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WHOLE PT > Cardio > Flashcards

Cardio Flashcards

1
Q

What are RF for stable angina?

A

1) DM
2) low LDL
3) HTN
4) family hx
5) age (males >45yo; females > 55yo)
6) family hx

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2
Q

How to tx stable angina?

A

lifestyle changes and ASA in all
mild- nitrates + beta blockers (atenolol or metoprolol)
CCB if nitrates + beta blockers don’t help
mod - revascularization via PCI (angioplasty) or CABG
severe - CABG

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3
Q

What labs/imaging to run for stable angina?

A
  • stress test
  • pharmacologic stress test (if cannot do exercise stress test)
  • holter
  • cardiac catherization w/ coronary angiography
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4
Q

What are some beta blockers?

A

atenolol

metoprolol

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5
Q

Pt has chest pain upon exertion but goes away with rest?

A

stable angina

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6
Q

Pt has chest pain during rest?

A

unstable angina OR non-stemi

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7
Q

How to differentiate between unstable angina and non-stemi?

A

cardiac enzymes

if elevated = non-stemi

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8
Q

Labs/imaging for unstable anigina?

A

EKG - looks like non-stemi –> get cardia enzymes

coronary angiograph

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9
Q

Tx for unstable angina?

A

admit + IV + O2 +/- morphine
1) ASA
2) first line - nitrates + beta blockers
-clopidogrel
-LMWH (low molecular wt heparin) –> Enoxaparin
+/- angioplasty or CABG - use TIMI score
3) discharge: ASA + nitrates + beta blocker

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10
Q

Pt has chest pains occasionally at night?

A

variant/prinzmetal angina

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11
Q

RF for varient/prinzmetal angina?

A

smoking

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12
Q

Hallmark for varient/prinzmetal angina?

A

transient ST segment ELEVATION w/ chest pain

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13
Q

What else is associated with chest pains in varient/prinzmetal angina?

A

ventricular dyshythmias

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14
Q

Tx for varient/prinzmetal angina?

A

CCB + nitrates

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15
Q

Dx for varient prinzmetal angina?

A

coronary angiography - coronary vasopasms w/ chest pains

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16
Q

Pt has substernal chest pain for 30min and diaphoresis?

A

MI

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17
Q

What EKG findings for MI?

A

peaked T wave - EARLY, usually missed
ST elevation -diagnostic
Q waves - previous MI
ST depression

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18
Q

CXR for MI pts?

A

CLEAR lungs

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19
Q

What does ST elevation mean?

A

transmural - LARGER

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20
Q

What is the gold standard for dx MI?

A

troponin

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21
Q

Pt has “crushing” pain that radiates?

A

MI

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22
Q

What population has asymptomatic sx w/MI?

A

elderly
DM
women

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23
Q

Labs/imaging for MI?

A

EKG

troponin

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24
Q

When should troponin be high and normalize?

A

check q8hrs for 24hrs

doubles 5-8hrs then normalize 5-14days later

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25
Q

What to do if pt has non-ST elevation?

A

check troponin - if high –> MI

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26
Q

What other lab can be used for MI?

A

CK MB

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27
Q

Tx for MI?

A

1) admit + IV + O2 + morphine
2) ASA + Beta Blocker + Nitrates + ACE-I + statins + LMWH
3) +/- CABG/stent/angioplasty/tPA (Alteplase)

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28
Q

Meds for discharge-MI?

A

ASA
Beta Blocker
ACE-I
Statins

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29
Q

What drug should be avoided in stable angina but used in unstable and MI?

A

LMWH - enoxaparin

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30
Q

When can tPA be used (time)?

A

w/in 12 hrs

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31
Q

When should you NEVER use tPA?

A

head injury
bleeding (internal)
stroke
surgery

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32
Q

Pt has orthopnea and paroxysmal nocturnal dyspnea and diaphoresis?

A

lef sided CHF

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33
Q

What is left sided CHF?

A

fluid backs up into the lungs

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34
Q

What is the biggest cx of CHF?

A

HTN

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35
Q

What is the pathophys behind CHF?

