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Medicine > cardiac > Flashcards

cardiac Flashcards

1
Q

when does right ventricular failure occur and what coronary artery is involved

A

acutely. RCA

presents as hypokinetic RV

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2
Q

How does right ventricular failure present clinically

A

hypotension, clear lungs, kussmaul sign.

kussmaul sign is a paradoxical rise in JVP with inspiration (this typically doesn’t happen).

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3
Q

when does papillary muscle rupture occur and what artery is involved

A

acutely or within 3-5 days. the RCA

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4
Q

what is the clinical presentation of papillary muscle rupture

A

severe pulmonary edema, new holosystolic murmur.

this is caused by severe mitral regurgitation and flail leaflet.

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5
Q

when does interventricular septal rupture occur and what artery is involved

A

acutely or within 3-5 days. the LAD (apical septal) or RCA for basal septal

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6
Q

what is the clinical presentation of septal wall rupture.

A

chest pain, new holosystolic murmur, biventricular failure, shock
there is a left-right shunt and increase in the O2 level from RA to Right ventricle.

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7
Q

when does free wall rupture occur and what artery is involved

A

within 5 days to two weeks. and the LAD is involved

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8
Q

what is the clinical presentation of free wall rupture.

A

chest pain, shock, distant heart sounds.

this causes pericardial effusion and tamponade

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9
Q

when does left ventricular aneurysm occur and what artery involved

A

up to several months and the LAD is involved

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10
Q

what is the clinical presentation of ventricular aneurysm

A

subacute heart failure or stable angina.

there will be thin and dyskinetic myocardial wall.f

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11
Q

what are the signs of left sided heart failure

A

shortness of breath, coughing, dyspnea on exertion.

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12
Q

what are the signs of right sided heart failure

A

peripheral edema, hepatomegaly, ascites, weight gain, loss of appetite.

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13
Q

what is the single most important modifiable risk factor for ischemic heart disease and some others

A

LDL levels is the single most important.

others are HTN, tobacco use, obesity, DM

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14
Q

what are the major unmodifiable risk factors

A

age, male sex, hereditary. stress plays a minor role

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15
Q

how is unstable angina or NSTEMI managed medically

A

aggressive medical treatment without consideration of age.

all patients should be given aspirin. p2y12 inhibitors added for dual anti platelet.

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16
Q

what EKG changes are seen in an inferior infarct

A

II, III, AVF

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17
Q

which artery is involved in an inferior infarct

A

right coronary

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18
Q

what EKG changes are seen in an anteroseptal infarct

A

V1-V3

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19
Q

which artery is involved in an anteroseptal infarct

A

LAD

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20
Q

what EKG changes in an anterior infarct

A

V2-V4

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21
Q

what artery is involved in an anterior infarct

A

LAD

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22
Q

what EKG changes in a lateral infacrt

A

I, AVL, V4, V5, and V6

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23
Q

which artery is involved in a lateral infarct

A

LAD or circumflex

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24
Q

what EKG changes in a. posterior infarct

A

V1-V2 with tall broad initial R wave. ST depression, tall upright RT wave. usually occurs with inferior or lateral MI

25
Q

which artery is involved in a posterior infarct

A

posterior descending.

26
Q

when is coronary intervention not recommended

A

if presenting after 12 hours of onset. usually recommend CABG.

27
Q

what are the absolute contraindications to thrombolytic therapy for acute coronary syndrome

A

active bleeding, significant closed head trauma or facial trauma that occurred within three months. aortic dissection, prior intracranial hemorrhage, ischemic stroke within 3 months.

28
Q

what are the relative contraindications for thrombotic therapy for acute coronary syndrome

A

recent major surgery within 3 weeks, traumatic or prolonged cardiopulmonary resuscitation, recent internal bleeding (4 weeks), active peptic ulcer, severe poorly controlled HTN, ischemic stroke within < 3 months.

29
Q

what are the cardiac complications of acute coronary syndrome

A

arrhythmias, pump dysfunction, ischemia and post-infarct angina, pericarditis-dressler syndrome, thromboembolism, sudden cardiac death (most often due to arrhythmia),

30
Q

what are the non-cardiac complications of acute coronary syndrome

A

depression (3X more common), erectile dysfunction (sildenafil should be used cautiously and to with nitrates),

31
Q

what are some causes of non-atherosclerotic coronary syndrome

A

vasculitis (lupus, kawassaki, temporal arteritis, polyarteritis nodosum), spasm (cocaine, variant), embolus, hyper coagulable states (polycythemia, factor V, protein C deficiency, antiphospholipid).

