CVS USMLE
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| ECG features of PVCs | wide, bizarre QRS, don't see P wavesb bc within QRS
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| tx for A fib | 1) unstable: cardiovert; 2) stable: rate control w CCB, cardiovert (but if >48hrs either need to use TEE to check for clot or anticoag 3 wks, then cardiovert…continue 4 wks anticoag after
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| atrial and ventricular rate for A fib | atrial ~400, ventricular 75-175
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| atrial and ventricular rate for A flutter | atrial: 250-350, ventricular: 1/2 to 1/3
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| name arrhythm: saw-tooth baseline w QRS every 2-3 | A flutter
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| MC cause A flutter | COPD
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| long term tx of A fib | rate control w b-blocker or CCB, anti coag (exc if no heart dz <60)
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| dzs/causes assoc w A Fib | PIRATES: Pulmon, Isch, RHD, Anemia/atrial myxoma, Thyroid, EtOH, Sepsis…also post-op stress, and pericarditis/pericardial trauma(sx)
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| differentiate A fib, A flutter, and MAT based on p-waves | Afib: no distinct p waves, Aflutter: saw tooth, MAT: at least 3 difft morph of P waves
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| tx MAT | if nml LV fxn: verapamil, b block; if abnml fxn digoxin, diltiazem, amiodarone
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| MAT usu assoc w | severe pul dz, ie COPD
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| how pathophysiol difft AVNRT and AVRT | in AVNRT the access path is within the AV node; in AVRT the path conducts retrograde
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| how are pwaves difft AVNRT v AVRT | in AVNRT p wave is in QRS, so don't see it; AVRT may see p-wave after QRS
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| tx of AVNRT | vagal maneuvers, IV adenosine (cardiovert if Rx doesn't work); longterm: digoxin (+/- radiofreq ablation)
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| tx of AVRT | same as AVNRT
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| describe ECG of WPW | narrow QRS w delta wave, short PR
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| what Rx can use for WPW, can NOT use | can use procainamide or quinidine; can NOT use Rx that work on AV node (digoxin, verapamil)
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| tx WPW | can use procainamide or quinidine, then radiofreq ablation
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| pathophysiol of WPW | accessory path from atria to ventricle, so don't have AV node delay
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| how define VT | 3 or more PVC in a row
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| describe ECG of VT | nml P waves dissoc from wide, bizarre QRS that can be of the same or difft morphs
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| tx of nonsustained VT | if <30 sec and sympt, no tx nec; but look closely for heart dz; if heart dz do electrophysiol and if inducible, sustained VT then place ICD
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| MC causes VT | CAD w prior MI, also prolonged QT
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| if can't place an ICD for VT, what Rx use longterm | amiodarone
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| tx sustained VT | if hemo stable, SBP>90, mild symot: IV amiodarone; if unstable: synch cardiovert then IV amiodaron
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| longterm tx of sustained VT | ICD, unless nml LV fxn: amiodarone
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| risk of sustained VT | can progress to Vfib
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| rate of VT | 100-250
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| ECG of Vfib | no waves, very irreg rhythm
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| acute tx Vfib | 1) unsynch cardiovert, up to 3 assess rhythm after ea; 2) if persists then IV epi (1mg q3-5min); 3) if refractory then IV amiodarone followed by shock; once rhythm continue IV amiodarone or the Rx that worked
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| chronic tx Vfib | if <48hrs of acute MI, no chronic tx; if not assoc MI: ICD (or amiodarone 2nd line)
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| tx torsades de pointes | IV Mg++
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| what is torsdes de pointes assoc w | long QT (can lead to Vfib)
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| how is stable angina managed acutely | ASA, b-blocker, nitrate (+/- CCB)
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| how is stable angina managed chronically | same as acutely: ASA, b-blocker, nitrate (+/- CCB)
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| how is unstable angina managed acutely | IV access, O2, ASA, nitrate, morphine, b-blocker, heparin [LMWH enoxoparin is best] **so same as stable angina chronic tx + heparin
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| how is acute MI tx Rx | same as unstable angina [IV access, O2, ASA, nitrate, morphine, b-blocker, heparin/LMWH + ACEI and statins
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| how is MI tx after acute phase | ASA, b-block, nitrate, ACEI, statins (so same as angina but also statin and ACEI)
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| how is acute CHF tx | IV access, O2, diurese, ACEI, **NOT b-blocker