A

CO is too low –> renin-angiotensin-aldosterone is activated –> increase in preload

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36
Q

What are 2 types of CHF?

A

systolic - problem squeezing

diastolic - problem filling

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37
Q

What is happening in systolic CHF?

A

cardiomyopathy - too big and won’t squeeze effectively

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38
Q

Pt has orthopnea and paroxysmal nocturnal dyspnea and diaphoresis -what to expect on PE?

A 
dullness on percussion
rales
S3 gallop
displaced PMI 
rales
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39
Q

What is happening in diastolic CHF?

A

myocardial hypertrophy - too much muscle and will not fill all the way but squeezing is fine

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40
Q

What are the NYAH classifications?

A

I - only w/ aggressive activity
II - climbing stairs; little limitation
III - daily activities are affected; mod limitation
IV - sx at rest; BAD

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41
Q

Pt has pitting edema, JVD, ascities?

A

right sided CHF

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42
Q

What test/labs to order for CHF?

A 
CXR
EKG
cardiac enzymes - r/o MI
CBC - r/o anemia (can cx CHF)
echocardiogram - first line and gold standard
bnp
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43
Q

What to see on CXR - CHF?

A

cardiomegaly

Kerle B lines

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44
Q

Tx for CHF-systolic?

A 
mild/I-II
-first line: ACE-I
\+/-diuretic
mod/II-III
-ACE-I + diuretic + Beta blocker
severe/III-IV
-ACE-I + diuretic + Beta blocker + digoxin
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45
Q

Discharge drugs for CHF systolic?

A

ACE-I

beta-blockers

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46
Q

What to use if pt cannot use ACE-I?

A

ARB

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47
Q

What drugs are CONTRAINDICATED in CHF pts?

A

metformin

NSAIDs

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48
Q

Tx for diastolic CHF?

A 
lifestyle changes
beta-blockers
diuretics
digoxin
\+/-ACE-I
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49
Q

Pt comes in with S3 + S4, dyspnea, pitting edema?

A

dilated cardiomyopathy

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50
Q

Cx of cardiomyoptahy?

A

idiopathic

CAD

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51
Q

How to dx dilated cardiomyopathy?

A

CXR - cardiomegaly, Kerley B lines , pleural effusion

echocardiogram - gold standard - dilated chamber

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52
Q

How to tx dilated cardiomyopathy?

A

admit + nitrate + O2 + B blockers + diuretics + ACE-I/ARB

ASA at discharge

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53
Q

Pt suddenly drops dead - literally?

A

dilated cardiomyopathy

most likely hypertrophic cardiomyopathy

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54
Q

Is hypertrophic cardiomyopathy genetic?

A

yes - autosomal dominant

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55
Q

YOUNG pt has chest pain on exertion, syncope, and palpitations?

A

hypertrophic cardiomyopathy

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56
Q

What is the pathophys of hypertrophic cardiomyopathy?

A

diastolic problem - overworks during exercise causing increase in HR + contractility

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57
Q

How to dx hypertrophic cardiomyopathy?

A

echocardiogram

family hx

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58
Q

How to tx hypertrophic cardiomyopathy?

A

AVOID STRENUOUS EXERCISE
B blocker - first line
CCB if B blocker doesnt work
+/- diuretics

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59
Q

Young male w/ lyme dz + fatigue, fever, chest pain, pericarditis?

A

myocarditis

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60
Q

How to tx myocarditis?

A

supportive - usually viral infxn

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61
Q

How to monitor myocarditis?

A

cardiac enzymes - troponin

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62
Q

Pt has postviral illness + chest pain when breathing?

A

acute pericarditis

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63
Q

Complications of acute pericarditis?

A

pericardial effusion

cardiac tamponade

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64
Q

Other cx of acute peridicitis?

A 
acute MI OR after MI 
usually viral (coxsackivirus, EBV, influenza) or bacterial (TB)
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65
Q

Pt has chest pain, pericardial friction rub, what to expect on EKG?

