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CVS USMLE
| Question | Answer |
|---|---|
| ECG features of PVCs | wide, bizarre QRS, don't see P wavesb bc within QRS |
| 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 |
| atrial and ventricular rate for A fib | atrial ~400, ventricular 75-175 |
| atrial and ventricular rate for A flutter | atrial: 250-350, ventricular: 1/2 to 1/3 |
| name arrhythm: saw-tooth baseline w QRS every 2-3 | A flutter |
| MC cause A flutter | COPD |
| long term tx of A fib | rate control w b-blocker or CCB, anti coag (exc if no heart dz <60) |
| 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) |
| 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 |
| tx MAT | if nml LV fxn: verapamil, b block; if abnml fxn digoxin, diltiazem, amiodarone |
| MAT usu assoc w | severe pul dz, ie COPD |
| how pathophysiol difft AVNRT and AVRT | in AVNRT the access path is within the AV node; in AVRT the path conducts retrograde |
| 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 |
| tx of AVNRT | vagal maneuvers, IV adenosine (cardiovert if Rx doesn't work); longterm: digoxin (+/- radiofreq ablation) |
| tx of AVRT | same as AVNRT |
| describe ECG of WPW | narrow QRS w delta wave, short PR |
| 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) |
| tx WPW | can use procainamide or quinidine, then radiofreq ablation |
| pathophysiol of WPW | accessory path from atria to ventricle, so don't have AV node delay |
| how define VT | 3 or more PVC in a row |
| describe ECG of VT | nml P waves dissoc from wide, bizarre QRS that can be of the same or difft morphs |
| 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 |
| MC causes VT | CAD w prior MI, also prolonged QT |
| if can't place an ICD for VT, what Rx use longterm | amiodarone |
| tx sustained VT | if hemo stable, SBP>90, mild symot: IV amiodarone; if unstable: synch cardiovert then IV amiodaron |
| longterm tx of sustained VT | ICD, unless nml LV fxn: amiodarone |
| risk of sustained VT | can progress to Vfib |
| rate of VT | 100-250 |
| ECG of Vfib | no waves, very irreg rhythm |
| 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 |
| chronic tx Vfib | if <48hrs of acute MI, no chronic tx; if not assoc MI: ICD (or amiodarone 2nd line) |
| tx torsades de pointes | IV Mg++ |
| what is torsdes de pointes assoc w | long QT (can lead to Vfib) |
| how is stable angina managed acutely | ASA, b-blocker, nitrate (+/- CCB) |
| how is stable angina managed chronically | same as acutely: ASA, b-blocker, nitrate (+/- CCB) |
| 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 |
| how is acute MI tx Rx | same as unstable angina [IV access, O2, ASA, nitrate, morphine, b-blocker, heparin/LMWH + ACEI and statins |
| how is MI tx after acute phase | ASA, b-block, nitrate, ACEI, statins (so same as angina but also statin and ACEI) |
| how is acute CHF tx | IV access, O2, diurese, ACEI, **NOT b-blocker |
| 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] |
| 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) |
| when is CABG indicated | 1) L main, 2) 3 vessel and decrsd EF, 3) 2 vessel and prox LAD |
| define unstable angina | incrsd in freq, duration or intensity of angina, angina at rest |
| name glycoprotein Iib/IIIa inhib | abciximab, tirofiban |
| what is a tx specific to hyperhomocystenemia | folate |
| should thrombolytics or CCB be used in unstable angina | haven't been shown to be beneficial, so no |
| how manage dx of unstable angina | give medical tx, if respond send for stress ECG, otherwise send to cath |
| how confirm Prinzmetal's angina | during cor angiography give IV ergonovine and it will cause symptoms |
| how does Prinzmetal's angina present | angina at rest, ST elevation during episodes, but negative cardiac enzymes |
| what defines a + stress test | ST segment depression (subendo isch), hypotension, chest pain, arrhythmias, onsert CHF |
| define stable angina | pain 1-5 min (<15min), comes on w exertion or emotion, relived w NG or rest |
| how differentiate unstable angina and NSTEMI | NSTEMI has positive cardiac enzymes |
| what ECG changes would you see early in a MI, but not later | peaked T |
