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COMLEX 2 > Cardio > Flashcards

Cardio Flashcards

1
Q

Treatment for child with coarctation of the aorta presenting in cardiogenic shock?

A

PGE1 (to keep ductus arteriosus open)

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2
Q

Acute Aortic Dissection early Tx:

A

Esmolol (short acting B1 easily titratable)

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3
Q

Prinzmetal’s angina.

d/t

EKG findings

Tx

Do not give ____? Why? What other related condition should you not give this med?

A

Substernal chest pressure at rest and during activity worse in the AM and with smoking.

Dx: Transient ST Elevations on EKG

Tx: CCB, Nitrates

Do not give Propranolol. Unopposed alpha vasoconstriction can cause death. Don’t give Propranolol in Intermittent Claudication (for the same reason).

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4
Q

EKG findings of myocardial infarction.

A

Sustained ST elevations (transmural)

Transient or sustained ST depressions

Q waves (Old MI)

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5
Q

Digoxin

MOA

What is it used for?

A

Blocks Na/K ATPase of cardiac myocytes to slow conduction through SA and AV nodes.

For A.Fib

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6
Q

Digoxin Toxicity S&S.

Antidote?

A

Yellow vision

Abd pain

2º AV Node Type I (Wenckebach) Block.

Tx: Digoxin Immune Fab

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7
Q

S&S of Left sided Heart Failure (weeks after Anterior MI.)

Most likely caused by?

A

Dyspnea, crackles

↑ PCWP (> 15) and ↑ RA pressure (>6)

d/t Ventricular Aneurysm (ST elevations in V1-V4)

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8
Q

What is the 1st line med in all Acute Coronary Syndromes?

A

Aspirin. (Clopidogrel if unable to tolerate). Reduces morbidity and mortality.

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9
Q

Management of Symptomatic A. Fib

Dx?

A

Dx: TEE to check for intracardiac thrombus OR

Anticoagulate for 3 wks before cardioversion

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10
Q

LBBB

A

No R in V1

Tall R in V6

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11
Q

RBBB

A

RSR1 “Rabbit ears”

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12
Q

Hypo/Hypercalcemia EKG changes?

A

Hypocal = “po“longed QT.

Hypercalcemia is opposite (shortened QT)

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13
Q

What is Kussmaul’s sign?

A

JVP Increased with Inspiration

[Norm JVP= 6-8]

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14
Q

Aortic Stenosis keywords

A

Pulmonic Post (L 2 ICS)

Ejection

“Parvus”

Radiates to Carotids

Assoc: Turner’s Syn, Heyde’s angiodysplasia of colon

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15
Q

Mitral Regurg keywords

A

@ Apex

Radiates to Axilla

Blowing

Marfan’s (also seen in Aortic Regurg)

Papillary mm. rupture

Weight loss meds

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16
Q

Mitral Valve Prolapse keywords

A

@ Apex

Midsystolic (Think MVP of the mid-season)

Better w/ squat

Klinefelter

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17
Q

Hypertrophic (Systolic) Cardiomyopathy keywords

A

LSB

S in V1 + R(V5/V6) > 35mm

Louder w/ Valsalva, standing, vasodilators, diuretics (anything that ↓ preload/afterload)

Tx: BB, CCB

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18
Q

Aortic Regurg keywords

A

@ LSB/Pulmonic post (L 2 ICS)

High pitched blowing

Flash pulmonary edema

(Austin Flint, Duroziez, Corrigan, DeMusset, Quincke),

Marfan’s (also seen in Mitral Regurg)

Syphilis

Tx: Hydralazine, ACEi, CCB

Valve replace if Austin Flint

HAC V?

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19
Q

What is Austin Flint? Significance?

A

backward flow of blood hitting mitral valve leaflet.

Time to REPLACE the AORTIC VALVE

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20
Q

What is Duroziez sign?

A

Femoral bruit

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21
Q

What is Corrigan’s Pulse?

A

Water hammer bounding pulse

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22
Q

What is DeMusset’s sign?

A

Head Bobbing

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23
Q

What is Quincke’s Pulse?

