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PANCE > 3) Cardio > Flashcards

3) Cardio Flashcards

1
Q

PE: sustained point of max impulse, jugular vein pulsations, w/ prominent a-wave
-can look/sound like aortic stenosis b/c when dehydrated/severe dz the septum covers the aortic outlet

A

Hypertrophic Cardiomyopathy

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2
Q

Tx of Hypertrophic Cardiomyopathy

A

avoid dehydration & increase diastole w/ Betablockers (increase preload), ablation of septum

  • may need dual chamber pacing, implantable defibrillators, or mitral valve replacement
  • heart transplant is definitive tx
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3
Q

Signs of Restrictive cardiomyopathy

A

decreased exercise tolerance; R sided CHF; pulmonary hypertension

  • ECHO is key to diagnosis
  • biopsy may be necessary to differentiate restrictive disease from other forms of cardiomyopathy or pericarditis
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4
Q

Tx of Atrial Fib

A
  • If pulseless = CPR and defibrillation
  • Unstable = emergent synchronized cardioversion
  • Stable = rate control w/ CCB, BB, or digoxin
  • *if Afib of >48h should be anticoagulated for 3wks before attempted cardioversion
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5
Q

Wolf Parkinson White

A

Type of SVT (congenital accessory pathways) = delta waves Tx = Vagal man, procainamide, **ABLATION

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6
Q

Paroxysmal SVT

A
  • recurrent attacks of tachycardias w/ sudden onset and abrupt termination
  • caused by ectopic focus above the ventricles (atrial or junctional)
  • generally caused by AV nodal re-entry or increased automaticity of an ectopic focus
  • Causes: ischemia or infarction, WPW**, electrolyte disturbances, drugs (dig tox), hyperthyroidism
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7
Q

Tx of SVT

A

Vagal maneuvers, Adenosine, CCB, BB, synchronized cardioversion

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8
Q

Ventricular Tachycardia

A
  • series of 3 or more PVCs in a row (wide QRS complexes w/ no P-waves)
  • Causes: MI, cardiomyop, drug tox, hypoxia, electrolyte abn
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9
Q

Tx of Ventricular Tachycardia

A
  • Unstable w/o pulse = defibrillation
  • Unstable w/ a pulse = synchronized cardioversion
  • Stable: amiodarone, lidocaine, procainamide, sotalol
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10
Q

Torsades

A

-Causes: tricyclic antidepressants, antiarrhythmic drugs, MI, hypokalemia, hypomagnesemia, congenital QT prolong, CNS lesions, subarachnoid or intracerebral hemorrhage

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11
Q

Tx of Torsades

A

-Tx: Replete Mg and K, Cardiac Pacing

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12
Q

Brugada Syndrome

A
  • genetic disorder, more common in Asians and men
  • Symp: syncope, ventricular fibrillation and sudden death
  • EKG: RBBB and coved ST segment elevation in V1 – 3
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13
Q

Tx of Brugada Syndrome

A

-Tx: Implantable defibrillator

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14
Q

V fib

A
  • *most life threatening**
  • disorganized depolarization and contraction of small areas of ventricular myocardium (erratic rapid twitch)
  • totally disorganized w/ no effective ventricular pumping activity
  • Causes: MI, hypoxia, hypothermia, electrocution, shock, elect abn, drugs (digoxin or quinidine)
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15
Q

Tx of V-fib

A

-Immediate defibrillation

if initial 3 attempts fail = CPR and IV drugs and defib

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16
Q

1st Degree AV block

A
  • usually due to slowing of conduction through the AV node
  • prolonged PR interval (>0.20)
  • Causes: normal variant in healthy YA, hyperkalemia, hypermagnesemia, BB, dig, CCB, narcotics, MI, ischemia, hypothermia, increased ICP, rheumatic fever, myocarditis
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17
Q

Tx of 1st Degree AV block

A
  • Tx: Usually asymp

- If symp/signs of hypoperfusion = Atropine, elective pacemaker, maybe immediate ext or internal pacing

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18
Q

2nd Degree AV block Mobitz Type 1

A
  • aka Wenchebach
  • EKG = grouped beating
  • prolonged PR interval until a P wave is dropped completely
  • Causes: hyperkalemia, hypermagnesemia, BB, dig, CCB, narcotics, MI, ischemia, hypothermia, increased ICP
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19
Q

Tx of 2nd Degree AV block Mobitz Type 1

A
  • Tx: usually benign, and rarely progresses to complete heart block
  • If symp/signs of hypoperfusion = Atropine, elective pacemaker, maybe immediate ext or internal pacing
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20
Q

2nd Degree AV block Mobitz Type 2

A
  • conduction block in the His-Purkinje system
  • PR interval is normal; but P waves are dropped
  • Causes: ischemia, infarct, hyperkalemia, increased vagal tone, BB, dig, CCB
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21
Q

Tx of 2nd Degree AV block Mobitz Type 2

A
  • Tx: May progress to complete heart block, thus PACEMAKER IS INDICATED
  • *EMERGENT CARDIOLOGY CONSULT
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22
Q

