CARDIO conditions w clear management

*** Anything in this color v Mortality*** Remember: a drug lowers mortality for a specific condition,
while not for another, pay attention to the dz tittle.

ISCHEMIC HEART DZ= CAD: (MI, Angina..) GENERAL:

Risk f. #1 Diabetes #2 HTN #3 smoking

Premature: M <55. F <65
Ischemia Pain is: dull, substernal(middle), lasts 15-30min

ANGINA:

Dx.
1 Clinical (Hx. & Physical)
2 EKG
#3 Stress test
TX.
#1 B-Block and aspirin
#2 Nitrates (pain)
#3 ACE/ARB (EF<35)
Further management:
Angiography (to see if bypass needed)

HYPERTENSIVE EMERGENCY

BP 180/120 + end organ damage (retin hemorr, papilledem, stroke, renal fail, HTN
enceph (N/V, HA, confus))
1 CT-scan (to r/o stroke!) (sudden BP catastrophic w stroke).
2 no stroke? Give Nitroprusside!

MI

#1 Aspirin + Clopidogrel (anti-platelet)

PCI (90min from ER) + Prasugrel
Thrombolytics <12hrs from event
Metoprolol + Statins + ACE/ARB + Morphine + nitrates + O2
PaceMaker use if:
3rd block
2nd block
New LBBB
Symptomatic Bradycardia (Hypot, dizzy, syncope, HF)
Tx. #1 Atropine #2 Pacemaker
NSTEMI

Dx.
no ST elevation
+ cardio enzymes
Tx.
1 Aspirin
2 LMW Heparin or PCI + Abciximab (glycoprot IIb/IIIa)
3 BB, Statins, ACE, O2, morphine, nitrates

CHF

Bilat rales, S3, Orthopnea, edema, JVD. Hx of HTN, MI

1 Hx and physical
2 Acute lung edema sx?
#1 Furosemide, O2, Morphine, nitrates. will fix it in 90%
if still edema sx add Dobutamine (^ contxn, inotrope)
3 ECHO (sys or dias dysf?) -only once lung edema is controlled
Sys dysf = v EF
Dias dysf = nl EF
Systolic dysf: ( EF)
Tx.
ACE/ARB + B-blocker(carvedilol, metoprol, bisoprolol) for ALL!
Digoxin - ( hospitalizations)
Spironolactone/Eplerenone - for moder to severe dz
Hydralazine+nitrates ( afterload)- give if ACE/ARB cant be used
implantable Defibrillator (done if after drug tx, EF<35)
Diasto Dysf: (nl EF)
Beta blockers and Diuretics

MURMURS

AR
ACE/ARB or Nifedipine (vasodilator)
Surgery if EF< 55
MR
ACE/ARB or Nifedipine
Surgery if EF< 60
VSD
ACE/ARB or Nifedipine
AS
1 Diuretics (not ace/arb)
2 Surgery! (tx of choice) (can be done in elderly)
MS
 #1 Diuretics (not ace/arb)
#2 Balloon valvuloplasty (can be done in pregnant)

DILATED CARDIOMYOPATHY

Dx. ECHO
Tx. ACE/ARB + Beta blockers + Spironolactone

HYPERTROPHIC CARDIOMYOPATHY

SOB on exertion + S4
Dx. ECHO
Tx. BB + diuretics

PERICARDITIS

Pleuritic positional sharp pain. friction rub

due to Viral infxn, trauma, CA
1 Dx. EKG (ST elevation all leads/ PR seg depress)
2 Tx. #1 NSAIDS Colchicine #2 Prednisone (if pain persists)
3 Further Manage: ECHO to r/u Eusion or Tamponade(which is severe eusion that is now
compressing heart chambers). Pericarditis is the mcc of tamponade.

TAMPONADE

1 Dx. Clinical! Hypotension, JVD, heart sounds (Becks Triad)

extras: Pulsus paradoxus (v BP>10 on inhalation), SOB
2 Tx. Pericardiocentesis. (immediately)
3 Dx. #1 TTE
EKG wil show low voltage and electrical alternans.
Chest X-ray
Catheter(wedge) will show same pressure in LA(wedge p), RA, and Pulm Artery.