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| how is CHF tx based on NYHA | NYHA I, II: Na restrict, diuretic, ACEI; II-II: add b-blocker; II-IV: digoxin +/- spironolactone [if isch then also need ASA and statin +/- nitrates]
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| what Rx are used for pharmacol stress test and how do they work | dobutamine (incrses HR, BP, contractility, so incrses cardiac demand), adenosine and dipyramidole (vasodilate, dz'd vessels already dilated so they get relatively less blood)
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| when is CABG indicated | 1) L main, 2) 3 vessel and decrsd EF, 3) 2 vessel and prox LAD
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| define unstable angina | incrsd in freq, duration or intensity of angina, angina at rest
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| name glycoprotein Iib/IIIa inhib | abciximab, tirofiban
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| what is a tx specific to hyperhomocystenemia | folate
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| should thrombolytics or CCB be used in unstable angina | haven't been shown to be beneficial, so no
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| how manage dx of unstable angina | give medical tx, if respond send for stress ECG, otherwise send to cath
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| how confirm Prinzmetal's angina | during cor angiography give IV ergonovine and it will cause symptoms
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| how does Prinzmetal's angina present | angina at rest, ST elevation during episodes, but negative cardiac enzymes
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| what defines a + stress test | ST segment depression (subendo isch), hypotension, chest pain, arrhythmias, onsert CHF
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| define stable angina | pain 1-5 min (<15min), comes on w exertion or emotion, relived w NG or rest
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| how differentiate unstable angina and NSTEMI | NSTEMI has positive cardiac enzymes
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| what ECG changes would you see early in a MI, but not later | peaked T
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| what ECG changes are seen late after MI | Q waves (specific for necrosis)
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| what 4 ECG changes are seen w MI | peaked T, ST elevation, T wave inversion, Q waves
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| describe timing for cardiac enzyme elev | CK-MB: rises 4-8h, peak 24h, nml 48-72h; TnI, T: rises 3-5h, peak 24-48h, nml 5-14d
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| when test cardiac enzymes (how often) | on admission and q8h for 24h
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| what condition can incrs Tn I | renal failure
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| what are indications for thrombolysis in MI | ST elev in 2 contiguous ECG leads w pain onset <6 h that doesn't respond to NG
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| what are contraindications for thrombolysis in MI | HTN >180/110, recent head trauma or traumatic CPR, active PUD, h/o stroke, recent surgery or invasive procedure, dissection Ao aneurysm
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| what ECG changes seen in anterior infarct | ST elev in V1-4 (Acute) that become Q late
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| what ECG changes seen in posterior infarct | large R, ST depress, and upright and prominent T in V1,2
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| what ECG changes seen in lateral infarct | Q in I and aVL (late)
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| what ECG changes seen in inferior infarct | Q in II, III, and aVF (late)
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| agents in acute MI tx that decrease mortality | ASA, b-blocker, ACEI
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| what's Dressler's syndrome, how tx? | F, malaise, pericarditis, incrsd WBC, pleuritis wks-mos after MI; tx w ASA
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| how tx acute pericarditis s/p MI | ASA (not NSAIDs or steroids or will impair scar formation)
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| how differentiate systolic and diastolic dysfxn in CHF | systolic=EF<40-45% MC due to recent MI, also cardiomyopathy; diastolic usu from HTN leading to hypertrophy, also valve and restrictive cardiomyopathy ie infiltrates
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| define S3 and S4 | S3=rapid filling into LV (can be nml in kids); S4=atrial systole into stiff ventricle (ie diastolic dysfxn)
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| signs/sympt L sided heart failure | dyspnea/orthopnea/paroxysmal nocturnal dyspnea (1-2 hrs after sleep); nocturnal cough; S3, S4; pul congestion; Kerley B lines
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| signs/sympt R sided heart failure | peripheral pitting edema (pedal edema often in elderly due to vascular insuffic); nocturia, JVD; hepatomegaly/hepatojugular reflex; ascites
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| what nuclear agent used in ventriculography | technetium-99 which tags RBCs
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| when do hear S3 and S4 relative to other sounds | S4-S1-S2-S3
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| in CHF which b-blocker is best | carvedilol > metoprolol
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| when use digitalis in CHF | EF<30%, severe CHF or severe A Fib [provides sympt relief, need to check serum digoxin levels]