A

diffuse ST elevation + PR depression

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66
Q

Pt has acute pericarditis - what temporarily relieves pain? What would you hear on PE?

A

leaning forward

pericardial friction rub

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67
Q

How to tx acute pericarditis?

A

self limiting

NSAIDs

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68
Q

Pt has ascities + hepatomegaly + distended neck veins?

A

cirrhosis

constrictive pericarditis

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69
Q

Pathophys of constrictive pericarditis?

A

pericarditis becomes very fibrous and scarred –> causes diastolic dsyfxn

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70
Q

Cx of constrictive pericarditis?

A

idiopathic

TB

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71
Q

Pt has muffled heart sounds, dullness at LEFT lung base, soft PMI?

A

pericardial effusion

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72
Q

Pt is SICK, JVD, ascities, and dependent edema?

A

constrictive pericarditis

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73
Q

How to dx constrictive pericarditis?

A

echocardiogram - increased pericardial thickness

CT/MRI - increased pericardial thickness

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74
Q

Tx of constrictive pericarditis?

A

+/- diuretics

tx underlying cx

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75
Q

What can pericardial effusion lead to?

A

cardiac tamponade

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76
Q

Cause of acute pericarditis?

A

pericardial effusion

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77
Q

How to dx pericardial effusion?

A

echocardiogram - first line

CXR - silhouette; water bottle sign

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78
Q

How to tx pericardial effusion?

A

depends on pt’s current status

pericardiocentesis is NOT indicated

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79
Q

Pt has stab wound on chest?

A

cardiac tamponade

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80
Q

What is an iatrogenic cause of cadiac tamponade?

A

central line
pacemaker placement
pericardiocentesis

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81
Q

What is important to know about cardiac tamponade?

A

how FAST fluid is getting in NOT how MUCH

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82
Q

Pathophys of cardiac tamponade?

A

too much fluid on the OUTSIDE of the heart –> problems with filling (diastolic dysfxn)

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83
Q

What is the beck’s triad?

A

hypotensive
muffled heart sounds
JVD

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84
Q

what is pulses paradoxus?

A

late decrease of arterial pressure when breathing in

85
Q

How to dx cardiac tamponade?

A

echocardiogram - diagnostic

CXR - silhouette; CLEAR LUNGS

86
Q

How to tx if cardiac tamponade is NOT hemorrhagic and pt is stable?

A

observe with echocardiograms and CXR

87
Q

How to tx if pt is unstable but non hemorrhagic cardaic tamponade?

A

pericadriocentesis

88
Q

What can mitral stenosis eventually lead to?

A

pulmonary HTN

right ventricular failure

89
Q

How to diagnose mitral stenosis?

A

echocardiogram - diagnostic: big left atrium, thick mitral valve
CXR: large left atrium

90
Q

How to tx mitral stenosis?

A

mild: diuretics and B blockers
mod to severe: surgery - percutaneous balloon valvuloplasty
a fib: anticoagulant + warfarin

91
Q

Cx of mitral stenosis?

A

rheumatic fever

92
Q

What is the cx of aortic stenosis?

A

age
rheumatic fever
congenital

93
Q

What haps to the heart during aortic stenosis?

A

the left ventricle gets overworked –> big

94
Q

Sx of aortic stenosis?

A

angina
syncope
HF sx: dyspnea

95
Q

How to dx aortic stenosis?

A

echocardiogram - diagnostic: big LV and LA; aortic valve is calcified
CXR: calcified valve is late finding
cardiac cath: DEFINITIVE dx test: can exactly measure the valve

96
Q

Tx of aortic stenosis?

A

valve replacement

97
Q

What is the sx timeline for aortic stenosis and aortic regurgitaiton?

A

angina –> syncope –> HF

98
Q

Pathophys of aortic regurgitation?

A

the leaflet valve is not closing all the way so blood is getting leaked back into heart –> LV pushes harder –> overworked –> big

99
Q

What are cx for ACUTE aortic regurgitation?

A

infective endocarditis
trauma
aortic dissection

100
Q

What are cxs for CHRONIC aortic regurgitation?

