Cardio Flashcards
Pt with MS, on auscultation; opening snap indicate»>
NON-calcified mitral valve
Most common finding on cardiac examination in patient with miral valve disease?
atrial fibrillation
ejection systolic murmur radiate to carotid
AS
wide fixed splitting of S2
ASD
pansystolic murmur radiating to whole myocardium
VSD
continuous machinery murmur
PDA
Pt with well developed UL& underdeveloped LL. Exam shows delayed femoral pulsation»>
Coarctation of Aorta (COA)
COA murmur»>
at whole precordium radiating to back
MCC of cyanotic congenital heart disease?
TOF
Cyanotic spells in pt with TOF occur at childhood (not directly after birth)
1st step in management of cyanotic spells in TOF?
Squatting position
Cyanosis since birth (at 1st day of life)»>
TGVs
1st step in management TGV?
PG infusion (to maintain patency of PDA)
Heart failure symptoms few days after birth»>
hypo-plastic left heart $
Most imp drug for AR?
ACEI
Fixed split S2?
ASD
More common association with ASD?
RBBB
Most common cyanotic heart disease?
TOF
Most common complication of TOF?
cyanotic spells
3 day child with symptoms of HF and shock»>
hypoplastic ventricle
Systolic murmur over aortic area with syncope»>
AS
Cyanosis since birth»>
TOG
Cyanosis relieved by squatting»>
TOF
Systolic murmur radiating to the back»>
coarctation of aorta
Continuous machinery murmur?
PDA
Mid-diastolic rumbling murmur?
MS
Decrescendo early diastolic murmur?
AR
Systolic murmur over apex radiate to axilla?
MR
Systolic murmur over apex radiate to carotid?
AS
Most common drug addiction causing CHD?
Cocaine
Most common material causing CHD?
Alcohol
Most common CHD with down?
endocardial cushion
Most common CHD with DM?
VSD
Marked difference bet upper body pressure and lower body pressure (delayed femoral pulse)»>
Coarctation of aorta (COA)
Most common complication with MS?
AF
1st step in TOGV?
prostaglandin infusion
Pt with chest pain improve with setting & leaning forward»>
pericarditis
MCC of pericardutis
Viral infection (coxackie virus)
TTT of pericarduti
NSAIDs
TTT of uremic pericarditis?
Dialysis
Best inv of constrictive pericarditis?
CT (calcified pericardium)
TTT constructive pericarditis
pericardiectomy
Pt with distant heart sounds, ++ JVP, hypotension»>
Pericardial effusion and tamponade…….next step is chest x-ray
Main TTT of pericardial effusion?
Pericardiocentesis
Immigrant from Iraq/ Aboriginal with erythema marginatum. Lab shows ++ ASO titer. ECG shows prolonged PR interval»>
Rheumatic fever
Aboriginal with rash, migratory arthritis and H/O URTI»>
..next step
RHEUMATIC FEVER……..oral penicillin
Most imp ECG findings in rheumatic fever?
prolonged PR interval
Organisms causing Infective Endocrditis:
Most common over all?
strep viridians
Organisms causing Infective Endocrditis
After dental procedure?
strep. viridians
Organisms causing Infective Endocrditis
Drug addict?
.staph
Organisms causing Infective Endocrditis
After cardiac cath?
staph
Organisms causing Infective Endocrditis
After GIT or genitourinary procedure?
strep fecalis
Organisms causing Infective Endocrditis
Colon cancer»>
strep bovis… vvvvvvvvvvv imp
Pt with IE, Blood culture grows step bovis»>
Next step
: colonoscopy
MC affected valve in drug addict with IE»>
Tricuspid valve
MC valve lesion in drug addict with IE?
Tricuspid regurge
1st most imp inv of IE?
Trans-esophageal Echo (detect vegetation)
2nd most imp inv of IE?
Blood culture (identify organism)
Prophylaxis against IE?
2 conditions MUST be met;
Significant cardiac defect (prosthetic valve, previous IE)
Dental procedure
Prophylaxis against IE?
Amoxicillin 1h before & ½ an hour after procedure
1st MCC of dilated CM?
Alcohol
2nd MCC of dilated CM
Viral (MC virus: coxackie virus)
Young pt with Syncope/ Arrhythmias or Sudden death during exercise with F/H of sudden death during exercise at young age»>
HOCM
Genetics of HOCM?
AD
Symptoms of HOMC are more severe with exercise, dehydration, valsalva or standing
MCC of death in HOCM?
Obstruction
2nd MCC of death in HOCM?
Arrhythmias
MC type of arrhythmias in HOCM?
V.tach and V.fib
Inv of choice of HOCM?
Echo
TTT of choice of HOCM?
1st line: BB & 2nd line: CCB
TTT of arrhythmias in HOCM?
Implantable defibrillator
1st MC RF of IHD?
HTN
2nd MC RF of IHD?
Smoking
Highest risk of MI in pt with IHD?
Angina (not HTN)
Young smoker with recurrent attacks of typical chest pain»>
Variant angina
TTT of variant angina?
stop smoking, nitrates during attack
Pt with H/O typical chest pain, ECG is normal… Next step?»>
Exercise ECG
?Relieve chest pain in IHD
Nitrates
Pt with DM, HTN, hyperlipidemia lose consciousness, lab shows serum glucose of <40… which medication is responsible?
BB
BB mask the signs of hypoglycemia BUT it doesn’t cause it
Imp findings in ECG in MI?
ST segment elevation
ST elevation at II, III& aVF?
inferior wall infarction
The earliest cardiac enzyme to appear MI?
Myoglobin
The most accurate enzyme in MI?
