ClinMed Cardio

hearts own circulation

coronary ostia (aortic recoil)

cardiac stretch receptor lab

measures what?

BNP, NTProBNP

(measures fluid status in CHF)

2D echo colors

BART

(blue = away red = towards)

nuclear stress testing is used to..

directly observe myocardial perfusion

if pt can't walk...what form of stress test should you order?

nuclear

cardiac rehab uses

(it IS used for) psychosocial sx (--> pt's depressed after MI)

MC congenital defect

tx?

VSD

(tx = surgical closure vs. trans catheter closure

electron beam CT used for what?

assessing arterial calcium deposits (plaque caps)

DOC for HTN in pregnancy

methyldopa

cardiac tamponade tx

drainage of pericardium (pericardial window?)

5 t's of shock

tension pneumo tamponade toxins thrombosis (- PE) thrombosis (- MI)

leading cause of SCD in competitive athletes \>35 y/o

HOCM

MC reason for pacemaker placement

sick sinus syndrome

PSVT tx

IV adenosine

TEE to r/o what?

LA/LAA thrombus

CHADSVASC score

used for what?

(C - CHF H - HTN >140/90 A(2 pts) - age >75 D - DM S (2 pts) = prior clot (stroke, TIA, embolism) V - vascular disease A - 65-74 y/o Sc - female gender)

afib

PR intervals progressively increase

MC form of 2nd degree block

Mobitz 1 (Wencke)

pulseless vtach tx

SHOCK

MC cause of mitral stenosis

rheumatic heart disease

painful red lesions on hands/feet associated w/ bacterial endocarditis

osler nodes

LDL is more increased in what gender?

male

HDL and TG more decreased in what gender?

female

MAP equation

MAP \= DBP + 1/3(SBP-DBP)

tx for 3rd degree heart block

old man who fainted in church

pacemaker

check a \_________ for initial HTN workup

urinalysis (--> assess renal damage -also include microalbumin)

normal amount of fluid in pericardium

50 mL

hypertensive EMERGENCY requires what to dx?

end organ damage (includes eyes)

75% of aortic aneurysms are \__________

MC in what gender?

abdominal, men

ABI for PAD

how do you measure?

scoring?

take BP in FOOT of interest and BOTH ARMS (normal = 1-1.4 acceptable = 0.9-1 mild = 0.8-0.9 moderate = 0.5-0.8 severe = less than 0.5)

holosystolic murmur, high pitched blowing, best heard at apex

mitral regurg

harsh high pitched crescendo-decrescendo murmur best heard at RUSB --\> can have diminished or absent S2

aortic stenosis

systolic crescendo-decrescendo murmur best heard at 3-4 ICS

pulmonic stenosis

low pitched diastolic murmur at 3-4 ICS, split S2

pulmonary regurg

low pitched diastolic murmur w/ possible opening snap, best heard at LLSB, INCREASES w/ inspiration

tricuspid stenosis

pansystolic murmur that increases with inspiration, heard at LLSB, right sided S3/S4 (accentuated P2 w/ pulmonary HTN)

tricuspid regurg

aortic stenosis intensity does not always correlated with \_________

severity

metabolic syndrome criteria (need 3+)

waist circumference (>40 men >35 women)

elevated TG (>150)

reduced HDL (

drug eluting stent anticoagulation

ASA lifelong + dual anti PLT therapy (12 mo or longer --> can only stop ASA for emergent surgery)

(HIGHER risk than bare metal stent)

bare metal stent anticoagulation

ASA lifelong + dual anti plt therapy (3 mo or longer)

troponin takes how long to rise after onset of ischemia?

3-12 hours

mechanism in which increased blood volume stretches ventricles and causes it to contract w/ more force (rubber band mechanism, pre load)

frank starling mechanism

thin, weak heart muscle, S3 gallop, decreased EF, "pump" problem

what type of HF?

exam findings?

SYSTOLIC HF

(rales, elevated JVD, edema and ascites, laterally displaced PMI, cool extremities w/ decreased pulses, HYPOtension)

thick heart muscle, S4 gallop, PRESERVED EF, "filling" problem

what type of HF?

exam findings?

DIASTOLIC HF

(aortic stenosis murmur, edema, rales)

direct vasodilators and where they work

amlodipine
hydralazine
minoxidil

amlodipine- veins hydralazine- arteries minoxidil- capillaries

inflammation/damage to the heart WITHOUT blockage...what disease?

MC caused by?

myocarditis, VIRUS

dilated cardiomyopathy is a \_______ problem

pump problem

(weak contractions, decreased SV, S3

with aging everything decreases except...

fibrosis, wall thickness, lens opacities

edema, JVD, abd distension, organomegaly, weight gain, diuresis, S4

what side of HF?

RIGHT (think everything is backing up into body)

dyspnea, tacky, crackles, rales, cough, orthopnea, PND

what side of HF?