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| signs of digoxin toxicity | N/V, PVCs, AV block, A fib, visual disturbances (yellow or green halos around objects) or disorientation
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| differentiate bw cardioversion and defib, when use which | cardiovert=shock in synch w QRS, use for A fib, A flutter, VT w pulse, SVT **if during T wave can cause V Fib; defib is not insynch and used for V Fib and VT w/p pulse
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| when does bradycardia become clinically signif (what bpm)? What rx used | <45bpm, can use atropine to block vagal input
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| how dx 1st degree heart block | PR >0.2
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| describe types of 2nd degree heart block and tx | Mobitz I (Wenkebach)=progressive prolong PR until drop a beat, no tx; Mobitz II=sudden drop beat, tx: pacemaker
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| what is the pathophysiol of Mobitz II and why treat | thgt problem in His-Purkinje (v AV node for MobitzI); can progress to 3rd degree
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| how identify 3rd degree heart block, what is HR | P and QRS are dissoc, overall rate 25-40bpm
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| causes of DCM | MC: CAD w prior MI, but also toxic (EtOH, doxorubicin, adriamycin), myocarditis (viral, Chagas, Lyme, HIV), cocaine, etc
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| how tx DCM | similar to CHF w diuretics, digoxin, ACEI, b blockers & conisder anti coag
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| when might consider adding an ICD in DCM | if EF <30-35%
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| causes hypertrophic cardiomyopathy | often genetic AD inheritence
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| describe physiology of hypertrophic cardiomyopathy | diastolic dysfxn where can't fill ventricles, but also dynamic outflow obstruction bc assym hypertrophy of septum
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| describe murmur and how it changes in hypertrophic cardiomyopathy | systolic ejection murmur that decrses w squatting or straight leg raise, incrs w Valsalva (decrsd LV size), and decrs w handgrip (incrsd SVR causes decrsd flow across AV) **also loud S4
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| presentation of hypertrophic cardiomyopathy | syncope/dizziness after exercise, angina, palpitations/arrhythmias from persistent incrsd cardiac P--if not sudden death in athlete
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| tx hypertrophic cardiomyopathy | all pts avoid strenous exercise, for sympt pts give b block (decrsd HR improves filling and decrs myocardial demand) [CCB if not responding to b block]
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| tx of restrictive cardiomyopathy | tx underlying (often infiltrative dzs)
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| common causes of myocarditis | Lyme, Cox B, Chagas, Lupus
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| causes of pericarditis | infxs: Cox A, B, TB; MI (w/in 24 hr or much later (Dresslers)), collagen vascular dz, uremia, radiation
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| ECG changes in pericarditis and which is **specific to pericarditis | PR depression is specific, also see in progression: diffuse ST elev that returns to nml, then T wave inversion that returns to nml
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| tx pericarditis | usu self limited and resolves 2-6wks; NSAIDs for pain
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| clinical findings of pericarditis | pleuritic chest pain, relieved by sitting and leaning fwd, pericardial friction rub +/- F and non productive cough
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| how difft constrictive pericarditis and cardiac tamponade | in constrictive pericarditis ventricular filling suddenly halted in late diastole, see JVD w prominent x AND y descents
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| unique clinical findings of constrictive pericarditis | JVD w prominent x and y descents; Kussmaul's sign: JVD doesn't decrs w inspiration
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| dx and tx pericardial effusion | dx=Echo, tx=repeat Echo 1-2 wks, only pericardiocentesis if cardiac tamponade or if want to analyze fluid
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| unique clinical findings of cardiac tamponade | JVD w prominent x and NO y descents; pulsus paradoxus: BP drop >10mmHg during inspiration
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| describe 4 heart sounds, their order, and what mean | (S4)-S1-S2-(S3); S1=MV/TV, S2=AV/PV, S3=rapid LV filling, poor LV fxn, S4=stiff/hypertrophied ventricle
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| describe murmur for MS, MR, and MVP | MS=opening snap, late dias rumble, MR=holosystolic murmur; MVP=midsys click, late sys murmur
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| describe murmur AS and AR | AS=harsh systolic ejection murmur, AR=early dias murmur
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| cause of MS, tx | usu RHD, tx=anti coag, diuretics for pul congestion, endocarditis prophylaxis, if severe perQ valvuloplasty
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| what is progression of symptoms in AS and px | asympt for yrs then angina (3yrs avg survival), syncope (2yrs), CHF (1.5yrs)
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| compare murmurs and what incrs/decrs them in HCM and MVP | both have sys murmur that incrs w standing and valsalva, decrs w squatting but handgrip will incrs murmur of MVp and decrs murmur in HCM
