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PANRE > Cardio > Flashcards

Cardio Flashcards

0
Q

Tetralogy of fallot

A

Prov

Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

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1
Q

Dressler’s syndrome

A

Inflammatory response characterized by low grade fever, chest pain, pericardial effusion. Typically occurs 1 to 6 weeks status post MI . can cause constrictive pericarditis or cardiac Tamponade

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2
Q

Ebsteins anomaly

A

Congenital. Downward displacement of septal and posterior leaflets of the tricuspid valve into right ventricle below the AV junction

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3
Q

Infective endocarditis affects what valves first?

A

Prosthetic valves and typically on the left side of the heart for example a prosthetic mitral valve.

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4
Q

Preload

A

End diastolic volume. Increased right ventricular preload from CHF inspiration or exercise. Decreased right ventricular preload by decreasing left ventricular output, exhalation

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5
Q

Pulse pressure

A

The difference between systolic and diastolic blood pressure

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6
Q

Jones Criteria

A

Must be 2 Major or 1 Major + 2 Minor
MAJOR: PACES: PolyArthritis, Chorea, Erythema Marginatum, Subcutaneous nodules
MINOR: Fever, Arthralgia, Labs (elevated ESR), Prolonged PRI (FALPP)

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7
Q

1 cause of Mitral Stenosis

A

Rheumatic Fever. Will cause atrial irritation and A. Fib

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8
Q

Tx Myocarditis

A

Lasix + ACEI/ARB

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9
Q

Sx Myocarditis

A 
Antecedent viral syndrome (Coxsackie)
DOE
Palpitations
\+/- fever
Tachycardia out of proportion to fever
JVD, crackles, edema
Can cause dilated cardiomyopathy
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10
Q

SBE: Subacute bacterial endocarditis: ETIO

A

Typically strep viridian’s (usually occurs in pts with established VHD)

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11
Q

Triad Sx of Endocarditis

A

Fever, murmur, + blood cultures

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12
Q

ETIO Acute bacterial Endocarditis

A

Staph aureus

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13
Q

ETIO Pulmonic Stenosis

A

typically congenital disease of the young

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14
Q

TX Infective Endocarditis

A

PCN and Ceftriaxone
ETio: IVDU: Tricuspid valve, staph aureus
Non IVDU: Mitral valve: strep viridans

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15
Q

3 drugs associated with Myocarditis

A

Cocaine, Lithium, AZT

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16
Q

ETIO: Mitral Regurg

A

AMI–> papillary muscle dysfunction or rupture of the chordae tendineae

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17
Q

Pulsus Paradoxus

A

Drop in systolic pressure > 10mmHg with INSPIRATION. = pericardial tamponade

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18
Q

ETIO: Pericarditis

A

VIRAL: Coxsackie
If it is bacterial, typically Strep Pneumoniae
Pain is relieved by leaning forward

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19
Q

CKMB Vs Troponin

A

Both rise in appx 4 hours (trop faster?)
CKMB normal in 2-3d
Troponin normal in 7 days

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20
Q

Goal Digoxin level in HF pt

A

Between 0.5 and 0.8ng/dl

Good in pts with A. Fib

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21
Q

AHA/ACC HF Staging

A

Focused on prevention
Stage A: at RISK but no sx or structural changes of HF
Stage B: Structural changes but no sx HF
Stage C: Structural change with prior or current sx
Stage D: Refractory HF requiring specialized interventions

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22
Q

NYHA Classification

A

Class I: Cardiac disease without limitation. No sx with normal activity
Class II: Slight limitation. Ok at rest but sx with normal activity
Class III: Marked limitation. Ok at rest but sx with less than normal activity
Class IV: Sx at rest. Unable to do any physical activity

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23
Q

EF in Diastolic HF?

A

Normal or “Preserved”

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24
Q

L sided HF vs R sided

A

L sided: pulmonary congestion

R sided: venous congestion (liver and periphery)

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25
Q

Hypertrophic vs Dilated Cardiomyopathy cause what kind of heart failure

A

Hypertrophic–> Diastolic

Dilated–> Systolic

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26
Q

Pts with what type of VHD have a higher incidence of nitroglycerin induced syncope?