A

Pulsating Nail Bed

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24
Q

Mitral Stenosis keywords

A

@ Apex

Hemoptysis

Mid-diastolic rumble with *Opening snap*

Loud S1

Rheumatic Fever, Group A Strep.

Tx: Balloon Valvotomy

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25
Q

What can cause 1st Degree AV Block?

A

Vagal tone

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26
Q

Wenckebach Tx.

A

Stop BB, CCB, or Digoxin

Atropine

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27
Q

Tx. for Mobitz 2, 3rd Degree AV Block, and Sick Sinus Syndrome

A

Pacemaker (Transcutaneous pacing)

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28
Q

A. Fib Tx parameters

A

1) Anticoagulate if CHADS2 >=2.
2) If 48 hrs, Anticoagulate,
3) If 3-6 weeks of Warfarin (INR 2-3) can cardiovert

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29
Q

Multifocal Atrial Tachycardia Tx

A

BB or CCB for rate control

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30
Q

Tx. for AVNRT or AVRT

A

1) Carotid massage, Valsalva.
2) Adenosine.
3) Cardiovert if hemodynamically unstable

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31
Q

Tx. Unstable supraventricular tachycardia

A

Synchronized Cardioversion (If conscious add sedation)

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32
Q

CHF acute exacerbation management

A

LMNOPA:

Lasix, Morphine, Nitrates, O2, Position upright, ACEi/ARB

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33
Q

Cilostazol MOA, indications, and contraindications

A

Phosphodiesterase inhibitor that decreases platelet aggregation and causes arterial vasodilation, that used for Intermittent Claudication and PVD.

Contraindicated in CHF

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34
Q

NYHA Class I

A

No limitations.

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35
Q

NYHA Class II

A

Slight activity limits. Comfortable at rest, but ordinary activity results in angina, dyspnea, fatigue, or palpitations. Tx: ACEi, BB, Loops for exacerbations

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36
Q

NYHA Class III

A

Comfortable ONLY at rest. Tx: ACEi, BB, Loops, Spironolactone

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37
Q

NYHA Class IV

A

Symptoms at rest. Can’t carry out any physical activity without discomfort. Tx: ACEi, BB, Loops, Spironolactone

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38
Q

Tx of Ventricular Tachycardia

A

Cardioversion is your PAL (Procainamide, Amiodarone, Lidocaine)

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39
Q

What EKG abnormality is Brugada Syndrome associated with?

A

V. Fib

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40
Q

Torsades can be d/t taking what medications?

A

Haloperidol

Atypical antipsychotics

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41
Q

Torsades de Pointes tx

A

Mg

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42
Q

Chronic CHF Tx

A

Chronic CHF is BADS

BB

ACEi/ARB, ASA

Diuretics (Loops + Thiazide + Spironolactone)

Statin

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43
Q

Loop Diuretics [Lasix, Ethacrynic Acid, Torsemide]

MOA

AE

A

↓ Na/K/Cl/Ca reuptake.

Ototoxicity, HypO-K and Ca

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44
Q

Which Loop diuretic is not part of the Sulfa family?

A

Ethacrynic Acid

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45
Q

Thiazides [Chlorothiazide, Chlorthalidone]

MOA

AE?

A

↓ NaCl reuptake.

Cause HypO-K and alkaLOsis, HyperGLUC

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46
Q

Aldosterone antagonists/K sparing [Spironolactone, Triamterene, Amiloride]

MOA

AE

A

Spironolactone: aldosterone rec antagonist

Triamterene, Amiloride: block Na channels

HyPER-K, Gynecomastia

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47
Q

Carbonic Anhydrase Inhibitors MOA

AE

A

Decreased HCO3- retention

HyPER-Chloremia and aCidosis, Sulfa allergy

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48
Q

Wet Beriberi

A

B1 deficiency manifesting as:

Tachycardia, vasodilation, ↓ SVR, ↑ JVP, DOE, Edema

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49
Q

What is the gold standard for diagnosing atherosclerosis or if there’s unstable angina?

