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PNCE > Cardio > Flashcards

Cardio Flashcards

1
Q

MC cardiomyopathy

A

dilated

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2
Q

dilated cardiomyopathy causes

A

ETOH
pregnancy -> postpartum
viral myocarditisL enterovirus MC (coxsackie B)

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3
Q

dilated cardiomyopathy sx

A

dyspnea, JVD, edema, orthopnea, hepatosplenomegaly, frothy red sputum, pulses alternans
mitral or tricuspid valve regurgitation (holosystolic)
laterally displaced PMI

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4
Q

dilated cardiomyopathy test

A

BNP inc
EKG: tachycardia, LBBB, afib
echo: LV dilation and thickening
dec EF

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5
Q

dilated cardiomyopathy tx

A

low salt
short term: diuretics (furosemide)
long term: ACE (enalapril), BB (metoprolol), spironolactone
severe: LVAD or heart transplant

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6
Q

dilated cardiomyopathy complications

A

arrhythmias
CHF

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7
Q

hypertrophic cardiomyopathy type of HF

A

diastolic

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8
Q

dilated cardiomyopathy type of HF

A

systolic

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9
Q

hypertrophic cardiomyopathy MCC

A

genetic, autosomal dominant

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10
Q

hypertrophic cardiomyopathy sx

A

syncope, dyspnea on exertion, S4, bisfrens pulse (water hammer), sudden death

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11
Q

HOCM murmur sx

A

systolic crescendo decreascendo at LLSB
S4
worse w/ standing of valvalvs
dec w/ grip or swat

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12
Q

hypertrophic cardiomyopathy test

A

echo: asymmetrical wall thickness, LVH

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13
Q

hypertrophic cardiomyopathy tx

A

mainstay: BB (metoprolol), CCB (verapamil)
myomectomy for HOCM

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14
Q

hypertrophic cardiomyopathy tx CI

A

digoxin
ACE
nitrates

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15
Q

restrictive cardiomyopathy common causes

A

Amyloidosis
sarcoidosis
hemochromatosis

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16
Q

restrictive cardiomyopathy sx

A

inc JVP on inspiration (kussmaul sign)
S3, SOB, ascites
peripheral edema, hepatosplenomegaly
RHF sx

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17
Q

restrictive cardiomyopathy test

A

CXR: pulmonary congestion
EKG: low QRS, LBBB
echo: rapid diastolic filling, bilateral atrial enlargement
bx

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18
Q

restrictive cardiomyopathy tx

A

low salt diet
diuretics (furosemide), BB (carvedilol), CCB
tx underlying
heart transplant

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19
Q

takotsubo patho

A

inc sympathetic stimulation resulting in ventricular dilation
from increase of stress or acute stress event

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20
Q

takotsubo sx

A

CP, mimics STEMI w/ no true occlusion

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21
Q

takotsubo test

A

echo: apical ballooning
EKG: ST elevation

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22
Q

takotsubo tx

A

supportive care
anticoagulants

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23
Q

order of conduction system of the heart

A

SA node
AV node
bundle of his (L and R bundle)
purkinje fibers

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24
Q

indications for cardio version

A

afib
aflutter
VT w/ pulse
SVT

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25
Q

when to shock during cardioversion

A

do not shock on T wave

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26
Q

defibrillation indication

A

VTach w/o pulse
Vfib

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27
Q

when pharmacologic cardio version used

A

if electrocardioversion fails

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28
Q

pharmacologic cardioversion

A

IV ibutilide
procainamide
flecainide
Sotalol
amiodarone

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29
Q

sinus brady tx

A

1st line: atropine
definitive: pacemaker

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30
Q

sick sinus syndrome tx

A

permanent pacemaker

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31
Q

1st degree AV block tx

A

observation

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32
Q

2nd degree type I wenkenbach tx

A

atropine
epinephrine
sx: pacemaker

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33
Q

second degree type 2 Mobitz tx

A

permanent pacemaker

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34
Q

third degree heart block tx

A

permanent pacemaker
transcutaneous pacing 1st line

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35
Q

Wolff Parkinson white syndrome patho

A

bundle of Kent
delta wave, shortened PR, wide QRS

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36
Q

Wolff Parkinson white syndrome tx

A

vagal
wide: procainamide
definitive: radio frequency ablation

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37
Q

Wolff Parkinson white syndrome meds to avoid

A

ABCD
adenosine
BB
CCB
digoxin

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38
Q

Wolff Parkinson white syndrome complication

A

A. fib

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39
Q

Wolff Parkinson white syndrome w/ afib tx

A

U= ibutilide

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40
Q

causes of torsades

A

hypomagnesemia
hypocalcemia
hypokalemia

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41
Q

Torsades tx

A

stable: IV Mg bolus
unstable: defibrillation

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42
Q

PEA tx

A

CPR
epinephrine

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43
Q

bundle branch block patho

A

from bundle of his (damaged)
causes wide QRS

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44
Q

atrial flutter sx

A

pt will usually have COPD
inc fatigue, palpitations
can form emboli

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45
Q

atrial flutter tx

A

stable: rate control (CCB, BB, digoxin, vagal)
unstable: cardiovert (chemical: amiodarone, procainamide)
definitive: radio frequency ablasion
anticoagulants

