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OME Cards > Cardio > Flashcards

Cardio Flashcards

1
Q

Treatment of constrictive pericarditis

A

Constrictive pericarditis is a product of chronic inflammatory changes in the pericardium that makes it a rigid box.

Peristernal “knock”

tx: Pericardiectomy

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2
Q

Right sided infarct

A

Right sided infarcts are preload-dependent

Morphine and nitroglycerin should NOT be given in these instances. They are both venodilators

Instead, support their blood pressure with fluid.

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3
Q

Syncope in a CAD patient

A

Sudden onset syncope in someone with known coronary artery disease or structural heart disease gets admitted for 24 hour telemetry monitoring to try to catch the arrhythmia (often, one is not caught and an event recorder is required to identify it).

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4
Q

Indications for Automatic Implantable Cardioverter Defibrillator (AICD)

A

Patients with CHF who are referred for AICD placement for primary prevention of cardiac arrhythmias.

class I w/ EF < 30%.

Class II-III with an EF < 35%

Those in class IV are not referred. Bad CHF

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5
Q

Presentation of pericardial tamponade

A

Hypotension, jugular venous distention, muffled heart sounds (Beck’s Triad)

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6
Q

Treatment of pericardial tamponade

A

An emergent ultrasound guided pericardiocentesis is the definitive therapy for pericardial tamponade. While cardiology is coming to the bedside to perform it, support their preload with intravenous fluid.

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7
Q

statin therapy for CAD patients

A

high potency statins are required in known coronary artery disease either rosuvastatin 40 or atorvastatin 80.

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8
Q

Aortic stenosis treatment

A

Symptomatic or severe aortic stenosis requires valve replacement becuz usually due to calcifications

Mitral valve stenosis is less often from calcification and can therefore respond to valvuloplasty more regularly.

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9
Q

Niacin side effect

A

Niacin-associated flushing can be treated with aspirin. However, the utility of adding this to a patient already on a statin is debatable.

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10
Q

Evaluation of patient for heart failure

A

The BNP is the first test in the evaluation of someone who has heart failure, followed by echocardiogram, then catheterization, stress test and PFTs as suggested by patient history.

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11
Q

Long term complication if patient is left with patent ductus arteriosus?

A

Machine like murmur

Large PDA causes large left-to-right shunt and can lead to pulmonary arterial hypertension

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12
Q

What is central retinal artery occlusion?

A

acute painless monocular visual loss

cherry-red fovea

Due to atrial fibrillation, infective endocarditis, paradoxical deep vein thrombosis, or atherosclerosis from major arteries

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13
Q

What is central retinal vein occlusion?

A

acute onset of painless blurred vision in one eye

“blood and thunder”

Retinal hemorrhages, edema, dilated retinal veins, and possibly cotton-wool spots

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14
Q

Aortic regurgitation

A

Wide pulse pressure

Diastolic decrescendo murmur @ left lower sternal border

Late diastolic rumble (Austin-Flint murmur)

Bounding pulses

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15
Q

Aortic stenosis

A

Weak S2, murmur decreases with valsalva

Crescendo–decrescendo systolic murmur with radiation to the neck/carotids

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16
Q

mitral regurgitation

A

Holosystolic murmur radiating to the axilla, increased with maneuvers that increase afterload, such as handgrip.

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17
Q

Which treatments is contraindicated in WPW and Afib?

A

In patients with Wolff-Parkinson-White with atrial fibrillation, use of atrioventricular nodal–blocking agents should be avoided, especially digoxin, as they can increase the risk of ventricular fibrillation.

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18
Q

Worsening of the murmur on inspiration suggests a

A

right-sided murmur

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19
Q

Aortic regurgitation

A

early diastolic murmur along the upper left side of the sternum.

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20
Q

Mitral regurgitation

A

holosystolic (pansystolic) murmur located at the apex that increases with maneuvers that increase afterload, such as handgrip

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21
Q

Mitral stenosis

A

mid to late diastolic murmur, best heard at the apex.

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22
Q

Tricuspid regurgitation

A

holosystolic murmur at the left lower sternal border that increases with deep inspiration

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23
Q

Prophylaxis for toxoplasmosis

A

Prophylaxis for toxoplasmosis is trimethoprim-sulfamethoxazole (CD4<100)

Toxoplasmosis will often present with flu-like symptoms and lymphadenopathy.

Once a patient is diagnosed with toxoplasmosis by MRI findings, treatment is with sulfadiazine and pyrimethamine.

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24
Q

Tumor marker for ovarian cancer

A

CA-125

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25
Q

Tumor marker for pancreatic and biliary tract cancer

A

CA 19-9

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26
Q

Tumor marker for medullary thyroid cancer

A

Calcitonin

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27
Q

Tumor marker for Colorectal carcinoma

A

CEA

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28
Q

Subarachnoid hemorrhage

A

Most common cause of a subarachnoid hemorrhage is a ruptured berry aneurysm.

