cardio Flashcards
smarty pance flash cards
A 13 year old boy passes out while
having an argument with his principal.
His examination findings are normal.
What heart conduction condition do you
suspect?
Long QT syndrome
. A 24 year old has a syncopal event.
EKG demonstrates a short PR interval
with an upswept initial QRS. What
underlying condition caused the
syncope?
Wolf Parkinson
White
A 30 year old male has a syncopal
event three days after taking an
antibiotic. EKG at the scene reveals
ventricular tachycardia. What disease
condition do you suspect?
Acquired long QT
syndrome due to
the antibiotic or
medications
A 75 year old patient passes out while
having an argument with his landlord
over money. What three conditions
should you rule out first?
Acute coronary
syndrome -
Ventricular
arrhythmia - Aortic
stenosis
- Acute Rheumatic fever occurs after
what event?
Strep throat
adrenal tumor which causes HTN?
Pheochromocytoma
. After a stent, in addition to ASA, what
oral antiplatelet agent is used?
Clopidogrel
. After running a mile a 16 year old
suffers chest pain and syncope. He is
asymptomatic in the ER. Examination
is normal. What underlying condition do
you suspect?
Anomalous
coronary artery
Agent of choice for acute angina
treatment?
Nitroglycerine
Angina syncope and heart failure in a
child likely represents ____________.
HOCM
(Hypertrophic
Cardiomyopathy)
Angina syncope and heart failure in an
adult likely represents _____________.
Aortic stenosis
Aortic stenosis in a 50 year old is
likely due to what abnormality?
Bicuspid aortic
valve
Austin Flint murmur is associated with
which murmur?
Aortic regurgitation
Best medication for blood pressure
support in cardiogenic shock?
Dobutamine
Cancer is an example of what part of
Virchow’s triad?
Hypercoagulable
state
Can digoxin be used for HTN?
no
Combination therapy with at least 2
agents is recommended for patients
with which stage of HTN?
Stage 2 HTN -
Initiate treatment
with 2 or more
agents
Constrictive Cardiomyopathy
occurs by what mechanism?
Pericardial sac constricts
- Digoxin should never be
used for which type of heart
failure?
Diastolic
- Does pregnancy fit into the
Virchows triad?
Yes - Pregnancy is a
hypercoagulable state
- Does renal artery stenosis
cause primary or secondary
HTN?
Secondary
- During pregnancy what
murmur is commonly first
discovered?
Mitral stenosis
. First line HTN agent for
Diabetic?
Ace inhibitor
- First medication to give in a
patient suspected of having
an AMI?
Aspirin
- Gallavardin Phenomena is
associated with what
valvulopathy?
Aortic Stenosis
. Initial procedure to evaluate
for PVD?
ABI (Ankle brachial index) -
ABI < 0.8 = PAD
JVD and clear lung fields
describes what type CHF?
Right Heart Failure
List 5 causes of systolic
heart failure.
CAD (ischemia)
- Tako Tsubo
- Cocaine
- Viral illness
- Chemo/radiation
- List 5 side effects of
amiodarone.
Pulmonary HTN
- Elevated
LFTs
- Hypothyroid
- Hyperthyroid
- Iodine allergy
List 6 causes of restrictive
cardiomyopathy.
Amyloidosis -
Hemochromatosis -
Sarcoidosis -
Scleroderma -
Fibrosis -
Cancer
List the classifications of
blood pressure as per JNC
VII.
Prehypertension = 120-139/80-
90
- Stage 1 = 140-159/90-99
- Stage 2 = >160/100
- List the major systemic
affects of amiodarone
therapy?
Pulmonary fibrosis
- Infiltrative
liver disease
- Hyper OR
hypothyroid state
List the NYHA classification
of CHF.
I asymptomatic
- II symptoms
with moderate exertion
- III symptoms with minimal
exertion
- IV symptoms at rest
List three medications which
may be used both to prevent
arrhythmia and ease
symptoms with HOCM.
Diuretics - Beta blockers -
Non-dihydropyridine CCB
(verapamil or diltiazem)
List two types of surgical
procedures to correct
HOCM.
Open heart and excision -
Alcohol ablation done through
cardiac cath
Meds for chronic diastolic CHF?
