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Cardio Flashcards

1
Q

Three types cardiomyopathy + which is most common?

A

dilated** (MC)
hypertrophic
restrictive

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2
Q

Dilated cardiomyopathy:
common cause
prognosis
symptoms same as

A

CAD w/ prior MI (ischemic damage)
death w/in 5 years
CHF symptoms

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3
Q

Treatment of Dilated Cardiomyopathy

A

-Dig
-Diuretics
-Vasodilators
+/- anticoagulation

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4
Q

HCOM:

  • inheritance pattern
  • type of dysfunction
A
  • AD

- diastolic dysfunction

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5
Q

Murmur assc with HCOM?

Worse with?

A

Loud S4 + systolic ejection murmur @ LLSB

worse with Valsalva, standing

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6
Q

Initial drug to treat symptomatic HCOM

A

BBers

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7
Q

Surgical treatment of HCOM

A

myomectomy

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8
Q

Restrictive Cardiomyopathy:

-dysfunction type

A
  • impaired diastolic filling

- systolic function variable

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9
Q

Causes of Restrictive Cardiomyopathy

A 
SASH CC 
sarcoid 
amyloid 
scleroderma 
hemochromatosis 
chemo 
carcinoid 
....or idiopathic
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10
Q

Echo findings in restrictive cardiomyopathy

A

large atria, normal ventricles

bright myocardium in amyloidosis

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11
Q

Definitive diagnosis of restrictive cardiomyopathy

A

biopsy

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12
Q

Hemochromatosis treatment

sarcoid treatment

A

hemochromatosis- phlebotomy, deferoxamine

sarcoid- steroids

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13
Q

Dig is contraindicated in what type of restrictive cardiomyopathy?
Needed when?

A

amyloid

used in other cases if systolic dysfunction is present

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14
Q

Three viral causes myocarditis

A

HHV6
parvo
coxsackie

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15
Q

Bacterial causes myocarditis (3)

A

GAS
Lyme
mycoplasma

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16
Q

Medication that may cause myocarditis

A

sulfonamides

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17
Q

Acute pericarditis most common causes

A

post viral/ coxsackie

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18
Q

Complications of acute pericarditis

A

effusion

tamponade

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19
Q

How is pericarditis distinguished from MI? (4)

A

pleuritic pain (assc with breathing)
pain relieved when sitting up
friction rub
DIFFUSE STE, PRD

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20
Q

Specific EKG finding in pericarditis

A

PRD

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21
Q

Treatment of pericarditis

A

NSAIDs

colchicine

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22
Q

Fibrous scarring of the pericardium is termed ____.

Dysfunction type is ____.

A

constrictive pericarditis

diastolic dysfunction

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23
Q

Constrictive pericarditis auscultation:

EKG:

A

pericardial knock

low voltage QRS, T waves

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24
Q

Pericardial effusion clinical findings

A

dull heart sounds

soft PMI

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25
Q

Pericardial effusion CXR findings

A

enlarged heart without pulm vascular congestion

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26
Q

When is pericardiocentesis indicated?

A

evidence of cardiac tamponade

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27
Q

What causes cardiac tamponade?

dysfunction type?

A

high rate pericardial fluid accumulation, volume irrelevant

diastolic dysfxn

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28
Q

Aside from penetration, what conditions lead to tamponade?

A

post MI

pericarditis (neoplastic, uremic esp.)

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29
Q

(3) clinical features of tamponade

A

high JVP
narrow pulse pressure
pulsus paradoxus

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30
Q

Define pulsus paradoxus

A

decreased arterial pressure (more than 10) during inspiration

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31
Q

Best diagnosis of tamponade

A

echo

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32
Q

EKG finding in tamponade

A

electrical alternans

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33
Q

Mitral Stenosis:

  • MCC
  • cardiac cascade assc with MS
A
  • RF

- elevated LAP –> pulm congestion & a fib

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34
Q

Unique symptoms of MS (4)

A
  • hemoptysis
  • purple/pink cheeks
  • emboli
  • hoarseness (LAE –> RLN compression)
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35
Q

EKG finding assc with MS

A

broad based notched P waves

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36
Q

Murmur assc with MS + severity determinant

A

S2 –> opening snap –> loud S1

decreased distance between S2 –> OS= increased severity

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37
Q

Treatment of MS

A
  • Diuretics
  • BBers
  • warfarin

(symptomatic only)

