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LMCC > Cardio > Flashcards

Cardio Flashcards

1
Q

CHF findings on CXR

A 
Kerley B-lines 
Vascular redistribution
Cardiomegaly 
Peribronchial cuffing 
Perihilar infiltrates 
Pleural effusion
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2
Q

Galactin-3-mediated heart failure

A

Galectin-3 instigates fibrosis after cardiac ischemia or MI –> a/w heart remodelling, increased stiffening of heart which reduces cardiac output = heart failure

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3
Q

Pulmonary capillary wedge pressure in cardiogenic pulmonary edema

A

> 25mmHg

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4
Q

Pulmonary capillary wedge pressure in ARDS-induced pulmonary edema

A

<18mmHg

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5
Q

Cheyne-Stokes respirations

A

Triggered by hyperventilation and hypocapnia
Form of periodic breathing in which central apneas and hypopnea alternate with periods of hyperventilation –> waxing and waning of tidal volume

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6
Q

PE on ECG

A 
Sinus tachy 
New RAD 
Complete or incomplete RBBB 
Dominant R wave in V1 (RV dilatation) 
S1Q3T3 pattern
Deep S in lead I 
Q wave in lead III 
Inverted T wave in lead III
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7
Q

Tx for MI

A

B-MONAA + PCI/thrombolysis
Betablocker
Morphine
O2
Nitro (beware in RH infarction ie. inferior or posterior)
Antiplt (ASA 320mg + Clopidogrel for PCI or Ticagrelor if more invasive)
Anticoag (UFH if PCI, LMWH if thrombolysis)
PCI if door to balloon time <90 min and within 12h of symptom onset
Thrombolysis (Alteplase) if no C/I and within 12h of symptom onset

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8
Q

Septal MI

A

V1, V2

LAD

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9
Q

Anterior MI

A

V3, V4

LAD

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10
Q

Anterolateral MI

A

V5, V6

LAD

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11
Q

Inferior MI

A

II, III, aVF
RCA (Lead III ST elevation > Lead II, ST depression in I and AVL)
LCx (ST elevation in II is equal to that in III + ST segment depression in V1-V3)

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12
Q

Lateral MI

A

I, aVL

LCx

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13
Q

Posterolateral MI

A

V7, V8, V9

RCA

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14
Q

Normal QTc length in men and women

A

Men: <450

Women <460

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15
Q

Hypertrophic cardiomyopathy P/E

A

Double apical pulse (forceful LA contraction against highly noncompliant LV)
Carotid bifid pulse (rises quickly b/c increased velocity of blood through LV outflow tract into aorta, then declines in mid-systole as gradient develops)
Increased murmur on Valsalva

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16
Q

HOCM tx

A

Main goal is symptomatic relief
Beta blockers = reduce ventricular contractility, increased ventricular volume, compliance and reduce pressure gdt across LV outflow tract
AVOID drugs that REDUCE preload (ie. ACEi, diuretics, nitrates)

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17
Q

HOCM mostly affects ___ side of heart

A

Left

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18
Q

Left sided murmurs increase by conditions that increase _____ and decrease by conditions that decrease ______

A

Increase by increased preload
Decrease by deccreased preload
Ie. Aortic stenosis murmur is increased by rapid leg raising/squatting, but is decreased by valsalva/standing

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19
Q

3 characteristics of WPW syndrome on ECG

A 
Shortened PR interval (<0.12s) 
Slurred upstroke of R-wave 
Broadened QRS (>100ms)
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20
Q

HOCM characteristics on ECG

A 
T wave inversion
ST segment depression
Pathological Q waves
Conduction delay
LAD
LAE
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21
Q

Debakey aortic dissection classifcation

A

BAD
I = both ascending and descending
II = ascending only
III = descending only

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22
Q

Stanford aortic dissection classification

A 
A = ascending +/- descending 
B = descending only
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23
Q

