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CARDIO Flashcards

1
Q

Murmur of MVP

A

Late systolic murmur with a

Mid SYSTOLIC click

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2
Q

Opening Snap

A

Mitral stenosis

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3
Q

Fixed splitting

A

ASD

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4
Q

Loud P2, split S2

A

Pulmonary HTN

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5
Q

Paradoxical Split/ Reverse splitting/ P2 closes earlier than A2

A

AS, LBBB, HTN

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6
Q

Pericardial friction rub/ pericardial knock

A

Constrictive Pericarditis

*Sharp early diastolic sound

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7
Q

Physiologic Split

A

A2 comes before P2

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8
Q

Pulsus Tardus et parvus

A

Aortic stenosis

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9
Q

Pulsus Bisfiriens

A

HOCM

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10
Q

Pulsus Alternans

Cheyne-Stokes Respiration

A

Severe heart failure

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11
Q

Pulsus Paradoxus

A

Cardiac tamponade
SVC syndrome
Pulmonary Obstruction

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12
Q

Late diastolic murmur with a “plop”

A

Atrial Myxoma

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13
Q

Continuous murmur, 3rd L ICS

A

PDA

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14
Q

What happens to murmurs with handgrip/phenylephrine?

A

All murmurs will increase (due to increased afterload) EXCEPT HOCM, MVP, AS

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15
Q

What happens to murmurs with amyl nitrite?

A

All murmurs will decrease (due to decreased afterload) EXCEPT MVP, HOCM, AS

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16
Q

Post PVC what happens to murmur of HOCM, MVP, AS?

A

HOCM, AS - increase

MVP- decrease

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17
Q

Increased neck vein distention on inspiration?

A

Kussmaul’s sign

Found in constrictive pericarditis, cardiac tamponade, RV infarct, pulmonary (BA, COPD), abdominal compartment syndrome

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18
Q

RCA supplies what

A

Inferior, posterior, RV

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19
Q

LAD supplies what

A

Anteroseptal, apicolateral

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20
Q

L circumflex supplies what

A

Apicolateral

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21
Q

Post descending artery supplies what

A

Apical

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22
Q

Diagonal branch supplies what

A

High lateral

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23
Q

When to use MUGA scan

A

To det EF in pxs with wall motion ab(N); EF poor prognosticating factor for MI

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24
Q

When is Exercise stress test +

A

ST elevation

ST dep > 1mm for > 0.08 sec

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25
Q

When to stop stress test

A

Symptomatic (CP/SOB)
Vtach
ST dep > 2 mm
SBP drops > 15 mmHg

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26
Q

When to do cardiac cath?

A

Poor prognostic factor on stress test
Post infarct angina
UA still symptomatic despite tx or becomes NSTEMI (+ ekg, cardiac enz)

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27
Q

Findings in Microvascular Angina

A

CP, EKG neg, Stress test reversible ischemia, cath neg

TX: BB, nitrates, CCB

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28
Q

Wellens Syndrome

A

ST dep in V2-V4

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29
Q

Indications for PCI

A
  • STEMI > 12hrs
  • TPA contraindicated
  • 75 years
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30
Q

Indications for thrombolysis

A

-STEMI

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31
Q

T/F in pxs going for PCI, clopidogrel should be used

A

True

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32
Q

T/F in pxs going for cabg, clopidogrel should be used

A

False

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33
Q

When is CABG better than PCI

A

L main dse
DM w/ CAD
3V dse with dec EF
2V dse with Involvement of proximal LAD & low EF

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34
Q

Dressler’s syndrome

A

Post-MI pericarditis

Tx: high dose ASA (6-8g/d) or ibuprofen 800 mg TID

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35
Q

T/F Mortality benefit of ICD > 40 days post-MI, warfarin in large ant wall MI x 3-6mos

A

T

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36
Q

T/F Vtach & Vfib within 48hrs postMI need long term therapy

A

F

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37
Q

Mech of reperfusion arrhythmias

A

Change in frequency fr accumulated Ca

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38
Q

What to do if px has sustained Vtach 48hrs after MI?

