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ESWS C5I > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the parts of the pericardium?

A

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.

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2
Q

What is the function of the pericardium?

A

Protects & holds heart in place.

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3
Q

What are the 3 main divisions of the AORTA?

A

Ascending Aorta
Aortic Arch
Descending Aorta

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4
Q

25 y F with INFLUENZA 2 weeks ago and now has CHF symptoms? What is the diagnosis?

A

Pericarditis

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5
Q

What does an EKG on patient with pericarditis look like?

A

Diffuse ST-segment elevation

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6
Q

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?

A

Endocarditis

Streaks in finger nails = splinter hemorrhage

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7
Q

What medication do you use to treat DVT or PE?

A

Lovenox 1mg or Heparin 80 units

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8
Q

What color is blood on US (ultrasound)?

A

Red: Flowing TOWARD probe.
Blue: Flow going AWAY from probe.

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9
Q

What would an CXR show on dissecting aortic aneurysm?

A

Widened mediastinum

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10
Q

What vessels we look for in bruits?

A

Temporal arteries
Carotid arteries
Abdominal aorta
Renal arteries
Iliac arteries
Femoral arteries

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11
Q

Ultrasound: You see a large dark ring around the heart on ultrasound exam…what is this called?

A
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12
Q

What color is blood on ultrasound? Solids?

A

Red: flowing toward probe
Blue: flowing away from probe

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13
Q

What is the dial called to adjust the brightness on ultrasound?

A

Gain or “amplification”

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14
Q

What is difference between bell and diaphragm?

A

Bell hears low-pitched sounds.
Diaphragm hears high-pitched sounds.

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15
Q

On exam we do 3 different portions? Avoid ?

A
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16
Q

What physical exam test is positive in suspected DVT?

A

Homan’s sign

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17
Q

What does pitting edema represent?

A

Fluid retention

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18
Q

What are crackles?

A

Pulmonary edema

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19
Q

Pitting edema 2mm =
Pitting edema 4mm =
Pitting edema 6mm =
Pitting edema 8mm =

A

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).

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20
Q

What is claudication?

A

Cramping pain or tiredness in the thigh, calf, or foot with
walking or exercise and relieved by rest.

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21
Q

Where would you best hear the AORTIC VALVE? Mitral Valve?

A

Aortic valve: 2nd R intercostal space at R sternal border
Mitral valve: Apex 5th intercostal space midclavicular line

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22
Q

Pitting edema usually means what? Coming from arteries or veins?

A

Fluid build-up in veins

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23
Q

Is CHF usually unilateral or bilateral?

A

Unilateral
Most common type of CHF is left ventricular systolic failure.

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24
Q

Is DVT usually unilateral or bilateral?

A

Unilateral

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25
Q

-MURMUR – Young female asymptomatic (or mild symptoms) with midsystolic click
-MURMUR – Old patient with crescendo – decrescendo murmur. Thinking?
-MURMUR – Pansystolic in old person

A

-Mitral valve prolapse
-Aortic stenosis
-Rheumatic heart disease

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26
Q

What is JVD? When and why do we use? When is it positive ? (>9cm)

A

Jugular vein distention
Suggests ventricular failure.

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27
Q

Vessels we look for in bruits?

A

Carotid arteries

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28
Q

PMI – how can it be used clinically?

A

Point of apical impulse being most readily seen/felt. Diameter shouldn’t exceed 1 cm.

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29
Q

Pulses rated?

A

Bradycardia: Below 60 BPM
Tachycardia: Above 100 BPM

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30
Q

What would an CXR show on dissecting aortic aneurysm?

A

Widened mediastinum

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31
Q

What are the locations of the chest leads? Limb leads?

A

You knowwwwww

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32
Q

Best test to get in someone that has a murmur or CHF?

A

ECG

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33
Q

What are the different parts of basic EKG? What do they represent?

A

-P wave: Representing atrial depolarization
-QRS Complex: Representing ventricular depolarization (masks atrial
repolarization due to size).
-T wave: Representing ventricular repolarization

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34
Q

How do we diagnose a DVT?

A

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.

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35
Q

How do we diagnose a PE?

A

-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.

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36
Q
  1. All patients with CP should get?
A
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37
Q

A patient has HTN emergency. What are the treatment goals?

A

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.

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38
Q

Potential symptoms of HTN emergency?