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| describe murmur in AS and location to hear it | 2nd R intercostal, cresc-decresc sys murmur radiates to carotids
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| what's parvus et tardus | delayed and decreased carotid upstrokes seen in AS
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| sustained PMI and precordial thrill can be seen in | AS
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| at what AV area is stenosis severe | <0.8 (nml is 3-4 cm^2)
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| tx AS? Timing? | valve replace in all sympt pts
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| which connective tissue/rheum dzs can get AR | AV=Ehlers-Danlos, ankyl spondyl, MarfansSLE; Aortic root=Behcets, Reiters, OI
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| clinical findings of AR | widened pulse P/Corrigans pulse/water hammer pulse; early dias murmur/Austin Flint murmur (BF hits MV)
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| when in the dz process would LV EF start to fall in AR | very late
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| how does acute MR v chronic MR present differently | in acute LA doesn't accommodate and BF into lungs causes pul edema, in chronic see pul HTN
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| causes of actue and chronic MR | acute=pap rupture s/p MI; chronic=RHD, Marfans, cardiomyopathy
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| tx MR | decrs afterload w vasodilators
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| causes of TR | usu RV dilation, MC 2ry to LV failure (also TV endocarditis in IV drug users)
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| clinical findings in TR | RV failure (incrsd JVD, ascites, hepatomegaly), pulsatile liver, v waves in JV pulse w rapid y-descent
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| where listen for TR, describe murmur | LLSB, holosys murmur incrs w inspiration
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| when consider TR repair/replace | if severe TR and no pul HTN (usu repair or annuloplasty, rarely replace)
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| describe pathophysiol of MVP | excessive tissue from myxomatous changes, rarely MR, usu asympt
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| tx MVP | usu asympt, endocarditis prophyl, surgery rarely needed
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| which valves MC involved in RHD | MV, but also can include AV or TV
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| name 5 major criteria for RHD | migratory polyarth, eryth marginatum, cardiac, chorea, subQ nodules
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| name 6 minor criteria for RHD | h/o RF, evidence h/o strep, F, incrsd ESR, incrsd PR, polyarthralgias
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| how dx RHD | if 2 major criteria or 1 major and 1 minor
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| tx acute RF, how monitor progression | NSAIDs, C reactive protein monitors tx
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| if P of RA, RV, PA, PCWP all incrs, what dz | MS
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| if PA incrsd, PCWP nml, what dz? | pul HTN
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| if RA, RV P incrsd, but PA and PCWP nml, what dz? | R heart failure
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| what's the bug and pt who usu presents w acute endocarditis | Staph Aureus on nml valve in IV drug user (usu TV)
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| in subacute endocarditis name bug for native valves, prosthetic | prosthetic=Staph Epi (<60d, otherwise more likely Strep); native=Strep viridans
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| cxns endocarditis (or may present with these findings) | GN, pul emboli
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| name Duke's major criteria for endocarditis (3) | sustained bacteremia w bug known to cause endocarditis, new valve regurg, echo showing endodamage (ie veg, abscess, valve perf, prosthetic dehisc)
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| name Duke's minor criteria for endocarditis (6) | predisposition (abnml valve or risk of bacteremia), F, vascular signs (emboli, intracranial hemorr, Janeway), immune signs (Osler, GN, Roth spots, rheumatoid factor), + blood cx not meeting Major criteria, + Echo not meeting Major criteria
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| how dx endocarditis using Duke's criteria | 2 major OR 1 major, 3 minor OR 5 minor
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| MC ASD | secondum
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| key clinical exam finding ASD | wide, fixed split of S2
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| when repair ASD | when Qp:Qs >1.5-2
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| MC CHD | VSD
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| signs of Eisenmonger for VSD | once switched to R to L shunt get SOB, dyspnea, chest pain **cyanosis
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| where listen for VSD, what hear | 4th L intercostal, hear blowing holosystolic
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| describe CXR findings for coarct | may see rib notching and 3 from dilation before and after coarct
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| when see pul HTN w VSD? ASD? | pul HTN pretty common in VSD, occurs later (40yo) in ASD
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| clinical findings PDA | wide pulse P, bounding peripheral pulse
