1 PANCE Treatments and Tests of Choice Cardiology:

1 PANCE Treatments and Tests of Choice Cardiology: Dilated cardiomyopathy treatment: Correct Answer: ACE inhibitors, beta blockers, diuretics , dig, stop offending agent HOCM treatment: Correct Answer: Beta Blockers Defibrillators Dilated Cardiomyopathy test of choice: Correct Answer: TTEcho (LVH dilation, reduced EF) HOCM test of choice: Correct Answer: Doppler echo Restrictive cardiomyopathy test of choice: Correct Answer: Echo Restrictive cardiomyopathy treatment: Correct Answer: None specific Symptomatic diuresis, vasodilators First degree AV block treatment: Correct Answer: None Second degree AV block/Mobitz 1/wenkebach treatment: Correct Answer: None; Atropine or Transcutaneous pacing if asymptomatic Second degree AV block/Mobitz 2 treatment: Correct Answer: Permanent pacemaker Third degree AV block treatment: Correct Answer: Permanent pacemaker SVT treatment: Correct Answer: 1. Vagal maneuvers 2. Adenosine AVN blockers amiodarone cardioconversion Aflutter treatment: Correct Answer: Stable:Vagal, BB,CCB Unstable: Synchronized Cardioversion Afib treatment: Correct Answer: Stable: Vagal, BB, CCB Unstable: Synchronized cardioversion Aflutter definitive treatment: Correct Answer: Radiofrequency ablation Stable V tach treatment: Correct Answer: Stable: Procainamide, Lidocaine, Amiodarone Vfib treatment in setting of acute ischemia or infarction: Correct Answer: Unsynchronized cardioversion (defibrillation) + CPR Vfib treatment if there is no identifiable cause: Correct Answer: Implantable cardioverter defibrillator " Polymorphic vtach treatment: Correct Answer: Cardiovert/defibrillate if unstable Torsades de pointes treatment: Correct Answer: Mg Recurrent vtach with no reversable cause treatment: Correct Answer: Implantable cardiodefibrillator Sinus Sick Syndrome treatment: Correct Answer: PPM PPM with AICD if alternating vtac Bundle Branch Block treatment: Correct Answer: Transcutaneous pacing Intra-aterial thrombus test of choice: Correct Answer: TEE Paroxysmal SVT treatment: Correct Answer: Valsalva maneuve, splashing water on face, vasovagal maneuver Adenosine (if physical measures fail) PVC treament (if sx): Correct Answer: BB PDA test of choice: Correct Answer: Echo PDA treatment CHF picture: Correct Answer: Diuretics (Furosemide) PDA treatment: Correct Answer: Indomethacin (premature infants) Surgical ligation Tetrology of fallot test of choice: Correct Answer: Echo Tetrology of fallot treatment: Correct Answer: Prostaglandin E1 to open duct and stabilize--surgery "Tet spell" treatment: Correct Answer: BB Children will often be squatting Coarctation of the aorta test of choice: Correct Answer: Angiogram Coarctation of the aorta treatment (infants): Correct Answer: Prostaglandin E1 to open duct and stabilize--balloon angioplasty ASD test of choice: Correct Answer: TEE ASD treatment (young): Correct Answer: None (50% close spontaneously) Surgery/patch VSD treatment: Correct Answer: Close spontaneously Surgery Sx sinus bradycardia first line treatment: Correct Answer: Atropine Sx sinus bradycardia second and third line treatment: Correct Answer: Transcutaneous pacing Permanent pacemaker Wolfparkinson White definitive treatment: Correct Answer: Radiofrequency ablation Wolfparkinson White initial treatment: Correct Answer: Vagal maneuvers Procainamide Pulseless Vtac treatment: Correct Answer: Defib/CPR Unstable VT w/pulse treatment: Correct Answer: Synchronized cardioversion PEA treatment: Correct Answer: CPR, epi, check for shockable rhythm every 2 minutes Asystole treatment: Correct Answer: CPR, epi, check for shockable rhythm every 2 minutes 1 or 2 vessel disease NOT involving the Left Main CA and a normal left ventricular function treatment: Correct Answer: PCTA/PCI Left Main CA involvement, 3 vessel disease, or left EF40% treatmentL Correct Answer: CABG Acute angina treatment: Correct Answer: SL nitroglycerin Chronic angina first line treatment: Correct Answer: Beta blockers HF test of choice: Correct Answer: Echo HF first line treatment: Correct Answer: ACEi HF most effective symptomatic treatment: Correct Answer: Diuretics HF EF 35% treatment: Correct Answer: Implantable defibrillator Acute CHF failure: Correct Answer: Lasix Morphine Nitrates Oxygen Position Nesiritide used in ED or inpatient if severe Transposition of the great vessels treatment: Correct Answer: Prostaglandin E1 --surgery Treatment of HTN in a patient with gout: Correct Answer: CCB First line therapy for uncomplicated HTN: Correct Answer: Thiazide diuretic (HCTZ, chlorthalidone) First line HTN therapy for AAs: Correct Answer: Thiazide diuretics Hypertensive Emergency drug of choice if unspecified issue: Correct Answer: Sodium Nitroprusside HTN Urgency drug of choice: Correct Answer: Captopril Clonidine Labetolol Nicardipine HTN Emergency drug of choice encephalopathy: Correct Answer: Sodium Nitroprusside + Nicardipine (slow rate and reduce swelling) HTN Emergency drug of choice cerebral infarct or hemorrhage: Correct Answer: Labetalol HTN Emergency drug of choice aortic dissection: Correct Answer: Labetalol + Sodium Nitroprusside (reduce wall stress) HTN Emergency drug of choice due to cocaine overdose: Correct Answer: Benzos (NO BB!) Hypertensive Emergency drug of choice due to eclampsia: Correct Answer: Labetalol or hydralazine Give mg Hypertensive Emergency drug of choice due to ACS: Correct Answer: Nitroglycerine Addisonian crisis treatment: Correct Answer: IV hydrocortisone Most useful non-invasive test for angina pectoris: Correct Answer: Stress test (EKG) Angina pectoris definitive diagnosis/gold standard: Correct Answer: Coronary angiography Normal EKG with angina pectoris, next best diagnostic step: Correct Answer: Stress test (EKG) Abormal EKG with angina pectoris, next best diagnostic step: Correct Answer: Pharmacologic stress testing w/vasodilators (adenosine, dypyrimadole) Mainstay treatment of STEMI: Correct Answer: PCI or thrombolytics (Reperfusion therapy w/in 12 hours of symptom onset ) 6 main pharmacologic treatments of STEMI: Correct Answer: Thombplytic (reperfusion) Heparin (anti-thrombotic) ASA (anti-thrombotic) Nitroglycerin BB ACE-I