Cardio Flashcards
What are the parts of the pericardium?
Fibrous: Tough, inelastic, & outer connective tissue. Anchors & prevents over-stretching.
Serous: Thinner, delicate, & forms double layer.
Parietal layer: Fused to fibrous pericardium.
Visceral layer (epicardium): Adheres tightly to heart.
Lubricating fluid: Prevents friction.
What is the function of the pericardium?
Protects & holds heart in place.
What are the 3 main divisions of the AORTA?
Ascending Aorta
Aortic Arch
Descending Aorta
25 y F with INFLUENZA 2 weeks ago and now has CHF symptoms? What is the diagnosis?
Pericarditis
What does an EKG on patient with pericarditis look like?
Diffuse ST-segment elevation
45 y M IV drug user or recent dental procedure with new murmur and fevers. Very sick. Streaks on a couple fingers nails. Painless nodules on hands /feet. What is your diagnosis?
Endocarditis
Streaks in finger nails = splinter hemorrhage
What medication do you use to treat DVT or PE?
Lovenox 1mg or Heparin 80 units
What color is blood on US (ultrasound)?
Red: Flowing TOWARD probe.
Blue: Flow going AWAY from probe.
What would an CXR show on dissecting aortic aneurysm?
Widened mediastinum
What vessels we look for in bruits?
Temporal arteries
Carotid arteries
Abdominal aorta
Renal arteries
Iliac arteries
Femoral arteries
Ultrasound: You see a large dark ring around the heart on ultrasound exam…what is this called?
What color is blood on ultrasound? Solids?
Red: flowing toward probe
Blue: flowing away from probe
What is the dial called to adjust the brightness on ultrasound?
Gain or “amplification”
What is difference between bell and diaphragm?
Bell hears low-pitched sounds.
Diaphragm hears high-pitched sounds.
On exam we do 3 different portions? Avoid ?
What physical exam test is positive in suspected DVT?
Homan’s sign
What does pitting edema represent?
Fluid retention
What are crackles?
Pulmonary edema
Pitting edema 2mm =
Pitting edema 4mm =
Pitting edema 6mm =
Pitting edema 8mm =
1) 1+ Slight pit, disappears rapidly (2-3 mm in depth).
2) 2+ Somewhat deep pit, disappears in 10 to 15 seconds (4-5 mm in depth).
3) 3+ Noticeable deep pit that lasts more than a minute (6-7 mm in depth).
4) 4+ Very deep pit that lasts 2 to 5 minutes (8-9 mm in depth).
What is claudication?
Cramping pain or tiredness in the thigh, calf, or foot with
walking or exercise and relieved by rest.
Where would you best hear the AORTIC VALVE? Mitral Valve?
Aortic valve: 2nd R intercostal space at R sternal border
Mitral valve: Apex 5th intercostal space midclavicular line
Pitting edema usually means what? Coming from arteries or veins?
Fluid build-up in veins
Is CHF usually unilateral or bilateral?
Unilateral
Most common type of CHF is left ventricular systolic failure.
Is DVT usually unilateral or bilateral?
Unilateral
-MURMUR – Young female asymptomatic (or mild symptoms) with midsystolic click
-MURMUR – Old patient with crescendo – decrescendo murmur. Thinking?
-MURMUR – Pansystolic in old person
-Mitral valve prolapse
-Aortic stenosis
-Rheumatic heart disease
What is JVD? When and why do we use? When is it positive ? (>9cm)
Jugular vein distention
Suggests ventricular failure.
Vessels we look for in bruits?
Carotid arteries
PMI – how can it be used clinically?
Point of apical impulse being most readily seen/felt. Diameter shouldn’t exceed 1 cm.
Pulses rated?
Bradycardia: Below 60 BPM
Tachycardia: Above 100 BPM
What would an CXR show on dissecting aortic aneurysm?
Widened mediastinum
What are the locations of the chest leads? Limb leads?
You knowwwwww
Best test to get in someone that has a murmur or CHF?
ECG
What are the different parts of basic EKG? What do they represent?
-P wave: Representing atrial depolarization
-QRS Complex: Representing ventricular depolarization (masks atrial
repolarization due to size).
-T wave: Representing ventricular repolarization
How do we diagnose a DVT?
D-dimer is one of the protein fragments produced when a
blood clot gets dissolved in the body. It is normally undetectable or
detectable at a very low level unless the body is forming and breaking
down blood clots.
How do we diagnose a PE?
-CXR: Will be normal
-EKG: Is abnormal in 70% of patients, however the most common
abnormality is Sinus Tachycardia or non-specific ST and T wave
changes.
-Helical CT pulmonary angiography is the imaging study of choice.
-Ultrasonography of extremities to look for DVT.