LEFT (think everything backing up into lungs)

inject pt w/ cardio lite --\> wait 45 min for liver to clear --\> obtain scan at rest

resting scan - nuclear stress test

adenosine given --\> repeat cardiolite injection

dead coronaries don't dilate well and will have decreased perfusion

post stress scan - nuclear stress test

if no perfusion defect found...

no old MI or ischemia

if perfusion defect at rest and after exercise...

old MI, injury, congenital defect or big boobs (artifact)

pt fails stress test, what next?

cardiac cath is gold standard

anytime you need to evaluate structure/performance/function/wall motion of heart you should order what?

ECHO

tx for 25 yo anxious female PA student with CC of palpitations?

(IV adenocard -) adenosine

BNP indicates?

from cardiact stretch receptors, indicates) heart is being stretched by fluid

what is evaluated with a transesophageal echo/ echocardiogram

size, structure, wall motion, pump performance (CANT SEE CARDIAC CONDUCTION)

whats the normal cardiac response upon standing? what happens when your PNS is too sensitive?

HR increases (to maintain cerebral perfusion - if not, syncope the parasympathetic NS watch for excessive HR increase, increase sensitivity decreases HR) syncope or near syncope

what does the tilt test procedure test?

neurally- mediated syncope

best test to show myocardial perfusion for a 79 y/o with a previous cardiac stent? A positive result shows?

nuclear stress testing

positive = perfusion defect/ ischemia

pt with mild ischemic changes on stress test trying to get cleared for surgery - what do you do?

delay surgery and do other tests

what does electron bean CT give?

gives calcium score

what is the most common congenital heart defect?

patent foramen ovale

How is a PFO dx? increases risk for?

echocardiogram with bubble study (NOT you would hear murmur) risk for CVA

VSD increases risk for?

infective endocarditis

what is the most common form of cyanotic heart disease in newborns?

tetralogy of fallot

what are the 4 major defects required for tetralogy of fallot

pulmonary stenosis/right ventricular outflow tract
right ventricular hypertrophy
overriding aorta
ventricular septal defect

what is dextro-transposition of the great vessels?

aorta and pulmonary arteries are reversed (cyanotic defect - most common of the cyanotic conditions)

What is Levo-transposition of the great arteries?

RV and LV are reversed

what are the systemic impacts of hypertension?

Encephalopathy, stroke, retinopathy, acute CHF, ACS, MI, pulmonary edema, AAA acute renal failure (NOT stenosis or regurg)

how do you diagnosis HTN

at rest, confirm on separate occasions

dx for extent of HTN for end organ damage?

urinalysis

good tx for bradycardia and HTN that can cause reflex increase in HR?

hydralazine (peripheral artery vasodilator)

definition of HTN emergency?

\>220/\>120 with end organ damage present

post MVA, femur fx, hypotension, pulse 140 likely cause?

hypovolemic shock

75% of aortic aneurysms are?

AAA (NOT thoracic)

ankle brachial index of 1.1 in left leg and 0.45 in right leg, what does this mean

r leg is severe disease
l leg is normal

women have CAD more frequently where?

very small branching arteries ("microvascular disease" not obstructive dz)

low HDL is more predictive for CAD in \___?

women

what levels are especially important in women for CAD?

triglycerides

a pt with pre-existing HTN becomes pregnant, what's the best plan?

(may have to change meds - )stop lisinopril & losartan, switch metoprolol to acebutolol

less than 20% of PCPs, gyno and cardiologists don't know what?

more females die of CAD than men

common meds to tx ischemic heart disease

nitro, antiplatelet, beta-blocker, ACE inhibitor, CCB, long acting nitrates, ranexa (NOT hydralazine)

dx and next steps for STEMI?

ST segment elevation & J point elevation
send to cath lab

whats necessary to see on MRI to dx STEMI

2 contiguous leads, 1mm ST elevation, J point elevation

what arteries are involved and what leads can an inferior MI be seen

r coronary artery (80%), left circumflex (20%)
Leads II, III, and aVF

coagulation requirements for a drug eluting stent (DES)

ASA lifelong, DAPT minimum of 12 months or longer

wait period prior to ICD post MI with revascularization?

90 days

what does BNP indicate

(ventricles secrete in response to stretching of myocytes) indication of acute CHF (- used to assess fluid status and check for volume overload)

first line treatments for CHF?

beta blockers
ACE/ARB
aldosterone antagonists (or loop)

AHA/ACC Stage C for CHF

pts with structural heart dz w/prior/current sx of HF

features of systolic CF? whats seen on PE?

impaired EF

features of diastolic CHF?

filling problem HF with preserved EF (NOT low ventricular EF)

features of right sided CHF?

dependent edema, JVD, abdominal distention/hepatomegaly splenomegaly, anorexia/nausea/wt gain, nocturnal diuresis

nonmedical options for management of CHF?

daily wt, NA+ restriction, medicatio compliance, HF clinic, ultrafiltration
NOT let him drink free water whenever he wants

EKG findings for myocarditis?

diffuse T wave inversion and/or ST segment elevation, Q wave, BBB (kinda present like an acute MI)

leading cause of death in athletes?

HOCM

describe murmur associated with HOCM

harsh systolic ejection murmur (crescendo-decrescendo)

presentation of acute pericarditis and tx?

pleuritic chest pain, fever, dyspnea, pericardial friction rub

tx is NSAID, ASA, Colchicine