Troponin
The best enzyme to detect Re-infarction?
CK-MB
Definitive TTT of MI?
Angioplasty
Best TTT in case of late presentation of MI?
Heparin
Late presentation of MI with significant chest pain?
Nitrates
Which medications decrease mortality in MI?
BB, ACE-Is& statin
Best inv/TTT of myocardial aneurysm?
Echo/ Surgery
What to avoid After MI?
No operation for 6 months
Emergent surgery (e.g. fracture femur) with H/O angioplasty & stent in the last 6 months»>
Don’t stop clopidogrel (high risk of thrombosis)
Elective endoscpoy with H/O angioplasty & stent in the last 6 months»_space;>
Don’t stop clopidogrel (high risk of thrombosis)
Female on OCP develops HTN»>
1st: stop OCP and 2nd: re-evaluate
Pt with BP > 140/90 for the 1st time»>
Ask pt to come back in 1-2 Ws
Best inv for HTN?
ambulatory monitoring
Best inv for paroxysmal arrhythmia?
Holter monitor
Imp inv of arrhythmia?
TFT, CBC and electrolytes
1st life style modification in TTT of HTN?
Wt loss
2nd life style modification in TTT of HTN?
low Na diet
Best initial drug for HTN?
Thiazides
First drug for DM with HTN?
ACEI
First line for DM + Protenuria?
ACEI
HTN + unilateral renal artery stenosis?
ACEI
HTN + bilateral renal artery stenosis?
Angioplasty& stent
HTN + OSTEOPOROSIS?
THIAZIDES
HTN + Hyperthyroidism?
BB
HTN + BPH?
Alpha blockers
HTN + HF?
ACEI
HTN and pregnancy?
alpha methly dopa and labetalol
Hypertensive emergency?
Hospitalization & 1st line: Labetolol/ 2nd line: Na nitroprusside
MC RF of digitalis toxicity?
hypokalemia
Presentation of digital is toxicity
Vomiting, abd pain, colored vision& arrhythmia in ECG
Most imp ECG finding in digitalis toxicity?
down sloping ST segment with sagging appearance
TTT of digital toxicity
Digitalis antibodies
Patient on digoxin develop arrhythmia, what to do?
stop digoxin and give potassium
MCC of Lt sided HF (LHF)?
MI
MCC of Rt sided HF (RHF)
Left sided HF
Most imp sign of LHF?
Bilateral basal lung crepitation
Most imp sign of RHF?
Systemic congestion
Inv of choice of HF?
Echo
Hepato- jugular reflux»>
+ve in hepatomegaly due to
congestive HF
Hepato- jugular reflux»>
-ve in hepatomegaly DT
liver pathology
Medications MUST be given in HF»>
ACE-Is, BB and aldosterone antagonist
Most dangerous type of lipids?
LDL
Most imp in exam to say familial?
tendon xanthoma (NOT xanthelasma)
DOC for hyperlipidemia»>
Statin
Mechanism of action statins
HMG-COA reductase inhibitor
Pt on statin, BB, ACE-I, aspirin develop myopathy… Cause?
Statin
Inv of choice in suspected statin- induced myopathy?
CK
Imp SE of statin? (2)
myopathy (check CK)
Hepatitis (check AST, ALT)
Imp forbidden combinations:
Statin and gemfibrizol?
Will cause
Severe rhabdomyolysis
Nitrates and sildenafil cause
Severe hypotension
Allopurinol and azathioprine?cause
severe toxicity
Pt with severe chest pain radiating to the back»>
Aortic dissection
MC RF of aortic dissection»>
HTN
X-ray of aortic dissection»>
Wide mediastinum
Aortic dissection and stable patient»>
CT angio
Aortic dissection and unstable patient»>
Trans-esophageal echo
1st step in TTT of aortic dissection?
Lower BP (BB is the best to start with)
MC medication causing orthostatic hypotension?
Diuretics
1st line of TTT orthostatic hypotension?
IV fluid
2nd line orthostatic hypotension?
Stop the offending drug
Inv of choice orthostatic hypotension?
Upright tilt table test
Pt with BPH loses conscious while micturating»>
Situational syncope
quick recovery
HOCM vs AS??
VVVVVVV IMP
Both of them?
young age
Both of them?
sudden syncope
Both of them?
risky with exercise
Both of them?
sudden death
HOCM…
positive family history
HOCM…
systolic murmur over sternal border
HOCM murmur….
noooo radiation
AS?
systolic murmur over aortic area radiate to carotid
Chest pain»>
more with Aortic stenosis
MI and surgery:
No operation before 6 months
Stent and urgent operation:
Do not stop clopidogrel…..risk of thrombosis
Target lipid profile????
Total Cholesterol…
less than 4 mmol/l
LDL target
less than 2 mmol/l
HDL?target target
more than 1 mmol/l
TG?target target
less than 2 mmol/l
Drug of choice of hypercholssterol
statin to maximum tolerated dose
Sudden tearing chest pain referred to the back and HTN»>
aortic dissection
Next step………CXR……..wide mediastinum
47 yrs male patient HTN, DM and smoker next best step?
CVS risk assessment
Best assessment for obesity causing CVS disease?
waist hip ratio
DM type 2 with any CVS risk factor ?
add statin regardless lipid profile
How long to take clopidogrel for after STE MI?
after NSTEMI
4 weeks
12 months
Meds > 4 weeks post MI?
SABA Statin Aspirin Beta Blockers ACEI
Meds for Pulmonary edema?
MONaD Morphine Oxygen Nitrates Diuretics
Afib Pt with HF, what meds to avoid
CCB such as VD
verapamil
diltiazam
