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cardio and pulm > Cardiac 2024 > Flashcards

Cardiac 2024 Flashcards

MI, AV blocks, congenital abnormalities, BBB, percarditis, ...

1
Q

Afib and Aflutter med tx

A

BB, CCB(diltiazem, verapamil).
Also for Afib- digoxin for allergy to BB and CCB

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2
Q

EKG for afib and aflutter

A

sawtooth for flutter. smaller sawtooth in afib.

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3
Q

1,2,3 degree heart blocks

A

1st: prolonged PR interval(>200), every p has a qrs
2nd: dropped qrs
Mobitz 1: prog lengthening PR w/ dropped qrs
Mobitz 2: same length PR w/ occ dropped qrs
3rd: AV dissociation

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4
Q

Causes can be from fibrosis, increased vagal tone, drugs, CAD, nml variant, mitral valve surgeries,
* delay in conduction thru AV node
*poss electrolyte imbalance causes are what

A

1st degree AV block

hypokalemia and hypomagnesiumia

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5
Q

1st degree AV block symptoms? What is a big risk of having this? tx?

A

Asymptomatic usually. 3 x risk for Afib, pacemaker if over 300 PR interval and symptomatic

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6
Q

Wenkebach tx

A

Mobitz 1; usually no tx. Atropine for bradycardia and hypotension, maybe pacing.

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7
Q

Causes can be from increased vagal tone, drugs, nml variant, mitral valve surgeries, MI, HYPERkalemia

A

mobitz 1, wenkeabach

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8
Q

4 types of afib

A
  1. Paroxysmal: self terminating in 7 days, usually 24 hrs, +/- recurrent
  2. Persistent: fails to self terminate, lasts > 7 days. Requires termination.
  3. Permanent: persistent AF > 1 year- refractory to cardioversion.
  4. Lone: Paroxysmal, persistent, or permanent w/out evidence of heart disease.
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9
Q

symptoms in unstable afib

A

due to hypoperfusion: HYPOtension, altered mental status, refractory CP

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10
Q

tx for unstable afib and aflutter

A

direct synchronized cardioversion

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11
Q

AV nodal blocking agents

A

BB, digoxin, CCB

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12
Q

bradycardia related decreased perfusion symptoms

A

fatigue, dizziness, CP, syncope
-think second degree heart block, mobitz type 1 Wenckebach

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13
Q

TX for symptomatic wenckebach, what if it is persistent?
tx for mobitz type 2

A

atropine; pacemaker;

type 2: atropine or temp pacing. Progression to type 3 is common so permanent pacemaker is definitive.

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14
Q

AV block commonly at bundle of HIS

A

mobitz type 2

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15
Q

AV block rarely seen in patients w/out structural heart disease: myocardial ischemia, myocardial fibrosis, myocarditits(LYME), endocarditis

A

mobitz type 2

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16
Q

avoid atropine in what heart block

A

it can precipitate 3rd degree heart block

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17
Q

No atrial impulses reach ventricles leading to escape rhythm. More P waves then QRS complexes

A

3rd degree heart block

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18
Q

causes of 3rd degree heart block

A

INFERIOR wall infarction, AV node blocking agents, degeneration of conduction system

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19
Q

which AV block often symptomatic? symptoms?

A

3rd degree. syncope, fatigue, CP, death

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20
Q

tx of 3rd degree heart block

A

maybe dopamine or adrenaline.
For sure pacemaker

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21
Q

Valves most affected in endocarditis

A

M>A>T>P

except IV drug use: tricuspid

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22
Q

describe acute bacterial endocarditis

A

infection of normal valves with virulent organism (eg S. aureus)

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23
Q

describe subacute bacterial endocarditis

A

indolent infection of abnormal valves with less virulent organism (eg s viridans)

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24
Q

organisms with IV drug related endocarditis

A

most commonly s aureus(especially MRSA), pseudomonas, candida

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25
Q

describe prosthetic valve endocarditis

A

early(within 60 days): staph epidermis most common.

late: resembles native valve endocarditis.