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46
Q

holiday heart syndrome

A

drinking ETOH and afib

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47
Q

afib complication

A

emboli –> stroke

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48
Q

anticoagulation for afib

A

NOAC: dabigatran, riveroxiban, apixiban, edoxibam
warfarin
dual antiplt: ASA + clopidogrel

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49
Q

afib tx

A

stable: CCB (IV diltiazem), BB (metoprolol), digoxin, permanent pacemaker
unstable: synchronized cardio version

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50
Q

PSVT tx

A

stable: vagal, valsalva –> adenosine or CCB
unstable: cardio version
long term therapy: radio frequency catheter ablation

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51
Q

PAC tx

A

BB/CCB
stop causative agent
radiofrequency ablation

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52
Q

PAC causes

A

electrolyte imbalances
anxiety, cocaine use, ischemic damages
reentrant loop (scar tissue post MI)

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53
Q

PVC tx

A

reassurance
BB/CCB
radiofrequency ablation

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54
Q

what can cause PVC

A

anxiety, triggered activity
hypoxia, CAD, hypokalemia

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55
Q

Vtach criteria

A

3+ PVC

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56
Q

V tach complication

A

V fib

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57
Q

V tach tx

A

stable: amiodarone
unstable w/ pulse: sync cardioversion
unstable w/o pulse: defibrillator w/ CPR

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58
Q

v fib tx

A

defibrillation
lidocaine or procainamide
CPR, epinephrine

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59
Q

MC ASD

A

osmium secundum

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60
Q

MC congenital heart defect in adults

A

ASD

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61
Q

osteum premum RF

A

1st septum
downs
fetal alcohol syndrome
often related to mitral/tricuspid valve clefts and VSD

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62
Q

ASD shunt

A

left to right

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63
Q

ASD sx

A

cyanotic
fixed split S2, systolic crescendo decrescendo in 2nd and 3rd LUSB
parasternal heave

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64
Q

ASD test

A

CXR: cardiomegaly
EKG: RAD, RVH, RBBB
echo (diagnostic): RA, RV overload, ASD

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65
Q

ASD tx

A

spontaneous closure in 1st year if small
surgery

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66
Q

ASD complications

A

paradoxical emboli -> cryptogenic stroke
HF
eisenmengers

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67
Q

coarctation of aorta seen in which condition

A

turners syndrome

68
Q

coarctation of aorta infant type

A

MC: preductal

69
Q

coarctation of aorta adult type

A

post ductal: distal to ductus arteriosum

70
Q

coarctation of aorta sx

A

HF in infant
systemic HTN, BP UE>LE
cyanosis of LE, ayanosis of UE
LV failure, delayed/weak femoral pulse
harsh systolic murmur head on back

71
Q

coarctation of aorta test

A

CXR: rib notching, figure 3 sign
EKG: LVH
echo: diagnostic
CT/MRI: coarctation

72
Q

coarctation of aorta tx

A

prostaglandin E1 preop
diuretics: HF sx
surgery: balloon angioplasty stent

73
Q

PDA sx

A

cyanotic, pulmonary HTN, L to R shunt
continuous (Gibson’s) machine like murmur, thrill
wide pulse pressure: bounding pulses (water hammer)
hyper dynamic precordium

74
Q

PDA sx later in life

A

pulmonary HTN, inc pressure -> R to L shunt =
eisenmengers syndrome –> cyanotic

75
Q

PDA test

A

EKG: LVH
CXR
Echo: best
MRI/CT
inc BNP

76
Q

PDA tx

A

indomethacin
surgical correction
usually close w/in 1st week of life

77
Q

tetralogy of fallot abnormalities

A

pulmonary stenosis
RV hypertrophy
VSD
overriding aorta

78
Q

tet spells

A

in tetralogy of fallot
acute extreme hypoxia, cyanosis, syncope, and hyperpnea
worse w/ crying/feeding