A

Treat with amio (if stable), defibrillate if unstable, then place ICD

*Vtach > 48h post MI is a predictor of mortality after discharge

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39
Q

Vtach post MI, with recurrent discharges from ICD?

A

Start amiodarone

If persistent, radiofrequency ablation

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40
Q

How many mos after MI should you do elective surgery?

A

After 6 mos

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41
Q

Treatment for recurrent pericarditis

A

Colchicine

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42
Q

Most common cause of constrictive pericarditis?

A

Post CABG

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43
Q

Square root sign

A

Constrictive pericarditis

Also with:
Pericardial knock (early 3rd heart sound)
Pericardial friction rub
Heart pressures are within 5mmHg of each other

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44
Q

Treatment of constrictive pericarditis

A

Surgical stripping

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45
Q

Most common cause of CHF

A

Ischemic

Also caused by:
Dilated CMP, valvular dse, congenital heart dse

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46
Q

Drug shown to be of most benefit in HFpEF

A

Candesartan

47
Q

ACE-I with mortality benefit in MI

A

Ramipril (fr studies)

48
Q

ACE-I with mortality benefit in TIA

A

Perindopril

49
Q

Most common cause of decompensated CHF

A

Inc Na intake

50
Q

If px with CHF becomes hyperkalemic on ACE-I what to do?

A

D/C Ace-I and start hydralazine-isordil

51
Q

Flow of drugs in CHF

A

Diuretics for acute decompensation -> ACE-I -> BB -> +/- spironolactone

52
Q

When to put ICD in CHF?

A

After 3 mos of maximal medical therapy (non-ischemic cause),40 days after MI (ischemic)

53
Q

Unilateral gynecomastia on spironolactone?

54
Q

Bilateral gynecomastia on spironolactone?

A

D/C spiro and start eplerenone

Alternative to eplerenone?
Amiloride

55
Q

Poor prognostic factors in CHF

A 
S3
HypoNa
PCWP > 12
PAP > 50
peak O2 uptake
56
Q

Which coxsackie virus causes viral myocarditis?

57
Q

Never drugs in CHF

A

NSAIDs
Glitazones & Metformin (in advanced CHF)
Cilostazol
CCB

58
Q

Symmetrical hypertrophy on echo

A

Athlete’s heart
DM
Obesity

59
Q

Poor prognostic factors for HOCM

A

Familial, FHx of sudden cardiac death
Age 3cm
Failure to inc SBP by 20mmHg during exercise

60
Q

Echo definition of severe AS

A

Gradient > 40mmHg, valve area

61
Q

Asymptomatic Mild AS, echo frequency?

62
Q

Asymptomatic moderate AS, frequency of echo?

63
Q

Asymptomatic severe AS, frequency of echo?

64
Q

T/F compared to surgery, complications w/ TAVR are increased

65
Q

Criteria for repair in AS

A

Severe AS w/ symptoms

If asymptomatic, do serial echo depending on valve area

66
Q

Criteria for repair in AR

67
Q

When to do echo for AR with LVED 60-70

A

Echo every 12mos

68
Q

When to do echo for AR with LVED 70-75

A

Every 3-6mos

69
Q

What to do for AR with LVED >75

70
Q

Criteria for MS repair

A

Valve area

71
Q

Criteria for MR repair

A

symptoms

EF

72
Q

When to repair PDA

A

Percutaneous repair is beneficial at all times

73
Q

When to repair ASD/VSD

A

When L to R shunt is > 1.7:1

74
Q

Pathology in septum primum defect

A

Septum primum did not connect w/ endocardial cushion

-assoc w/ MR

75
Q

Pathology in septum secundum defect

A

Incomplete covering of foramen ovale by septum primum

Associated w/ MVP

76
Q

Pathology in patent foramen ovale

A

Incomplete fusion of septum primum

77
Q

Right to left shunt

A

Eisenmenger syndrome

78
Q

The most common presentation of eisenmenger syndrome

79
Q

3 sign is seen in?

