Cards step2

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gm1147
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166146
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Cards step2
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2012-08-15 13:56:24
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Cards cardiology step2
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Kaplan
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  1. Tako-Tsubo cardiomyopathy
    • Acute myocardial damage following stressful event (deaths, earthquakes, hypoglycemia)
    • Most often in postmenopausal women, normal coronaries
    • Leads to ballooning and LV dyskinesis
    • Manage with bblockers and ACEi
  2. Maximum heart rate
    220-age
  3. Dipyridamole aka and contraindication
    • Persantine
    • Asthmatics
  4. Stress tests with equal sensitivity and specificity
    • Exercise thallium=Excerise Echo
    • Dipyridamole thallium=Dobutamine Echo
  5. Meds which lower mortality in chronic angina
    • ASA
    • Bblocker
    • Nitroglycerin - oral or patch
  6. Clopidogrel indications
    • Chronic angina with ASA allergy
    • Recent stenting
  7. Prasugrel
    • Thienopyridine
    • Antiplatelet for those undergoing angioplasty and stenting
    • dangerous in >75yo bc of stroke
  8. Ticlopidine
    • For intolerant to both ASA and clopidogrel
    • Antiplatelet
    • Cuases neutropenia
    • Ranolazine
    • Additional tx for angina if refractory
  9. ACEi cardiac indications with mortality benefit, sides and alternative
    • Low EF/systolic dysfunction
    • Regurgitant valvular disease
    • Cough, hyperK. Hydralazine with nitrates
  10. CAD equivalents
    • Peripheral artery disease
    • Carotid disease
    • Aortic artery disease
    • DM
  11. Niacin: use, sides
    • To raise HDL after on statin with exercise and tobacco cessation
    • Glc intolerance, inc uric acid, itchiness
  12. Gemfibrozil: use, sides
    • Lower TG more than statin but not as much mortality benefit
    • inc risk of myositis if combined with statins
  13. Cholestyramine: sides
    Interactions with other drugs, constipation, flatus
  14. Ezetimibe: use, sides
    • Lowers LDL with no proven benefit
    • well tolerated
  15. CCB use in CAD, which ones, sides
    • -Severe asthma so cant take bblocker
    • prinzmetal angina
    • cocaine induced angina (bblockers are contraindicated)
    • -Verapamil and diltiazem since do not inc heart rate
    • -Edema, constipation, rare heart block
  16. CABG indications, time to occlusion
    • 70% in 3 vessels
    • Left main
    • 2 vessels + DM
    • Persistent on medical tx
    • -Saphenous vein, 5yrs. internal mammary 10yrs
  17. Pulsus paradoxus
    • dec in BP of >10 on inhalation
    • assoc with cardiac tamponade
  18. Kussmaul sign
    • Inc in JVD on inhalation
    • assoc with constrictive pericarditis or restrictive cardiomyopathy
  19. Wall MI leads and mortality rates
    • inferior (II, III, aVF): 5%
    • anterior (V2-4): 35%
    • posterior (V1,2 depression): low
  20. ACS meds with whether mortality benefit
    • Benefit: ASA (do first)
    • Statins, ACEi, Bblockers - timing doesnt matter
    • no mortality benefit: Morphine, O2, nitroglycerin
  21. Cardiac enzyme timings
    • Troponin: 4-6hrs to 10-14days
    • CK-MB: 4-6hrs to 1-2days
    • Myoglobin 1-4 hrs to 1-2 days
  22. Most common cause of death in first days after MI
    Ventricular arrhythmia
  23. Angioplasty vs thrombolytics in ACS
    • Angioplasty has inc mortality benefit, fewer hemorrhages, and less MI complications. Perform within 90 minutes
    • Complications of angioplasty are rupture, restenosis, and hemaotma at entry site
    • Thrombolytics should be within 30min in rural places
  24. Restenosis rates 6 months post PCI
    • No stent: 35%
    • Metal stent 20%
    • Drug eluting: 10% - paclitaxel or sirolimus, Tcell inhibitors)
  25. Contraindications to thrombolytics
    • Bowel or brain bleeding
    • Surgery within 2 weeks
    • BP>180/110
    • Nonhemorrhagic stroke within 6mo
  26. Glycoprotein IIb/IIIa inhibitors
    • Abciximab, tirofiban, eptifibitide
    • ST depression of angioplasty and stenting get benifit
  27. nSTEMI tx
    • ASA then LMWheparin first
    • bblocker, nitrate, GPIIb/IIIa
    • no thrombolytic
  28. STEMI tx
    • ASA first
    • then angioplasty
    • Also bblocker and nitrates
    • If no angioplasty, thrombolytic and heparin
  29. Cannon A waves
    • Atrial systole against closed tricuspid valve in 3rd degree heart block post MI
    • Bounding JVD wave
    • Tx with atropine then pacemaker
  30. RCA supply, EKG, tx of infarct
    • -RV
    • AV node
    • Inferior wall
    • -V4 elevation in flipped EKG
    • -Needs high volume fluid replacement and avoidance of nitroglycerin
  31. PostMI meds to go home on and sex
    • ASA
    • Metoprolol
    • Statin
    • ACEi
    • Bblockers and mostly anxiety cause erectile disfunction. If symptom free or normal postMI stress test, can have sex
  32. CHF causes
    • Infarction
    • Cardiomyopathy incl from HTN
    • Valve
    • Etoh
    • Postviral myocarditis
    • Radiation
    • Adriamycin/doxorubicin
    • Chagas
    • Hemochromatosis
    • Thyroid
    • Peripartum
    • Thiamine deficiency
  33. CHF gallop
    S3
  34. Tests for EF
    • Initial: TTE
    • Accurate: Multiple gated acquisition scan or nuclear ventriculography
  35. Systolic CHF tx (mortality benefit*)
    • *ACEi - if cough give ARB, if hyperK give hydralazine and nitroglycerin
    • *Bblockers- metoprolol, bisoprolol, carvedilol. Used for chronic to prevent sudden death from arrhythmias
    • *Spironolactone - for class III and IV
    • Diuretics - loop
    • Digoxin - no mortality benefit, dec hospitalizations and symptoms
    • *Defibrillator - if <35% EF and ischemic cardiomyopathy
    • Biventricular pacemaker - if <35% EF and dilated cardiomyopathy and wide QRS
  36. Spironolactone alternative
    • eplerenone
    • no gynecomastia
  37. Diastolic CHF tx
    • Bblockers
    • Diuretics
    • Not: digoxin, spironolactone
    • Uncertain: ACEi, ARB, hydralazine
  38. Acute pulmonary edema tx
    • O2
    • Loop diuretic
    • Morphine
    • Nitrates
    • Nesiritide is unclear (IV atrial natriuretic peptide)
    • Then dobutamine, amrinone, or milrinone for positive inotropy
    • Nitroprusside and IV hydralazine for afterload reduction
    • D/c: ACEi

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