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| what PDA assoc w | congenital rubella, hi altitude, premie
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| describe murmur in PDA, where hear? | continous machinery murmur, hear at L 2nd intercostal
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| tx PDA | if no pul vascular dz correct, if pul HTN or R to L shunt **DON'T CORRECT
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| what is cut-off for hypertensive emergency | end organ damage + BP of > 220/120 (can be either systolic or diastolic)
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| what are end organ damage signs for hypertensive emergency dx | CNS: papilloedema, altered mental status/hypertensive encephalopathy, intracranial hemorr; Renal=RF or hematuria; Heart=unstable angina, MI, Ao dissection; Lungs=pul edema
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| tx hypertensive emergency | reduce BP 25% in 1-2hrs,
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| what tx/management paradigm for pt w severe HA and very hi BP | first lower BP, then order CT (r/o subarachnoid hemorrh), then LP
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| what class of Rx are dihydropyridines? What are they used for? Name some | CCB, vasodilation (ie decrs BP), nifedipine, amlodipine [as opposed to other CCBs like verapamil, diltiazem]
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| name some alpha1 adrenergic agonists used for BP | phenoxybenzamine, prazosin, terazosin
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| name some direct acting vasodilators | hydralazine, minoxidil
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| what are some central acting agents that lower BP, how? | methyl dopa and clonidine, both are central acting adrenergic agonists
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| what are 2 types of Ao dissections, and how might they present differently | type A=proximal can have anterior chest pain and AV regurg; type B=distal can have interscapular pain
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| immed tx of Ao dissection | lower BP w IV b blockers and Na nitroprusside (BP <120)
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| describe MC pathophysiol and pt for abd Ao aneurysm | usu atherosclerosis (+/- trauma, HTN, smoking), in male 65-70 bw renals and iliac
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| describe location atherosclerotic Ao aneurysm v syph or CT dz | syph or CT dz more often thoracic than abd
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| long-term tx Ao aneurysm | type A=surgery, type B=medical management
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| clinical signs of ruptured abd ao aneurysm | hypotension, abd pain, palpable abd mass--if those signs, don't do any more tests, take to emergent laporatomy
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| dx abd ao aneurysm | US
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| tx of unruptured abd ao aneurysm | surgery if >5cm or symptomatic
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| MC locations of PVD | MC=femoral artery, also popliteal artery and aortoilliac
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| signs of PVD of aortoilliac, name? | Lehriche syndrome-claudication of butt/thigh, impotence bc paralyzed L1, decrsd femoral pulse
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| describe intermittent claudication | reliable reproducible pain, ie walk same distance, that completely resolves w rest
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| physical exam findings PVD | decrsd pulses, decrsd hair, thickened toe nails, decrsd temp skin
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| dx of PVD, cut-offs | ankle to brachial index (compares S BP of ankle to arm): nml 1 or grtr, claudication <.7, rest pain <.4
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| key tx PVD, new Rx | **stop smoking!! Modify other risk factors, trental (pentoxifylline) decrs viscosity; surgery only when severe refractory pain (bypass or angioplasty)
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| MC presentation, location of acute arterial occlusion | usu embolizaion in femoral artery, MV from heart, esp A fib
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| tx acute arterial occlusion | immed anti coag w IV hep, emergent embolectomy using Fogarty cath [bypass if fails]
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| dx of DVT | US (good to see in popliteal and femoral, less good for calf), D-dimer can use to r/o (high sensitivity, low specif)
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| how to decide when to tx for DVT | is intermed/hi probab DVT and US + then anticoag, if US - then repeat US q2-3d for up to 2wks; if low/intermed probab and US - then redo US in 2d
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| how anticoag for DVT | IV hep for PTT 1.5-2; start warfarin once heparin is therapeutic, once warfarin is INR 2-3 then keep heparin for another 48hrs, then d/c heparin and continue warfarin for 3-6 mos
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| cause of chronic venous insuffic | usu thgt to be DVT, even if no evidence of past DVT
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| pathophysiol of chronic venous insuffic | DVT destroys valves in veins, leads to ambulatory venous HTN-> edema, extravasation or RBC (pigmentation), local hypoxia (so ulcer w little trauma)
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| tx of chronic venous insuffic ulcer | wet to dry dressin, unna venous boot (external compression stocking), 80% will heal, otherwise need split-thickness skin graft