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26
Q

PE of endocarditis around body

A
  • Persistent fever
  • new onset murmur or worsening of an existing murmur
    S: splinter hemmorhages
    O: Osler nodes (hands/feet) painful
    R: roth spots (eye)
    J: Janeway lesions (hands/feet/ashtray)
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27
Q

3 biggest causes of endocarditis

A

IV drugs/needles, valve replacement surg, dental visits

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28
Q

6 organisms of endocarditis

A

staph aureus
strep viridans
staph epidermis
enterococcus
HACEK
strep bovis

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29
Q

describe staph aureus in endocarditis

A

most common cause of acute endocarditis, rapidly progressive, affects NORMAL valves. also common in pts with IV drug use (esp MRSA)

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30
Q

describe strept viridans in endocarditis

A

most common cause of subacute infective endocarditis; affects DAMAGED valves. part of oral flora(dental procedures)

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31
Q

describe staph epidermis in endocarditis

A

most common in early prostetic valve endocarditis, especially within 60 days of the procedure

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32
Q

describe enterococcus in endocarditis

A

seen especially in men over 50 years old with recent history of GI or genitourinary procedure

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33
Q

describe HACEK in endocarditis

A

Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella, Enterococci; all gram neg and hard to culture. Suspect these in endocarditis and neg blood cultures

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34
Q

describe strep bovis in endocarditis

A

especially in patients with colon cancer or UC

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35
Q

endocarditis blood cultures

A

3 sets at least 1 hour apart;
labs: leukocytosis, anemia(microchromic, normocytic), increased ESR/rheumatoid factor

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36
Q

left vs right sided emboli from heart

A

left to other organs(brain, kidney, spleen, heart)
right to lungs

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37
Q

imaging for endocarditis

A

Get TTE first (transesophageal echocardiogram more sensitive than TTE)

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38
Q

endocarditis, DUKE criteria

A

2 major OR 1 major with 3 minor, OR 5 minor

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39
Q

describe major criteria (DUKE)

A
  1. sustained bacteremia with 2 pos blood cultures by organism known to cause endocarditis
  2. endocardial involvement: + echo and new valvular regurgitation(AR or MR)
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40
Q

describe minor criteria (DUKE)

A
  1. predisposing condition
  2. fevers>38 degrees or 100.4
  3. vascular and embolic phenomena(janeway, septic arterial or pulmonary emboli, ICH)
  4. immunologic phenomena: oslers nodes, roth spots, +RF, acute glomerulonephritis
    • blood culture not meeting major criteria
    • echo not meeting major criteria (worsening existing murmur)
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41
Q

refractory CHF, persisent or refractory infection, invasive infection, prostetic valve, recurrent systemic emboli, fungal infections

A

indications for surgery for endocarditis

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42
Q

empiric endocarditis tx: native valve

A
  • anti staph PCN: (nafcillin, oxacillin) plus ceftriaxone 4-6 weeks or gentamycin (aminoglycocides only 2 weeks)
  • vanco if needed due to allergy
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43
Q

empiric endocarditis tx: prosthetic valve

A

vanco plus gentamicin plus rifampin

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44
Q

empiric endocarditis tx: fungal

A

amphotericin B for 6-8 weeks, often will need surgery

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45
Q

great gram positive coverage

A

PCN and Vanco

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46
Q

great gram neg coverage

A

gentamicin, ceftriaxone

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47
Q

Prophylaxis for which procedures to prevent endocarditis

A

dental, respiratory, and procedures involving infected skin/musculoskeletal tissues

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48
Q

Prophylaxis medications to prevent endocarditis

A

amox 2 gms 30-60 min before procedure

clinda 600 mg if PCN allergic

Macrolides or cephalexin are other options

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49
Q

4 things to ask if bradycardic pulse

A

Hypotension, AMS, refractory CP, acute heart failure

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50
Q

bradycardic med tx and exception

A

atropine 1st line; next is epi infusion or dopamine infusion, pacing

**exception is 3rd heart block- must pace then permanent pacemaker

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51
Q

When left side of the heart malfunctions, what happens?

A

blood will get backed up in the lungs, you get SOB, body does not get O2 rich blood to the body(fatigue), kidneys getting too little blood(doesn’t make enough urine causing fluid build up in the body[legs]

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52
Q

When right side of the heart malfunctions, what happens?

A

blood gets backed up from tissues in the body[swelling in feet/LL], sluggish flow of blood and heart failure can lead to blood clots forming in heart, leading to clots in brain to cause a stroke OR clots in legs can travel to lungs

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53
Q

what is a cardiac arrest?