| what ECG changes are seen late after MI | Q waves (specific for necrosis) |
| what 4 ECG changes are seen w MI | peaked T, ST elevation, T wave inversion, Q waves |
| 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 |
| when test cardiac enzymes (how often) | on admission and q8h for 24h |
| what condition can incrs Tn I | renal failure |
| 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 |
| 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 |
| what ECG changes seen in anterior infarct | ST elev in V1-4 (Acute) that become Q late |
| what ECG changes seen in posterior infarct | large R, ST depress, and upright and prominent T in V1,2 |
| what ECG changes seen in lateral infarct | Q in I and aVL (late) |
| what ECG changes seen in inferior infarct | Q in II, III, and aVF (late) |
| agents in acute MI tx that decrease mortality | ASA, b-blocker, ACEI |
| what's Dressler's syndrome, how tx? | F, malaise, pericarditis, incrsd WBC, pleuritis wks-mos after MI; tx w ASA |
| how tx acute pericarditis s/p MI | ASA (not NSAIDs or steroids or will impair scar formation) |
| 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 |
| define S3 and S4 | S3=rapid filling into LV (can be nml in kids); S4=atrial systole into stiff ventricle (ie diastolic dysfxn) |
| 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 |
| signs/sympt R sided heart failure | peripheral pitting edema (pedal edema often in elderly due to vascular insuffic); nocturia, JVD; hepatomegaly/hepatojugular reflex; ascites |
| what nuclear agent used in ventriculography | technetium-99 which tags RBCs |
| when do hear S3 and S4 relative to other sounds | S4-S1-S2-S3 |
| in CHF which b-blocker is best | carvedilol > metoprolol |
| when use digitalis in CHF | EF<30%, severe CHF or severe A Fib [provides sympt relief, need to check serum digoxin levels] |
| signs of digoxin toxicity | N/V, PVCs, AV block, A fib, visual disturbances (yellow or green halos around objects) or disorientation |
| 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 |
| when does bradycardia become clinically signif (what bpm)? What rx used | <45bpm, can use atropine to block vagal input |
| how dx 1st degree heart block | PR >0.2 |
| 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 |
| 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 |
| how identify 3rd degree heart block, what is HR | P and QRS are dissoc, overall rate 25-40bpm |
| causes of DCM | MC: CAD w prior MI, but also toxic (EtOH, doxorubicin, adriamycin), myocarditis (viral, Chagas, Lyme, HIV), cocaine, etc |
| how tx DCM | similar to CHF w diuretics, digoxin, ACEI, b blockers & conisder anti coag |
| when might consider adding an ICD in DCM | if EF <30-35% |
| causes hypertrophic cardiomyopathy | often genetic AD inheritence |
| describe physiology of hypertrophic cardiomyopathy | diastolic dysfxn where can't fill ventricles, but also dynamic outflow obstruction bc assym hypertrophy of septum |
| 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 |
| presentation of hypertrophic cardiomyopathy | syncope/dizziness after exercise, angina, palpitations/arrhythmias from persistent incrsd cardiac P--if not sudden death in athlete |
| 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] |
| tx of restrictive cardiomyopathy | tx underlying (often infiltrative dzs) |
| common causes of myocarditis | Lyme, Cox B, Chagas, Lupus |
| causes of pericarditis | infxs: Cox A, B, TB; MI (w/in 24 hr or much later (Dresslers)), collagen vascular dz, uremia, radiation |
| 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 |
| tx pericarditis | usu self limited and resolves 2-6wks; NSAIDs for pain |
| clinical findings of pericarditis | pleuritic chest pain, relieved by sitting and leaning fwd, pericardial friction rub +/- F and non productive cough |
| 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 |
| unique clinical findings of constrictive pericarditis | JVD w prominent x and y descents; Kussmaul's sign: JVD doesn't decrs w inspiration |
| dx and tx pericardial effusion | dx=Echo, tx=repeat Echo 1-2 wks, only pericardiocentesis if cardiac tamponade or if want to analyze fluid |
