Cardio Flashcards
Chest pain upon exertion
Angina
Worsening angina that occurs at rest
Unstable angina
Treatment for unstable Angina
Aspirin or glycoprotein inhibitor, heparin, oxygen, nitroglycerin, and beta blocker
What is the lap work for and Mi
CBC, troponin, CPK – MB,
What is the treatment for an acute myocardial infarction
Give the oxygen aspirin, glycoprotein inhibitor, beta blocker, nitroglycerin, morphine, consider Thrombolysis or angioplasty patient presents and initial 12 hours; Heparin should be administered for up to 48 hours to reduce the risk off
ECG changes in v2, v3, v4
Anterior infarct, left anterior descending
ECG changes in v1, v2, v3
Septal infarct; left anterior descending
Leads II, III, aVF
Inferior infarct; posterior descending or marginal branch
I, aVL, V4, V5, V6
Lateral infarct; left anterior descending or circumflex
V1, v2
Posterior infarct; posterior descending
Delta wave before that QRS complex
Wolff – Parkinson – White syndrome
Patient with atrial fibrillation you must do ECG before doing a cardioversion. WHY?
You want to rule out a mural thrombus
Torsades de pointes is a ventricular tachycardia with a sine wave morphology.
You can use Magnesium to treat
Austin Flint murmur, quincke’s sign
Aortic regurgitation
Patient shows up with pleuritic chest pain upon inspiration with pulsus paradoxus, and global ST elevation with PR depression
acute pericarditis
Hypotension, distant heart sounds, and distended neck veins
Cardiac tamponade, perform urgent pericardiocentesis
Normotensive patient with a reading of >140/>90 recheck when?
In 2 months
Leg pain with activity that improves with rest
Peripheral vascular disease-arterial
Young patient with arthritis, fever, neuropathy, ulcers, purpura, etc. p-ANCA positive and associated with hepatitis B Or C
Polyarteritis nodosa
Female with new onset of headache that is in the temporal region with jaw claudication and vision disturbances, and possible polymyalgia rheumatica.
Temporal arteritis
Young women with fever and malaise of asian heritage. Affected aorta and its branches
Takayasus
Asthmatic symptoms with an erythematous rash p-ANCA positive.
Churg-strauss disease
Young child with abdominal pain and a recent URI with palpable purpura
Henoch-schonlein purpura
Young child with fever, lymphadenopathy, conjunctival lesions, rash, and desquamation of hands and feet.
Kawasaki - coronary artery involvement
Patient with symptoms of pericarditis, anemia, and increased BUN
Uremic pericarditis, hemodialysis is recommended unless contraindicated
Not papable point of maximum impulse, water bottle shaped mediastinum on x-ray and recent upper respiratory infection
Pericardial effusion
PSVT are relieved generally by cold water immersion or vagal maneuvers. What is the mechanism?
AV node conductivity decreases by increasing the vagal tone.
Patient after an MI starts feeling symptoms of a cold leg unilateral. What is the reason for it? What studies should be pursued?
Reason is a thrombus from the akinetic heart muscle that has embolized in the LE. The choice of study would be an ECHO to rule out or confirm the thrombus in the left ventricle.
What does a prolonged QRS interval mean?
Bundle branch block can suggest a bradyarrythmia.
If the patient has a narrow complex tachycardia what is the next step of management?
If the patient is hemodinamically unstable, do immediate DC cardioversion.
What is the best management in patients with prolonged tachysystolic atrial fibrillation?
rate or rhythm control.
When the patient presents with a STEMI what intervention will most improve the long term prognosis?
Restore coronary blood flow (PTCA or fibrinolysis)
A patient with suspected aortic dissection. What test is preferrable?
Transesophageal echocardiography
When a patient has a right ventricular infarct what is the best next step in management?
IV fluid resusciation and stop nitrates or beta blockers because they decrease the venous return to the heart.
A patient with PEA needs
CPR! Chest compressions!
What are unfavorable effects of thiazides?
dyslipidemias, hypercalcemia, hyponatremia, hypokalemia, hyperglycemia and hyperuremia.
heart murmur at the left lower sternal border that decreases with an increase in preload.