A

Heart has stopped pumping blood effectively due to an electrical issue, brain not getting enough O2, person unconscious, may not be breathing or breathing abnormally

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54
Q

Beck’s triad

A

B E C
B: big jugular vein distention
E: extreme low BP (hypotension) C: can’t hear heart sounds, distant muffled heart sounds

**Cardiac tamponade

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55
Q

5 initial symptoms of hypoxemia

A

restless & confusion, dizziness (syncope), fatigue, SOB, tachycardia

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56
Q

first sign of decreased cardiac output

A

tachycardia

57
Q

pulses paradoxes

A

think cardiac tamponade;
systolic drop by 10mmhg upon respiration;
pulse pressure gets closer due to heart being compressed (systolic minus diastolic)

58
Q

what tests to get for cardiac tamponade?

A

** echo: pericardial effusion and diastolic collapse of cardiac chambers (swinging heart)
1st, EKG: short and uneven qrs complexes , electrical alternans
- cardiac cath shows all pressures in chambers to be equal

59
Q
  • EKG: short and uneven qrs complexes , electrical alternans
A

cardiac tamponade

60
Q

cardiac tamponade 6 symptoms

A

dyspnea, fatigue, peripheral edema, shock, reflex tachycardia, cool extremities

61
Q

dyspnea, fatigue, peripheral edema, shock, reflex tachycardia, cool extremities

A

cardiac tamponade symptoms

62
Q

Normal inspiration causes ___ pressure and pulls ___ into the___, the ___ ventricle ____, and this ______ affect left heart volume at all.

A

negative, pulls blood in the heart, the right ventricle expands and this does not affect left heart volume.

63
Q

In tamponade, extra volume pushes ______ to the left and causing 3 things

A

interventricular septum to the left,
1. less left ventricular diastolic volume
2. lower stroke volume
3. lower systolic BP during inspiration

64
Q

In tamponade, what happens to the atria

A

The atria can’t distend enough to accomodate VENOUS blood so blood backs up and you see JVP

65
Q

electrical alternans

A

QRS complexes have different heights, think tamponade

66
Q

What is cardiogenic shock?

A

Heart’s fault that pt is in shock.

inadequate tissue perfusion causing low cardiac output with increased systemic vascular resistance. Often systolic in nature.

67
Q

difference between cardiogenic shock and hypovolemic shock

A

cardiogenic produces increased respiratory effort/distress, hypovolemic does not.

68
Q

3 main Causes of cardiogenic shock

A

MI, heart failure(CHF), lethal rhythm

69
Q

signs in cardiogenic shock

A

hypoTN, rales(blood backed up in lungs), JVD(heart failure), increased RR, decreased sp02(hypoxia)

70
Q

myocarditis, valve dysfunction, congenital heart ds, cardiomyopathy, arrhythmias, MI

A

etiologies of cardiogenic shock

71
Q

hypoTN, rales, JVD, increased RR, decreased sp02

A

signs in cardiogenic shock

72
Q

symptoms in cardiogenic shock

A

CP, dyspnea, cold extremities with delayed capillary refill

73
Q

increased pulmonary capillary wedge pressure(>15mmHg)

A

cardiogenic shock

74
Q

cardiogenic shock and pulmonary capillary wedge pressure

A

increased pulmonary capillary wedge pressure(>15mmHg)

75
Q

Vaso constriction or dilation in cardiogenic shock

A

vasoconstriction- increased SVR

76
Q

Which shock do you do not give large amounts of fluid

A

cardiogenic shock

77
Q

Tx of cardiogenic shock

A

O2, ISOtonic fluids(avoid aggressive IV fluid tx); inotropic support to increase myocardial contractility and CO:
1. dobutamine: positive inotrope
2. epi: positive inotrope and vasoconstrictor
3. Amrinone: may be used if refractory, positive inotrope

intraaortic balloon pump support

78
Q

describe these meds:

  1. dobutamine
  2. epi
  3. Amrinone
A
  1. dobutamine: positive inotrope
  2. epi: positive inotrope and vasoconstrictor
  3. Amrinone: may be used if refractory, positive inotrope
79
Q

Foramen Ovale

A

Shunts 2/3 of oxygenated blood from right atrium directly into the left atrium. Remaining 1/3 passes into right ventricle. Most of the remaining 1/3 goes through the right ventricle and gets pumped into the pulm artery.

