Cardio Flashcards
1
Q
What artery is supplied by septal?
A
Left Anterior Descending (LAD)
2
Q
MCC acute viral pericarditis
A
Coxsackie
3
Q
Tx for V. Tach - Stable
A
- Amiodarone
- Procainamide
4
Q
Which murmur maneuvers ↓ preload? (sends blood out). What Dx love this bc it makes them LOUDER?
A
- Valsalva and Standing
- MVP and HCM
5
Q
What Dx is CI with diuretic use and why?
A
- Hypertrophic Cardiomyopathy
- D/T volume depletion
6
Q
Tx for Hypertrophic Cardiomyopathy
A
BB > CCB
7
Q
Maneuver to differentiate between MVP and HCM. What happens?
A
- Handgrip
- Blood back to heart so it lowers HCM but the click in MVP stays the same.
8
Q
Maneuver that lowers sound of Aortic Stenosis
A
- Handgrip (“sits” on it and stops)
- Valsalva
- Standing
9
Q
What does handgrip do to Mitral Regurgitation?
A
- LOUDER
- No blood can leave the left ventricle so blood pushes against it.
10
Q
Supraventricular Tachy (PSVT) Tx for stable narrow complex
A
Adenosine
11
Q
V. Tach Tx for unstable
A
Synchronized cardioversion
12
Q
Pericarditis Tx
A
NSAIDs or ASA
13
Q
MC complaint with Mitral Stenosis
A
Exertional dyspnea
14
Q
What do Ionotrope do?
A
Alter force of myocardial contraction
15
Q
What makes up the abdominal aortic aneurysm triad?
A
1- MC Pulsatile abdominal mass
2- Abdo/back pain
3- hypoTN
16
Q
MC patho and valve for Endocarditis
A
- Streptococci
- Mitral
17
Q
Tx for pulseless V. Tach
A
Defibrillation ASAP
18
Q
Dx initial, tool for monitoring, and GOLD of Abdominal Aortic Aneurysm (AAA)
A
-Initial: US
-Monitor: CT
GOLD: Angiography
19
Q
Tx for Antidromic AV Reciprocating Tachy (WPW) in a hemodynamically stable patient
A
Procainamide
20
Q
Who should get dental prophy with Endocarditis?
A
- Prosthetic valve
- Stent
- Hx of Endocarditis
- Congenital heart disease
21
Q
MCC of Mitral and Tricuspid STENOSIS
A
Rheumatic heart disease
22
Q
Is rightward axis in <1 mo old normal? (with no other Sxs)
A
- Yes!
- Infants < 1mo normally have a degree of RVH
23
Q
Troponin levels take up to ___ to return to baseline
A
5-14 days
24
Q
In which Dx would we find Beck’s Triad?
A
Tamponade
25
Tx for IVDA Endocarditis
Vanco
26
Which heart condition has ECG findings of tachycardia-bradycardia syndrome?
Sick Sinus Syndrome (SSS)
27
MCC of tricuspid regurgitation
RV dilatation/pressure
28
What biomarker is seen 1st in an MI?
Myoglobin
| -Also 1st to peak and to decline.
29
-Distant Heart Sounds
-JVD
-HypoTN
Triad?
Beck’s
30
In what various Dx do we find Pulsus Paradoxus?
- Tamponade
- Constrictive pericarditis
- Pneumothorax
- Asthma
- ----------------------------------
- Chronic sleep apnea
- Croup
- Obstructive lung disease
31
What 3 electrolyte abnormalities can cause Prolong QT (which can lead to Torsades)?
- HypoK
- HypoMg
- HypoCa
32
What ECG findings are in Wolff-Parkinson-White (WPW) besides delta wave?
- Short PR interval
| - Wide QRS
33
At what size is surgery needed for Abdominal Aortic Aneurysm (AAA)?
> 5.5cm
34
After BB, what is next Tx for Prolonged QT Syndrome
Implanted cardiovert defibrillators
35
GOLD Dx for DVT
Venography
36
BBs beneficial in heart failure (HF)
- Bisoprolol
- Carvedilol
- Metoprolol
- -----------------------
- Beta 1 selective
37
Peripheral edema, JDV, GI and hepatic congestion. What side HF is this?
Right-sided HF
38
What tool is used for Unstable Angina and NSTEMI?
