Cardiology

general symptoms of arrhythmias

1. lightheaded/dizzy

2. fatigue

3. syncope/presyncope

4. chest pain

5. palpitations

6. exercise intolerance

common meds that can cause bradycardia

1. BB

2. CCB

3. Digoxin

4. adenosine

5. narcotics

describe sinus arrhythmia

regularly irregular (ASSOCIATED W RESP) normal variation

inspiration inc rhythm

expiration dec rhythm

MCC of sick sinus syndrome

degenerative fibrosis (age-related fibrous tissue)

difference between wandering atrial pacemaker vs multifocal atrial tachycardia

WAP → multiple ectopic atrial foci

MAT → same as WAP but >100bpm

difference between AVNRT and AVRT

AVNRT → 2 pathways within the AV node (MC) → tx usually targets the AV node (vagal and adenosine)

AVRT → accessory pathway is outside of node → tx depends if narrow or wide complex to see what needs to be targeted

how to dx wolff parkinson white syndrome

delta wave on EKG

treatment for stable wide QRS complex tachycardia

amiodarone

if WPW (has delta wave) → procainamide

treatment for stable narrow QRS complex tachycardia

vagal; adenosine

MC location for irritable atrial foci in atrial flutter

tricuspid valve annulus in right atrium

sawtooth pattern on EKG

atrial flutter

irregularly irregular pattern on EKG

atrial fibrillation

which type of 2nd degree block would worsen with vagal maneuvers

2nd degree type 1 because block is at level of AV node

improves with exercise

bradycardia algorithm

1. atropine

2. transcutaneous pacing ± dopamine or epinephrine

dosing for atropine vs adenosine

ATROPINE

1mg every 3-5 minutes

max dose is 3mg

ADENOSINE

6mg

then 12 mg

what is R on T phenomenon

for premature ventricular contraction or torades when the heart is repolarizing during T wave and another ventricular contraction occurs at the same time during the vulnerable moment → leads to reentrant arrhythmias like ventricular tachycardia or fibrillation

treatment for torsades

IV magnesium sulfate

medication tx for stable ventricular tachycardia

amiodarone

what are the nonshockable rhythms

1. pulseless electrical activity

2. asystole

reversible causes of cardiac arrest

6 Hs and 5 T;s

1. Hypovolemia

2. Hypoxia

3. Hypothermia

4. Hypoglycemia

5. Hyper/Hypokalemia

6. H+

T’s

1. trauma

2. tension pneumo

3. tamponade

4. toxins

5. thrombosis

definitive dx of stable angina

coronary angiography

classes of angina

1: angina with unusually strenuous activity; no limits

2: angina with prolonged or rigorous activity; slight limits

3: daily activity; marked limitation

4: at rest

ADR of nitrates

1. headache

2. orthostatic hypotension

3. tolerance

4. syncope

(HOTS)

MCC of MI

atherosclerosis

atypical MI sxs

in women, elderly, and diabetics:

1. abdominal pain

2. jaw pain

3. dyspnea

nitrate MOA

converted to Nitric oxide → vasodilation → inc myocardial blood supply

Nitrates CI

1. hypotension

2. inferior/posterior MI

3. PDE-5 inhibitors (sildenafil, tadalafil)

Indications for CABG

1. 3 vessel disease

2. left main coronary artery

3. EF <40%

treatment of prinzmetal angina

nitrates and CCB

left sided heart failure sxs

1. dyspnea

2. cough

3. rales

right sided HF sxs

1. JVD

2. peripheral edema

3. GI and hepatic congestion → loss of appetite, ascites, JVD w palpation of liver

MCC of heart failure with reduced ejection fraction

post MI

MCC of heart failure with preserved ejection fraction

longstanding hypertension

which gallop is seen in systolic vs diastolic heart failure

systolic → S3

diastolic → S4

cheyne-stokes breathing associated with

heart failure

MC viral cause of myocarditis

coxsackie B virus

previously healthy patient has chest pain and heart failure symptoms in a patient who recently recovered from viral illness suggests

myocarditis

definitive dx for myocarditis

endomyocardial biopsy

MC medication for peripartum dilated cardiomyopathy

beta blocker

True or false: stress cardiomyopathy (takotsubo) presents as dilated cardiomyopathy transiently

