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Cardiac HY Flashcards

1
Q

LLSB Holosystolic murmur + apical diastolic rumble

A

VSD
(Intraventricular Septal Defect)

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2
Q

IVDU
subacute fevers & malaise
new murmur heard on auscultation
Dx/Dxt (2)/Tx

A

Infective Endocarditis
Blood Cx (1st)
TEE (2nd)
empiric abx → Penicillin + Vancomycin

IV drugs get PV meds

–septic emboli on CXR–

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3
Q

What 3 types of pts need ppx antibiotics before surgery?

A

Endocarditis hx
Mechanical Valves in place
Unrepaired Cyanotic Congenital Heart Defect (ToF, TGA, TAPVR, PTA, HPLH)

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4
Q

2 Blood culture (+) bugs that require colonoscopies

A

Clostridium Septicum

Streptococcus BOVIS

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5
Q

Very short female with chronic calf pain (claudication)
Dx/Dxt/Tx?

A

Coarctation of Aorta (Turner syndrome)
Xray (Rib Notching s/t collateral intercostal circulation)
Surgery (repair aorta)

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6
Q

Murmurs associated with wide pulse pressure

SBP–DBP >60mmHg (wide)

A

Aortic Regurgitation/Insufficiency
Patent Ductus Arteriosus

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7
Q

Wide, fixed split of the S2 heart sound

A

ASD

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8
Q

Neonate with heart failure
upward-slanting palpebral fissures
epicanthal folds
transverse palmar crease
protruding tongue/ sandal gap
Dx of heart defect?

A

Endocardial Cushion Defect
(Down’s syndrome)

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9
Q

Life long treatment of new prosthetic aortic valve?
Therapeutic target:

A

Life long anti-coagulation (usually Warfarin)
INR 2.5– 3.5

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10
Q

3m hx of new heart valve
now dark urine and indirect hyperbilirubinemia

A

valvular hemolysis

(valves shearing blood cells)

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11
Q

High pitched mid-systolic click at the apex
worsens with valsalva (lowers pre-load)

A

Mitral Valve Prolapse

(prolapse clacks)

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12
Q

MCC of death within 24hrs of having an MI
(ex: pt dies intra-op during PCI placements)

A

V-Fibrillation

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13
Q

Recent MI now has dyspnea, crackles, and
holosystolic murmur at apex

A

Mitral insufficiency
s/t Papillary Muscle Rupture

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14
Q

Recent MI now has dyspnea, crackles, and
holosystolic murmur at LLSB

A

VSD
s/t Intraventricular Septal Rupture

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15
Q

Recent MI now has
Low voltage EKG (fluid in pericardium)
Cardiac arrest (PEA: pulseless electrical arrest)

A

Cardiac Tamponade
s/t ventricular FREE wall rupture

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16
Q

diastolic murmur at the apex with opening snap

A

Mitral Stenosis

(stenosis snaps)

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17
Q

Always get an Echo for what 4 types of murmurs?

A

Diastolic (deadly)
3/6 (or higher)
Holosystolic
Symptomatic

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18
Q

Presents with fever, malaise, joint pain, non-pruritic red rash, heart problems
± skin nodules
Recent hx of URI
Dx/Tx/Cx?

A

Rheumatic Fever (GAS)
Penicillin V + NSAIDs
Mitral Stenosis → A-fib

(J♡NES criteria: joint pain travels, Pericarditis/Murmur, nodules on skin, erythema marginatum,
Sydenham chorea).

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19
Q

Anticoagulant used to treat A-fib in a pt with
◆Valvular heart problem
or
◆hx of Rheumatic Fever

(probably won’t give away h/o RF but may say pt is an immigrant w/murmur)

A

Warfarin
INR 2-3
(use warfarin if A-fib s/t valvular problem)

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20
Q

Opening snap at the apex diastolic murmur:
Biggest risk factor for this murmur:
Most common arrhythmia present:
Anticoagulant strategy if this arrhythmia is present:

A

Mitral Stenosis
Rheumatic Fever
Atrial Fibrillation
Warfarin (if A-fib s/t valvular problem)

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21
Q

Middle age female, very short, syncopal episodes + systolic murmur (RUSB)
Dx?

