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PANCE Exam Review > Cardio > Flashcards

Cardio Flashcards

1
Q

What artery is supplied by septal?

A

Left Anterior Descending (LAD)

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2
Q

MCC acute viral pericarditis

A

Coxsackie

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3
Q

Tx for V. Tach - Stable

A
  • Amiodarone

- Procainamide

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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

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5
Q

What Dx is CI with diuretic use and why?

A
  • Hypertrophic Cardiomyopathy

- D/T volume depletion

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6
Q

Tx for Hypertrophic Cardiomyopathy

A

BB > CCB

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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.

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8
Q

Maneuver that lowers sound of Aortic Stenosis

A
  • Handgrip (“sits” on it and stops)
  • Valsalva
  • Standing
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9
Q

What does handgrip do to Mitral Regurgitation?

A
  • LOUDER

- No blood can leave the left ventricle so blood pushes against it.

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10
Q

Supraventricular Tachy (PSVT) Tx for stable narrow complex

A

Adenosine

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11
Q

V. Tach Tx for unstable

A

Synchronized cardioversion

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12
Q

Pericarditis Tx

A

NSAIDs or ASA

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13
Q

MC complaint with Mitral Stenosis

A

Exertional dyspnea

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14
Q

What do Ionotrope do?

A

Alter force of myocardial contraction

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15
Q

What makes up the abdominal aortic aneurysm triad?

A

1- MC Pulsatile abdominal mass
2- Abdo/back pain
3- hypoTN

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16
Q

MC patho and valve for Endocarditis

A
  • Streptococci

- Mitral

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17
Q

Tx for pulseless V. Tach

A

Defibrillation ASAP

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18
Q

Dx initial, tool for monitoring, and GOLD of Abdominal Aortic Aneurysm (AAA)

A

-Initial: US
-Monitor: CT
GOLD: Angiography

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19
Q

Tx for Antidromic AV Reciprocating Tachy (WPW) in a hemodynamically stable patient

A

Procainamide

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20
Q

Who should get dental prophy with Endocarditis?

A
  • Prosthetic valve
  • Stent
  • Hx of Endocarditis
  • Congenital heart disease
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21
Q

MCC of Mitral and Tricuspid STENOSIS

A

Rheumatic heart disease

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22
Q

Is rightward axis in <1 mo old normal? (with no other Sxs)

A
  • Yes!

- Infants < 1mo normally have a degree of RVH

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23
Q

Troponin levels take up to ___ to return to baseline

A

5-14 days

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24
Q

In which Dx would we find Beck’s Triad?

A

Tamponade

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25
Q

Tx for IVDA Endocarditis

A

Vanco

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26
Q

Which heart condition has ECG findings of tachycardia-bradycardia syndrome?

A

Sick Sinus Syndrome (SSS)

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27
Q

MCC of tricuspid regurgitation

A

RV dilatation/pressure

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28
Q

What biomarker is seen 1st in an MI?

A

Myoglobin

-Also 1st to peak and to decline.

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29
Q

-Distant Heart Sounds
-JVD
-HypoTN
Triad?

A

Beck’s

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30
Q

In what various Dx do we find Pulsus Paradoxus?

A
  • Tamponade
  • Constrictive pericarditis
  • Pneumothorax
  • Asthma
  • Chronic sleep apnea
  • Croup
  • Obstructive lung disease
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31
Q

What 3 electrolyte abnormalities can cause Prolong QT (which can lead to Torsades)?

A
  • HypoK
  • HypoMg
  • HypoCa
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32
Q

What ECG findings are in Wolff-Parkinson-White (WPW) besides delta wave?

A
  • Short PR interval

- Wide QRS

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33
Q

At what size is surgery needed for Abdominal Aortic Aneurysm (AAA)?

A

> 5.5cm

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34
Q

After BB, what is next Tx for Prolonged QT Syndrome

A

Implanted cardiovert defibrillators

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35
Q

GOLD Dx for DVT

A

Venography

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36
Q

BBs beneficial in heart failure (HF)

A
  • Bisoprolol
  • Carvedilol
  • Metoprolol
  • Beta 1 selective
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37
Q

Peripheral edema, JDV, GI and hepatic congestion. What side HF is this?