A

valvular - rheumatic fever, bicuspid aortic valve, MARFAN

aortic - osteogenesis imperfecta, aortic dissection, reiter’s sx, HTN

101
Q

What are special PE for aortic regurgitation?

A

de musset sign - head bobbing
WIDENING PULSE PRESSURE: increased systolic w/ decreasing diastolic
water hammering pulse/ Corrigan’s

102
Q

How to dx aortic regurgitation?

A

CXR - big LV
echocardiogram - big LV
cardiac cath - determine valve damage

103
Q

How to tx aortic regurgitation?

A

surgery is definitive (replacement)

mild- observe w/ VASODILATORS, ACE-I/ARB

104
Q

Endocarditis can cause what to the valves?

A

aortic regurgitaiton

mitral regurgitation

105
Q

What can rheumatic fever cause to the valve?

A

mitral stenosis
aortic regurgitation
mitral regurgitation
rheumatic heart dz

106
Q

What can Marfan sx cause to the valve?

A

aortic regurgitation
mitral regurgitation
mitral valve prolapse

107
Q

Dilated LV on CXR/echocardiogram?

A

mitral stenosis
aortic stenosis
aortic regurgitation
mitral regurgitation

108
Q

How to tx mitral regurgitation?

A

vasodilators + surgery

109
Q

Pulsatile liver?

A

tricuspid valve regurgitation

110
Q

Who are at high risk for tricuspid regurgitation?

A

IV drug users

111
Q

How to dx tricuspid regurgitation?

A

echocardiogram only

112
Q

How to tx tricuspid regurgitation?

A

diuretics (B blockers, ARB-I)

valve REPLACEMENT IS RARE -just fix the valve

113
Q

Hypertrophic cadriomyopathy increase/decrease with squatting/valsalva?

A

increase

114
Q

How to dx mitral valve prolapse?

A

echocardiogram only

115
Q

How to tx mitral valve prolapse?

A

asymptomatic - nothing
chest pain - beta blocker
surgery is NOT required

116
Q

Pathophys of rheumatic heart dz?

A

complication of strep A

occurs after rheumatic fever

117
Q

How to dx rheumatic fever?

A

2 major or 1 major + 2 minor

major: polyarthritis, erythmema marginatum, cardiac probs, chorea, subcutaneous nodules
minor: fever, increase ESR, polyarthritis, hx of rheumatic fever, prolonged PR, hx of strep infxn

118
Q

Tx of rheumatic heart dz?

A

tx strep from the start w/PCN or erythromycin

rheumatic fever tx w/ NSAIDs

119
Q

Pt has new heart murmur + fever?

A

infective endocarditis

120
Q

What are the two types of endocarditis?

A

acute and subacute

121
Q

Bug for acute endocarditis (nosocomial)? What kind of valve?

A

s aureus

NORMAL VALVE

122
Q

Bug for subacute (community)? What kind of valve?

A

strep viridans, enterococcus

on DAMAGED valves

123
Q

IV drug users are at high risk for?

A

tricuspid regurgitation

endocarditis

124
Q

Tx for endocarditis?

A

culture to find out which abx to use

125
Q

What is the duke criteria used for?

A

endocarditis

126
Q

Wide fixed splitting of S2?

A

atrial septal defec

127
Q

What is hap to the heart w/ ASD?

A

right heart is working hard –> RV gets big

128
Q

Sx of ASD?

A

if mild may be asymptomatic for life

if not, 40yo start to feel sx similar to stable angina

129
Q

Right bundle branch block on EKG?

A

ASD

130
Q

What complication can occur 40yo+ w/ ASD?

A

pulmonary HTN

131
Q

Tx for ASD?

A

nothing unless pt is symptomatic (surgery)

132
Q

What sx for VSD?

A 
if PVR (pulmonary vascular resistance) is 0 = CHF, lower respiratory infxn
if PVR is high = chest pain, dyspnea
133
Q

How to dx VSD?

A

Echocardiogram

134
Q

How to tx VSD?

A

if small - nothing

if big - surgery

135
Q

Who are at risk for coarctation of aorta?

