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Step 2 UWORLD > Cardio > Flashcards

Cardio Flashcards

1
Q

Delayed and diminished carotid pulses

A

Pulsus Parvus et Tardus…AORTIC STENOSIS

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2
Q

Prominent capillary pulsations in fingertips/nail beds

A

Widened Pulse Pressure…Aortic Regurg

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3
Q

When do you see Pulsus Paradoxus? (exag. decrease in SBP with inspiration)

A

Pericardial diseases (Cardiac Tamponade), Severe Asthma and COPD

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4
Q

______ can trigger bronchoconstriction in patients with asthma

A

Aspirin or beta-blockers

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5
Q

Tx for vasospastic angina

A

Preventative: CCB
Abortive: Sublingual Nitroglycerin

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6
Q

Young patients (<50), hx of smoking, recurrent chest pain lasting <15 min (at rest/sleep)

A

Vasospastic angina (Hyper-reactivity of smooth muscle)

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7
Q

ECG findings in vasospastic angina

A

Leads to transmural myocardial ischemia = ST-elevation

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8
Q

Electrical alternas + Sinus Tachycardia

varying amplitude of QRS complex

A

PERICARDIAL EFFUSION (b/c swinging motion of heart in the sac= beat-beat variation)–>leads to cardiac tamponade. Tx with with emergency pericardiocentesis

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9
Q

Common Complications after MI:

  • Hours-2 days =
  • hours-1 week =
  • hours - 2 week =
  • hours - 1 month =
  • 2 days - 1 weeks =
  • 1 day - 3 months =
  • 5 days - 3 months =
A

hours - 2 days = Re-infarction
hours - 1 week = Ventricular septal rupture
hours - 2 week = Free wall Rupture
hours - 1 month = Post-infarction Angina
2 days - 1 week = Papillary muscle rupture
1 day - 3 months = Pericarditis (Dressler)
5 day - 3 months = Left ventricular aneurysm (ST-elevation, deep Q waves; thin dyskinetic LV; risk of mural thrombus)

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10
Q

Classic Pericarditis ECG findings

A

Diffuse ST-segment elevations

won’t be seen in Uremic pericarditis

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11
Q

most accurate test for detecting coronary artery disease

A

Coronary angiogram (cath lab)

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12
Q

What would you expect LV EDV to be in patient with CHF?

A

Increased LV EDV: due to renal sodium and H20 retention

SVR: Increased (reflexive)

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13
Q

Which anti-htn med has side effect of peripheral edema?

A

CCB: Amlodipine/Nifedipine

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14
Q

what stimulates renin from JGA? alpha/beta agonist/antagonist?

A

Beta agonist

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15
Q

What effect would acute MR have on LA or LV?

A

Wouldnt change LA size/compliance unless chronic; acutely, have increased LV filling pressures

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16
Q

Tx of afib in patient with Wolf Parkinson White

A

IV Procainamide (or ibutilide)

Note: do NOT use adenosine, beta blockers, digoxin b/c promotes conduction across accessory pathway and thus VFib

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17
Q

What do you need to monitor when using Amiodarone for arrythmias?

A

PFTs, LFTs, TFTs. Get baseline levels + cxr before initiating

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18
Q

Effect of _____ on Mobitz type 1 vs 2:

  • Vagal manuevers
  • exercise/atropine
A

Vagal: worsens type 1, improves type 2

Exercise/atropine: improves 1, worsens 2

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19
Q

what should you look out for in a patient given nitroprusside?

A

Cyanide toxicity (most common in pt with renal insuff)! AMS, seizures, coma, lactic acidosis

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20
Q

Tx for cyanide toxicity

A

(i.e. in a pt given nitroprusside and develops seizures/AMS)

Nitrite + thiosulfate, hydroxycobalamin

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21
Q

what should be started in pts with MI within 24 hours (unless CI)?

A

ACE-I to prevent remodeling (which would lead to DCM)

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22
Q

Recent URI + new-onset CHM

A

DCM secondary to viral myocarditis (usually coxsackie)

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23
Q

Echo finding in DCM

A

Dilated ventricles + diffuse hypokinesia (resulting in low EF)

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24
Q

High voltage QRS + lateral ST depression + lateral T-wave inversion

A

Left Ventricular Hypertrophy (usually due to long standing or secondary htn)

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25
Q

T/F: Mitral stenosis patients commonly develop A-fib due to significant left atrial deviation

