CARDIO Flashcards
How to you ensure you’re in the pericardium when doing a pericentesis?
blood should NOT clot
What is the rise in the jugular pressure that increases with inspiration with pericardial tamponade?
kussmauls
What are the 3 Ds of pericardial tamponade?
Distant heart sounds, distended jugular, decreased arterial pressure
What are the different types of aortic dissection?
stanford A and B
What is the initial dose of plavix/clopidgrel for MI?
300mg
Can you use heparin with patients with CrCl
NO
What other diuretics can be used other than furesomide?
bumetanide
What are the ADRs of amiodarone?
pulm HTN, hyper/hypothyroid, elevated LFT, iodine allergy
What statins are approved for acute MI treatment?
Atrovastatin 80mg OR Rosuvastatin 40mg
Patient passes out after standing for too long?
neurocardiogenic syncope
What is the most likely cause of a child fainting after an argument?
cardio - QT prolongation
What is the most likely cause of an adult fainting after an argument?
cardio - MI
What is the most likely cause of fainting after getting up from a chair?
orthostatic
What is the most likely cause of orthostatic hypotension if the patient does not have a reflex of increasing HR?
autonomic dysfxn
What is emergency HTN
> 180/120 + organ damage
What HTN meds are cautioned after MI?
Minoxidil and Clonidine
What HTN meds are cautioned after cataract surgery?
alpha blockers
What HTN meds are contraindicated with bradycardia or heart block?
beta blockers, clonidine, CCB
What HTN meds are contraindicated with asthma and PAD?
beta blockers
What HTN meds are contraindicated with pregnancy?
ACE, ARB, thiazide
What HTN meds are contraindicated with renal artery stenosis?
ACE, ARB
What HTN meds can cause pericardial effusion?
minoxidil
-asozin?
alpha blockers
-dipine?
CCB
-sartan?
ARB
What HTN meds can cause hypertrichosis?
minoxidil
What HTN meds can cause hyperurecmia?
thiazide
What HTN meds can cause peripheral edema?
CCB
What HTN meds can cause diarrhea?
direct renin inhibitors
What HTN meds can cause hypokalemia?
thiazide
What HTN meds can cause constipation?
CCB (Verapamil), clonidine
What HTN meds can cause depression?
beta blockers
What HTN meds can cause hyperkalemia?
ACE, ARB, spironolactone
What are the 5 common causes of restrictive cardiomyopathy?
1) cancer
2) amlyoidosis
3) radiation
4) fibrosis
5) hemachromatosis
6) scleroderma
Angina syncope is a child?
child- hypertrophic cardiomyopathy
What is the difference between systolic and diastolic HF?
systolic: prob pumping out, no prob filling; diastolic: prob filling, no prob pumping
What are the 5 common causes for systolic HF?
radiation/chemo, tako tsubo, MI, cocaine, viral infxn
Patient on a ratio of __ can have balloon pump removed?
3:1
Acute MI treatment balloon pump ratio?
1:1
What will happen to patient’s INR when on amiodarone?
increases
What is the INR goal for mechanical valve?
2.5-3.5
What is thrombophlebitis?
PE + inflammed vessel walls
What is tx for thrombophlebitis?
one month of low molecular heparin
What test should be ordered for supsicion of pheochromocytoma?
UA for VMA
When treating a patient with HTN urgency, __% in __hours should be avoided?
more than 25% in 1-2hrs
What are JNC 7 classification?
pre - 140/90; stage 1 - 160/100; stage 2 - >160/100
What is the difference between constrictive and restrictive cardiomyopathy?
constrictive - pericardium constricts; restrictive - deposits within the pericardium
What causes death in HOCM?
venticular tachycardia –> ventricular fib
How to treat diastolic HF?
same as systolic HF: beta blocker, diuretic, ACE
What arrythemia can occur with structural changes?
ventricular tachycardia
What types of murmurs are associated with a. fib?
MITRAL regurg and MITRAL stenosis
What murmur RARELY causes sx?
pulm regurg
What electrolyte disorder can increase digoxin toxicity?
hypokalemia
What med can cause vision to turn blue?
sildenfil
What med can cause vision to turn yellow?
digoxin
What drug decreases afterload in post MI?