| unique clinical findings of cardiac tamponade | JVD w prominent x and NO y descents; pulsus paradoxus: BP drop >10mmHg during inspiration |
| 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 |
| describe murmur for MS, MR, and MVP | MS=opening snap, late dias rumble, MR=holosystolic murmur; MVP=midsys click, late sys murmur |
| describe murmur AS and AR | AS=harsh systolic ejection murmur, AR=early dias murmur |
| cause of MS, tx | usu RHD, tx=anti coag, diuretics for pul congestion, endocarditis prophylaxis, if severe perQ valvuloplasty |
| what is progression of symptoms in AS and px | asympt for yrs then angina (3yrs avg survival), syncope (2yrs), CHF (1.5yrs) |
| 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 |
| describe murmur in AS and location to hear it | 2nd R intercostal, cresc-decresc sys murmur radiates to carotids |
| what's parvus et tardus | delayed and decreased carotid upstrokes seen in AS |
| sustained PMI and precordial thrill can be seen in | AS |
| at what AV area is stenosis severe | <0.8 (nml is 3-4 cm^2) |
| tx AS? Timing? | valve replace in all sympt pts |
| which connective tissue/rheum dzs can get AR | AV=Ehlers-Danlos, ankyl spondyl, MarfansSLE; Aortic root=Behcets, Reiters, OI |
| clinical findings of AR | widened pulse P/Corrigans pulse/water hammer pulse; early dias murmur/Austin Flint murmur (BF hits MV) |
| when in the dz process would LV EF start to fall in AR | very late |
| 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 |
| causes of actue and chronic MR | acute=pap rupture s/p MI; chronic=RHD, Marfans, cardiomyopathy |
| tx MR | decrs afterload w vasodilators |
| causes of TR | usu RV dilation, MC 2ry to LV failure (also TV endocarditis in IV drug users) |
| clinical findings in TR | RV failure (incrsd JVD, ascites, hepatomegaly), pulsatile liver, v waves in JV pulse w rapid y-descent |
| where listen for TR, describe murmur | LLSB, holosys murmur incrs w inspiration |
| when consider TR repair/replace | if severe TR and no pul HTN (usu repair or annuloplasty, rarely replace) |
| describe pathophysiol of MVP | excessive tissue from myxomatous changes, rarely MR, usu asympt |
| tx MVP | usu asympt, endocarditis prophyl, surgery rarely needed |
| which valves MC involved in RHD | MV, but also can include AV or TV |
| name 5 major criteria for RHD | migratory polyarth, eryth marginatum, cardiac, chorea, subQ nodules |
| name 6 minor criteria for RHD | h/o RF, evidence h/o strep, F, incrsd ESR, incrsd PR, polyarthralgias |
| how dx RHD | if 2 major criteria or 1 major and 1 minor |
| tx acute RF, how monitor progression | NSAIDs, C reactive protein monitors tx |
| if P of RA, RV, PA, PCWP all incrs, what dz | MS |
| if PA incrsd, PCWP nml, what dz? | pul HTN |
| if RA, RV P incrsd, but PA and PCWP nml, what dz? | R heart failure |
| what's the bug and pt who usu presents w acute endocarditis | Staph Aureus on nml valve in IV drug user (usu TV) |
| in subacute endocarditis name bug for native valves, prosthetic | prosthetic=Staph Epi (<60d, otherwise more likely Strep); native=Strep viridans |
| cxns endocarditis (or may present with these findings) | GN, pul emboli |
| 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) |
| 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 |
| how dx endocarditis using Duke's criteria | 2 major OR 1 major, 3 minor OR 5 minor |
| MC ASD | secondum |
| key clinical exam finding ASD | wide, fixed split of S2 |
| when repair ASD | when Qp:Qs >1.5-2 |
| MC CHD | VSD |
| signs of Eisenmonger for VSD | once switched to R to L shunt get SOB, dyspnea, chest pain **cyanosis |
| where listen for VSD, what hear | 4th L intercostal, hear blowing holosystolic |
| describe CXR findings for coarct | may see rib notching and 3 from dilation before and after coarct |
| when see pul HTN w VSD? ASD? | pul HTN pretty common in VSD, occurs later (40yo) in ASD |
| clinical findings PDA | wide pulse P, bounding peripheral pulse |
| what PDA assoc w | congenital rubella, hi altitude, premie |
| describe murmur in PDA, where hear? | continous machinery murmur, hear at L 2nd intercostal |
