ACE inhibitor or ARB

(proven to decrease vascular and renal dz)

ACE inhibitors, ARB, Beta-blocker, and K-sparing diuretic

(all proven to decrease mortality)

Beta blocker and ACE inhibitor

(proven to decrease mortality)

Thiazide Diuretics

(decrease Ca2+ excretion)

1st line Tx for HTN with Prostatic dz

(treat HTN and BPH concurrently)

Diltiazem/verapamil

(can also use beta blocker)

CHF

(due to depression of contractility)

Tx for Severe, refractory HTN 

Must combine with Beta blocker to prevent reflex tachycardia and diuretic to counteract edema resulting from aggressive arteriolar vasodilation

1. Diabetes

2. Smoking

3. HTN

4. Hypercholesterolemia

5. FHx

6. Age (men > 45, women > 55)

7. HDL (< 40 mg/dL)

8. Chronic renal failure

SMOKING IS THE #1 PREVENTABLE RISK FACTOR

EKG and Labs during unstable angina

ST depression or T wave inversions

Labs: cardiac enzymes are negative

ST depression or T wave inversions

Labs: Troponin and CK-MB are elevated, but CK-MB normalizes after 72 hrs and Troponin remains elevated up to 1 wk

ST elevation (tombstone sign) and Q waves

Labs: Elevation of Troponin I or CK-MB

thrombolysis within 6 hours using tPA + heparin(first line) or streptokinase

Adjuvant medical therapies:

#1 ASPIRIN!

#2 BETA BLOCKER

Transient ST elevation

Labs: Negative cardiac enzymes

Vasodilators (nitroglycerin or Ca2+ channel blockers)

and Catheterization

TCAs

Antipsychotics

Some antiarrhythmics (quinidine, procainamide)

Clarithromycin

Erythromycin

Sublingual Nitroglycerin

if after 3 doses, no pain relief, may be infarcting

Isordil (long-acting nitrate)

Beta blockers

Aspirin

Quit smoking

Decrease LDL, Increase HDL with diet, Increase exercise, Increase fiber, Lose weight

Percutaneous Transluminal coronary angioplasty (PTCA)

Indicated with failure of medical mgmt

Platelet GPIIb-IIIa antagonists

CABG

Failure of medical tx, 3-vessel CAD, or 2-vessel dz in DM

Aspirin, O2, Beta blocker, Sublingual NTG, LMW-Heparin

Nitro drip for pain

GPIIb-IIIa

Clopidogrel

"early repolarization" i.e J point elevation

concave J point on the tracing is the gentle concave upward slope of the transition from the S wave to the ST segment

ACE inhibitors or ARBS

Beta-blocker (after pt diuresed)

Diuretics - Furosemide and Spironolactone

SVT with AV block and yellow vision

Tx: antidigitalis Fab antibodies

HMG-CoA Reductase Inhibitors

-statins

Inhibits VLDL production, primary effect is TG reduction

Used for Isolated hypertriglyceridemia

Do NOT add to statins due to increased risk of rhabdo

LDL goal for Low risk CAD pts

< 2 risk factors

LDL at drug initiation

< 160

> 190

<130

>160

< 100

> 130

< 100, consider < 70

> 100

Wide pulse pressure presenting with forceful arterial pulse upswing with rapid falloff

Classic sign of AR

pistol-shot bruit over femoral pulse

Classic sign of AR

unusually large carotid pulsations

Classic sign of AR

pulsatile blanching and reddening of fingernails upon light pressure

Classic sign of AR

head bobbing caused by carotid pulsations

Classic sign of AR

pulsatile bobbing of uvula

Classic sign of AR

to-and-fro murmur over femoral artery heard best with mile pressure applied to the artery

Classic sign of AR

Pain

Pulselessness

Pallor

Paresthesias

Paralysis

(five P's)

Electrical Alternans - varying amplitudes of the QRS complexes from beat to beat on EKG

and Sinus Tachycardia on EKG is specific for

Cor Pulmonale

(right sided heart failure most commonly due to COPD)

Pulsus Bisferiens

(biphasic pulse)

Appear as an enlarged "water bottle" shape cardiac silhouette on CXR

Physical exam findings include diminished heart sounds on auscultation and difficult to palpate point of maximal impulse

Benzodiazepines

along with aspirin and nitrates

DASH Diet

(High in fruits and vegetables and low in saturated and total fats)

Within a few days of Acute MI pt presents with hypotension, clear lungs, and Kussmaul sign

ECG: ST depression in leads I and aVL with ST elevations in inferior leads.