ACE
What do V1, 2, 3, 4, 5, 6 leads mean?
1, 2 -posterior? ; 3, 4 - anterior; 5, 6 - lateral
Calf pain that is resolved with rest?
peripheral artery disease
What is the term for calf pain that is resolved with rest?
claudication
What do low ejection fraction and HOCM have in common?
death from VT
What mechanical intervention can improve coronary perfusion and work load?
aortic balloon pump
What is the best medication for HTN in MI?
dobumatine
What meds are recommended with patients with CAD?
ACE and BB
What type of adrenal tumor causes HTN?
pheochromocytoma
First line HTN with NO DM?
thiazide
First line HTN with DM?
ACE
Common cause of diastolic HF?
HTN
What meds for HF?
ACE, loop diuretic, nitro
What meds are recommended with chronic HF?
ACE and BB
Vitamin deficiency that causes HF?
thiamine
What 2 CCB affects AV node?
verapamil, diltiazem
What rash is seen with endocarditis?
petechial
Roth spots in a drug user is associated with what bug?
s. aureus
How to tell the difference between tricuspid and mitral regrug?
Carvallo’s sign - murmur of TRICUSPID regurg increases during held in inspiration
What is the physical sign seen with tricuspid stenosis?
JVD
Common cause of tricuspid stenosis?
rheumatic fever
Rheumatic fever attacks which valve first?
mitral
What murmur is heard with pregnancy?
mitral stenosis
What are the 3 common causes of mitral and tricuspid regurg?
leaflet degeneration, chordea tendinae rupture, dilation
What are the common causes of aortic and pulm regurg?
leaflet degeneration, dilation
What is the diff between chronic systolic and diastolic HF?
systolic: ACE, loop diuretic, BB; diastolic: ACE and BB
What is gallavardin phenomenon associated with?
aortic stenosis
What is austin flint associated with?
aortic regurg: low rumbling murmur
What are the 3 symptoms of aortic stenosis?
ASH (Angina, Syncope, Heart failure)
What are the 3 symptoms of mitral stenosis?
PHD (Palpitation, Heart failure, Dyspnea on exertion)
Machine murmur?
PDA
What is pathognomonic for rheumatic fever?
aschoff bodies - subcutaneous nodules
What cyanotic heart defect causes right heart failure?
eisenmenger syndrome
Pansystolic murmur?
VSD
What are the 4 components for tetratology of fallot?
overriding aorta, VSD, RVH, pulmonary valve stenosis
Venous ulcer occurs commonly where?
medial mallelous
What cardiac abnormality is associated with bicuspid aortic valve?
coarctation of aorta
Murmur with pulmonic area ejection murmur and fixed split S2?
ASD
What 2 CXR indicates PE?
hamptons hump and westermark sign
Imaging study for PE in pregnancy?
VQ scan
Patient has a cold L arm d/t arterial clot - what is the valvulopathy?
mitral stenosis
What must be r/o’d in marfan sx?
aortic dissection
What is first line for varicose veins?
compresison stockings
What med for arterial emboli?
heparin
What valvulopathy is associated with periperhal arterial emboli?
mitral stenosis
What HTN makes peripheral arterial emboli sx worse?
BB
Gold standard for peripheral artery?
angiograhy
Claudication calls for what first test?
ABI
What is associated with giant cell arteritis?
polymyalgia rheumatica
30yo male has a syncopal episode after taking abx and EKG shows VT, cause?
QT prolongation from abx
70yo male passes out after arguing, what 3 conditions should be r/o’d?
acute coronary syndrome (clot in the heart: MI, unstable angina, angina), ventricular arrhythmia, aortic stenosis
What HTN med causes impotence in men?
BB
Patient going under radiation is likely to get what type of cardiomyopathy?
constrictive cardiomyopathy
Signs of constrictive cardiomyopathy?
JVD, dyspnea on exertion
What is affected in HOCM?
sacromere
What are causes of HF?
thiamine deficiency, hyperthyroidism, severe anemia, AV shunts
Where are the apical impulses located in systolic and diastolic HF?
systolic -downward and L; diastolic: midclavicular and 5th intercostal
S4 is associated with?