A

Right-sided HF

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38
Q

What tool is used for Unstable Angina and NSTEMI?

A

TIMI (Thrombolysis in Myocardial Infarction)

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39
Q

GOLD Tx for Wolff-Parkinson-White (WPW)

A

Ablation

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40
Q

What is the QT interval time in Prolonged QT Syndrome?

A

> 440 m/sec

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41
Q

Egg-shaped heart CXR is seen in:

A

Transposition of great arteries

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42
Q

What med is CI in an Inferior STEMI? Why?

A
  • Nitro

- Vasodilation would make RCA MI worse.

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43
Q

What tool predicts risk of thromboembolic stroke in patients with A. fib?

A

CHADS 2 Score

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44
Q

MC cyanotic congenital heart defect

A

Tetralogy of Fallot

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45
Q

↓ oxygen signs (cyanosis, fainting, clammy hands, weak) and pulm issues (MC DYSPNEA, rales), S3/S4. What side HF is this?

A

Left-sided HF

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46
Q

What 5 Dx cause low-output HF?

A
  • MC Ischemic heart disease*
  • Dilated Cardiomyopathy
  • Chronic HTN
  • Valvular Heart Disease
  • Aortic Stenosis
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47
Q

Kid presents to clinic with mild SOB and blue lips. She feels better with knee raised or squatting. Dx?

A

Tetralogy of Fallot

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48
Q

MCC Restrictive Cardiomyopathy

A

Amyloidosis > Sarcoidosis

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49
Q

Echo: ↑ wall thickness and ↓ cavity size RV + enlarged biatrial but normal appearing LV. Dx?

A
  • Restrictive Cardiomyopathy

- Right affected more than left.

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50
Q

1st degree heart block PR interval length. Is it constant?

A

> 0.20 s (200 msec)

-Yes

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51
Q

Which is MC: low output or high output?

A

Low output

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52
Q

What Dx are associated with HIGH-output HF?

A
  • Severe anemia
  • Paget’s
  • Hyperthyroid
  • AV fistula
  • Beriberi (Deficiency Thiamine - Vit. B1)
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53
Q

Pulm HTN → L to R shunt switches to R to L. What is this called and what Dx?

A
  • Eisenmenger’s syndrome

- Patent Ductus Arteriosus

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54
Q

Initial Tx regimen for HF

A

ACE-I + Diuretic →

-Can add BB

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55
Q

T/F:

All patients ≥ 40 yo with DM2 should receive statin therapy.

A

True!

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56
Q

Rate: 100 to 200
Rhythm: Irregular
≥ 3 different P-wave forms

A

Multifocal Atrial Tachycardia

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57
Q

What Dx’s cause Right-to-left shunt?

A
  • Tetralogy of Fallot
  • Pulm HTN
  • Eisenmenger’s syndrome
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58
Q

What is important with P-waves in A. Fib?

A

No definable P waves

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59
Q

What dysrhythmia is seen associated with COPD and elderly?

A

Multifocal Atrial Tachycardia

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60
Q

DVT Tx

A

Anticoagulation → Enoxaprin (LMWH)

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61
Q

Stress-induced cardiomyopathy or “broken-heart” syndrome AKA:

A

Takotsubo

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62
Q

What PE should be done in those with essential HTN?

A

Ocular fundus

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63
Q

Findings in Takotsubo (stress-induced cardiomyopathy)

A
  • ST elevations
  • Transient regional wall motion abnormalities of apex and mid ventricle
  • NO evidence of CAD
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64
Q

Tx for Low-Output HF

A
  • Oxygen
  • BiPAP
  • Nitrates
  • Furosemide
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65
Q

GOLD Dx Myocarditis

A

Endomyocardial Bx

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66
Q

Which systolic murmur radiates to the axilla?

A

Mitral Regurgitation

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67
Q

Diminished pulses, skin changes, cold/pale extremities. Dx?

A

Peripheral Artery Disease (PAD)

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68
Q

Venous ulcers MC seen on the medial or lateral malleolus?