Ace inhibitor plus either a
beta blocker or calcium
channel blocker
A military recruit passes out
while standing in formation for a
long period of time. What type of
syncope is this called?
Neurocardiogenic syncope
a.k.a. Vasovagal syncope
Most common cause of
cardiogenic shock?
Myocardial Infarction
Most common cause of Diastolic
CHF?
Hypertension
Most common cause of tricuspid
stenosis?
Rheumatic fever
Myocardial damage occurs after
how many minutes of ischemia?
30 minutes
. Name the 4 components of
Tetralogy of Fallot.
Pulmonary valve stenosis
-VSD (Ventricular Septal
Defect)
- Overriding aorta
- RVH (Right Ventricular
Hypertrophy)
Name the Major Jones criteria.
Carditis
- Migratory
polyarthritis
- Subcutaneous nodules
- Erythema marginatum
- Chorea
Non-cardiac hypoxia (e.g.
pneumonia, COPD) commonly
causes what arrhythmia?
a fib
Once a patient is diagnosed with
HOCM what family counseling
must be done?
Entire family must be
screened for HOCM
Once a patient on a balloon
pump can tolerate a ratio of
___:___ removal may be
considered.
3 : 1 - Once patient only
requires assist every third
beat removal may be
considered
Orthostasis is defined as a
change of > __ mmHg systolic
or __ mmHg diastolic BP __
minutes after change from
supine to standing.
> 20 mmHg systolic or 10
mmHg diastolic BP 2-5
minutes after change from
supine to standing
. A patient has a cold left arm due
to arterial clot - what is the
most likely valvulopathy?
Mitral stenosis
Patient has DVT and unable to
take Coumadin what is next
step?
IVC Filter
A patient with pericarditis feels
better in what position?
Leaning forward
PVD commonly manifests as
what symptom?
Calf pain with exertion that
relieves with rest
(claudication)
Radiologic test of choice in
pregnant woman suspect of
pulmonary embolus?
VQ scan
Restrictive Cardiomyopathy occurs by
what mechanism?
Deposition into or
between the
myocardial cells
Rheumatic fever affects which valve
first?
Mitral valve
. Roth spots in a drug user are most
likely caused by which organism?
staph aureus
Should heparin or enoxaparin (Lovenox)
be used for a patient with a CrCl < 15?
Heparin (enoxaparin
is contraindicated
for CrCl < 15)
Three meds for acute decompensated
CHF?
Nitroglycerin
- ACE inhibitor
- Loop Diuretic
Untreated amaurosis fugax with
temporal arteritis leads to what?
Blindness (High
dose steroids most
be started ASAP to
avoid blindness)
Upon auscultation of a patient’s carotid
artery they become bradycardic with a
three second pause. What is the
suspected underlying condition?
Carotid sinus
hypersensitivity
Use of which antihypertensive
medications is cautioned after cataract
surgery?
Alpha blockers
Use of which antihypertensive
medications is cautioned after recent
MI?
Minoxidil - Clonidine
Venous insufficiency is differentiated
from right heart CHF in a patient with
lower extremity edema by what exam
finding?
A patient in CHF will
have JVD and
hepatojugular reflux
A venous ulcer most often forms
where?
on the inside of the leg, above the ankle and below the calf
Vitamin deficiency that causes high
output cardiac failure?
Thiamine - Beriber
What are painful lesions on the hands
which occur with endocarditis?
Osler’s nodes =
“Ouch”
What are painless lesions on the hands
which occur with endocarditis?
Janeway lesions
What are the 2 recommended statins
for treatment in acute MI?
Atorvastatin 80 mg
or rosuvastatin 40
mg
What are the 3 “D” findings of
pericardial tamponade?
Distant heart
sounds
- Distended
jugular veins
- Decreased arterial
pressure
What are the 3 main causes of
mitral and tricuspid regurgitation?
Dilatation (Aneurysm) -
Degeneration of leaflets
- Chordae tendineae
rupture
What are the big three meds for
chronic systolic heart failure?
Beta blocker - ACE
inhibitor - Loop diuretic
What are the mainstay meds for
chronic diastolic heart failure?
ACE inhibitor - Beta
blocker or calcium
channel blocker
(diltiazem or verapamil)
- What are the mainstay meds of
acute decompensated heart
failure?