A

True

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26
Q

Loud S1 and diastolic rumbling

A

Mitral Stenosis

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27
Q

Tx for Aortic Dissection

A

BETA BLOCKERS, then Vasodilators

–>bb’s help to reduce HR, SBP, and LV contractility

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28
Q

Irregularly irregular rate, ____ p waves, ____ QRS complexes = afib ecg findings

A

absent

narrow

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29
Q

Management of A-Fib

A

1a. Rate Control (stable pts): Beta blockers, Diltiazem, Digoxin
1b. Rhythm Control: Anti-arrythmics (i.e. Amiodarone)
2. ALL PATIENTS SHOULD UNDERGO CHADS-VASC thromboembolism risk assessment

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30
Q

Mgmt of pt with acute STEMI

A
  1. Medical:
    - Oxygen
    - Full-dose aspirin (chewed = better absorption)
    - Anti-platelet (Clipidogrel/Ticragrelor)
    - Nitroglycerin with Morphine (pain)
    - Anti-coagulation (heparin)
    - Beta blocker
  2. PROMPT REPERFUSION with PCI (ideal, w/in 2 hrs) or fibrinolytic (within 12 hours)
  3. Start statins after acute
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31
Q

How much carotid stenosis until you need to do surgery (carotid endarterectomy)?

A

Asx or sx: >60% (men) ; >70% (women)

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32
Q

Management for HCM:

A
  • Avoid volume depletion
  • BETA BLOCKERS (pref)…or CCB’s (verapamil/disopyramide)
  • ->they prolong diastole and reduce contractility = decreased obstruction

…avoid vasodilators (i thought its good b/c dec afterload) b/c this can in turn decrease preload

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33
Q

mgmt of vasovagal syncope

A
  1. Reassurance
  2. Avoidance of triggers
  3. Counterpressure Techniques for recurrent eps (assume supine position and do leg raises; leg crossing with muscle tensing; handrgrip; fist clenching)
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34
Q

Syncope associated with emotional/painful stimuli, often ass. with a prodrome (dizziness, pallor, diaphoresis, abdominal pain, sense of warmth)

A

Vasovagal syncope

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35
Q

predisposition for aortic dissection

A

<40: many of them from Marfans or cocaine

Most important risk factor in gen population: HYPERTENSION

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36
Q

leads to LV hypertrophy, diastolic HF with preserved EF

A

severe and long standing HTN (hypertensive heart disease)

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37
Q

Which electrolyte abnormality is a marker for severity of CHF?

A

Hyponatremia…an independent predictor of adverse outcome

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38
Q

T/F: Increasing Na intake is the initial tx for CHF pts with hyponatremia

A

False…its to limit water intake

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39
Q

Why does dobutamine help in heart failure?

A

Primarily acts as Beta-1 agonist = increase contractility (also get inc hr)

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40
Q

Diffuse ST elevation in all leads, except reciprocal depression in aVR

A

Pericarditis!!! (vs in STEMI, its only ST elevation in select leads)

…Dressler syndrome = post MI pericarditis, within weeks. Tx = NSAIDS

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41
Q

which drugs increase digoxin levels and increase likelihood of toxicity (GI sxs, weakness, arrythmia, neuro signs)?

A

Amiodarone (decrease digoxin dose by 25% when its started), also verapamil, quinidine, propafenone

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42
Q

What is use-dependance and which anti-arrythmics is this seen with?

A

-Seen with Class IC (= Flecainide, Propafenone) and Class 4 (CCB Verapamil, Diltiazem)

  • enhanced pharm effects during faster heart rates
  • class 1C = widening of QRS complex because decrease in impulse conduction during faster hr
  • Class 4 = increase PR interval b/c prolong refractory period of AV node
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43
Q

What does hepatojugular reflex indicate?

A

failing RV that cannot accomodate an increase in venous return with abdominal compression

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44
Q

What do you give patients with chest pain and suspected Acute Coronary Syndrome initially in the ED?

A

Give Aspirin asap! prevents progression to MI and mortatlity

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45
Q

Tx for STEMI, NSTEMI

A

STEMI: Immediate cath or thrombolysis
NSTEMI: Anti-coagulation

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46
Q

T/F: Diuretics improve long-term survival in patients with LH failure i.e. post MI

A

FALSE.

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47
Q

Which meds improve long-term survival in pts with LV failure i.e. post-MI

A

ACE-I
ARB
Beta-blocker
Mineralocorticoid-R antagonists (Eplerenone, Spironolactone)

Note: CCB, Digoxin and Diuretics = only sx tx

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48
Q

What happens first after MI, papillary muscle rupture or free wall rupture?

