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PANCE > Cardio > Flashcards

Cardio Flashcards

1
Q 
ASD
Path:
Pt:
Dx:
Tx:
A

Path: Patent foramen ovale -> blood shunting between atria
Ostium secundum MC

Pt: Most asx

Dx:

  • Systolic ejection crescendo-decrescendo murmur @ pulmonic area (think pulmonic stenosis)
  • Fixed splitting of S2-does not vary with inspiration
  • TTE

Tx: Spontaneous vs surgical closure

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2
Q 
CoArc
Path:
Pt:
Dx:
Tx:
A

Path: Congenital narrowing of descending thoracic aorta

Pt: 
Secondary HTN
Bilateral claudication 
Infantile: pre-ductal
Adultas: post-ductal 
Dx: 
Systolic murmur that radiates to the back/scapula/chest
Inc BP upper > lower extremities 
Delayed/weak femoral pulses 
CXR: rib notching; “3 sign”

Tx: Balloon angioplasty +/- stent

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3
Q 
PDA
Path:
Pt:
Dx:
Tx:
A

Path: PDA fails to close

Pt: Dyspnea, FTT, tachy, hypoxia

Dx:
Continuous machinery murmur
Loudest at pulmonic area
Wide pulse pressure; bounding peripheral pulses

Tx:
Close PDA
-IV indomethacin
-Surgery 
Keep PDA open: Prostaglandin E (PGE)
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4
Q 
TET
Path:
Pt:
Dx:
Tx:
A

Path:

  1. RV outflow obstruction (PA stenosis)
  2. RV hypertrophy
  3. VSD (large unrestrictive)
  4. Overriding aorta

Pt: Cyanotic; Tet spells: relieved by squatting

Dx:
Harsh holosystolic murmur at left upper sternal border
RV heave
CXR: boot-shaped heart

Tx: Surgery

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5
Q 
VSD
Path:
Pt:
Dx:
Tx:
A

Path:
Hole in ventricular septum
MC congenital heart dz
Perimembranous MC type

Pt: Larger the VSD, more severe the symptoms

Dx: Loud high-pitched harsh, holosystolic murmurs at left sternal border

Tx: Spontaneous closure vs surgery

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6
Q

Continuous machinery murmur

A

PDA

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7
Q

Systolic ejection crescendo-decrescendo murmur @ pulmonic area
Fixed splitting of S2

A

ASD

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8
Q

Inc BP upper > lower extremities

Delayed/weak femoral pulses

A

CoArc

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9
Q

Harsh holosystolic murmur at left upper sternal border

A

TET

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10
Q

Wide pulse pressure; bounding peripheral pulses

A

PDA

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11
Q

CXR: rib notching; “3 sign”

A

CoArc

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12
Q

CXR: boot-shaped heart

A

TET

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13
Q

Loud high-pitched harsh, holosystolic murmur at left sternal border

A

VSD

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14
Q

Absolute CI to TPA

A

Hx cerebrovascular hemorrhage
CVA in past year
HTN: SBP >180; DBP >110

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15
Q 
Prinzmetal angina 
Path:
Pt:
Dx:
Tx:
A

Path: Coronary spasm -> transient ST elevations usually without an MI

Pt: CP (MC non-exertional)

Dx:
EKG-> ST elevations
Sx and ST elevations resolve with CCB and nitroglycerin

Tx:
CCB (nondihydropyridine)!!!: verapamil, diltiazem
Nitrates prn

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16
Q

Hypertensive emergency:
Path:
Pt:
Tx:

A

Path: Inc BP with acute end organ damage

Pt: 
Neuro: 
-encephalopathy: nicardipine, labetalol
 -stroke: nicardipine, labetalol (ischemic stroke only if BP >185/110 and getting TPA)
-seizure

Cardiac:

  • Aortic direction: esmolol, labetalol
  • ACS: nitroglycerin, BB
  • Acute HF: nitroglycerin, furosemide

Renal: AKI, proteinuria, hematuria (glomerulonephritis)
-Tx: fenoldopam

Retinal: malignant HTN/Grade IV retinopathy (papilledema) blurred vision

17
Q

Hypertensive urgency
Path:
Tx:

A

Path: BP >180/110 w/o sx

Tx: Reduce BP within 1 hr
Clonidine (alpha-2): rebound hypertension if d/c abruptly
Captopril (ace): angioedema, AKI
Furosemide: electrolyte abnormalities, alkalosis
Labetalol (alpha-1; beta-1&2): CI asthma, COPD, AV heart block, CHF
Nicardipine (DPP CCB): reflex tachycardia, HA, NA, flushing

18
Q

Cardiogenic shock
Path:
Tx:

A

Path:
Myocardial dysfunction-> inadequate tissue perfusion -> dec CO with inc SVR
MI, myocarditis, valve dysfunction, congenital heart dz, cardiomyopathy, arrhythmias

Tx:
Oxygen + limited fluid resuscitation (isotonic)- only shock where fluids are limited
Inotropic support: dobutamine, epi, intraaortic balloon pump
Tx underlying cause

19
Q 
Dilated cardiomyopathy 
Path:
Pt:
Dx:
Tx:
A

Path:

  • Idiopathic MC cause: autoimmune
  • Systolic dysfunction: Ventricular dilation -> dilated weak heart; MC present 20-60yr; MC in men
  • Viral myocarditis; ex. Enteroviruses
  • Toxic: ETOH, Cocaine, Pregnancy, Radiation, Doxorubicin, Daunorubicin