A

Turner syndrome

(BICUSPID aortic valve → Aortic Stenosis)

Exercise Stress test is c/i in AS

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22
Q

Hx of RF + Continuous, Involuntary, irregular movements of the extremities
Dx/Tx?

A

Sydenham’s Chorea (s/t molecular mimicry)
self resolves

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23
Q

Involuntary, irregular movements of the extremities
+ new or worsening OCD and/or a tic disorder
Dx/Tx?

A

PANDAS
(Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
Self-Resolves

Hx of RF

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24
Q

SBP decreases by more than 10 with inspiration
Low voltage EKG (tiny QRS complex) or alternans (QRS points up and down)
Dx/Tx?

A

Cardiac Tamponade
u/s guided pericardiocentesis

CXR: Water bottle shaped heart

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25
Neck veins distend on inspiration Prominent JVP waves Dx/Tx
Constrictive Pericarditis → (calcified pericardial tissue) Pericardiectomy (CT guided?) (Kussmaul sign)
26
On EKG Diffuse ST elevations and diffuse PR depressions Dx/Tx?
Acute Pericarditis NSAIDs+Colchicine (together) (if recent MI, Aspirin only)
27
Fib vs tach rule
Fib rule: → unequal spaces between QRS (A-fib/V-fib) Tach rule: → equal spaces between QRS complex (v-tach/SVT)
28
ventricle vs atrial (above ventricle) rule
ventricle (V-fib/V-tach) → Wide QRS atrial/above (A-fib, SVT, WpW) → Narrow QRS
29
Pt is Hemodynamically **unstable** (≤ 90/50s) Bradycardia <60 bpm → NBSIM Tachycardia >100 bpm → NBSIM
Unstable + Brady → Transcutaneous **Pacer** Unstable + Tachy → Synchronized **Cardioversion**
30
Management for V-Fibrillation
Defibrillate (Unsynchronized cardioversion) V-fib → D-fib
31
Regular, Wide QRS, Tachycardia
V-Tach
32
Management for **mono-morphic** 1. Pulseless V-tach 2. BP <90/50 (pulse + unstable) V-tach 3. stable V-tach Management for 4. Pulseless **poly-morphic** V-tach (TdP) 5. BP <90/50 (pulse + unstable) TdP 6. Stable Tdp
1. Defibrillate (Unsynchronized cardioversion) 2. Synchronized cardioversion 3. Amiodarone 4. Defibrillate 4. Defibrillate 6. IV Magnesium
33
Regular, Narrow QRS, Tachycardia
Supraventricular Tachycardia (SVT)
34
Treatment algorithm for Supraventricular Tachycardia (SVT)
1st: vagal maneuver (massage carotids, cold water, blow a straw) 2nd: Adenosine (if, 1st fails) 3rd: Verapamil, Diltiazem, or Beta Blocker (after Adenosine)
35
sawtooth pattern on EKG
Atrial Flutter
36
Management of A-Fib & A-Flutter: 1. Unstable (BP <90/50s) 2. Any pt **NOT** unstable
1. Synchronized Cardioversion 2. **1st give** a Beta Blocker *or* (**Diltiazem/Verapamil**) → Rate Control ─── 2b. **Anticoagulation** 2c. **Amiodarone** → Rhythm Control ─── AC can be anything: DOACs, Heparin, LMWH (enoxaparin), Warfarin (MUST be **Warfarin** if h/o valvular dz)
37
Pt presents with palpitations and tachycardia h/o **smoking** or COPD EKG shows irregular tachycardia with **messed up/weird looking** P waves all over Dx/Tx/BRF?
Multifocal Atrial Tachycardia **Diltiazem/Verapamil** (NDDHP-CCB) **Stop smoking**! (biggest risk factor)
38
**Bradycardia** + Long PR interval only (aka **bigger than one big box**) Dx/Tx?
1º heart block no treatment
39
Bradycardia + Long PR interval that keeps getting longer until QRS disappears Dx/Tx?
2º heart block (Mobitz I) no treatment
40
Bradycardia + Long PR interval and QRS disappears after 1-2 beats (QRS complex present once then disappears the reappears and disappears etc.) Dx/Tx?
