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Step 2 Amboss > Cardio > Flashcards

Cardio Flashcards

1
Q

Sudden vs gradual LOC

A

Sudden loss usually has cardiac or neruologic etiology such as arrhythmia or seizure

Gradual Loss usually stems from toxins or metabolic problems such as hypoglycemia, hypoxia or drug intonations

vaso vagal syncope can be sudden or gradual in onset

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2
Q

sudden or gradual regaining of conciousness

A

Sudden regaining usually has a cardiac etiology such as arrhythmia, valve disease or ischemia

gradual usually stems from tonic-clonic generalized seizures (post octal state of confusion for 24hrs

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3
Q

LOC and regaining are both sudden. Next best step (NBS)

A

cardiac evaluation

exam normal: ischemia or arrhythmia - needs EKG, telemetry monitor, and troponin level

exam abnormal: need echocardiogram, exclude AS< HOCM, MS

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4
Q

Abnormal cardiac findings for LOC

A

HOCM: harsh systolic ejection murmur louder with decreased preload (standing) LLsternal

AS: pulses parvus et trades, paradox split S@ systolic crescendo decrecendo

MS: opening snap and mid diastolic murmur, pulmonary edema (sever with split of S2)

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5
Q

CAD risk factors

A 
DM (most serious)
Hypertension (most common)
family history of premature CAD
Hyperlipidemia 
Tabacco Smoking
Age >45 men, >55 women
renal disease
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6
Q

Most likely Dx and Most Accurate test

Chest wall tenderness

A

Costochondritis

Physical exam

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7
Q

Most likely Dx and Most Accurate test

chest pain with radiation to the back unequal BP arms

A

Aortic dissection

Chest X-ray with widened mediastinum, chest CT, MRI or TEE confirms

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8
Q

Most likely Dx and Most Accurate test

Chest Pain worse with lying flat meter with sitting, young (<40)

A

Pericarditis

EKG with ST elevation everywhere, PR depression

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9
Q

Most likely Dx and Most Accurate test

chest pain with Epigastric pain better when eating

A

Duodenal ulcer disease

Endoscopy

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10
Q

Most likely Dx and Most Accurate test

Chest pain with bad taste, cough and horseness

A

GERD

response to PPI, aluminum hydroxide and magnesium hydroxide, viscous lidocaine

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11
Q

Most likely Dx and Most Accurate test

chest pain with cough, sputum and hemoptysis

A

Pneumonia

Chest X ray

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12
Q

Most likely Dx and Most Accurate test

chest pain with sudden onset shortness of breath, tachycardia and hypoxia

A

Pulmonary embolism

Spiral CT, V/Q scan

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13
Q

Most likely Dx and Most Accurate test

Chest pain as sharp pleuritic pain, tracheal deviation

A

Pneumothorax

Chest xray

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14
Q

Best initial test for all Chest pain

A

EKG

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15
Q

Indication and signs of ischemia with exercise tolerance test

A

indication: determine presence of ischemia

ST segment depression

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16
Q

Indication and signs of ischemia with exercise thallium or exercise echo

A

inability to read EKG, baseline ST segment abnormalities

Decreased uptake of nuclear isotope or wall motion abnormalities

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17
Q

Indication and signs of ischemia with dipyridamole thallium or dobutamine echo

A

inability to exercise to target HR.. (stop caffeine before dipyridamole)

Decreased uptake of nuclear isotope or wall motion abnormalities

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18
Q

Exam findings that indicate coronary angiography

A

Normal at least decreased with exercise and then normal at rest again. reversible ischemia and can benefit from angio. No change means irreversible “fixed” defect or dead tissue.

angio is the most accurate method to detect CAD and which intervention is needed

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19
Q

Angioplasty vs CABG

A

angioplasty (precutaneous coronary intervention)- 1-2 vessels the persists past medical therapy. best therapy in acute coronary syndrome, no change in mortality

CABG- 3 vessels, left main or 2 vessels in diabetics, >70% (lowers mortality)

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20
Q

First line stable anginia teraphy

A

Beta Blocker. decrease myocardial contractility, HR, and O2 demand. Decreased HR, prolongs diastole, increased percussion.

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21
Q

Most common adverse effects of statin medications

A

Lyver dysfunction: elevated transaminases. routine AST ALT testing

myositis, and rhabdo soccer in less the 0.1% worsened by gemfibrozil

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22
Q

Clear indications for statin use

A 
acute coronary syndrome
MI/ Stenting 
Any arterial disease
10yr risk of CAD >7.5%
CAD- LDL goal <70
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23
Q

Should yo use calcium channel blockers in CAD?

A

CCB increases mortality in CAD bc of raising heart rate effect.

