Cardiology

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Author:
shosh114
ID:
159981
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Cardiology
Updated:
2012-06-26 02:21:34
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step II
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step II
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  1. Workup of a patient with suspected MI
    • ECG
    • CK-MB
    • Troponin I
    • Myoglobin (usually drawn every 8 hours, 3x)
  2. Management of a patient with MI
    • 1. ECG monitoring
    • 2. Oxygen
    • 3. Morphine
    • 4. Nitro
    • 5. Beta blocker
    • 6. Clopidogrel
    • 7. LMWH
    • 8. ACE inhibitor or ARB
    • 9. Statin

    REPERFUSION within 12 hours
  3. Causes of pericarditis
    • Coxsackie virus (most common)
    • TB
    • Uremia
    • Malignancy
    • SLE
  4. Management of unstable angina
    • 1. Oxygen
    • 2. Aspirin
    • 3. Nitro
    • 4. Beta blocker
    • 5. LMWH
    • 6. GP IIb/IIIa inhibitor
    • 7. ACE inhibitor or ARB

    Emergency PTCA if pain does not resolve
  5. Late diastolic murmur, best heard at apex
    Mitral stenosis
  6. Holosystolic murmur that radiates to axilla
    Mitral regurg
  7. Harsh systolic ejection murmur best heard in aortic area that radiates to carotids
    AS
  8. Early diastolic decrescendo murmur, best heard over apex
    Aortic regurg
  9. Midsystolic click, late systolic murmur
    Mitral prolapse
  10. What psychiatric condition is associated with mitral prolapse?
    Panic disorder
  11. What antibiotic should be used for prophylaxis in patients with predisposing conditions to bacterial endocarditis?
    Amoxicillin
  12. Conditions that predispose to DVT
    • Recent surgery/immobility
    • Malignancy
    • Pregnancy
    • OCPs
    • DIC
    • Coagulation disorder (e.g. factor V Leiden deficiency)
  13. What can recurrent superficial thrombophlebitis indicate?
    Underlying malignancy (Trousseau syndrome)
  14. DVT management
    • Start with IV LMWH or heparin
    • Switch to warfarin, keep px on warfarin for 3-6 months
    • Pneumatic compression stockings for patients at high risk for bleeding
  15. Management of PE
    • Start LMWH or IV heparin, gradually switch the px to oral warfarin, for the next 3-6 months
    • Greenfield filter for recurrent clots + contraindications to anticoagulation
    • t-PA only for really massive emboli
  16. Major side effect of heparin
    HIT, usually on day 3-7 (monitor CBC)
  17. How are the effects of heparin monitored?
    • Unfractionated heparin--measure PTT
    • LMWH--use anti-Xa to measure effect
  18. How can heparin be reversed?
    Protamine
  19. Management of chronic CHF
    • Na restriction
    • ACE inhibitors (first line agents)
    • Beta blockers
    • Diuretics
    • Spironolactone
    • Digoxin (moderate to severe with low EF)
    • Vasodilators
  20. Management of CHF exacerbation
    • Oxygen
    • Diuretics
    • Inotropic agents (Digoxin, if px is stable, can also use dobutamine, dopamine, or amrinone)
  21. What can precipitate a CHF exacerbation?
    • Medication non-compliance
    • MI
    • Severe HTN
    • Arrhythmia
    • Infection, fever
    • PE
    • Anemia
    • Thyrotoxicosis
  22. Causes of dilated cardiomyopathy
    • Chronic CAD or ischemia
    • Alcohol abuse
    • Myocarditis
    • Doxorubicin
  23. Management of hypertrophic cardiomyopathy
    Beta blockers or disopyramide
  24. Normal PR interval
    0.12-0.2
  25. Management of A fib
    • 1. Rate control--beta blocker or CCB
    • 2. Ask if duration is more or less than 48 hours-
    • If less than 48 hours: cardiovert (DC, amiodarone, or procainamide
    • If more than 48 hours: do TEE to look for clots and then cardiovert, or anticoagulate for 3 weeks and then cardiovert
  26. Management of first degree heart block
    • Leave it alone
    • Don't give beta blockers or CCBs (slow conduction through AV node)
  27. Management of second degree heart block
    • Mobitz I--pacemaker or atropine in symptomatic patients
    • Mobitz II--pacemaker
  28. Management of WPW
    • Control rhythm with procainamide or quinidine
    • DON'T use digoxin or verapamil (they slow conduction through the AV node, which exacerbates the effect of the accessory pathway)
  29. Management of V tach
    • Pulseless--defibrillation, epi, vasopressin, and amiodarone or lidocaine
    • Pulse present--amiodarone + synchronized cardioversion
  30. Fixed split S2 + palpitations
    ASD--most close on their own and are asymptomatic
  31. Teratology of Fallot
    • Pulmonic stenosis
    • RVH
    • Overriding aorta
    • VSD

    Most common cyanotic congenital heart disease
  32. How often is cholesterol screened?
    Total cholesterol and HDL every 5 years after a person turns 20
  33. What are goal LDL levels?
    • If there are no CHD risk factors:
    • LDL under 160 is normal
    • Under 190 is medium risk
    • Over 190 is high risk

    • If there are 2 CAD risk factors:
    • LDL under 100 is normal
    • LDL under 130 is medium risk
    • LDL over 130 is high risk

    • If there is known CAD:
    • Goal LDL is always under 100

    If there is known CAD in a very high risk px (e.g. poorly controlled metabolic syndrome) the LDL goal is under 70
  34. What are the major risk factors for CAD?
    • 1. Age over 45 in men, 55 in women
    • 2. Family hx (MI in a man under 55 in a man or 65 in a woman)
    • 3. Smoking
    • 4. HTN
    • 5. DM
    • 6. Low HDL (under 40)
  35. How is LDL calculated?
    LDL=total cholesterol - (HDL - TG/5)
  36. When should a patient with hypercholesterolemia be started on anti-lipid meds?
    • LDL over 160 in a patient without CAD risk factors
    • LDL over 100 in a patient with CAD risk factors
  37. What are first line lipid lowering meds?
    • Statins--watch for MSK and hepatic toxicity
    • Second line agents are niacin, ezetimibe (selectively inhibits cholesterol absorption), and cholestyramine

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