Cardiac (Exam #1) Flashcards
Which diagnostic test is used to detect electrical activity?
EKG (electrocardiography)
Which diagnostic test is used to evaluate acute chest pain or acute palpitations?
EKG (electrocardiography)
What is continuous EKG monitoring in an inpatient setting?
Telemetry
What is the primary/preferred biomarker of cardiac injury (lab test), and when is it used?
Troponin
- Diagnose/prognose acute MI
Besides Troponin, what two cardiac enzymes are used to evaluate cardiac injury?
- Creatine Kinase (CK)
- Creatine Kinase Myocardial Band (CK-MB)
Which diagnostic test is the primary modality for evaluation of cardiac anatomy and function?
Echocardiography
What is US machine transmits sound pulses into tissue using crystal probe → sounds wave travels and hits tissue → some sound waves reflected back to probe → waves picked up by probe, relayed to machine/2D image made?
Echocardiography
Is TTE or TEE Echocardiography preferred?
TTE
Which diagnostic test is used to evaluate wall motion during/after MI, calculate EF/systolic function, evaluate valve structure/function?
TTE Echocardiography
Which diagnostic test is used to detect clots, valvular pathology (endocarditis), septal defects/patent foramen ovale?
TEE Echocardiography
Which diagnostic test measures the heart’s ability to respond to external stress in controlled environment?
Cardiac Stress Tests (EKG Stress Test, Nuclear Stress Test, Stress Echocardiogram)
Which diagnostic test is used to evaluate exertional chest pain, CHD with new/worse symptoms, newly diagnosed CHF/cardiomyopathy?
Cardiac Stress Tests (EKG Stress Test, Nuclear Stress Test, Stress Echocardiogram)
Which two diagnostic tests have high sensitivity, can localizes ischemia, have more information on cardiac structure/function and are good pre-op evaluation?
- Nuclear Stress Test
- Stress Echocardiogram
Which of the cardiac stress tests prefers exercise stress to pharmacologic stress? Which two use pharmacologic?
EKG stress test = exercise
Nuclear Stress Test, Stress Echocardiogram = pharmacologic
Which diagnostic test involves rest EKG → exercise to target HR/symptoms/time limit → EKG/symptoms taken during exercise?
EKG stress test
Which diagnostic test involves Technetium-99 administered IV → waiting period to allow radioactive tracer distribution → gamma-ray scan at rest → stress induced via exercise/pharm → target HR/symptoms achieved, and another radiotracer injected IV → second waiting period → second gamma-ray scan obtained → two images compared?
Nuclear Stress Test
Which diagnostic test involves TTE at rest → stress induced via exercise/pharm → target HR/symptoms achieved → stress echo images obtained → two images compared?
Stress Echocardiogram
Which diagnostic test requires the use of vasodilators (Adenosine, Dipyridamole) or ionotropes (Dobutamine)?
Nuclear Stress Test
Which diagnostic test is indicated if abnormal resting EKG, assess areas of myocardial ischemia, determine location/size of injured muscle after MI?
Nuclear Stress Test
Which diagnostic test is indicated if known/suspected CAD, evaluate CP, SOB, exertional dyspnea, evaluate valvular abnormalities?
Stress Echocardiogram
What medication is preferred when performing a Stress Echocardiogram?
Dobutamine
Which diagnostic test involves continuous ambulatory electrocardiography over 1-2 days + symptom diary?
Holter Monitor
Which diagnostic test is indicated if DAILY palpitations, syncope?
Holter Monitor
Which diagnostic test involves NON-continuous ambulatory electrocardiography over 30-60 days + symptom diary?
Event Monitor
Which diagnostic test is indicated if WEEKLY/MONTHLY palpitations, syncope?
Event Monitor
Which diagnostic test involves a subcutaneous device that can record up to 3 years?
Implantable Cardiac Monitor
Which diagnostic test is indicated if INFREQUENT symptoms (ex. syncope 3x/year); suspected arrhythmia but testing inconclusive?
Implantable Cardiac Monitor
Which diagnostic test involves instant portable at-home EKG used PRN?
Fingertip Monitor
Which diagnostic test is indicated if symptomatic arrhythmias (A Fib) present?
Fingertip Monitor
Which diagnostic test is indicated to detect aortic dissection, stable angina, detect coronary a. calcium deposits as indicator for atherosclerosis, extent of CAD?
Cardiac CT Scan (Coronary CT Angiography (CCTA), Coronary CT Calcium Scan)
Which diagnostic involves IV contrast → CT heart to evaluate presence/extent of coronary a. occlusion?
Coronary CT Angiography (CCTA)
Which diagnostic test involves assesses for calcium deposits in coronary aa. = evaluates MI risk?
Coronary CT Calcium Scan
Which diagnostic test assesses functional and tissue properties of heart; used for complicated/advanced patients after evaluation with first-line testing like echocardiogram?
Cardiac MRI
Which diagnostic test is the gold standard for diagnosing CAD?
