Cardio Flashcards
What is the difference between chronic stable and unstable angina?
Stable: chest pain w/same frequency & intensity for 2 months, substernal/exertional chest pain that is relieved w/rest
Unstable: chest pain at rest
What presents with ST elevation during an episode of chest pain?
Prinzmetal angina
What tests should be ordered and what is the treatment for suspected/diagnosed Prinzmetal agina?
Test: angiography
Tx: CCBs and nitrates
What diagnosis is commonly associated with chest pain at rest and during emotional stress?
Microvascular Angina (Syndrome X)
What is caused by a bacterial infection due to things such as IV drug use, indwelling catheters, failed dental prophylaxis, etc?
Endocarditis
What condition is most commonly caused by S. viridans from the mouth?
Subacute Bacterial Endocarditis
What is commonly caused by staph aureus, presents with dyspnea, cough, chest pain, confusion/AMS, higher fever, splinter hemorrhages, and may be associated with IV drug use?
Acute Bacterial Endocarditis
What is the treatment for subacute/acute bacterial endocarditis?
Abx for 4-6 weeks
Acute may need valve replacement
If a patient presents with angina >30 minutes that radiates, diaphoresis, N/V, dyspnea, anxious appearing, hypertension, and increased respiratory rate, what is your suspected diagnosis?
STEMI
What is the treatment for a patient with suspected/confirmed STEMI?
Aspirin, nitro, O2, IV morphine (MONA), thrombolysis (tPA) or PCI
How is hypertension defined?
BP > or = 130/80
What are treatment options for hypertension?
ACEi/ARB
CCBs
Thiazide diuretics
Beta blockers
What are the differences between malignant, urgent, and emergent hypertension?
Malignant: SBP >140 w/papilledema
Urgent: BP > or = 180/110, treat w/Clonidine
Emergent: BP > or = 180/110 w/organ damage, treat w/nitroprusside
What is your suspected diagnosis for a patient who presents with dyspnea, cough, angina, frothy sputum, pulmonary rales, lower extremity edema, and recent weight gain?
Congestive Heart Failure
What are the treatment options for CHF?
Stage A: control risk factors (HTN, CAD, lipids, lifestyle)
Stage B, C, D: loop diuretics (symptom control), ACEi/ARBs, beta blockers (carvedilol, metoprolol succinate, bisoprolol), spironolactone
Potentially revascularization, valve replacement, mechanical implants, heart transplant
How is atrial fibrillation defined on an EKG?
Irregularly irregular w/no P waves
What is the treatment atrial fibrillation?
Cardioversion (electrical or w/pharm) or ventricular rate control & prevention of thromboembolism
Anticoagulation for cardioversion (3 weeks before & 4 weeks after)
Rate control w/beta blockers, verapamil or dilt (CCBs), or digoxin
Amiodarone for refractory
Pacemaker possibly
What commonly presents with dyspnea, chest pain, and exertional syncope in teens and young adults?
Hypertrophic Obstructive Cardiomyopathy
What is the treatment for hypertrophic obstructive cardiomyopathy?
Avoid strenuous exercise, no treatment if asymptomatic
Ff symptomatic: non-DHP CCB (verapamil) & beta blockers (metoprolol)
IDC implant possibly
What condition commonly presents with complaints of paroxysmal nocturnal dyspnea?
Restrictive cardiomyopathies
What is the treatment for restrictive cardiomyopathies?
Transplant (no other effective treatment)
What is the leading cause of sudden death in young athletes that is characterized by abnormal heart rhythms & sudden death?
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
What is defined as a viral infection that causes inflammation of the heart muscle?
Myocarditis
What condition presents with a rubbing sound on auscultation of the heart that is relieved w/leaning forward?
Pericarditis
What is the treatment for pericarditis?
Supportive (NSAIDs - indomethacin, possibly steroids)
What are the signs/symptoms of peripheral vascular disease (PVD)?
5 P’s
Pain
Pallor
Pulselessness
Poikilothermia (cool feeling)
Paresthesias
What is the 1st line treatment for PVD?
