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Internal Medicine EOR > Cardio > Flashcards

Cardio Flashcards

1
Q

Angina Pectoris Path

A

Exertional chest pain d/t increased demand and decreased supply

Typically caused by fixed plaque

Pain lasts LESS THAN 30 minutes and is relieved by rest and/or Nitro

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2
Q

Classes of Angina

A

I: only with unusally strenuous activity, no limitations

II: with more prolonged/rigorous activity, slight limit

III: with usual daily activity, marked limts

IV: at rest, unable to do activity

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3
Q

Dx of Ischemic Heart Disease

A

EKG: ST depression
Stress test: most useful noninvasive tool
Myocardial Perfusion imaging
Coronary angiography: GOLD STANDARD

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4
Q

Surgical Tx of ischemic heart disease

A

PTCA: not involving the left main coronary artery, vent function is near normal

CABG: for left main coronary or critical stenosis

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5
Q

Nitro and ischemic heart disease

A

Increases O2 and increases collateral blood flow, reducing coronary vasospasm and increasing dilation.
If no relief with first dose give a 2nd and 3rd evert 5 minutes. If still not relief – ACS!!!

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6
Q

Contraindications to Nitro

A

SBP <90
RV infarction
PDE-5i’s

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7
Q

BBs

A

increase diastolic timing, first line drug of choice for ischemic heart disease management

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8
Q

CCBs

A

used by patients that cannot use BBs, Prinzmetal angina

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9
Q

Prinzmetal angina

A

almost ALWAYS occurs at rest, usually between midnight and early morning

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10
Q

ASA and ischemic heart

A

prevents progression of stable angina to ACS

CAUTION in pts with PUD or increased bleeding risk

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11
Q

Sinus Arrhythmia

A

Same as NS except irregular

HR increases during inspiration and decreases with expiration

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12
Q

Since sinus syndrome

A

“Brady-Tachy”
Combo of sinus arrest with alternating paroxysms of atrial tach and brady. Commonly caused by sinoatrial node disease

NEED PACER

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13
Q

AV block

A

Interuption of normla impulse from SA to AV

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14
Q

A Flutter

A

Saw tooth waves @ 250-350 BPM with no P waves.
Rate: regular

Stable: vagal, BB, CCB
Unstable: cardiovert
Cure: ablation

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15
Q

Afib

A

Rhythm: Irregular
Narrow QRS
No p wave
80-140bpm

Can lead to ischemic stroke

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16
Q

Ashmens Phenomenon

A

occasional aberrantly conducted beats and short R-R cycles

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17
Q

AFIB MANAGEMENT of stable patients

A

rate control

BB: metoprolol but be careful in pts with reactive airway disease

CCB Diltiazem

Digoxin: Preferred in pts with hypotension or CHF

Rhythm Control: cardiovert, flecinide, sotalol, amiodarone, ablation

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18
Q

Afib management o Unstable patients

A

Cardiovert

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19
Q

Anticoags for Afib

A

Warfarin w/ goal INR 2-3

Dual Antiplatelet: ASA + clopidogrel

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20
Q

Long QT syndrome

A

d/t congenital or macrolides/TCAs and electrolyte abnormalities. Can lead to sudden cardiac death

Tx: d/c offending med and correct abnormalities

Congenital: AICD

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21
Q

PSVT

A

HR>100
Regular, narrow QRS, P waves hard to see

Paroxysmal: sudden onset and termination

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22
Q

PSVT types

A

AV nodal reentry: 2 pathways both within AV node –> MC

AV reciprocating Tach: 1 pathway in AV and second outside AV

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23
Q

PSVT tx

A

Stable: vagal, adenosine 1st line, BB/CCB

Unstable: cardiovert
Cure: ablation

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24
Q

Wandering atrial pacemaker/ Multifocal Atrial Tach

A

WAP: <100 BPM >/= 3 P waves

MAT: >100 BPM >/= 3 P waves –> SEVERE COPD

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25
Q

Wolff Parkinson White

A

Bundle of Kent excites ventricles

DELTA waves
Wide QRS
Short PR

Tx: vagal, antiiarhythmics, procainamide

AVOID ABCD: adenosine, BBs, CCBs, Digoxin

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26
Q

Lown Ganong Levine Syndrome

A

Short PR with normal QRS

Bundle of James connects with His

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27
Q

PVC

A

Premature beat from ventricle
WIDE bizarre QRS earlier than expected with a pause