Cardiac Catheterization and Coronary Angiography
Which diagnostic test involves catheter threaded through vessel → contrast dye injected to view coronary a. patency?
Cardiac Catheterization and Coronary Angiography
Which diagnostic test is indicated if known/suspected CAD (unstable angina, angina with positive stress test, history of MI with EKG changes, post cardiac arrest)?
Cardiac Catheterization and Coronary Angiography
Unhealthy levels of cholesterol are a risk factor for what?
Atherosclerosis
Is lipid screening recommended, and if so, at what age(s)?
YES (9-11 and 17-21)
What are the borderline ranges for total cholesterol?
Borderline: 200-239
- Good/Healthy: <200
- High risk: 240+
What are the borderline ranges for TGs?
Borderline: 150-159
- Good/Healthy: <150
- High risk: 200-499
What are the borderline ranges for HDL?
Borderline: 35-45
- Good/Healthy: 60
- High risk: <35
What are the borderline ranges for LDL?
Borderline: 130-159
- Good/Healthy: 60-130
- High risk: 160-189
What can cause falsely low levels of cholesterol/LDL/HDL?
Acute coronary syndrome or MI
What are cholesterol-filled, soft, yellow plaques found in various places on body (armpit, chin, eyes, fingers)?
What two types of hypercholesterolemia are they associated with?
Plane Xanthomas
- Familial
- Secondary causes
What are yellow-orange nodules often on elbows, knees, tendons?
What type of hypercholesterolemia are they associated with?
Tuberous Xanthomas
- Familial
What are small red-yellow papules with abrupt onset often on extensor surfaces or buttocks?
What type of hypercholesterolemia are they associated with?
Eruptive Xanthomas
- Familial
What are white/grey ring around cornea; can be seen in patients over 40 years WITHOUT high lipids?
Corneal Arcus
Which three hypercholesterolemia medications are used ONLY to lower LDL?
- Statins (HMG-CoA Reductase Inhibitors)
- Resins (Bile Acid Sequestrants)
- PCSK9 Inhibitors
Which hypercholesterolemia medication is best used in those with elevated TGs?
Fibric Acid Derivatives
With which medication is myositis/rhabdomyolysis possible, and if suspected, what should you do?
Statins (HMG-CoA Reductase Inhibitors)
- STOP and check CK levels
Which hypercholesterolemia medication is safe in pregnancy?
Resins (Bile Acid Sequestrants)
Which hypercholesterolemia medication is used to raise HDL, lower LDL?
Nicotinic Acid (Niacin)
Which hypercholesterolemia medication has a side effect of flushing?
Nicotinic Acid (Niacin)
Which hypercholesterolemia medication can increase TGs?
Resins (Bile Acid Sequestrants)
Which hypercholesterolemia medication is always combined with Statin?
Ezetimibe
A focus on ASCVD risk reduction as this will correlate with a decrease in what?
LDL levels
In what four groups should a high or moderate intensity statin regimen be used?
- Clinical ASCVD (secondary)
- LDL >190 mg/dL (primary)
- DM aged 40-75 years with LDL >70 mg/dL (primary)
- Without ASCVD or DM with LDL 70-189 mg/dL and estimated 10-year ASCVD risk >7.5% (primary)
What is “HTN, hypokalemia, metabolic alkalosis” the triad for?
Primary hyperaldosteronism triad
What is “HA, sweating, tachycardia” the triad for?
Pheochromocytoma triad
What do signs of striae, skin atrophy, proximal muscle weakness indicate?
Cushing syndrome
At what age should you being HTN screening?
18+ years
- Annual if normal
- Semi-annual if borderline
What can be used to confirm and diagnose elevated HTN out of office?
Ambulatory Blood Pressure Monitoring (ABPM)
Male, black, older age, FH, stress, sleep apnea, smoker, alcohol use, weight gain, sedentary, poor diet, etc. are risk factors for what?
HTN
What are the four primary systems affected by target organ damage (TOD) in HTN?
- Brain
- Heart
- Eyes
- Kidneys
What are the seven labs that should be ordered to evaluate primary HTN?
- Fasting blood glucose
- CBC
- Lipids profile
- Serum creatinine with eGFR
- TSH (thyroid-stimulating hormone)
- UA
- EKG
Thiazide diuretics, CCBs AND ACE inhibitors or ARBs is 1st line treatment options for which disease?
HTN
What is considered Stage 1 HTN, and what is the recommended medication regimen?
Stage 1 HTN: 130-139 systolic OR 80-89 diastolic
- 1 of the following: thiazide diuretics, CCBs, ACE inhibitors/ARBs
What is considered Stage 2 HTN, and what is the recommended medication regimen?
Stage 2 HTN: 140+ systolic OR 90+ diastolic
- 2 of the following (from different classes): thiazide diuretics, CCBs, ACE inhibitors/ARBs
What are the big 4 HTN medications?