A

Papillary muscle rupture (within 3-5 days)

Free wall rupture occurs 5days - 2weeks later

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49
Q

Acute, severe pulmonary edema and new systolic murmur 3 days after MI

A

Papillary muscle rupture

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50
Q

shock, distant heart sounds, and JVD 1-2 weeks after MI

A

Free wall rupture

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51
Q

Digoxin (digitalis) toxicity arrythmia:

A

Atrial tachy + AV block

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52
Q

T/F: S3 heard in CHF pt

A

true

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53
Q

isolated systolic hypertension in the elderly

A

increased stiffness/decreased elasticity of the arterial wall
(SBP >140, DBP <90)

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54
Q

Blue toe syndrome, livedo reticularis, AKI after catheterization

A

Cholesterol emboli

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55
Q

Screening for AAA

A

USPSTF recommends men 65-75 who have smoked get a 1-time abdominal US

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56
Q

When do you see Pulsus Paradoxus?

A

Cardiac Tamponade, Severe asthma or COPD, OSA, Pericarditis, Croup

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57
Q

T/F: Aortic regurg is characterized by pulsus paradoxus

A

False. Widened pulse pressure.

vs pulsus paradoxus = decrease in amplitude systolic BP >10 on inspiration

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58
Q

T/F: Aortic dissection characterized by widened pulse pressure

A

false, aortic regurg

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59
Q

Sound created by turbulent flow to ventricles due to increased volume

A

S3

Mitral regurg, HF

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60
Q

Sound created by atrial contraction fluid hitting stiff ventricle

A

S4

Aortic stenosis, LVH, Acute MI

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61
Q

Cardiac manifestations of sarcoidosis (pt with Uveitis, dyspnea, erythema nodosum, arthritis, bell’s palsy)

A

Arrythmia, Heart block, Sudden death. Restrictive cardiomyopathy early, dilated cardiomyopathy late.

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62
Q

Why do patients with sarcoidosis (uveitis, dyspnea, lymphadenopathy) have hypercalcemia?

A

Increased 1-alpha-hydroxylase mediated vitamin D activation in Macrophages (granuloma)

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63
Q

Uveitis is caused by:

A

PAIR (including Crohns and UC and Reiters/chlamydia)

Sarcoidosis

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64
Q

causes of Afib

A
  • Hypertensive heart disease (#1), CAD
  • Rheumatic mitral valve dz
  • OSA, PE
  • Hyperthyroidism, Obesity, Alcohol, Cocaine, Theophylline
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65
Q

How to tell if syncope is cardiac or vasovagal/neurogenic?

A

Cardiac: no prodrome. underlying structural heart dz

Vagal/neuro: prodome = nausea, pallor, dizziness, diaphoresis, warmth

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66
Q

Patient with hypotension has equal diastolic pressures throughout chambers

A

Cardiac tamponade

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67
Q

Beck’s triad

A

Cardiac tamponade clinical signs = Hypotension, Increased JVD, distant heart sounds (due to the pericardial effusion)

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68
Q

Mgmt of patient in ED with hypotension, JVD, distant heart sounds, pulsus paradoxus, tachycardia, electrical alterans

A

This patient has cardiac tamponade.

Need STAT ECHO to dx, and then can surgical/percutanous drainage

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69
Q

Narrow QRS complex

A

SVT –> typically caused by sinus tachy, aflutter/afib, re-entrant

  • ->if hemodynamically stable, can’t give meds…need CARDIOVERSION
  • ->otherwise, IV Adenosine. CCB and BB are alternatives.
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70
Q

Ankle-Brachial Index

A

PVD bitch PVD

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71
Q

Dual platelet therapy

A

Needed post MI/CAD.

Aspirin + ADP Inhibitor AKA P2y12 receptor blocker (clopidogrel, ticagrelor, ticlodipine)

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72
Q

When does post Mi pericarditis occur?

A

PERI means around “the date” 4 letters so within 4 days

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73
Q

New S3 after recent travel, no rash, signs of CHF

A

Viral myocarditis –> causes DCM –> decompensated HF

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74
Q

most common form of paroxysmal SVT

A

AV nodal re-entrant tachycardia –> re-entrant in AV node.

–>vagal manuevers i.e. cold-water submersion can fix this

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75
Q

Afterload and mixed venous oxygen saturation separate septic shock from cardiogenic/hypovolemic how?

A

Afterload in septic: low (get vasodilation). Cardiogenic/hypovolemic =high (because constricting down)

MvO2: Septic is high (hyperdynamic circulation due to low afterload, CO is increased and tissues cant extract enough O2. Cardiogenic/hypovolemic low (low tissue perfusion so tissues desperately grab as much O2 as they can)

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76
Q

What drugs should you use for thromboembolism prophy in afib pt?