Tx: IV fluids and AVOID Nitroglycerin and Diuretics

Right Ventricular Failure or Infarct

(RCA is involved)

Within 3-5 days of Acute MI, Pt presents with acute, severe pulmonary edema and New holosystolic murmur that radiates to axilla, Soft S1

Papillary Muscle Rupture

(RCA is typically involved, echo shows severe mitral regurg with flail leaflet)

Interventricular septum rupture/defect

(LAD -> apical septal rupture)

(RCA -> basal septal rupture)

Within first 5 days to 2 weeks of acute MI, pt presents with Shock and chest pain, JVD, Distant Heart sounds, Hypotension with compensatory sinus tachycardia

Pt with PEA and no signs of heart failure after a recent first MI

Free Wall Rupture

(Pericardial effusion with cardiac tamponade seen)

(LAD is typically involved)

Drug Induced Hypothyroidism

Can also cause lung fibrosis and liver toxicity

Drug that can cause N/V, Diarrhea, blurry yellow vision, and arrhythmias.

Used to treat a fib and atrial flutter

Ascending Aorta

Tx: with meds and SURGERY (it's an emergency)

Descending Aorta Only

Tx: Usually medical therapy alone

Mitral Regurg from Papillary muscle rupture

Left ventricular free wall rupture

Interventricular septum rupture

(all 3 can result in hypotension)

Beta Blockers

or 

cardiac acting Calcium Channel Blocker (diltiazem)

ST segment elevations in leads I, II, III, and aVL

Used to Tx atrial and ventricular arrhythmias

Potential side effects include Nausea, drug-induced lupus, agranulocytosis, and QT prolongation

Class IB antiarrhythmic used to tx ventricular arrhythmias

High doses cause confusion, seizures and respiratory depression

Inotrop used to tx atrial arrhythmias

Can cause nausea, anorexia, AV block, and Ventricular and supraventricular arrhythmias

Class III antiarrhythmic agent us to tx V Tach.

Can cause Pulmonary fibrosis, thyroid dysfunction, hepatotoxicity, corneal deposits and skin discoloration.

large diameter

rate of expansion

current cigarette smoking

older age (> 60)

cigarette smoking

Family Hx

White race

Atherosclerosis

Internal Jugular

Subclavian

Femoral

syncope in young healthy individual

triggered by physical or emotional stress

sweating, palpitations, nausea, and yawning commonly occur before the episode

Choledocholithiasis

Hypothyroidism

Smoking

HTN

Age (male > 45, female > 55)

Family Hx of CAD (male < 55, female < 65)

HDL < 40

(Note: an HDL > 60 removes one risk factor, so -1 point)

History of:

MI

PVD

CVA

DM

What type of hypothermia?

Ataxia and risk of arrhythmias

Mild Hypothermia

(<95.8 F)

What type of hypothermia?

Progressive decrease of level of consciousness with increasing slurring of speech, decrease in heart rate, respiration rate, and cardiac output

Shivering mechanism disappears

Moderate hypothermia

(82.4 - 90 F)

What type of hypothermia?

Loss of DTRs and loss of response to pain

Risk of ventricular fibrillation or even asystole are high

Severe hypothermia

(< 82.4 F)

Passive external re-warming

(warm room with blankets)

Active core re-warming along with possibly active external re-warming

(Warm GI irrigation with saline enemas and NG tube along with warmed D5 NS w/out K+)

(external rewarming is immersion in warm bath water; however only indicated in previously healthy, young persons with acute immersion hypothermia; CI in all others b/c can cause life-threatning shock)

Depressed T wave

ST segment depression

U-wave (a positive wave following the T-wave)

Therapeutic INR for Mechanical heart valves, post-MI, and antiphospholipid syndrome?

for acute PE?

2.5-3.5

2.0-3.0