- Diuretics
- ACE inhibitors
- ARBs
- CCBs
Patient has CKD AND albuminuria, what is always 1st line HTN medication?
ACE inhibitor
Patient has DM AND albuminuria, what is always 1st line HTN medication?
ACE inhibitor OR ARB
Patient has HF and EF is reduced, which HTN medication should be avoided?
Nondihydropyridine CCBs
What is the 1st line treatment for ALL patients with essential HTN?
Lifestyle modifications
- Low sodium, DASH diet, reduce alcohol
- Exercise 3-4 times/week fo 40 minutes
- Smoking cessation
Which HTN medication has side effects of gout, electrolyte imbalance?
Diuretics/Thiazide (Chlorthalidone)
Which HTN medication has side effects of cough, hyperkalemia?
ACE Inhibitors
Which two HTN medications should NOT be combined?
ACE Inhibitors and ARBs
What is the primary indication for using Diuretics/Thiazide (Chlorthalidone)?
Primary aldosteronism
Are Thiazide or Loop diuretics preferred for patients with symptomatic HF?
Loop diuretics
Which HTN medication is contraindicated if you have a Sulfa allergy?
Diuretics/Thiazide (Chlorthalidone)
What type of HTN/HF medications are “-pril”?
ACE Inhibitors
What type of HTN/HF medications are “-sartan”?
ARBs
What type of HTN medications are “-dipine”?
CCBs
What type of HTN/HF medications are “-olol”?
Beta Blockers
What type of HTN medications are “-zosin”?
Alpha Blockers
Which type of HTN medication is safe in pregnancy and often used?
Beta Blockers
With which two HTN medications should you avoid abrupt cessation?
- Beta Blockers
- Central Alpha Agonists
Which type of HTN medication is often used to treat BPH?
Alpha Blockers
Which type of HTN medication is safe in pregnancy but rarely used due to its CNS adverse effect?
Methyldopa (Central Alpha Agonists)
Which type of HTN medication can NOT be combined with ACE inhibitor or ARB in DM?
Direct Renin Inhibitors
What is asymptomatic severe HTN, NO evidence of end-organ damage?
Hypertensive urgency
What is severe HTN WITH evidence of end-organ damage; rare?
Hypertensive emergency
In a hypertensive emergency, which medication should NOT be used?
Sublingual nifedipine
With which condition is treatment OUTPATIENT; goal is to reduce BP to <160/120 mmHg SLOWLY (rest in quiet room, increase current antihypertensive meds, add meds (diuretic), low sodium, follow up to monitor for symptoms of hyper OR hypotensive (don’t overtreat))?
Hypertensive urgency
With which condition is treatment INPATIENT (ICU hospitalization); address underlying cause and reduce BP, check neuro exam, CXR, EKG, UA, electrolytes and creatinine, CT/MRI; use IV nitrates, CCBs, adrenergic blockers or hydralazine to reduce BP no more than 25% in minutes/hours; goal is 160/110 mmHg over 2-6 hours then to normal over 1-2 days?
Hypertensive emergency
What is 20 mmHg fall in systolic or 10 mmHg fall in diastolic with 2-5 minutes of standing AFTER 5 minutes of lying supine?
Orthostatic Hypotension
What condition involves cellular/tissue hypoxia with hypotension often being first manifestation?
Cardiogenic Shock
What is the recommended treatment for Cardiogenic Shock?
Stabilize patient (ABCs, IV placement, fluids) and determine/treat underlying cause
With which condition does diet play a large role; begins in childhood?
Ischemic Heart Disease (IHD)
What is the most common cause of death/disability in women in U.S.?
Coronary Heart Disease (CHD)
In what three populations does IHD often present atypically, and what does this look like?
- Women
- Elderly
- Patients with DM
Often present as SOB, diaphoresis induced by rest, sleep and mental stress
With which condition do endothelial cells produce nitric oxide (inhibits plaque formation and has anti-inflammatory properties)?
Ischemic Heart Disease (IHD)
Which condition involves substernal chest discomfort (heaviness, pressure, tightness, squeezing, smothering, choking) with radiation to shoulders/arms/neck/jaw/teeth lasting 2-10 minutes (crescendo-decrescendo)?
Stable Angina (Angina Pectoris) - IHD
Which condition involves “Levine’s sign” (fist over sternum), tachycardia, HTN, abnormal heart sounds?
Stable Angina (Angina Pectoris) - IHD
Which condition looks for EKG changes, decreased myocardial perfusion seen on nuclear imaging, drop in systolic BP >10 mmHg or any other symptoms on exercise stress test?
Stable Angina (Angina Pectoris) - IHD
Which condition utilizes the Bruce Protocol (speed/incline increased every 3 minutes until HR is at 85% maximum for age)?
Stable Angina (Angina Pectoris) - IHD
Which condition looks for a perfusion defect seen in areas of hypoperfusion on nuclear stress test?
Stable Angina (Angina Pectoris) - IHD
Which diagnostic test diagnoses wall motion abnormalities in Stable Angina (Angina Pectoris)?
