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Heart Diseases/Complications - Coggle Diagram
Heart Diseases/Complications
Right Side
Right Side
Valves (Exam 2)
Valves
Pulmonary Valve (S2)
Disease
Valvular Disease
Pulmonary Stenosis
Sound
1 more item...
Tricuspid Valve (S1-Expiration) :check:
Disease
Valvular Disease
Tricuspid Regurgitation
Acute/Chronic
2 more items...
Sounds/Murmur
1 more item...
Presentation
3 more items...
Associations
2 more items...
Chambers
Chambers
R. Ventricle
R. Atrium
Intake/Outtake
Intake/Outtake
Superior/Inferior Vena Cava
Superior Vena Cava
Disease
Superior Vena Cava Syndrome
Etiology
:
Mass/Thrombosis
Obstructing the Superior Vena Cava
Presentation
3 more items...
Inferior Vena Cava
Disease
Inferior Vena Cava Syndrome
Pulmonary Artery
R. Heart Vascular
Right Heart Vascular System
Right Coronary Artery
Nervous System (Exam 2)
Nervous System
Right Bundle Branch
Disease
RBBB
Sound
Wide S2 Split
RSHF (Exam 1)
R. Heart Failure
General RSHF
Complications
Vessel
Hypoxic Pulmonary Vasoconstriction (Pulmonary HTN)
JVD
Peripheral Edema
GI
Hepatomegaly (Nutmeg Liver)
Ascites
Heart
Tricuspid Valve Regurgitation
Left Parasternal Lift
Left Parasternal Lift
Left Side
Left Side
Nervous System
Nervous System
Left Bundle Branch
Disease
LBBB
Sounds
Paradoxical
Intake/Outtake
Intake/Outtake
Intake/Outtake
Pulmonary Vein
Aorta :
Diseases
Aortic Dissection
Pathophysiology
2 more items...
Etiology
2 more items...
Presentation
3 more items...
Complications
4 more items...
Types
2 more items...
Imaging
4 more items...
Aortic Aneurysms
Pathophysiology
2 more items...
General Risk Factors
2 more items...
Presentation
2 more items...
Locations
2 more items...
Aortic Coarctation
Patholphysiology
1 more item...
Associations
4 more items...
Presentations
3 more items...
Management
1 more item...
Types
2 more items...
Chambers
Chambers
Left Ventricle
Left Atrium
Valves
Valves
Valves
Mitral Valve (S1-Expiration) (Exam 2) :check:
Disease
Valvular Disease
Mitral Stenosis
5 more items...
Mitral Regurgitation
4 more items...
Mitral Valve Prolapse
5 more items...
Aortic Valve (S2) (Exam 2) :check:
Disease
Valvular Disease
Aortic Stenosis
7 more items...
A. Regurgitation
5 more items...
L. Heart Vascular
Left Heart Vascular
LCA
LCX
LAD
LSHF
LSHF (Exam 1)
L. Heart Failure
Pathology
General LSHF
Complications
Pulmonary Edema
1 more item...
Pleural Effusion
Mitral Valve Regurgitation
Shifted Point of Maximal Impulse
Systolic Heart Failure (LV Pumping is impaired)
Pathophys
Decreased Contractility
(Decreased EF)
3 more items...
Heart Failure with
Reduced Ejection Fraction (HFrEF)
- Not Ejecting Enough Blood getting to tissue
2 more items...
Eccentric Hypertrophy (Dilated Cardiomyopathy)
:red_flag:
5 more items...
Causes
Ischemic Heart Disease
Viral Myocarditis
Chronic Alcohol Use
Diastolic Heart Failure (LV Cant relax and Fill)
Pathophys
Increased Pressure --> Decreased Compliance
1 more item...
Increased L. Ventricular Pressure
1 more item...
Concentric Hypertrophy
4 more items...
Heart Failure with Preserved Ejection Fraction (HFpEF
)
Causes
Hypertension
Aortic Stenosis
Infiltrative Disorders
Infiltrative Cardiomyopathy
Sounds
S4 (Stiff Ventricle)
Pharm (LSHF + RSHF)
RAAS Inhibitors
Ace Inhibitors
Medications (-Pril)
3 more items...
Adverse
Angiotensin Receptor Blockers (ARBs)
Medications (-Sartan)
2 more items...
Neprilysin Inhibitors
Medications
1 more item...