A

Aortic Stenosis

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27
Q

Water hammer pulse

A

(variable pulse) seen with aortic regurg

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28
Q

Mitral Stenosis: where best heard? What sound?

Associated with what other heart problem ?

A

Diastolic opening snap
New onset A. Fib in 80% of pts
Most common valvular disorder caused by rheumatic fever
Sx best heard at apex

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29
Q

Mitral Regurg etiology

A

Spontaneous chordae tendineae rupture s/p MI typically LAD.

MVP most common cause

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30
Q

Patent Ductus Arteriosus: location and type of sound?

A

Continous machinery murmur

Heard best at L middle and L upper sternal border with radiation to back

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31
Q

TX A. Fib

A

Hemodynamically stable: 1st line Cardizem. 2nd line B blockers (becomes 1st line if pt has A. Fib from Graves Disease) 3rd line= Cardioversion 100-200 Joules. Only if less than 6 hours
Use PO Digoxin to control the ventricular rate

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32
Q

V Tach treatment

A

If Hemodynamically unstable 1st step is cardioversion

If Hemodynamically stable: 1st line Lidocaine 2nd line Amiodarone

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33
Q

V Fib tx

A 
CPR
Defib 200J or 360J
CPR
Defib 200J or 360 J
CPR
Epi 1mg IV
Defib
Amiodarone 300mg once or Lidocaine 1 to 1.5mg/kg
Defib
Repeat Amiodarone 150mg once or lidocaine 0.5 to 0.75mg max of three doses
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34
Q

PSVT TX

A

1st line: Adenosine
2nd line: Diltiazem
3rd line: Electrical cardioversion

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35
Q

Group A Strep: how soon does it cause post strep glomerulonephritis vs Rheumatic heart disease

A

Post Strep Glomerulonephritis: 2-4 weeks after infection

Rheumatic Heart Disease: years after infection

36
Q

Avoid CCBs in what heart problem ?

A

CHF

37
Q

HTN tx for pregnant women?

A

Methlydopa 1st line

Hydralazine 2nd line

38
Q

Most common cardiac malformation

A

VSD

39
Q

Suspect what pediatric CV abnormality if patient squats after exercising?

A

Tetralogy of Fallot

40
Q

Where does Mitral Regurg radiate?

A

Axilla

41
Q

Hoarseness is a sx of what valvular disorder?

A

Mitral Stenosis: RA enlargement pushes on L recurrent laryngeal nerve

42
Q

How can the sound of A. Regurg be accentuated?

A

Sit up, lean forward and hold breath, or after deep inspiration or squatting

43
Q

Where does A. Stenosis radiate?

A

Carotids

44
Q

PDA is associated with what disease during the 1st trimester?

A

Rubella

45
Q

PDA: what vessel?

A

Persistence of the vessel joining pulmonary artery and aorta

46
Q

Tetralogy of Fallot vs ASD: shunting/cyanosis?

A

ASD: Acyanotic, L to R shunt

Tetralogy of Fallot: cyanotic, R to L in VSD

47
Q

ASD: which way is the shunting? ASD is associated with increase in the pressure of the _______

A

L to R shunt. (typically high to low flow from L to R side of the heart during diastole). Associated with increased pressure in the pulmonary arteries causing Pulmonary HTN.

48
Q

Coarctation of the Aorta

A

narrowing of the aorta, typically found just after the vessels are given off to the left arm

49
Q

Response of the kidneys in Coarctation of the Aorta

A

Kidneys release more renin in attempt to increase pressure and flow to the kidneys which was decreased because of narrowing of the aorta. This causes HTN, especially in the arms, with LOW BP in the legs. pulses in the legs may be decreased in intensity or delayed compared with the arms.

50
Q

Coarctation of the Aorta occasionally co-exists with what other congenital heart disease?

A

Aortic valve abnormality

51
Q

Ductus Arteriosus

A

A normal fetal structure that allows blood to bypass circulation to the lungs (shunts blood from the L pulmonary artery to the aorta)

52
Q

What causes the ductus arteriosus to close after birth?

