CARDIOLOGY
STEMI Mortality Scores
Heart failure goals (CI, PCWP, MAP,
SVR)
Difference between interval and
segment
AFib suppression
AFib prophylaxis after CABG
VTach characteristics
Time needed with triple anticoagulation
after PCI
Difference between paroxysmal,
persistent and permanent AFib
Echo “BART”
Bubble study interpretation
Indication to lower apixaban dose to 2.5
mg BID instead of 5 mg BID
Sever Aortic Stenosis Criteria
Wall abnormalities in Takatsubo
cardiomyopathy
Echo characteristic of mitral valve in
rheumatic disease
Indication to increase furosemide dose
at home
Prophylaxis for Bicuspid Aortic Valve
Digoxin effectivity during exercise
New HTN Classification
BP Goal for PX with CV Risk >10 and
HTN
COPD most common arrhythmia
Most common SVT
TIMI Score and GRACE Score
CI >2.2, PCWP <18, MAP >60, SVR <800
Intervals have waves, segments don’t
Amiodarone
Amiodaron
Regular rhythm, wide QRS
It is only recommended for one month: 2 antiplatelets + oral anticoagulants
Paroxysmal <7 days, Persistent 7 days – 1 year, Permanent >1 year
Blue – Away, Red – Towards
<4 beats: shunt, 4-7: indeterminant, >7: pulmonary shunt
>80 yo, Cr >1.5, Weight: <60 kg
Mean Gradient: 40, Vmax: 400 cm, Area: < 1 cm
There is hypokinesis at the point of the ventricle and hyperkinesia at the base.
Reverse Takatsubo: other way around
Posterior leaflet is fixed. Looks like a “hockey stick”
If in the morning you weigh >3 lbs more than the previous day. Take 20 additional
mgs.
Not indicated
Digoxin only works with HR at rest, will not improve function during periods of
exercise
Elevated BP: 120-129/80, Stage 1 HTN: 130-139/80-89, Stage 2 HTN: >140/>90
130/90 (plus TX for risk factors)
Multifocal atrial tachycardia
AVNRT
ST changes in pericarditis
Definition of Low Voltage in EKG
Hypertrophic cardiomyopathy EKG
characteristics
Q differences in infarction vs
hypertrophy
Contrainidicated medications in WPW
TX for WPW
Effects on afterload or preload of
handgrip, Valsalva, squatting
Defect in left-right dynein results in…
>QT interval increases risk for…
Congenital >QT interval causes
SCN5A mutacion
Bundle of Kent
Recombination form of BNP
Drugs used in pharmacological stress
test
Culture (-) endocarditis
Hemodynamic parameter to use in HF
PWP in pulmonary edema
Normal pressure ranges in
cardiovascular system
CHA2DS2 Vasc
WPW predisposes to ..
Selective pulmonary vasodialtors (NOT
for left HF)
Cause of redunces BNP
Levosimendan
Indications for cardiac
resynchronization therapy
ST elevations WITHOUT reciprocal ST depressions
<5 mV in limb leads; <10 mV in precordial leads
Dager Q waver (v5-v6) + high voltaje
Infarction Q >40 ms; hypertrophy Q <40 ms
NO ß-blockers; would inhibit AV node that controls rate = arrhythmia
Procainamide
Handgrip increases afterload, Valsalva decreases preload, squatting increases
preload and afterload
Dextrocardia (Kartagener SX)
Torsades de Pointes
Romano Ward (AD) and Jowell and Lange-Nielsen (AR, deafness)
Brugada syndrome
Accessory conduction of WPW Sx
Nesiritide
Dipyridamole, regadenoson
HACEK (Haemophilus, aggregaticobacter, cardiobacterium, eikenella, kingella),
bartonella, Coxiella
MAP (normal 65-75), NOT BP
>20 mmHg
Central venos 3-8, RV 15-30/3-8, PA 15-30/4-12, PV (wedge) 2-15, LV (100-140/3-
12)
CHF, Htn, Age (65-74 1 pt, >75 2 pts), diabetes, previous stroke, vascular disease,
female. >1 consider anticoagulation, ≥ 2 mandatory
AVRT
Prostaciclins (epoprostenol, iloprost, treprostinil), nitric oxide, PDE-5 inhibitores,
endotelin antagonists (bosentan, dorusentan)
Obesity
Calcium sensitizer for management of acutely decompensated HF
EF <35%, NHYA III-IV, maxium medical TX, QRS >120 ms (LBBB)
ß-blockers used in HF
PX population for eplerenone use
TX for pulmonar edema
EKG criteria ventricular Hypertrophy
Drugs contraindicated before stress
tests:
Meds contraindicated in vasospastic
angina
If used, Ca channel blockers in HF must
be used with ..