80
Q

ductus arteriosus

A

shunts blood from the pulm artery directly into the aorta(systemic circulation), bypassing fetal lungs

81
Q

as baby takes its first breath, what happens

A

left side pressure becomes > right side pressure, promoting closure of openings

82
Q

prostaglandins and PDA and ductus arteriosus

A
  1. to close PDA, give a prostaglandin inhibitor (IV indomethacin or Ibuprofen)
  2. To keep ductus arteriosus open, administer a prostaglandin
83
Q

Left to right congenital heart disease

most common

A
  1. VSD, most common
  2. ASD
  3. PDA
84
Q

Eisenmenger syndrome

A

lt to right shunt eventually develops into a right to left shunt

85
Q

4 types of VSD

A
  1. perimembranous, most common, hole in LV outflow tract near tricuspid
  2. muscular: swiss cheese pattern
  3. inlet(posterior): located posterior to septal leaflet of tricuspid valve
  4. supracristal(outlet): beneath pulmonic valve. May have aortic valve insuffiency.
86
Q
A
87
Q

symptoms of moderate VSD

A

excessive sweating or fatigue, especially during feeds, lack of adequate growth, frequent respiratory infections

88
Q

excessive sweating or fatigue, especially during feeds, lack of adequate growth, frequent respiratory infections

A

symptoms of moderate VSD

89
Q

symptoms of large VSD

A

severe sx. No pressure differences between ventricles.

90
Q

High pitch harsh holosystolic murmur best heard at LL sternal border.

May be associated with a thrill or diastolic rumble at the mitral area

A

VSD

91
Q

VSD heart sound

A

High pitch harsh holosystolic murmur best heard at LL sternal border.

May be associated with a thrill or diastolic rumble at the mitral area

92
Q

smaller VSDs heart sound

A

usually louder and associated with more palpable thrills then larger ones

93
Q

testing for VSD

A

echo preferred over cath.

94
Q

ECG and CXR in VSD

A

ECG: LVH.
CXR: may be nml, show left atrial enlargement or RVH.

95
Q

When to repair large VSD

A

at 2 years to prevent pulm HTN

96
Q

4 types of ASD, most common

A
  1. ostium secundum 80%
  2. ostium primum(assoc with mitral valve abn)
  3. sinus venosus
  4. coronary sinus
97
Q
  1. ostium secundum 80%
  2. ostium primum(assoc with mitral valve abn)
  3. sinus venosus
  4. coronary sinus
A

ASD

98
Q
  1. perimembranous, most common, hole in LV outflow tract near tricuspid
  2. muscular: swiss cheese pattern
  3. inlet(posterior): located posterior to septal leaflet of tricuspid valve
  4. supracristal(outlet): beneath pulmonic valve. May have aortic valve insuffiency.
A

VSD

99
Q

ASD symptoms occur when usually

A

around 30 years old

100
Q

symptoms of ASD in infants and young children

A

recurrent resp infection, failure to thrive, exertional dyspnea

101
Q

recurrent resp infection, failure to thrive, exertional dyspnea

A

symptoms of ASD in infants and young children

102
Q

symptoms of ASD in adolescents and young adults

A

exertional dyspnea, easy fatigability, palpitations, atrial arrhythmias, syncope, heart failure

103
Q

paradoxical emboli

A

stroke from venous clots, think ASD

104
Q

exertional dyspnea, easy fatigability, palpitations, atrial arrhythmias, syncope, heart failure

A

symptoms of ASD in adolescents and young adults

105
Q

murmur with ASD

A

systolic murmur best heard at left sternal border; fixed S2 splitting

106
Q

systolic murmur best heard at left sternal border, fixed S2 splitting

A

ASD

107
Q

crochetage sign

A

notching of peak of r wave in inferior leads, think ASD

108
Q

ECG in ASD

A

incomplete RBBB. echo best test.