3rd Degree AV block

A
  • Complete heart block
  • AV dissociation w/ no relationship between P waves and QRS complexes
  • atrial rate and ventricular rate are unrelated
  • Causes: Ischemia or infarct (inferior or posterior), BB, Dig, CCB, lenegre dx (fibrous degen from aging), infection and inflamm processes: abscesses, tumors, infiltrative dz or myocardium, sarcoid nodules, myocarditis, rheumatic fever
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23
Q

Tx of 3rd Degree AV block

A
  • Tx: Atropine, Epi, Dopamine, elective pacemaker

- may need immediate external or internal pacing

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24
Q

Bundle Branch Block

A
  • failure of conduction through a part of the heart
  • these have an RR’ pattern on EKG; the leads these are in tell you where the block is
    - V1 and V2 = RBBB
    - V5 and V6 = LBBB
  • Tx: treat underlying disorder; pacemaker
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25
Q

PACs

A
  • Causes: Stress, Caffeine, Cocaine
  • EKG = irregular rhythm (extra P followed by a QRS)
  • SA node resets in sync with the PAC (in the distance of one cycle)
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26
Q

PVCs

A
  • may be asymptomatic or aware of skipped beats
  • wide complex
  • there is a compensatory pause
  • Tx: Beta blockers only if the patient is symptomatic
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27
Q

Sick Sinus Syndrome

A
  • Most often = found in the elderly
  • Causes: digitalis, CCB, BB, sympatholytic agents, antiarrhythmic drugs; underlying collagen vascular or metastatic dz, surgical injury or rarely coronary disease
  • Most = asymptomatic (may have: syncope, dizziness, confusion, heart failure, palptiations, angina)
  • Tx: Most symptomatic patients require permanent pacing
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28
Q

Tetralogy of Fallot =

A

1) Pulm Stenosis 2)R ventricular hypertrophy 3)overriding aorta 4)VSD
- TET spells = extreme cyanosis, hyperpnea, and agitation (Medical Emergency)

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29
Q
  • Crescendo-decrescendo holosystolic murmur at LSB, radiating to the back
  • cyanosis, clubbing, increased RV impulse at LLSB
  • loud S2
  • Polycythemia is usually present
A

Tetralogy of Fallot (C)

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30
Q
  • 2nd most common
  • Systolic ejection murmur at second LICS; early to middle systolic rumble
  • Failure to thrive, fatigability, RV heave, wide-fixed S2
A

ASD (NC)

-Ostium secundum is the most common type

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31
Q
  • systolic murmur at LUS and left interscapular area; may be continuous
  • Infants may present w/ CHF
A

CoA (NC)

  • older children may have systolic HTN or murmur
  • *differences between arterial pulses and blood pressure in UE and LE are pathognomonic
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32
Q
  • higher rate in premature infants
  • continuous (machinery) murmur
  • wide pulse pressure
  • hyperdynamic apical pulse
A

PDA (NC)

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33
Q
  • most common of all congential heart defects
  • systolic murmur at LLSB
  • asympt to signs of CHF
A

VSD (NC)
(other characteristics depend on severity of defect)
-Outlet VSDs more common in japanese and chinese

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34
Q

What causes high output fialure

A

Non-cardiac causes: aka thyrotoxicosis and severe anemia

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35
Q

S4 gallop =

A

diastolic heart failure

36
Q

Tx of heart failure

A

loop diuretic and ACEI

37
Q

BP classification

A

Normal 160/>100

38
Q

1st line tx of HTN

A

HCTZ

ACEI in diabetics

39
Q

young white pts w/ HTN 1st line

A

beta blockers

40
Q

old and black pts w/ HTN 1st line

41
Q

HTN urgency tx

A

BB, CCB, ACEI (reduce diastolic to 105-110)

42
Q

HTN emergency tx

A

Nitroprusside IV drip (alter = labetolol)

***cannot give nitroprusside in pregnancy

43
Q

Tx of intrinsic cardiogenic shock

A

Tx MI or underlying d/o
judicial use of fluids
ionotropes

44
Q

Tx of cardiogenic shock caused by compressive dz

A

Tx underlying d/o (tamponade, PTX, mediastinal hematoma, positive pressure from ventilation)

45
Q

Definition of orthostatic hypotension

A

> 20mmHg drop in systolic BP between supine and sitting or standing

  • if accompanied by rise of pulse >15bpm depleted blood volume is the probable cause
  • if not change in pulse occurs, consider CNS dz or peripheral neuropathies
46
Q

What is a marker for atherosclerotic dz

47
Q

acute MI progression

A
  • peaked t-waves
  • ST segment elevations or depressions
  • Q waves
  • T wave inversions
48
Q

Inferior MI

A

Leads II, III, AVF

49
Q

Posterior MI

50
Q

Anteroseptal MI

51
Q

Anterior MI

A

V1, V2, V3

52
Q

Anterolateral MI

A

V4, V5, V6

53
Q

What is dresser’s syndrome?

A

aka Post MI syndrome

-pericarditis, fever, leukocytosis, and pericardial or pleural effusion usually 1-2 weeks post MI

54
Q

Prinzmetal variant angina

A

caused by vasospasm at rest w/ preservation of exercise capacity
Tx = CCB

55
Q

What is the most sensitive clinical sign of angina?

