Cardio Flashcards
risks assc with right sided endocarditis vs left sided
Right: (IV drug use) –> PE
Left: roth spots, splinter hemor (not specific), janeway lesions (asymptomatic lesions of palms and soles), ossler nodes (not seen in acute IE)
most common endocarditis bugs
predamaged valve (ie bicuspid)= S. sanguinis, viridans IV drug user: staph a
prostethic valve: staph epi
another way to think of it:
- ACUTE= staph A
- Subacute= S. Sanguinis
explain pulsus paradoxus
inhale –> inc venous return in RA –> RV bulges with blood, pushes IV septum into LV –> decrease systolic BP
new onset murmur in post op patient with shock like vitals?
consider post op MI with subsequent papillary muscle rupture
how do you manage acute rheumatic fever recurrence?
with carditis: IM pen G benz for 10 years or until age 21
without carditis= 5 years
first line PSVT?
vagal maneuvers
next: IV adenosine
what type of valve in young persn (<65) for AR?
mechanical
“plop” on auscultation with orthostatic signs
cardiac myxoma
pulse control goal in chronic stable angina with Beta blockers?
<70 bpm
first line dx for chronic venous stasis
duplex ultrasound
true vs false aneurysm
true: involves all three layers of vessel wall
false: break in vessel wall with extravascular hematoma
treatment of post catheter pseudoaneurysms?
ultrasound guided thrombin injection
abi
1-1.3 is normal
.4-.9= borderline >1.3= medial sclerosis
how does an AV fistula create high output heart failure
dec peripheral vascular resistance –> dec SVR–> dec CO –> inc RAAS –>
strongest risk factor for development/ rupture of AAA
smoking
cause of polycythemia in VSD?
eisinmengers
PVR inc as inc blood flow through R side –> shunt reversal –> dec O2 sats –>body responds with EPO
a murmur found in kids that goes away with neck compression?
venous hum –> turbulence in internal jugular
continuous murmur in supraclavicular region
digeorge
CATCH22
Cleft palate
Abnormal facies –> short philthrum, low set ears
Thymic aplasia –> recurrent infx
Cardiac defects –> TOF, truncus arteriousos
Hypocalcemia –> no parathyroids
what determines the degree of cyanosis in TOF
R ventricular outflow obstruction
transposition of great vessels assoc with?
maternal diabetes
findings in coarctation
rib notching –> doesn’t happen until 5-10 yo
arm diff in BP –> only if proximal to subclavian
tricuspid atresia
blood moves from RA through ASD –> LA/LV –> systemic circ (hypoxic blood) and through VSD into RA –> into lungs
hypertrphied LV –> left axis dev
mech/ prevention of flushing with niacin?
niacin upregulates prostaglandin synth –> take an NSAID 30 mins before
approach to premature atrial beats
1) avoid triggers
2) sx–> flecanaide, metop
timing of Trop vs CKMB
CKMB: peak 12-24h, fall 2-3 days
Trop: normalize in 6-14 days –> BUT 20% rise 3-6 hours after initial suggests reinfarction
beta blocker CI in cocaine induced ischemia
selective beta blockade –> can cause unopposed alpha blockage
***use CCB
hereditary angioedema
AD, C1 inhibitor deficiency
episodes are self limiting, resolve 2-4 days
triggers: trauma (dental procedures), stress
describe a WPW EKG and moa
- shortened PR intervals during preexcitation
- slurred to wide QRS complex
- delta waves
AV reentrant pathway
describe PR interval: first degree second degree -----> mobitz I ----->mobitz II
first degree= prlonged > 200ms
mobitz I= prolonging followed by drop
mobitz II= constant!! single or intermittent non conducted P waves
name the three HOLOSYSTOLIC murmurs
mitral regurg
tricuspid regug
VSD
open PDA is required for survival in…..
transposition of great vessels
hypoplastic left heart
presentation of hypoplastic left heart
absent pulses with single S2
R axid dev
grayish cyanosis
****truncus art also has single S2 (bc only one valve) but will have bounding pulses
infant who is otherwise health, with holosystolic murmur, developing sx of FTT
VSD with rvh
pda anatomy
connects pulmonary artery to aorta
*machinery like murmur is pathologic 24 hours after birth
PGE keeeeeps the pda open –> NSAIDS (indomethacin) closes it
presentation of long QT syndrome. Tx?
Jervell and Leing Nielson syndrome: syncope, hearing loss, fam hx of sudden death
The AD form has no deafness
beta blockers
as far as lifestyle factors, what will result in most immediate decrease in CAD risk
smoking cessation
reasons for baseline EKG abnormality in which you have to do nuc stress test or echo
LBBB
LVH
pacemaker
dig
drugs that lower mortality in CAD
aspirin, beta blockers
CCBs DO NOT!!
antiplatelet therpay in CAD
stable= 1 agent= aspirin
ACS= 2 agents= aspirin + clopidogrel, prasugrel, ticagrelor
prasugrel is CI in…
ticlopidine causes….
patients > 75 –> inc risk of hemorragic stroke
neutropenia, ttp
fibrates vs statins
fibrates are better for tris
when combined, inc risk for myositis
how is an S4 related to ACS
ischemia –> non compliant, stiff ventricle
other EKG findings in inferior MI (II, III, avF)
ST dep in I, avL –> reciprocal
depression or elevation in V2,V3 –> this means POSTERIOR inferior RV
someone has STEMI in ambulance, you give them ASA and sublingual nitrogen bc you’re a good EMT, and then they’re pressures tank. What happened?
RV MI!
decreased preload –> give ICF
ST depression in V1, V2
posterior wall MI (read these leads backwards)
distinguish third degree AV block from bradyardia
cannon A wave
first line meds for vasospastic angina
CCB
pulsus parvus et tardus
delayed pulse in AS
aliskiren
direct renin inhibitor
leriche’s syndrome triad
triad of
- hip/thigh/buttock pain
- impotence
- absent/diminished distal pulses, generally symetrically
*cause by arterial occlusion at aortoiliac jx
best test for suspected thoracic aortic an rupture?
CT with contrast vs TEE if poor renal function
presentation of adult with coarctation
high blood pressure
continuous murmur –> collaterals –> rib notching
S4 –> hypertrophied LV from HTN