Stress echocardiogram
What is the gold standard test used to evaluate for Stable Angina (Angina Pectoris)?
Coronary angiography/cardiac catheterization
What is the primary recommended treatment for Stable Angina (Angina Pectoris)?
Modifiable risk factor modification
What is the 1st line medication treatment for acute angina? What two things does this medication do specifically?
Nitrates
- Decrease O2 demand
- Reduce preload
What is the 1st line medication treatment for chronic angina? What two things does this medication do specifically?
Beta blockers
- Decrease O2 demand
- Reduce afterload
What type of medication is given at onset of pain and every 5 minutes for up to 3 doses?
Nitrates (NTG)
What type of medication is given to stabilize plaques (reduce clinical event, slow progression/induce regression of atherosclerosis), and for which condition is it used in this way?
Statins
- Treating Stable Angina (Angina Pectoris) - IHD
Unstable angina (UA) and MI (NSTEMI vs. STEMI) are examples of what overall condition?
Acute Coronary Syndrome (ACS) - IHD
Which condition involves plaque rupture/erosion with superimposed occlusive thrombus as most common pathophysiology?
Acute Coronary Syndrome (ACS) - IHD
Which condition involves ischemic symptoms due to vasospasm; chest pain at rest with transient ST-segment elevation; usually in younger patients with few risk factors?
Prinzmetal’s Angina
Which condition occurs at rest OR with increasing severity, frequency, duration
Unstable Angina (UA) - ACS/IHD
Which condition shows negative cardiac enzymes; usually normal EKG (may have ST depression or T wave inversion)?
Unstable Angina (UA) - ACS/IHD
Which condition involves treatment of bedrest/cardiac monitoring/IV access/labs, sublingual NTG x3 every 5 minutes and beta blockers then CCBs if neither offer relief, high-intensity statins, ASA/heparin?
How does this differ from NSTEMI?
Unstable Angina (UA) - ACS/IHD
For NSTEMI, add anti-platelet therapy
Which condition involves a NON-occlusive thrombus?
Non-ST Elevation MI (NSTEMI) - ACS/IHD
Which condition shows positive cardiac enzymes; may have ST depression or T wave inversion on EKG?
Non-ST Elevation MI (NSTEMI) - ACS/IHD
Which two conditions involve symptoms of ischemic discomfort AND occurs at rest, OR severe/new onset or crescendo/progressive pattern?
- Unstable Angina (UA) - ACS/IHD
- Non-ST Elevation MI (NSTEMI) - ACS/IHD
What two conditions utilize TIMI variables to evaluate for progression?
- Unstable Angina (UA) - ACS/IHD
- Non-ST Elevation MI (NSTEMI) - ACS/IHD
Which condition involves acute MI, occlusive thrombus; rupture of vulnerable plaque (ASCAD) → complete occlusion is most common?
ST Elevation MI (STEMI) - ACS/IHD
Which condition shows positive cardiac enzymes AND ST elevation on EKG?
ST Elevation MI (STEMI) - ACS/IHD
What is the leading cause of inpatient death for post-MI complications?
Pump failure
Which two medications are often prescribed post-MI?
- Beta Blockers
- ASA
Which condition often involves treatment of risk stratification (angiography vs. revascularization with early PCI/CABG); possible thrombolytic/fibrinolytic therapy if PCI not available?
ST Elevation MI (STEMI) - ACS/IHD
When is thrombolytic/fibrinolytic therapy recommended, and for which condition?
EARLY and if no contraindications (history of intracranial hemorrhage, history of stroke within 1-year, uncontrolled HTN, aortic dissection, internal bleed)
- ST Elevation MI (STEMI) - ACS/IHD
What is the most common etiology associated with HF?
CAD
What is the most common type of HF?
Left ventricular systolic dysfunction
Which type of HF involves reduced ejection fraction <40%? Is it diastolic or systolic?
HFrEF (left-sided) - systolic
Which type of HF involves preserved ejection fraction? Is it diastolic or systolic?
HFpEF (left-sided) - diastolic
Does HFrEF or HFpEF involve volume overload?
HFrEF (left-sided)
Does HFrEF or HFpEF involve pressure overload?
HFpEF (left-sided)
What is the most common etiology of RIGHT HF?
LEFT HF!!!!!!!!
Which condition has specific risk factors of tend to be older, overweight women with HTN; may have CAD or DM?
HFpEF (left-sided)
What condition involves progressive dyspnea, fatigue/weakness, dependent edema, weight gain?
HF
What specific condition involves dyspnea, diaphoresis, tachypnea, tachycardia, rales/crackles, S3/S4 heart sound?
LEFT HF
What specific condition involves peripheral edema, RUQ pain/discomfort, JVD, ascites?
RIGHT HF
What condition involves edema, elevated JVD, crackles at bases, displaced PMI, S3/S4 gallop, hepatomegaly, hepatojugular reflex on PE?