A

Medial

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69
Q

Dx in which palpable cord is found

A

Phlebitis

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70
Q

Skin changes, edema, ulcers. Dx?

A

Venous Insufficiency

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71
Q

2ry form of pericarditis post injury to heart or the pericardium, commonly post MI

A

Dressler syndrome

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72
Q

Viral prodrome, HF, +/- Pericarditis. Dx?

A

Myocarditis

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73
Q

-Syncope in elderly
-Brief / absent prodrome
-Palpitations
-Many in short time and NO Hx
Cause of syncope?

A

Cardiac dysrhythmia

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74
Q

17 yo with CP and Hx recent URI. ST elevations. Dx?

A

Acute pericarditis

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75
Q

Refractory/Chronic pericarditis Tx and Prophy

A

Colchicine

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76
Q

Most predictive RF for cardiac ischemia?

A

Hx of CAD

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77
Q

Hypertensive Emergency + symptoms Tx

A

IV Labetalol (or IV Nicardipine), goal in 1-2 hrs.

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78
Q

Tx for HTN with CAD

A

BB + ACE-I

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79
Q

Ventricular Fibrillation Tx

A

Defibrillation

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80
Q

Med with greatest impact on ↓mortality in acute coronary syndrome?

A

ASA

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81
Q

MCC myocarditis in kids

A

Viral infxn

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82
Q

Tx for HTN in Non-Black >60 yo

A

CCBs or Thiazide

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83
Q

Tx for Orthodromic AVRT (WPW) with failed vagal maneuvers

A

V-ABCD

1) Vagal maneuvers
2) Adenosine
3) BB
4) CCB
5) Digoxin

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84
Q

Drug class MOA of “-pine” meds and how can we remember that for what they do?

A
  • Dihydropyridine (DHP)

- “Don’t Hurt Pulse” → Don’t drop HR, only BP.

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85
Q

Tx for Temporal (Giant Cell) Arteritis

A

High steroids ASAP

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86
Q

Unstable angina definition

A

New onset, occurs at rest or minimal exertion, or a worsening change in a previously diagnosed stable angina

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87
Q

Class 1-C of Antiarrhythmics and meds

A
  • Na+ blockers (All class 1)
  • Flecainide
  • Propafenone
  • “Can I have Fries, Please?”
88
Q

Triad: Dyspnea, CP, syncope. Murmur?

A

Aortic Stenosis

89
Q

In >50 yo and labs ESR > 50, what is the suspected Dx?

A

Temporal (Giant Cell) Arteritis

90
Q

When we see low HDL and high TG, what must we think?

A

Insulin insensitivity

91
Q

Bypass pathway associated with WPW

A

Bundle of Kent

92
Q

Wide, fixed split S2 is seen in:

A

Atrial Septal Defect (ASD)

93
Q

Murmur that radiates to the carotids

A

Aortic Stenosis

94
Q

1st line Abx is for endocarditis prophy before dental procedure. How long before is it given?

A
  • Amoxicillin

- 1 hr

95
Q

Dx for Temporal (Giant Cell) Arteritis

A

Temporal artery Bx

96
Q

Class 3 of Antiarrhythmics and med

A
  • K+ blockers

- Amiodarone

97
Q

In the elderly with SOB and CP, what murmur would be most likely? Why?

A
  • Aortic Stenosis

- Degenerative calcification found in elderly.

98
Q

MC tachydysrhythmia associated with Sick Sinus Syndrome (SSS)

A

A. Fib

99
Q

CI of using Nitrates (vasodilators) in HF

A

HypoTN (preload-dependent) states like: Aortic Stenosis, RV infarction, Hypertrophic Obstructive Cardiomyopathy.

100
Q

Hypertensive Emergency + asymptomatic Tx

A

Resume outpatient meds

101
Q

Structural disease + Sxs. HF Stage?

A

C

102
Q

Aortic Stenosis Tx

A

IVF, referral for aortic valve replacement

103
Q

1st and 2nd MC sites Peripheral Artery Disease (PAD)

A

Superficial femoral artery (calf) > aortoiliac system (thigh/butt)

104
Q

Antipsychotic use causes which dysrhythmia?