HOCM, MI, diastolic HF
S3 is associated with what HF?
systolic HF
What is graham steel murmur?
pulm regurg
Opening snap and decrescendo diastolic murmur?
mitral stenosis
Crescendo decrescendo systolic murmur?
pulm stenosis
Ebstein anomaly?
tricuspid is not formed properly and is not long enough to close the valv resulting to triscupid regurg
Why does squatting help kids with tetralogy fallot?
squatting temp closes the shunt so they get more O2 throughout the body
What is another word for pansystolic?
holosystolic
What is the most common cardiac defect?
VSD
12yo male gets leg cramps when running and notice a radial femoral pulse, what to suspect?
coarctation of aorta
Common cause of aortic dissection?
HTN
Pulmonic area ejection murmur with fixed splitting of S2 , what to expect on CXR?
dilated pulmonary arteries
Gold standard for 56yo male with tearing sensation to the back?
aortic angiography
Patient presents to ER for CP but cardiac work up is neg. Has many RF for CAD and strong family hx, what work up should he do as out patient?
walking nuclear test
Which cardiac enzyme lasts the longest?
troponin
Which cardiac enzyme peaks the first?
CKMB
How does elderly patient first present when having an ACS?
syncopal event
Do a. fib patients have preload?
NO b/c atrium isnt contracting = no blood
What is preload vs afterload?
preload: the stretch of the ventricles after the atrium contracts
afterload: the resistance and “push” the ventricles have to do inorder to get the blood through the aortic valve (meaning higher afterload = HTN)
Which of the following medications is best avoided when treating a hypertensive patient who has insulin-dependent diabetes mellitus?
Propanolol
A 15-year-old boy faints while playing basketball. In the emergency department he is alert and non-cyanotic. Blood pressure 140/90 mm Hg, pulse 72/min/regular and respiratory rate 16/min. Examination shows apical lift, 2/6 ejection murmur at the apex and bisferiens carotid pulse. Which of the following is the preferred initial therapy?
Verapamil
A 67-year-old man who has known chronic bronchitis and atherosclerotic heart disease has a 1 week history of increasing exertional dyspnea. Which of the following is the preferred diagnostic test to differentiate pulmonary dyspnea from cardiac dyspnea?
Bnp
A 44-year-old woman has an acute ischemic cerebellar stroke. Blood pressure 146/92 mm Hg, pulse 102/min/regular, rectal temperature 102.4 degrees F, and respirations 22/min. Lungs are clear to auscultation. Cardiac examination shows a 2/6 left sternal border diastolic heart murmur. Which of the following is the most likely diagnosis?
Infective endocarditis
A 70-year-old man who has a prosthetic aortic valve is to undergo gum surgery. He has no allergies. Which of the following is the preferred agent in endocarditis prophylaxis?
Ampicillin
A 70-year-old man has a 2 week history of fatigue and low grade fever. Presence of which of the following would suggest endocarditis as the underlying disease?
Petechiae
A 48-year-old man with bipolar disorder is well-controlled on lithium. He recently developed hypertension. Which of the following antihypertensive drugs is most likely to cause lithium toxicity if prescribed to him by your practice?
Hydrochlorothiazide
A 56-year-old woman has a 4 month history of poor concentration, forgetfulness, constipation, and dry skin. Hypothyroidism is diagnosed. Which of the following is the most likely electrocardiographic abnormality to be noted?
Low voltage
Thirty minutes after using cocaine, an 18-year-old man has agitation, sweating, and restlessness. Blood pressure 220/116 mm Hg, pulse 138/min. Which of the following effects is most likely to be noted if intravenous propranolol is administered?
Further elevation of BP
A 67-year-old man has a 2 week history of increasing facial swelling with onset of facial cyanosis. Examination shows elevated jugular venous pressure and dilation of the veins of the anterior chest and both arms. Cardiac examination is normal. Which of the following is the most likely diagnosis?
Superior vena cava syndrome
A 33-year-old woman has systolic heart failure related to dilated cardiomyopathy. Which of the following is the least likely cause of the cardiomyopathy?
Prior hx of viral hep
Which of the following is the mechanism of action of a thrombolytic medication?
Activates plasminogen