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| clinical presentation of superficial thrombophlebitis | pain, tenderness, errhyth, specifically coursing vein
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| tx of superficial thrombophlebitis? If cellulitis also present? | just analgesic, if cellulitis need bed rest, elevation, hot compress, and Abx ONLY if suppurative drainage
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| name 4 types of shock | cardiogenic, neurogenic, hypovolemic, septic
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| common features to all shock | lactic acidosis, anuria/oliguria, hypotension and tachycardia, altered mental status
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| cut offs for cardiogenic shock | SBP<90, UO<20 and adequate LV filling P
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| describe CO, SVR, and PCWP in cardiogenic shock, what key relative to other types of shock? | CO decrsd, SVR incrsd, PCWP incrsd; only one where JVP/PCWP incrsd
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| tx cardiogenic shock | dopamine, +/- dobutamine; IV fluids harmful if hi LV P, IABP can help
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| how does IABP work and help | sits just distal to subclavian, deflates just before onset of systole (reduce afterload), inflating at onset of diastole (to incrs coronary perfusion); net incrs CO, coronary perfusion and decrs myocardial workload
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| define difft classes/stages of hypovolemic shock and changes at each | Stage I=<20% blood loss, body compensates; stage II=<30% see incrs pulse and RR and decrsd UO; stage III=<40% those get worse then also get decrsd sys BP, confusion; Stage IV=>40%, no UO
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| describe CO, SVR, and PCWP in hypovolemic shock | incrsd SVR, decrsd CO and PCWP
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| describe CO, SVR, and PCWP in septic shock, what key relative to other types of shock? | dilation (decrsd SVR and PCWP) with heart trying to keep up (incrsd CO)--only one w incrsd CO
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| t/f septic shock can present w hypothermia | t
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| describe SIRs | if 2 or more are present: F or hypothermia, hyperventilation, tachycardia, incrsd WBC
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| describe progression from SIRs to septic shock | SIRs present, then once blood cx + becomes sepsis, then once hypotension despite adequate fluid resusc=septic shock
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| describe CO, SVR, and PCWP in neurogenic shock, what key relative to other types of shock? | CO ~nml, decrsd SVR (v septic shock where CO is incrsd)
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| MC primary cardiac neoplasm, describe, describe key clinica exam finding | atrial myxoma, benign, pedunculated usu on septum near fossa ovalis, hear diastolic plop
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| what's the cut-off for preHTN? HTNI? HTNII? | PreHTN=120-139 and 80-89; HTN I=140-159 OR 90-99; HTN II=160 OR 100; needs to be measured 2x >4wks apart w/o caffeine or smoking
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| MC 2ry causes of HTN | MC=renal artery stenosis, MC in young women=OCP, also CRF, endocrine (aldosterone, steroids, Cushing), coarct of Ao and sleep apnea
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| MC tx HTN | b blocker and thiazide
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| Rx HTN in DM | ACEI
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| before prescibe diuretic what test? | preg test in young women
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| what cut-offs of HDL count as CAD risk | HDL<35 (>65 counts as negative risk)
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| what's considered fam hx CAD | MI m: <55, f<65 yo
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| name 3 MC familial hyperlipidemias and what's elevated in ea | Iia=fam hypercholesterol (hi LDL); Iib=combined hyperlipoprotein (hi LDL, vLDL); IV=endogen hyperlipid (hi vLDL)
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| causes of 2ry hyperlipid | endocrin (hypothyr, DM, Cushing, steroid Rx, estrogen), nephrotic syn, uremia, chronic liver dz, Rx=thiazide, b blocker, HIV protease inhib
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| what does EtOH do to lipid profile | incrs TG and HDL, but not overall
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| how calc LDL | LDL=tchol - HDL - (TG/5) **note: can't measure LDL directly, always calculate
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| what are cut-offs for lipid profiles | [tchol/LDL/TG] ideal: <200/130/125; high 240/160/250; bw those 2 is considered borderline
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| what's screening for lipids | >20 screen q5 yrs (just tChol and HDL), if abnml to full fasting lipid panel, which includes TG and calc of LDL
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| at what LDL do you start Rx | if CAD or no CAD and >2 risk factors: 130; if 2 risk factors: 160; if 0-1 risk: 190
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| what is goal LDL for difft pt grps | if CAD=100, if 2 or more risk=130; if 0-1 risk factors=160
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| at what TG start tx | >500
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| dietary therapy for lipid | <30% calories from fat and <10% from sat'd fat, <300mg/d chol
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| Rx for LDL | statins (atorvastatin and simvastatin are most potent)