A

High levels of oxygen (in a normal baby- typically closes in 24 hours)

53
Q

What type of intervention required with PDA?

A

Typically corrects itself within several months of birth but may require infusion of chemicals, placement of “plugs” via catheters or surgical closure. Also may be treated with high flow O2 and Indomethacin.

54
Q

What EKG findings associated with pericarditis?

A

ST elevation in all leads

55
Q

IVDU with infective endocarditis what bacteria and what valve?

A

Staph aureus, Tricuspid

56
Q

Non IVDU with endocarditis what bacteria and what valve

A

Strep viridans, mitral

57
Q

In 80% of these patients (new onset) they have A. Fib and typical diastolic opening snap accentuated S1

A

Mitral stenosis

58
Q

What valve most commonly affected by rheumatic fever?

A

Mitral

59
Q

Most common heart abnormality in children?

A

VSD

60
Q

What class of drugs is contraindicated in pts with 1st degree AV block?

A

CCBs

61
Q

Which coronary artery is associated with a LATERAL MI?

A

L circumflex

62
Q

Which coronary artery is associated with an ANTERIOR Mi?

A

LAD

63
Q

Which coronary artery is associated with INFERIOR MI

A

RCA

64
Q

Why do ACEI not work well in the black male population?

A

Tend to have lower levels of Renin. Can use ARBs instead.

65
Q

What antihypertensives work well in pts with osteoporosis?

A

Thiazides (low dose, may prevent fractures)

66
Q

Lipid lowering agent of choice in pts with liver disease

A

Bile acid sequestrants

67
Q

Pt with Von Willebrands will affect the PT or PTT?

A

PTT (will have normal PT, normal platelets and abnormal PTT)

68
Q

Heparin will affect the PT or PTT?

A

PTT

69
Q

ASA will affect PT or PTT?

A

PT

70
Q

1st and 2nd line treatment of pericarditis?

A

Typically viral:

1st: Indomethacin
2nd: Steroids (unless it is bacterial in which case treat with antibiotics)

71
Q

Rheumatic heart disease commonly affects what 3 valves (in order)

A

Mitral
Aortic
Tricuspid

72
Q

General rule regarding where murmurs are heard?

A

Sound radiates in the direction of blood flow

73
Q

Murmur of Aortic Stenosis vs Hypertrophic cardiomyopathy relationship to squatting

A

AS Murmur increases with squatting, improves standing

Hypertrophic Cardiomyopathy increases standing and decreases with squatting

74
Q

Why is the murmur of AS better heard when pt sits up and exhales?

A

It decreases the after load and the murmur can blow without resistance

75
Q

You give adenosine to a pt suspected to have PSVT and they get worse: V fib or V tach, what is the dx?

A

WPW

76
Q

New L BBB concerned about what?

A

AMI

77
Q

Tx stable angina vs Prinzmetal’s angina?

A

BBblocker stable angina

CCB Prinzmetal’s (coronary vasospasm)

78
Q

Difference between unstable angina and NSTEMI/STEMI

A

Enzymes elevated in NSTEM/STEMI

79
Q

AAA tx

A

5.5 repair

80
Q

Aortic Dissection tx

A

Type A= ascending aorta= surgery

Type B= descending aorta= B blockers. If complete rupture or end organ damage–> surgery

81
Q

RX for hypertrophic cardiomyopathy

A

Verapamil

82
Q

Physical exam finding of LVH

A

S4 gallops, apical lift or heave. LVH is compensatory response to systemic HTN or aortic valve stenosis and can cause diastolic heart failure as the L ventricle becomes stiff.f

83
Q

Diastolic heart failure associated with what changes in the heart?

A

LVH

84
Q

What is anginal equivalent

A

Is dyspnea without anginal discomfort caused by ischemia.

85
Q

What medication should be avoided in cocaine induced HTN?

A

B blockers. Instead use CCBs and alpha blockers or combined alpha beta like labetolol.

86
Q

Xray shows rib notching and 3 sign?

A

Coarctation of the aorta

87
Q

Fixed wide splitting S2

A

ASD

PANRE (11 decks)

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