A

Coarctation of the aorta

80
Q

Most common associated congenital anomaly in coarctation of the aorta

A

Bicuspid aortic valve

81
Q

How often is echo done in Marfan’s?

A

Yearly until aortic dilatation is 4.5 cm then every 6 mos til 5.5 cm then repair

82
Q

Best way to prevent aortic dissection in Marfan’s?

A 
Beta blockers
Then losartan (shown to dec risk of dissection)
83
Q

Screening age for AAA

A

Men w/ hx of smoking age 65-75

84
Q

Thoracic aneuryms are repaired at what size?

85
Q

AAA are repaired at what size?

86
Q

What to give for HTN in dissecting aneurysm?

A

Beta blocker then nitroprusside

87
Q

If found to have small AAA how often is US repeated?

A

Every 6 mos

88
Q

Best test for dissection?

A

TEE

If not available, CT w/ contrast

89
Q

Anticoagulate porcine valves?

90
Q

In AF rate control + anticoagulation compared to cardioversion has shown

A

Decreased stroke & hospitalizations

91
Q

Drugs for chemical cardioversion of AF

A 
Amiodarone 
Dronedarone- only med shown to dec hospitalization
Quinidine
Procainamide- for WPW
Ibutilide
Dofetilide
92
Q

AF + CAD + CHF, which drug?

A

Amiodarone

93
Q

AF + CAD, no CHF, which drug?

A

Sotalol, amiodarone, dronedarone, dofetilide

94
Q

AF no CAD which drug?

A

Flecainide, propefenone

95
Q

CHADS2

CHAD Vasc

A 
CHF
HTN
Age > 75, in chad vasc, age 65-74
DM
Stroke/TIA/embolism
Vascular dse
Female

Also high risk, MS, HOCM, prosthetic valve

96
Q

For elective major surgery on pxs with AF on warfarin, if risk factor

A

D/C warfarin 5 days before surgery, no bridging

97
Q

For elective major surgery on pxs with AF on warfarin, if risk factor > 3

A

D/C warfarin 5 days before and bridge with lovenox BID with last dose 24hrs before surgery; or lovenox OD with last dose 1/2 dose on AM of surgery

98
Q

AF refractory to medical treatment

A

AV ablation w/ pacemaker insertion

99
Q

Young px with AF refractory to medical treatment

A

Circumferential pulmonary vein ablation

100
Q

Target HR for AF control

101
Q

Mgt if atrial flutter?

A

Same as AF

  • rate control
  • cardioversion
  • EPS w/ ablation
102
Q

Wheezing px w/ SVT, what to give?

A

Ca channel blocker

103
Q

Delta wave and short PR interval

104
Q

Tx for MAT

A

O2, Mg, bronchodilators

105
Q

If w/ multiple PVCs, look for organic heart disease, then?

A

If neg, no sx – no tx
If neg, w/ sx – beta blocker
If pos, low EF – ICD

106
Q

2nd deg type 2 fr inf wall MI, what to do?

A

May be transient, wont require pacing

107
Q

2nd deg type 2 fr ant wall MI, what to do?

A

May require pacing

108
Q

Indications for pacing

A

SA node ab(N): HR 3 sec

2nd deg AV block type 2
3rd deg AV block
Pause dependent vtach
CHF w/ prolonged QRS (biventricular)

109
Q

Quinidine toxicity

A

Prolonged QT, dec platelets

110
Q

Procainamide toxicity

A

Drug induced lupus

111
Q

Lidocaine toxicity

112
Q

Amiodarone toxicity

A

Hypo/hyperthyroidism, pulmonary fibrosis, corneal deposits

113
Q

Drugs which inc digoxin level

A 
Amiodarone
Quinidine
Verapamil
Spironolactone
Chlothalidone
HCTZ
114
Q

Inc incidence of what valvular disorder in septum secundum defect?

CARDIO (4 decks)

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