A

1) Hypertensive encephalopathy
2) Intracranial hemorrhage
3) Ischemic stroke
4) Hypertensive nephropathy
5) Unstable angina, AMI, CHF, or Aortic dissection.
6) Pulmonary edema

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39
Q

Do we use PO or IV in HTN Emergency?

A

IV

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40
Q

Do we use PO or IV in HTN urgency?

A

PO

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41
Q

Difference between HTN emergency & urgency? Even + UA for blood or protein.

A

END ORGAN DAMAGE

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42
Q

What are the 2 stages of HTN?

A

Stage 1 HTN: 130-139/80-89
Stage 2 HTN: >140/>90

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43
Q

What meds are first line in treatment of HTN? MOAs?

A

-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.

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44
Q

-Patient has a BP of 130/85. Stage?
-Patient has a BP of 165/95. Stage?

A

-Stage 1
-Stage 2

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45
Q

How many times do we need BP checked to confirm HTN diagnosis?

A

Patients must have elevated BP recordings on 3-5 separate
visits. R/O causes of secondary HTN if suspect due to
secondary causes.

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46
Q

-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?

A

-

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47
Q

80 y M has significant pain on walking in both LE. Better with rest? This is called? Likely diagnosis?

A
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48
Q

Major preventable RF for PVD?

A

Smoking cessation

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49
Q

PVD occurs in what vessels ?

A

Any blood vessel outside the heart: Veins, arteries, lymphatic vessels

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50
Q

Uncontrolled __________ leads to arterial disease and plaque formation?

A

Blood pressure

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51
Q

What are 6 P’s in patient with acute occlusion in PVD? What could you treat with ?

A

Pain
Pallor
Poikilothermia
Pulselessness
Parenthesis
Paralysis

Treat with Lovenox 1mg & Heparin 5000-10000

52
Q

What does a patient with chronic PVD look like? Think blood supply less

A

Claudication
Erectile dysfunction
Hair loss
Thinning hair, cool skin
Diminished peripheral pulses

53
Q

What family history would be important when assessing someone’s risk for CAD?

A
54
Q

First things we want to rec in patients with HLD/HLD/CAD ?

A
55
Q

*Fat reduction goal in lifestyle diet changes ?

A

25-30%

56
Q

Overall BP goal when starting patients on meds?

A
57
Q

Medications that can impact BP?

A

Diuretics
ACEi
ARBs
CCB
Alpha blockers

58
Q

Risk factors for CAD?

A

Family hx
Male gender
Hypercholesterolimia
Diabetes
HTN
Physical inactivity
Abdominal obesity
Smoking
Excessive ETOH
Poor diet

59
Q

What med do we put people on for hyperlipidemia? Need to check what at 3 months?

A

Simvastatin 5-10mg

60
Q

FIT active young patient with pulse 45. Asymptomatic. Concerning?

A

No concern

61
Q

Why is quitting smoking important?

A

Reduces development of subclinical atherosclerosis & slows its progression.

62
Q

MOA HCTZ? MOA ACE /ARB? MOA LOVENOX

A

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

63
Q

What are LDL and HDL?

A

LDL is bad
HDL is good

64
Q

Mobitz II types? Vs type 3

A
65
Q

Med treatment for bradycardia?

A

If unstable, use the following in order:
Atropine 0.5mg

Dopamine 2-10mcg

Epinephrine 2-10mcg

66
Q

Med treatment for PSVT?

A

Anti-arrhythmic: Adenosine 6mg
Beta Blocker: Metoprolol 5mg (max 15mg) & Metoprolol 50mg
CCB: Diltiazem 0.25mg

67
Q

25 y F with INFLUENZA 2 weeks ago and now has CHF symptoms? What is the diagnosis?

A

Myocarditis?

68
Q

What is a potential SE of myocarditis?

A

Sinus tachycardia out of proportion to temperature
Retrosternal chest pain (deep chest pain)

69
Q

What are the classic symptoms of pericarditis?

A

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

70
Q

Generally chest pain gets better when in pericarditis?

A

Sitting up and leaninig forward

71
Q

Major cause of pericarditis? Virus?

A

Virus: Influenza, Epstein-Barr (mono), Hepatitis, Mumps, CMV, HIV
Bacteria: Gonorrhea, Chlamydia, small pox, mycoplasma, Lyme

72
Q

What does an EKG on patient with pericarditis look like?

A

Diffuse ST segment elevation

73
Q

Infective endocarditis is most likely caused by what? Bacteria or Virus or fungus?

A

Bacteria: Staph or Strep

74
Q

Hallmarks of Endocarditis

A

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

75
Q

Are patient with IE sick?