A definitive treatment to prevent rebleeding is endovascular coiling of the aneurysm.

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29
Q

FUNGAL Cerebrospinal fluid analysis

A

Elevated white blood cell count (10s-100s)

Lymphocytic predominance

Significantly elevated pressure

Decreased glucose

Elevated protein

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30
Q

BACTERIAL Cerebrospinal fluid analysis

A

VERY HIGH white blood cell count (1000s)

Neutrophilic predominance

Significantly elevated pressure

Decreased glucose

Elevated protein

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31
Q

VIRAL Cerebrospinal fluid analysis

A

Elevated white blood cell count (10s-100s)

Lymphocytic predominance

Slightly elevated pressure

Normal glucose

Normal protein

32
Q

DeBakey classification of aortic dissection

A

Type I- involves the ascending aorta, arch, and descending thoracic aorta.

Type II is confined to the ascending aorta

Type IIIa involves the descending thoracic aorta between the left subclavian artery and the celiac artery.

Type IIIb dissection involves the thoracic and abdominal aorta after the left subclavian artery.

33
Q

Stanford classification of aortic dissection

A

Type A - Any dissection that involves the ascending aorta- Surgery

Type B- involves the descending thoracic or thoracoabdominal aorta distal to the left subclavian artery without involvement of the ascending aorta (medical management)

34
Q

Stable angina

A

Chest pain or substernal pressure that is brought on by exertion that lasts less than 15 minutes and is relieved by rest or nitroglycerin.

Confirmed by ST-segment depression on a stress ECG

35
Q

Unstable angina

A

Chest pain at rest or with minimal exertion that is not entirely relieved by nitroglycerin

Cardiac enzymes are negative

36
Q

Rouse v. Pitt County Memorial Hospital

A

Attending physician can be vicariously responsible for residents’ negligence under the borrowed-servant doctrine

37
Q

Hypomagnesemia

A

Common in alcoholics

Prolonged QT interval on ECG

Tremor, hyperactive deep tendon reflexes, and tetany. Patients may have a positive Chvostek and Trousseau sign (similiar to Hypocalcemia)

Tx: IV magnesium sulfate

38
Q

Hypercalcemia

A

kidney stones, muscle and bone pain, constipation and non-specific abdominal pain, and psychiatric symptoms such as anxiety, depression, or cognitive dysfunction

shortened QT interval

Tx: vigorous fluid resuscitation, bisphosphonate therapy, and calcitonin.

39
Q

Central venous access

A

Defined as a catheter tip located in the superior vena cava, the right atrium, or the inferior vena cava

Internal jugular vein-Risk of pneumothorax

Subclavian vein- Lowest risk of infection. Higher risk of pneumothorax.

Femoral vein- Highest rate of infections due to proximity to groin

40
Q

Indications for valve replacement in infective endocarditis

A

1) Prosthetic valve endocarditis
2) Uncontrolled infection leading to conduction abnormalities, periannular suppuration, and fistula despite appropriate antibiotic treatment for at least 1 week
3) Repeated systemic embolizations despite appropriate antibiotic treatment
4) severe valvular disease resulting in refractory congestive heart failure

41
Q

Right Bundle Branch Block (RBBB)

A

Widened QRS complex

“MarroW” (Bunny ears in V1)

Lead V1= M
Lead V6= W

42
Q

Left Bundle Branch Block (LBBB)

A

Widened QRS complex

“WilliaM” Bunny ears in V6

Lead V1= W
Lead V6= M

43
Q

What is Brugada syndrome?

A

Genetic disease

Look for sudden death in a young asian man

ECG findings- persistent ST elevations in the V1–V3 leads with a right bundle branch block appearance with or without terminal S waves in the lateral leads

44
Q

Treatment for Brugada syndrome

A

Implantable cardioverter defibrillator (ICD)

Most patients die from ventricular tachycardia (VT)/ventricular fibrillation

45
Q

Contraindications to Beta blockers during MI

A
  • Heart rate of < 60/min
  • Systolic blood pressure of < 120 mmHg
  • Second- and third-degree AV blocks
  • Moderate to severe congestive heart failure
46
Q

Sensory innervation- Median Nerve

A

Median Nerve- Palmar aspect of lateral 3.5 digits and thenar eminence

47
Q

Sensory innervation- Ulnar Nerve

A

Medial 1.5 digits and hypothenar eminence

48
Q

Sensory innervation- Radial nerve

A

Dorsal aspect of lateral 3.5 digits and anatomical snuffbox

49
Q

Sensory innervation- musculocutaneous nerve

A

Sensory innervation to the radial side of the forearm.

50
Q

Most common valvular disease caused by rheumatic heart disease

A

Mitral stenosis

Loud S1, along with a mid-diastolic rumble at the cardiac apex.