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38
Q

Aortic Stenosis:

cardiac cascade assc

A

AS –> LVH –> mitral regurg

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39
Q

Three causes of AS

A
  • senile calcification (70+)
  • bicuspid valve
  • RHD
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40
Q

Murmur assc with AS

A

crescendo-decrescendo systolic murmur at RSIS

radiates to carotids

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41
Q

Pulse abnormality assc with AS

A

parvus et tardus

diminished pulses, delayed carotid upstrokes

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42
Q

Treatment of AS

A

valve replacement

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43
Q

Cause of UE differential BP

A

supravalvular aortic stenosis

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44
Q

Cause of systolic anterior motion of mitral valve

A

HCOM

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45
Q

Cause of Sudden Cardiac Arrest in post-infarct patients

A

re-entrant ventricular arrhythmia

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46
Q

4 Labs in initial evaluation of HTN

A
  • U/A
  • chem panel
  • lipids
  • EKG
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47
Q

Aortic Insufficiency (Regurg) PE findings

A

head bobbing
uvula bobbing
pistol shot sound over femoral arteries

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48
Q

Murmur and pulse assc with AI

A

widened pulse pressure

diastolic decrescendo murmur

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49
Q

Treatment of acute AR

A

replace valve emergently

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50
Q

Medical treatment of chronic AR

A

diuretics
dig
vasodilators
reduce afterload, limit salt

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51
Q

Three acute causes of MR

A

endocarditis
papillary muscle rupture
chordae tendineae rupture

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52
Q

MR:
murmur
common arrhythmia

A

holosystolic murmur at apex

afib

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53
Q

MR treatment

A

vasodilation + anticoagulation with afib

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54
Q

How common is TR?

A

70% normal adults have asx TR

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55
Q

TR is secondary to ____.

A

RVD

as in heart failure, inferior MI

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56
Q

Tricuspid endocarditis cause

A

IVDA

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57
Q

MVP histology

A

myxomatous degeneration

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58
Q

Murmur assc with MVP (+2 maneuvers that increase)

A

midsystolic click , increased by Valsalva/ standing

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59
Q

Treatment of MVP

A

generally benign, none indicated

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60
Q

MC valvular abnormality assc with RF

A

mitral stenosis

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61
Q

Diagnostic requirements RF

A

2 major or 1 major/2 minor

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62
Q

Major criteria RF

A

JONES

  • joints (polyarthritis)
  • cadiac involvement
  • nodules
  • erythema marginatum
  • Sydenham chorea
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63
Q

How is ARF treated?

A

NSAIDs, monitor with CRP

px is penicillin/e-ymcin in GAS pharyngitis

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64
Q

New heart murmur + unexplained fever =

A

endocarditis

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65
Q

Acute endocarditis:
bug
valve type

A

staph, normal valve

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66
Q

Subactue endocarditis:
bug
valve type

A

strep viridans, enterococcus

diseased valve

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67
Q

Culture negative endocarditis bugs

A 
HACEK
haemophilus 
actinobacillus 
cardiobacterium
eikenella 
kingella
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68
Q

Most common bug assc with post op endocarditis

A

staph epi

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69
Q

MC valve + bug assc with IVDA endocarditis

A

tricuspid, staph

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70
Q

Gold standard endocarditis dx

A

transesophageal echo

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71
Q

Major criteria endocarditis

A

bacteremia , TEE diagnosed endocardial involvement OR new valve regurg

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72
Q

Treatment duration of endocarditis

A

4-6 weeks

vanc + AG until bug isolated

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73
Q

Marantic endocarditis cause + makeup of vegetations

A

cancer

fibrin + platelets

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74
Q

Treatment for Libman Sacks Endocarditis

A

anticoagulate

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75
Q

Most common type ASD + age at onset

A 
ostium secundum (central portion of septum) 
age at onset- 40
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76
Q

ASD murmur + Dx

A

wide, fixed split S2 - dx with TEE

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77
Q

Murmur assc with VSD

A

blowing, holosystolic

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78
Q

Coarctation of the Aorta is assc with what syndrome?

A

Turners

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79
Q

ECG findings in coarctation

A

LVH –> Left Axis Deviation

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80
Q

PDA is assc with what syndrome?