T wave is opposite direction

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28
Q

Ventricular Tach

A

> /= 3 PVCs at a rate of >100bpm

No pulse: defib/CPR

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29
Q

Torsades De Pointes

A

MC d/t Hypomagnesemia, hypokalemia, V Tach that twists around baseline

Tx: IV mag

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30
Q

V Fib Tx

A

Unsynchronized cardiovert and CPR

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31
Q

PEA

A

NSR without a pulse

CPR/Epi

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32
Q

Dilated Cardiomyopathy etiology (95% of cases)

A

Post viral, MC is enterovirus
Also: chagas, ETOH, prego, cocaine

TAKE A GOOD Hx

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33
Q

Dilated Cardiomyopathy Sx

A

Systolic heart failure sx
S3
Laterally displaced PMI
Mitral/Tricuspid Regurg

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34
Q

Dilated Cardiomyopathy Dx/ Tx

A

Echo -> LV dilation, decreased EF

Tx: ACEi, Diuretics, BBs

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35
Q

Restrictive Cardiomyopathy etiology

A

Impaired disatolic function with preserved contractility

Amyloidosis MC cause
Also: sarcoidosis and infiltrative disease

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36
Q

Restrictive cardiomyopathy Sx/ PE

A 
Right sided failure sx
Kussmauls sign (JVP increases with inspiration)
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37
Q

Restrictive Cardiomyopathy dx/ tx

A

CXR: atrial enlargement, pulm congestion

Tx: tx sx and underlying issue

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38
Q

HOCM etiology

A

Genetic disorder of LV and/or RV hypertrophy

Subaortic outflow obstruction

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39
Q

HOCM Sx

A

Dyspnea MC CC, angina, syncope, arrythmias, sudden cardiac death

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40
Q

HOCM PE

A

HARSH systolic Cresendo-Decresendo murmur heard at lower left sternal border, similar to AS except HOCM decreases with squatting

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41
Q

HOCM Dx and TX

A

Echo: >15mm wall thickness

Tx: BB is 1st line, the myomectomy, and alcohol septal ablation

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42
Q

CHF L vs R

A

L: MC causes CAD and HTN

R: MC causes is left sided failure

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43
Q

CHF systolic vs diastolic

A 
Systolic: 
decreased EF
S3
MC form
Etiology: post MI, dilated cardiomyopathy, myocarditis

Diastolic: normal EF
S4
Stiff ventricle
Etiology: HTN, LVH, Elderly

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44
Q

High Output CHF

A

metabolic demands of hte body exceed normal cardiac fxn

Thyrotoxicosis, wet beriberi, severe anemia, AV shunting

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45
Q

Low output CHF

A

Inherent problem of myocardial contraction, ischemia, chronic HTN

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46
Q

NY heart CHF Classificaiton

A

I: no sx/ limits
II: mild sx, slight limits
III: sx cause marked limits with activity, comfy at rest
IV: sx at rest, severe limits

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47
Q

Sx of L CHF

A

Increased pulmonary pressure from fluid backup
Dyspnea, Pulm edema/congestion (rales, rhonchi)
Productive cough, Transudative pleural effusions

HTN, S3/S4, cheyne stokes breathing, dusky pale skin, diaphoresis, sinus tachy, cool extremities

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48
Q

Sx of R CHF

A

Peripheral edema, JVD, GI/Hepatic congestion

N/V, RUQ t, Anorexia

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49
Q

CHF Dx

A

Echo for EF
CXR: kerley B lines, butterfly pattern, cardiomegaly, Pulm Edema, Pleural Effusions

CEPHALIZATION: increased vascular flow to apices
Increased BNP

50
Q

CAD

A

Inadequate perfusion d/t imbalance between decreased coronary blood supply and increased demand

MC etiology: artherosclerosis, AS,AR, Pulm HTN

Rsk: DM, Sm, HTN, HLD, Male, >45, Fam hx

51
Q

CAD PE

A

Sx only with >70% reduction in lumen
ABI<0.9
Delayed cap refull, cool limbs, pale on elevation, lateral malleolar ulcers

52
Q

CAD tx

A

Cilostazol, ASA

53
Q

CVD

A

Atherosclerosis MC

DM (worst rsk factor)
Sm, HLD, HTN , Males, Age, Hx

54
Q

ACS

A

UA, NSTEMI, STEMI

Retrosternal pressure not relieved by rest or nitro
a/w diaphoresis and n/v

55
Q

UA/ NSTEMI tx

A

ASA, GPIIb/IIa i’s, BBs, Nitrates, CCBs

56
Q

STEMI Tx

A

PCI within 3 hours of onset. Alteplase if no PCI

57
Q

Exceptions to STEMI Tx

A

Cocaine: NO BBs
R vent infarct: give IVF, no nitrates or morphine
Viagra: no nitrates