TIMI (Thrombolysis in Myocardial Infarction)
39
GOLD Tx for Wolff-Parkinson-White (WPW)
Ablation
40
What is the QT interval time in Prolonged QT Syndrome?
>440 m/sec
41
Egg-shaped heart CXR is seen in:
Transposition of great arteries
42
What med is CI in an Inferior STEMI? Why?
- Nitro
| - Vasodilation would make RCA MI worse.
43
What tool predicts risk of thromboembolic stroke in patients with A. fib?
CHADS 2 Score
44
MC cyanotic congenital heart defect
Tetralogy of Fallot
45
↓ oxygen signs (cyanosis, fainting, clammy hands, weak) and pulm issues (MC DYSPNEA, rales), S3/S4. What side HF is this?
Left-sided HF
46
What 5 Dx cause low-output HF?
- MC Ischemic heart disease*
- Dilated Cardiomyopathy
- Chronic HTN
- Valvular Heart Disease
- Aortic Stenosis
47
Kid presents to clinic with mild SOB and blue lips. She feels better with knee raised or squatting. Dx?
Tetralogy of Fallot
48
MCC Restrictive Cardiomyopathy
Amyloidosis > Sarcoidosis
49
Echo: ↑ wall thickness and ↓ cavity size RV + enlarged biatrial but normal appearing LV. Dx?
- Restrictive Cardiomyopathy
| - Right affected more than left.
50
1st degree heart block PR interval length. Is it constant?
>0.20 s (200 msec)
| -Yes
51
Which is MC: low output or high output?
Low output
52
What Dx are associated with HIGH-output HF?
- Severe anemia
- Paget's
- Hyperthyroid
- AV fistula
- Beriberi (Deficiency Thiamine - Vit. B1)
53
Pulm HTN → L to R shunt switches to R to L. What is this called and what Dx?
- Eisenmenger’s syndrome
| - Patent Ductus Arteriosus
54
Initial Tx regimen for HF
ACE-I + Diuretic →
| -Can add BB
55
T/F:
| All patients ≥ 40 yo with DM2 should receive statin therapy.
True!
56
Rate: 100 to 200
Rhythm: Irregular
≥ 3 different P-wave forms
Multifocal Atrial Tachycardia
57
What Dx's cause Right-to-left shunt?
- Tetralogy of Fallot
- Pulm HTN
- Eisenmenger’s syndrome
58
What is important with P-waves in A. Fib?
No definable P waves
59
What dysrhythmia is seen associated with COPD and elderly?
Multifocal Atrial Tachycardia
60
DVT Tx
Anticoagulation → Enoxaprin (LMWH)
61
Stress-induced cardiomyopathy or “broken-heart” syndrome AKA:
Takotsubo
62
What PE should be done in those with essential HTN?
Ocular fundus
63
Findings in Takotsubo (stress-induced cardiomyopathy)
- ST elevations
- Transient regional wall motion abnormalities of apex and mid ventricle
- NO evidence of CAD
64
Tx for Low-Output HF
- Oxygen
- BiPAP
- Nitrates
- Furosemide
65
GOLD Dx Myocarditis
Endomyocardial Bx
66
Which systolic murmur radiates to the axilla?
Mitral Regurgitation
67
Diminished pulses, skin changes, cold/pale extremities. Dx?
Peripheral Artery Disease (PAD)
68
Venous ulcers MC seen on the medial or lateral malleolus?
Medial
69
Dx in which palpable cord is found
Phlebitis
70
Skin changes, edema, ulcers. Dx?
Venous Insufficiency
71
2ry form of pericarditis post injury to heart or the pericardium, commonly post MI
Dressler syndrome
72
Viral prodrome, HF, +/- Pericarditis. Dx?
Myocarditis
73
-Syncope in elderly
-Brief / absent prodrome
-Palpitations
-Many in short time and NO Hx
Cause of syncope?
Cardiac dysrhythmia
74
17 yo with CP and Hx recent URI. ST elevations. Dx?
Acute pericarditis
75
Refractory/Chronic pericarditis Tx and Prophy
Colchicine
76
Most predictive RF for cardiac ischemia?
Hx of CAD
77
Hypertensive Emergency + symptoms Tx
IV Labetalol (or IV Nicardipine), goal in 1-2 hrs.
78
Tx for HTN with CAD
BB + ACE-I
79
Ventricular Fibrillation Tx
Defibrillation
80
Med with greatest impact on ↓mortality in acute coronary syndrome?