A

Congenital rubella

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81
Q

Murmur assc with PDA

A

continuous machine like murmur

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82
Q

TOF defects

A 
IHOP
interventricular septal defect 
hypertrophy of RIGHT ventricle 
(Right is right answer)
overlying aorta 
pulmonic stenosis
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83
Q

Murmur assc with TOF

A

LUSB crescendo decrescendo

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84
Q

EKG + CXR findings in TOF

A

RAD

Boot shaped heart

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85
Q

Amiodarone complications + most common

A 
pneumonitis **MC
thyroid tox 
liver tox 
corneal deposits 
skin discoloration (blue --> gray) 
neuropathy
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86
Q

Mechanical failure assc with MI at:
day 1
days 3-5
weeks 1-2

A

day 1: RVF
days 3-5: papillary/ septal defect
weeks 1-2 free wall rupture

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87
Q

Definition of HTN emergency?

urgency?

A
  • BP above 220/120
  • end organ damage

(urgency= BP above 220/120 w/o end organ damage)

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88
Q 
Effect of severe HTN on:
brain 
pulm 
cardio 
kidneys
A

brain- AMS, ICH
pulm- pulm edema
cardiac- angina/MI/CHF/dissection
hematuria, renal failure

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89
Q

PRES- define

A

Posterior reversible encephalopathy syndrome

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90
Q

PREs- radiographic finding

A

posterior cerebral white matter edema

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91
Q

Treatment of HTN emergency

A 
hydralazine 
nitroprusside 
esmolol
labetolol 
(IV)
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92
Q

Ilicit drugs that cause HTN emergency

A

LSD
meth
cocaine
(+alcohol withdraw)

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93
Q

Management of serve H/A and HTN?

A

antiHTN agent –> CT –> LP

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94
Q

Goal reduction of BP in HTN emergency? urgency?

A

emergency-reduce by 25% in 1-2 hours w/ IV meds

urgency- reduce BP over 24 hours with oral meds

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95
Q

Aortic Dissection:

causes

A
  • longstanding HTN
  • cocaine
  • trauma
  • CT disorder
  • bicuspid aortic valve, coarctation
  • third trimester pregnancy
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96
Q

Two types of aortic dissection:

A 
Type A:
ascending aorta involved, retrograde flow 
**surgical**
Type B: 
distal to subclavian artery
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97
Q

Location of pain in dissection

A

Type A: anterior chest

Type B: intrascapular

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98
Q

Pulse, BP, auscultation abnormalities in AD

A

pulse asymmetric between limbs
BP usually ^^ but may be low
aortic regurg

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99
Q

CXR finding in AD

A

mediastinal widening

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100
Q

Preferred tests in dx of AD

A

CT

TEE

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101
Q

Medical treatment of AD

A
  • BBer

- IV nitroprusside until BP under 120

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102
Q

Location of most AAAs + MC age/ sex

A

between renal arteries and iliac bifurcation

males over 50

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103
Q

Signs of impending AAA rupture

A

flank/umbilical ecchymoses

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104
Q

Triad of AAA rupture

A

hypotension
palpable pulsatile abdominal mass
abdominal pain

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105
Q

Dx test of choice for AAA

A

U/S

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106
Q

What AAAs are surgical?

A

greater than 5 cm or symptomatic

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107
Q

Peripheral Vascular Disease is aka?

A

Chronic Arterial Insufficiency

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108
Q

Signs of PVD in lower extremities

A
  • color change
  • ulcers
  • muscle atrophy
  • thickened toenails
  • hair loss
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109
Q

PVD most important risk factor

A

smoking

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110
Q

MC site of stenosis in PVD

A

superficial femoral artery

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111
Q

Symptoms of PVD

A

intermittent claudication/ rest pain (severe, poor prognosis)

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112
Q

Arteries related to calf claudication? hip?

A

calf- femoral, popliteal

hip- aortoiliac

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113
Q

Diagnosis of PVD

A
  • ankle to brachial index
  • pulse volume
  • arteriography (gold standard)
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114
Q

Define ankle to brachial index (ABI)

A

systolic BP in ankle: arm
normal 0.9-1.3

claudication occurs at 0.7

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115
Q

Medical treatment PVD

A

reduce risk factors
symptom control (ASA)
cilostazol (PDEi)

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116
Q

Acute arterial occlusion- most common location + common causes

A

femoral artery

  • afib
  • aneurysms
  • atheromatous plaque
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117
Q

Treatment of acute arterial occlusion

A
  • IV heparin

- surgical embolectomy

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118
Q

Cholesterol Embolization Syndrome most common cause + symptoms

A

triggered by procedure

small areas of tissue ischemia

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119
Q

Treatment of cholesterol embolization syndrome

A

supportive, no anticoagulation

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120
Q

Mycotic aneurysm: cause and location

A

infection, aortic wall

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121
Q

Luetic heart is caused by ____.,

Location? Sex? Age?

