daily ASA

sublingual NTG prn for pain

daily BB

statin (if increased LDL)

SBP < 90

right ventricular infarction

use of viagra (sildenafil) & other PDE-5 inhibitors

treadmill test 

DOESNT assess region of ischemia

radionuclide myocardial perfusion imaging (MPI)

DOES identify regions of ischemia

Adenosine or Dipyridamole (Persantine)

Pharmacologic stress testing

Adenosine or dipyridmaole 

vasodilators preferred with MPI

caution: avoid vasoconstrictors 24h prior

usues dobutamin

used in pts w CI to vasodilators or w/ recent vasoconstrictor use

1. PTCA (percutaneous transluminal coronary angioplasty)/ PCI (Perc coronary intervention)

2. CABG (coronary artery bypass graft)

1 or 3 vessel dz NOT involving main left coronary artery + normal or near normal left ventircular function

combo of ASA + clopidogrel (Plavix) used after

ARMS rest

Aortic regurg, Mitral stenosis

Apple Pies Taste Mmmmm

Aortic : R 2nd ICS 

P : L 2nd ICS

Tricuspd: L 4th ICS (erbs @ 3 ICS)

Mitral : 5th ICS (mid clavicular line) apex

mitral 

(MR, MS)

ALL MURMURS/ opening snap

ie squatting, leg raise, laying down

****exceptions: decreased murmur of HCM & delayed ejection click (decreased prolapse/shorter murmur duration) of MVP

increases ALL murmurs/opening snap on the R side (decreased ejection click R side)

right sided murmurs heard best w/ inspiration

increase all murmurs/opening snap on the L side 

(delayed ejection click on the L side)

left sided murmurs best heart after maximal expiration

AR, MR, increases with hangrip d/t backward flow

MS increases d/t to afterload

AR, MR decreases with amyl nitrate

(this is why afterload reducers like ACEI are used in tx)

35% close spontaneously

sx

diuretic 

digoxin early

LV outflow obstruction --> fixed CO

increased afterload --> LVH

degeneration >70

congenital <70

rheumatic fever

angina 

syncope

CHF

aortic valve replacement (AVR) once sxatic

severe AS is preload dependent --> avoid exertion, venodilators, & negative inotropes (CCB, BB)

rheumatic heart disease (RHD)

MC cause by far

• R-sided heart failure
• pulmonary HTN - hemoptysis
• ATRIAL FIBRILLATION
• mitral facies (flushed cheeks)

valvotomy in young pts

if rheumatic dx, sxatic, & valve orficie < 1.0 cm

repair preferred over replacement 

rheumatic dz, HTN

endocarditis, Marfan

Syphilis

Anklyosing Spondylitis

aortic regurgitation

pulse bisferiens (if combined AS+ AR)

Hill- popliteal mmHg > brachial pressure

Demussets- head bobbing 

Quincke pulses - nailbed pulsations

water hammer pulse

pistol shot over fem art.

Meds: vasodilators (decreased afterload increases forward flow)

Sx: acute or sxatic AR or decreased LV <55% (need hyperdynamic ventricle to maintain CO)

MVP is MCC

RHD, endocarditis

ischemia (ruptured papillary muscle/chordae s/p MI)

Acute: pulm edema, dyspnea

Chronic: A fib, CHF. Maybe pulm HTN (not as often as MS)

Meds: vasodilators-decrease afterload increases forward flow (ACEI)

SX: valve repair preferred vs valve replacement (acute/sxatic or LV < 55%)

MC in young women

connective tissue dz (Marfan, Ehlers Danlos)

Most asymptomatic

1. autonomic dysfunction: CP, panic attacks; arrhythmia --> fatigue

2. sx assoc w/ MR progression: fatigue, dyspnea, PND, CHF

3. stroke, endocarditic, PVC's

mitral valve prolapse

+- mid-late systolic murmur (MR)

reassurance good prognsis in asymptomatic pts or mild sx

BB for autonomic dysfunction

tricuspid regurgitaiton

Carvallo's sign helps to distingush TR from MR