| tx PDA | if no pul vascular dz correct, if pul HTN or R to L shunt **DON'T CORRECT |
| what is cut-off for hypertensive emergency | end organ damage + BP of > 220/120 (can be either systolic or diastolic) |
| 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 |
| tx hypertensive emergency | reduce BP 25% in 1-2hrs, |
| 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 |
| 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] |
| name some alpha1 adrenergic agonists used for BP | phenoxybenzamine, prazosin, terazosin |
| name some direct acting vasodilators | hydralazine, minoxidil |
| what are some central acting agents that lower BP, how? | methyl dopa and clonidine, both are central acting adrenergic agonists |
| 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 |
| immed tx of Ao dissection | lower BP w IV b blockers and Na nitroprusside (BP <120) |
| describe MC pathophysiol and pt for abd Ao aneurysm | usu atherosclerosis (+/- trauma, HTN, smoking), in male 65-70 bw renals and iliac |
| describe location atherosclerotic Ao aneurysm v syph or CT dz | syph or CT dz more often thoracic than abd |
| long-term tx Ao aneurysm | type A=surgery, type B=medical management |
| 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 |
| dx abd ao aneurysm | US |
| tx of unruptured abd ao aneurysm | surgery if >5cm or symptomatic |
| MC locations of PVD | MC=femoral artery, also popliteal artery and aortoilliac |
| signs of PVD of aortoilliac, name? | Lehriche syndrome-claudication of butt/thigh, impotence bc paralyzed L1, decrsd femoral pulse |
| describe intermittent claudication | reliable reproducible pain, ie walk same distance, that completely resolves w rest |
| physical exam findings PVD | decrsd pulses, decrsd hair, thickened toe nails, decrsd temp skin |
| 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 |
| key tx PVD, new Rx | **stop smoking!! Modify other risk factors, trental (pentoxifylline) decrs viscosity; surgery only when severe refractory pain (bypass or angioplasty) |
| MC presentation, location of acute arterial occlusion | usu embolizaion in femoral artery, MV from heart, esp A fib |
| tx acute arterial occlusion | immed anti coag w IV hep, emergent embolectomy using Fogarty cath [bypass if fails] |
| 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) |
| 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 |
| 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 |
| cause of chronic venous insuffic | usu thgt to be DVT, even if no evidence of past DVT |
| 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) |
| 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 |
| clinical presentation of superficial thrombophlebitis | pain, tenderness, errhyth, specifically coursing vein |
| tx of superficial thrombophlebitis? If cellulitis also present? | just analgesic, if cellulitis need bed rest, elevation, hot compress, and Abx ONLY if suppurative drainage |
| name 4 types of shock | cardiogenic, neurogenic, hypovolemic, septic |
| common features to all shock | lactic acidosis, anuria/oliguria, hypotension and tachycardia, altered mental status |
| cut offs for cardiogenic shock | SBP<90, UO<20 and adequate LV filling P |
| 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 |
| tx cardiogenic shock | dopamine, +/- dobutamine; IV fluids harmful if hi LV P, IABP can help |
| 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 |
| 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 |
| describe CO, SVR, and PCWP in hypovolemic shock | incrsd SVR, decrsd CO and PCWP |
| 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 |
| t/f septic shock can present w hypothermia | t |
| describe SIRs | if 2 or more are present: F or hypothermia, hyperventilation, tachycardia, incrsd WBC |
| describe progression from SIRs to septic shock | SIRs present, then once blood cx + becomes sepsis, then once hypotension despite adequate fluid resusc=septic shock |
| 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) |
| MC primary cardiac neoplasm, describe, describe key clinica exam finding | atrial myxoma, benign, pedunculated usu on septum near fossa ovalis, hear diastolic plop |
