Cardiology - Revision history

Aesetholephews at 20:37, 7 February 2023

2023-02-07T20:37:46Z

Aesetholephews at 19:39, 7 February 2023

2023-02-07T19:39:59Z

Aesetholephews: /* Pericarditis */

2023-01-17T05:13:27Z

Pericarditis

Aesetholephews: /* Dyslipidemia */

2023-01-17T05:02:15Z

Dyslipidemia

Aesetholephews: /* Unstable Angina/NSTEMI */

2023-01-17T04:59:27Z

Unstable Angina/NSTEMI

Aesetholephews: /* Congestive Heart Failure */

2023-01-17T04:53:00Z

Congestive Heart Failure

Aesetholephews: /* Bradyarrhythmias and Conduction Abnormalities */

2023-01-17T04:50:02Z

Bradyarrhythmias and Conduction Abnormalities

Aesetholephews: /* Hypertrophic Cardiomyopathy */

2023-01-17T01:39:38Z

Hypertrophic Cardiomyopathy

Aesetholephews: /* STEMI */

2023-01-16T19:53:00Z

STEMI

Aesetholephews: /* Unstable Angina/NSTEMI */

2023-01-16T19:51:58Z

Unstable Angina/NSTEMI

← Older revision		Revision as of 20:37, 7 February 2023
Line 1:		Line 1:
−	~~{\| class="wikitable sortable"~~
−	~~\|+ Caption text~~
−	\|-
−	~~! Header text !! Header text !! Header text~~
−	\|-
−	~~\| Sinus bradycardia \|\| Example \|\| Example~~
−	\|-
−	~~\| Sick sinus syndrome \|\| Example \|\| Example~~
−	\|-
−	~~\| 1st degree AV block \|\| Example \|\| Example~~
−	\|-
−	~~\| 2nd degree AV block - type I \|\| Example \|\| Example~~
−	\|-
−	~~\| 2nd degree AV block - type II \|\| Example \|\| Example~~
−	\|-
−	~~\| 3rd degree AV block \|\| Example \|\| Example~~
−	\|-
−	~~\| Sinus tachycardia \|\| Example \|\| Example~~
−	\|-
−	~~\| Multifocal Atrial Tachycardia \|\| Example \|\| Example~~
−	\|-
−	~~\| Atrial fibrillation \|\| Example \|\| Example~~
−	\|-
−	~~\| Atrial flutter \|\| Example \|\| Example~~
−	\|-
−	~~\| AVNRT \|\| Example \|\| Example~~
−	\|-
−	~~\| AVRT \|\| Example \|\| Example~~
−	\|-
−	~~\| Wolff-Parkinson-White \|\| Example \|\| Example~~
−	\|-
−	~~\| Ventricular tachycardia \|\| Example \|\| Example~~
−	\|-
−	~~\| Ventricular fibrillation \|\| Example \|\| Example~~
−	\|-
−	~~\| Torsades de Pointes \|\| Example \|\| Example~~
−	\|-
−	~~\| HFpEF \|\| Example \|\| Example~~
−	\|-
−	~~\| HFrEF \|\| Example \|\| Example~~
−	\|-
−	~~\| Dilated cardiomyopathy \|\| Example \|\| Example~~
−	\|-
−	~~\| Hypertrophic cardiomyopathy \|\| Example \|\| Example~~
−	\|-
−	~~\| Restrictive cardiomyopathy \|\| Example \|\| Example~~
−	\|}
−
	=Missed Concepts=		=Missed Concepts=
	*'''Verapamil inhibits renal tubular secretion of digoxin, leading to toxicity'''		*'''Verapamil inhibits renal tubular secretion of digoxin, leading to toxicity'''