32
Q

what are two examples of systolic HF and what is the underlying deficit

A

ischemic cardiomyopathy and dilated cardiomyopathy

disrupted pump function and reduced EF.

33
Q

what is HF with preserved EF and what are some characteristic etiologies

A

this is when there is a diastolic dysfunction; the ejection fraction is the same, but the ventricles cannot fill properly. this can occur in amyloidosis, normal aging causes stiffening of the ventricles, hypertension is the most common cause.

34
Q

what is congestive heart failure

A

this is a clinical syndrome of dyspnea and fatigue as well as evidence of circulatory congestion, such as peripheral edema, elevated JVP. the rate of fluid accumulation exceeds the lymphatic absorption parameters.

35
Q

what are the causes of acute decompensated HF

what is the most common cause

A

the most common is ischemia. others include

medication non-compliance, increased salt intake, acute ischemia, tachycardia, pulmonary infection.

36
Q

what is the presentation of HF

A

pulmonary rales,, peripheral edema, hepatomegaly and ascites, JVD, displaced apical pulse.

37
Q

what medications should patients be discharged on for acute coronary syndrome

A

aspirin (all patients unless contra), clopidogrel (p2y12 inh) (9-12 after acute infarct and especially after stenting), beta-blocker (metroprolol or carvedilol) and continued indefinitely unless contra. ACEi in patients with ACS in HF or with EF <40% (can be discontinued if HF resolves). statins should be initiated in all patients unless non-atherosclerotic, nitrates are reserved for patients with chest pain,

38
Q

when is warfarin given

A

warfarin only for a fib or thromboembolism risk

39
Q

what drugs decrease mortality in HF

A

ACEi and beta blockers –this is irrespective of BP status.

40
Q

what is the test of choice for diagnosing HF and what other tests can be used

A

echocardiogram
ECG
chest x
BNP

41
Q

what is the first line treatment in HF.

A

ACEi and loop diuretics are given first. then BB.
ACEi irrespective of BP status. (improve survival and reduce hypertrophy). reduce preload and after load. can add spironolactone for added benefit.
beta blockers are given to all.
thus all patients get ACEi, BB, and loop diuretics (to reduce symptoms).

42
Q

why do we use loop diuretics in HF

A

for reducing symptoms. there is no survival benefit.

43
Q

what are the causes of hypertrophic cardomyopathy

A

HTN, aging, inherited.

44
Q

what is the first line treatment of hypertrophic cardiomyopathy

A

diltiazem

45
Q

how do you diagnose pericardial effusions

A

with transthoracic echo

46
Q

what is the presentation of cardiogenic shock

A

characterized by chest pain, respiratory distress, hypotension, jugular venous distention, crackles in both lower lung fields heard on auscultation and ECG findings (ST-elevation on anterior leads) that are consistent with myocardial infarction of the left ventricle.

47
Q

what is the first thing you do after establishing a cardiac rhythm after electrical shocks?

A

check the patients pulse.

48
Q

what is the treatment for hyperkalemia

A

calcium gluconate. acutely lower the potassium with insulin and glucose.

49
Q

in the setting of infarct with hypotension what is the most appropriate first step

A

bolus saline. this will increase preload and CO, while reducing tachycardia..
next give aspirin and heparin.

50
Q

what is the most effective way to reduce blood pressure

A

reduce BMI to under 25

51
Q

what is the second most effective way to reduce blood pressure –given BMI less than 25

A

DASH diet.

52
Q

what are other effective ways to reduce BP

A

exercise, reduce sodium intake, reduce alcohol intake. in this order

53
Q

what heart sound is heard during the acute phase of MI and why

A

S4 atrial gallop. this is due to ventricular stiffening.

54
Q

1) what is the treatment for pulseless Vtach
2) pulseless electrical activity
3) asystole
4) stable Vtach
5) unstable Vtach

A

1) defibrillation
2) epi and compression
3) epi and compression
4) amiodarone
5) cardioversion

55
Q

how does constrictive pericarditis present

A

JVD, hepatomegaly, dyspnea, peripheral edema and ascites, pulsus paradoxus and kussmauls sign

56
Q

how is SVT treated

A

first by carotid massage and then cold water immersion and valsalva. then hit em wth adenosine

57
Q

what is pulmonary insufficiency

A

when the pulmonic valve allow blood flow back into the right ventricle.

58
Q

what is there presnetation of pulmonic insufficiency

A

dyspnea, dizziness and a decrescendo diastolic murmur.

59
Q

what is cor pulmonale

A

this is right ventricular failure and hypertrophy caused by pulmonary hypertension.

Medicine (14 decks)

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