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