Sum - Cardio

Score used to determine if patients with Afib/Aflutter require anticoagulation

CHA2DS2-VASc: CHF, HTN, Age > 75 y/o (2 pts), DM, Stroke (2 pts), Vascular disease, Age 65-74 y/o, Sex (female)

**2 or more points --> Anticoagulation recommended

MCC of SVT

Reentry (AV nodal)

ECG shows HR < 100 bpm + ≥3 p-wave morphologies

Wandering atrial pacemaker

Slurred upstroke of QRS

Delta wave: WPW

Torsades de pointes is a result of

QTc prolongation

Tx for Torsades de pointes

Mag sulfate

Class of Procainamide

Class 1A antiarrhythmic- Na+ channel blocker

Class of Quinidine

Class 1A antiarrhythmic- Na+ channel blocker

Class of Lidocaine

Class 1B antiarrhythmic- Na+ channel blocker

Class of Flecainide

Class 1C antiarrhythmic- Na+ channel blocker

Class of Amiodarone

Class III antiarrhythmic- K+ channel blocker

Class of Verapamil

Class IV antiarrhythmic- Ca2+ channel blocker

Class of Diltiazem

Class IV antiarrhythmic- Ca2+ channel blocker

What artery is involved in an anterior wall MI?

LAD

What artery is involved in a lateral wall MI?

Circumflex

What artery is involved in an inferior wall MI?

RCA

What artery is involved in a posterior wall MI?

RCA or Circumflex

Which of the following cardiac markers appears the fastest?

a. CK-MB

b. Troponin

c. Myoglobin

Myoglobin

Which of the following cardiac markers returns to baseline after 7-10 days?

a. CK-MB

b. Troponin

c. Myoglobin

Troponin

Which of the following cardiac markers is the most sensitive & specific for detecting MIs?

a. CK-MB

b. Troponin

c. Myoglobin

Troponin

Dressler syndrome

post-MI pericarditis + fever + pulmonary infiltrates

Adverse effects of ACE inhibitors

Angioedema, cough

Spontaneous episodes of angina accompanied by transient ECG ischemic ST changes

Variant/Prinzmetal angina

Tx for variant/Prinzmetal angina

CCBs + Nitro

MCC of left-sided HF

CAD

MCC of right-sided HF

Left-sided HF

HFrEF = (systolic/diastolic) dysfunction

Systolic

HFpEF = (systolic/diastolic) dysfunction

Diastolic

Clinical manifestations include pulmonary symptoms such as dyspnea & cough

a. Left-sided HF

b. Right-sided HF

Left-sided HF

Clinical manifestations include peripheral edema, JVD, GI/hepatic congestion

a. Left-sided HF

b. Right-sided HF

Right-sided HF

-pril

ACE inhibitors

1st line tx for HFrEF

ACE inhibitors + diuretics

-artan

ARBs

Class of Furosemide

Loop diuretic

Class of Bumetanide

Loop diuretic

Class of Torsemide

Loop diuretic

Class of Spironolactone

K+ sparing diuretic

Class of Eplerenone

K+ sparing diuretic

-gliflozin

SGLT2 inhibitors

Lab value for CHF

BNP

Disease of the heart muscle characterized by systolic dysfunction (impaired contraction) and dilatation of 1 or both ventricles

Dilated cardiomyopathy

MC viral cause of myocarditis

Coxsackie B virus

What should patients with myocarditis avoid?

NSAIDs, heavy alcohol, Digoxin, Exercise, Cardiotoxic meds

Diastolic dysfunction in a non-dilated, rigid ventricle, which impedes ventricular filling

Restrictive cardiomyopathy

MCC of restrictive cardiomyopathy

Amyloidosis (also sarcoidosis & hemochromatosis)

Sudden cardiac death especially in adolescent or preadolescent children especially during times of extreme exertion often due to ventricular arrhythmias

Hypertrophic cardiomyopathy (HOCM)

Transient regional systolic dysfunction that can imitate an MI, but is associated with the absence of significant obstructive coronary artery disease.

** MC in postmenopausal women exposed to physical/emotional stress

Takotsubo cardiomyopathy

MC type of HTN

Primary/essential

MCC of secondary HTN

Renal artery stenosis

SBP > 180 mmHg and/or DBP > 120 mmHg without evidence of end organ damage

Hypertensive urgency

How do you treat hypertensive urgency?