79
Q

MC cyanotic heart defect

A

tetralogy of fallot

80
Q

tetralogy of fallot patho

A

chromosome 22 deletion
digeorge syndrome
maternal retinoid acid exposure

81
Q

tetralogy of fallot murmur

A

crescendo decreascendo holosystolic along LLSB
radiating to back

82
Q

tetralogy of fallot sx

A

cyanotic
clubbing
failure to develop

83
Q

tetralogy of fallot test

A

CXR: boot shaped heart, no interstitial lung markings
echo: gold standard
EKG: RAD

84
Q

tetralogy of fallot tx

A

squatting during tet spell
calming, O2, IV fluids
IV prostaglandin E1 (keep PDA open for PE perfusion)
definitive: surgery, can play sports w/ R vent pressure <50

85
Q

IV prostaglandin E1 AE

A

apnea

86
Q

MC baby heart defect of membrane
MC congenital heart disease

A

VSD

87
Q

VSD seen in which conditions

A

downs syndrome

88
Q

VSD sx

A

small: cyanotic, SOB
large: pulmonary HTN –> R to L shunt –> eisenmenger –> cyanotic

89
Q

VSD murmur

A

loud high pitch harsh pan/holosystolic murmur @ LLSB

90
Q

VSD test

A

echo: definitive

91
Q

VSD tx

A

may spontaneously close in 10y
larger VSD: diuretics
+/- digoxin or surgical closure (sx of HF)

92
Q

MC coronary artery to occlude

A

LAD

93
Q

tx unstable angina

A

antithrombotic therapy: ASA, UF heparin, LMWH
adjunct: BB (metoprolol), nitrates, morphine, CCB
BB first line

94
Q

AE LMWH

A

thrombocytopenia

95
Q

RCA occlusion sx

A

affects SA and AV node –> bradycardia

96
Q

hypertension meds safe in pregnancy

A

hydralazine
methyldopa
labetalol
nifedipine

97
Q

hypertensive urgency tx

A

clonidine
captopril
nifedipine
labetalol

98
Q

hypertensive emergency tx

A

sodium nitroprusside
labetalol
hydralazine

99
Q

sodium nitroprusside AE

A

potential thiocyanate and cyanid toxicity w. prolonged use or if renal/hepatic failure

100
Q

hypotension tx

A

fludrocortisone
pyridostigmine
dopamine

101
Q

cardiogenic shock tx

A

ABC
IV dobutamin, milrinone

102
Q

orthostatic hypotension tx

A

fludrocortisone

103
Q

fibric acid derivative CI

A

gemefibrozin, clofibrate
CI in biliary disease

104
Q

acute endocarditis MCC

A

S aureus

105
Q

subacute endocarditis MCC

A

strep viridian’s

106
Q

acute endocarditis tx

A

nafcillin + gent or
vanco + gent

107
Q

subacute endocarditis tx

A

penicillin/ ampicillin + gent
ceftriaxone/ vanco + gent

108
Q

endocarditis IVDU MCC

A

pseudomonas
candida

109
Q

IVDU endocarditis tx

A

vanco

110
Q

prosthetic endocarditis MCC

A

Staph epidermis

111
Q

prosthetic endocarditis tx

A

vanco + gent + rifampin

112
Q

MCC myocarditis

A

viral (coxsackie)

113
Q

myocarditis sx

A

dyspnea, cough, chest fullness,
fatigue, palpitations, edema, S3 murmur
viral prodrome

114
Q

myocarditis test

A

BIT: EKG
cardiac enzymes (may be elevated)
MAT: myocardial bx

115
Q

myocarditis tx

A

tx like CHF until resolve
do not give steroids

116
Q

acute pericarditis MCC

A

viral: coxackie B

117
Q

acute pericarditis sx

A

positional sharp pleuritic CP
worse w/ inspiration or laying down
Bette when sitting up or leaning forward
friction rub
conductive: pericardial knock, S3, RHF sx

118
Q

acute pericarditis test

A

diffuse ST elevation
PR segment depression
echo: definitive
inc ESR/CRP

119
Q

acute pericarditis tx

A

NSAIDS (indomethacin, colchicine) w/ or w/o steroids
surgical: pericardiocentesis
pericardectomy definitive

120
Q

AE colchicine

A

diarrhea

121
Q

cardiac tamponade tx

A

ASAP pericardiocentesis

122
Q

cardiac tamponade patho

A

heart does not stretch fully between contractions
build up fluid in pericardium puts pressure on outside of the heart

123
Q

cardiac tamponade test

A

echo: diagnostic
EKG: low voltage QRS + pulsus alternans

124
Q

pericardial effusion tx

A

colchicine
pericardiocentesis for severe effusion

125
Q

acute rheumatic fever MCC

A

GABHS (S. pyogenes)

