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pszurnicki
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when do you do thallium echo or thallium with adenosine?
- under 5 conditions
- LBBB
- ST segment abnormality
- Digoxin use
- Pacemaker
- LVH
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When do ACE inhibitors lower mortality in MI?
- in LV dysfunction
- decreased EF
- systolic dysfunction
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When do you give prasugrel or clopidogrel?
if you will do angioplasty and stent
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when does the classical treatment for stemi not apply?
- posterior wall MI
- MI causing pulmonary edema
- MI with bradycardia
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Sokolow-Lyon criteria for LVH?
S in V1 + R in V5-V6 > 35mm
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When do you give CCB for MI?
- 3 conditions
- asthma
- prinzmetals angina
- Cocained induced ischemia
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Most accurate test for STEMI?
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What are the first cardiac biomarkers present post MI?
cardiac myoglobin
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in an unequivical case of STEMI, EKG or treatment?
- Treatment
- Aspirin
- BB
- statin
- oxygen
- morphine
- ace inhibitors
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Risk factors for CAD
- FH of CAD <55 for males <65 for females
- Age >45 for males > 55 females
- Smoking
- HTN/HDL low
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When do you do CABG vs stenting
- 3 vessel dz
- 2 vessel dz + DM
- Left main coronary
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TIMI score for UA/NSTEMI
- Age >65
- Markers--troponins or ckmb +ve
- EKG--st changes of 0.5 mm
- Risk factors for Cad >3
- Ischemia-2 episodes in 24 hours
- Cad >50% stenosis
- Aspirin use in past 7 days
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When do you use PM in acute MI management?
- new LBBB
- Bifascicular block
- 3 degree heart block
- 2 degree type 2 morbitz
- symptomatic bradycardia
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When do you give intra-aortic balloon pump?
valve rupture
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Difference in management of NSTEMi from STEMI?
- no thrombolytics
- Heparin
- G2B inhbitors--abxicimab
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How far should you move a clock in the ICU or ED?
15min-30 mins
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What is the initial mngt of Pulmonary Edema
- Diretics
- dilators--
- Oxygen
- Morphine
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what are the + ionotropes used for CHF?
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When do you give an ICD for a pts with CHF?
EF<35%
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When do you use biventricular pacemaker vs ICD?
- biventricular PM--QRS >120 msec
- ICD- EF <35%
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Bicuspid aortic valve is most commonly seen with what two conditions?
- turners syndrome
- coarctation of aorta
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which murmurs are best heard at LSB?
- aortic regurg
- Tricuspid regurg
- VSD
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best initial test for valvular lesions?
most accurate
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How do you treat murmurs which are decreased by valsalva?
decrased by amyl nitrate?
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what tests need to be ordered for valvular disorders?
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when do you dilate aortic stenosis ?
if can't do surgery
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difference between metallic valves vs bioprostehtic valve like bovine or procine?
metal require warfarin but last forever
bioprostethic--- no warfarin , last 10 years
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when is sx indicated for aortic stenosis
- pressure of >40
- area <1 cm^2
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when do you do sx for aortic regurg?
Mitral regurg sx?
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For wall valvular lesions, what tests are ordered initially?
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For valvular lesions, surgical repair/replacement is the best treatement except for what valvular lesion?
mitral stenosis
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ankylosing spondylitis and reiters syndrome can cause what type of valvular lesion?
aortic regurg
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what happens to opening snap with worsening MS?
moves closer to S2
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at what nyha stage, do bb and aceI lower mortality?
at all stages
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when suspecting valvular disease, what exams shoudl be done?
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most accurate way to dx restrictive cardiomyopathy
endomyocardial biopsy
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what ekg findings are seen with paricarditis?
- diffuse st segment elevation
- pr depression
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constrictive pericarditis presents how?
- like right heart failure
- -edema
- -jvd
- -hepatosplenomegaly
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treatment for constrictive pericarditis vs cardiac tamponade?
- diuretics
- cardiac tamponade- pericardiocentesis
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management of dissection of aorta?
- bp controle--ekg, chest xray
- then further bp control + ct angiography or tee or mra
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which murmur is not affected by either handgrip or amyl nitrate?
mitral stenosis
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stenotic lesions are best treated how?
anatomic repair
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how are asd repaired?
percutaneous or catheter
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what is the strongest indication for asd repair?
shunt ratio exceeds 1.5:1
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catheterization of heart in cardiac tamponade will show what?
equalization of pressure in all chambers
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most dangerous therapy in cardiac tamponade?
diuretics
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difference in presentation between acute pericarditis and constrictive pericarditis?
acute pericarditis--- kaussmal sign, sob
constricitve --chronic heart heart failure--hepatomegaly, edema, jvd
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best initial therapy for constrictive pericarditis?
most effective therapy
diuretics
pericardial stripping
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best initial therapy for pad?
- aspirin
- bp controll
- cilostazol
- smoking cessation
- exercise as tolerate
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how do you diagnose afib in the hospital if the initial ekg doesnt show it>
outpatient setting?
telemetry monitoring
holter monitoring
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what tests are ordered once afib is found?
- echo
- cardiac enzymes
- electrolytes
- Thyroid function tests
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rx for unstable afib?
synchronized cardioversion
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after how many days do you anticoagulate afib?
if the questions doesnt state how long afib has been, do you anticoagulate?
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when do you give digoxin for afib or a flutter?
with borderline hypotension
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what are the 3 rhythms originating from the atria that can be irregularly irregular?
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under what circumstances should you order echo?
in all cases of arrhythmias
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when do you give ionotropes for chf exacerbtion?
if it fails to respond to the initial treatment and you have pulmonary edema
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Best SVT treatment
catheter ablation of aberrant foci
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best long term rx for wpw
catherer ablation
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what drugs can throw svt into wpw?
- any drug that delays the av node
- ccb
- bb
- digoxin
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2 causes for sudden loss of consciesness?
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regaining of consciesness from syncopy?
sudden--cardiac
gradual--neurologic
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most important to do during a syncopal episode?
exclude cardiac cause
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if after intial work up the cause of syncopy is not clear, next step?
- urine tox
- telemetry/holter monitoring
- tilt table testing
- EP testing
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what do you not order during a syncopal workup
carotid doppler
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