First Aid: Cardio I

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shosh114
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107487
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First Aid: Cardio I
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2011-10-11 12:52:07
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Internal medicine rotation cardio
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Internal medicine rotation cardio
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  1. Prognostic indicators of CAD
    • EF under 50%
    • LCA stenosis
    • 3 vessel disease--indicates poor prognosis
  2. Metabolic syndrome
    • Hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, and HTN
    • Due to insulin resistance
  3. Indicators of a positive stress test
    • ST depression
    • Chest pain
    • Hypotension
    • Arrhythmias
    • (all during exercise)
  4. What is a postive stress echo?
    • Abnormal wall motion after exercise, due to ischemia
    • More sensitive at identifying ischemia than stress ECG
  5. Sharp, localized chest pain, exacerbated by exercise
    Costochondritis (MSK)
  6. Chest heaviness or pressure, often radiating to the left shoulder, arm, or jaw
    MI/angina
  7. Chest pain radiating to the shoulder, neck, or back, that worsens on deep breathing and leaning forward
    Pericarditis
  8. Which patients are particularly prone to silent MI?
    Diabetics, due to peripheral neuropathy
  9. Severe chest pain that radiates to the back + unequal pulses
    Aortic dissection
  10. What type of chest pain will an abscess or mass cause?
    Sharp, localized, and pleuritic
  11. Pleuritic chest pain plus tachypnea and tachycardia
    PE
  12. DD for chest pain
    • Costochondritis
    • MI
    • Pericarditis
    • Aortic dissection
    • Abscess/mass
    • PE
    • Pneumonia
    • GERD
    • Peptic ulcer disease
    • Biliary disease
    • Herpes zoster
    • Pneumothorax
  13. What constitutes a positive family hx for MI?
    • MI before 40 in men
    • MI before 55 in women
  14. Functions of LDL and HDL
    • LDLs are metabolized from VLDLs, and transport cholesterol in the blood to the tissues
    • HDLs uptake free cholesterol secreted by the tissues, and transport it back to the liver
  15. Apo B100 deficiency
    • LDL will be elevated
    • Patients are prone to MI
  16. Apo CII deficiency
    • Chylomicrons will be elevated
    • Patients are hypertriglyceridemic, and at risk for pancreatitis
  17. How are LDL levels calculated?
    LDL=TC-HDL-VLDL
  18. How are VLDL levels calculated?
    VLDL=Triglycerides/5
  19. Nicotinic acid
    • Reduces lipolysis in adipose tissue and cholesterol synthesis in the liver
    • Lowers LDL
    • Side effects include flushing, abdo pain, and nausea
  20. Fibrates
    • Reduce triglyceride levels
    • Increase HDL
  21. Acute coronary syndrome
    Atherosclerotic plaque rupture, thrombosis, or occlusion, that manifests with unstable angina or acute MI
  22. Causes of acute MI
    • Ruptured plaque with local thrombus
    • Coronary vasospasm
    • Embolized thrombus
    • Decreased coronary perfusion due to shock
  23. New Q waves or loss of R waves
    Indicates transmural MI
  24. Inferior wall MI
    ST elevation in II, III, and aVF
  25. Cor pulmonale
    ST depression in II, III, and aVF
  26. Anteroseptal MI
    ST elevation in V1-3
  27. Lateral wall MI
    ST elevation in V4-6
  28. Posterior wall MI
    ST depression in V1-2
  29. Which CK isoenzyme indicates MI?
    The MB fraction
  30. Absolute contraindications for using beta blockers in an MI
    • HR under 60 bpm
    • Systolic BP under 100 mmHg
    • 2nd or 3rd degree heart block
    • Moderate to severe LV dysfunction
    • Severe COPD
    • Signs of peripheral hypoperfusion
  31. Can heparin be used for thrombolysis?
    No, because although it can prevent clots from forming, it does not dissolve already formed clots
  32. Indications for thrombolysis
    • ST elevation over .1 mV in at least 2 contiguous leads
    • New LBBB
  33. Caveat for streptokinase
    Because it is highly immunogenic, it should not be used in the same patient more than once within a 6 month period
  34. What does PTCA stand for, and what is it?
    • Percutaneous transluminal coronary angiography--using a balloon catheter to break up a clot
    • Should be performed within 90 min of diagnosis to be effective
  35. 2 weeks post-MI, a patient presents with fever, chest pain, and malaise. ECG shows diffuse ST changes
    • Dressler's syndrome (post-MI pericarditis)
    • Treat with NSAIDs
  36. Absolute contraindications for ACE inhibitors
    • Pregnancy
    • Bilateral RAS
    • Severe renal disease
  37. Stable angina
    Chronic, episodic chest pain due to temporary myocardial ischemia that resolves with rest or medication
  38. Prinzmetal's angina
    • Angina caused by coronary vasospasm, not related to exertion
    • Pain usually occurs at a specific hour in the early morning
    • Coronary angiography will be normal
  39. Meds for stable angina
    • Aspirin
    • Beta blockers
    • Sublingual nitroglycerin
    • Drugs that modify risk factors (e.g. HTN, hyperlipidemia)
  40. Maximum predicted HR for a patient taking a stress test
    220-age
  41. Pharmacological agent that can be administered to simulate a stress test
    Dobutamine
  42. When is a stress test considered positive?
    • Early ST depression
    • ST depression over 2 mm in multiple leads
    • ST elevation
    • Decreased BP
    • Failure to exercise over 2 min, due to cardiac symptoms
  43. Definition of CHF
    • Failure of heart to pump enough blood to the tissues
    • Left heart failure can cause pulmonary venous congestion and compromised systemic circulation
    • Right heart failure can cause systemic venous congestion
  44. Causes of CHF
    • MI
    • PE
    • Arrhythmias
    • Anemia
    • Pneumonia
    • Thyrotoxicosis
    • Wet beriberi
  45. Signs of LHF
    • Orthopnea
    • PND
    • Rales
    • Dyspnea on exertion
    • Cough
    • Nocturia
    • S3 gallop
    • Diaphoresis
    • Tachycardia
  46. Signs of RHF
    • RUQ pain (due ot hepatic congestion)
    • Hepatomegaly
    • Hepatojugular reflex
    • JVD
    • Ascites
    • Cyanosis
    • Peripheral edema
  47. Symptoms that differentiate RHF from cirrhosis
    Orthopnea and JVD are usually seen in RHF, but not in cirrhosis
  48. What antihypertensives to blacks tend to respond well to?
    CCBs
  49. Etiologies of acute pulmonary edema as a CHF exacerbation
    • Arrhythmias
    • MI
    • Medication noncompliance
    • Increased Na load
    • Drugs that decrease inotropy
    • Strain
  50. First line therapy for acute pulmonary edema
    • Nitroglycerin
    • Oxygen
    • Morphine
    • Aspirin
    • Diuretics
    • ("NOMAD")
  51. What causes PND?
    Increased venous return to the heart when the patient is in the supine position
  52. Major and minor criteria for diagnosis of rheumatic heart disease (requires either two major, or one major and two minor criteria)
    • Major
    • Migratory polyarthritis
    • Carditis (endo, myo, or peri)
    • Erythema marginatum rash
    • SubQ nodues
    • Sydenham's chorea
    • Minor
    • Fever
    • Arthralgias
    • Elevated ESR
    • Prolonged PR
    • Recent strep pharyngitis
  53. What serological test indicates rheumatic fever?
    Elevated streptolysin O

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