Cardi-NOOOOO Flashcards
Kussmauls sign is seen in which cardiac condition?
Constrictive pericarditis or R. ventricular infarct
Kussmaul’s sign is an increase rather than the normal decrease in the CVP during inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction
How is Myocardial ischemia or anginal pain described?
5-15 minutes, described as dull, aching or pressure
Eliciting a history from a patient presenting with dyspnea due to early heart failure the severity of the dyspnea should be quantified by
Amount of activity that precipitates it
A 65-year-old white female presents with dilated tortuous veins on the medial aspect of her lower extremities. Which of the following would be the most common initial complaint?
Dull aching heaviness or a feeling of fatigue brought on by periods of standing is the most common complaint of patients presenting initially with varicosities.
The diagnosis of pericardial tamponade is strongly supported by the presence of
Distended neck veins
Cardiac compression will manifest with distended neck veins and cold clammy skin
ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6. The ST elevations found in leads V5-V6
Where is the infarct, which artery is affected?
Leads V5 and V6 are most commonly associated with pathology in the left lateral ventricular wall, which is supplied by the left circumflex (LCX) coronary artery
Which test should be ordered to assess for atrial or ventricular mural thrombi?
A
TEE
In vascular occlusive disease, evaluation of arterial blood flow is assessed using
Arterial duplex scanning
U/S would not give information about arterial perfusion
36-year-old male complains of occasional episodes of “heart fluttering.” The patient describes these episodes as frequent, short-lived and episodic. He denies any associated chest pain. Based on this information, which one of the following tests would be the most appropriate to order?
Holter monitor = Best first test to assess for arrhythmia
Stress testing and cardiac nuclear scanning are non-invasive testing maneuvers done to assess coronary artery disease.
Coumadin interferes with Vitamin K synthesis which is needed in the manufacture of factors II, VII, IX, X which are part of what pathway?
Extrinsic
Fluid retention, edema, hepatic congestion and possibly ascites, should make you think of what diagnosis?
Right ventricular failure
Physical examination reveals the left leg is cool to the touch and the toes are cyanotic. The popliteal pulse is absent by palpation and Doppler. The femoral pulse is absent by palpation but weak with Doppler. What is the most likely diagnosis?
Arterial thrombosis
Femoral artery - has no pulse
Malignant HTN is characterized by
diastolic reading greater than 140 mm Hg with evidence of target organ damage
Besides a delta wave, what else is seen on EKG if a patient has WPW?
EKG include a shorten PR interval, widened QRS
irregularly, irregular rhythm at a rate of 120/minute with at least three varying P wave morphologies.
Multifocal atrial arrhythmia
Afib = NO definable P waves
Multifocal atrial tachycardia is seen most commonly in patients with COPD
irregularly, irregular rhythm at a rate of 120/minute with at least three varying P wave morphologies.
Multifocal atrial tachycardia (MAT)
Afib = NO definable P waves
Multifocal atrial tachycardia is seen most commonly in patients with COPD
Which drug is structurally related to thyroxine and contains iodine, which can induce a hyper- or hypothyroid state.
Amiodarone
*can cause hypo/hyperthyroid in longterm use
Which hypertensive emergency drugs has the potential for developing cyanide toxicity?
Sodium nitroprusside metabolization results in cyanide ion production. It can be treated with sodium thiosulfite, which combines with the cyanide ion to form thiocyanate, which is nontoxic.
What are contraindication to beta blocker use following an acute MI?
Beta blockade is contraindicated in second and third heart block
Which medication interact with statins causing a QT prolongation and possibly rhabdo?
Statins are known to interact with the macrolides as they may cause prolonged QT interval, myopathy and rhabdomyolysis
What is the mechanism of action of Class I, Class II, Class III, and Class IV antiarrhythmic drugs?
Class I = Na+ channel blockers
Class II = Beta-adrenoreceptor blocker
Class III = K+ channel blockers
Class IV = Ca ++ blockers
M- Membrane stabilization
B- Beta blockade
A - Action potential widening
C- Calcium channel Blockers
In congestive heart failure the mechanism responsible for the production of an S3 gallop is
Rapid ventricular filling during early diastole is the mechanism responsible for the S3 = SYSTOLIC
What is the most likely mechanism responsible for retinal hemorrhages and neurologic complications in a patient with infective endocarditis?
