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IPAP > Cardio Block 2 Cram > Flashcards

Cardio Block 2 Cram Flashcards

1
Q

UA/NSTEMI Medical Therapies

A 
BB- beneficial in acute MI
O2- <90%
Nitro- sublingual then IV, avoid in inf MI and Sev AS, c/i in PDE5 inhib in past 24hrs
Statin- all PTs w/ ACS @ high intensity
Anti-platelet- ASA for all
Morphine- caution
Anti-coag- UFH or LMWH
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2
Q

Acute Decompensated HF

A

S/Sxs: Exertional dyspnea, orthopnea
Dx: BNP +500
CXR: Kerley Bs, Effusion, Cardiomegaly
Tx: BiPap, Nitro, Furosemide, HOTN w/ no shock- Doubtamine/HOTN w/ shock- NorEpi

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3
Q

College of Cardio Staging categories

A

A- high risk, no Sxs/Dz
B- structure Dz w/out Sxs
C- structure Dz w/ Sxs
D- refractory HF

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4
Q

Why are NSAIDs avoided in HF?

A 
Na retention
Negative ionootropic effects
Direct cardiotoxicity
Impaired ACEI/Diuretic response
Inc renal dysfunction
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5
Q

NYHA HF Classifications

A

1- ASx
2- Sxs w/ ordinary activity
3- ASx only at rest
4- Sx at rest

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6
Q

Nitroprusside contains cyanide ligands which can accumulate and cause toxicity which manifests as ?

A

N/V
Anorexia
AMS

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7
Q

What is the most common vasculitis in the US?

A

GCA
S/Sxs- monocular vision loss, unilateral HA, jaw claudication
ESR >50 but Biopsy= Dx
Tx high dose NSAID, No vision loss= prednisone PO, + Vision loss= IV Methylprednisolone
Assoicated w/ Polymyalgia Rheumatica

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8
Q

What maneuvers increases HCM

What maneuver decreases it?

A

Valsalva and Standing due to decreased venous return

Squatting- increased venous return

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9
Q

What are the top two most common Sxs of HCM?

A

First- death

Common- dyspnea, chest pain

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10
Q

Peripheral Artery Dz

A

Caused by atherosclerosis
Presents w/ intermittent claudication, cool/shiny skin and dec hair
PE: cool to touch and decreased pulses
Dx: ankle brachial index (<0.9= stenosis, <0.4= ischemia)
THESE PTS ARE REQ’D TO BE ON STATINS

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11
Q

What is the classic presentation of Conn Syndrome?

A

Primary Hyperaldosteronism- common cause of 2* HTN

HTN, Unexplained HypoK, Metabolic alkalosis

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12
Q

Rheumatic Fever

A 
Hx of GAS- Strep Pyogens Infxn
S/Sxs: Fever, Red lesions on trunk/extremities, Non-tender joint lumps
JONES Criteria
Tx: PCN/Macrolide, ASA
2 Major, 1 Major 2 Minor; 5 minor
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13
Q

All PTs w/ Systolic HF need to be on what 2 meds?

A

ACEI/ARB

BB- Metoprolol Succinate is DOC

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14
Q

CHADS2VASC use and score method

A

Estimates risk of stroke in PTs w/ A-fib

CHF, HTN, Age (75 or more=2), DM, Stroke/Clot (2), Vascular Dz, Age, Sex (F-1)

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15
Q

Aortic Stenosis

A

Old PT- calcification of trileaflet valve
Young PT- bicuspid
NARROW Pulse Press, syncope, dyspnea
Crec/Decrec Systol murmur w/ S4, can radiate to carotid
Dec w/ Valsalva
Tx w/ Valve replacement

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16
Q

Associations w/ endocarditis and colonic neoplasms are most closely linked to ?

A

Strep Gallolyticus

S. Bovis Biotype I

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17
Q

Aortic Regurgitation

A

Abnormal leaflet on proximal root
S/Sxs: CHF, Dyspnea, Fatigue
PE: WIDE pulse pressure, 5 Sign Names
Dx w/ Echo
Tx- Diuretics, Digoxin, ACEI, Na restriction
Surgery if EF <55% or end diastolic >55mm

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18
Q

Regardless of etiology, what med is beneficial for Sx and ASx PTs w/ reduced LV systolic function?