Mineralocorticold Receptor Antagonists
Medications
Spironolactone
Epierenone
Beta-Blockers
Medications
Metoprolol
Carvedilol
Ion Transporter/Enzyme
Thiazide Diuretics
Medications
1 more item...
Digoxin
Loop Diuretics
Medications
1 more item...
Hypertension (Exam 1) - Systolic over 139. Diastolic over 89
Hypertension (Exam 1) - Systolic over 139. Diastolic over 89
Pharmacology (Antihypertensives)
Sufix
Ace-Inhibitors (-Pril)
Medications
Enalapril
Lisinopril
Captopril
Angiotensin Receptor Blockers (ARBs) (-Sartan)
Medications
Losartan
Valsartan
Dihydropyridine Calcium Channel Blockers (-PINE)
Medications
Amlodipine
Nifedipine
Indications
Adverse
MOA
Beta-Blockers (LOL)
Medications
Metoprolol
No-Sufix
Thiazide Diuretics
Medications
Chlorthalidone
Hydrochlorothiazide
Nitrates
Hydralazine + Minoxidil
Pathology :check:
Pathology
Hypertensive End-Organ Disease
Cardiovascular
Concentric LV Hypertrophy --> Diastolic Heart Failure (Increase Beta-Myosin Heavy Chain)
Coronary Artery Disease
Aortic Dissection
Neurovascular
CNS Presentations
Lacunar CVA (Lacunar Ischemic Stroke - Brain)
Retina Presentations
Hypertensive Retinopathy
Exudate (Cotton Wool Spots)
Copper Wiring
Renovascular
Chronic Kidney Disease
Hyperplastic Arteriosclerosis
Onion Skin Appearance
Secondary Hypertension
Endocrine
Other
Hyperthyroidism (Myxedema)
Labs
1 more item...
Presentations
3 more items...
Pheochromocytoma
Presentations
2 more items...
RX
1 more item...
Adrenocortical Hyperfunction
Cushing Syndrome
Cause
1 more item...
Presentations
3 more items...
Conn's Syndrome (Primary Aldosteronism)
Presentations
3 more items...
Organ
Cardiovascular
Aortic Coarctation
Presentations
2 more items...
Polyarteritis Nodosa
Renal
Renal Artery Stenosis
Disease (Renovascular Hypertension)
3 more items...
Pathophys
1 more item...
Presentations
2 more items...
Other
Obstructive Sleep Apnea
Presentations
Snoring
Daytime Sleepiness
Malignant Hypertension
Pathophys
Heart Rate rapidly rising to over 200/120
Complications
Kidney
1 more item...
Retina
1 more item...
CNS
1 more item...
Cardiovas
1 more item...
Essential Hypertension
Pathophysiology
(MAP = CO x TPR) (MAP = (SV x HR) x TPR)
High Na+ --> High Blood Volume --> High Preload --> High SV --> High CO
Reduced Na+ Excretion
Vasoconstriction
High Na+ Retention
Anxiety/Stress --> High HR
Atherosclerosis --> High TPR
Risk Factors
Nonmodifiable
Older age/Ethnicity (African Americans)
DM1
Modifiable
Obesity
Tobacco Use
High Na+
Pericardial Diseases
(Exam 2)
Pericardial Diseases
(Exam 2)
Pathology
Constrictive Pericarditis
Pericardial Effusion
Cardiac Tamponade
Acute Pericarditis
Congenital Heart Defects
(Exam 1 and 2)
Congenital Heart Defects
(Exam 1 and 2) :check:
Cyanotic Congenital Heart Defects (5Ts)
General
Shunting
Right to Left
Presents as Cyanotic because De-O2 Blood is being shunted to the L. Side of heart
Septal Defects
ASD
Tricuspid Atresia
Pathogenesis
Absent Tricuspid Valve :red_flag:
Pathophys
Decreased Blood to RV resulting in RV Hypoplasia (RA Dilation)
Most Living Patients have an ASD to allow Deoxygenated from RA blood to enter the LA. This Deoxygenated blood to enter the 1 ventricle, then to the PA, then return PV, Then sent back out through Aorta. (The blood is still mixed with O2 and De-O2 Blood
Presentation
Physical
Tachypnea
Cyanosis
Cardiac
RV Hypoplasia :red_flag:
RA Dilation :red_flag:
Cardiomegaly
Management
PGE1 (to keep ASD open)
Associations
Ebstein Anomaly (Li+ Exposure)
EKG
2 more items...