A

turner sx

136
Q

What are sx of coarctation of aorta?

A

delayed femoral pulses compared to radial
cold extremities
HA
leg fatigue

137
Q

What dx coarctation of aorta?

A

CXR-notching of the ribs and “3”

138
Q

Tx of coarctation of aorta?

A

surgery

139
Q

Machine like murmur?

A

patent ductus arteriosus

140
Q

Who are at high risk for PDA?

A

premature babies

141
Q

What can kill pts with PDA?

A

HF and infective endocarditis

142
Q

How to dx PDA?

A

echocardiogram

143
Q

How to tx PDA?

A

surgery unless SEVERE PULMONARY HTN -> surgery is contraindicated

144
Q

What keeps PDA open? close?

A

open: prostaglandins
closed: indomethacin
in newborns - use prostaglandins until hand off

145
Q

What is tetralogy of fallot?

A

VSD
right ventricular hypertrophy
pulmonary artery stenosis
overriding aorta

146
Q

Crescendo-decrescendo at left upper sternal border?

A

tetralogy of fallot

147
Q

What is a tet spell? What is the most common sx?

A

when pt squats to increase SVR

cyanotic

148
Q

What is used to dx tetralogy of fallot?

A

echocardiogram

149
Q

What is found on CXR w/ tetralogy of fallot?

A

boot shaped heart

150
Q

How to tx tetralogy of fallot?

A

surgery

151
Q

What organs should be inspected with hypertensive emergency and what will hap to those organs?

A 
eyes: papilledema
CNS: altered mental status
kidneys: renal failure
heart: unstable angina, MI, CHF
lungs: pulmonary edema (CHF)
152
Q

What could hypertensive emergency lead to?

A

posterior reversible encephalopathy syndrome

153
Q

Pt has severe HA + HTN - steps to do?

A

1) lower Bp w/ hydralazine
2) CT scan to r/o bleeding
3) CT is neg –> LP

154
Q

Pt has HA + visual disturbances + altered mental status?

A

hypertensive emergency

155
Q

Pt has tearing/ripping/stabbing pain in chest, acute?

A

MI

aortic dissection

156
Q

What to do when differentiating MI and aortic dissection?

A

EKG - MI –> may be non stemi –> cardiac enzymes

CXR - aortic dissection –> WIDENING MEDIASTINUM

157
Q

What two areas can pt have pain for aortic dissection?

A

ascending - front

descending - back

158
Q

What is dx for aortic dissection?

A

CXR- can be used to r/o MI
TEE
CT/MRI

159
Q

How to tx aortic dissection?

A

MEDICAL EMERGENCY
type A (ascending) - SURGERY
type b (descending) - medicine (B blocker) + morphine
NO TPA

160
Q

Pt has cullen sign?

A

ecchymoses around umbilicus

about to rupture AAA

161
Q

What is the triad of ruptured AAA?

A

abdominal pain
hypotension
pulsatile abdominal mass

162
Q

Who are at high risk for AAA?

A

Marfan sx

163
Q

How to dx AAA?

A

US

CT

164
Q

How to tx AAA?

A

surgery

165
Q

Pt has leg off the end of the bed and foot feels better?

A

peripheral vascular disease

166
Q

What are other PE for dangerous peripheral vascular disease?

A

no hair
thick toenails
decreased skin temp
no pulses

167
Q

Which peripheral vascular disease has good prognosis? Why?

A

intermittent claudication

pain goes away w/ rest

168
Q

Where does the pain occur the most in peripheral disease? Why?

A

distal metatarsals b/c it has the smallest arteries

169
Q

Highest RF for peripheral disease? Most people have what as cx?

A

smoking

underlying cardio prob - CHF, CAD

170
Q

What is normal ABI? What is bad ABI?

A
  1. 9-1.3

1. 3 - severe dz

171
Q

What is the gold standard for peripheral disease?

A

arteriography

172
Q

Who has the highest risk for peripheral disease?

A

DM

173
Q

Tx for peripheral dz?