HF
What is the most useful diagnostic tool for HF?
What other two tests are often utilized?
Echocardiogram
- EKG, CXR (also exercise stress test, cardiac cath)
Which condition utilizes Brain-Type Natriuretic Peptide (BNP), N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) for diagnostic purposes?
What other three tests are often utilized?
HF
- Cardiac enzymes, CBC, CMP
Of the ACC/AHA Stages for HF, what stage involves risk for HF; NO structural changes or symptoms – goal is to intervene at this stage?
Stage A
Of the ACC/AHA Stages for HF, what stage involves risk for HF; structural changes present but NO symptoms?
Stage B
Of the ACC/AHA Stages for HF, what stage involves active HF; structural changes with prior/current symptoms?
Stage C
Of the ACC/AHA Stages for HF, what stage involves active HF; refractory HF with specialized interventions?
Stage D
Of the NYHA Functional Classification for HF, what class involves no limitations on physical activity?
Class I
Of the NYHA Functional Classification for HF, what class involves slight limitations on physical activity?
Class II
Of the NYHA Functional Classification for HF, what class involves marked limitations on physical activity?
Class III
Of the NYHA Functional Classification for HF, what class involves being unable to carry on with any physical activity without discomfort/symptoms, even AT REST
Class IV
What condition involves early detection/treatment of predisposing conditions and high-risk candidates?
Obviously a lot of them lol but this is for HF
What is the recommended initial medication therapy for HFrEF (2)?
- ACE inhibitor
- Diuretics
What is the recommended treatment for HFpEF?
Identify/treat co-morbidities, diuretics for symptomatic relief
What is the recommended starting dose for a patient beginning loop diuretics with HF?
Begin with 20-40 mg Lasix (Furosemide)
- Or Bumetanide/Torsemide
For which two HF medications should you titrate dose and start low, go slow?
- ACE Inhibitors
- Beta Blockers
Carvedilol, Bisoprolol, Metoprolol are examples of which group of medications for HF?
Beta Blockers
Which type of medication should be considered for use in chronic symptomatic HF? Why is this recommended over the typical 1st line options?
ARNI (Ernesto)
- Offers additional vasodilation compared to ACE-I or ARBs
Spironolactone, Eplerenone are examples of which group of medications, and when are they utilized?
Mineralocorticoid Receptor Antagonist (MRA)
- Indicated late in HF treatment process
What type of HF medication should be considered in black patients with no response to ACE-I or ARBs or ARNI?
Hydralazine
What type of HF medication should be considered in patients with concomitant A Fib?
Digoxin
- Titrate dose and start low, go slow
What type of medication is NOT recommended for systolic HF?
Statins
What is a predictor for higher mortality rate in HF patients?
Loss of ADLs
What is the prognosis for HF, and which two causes often lead to death from HF?
Poor prognosis
- Death usually due to progressive pump failure or malignant arrhythmias
Which condition involves treatment of hospital admission with close monitoring of vitals, daily weight, I&Os, potassium changes, give O2 (sat should be 90+); diuretics and NTG?
Acute Decompensated HF
What condition involves heart muscle is structurally and functionally abnormal in the absence of CAD, HTN, valvular disease and CHD?
Cardiomyopathy (CM)
What are the three types of Cardiomyopathy (CM)?
- Hypertrophic CM (HCM)
- Dilated CM (DCM)
- Restrictive CM (RCM)
Which type of CM presents as heart muscle thins, LV dilates?
Dilated CM (DCM)
Which type of CM presents as heart muscle thickens?
Hypertrophic CM (HCM)
Which type of CM presents as heart muscle rigid and unable to relax/fill with blood?
Restrictive CM (RCM)
Which type of CM involves systolic dysfunction; affects males = females?
Dilated CM (DCM)
Which two types of CM involve diastolic dysfunction?
- Hypertrophic CM (HCM)
- Restrictive CM (RCM)
What is the most common cause of Dilated CM (DCM)?
Idiopathic
Which type of CM involves viral is most common cause of infectious in U.S.; diagnose with endomyocardial biopsy?
Dilated CM (DCM)
Which type of CM involves exertional intolerance with SOB, fatigue, CP, palpitations, edema; PE: mitral/tricuspid regurgitation murmur, S3 gallop, JVP, basal crackles?
Dilated CM (DCM)
Which type of CM shows echocardiogram with dilated ventricles and reduced EF; non-specific EKG changes?
Dilated CM (DCM)
What is the 1st line medication treatment for Dilated CM (DCM)? What can be used as alternatives if this fails (3)?
ACE Inhibitors
- Consider diuretics, Beta Blockers, Digoxin if failure to response to 1st line options
Which type of CM involves LVH in absence of a cause like CAD, HTN, valvular disease, CHD?
Where is the most cause of LVH?
Hypertrophic CM (HCM) - Asymmetric LVH of septum
What is the leading cause of sudden cardiac death (SCD) in young persons?