Total Anomalous Pulmonary Venous Return (TAPVR)
Pathogenesis
Anomalous Pulmonary Veins
Pathophys
Blood Flow
Instead, Pulmonary Veins drain into the SVC/IVC then RA
Pulmonary Veins do not connect with LA
How ASD Helps
ASD helps get O2 Blood from RA into LA
O2 blood enters the RA (Mixing of blood)
Presentation
Physical
Tachypnea
Cyanosis
Imaging
Snowman Sign
VSD
Persistent Truncus Arteriosus (PTA)
Pathogenesis
Partial aorticopulmonary Septum Formation
Failure of Neural Crest Cell Migration :red_flag:
Pathophys
Mixing of Oxygenated and Deoxygenated Blood at
Ventricles
Ventricular Septal Defect
Presentation
Tachypnea
Cyanosis
Harsh Systolic Ejection Murmur (Left Lower Sternal Boarder) :red_flag:
Association
DiGeorge Syndrome :red_flag:
Other
Tetralogy of Fallot
Pathogenesis (steps)
Cause
Deviation of Infundibular Septum due to Neural Crest Migration
Complications
1: Pulmonary Stenosis :red_flag:
Right Ventricular Outflow Tract Obstruction (RVOTO)
2: Overriding Aorta :red_flag:
Occurs in the case of a VSD :red_flag:
1B: RV Hypertrophy :red_flag:
Occurs because of the Pulmonary Stenosis
Note: RV Hypertrophy will be less in the case of a VSD
Pathophys
The Degree of the RVOTO determines the shunting
Mild RVOTO: Left to Right Shunting
Severe RVOTO: Right to Left Shunting (cyanosis)
Presentation
Physical Exam
Tet Spells
during Crying/Breast Feeding (Hypoxia/Tachypnea) :red_flag:
Harsh Systolic Ejection Murmur (L. Upper Sternal Border - due to Pulmonary Stenosis) :red_flag:
Imaging
Boot-Shaped Heart :red_flag:
Management
Knee to Chest (during Tet Spells) - increases TPR, preventing deoxygenated blood entering the aorta. :red_flag:
PGE1 - To keep Ductus Arteriosus open to increase Oxygenated blood into Aorta
Oxygen
Associations
DiGeorge :red_flag:
Down Syndrome
Fetal Alcohol Syndrome
Transposition of Great Vessels
Pathogenesis/Pathophys
Failed
Spiraling
of Aorticopulmonary Septum resulting in
reversal of the pulmonary artery and aorta
Deoxygenated Blood Flows from RV to the Aorta
Oxygenated blood from LV enters the Pulmonary Artery
Presentation
Physical
Cyanosis
Tachypena
Imaging
"Egg-on-a-string"
Thymic Aplasia
Management
PGE1
Balloon Septoplasty
Association
Maternal Diabetes
Acyanotic Congenital Heat Defects (3Ds)
Septal :
Ventricular Septal Defect (VSD) - Child
Presentation
RV Volume Overload (because of L to R shunt
Harsh Holosystolic Murmur (L. Lower Sternal Boarder) :red_flag:
Murmur Severity is inversely proportional to the Opening size
Large opening (Low Murmur)
Small Opening (Loud Murmur)
Pulmonary Hypertension
Associations
Down Syndrome
Maternal Diabetes
Pathophys
Left to Right Shunting
Opening between LV and RV
Defect in
Membranous
Part of Ventricular Septum :red_flag:
R. to L. Shunting Causes Dilated Cardiomyopathy (Eccentric Hypertrophy) :question:
Atrial Septal Defect (ASD) - Teen/Adult
Pathophys
How to Change the Shunt: Valsalva/Cough/Pulmonary Hypertension
causes Increased R. Atrial Pressure with R. to L. Shunting
Left to Right Shunting
through Defect of Atrial Septum
Defect in Inter-atrial Septum (Ostium Secundum Defect) :red_flag:
Presentations
Sound
Wide Fixed Split S2
Paradoxical Embolism (resulting in Cryptogenic Stroke) :red_flag:
Thrombus from Vein enters the LA then brain
through the opening (Needs Increase increase in RA pressure for this to happen.