Hypertrophic cardiomyopathy (Autosomal Dominant)
By what mechanism do statins produce myopathy?
Synthetic reaction inhibition. The inhibition of the enzyme also applies to other molecules.
If a patient has Afib a lot of things to consider. If hemodynamically unstable? if stable with afib for less than 48hr? >48hr?
If pt is unstable = cardioversion
If pt stable with >48hr rate control with beta blocker or calcium channel blocker
If pt stable with <48hr electrical or pharmacological cardioversion appropriate.
dipyridamole injection produces inhomogenesity distribution of blood flow in a patient with angina pectoris.
Coronary steal
What factor is the most significant in reducing aortic aneurysm enlargement?
Smoking cessation
How does nitroglycerin relieve retrosternal chest pain?
Capacitance of the vessels reducing preload
Which medication should a patient get after a Percutaneous coronary intervention?
Aspirin, beta-blockers, ACE-inhibitors, statin, and clopidogrel.
Electrical alternans - amplitude of QRS alternating.
Cardiac tamponade
What are the symptoms of digoxin toxicity?
nausea, vomiting, decreased appetite, confusion, weakness, visual problems.
Which most likely increases murmur intensity in hypertrophic cardiomyopathy?
Vasalva maneuver - decreases preload
What explains edema in patients with uncontrolled poor COPD?
Pulmonary artery systolic pressure (pulmonary hypertension)
What cardiac condition are marfanoid patients most susceptible to?
Aortic dissection - can cause an early diastolic murmur (aortic regurgitation)
What drug do you use to treat Wolff-Parkinson-White Syndrome?
Procainamide. AVOID Calcium channel blockers, digoxin, or adenosine.
Hypertension that doesn’t resolve with medications
renal artery stenosis
DOC for exertional angina and hypertension?
beta blocker
How do you DX malignant hypertension?
> 200/140 and papilledema
How to treat premature atrial beats?
No treatment - benign
Which treatment is best in young patients with a PMH of Rheumatic fever and a murmur?
Penicillin
What is the 1st step in management after an aortic dissection is suspected?
Antihypertensive TX then after transesophageal echocardiogram
Hearing impairment, syncopal episode w/out disorientation, and QT prolongation?
Jervell-Lange-Nielson syndrome (ion channel defect). TX is beta blocker
What are the changes in renin, aldosterone, and bicarbonate in Conn’s syndrome?
Elevated aldosterone and bicarb.
Decreased plasma renin.
Bicarb is elevated because potassium and hydrogen ions are secreted.
How does nitroglycerin relieve retrosternal chest pain?
Dilates capacitance vessels causing decreased preload
What finding is most likely in an echo of a young patient with a recent URI and with symptoms of CHF?
Dilated ventricles with diffuse hypokinesia
Which medication is contraindicated in STEMI patients?
Nifedipine because of the reflex tachycardia
What would the administration of lidocaine in a patient with acute coronary syndrome result?
Increase in the risk of asystole. Lidocaine is useful to treat ventricular arrhythmias
Which medication causes patients to have a heart rate increase and a increased QRS complex duration during a stress test?
Flecainide Class IC antiarrhythmics. The reason is because they elongate the period of depolarization by blocking sodium channels.
What is the most likely cause of LE edema in a older patient that has been eating less food (poor nutrition)?
most likely will be decreased plasma oncotic pressure due to decreased albumin
Which is the most likely diagnosis in a 37 yoF from a 3rd world country experiencing acute left-sided weakness with a progressive extertional dyspnea, nocturnal cough and occasional hemoptysis, palpitations, and irregular heart beats.
Mitral stenosis (rheumatic fever)
What accounts for patient’s symptoms of atrial flutter? (palpitations, chest pain, sob, and lightheadedness)
Variable AV node conduction
Patient admitted with hypotension. BP is 72/46, HR is 120, PCWP is 6mmHg, Mixed venous oxygen concentration is 16vol%. What is the most likely cause?
Septic shock. Elevated CO, low SVR r atrial pressure and PCWP, and a frequently normal Vo2.
What is the diagnosis of a 60 YOF who comes with symmetrical thickening of the ventricular walls, liver and kidney function delcine?
Amyloidosis