Hypertrophic CM (HCM)
What is the etiology of Hypertrophic CM (HCM)?
Familial
With Hypertrophic CM (HCM), why would the symptoms of DOE, exertional angina, fatigue, presyncope/syncope, palpitations be present (hint: think subtypes of HCM)?
Obstructive/LV Outflow Tract (LVOT) present
- Otherwise, often asymptomatic
Which condition involves crescendo-decrescendo systolic ejection murmur (increases with Valsalva and standing, decreases with squat and isometric handgrip)?
Hypertrophic CM (HCM)
With Hypertrophic CM (HCM), what positions can increase or decrease the sound of the crescendo-decrescendo systolic ejection murmur?
- Increases with Valsalva and standing
- Decreases with squat and isometric handgrip
Which type of CM shows echocardiogram with increased LV wall thickness?
Hypertrophic CM (HCM)
Which two medications are 1st line for SYMPTOMATIC Hypertrophic CM (HCM)?
When would surgery be considered?
Beta Blockers OR Non-dihydropyridine CCBs
- Surgery considered if advanced HF or refractory to 1st lines
Which condition involves risk factors of VT (prior sustained or non-sustained); young age, FH of HCM, massive LVH, unexplainable syncope, brady arrhythmias?
Sudden Cardiac Death
Which of the three CM is least common?
Restrictive CM (RCM)
What is the most common etiology of Restrictive CM (RCM)?
Amyloidosis (infiltrative)
What two tests are diagnostic for Amyloidosis (leading cause of Restrictive CM (RCM))?
- Echocardiogram
- Endomyocardial biopsy is definitive
How does Restrictive CM (RCM) often present clinically?
Right HF symptoms (edema, abdominal discomfort, ascites)
Which condition should Restrictive CM (RCM) be differentiated from (similar sxs, but different hx)?
What is different on PE?
Differentiate from constrictive pericarditis
- S3 gallop heard with RCM but NOT with constrictive pericarditis
Which CM shows echocardiogram with bi-atrial enlargement and large ventricular cavity; non-specific EKG changes?
Restrictive CM (RCM)
Which CM involves treatment of treat underlying cause; low-dose loop diuretics?
Restrictive CM (RCM)
Which type of CM is also called stress CM, apical ballooning syndrome/broken heart syndrome?
Takotsubo Cardiomyopathy (TCM)
Which type of CM is triggered by emotional or physical trigger; mainly in postmenopausal women?
Takotsubo Cardiomyopathy (TCM)
Which CM type involves abrupt onset of acute MI-like symptoms (substernal CP, SOB, syncope); HF symptoms?
Takotsubo Cardiomyopathy (TCM)
Which CM type involves elevated troponin and BNP; ST-segment elevation on EKG that gradually resolves; reduced EF on echocardiogram; wall motion abnormalities on cardiac MRI?
Takotsubo Cardiomyopathy (TCM)
Which type of CM involves treatment of stabilize patient/immediate treatment similar to acute MI with catheterization?
Takotsubo Cardiomyopathy (TCM)
Which condition involves involves HF symptoms (dyspnea, fatigue, angina, syncope, palpitations); on PE, check for heart sounds and murmurs, venous/arterial pulses?
Valvular Heart Disease (VHD)
What is the test of choice for diagnosis of Valvular Heart Disease (VHD)?
Echocardiogram
With valve surgery, what is there increased risk of? What should be given prophylactically to avoid this?
Increased risk of endocarditis
- Require abx prophylactically
Which condition involves narrowing of aortic outflow?
At what location is this most common?
Aortic Stenosis
- Aortic valve most common
Which condition involves 65+ years (valve degeneration/sclerosis); if younger, consider congenital bicuspid valve (30-65 years) OR congenital unicuspid valve (<30 years)?
Aortic Stenosis
Which condition involves the triad symptoms of angina, syncope and HF with late disease?
Aortic Stenosis
Which condition involves grade 3-4/6 midsystolic murmur (crescendo-decrescendo) best heard at 2nd RICS?
Aortic Stenosis
Which condition involves murmur louder with squatting and radiates to neck; thrill in 2nd RICS or suprasternal notch?
Aortic Stenosis
Which condition involves a small pulse pressure = severe disease?
Aortic Stenosis
Which condition shows immobile/calcified leaflets and LVH on echo?
Aortic Stenosis
Of Prosthetic Aortic Valves, which one lasts longer, and which one does NOT require anticoagulation treatment?
- Mechanical last longer, but require lifelong anticoagulation (Warfarin with INR of 2.5-3.5)
- Bioprosthetic do not require anticoagulation, but do not last as long
What condition is a form of subvalvular Aortic Stenosis, and how does the aortic valve present differently (from when aortic valve itself is affected)?
Hypertrophic CM (HCM) - With HCM, the aortic valve is NOT calcified
NOTE: similar symptoms
On PE, how does a HCM murmur differentiate from a murmur of Aortic Stenosis at the valve?