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| Rx for TG and HDL | niacin
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| when use colestipol for hyperlipidemia? How change which lipids? | bile binding (colestipol, cholestyramine) only used in hi risk w statins and niacin bc bad GI SE and poorly tolerated, will decrs LDL and incrs TG
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| SE statins | harmless CPK, but need to monitor LFTs (q 1mo for 3mos, then q 3-6mo)
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| SE niacin | same LFT as statins, also flushing and pruritus
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| what's last line for hyperlipidemia? What do to which lipids? SE? | fibrates (gemfibrozil) decrs vLDL and incrs HDL, SE mild GI, mild LFT, gynecomastia, gall stones, wgt gain, myopathies
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| supraventricular tachycardias w reg QRS (4) and distinguishing features on EKG | (parox) atrial tach (abnml P, consistent), atrial flutter (saw tooth P), AVNRT (no P, reg QRS), AVRT (retro P after QRS)
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| how divide arrhythmias based on QRS (3) | reg QRS (supravent tachycardias), wide QRS, irreg QRS
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| causes of wide QRS (2) | supravent tachycard, VT
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| how treat atrial flutter | anti coag and rate control, cardiovert like atrial fib
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| pathophysiol of atrial tachycardia | ectopic pacemaker in atrium (adenosine can unmask underlying atrial activ)
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| pathophysiol of AVNRT | reentry circuit in AV node, depol atria and ventricle at same time
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| treatment AVNRT | carotid massage, adenosine (cardiovert if unstable)
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| pathophysiol of AVRT | (AV reenatrant tachycardia bypass tract (WPW)
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| treatment AVRT | same as AVNRT, carotid massage, adenosine (cardiovert if unstable)
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| EKG signs of VT | 3 or more PVC, AV dissoc, wide QRS w reg rhythm
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| treatment VT | cardiovert + antiarrhythm (amiodorane, lidocaine, procainamide)
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| causes of irreg QRS (4) | MAT (3 or more difft P), A fib (no P), V fib (EKG totally erratic), torsades de points
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| causes of MAT | COPD, hypoxemia, multiple atrial foci
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| treatment MAT | underlying dz (ie COPD), verapamil and b blocker to control rate and suppress foci
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| causes of A fib | PIRATES=pul dz, ischemia, RHD, anemia, thyrotoxicosis, EtOH, sepsis
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| when cardiovert in A fib | <48hrs and no atrial clot by TEE or >6 wk warfarin
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| tx A fib | anticoag and rate control (CCB, B block, digoxin), cardiovert when nec
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| tx WPW | procainamide or quinidine (not digoxin or verapamil) [yet AVRT says carotid massage, adenosine and cardiovert if nec]
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| key EKG changes for K+, Ca++ | hyperK=tall tented T waves, hypoK=loss T waves + U waves; QT prolong if hypoCa++; QT shorten if hyperCa++
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| premature atrial complexes (PACs); look on EKG, incidence, tx | early P waves of difft morph than nml P waves; found in 50% nml adults no signif but can be precursor to isch in dzd; no tx but b blocker can help if sympt (palpitations)
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| PVCs; look on EKG, incidence, tx | wide QRS w compensatory pause (p wave buried); found 50% men most pts asympt--if sympt b-blocker; freq PVC and underlying heart dz at risk SCD, consider iCD
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| what's bigeminy on EKG? Trigeminy? | sinus beat followed by PVC, sinus beat followed by 2PVCs,
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| what's the diff cardioversion and defib? When use which? | cardioversion=shock delivered in synchrony w QRS (don't hit t-wave or can cause V-fib), for Afib/flutter, SVT, VT w pulse; defib=not in time w QRS--use for V Fib or VT without a pulse
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| what's the order of tx of Afib in hemo stable pt? | rate control (60-100, use Ca over b-blockers), cardiovert (electric prefered), anticoag (INR 2-3)
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| t/f: chronic A fib w/o other signs heart dz <60 require anticoag | no
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| EKG of AVNRT? AVRT? | narrow QRS, no p waves; narrow QRS w retro p waves
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| how ID 1st deg block? Tx? | PR >0.2 w QRS after every p; no tx
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| how ID 2nd deg block? Type I v II? | Mobitz I: progressive prolong of PR until lose a QRS; Mobitz II: sudden drop of QRS
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| tx 2nd deg block? | I: no tx; II: often progress to complete heart block, need pacemaker
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| how ID 3rd deg block? Tx? | no corresp bw p and QRS; need pacemaker
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|
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