126
Q

acute rheumatic fever patho

A

inflammatory dz that can damage heart tissue
hx of strep infection
develops after strep pharyngitis

127
Q

acute rheumatic fever tx

A

rest
PCN or macrolide
NSAIDs/ASA

128
Q

cardiac tamponade complication

A

PANDAS syndrome

129
Q

MC valve in rheumatic heart disease

A

mitral valve

130
Q

rheumatic heart disease h/o

A

repeated episodes of acute rheumatic fever

131
Q

rheumatic heart disease sx

A

mitral stenosis or mitral regurgitation
palpitation, fatigue, CP, dyspnea

132
Q

rheumatic heart disease test

A

echo: confirm
histology: Aschoff bodies (granulomas)
previous strep infx
inc ESR/ASO

133
Q

rheumatic heart disease tx

A

prevent strep infection
prolonged abx tx until 21yo (IM penicillin G or sulfadiazine)
valve repair or replacement

134
Q

kawasaki complication

A

CAD
coronary artery aneurisms
MI

135
Q

harsh systolic creasendo decrescendo rad to neck/carotids
dec w/ valsalva
S2 split

A

aortic stenosis

136
Q

aortic stenosis tx

A

IV fluids
valve replacement definitive

137
Q

early diastolic blowing decrescendo 3rd ICS
water hammer pulse

A

aortic regurgitation

138
Q

de musset sign

A

in aortic regurgitation
head bobbing

139
Q

quinck’s sign

A

aortic regurgitation
fingers pulsing and nail bed change to pale color

140
Q

aortic regurgitation tx

A

low Na diet
furosemide
valve replacement
prophylactic abx

141
Q

MCC mitral stenosis

A

rheumatic fever

142
Q

opening snap followed by S2
diastolic rumble
low pitched murmur at apex

A

mitral stenosis

143
Q

mitral stenosis tx

A

low Na diet
pulmonary congestion -> lasix
afib: digoxin and warfarin
surgery: balloon valvuloplasty or replacement

144
Q

holosystolic blowing murmur at apex
radiating to axilla, loud S3

A

mitral regurgitation

145
Q

mid systolic click rad to axilla w/ palpitations

A

MVP

146
Q

mitral regurgitation tx

A

tx afib: cardiovert, warfarin
pulmonary congestion: diuretic and vasodilators
surgery: valve repair for prolapse, replacement
BB for palpitation (propranolol)

147
Q

ejection click
harsh mid systolic crescendo decrescendo @ LUSB, wide split S2

A

pulmonary stenosis

148
Q

pulmonary stenosis tx

A

balloon valvuloplasty

149
Q

graham steele murmur

A

brief decrescendo best @ LUSB
wide split S2

150
Q

pulmonary regurgitation

A

graham steel murmur

151
Q

pulmonary regurgitation tx

A

none, usually well tolerated
valve replacement

152
Q

tricuspid regurgitation MCC

A

carcinoid heart disease
rheumatic heart disease

153
Q

mid diastolic rumble @ LLSB
opening snap

A

tricuspid stenosis

154
Q

tricuspid stenosis tx

A

diuretics
sodium restriction
valve repair or replacement

155
Q

LLSB holosystolic blowing
radiates to R sternum and xiphoid
inc w/ inspiration

A

tricuspid regurgitation

156
Q

tricuspid regurgitation tx

A

diuretics
salt restriction
valve repair/replacement

157
Q

Aortic aneurism tx

A

<3cm none
3-4cm US Q2-3y
<4.5cm US Q6mo
4.5-5cm Q3-6mo
>5.5cm surgery

158
Q

thoracic aneurism tx

A

BB prevent growth
>5cm repair if bicuspid aortic valve/ morfan

159
Q

aortic dissection tx

A

IV BB
nitroprusside
definitive repair
crystalloids for hypoTN

160
Q

most important RF for aortic dissection

A

HTN

161
Q

Diseases from coxsackie A

A

hand foot and mouth
herpangina

162
Q

diseases from coxsackie B

A

pericarditis
myocarditis
pleurodynia

163
Q

pediatric functional murmurs

A

stills (MC)
venous hum
pulmonary ejection

164
Q

congenital cyanotic heart diseases

A

truncus arteriosis
transposition of great arteries
tricuspid atresia
Tetralogy
total anomalous pulmonary venous return

165
Q

ototoxic drugs

A

abx: aminoglycosides, vanco, macrolides
loop: furosemide, ethacrynic acid
chemotherapeutic: platinum agents, cytarabine
temp: NSAIDs, aspirin, quinine

PNCE (33 decks)

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