A
76
Q

What are the symptoms and signs of IE?

A

Days to weeks to get symptoms
Fever
Non-specific symptoms

77
Q

What changes in the heart with patients with IE?

A
78
Q

Skin findings in patients with IE?

A
79
Q

IE must be treated with ?

A

Ertapenem 1g or Vancomycin 1g

80
Q

A patient with IE –cause? Bact or Viral. Most common specific bug? Think skin.

A
81
Q

Rare but potential SE of pericarditis? What are the symptoms?

A
82
Q

What is becks triad? What diagnosis is this with ?

A

Muffled heart sounds
Jugular vein distention
Hypotension unresponsive to fluid challenge

83
Q

Does positional chest pain make you more likely to think MI or less likely?

A

Less likely

84
Q

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?

A

Endocarditis based on dental procedure and splinter hemorrhage

85
Q

Young Patient with recent URI and now with CHF symptoms.

A

Pericarditis

86
Q

Treatment for pericarditis?

A

Aspirin 325-650mg
NSAIDs

87
Q

Acute chest pain “radiating to back” - first thing that comes to mind

A

Dissecting aortic aneurysm

88
Q

Altered HYPOTENSIVE patient in AMI. What med to avoid?

A
89
Q

T-wave inversion ? ST elevation ? difference? Significance?

A
90
Q

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?

A
91
Q

What physical test can lead to suspected DVT?

A

+ Homan’s sign

92
Q

What medication do you use to treat DVT or PE?

A

Lovenox 1mg
Heparin 80 units

93
Q

A patient has chest pain with ST elevation in leads v3-6. What is this called?

A
94
Q

What is the MOA of Lovenox?

A

Anticoagulant

95
Q

A patient with severe sharp chest pain that radiates to back  what are you thinking?

A
96
Q

Besides getting a patient to surgery in a patient with a dissecting aortic aneurysm…what should be a primary treatment goal? What med?

A
97
Q

TYPE A vs TYPE B aortic dissection ? Worse?. Treat acutely ? Will need _____soon?

A
98
Q

First medications we should give in patient with suspected AMI?

A
99
Q

AMI occurs in what vessels?

A
100
Q

Diagnostic testing in patient with CHF or Murmur?

A
101
Q

What is becks triad? What diagnosis is this with ?

A
102
Q

Regurgitation ? Doors doing what?

A
103
Q

Stenosis? Doors doing what?

A
104
Q

What is claudication?

A
105
Q

All patients with a cardiac contusion should be _________? For > 6 hours? Why?

A
106
Q

Trauma to the chest -> always need to think?

A
107
Q

Treatment for pericardial tamponade in acute setting?

A
108
Q

Becks triad?

A
109
Q

Post MI complications?

A
110
Q

You confirm the diagnosis of CHF in 75 y M patient? What med could we give to help relieve symptoms?

A
111
Q

Patient with recent surgery or prolonged travel (+smoker or BCP) – with UNILATERAL LE swelling. Now very SOB Thinking? How would you diagnose?

A
112
Q

Risk factors for someone to get a PE or DVT?

A
113
Q

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?

A
114
Q

When can compression be interrupted?

A
115
Q

You find a patient down with asystole? Besides CPR what would you do? Is this shockable?

A
116
Q

-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?

A
117
Q

You find a patient altered and find them to be bradycardic? What could you do? Meds? Other?

A
118
Q
  1. You find an unconscious patient down with no pulse. First thing you should start?
A
119
Q
  1. What are considered shockable rythyms? VF and pVT
A
120
Q
  1. What does VTAC look like? Wide or narrow? (look at slide – get pattern down)
  2. What does SVT look like? Wide or narrow? (look at slide – get pattern down)
  3. What 2 findings make afib unique on EKG? (look at slide – get pattent down)
A
121
Q
  1. We said afib and atrial flutter are treated similar,. How are EKGS different?
A
122
Q
  1. Patients with AFIB or Aflutter are rate controlled with?
A
123
Q
  1. All patients with afib or flutter should be on? Because or risk for what?
A
124
Q
  1. What does a STEMI look like on EKG? What does pericarditis look like on EKG?
A
125
Q
  1. What does a LBBB look like?
A
126
Q
  1. Patient with cardiac contusion and intermittent a flutter . Should we monitor this patient?
A
127
Q
  1. Heart blocks on EKG
A

ESWS C5I (18 decks)

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