Associations
Down Syndrome (ostium primum type)
Fetal Alcohol Syndrome
Holt-Oram Syndrome
Patent
Patent Ductus Arteriosus (PDA)
Pathogenesis
Impaired Closure of
Ductus Arteriosus
:red_flag:
Ductus Arteriosus is derived from the Sixth, Left Aortic Arch
Pathophys
Left to Right Shunt
from
Aorta to Pulmonary Vessels
:red_flag:
Prostaglandins and Low O2 Tension maintains PDA
Presentation
Machine-Like Murmur
(L. Infraclavicular Region) :red_flag:
Wide Pulse Pressure
(Similar to Aortic Regurgitation :red_flag:
Associations
Rubella (1st Trimester)
Fetal Alcohol Syndrome
Fetal Hydantoin Syndrome
Management
Premature Symptomatic Infant
Indomethacin
- NSAID-Inhibits Prostaglandin (to close PDA)
Cyanotic Congenital Heart Defect
Prostaglandin E1
(Alprostadil) - To Maintain PDA :red_flag:
Patent Foramen Ovale (PFO)
Pathogenesis
Impaired Fusion
of
Septum Primum
and
Septum Secundum
:red_flag:
Pathophysiology
Left to Right Shunt
Through
Atrial Septum Defect
How to Reverse Shunting: Valsalva/Increase R. Atrial Pressure
Presentation
Asymptomatic (because it is partially closed)
Paradoxical Embolism
(resulting in Cryptogenic Stroke) :red_flag:
Thrombus from Vein enters the LA then brain
through the opening (Needs Increase increase in RA pressure for this to happen.
Syndrome
Eisenmenger Syndrome
Pathophysiology of Shunt Reversal :red_flag:
2nd This causes Pulmonary Hypertension
1st Chronic Left to Right Shunting causes Pulmonary Vessel Sclerosis
3rd Hypertension causes R. Ventricular Hypertrophy
4th This causes the R. Ventricular pressure to be more than the L. Ventricular Pressure
5th The pressure difference causes Right to Left Shunting :red_flag:
Presentation
1st Left to Right Shunting... Then Right to Left Shunting
Cyanosis
Fingernail Clubbing
Heart Failure
General
Shunting
Left to Right
Presents as Acyanotic because O2 Blood is being shunted to the R. Side of heart
Coronary Artery Disease
(Angina and STEMI/NSTEMIS
Coronary Artery Disease
(Angina and STEMI/NSTEMIS) (Exam 2) :warning:
Myocardial Infraction
Acute Coronary Syndromes
(Atheromatous Plaque Rupture --> Occlusion
NSTEMI
- aka -
Subendocardial Infarction
(ST-Depression)
Pathophys
Atheromatous Plaque Rupture causing incomplete occlusion resulting in
subendocardial infarction
ECG
T-Wave Inversion
ST-Depression
Q-Waves Absent
Cardiac Biomarkers
Troponin Elevated
STEMI
-aka-
Transmural Infraction/Q-Wave Infraction
(ST-Elevation)
Pathophys
Atheromatous Plaque Rupture resulting in
Complete Occlusion
causing a
Transmural Infraction
Involves Full Thickness of Myocardium
Due to: Atherosclerosis, Acute Plaque Change, Superimposed Thrombosis
ECG
New Q-Wave (hours)
ST-Elevation (Minutes)
Hyperacute (Peaked) T-Wave
New LBBB because L. Heart Infarction
Cardiac Biomarkers
Elevated
Unstable Angina (ST-Elevation or Depression)
Pathophys
Atheromatous Plaque Rupture leading to
incomplete occlusion
resulting in
No appreciable infraction
Forms from unstable thrombus formation in a coronary artery
ECG
T-Wave + ST-Abnormalities (Appears as ST-Depression or Elevation)
Cardiac Biomarkers
Not Significantly Elevated (Normal Troponin)
Presentation
Occurs while Resting or sleeping
Rest or Rx does not relieve symptoms
May worsen over time
Myocardial Infraction
Pathophys/Pathogenesis
Pathogenesis
Atheromatous Plaque Rupture
resulting in Acute
Thrombus Occlusion
of Vessel Lumen
Complete Occlusion (LAD)
Most Common
Pahtophys
Decreased Aerobic Metabolism resulting in increased Anerobic Metabolism
Increased Lactate,
Decreased ATP
:red_flag:
