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29 Cards in this Set
- Front
- Back
Stable Angina Medical Guidelines |
1) ASA, Statin, B-blocker (Goal HR 55-60), long acting nitrate, PRN sublingual nitrate if still having symptoms 2) increase dse of beta blocker and long acting nitrate, add CCB if still having symptoms --> cath |
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Diabetes w/CAD guidelines with regards to stress test |
They will need a stress test if 1) Symptomatic 2) About to undergo excercise program 3) Have known CAD and haven't had stress test in > 2 years |
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Causes of HFrEF |
Ischemia/CAD Drugs (EtOH, cocaine, amphetamines) HTN SLE,HIV Hyper/Hypothyroidism |
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Causes of HFpEF |
HTN CAD |
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Drugs that reduce mortality in heart failure |
Beta blocker (Coreg, Metoprolol, Bisoprolol), Ace Inhibitor, Aldosterone receptor antagonist, Bidil (In blacks Coreg corrects mortality |
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ICD Indications |
1) Patient's with MI > 40 days ago and an EF less than or equal to 30% 2) NICM w/EF < 35% on max medical therapy for 3 months 3) Hx of Vfib arrest |
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BivICD Indications (Cardiac Resynchronization Therapy) |
1) NYHA Class III-IV HF sx 2) EF less than or equal to 35% on guideline medical therapy 3) Ventricular Dysynchrony ***Need all 3 |
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Constrictive Pericarditis vs restrictive cardiomopthay |
Restrictive cardiomyopathy primarily affects LV, so you will see increased LV End Diastolic pressure which can lead to pulm HTN CP affects all of pericardium so you will see equalization of pressures in all heart chambers on echo |
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Pacemaker indications |
1) Symptomatic bradycardia 2) HR <40 3) A fib w/5 second pauses 4) SSS 5) Mobitz type 2 or 3rd degree |
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Screening for PAD w/ ABI |
1) exertional leg pain, non healing wounds, age >50 w/smoking and DM hxx Normal ABI 1-1.4, if > 1.4 it's from non compressible vessel 2/2 calcification, need to do toe brachial index, if <.7 it's PAD |
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Premature CAD age definitition |
Men < 45 Women < 55 |
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Stress Echo |
Used when excercise EKG not an option (baseline EKG abnormalities ie. LVH) |
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Nuclear SPECT Perfusion Stress Test |
Type of excercise stress test (Single Photon Emission CT) that uses technetium 99 to evaluate function of heart muscles |
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length of time patients should excercise for during stress test |
goal of 6-12 minutes but ideally for as long as they can until they get symptoms |
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Cardiac Meds and stress test |
If the diagnosis of CAD is trying to be established, B-blockers and nitrates should be held for 24 hours If stress test is being performed to evaluate sx in ptnt with known CAD, medications should not be held |
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Class IA anti-arrthmics |
Procainamide/Quinidine. Block Na channels to decrease speed depolarizations. Not used very often except in specific arrythmias (WPW) |
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Class 1B anti-arrythmics |
Lidocaine. Blocks Na channels to delay depolarizations. Used in Ventricular arrythmias. Only anti-arrythmic that does not prolong QTc |
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Class 1C anti-arrythmics |
Flecanide/Propafenone. Cannot be used in patients with CAD/structural heart disease. Used in Afib/SVT/Ventricular arrythmias |
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Class II anti-arrythmics |
Beta Blockers |
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Class III anti-arrythmics |
Potassium channel blockers which prolongs action potential Sotalol/Dofetilide. Used in in Afib/Ventricular administers **Usually initiated in hospital setting as they can prolong QTc, contraindicated in renal ds. |
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Class IV anti-arrythmics |
Calcium channel blockers |
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Typical AVNRT |
(Slow to Fast) or short RP tachycardia Occurs when a PAC occurs and normal fast pathway is in refractory period so it gets conducted down slow pathway (Which has shorter refractory time). Because of this, the PR interval will be longer since impulse is being conducted down slow pathway. By the time the impulse gets conducted down slow pathway, the fast pathway is available for conduction, and the impulse travels retrograde up fast pathway, initiating a tachycardia. P waves are are within QRS |
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Atypical AVnRT |
(Fast to slow) long RP tachycardia
anterograde down fast, retrograde up slow pathway
Conduction goes down fast pathway and comes back up slow pathway which creates normal PR, long RP
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Orthodromic AVRT |
Orthodromic indicates impulse is conducted through normal fibers (ie. down AV node) Initiated by PACs or PVCs. When there is a PAC, accessory pathway is usually blocked, so it travels anterograde through AV node. Once it reaches ventricle, it travels retrograde back to atria via accessory pathway. When there is a PVC, AV node is blocked but PVC can travel retrograde up accessory pathway to Atria, and then anterograde to ventricle via AV node. ECG Findings: inverted P wave with short RP and narrow QRS. **You get short RP because impulse travels faster through accessory pathway, activating atria right after QRS |
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Antidromic AVRT |
Impulse gets conducted up AV node (retrograde) and down accessory pathway(anterograde) Can be initiated via PAC or PVC If PAC initiates conduction, impulse first gets conducted through accessory pathway to ventricles. If PVC initiates impulse, it gets conducted retrograde through AV node, and then gets continued from atria to ventricle via accessory pathway. Will have wide QRS with short PR and long RP RP interval > 1/2 RR Adenosine and AV nodal agents are contraindicated here because they can create ventricular arrythmias ***WPW is only seen in antidromic AVRT where accessory pathway gets anterograde conduction |
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TOC for mitral stenosis |
balloon valvotomy is preferred TOC, if unsuccessful --> valve replacement |
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Duke Criteria for endocarditis |
Major: positive blood cultures of organism known to cause endocarditis, vegetations seen on echo Minor: Fever, positive blood cx of organism not known to cause endocarditis, embolic phenomenon, immune phenomenon (glomerulonephritis), hx IV drug use Need 2 major or 1 major with 3 minor |
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ASD murmur |
Ostium Secundum are most common type and are isolated Ostium Primum are associated with VSD, endocardial cushion defects ***Will hear fixed splitting of S2, JVD and systolic flow murmur |
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Patent Ductus Arteriosus |
Abnormal connection between aorta and pulmonary artery that creates a continues machine like murmur under left clavicle. |