Cardio 1 Flashcards by Kelsey Johnson

Q

Hamman’s Sign

A

Diangosis- Spontagnous Pneumomediastium

crunching sound heard on auscultation of the mediastinum with each heartbeat

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Treatment for Spontagnous Pneumomediastium

A

Self limiting
on CXR will show air around heart
* painful neck area and crunching heard

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

PPD what size of induration to be postitive

HIV

A

<5mm

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

PPD what size of induration to be postitive

Health Care worker

A

> 10mm

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

PPD what size of induration to be postitive

IV drug user

A

> 10mm

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

PPD what size of induration to be postitive

Child

A

> 10mm

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

PPD what size of induration to be postitive

know risk factor for TB

A

> 15 mm

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

which of the following findings is most suggestive of Pneumocystis jiroveci pneumonia

A

Serum Lactate dehydrogenase

the higher the value the worse prognosis

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Sarcodosis will have what main buzz words

A

cough, fever
uveitis
bilateral adenopathy
Subcutanous nodules - erythema nodosom

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Causes of Trasudative pleural effusion

A

CHF
Cirrohsis
PE
Nephrotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Causes of Exudative pleural effusion

A

Maligancy
TB 
Bacterial or viral PNA 
pancreatitis 
Collagen disorders 
Esophagus rupture
lupus *

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Age 55-80 history of 30 years Smoking what is the screening test

A

low dose CT scan

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What lab value is elevated in Scarcodosis

A

ACE
serum angiotensin converting enzyme *
ESR
Hypercalcemia

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

most common cause of restrive cardiomyopathy

A

amlyodosis

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

what is the most common cardiomyopathy

A

dilated - “Fat heart”

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Systolic or diastolic

Dilated

A

Systolic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Systolic or diastolic

Restricitive

A

Diastolic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Systolic or diastolic

Hypertrophic

A

Diastolic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Most common cause of Dilated cardiomyopathy

A

*Virus- young healthy
Genetic
*Alcoholism 
postpartum 
chem
heroin

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Key terms- CHF, weakness, SOB, periperal edema
on exam- crackles, S3, JVD
xray- fluffy inflitrates, increased cardiac sillouette

A

Dilated cardiomyopathy

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Best diagnostic tool for cardiomyopathies

A

ECHO-> either
TTE
TEE

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Most common cause of restricitive cardiomyopathy

A

*Amyloidosis
Sarcoidosis
radiaion
Diabetes

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What is the diagnosis-

TTE shows marked biatrial enlargment with non-dialted ventricles

A

Restrictive cardiomyopathy

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Best diagnostic test for Restrictive cardiomyopathy

A

TTE & definitive Biopsy

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Key terms- heart murmur | middiastolic crecendo-decredo increases with valsalva and decreases with squatting

Hypertrophic cardiomyopathy

Treatment for HOCM | what do you want to avoid?

BBlockers, impant defib | avoid postitive ionotropes - epi

Rate is 50 P waves in II, III, AVF

Sinus bradycardia

Rate 50 No P waves in II, III AVF, QRS narrow

Junctional Rhythm

Rate 20-40 wide QRS

Ventricular rhythm

1 P wave for every QRS, PR prolonged >0.2 constant

1 degree AV block

P waves upright, QRS narrow, PR progessively increasing and one dropped QRS not followed by a P wave

2 degree, Type I AV block | Wenckebach

P waves upright, QRS narrow, PR is contant, dropped QRS not followed by a P wave

2 degree, Type II AV block | PACE THEM

P waves upright, QRS regular, but irregular PR intervals | P waves and QRS waves are unrelated

3 degree AV block | PACE THEM

Rate >100, P wave for every QRS

Sinus Tachycardia | P wave can be attached to T wave - camel hump

Rate >150, P waves can be hidden or followed by a QRS

Superaventricular Tachycardia

Rate >300, sawtooth waves

Atrial flutter

Treatment for Atrial Flutter

AV node blockers amiodarone cardioverision anticoagulation

No distinct P waves, regular artial activity but irregularly irregular

Atrial Fibrillation- A fib

Treatment for A fib

AV node blockers amiodarone cardioverision anticoagulation

3 or more P wave Morphology

Multifocal artial tachycardia caused by: COPD Theophyllin

How do you figure out someones max heart rate?

Their age - 220

Rate >120, Wide QRS complex, no clear P waves

Ventricular Tachycardia

Treatment of V tachycardia

Liocaine Procainamide Amiodarone Cardioversion

Polymorphic V- Tach

Torsades de pointes

Prolonged QT >500msec

Polymorphic V- Tach | Torsades de pointes

Causes of Polymorphic V- Tach

``` Torsades de pointes : Hypo K Hypo mag Hypo Calcium sodium channel blockers increase intracrainal pressure Hypothermia ```

What drugs do you need to avoid in WPW

``` AV node blockers -> bblockers -> calcium channel blockers -> digoxin -> amirodarone YOU WILL KILL THEM ```

Exteme rapid rate, disorganized ventricular activity, No pulse, patient is unresponsive what is diagnosis & treatment

Ventricular Fibrillation | DEFIBRILLATION

What are the two Tachycardias that you DO NOT SHOCK

Sinus tachy and Multifocal atrial tachy

Treatment for SVT

1. Vagal - ice pack on face 2. Bolus of saline 3. Adenosine- type IA 4. Bblockers 5. Amidrodrone

How do you administer Adenosine? what are some side effects to warn the patient?

PUSH ! half life of 10sec Then follow by saline and elevate arm warn the patient they will feel super flushed and feel pressure in their chest

What is the most effective medication for cardioversion

Procainimide

Drug category: Pheneizine Tranylcypromine Selegiline

Monoamine Oxidase Inhibitors- MAOI's

MOA: inhitibts MAO which breaks down catecholamines

Monoamine Oxidase Inhibitors- MAOI's Pheneizine Tranylcypromine Selegiline

Side effect: Hypertensive crisis with tyramine containing foods like cheese, wine.