Increase Adenosine
(Vasodilator that helps with O2 delivery)
Lasts 5 min
:red_flag:
Ischemic Insult resulting in decreased Contractility
Heart Failure + Cardiogenic Shock
Ventricular Dysfunction
LV Dysfunction
MI Location
Anterolateral -aka-
Superior/Lateral MI
(Leads I, aVL, V1-V6
) :red_flag:
Blood Supply affected
LCX and/or LAD
:red_flag:
Pathophys
Decreased Contractility Causing Decreased Cardiac Output,
resulting in
Cardiogenic Shock
:red_flag:
LSHF causing
increased PCWP
, resulting in
Pulmonary Hypertension
, causing
Pulmonary Edema
, yielding
Increased Central Venous Pressure
RV Dysfunction
(Preload Dependent)
MI Location
Inferior Wall
MI (
Leads II, III, aVF
) :red_flag:
Blood Supply Affected
PDA :red_flag:
Pathophys
RSHF causing
decreased Preload-Dependency
, Resulting in
Increased Central Venous Pressure
and
Decreased PCWP
Contraindications
Venodilators and Diuresis (anything that decreases Preload)
The goal of RSHF Treatment is to increase Preload :red_flag:
Delay/Injury Post MI
Myocardial Stunning
Pathophys
Reperfusion to Myocardium (Delay in return of complete normal cardiac function)
After MI, the myocardium takes time to reperfusion
Myocardial Hibernation
Pathophys
Chronic Ischemic Myocardium resulting i
n LV Adaptation
causing
Ischemic Cardiomyopathy + LV Systolic Dysfunction
Causes
Eccentric Hypertrophy
due to
chronic ischemia
of myocardium :red_flag:
Reperfusion Injury
Pathophys
Reperfusion to Myocardium
Causing in
Oxidative/Inflammatory Damage
to Myocardium
ECG Localization in STEMI
Post-Myocardial Infarction Timeline
:check:
First 24 Hours (Acute Phase)
Pathology
Gross Exam
12-24hr
Mild to Dark Mottling :red_flag:
1 more item...
0-12hr
No Gross Changes
Microscopy
0-4hr
No Changes
4-24hr
3-12hr
2 more items...
12-24hr
1 more item...
Complications
Arrhythmias
Sinus Bradycardia
Sinus Tachycardia
Ventricular Fibrillations
(Most Common Cause of Death) + Cardiogenic Shock :red_flag:
Congestive Heart Failure :red_flag:
Cardiac Markers
2nd
Creatine Kinase Isoenzyme MB (CK-MB)
Peaks 24hr
Disappears 2-3 days
Appears 4-8hr
1st
Cardiac Troponins I (
cTnL
) and T (
cTnT
) Gold Standard for Acute MI
Peaks 24hr
Disappears 7-10 days
Appears 3-6hr
4th
LDH 1-2 (identifies MI post 3 days)
Peaks at 2-3 days
Disappears within 7 days
Appears within 10hr
3rd
AST
Peaks 1-2 days
Returns to normal in 7 days
Appears 6-12hr
(1-7 days) Inflammatory + Proliferative Phase
Pathology
1-3 days
Gross Exam
Pallor of Infracted Myocardium
1 more item...
Microscopy
Dense Neutrophilic Infiltrate Lyse Dead Myocardial Cells :red_flag:
1 more item...
4-7 Days (Increased Rupture Risk)
Gross Exam
Red Granulation Tissue Surrounds Yellow/Tan area of infraction
1 more item...
Microscopy
Macrophage begin to Removal Necrotic Debris :red_flag:
1 more item...
Granulation tissue (Loose Collagen, Capillaries, Myofibroblasts
1 more item...
Complications
Rupture (3-7th day)
Anterior Wall Rupture
:red_flag: :star:
Causes
2 more items...
Associated
1 more item...
Posteromedial Papillary Muscle Rupture :red_flag:
Causes
2 more items...
Interventricular Septum Rupture
:red_flag: :star:
Causes
1 more item...
Associated with
1 more item...
Fibrinous Pericarditis (1-7 days) :red_flag:
Presentation
Substernal Chest
Pain Relived by leaning forward
Precordial Friction Rub
due to Increased Vessel Permeability in Pericardium
Weeks - Months
Pathology
7-10 days
Gross Exam
Necrotic area is Bright Yellow/Tan
1 more item...
Microscopy
Granulation Tissue + Collagen Formation are Well Developed
1 more item...