A 
lifestyle changes
PDE inhibitor (vasodilator)
surgery -angioplasty, bypass IF pt has pain w/ rest and affects life activties
174
Q

Where it is likely for a clot to occur in LE?

A

femoral artery

175
Q

What are the 6 P’s for acute arterial occlusion? What else can this be used for?

A 
Pain
Pallor
Pulseless
Paresthesias
Paralysis
Polar (Cold)
can also be used for compartment sx
176
Q

Tx for acute arterial occlusion?

A

anticoags

surgery

177
Q

What is the virchow triad?

A

injury to vessel
stasis
hypercoagulability

178
Q

Pt has swollen leg after taking OCP?

A

DVT

179
Q

First line imaging for DVT?

A

doppler

180
Q

If doppler is positive for DVT - next step?

A

anitcoagulation

181
Q

How to tx and manage DVT?

A

heparin bolus then warfarin

manage w/ PTT and INR

182
Q

If pt has right sided CHF + DVT - how to tx?

A

tpa

183
Q

Hx of DVT can cause…?

A

destruction of valves

does not allow blood to pass from superficial to deep

184
Q

What does hx of DVT lead to?

A

ambulatory venous HTN –> edema d/t increase interstitial fluid accumulation –> weeping of skin –> brown color of the skin

185
Q

How to tx chronic venous insufficiency? Complications? and how to tx complications?

A

stockings
avoid long standing time
elevate leg
ulcers can occur - dressing/unna boot

186
Q

Pt has hypotension. oliguria, tachycardia, and altered mental status?

A

shock!

187
Q

Pt has fever? Type of shock?

A

septic

188
Q

Pt has trauma, GI bleeding, vomiting/diarrhea? Type of shock?

A

hypovolemic shock

189
Q

Pt has leg swelling and skin color changes but relieved when leg is elevated?

A

chronic venous insufficiency

190
Q

Pt has JVD? Type of shock?

A

cardiogenic

191
Q

Pt has MI, angina, heart disease? Type of shock?

A

cardiogenic

192
Q

Pt has spinal cord injury? Type of shock?

A

neurogenic shock

193
Q

What is the first step to tx shock?

A

fluids-make sure pt is hemodynamically stable

vasopressors (dopamine/norepinepherine)

194
Q

What to keep in mind for cardiogenic shock pts when tx?

A

fluids can overexert the heart –> use diuretics if LV is too high

195
Q

What are some causes for hypovolemic shock?

A

hemorrhage - trauma

nonhemorrhagic- severe dehydration

196
Q

What is pre HTN?

A

120/80+

197
Q

What is stage I and stage II HTN?

A

> 140/90 and >160-/100

198
Q

What is OK for 80yo - HTN?

A

150

199
Q

What is HTN ER?

A

220/125

200
Q

What is malignant HTN?

A

HTN + sx

201
Q

How to tx stage I HTN? stage II?

A

over 60yo: CCB/ diuretic + ACE/ARB

younger 60: ACE/ARB + CCB/diuretic

202
Q

ATP III - cholesterol: norm, borderline, high?

A

norm: 200
borderline: 240
high: 240+

203
Q

ATP III - LDL: norm, borderline, high, very high?

A

norm: 130
borderline 160
high 190
very high 190+

204
Q

ATP III - HDL: low, high?

A

low: less than 40
high: more than 60

205
Q

ATP IIII - triglyceride: norm, borderline, high, very high?

A

norm: 150
borderline: 200
high: 500
very high: 500+

206
Q

ATP IV - mod statin?

A

clinical ASVCD + 75yo OR cannot use high statin
LDL is lower than 190 + DM1/2+40-75yo
7.5% ASCVD + 40-75yo

207
Q

ATPIV - severe statin?

A

clinical ASVCD + less than 75yo
LDL greater than 190
LDL less than 190 + 7.5% ASCVD + DM1/2

208
Q

Dressler’s sx?

A

low grade fever + pleuretic chest pain + pericardial effusion AFTER injury to heart (2wks post MI)

WHOLE PT (19 decks)

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