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2013-06-10 18:49:11
im cv

cardiovascular key points for IM
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  1. NSTEMI is characterized by chest pain at rest, absence of ST-elevation on EKG, and elevated biomarkers of myocardial injury
    2 of the following 3 are needed to dx acute pericarditis: 1) pleuritic chest pain 2) friction rub 3) diffuse concordant ST-segment elevation on EKG
  2. Percutaneous angioplasty and stent placement are preferred therapy for pt with STEMI
    Ischemic cardiac pain has a predictable relation to exercise and relief with rest or nitroglycerin
  3. Volume expansion is primary supportive tx for hemodynamic abnormalities of RV myocardial infarction (tx with normal saline infusion)
    Empiric PPI is first step to managing esophageal noncardiac chest pain
  4. Third degree AV block is the complete absence of conduction of atrial impulses to the ventricle and is most common cause of marked bradycardia
    Panic disorder is char by recurrent, unexpected panic attacks featuring abrupt onset of palpitations, sweating, tremulousness, dyspnea, chest pain, nausea, dizziness, and numbness
  5. Mobitz type I second degree AV block is char by progressive prolongation of PR interval until dropped beat occurs
    To tx chronic stable angina: titrate beta blocker dose to achieve resting HR of 55-60 bpm and approximately 75% of the HR that produced angina with exertion
  6. Normal wall motion on echo during chest pain excludes coronary ischemia or infarction
    Exercise EKG stres stesting is primary approach to dx of coronary arter disease in pt who can exercise and have normal resting EKG
  7. atrial flutter is a narrow-complex tachycardia char by multiple regular atrial contractions (flutter waves) that create a sawtooth baseline pattern prior to the QRS complex
    Most patients with chronic stable angina are tx with aspirin, Beta blocker, ACE inhibitor, nitro, and a statin
  8. A fib char by irregularly irregular rhythm with no discernable P waves and atrial fibrillation waves that create an irregular baseline
    Avoid screening asx adults who are at low risk for CAD
  9. Combo of short PR inverval and delta wave plus tachycardia confirms dx of Wolff-Parkinson-White syndrome (a type of atrioventricular tachycardia)
    Coronary angiography is indicated in pt with chronic stable angina who experience lifestyle-limiting angina despite optimal medical therapy
  10. V tach is char by wide QRS tachycardia in presence of known structural heart disease (esp prior MI)
    Treat NSTEMI with beta blocker (early IV beta blocker therapy reduces infarct size, decreases frequency of recurrent myocardial ischemia, and improves both short and long term survival)
  11. Presence of new systolic murmur and respiratory distress several days after acute MI indicates possibility of ventricular septal rupture or mitral regurg (likely due to papillary muscle rupture)
    Tx STEMI with thrombolytic therapy, an alternative to primary percutaneous coronary intervension; should be administered within 12 hrs after onset of chest pain
  12. First degree AV block is PR interval >.2 sec
    In setting of inferior wall STEMI, the clinical triad of hypotension, clear lung fields, and JVD suggests right ventricular infarction
  13. VSD following STEMI results in respiratory distress, hypotension, a new systolic murmur, and a palpable thrill
    Sinoatrial node dysfunction comprises a collection of pathological findings (sinus arrest, sinus exit block, and sinus bradycardia) that result in bradycardia
  14. Donepezil (AChE inhibitor) can causse peripheral cholinergic side effects like increased vagal tone, bradycardia, and AV block
    Electrical cardioversion is indicated in hemodynamically unstable pt with arrythmia
  15. Sinus tach originates from SA node and is a rate >100/min; common causes include normal response to exercise, increased catecholamine release (fear, pain, anxiety, EtOH withdrawal), fever, hypovolemia, sepsis, HF, pulmonary embolism, hypoxia, and hyperthyroidism
    Treat a-fib with metoprolol and warfarin (rate control and long-term anticoagulation)
  16. Premature ventricular contractions at rest in setting of structurally normal heart are associated with little to no increased risk of CV events (esp if pt is <30 yr)
    Tx pt at risk for sudden death with implantable cardioverter defibrillator; primary eligibility criteria is LVEF <35%
  17. Cardiac arrest occuring within first 48 hr of acute, transmural MI does no require secondary prevention therapy other than standard post-MI care
    Pt with long QT syndrome have syncope and cardiac arrest due to torsade de pointes ventricular tachycardia
  18. Digoxin alleviates sx and decr hospitalizations but provides no survival benefits in pt with heart failure (use it to tx NYHA class IV HF)
    Elevated central venous pressure, pulmonary crackles, ventricular gallops (S3 or S4), any cardiac murmur, and lower ext edema all incr likelihood of heart failure
  19. Pt with new onset HF and angina should be evaluated with cardiac catheterization and agiography if they are possible candidates for revascularization
    All pt with newly dx or suspected HF should get an echocardiogram
  20. Tx with ACE inhibitor and beta blocker is indicated for all pt with systolic HF regardless of sx or functional status, including asx or very functional pts (reat NYHA class I or II systolic HF with Beta blocker)
    ACE inhibitors are indicated for tx of all NYHA functional classes (I-IV)
  21. Treat NYHA functional class III or IV heart failure with spironolactone (in addition to ACE inhibitors and beta blockers; they all reduce mortality in pt)
    In pt with aortic stenosis, a fib can be associated with rapid and severe clinical deterioration due to more rapid rate and loss of atrial contribution to ventricular filling
  22. Failure of prosthetic aortic valve often leads to aortic insufficiency
    Short, soft, midsystolic murmurs in the elderly are usually benign and caused by minor, age-related changes of arotic vale (aortic sclerosis)
  23. Typical findings of mitral stenosis include opening snap and low-pitched, diastolic murmur
    Valsalva maneuver and squat-to-stand maneuver increase murmur of hypertrophic cardiomyopathy (because it causes the septum and anterior mitral leaflet to come closter together and increases turbulent flow)
  24. Chronic aortic regurg is a high-pitched diastolic murmur that begins immediately after S2 and is heard best with pt leaning forward and in end-expiration at the second right or third left intercostal space
    Mitral valve prolapse is characterized by midsystolic clic followed by late apical systolic murmur
  25. Asx pt with chronic aortic regurg and normal left ventricular size and function have excellent prognosisand do no require prophylactic surgery