Difference between revisions of "Cardiology"
Jump to navigation
Jump to search
Line 12: | Line 12: | ||
**H&P: palpitations, syncope | **H&P: palpitations, syncope | ||
**DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW | **DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW | ||
− | **Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. | + | **Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective [[AC]] is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach. |
=Congestive Heart Failure= | =Congestive Heart Failure= | ||
Line 33: | Line 33: | ||
=Dyslipidemia= | =Dyslipidemia= | ||
+ | * Age 45-74, LDL > 190 | ||
+ | * Age 45-74, LDL 70-190 ASCVD > 10% | ||
+ | * Age 45-74, LDL 70-190 ASCVD > 7.5% | ||
+ | * Age 45-74, Diabetes | ||
+ | * ACS = HD | ||
+ | * > 75 = MD | ||
=Hypertension= | =Hypertension= | ||
− | * Primary Hypertension | + | * Primary/Essential Hypertension |
− | * | + | ** Dx: Rule out secondary causes, BP > 130/90 on two separate occasions. |
− | ** RAS, Hypo/Hyper(para)thyroidism, Conn syndrome, Cushing's syndrome, Pheochromocytoma | + | ** DDx: Secondary HTN--RAS, Hypo/Hyper(para)thyroidism, Conn syndrome, Cushing's syndrome, Pheochromocytoma |
− | * Hypertensive | + | ** Tx: Can start with 1 or 2 agents depending on severity. First line: ACEI/ARB (good for kidney protection), (Non)Dihydropyridine CCB, Beta Blockers (cardiac selective, non-selective), Thiazide/Non-Thiazide Type Diuretics (second line) |
+ | * Hypertensive Urgency BP > 180 | ||
+ | * Hypertensive Emergency BP > 180 + symptoms | ||
=Pericardial Disease= | =Pericardial Disease= | ||
* Pericarditis | * Pericarditis | ||
− | * Cardiac Tamponade | + | * Cardiac Tamponade (Beck's triad) |
=Valvular Heart Disease= | =Valvular Heart Disease= | ||
+ | {| class="wikitable sortable" | ||
+ | |+ Cardiac Murmur Descriptions and Maneuvers | ||
+ | |- | ||
+ | ! Murmur !! Description !! Provocative Maneuvers | ||
+ | |- | ||
+ | | AR || Diastolic, M || Example | ||
+ | |- | ||
+ | | AS || Systolic, A || Example | ||
+ | |- | ||
+ | | MR || Systolic, A || Example | ||
+ | |- | ||
+ | | MS || Diastolic, Blowing, M || Example | ||
+ | |- | ||
+ | | MP || Systolic, Click, A || Example | ||
+ | |- | ||
+ | | TR || Systolic || Example | ||
+ | |- | ||
+ | | PDA || Continuous, Machine-like || Example | ||
+ | |} | ||
+ | * Maneuvers increase afterload (hand grip, standing), preload (passive leg raise, lying down), or both (vagal). | ||
+ | |||
+ | * Endocarditis: Janeway lesions, Osler nodes, Splinter hemorrhages | ||
=Vascular Diseases= | =Vascular Diseases= | ||
− | * Aortic Aneurism | + | * Aortic Aneurism: Different types of repair (open vs endovascular), when to intervene (> 5.5 cm or rapidly enlarging), one time screening abd US in ever smokers at age 50 |
− | * Aortic Dissection | + | * Aortic Dissection: Stanford classification: type B (post arch and descending aorta) is medically managed; type A (ascending or arch) is surgical emergency. |
− | * Deep Venous Thrombosis | + | * Deep Venous Thrombosis: Virchow's triad |
− | * Peripheral Arterial Disease | + | * Peripheral Arterial Disease: ABI |
* Lymphedema | * Lymphedema | ||
=Syncope= | =Syncope= |
Revision as of 01:56, 18 December 2022
Electrocardiogram
Cardiac Physical Exam
Arrhythmias
SA node -> AV node -> bundle of His -> left/right bundles -> Purkinje fibers
- Bradyarrhythmias and Conduction Abnormalities
- H&P: syncope, nausea, vomiting, blurred vision, dizziness
- DDx: sinus brady, SSS, 1st degree AV block, 2nd degree AV block (Mobitz 1), 2nd degree AV block (Mobitz 2), 3rd degree AV block
- Tx: correct electrolytes/hypothermia, atropine/dopamine, transcutaneous pacing, transvenous pacing, leadless pacing, permanent pacemaker
- Tachyarrhythmias
- H&P: palpitations, syncope
- DDx: Sinus tach, Afib, Aflutter, Vtach, Vfib, Vflutter, AVNRT, AVRT, WPW
- Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers, atropine, beta blockers, amiodarone, digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHAD2S2VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective AC is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach.
Congestive Heart Failure
- Systolic Dysfunction/HFrEF
- Non-systolic Dysfunction/HFpEF
Cardiomyopathy
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy
Coronary Artery Disease
- Angina Pectoris
- Prinzmetal Angina
- Carotid Artery Stenosis
Acute Coronary Syndromes
- Unstable Angina/NSTEMI
- STEMI
Dyslipidemia
- Age 45-74, LDL > 190
- Age 45-74, LDL 70-190 ASCVD > 10%
- Age 45-74, LDL 70-190 ASCVD > 7.5%
- Age 45-74, Diabetes
- ACS = HD
- > 75 = MD
Hypertension
- Primary/Essential Hypertension
- Dx: Rule out secondary causes, BP > 130/90 on two separate occasions.
- DDx: Secondary HTN--RAS, Hypo/Hyper(para)thyroidism, Conn syndrome, Cushing's syndrome, Pheochromocytoma
- Tx: Can start with 1 or 2 agents depending on severity. First line: ACEI/ARB (good for kidney protection), (Non)Dihydropyridine CCB, Beta Blockers (cardiac selective, non-selective), Thiazide/Non-Thiazide Type Diuretics (second line)
- Hypertensive Urgency BP > 180
- Hypertensive Emergency BP > 180 + symptoms
Pericardial Disease
- Pericarditis
- Cardiac Tamponade (Beck's triad)
Valvular Heart Disease
Murmur | Description | Provocative Maneuvers |
---|---|---|
AR | Diastolic, M | Example |
AS | Systolic, A | Example |
MR | Systolic, A | Example |
MS | Diastolic, Blowing, M | Example |
MP | Systolic, Click, A | Example |
TR | Systolic | Example |
PDA | Continuous, Machine-like | Example |
- Maneuvers increase afterload (hand grip, standing), preload (passive leg raise, lying down), or both (vagal).
- Endocarditis: Janeway lesions, Osler nodes, Splinter hemorrhages
Vascular Diseases
- Aortic Aneurism: Different types of repair (open vs endovascular), when to intervene (> 5.5 cm or rapidly enlarging), one time screening abd US in ever smokers at age 50
- Aortic Dissection: Stanford classification: type B (post arch and descending aorta) is medically managed; type A (ascending or arch) is surgical emergency.
- Deep Venous Thrombosis: Virchow's triad
- Peripheral Arterial Disease: ABI
- Lymphedema