- Aortic Stenosis: louder with squatting
- HCM: louder with standing or Valsalva
Again, what are the 1st line medication treatments for Hypertrophic CM (HCM) (2)?
- Beta Blockers
- Nondihydropyridine CCBs
What condition involves blood leaks back through aortic valve during diastole ?
Aortic Regurgitation
What are the two primary causes of ACUTE Aortic Regurgitation?
- Endocarditis WITH murmur
- Aortic dissection WITH murmur
What are the three primary causes of CHRONIC Aortic Regurgitation?
- Valve disease
- Aortic root dilation
- Combination
Which condition involves a high-pitched/blowing diastolic decrescendo murmur best heard at 2nd-4th LICS?
Aortic Regurgitation
Which condition involves a wide pulse pressure (“water hammer” or “Corrigan” pulse)?
Aortic Regurgitation
Which condition involves Austin-Flint murmur (slow, low-pitched diastolic murmur at apex)?
Aortic Regurgitation
Which condition shows LVH on EKG; LVH and cardiomegaly on CXR; backflow of blood and LVH on echo?
CHRONIC Aortic Regurgitation
- Acute often shows only backflow of blood and LVH on echo
Which condition involves treatment of EMERGENT valve surgery within 24 hours; stabilize with IV vasodilators?
ACUTE Aortic Regurgitation
Which two VHD conditions have similar treatments depending on asymptomatic (monitor sxs and echo) vs. symptomatic (surgery)?
- Aortic Stenosis
- CHRONIC Aortic Regurgitation
Which condition involves leakage of blood from LV back into LA?
Mitral Regurgitation
Which VHD condition can be ischemic (papillary muscle rupture/damage) vs. non-ischemic (endocarditis, trauma, RHD)?
ACUTE Mitral Regurgitation
Which two VHD conditions present as ILL/TOXIC with hypotension, pulmonary edema, shock?
- ACUTE Mitral Regurgitation
- ACUTE Aortic Regurgitation
Which condition involves holosystolic murmur loudest at apex, radiates to left axilla?
Mitral Regurgitation
Which condition shows LAE, LVH and hyperdynamic LV wall motion on echo?
Mitral Regurgitation
Which condition involves urgent surgical consult; stabilize with IV vasodilators (Nitroprusside)?
Mitral Regurgitation
If CHRONIC Mitral Regurgitation and HTN are present, what is the recommended treatment (2)?
- ACE Inhibitors
- Vasodilators (reduce afterload)
If CHRONIC Mitral Regurgitation and hypervolemia are present, what is the recommended treatment (2)?
- Diuretics
- Restrict Na+ intake (reduce preload)
If CHRONIC Mitral Regurgitation and A Fib are present, what is the recommended treatment (2)?
- Warfarin (INR 2.0-3.0)
- Digoxin/antiarrhythmic
Which condition involves ballooning of mitral leaflets back into LA during systole; usually mild and benign?
Mitral Valve Prolapse
Which condition involves atypical/non-anginal chest pain +/- other cardiac, respiratory, neuro, psych sxs?
Mitral Valve Prolapse
Which condition involves mid-late systolic clicks +/- mitral regurgitation?
Mitral Valve Prolapse
Which condition involves treatment of often mild so reassurance, lifestyle changes; if arrhythmias present, use Beta Blockers?
Mitral Valve Prolapse
Which condition involves can be due to mitral valve narrowing, obstructed flow from LA to LV?
Mitral Stenosis
Which condition involves etiology of RHD (Rheumatic Heart Disease) including ARF, pericarditis, myocarditis, valvular lesions (most common) → diffusely thickened valve leaflets or immobile/rigid leaflets?
Mitral Stenosis
Which condition involves symptoms that are often precipitated by sudden exertion, excitement, fever, severe anemia, tachycardia, sexual intercourse, pregnancy, thyrotoxicosis, A Fib?
Mitral Stenosis
What other condition is often associated with Mitral Stenosis?
A Fib
Which condition involves opening snap; mid-late diastolic rumbling murmur best heard at apex?
Mitral Stenosis
Which condition shows valve thickening, reduced valve excursion on echo?
Mitral Stenosis
Which condition are Dabigatran, Rivaroxaban, Apixaban or Edoxaban used to treat?
A Fib
Which condition involves treatment of prevent systemic embolization (can lead to stroke); Warfarin (INR 2.0-3.0); control rhythm and rate to improve symptoms?
A Fib
Which condition involves increased pericardial fluid in closed pericardial sac → increased pressure on the heart and vessels?
Pericarditis
Which condition is associated with viral (Coxsackie, Influenza) vs. idiopathic etiology?
Pericarditis
Which two viruses are often the cause of viral Pericarditis?
- Coxsackie
- Influenza
Which condition involves sharp/pleuritic chest pain: VERY common; sudden onset, occurs in anterior chest?
Pericarditis
Which condition involves chest pain better with sitting up and leaning forward, worse with lying flat, deep inspiration, coughing, sneezing?