2º heart block (Mobitz II) Permanent Pacemaker
41
Bradycardia + QRS complexes **very** far apart (like ~ 10 boxes apart), but regular 2-3 P waves without a QRS complex before one shows up (Kinda looks like A-Fib *except* its brady/not tachy & regular/not irregular) Dx/Tx?
3º heart block (Complete heart block) Permanent Pacemaker
42
Unstable (BP <90/50s or AMS) Bradycardia management
Transcutaneous pacing (seems like NBME doesn't care for first-line: IV *atropine*; but Q banks)
43
Hemodynamically **stable** + Polymorphic V-Tach (TdP) NBSIM?
IV Magnesium
44
**Tachycardia** on EKG Wide QRS, with a slurred, slanted start short PR interval (**< 1 big box**) Dx/Acute Tx/Long-Term Tx?
Wolf Parkinson White Acute: **Procainamide** Long-Term: Electrical **Ablation** (via cardiac cath) Ablate accessory pathway (bundle of Kent) that connects atria to ventricles & **bypasses AV node** → ventricular pre-excitation.
45
AMS + flushed skin + dilated pupils + dehydrated Wide QRS Tachycardia + short fat QRS in **aVR** Dx/Tx?
Tricyclic Antidepressants (**TCA**) Toxicity **Sodium Bicarbonate** (TCAs: Desipramine/Imipramine, Amitriptyline/Nortriptyline) Anticholinergic toxidrome: fast fiddle/ hot hare/ blind bat/ dry bone/ empty flask/ red beet/ mad hatter s/t **sodium** channel blockade
46
Dx/Tx?
Hyperkalemia 1. **Calcium Gluconate** 2. Insulin + D5W (glucose) 3. Albuterol (Beta 2 agonist) 4. Kayexelate ──── EKG shows Wide QRS + Tall, peaked P waves
47
Treatment for A-Fib with WpW (irregular tachycardia, wide complex QRS, short PR) What about unstable WpW?
Procainamide (stable) Synchronized Cardioversion (unstable)
48
EKG shows a small bump at the end of the S in the QRS complex (looks like an ST elevation, but it's not. There's a discrete bump as the S ends) aka Osborn or J wave Dx?
Hypothermia
49
7 Drugs that improve survival/mortality in patients with CHF? (one of which primarily in Black pts)
**ACE inhibitors** (Ramipril, Enalapril, Lisinopril) **ARBs** Angiotensin Receptor Blockers (Valsartan, Losartan) **ARNI**: ARBs + Neprylysin inhibitors (Valsartan + Sacubitril) **Beta blockers** (Carvedilol, Metoprolol) **Spironolactone**, Eplerenone (MR antagonist) **SGLT-2 Inhibitors** (Empagliflozin) In African Americans combo of **Dinitrite** Isosorbide + **Hydralazine**
50
Acute Coronary Syndrome management (5)
(1st) **Aspirin** full dose (2nd) Heparin **Anti-Coagulation** (3rd) Clopidogrel **Anti-Platelet** for chest pain: **Morphine** or **Nitrate** ––– (*NO nitrate if **II,III, aVF** changes*)
51
Chest pain worse at night w/ hx of ST elevations & non-occluded coronary arteries Patient is an active smoker and middle aged or younger ± stimulant/cocaine use Dx/Tx?
Variant Angina **CCB** (any kind) + advise **smoking cessation** (Transient coronary vaso-spasms → avoid Beta Blockers)
52
**Pulmonary Embolism** 1. ABG findings __pH __Co2 2. Calcium & Potassium levels 3. NBSIM 4. Diagnostic confirmatory test
1. ↑ pH (Respiratory Alkalosis) ↓ CO2 (Hyperventilating) 2. ↓Ca2+ ↓K+ 3. IV Heparin 4. CT Angiography (+ct) –––– FYI: basic blood is negatively charged thus positive ions are bound
53
When is Tissue plasminogen activator (tPA) indicated in **Pulmonary Embolism**
**Unstable** (AMS, ≤90/50s) or Echo has evidence of R heart strain • RV **enlarged/bulging/abnormal septal motion** • RV **same size** as LV
54
Biggest risk factor for Mitral Stenosis? associated with what arrhythmia?