IV UFH
What can present with symptoms that are described as severe interscapular pain that radiates, and is described as “tearing”?
Aortic dissection
What can present with the classic triad of abdominal pain, shock, pulsatile mass, but is usually an incidental finding?
Abdominal Aortic Aneurysm (AAA)
What are the 2 types of aortic dissections?
Type A (Ascending) - younger patients, collagen vascular disorders
Type B (Descending) - older patients, hypertensive, atherosclerosis
What is the treatment for an aortic dissection?
ICU admission, control BP, beta blockade
Surgery on all ascending types
Surgery on descending if rupture, ischemia, or pain
What is the suspected diagnosis in a patient who presents with an ulcer over the distal 1/3 of their leg near the medial malleolus that has brawny (wood) edema?
Venous insufficiency
What are the treatment options for venous insufficiency?
Saphenous vein ablation
Vein stripping
Sclerotherapy
What are possible signs/symptoms of a pulmonary embolism?
Chest pain
SOB
Tachycardia
Anxiety
Hemoptysis
Low O2 sats
Low grade fever
What is the gold standard for diagnosing a PE?
Pulmonary angiography
Spiral CT
What is the treatment for a PE?
Heparin
Must be anticoagulated for 3 months
What is the suspected diagnosis in a patient who presents with unilateral lower extremity swelling that is painful and warm?
Deep Vein Thrombosis
What is the gold standard for diagnosing a DVT?
Contrast venography
Doppler ultrasound
What is the treatment for a DVT?
Heparin (esp. LMWH)
Long-term treatment with Warfarin (monitor PTT with heparin for 3 months, PT/INR w/Warfarin)
LE intermittent compression
If a patient has a distal DVT and is asymptomatic, how can you manage it?
Monitor
What are the characteristics of aortic regurg?
Backflow into L ventricle
Diastolic murmur at L lower sternal border
What might be heard on auscultation of mitral stenosis?
Diastolic murmur w/opening snap at apex
What are the characteristics of mitral regurg?
Backflow into the L atrium
Blowing systolic murmur at apex w/radiation to left axilla
What are the characteristics of mitral valve prolapse?
Bulging of mitral valve leaflet into L atrium during systole
Mid-systolic click at apex
What might be heard during auscultation of tricuspid stenosis?
Rumbling diastolic murmur at L lower sternal border
What are the characteristics of tricuspid regurg?
Backflow into the R atrium
Systolic murmur at L lower sternal border w/radiation to sternum
JVD
What might be heard during auscultation of pulmonary stenosis?
Harsh systolic murmur at upper L sternal border w/radiation to L shoulder
What are the characteristics of pulmonary regurg?
Backflow into the R ventricle
Diastolic murmur at L upper sternal border
Suspected regurg/stenosis should have what test ordered and are commonly treated with what medications?
Test: echo
Tx: ACEi/ARBs, beta blockers, diuretics, or surgery
What disorder presents with palpitations, rapid HR >120, and widened QRS and delta waves on EKG?
Wolf-Parkinson-White Syndrome
What is the treatment for Wolf-Parkinson-White Syndrome?
Radiofrequency catheter ablation
What is beck’s triad, and what diagnosis do these symptoms commonly present in?
Triad: hypotension, JVD, muffled heart sounds
Commonly seen in cardiac tamponade
What test should be done for suspected cardiac tamponade and what is the treatment?
Test: echo
Tx: pericardiocentesis
What commonly presents as QT prolongation due to drugs or alcohol with palpitations, syncope, and dizziness?
Torsades des pointes
What is the treatment for torsades?
IV magnesium
If during auscultation you hear a fixed split S2, systolic murmur at L upper sternal border, what is your suspected diagnosis?
Atrial septal defect
What is the treatment for atrial septal defect?
If small, it may close on its own
Larger defects may require surgical closure
What presents with a continuous machinery murmur on auscultation?
Patent ductus arteriosus
What is the treatment for a patent ductus arteriosus?
Indomethacin