A

horizontal or downsloping ST segment depression on EKG

56
Q

What is a positive stress test

A

an ST segment depression of 1mm

57
Q

major SE of nitrates

A

HA, nausea, light headedness, hypotension

58
Q

First line therapy for chronic angina =

A

Beta blockers (prolong life and 1st line tx)

  • ranolazine prolongs exercise duration and time to angina
  • 3rd line = CCB (only for those who can’t take BB or nitrates)
59
Q

Number one cause of aortic aneurysm/dissection

A

atherosclerosis

60
Q

Classic picture of aortic aneurysm/dissection

A

elderly male smoker w/ coronary heart disease, emphysema, and renal impairment

61
Q

Study of choice for abdominal aneurysms

A

abdominal US

62
Q

Study of choice for thoracic aneurysms

A

CT or MRI >US

63
Q

Tx of temporal arteritis

A

High dose prednisone for 1-2 mo and then taper and low dose aspirin

64
Q

Types of PAD

A 
1 = LEAST common, aorta and common iliac artery; most commonly in 40-55y/o men and women who smoke heavily or have hyperlipidemia
2 = invovles aorta, common iliac artery, and external iliac artery
3 = MOST common; multilevel dz affecting the aorta, iliac, femoral, popliteal and tibial arteries
65
Q

first symptom of PAD

A

claudication

66
Q

What is Leriche syndrome

A

Erectile dysfunction that occurs w/ PAD affecting the iliac artery

67
Q

Erectile Dysfunction tx

A

-revscularization or tx w/ phosphodiesterase

68
Q

ABI in PAD

A

<0.9 = severe dz

69
Q

Tx of phlebitis/thrombophlebitis

A

bed rest, local heat, elevation of the extremity, and NSAIDs

70
Q

Tx of varicose veins

A

graduated eleastic stockings, leg elevation, regular exercise
(interventional techniques = radiofrequency or laser ablation, compression sclerotherapy, and surgical stripping of saphenous tree)

71
Q

Chronic venous insufficiency

A

progressive edema that starts at the ankle, itchy, dull pain w/ standing, pain w/ ulceration, skin is thin, shiny, and atrophic w/ dark pigmentary changes
**ulcers commonly occur just above the ankles
Tx: zinc oxide

72
Q

D-dimer and DVT

A

D-dimer t have to do doppler US

73
Q

Preferred tx of DVT

A

anticoagulation w/ LMWH

alt = heparin followed by warfarin

74
Q

Tx of stasis dermatitis

A

wet compresses and hydrocortisone cream

75
Q

tx of venous insufficiency ulcers

A

wet compresses, compression boots or stockings and occasionally skin grafting

76
Q

Rheumatic Heart Dz Criteria/Jones Criteria-MAJOR

A

1) pancarditis
2) polyarthritis
3) sydenham chorea
4) subcutaneous nodules
5) erythema marginatum
* *must have 2 major or 1 major + 2 minor**

77
Q

Rheumatic Heart Dz Criteria/Jones Criteria-MINOR

A

1) Fever
2) Arthralgia
3) Prolonged PR interval
4) Increased ESR or CRP
5) Leukocytosis
* *must have 2 major or 1 major + 2 minor**

78
Q

About Rheumatic heart dz

A
  • systemic immune response occurring usually 2-3 wks after beta hemolytic strep pharyngitis
  • most common in recent immigrants
  • children 5-15 most affected
  • *mitral valve most often involved (75-80%); aortic valve 30%
79
Q

Tx of rheumatic heart disease

A
  • strict bed rest is essential until stable
  • salicylates for fever and joint pain
  • IM penicillin for strep infectionif allergic = erythromycin
  • Prevention of recurrence is essential (benzathine penicillin q 4wks)
80
Q

Most common organisms to cause bacterial endocarditis

A
  • s. aureus (#1 in IV drug use & tricuspid commonly involved)
  • group D strep
  • enterococci
  • HACEK organisms
81
Q

Osler nodes

A

-painful, violaceous, raised lesions of the fingers, toes, or feet

82
Q

Janeway lesions

A

-painless lesions of the palms or soles

83
Q

Roth spots

A

-exudative lesions of the retina

84
Q

Criteria for Dx of Bact Endocarditis

A

Duke Criteria
must have 2 major OR 1maj + 1min OR 3min
Major:
-2 positive blood cultures of a typical causative org
-evidence of endocardial involvement on echo
-development of new regurg murmur
Minor
-predisposing factor
-fever >100.4 (>38.8)
-vascular phenomena
-immunologic phenomena
-positive blood culture not meeting major criteria

85
Q

Tx of Bacterial Endocarditis

A

Empiric Abx = Vanco + ceftriaxone

  • abx prophilaxis before dental work or surgical procedures (amoxicillin)
  • may need valve replacement
  • *anticoags are not beneficial**
86
Q

Cardiac tamponade presentation

A
  • tachycardia
  • tachypnea
  • narrow pulse pressure
  • pulsus parodoxus

PANCE (18 decks)

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