A

syphilis
aorta (ascending aneurysm)
male: 40s-50s

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122
Q

Treatment of luetic heart

A

IV penicillin + surgery

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123
Q

Virchows triad

A

endothelial injury
venous stasis
hypercoagulability

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124
Q

Why are many DVT patients asx?

A

superficial vein remains patent

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125
Q

What is Homans sign?

A

calf pain on ankle dorsiflexion (DVT sign) I

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126
Q

DVT : Dx

A

d-dimer, Doppler U/S (sensitive not specific)

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127
Q

Phlegmasia cerulea dolens:

define + cause

A

severe leg edema = caused by extreme DVT

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128
Q

Treatment of DVT

A

Heparin to PTT at 1.5-2x aPTT, INR 2-3.

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129
Q

What DVT patients receive tPa/ kinase

A

massive PE, unstable, no contraindications

130
Q

LMWH:
benefits
downside?

A

long half life (once daily)
outpatient
no levels

**more expensive

131
Q

Postphlebetic syndrome is aka? Pathogenesis?

A

chronic venous insufficiency
valve destruction –> ambulatory venous HTN =
fluid accumulation + RBCs into tissue (pigmentation)
eventual tissue death = non-healing ulcers

132
Q

Dig tox- classic EKG finding + cause

A

a tach with AB block due to increased ectopy and vagal tone

133
Q

CXR finding in perforated ulcer

A

air under diaphragm

134
Q

PE classic symptoms (four)

A

dyspnea
pleuritic pain
tachycardia
tachypnea

135
Q

Amlodipine:
MOA
Common ADR?

A

DHP CCB

edema

136
Q

Scleroderma renal crisis causes what two phenomena in addition to renal failure?

A

HTN emergency

DIC

137
Q

Cardiac amyloidosis:

EKG and echo findings

A

EKG: low voltage
Echo: LV wall thickening, normal chamber

138
Q

Common systemic symptoms assc with cardiac amyloidosis

A

easy bruising

proteinuria

139
Q

Amyloidosis may be primary or secondary to what ?

A

chronic inflammatory disoders… IBD, RA etc.

140
Q

Definitive diagnosis of amyloidosis?

A

tissue biopsy (fat pad)

141
Q

When is sinus brady treated?

A

below 50 BPM, symptomatic

142
Q

Dosage of atropine for bradycardia?

A

0.5mg q3-5 min up to 3mg

143
Q

Dosage of dopamine for bradycardia? epi?

A

dopa: 2-10 uq/lg/min
epi: 2-10 uq/min

144
Q

How might MVP cause holosystolic murmur?

A

longstanding MVP –> MR (mid systolic click) –> progresses to holosystolic murmur

MVP –> MR MCC MR

145
Q

HyperPTH findings

A

neuropsych
stones
HTN

146
Q

Shockable Rhythmns

A

PEA

Vfib

147
Q

Anterior MI:
STE or STD?
Assc artery?

A

V1-6 STE, LAD

148
Q

Lateral MI:
STE or or STD?
Assc artery?

A

STE: I & AvL
STD: II,III,and avF
LCX

149
Q

Right Ventricle MI:
STE or STD?
Assc artery?

A

STE V4-6

RCA

150
Q

Posterior MI:
STE or STD?
Assc artery?

A

V1-3 STD
I&AVL STE-LCX
I&AVL STD- RCA

151
Q

Inferior MI:
STE or STD?
Assc Artery?

A

II,III,AVF

LCX or RCA

152
Q

Hypovolemic shock:

CO?
CVP?
MVO2?
PCWP?
RAP?
SVR?
A

All low except SVR = ^^^

153
Q 
Cardiogenic Shock:
CO?
CVP?
MVO2?
PCWP?
RAP?
SVR?
A

CO, MVO2 low

others high

154
Q

Septic Shock
Hypovolemic shock:

CO?
CVP?
MVO2?
PCWP?
RAP?
SVR?
A

CO, MVO2 high

others low

155
Q

Location of most venous ulcers?