Vegetations - Systemic arterial embolization of vegetations
The vegetations that occur during infective endocarditis can become emboli and can be dispersed throughout the arterial system
During an inferior wall myocardial infarction the signs and symptoms of nausea and vomiting, weakness and sinus bradycardia are a result of what mechanism?
Increased vagal tone
Sinus bradycardia may result from high vagal tone, hypothermia, acidosis, increased intracranial pressure, drug toxicities, or direct surgical trauma to the sinoatrial (SA) node
What are the top 5 causes of secondary hypertension?
Renovascular disease
Obstructive sleep apnea
Renal parenchymal disease
Primary aldosteronism
Drug- or alcohol-induced
What is the medication classes is the treatment of choice in a patient with variant or Prinzmetal’s angina
CCB
What is the EKG manifestation of cardiac end-organ damage due to hypertension?
LV hypertrophy
What causes a RBBB
Right bundle branch block is caused by a delay in the conduction system in the right ventricle. It may be caused by right ventricular hypertrophy or conditions with higher pulmonic resistance such as cor pulmonale.
ST segment elevation is a sign of
Acute MI
Annual blood pressure determinations should be obtained beginning at the age of
3
Periodic measurements of blood pressure should be part of routine preventive health assessments beginning at the age of 3 years
When would you see an increase in pulse pressure?
Pulse pressures reflect the difference in aortic and left ventricular volumes that occur during ventricular systole Increased pulse pressures are seen in aortic regurgitation which is a different entity than atrial septal defect.
Tx of choice for acute pericardiits
NSAID - indomethacin
Medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining
Hypertrophic cardiomyopathy
Acute rebound hypertensive episodes have been reported to occur with the sudden withdrawal of
Beta blockers
Clonidine (Catapres) is a central alpha agonist
A patient presents for a follow-up visit for chronic hypertension. Which of the following findings may be noted on the fundoscopic examination of this patient?
AV nicking
When is CABG the treatment of choice?
CABG is the treatment of choice in patients with more than 75% occlusion of the LAD or two-three vessel disease
An elderly female presents for evaluation of exertional syncope, dyspnea, and angina. She admits that previous to these symptoms she had insidious progression of fatigue that caused her to curtail her activities. Which of the following is the most likely diagnosis?
Aortic stenosis
The major symptoms of aortic stenosis are exertional syncope, dyspnea, and angina. Symptoms do not become apparent for a number of years and usually are not present until the valve is narrowed to less than 0.5 cm to 2 cm of valve surface area.
Mid-diastolic opening snap
Mitral stenosis
Mid-systolic clicks are noted in
mitral valve prolapse
What is the MCC of acute myocardial infarction?
Coronary artery thrombus develops rapidly at a site of vascular injury. In most cases, infarction occurs when an atherosclerotic plaque fissures, ruptures, or ulcerates and when conditions favor thrombogenesis, so that a mural thrombus forms at the site of rupture and leads to coronary artery occlusion.
What is the most common cause of arterial embolization?
Atrial fibrillation is present in 60-70% of patients with arterial emboli and is associated with left atrial appendage thrombus.
What is the most common arrhythmia encountered in patients with mitral stenosis is
A. fib
Mitral stenosis leads to enlargement of the left atrium, which is the major predisposing risk factor for the development of atrial fibrillation
Which two cardiac drugs are most likely to cause drug induced lupus
Procainamide and hydralazine are the most common drugs that may cause a lupus-like eruption
What are examples of causes of high output heart failure
High output heart failure occurs in patients with reduced systemic vascular resistance. Examples include:
thyrotoxicosis, anemia, pregnancy, beriberi and Paget’s disease. Patients with high output heart failure usually have normal pump function, but it is not adequate to meet the high metabolic demands.
Patients will commonly have a history of a recent febrile illness. Chest pain may mimic that of a myocardial infarction and Troponin I levels maybe elevated in one-third of patients. Contractile dysfunction is seen on catheterization and/or echocardiogram. What diagnosis should this make you think of?