2 Months
Gross Exam
Infracted Tissue Replaced by white, Patch, Non-Contractile Scar Tissue
1 more item...
Microscopy
Granulation Tissue Leading to Dense Fibrous Tissue
1 more item...
Complications
Dressler's Syndrome (Autoimmune Pericarditis) 6-8 Weeks :red_flag: :star:
Pathophys
Autoantibodies directed against pericardial antigens
Presentation
Fever, Joint Pain, Pericardial Friction Rub
Ventricular Aneurysm (4-8 weeks)
Presentation
Precordial Bulge During Systole
(Blood enters the aneurysm causing anterior Chest Wall Movement) :red_flag:
Complications
Congestive Heart Failure
(Lack of contractile tissue)
Mural Thrombi :red_flag:
Angina (Troponin Normal)
Prinzmetal (Vasospastic) Angina (ST-Elevation)
Pathophys
Transient,
Spontaneous Coronary Vasospasms
Temp Vasoconstriction) :red_flag:
Deficiency: Nitric Oxide
Presentations
Chest Pain
Recurrent Pain/Discomfort
Resolving with Minutes
Occurs during night
(due to Increased Vagal Tone because lack of Nitric Oxide) :red_flag:
Not Affect by Exertion :red_flag:
Demographic
Younger Patient that lack CAD Risk Factors
Smokers :red_flag:
Symptoms
ST-Elevation :red_flag:
Symptoms Decrease with Nitroglycerin :red_flag:
Symptoms do not improve with Rest :red_flag:
Associations
Drugs
Tobacco :red_flag:
Cocaine :red_flag:
Alcohol
Medications
Amphetamines
Triptans (Migraine Rx) :red_flag:
Ergot Alkaloids (Migraine Rx)
Management
Acute
Nitroglycerine(increases Preload) :red_flag:
Preventative
Avoid Smoking
(second line) Ca+ Channel Blockers :red_flag:
Stable Angina (ST Depression-during ischemia)
Pathogenesis
Fixed Stenosis of Coronary Vessel WITHOUT tissue Infarction
:red_flag:
Pathophys
Atherosclerotic Disease (Fibrous Cap) causing Decreased Coronary Perfusion
:red_flag:
Temporary O2 Supply-Demand Mismatch with Activity
Presentation
Exercise Symptoms
Increase Symptoms
with
Exercise
/O2 Demand (
Excretion
)
Decreased Symptoms with Rest
/Nitroglycerine or Decreased O2 Demand
Reproducible Symptoms With Activity
Chest Pain
Retrosternal :red_flag:
Radiating (Arm/Jaw) :red_flag:
Non-Pleuritic (No pain with deep breath in)
Non-Reproducible on Palpation
Descriptions
Chest Pressure
Tightness :red_flag:
Squeezing :red_flag:
Increased Myocardial O2 Demand will cause...
Increase HR
Increase Contractility (Disease Compensation-Decrease) :red_flag:
Increase Preload (LVEDV) (
Disease Compensation-Decrease
) :red_flag:
Increase Afterload (
Disease Compensation-Decrease
) :red_flag:
RX (Goal: Decrease O2 Demand)
Indications
Antianginal Therapy :red_flag:
Nitrates
(Symptomatic Relief)
Antiplatelet Therapy :red_flag:
Aspirin/Clopidogrel
(Decreases Risk of Occlusive Thrombus Formation
Statin Therapy :red_flag:
Atorvastatin (Decrease Risk of Acute Coronary Event)
Antihypertensive Therapy :red_flag:
Ace-Inhibitors
Angiotensin Receptor Blockers (ARB)
(First line)
Ca+ Blockers
:red_flag:
Contraindications
Dobutamine (Increases O2 Demand) :red_flag:
ST-Elevation vs No ST-Change
ST-Depression = Subendocardial Ischemia :red_flag:
No ST-Change = Non-Ischemic Stable Angina :red_flag:
Antianginal Therapy
Nitrates
Avoid with..
Avoid with Concomitant use of PDE-5 Inhibitors (Sildenafil)
Agents that decrease Preload (they can cause Right Ventricular MI)
Adverse
Hypotension, Flushing, Headaches
Beta-Blockers
Medication
Metoprolol
Avoid if patient has AV Block
Nondihydropyridine Ca+ Channel Blockers
Medication
Verapamil
Diltiazem
Avoid if patient has AV Block
Ranolazine
Adverse: QT Prolongation
