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dihydropiridines - nifedipine, amlodipine, felodipine nonhydropiridines - diltiazem, verapamil - can be used for rate control in atrial fibrillation atrial fibrillation rate control fails with medications, next step and complication - ablation of AV junction, could cause pacemaker dependence difference in pacemakers for atrial fibrillation - Paroxysmal afib - dual chamber, permanent afib - single chamber ventricular pacemaker What medications can be used for rhythm control in atrial fibrillation? - Propafenone, flecainide - avoid in patients with prior heart disease. Amiodarone and doetilide - safe with prior myocardial infarction. How long does anticoagulation need to continue after cardioversion in atrial fibrillation? - 4 weeks Medication to terminate paroxysmal supraventricular tachycardia - IV adeonosine or verapamil Define multifocal atrial tachycardia - 3 or more atrial foci expressed by 3 different p waves and rate of 100 Criteria for Wolff-Parkinson-White - delta wave, pr interval less than 0.12 seconds, symptomatic tachycardia, prolonged qrs >0.12 seconds worst complication of Wolff-Parkinson-White - atrial fibrillation with rapid ventricular response then ventricular fibrillation EP testing in WPW - indication and what does it evaluate? - identifies pathway location, determines if arrythmia is caused by AV node reentry or accessory pathway reentry, used for catheter ablation, indicated only in symptomatic patients AV nodal blocking medication avoided in WPW - Digoxin Medication to slow the rate of WPW with Afib and wide complex qrs. What happens with other agents? - Procainamide slows the accessory pathway and intra-atrial conduction. Other agents - adensosine, calcium channel blockers, b-blockers or digoxin - can block av nodal conduction and lead to increaed rapid ventricular response and ventricular fibrillation Causes of torsades de pointes - Prolonged qt - quinidine, procainamide, disopyramide, TCAs, sotalol. Hypokalemia. Bradycardia after MI Indication for ICD after MI - Ventricular tachycardia and fibrillatiion after 24 hours Treatment for recurrent ventricular tachycardi and fibrillation during acute MI - IV lidocaine or amiodarone Conduction blocks after an MI - 5 to 10% Mobitz I second degree or third degree block, 10-20% bundle branch block Medications for vasovagal syncope - Primary is midodrine. SSRI can be tried Classic triad of right ventricular myocardial infarction - hypotension, clear lung fields, elevated central venous pressure Contraindications in right sided myocardial infarction - B-blocker since SA node ischemia could cause bradycardia, nitroglycerin can cause venodilation and hypotension. Volume expansion is the primary treatment. Indication for valve replacement instead of baloon valvuloplasty in mitral stenosis - presence of mitral regurgitation also Severe mitral stenosis - Valve area less than 1.5 cm2, pulmonary pressures greater than 50 mm Hg, gradient greater than 10, enlarged left atrium Indications for biventricular pacemaker-defibrillator in heart failure - NYHA Class III-IV, EF < 35%, QRS > 120-130 msec EKG findings for acute pericarditis - diffuse st-segment elevation concave upward and pr segment depression Prefferred medication to treat Dressler's pericarditis after STEMI - Aspirin. NSAIDS contraindicated since they impair myocardial scar formation. HOCM murmur - systolic murmur increases with Valsalva maneuver Pulmonary hypertension auscultation - Loud S2 changes with respiration, parasternal impulse Rheumatic mitral stenosis auscultation - Loud S1, variable S2, opening snap, low pitched diastolic murmur. With pulmonary hypertension, loud S2, splits with inspiration, does not split with expiration Atrial septal defect exam - Fixed splitting of S2, pulmonary mid-systolic murmu, tricuspid diastolic flow murmur, right ventricular impulse Idiopathic pericardial effusion persists for longer than three months - needs pericardiocentesis Left subclavian artery stenosis - Low blood pressure, diminished pulses, systolic murmur in left clavicular region due to stenosis and retrograde flow in ipsilateral vertebral artery Kussmaul sign - increased jugular venous pressure during inspiration Two findings for constrictive pericarditis - Kussmaul sign and pericardial knock - early diastolic sound Indications for repair of an asymptomatic abdominal aortic aneurysm - Diameter greater than 5.5 cm or expanding greater than 0.5 cm per year Class C antiarrhythmics - Digoxin, Diltiazem, Metoprolol, Adenosine ACE inhibitors and pregnancy - congenital cardiovascular and CNS malformations, oligohydraminos, neonatal anuria, renal failure Indication to use spironolactone in heart failure - NYHA Class III or IV, symptomatic with beta blocker and ACE Signs of cardiac transplant rejection - new onset heart failure symptoms or atrial arrhythmias Side effects of cyclosporine - Hypertension, tremor, hypertryglyceridemai, gingival hyperplasia, hirsutism, nephrotoxicity Normal increase in pulmonary pressure with excercise - 10 to 25 mm Hg Holosystolic murmur at the apex radiates to the axilla without respiratory variation - Chronic mitral valve regurgitation Holosystolic murmur at left sternal border, jugular venous pulse with a prominent v wave - tricuspid valve regurgitation NSTEMI with recurrent anginal pain after ASA, Nitroglycerin, LMWH, metoprolol - Start Glycoprotein IIb/IIIa inhibitor |
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