A

medial malleolus (and less painful than arterial ulcers)

156
Q

Superficial thrombophlebitis:

common locations

A

site of IV infusion

varicose veins in greater saphenous system

157
Q

Common cause of septic thrombophlebitis

A

infection of IV cannula

158
Q

Most common cardiac tumor

A

primary tumors rare (usually mets)

atrial myxoma is most common primary tumor

159
Q

Most common location cardiac myxoma

A

interatrial septum

160
Q

Murmur assc with myxoma

A

diastolic “plop” changes with position

161
Q

Signs common to all forms of shock?

A 
HOTA 
hypotension 
oliguria 
tachy
AMS
162
Q

Effect of neurogenic shock on CO SVR PCWP

A

all decreased

163
Q

What one sign suggests cardiogenic shock?

MCC?

A

JVD

MI

164
Q

BP/ urine output assc with cardiogenic shock?

A

systolic under 90

urine output less than 20ml/hr

165
Q

Intraaortic balloon pump:

function

A

pumps during diastole, relaxes during systole
increases ventricular emptying
increases coronary perfusion

166
Q

Pulse + urine output assc with classes I-IV hypodynamic shock

A

normal, normal
above 100, 20-30 ml/hr
above 120, 20 ml/hr
above 140/ not palpable, none

167
Q

Amount of fluid lost in classes I-IV hypovolemic shock

A

10-15
20-30
30-40
40+

168
Q

How to monitor treatment success in hypovolemic shock

A

urine output

169
Q

Clinical progression from SIRS

A

SIRS –> sepsis –> septic shock –> multiorgan dysfunction

170
Q

Criteria for SIRS

A 
2+: 
fever/hypothermia 
hyperventilation
tachycardia 
increased WBC count
171
Q

Sepsis criteria

A

Sepsis:

SIRS + culture +

172
Q

Septic Shock

A

Sepsis + hypotension refractory to fluid

173
Q

Multiorgan dysfunction syndrome:

prognosis

A

most die

174
Q

Main characteristics of neurogenic shock

A

peripheral vasodilation/decreased SVR

175
Q

Causes of neurogenic shock

A

spinal cord/ head injury
spinal anesthesia
pharmacologic

176
Q

Most important lifestyle modifications for lowering BP

A 
#1 weight loss 
#2 DAG 
#3 decrease Na/ alcohol

**smoking cessation does not decrease BP

177
Q

Aortic regurg:
worst position?
pulse?

A

AR worst in LLD positon

bounding pulse

178
Q

1 Study for AAA

A

AUS

179
Q

Cause of OrthoHTN in elderly

A

decreased baroreceptor responsiveness

180
Q

Shockable rhythms?

Rhythms for CPR?

A

shock: Vfib/ pulseless Vtach
CPR: asystole/ PEA

181
Q

Coarctation buzzword symptoms

A

epistaxis

LE claudication

182
Q

BBer OD symptoms & tx

A

sx: brady, AVB, hypotension
tx: IVF, atropine, glucagon

183
Q

Treatment of stable/unstable afib

A

stable: BBer/CCB
unstable: SCD

184
Q

Management of Acute MI W/ DHF

A

NO BBer

Give diuretics

185
Q

Cause of stenosis post-stenting

A

early cessation of antiplatelet therapy

noncompliance

186
Q

Treatment of symptomatic HCOM

A

Bber –> verapamil/CCBs

187
Q

Drug that prevents post MI remodeling

A

ACEi + BBer

188
Q

Signs of constrictive pericarditis (3)

A
  • pericardial calcifications
  • right heart failure
  • pericardial knock (mid-diastolic)
189
Q

Myocarditis findings on echo

A

all ventricles dilated

diffuse hypokinesis

190
Q

Afib clot prevention

A

warfarin or anticoag

not antiplatelet

191
Q

Cause of syncope + murmur in young person

A

HCOM

interventricular septal hypertrophy

192
Q

1 risk Aortic Dissection

A

systemic HTN

193
Q

Diagnosis heat stroke

A

temp 104+
CNS dysfunction
additional organ failure

194
Q

initial diabetic therapy

A

lifestyle modification + statin

+metformin if a1c above 7.5

195
Q

Mitral valve abnormality in HCOM

A

anterior motion mitral valve

contacts septum in systole= LVOT obstruction

196
Q

MCC constrictive pericarditis outside of US

A

TB

197
Q 
Drug class and use for: 
Xa inhibitor 
P2y12i 
colchicine 
PDE5i
A

Xa: anticoag, afib
P2y12i: antiplatelet, post MI
colchicine: antitubular, pericarditis
PDE5i: ED