A

Coronary Angiography

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50
Q

Angina Pectoris Acute tx.

A

MONAB:

Morphine, O2, Nitrates, ASA + ACEi, BB

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51
Q

Angina Pectoris Chronic tx

A

“BAN”

BB

ACEi + ASA

Nitrates

52
Q

NSTEMI tx

A

CASH CAB:

Cath,

ASA,

Statin,

Heparin

Clopidogrel,

ACEi,

BB

53
Q

What does it mean if you see ST Elevations in II, III, aVF? What blood supply is affected?

What do you do?

A

Inferior MI (which will involve the RV 50% of the time), RCA/PDA and LCA.

  • Right sided MI will usually have Hypotension and Bradycardia (RCA s> SA node)

Dx: Get Right-sided EKG

Tx: Give Fluid Bolus (because RV function will be ‘preload’ dependent)

54
Q

What meds are contraindicated in RV infarction?

A

NITRATES contraindicated in RV infarction

55
Q

If there’s a Coronary A. Reocclusion after MI, what labs do you look at?

A

CK-MB

56
Q

ST depression V1-V2 indicates what?

A

Acute Posterior Wall Transmural Infarct

57
Q

If an MI pt. is in heart failure (hypoxia, S3, pulm edema) or Cardiogenic shock, DON’T give what?

A

NO BB. Gives ACEi

58
Q

STEMI tx

A

Angiography.

PCI within 90 min.

>90 then do TPA

59
Q

Most common cause of death following acute MI?

Tx?

A

Ventricular Arrhythmia

Tx: Immediate unsynchronized Cardioversion

60
Q

Post MI complication Day 1

A

Heart failure

Arrhythmia is most common complication (within 24 hrs, and days 2-4) following MI.

61
Q

Post MI complications days 3-7 (or 5-10)

A

Intraventricular septal rupture: hemodynamic instability and new holosystolic murmur @ LSB

Ventricular free wall rupture: leads to hemopericardium/ cardiac tamponade with Beck’s triad

Papillary mm. rupture: mitral regurg and left heart failure

62
Q

Post MI complication Weeks-Mo. after

A

CHF, persistent ST Elevation, mitral regurg, ventricular aneurysm

63
Q

Which lipid lowering agent causes angioedema?

A

Ezetimibe (cholesterol absorp inhibitor)

64
Q

How to diagnose and tx. Renal A. stenosis?

A

MRA or Renal A. Doppler US. Tx: Angioplasty, stenting, ACEis ONLY if unilateral

65
Q

Conn’s syndrome Triad

A

HTN, HypO-K and AlkaLOsis. Increased Aldo v Renin

66
Q

Malignant HTN

S&S

Tx?

A

>180/120.

Retinal hemorrhages, exudates, encephalopathy, papilledema (NOT Renal failure)

Tx: IV Sodium Nitroprusside (1st line), Hydralazine, Labetolol (if no COPD), Enalapril

67
Q

Mean Arterial Pressure

A

[SBP + 2(DBP)] / 3

68
Q

ACEi Adverse Effects

A

HyPER-K, Angioedema, Cough

69
Q

MOA of Methyldopa

A

centrally acting adrenergic agonist

70
Q

Constrictive Pericarditis keywords

A

pericardial knock

71
Q

Aortic Dissection keywords

A

Spiral CT angiography, Between media & adventitia, diastolic decrescendo @ aortic post

72
Q

Stanford A of Aortic Dissection

A

Left Subclavian, Proximal. Surgical emergency

73
Q

Stanford B of Aortic Dissection

A

Left Subclavian, Distal. Medically manage

74
Q

Debakey I

A

Ascending & Descending

75
Q

Debakey II

A

Ascending

76
Q

Debakey III

A

Descending

77
Q

Leriche Syndrome

A

Butt claudication, v femoral pulses, impotence

78
Q

What drains to Right lymphatic Duct

A

R Head and Neck, R upper extremity, Heart, Lungs

79
Q

Vasovagal syncope

A

excess parasympathetics. Tilt-table test. Tx BB

80
Q

Brugada Syn keywords

A

Na chan mutation in myocytes. ST elevation V1-V3 + RBBB + S waves in lateral leads.