Gradual reduction of MAP by 25% over 24-48 hours using PO BP reduction agents

SBP > 180 mmHg and/or DBP > 120 mmHg with evidence of end-organ damage

Hypertensive emergency

Testing for orthostatic hypotension

Tilt-table test

MCC of syncope

Vasovagal syncope

MC valve involved in infective endocarditis

Mitral valve

MC valve involved in infective endocarditis in IV drug abuse pts

Tricuspid valve

MCC of acute bacterial endocarditis

S. aureus

MCC of subacute bacterial endocarditis

S. viridans

MCC of IVDA endocarditis

S. aureus

Clinical manifestations of infective endocarditis

Janeway lesions, Osler nodes, Splinter hemorrhages, Roth spots

Painful or tender raised violaceous nodules on the pads of the digits and the palms

Osler nodes: infective endocarditis

Painless erythematous macules on the palms & soles

Janeway lesions: infective endocarditis

Retinal hemorrhages with central clearing

Roth spots: infective endocarditis

Cardiac conditions requiring endocarditis prophylaxis for dental/respiratory/skin & MSK procedures

Prosthetic heart valves, Heart repairs with prosthetic material, Hx of endocarditis, Congenital heart disease

Med for endocarditis prophylaxis

Amoxicillin

Supine position

a. Increases venous return

b. Decreases venous return

Increases venous return

Squatting

a. Increases venous return

b. Decreases venous return

Increases venous return

Leg elevation

a. Increases venous return

b. Decreases venous return

Increases venous return

Standing

a. Increases venous return

b. Decreases venous return

Decreases venous return

Valsalva

a. Increases venous return

b. Decreases venous return

Decreases venous return

Increase/Decrease in venous return increases/decreases the intensity of ALL murmurs except _________

HOCM & MVP

Inspiration increases the intensity of (right/left)-sided murmurs

Right

Clinical manifestations of aortic stenosis

Dyspnea, Angina, Syncope

Harsh, low-pitched, systolic, crescendo-decrescendo murmur best heard at the right upper sternal border and radiates to the coronary arteries

Aortic stenosis

2 MCCs of aortic regurgitation in a native valve

Endocarditis & Aortic dissection

High-pitched, blowing, decrescendo diastolic murmur best heard over the 3rd or 4th intercostal space at the left sternal border (Erb's point)

Aortic regurgitation

Mid-late diastolic rumble at the apex secondary to retrograde regurgitant jet competing with antegrade flow from the left atrium into the left ventricle

Austin-Flint murmur

swift upstroke and rapid fall of radial pulse accentuated with wrist elevation

Water hammer pulse

swift upstroke and rapid fall of carotid pulse

Corrigan's pulse

Head-bobbing with each heartbeat

De Musset's sign

Visible fingernail bed pulsations with light compression of the fingernail bed

Quincke's pulse

Water hammer pulse, Corrigan's pulse, Quinicke's pulse, De Musset's sign are all clinical findings of ______

Aortic regurgitation

MCC of mitral stenosis

Rheumatic heart disease

Clinical manifestations of mitral stenosis

Palpitations, dyspnea, HF, Afib, Ortner's syndrome

Palpitations, dyspnea, HF, Afib, Ortner's syndrome

Mitral stenosis

Recurrent laryngeal nerve palsy due to compression by the dilated left atrium resulting in hoarseness

Ortner's syndrome

Opening snap

Mitral stenosis

MCC of mitral regurgitation

MVP

High-pitched, holosystolic murmur best heard at the apex with radiation to the left axilla & subscapular region

Mitral regurgitation

Mid-late systolic click

MVP

Brief high-pitched decrescendo early diastolic murmur heard at the left upper sternal border

Graham-Steel murmur

Low-pitched, mid-diastolic murmur heard at the left lower sternal border

Tricuspid stenosis

High-pitched holosystolic murmur at the subxiphoid, left mid sternal border

Tricuspid regurgitation

Widespread, diffuse ST elevations

Pericarditis

Tx for pericarditis

NSAIDs, colchicine (recurrent), ASA

Electrical alternans on EKG

Pericardial effusion

Beck's triad

JVD, hypotension, muffled heart sounds --> cardiac tamponade

Chest pain worse when laying supine and relieved when leaning forward

Pericarditis

HMG-CoA Reductase Inhibitors

Statins

Most powerful drugs for lowering LDL

Statins