198
Q

Drugs that increase warfarin bleeding

A

NSAID
amio
abx

199
Q

Foods that decrease warfarin fxn

A

leafy greens

ginseng

200
Q

Viral myocarditis can result in _____

A

decompensated heart failure (DHF)

201
Q

Cause of ascending and descending AD

A

ascending: cystic medial necrosis (CT disorder)
descending: atherosclerosis

202
Q

Stable angina:
worst risk
most common risk

A

worst DM

most common HTN

203
Q

Labs for stable angina

A

normal EKG & enzymes

abnormal stress test

204
Q

Treatment of ACS

A 
MONA 
antiplatelet 
BBEr 
statin 
ACEi
\+thrombolytics/PCI
205
Q

Drugs that lower mortality post MI

A

ASA, BBer, ACEi

ACEi+BBer prevent remodeling

206
Q

Pathogenesis prinzmetal angina

aka?

A

variant angina

vasospasm; fixed lesion; ventricular dysrhythmia

207
Q

Prinzmetal:
timing of pain
EKG finding
drug that provokes

A

night
STE with pain
ergonovine prokokes

208
Q

Treatment of prinzmetal

A

CCB

nitrates

209
Q

MI pain radiates to….

A

L side of body, jaw, arm, epigastrum, back etc.

210
Q

Cause of SCD in first 24 hours following MI

A

vfib

211
Q

Two signs of RV infarct

A

JVD

hepatomegaly

212
Q

EKG changes in MI (broad)

A

T peaks –> STE –> Q waves

213
Q

Troponins vs CK:

sensitive? specific?

A

Troponin more sensitive and specific

obtain every 8 hours first 24 hours following ACS

214
Q

Marker to rule out second MI

A

CKMB

215
Q

Treatment of Dressler syndrome

A

ASA

216
Q

Life threatening causes of chest pain (5)

A 
ACS 
dissection
PE 
tension PTX 
esophageal rupture
217
Q

7 factors in TIMI score

A 
65+
3+ CAD risk factors 
known stenosis 
2 episodes angina/day
ASA used last 7 days 
enzymes 
EKG changes
218
Q

“Syndrome X” characteristics

A

stable angina, + stress
- cath

good prognosis

219
Q

Metabolic Syndrome X characteristics

A

obesity -> insulin resistance –> HTN etc

220
Q

Grading Heart failure I-IV characteristics

A

I: nearly asx
II: symptoms with mod exertion
III: symptoms with mild exertion
IV: symptoms at rest

221
Q

Auscultation findings in HF

A

S3 at apex
S4 at LSB
PMI shifted
crackles and rales

222
Q

BNP suggestive of heart failure

A

above 150

223
Q

First line treatment heart failure
NOT DECOMP.
(systolic?)(diastolic?)

A

Diuretics + ACEi – systolic

BBer + Diuretic– diastolic

224
Q

Treatment acute decompensated heart failure

A

diuretics
nitrates
O2/resp support

225
Q

Treatment of symptomatic PVCs

A

BBers

226
Q

Define couplet/bigeminy/trigemini PVCs

A

couplet: 2 consecutive
bigeminy: every other
trigeminy: every third

227
Q

Afib EKG findings

A

no clear P waves
irregularly irregular
a rate 75-175

228
Q

Define “lone afib”

Management?

A

lone: no other abnormalities, under 60, asx

no treatment. observe. low risk.

