FM ITE Cardio

ACS

CAD

• β-Blockers are first-line antihypertensive medications for patients with coronary artery disease (CAD) and have been shown to reduce the risk of death by 23% at 2 years.
• They should also be given to normotensive patients with CAD if tolerated.
• Cardioselective (β1) β-blockers such as metoprolol and atenolol are preferred, as they cause fewer adverse effects.

Murmurs

Aortic regurgitation murmur

• Early decrescendo diastolic murmur-high pitched “blowing” along the upper right sternal border down to the lower left sternal border where it is the loudest. Best heard when the patient is sitting, leaning forward, holding his or her breath in expiration.

Aortic stenosis murmur

• Mid-systolic crescendo-decrescendo ejection murmur, loudest at the right upper sternal border/2nd right ICS, often radiating to the carotid arteries. The later the peak, the worse the stenosis.
   

New York Heart Association (NYHA) functional classification

• Class I (mild): no sx, no limitations
  
• Class II (mild): no sx @ rest, slight limitation, ordinary activity leads to sx
  
• Class III (moderate): no sx @ rest, marked limitation w/ physical activity, less than ordinary activity results in sx
  
• Class IV (severe): sx @ rest, unable to do any physical activity w/o discomfort

Superior Vena Cava Syndrome

Treatment of superior vena cava syndrome

• Urgent treatment with IV corticosteroids, chemotherapy, radiation, and occasionally intravascular stenting

Medication

Warfarin

When is warfarin recommended for anticoagulation over DOACs?

• Valvular AFib that occurs in the presence of moderate to severe mitral stenosis OR a mechanical heart valve