A

Torsades

105
Q

When do we place pacemaker for Mobitz 2?

A

Now, regardless of symptoms! It can quickly progress to complete HB.

106
Q

Dx for Aortic Dissection

A

CT or TEE

107
Q

Tx for Mobitz I, Wenkebach

A

None

108
Q

20-30 yo with risk of coronary disease. What’s the next step in mgmt?

A

Lipid panel (screen)

109
Q

What maneuvers make Aortic Stenosis quiet?

A

Valsalva and standing

110
Q

What closes ductus arteriosus?

A
  • Bradykinin
  • Oxy
  • NSAIDs
111
Q

Tx for Tamponade

A

Pericardiocentesis (draining fluid)

112
Q

What 2 conditions decrease BNP?

A
  • Obese

- Pericardial constriction

113
Q

CXR finding in Aortic Dissection

A

Wide mediastinum

114
Q

What keeps ductus arteriosus open?

A

Prostaglandin E1

115
Q

New LBBB + Chest Pain =

A

MI until proven otherwise

116
Q

In what Dx do we see low voltage QRS and electrical alterans?

A

Tamponade (with pleural effusion)

117
Q

For bradycardia, when do we choose Atropine vs adjusting meds?

A

If hemodynamically stable vs unstable. Atropine if unstable.

118
Q

Best med class to lower triglycerides and names

A
  • Fibrates

- Fenofibrate and Gemfibrozil

119
Q

In adults with HTN, special attention is given to which 2 diseases?

A
  • DM

- CKD

120
Q

What life-threatening arrhythmia QT prolongation can progress to?

A

Torsades

121
Q

In HIGH suspicion of DVT, what can confirm Dx?

A

Compression US preferred over Venography

122
Q

1st line Tx for Chronic Stable Angina

A

BB

123
Q

Order of electrical current through the heart

A

SA → AV → Bundle of His → Bundle branches → Purkinje fibers

124
Q

In what dysrhythmia do we see fusion and capture beats?

A

V. tach

125
Q

MC complication of Kawasaki Disease

A

Coronary artery aneurysm

126
Q

Ventricular Septal Defect (VSD): Affects muscle or membrane?

A

Membrane

127
Q

Electrolyte abnormality seen with kidney issues

A

Hyperkalemia

128
Q

When should we do elective surgical in asymptomatic AAA?

A

1) ≥ 5.5 cm

2) Grows > 0.6 to 0.8 cm in 6 months

129
Q

What happens in the heart that causes Supraventricular Tachy (PSVT)

A

Re-entrant pathway in AV node

130
Q

Bile acid sequestrant meds

A

“chole-“ or “cole”

131
Q

Cardiac vs pulmonary cause differentiated by:

A

BNP → secreted by the cardiac myocytes

132
Q

What Dx’s have a holosystolic murmur? Where are they heard?

A
  • Mitral regurgitation: apex
  • VSD: left LSB
  • Tetralogy of Fallot: left USB
  • Tricuspid Regurge: LSB louder w/ inspiration
133
Q

4 findings of Tetralogy of Fallot

A
  1. Pulmonary stenosis
  2. Overriding aorta
  3. VSD
  4. RVH
134
Q

Hyperkalemia findings

A
  • Wide QRS
  • Peak T-waves
  • Long PR
135
Q

MC complication of mitral stenosis

A

A. Fib

136
Q

DVT Tx in pregnancy

A

LMWH

137
Q

Fibrates are CI in what 2 Dx’s?

A

-Biliary and severe renal disease

138
Q

Type of Endocarditis in Colon CA

A

Strep. bovis

139
Q

Prostaglandin E1 med name:

A

Alprostadil

140
Q

Pericardial knock presents with:

A

Constrictive pericarditis

141
Q

Temporal arteritis can also be seen with what MSK Dx?

A

Polymyalgia

142
Q

Common cause of sudden death, in kids and adolescents.