A

ACEI

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19
Q

Mitral Stenosis

A

Exertional dyspnea, Hemoptysis
Loud S1, Open Snap, Low diastolic rumble at apex
Prophylaxis if undergoing procedures prone to bacteremia

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20
Q

What two meds can be used in the presence of heart block to increase HR?

A

Atropine

Isoproterenol

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21
Q

A 10yr atherosclerotic CV Dz score of __% is an indication to start a statin

A

> 7.5%

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22
Q

Mitral Regurg

A

Dyspnea
Blowing holosystolic mrmur heard at apex to axilla
Manage: Nitroprusside, Dobutamine, Intra Aorta Bolloon, Surgery

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23
Q

Mitral Valve Prolapse

A

Non-exertional chest pain, dyspnea
Mid-systolic click w/ late systolic murmur
Dx w/ Echo

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24
Q

What are the first two drugs usually utilized in HF and why?

What is the only diuretic proven to improve survival in HF?

A

ACEI- anti-HTN, dec AL, Inhib RAAS, Prevent remodel

BB- anti-HTN, dec O2 consumption, anti-arrhythmic effect

Spirinolactone

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25
Q

Difference between aortic dissection and aortic coarctation BP measurements?

A

Dissection- low arm BP, high leg BP

Coarc- high arm BP, low leg BP

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26
Q

MAT

A

Elderly/COPD PTs
Irr/Irr w/ rate 100-200
3 different P-waves w/ 3 different PR morphologies
Tx- CCBs, O2 NEVER use electricity

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27
Q

1* Block

A

Can be caused by Digitalis, Ischemia, BBs, Inflammation, Cardiomyopathies
Regular rhythm, PR interval >0.20sec
Can also be caused by Lyme Carditis

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28
Q

Define the Cardiac Box

A

Anterior chest wall w/ highest likelihood to sustain injury from penetrating trauma: RV is most commonly injured structure

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29
Q

Type 2 Blocks, 1 and 2

A

Type 1/Wenk: irregular rhythm w/ PRs progressively longer then dropped

Type 2/Mobitz: Fixed PR interval w/ dropped beat

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30
Q

3* Block

A

From Age, Infection or Digitalis
Tx:
Sxs- Atropine, Isoproterenol
Definitice- pacemaker

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31
Q

WPW

A 
Accessory path through bundle of Kent that bypasses AV node and connects atria to ventricles
Triad=
1- D/up slope wave
2- QRS > 20msec
3- PR <120msec
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32
Q

Atherosclerosis begins with injury to the ?

Injury results from the accumulation of ? and ? leading to ?

A

Intimal endothelium

Lipids and inflammation causing turubulent flows and intimal damage

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33
Q

Alcoholic cardiomyopathy is a form of ?

What are other causes of this form of HF?

A

Dilated cardiomyopathy, causes systolic CHF

Coxsackie B, pregnancy, idiopathic, genetic

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34
Q

RBBB

A

Wide QRS
“Bunny Ears” V1
Wide S Led 1/V6

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35
Q

Define Cor Pulmonale

A

Most common chronic cause- COPD
Most common acute cause- Pulmonary Embolism
Causes- Amiodarone induced fibrosis, Sarcoidosis
Severe lung dz elevated pulmonary artery pressure transmits back into RV causing RV failure
Manage- R heart cath

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36
Q

Atypical MI presentation

A

Female
Elderly
Diabetic

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37
Q

Viral myocarditis can lead to ? which presents w/ diffusely decreased systolic function and ?

What is the most common cause of sudden cardiac death post-MI?

A

Dilated cardiomyopathy
Chamber dilation

Ventricular arrhythmia

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38
Q

LBBB

A

Wide QRS >120msec
Large R in V1
Neg QS or rS in V1

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39
Q

PSVT

A

Presents w/ palpitations and anxiety
HR between 120-200
Mange: Vagal, Adenosine (DOC) 6mg then 12mg w/ saline flushes
Unstable- conversion

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40
Q

Pathology of mesenteric ischemia is similar to ?