A

Warfarin or Direct X Inhibitor (Apixaban/Rivaroxaban/Dabigatrin)
–>NOT ASPIRIN OR CLOPIDOGREL

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77
Q

how do you avoid flushing rxn from Niacin?

A

It is Prostaglandin-medicated vasoDILATION

–>avoid using Aspirin

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78
Q

Atrial fluid is most commonly caused by:

A

ectopic foci in pulmonary veins

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79
Q

Atrial flutter is most commonly caused by:

A

reentrant circuit around tricuspid annulus

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80
Q

Most common cause of Mitral regurg

A

Mitral valve prolapse (myxomatous degeneration of mitral valve)

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81
Q

Why do you give Adenosine or perform vagal manuevers in patient with some form of supraventricular tachycardia?

A

Because these cause AV block (aids in dx)

  1. abolish AV dependent arrythmias i.e. re-entrant tachy like Paroxysmal SVT
  2. unmask hidden p waves in atrial flutter/fib
  3. if MAT, atrial tachy is not disrupted
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82
Q

what drugs do you avoid in WPW?

A

AV nodal blocking drugs like Adenosine, beta blockers, CCB (verapamil), and digoxin
–>promotes conduction across accessory pathway

(these are typically drugs used from SVT’s so keep this exception in mind)

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83
Q

what drugs do you use for WPW

A

Class IA and IC anti-arrythmics (avoid adenosine/beta blocker/digoxin)

84
Q

what’s one way clinically distinguish SVT from VT?

A

Supraventricular tachycardia’s respond to Adenosine/vagal manuevers. Vtach does not

85
Q

tx of vtach

A

Amiodarone is first line. can also use sotalol, procainamide.

(avoid adenosine/beta blockers/digoxin)

86
Q

T/F: Chronic therapy is always necessary for patients with Vfib

A

False

IF vfib not ass. with MI, need chronic therapy (amiodarone or ICD)
If vfib within 48 hours of MI, don’t need therapy

87
Q

If you can’t measure patient BP and they have absent pulse and heart sounds, what arrythmia do they have?

A

VFib

88
Q

Atropine treats _______cardia

A

bradycardia

so NOT supraventricular tachycardia

89
Q

3 things to do for VFib

A

Cardioversion
CPR
Epinephrine

90
Q

P-R >0.20, a QRS follows each P

A

1st degree Heart Block

91
Q

tx for DCM

A

similar to CHF

Digoxin, diuretics, vasodilators,

92
Q

why do all patients with pericarditis get an echo?

A

to r/o pericardial effusion

93
Q

loud s1 vs soft s2

A

MS vs AS

94
Q

Tx for mitral stenosis

A

Diuretics and beta blockers (pulm congestion ; dec HR and CO)
Can do Percutaneous balloon valvulopasty. Watch out for Afib developing

95
Q

Patient with Aortic Stenosis develops new murmur

A

Mitral regurg. LV hypertrophy pulls mitral valve annulus apart

96
Q

causes of Aortic Stenosis

A

calcification of congenital bicuspid aortic valve (doesn’t necessary present in childhood)
rheumatic fever
calcifcation of tricuspic aortic valve in elderly

97
Q

early/mid/late peaking systolic murmur

A

Aortic stenosis. Early = mild, late = severe

98
Q

Parvus et tardus pulses

A

Aortic stenosis

99
Q

Tx for Aortic stenosis

A

aortic valve replacement. meds don’t really help

100
Q

T/F: Aortic regurg murmur increases with handgrip

A

True…this increases SVR = increased backflow through valve

101
Q

most common cause of MR

A

MVP (in developed countries)

102
Q

HTN urgency vs emergency

A

Emergency includes end-organ damage, need IV meds
(urgency can use oral)

for both SBP>220 or DBP>120

103
Q

Signs of end-organ damage (htn emergency)

A 
Eyes: Papilledema
CNS: AMS, ICH, HTN ecenphalopathy
Kidneys: Renal failure, hematuria
Heart: USA, MI, CHF w/pulm edema, Aortic dissection
Lungs: pulm edema
104
Q

what causes PRES?

A

Posterior Reversible encephalopathy syndrome…caused by htn emergency

105
Q

what are the sxs of PRES?