Myocarditis
Which antihypertensive agents is considered to have both alpha- and beta-blocker activities?
Carvedilol
What are absolute contraindications to TPA
Absolute contraindications to thrombolytic therapy include a previous hemorrhagic stroke, a stroke within one year, a known intracranial neoplasm, active internal bleeding, and a suspected aortic dissection
Severe, but controlled hypertension, use of anticoagulation, and active peptic ulcer disease are relative contraindications in which the risk/benefit ratio must be weighed in each patient.
What is the #1 killer of postmenopausal women
Heart disease
If a patient has new onset hypertension and hypokalemia, what should be suspected as the cause of hypertension?
Primary aldosteronism has an increased aldosterone secretion, which causes the retention of sodium and the loss of potassium
Which electrolyte abnormality is associated with an increase in the risk for digoxin toxicity?
Hypokalemia
Decreased concentration of potassium results in the increased activity of cardiac glycosides by increasing tissue binding and decreasing renal excretion of digoxin. Potassium loss is the only significant electrolyte abnormality that significantly affects digoxin metabolism.
A grade IV/VI systolic murmur heard best at the apex with radiation to the left axilla
mitral regurgitation
Blood being put back into the right side of the body with increased jugular pulsation in the neck, along with a palpable venous pulse in the liver, is most likely caused by?
Tricuspid insufficiency
What is the primary cause for patients with chronic venous insufficiency predisposes them to development of skin ulcers?
Leakage of fibrinogen and growth factors into the interstitial space, leukocyte aggregation and activation, and obliteration of the cutaneous lymphatic network can predispose a patient to skin ulcers
What medication is contraindicated in a patient who tests positive for cocaine?
Pure Beta blockers, such as propranol, can cause a paradoxical hypertension because of unopposed alpha- adrenergic effects
Which population groups represent the greatest risk for developing primary hypertension?
Black non-Hispanic adults have the highest risk of hypertension
Jugular venous pulsations a prominent a wave represents
Jugular venous pulsations a prominent a wave represents
Right atrial contraction
What murmur is most common in Marfan?
This murmur is most consistent with aortic regurgitation which can be present in patients with Marfans syndrome and a dilated aortic root.
What would be the most likely initial effect on the left ventricle from aortic stenosis?
Concentric hypertrophy with preserved function
Persistent ST elevation in the leads where a previous or recent anterior MI occurred is most likely due to
Ventricular aneurysm
Patients with mechanical MV prostheses should maintain an INR between
2.5-3.5
Physical exam findings suggests worsening or severe aortic stenosis
A palpable thrill or LV heave with associated murmur suggests severe AS
When does perfusion of coronary arteries occur, systole or diastole?
Diastole, when everything is relaxed
What does pulmonary capillary wedge measure?
Indirectly measures left atrial filling pressures
Which of the following lifestyle recommendations would most benefit the heart failure patient’s quality of life?
Exercise program
Exercise training improves activity tolerance and deconditioning offering some recompensation.
A two month-old infant appeared well until three weeks ago when he became dyspneic and had difficulty feeding. A 4/6 holosystolic murmur is heard at the left lower sternal border in the 3rd ICS. An electrocardiogram (ECG) shows left and right ventricular hypertrophy. What is the most likely diagnosis?
VSD
A 24 year-old male comes to the clinic with a one week history of pain and swelling that involves the entire right upper extremity. He exercises frequently and has noticed the pain worsening while lifting weights. Examination shows enlarged cutaneous veins over the right anterior chest wall with a palpable cord. His right hand appears dusky. Which of the following is the most likely diagnosis?
Axillary subclavian venous thrombosis
Axillary-subclavian venous thrombosis can occur in someone who strenuously exercises, has had a central venous catheter or history of venous thrombosis.
What murmur is worsened by conditions that cause reduced ventricular volume such as the Valsalva maneuver, sudden standing, and tachycardia
HCOM
Ulceration in the area of the medial malleolus should make you think of what type of ulcer?
Venous ulcer
Blue discoloration of the digits, usually of the peripheral extremities in newborns, which worsens with exposure to cold and improves with warming
Acrocyanosis