ASA
81
MCC myocarditis in kids
Viral infxn
82
Tx for HTN in Non-Black >60 yo
CCBs or Thiazide
83
Tx for Orthodromic AVRT (WPW) with failed vagal maneuvers
V-ABCD
1) Vagal maneuvers
2) Adenosine
3) BB
4) CCB
5) Digoxin
84
Drug class MOA of "-pine" meds and how can we remember that for what they do?
- Dihydropyridine (DHP)
| - "Don't Hurt Pulse" → Don't drop HR, only BP.
85
Tx for Temporal (Giant Cell) Arteritis
High steroids ASAP
86
Unstable angina definition
New onset, occurs at rest or minimal exertion, or a worsening change in a previously diagnosed stable angina
87
Class 1-C of Antiarrhythmics and meds
- Na+ blockers (All class 1)
- Flecainide
- Propafenone
- "Can I have Fries, Please?"
88
Triad: Dyspnea, CP, syncope. Murmur?
Aortic Stenosis
89
In >50 yo and labs ESR > 50, what is the suspected Dx?
Temporal (Giant Cell) Arteritis
90
When we see low HDL and high TG, what must we think?
Insulin insensitivity
91
Bypass pathway associated with WPW
Bundle of Kent
92
Wide, fixed split S2 is seen in:
Atrial Septal Defect (ASD)
93
Murmur that radiates to the carotids
Aortic Stenosis
94
1st line Abx is for endocarditis prophy before dental procedure. How long before is it given?
- Amoxicillin
| - 1 hr
95
Dx for Temporal (Giant Cell) Arteritis
Temporal artery Bx
96
Class 3 of Antiarrhythmics and med
- K+ blockers
| - Amiodarone
97
In the elderly with SOB and CP, what murmur would be most likely? Why?
- Aortic Stenosis
| - Degenerative calcification found in elderly.
98
MC tachydysrhythmia associated with Sick Sinus Syndrome (SSS)
A. Fib
99
CI of using Nitrates (vasodilators) in HF
HypoTN (preload-dependent) states like: Aortic Stenosis, RV infarction, Hypertrophic Obstructive Cardiomyopathy.
100
Hypertensive Emergency + asymptomatic Tx
Resume outpatient meds
101
Structural disease + Sxs. HF Stage?
C
102
Aortic Stenosis Tx
IVF, referral for aortic valve replacement
103
1st and 2nd MC sites Peripheral Artery Disease (PAD)
Superficial femoral artery (calf) > aortoiliac system (thigh/butt)
104
Antipsychotic use causes which dysrhythmia?
Torsades
105
When do we place pacemaker for Mobitz 2?
Now, regardless of symptoms! It can quickly progress to complete HB.
106
Dx for Aortic Dissection
CT or TEE
107
Tx for Mobitz I, Wenkebach
None
108
20-30 yo with risk of coronary disease. What's the next step in mgmt?
Lipid panel (screen)
109
What maneuvers make Aortic Stenosis quiet?
Valsalva and standing
110
What closes ductus arteriosus?
- Bradykinin
- Oxy
- NSAIDs
111
Tx for Tamponade
Pericardiocentesis (draining fluid)
112
What 2 conditions decrease BNP?
- Obese
| - Pericardial constriction
113
CXR finding in Aortic Dissection
Wide mediastinum
114
What keeps ductus arteriosus open?
Prostaglandin E1
115
New LBBB + Chest Pain =
MI until proven otherwise
116
In what Dx do we see low voltage QRS and electrical alterans?
Tamponade (with pleural effusion)
117
For bradycardia, when do we choose Atropine vs adjusting meds?
If hemodynamically stable vs unstable. Atropine if unstable.
118
Best med class to lower triglycerides and names
- Fibrates
| - Fenofibrate and Gemfibrozil
119
In adults with HTN, special attention is given to which 2 diseases?
- DM
| - CKD
120
What life-threatening arrhythmia QT prolongation can progress to?
Torsades
121
In HIGH suspicion of DVT, what can confirm Dx?
Compression US preferred over Venography
122
1st line Tx for Chronic Stable Angina
BB
123
Order of electrical current through the heart
SA → AV → Bundle of His → Bundle branches → Purkinje fibers
124
In what dysrhythmia do we see fusion and capture beats?
V. tach
125
MC complication of Kawasaki Disease
Coronary artery aneurysm
126
Ventricular Septal Defect (VSD): Affects muscle or membrane?