58
Q

Lateral leads

A

I, aVL, V5-V6

59
Q

Inferior Leads

A

II, III, aVF

60
Q

Anterior/Septal leads

A

V1-V4

61
Q

Endocarditis

A

Mitral valve MC

IVDA –> tricuspid MC

62
Q

Types of endocarditis

A

Acute bacterial (S. Aureus)
Subacute Bacterial (S. Viridans)
IVDA: MRSA
Prosthetic: S. Epidermis

63
Q

HACEK

A

Haemophlius, Actinobacillus, Cardiobacterium, Eikenella, Klingella

Gram Neg organisms a/w large vegetations and hard to culture

64
Q

Endocarditis

FROM JANE

A 
Fever
Roth Spots
Osler Nodes
Murmur
Janeway Lesions
Anemia
Nailbed Hem
Emboli
65
Q

Duke Criteria

A

Blood Cx: 3 sets at least 1 hour apart
EKG: arrythmias
Echo: TTE first, consider TEE
Labs: Leukocytosis, anemia, increased EST/rheumatoid factor

66
Q

Tx of Endocarditis

Surgery indication

A

Refractory CHF, persistent infection, invasive, prosthetic valve, fungal

67
Q

Tx of endocarditis acute/subacute

A

Native valve: Naficillin and Gentamicin 4-6 weeks

Subacute: PCN or Ampicillin and Gentamicin OR Vanc in IVDA

68
Q

Tx of Endocarditis Prosthetic Valve

A

Vanc and Genta micin and Rifampin

69
Q

PPX abx for endocarditis

A

Prosthetic valves, heart repairs with prosthetic material, prior hx of endocarditis, congenital heart disease

Procedures: dental, respiratory, infected skin

70
Q

PPX regimen

A

Amoxicillin 2g 30-60 minutes prior to procedure

71
Q

Hyperlipidemia Etiology

A

Hypercholesterolemia: hypothyroidism, pregnancy, kid failure

Hypertriglyceridemia: DM, ETOH, Obesity, Estrogen, Steroids

72
Q

HLD Sx

A

Xanthomas, Xanthelasma, usually asx

73
Q

Statin therapy guidelines

A

DM 40-75 y/o
CVD 40-75 y/o w/ >7.5% risk
>21 y/o w/ LDL >190
ANY ASVCD

74
Q

Lipid medications

A

Lower LDL: statins
Lower Triglycerides: Fibrates
Increase HDL: Niacin
Type II DM: Fibrates/Statins

75
Q

HTN

A

> 2 readings on >2 visits of >140 SBP and/or >90 DBP

76
Q

Primary vs Secondary HTN

A

Primary: d/t idiopathic cause, onset 25-55, Fam hx

Secondary: d/t an outside cause

77
Q

HTN sx

A

Papilledema, renal artery bruits, decreased femoral pulses, presence of S4

78
Q

Goal BP

A

<140/90 for general population

<150/90 if > 60yo

79
Q

Chlorthialidone

A

Prevents Kidney NA/H2O reabsorption

SE: hyponatremia, hypokalemia, hypercalcemia, hyperglycemia

80
Q

Furosemide Loop Diuretic

A

Ihibits H2O transport

SE: Water depletion, hypokalemia/calcemia, hyperglycemia, acidosis, ototoxicity

81
Q

Spirnolactone, amiloride

A

K sparing
Inhibits aldosterone mediated H2O and NA absorption

SE: hyperkalemia, gynecomastia

82
Q

ARB

A

Contraindicated in Pregnancy

83
Q

ACEi

A

Decreases preload/afterload
Good for DM, nephropathy, CHF, post MI

SE: azotemia, hyperkalemia, cough

84
Q

CCB: Nifedipine, Amlodipine, Verapamil, Diltiazem

A

DHP> non DHP

SE: HA, flushing
Contraindicated in CHF 2/3 heart block

85
Q

BBB Atenolol, metoprolol, esmolol, propanolol

A

SE: Fatigue, depression, impotence

Contraindicated in Heart block, CHF, Asthma, COPD, Raynauds, Hypotension

86
Q

Prazosin/Terazosin

A

Good for HTN w/ benign prostatic hypertrophy

SE: Syncope, HA, Dizziness

87
Q

Myocarditis

A

Inflamm of heart muscle MC d/t viral infection or post viral immune mediated cardiac damage