← Older revision		Revision as of 19:39, 7 February 2023
Line 1:		Line 1:
		+	{\| class="wikitable sortable"
		+	\|+ Caption text
		+	\|-
		+	! Header text !! Header text !! Header text
		+	\|-
		+	\| Sinus bradycardia \|\| Example \|\| Example
		+	\|-
		+	\| Sick sinus syndrome \|\| Example \|\| Example
		+	\|-
		+	\| 1st degree AV block \|\| Example \|\| Example
		+	\|-
		+	\| 2nd degree AV block - type I \|\| Example \|\| Example
		+	\|-
		+	\| 2nd degree AV block - type II \|\| Example \|\| Example
		+	\|-
		+	\| 3rd degree AV block \|\| Example \|\| Example
		+	\|-
		+	\| Sinus tachycardia \|\| Example \|\| Example
		+	\|-
		+	\| Multifocal Atrial Tachycardia \|\| Example \|\| Example
		+	\|-
		+	\| Atrial fibrillation \|\| Example \|\| Example
		+	\|-
		+	\| Atrial flutter \|\| Example \|\| Example
		+	\|-
		+	\| AVNRT \|\| Example \|\| Example
		+	\|-
		+	\| AVRT \|\| Example \|\| Example
		+	\|-
		+	\| Wolff-Parkinson-White \|\| Example \|\| Example
		+	\|-
		+	\| Ventricular tachycardia \|\| Example \|\| Example
		+	\|-
		+	\| Ventricular fibrillation \|\| Example \|\| Example
		+	\|-
		+	\| Torsades de Pointes \|\| Example \|\| Example
		+	\|-
		+	\| HFpEF \|\| Example \|\| Example
		+	\|-
		+	\| HFrEF \|\| Example \|\| Example
		+	\|-
		+	\| Dilated cardiomyopathy \|\| Example \|\| Example
		+	\|-
		+	\| Hypertrophic cardiomyopathy \|\| Example \|\| Example
		+	\|-
		+	\| Restrictive cardiomyopathy \|\| Example \|\| Example
		+	\|}
		+
	=Missed Concepts=		=Missed Concepts=
	*'''Verapamil inhibits renal tubular secretion of digoxin, leading to toxicity'''		*'''Verapamil inhibits renal tubular secretion of digoxin, leading to toxicity'''

@@ Line 108: / Line 108: @@
 *H&P: Possible history of recent MI, improved when leaning forward, can have pleuritic chest pain, cardiac rub
 *Dx: Can show calcifications on CXR
-*Tx: '''High-dose aspirin for post-MI acute pericarditis, otherwise NSAIDs and colchicine for normal pericarditis'''.
+*Tx: '''High-dose aspirin''' for post-MI acute pericarditis, otherwise '''NSAIDs and colchicine''' for normal pericarditis.
 ==[[Cardiac Tamponade]]==
 *H&P: Beck's triad

@@ Line 76: / Line 76: @@
 ! Group !! Intervention
 |-
-| 21+ w/ ASCVD or LDL > 190 || High dose statin
+| 21+ '''w/ ASCVD''' or LDL > 190 || High dose statin
 |-
 | 40+ w/ LDL 70-189 w/o diabetes || Calculate 10-yr ASCVD risk:

@@ Line 60: / Line 60: @@
 ==Unstable Angina/NSTEMI==
 *Tx: NSTEMI with '''high risk features (refractory pain, TIMI score ≥ 3)''' should get PCI. '''No role for thrombolytic therapy in NSTEMI'''
-** MONA BAsH—'''morphine/metoclopramide (for pain/nausea), oxygen (if SpO2 <95%/breathless), nitrates, ASA, β-blockers (''if LVEF < 40%, HTN, tachycardic''), Antiplatelet (if doing angioplasty/stenting, prasugrel or ticagrelor are preferred agents), (spironolactone?), Heparin (LMWH)'''.
+** MONA BAsH—'''morphine/metoclopramide (for pain/nausea), oxygen (if SpO2 <95%/breathless), nitrates, ASA, β-blockers (''if LVEF < 40%, HTN, tachycardic, no heart failure''), Antiplatelet (if doing angioplasty/stenting, prasugrel or ticagrelor are preferred agents), (spironolactone?), Heparin (LMWH)'''.
 ** Send home on 12 months DAPT (if stending/angioplasty performed), ACEI/ARB, and statin.