A

Headache, AMS, visual changes, seizure. high BP overwhelms autoregulation of cerebral vessels = arteriolar dilation and fluid into brain
–>Radiograph = opsterior cerebral white matter edema

106
Q

imaging for Aortic dissection

A

TEE and CT

note: CXR will show widened mediastinum

107
Q

most important factor in tx of peripheral vascular dz

A

STOP SMOKING

108
Q

When do you use the ankle-brachial index?

A

Dx of Peripheral Vascular Dz

109
Q

T/F: Intermittent claudication indicates severe PVD

A

False, it actually is associated with good prognosis

110
Q

Cramping leg pain that is reliably reproduced by walking the same distance, completely relieved by rest

A

Intermittent claudication, associated with peripheral vascular dz (usually good prognosis if this is present)

111
Q

The 6 P’s of acute arterial occlusion (embolization)

A 
Pain
Pallor
Polar (cold)
Paralysis
Paresthesias
Pulselessness (using doppler to assess)
112
Q

When would you give a patient with diabetes statin?

A

Any diabetic >40 years old should be on a statin, decreased lifetime risk. So even if their cholesterol is within normal limits, they should get the statin .

113
Q

where does aortic dissection pain radiate?

A

Anterior chest or interscapular back. “Knifelike”

114
Q

How do you make dx of aortic dissection?

A

TEE is very good!

CXR shows widened mediastinum, CT angiography is also very good (can’t use if renal insuff though b/c nephrogenic systemic fibrosis from gad contrast).

115
Q

T/F: You should get a BNP level whenever you’re worried about cardiac invovlement

A

False.

Get it when you have a patient with dyspnea to see if its related to CHF.

116
Q

What murmur would you expect a patient with aortic dissection to develop?

A

Aortic Regurg…decrescendo diastolic murmur

117
Q

most common valvular abnormality in rheumatic fever

A

Mitral Stenosis (this is uncommon in developed countries)

118
Q

Septal hypertrophy + __________ = HCM

A

Systolic anterior leaflet motion of mitral valve

Contact btwn mitral valve and septum = LVOT

119
Q

what kind of murmur is heard in HCM?

A

Harsh Crescendo-Decrescendo @ apex and LSB

120
Q

murmur that radiates to the carotids

A

Aortic stenosis

121
Q

Patient that is >40 and non-diabetic gets a statin when 10 year risk is > _____ %

A

7.5

122
Q

First line tx for chronic stable angina

A

BETA BLOCKERS

CCB are also used but not first line

123
Q

How do beta blockers, ccb and nitrates help alleviate angina?

A

Beta blockers: dec myocardial contractility and HR
CCB: Coronary artery vasodilation (increase O2 supply) and systemic arterial dilation (dec afterload)
Nitrates: Venodilation = dec preload

124
Q

what are the 2 ways to reperfuse the heart (increase blood flow through coronary arteries) immediately after STEMI?

A

PCI (Percutaneous intervention) or fibrinolysis

125
Q

Narrow QRS complexes

A

SVT

126
Q

T/F: You need to defribillate in a patient with afib and sxs

A

False, you need to do Cardioversion!

Defibrillation is for vfib

127
Q

Why does pulsus paradoxus occur in tamponade?

A

Normal: Inspiration = decreased intrathoracic pressure = increased venous return

In tamponade, RV expansion is limited due to the fluid surrounding the heart, so causes septal deviation and you get less filling in the LV

128
Q

what are the anti-ischemic and anti-anginal effects of nitrates due to?

A

They are vaso/veno dilators. Systemic vasodilation = decreased preload and LVEDV and reduces myocardial oxygen demand by reducing wall stress

129
Q

systolic murmur that decreases on intensity when squatting and/or leg raise

A

HOCM. Squatting and leg raise = increased venous return (and thus preload)

130
Q

T/F: Valsalva and hand grip decrease preload

A

false. Valsalva decreases preload but hand grip increases after load

131
Q

strongest predictor of stent thrombosis (pt presents with MI after recent stent placement) in first 12 months

A

medication noncompliance: they need double platelet therapy (Aspirin + Clopidogrel/Ticragrelor/Prasugrel)

132
Q

What kind of shock leads to an increased mixed venous o2?

A

Septic (inability of tissues to extract O2 due to hyperdynamic circulation…CO is increased to maintain perfusion because SVR is low)

133
Q

Which shock leads to a decreased afterload?