229
Q

A flutter EKG finding

A

saw tooth pattern
300 a rate
1/3 a rate = v rate

230
Q

MCC a flutter

A

CHF

231
Q

MAT:

EKG appearance + MCC

A

at least 3 p wave morphologies
rate 60-100
severe pulm disease

232
Q

PSVT
MCC
EKG appearance

A

AVNRT (assc with ischemia)

narrow QRS, no P waves

233
Q

Treatment PSVT

A

vagal

adenosine

234
Q

WPW:
location of re-entrant path
treatment

A

Bundle of Kent
procainamide
quinidine
ablation

235
Q

EKG appearance WPW

A

narrow tachy
short PR
delta wave

236
Q

Drugs to avoid in WPW

A

dig

CCB

237
Q

MCC vtach

A

CAD + MI

238
Q

V tach progression

A

Vtach –> torsade –> V fib –> death

239
Q

Treatment of v tach

A

if lasts 30+ seconds

amio and SCD

240
Q

Vfib appearance

A

chaotic, irregular, quivering

241
Q

When to treat sinus brady

A

under 45

symptomatic

242
Q

sick sinus syndrome appearance

A

persistent spontaneous bradycardia

243
Q

Which AV blocks get pacers

A

II/II, III

244
Q

Electrical alternans:
appearance
association

A

QRS varies each beat

assc with pericardial effusion

245
Q

How do vagal maneuvers slow PSVT?

A

decrease AV node activity

246
Q

Aflutter

-3 findings

A

“F” waves on EKG
JVD
Hypotension

247
Q

High creatinine + recurrent flash PE=

A

renovascular HTN

248
Q

Fat embolus symptoms

A

rash (petechial)

dyspnea

249
Q

Dig tox symptoms

A
  • N/V/D
  • changes in vision
  • arrhythmia
250
Q

Easy bruising, waxy skin are assc with what kind of heart failure?

A

amyloidosis, restrictive

251
Q

Unexplained heart failure (no HTN)

+LVH + proteinuria =

A

amyloidosis

252
Q

Findings assc with ventricular aneurysm?

A

mitral regurgitation
CHF
angina
ventricular arrhythmia

253
Q

Acute limb ischemia following MI is caused by?

A

LV thrombus

common in large anterior STEMIs

254
Q

How to Na levels correlate to CHF severity?

A

Low Na= severe disease

255
Q

MI type that causes hypotension

A

RV Mi; will need IV bolus

256
Q

MOA class I antiarrythmics

A

block Na/ phase 0 of depolarization

257
Q

Murmur assc with aortic dissection

A

ascending dissection –> aortic regurgitation

258
Q

Causes of pulsus paradoxus

A

tamponade
asthma
COPD

259
Q

Treatment for chest pain assc with cocaine

A

BDZ

260
Q

Sudden limb ischemia without any previous symptoms=

A

arterial embolus

261
Q

How does amiodarone effect dig levels?

A

increases = NVD + vision changes etc

262
Q

Treatment of PHTN in the setting of LV dysfxn

A

diuretics

ACEi

263
Q

Treamtent of idiopathic PHTN

A

endothelin inhibitors

264
Q

How can AV fistula effect cardiac function?

A

high output heart failure

265
Q

Acquired causes of AV fistula

A

trauma, cancer, etc

266
Q

Who gets statins?

A

40-75 year olds with CVD risk about 75%

267
Q

Location of ectopic foci in afib

A

pulmonary veins

268
Q

Location of re-entry in aflutter

A

tricuspid annulus

269
Q

WPW EKG findings

A

delta wave
short PR less than 3 small blocks
ST changes

270
Q

Diagnosis of aortic dissection

A

stable- CTA

unstable- TEE

271
Q

Treatment of Dresslers

A

NSAIDs

no anticoagulation

272
Q

Aortic stenosis murmur

A

Right 2nd ICS murmur (systolic)

soft second heart sound

273
Q

Murmur assc with IVDU endocarditis

A

Tricuspid regurg (systolic, ^^ with inspiration)

274
Q

Fibromuscular dysplasia:

in addition to female HTN, what are findings?

A

neck, abdominal bruits

275
Q

Pericarditis + ^^BUN=

A

uremic pericarditis

tx with hemodialysis

276
Q

Who should be screened for AAA?

A

smokers 65-75 one time

277
Q

MOA statins

A

inhibits HMG CoA —-> mevalonic acid
increases LDL
decreases CoQ (=statin myopathy)

278
Q

What medications should be held 48 hours before stress test

A

BBer
CCB
nitrates
+caffeine 12 hours before

279
Q

SLE = risk factor for what heart condition

A

early CAD

280
Q

NG MOA

A

systemic vasodilation = decreased LVEDV

281
Q

Peripheral artery disease increases risk for?

A 
mainly MI (20% 5 year risk)
rarely limb amputation (1-2% 5 year risk)
282
Q

When do alcohol withdrawal seizures occurs?