Only use CCB in CAD if

  • sever asthma (preclude use of BB)
  • prinzmetal angina
  • cocine induced chest pain (BB contraindicated)
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24
Q

Adverse effects of calcium channel blockers

A

Edema
constipation
heart bloak

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25
Q

ADR Niacin

A

Elevation in glucose anuric acid level, pruritus

Aspirin reduces flushing

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26
Q

ADR cholestyramine

A

flatus and abdominal cramping

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27
Q

What is an S4 gallop? What is associated with it

A

S4 gallop is the sound of atrial systole as blood is ejectied into a stiff ventricle.
acute coronary syndromes (ACS) are associated with an S4 gallop because of ischemia leading to noncompliance of the left ventricle

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28
Q

Kussmaul Sign

A

increase in JVP on inhalation.

associated with constrictive pericarditis or restrictive cardiomyopathy

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29
Q

EKG MI Findings with prognosis

A

Anterior (worse): V2-V4 ST elevation
Inferior: II,III, aVF ST elevation
Posterior/ Septal (best): V1-V2 ST depression
Lateral: I, VL,VR, V5, V6

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30
Q

Most appropriate first step in MI

A

Aspirin and a second anti-platelet- lowers mortality in ACS

  • angioplasty (greatest mortality benefit) within 90min
  • thrombolytics (less mortality benefit)
31
Q

Checking for reinfaction

A

EKG new ST segment abnormalities

CK-MB- better at detaching reinfection returns to normal in 24-48 hrs

32
Q

Decreasing risk of restenosis after stenting

A

P2Y12 antiplatelets: Clopidogrel, Prasugrel (best evidence)

Drug-eluting stent (paclitacel, sirolimus)- inhibit local T cell response

33
Q

Complications of PCI

A

Rupture of coronary artery with inflation
Restenosis
Hematoma at site of entry to artery (femoral artery)
Distal cholesterol embolization

34
Q

Symptoms of distal; cholesterol embolization

A

lived reticularis
eosinophilia/eosinophiluria after cath
low complement
high ESR

35
Q

Contraindications to throb-lyrics

A 
major bleeding into bowel or brain 
recent surgery (2weeks)
Severe hypertension (>180/110)
Nonhemorrhagic struck within 6mos
36
Q

Time of correct answer to thrombolytics

A

in any patient with chest pain and ST segment elevation within 12hrs of onset of pain. ideal within 30min of ED door, best benefit within 2hours of pain

37
Q

Treatment in chest pain with st segment depression

A 
LMW heparin (better than unfrac interns of mortality)
prevent clot from growing and closing off artery

GP2b3a (abiximab)- best for non st elevlation undergoing pci and stent

38
Q

PCI indication in non ST elevation ACS

A 
Not better:
-persistent pain
S3 gallop of CHF
Worse EKG or sustained ventricular tachy
rising troponin
39
Q

MI Complication Bradycardia

A

Sinus Brady- insufficiency of SA node
3 AV Block- cannon A waves

Atropine
pacemaker (if atropine not effective)

40
Q

MI Complications Tachycardia: Right ventricular infaction

A

inferior was MI and clear lungs

treat with high volume fluid replacement 
avoid nitroglycerin (worsens cardiac filling)
41
Q

MI Complications Tachycardia: Tamponad / Free wall rupture

A

Sevral days
sudden loss of pulse
lungs are clear
PEA

Emergency pericariocentesis
Repair

42
Q

MI Complications Tachycardia: V Tach/ V fib

A

monitor MI in ICE for several days

defibrillator/ cardioversion

43
Q

MI Complications Tachycardia: Valve or septal rupture

A

new onset murmur
pulmonary congestion

Mitral regurgitation- apex and radiation to axila
Ventricular septal- LL sternal border, step up oxygenation

Most accurate test: Echo

44
Q

MI Complications Tachycardia: extension of the infection/reinfaction

A

recurrence of pain
new rales
new bump in CKMB
sudden pulmonary edema

Redo MI treatment

45
Q

Discharge meds for MI

A 
Aspirin (forever) & P2Y12 (12mo)
Beta Blocker 
Statin 
ACEi (AWMI or EF <40)
Spironalactone if EF<40

Prophylactic antiarrythmics increase mortality

46
Q

Causes of CHF

A

infection
cardiomyopathy
valvular disease

47
Q

Presentation fo CHF (clinical diagnosis)

A 
Orthopnea
peripheral edema
rales 
JVD
paroxysmal nocturnal dyspnea 
S3 gallop
Pulmonary edema (worst form of CHF)
48
Q

Hemodynamic changes in CHF

A 
decreased CO
increased PWCP
increased LVED volume
increased TPR
no changes in CVP
49
Q

CHF tests

A 
Echo (most important- evaluated EF)
TTE (best initial exam 
Nuclear ventriculogram (most accurate- rare use)
50
Q