CONSTRICTIVE PERICARDITIS

Calcification Around Heart. due to chronic infxn, inflam, or CA

Sx. Kusmmaul sign (^ JVD in inhalation), Pericardial Knock (hitting calcified pericardium)
Sx. SOB + signs of R.heart fail (cause it can't fill)
Edema, JVD, Hepatosplenomeg, Ascites
Dx. #1 Chest X-ray(calcifications) #2 CT or MRI (shows thick pericard)
Tx. #1 Diuretics #2 Surgical removal of pericardium
THORACIC AORTIC DISSECTION

Sx. di bp between arms; pain radiates to back; BP

1 Dx. Chest X-ray (wide mediastinum)
2 Tx. IV BB (Labetalol/Esmolol/Nitroprusside)
3 Dx. CT angiography or CT-scan or TEE or MRA(magn reson angiograph)
Tx. 4 Nitropruside
Tx. 5 Surgery

ABD AORTIC ANEURYSM (not dissected/ruptured)

SCREENING
Dx. U/S: 65-75y/o men who ever smoked
Tx. Observe. Surgery if aneurysm 5cm or if tender" (will rupture in days)

ABD AORTIC ANEURYSM RUPTURED

Dx. CT-scan w contrast

Tx. Laparotomy

PERIPHERAL VASCULAR DZ

Can be arterial or Venous!

VENOUS
No specific Tx. Will no cause necrosis or amputation

PERIPHERAL ARTERIAL DZ

"Angina of calfs
pulse, pain on exertion, smooth.shinny skin, hair
Dx.
1 Ankle-brachial index
(nl>0.9) bp in legs should be bp in arms
ABI < 0.9 = PAD
#2 Angiography
Tx. #1 Aspirin, ACE, Exercise , Statin, Anti-platelets

ACUTE ARTERIAL EMBOLUS:

Very sudden! Severe pain, Loss of Pulse, Cold extremity.

Assoc: A. fib and Aortic Stenosis
A. FIB

palpitation + irregular pulse

Dx. #1 EKG #2 Telemetry #3 Holter (oce, stable pt)
Tx.
UNSTABLE PT (chest pain, sob, hypot, confus)
Synchronized Cardioversion
STABLE PT
Rate control
#1 BB #2 Diltiazem(CCB) #3 Digoxin
Anti-Coagulation
only IF A.fib >2days! + 2 on CHADS
Give a NOAC (rivaroxaban, apixaban, exodaban)

A FLUTTER

Regular Rythm
Manage just like A.fib

SUPRAVENTRICULAR TACHYCARDIA

Seen in young pt or those without structural abnr.

Dx. EKG = narrow (nl) QRS, Pwave not seen (buried in Twave due to HR.)
Tx: #1 Vagal maneuvers: Valsalva, carotid massage, cold water inmersion #2
Adenosine (Slows sinus rate and Slows AV)
*SVT goes in to A DEN = ADENOSINE for SupraVentricular Tachycardia

MULTIFOCAL ATRIAL TACHYCARDIA (MAT)

assoc COPD, emphysema

Dx. EKG: polymorphic Pwaves, irregular chaotic rhythm(di space between QRSs)
 Tx. Diltiazem (dont use BB due to COPD)

"Hard calcified matted lungs" = MAT due to LUNG problems = treat with Ca-Blocker"

https://www.khanacademy.org/science/health-and-medicine/circulatory-system-
diseases/dysrhythmias-and-tachycardias/v/multifocal-atrial-tachycardia

WOLF PARKINSON WHITE SYND (WPW)

CCP: SVT that alternates w VT.

look for SVT that worsens w CCB or digoxin (they force more conduction down abn track.
Dx.
1 EKG : Delta wave
2 Electrophysiologic study (cath in heart try to provoke arrythmia)
Tx. #1 Procainamide
Tx. #2 Radiofrequency Cath ablation

"An accessory pathway(Kent bundle) that looks like P-shaped Cane"= ProCAINE for Wol-
Parkinson-White