A

12-48 hours after last drink

283
Q

How to decrease BP in HTN emergency

A

down by 10-20% first hour

5-15% next 23 hours

284
Q

Pulm effusion + widened mediastinum=

A

AD (get CTA or TEE)

285
Q

Left sided neck pain + substernal burning-

A

MI

286
Q

Risk for AAA rupture

A

smoking
rapid growth
large diameter

287
Q

When to operate on AAA

A

more than 5.5 cm
more than 1cm/yea growth
symptomatic

288
Q

Treatment of ADHF with Pulm Edema

A

vasodilators, diuretics

289
Q

MCC sudden onset afib

A

hyperthyroid

290
Q

pressor effect on digits

A

distal ischemia

291
Q

treatment of variant angina

A

CCB
nitrates

(no BBer, ASA)

292
Q

1mm STE w/ stress test: dx?

A

nondescript

293
Q

Treatment of PAD

A

exercise
statins
antiplatelets

294
Q

Common cause of AR + assc murmur

A
  • Bicuspid AV in developed countries

- LSB diastolic decrescendo murmur

295
Q

Cause of ISH in elderly

A

arterial wall stiffening

296
Q

Situational (aka ___) syncope:

  • caused by?
  • occurs during?
A

reflex
altered autonomic response (cardioinhibitory, vasodepressor)
peeing, pooping, coughing etc

297
Q

Chronic tachycardia may lead to?

A 
heart remodeling (dilation, hypokinesis)
=tachycardia mediated cardiomyopathy
298
Q

Treatment for tachycardia mediated cardiomyopathy?

A

rate and rhythm control

299
Q

1st line therapy for stable angina

A

BBer

+/-CCB, nitrate

300
Q

Pericardial effusion:

  • CXR appearance
  • exam findings
A
  • big heart (“water bottle”), clear lung fields

- diminished heart sounds, hard to find PMI

301
Q

Weight loss, lid lag, tremor, afib= ? tx?

A

hyperthyroidism, BBer

302
Q

Decreased cardiac index + increased PCWP =

A

Acute MI

303
Q

Maneuvers that decrease MVP and HCOM

A

Valsalva

standing

304
Q

Handgrip decreases what murmurs

A

HCOM

AS

305
Q

Post MI ventricular aneurysm:

clinical findings

A

heart failure, angina, ventricular arrhythmia

306
Q

Post MI ventricular aneurysm:
ECG findings
echo

A

persistent Q waves

thinned myocardial wall

307
Q

Treatment for cardiomyopathy 2/2 alcohol use

A

abstinence will ^^ LV fxn

308
Q

cholesterol emboli lab findings

A

eosinophilia
high creatinine/BUN
low complement

309
Q

Meds that increase survivial in LV systolic dysfunction

A

BBer
ACEi/ ARB
mineralocorticoid antagonists

In AA:
hydral
nitrates

310
Q

Adenosine treats ?

mechanism?

A

narrow tachy, can help identify P waves

slows AV node

311
Q

electrical alternans + sinus tach=

A

large pericardial effusion –> do pericardiocentesis

312
Q

Cor pulmonale sequence of events

A

^^Pulm art pressure –> RVP –> RV failure

313
Q

Marfarns murmur

A

early LSB diastolic murmur

aortic regurg

314
Q

AV block + infective endocarditis=

A

perivavular abscess

315
Q

Wells Criteria scoring

A 
more than 4= likely PE 
3+= 
DVT on exam, no other cause likely 
1.5+= 
hx DVT/ PE
HR above 100
recent sx/ immobilization 
1+ =
cancer 
hemoptysis
316
Q

Any diastolic murmur requires

A

echo

317
Q

CHF effect on kidney

A

^^RAAS
efferent constriction
high IG pressure
high GFR

318
Q

Treatment of all persistent tachyarrythmia (narrow and wide)

A

SCD

except v fib, pulseless vtach

319
Q

Adult Coarctation:

symptoms

A

UE HTN
H/A
epistaxis
brachial femoral delay

320
Q

Adult Coarctation murmur

A

systolic murmur +/- continuous murmur if there are collaterals

321
Q

Treatment of afib in WPW

A

cardiovert or antiarrythmics

cannot use BBer, CCB, dig, adenosine in WPW b/c ^^ accessory conduction

322
Q

Acute inferior MI assc murmur

A

MR –> pulm edema and ^^LV filling pressure

Internal (2 decks)

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