| 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 |
| 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 |
| MC tx HTN | b blocker and thiazide |
| Rx HTN in DM | ACEI |
| before prescibe diuretic what test? | preg test in young women |
| what cut-offs of HDL count as CAD risk | HDL<35 (>65 counts as negative risk) |
| what's considered fam hx CAD | MI m: <55, f<65 yo |
| 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) |
| causes of 2ry hyperlipid | endocrin (hypothyr, DM, Cushing, steroid Rx, estrogen), nephrotic syn, uremia, chronic liver dz, Rx=thiazide, b blocker, HIV protease inhib |
| what does EtOH do to lipid profile | incrs TG and HDL, but not overall |
| how calc LDL | LDL=tchol - HDL - (TG/5) **note: can't measure LDL directly, always calculate |
| what are cut-offs for lipid profiles | [tchol/LDL/TG] ideal: <200/130/125; high 240/160/250; bw those 2 is considered borderline |
| 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 |
| 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 |
| what is goal LDL for difft pt grps | if CAD=100, if 2 or more risk=130; if 0-1 risk factors=160 |
| at what TG start tx | >500 |
| dietary therapy for lipid | <30% calories from fat and <10% from sat'd fat, <300mg/d chol |
| Rx for LDL | statins (atorvastatin and simvastatin are most potent) |
| Rx for TG and HDL | niacin |
| 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 |
| SE statins | harmless CPK, but need to monitor LFTs (q 1mo for 3mos, then q 3-6mo) |
| SE niacin | same LFT as statins, also flushing and pruritus |
| 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 |
| 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) |
| how divide arrhythmias based on QRS (3) | reg QRS (supravent tachycardias), wide QRS, irreg QRS |
| causes of wide QRS (2) | supravent tachycard, VT |
| how treat atrial flutter | anti coag and rate control, cardiovert like atrial fib |
| pathophysiol of atrial tachycardia | ectopic pacemaker in atrium (adenosine can unmask underlying atrial activ) |
| pathophysiol of AVNRT | reentry circuit in AV node, depol atria and ventricle at same time |
| treatment AVNRT | carotid massage, adenosine (cardiovert if unstable) |
| pathophysiol of AVRT | (AV reenatrant tachycardia bypass tract (WPW) |
| treatment AVRT | same as AVNRT, carotid massage, adenosine (cardiovert if unstable) |
| EKG signs of VT | 3 or more PVC, AV dissoc, wide QRS w reg rhythm |
| treatment VT | cardiovert + antiarrhythm (amiodorane, lidocaine, procainamide) |
| causes of irreg QRS (4) | MAT (3 or more difft P), A fib (no P), V fib (EKG totally erratic), torsades de points |
| causes of MAT | COPD, hypoxemia, multiple atrial foci |
| treatment MAT | underlying dz (ie COPD), verapamil and b blocker to control rate and suppress foci |
| causes of A fib | PIRATES=pul dz, ischemia, RHD, anemia, thyrotoxicosis, EtOH, sepsis |
| when cardiovert in A fib | <48hrs and no atrial clot by TEE or >6 wk warfarin |
| tx A fib | anticoag and rate control (CCB, B block, digoxin), cardiovert when nec |
| tx WPW | procainamide or quinidine (not digoxin or verapamil) [yet AVRT says carotid massage, adenosine and cardiovert if nec] |
| 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++ |
| 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) |
| 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 |
| what's bigeminy on EKG? Trigeminy? | sinus beat followed by PVC, sinus beat followed by 2PVCs, |
| 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 |
| 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) |
| t/f: chronic A fib w/o other signs heart dz <60 require anticoag | no |
| EKG of AVNRT? AVRT? | narrow QRS, no p waves; narrow QRS w retro p waves |
| how ID 1st deg block? Tx? | PR >0.2 w QRS after every p; no tx |
| 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 |
| tx 2nd deg block? | I: no tx; II: often progress to complete heart block, need pacemaker |
| how ID 3rd deg block? Tx? | no corresp bw p and QRS; need pacemaker |
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ehstephns
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