Monoamine Oxidase Inhibitors- MAOI's Pheneizine Tranylcypromine Selegiline

Drug category: Amitriptyline Imipramine Doxepin

Ticyclics

MOA: inhibits reuptake of serotonin, norepinephrine and dopamine

Ticyclics Amitriptyline Imipramine Doxepin

Side effects: Dry mouth, urinary retention, blurred vision, sedation, orthostatic hypotension, setotonin syndrome

Ticyclics Amitriptyline Imipramine Doxepin

``` Drug category: Fluoxetine paroxetine Sertaline Citalopram Escitalopram ```

Selective serotonin reuptake inhibitors- SSRI's

MOA: Inhibitis reuptake of serotonin

Selective serotonin reuptake inhibitors- SSRI's

Side effects of this drug: Loss of libido weight gain serotonin syndrome

Selective serotonin reuptake inhibitors- SSRI's

Drug category: Venlafaxine Desvenlafaxine Duloxetine

Serotonin Norepinephrine reuptake inhibitors - SNRI

MOA: inhbits reuptake of serotonin and norepinephrine

Serotonin Norepinephrine reuptake inhibitors - SNRI

Side effects of this drug: Loss of libido, increased blood pressure, serotonin syndrome

Serotonin Norepinephrine reuptake inhibitors - SNRI

``` Drug category: Nefazodone Vortixetine trazodone Vilazodone ```

SSRI/ 5HT agonists

MOA: norepinephrine and dopamine retuptake inhibitor

Bupropion

Bupropion side effects

anxiety Restlenssness insomnia lowers seizure threshold * do not give to anorexic patient

``` Drug cateogry: Diazepam Lorazepam Temazepam Oxazepam ```

Benzodiazepine

MOA: GABA agonist, decreases neuronal excitability

Benzodiazepines & Barbiturates

What is the reversal agent to Benzodiazepines

Flumazenil

Drug category: Phenobarbital Pentobarbital

Barbiturates - used for anesthesia and seizures

what drug increases the P450 system

Barbiturates: Phenobarbital Pentobarbital

what are the two types of heart failure

low out put | high out put

What are cause of low-out put heart failure

1. Coronary artery disease 2. hyptertension 3. valve disease 4. cardiomyopathies

EXAM* | What are cause of High-out put heart failure

1. Thyrotoxicosis 2. Severe anemia 3. Beriberi - thiamine def 4. Paget's disease

What is the most common cause of right heart failure

LEFT heart failure

BNP levels are important for what disease state?

Heart failure >500 decompensated CHF if chronic 100-500

what conditions can cause mild elevation in BNP | EXAM*

1. chronic CHF 2. eldery women 3. Pulmonary embolism 4. COPD 5. pulmonary hypertension

What will a x-ray of CHF look like | in progression of disease

1. cardiomegaly 2. cephalization-> fluid in upper lungs 3. Kerley B lines-> lateral lung fields 4. Alveolar fluid 5. Pleural effusions

what two medications have been proven to reduce morality in Heart Failure

ACE - reduces afterload | BBlockers

What medications decrease preload?

Nitrates | Loop diuretics

What medications decrease afterload ?

ACE high nose nitrates Nitroprusside

What medication decrease preload and afterload

Nitrates

Most common cause of Primary essential hyptertension

``` Alcohol AA Smokers Lack of exercise NSAIDS ```

Normal BP Prehypertension Stage 1 Stage 2

<120 / 80 120-139 / 80-90 140-159 / 90-99 >160

What are blood pressure goals for ALL >60, DM & CKD

< 140 / 90 | <150 / 90

If an african amercian is placed on ACE what are they are risk for?

Angioedema

Causes of refactory hypertension

``` phenochromocytoma Renal artery stenosis coractation of the aorta Cushings chronic steroid use hyperaldosteronism ```

what are some causes of hypertensive emergencies

``` Aortic dissection pulmonary edema MI Cerebral hemorrhage encephalopathy preeclampsia/ ecclam ```

Severe HTN, elevated BUN, optic disc is fuzzy

Malignant hypertension | - > paplliedema

What is the BP level of Hypertensive urgency | Hypertensive emergency

urgency > 180 / 120 no organ damage Emergency > 160/120 organ damage

Treatment for urgency

Quicker! 24 hour rule 25% within the first few hours IV drip

Treatment for Emergency

Gradually! 24-48 hour rule less than 25% within the first hour Goal 2-6 hours get BP 160/100

Hypertensive emergency will have what organs affected?

``` Hypertensive stroke seizure Encepahlopathy retinopathy- hemorrhages, exudates, papilledema elevated BUN/creatinin ```

Treatment for Acute aortic syndrome with | hypertensive emergency

this one you can decrease BP as fast as you can IV bblocker <60bpm, systolic 100/120

Treatment for Neuologic hypertensive emergency

CCB first line | Nicradipine

Treatment for Aortic hypertensive emergency

1. bblocker : Esmolol | 2. Nitroprusside

Treatment for Acute MI hypertensive emergency

1. Nitro | 2. BBlocker - give 2

Treatment for | Acute heart failure hypertensive emergency

Nitroprusside

What cardiac drug can cause cyanidie toxicity and drug is light sensitivity

Nitroprusside

Treatment for | Renal hypertensive emergency

1. CCB- nicardipine | 2. BBlocker- lobetalol

Treatment for | Pregnancy with hypertensive emergency

1. Hydralazine 2. Labetalol 3. magnesium sulfate with preclampsia/eclampsia