Membrane
127
Electrolyte abnormality seen with kidney issues
Hyperkalemia
128
When should we do elective surgical in asymptomatic AAA?
1) ≥ 5.5 cm
| 2) Grows > 0.6 to 0.8 cm in 6 months
129
What happens in the heart that causes Supraventricular Tachy (PSVT)
Re-entrant pathway in AV node
130
Bile acid sequestrant meds
"chole-" or "cole"
131
Cardiac vs pulmonary cause differentiated by:
BNP → secreted by the cardiac myocytes
132
What Dx's have a holosystolic murmur? Where are they heard?
- Mitral regurgitation: apex
- VSD: left LSB
- Tetralogy of Fallot: left USB
- Tricuspid Regurge: LSB louder w/ inspiration
133
4 findings of Tetralogy of Fallot
1. Pulmonary stenosis
2. Overriding aorta
3. VSD
4. RVH
134
Hyperkalemia findings
- Wide QRS
- Peak T-waves
- Long PR
135
MC complication of mitral stenosis
A. Fib
136
DVT Tx in pregnancy
LMWH
137
Fibrates are CI in what 2 Dx's?
-Biliary and severe renal disease
138
Type of Endocarditis in Colon CA
Strep. bovis
139
Prostaglandin E1 med name:
Alprostadil
140
Pericardial knock presents with:
Constrictive pericarditis
141
Temporal arteritis can also be seen with what MSK Dx?
Polymyalgia
142
Common cause of sudden death, in kids and adolescents.
Aortic stenosis
143
Biggest RF for Aortic dissection (and list others)
MC HTN
- chronic cocaine use
- bicuspid aortic valve
- collagen disorders
- pre-existing aortic aneurysm
144
Most characteristic type of pain of Prinzmetal angina
CP early morning
145
Vasospastic Angina Dx
Stress test
146
Adenosine MOA
AV node blocker
147
Frequent association with bicuspid aortic valve
Dilation of the ascending aorta
148
During exercise stress test, what is most specific for myocardial ischemia?
2 mm DOWN ST-segment depression
149
MCC low-output HF
Ischemic heart disease
150
Tx for Hyperkalemia
- IV Calcium Gluconate*
| - Insulin, Albuterol, Bicarbonate
151
Who gets screened for Abdominal Aortic Aneurysm (AAA)?
Men smokers 65-75yo
152
Wide QRS with NO preceding P wave. Dx?
Premature Ventricular Contractions (PVCs)
153
NSTEMI mgmt steps
MONA (or Clopidogrel), then BB, then ACE-I
154
What type of output HF is hyperthyroid?
HIGH
155
Tx for Brugada Syndrome
Implantable cardioverter defibrillator
156
Besides CP, what other complaint is heard in Aortic Dissection?
Back pain, esp. descending.
157
How do we Tx Ascending Aortic Dissection vs Descending?
A: surgery
D: BP control
158
MC RF for Abdominal Aortic Aneurysm (AAA)
- Atherosclerosis
| - 2nd: Smoking
159
1st line rate control A. Fib w/ Rapid Ventricular Response compensated systolic HF
- Beta 1 selective
- -----------------------
- Bisoprolol
- Carvedilol
- Metoprolol
160
MC complication in Brugada Syndrome
V. Fib (~sudden death)
161
What artery is supplied by lateral and anterior?
Circumflex
162
How do we classify HF as systolic or diastolic?
↓ EF in systolic
163
HF Sxs w/ minimal activity. Class?
III
164
With what murmur do we find Ebstein’s anomaly?
Tricuspid Regurgitation
165
Antiarrhythmic med CI with CAD or structural heart disease
Flecainide
166
High-pitched, blowing diastolic murmur heard best LSB, wide pulse pressure. Murmur?
Aortic Insufficiency
167
LBBB leads and what do they show?
- I: Large, wide pointed up R-wave
| - V1: Negative QS
168
BP goal range for < 60yo or Diabetic
140/90
169
At what ages are lipid screenings initiated?
Men: 35yo
Women: 45yo w/RFs
170
MC SE after giving IV Amiodarone
HypoTN
171
In HIGH suspicion of DVT and (--) US 5-7 days ago, what is the next step?
Repeat US
172
Can Vasovagal Syncope present with myoclonic or other involuntary movements?
Yes!
173
With MI, what is done FIRST?
ABCs + ASA! Then cath lab.
