STABLE angina definiton - Answer- substernal "gripping" chest pain or pressure on exertion, relieved w/ rest or NTG
what is involved in a
... [Show More] pharmacological stress test - Answer- : IV adenosine, dipyridamole, or dobutamine can stress the heart in place of exercise
The cardiac markers- when do they pick which is most specific? - Answer- CK-MB: peaks in 24 hrs and lasts 2-3 days, good for recurrence
Troponin I: peaks in 24 hrs and lasts 1-2 weeks, most specific
Difference between left-sided and right-sided CHF? - Answer- Left-sided CHF: dyspnea, orthopnea, PND
Right-sided CHF: pitting edema, hepatic congestion, JVD, ascites
NYHA classificaitons in order - Answer- NYHA class I: sx only w/ vigorous activity (e.g. sports) NYHA class II: sx w/ moderate activity (e.g. stairs)
NYHA class III: sx w/ ADLs
NYHA class IV: sx at rest
CHF classes and treatment - Answer- class I → Tx loop diuretic + ACE inhibitor •
class II-III → add β-blocker
class IV → add digoxin
what is PAC and how do we treat? - Answer- premature atrial contractions
early P wave that looks differently than other P waves,
tx is reassurance
Afib - Answer- acute, stable → anticoagulate + • rate control w/ Ca-blockers
• then cardioversion
wpw, what is the characteristic wave and how do we treat - Answer- "delta wave" reflects accessory conduction pathway from atria to ventricles, tx is ablation
VTACH TRAETMENT - Answer- Sustained VTach: lasts >30 sec, always symptomatic
Nonsustained VTach: lasts <30 sec, usually asx
Torsades de pointes: rapid, polymorphic VTach due to QT prolongation
sustained → Tx IV amiodarone •
nonsustained → reassurance •
torsades → Tx IV mag sulfate
VFIB tx - Answer- • Tx immediate defib + CPR, then • continue IV amiodarone
sinus brady tx - Answer- usually insignificant; if sx → Tx • atropine (blocks vagus nerve)
first degree meaning and tx - Answer- PR interval >0.2 .. needs reassurance
DCM management - Answer- echo and CXR to diagnose and tx for CHF AN HEART TXP
HCM presentation - Answer- exertional dyspnea and sudedn deaht, murmur enhanced by decrease preload eg handgrip and valsalva
HCM dx - Answer- echo and family hx, asx aoid exercise, sx beta blcokers vs myomectomy vs pacemaker implantaiton
DX OF MYOCARDITIS - Answer- d increase cardiac enzymes, increase in ESR and tx underlying cause
dc of acute pericaridtis and tx - Answer- dx EKG (diffuse ST elevation + PR dePRession) • Tx NSAIDs
• pericarditis + uremia → Tx hemodialysis
pericardial effusion, presentation, tx and dx - Answer- muffled heart sounds, soft PMI, ±pericardial friction rub
Dx echo (gold standard), CXR shows "water • bottle" silhouette
• small/asx → repeat echo in 1-2 wks
• rapidly developing → pericardiocentesis
cardiac tamponade dx and tx - Answer- pulsus paradoxus + Beck's triad (hypotension, JVD, muffled heart sounds)
Dx echo (gold standard), EKG shows electrical • alternans
• nonhemorrhagic, stable → close monitoring
• nonhemorrhagic, unstable →
• pericardiocentesis
• hemorrhagic → ER thoracotomy
loud S1, opening snap w/ late diastolic rumble and etiology - Answer- mitral stenosis..Etiology: rheumatic heart disease (MCC)
systolic crescendo-decrescendo murmur following opening snap, "parvus et tardus"; triad of angina, syncope, dyspnea AND ETIOLOGY - Answer- aortic stenosis... Etiology: calcified tricuspid valve (old), calcified bicuspid aortic valve (young)
Px: usually asx until old age, then 1-3 yrs after development of sx
holosystolic blowing murmur AND ETILOGY - Answer- Mitral regurgitation Etiology: ischemic heart dz, MVP, LV dilation
high-pitched blowing diastolic murmur, wide pulse pressures, head bobbing, pulsating uvula, pistol-shot over femoral arteries - Answer- Aortic regurgitation,,,Etiology: bicuspid aortic valve, syphilitic aortitis, rheumatic fever
holosystolic blowing murmur, pulsatile liver - Answer- Tricuspid regurgitation.. Etiology: tricuspid endocarditis (IVDA), RV dilation
midsystolic click, late systolic crescendo murmur; enhanced by ↑TPR (Valsalva, hand grip) - Answer- Mitral valve prolapse...Etiology: connective tissue d/o, MCC Marfan's
Rheumatic fever, PRESENTATION, mangagmenet and dx and tx - Answer- strep throat (GAS) → anti-M ab → type 2 hypersensitivity → FEVERSS - fever, erythema marginatum, valvular damage, ↑ESR, red-hot joints (migratory polyarthritis), subcutaneous nodules, Sydenham chorea
• Dx ASO titers
• strep throat → Tx PCN or erythromycin • rheumatic fever → Tx steroids
rheumatic heart disease murmur - Answer- mitral stenosis
dx of infectious endocariditis and tx - Answer- Dx Duke's criteria (sustained bacteremia,
• endocardial involvement, fever, immune or • vascular phenomena, +blood cx, +echo)
• Tx IV abx
bacteria of infectious endocarditis depending on procedure and location - Answer- Rapid onset: S. aureus
Dental procedures: S. viridans GI/GU procedures: enterococcus Colon cancer: Strep bovis, Clostridium septicum
IVDA: S. aureus on tricuspid valve >> Pseudomonas, Candida Prosthetic valves: S. epidermidis Cx-negative: HACEK group
low-grade diastolic rumble murmur w/ fixed split S2 - Answer- asd
holosystolic murmur at mid-LSB - Answer- vsd
ontinuous, machinery-like murmur - Answer- pda
Dx CXR (rib notching + "figure 3" aorta) • Tx surgical decompression. - Answer- aortic coarctation
presentation of aortic coarctation - Answer- HTN in upper extremities, hypotension in lower extremities; midsystolic murmur heard over back
BP >220/120 + end-organ damage (e.g. headache, renal failure, pulmonary edema) tx - Answer- lower BP by 25% in 1-2 hrs w/ IV nitroprusside • severe HA → get head CT to r/o intracranial
• bleeding → lumbar puncture if CT is negative
Aortic dissection dx and tx - Answer- Dx screen w/ CXR (widened mediastinum),
• confirm w/ TEE or CT scan
• type A → Tx β-blockers + surgery
• type B → Tx β-blockers
AAA dx and tx - Answer- • Dx abdominal U/S
• <5 cm → close f/u vs. elective repair • >5 cm or sx → Tx synthetic graft
triad of tearing abdominal pain, hypotension, pulsatile mass - [Show Less]