over PCI?DM, 3 vessel disease, left main coronary artery disease
what are the DISCHARGE medications for patients with acute coronary syndromes?AABBCCDEF = ASA, ACEI/ARB, Beta Blocker, Clopidogrel, Cholesterol (statin), Diet, Exercise, Fish oil
whats the most common cause of death post-MI?arrhythmias
Within 10 days post-MI, pt develops new harsh systolic murmur at LLSBVSD from rupture of interventricular septum
One to four days post-MI, pt develops sudden onset shortness of breath with muffled heart sounds, JVD, and hypotensioncardiac tamponade
after MI, pt develops SOB, blowing systolic murmur radiating to apexpapillary muscle rupture leading to acute MR
whats the treatment for prinzmetal's angina?CCB
in patients with MI, what the 3 drugs only shown to reduce mortality?aspirin, beta-blockers, ACEI
what 7 drugs are indicated in pts with MI?MONA + ACEI, beta-blocker, heparin

Section 2

Question Answer
whats the treatment for acute heart failure?LMNOP = lasix, morphine, NITRATES, oxygen, position
heart failure with REDUCED ejection fractionSYSTOLIC dysfunction
which coronary syndrome is herparin NOT used for?stable angina
what 6 medications have shown to lower mortality in CHF patients?ACEI/ARB, beta-blockers, spironolactine, hydralazine + nitrate
heart failure with preserved EFdiastolic dysfunction d/t impaired relaxation
whats the most common cause of a-fib?HTN then CHF
what are other causes of a-fib (PIRATES)PIRATES = pulmonary, ischemic/idiopathic, rheumatic heart disease, atrial myxoma, thyrotoxicosis, ethanol, sepsis
what are the CHADS2 criteria?CHF, HTN, Age >75, DM, Stroke/TIA
how do you tx pt with a-fib and hemodynamically unstableCARDIOVERT!
how do you treat a-fib, stablerate control = metoprolol --> anticoagulate with heparin --> cardiovert (if <48 hours) or check TEE or empiric anticoagulation x3 weeks
in a patient with new onset a-fib, which 2 lab values should you check for other sources?TSH and electrolytes
how can you tell the difference btw supraventricular tachycardia versus ventricular tachycardia?Supraventricular tachycardia = NARROW QRS.
Ventricular tachycardia = wide QRS complex
whats the most common rhythm in digoxin toxicity?atrial TACHYCARDIA with AV block
whats the treatment for WPW?procainamide = to control rate
how do you treat ventricular fibrillation or pulseless ventricular tachycardia?defibrillate!
whats are serious evolution of ventricular tachycardia?torsades de pointe with prolonged QT
how do you treat torsades?MAGNESIUM!!!
whats the tx for 2nd degree Mobitz II, 3rd degree (complete) heart block?PACEMAKER!

Section 3

Question Answer
midsystolic crescendo-decrescendo murmur at RUSB, radiating to carotidsaortic stenosis
heart murmur that causes DELAYED CAROTID UPSTROKEaortic stenosis
whats the cause of aortic stenosis in young and old patient?young: congenital bicuspid valve
older pt: senile calcified valve
what are the 3 classic symptoms of patient with aortic stenosis (SAD)syncope, angina, dyspnea of heart failure
whats the tx of aortic stenosis?valve replacement
early diastolic decrescendo murmur at LUSBaortic regurg = aortic insufficiency
what are the 2 main causes of aortic regurg?isolated dilated aortic root or infective endocarditis
pt presents with WIDE pulse pressureaortic regurg
pt presents with head bobbingaortic regurg
“opening snap with low pitched mid diastolic rumble at apexmitral stenosis
whats the tx for CHF?loop diuretic + ACEI --> add beta-blocker if moderate disease --> add digoxin if systolic dysfxn
how do you know if mitral stenosis is worse?Tight is tight” (closer opening snap to S2 = worse MS
whats the tx for mitral stenosispercutaneous mitral valvotomy, surgery, medical management with beta blockers and careful diuresis
whats a common complication of mitral stenosis?a-fib due to LA enlargement
high pitched “holosystolic blowing murmur at the apex radiating to the axillamitral regurg
midsystolic click “+/- late systolic murmurmitral valve prolapse
pt presents with NEW onset pulmonic valve regurg or tricuspid regurg...worried about?infective endocarditis in IV drug users
name the only 2 murmurs to get louder with valsalvaHCM and MVP

Section 4

Question Answer
whats the common EKG finding in pts with PERICARDITIS?EKG: diffuse ST elevation and PR depression!
name the 6 most common causes of pericarditis?coxsackie, HIV, TB, uremia, Dressler's syndrome, radiation
chest x-ray shows WATER BOTTLE SIGNpericardial tamponade
whats becks triad a/w cardiac tamponademuffled heart sounds, JVD, hypotension
pulsus paradoxus is a/w cardiac diseasepericardial tamponade
echo shows septal shift with inspiration and diastolic collapse of RA/RVpericardial tamponade
whats the tx for pericardial tamponade??pericardiocentesis --> if unstable, give fluids and inotropes
CXR shows thickened/calcified pericardium constrictive pericarditis
whats the treatment of constrictive pericarditis?diuresis if overloaded or pericardiectomy
whats the tx for patients with nonsustained VT?implantable defibrillator
where do narrow complex tachycardias orginate versus wide complex tachycardias?narrow complex tachycardia: ABOVE the ventricles. Wide complex tachycardia: WITHIN the ventricles
whats the tx of asystole?transcutaneous pacing (defibrillation does NOT work)
whats the specfic EKG finding in acute pericarditis?PR depression and diffuse ST elevation
whats the tx for restrictive carditis due to sarcoidosis?glucocorticoids
whats the endocarditis prophylactic drug for pts with known valvular heart disease or prosthetic valves who are about to undergo oral surgery AMOXICILLIN
whats hypertensive emergency?>220/120 with end organ damage
whats the most significant risk factor for aortic dissection versus AAA?aortic dissection: HTN.
AAA: atherosclerosis causing weakening of aortic wall
what 2 diagnostic tests are ordered for aortic dissection?TTE and CT scan
what diagnostic tests are ordered for AAA?abdominal US --> CT scan

Section 5

Question Answer
Whats the most important risk factor for PVD?smoking!
Whats the most accurate tests for pts with DVT?venogram
What are the 3 main indications for starting thrombolytic therapy in pts with DVT/PE?indicated for massive PE, pts who are hemodynamically UNSTABLE, pts with evidence of right heart failure
whats the difference btw LMWH and UF heparain?LMWH has longer half-life and dosed ONCE daily
which shock is the only one with INCREASED JVP/PCWP?cardiogenic shock
which shock: decreased cardiac output, increased SVR, increased PCWPcardiogenic shock
which shock: decreased cardiac output, increased SVR, decreased PCWPhypovolvemic shock
which shock: decreased cardiac output, SVR, PCWPneurogenic shock
which shock: INCREASED cardiac output, decreased SVR, decreased PCWPseptic shock
skin wise, whats the difference btw septic shock and hypovolemic shock?septic shock = flushed/warm skin since a/w severe peripheral vasodilation.
hypovolemic shock = cool skin since a/w peripheral vasoconstriction
whats the cause of neurogenic shock?failure of sympathetic nervous system to maintain adequate vascular tone (sympathetic denervation)

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