Verapamil increases toxicity for…
Trunetazidine use
Echo criteria for diastolic dysfunction
Advantages of milrinone vs dobutamine
EKG if tachycardia does not come from
SA node
Meds that decrease mortality post-MI
Pericarditis EKG
TX of symptomatic antidromic AVRT
TX of symptomatic orthodromic AVRT
Medication CI in WPW due to increased
risk of V fib
Dopamine doses and effects
Changes in PR interval with increased
HR
Formulas to correct QT interval
QRS Axis
Bisoprolol, metoprolol, carvedilol (alpha + beta); PX has to be euvolemic
Diabetics or post-MI
O2, morphine, diurectics, when systolic BP >90-100 give vasodilators
(nitroglycerine, nitroprussiate), inotropic meds, aortic balloon, ß-blockers/calcium
antagonists  cardioversion
Tall Rs in V5-V6, deep Ss in V1-V2 (Sokolow index >35 mm, Lewis index >17 mm)
ß blockers, non-DHP calcium channel blockers, amiodarone, sotalol, digoxin,
nitrates
Aspirin, non-selective ß blockers, sumatriptan
ACE-inhibitors; they tend to be avoided in HF. DHF for aortic insufficiency,
verapamil/diltiazem for hypertrophic cardiomyopathy
Digoxin
Protect cells from free radicals after isquemia
Small E wave; EA ration ≤0.8 (normal is 0.8-2)
Milrinone can be used in the presence of ß blockers but dobutamine is easier to
titrate
Wide QRS
ß blockers
Global ST segmental elevation (sensitive), PR depression (specific), pericardial
effusion (low voltage + electrical alternans)
Procainamide IV (definitive: radiocatheter ablation)
Vagal maneuvers – AV nodal blocking agents (adenosine > verapamil). If
hemodynamically unstable = cardioversion.
Digoxin
Low: 0.5-2 µg/kg/min (renal + splenic vasodilation), Medium: 2-6 µg/kg/min
(inotropic + cronotropic), High >10 µg/kg/min (vasoconstriction)
Shorter PR interval (atrial T wave can be seen after QRS altering J point = do not
confuse with ST depression)
Bazetts and Hodges formulas.
Normal: positive I and II / leftward: positive in I, negative II / rightward: negative I,
 positive aVF / extreme: negative I and aVF
Right deviation EKG causes RV hypertrophy, RBBB left posterior fascicular block, WPW, lateral wall SX
Left deviation EKG causes LV hypertrophy, LBBB, left anterior fascicular block, hyperpotasemia, inferior wal
MI
Possible normal negative P waves Always in aVR, sometimes III, V1
Normal QT interval <0.45 in men, <0.46 women
Causes of T wave inversion Isquemia, Brugada SX, arrythmogenic, right ventricular cardiomyopathy
EKG aneurysm Persisten ST elevation post MI (>3 weeks); can also be result of dyskinetic wall
Causes of short QT Hypercalemia, hypercalcemia, digitalis use
Tall T waves causes Hyperkalemia (>10 mm in precordial, >5 mm in limbs), early MI, LBB, LVH
Prominent U waves Hypocalemia, bradycardia, intracranial hemorrhage, class 1A and 3 antiarrythmics
EKF left anterior fasciscular block Left axis deviation, QRS negative II, III and aVF (r, deep S), aVL: small q, tall R
AFib prophylaxis after CABG Amiodarone; it can also be used to suppress the arrhythmia
TX to reduce degree of chronic cardiac Colchicine
tamponade
Triple anticoagulation therapy indication Only recommended for 1 month post-stent placement; then you drop aspirin and
continue for a year
Reverse agent dabigatran Idarucizumab
EKG Mi Criteria ST elevation at J point in two contiguous leads of ≥0.1 mV in leads, EXCEPT: 1)
V2-V3 ≥0.2 mV in men ≥40 years or ≥0.25 mV in <40 years or ≥0.15 in women / 2)
posterior STEMI V1-V3 depression (posterior EKG would show elevation in V7-V9)
KDIGO Acute Kidney Injury Criteria Increase of Cr ≥0.3 mg/dl within 48 hrs, increase CR to ≥1.5 x baseline within 7
days, urine volume <0.5 ml/kg/hr for 6 hours
Shones SX Supravalvular mitral membrane (parachute mitral valve, inserted to only 1 papillary
muscle) + subaortic stenosis + coarctation of the aorta
Williams SX Intellectual disability / learning problmes (visual-spacial) + facial abnormalities +
cardiovascular abdormalities (supravalvular aortic stenosis)
Spironolactone in HF recommendation NYHA clasee II – IV + EF <35% OR PX post-STEMI with therapeutic doses of ACE
inhibitors and ARBA + LVEF <40% + symptomatic HF or DM
Labs contraindications for K >5.0 mEq or GFR <30
spironolactone
TIMI Scores % of mortality risk at 14 days post-MI
GRACE Score Estimates admission and 6 month mortality for PX w/ acute coronary syndrome
Killip Class Stratify mortality post-MI first 30 days. I – no signs (6%), II – rales on crackels, S3,
increased JV pressure (17%), III – acute pulmonary edema (38%), IV – cardiogenic
shock or hypotension + peripheral vasoconstriction (81%)
Scarbossa criteria SX MI in PX with LBBB; concordant ST elevation >1 mm in leads with positive QRS
complex (5 pts) / concordant ST depression >1 mm in V1-V3 (3 pts), excessively
discordant ST elevation >5 mm (25%) in leads aVR QRS complex