NTG - ACE inhibitor -
Loop diuretic
What are the modifiable cardiac
risk factors?
Smoking - DM -
Cholesterol - Blood
pressure - Obesity
What are the most common side
effects of dihydropyridine calcium
channel blockers (amlodipine
felodipine)?
Lower extremity edema
and headache
What are the signs of HOCM on
exam?
Apical lift - S4 gallop -
Ejection murmur medial
to apex
What are the three main symptoms
of Aortic stenosis?
ASH (Angina - Syncope
- Heart Failure)
What are the three main symptoms
of Mitral stenosis?
PHD (Palpitations -
Heart Failure - Dyspnea
on exertion)
What are the two main causes of
aortic and pulmonic regurgitation?
Dilatation (Aneurysm) -
Degeneration of leaflets
What are two CXR findings in
pulmonary embolus?
Hamptons hump -
Westermark sign
What arm does anginal pain tend to
radiate toward?
left
What arrhythmia can occur with
structural changes such as
hypertrophy or dilatation of the
ventricle?
Ventricular tachycardia
What arrhythmia is associated
with arterial embolism?
Atrial fibrillation
What balloon pump setting would
be best for initial treatment of the
acute patient in cardiogenic
shock?
1 : 1 Balloon pump
assists with every beat
What blood pressure medication
can make peripheral artery
disease symptoms worse?
Beta blockers
What blood pressure medicine is
commonly associated with
impotence in men?
Beta blockers
What cardiac abnormality is
associated with a bicuspid aortic
valve?
Coarctation of aorta
What cardiac drug can cause hypo
or hyperthyroidism?
Amiodarone
What cardiac drug can produce
yellow vision?
Digoxin
What causes the sudden cardiac
death in a HOCM patient?
Ventricular tachycardia
that degenerates into
ventricular fibrillation
What characteristic will be seen in
blood which is drawn from with in
the pericardial sac during
pericardial centesis?
Blood does not clot
when put into tray (+
clotting = not in the
pericardial space)
What class of medication should
you think of when you see the
suffix “azosin”?
Alpha blockers -
example doxAZOSIN
What class of medication should
you think of when you see the
suffix “dipine”?
Dihydropyridine
calcium channel
blockers - example
amloDIPINE
What condition is right ventricular
collapse on echocardiogram
pathognomonic for?
Pericardial tamponade
What condition occurs when
congenital cyanotic heart murmurs
cause right heart failure?
Eisenmenger
syndrome
What congenital abnormality should
be considered with a child who
frequently squats?
Tetralogy of Fallot
What disorder is most likely in a
patient with calf pain with walking
that improves with rest?
Peripheral Artery
Disease
What diuretic can be used if
furosemide is not available?
What diuretic can be used if
furosemide is not available?
Bumetanide
What does a Beta blocker do for a
post AMI patient?
Prevents arrhythmia
and reduces cardiac
work load
what does a BP> 180/120 with end
organ dysfunction define?
Hypertensive
emergency
What does an ACE
inhibitor/ARB do for a post
AMI patient?
Decreases afterload to rest
myocardium and
prevents/decreases remodeling
What do low ejection
fraction and hypertrophic
(HOCM) heart have in
common?
Sudden death due to VT
what drug can produce
blue vision?
Sildenafil
What EKG changes are
seen in a patient during a
Prinzmetal attack?
ST elevations which resolve
after attack (Persistent
elevations suggest MI)
What EKG changes are
seen with a ring abscess
of the mitral valve?
Variable heart block
What finding is
pathognomonic for
Rheumatic fever?
Aschoff bodies (Subcutaneous
nodules)
What happens to renal
function during cardiogenic
shock?
Reduced cardiac flow =
reduced kidney perfusion this
leads to pre-renal failure then
ATN if not corrected
What heart sound will
likely be present with
HOCM?
S4
What heart valve murmur
rarely causes a
symptomatic problem?
Pulmonary regurgitation
What HTN med classes can
cause bradycardia?
Beta Blockers - Central agents
(clonidine) - Verapamil and
Cardizem
What hypertension agent is
commonly associated with
edema in the lower
extremities?
Calcium channel blockers
What is a complication of
cardiac cath that causes
Grey-Turner’s sign?
Retroperitoneal hematoma
What is calf pain with walking
that improves with rest called?