- All patients with CP should get?
A patient has HTN emergency. What are the treatment goals?
Need to establish IV, Oxygen if saturation < 94%, monitor with
telemetry.
Goal is to reduce BP by 25% within one to two hours, then slowly
decrease to 160/100 in the next 24 hours.
Potential symptoms of HTN emergency?
1) Hypertensive encephalopathy
2) Intracranial hemorrhage
3) Ischemic stroke
4) Hypertensive nephropathy
5) Unstable angina, AMI, CHF, or Aortic dissection.
6) Pulmonary edema
Do we use PO or IV in HTN Emergency?
IV
Do we use PO or IV in HTN urgency?
PO
Difference between HTN emergency & urgency? Even + UA for blood or protein.
END ORGAN DAMAGE
What are the 2 stages of HTN?
Stage 1 HTN: 130-139/80-89
Stage 2 HTN: >140/>90
What meds are first line in treatment of HTN? MOAs?
-Diuretics: HCTZ 12.5-25mg reduce peripheral vascular resistance.
-ACEi: Lisinopril/Enalapril/Captopril 5-10mg. S/E is cough.
-ARBs: Losartan 50mg
-CCB: Diltiazem 180mg & Amlodipine 2.5mg
-Alpha Blockers: Terazosin 1mg used for prostate hyperplasia.
-Patient has a BP of 130/85. Stage?
-Patient has a BP of 165/95. Stage?
-Stage 1
-Stage 2
How many times do we need BP checked to confirm HTN diagnosis?
Patients must have elevated BP recordings on 3-5 separate
visits. R/O causes of secondary HTN if suspect due to
secondary causes.
-A 45 y M with ASCVD score of 7%? Treat?
-A 45 y M with ASCVD score of 11%? Treat with?
-A 45 y M with ASCVD score of 3%? Treat?
-
80 y M has significant pain on walking in both LE. Better with rest? This is called? Likely diagnosis?
Major preventable RF for PVD?
Smoking cessation
PVD occurs in what vessels ?
Any blood vessel outside the heart: Veins, arteries, lymphatic vessels
Uncontrolled __________ leads to arterial disease and plaque formation?
Blood pressure
What are 6 P’s in patient with acute occlusion in PVD? What could you treat with ?
Pain
Pallor
Poikilothermia
Pulselessness
Parenthesis
Paralysis
Treat with Lovenox 1mg & Heparin 5000-10000
What does a patient with chronic PVD look like? Think blood supply less
Claudication
Erectile dysfunction
Hair loss
Thinning hair, cool skin
Diminished peripheral pulses
What family history would be important when assessing someone’s risk for CAD?
First things we want to rec in patients with HLD/HLD/CAD ?
*Fat reduction goal in lifestyle diet changes ?
25-30%
Overall BP goal when starting patients on meds?
Medications that can impact BP?
Diuretics
ACEi
ARBs
CCB
Alpha blockers
Risk factors for CAD?
Family hx
Male gender
Hypercholesterolimia
Diabetes
HTN
Physical inactivity
Abdominal obesity
Smoking
Excessive ETOH
Poor diet
What med do we put people on for hyperlipidemia? Need to check what at 3 months?
Simvastatin 5-10mg
FIT active young patient with pulse 45. Asymptomatic. Concerning?
No concern
Why is quitting smoking important?
Reduces development of subclinical atherosclerosis & slows its progression.
MOA HCTZ? MOA ACE /ARB? MOA LOVENOX
Diuretic: HCTZ 12.5-25mg - decreasing volume and reduces peripheral vascular resistance
ACEi: Lisinopril/Enalapril/Captopril 5-10mg - prevents narrowing of blood vessels
ARBs: Losartan 50mg - similar to ACEi
Anticoagulant: Lovenox 1mg
What are LDL and HDL?
LDL is bad
HDL is good
Mobitz II types? Vs type 3
Med treatment for bradycardia?
If unstable, use the following in order:
Atropine 0.5mg
Dopamine 2-10mcg
Epinephrine 2-10mcg
Med treatment for PSVT?
Anti-arrhythmic: Adenosine 6mg
Beta Blocker: Metoprolol 5mg (max 15mg) & Metoprolol 50mg
CCB: Diltiazem 0.25mg
25 y F with INFLUENZA 2 weeks ago and now has CHF symptoms? What is the diagnosis?
Myocarditis?
What is a potential SE of myocarditis?
Sinus tachycardia out of proportion to temperature
Retrosternal chest pain (deep chest pain)
What are the classic symptoms of pericarditis?
Substernal chest pain pleuritic (sharp) radiates to neck, shoulder, or arm.
PAIN IS WORSE SUPINE AND IS RELIEVED BY SITTING UP LEANING FORWARD
Friction rub
Generally chest pain gets better when in pericarditis?