A

Septic

134
Q

components of CHA2DS2-VASc score

A 
CHF
HTN
Age>75 (2)
DM
Stroke/tia/thromboembolism (2)
Vascular dz (prior MI, PVD, etc)
Age 65-74
Sex category (female)
135
Q

CHF sxs in a patient with normal EF

A

Heart failure with preserved EF (HFpEF) = DIASTOLIC DYSFUNCTION.
due to HTN with LVH, restrictive CM, HCM, sarcoid (infiltrative CM)

136
Q

most common cause of death after MI

A

Vfib

137
Q

T/F: Afib and Vfib both respond to defibrilliation

A

False
AFib: Cardioversion
VFib: Defibrillation

138
Q

effects of AGII (i.e. in a pt with CHF)

A
  • preferential vasoconstriction of Efferent Renal Arteriole = increase intraglomerular P = maintain GFR
  • decrease in renal blood flow from constriction of both afferent and efferent glomerular arterioles = increase renal vascular resistance
  • Stim of Na reabosorption in proximal tubule and release of aldosterone (which inc Na reab in CD)
139
Q

T/F: Patient in Afib always gets cardioversion

A

False.
Hemo stable: Rate control with Beta Blockers or CCB (Diltiazem or Verapamil). digoxin is a low option.
Hemo unstable: Rhythm control w/ cardioversion

140
Q

Patient on digoxin develops Vtach few days after furosemide started. Why and mgmt?

A

Either due to hypokalemia/hypomagnesemia directly from the furesomide or b/c diuretics potentiate arrythmic effects of digoxin. Get serum electrolytes and serum digoxin levels.

141
Q

Fast and Narrow Arrythmia (stable)

A

N in narrow means use adeNosine –> Atrial rhythms (afib/flutter/SVT/sinus tachy)

142
Q

Fast and Wide Arrythmia (stable)

A

W is made of 2 V’s and flipped over is an M. So use aMiodarone for these Ventricular arrythmias (vfib/vtach/TORSADES)

143
Q

exertional dyspnea + S4

A

Diastolic HF, most commonly from LVH from long-standing HTN

144
Q

Tx of pericarditis

A

NSAIDS and Colchicine

viral may need anti-viral; uremic needs dialysis

145
Q

Most common causes of Afib, Aflutter

A

Afib: Ectopic foci in pulmonary veins
Aflutter: Re-entrant circuit around tricuspid annulus

146
Q

Digitalis toxicity arrythmia

A

atrial tachycardia with AV nodal block

147
Q

Systemic noninflammatory dz that affects Renal and Internal Carotid Arteries

A

Fibromuscular Dysplasia

  • ->ICA: Recurrent Headaches (most common sx of FMD)
  • ->Renal a. stenosis: Htn from 2nd HyperAldosteronism

Look for a subauricular bruit in a young pt. May have pulsatile tinnitus, neck/flank pain

148
Q

Patients with PAD and intermittent claudication have a 20% risk of ____ and ____ in the next 5 years

A

MI and Stroke (MI higher risk)

149
Q

increased JVP on inspiration (instead of normal decrease)

A

Kussmaul Sign

  • constrictive pericarditis (TB/viral)
  • restrictive CM
  • RA or RV tumor
150
Q

T/F: S3 indicates LV failure and requires diuretics

A

True

151
Q

What do you actually see on EKG when electrical alterans is present?

A

You look at the peak of the QRS complexes and see varying amplitudes

152
Q

systolic murmur that increases when patient stands up

A

HCM ejection murmur. Standing up decreases venous return to the heart

153
Q

when is paradoxical splitting seen?

A

Conditions that prolong aortic valve closure: Aortic Stenosis and LBBB

154
Q

Chagas patient will have recently traveled and present with cardiac dz (i.e. DCM or CHF) and _______/_______

A

megacolon/megaesophagus

155
Q

Systolic murmur at the apex that decreases with squatting

A

MVP (so its not only HCM that reduces with increases VR)

–>Apex = mitral valve

156
Q

These patients get secondary prevention of CVD with statin:

  • LDL>____
  • Hx of
  • current dz (2):
A
  • LDL>190
  • Hx of MI, ANGINA, TIA/stroke, PAD
  • DM or CKD
157
Q

What is a pericardial knock?

A

Very specific sign of Constrictive Pericarditis

–>mid-diastolic squeaky sound

158
Q

T/F: Cardiac amyloidosis will show increased ventricular wall thickness (concentric hypertrophy) on ECHO (restrictive cardiomyopathy), especially in absence of HTN hx. may have heavy proteinuria, waxy skin, enlarged tongue, neuropathy, hepatomegaly

A

True (amyloidosis in general)

159
Q

How are you going to handle all “identify the rhythm” questions

A
  1. Determine rate (tachy vs brady)

2. Determine QRS complex: >.12 = ventricular;

160
Q

Stable arrythmias medical tx:
Fast and narrow
Fast and wide
Slow

A

fast and Narrow = adeNosine [atrial]
fast and Wide = aMiodarone {VVide = Ventricular)
Slow = Atropine (anticholinergic)

161
Q

Afib/flutter tx: rate or rhythm?

