Cardiac

Question 1

Best physical exam indicator of Heart Failure

Answer 1

S3 heart sound

followed by: elevated JVP, Hepatojugular reflex

Question 2

Two most common causes of CHF

Answer 2

CAD- Coronary Artery Disease

Hypertension

Question 3

Acute mgmt of CHF exacerbation

Answer 3

IV diuretics like Furosemide (Lasix)

Question 4

What meds can improve survival in Heart Failure pts

Answer 4

ACE-I “pril”
ARB “sartan”
Long acting cardio-selective Beta blockers

Question 5

Abdominojugular reflux is most consistent with

Answer 5

Right sided Heart Failure

Question 6

Medication triggers to CHF exacerbation

Answer 6

NSAIDs
Non dihydro CCBs (Verapamil and Diltiazem)
TZDs (Pioglitazone)

Question 7

Non med triggers to CHF exacerbation

Answer 7

Non adhering to meds
Ischemia
Thyroid disorder
Uncontrolled HTN
Arrhythmia
Anemia

Question 8

Inflammation of the Pericardium (sac)

Answer 8

Pericarditis

Question 9

Infection of the heart muscle

Answer 9

Myocarditis

Question 10

Infection of the valves/or endocardium

Answer 10

Endocarditis

Question 11

Two most common causes of Pericarditis

Answer 11

Idiopathic (dk why)

Viral- Coxsackie or Echovirus

Question 12

2 most common viruses causing Pericarditis

Answer 12

Coxsackie

Echovirus

Question 13

Dressler synd

Answer 13

a type of Pericarditis, after MI
Tx: NSAIDs
Steroids or Colchicine if refractory

can use NSAIDs bc this is weeks-months after MI

Question 14

Pleuritic CP (relieved when sitting fwd)

Answer 14

Pericarditis

Question 15

Pericardial friction rub heard when pt is Exhaling and Leaning fwd

Answer 15

sign of Pericarditis

Question 16

EKG shows diffuse STE with PR deprerssion

Answer 16

Pericarditis

Question 17

Tx of Pericarditis

Answer 17

NSAIDs or ASA

Colchicine

Question 18

What usually causes Myocarditis?

Answer 18

VIRAL- Coxsackie, or

Auto-immune (Lupus)

Question 19

Sx are Fever, muscle ache, fatigue –> Systolic dysfx
Dilated Myocardiopathy

SOB, exercide induced
S3 gallop heard on PE

Answer 19

Myocarditis

Question 20

Sinus tachy, maybe increased ESR

Answer 20

Myocarditis

Question 21

Definitive dx of Myocarditis

Answer 21

Endomyocardial biopsy showing: Lymphocytes w/ myocardial tissue necrosis

(biopsy is reserved for severe cases though)

Question 22

Tx of Myocarditis

Answer 22

Same as HF:

ACE-I
B-blockers
Diuretics

Question 23

Endocarditis

Answer 23

infection of VALVES or endocardium

Question 24

Valve most commonly affected by Endocarditis

Answer 24

Mitral valve

Question 25

Valve most commonly affected by Endocarditis if person has hx of IVDU

Answer 25

Tricuspid

Question 26

IVDU --> Endocarditis

Answer 26

Staph Aureus

Question 27

Dental --> Endocarditis

Answer 27

Step Viridans

Question 28

Prosthetic valve --> Endocarditis

Answer 28

Staph epidermis

Question 29

GI/GU procedure --> Endocarditis

Answer 29

Entero

Question 30

Persistent fever, fatigue, Anorexia Osler nodes (PAINFUL, purple nodules on hands/feet) Janeway lesions (no pain, macules on palms/soles) Splinter hemorrhage Roth spots on eyes Splenomegaly

Answer 30

Endocarditis

Question 31

TIMI heart score

Answer 31

``` age >65 >3 CAD risk factors known CAD Aspirin use in past 7d severe CP EKG changes + cardiac marker ```

Question 32

CRITICAL causes of CP

Answer 32

``` MI Aortic dissection PE Tension PNX Tamponade Mediastinitis Esophogeal rupture Perforated ulcer ```

Question 33

Normal trop value

Answer 33

<10

Question 34

Post MI Pericarditis (2-3 days after heart attack)

Answer 34

AVOID NSAIDS | Do not want to mess up the healing process of the heart

Question 35

Cardiac tamponade- heart is getting pushed on by all the fluid surrounding it

Answer 35

Beck's triad: - hypotension - JVD - muffled heart sounds

Question 36

Tx for Tamponade

Answer 36

drain pericardial effusion

Question 37

How is Dressler's synd diff than Post MI pericarditis?

Answer 37

develops longer after MI weeks- months can use NSAIDs here- NSAIDs, Steroids, Colchicine

Question 38

Endocarditis

Answer 38

IVDU infection of the VALVES Osler nodes Janeway lesions Splinter hemorrhage Subungual petechiae

Question 39

Tx of Endocarditis | 3 things

Answer 39

Vanco + Ceftriaxone + Genta

Question 40

Two types of Aortic dissection

Answer 40

Acute ascending- type A- EMERGENCY Descending- managed w meds

Question 41

Tx of Aortic dissection

Answer 41

If hemodyn unstable, intubate Bedside echo, Vascular consult, admit Give: pain meds, BP CONTROL (IV beta blocker like Esmolol)

Question 42

Give what beta blocker to Aortic dissection

Answer 42

IV Esmolol

Question 43

Marfan syndrome is associated with what murmur

Answer 43

Mitral valve prolapse

Question 44

Peri-infarction (post MI) Pericarditis will appear 2-3 days after Heart Attack SOON AFTER

Answer 44

Supportive tx (usually self limited, Give Tylenol) can give: ASA +/- Colchicine AVOID NSAIDs bc want to let the heart heal

Question 45

Tx for Endocarditis Abx for 6 weeks

Answer 45

Vanco + Rocephin | or sub Rocephin for Genta