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WORST RISK FACTOR for CAD=DMMOST COMMON RISK FACTOR for CAD=HTNMOST EFFECTIVE MODIFYABLE RISK FACTOR for CAD=SMOKING

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MOST COMMON GI CAUSE for chest pain=Non-ulcer dyspepsia

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AORTIC STENOSIS PRESENTATION1. Angina (most common)2. CHF (worst prognosis)3. Syncope

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MOST COMMON CAUSE OF HEMOPTYSIS IN THE US=Bronchitis

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V/Q scan is the best test in a pregnant womanPulmonary angiogram is the overall best test (in non-pregnant)

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If unresponsive start STEROIDS

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Clot stabilizing factor (XIII)TPA has to be given before clot is stabilized (once stabilized it becomes an old clot and unresponsive to TPA)

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TARGET LDLCAD alone <100CAD+DM <70

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HR TARGET ACHIEVED ON ETT220-Age=maximum HR>85% of this maximum should be the target HR

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Lowering the LDL significantly lowers mortality

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ANGIOPLASTY1/3 re-stenose without a stent1/5 re-stenose with a stent

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GP IIB/IIa inhibitorsEPTIFIBATIDETIROFIBANABCIXIMAB

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T inversion in aVR and I is normal

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P-P regularR-R regularNo relation between P and QRSTreatmentSymptomatic: AtropineAsymptomatic: Pacer

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SYSTOLIC DYSFUNCTION= or synonymous with DILATED CARDIOMYOPATHY (low EF)

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FLUID BETWEEN THE LOBES=pleural effusionFLUID BETWEEN THE LOBULES (interlobular septa)=Kerley B lines

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In a normal heart=atrial contribution to CO is 10-20%In a sick heart atrial contribution to CO can be as high as 50%EKG to rule out cardiac arrhythmia

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PA CXR=need at least 200-250ml of fluid to view the effusionLateral CXR=need only 50mls to view effusion

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DIASTOLIC FAILURE= or synonymous withHYPERTROPHIC CARDIOMYOPATHY (normal EF)

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DIGOXIN TOXICITYPrecipitated by hypokalemiaCauses hyperkalemia

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Isosorbide by itself is combined with Hydralazine (to reduce the coronary steal phenomenon caused by hydralazine)Diuretics in general do not lower mortality except for spironolactone which acts to calm the RAA systemCHF=commonest reason to be admitted to hospital

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Balloon valvuloplasty was invented to keep the MS pregnant woman from out of the OR

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ALL REGURGITANT LESIONS AS A RULE have a supra normal increase in EFCriteria for operation of MR if,-EF<60%-LVESD>45mm

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BEST INITIAL TEST FOR VALVULAR DISEASE=ECHOMOST ACCURATE TEST FOR VALVULAR DISEASE=Cardiac catheterization

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ARTERIOLAR DILATORSACEARBHydralazine

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VALSALVA & STANDINGDecrease blood flow to the heartSQUATTING & LEG RAISINGIncrease blood flow to the heartSo, all left sided lesions enhance with squatting and leg raising, EXCEPT for-MVP-IHSS (HOCM)which do the opposite

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Most common cause of endocarditis in a valvular lesion-If murmur (MR+) then prophylaxis for dental procedures-If no murmur (MR-) then no prophylaxis required for only CLICK!

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Angina- most common presenting complaintCHF- worst prognosis (means hypertrophy has now turned into dilatation; same prognosis as metastatic cancer; death in 12 months)

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Criteria for surgery-valve area <0.8cm2-pressure gradient >50mm Hg

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AMYL NITRATE (same as ACE) decreases after loadHAND GRIP (opposite to ACE) increases after load

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CARDIOMYOPATHY EF(concept opposite that of regurgitant and stenotic valvular lesions)Low EF: dilated cardiomyopathyHigh EF: hypertrophic cardiomyopathy

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SAM=systolic anterior motion in HOCM leads to complete loss of CO

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DISOPYRAMIDE (IA): extremely negatively inotropic; increases ventricular filling

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KUSSMAUL SIGN: seen in-Restrictive cardiomyopathy-Constrictive pericarditisDCM: systolic dysfunctionHCM: diastolic dysfunctionRCM: both systolic & diastolic dysfunction

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P-R segment depression is the most specific finding for acute pericarditis

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CARDIAC TAMPONADEBeck's triadPulsus paradoxusElectrical alternans

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SINUS TACHY= p wave+SVT=p wave -