Cardiology (memo from NEJM knowledge plus and MKSAP)
・dual antiplatelet Tx for STEMI
avoid prasugrel for patient with h/o stroke, >75 yo, body weight < 60kg
・Tx for HTN in HFpEF patient
ARB (candesartan) reduce hospitalization in patient with HFpEF
・first-line monotherapy for hypertensive african-american patient
thiazide or CCB
・indication of echocardiography for patient with heart murmur
3/6 or louder SM or any diastolic or continuous murmur
・management of NSTEMI with high TIMI score (5-7)
anticoagulation (TIMI 3-7) and glycoprotein IIb/IIIa (eptifibatide) in addition to ASA, clopidogrel, BB, nitrate, statin
・complete heart block secondary to Lyme disease
reversible
・management of recurrent pericarditis
colchicine and aspirin
・management of perioperative (total hip replacement) anticoagulation for patient with mechanical aortic valve on warfarin
discontinue warfarin 3 days prior to surgery and restart on evening of surgery (no heparin bridge if no risk factor: afib, LVEF<30, hypercoagulable state, h/o thromboembolic event)
・intermittent claudication and borderline ABI
-> ABI after exercise increase sensitivity
・management of patient with suspected peripheral artery disease whose ABI is above 1.4
great toe pressure measurement
・diagnosis of type A aortic dissection
transesophageal echocardiography
・cocaine-induced chest pain
NTG + benzodiazepine
・widespread deeply inverted T waves
sign of severe brain injury
・new onset of widened QRS and QT interval secondary to TCA overdose
sodium bicarbonate
・patient with ACS managed with non-invasive fashion
LMWH has better outcome than unfractionated heparin
・indication for surgical intervention to aortic aneurysm
diameter > 5.5 cm or expand 0.5 cm/year
・indication for aortic valve replacement for AS
symptomatic or LVEF <50%
・initial management of congenital long-QT syndrome
beta blocker
・patient with severely depressed systolic function and fluid overload who responds poorly to IV diuretics or has worsening renal function
-> inotropic agent (milrinone)
・narrow-complex tachycardia in patient with h/o heart transplant
low dose of adenosine (3mg)
・atrial tachycardia with atrioventricular 2:1 block
digoxin toxicity
・ST-segment elevation more prominent in aVR than V1
obstruction of left main coronary artery
・patient with mechanical valves on warfarin
addition of low-dose ASA reduce the risk of thromboembolism
・ABX for endocarditis prophylaxis prior to dental procedure
amoxicillin 2 gram po once 1 hour prior to procedure
・6 months of intermittent fever, orthopnea, progressive SOB, chest pain
cardiac myxoma
・management of asymptomatic myxoma
surgical removal (risk for systemic embolic event)
・late cardiac complication of Hodgkin disease treatment
coronary artery disease, (valve disorder, restrictive cardiomyopathy, diastolic dysfunction)
・fixed splitting of the S2
ASD
・management of patient with pacemaker whose corner is eroding through skin without sign of systemic infection
extraction of pacemaker and leads
・management of severe pulmonary valve stenosis with peak gradient of 70
percutaneous pulmonary balloon valvuloplasty
・diagnosis of patient who has newly developed holosystolic murmur at left sternal border associated with palpable thrill 3 days after myocardial infarction
postinfarction VSD
・cardiovascular risk scoring system preferable for young female
Raynolds risk score (Framingham risk score underestimate risk of young female)
・cannon a wave
atrial contraction against closed tricuspid valve -> AV dissociation
・management of patient with ACS who is contraindicated to beta blocker
diltiazem
・clopidogrel Tx for patient with unstable angina or NSTEMI who is treated medically without stent placement
clopidogrel for at least 1 month, ideally up to 1 year
・management of patient with chronic stable angina who remains symptomatic despite optimal dose of beta blocker, cacium channel blocker and long-actign nitrate
ranolazine
・management of patient with ICD placement and pacemaker dependence who is about to undergo surgery
turn off shock therapy and change to asynchronous mode (ventricular pacing continue regardless of any native electrical activity)
・time window of thrombolytic Tx for STEMI
within 12 hours
・follow up aortic coarctation repair
MRI or CT for aort (to evaluate recurrent coarctation and aneurysm)
・biventricular pacing
QRS > 120
・complication of previous radiation to thorax
aortic regurgitation, ・・・
・ejection click that diminish in intensity during inspiration
pulmonary valve stenosis
・evaluation of newly diagnosed left ventricular systolic dysfunction
coronary angiography
・management of limb ischemia with dense anesthesia, severe motor impairment, lack of doppler vascular signal
prompt amputation (consistent with nonviable limb)
・DDx of patient with newly developed heart failure 5 years after heart transplant
cardiac allograft vasoculopathy
・ST change in myocarditis and pericarditis
myocarditis: nonspecific ST-T change (ST elevation, TWI)
pericarditis: concave ST elevation
・management of patient with cyanotic congenital heart disease who present with dyspnea on exertion, Hb 15, Hct 52, ferritin 10, transferrin saturation 13%
iron therapy
(normal Hb and Hct are 18-20 and 60-65% for cyanotic heart disease patient)
・management of severe MR
mitral valve repair or replacement?
・management of patient with STEMI brought to the facility without cardiac cath lab and the other facility with cardiac cath is in 1.5 hour drive
thromolytic Tx if not contraindicated (door-to-balloon time should be 90 minutes or less)