A

RATE CONTROL: Beta Blockers or CCB (verapamil, diltiazem)

162
Q

Why arrythmia do you use beta blocker/CCB to control?

A

Afib/flutter (stable)

163
Q

Typical vs atypical for cardiac chest pain (angina)

A

Typical (3/3): Substernal; exertional; relieved by nitroglycerin

Atypical = 2/3

164
Q

If someone has no ST changes on EKG, negative troponin, but suspect cardiac chest pain? What if they can’t use a treadmill?

A

-Stress test. If normal baseline EKG can use EKG, otherwise ECHO.
-Can medically induce: Dobutamine or Adenosine
+ stress test = straight to Cath

165
Q

What is a + stress test and how do you manage?

A

-+ chest pain during test or imaging modality changes
-EKG: ST elevations/t wave inversions
-Echo: Dyskinesia (akinesis)…dead things don’t move
(if akinesis at rest and during stress = Infarct; if only during exercise = Ischemia, shows salvagable tissue)
–>+ stress test = CATHETERIZATION

166
Q

What if asked for the “best test” for dx of coronary artery disease?

A

Catheterization. can tell severity of stenosis and r/o prinzmetal (if they were clean coronary arteries but producing ischemia, its prinz)

167
Q

Which medications are you giving someone presenting with true angina?

A

1st and foremost: ASPIRIN ASPIRIN ASPIRIN ASPIRIN
MONA BASH
Morphine, O2, Nitrates, Aspirin, Beta blocker, Ace-I, Statin, Heparin

168
Q

Which MONA BASH medications are avoided in right sided infarcts (II, III, aVF)?

A

Nitrates

169
Q

Name the 3 loop diuretics (can use these in heart failure patients to decrease preload)

A

Furesomide
Bumetanide
Torsemide
“-mide, -nide”

170
Q

Afterload reduction in HF patients

A
  1. ACE-I for everyone

2. if its pretty bad, add Spironolactone or Hydralazine

171
Q

Preload reduction in HF patients

A
  1. Decrease salt and fluid intake (everyone)
  2. If worse, Furesomide (or bumetanide)
  3. if pretty bad, can add Isosorbide dinitrate (venodilator)
172
Q

When is dobutamine used in HF patients?

A

Dire situation, when prepareing for transplant or ventricular assist device. Its an inotropic med (continuous infusion)

173
Q

Why are all HF patients on a beta blocker?

A

Reduce arrythmia and remodeling…reduces risk of sudden cardiac death.
…if EF<35% use AICD (defribillator) or Digoxin

174
Q

If a HF patient has ischemia, what meds should they also be on?

A

Aspirin and Statin

175
Q

MONA BASH vs LMNOP?

A

MONA BASH: Acute ischemia (EKG changes/MI)

LMNOP: CHF patients…Lasix, Morphine, Nitrates, O2, POSITION (sitting up). don’t use beta blocker during acute exacerbations

176
Q

T/F: Patient with acute CHF exacerbation needs beta blocker

A

False, never start one during acute ep (but they need one after to reduce risk of sudden cardiac death).
Give LMNOP during acute ep

177
Q

T/F: You should avoid dehydration/BB/CCB in concentric hypertrophy

A

True, it leads to diastolic HF. BB allow ventricle to fill

178
Q

T/F: Give beta blocker/diuretics/ACE-I for dilated cardiomyopathy

A

True, its a systolic CHF

179
Q

Aortic stenosis-like murmur heard at the apex and improves with increased preload

A

HOCM

180
Q

Tx for HCM

A

Avoid dehydration

Give beta blockers (or CCB) to allow an increase in ventricular filling (keep HR low)

181
Q

how do you differentiate btwn amyloid, sarcoid, and hemochromatosis as cause of restrictive CM?

A

Amyloid: look for peripheral neuropathy. Do a fat pad bx
Sarcoid: pulm dz. Do endomyocardial bx
Hemochromatosis: cirrhosis/DM. screen ferritin (Increased Fe and ferritin, low TIBC)

182
Q

T/F: The worse the mistral stenosis (usually caused by RF), the later the snap

A

False. Earlier snap = worse

183
Q

For which valvular disease (read: murmur) does balloon valvuloplasty work (vs having to straight replace the valve)?