51
Q

Mitral regurgitation

A

Holosystolic murmur heard best at the apex with radiation to the axillae

Long asymptomatic period, so when patients present, they are typically in heart failure

52
Q

Mitral valve prolapse (MVP)

A

Late systolic crescendo murmur with a mid-systolic click

Myxomatous degeneration, which is a pathological connective tissue deterioration, is the main cause of MVP.

53
Q

Takotsubo cardiomyopathy/ stress-induced cardiomyopathy/ “broken heart” syndrome

A

Often occurs in post-menopausal women due to an emotional or physical stressor and presents similarly to an ST segment elevated myocardial infarction with chest pain, ECG changes, and mildly elevated troponins.

It is reversible, resolving within days to weeks.

54
Q

Surveillance of Ascending Aortic Aneurysms

A
  1. 5-4.5cm Do annual CT angiogram and echo for aortic valve
  2. 5- 5.4cm Do biannual CT angiography nd echo for aortic valve

Symptomatic/ ruptured or aneurysms > 5.5 cm in diameter- Do surgery

55
Q

Surveillance of descending Aortic Aneurysms

A

4-5cm - Do annual contrast CT

5-6cm- Do biannual contrast CT

56
Q

Defibrillation is reserved for 2 distinct dysrhythmias

A

1) Pulseless ventricular tachycardia

2) Ventricular fibrillation

57
Q

Hemodynamically stable patient with supraventricular tachycardia

A

In a hemodynamically stable patient with supraventricular tachycardia, intravenous adenosine is the initial drug treatment of choice.

58
Q

Hemodynamically UNstable patient with supraventricular tachycardia

A

Synchronized cardioversion is the preferred treatment for unstable SVT, defined as SVT with hypotension, active chest pain, hypoxemia, abnormal mentation, and/or pulselessness.

59
Q

“widened mediastinum” on xray

A

Thoracic aortic aneurysms are typically asymptomatic and found incidentally on chest x-ray, appearing as a “widened mediastinum,” which is a non-specific sign. The diagnosis is confirmed with a contrast-enhanced CT of the chest.

60
Q

As a general rule in any advanced cardiac life support protocol, if the patient is unstable as a result of an arrhythmia, shocks of some sort will be required:

A

Bradycardia (transcutaneous pacing)

Tachycardia (synchronized cardioversion)

Pulseless (defibrillation)

If the patient is stable, medications can typically be tried first.

61
Q

First-line therapy in Prinzmetal (variant) angina is

A

calcium channel blocker such as diltiazem, nifedipine, or amlodipine.

62
Q

Hyperventilation syndrome

A

leads to respiratory alkalosis, hypocarbia, and secondary hypocalcemia.

63
Q

only beta blockers studied and proven effective for heart failure patients with reduced ejection fraction (EF) are

A

metoprolol succinate, carvedilol, and bisoprolol.

ACE-i/ARB and beta-blockers are the mainstay of HFrEF

64
Q

Bicipital tendonitis

A

Anterior shoulder pain, worst near the bicipital groove. Pain may be exacerbated with supination and/or flexion of the elbow.

Yergason’s and Speed’s tests may be positive.

65
Q

Intravenous medications that can be used to treat hypertensive emergencies include

A

nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam.

66
Q

Superior vena cava (SVC) syndrome is diagnosed with

A

CT venography

“Pemberton’s Sign”. When the patient brings his/her hands up to the face, this leads to obstruction of the thoracic outlet causing facial edema, congestion, and eventually respiratory distress.

67
Q

Cardiac abnormalities associated with Turner syndrome

A

Bicuspid aortic valve that can lead to aortic stenosis later in life

Aortic coarctation

68
Q

first-line medications in treating chronic myelogenous leukemia

A

Tyrosine kinase inhibitors (TKIs) such as imatinib, dasatinib.

TKIs inhibit the BCR-ABL tyrosine kinase, the constitutive abnormal gene product of the Philadelphia chromosome, in CML

69
Q

Complete heart block is a medical emergency that requires immediate temporary transcutaneous pacing.

A

The deterioration of third degree heart block to asystole is unpredictable and all patients should have a transcutaneous pacer until transvenous pacer can be setup.

70
Q

Treatment of Phyllodes tumor

A

Benign or malignant

Wide local excision

71
Q

Increased CO

Decreased PVR

Decreased PCWP

A

Anaphylactic (distributive) shock

72
Q

Decreased CO

Decreased PVR

Increased PCWP

A

Neurogenic shock

73
Q

Low CO

High PVR

High PCWP

A

Obstructive (tamponade, tension pneumothorax), or cardiogenic shock states

74
Q

When is the only time defibrillation is used?

A

ventricular fibrillation or pulseless ventricular tachycardia

75
Q

asystole or pulseless electrical activity

A

high-quality chest compressions and epinephrine

76
Q

Atropine

A

stable symptomatic bradycardia

77
Q

Amiodarone

A

stable patients with wide complex (QRS ≥0.12 seconds) tachycardia

OME Cards (20 decks)

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