CHF cause tests

A 
EKG- MI, heart block
Xray- Dilated cardiomyopathy
Holter- paroxysmal arrhythmia 
Cath- valve and septal defect
CBC anemia 
Thyroid function
Biopsy- amyloid, sarcoid and most accurate for infections.
51
Q

Tx systolic CHF

A

ACE/ARB- all patients at any stage BB (metropolis and carvedilol)- antiarrhythmics not for acute CHF
Spironolactone- first line (eplerenone is gynecomastia develops) Diuretics- symptomatic control

52
Q

Valvular Disease Diagnostic Tests

A

Best Initial: Echo (TEE more sensitive)
Most Accurate: Catherterization

Right sided increase in inhalation
left with exhalations
murmurs that dont change HOCM and MVP

53
Q

Valvular Disease Treatment

A

Stenosis: correction of anatomy
Regurg: vasodilator therapy (ACE/ARB, nifedipine, hydralazine). Surgical correction before heart dilation.

54
Q

Mitral Stenosis Clues

A

Pregnant and Immigrant (RF)

SOB, CHF

  • Dysphagia (dilated LA)
  • Hoarseness (LA pressing laryngeal nerve)
  • A-fib and stroke from emornouse LA
  • Hemoptysis
55
Q

Mitral Stenosis Murmur

A

after s2 with opening snap

increased by equating and leg raising

56
Q

Aortic stenosis clues

A

old or bicuspid valve
angina
syncope]left ventricular hypertrophy

57
Q

Aortic Stenosis murmur

A

systolic crescendo decrescendo murmur
second right intercostal space
standing, handgrip, and valsalva decrease murmur

58
Q

Mitral Regurgitation

A

Holosystolic
radiates to axilla
worse with handgrip, equating and leg raise

59
Q

Aortic regurgitation

A 
Wide pulse pressure
water hammer (bounding) pulse 
Quincke pulse (nail bed)
Hill Sign (BP legs 40 more then arms)
Head Bobbing (de Musset sign)
Diastolic decrescendo murmur
60
Q

Cardiomyopathy Best initial test

A

Echo. also most accurate

61
Q

Dilated Cardiomyopathy

A

causes
MI and ischemia

ABCCCD
alcohol
beri beri 
cocaine 
coxsackie (post viral)
chagas
Drugs (doxorubicin, radiation)
62
Q

Hypertrophic Cardiomyopathy

A

HF with preserved ejection fracture. heart can’t relax to fill in diastole
HTN most common cause

63
Q

HOCM

A

hypertrophic obstructive cardiomyopathy

genetic, septum is abnormally shaped. asymmetrical obstruction between septum and valve leaflet blocks blood leaving heart.

systolic anterior motion of heart

64
Q

HOCM tx

A

beta blockers best initial

ace and diuretics contraindicated

65
Q

Restrictive cardiomyopathy

A 
heart neither contracts nor relaxes. 
causes: 
sarcoidosis 
amyloid
hemochromatosis 
end-myocardial fibrosis 
scleroderma
66
Q

Pericarditis causes and tx

A

Infection: Coxsackie(mcc), Staph, Strep, fungal
Connective tissue: SLE (mcc), Wegener, good pasture, RA, PAN

TX: NSAID +Colchicine

67
Q

Pericarditis presentation

A

sharp chest pain that changes with respiration. worse with laying flat “stretch of pericardium”

EKG- defuse st elevation and PR segment depression (more specific)

68
Q

Pericardial Tamponad

A

Hypotension,
Tachycardia
Distended Veins
Clear Lungs.

tx: pericardiocentesis. window

69
Q

Constrictive pericarditis

A

Kussmaul sign
Knock- extra heart sound from filling again pericardium
Signs of RHF

Xray best initial
MRI/ CT most accurate
square root sign on cardiac cath

70
Q

PAD “most likely diagnosis”

A 
Leg pain walking up or down hills received by rest
loss of hair
loss of sweat glands
loss of sebaceous glands 
(smooth shinny skin)
71
Q

PAD testing and tx

A

ABI- best initial
angiogram- most accurate

cilostazol- most effective
aspirin or vorapaxar
place on statin
surgery

72
Q

Peripartum Cardiomyopathy

A 
Antibodies against myocardium
develops after delivery most cases
LV dysfunction (reversible but if not must undergo transplant).
will worsen if pregnant again
worst cardiac condition in pregnancy
73
Q

Peripartum Cardiomyopathy TX

A 
ACE/ARB (if after delivery)
BB
Spironalactone
diuretics 
digoxin
74
Q

Eisenmenger syndrome (pregnancy)

A

development of right to left shunt from pulmonary hypertension. preexisting VSD
2nd worst cardiac condition in pregnancy..

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