Card Set Information
Workup of a patient with suspected MI
Myoglobin (usually drawn every 8 hours, 3x)
Management of a patient with MI
1. ECG monitoring
5. Beta blocker
8. ACE inhibitor or ARB
REPERFUSION within 12 hours
Causes of pericarditis
Coxsackie virus (most common)
Management of unstable angina
4. Beta blocker
6. GP IIb/IIIa inhibitor
7. ACE inhibitor or ARB
Emergency PTCA if pain does not resolve
Late diastolic murmur, best heard at apex
Holosystolic murmur that radiates to axilla
Harsh systolic ejection murmur best heard in aortic area that radiates to carotids
Early diastolic decrescendo murmur, best heard over apex
Midsystolic click, late systolic murmur
What psychiatric condition is associated with mitral prolapse?
What antibiotic should be used for prophylaxis in patients with predisposing conditions to bacterial endocarditis?
Conditions that predispose to DVT
Coagulation disorder (e.g. factor V Leiden deficiency)
What can recurrent superficial thrombophlebitis indicate?
Underlying malignancy (Trousseau syndrome)
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
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
Major side effect of heparin
HIT, usually on day 3-7 (monitor CBC)
How are the effects of heparin monitored?
Unfractionated heparin--measure PTT
LMWH--use anti-Xa to measure effect
How can heparin be reversed?
Management of chronic CHF
ACE inhibitors (first line agents)
Digoxin (moderate to severe with low EF)
Management of CHF exacerbation
Inotropic agents (Digoxin, if px is stable, can also use dobutamine, dopamine, or amrinone)
What can precipitate a CHF exacerbation?
Causes of dilated cardiomyopathy
Chronic CAD or ischemia
Management of hypertrophic cardiomyopathy
Beta blockers or disopyramide
Normal PR interval
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
Management of first degree heart block
Leave it alone
Don't give beta blockers or CCBs (slow conduction through AV node)
Management of second degree heart block
Mobitz I--pacemaker or atropine in symptomatic patients
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)
Management of V tach
Pulseless--defibrillation, epi, vasopressin, and amiodarone or lidocaine
Pulse present--amiodarone + synchronized cardioversion
Fixed split S2 + palpitations
ASD--most close on their own and are asymptomatic
Teratology of Fallot
Most common cyanotic congenital heart disease
How often is cholesterol screened?
Total cholesterol and HDL every 5 years after a person turns 20
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
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)
6. Low HDL (under 40)
How is LDL calculated?
LDL=total cholesterol - (HDL - TG/5)
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
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