Download Cardiology 7 Step 3 PDF

TitleCardiology 7 Step 3
TagsHeart Failure Heart Cardiovascular System Diseases And Disorders Cardiovascular Diseases
File Size59.5 KB
Total Pages6
Document Text Contents
Page 1

Risk factors for CAD: DM, HTN, HLD, Age, Smoking, PAD, obesity, inactivity and family hx
(fem < 65, male < 55)

Jugular veins in CCS are part of CVS exam and not HEENT.

If the case is very clear to be ischemic pain and the exam asks to choose between EKG and
(Aspirin, Nitrates, O2 and morphine) go for treatment. While in CCS do EKG, enzymes, give
Rx, angio. BI test is EKG and MA is enzymes, CKMB is best for reinfarction, Myoglobin is
the first to rise, LDH has no role.

Stress test: do it in non acute case when it is equivocal. Never do angiography without
abnormal stress. In stress test we look for ST depression. If stress test shows reversible
ischemia then do angio. Persistent ischemia means scar.

In case of unreadable EKG (LBBB, digoxin use, pacemaker, LVH, any baseline abnormality if
ST segment) do stress echo or exercise thallium.
In case of inability to exercise do dipyridamole or adenosine thallium stress test, regadenosine
stress test (lexiscan) or dobutamine echo.
Sestamibi nuclear stress is used in obese or those with large breasts as it has greater ability to
penetrate tissues.
Never stress a patient with CP and stop the test if it shows ischemia, low BP, CP, any other
critical conditions like asthma, Arrhythmias.

First do stress then angio then bypass if needed. Valvular dysfunction needs echo. MA test for
EF is nuclear ventriculogram.

Aspirin and metoprolol decrease mortality. Nitrates should be used if patient has anginal pain
but has no effect on mortality. O2 is useless if patient is not hypoxic.

Add clopidogrel or prasugrel to any patient getting angio and stent or to any patient with acute
MI or in case of allergy to aspirin.

Do PCI within 90 min of arrival and do thrombolytic within 30 minutes and choose it if PCI
can't be done within time frame. Watch for CI of thrombolytic. Thrombolytic can be given to
any patient with CP for less than 12 hrs with ST elevation or new LBBB.

Give statin to all patients with ACS regardless of EKG or enzymes.

Aspirin, Clopidogrel or prasugrel, thrombolytic, PCI, metoprolol and statins always lower
mortality. ACE and ARBs will lower mortality only if there is low EF, ie: systolic dysfunction.
O2, morphine, nitrates, CCB, lidocaine and amiodarone never lower mortality. Give CCB if
patient can't tolerate BB, cocaine induced CP or prinzmetal angina.

Do pacemaker for MI if patient develops 3rd degree HB, ,mobitz II, bifascicular block, new
LBBB or symptomatic bradycardia. Use lidocaine or amiodarone for VF and VT and never for

Complications of MI: cardiogenic shock --> echo, swan ganz, Give ACEI and revascularize.

Ruptures: all of them need echo, septal will show step up of SO2 from right atrium to right
ventricle. Rx: valve: ACEI, nitroprusside, intra-aortic ballon pump as a bridg to surgery, Septal:

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