@@ Line 31: / Line 31: @@
 * Systolic Dysfunction/HFrEF
 ** H&P: History of CAD, hypertension, valvular disease, dilated cardiomyopathy (EtOH, Chagas, Coxsackie B), or MI. '''Dyspnea (most sensitive)''', PND, orthopnea, cough, hemoptysis, fatigue; '''S3 (most specific)''', displaced PMI, crackles, signs of right heart failure (S4, JVD, edema)
-** Dx: LVEF < 40%, enlarged cardiomediastinal silhouette on CXR, elevated BNP
+** Dx: Clinical. Supported by TTE (LVEF < 40%), CXR (enlarged cardiomediastinal silhouette on CXR), and labs (elevated BNP)
 ** Tx: ACEI/ARBs, ARNIs, β blockers, SGLT2 inhibitors, Spironolactone, and LVAD all have mortality benefit; Digoxin and diuretics don't have any mortality benefit but help with symptoms and decrease hospitalizations. For acute exacerbations use LMNOP (lasix, morphine, '''nitrates''', oxygen, positioning).
 * Non-systolic Dysfunction/HFpEF

@@ Line 19: / Line 19: @@
 SA node -> AV node -> bundle of His -> left/right bundles -> Purkinje fibers
 ==[[Bradyarrhythmias]] and Conduction Abnormalities==
-*H&P: syncope, nausea, vomiting, blurred vision, dizziness. '''Inferior MI''' can be complicated by symptomatic bradycardia and cardiogenic shock due to ischemia of the SA node leading to an increase in vagal tone.
+*H&P: syncope, nausea, vomiting, blurred vision, dizziness. '''Inferior MI''' can be complicated by symptomatic bradycardia and cardiogenic shock due to ischemia of the SA node leading to an increase in vagal tone. Beta blocker toxicity.
 *Dx: [[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
+*Tx: Correct electrolytes/hypothermia, Glucagon for beta blocker toxicity, '''atropine/dopamine''', transcutaneous pacing, transvenous pacing, leadless pacing, permanent pacemaker
 ==[[Tachyarrhythmias]]==
 *H&P: palpitations, syncope

@@ Line 42: / Line 42: @@
 *H&P
 *Dx:
-*Tx: Aim is to preserve or increase LV volume. '''Beta blockers (such as metoprolol) increase filling time and decrease inotropy'''. If patient is intolerant (e.g. asthma exacerbations), '''second line is verapamil''' (non-dhp CCB). If medical management fails, use EtOH septal ablation.
+*Tx: Aim is to preserve or increase LV volume. '''Beta blockers (such as metoprolol) increase filling time and decrease inotropy'''. If patient is intolerant (e.g. asthma exacerbations), '''second line is verapamil''' (non-dhp CCB). '''If medical management fails''', use EtOH septal ablation. Sudden cardiac death is prevented with ICD implantation.
 ==Restrictive Cardiomyopathy==

@@ Line 63: / Line 63: @@
 ==STEMI==
-*Tx: '''PCI within 90 minutes.''' Standard MONA BAsH—'''morphine/metoclopramide (for pain/nausea), oxygen (if SpO2 <95%/breathless), nitrates, ASA, β-blockers (''if LVEF < 40%, HTN, tachycardic, no heart failure''), Antiplatelet (if doing angioplasty/stenting, prasugrel or ticagrelor are preferred agents), (spironolactone?), Heparin (LMWH)'''. Look out for complications (DARTH VADER mnemonic). '''PCI for patients with ST depression on exercise stress ECG test'''. Afib as a complication of MI or cardiac surgery usually '''resolves spontaneously within a few days'''. Send home on 12 months DAPT (if stenting/angioplasty performed), ACEI/ARB, and statin.
+*Tx: '''PCI within 90 minutes (door-to-balloon time).''' PCI for patients with '''ST depression on exercise stress ECG test'''.
 =Dyslipidemia=