Claudication
What is first-line treatment for
varicose veins?
Compression stockings
What is most common cause of
right heart failure?
Left heart failure
What is most common genetic
hypercoagulable state?
Factor V deficiency
- What is most common
pathogen causing of subacute
endocarditis?
Strep. viridans
What is the diameter of an
aortic aneurysm at which
surgical intervention is
recommended?
> 5.4 cm
What is the first medication to
be given to a patient with an
acute arterial emboli?
Heparin
What is the first step and
evaluation of a patient with calf
pain when he walks that is
relieved with rest?
Ankle brachial index
What is the gold standard to
evaluate peripheral artery
disease?
Angiography
What is the initial dose of
clopidogrel (Plavix) in acute
MI?
300 mg
What is the INR goal for a
patient on warfarin for a
mechanical heart valve?
2.5 - 3.5
What is the likely cause of HTN
in a 30 year old female who is
still poorly controlled after 3
medications?
Renal Artery Stenosis
. What is the medical treatment
of patent ductus arteriosus
(PDA)?
Indomethacin
- What is the medication
suggested by JNC VII for a
patient who has no compelling
indications?
Diuretic
(Hydrochlorothiazide is the
most common)
What is the most common
cause of constrictive
cardiomyopathy?
Radiation therapy
. What is the most common skin
manifestation seen in
endocarditis?
Petechiae are not specific
for infective endocarditis
but are its most common
skin manifestation
What is the most likely cause
of orthostatic hypotension in
which there is no reflex
increase in heart rate?
Autonomic dysfunction
(examples: age diabetes)
What is the most likely cause of
syncope in an older adult which
occurs during an argument?
Myocardial ischemia
What is the most likely cause of
syncope which occurs after a
period of prolonged motionless
standing?
Neurocardiogenic
(vasovagal)
What is the most likely cause of
syncope which occurs while
shaving and has an associated
bradycardia?
Carotid sinus
hypersensitivity
What is the most likely disorder in
a patient with apical ballooning on
echo and a presentation similar to
MI?
Tako Tsubo
What is the pathognomonic
echocardiogram finding in
pericardial tamponade?
Collapse of the right
ventricle
What is the recommended initial
treatment for a Stanford type A
aortic dissection?
Surgical management
What is the recommended initial
treatment for a Stanford type B
aortic dissection?
Medical treatment
What is the rise in jugular pressure
which occurs with inspiration in a
patient with pericardial tamponade
called?
Kussmaul sign
What is the Stanford classification
of an aortic dissection of the
descending aorta?
Type B
What is the term for a hoarse voice
caused by mitral stenosis?
Ortner’s syndrome
What is the treatment for angina in
a patient who is allergic to
nitrates?
Calcium channel
blockers
What is the treatment for a nonsurgical cyanotic heart disease
causing polycythemia?
Phlebotomy
What is the treatment for
constrictive cardiomyopathy?
Pericardial stripping
What is the treatment for dilated
cardiomyopathy?
Same as systolic heart
failure - (Beta blocker -
Loop Diuretic - ACE
inhibitor)
What is the treatment for mitral
valve prolapse?
Reassurance and beta
blockers
What is the treatment for
phlebitis due to an IV?
Elevation - Warm
compress - NSAIDs
What is the treatment for
Prinzmetal angina?
Calcium channel blockers
What is the treatment for
thrombophlebitis?
One month of low
molecular weight heparin
What is Virchows triad?
Stasis
- Hypercoagulable
state
- Trauma (= risk of venous thrombus)
What lab most sensitive for
AMI?
Troponin
What leads represent anterior
wall?
V3 V4
What leads represent lateral
wall?
V5 V6 I AVL
What maneuver makes the
HOCM murmur louder?
Valsalva or standing
What mechanical intervention
can improve coronary perfusion
and work load of heart?
Aortic Balloon Pump
What medication can assist in
closing an open PDA (Patent
Ductus Arteriosus)?
Indomethacin
What medications are
recommended for a patient with
CAD?
Beta blocker and ACE
inhibitor
What murmur has a continuous
machinery quality?
PDA (Patent Ductus
Arteriosus)
What murmur has a Left
parasternal lift pulmonic area
ejection murmur and fixed
splitting of S2?