A

Mitral stenosis (think of it as being the one caused by an infection i.e. Rheumatic fever so its the one you can tx w/o replacing)

184
Q

Tx for mitral stenosis

A
  1. Preload reduction
  2. severe: Balloon valvotomy. Can do valve replacement.
  3. Look out for AFib! tx w/ anticoagulation, may need cardioversion
185
Q

T/F: Mitral regurg and MVP present the same way

A

False.
MR: Worse with increase preload, better w/valsalva. Tx with preload reduction; due to infx or infarction (papillary mm rupture after MI)

MVP: Better with more blood (dec murmur) i.e. leg raise/squatting. Tx w/increase preload (avoid dehydration and give BB)…presents in a young women (congenital)

186
Q

What are the 2 EKG changes you have to know for pericarditis?

A

diffuse ST elevation (except uremic)

PR SEGMENT DEPRESSION = PATHOGNOMONIC

187
Q

Tx of Pericariditis

A

NSAIDS AND COLCHICINE

nsaids CI if CKD, dec platelets, PUD

188
Q

What is kussmauls signs and when is it seen?

A

Increase in JVP on inspiration. CONSTRICTIVE PERICARDITIS!!!!!!!!!! can also be seen in RCM

189
Q

What 2 signs are pretty unique to constrictive pericarditis?

A 
Kussmaul sign (increase JVP on inspiration)
Pericardial Knock (extra diastolic sound from heart hitting a calcified/thick pericardium)
190
Q

how do you tx pericardial effusion

A

Same as pericarditis: Nsaids and colchicine.
If recurrent: create pericardial window (hole)
If tamponade: urgent pericardiocentesis (no time getting an echo)

191
Q

Person who turns his head or shaving and passes out briefly

A

vasovagal syncope (trigger: overactive carotid sinus)

192
Q

Syncope with no prodrome

A

95%: Arrythmia
IF theres FND, consider vertebrobasilar insufficiency (insufficient posterior circulation flow), would need a CTangio or carotid US to dx

193
Q

narrow tachycardia with loss of p waves vs wide tachycardia without p waves

A 
Supraventricular tachycardia (narrow) or afib if irregular
VTach (wide)
194
Q

how do you tx AV block? 1, 2nd etc

A

Bradycardia!!! So Atropine! expect narrow QRS since signals coming from atria

195
Q

Vascular dz or LDL > _____ = STATIN

A

190

196
Q

Niacin causes ____ HDL, ___ LDL, ___ TG. Treat flushing with _____

A

Increase HDL, Decrease LDL, no effect TG. Tx w/aspirin

197
Q

Side effect of statins (and fibrates)

A

Myositis, Increase LFTs. Just stop the statin and restart at a lower dose.

198
Q

which lipid lowering drugs cause fatty stools/osmotic diarrhea

A

Ezetimibe and Bile acid resins (block absorption)

199
Q

ACEI, ARB, Thiazide, Loops, Spironolactone all affect potassium. How?

A

Thiazides and loops are potassium wasting.

ACEI, ARB, and Spironolactone increase K

200
Q

difference between spironolactone and eplerenone (aldo antagonists)

A

s causes gyneomastia, e does not

201
Q

tumor of adrenal medulla

A

Kids: Neuroblastoma (less likely to cause HTN)
Adults: Pheochromocytoma (episodic HTN/HA)

202
Q

how do you tx pheochromo (episodic htn)

A
  1. Phenoxybenzamine (ALPHA ANTAGONIST): have to do this first (before beta blocker) to avoid htn crisis
  2. Propranolol
  3. Tumor resection
    (all of these in order)
203
Q

what medication should NOT be used (don’t add it, don’t increase if currently taking) during an Acute CHF exacerbation?

A

beta blocker!!! this is a mainstay of CHF tx b/c prevents arrythmia and remodeling…but NOT FOR ACUTE EXACERBATION

204
Q

how do you tx acute chf exacerbation?

A

aggressive diuresis with IV Furosemide

–>do NOT start/inc Beta blocker during acute CHF ep

205
Q

T/F: Since Afib is an atrial tachy, you use adenosine

A

False, other atrial tachy you use adenosine but Afib = RATE CONTROL with BETA BLOCKER/CCB (vera, dil)

206
Q

how do you distingush supraventricular tachycardia from sinus tachy?

A

HR>150 and LOSS OF P WAVES

207
Q

what sxs would you expect PBC patient to have in additional to abdominal pain/gallstone type pain?

A

Fatigue, PRURITIS, jaundice

Step 2 UWORLD (17 decks)

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