A

Aortic stenosis

143
Q

Biggest RF for Aortic dissection (and list others)

A

MC HTN

  • chronic cocaine use
  • bicuspid aortic valve
  • collagen disorders
  • pre-existing aortic aneurysm
144
Q

Most characteristic type of pain of Prinzmetal angina

A

CP early morning

145
Q

Vasospastic Angina Dx

A

Stress test

146
Q

Adenosine MOA

A

AV node blocker

147
Q

Frequent association with bicuspid aortic valve

A

Dilation of the ascending aorta

148
Q

During exercise stress test, what is most specific for myocardial ischemia?

A

2 mm DOWN ST-segment depression

149
Q

MCC low-output HF

A

Ischemic heart disease

150
Q

Tx for Hyperkalemia

A
  • IV Calcium Gluconate*

- Insulin, Albuterol, Bicarbonate

151
Q

Who gets screened for Abdominal Aortic Aneurysm (AAA)?

A

Men smokers 65-75yo

152
Q

Wide QRS with NO preceding P wave. Dx?

A

Premature Ventricular Contractions (PVCs)

153
Q

NSTEMI mgmt steps

A

MONA (or Clopidogrel), then BB, then ACE-I

154
Q

What type of output HF is hyperthyroid?

A

HIGH

155
Q

Tx for Brugada Syndrome

A

Implantable cardioverter defibrillator

156
Q

Besides CP, what other complaint is heard in Aortic Dissection?

A

Back pain, esp. descending.

157
Q

How do we Tx Ascending Aortic Dissection vs Descending?

A

A: surgery
D: BP control

158
Q

MC RF for Abdominal Aortic Aneurysm (AAA)

A
  • Atherosclerosis

- 2nd: Smoking

159
Q

1st line rate control A. Fib w/ Rapid Ventricular Response compensated systolic HF

A
  • Beta 1 selective
  • Bisoprolol
  • Carvedilol
  • Metoprolol
160
Q

MC complication in Brugada Syndrome

A

V. Fib (~sudden death)

161
Q

What artery is supplied by lateral and anterior?

A

Circumflex

162
Q

How do we classify HF as systolic or diastolic?

A

↓ EF in systolic

163
Q

HF Sxs w/ minimal activity. Class?

A

III

164
Q

With what murmur do we find Ebstein’s anomaly?

A

Tricuspid Regurgitation

165
Q

Antiarrhythmic med CI with CAD or structural heart disease

A

Flecainide

166
Q

High-pitched, blowing diastolic murmur heard best LSB, wide pulse pressure. Murmur?

A

Aortic Insufficiency

167
Q

LBBB leads and what do they show?

A
  • I: Large, wide pointed up R-wave

- V1: Negative QS

168
Q

BP goal range for < 60yo or Diabetic

A

140/90

169
Q

At what ages are lipid screenings initiated?

A

Men: 35yo
Women: 45yo w/RFs

170
Q

MC SE after giving IV Amiodarone

A

HypoTN

171
Q

In HIGH suspicion of DVT and (–) US 5-7 days ago, what is the next step?

A

Repeat US

172
Q

Can Vasovagal Syncope present with myoclonic or other involuntary movements?

A

Yes!

173
Q

With MI, what is done FIRST?

A

ABCs + ASA! Then cath lab.

174
Q

Tender migratory thrombophlebitis found in malignancy. Dx?

A

Trousseau’s Syndrome

175
Q

In AAs with CHF, what 2 meds combo ↓ mortality?

A

Hydralazine + Nitrates

176
Q

What mgmt will decrease total body potassium stores?

A
  • Dialysis
  • Loop or thiazide diuretics
  • Cation-exchange resins
177
Q

Curative Tx for Constrictive Pericarditis

A

Pericardiectomy

178
Q

Meds that should be avoided in patients with A. Fib and Wolf-Parkinson-White (WPW) syndrome

A

AV-node blockers: Adenosine, BBs, CCBs, and digoxin

179
Q

What heart med is CI in < 1yo? What happens?

A
  • CCBs

- Profound hypotTN and CV collapse

180
Q

MCC Acute Coronary Syndrome

A

Atherosclerosis

181
Q

With CHF classes III/IV, what med ↓ mortality?