Stanford A aortic dissection tx

A

Medical preferred (HTN mgmt) unless ruptured

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24
Q

Stanford B aortic dissection tx

A

Surgery

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25
Q

CHADS score

A 
Stroke risk assessment in AFib pt 
CHF (1)
HTN (1) 
Age >/=75 (1) 
Diabetes mellitus (1) 
Stroke/TIA (2)

1 : OAC needed depends
>/=2 : OAC
If CHADS 0 and NO CAD OR arterial vascular dz, NO ASA needed

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26
Q

Meds used in cardiac arrest algorithm

A

Epi 1mg IV q3-5min

Amiodarone 300mg IV (for VT/VF that’s unresponsive to shock, CPR and vasopressor)

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27
Q

1st degree AV block

A

PR interval >200ms
CONSTANT
No tx required

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28
Q

2nd degree AV block: Mobitz Type 1 (Wenkebach)

A

PR interval progressively increases until failed conduction

Usually A/W AV node disease

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29
Q

2nd degree AV block: Mobitz Type 2

A

Constant PR, either normal or prolonged with RANDOM failures
Usually A/W His Bundle disease
Worse than Type I

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30
Q

3rd degree AV block

A

Complete AV dissociation

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31
Q

Main medications used in bradycardia algorithm

A

Atropine 0.5mg IV q3-5min to total of 3mg

If atropine fails –> dopamine 2-20mcg/kg/min OR epi 2-10mcg/min

32
Q

Tx of choice in symptomatic brady pt with poor perfusion

A

Transcutaneous pacing

Start at 60/min and adjust by pt response

33
Q

Synchronized CV dose if narrow and regular tachycardia

A

50-100J

Use in atrial flutter, SVT

34
Q

Synchronized CV dose if narrow and irregular

A

150-200J biphasic or 200J monophasic

Use in afib

35
Q

Synchronized CV dose if wide and irregular

A

100J

Use in monomorphic VT

36
Q

CV dose if wide and irregular

A

Defibrillator dose
NOT synchronized
Pulseless VT/VF

37
Q

Atropine

A

Blocks vagus nerve –> increased SA node discharge –> increased HR

38
Q

Adenosine

A

Slows AV node conduction

Tx of choice for regular narrow complex tachy OR monomorphic wide complex, regular tachy

39
Q

Treatment choice for stable, wide QRS tachy?

A

Antiarrhythmics (Ie. amiodarone, procainamide, sotalol)

40
Q

Diameter of ___cm or greater of thoracic aorta is considered aneurysmal

41
Q

Average size of surgically corrected aneurysms

42
Q

Central Venous Pressure

A

AKA RA pressure
Pressure in thoracic vena cava near RA
Normal = 0-14cm H2O

43
Q

Screening for abdominal aortic aneurysm

A

Smoking men >60-75yo should have an U/S

If high risk (HTN, Marfan’s, Ehlers Danlos syndrome, affected first deg relative), start earlier or at age 60

44
Q

Framingham Risk Score

A

10y risk of CAD in pt with dyslipidemia

45
Q

Target lipid values for high risk framingham

A

LDL <2

TC:HDL <4

46
Q

Target lipid values for mod risk framingham

A

LDL <3.5

TC:HDL <5

47
Q

Target lipid values for low risk framingham

A

LDL <5

TC:HDL <6

48
Q

Aortic stenosis murmur

A

Crescendo-descrescendo
Ejection click
Diminished or absent A2
Paradoxical splitting of S2 (delayed A2 closure)
Prominent S4
Decreases with valsalva/standing b/c less blood ejected though aortic valve
Increases with squatting b/c increased venous return

49
Q

Waterhammer pulse

A

Aortic regurg

50
Q

Mitral regurg murmur

A

High pitched holosystolic murmur

51
Q

Meds for sinus tachy

A

Beta blocker
CCB if BB C/I
Ivabrudine

52
Q

Atrial flutter

A

Reentry tachycardia typically within RA
AV block usually occurs, typically 2:1 (reentry at 300bpm –> 150bpm HR)
Saw tooth pattern on ECG in inferior leads (II, III, aVF), narrow QRS
Tx: electocardioversion if unstable. If stable, rate and rhythm control (BB/CCB/Digoxin + amiodarone/sotalol)
Same anticoag parameters as afib