Sitting up and leaninig forward
Major cause of pericarditis? Virus?
Virus: Influenza, Epstein-Barr (mono), Hepatitis, Mumps, CMV, HIV
Bacteria: Gonorrhea, Chlamydia, small pox, mycoplasma, Lyme
What does an EKG on patient with pericarditis look like?
Diffuse ST segment elevation
Infective endocarditis is most likely caused by what? Bacteria or Virus or fungus?
Bacteria: Staph or Strep
Hallmarks of Endocarditis
Petechia on plate: conjunctiva or beneath nails
Splinter hemorrhage: Red linear streaks under nails
Janeway lesions: Erythematous lesions on palms and soles
Olser’s nodes: Painful
Roth spots: Exudative lesions in retina of 25% patients
Are patient with IE sick?
What are the symptoms and signs of IE?
Days to weeks to get symptoms
Fever
Non-specific symptoms
What changes in the heart with patients with IE?
Skin findings in patients with IE?
IE must be treated with ?
Ertapenem 1g or Vancomycin 1g
A patient with IE –cause? Bact or Viral. Most common specific bug? Think skin.
Rare but potential SE of pericarditis? What are the symptoms?
What is becks triad? What diagnosis is this with ?
Muffled heart sounds
Jugular vein distention
Hypotension unresponsive to fluid challenge
Does positional chest pain make you more likely to think MI or less likely?
Less likely
45 y M IV drug user or recent dental procedure with new murmur and fevers. Very sick. Streaks on a couple fingers nails. Painless nodules on hands /feet. Called? Thinking?
Endocarditis based on dental procedure and splinter hemorrhage
Young Patient with recent URI and now with CHF symptoms.
Pericarditis
Treatment for pericarditis?
Aspirin 325-650mg
NSAIDs
Acute chest pain “radiating to back” - first thing that comes to mind
Dissecting aortic aneurysm
Altered HYPOTENSIVE patient in AMI. What med to avoid?
T-wave inversion ? ST elevation ? difference? Significance?
40 y M healthy with recent surgery or long travel in car/plane now has UNILAERAL LE swelling. What are you think is up with this patient?
What physical test can lead to suspected DVT?
+ Homan’s sign
What medication do you use to treat DVT or PE?
Lovenox 1mg
Heparin 80 units
A patient has chest pain with ST elevation in leads v3-6. What is this called?
What is the MOA of Lovenox?
Anticoagulant
A patient with severe sharp chest pain that radiates to back what are you thinking?
Besides getting a patient to surgery in a patient with a dissecting aortic aneurysm…what should be a primary treatment goal? What med?
TYPE A vs TYPE B aortic dissection ? Worse?. Treat acutely ? Will need _____soon?
First medications we should give in patient with suspected AMI?
AMI occurs in what vessels?
Diagnostic testing in patient with CHF or Murmur?
What is becks triad? What diagnosis is this with ?
Regurgitation ? Doors doing what?
Stenosis? Doors doing what?
What is claudication?
All patients with a cardiac contusion should be _________? For > 6 hours? Why?
Trauma to the chest -> always need to think?
Treatment for pericardial tamponade in acute setting?
Becks triad?
Post MI complications?
You confirm the diagnosis of CHF in 75 y M patient? What med could we give to help relieve symptoms?
Patient with recent surgery or prolonged travel (+smoker or BCP) – with UNILATERAL LE swelling. Now very SOB Thinking? How would you diagnose?
Risk factors for someone to get a PE or DVT?
You find someone down with pulseless VTACH. CPR and what else would you want to do in this patient? After doing _____________ what med would you want to give?
When can compression be interrupted?
You find a patient down with asystole? Besides CPR what would you do? Is this shockable?
-You diagnose a young patient with SVT.
-First thing you want to assess?
-What could you ask them to do to break SVT?
-Those things fail - > meds or what?
You find a patient altered and find them to be bradycardic? What could you do? Meds? Other?
- You find an unconscious patient down with no pulse. First thing you should start?
- What are considered shockable rythyms? VF and pVT
- What does VTAC look like? Wide or narrow? (look at slide – get pattern down)
- What does SVT look like? Wide or narrow? (look at slide – get pattern down)
- What 2 findings make afib unique on EKG? (look at slide – get pattent down)
- We said afib and atrial flutter are treated similar,. How are EKGS different?
- Patients with AFIB or Aflutter are rate controlled with?
- All patients with afib or flutter should be on? Because or risk for what?
- What does a STEMI look like on EKG? What does pericarditis look like on EKG?
- What does a LBBB look like?
- Patient with cardiac contusion and intermittent a flutter . Should we monitor this patient?
- Heart blocks on EKG