A

Spironolactone

182
Q

MCC sudden cardiac arrest and sudden cardiac death

A

Ischemic heart disease

183
Q

What measures pulm. artery wedge pressure (estimate of left atrial pressure)?

A

Swan-Ganz catheter (AKA pulmonary artery catheter)

184
Q

Tx for Kawasaki Disease

A
  • HIGH dose ASA

- IVIG

185
Q

SEs of Nitroglycerin

A
  • Reflex tachy
  • Flushing
  • HA
186
Q

Tx for stable A. Fib + Wolff-Parkinson-White (WPW) syndrome

A

Ibutilide

187
Q

RBBB leads and what do they show?

A
  • V1: M-shaped

- I and V6: Wide S

188
Q

Anaphylaxis vs Cardiac arrest Epinephrine

A

A: IM Epi 1,000
CA: IV Epi 10,000

189
Q

MC patho and valve affected with Endocarditis in IVDA

A
  • Staph aureus

- Tricuspid

190
Q

What artery is supplied by inferior?

A

RCA (80%) > Circumflex (20%)

191
Q

MC physical finding in Endocarditis

A

Murmur

192
Q

HF w/structural disease and no Sxs. Class?

A

B

193
Q

What dysrhythmia (besides Torsades) is associated with QT prolongation?

A

Polymorphic V. Tachy

194
Q

What electrolyte abnormalities cause Torsades?

A
  • HypoMg
  • HypoK
  • HypoCa+
195
Q

Migrating arthralgias and (+) Antistreptolysin O titer. Dx?

A

Rheumatic Fever

196
Q

Perfusion of the coronary arteries occurs primarily during:

A

Diastole

197
Q

What 6 P’s are found in a patient with arterial embolism?

A

Pallor, Paresthesia, Pulselessness, Poikilothermia, Paralysis, Pain out of proportion

198
Q

Post-op fever on day 4-6 would likely be D/T:

A

Venous thrombosis

199
Q

Pericarditis symptoms present (Dressler’s Syndrome). What do you prescribe?

A

Aspirin** > (or Colchicine)

200
Q

What is the MC vein for DVT ?

A

Calf MC (posterior tibial and peroneal veins)

201
Q

65 yo presents with chest pain >5 mins, a negative Troponin level and negative ECG. What is your next step?

A

Cath (Percutaneous transluminal coronary angioplasty (PTCA), stent) or treadmill

202
Q

<40 yo presents with chest pain >5 mins, a negative Troponin level and negative ECG. What is your next step?

A

Repeat levels in 2 hours

203
Q

Which test yields the most reliable results in a pulmonary embolism?

A

Ventilation-Perfusion (VQ) Scan

204
Q

Most sensitive test for pulmonary embolism

A

Pulmonary arteriography

205
Q

What is the most important test to order for someone with atrial fibrillation?

A

TSH

206
Q

What is the best treatment for someone that has A. Fib and presents within 48 hours?

A

Cardiovert (they must give a time!)

207
Q

Tx for A. fib + CHF

A

Carvedilol

208
Q

Tx for A. flutter

A

1st: CCB, Flecainide (Or Ibutilide)
2nd: cardiovert

209
Q

What do you do if a patient goes into asystole (flat-line)?

A

CPR, Epi

210
Q

What heart med is CI in Cocaine Associated Chest Pain?

A

BB

211
Q

MCC for Aortic Dissection vs AAA

A

AD: HTN
AAA: athero > smoking

212
Q

35 yo presents with stroke. What congenital abnormality was he likely born with?

A

Patent Foramen Ovale (form of ASD).

213
Q

Tx for Inferior STEMI

A

IVF

214
Q

When do we use Lasix (Furosemide)?

A

Acute HF

215
Q

Which maneuver makes Aortic Regurgitation and Mitral Regurgitation sound louder?

A

Handgrip

216
Q

MC affected artery in an MI

A

RCA (Inferior)

217
Q

Pt. presents for a check-up and is found to have a BP of 135/85. What is the next step in management?

A

Treat (> 130)

PANCE Exam Review (32 decks)

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