174
Tender migratory thrombophlebitis found in malignancy. Dx?
Trousseau’s Syndrome
175
In AAs with CHF, what 2 meds combo ↓ mortality?
Hydralazine + Nitrates
176
What mgmt will decrease total body potassium stores?
- Dialysis
- Loop or thiazide diuretics
- Cation-exchange resins
177
Curative Tx for Constrictive Pericarditis
Pericardiectomy
178
Meds that should be avoided in patients with A. Fib and Wolf-Parkinson-White (WPW) syndrome
AV-node blockers: Adenosine, BBs, CCBs, and digoxin
179
What heart med is CI in < 1yo? What happens?
- CCBs
| - Profound hypotTN and CV collapse
180
MCC Acute Coronary Syndrome
Atherosclerosis
181
With CHF classes III/IV, what med ↓ mortality?
Spironolactone
182
MCC sudden cardiac arrest and sudden cardiac death
Ischemic heart disease
183
What measures pulm. artery wedge pressure (estimate of left atrial pressure)?
Swan-Ganz catheter (AKA pulmonary artery catheter)
184
Tx for Kawasaki Disease
- HIGH dose ASA
| - IVIG
185
SEs of Nitroglycerin
- Reflex tachy
- Flushing
- HA
186
Tx for stable A. Fib + Wolff-Parkinson-White (WPW) syndrome
Ibutilide
187
RBBB leads and what do they show?
- V1: M-shaped
| - I and V6: Wide S
188
Anaphylaxis vs Cardiac arrest Epinephrine
A: IM Epi 1,000
CA: IV Epi 10,000
189
MC patho and valve affected with Endocarditis in IVDA
- Staph aureus
| - Tricuspid
190
What artery is supplied by inferior?
RCA (80%) > Circumflex (20%)
191
MC physical finding in Endocarditis
Murmur
192
HF w/structural disease and no Sxs. Class?
B
193
What dysrhythmia (besides Torsades) is associated with QT prolongation?
Polymorphic V. Tachy
194
What electrolyte abnormalities cause Torsades?
- HypoMg
- HypoK
- HypoCa+
195
Migrating arthralgias and (+) Antistreptolysin O titer. Dx?
Rheumatic Fever
196
Perfusion of the coronary arteries occurs primarily during:
Diastole
197
What 6 P's are found in a patient with arterial embolism?
Pallor, Paresthesia, Pulselessness, Poikilothermia, Paralysis, Pain out of proportion
198
Post-op fever on day 4-6 would likely be D/T:
Venous thrombosis
199
Pericarditis symptoms present (Dressler’s Syndrome). What do you prescribe?
Aspirin** > (or Colchicine)
200
What is the MC vein for DVT ?
Calf MC (posterior tibial and peroneal veins)
201
65 yo presents with chest pain >5 mins, a negative Troponin level and negative ECG. What is your next step?
Cath (Percutaneous transluminal coronary angioplasty (PTCA), stent) or treadmill
202
<40 yo presents with chest pain >5 mins, a negative Troponin level and negative ECG. What is your next step?
Repeat levels in 2 hours
203
Which test yields the most reliable results in a pulmonary embolism?
Ventilation-Perfusion (VQ) Scan
204
Most sensitive test for pulmonary embolism
Pulmonary arteriography
205
What is the most important test to order for someone with atrial fibrillation?
TSH
206
What is the best treatment for someone that has A. Fib and presents within 48 hours?
Cardiovert (they must give a time!)
207
Tx for A. fib + CHF
Carvedilol
208
Tx for A. flutter
1st: CCB, Flecainide (Or Ibutilide)
2nd: cardiovert
209
What do you do if a patient goes into asystole (flat-line)?
CPR, Epi
210
What heart med is CI in Cocaine Associated Chest Pain?
BB
211
MCC for Aortic Dissection vs AAA
AD: HTN
AAA: athero > smoking
212
35 yo presents with stroke. What congenital abnormality was he likely born with?
Patent Foramen Ovale (form of ASD).
213
Tx for Inferior STEMI
IVF
214
When do we use Lasix (Furosemide)?
Acute HF
215
Which maneuver makes Aortic Regurgitation and Mitral Regurgitation sound louder?
Handgrip
216
MC affected artery in an MI
RCA (Inferior)
217
Pt. presents for a check-up and is found to have a BP of 135/85. What is the next step in management?
Treat (> 130)
