Cardio E2 Highlighted Stuff

What are the three cardiac killers that we have to rule out first thing?

Acute MI, aortic dissection, PE

How do you diagnose stable angina?

Stress test

How does an acute MI frequently present in women?

Fatigue, dyspepsia, vague abdominal pain, jaw/arm pain

What is defined as "classic" chest pain?

Substernal, pressure, heaviness, sitting on chest

What type of angina is > 30 min, crushing, SOB, predictable with exertion?

Stable

What type of angina is seen in DM, elderly, females?

Atypical

Which type of angina is seen in young females and is due to coronary vasospasms without high grade stenosis?

Variant/prinzmetal/spastic

What are the three types of ACS?

Unstable angina, NSTEMI, STEMI

How do you treat unstable angina?

Heparin, nitroglycerin, and GP IIb/IIa inhibitors

What are the clinical manifestations of MI (need ⅔ to diagnose)?

ACS chest pain, ECG injury, increased cardiac enzymes

What is the mechanical treatment for a STEMI?

PCI (door to balloon in 90 minutes)

What is the pharm treatment for STEMI if PCI is unavailable?

tPA (door to needle in 30 minutes)

If a PCI/stent is contraindicated, how do you treat a STEMI?

CABG

When is a PCI/stent contraindicated?

Severe left main or proximal LAD disease, failed stent placement

If a pt with a STEMI is in the ED, what things need to be done?

ECG, CXR, telemetry, 2 large-bore IVs, maintain O2, platelet inhibition (ASA), heparin or LMWH

What does THROMBINS stand for and what is it used for?

Thienopyridine (like clopidogrel)
Heparin
RAAS (ARN or ACE)
O2
Morphine
BB
Intervention (stent/CABG)
Nitrates
Statin
Salicylate (ASA)
Used for acute MI tx

What anticoagulant is preferred for angina and NSTEMIs?

Lovenox

What anticoagulant is preferred for STEMI?

Heparin

What do you prescribe after an acute event?

ASA for life, DAPT, BB, ACE-I, Statins

No signs of HF is what Killip class?

I

Rales or crackles, S3, JVD is what killip class?

II

Acute pulmonary edema is what killip class?

III

Cardiogenic shock, SBP <90, low CO is what killip class?

IV

What is killip classification used for?

Quantifies severity of heart failure in NSTEMI and predicts 30 day mortality

What is indicated when there is destruction of the critical region of impulse propagation (this eliminates the arrhythmia)?

RF catheter ablation

Electrical impulses delivered by electrodes to the heart to regulate rhythm?

Pacemaker

Treats patients at risk for sudden cardiac death due to v-fib?

AICD (automated implantable cardioverter-defibrillator)

How do you treat sinus brady?

Treat underlying cause
Atropine if symptomatic and severe
Pacemaker if unresponsive to atropine

How do you treat sick sinus syndrome?

Correct underlying cause
Pacemaker if normal EF
AICD if reduced EF

How do you treat sinus tachy?

Treat underlying cause

How do you treat acute unstable WPW?

Synchronized cardioversion

How do you treat afib + WPW?

Amiodarone or procainamide

What is the long term treatment for WPW?

RF ablation

What is the first line treatment for HR control in afib?

Diltiazem

What is the first line for afib?

DOACs (apixaban, dabigatran, edoxaban, rivaroxaban)

What do you use to treat afib with an artificial valve?

Warfarin

If you have a refractory cause of afib, how do you treat it?

Ablation

What is the first line treatment for SVT?

Vagal maneuvers (bear down, carotid massage, face in ice water)

What is the second line (pharmological tx) for SVT?

Adenosine

How do you treat severe PVCs?

Empiric BBs

How do you treat torsades de points?

IV mag sulfate
If unstable defibrillate!

How do you treat v-fib?

Immediate defibrillation

How do you treat stable vtach?

Amiodorone or procainamide

How do you treat unstable vtach?

Synch cardiovert

How do you treat pulseless vtach?

Defibrillator, CPR, amiodarone, EPi

How do you treat 2nd degree type I heart block?

Transcutaneous pacing, atropine

How do you treat 2nd degree type II heart block?

Transcutaneous pacing
Hemodynamically unstable - temporary transvenous pacing wire

How do you treat 3rd degree heart block?

Dual chamber PPM

What are the class IA antiarrhythmics?

Quinidine, procainamide, disopyramide

What class of antiarrhythmics prolong the QT interval (could cause torsades)?

IA

Which antiarrhythmic causes lupus like syndrome?

Procainamide (IA)

What are the class IB antiarrhythmics?