88
Q

Myocarditis Sx

A

Viral prodrome: fever, malaise, myalgias, heart failure

Dyspnea at rest, exercise intolerance, syncope, tachy, AMS

89
Q

Myocarditis Dx

A

CXR: cardiomegaly
Cardiac Enzymes: elevated CK-MB and troponin, and ESR

GOLD STANDARD: endomyocardial biopsy

90
Q

Myocarditis Tx

A

Supportive mainstay of T, standard systolic heart failure

tx: diuretics, ACEi, IVIG, no BBs in peds

91
Q

Acute pericarditis

A

Fibrinous inflammation of the pericardium

Enterovirus

92
Q

Pericarditis Sx

A

Chest pain pleuritic persistent and postural
Fever
Pericardial friction rub at end of expieration whilte upright

93
Q

Pericarditis Dx

A

EKG: ST elevations in precordial leads with PR depressions
Echo: assess for complications of pericarditis like effusion or tamponade

94
Q

Pericarditis tx

A

NSAIDS/ASA for 7-14 days

Colchicine is 2nd line

95
Q

PVD

A

Superficial
Deep
Perforating

96
Q

Superficial Thrombophlebitis

A

Thrombus in superficial vein, d/t IV cath, trauma, preg, varicose veins

97
Q

Superficial thrombophlebitis Dx/ Tx

A

Dx: venous duplex US

Tx: Supportive, elevation, warm compress, NSAIDS, stockings

98
Q

Trousseau’s Malignancy

A

Migratory Thrombophelbitis associated with malignancy (Pancreatic CA)

99
Q

DVT

A

U/L swelling of lower extremity >3cm is most specific sign

Dx: Venous Duplex is 1st line, VENOGRAPHY gold standard

Tx: Antigoag –> Heparin, IVC filter

100
Q

Rheumatic fever

A

Autoimmine inflammatory multi systemic illness found in 5-15 y/o

MC: mitral complications

101
Q

Rheumatic Fever PE

A

JONES criteria

  • Joint pain
  • Oh my heart
  • Nodules
  • Erythema Marginatm
  • Sydenhams Chorea

Also: fever, elevated ESR/CRP, Positive throat culture of Group A strep

102
Q

Rheumatic Fever Tx

A

ASA 2-6 weeks with taper, steroids

Pen G abx of choice

103
Q

Aortic Stenosis Etiology

A

1: Degenerative heart disease
2: Congenital heart disease
3: Rheumatic heart disease

104
Q

Aortic stenosis sx

A

Angina
Syncope
Congestive Herat Failure

SYSTOLIC CRES-DECRESEND MURMUR
RAD TO CAROTID

Narrow pulse pressure

105
Q

Aortic stenosis tx

A

AoV replacement, balloon pump

106
Q

Aortic Regurg Etiology

A

1: Rheumatic heart disease
2: Endocarditis
3: Aortic root dilation

107
Q

Aortic Regurg sx

A

CHF, Bounding pulses, Wide pulse pressure

DIASTOLIC DECRESENDO BLOWING MURMUR

108
Q

Aortic regurg tx

A

ACEi/ARB/Nifedipine, surg is definitive

109
Q

Mitral Stenosis etiology

A

Rheumatic Heart Disease MC

110
Q

Mitral Stenosis sx

A

Dyspnea, hemoptysis, cough, pulm HTN, Afib, R sided HF, Flushed cheeks

PROMINENT S1 OPENING SNAP, MID DIASTOLIC

111
Q

Mitral stenosis tx

A

Surgery

can use diuretics for congestion or BB for afib

112
Q

Mitral regurg etiology

A

Prolapse MC

2: Ischemia/infarct
3: Ruptured chordae tendinae

113
Q

Mitral regurg sx

A

Acute pulm edema, hypotension, dyspnea, chronic afib, CHF

BLOWING HOLOSYSTOLIC

114
Q

Mitral regurg tx

A

Surgery (repair>replacement)

OR

ACEi, hydralazine, nitrates

115
Q

Mitral valve prolapse

A

Palpitations, syncope, fatigue, dyspnea, mostly ASX

MID-LATE SYSTOLIC EJECTION CLICK

Tx: none

116
Q

Pulm Stenosis etiology

A

congenital

117
Q

Pulm Stenosis sx

A

harsh misystolic ejection crescendo decrescendo murmur radiates to neck

118
Q

Pulm Regurg etiology

A

pulm htn, TOF, endocarditis, rheumatic heart disease

119
Q

Pulm Regurg Sx

A

brief decrescendo early diastolic murmur with inspiration

TX: none

120
Q

Tricuspid stenosis sx

A

mid diastolic murmur

Tx: diuretics/ Na restriction

121
Q

Tricuspid regurg sx

A

holosystolic blowing high pitched murmur
CARVALLOs SIGN: increased with inspiration

Tx: diuretics, HF therapy

Internal Medicine EOR (8 decks)

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