53
Q

Multifocal atrial tachycardia

A

> /= 3 atrial foci, 3 distinct P waves, some not conducted
More common in pts with COPD/hypoxemia
Tx: tx underlying cause, may benefit from CCB (BB often C/I becasue of resp disease)
NO ROLE for electrical cardioversion, antiarrhythmics or ablation

54
Q

Who should get ASA 81mg?

A

Pts who have arterial disease (Coronary, aortic or peripheral) but NO CHADS65 risk factors

55
Q

AVNRT tx

A
  1. Vagal maneuvers, carotid sinus pressure
  2. Adenosine
  3. Metoprolol, digoxin, diltiazem, electrical CV if unstable
    Long term: BB, CCB, digoxin; 2nd line: flecainide, propafenon; 3rd line: catheter ablation
56
Q

Tx of AFib in WPW

A

IV procainamide, amiodrone

DO NOT use BB, CCB, Digoxin –> VF

57
Q

Meds post-MI

A

ASA 81mg
Ticagrelor or clopidogrel
Beta blocker
Nitro PRN
ACEi (if high risk, symptomatic CHF, reduced LVEF, anterior MI)
Spironolactone (if on ACEi, BB and LVEF <40% and CHF or DM)
Statins (atorvastatin 80mg daily)

58
Q

Aortic stenosis murmur

A

Crescendo/decrescendo systolic murmur radiating to R carotid
S4

59
Q

Aortic regurg murmur

A

Waterhammer pulse

Early decrescendo diastolic murmur

60
Q

Mitral stenosis murmur

A

Mid-diastolic rumble at apex

61
Q

Mitral regurg murmur

A

Holosystolic murmur at apex radiating to axilla
Loud S2
S3

62
Q

Tricuspid stenosis murmur

A

Diastolic rumble at 4th left intercostal space

63
Q

Tricuspid regurg murmur

A

Holosystolic murmur at LLSB

64
Q

Pulmonary stenosis mumur

A

Systolic murmur at 2nd left intercostal space
Pulmonary ejection click
Right sided S3

65
Q

Pulmonary regurg murmur

A

Early diastolic murmur at LLSB

66
Q

Mitral valve prolapse murmur

A

Mid-systolic click (from billowing of mitral leaflet into LA) mid to late systolic murmur at apex
Accentuated by valsalva or squat-to-stand maneuvers

67
Q

Causes high output heart failure

A

Anemia
Thyrotoxicosis
AV shunts

68
Q

C/I to statins

A

Active liver disease

Persistently high AST and ALT

69
Q

Wellen’s Syndrome

A

Deep symmetric T wave inversion in anterior leads

CALL CATH LAB

70
Q

Hallmark P/E finding of aortic regurg

A

Wide pulse pressure
(Sys pressure - dias pressure)
Diastolic pressure decreases b/c of decrease flow in aorta

71
Q

Pulsus arternans

A

Large pulse followed by small pulse

Seen with severe CHF

72
Q

Pulsus paradoxus

A

Exaggeration of normal fall in systolic pressure with inspiration
Normal decrease is <10mmHg
Pulsus paradoxus decrease is 15-20mmHg
Most commonly a/w constrictive or restrictive disease of heart or pericardium

73
Q

Amiodarone

A

Similar to thyroxine –> may cause toxic actions
Increased risk of interstitial lung dz due to dramatic decrease in diffusion of CO
= thyroid function tests and pulmonary function tests should be monitored regularly

74
Q

Receptors a/w dyspnea secondary to pulmonary congestion

A

J-receptors

75
Q

BNP and BMI

A

Lower BMI a/w higher BNP

LMCC (22 decks)

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