FALSE

presents more like ACS so must tx like its an MI → nitro, ASA, BB, statin, heparin

can only dx after coronary angiography shows no plaque

patho for takotsubo cardiomyopathy

catecholamine surge

systolic anterior motion of mitral valve is associated with

hypertrophic cardiomyopathy

most common symptom of hypertrophic cardiomyopathy

dyspnea on exertion

most concerning symptom of hypertrophic cardiomyopathy

sudden cardiac dealth (esp in adolescents)

1st line medical managment of hypertrophic cardiomyopathy

beta blockers preferred

MCC of restrictive cardiomyopathy

1. amyloidosis (MC in US)

2. sarcoidosis (if younger)

3. hemachromatosis

endomyocardial biopsy shows apple­green birefringence with Congo red stain which suggests

restrictive cardiomyopathy from amyloidosis

periorbital purpura, a thickened tongue, and hepatomegaly suggests

amyloidosis (restrictive cardiomyopathy)

ECHO shows bright myocardium (speckled) which suggests

restrictive cardiomyopathy

most common overall cause of endocarditis

staph aureus

what organism causes endocarditis that is associated with poor dentition

strep viridans

MCC of acute vs subacute endocarditis

Acute (normal valve) → staph aureus

subacute (abnormal valve) → strep viridans

pulmonary symptoms in endocarditis patient may indicate

right sided endocarditis; usually in IV drug user

cough, dyspnea, hemoptysis, pleuritic chest pain

2 major criteria for diagnosing endocarditis

Duke criteria

1. sustained bacteremia (2+ positive cultures)

2. ECHO within 12 hours of presentation

clinical manifestation of endocarditis

FROMJANE

1. fever

2. roth spots (retinal hemorrhages w central clearing)

3. Osler nodes (tender nodules on palm/fingers)

4. Murmur (regurgitation M>A>T>P)

5. Janeway lesions (red painless macules on palm)

6. Anemia/arthritis

7. Nailbed

8. Emboli

how long do endocarditis patients need to be on abx for

4-6 weeks

if fungal → 6+ weeks

endocarditis prophylaxis regimen

prior to dental, resp or infected skin/MSK tissues

amoxicillin 2g 30-60 minutes before procedure

MC valve involved in endocarditis

mitral

if IV drug user → tricuspid

empiric endocarditis treatment before cultures come back

vancomycin + ceftriaxone

pericardial knock associated with

constrictive pericarditis

treatment for constrictive pericarditis vs regular acute pericarditis

pericarditis → high dose NSAID or ASA

Constrictive pericarditis → diuretics (sxs); pericardiectomy (definitive)

MC malignancy that can cause pericardial effusion

1. lung

2. breast

Beck’s triad

cardiac tamponade

1. muffled heart sounds

2. JVD

3. hypotension

electrical alternans is associated with

pericardial effusion and cardiac tamponade

immediate vs definitive tx for cardiac tamponade

1. pericardiocentesis

2. definitive: pericardial window

medications that can increase cholesterol levels

big BODS

1. beta blockers

2. OCPs

3. Diuretics

4. steroids

what is good cholesterol vs bad cholesterol

good → HDL

bad → LDL

cholesterol screening

start at 20 or older, frequency just depends on CVD risk factors

1st line pharm for hyperlipidemia

statins

MOA for statins

inhibit HMG-CoA reductase → reduce LDL

criteria for metabolic syndrome

(GOTH B is fat)

1. Glucose >100

2. Obesity abdominal circ M>40; F>35

3. TG >150

4. HDL M>40; F>50

5. BP >130/85