ASD (Atrial Septal Defect)
What murmur is heard with MVP
(Mitral Valve Prolapse)?
Midsystolic click
What murmur is pansystolic and
is best heard mid sternal
border?
vSD (Ventricular Septal
Defect)
What must be ruled
out in a Marfan patient
with chest pain
radiating to the back?
Aortic dissection
What physical sign is
easily seen with
tricuspid stenosis?
JVD (Jugular Venous Distension)
What secondary cause
of HTN will present
with abdominal
bruits? What is the
first diagnostic test?
Renal artery stenosis - Renal artery
doppler is the initial test
What sign
distinguishes mitral
regurgitation from
tricuspid
regurgitation?
Carvallo s sign (The murmur of
tricuspid regurgitation increases in
intensity during held deep
inspiration)
What test can be
performed to evaluate
neurocardiogenic
syncope?
Tilt table test
- What test should be
ordered for a patient
with suspected
pheochromocytoma?
Urine for VMA (Vanillylmandelic acid)
What three criteria
define a heart attack?
EKG changes - Chest pain -
Elevated cardiac enzymes
What three tests are
recommended before
starting amiodarone?
Thyroid panel - Pulmonary function
testing - Liver function test
What two murmurs
are most associated
with atrial
fibrillation?
Mitral stenosis - Mitral regurgitation
What two populations
more commonly have
diastolic heart
failure?
Elderly women and black patients
- What type of heart
failure may
pericardial tamponade
initially present like?
Right heart failure: Tamponade looks
like right heart failure because the
right ventricle is the weakest of the
two and collapses first due to the
fluid around the heart
What underlying disease state is
likely in a patient with a malar
rash and recurrent DVT?
Systemic Lupus
Erythematosus(SLE) with
antiphospholipid
syndrome
What valvular abnormality is
most commonly associated with
a peripheral arterial emboli?
Mitral stenosis
What valvulopathy increases
afterload?
Aortic stenosis
What will most likely happen to
the INR of a patient on warfarin
when they are given
amiodarone?
INR increases
- When treating a patient with
hypertensive urgency the goal is
not to reduce the BP more than
__% in __ hours?
Goal is to reduce blood
pressure no more than
25% every 1-2 hours
Which antihypertensive
medications are contraindicated
with asthma and isolated PAD?
Beta blockers
Which antihypertensive
medications are contraindicated
with bradycardia or heart block?
Beta blockers - Nondihydropyridine CCB -
Central agents (clonidine)
. Which antihypertensive
medications are contraindicated
with pregnancy?
ACE inhibitors -
Angiotensin II receptor
blockers - Thiazide
diuretics - Direct renin
inhibitors
Which antihypertensive
medications are contraindicated
with renal artery stenosis?
ACE inhibitors and
Angiotensin II receptor
blockers (Note: caution
with direct renin inhibitors)
Which antihypertensive
medications can cause
angioedema?
ACE inhibitors -
Angiotensin II receptor
blockers (ARBs) - Direct
renin inhibitors
Which antihypertensive
medications can cause AV
block?
Non-dihydropyridine CCB -
Central agents (clonidine)
- Which antihypertensive
medications can cause
bradycardia?
Beta blockers - Nondihydropyridine CCB -
Central agents (clonidine)
- Which antihypertensive
medications can cause
constipation?
diarrhea?
Verapamil - Central
agents (clonidine)
Direct renin inhibitors
. Which antihypertensive
medications can cause
depression?
edema
Beta blockers - Central
agents (clonidine)
Dihydropyridine CCB (e.g. amlodipine nifedipine) - Benzothiazepine CCB
(diltiazem) - Minoxidil
Which antihypertensive medications can cause
hyperkalemia?
hyperuricemia
hypokalemia
ACE inhibitors - Angiotensin II receptor blockers (ARBs) - Direct renin
inhibitors - Aldosterone antagonists (spironolactone)
Thiazide
Thiazide
Which electrolyte disorder can increase the chance of
digoxin toxicity?
Hypokalemia
. Which lab value must be obtained before initiating ACE
inhibitor therapy
Potassium
Why are post menopausal women more prone to heart
disease?
Estrogen is cardio protective
You have performed pericardial centesis. How do you
ensure you are in the pericardial space?
Blood evacuated from the pericardial space does not clot