109
Q

PDA located where

A

descending thoracic aorta and main pulm artery

110
Q

PDA closes when

A

2-3 weeks

111
Q

PDA common in who

A

premature births

112
Q

How does blood move in a PDA

A

from aorta shunted to pulmonary vasculature

113
Q

cyanosis lower half of body

A

eismengers syndrome in PDA

114
Q

Symptoms in PDA; murmur

A

usually asymptomatic.
continuous machine like murmur loud at pulmonic area(left upper sternal border); wide pulse pressures(bounding peripheral pulses), loud S2

115
Q

usually asymptomatic.
continuous machine like murmur loud at pulmonic area(left upper sternal border); wide pulse pressures(bounding peripheral pulses), loud S2

A

PDA

116
Q

child has poor feeding, wt loss, frequent lower resp tract infections, pulm congestion, infective endocarditis

A

PDA

117
Q

PDA if they are symptomatic

A

child has poor feeding, wt loss, frequent lower resp tract infections, pulm congestion, infective endocarditis

118
Q

prostaglandins can keep what open

A

PDA

119
Q

EKG in PDA

A

LVH, left atrial enlargement.

echo best test

120
Q

R to L shunts

A
  1. Tet of fallot(most common cyanotic shunt)
121
Q

4 abn of tet of fallot

A
  1. RV outflow obstruction
  2. RVH
  3. large unrestrictive VSD
    4.OVERIDING AORTA
122
Q

Cyanosis at birth

A

tet of fallot

123
Q

older kid symptoms of tet of fallot

A

exertional dyspnea, cyanosis worsens with age

tet spells

124
Q

tet spells

A

agitation, cyanosis, rapid shallow breathing from hypoxemia- blood bypassing lungs and entering aorta;

squatting decreases right to left shunting, improving oxygenation

in infants, relieved by putting knees to chest

125
Q

tet of fallot murmur

A

harsh systolic murmur at left mid to upper sternal border(VSD), right ventricular heave

126
Q

harsh systolic murmur at left mid to upper sternal border(VSD), right ventricular heave

A

tet of fallot

127
Q

boot shaped heart on CXR

A

tet of fallot

echo best test.

128
Q

transposition of great arteries definition

A

Discordance b/t aorta and pulm trunk (the aorta arises from the RV and the pulm trunk arises from the LV

129
Q

What is the most common cyanotic heart disease presenting in the neonatal period(dextro)?

A

transposition of great arteries

130
Q

Dextro-TGA

A

Dextro-TGA: most common. Aorta arises from the RV and the pulm artery from the LV, leading to 2 parallel circuits. The systemic circuit sends systemic deoxygenated blood back to the systemic circulation. The pulm circuit sends oxygenated pulm venous blood back to the lungs. Prior to surgical correction, survival is dependent upon the presence of shunts b/t right and left circulation.

131
Q

Levo-TGA

A

Levo-TGA: cyanotic. Rt atrium sends blood to the morphologic LV, which is on the right side physically. This morphologic LV sends blood to the pulm system. The LA sends blood to morphologic RV located on the left side. The morphologic RV sends blood to the systemic circulation.

132
Q

symptoms of TGA

A

severe cyanosis and tachypnea within the first 30 days of life not affected by exertion or the use of oxygen.

133
Q

Egg on a string on CXR

A

TGA

134
Q

ECG and CXR TGA

A

ECG: nml or rt axis deviation or RVH.
CXR: egg on a string

135
Q

gold standard for TGA

A

cardiac cath; echo primary means of diagnosis.

136
Q

Hallmarks of congenital heart disease.

  1. 70% have bicuspid aortic valve
  2. continuous machine like murmur, loudest where
  3. boot shaped heart on cxr
  4. widely fixed, split S2, does it vary with respirations?
  5. Bounding pulses, wide pulse pressure
A
  1. COA
  2. PDA, pulmonic
  3. Tet of fallot
  4. ASD, no
  5. PDA
137
Q

Hallmarks of congenital heart disease.

  1. rib notching on cxr, “3”sign
  2. Systolic ejection murmur, heard best at pulmonic area
  3. MC cyanotic heart disease overall
  4. Suspect in a child with 2 year HTN, bilateral LE claudication
  5. May develop stroke due to paradoxical emboli
A
  1. COA
  2. ASD
  3. Tet of fallot
  4. COA
  5. ASD
138
Q
A

cardio and pulm (22 decks)

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