Rheumatic Fever history Atrial Fibrillation
55
Recent MI with sudden onset severe LLE pain. pulses are absenet Dx/Tx(2)/Dxt?
Acute Limb Ischemia IV Heparin (1st step) → CT Angiogram w/contrast of LE → Embolectomy (surgical emergency)
56
Treatment of Acute CHF exacerbation
1st IV Furosemide If edema persists → ACE-I → Nitrate (FAN of CHF management)
57
presents with carditis and migratory (spreading) arthritis Dx/Tx?
Rheumatic fever penicillin V + NSAIDs (eradicates GAS) –––– causes chorea-like movements (Sydenham chorea) JONES criteria
58
2 medications **contraindicated** in Right Heart MI (II, III, avF)
**Nitroglycerin** **Opioids** These are a **NO** for RHF --- Divine didn't mention this, but Technically, Beta Blockers (if Brady)
59
Treatment of Right Heart MI (II,III,avF)
Normal Saline
60
Recent DVT and then stroke. Dx/NBSIM?
Cryptogenic Stroke PFO (Patent Foramen Ovale) **TEE with a Bubble Study** (bubbles travel to left side heart)
61
systolic murmur radiating to the neck and axilla RUSB
Aortic Stenosis
62
Bounding Pulses Wide Pulse Pressures Diastolic Decrescendo murmur Severe stages → harsh, crescendo-decrescendo systolic murmur
Aortic regurgitation
63
systolic murmur in the 2nd Left ICS S2 **widely** split
Pulmonic Stenosis (wide **not** fixed split like ASD)
64
Holosystolic murmur at LLSB that **increases with Inspiration** ─ VERSUS ─ Holosystolic murmur at LLSB + **apical diastolic rumble** or **Thrill**
Tricuspid regurgitation ─ VSD
65
**Kawasaki disease** • 5+ day Fever • Unilateral cervical LAD • Edema/Desquamation of hands/feet • Red Rash/Eyes/Tongue Mc **Age** group: MC **Ethnicity**: Tx (2)?
children < 5 years Asian & Pacific-Islander Tx: IvIg + Aspirin get an **ECHO**
66
dx/tx? *Tip: look at how it changes in the center*
V-Fib D-Fibrillate Below is another example
67
dx/tx? *Tip: look at **QRS** complex (wide or narrow?) & look at **R-R interval** (Regular or Irregular)*
V-Tach Unstable → SCV Stable → Amiodarone Below is another more obvious example of V-Tach *again, wide QRS, Regular R-R intervals*
68
dx/tx/2 NBME causes *Tip: Look at certain strips and observe the amplitude*
**Torsade de Pointes** (Regular + Wide complex + Sinusoidal ampl) Unstable: **D-Fib** Stable: **IV Magnesium** --- • QT prolonging drugs • Hypo E'lytes (hypokalemia, hypomagnesemia, Hypocalcemia) (can progress to V-Fib)
69
Flip to compare V-Tach vs TdP
70
6 steps to Reading an ECG on NBME **First, r/o MI** → **ST segments** (Elevations/Depressions) Next: •  **Rate** (brady/tachy) → 300/150/100/75/60/50 •  **QRS** (wide/narrow or tall/inverted) nl 1.5 little boxes •  **R-R interval** (regular/irregular) List the next 5 steps
**T wave** (inverted/peaked) → MI/ Hyperkalemia **PR** int. nl 1 big box (depressed/long/sh) → Peri/AVb/WpW **QT** int. nl 2 boxes (long/short) → E'Lytes, Meds **P waves** (consistent/morphology) → MFAT **Extra waves** present? • U wave (inverted, after T wave) → Hypokalemia •  Delta wave (slurred upstroke start to QRS) → WpW • J wave (tiny hump after S wave) → Hypothermia
71
QT prolongation causes on NBME? (4)
Ziprasidone (Anti-psychotic) Hypo– E'lytes (Hypocalcemia) Sumatriptan (Migraines) Ondansetron (Nausea)
72
2 Antipsychotics with High Risk of Metabolic Syndrome
Olanzapine Clozapine (agranulocytosis)
73
Harsh, systolic murmur at cardiac base + ↓ S2 sound
Aortic Stenosis (or Crescendo Decrescendo at RUSB) s/t Chronic RF, Calcified valves, or Bicsupid valves

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