Lidocaine, tocainide, mexiletine, diphenylhydantoin

Which antiarrhythmic do you use for digitalis induced arrhythmias?

Diphenylhydantoin

Which antiarrhythmic causes 2nd degree blood dyscrasias?

Tocainide (IB)

Which class of antiarrhythmics are rarely used? What are they?

IC, flecainide, propafenone

Beta blockers are which antiarrhythmic class?

II

What are the class III antiarrhythmics?

Amiodarone, sotalol, bretylium tosylate, ibutilide, dofetilide

What are the side effects of amiodarone (amiterrible)?

Pulmonary toxicity
Thyroid abnormalities
Blue/gray hyperpigment

Which class of antiarrhythmics are the NDHP CCBs?

IV

What are the class V antiarrhythmics?

Adenosine, digoxin

What are some side effects of adenosine?

Transient SE, HA, chest pain, flushing, bronchoconstriction

What are some side effects of digoxin?

Neurotoxicity, GI, visual disturbances, arrhythmias, renal failure, hypokalemia

What is Cardarelli's sign?

Abnormal pulsation of the trachea (AAA)

What population needs to get an annual ultrasound to check for abdominal AA?

65-75 y/o male smokers

What are three risk factors for AAA?

CAD and HTN
Old male smokers
Hypercholesterolemia

At what measurement is there great risk of aortic rupture?

> 5.5 cm

What is the gold standard for diagnosis of AA?

CTA

What is the first line pharm treatment for aortic dissection?

IV BB

With aortic dissection repair surgery, the tear is resected and replaced with what?

Dacron graft

Severe tearing pain in the anterior chest is indicative of what?

Ascending aortic dissection

Severe tearing pain in the interscapular region is indicative of what?

Descending aortic dissection (acute pericardial tamponade is imminent)

What are the pulses like in PAD?

Absent/diminished

What is the recommended management for PAD?

Supervised exercise, ASA/clopidogrel, Cilostazol, Pentoxifylline

What are the 6 Ps of acute ischemia?

Pain, pallor, pulseless, paresthesias, paralysis, poiklothermia

What is defined as atheromatous disease of coronaries in the peripheries?

Arteriosclerotic obliterans

What is defined as NON-atheromatous intense inflammation followed by arterial and venous occlusive disease?

Thrombo-angitis Obliterans

What is also known as "Buerger's Disease?"

Thrombo-angitis Obliterans

This disease is associated with a triphasic color scheme?

Thromob-angitis Obliterans (white-blue-red)

What are the three types of arterial vasoplastic disorders?

Cold-sensitivity/Raynauds
Livedo reticularis
Acrocyanosis

How do you treat Raynauds?

CCBs, alpha blockers

Persistent cyanotic mottling of the skin, "fishnet" appearance?

Livedo reticularis

How do you treat vasculitis?

Steroids or immunosuppression

How do you treat varicose veins?

NSAIDs, sclerotherapy, compression socks, elevating legs, RF ablation, endovenous lasers, exercise, vein stripping (surgical)

Ulcers on the ends of the toes, top of the feet, and lateral ankle?

Arterial insufficiency

Ulcers on the medial parts of the lower legs?

Venous insufficiency

Ulcers with little drainage, little tissue granulation, necrotic, "punched out"

Arterial

Ulcers with drainage, granulation, irregular edges, shallow?

Venous

What are some S/S of left sided HF?

DOE, orthopnea, bibasilar rales, loud P2, S3 gallop

How do you treat acute HFrEF?

LMNOP
Lasix, morphine, nitrate, oxygen, position (upright)

How do you treat chronic HFrEF?

Fantastic 4!
MRA, BB, ARNI or ACE or ARB, SGLT2 inhibitor

What are some S/S of right sided HF?

Pitting edema, RUQ discomfort, JVD, hepatojugular reflex

What are the NYHA classes of HF?

I - asymptomatic
II - symptomatic with moderate exertion
III - symptomatic with mild exertion
IV - symptomatic at rest

What are the ACC/AHA HF stages?

A: high risk - CAD/HTN
B: structural dz - no symptoms
C: structural disease - symptoms
D: Refractory HF - interventions

In which cardiomyopathy is EF LOW?

Dilated

Which cardiomyopathy shows 4 chamber enlargement?

Dilated

What is the first line tx for dilated cardiomyopathy?

Treat HF (ACE/ARNI/MRA/BB)

What are some causes of dilated cardiomyopathy?

CAD/HT, alcoholic, perpartum

What type of dysfunction is dilated cardiomyopathy?

Systolic

How do you treat HOCM?

BBs and CCBs

PE findings in HOCM?

S4, EF normal or increased, LLSB murmur that increases w valsalva