Pericarditis
What is a fairly common PE finding specific to acute Pericarditis; scratchy, squeaking heart sound best heard over LSB and when patient is sitting up/leaning forward; varies in intensity
Pericardial friction rub
Which condition involves EKG changes showing new DIFFUSE ST elevation or PR depression?
Pericarditis
Which condition involves new pericardial effusion: fluid in pericardial sac (50+ mL)?
What diagnostic test is used to evaluate this?
Pericarditis
- Evaluate with echocardiogram
In a patient with acute Pericarditis, what diagnostic test should be obtained if high fever or septic/toxic appearing?
Blood cultures
What is the 1st line medication treatment for Pericarditis? What medication is often added on in conjunction?
NSAIDS!!!
- Colchicine often added to reduce symptoms and decrease rate of recurrent pericarditis
What medication is controversial for treatment of Pericarditis, and why?
Glucocorticoids
- Can increase risk for recurrent pericarditis and unwanted side effects
Which condition is associated with Beck’s Triad, and what are the three components?
Pericarditis/Cardiac Tamponade
- Beck’s Triad: hypotension, muffled heart sounds, JVD
Which condition is associated with the triad of hypotension, muffled heart sounds, JVD, and what is this triad called?
Pericarditis/Cardiac Tamponade
- Beck’s Triad
How do you treat Pericarditis/Cardiac Tamponade (2)?
DRAINAGE
- Pericutaneous (pericardiocentesis)
- Surgical (pericardiectomy/pericardial window)
How do you treat Recurrent Pericarditis?
NSAIDs and Colchicine ONLY
- No Glucocorticoids
Which condition involves scarring and loss of normal elasticity → cardiac filling impaired; often viral or idiopathic cause/chronic; can lead to pericardial tamponade; treat with pericardiectomy?
Constrictive Pericarditis
Which condition involves acute pericarditis + muscle involvement; Troponin often elevated?
Myopericarditis
Which condition involves infection of endocardial surface of heart (IE) due to infection of 1+ heart valves or infection of device?
Endocarditis
What are the four types of Endocarditis?
- Native valve IE
- Prosthetic valve IE
- IV drug abuse IE
- Nosocomial IE
What condition involves normal heart valves; rapidly progressive and often fatal?
ACUTE Endocarditis
What condition involves damaged heart valves; indolent = consider fever of unknown origin (FUO)?
CHRONIC Endocarditis
What condition involves “sticky” endocardium → organism introduced and adheres → invades leaflets = destroys valve?
Endocarditis
What is the most common general etiology of Endocarditis, and which two organisms are primarily responsible?
What are two other possible organisms?
BACTERIAL
- Staphylococci: healthcare-associated IE, IV drug abuse IE, community-acquired IE
- Streptococci: community-acquired IE
Also,
- Staphylococcus aureus
- Viridians streptococci
What is the most common symptom associated with Endocarditis?
Fever
Which condition involves fever (most common) +/- chills, anorexia, weight loss; cardiac murmurs; can have cutaneous (ex. Petechiae, Splinter Hemorrhages)?
Endocarditis
Which condition is associated with Janeway lesions?
Endocarditis
- Janeway lesions: non-tender erythematous macules on pads of palms and soles
Which condition is associated with Osler nodes?
Endocarditis
- Osler nodes: tender violaceous nodules on pads of fingers and toes
Which condition is associated with Roth spots?
Endocarditis
- Roth spots: rare, retinal capillary rupture (lesions of retina with pale centers)
Which condition utilizes the Modified Duke Criteria for diagnosis?
Endocarditis
Which diagnostic test is often utilized for Pericarditis because of its HIGH diagnostic yield (must get at least three sets from different puncture sites)?
Blood cultures
What is 1st line diagnostic test for suspected Endocarditis (IE)?
Echocardiogram (TTE)
Which condition is treated with bactericidal abx; referral to cardiac surgeon, ID and cardiology; surveillance with BCx?
Endocarditis
For Native IE, what is the recommended treatment?
Vancomycin for 4-6 weeks
For Prosthetic IE, what is the recommended treatment (2)?
May require surgical replacement of prostheses AND abx treatment for longer (may also need multiple abx)
- MUCH more difficult to treat
Which two types of Endocarditis are associated with higher mortality rate?
- Prosthetic valve IE
- IV drug abuse IE
Which condition involves increased mortality rate if female gender, S. aureus infection, large vegetations, aortic valve infection?
Endocarditis
Which Endocarditis complication etiology is most common?
Embolic
What is the most common indication for cardiac surgery in Endocarditis?
HF!!!
What is the most common cause of death in Endocarditis?
HF!!!
Which type of procedure/surgery requires prophylactic abx if patient has prosthetic heart valves, prior IE, CHD or infected skin/MSK tissue (i.e. Endocarditis concerns)?
DENTAL
How much do I hate myself for making 283 cards about the heart??????
A. L. O. T.