81
Q

Goal LDL for CAD/equivalents i.e. DM, PAD, Symptomatic Carotid a. dz, abdominal aortic aneurysm

A
82
Q

Goal LDL for 0-1 risk factors

A
83
Q

Goal LDL for 2+ risk factors

A
84
Q

When is measuring PCWP (~Left Atrial pressure) helpful?

A

for checking severity of LV HF, quantifying degree of mitral stenosis, inc. in tamponade, restrictive cardiomyopathy, hypertrophy, for checking for pulmonary HTN

85
Q

Loud holosystolic murmur @ LSB that is non-cyanotic

A

Ventricular Septal Defect

86
Q

What would an Atrial Septal Defect sound like?

A

wide, fixed split S2

87
Q

Tx. of Asymptomatic Sustained Monomorphic Vtach

A

Procainamide

88
Q

Tx. of Symptomatic Sustained Monomorphic Vtach

A

Cardioversion

89
Q

Tx. of Narrow QRS SVT

A

Adenosine

90
Q

Tx. of Severe Bradyarrhythmias causing hemodynamic collapse

A

Transvenous pacing

91
Q

What is the most appropriate next step in management in a patient with Intermittent Claudication?

A

Check Ankle-Brachial Index (ABI)

92
Q

Venous hum

A

systolic/diastolic @ RSB quiets with pressure to jugular vein

93
Q

Still murmur

A

early systolic, @ LSB, normal split S2

94
Q

Peripheral pulmonary a. stenosis of the newborn

A

mid systolic, radiates to back and axilla, resolves in 3-6 mo.

95
Q

Tx. for Atrial Flutter (hemodynamically stable pt)

A

Verapamil Metoprolol

96
Q

What is the leading cause of isolated mitral regurgitation requiring surgery?

A

mitral valve prolapse

97
Q

Tx. for 2nd Degree AV block (Wenckebach)?

A

Atropine, BB, CCB, Digoxin

98
Q

Tx. for Mobitz II?

A

Pacemaker

99
Q

Tx. for 3rd Degree AV Block?

A

Pacemaker

100
Q

What is the most common indication for pacemaker placement?

A

Sick Sinus syndrome

101
Q

Tx. Atrial Fib?

A

Anticoagulate if >48 hrs

BB, CCB, Dig Cardioversion

102
Q

Tx. for AVNRT and AVRT?

A

If unstable: Cardioversion

Stable: carotid massage, valsalva, Adenosine

103
Q

Tx: Unstable Supraventricular Tachycardia

A

Circulation, Airway, Breathing

Synchronized Cardioversion

104
Q

Defibrillation (not in synchrony with QRS) is Tx for what?

A

V. Fib

V. Tach no pulse

105
Q

Cardioversion (in synchrony with QRS) is tx for what?

A

A. Fib/ A. Flutter

SVT

VT w/ pulse

106
Q

CHF Dx?

Labs?

Tx?

A

Dx: Clinical diagnosis. Check EKG, BNP, 2D Echo.

Labs: ↓ Cardiac Index, ↑ SVR and LVEDV

Tx:

Restrict fluid and salt (H2O <2L/d, Na <2g/d), ACEi/ARB, BB, Lasix, Spironolactone, Imdur, Hydralazine

AICD for Ejection Fraction <35.

Dobutamine for cardiogenic shock.

107
Q

Tx. HOCM

A

BB, CCB, avoid dehydration

108
Q

Tx. of Acute Angina

A

MONAB (Morphine, O2, Nitrates, ASA/ACEi, BB)

109
Q

Tx. Chronic Angina

A

Nitrates, ASA/ACEi, BB

110
Q

How do Nitrates work?

A

Dilate capacitance vessels (veins) and ↓ ventricular preload

111
Q

NSTEMI

Dx?

Tx?

A

Myocardial infarction marked by elevated Troponin I and CK-MB without ST elevations

Tx: Stable: Clopidogrel, Heparin

Unstable: Cardiac Catheterization/PCI

112
Q

STEMI

Dx?