Pt:
Systolic heart failure sx (both R and L)
Embolic phenomena, arrhythmias
Viral Myocarditis: viral prodrome a few weeks-> signs of HF or chest pain, + cardiac enzymes, nonstop ST-T changes

Dx: 
BNP
*>500 w/ acute dyspnea suggestive of heart failure
*<100 heart failure is unlikely
*Levels do not correlate w/ HR severity 
Echo
-LV dilation: thin walls
-Dec EF
-Regional or global LV hypokinesis
CXR: cardiomegaly, pulmonary edema, pleural effusion

Tx:
Standard systolic HF tx
ACEi, BB, Diuretics, Na+ restriction, Digoxin
Implantable defibrillator if EF <35%

20
Q 
Hypertrophic cardiomyopathy
Path:
Pt:
Dx:
Tx:
A

Path:

  • Diastolic dysfunction due to impaired ventricular relaxation/filling
  • Subaortic outflow obstruction-> hypertrophic septum
  • Inherited genetic disorder of inappropriate left and/or RV hypertrophy

Pt: Often asx
Dyspnea-> MC initial complaint
Angina pectoris, syncope
Arrhythmias: AF; VT/VF (palpitations, syncope)
Sudden cardiac death: esp in adolescent/preadolescent Childrens (especially exertion) due to v-fib
Harsh systolic cres-decrescendo murmur @LLSB-> sounds like AS
-Dec murmur intensity: inc venous return-> squatting, supine); handgrip (inc. afterload)
-Inc murmur: dec. venous return (valsalva & standing) and exertion-> b/c dec LV volume & inc. contractility will dec CO
-Usually no carotid radiation
-Normal pulse
-Loud S4 +/- mitral regurgitation

Dx: 
Echo: 
-asymmetric wall thickness (esp septal)
-Systolic anterior motion mitral valve 
EKG: LV hypertrophy

Tx:
Avoid exertion, implantable defibrillator to prevent VF
Medical: BB, verapamil, disopyramide
Cautious use of digoxin, nitrate and diuretics
Digoxin inc contractility
Nitrates and diuretics dx volume
Surgical: myomectomy, ETOH ablation

21
Q 
Restrictive cardiomyopathy
Path:
Pt:
Dx:
Tx:
A

Path:

  • Diastolic dysfunction w/ relatively preserved contractility
  • Ventricular rigidity impedes ventricular filling (dec. ventricular compliance)
  • Infiltrative diseases: Amyloidosis (MC), Sarcoidosis, hemochromatosis, Scleroderma, metastatic dz; idiopathic

Pt:
R sided failure sx MC than L sided sx
Poorly tolerated tachyarrhythmias
Kussmaul’s sign: Inc JVP w/ inspiration

Dx:
Echo
-ventricle non-dilated w/ normal wall thickness
-MARKED DILATION OF BOTH ATRIA
-Diastolic dysfunction w/ normal/near normal systolic fn

Tx: Tx underlying cause

22
Q 
Aortic aneurysm
Path:
Pt:
Dx:
Tx:
A

Path: Focal dilation of aortic diameter at least 1-1.5x measured at renal arteries
>3cm, MC infrarenally
Risk factors-> atherosclerosis, age>60, smoking, males, HLD, connective tissue disorder (marfan’s), syphilis, HTN

Pt:
Most Asx-> Screening: Abd U/S in males aged 65-75 who have ever smoked
>60yr old male, severe back/abdominal pain, syncope, hypotension
Tender, pulsatile abdominal mass
+/- flank ecchymosis

Dx: 
Abdominal U/S
CT scan-> test of choice
Angiography-> gold standard
MRI/MRA
Abdominal radiograph 
Tx:
BB
Surgical repair-> endovascular stent graft or open repair 
Asx repair
AAA grows >/= 5.5cm
Grows > 0.6-0.8 cm in 6m
23
Q

Rheumatic fever
Path:
Dx:
Tx:

A

Path:
Acute autoimmune inflammatory multi-systemic illness; MC affect 5-15yr
Infection with GABHS (Strep pyogenes) stimulated antibody production to host tissues and damages organs directly; Infection usually precedes rheumatic fever by 2-6w

Dx: Jones Criteria 2 major OR 1 major + 2 minor AND evidence of recent GAS infection

Major

  • Joint-> migratory polyarthritis; 2+ joints affected or migratory (lower to upper)
  • Oh my heart-> active carditis
  • Nodules-> subcutaneous
  • Erythema marginatum: macular, erythematous, non-pruritic annular rash w/ rounded, sharply demarcated
  • Sydenham’s chorea: Sudden involuntary jerky, non-rhythmic, purposeless movements especially involving head/arms
Minor
Clinical
-Fever >101.3/38.5
-Arthralgia 
-Laboratory: Inc. ESR, CRP, Leukocytosis
ECG: prolonged PR interval

Evidence of recent group A streptococcal infection

    • throat cultures
  • Rapid antigen detection tests
  • elevated/increasing streptococcal antibody titers (ASO)

Tx:
Penicillin G (Erythromycin if PCN allergy)
Anti-inflammatory: ASA 2-6w taper
+/- corticosteroids in severe cases and carditis

PANCE (13 decks)

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