Tx?

Goals after hospitalization?

A

EKG, Troponins

Tx:

Angiography and PCI w/in 90 min

If no PCI, then TPA for thrombolysis

PMONAB: Plavix, Morphine, O2, Nitrates, ASA/ACEi, BB (but not if heart failure or cardiogenic shock. Just give ACEi)

On d/c: BASH –> BB, ACEi/ARB, Statin, Heparin

Goal: <130/80, A1C<7, LDL<70

113
Q

Fibrates (Gemfibrozil)

MOA

Effects on lipid profile

Adverse SE?

A

↑ LPL

↓ TGs and ↑ HDL

! LFTs, myositis

114
Q

Ezetimibe (Cholesterol absorption Inhibitors)

MOA

Effects on Lipid Profile

Adverse SE

A

↓ absorption at brush border to ↓ LDL

! diarrhea, angioedema

115
Q

Niacin

MOA

Effects on Lipid Profile

Adverse SE

A

↓ LDL synthesis and thus ↑ HDL

! skin flushing, LFTs

116
Q

Cholestyramine (Bile Acid resin)

Effects on Lipid Profile

Adverse SE

A

↓ LDL

! diarrhea, LFTs

117
Q

Vasovagal syncope

d/t?

dx?

Tx?

A

excess parasympathetic stimulation (i.e. carotid stim, coughing, micturition, defecation)

Dx: Tilt-Table Test

Tx: BB

118
Q

Neurogenic Shock

d/t?

Dx?

Tx?

A

hypotension, bradycardia, and hypothermia with + focal neurological deficit

unopposed vagal tone causes vasodilation which then ↓ SVR, which is why ↓ PCWP. In addition, vagal tone promotes ↓ HR, which then ↓ CO and ↓ BP

“warm and dry extremities” (also seen in septic shock)

Dx: CT angio, MR angio, US of Carotids

Tx: DA, Vasopressin, Atropine for bradycardia

119
Q

What is the tx. for acute decompensated Systolic Heart Failure refractory to medical management?

A

Milrinone: PDE inhibitor that increases cAMP and therefore increases cardiac contractility.

Dobutamine

Dopamine

120
Q

What is a feared complication of Carotid Endarterectomy (CEA)?

A

Hyperperfusion Syndrome:

Increased blood flow after stenosis is released that causes headache, seizure, hemorrhage in pts. who have a high degree of stenosis or recently suffered a stroke

121
Q

Cardiogenic Shock

d/t?

Dx?

Tx?

A

heart failure causes ↓ CO, ↓ BP so the body tries to compensate by ↑ SVR, ↑ HR and when blood comes back to left atrium, ↑ PCWP

“pale cool skin”, JVP

d/t heart failure e.g. MI

Dx: EKG, Troponins

Tx: Fluids, Dobutamine, inotropes, anti-arrhythmics (Adenosine, Amiodarone, BB), Intra-aortic balloon pump

122
Q

Septic Shock

d/t

Dx?

Tx?

A

↓ SVR (~↓ BP) which then leads to

↓ PCWP (~Left Arterial Pressure: too little fluid in)

↑ HR ↑ CO

“warm and dry” extremities

suspect in pts. with penetrating abdominal wounds and GI contamination

Tx: Fluids, Broad spectrum ABX (? GI: Cipro, Metronidazole, Vanco), Norepinephrine to vasoconstrict peripheral arterioles

123
Q

Anaphylactic Shock

A

↓ SVR (~↓ BP) which then leads to

↓ PCWP (~Left Arterial Pressure: too little fluid in)

↑ HR ↑ CO (heart wants to raise the system’s volume and flush out allergen?)

124
Q

Tx: DVT

A

SQ Heparin x 5d then Coumadin x 6 mo. [INR 2.0-3.0]

125
Q

Post MI complication 3-7 days

A

Intraventricular septal rupture: hemodynamic instability and new holosystolic murmur @ LSB

COMLEX 2 (19 decks)

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