A

Atherosclerosis in stable angina affecting watershed areas

Watershed- splenetic flexure (SMA), rectosigmoid junction (IMA)

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41
Q

Native valve w/ IE will be due to ?

IV drug user w/ IE is due to ? microbe?

Less than a year post-valve transplant will be ?

More than a year post transplant will be ?

A

Strep V/Staph A

Staph A/Strep V

Strep Epidermis/Staph Aureus

Strep V/Staph A

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42
Q

PTs need to be in LLD to listen for ? 3 murmurs?

PTs need to stand from squat to listen for ?

A

MS, S3, S4

MVP, HOCM

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43
Q

Non-ejection mid systolic click can be what 2

Ejection click will either be one of ? 2

A

MVP/TVP

AS/PS

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44
Q

Soft heart sounds can be due to ? 4 things

A

Low CO
Obesity
Emphysema
Pericardial effusion

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45
Q

What causes a soft S2?

What causes a loud S2?

A

AS/PS

HTN/PHTN

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46
Q

What can cause paradoxical splitting?

Define S3
Define S4

A

LBBB, AS, HTN, V-Fib, TR, WPW

3= Rapid ventricle filling, best heard w/ bell at apex
4= Pressure overload, best heard w/ bell at apex and is ALWAYS pathological
47
Q

PTs w/ MI are at risk of free wall rupture from day ? to day ? and will result in a ?

Post-MI complications include ? 2

A

3-14 days
Cardiac tamponade

Post-MI VSD or MR

48
Q

Restrictive Cardiomyopathy

A

From Amyloydosis, Sarcoidosis, Hemachromatosis or TEF
Kussamal Sign, Sx of HF, peripheral edema and dyspnea
EKG= low voltage, non-specific changes
Echo= preserved systolic function

49
Q

How do you determine Restrictive from Constrictive pericarditis?

Where does Loop/Thiazide diuretics exert their effects? Where does Spirinolactone exert it’s effect?

A

Restrictive= pericardial knock

L/T: LoH and DCT- promote K loss
S: antagonizes aldosterone, preserves K levels

50
Q

What maneuver increases HOCM?

Define Spike Dome pulse

A

Valsalva

Double carotid pulse due to HOCM

51
Q

What is the triad of aortic dissection?

Rheumatic heart disease usually affects ? valve and can lead to what 3 things?

A

Sharp tearing pain, BP difference between arm/leg and widened mediastinum on CXR
Dx w/ CT/TEE

MS- HF, A-FIb, Pulm Edema

52
Q

ACEIs are the anti-HTN DOC for what 3 conditions?

What is the most common cause of non-ischemic cardiomyopathy?

A

HTN, DM, Microalbuminemia

Chagas- T. Cruzi

53
Q

Ebstein abnormality have ? accessory pathway and Tx includes ?

A

WPW

TV repair, Ablation

54
Q

What measurement can be used to guide therapeutic efficacy?

What can this measurement be used to determine the severity of ?

A

Pulmonary Artery Occlusion Pressu (AKA Pulmonary wedge pressure)

LV failure, MS, pathology that increases LA pressure

55
Q

What is the initial approach to restoring hr in hemodynamically unstable bradycardia due to viral illness?

A

Inotropic support/pacing

56
Q

How to differentiate MS and TS

TS is most commonly caused by ?

A

TS is louder during inspiration (Carvallo Sign)

RV dilation, PHTN

57
Q

What 3 Sxs are indicative of severe TS?

If cardioversion is done improperly, what arrhythmia can be produced?

A

Pulses in neck, Pulsatile liver, Anasarca (whole body swelling)

V-Fib

58
Q

What is the MOA of Nitroprusside

ANP is released due to stretch and is associated with what 2 things?

A

Increased cyclic GMP which activates Ca sensitive K channels in cell membrane

Inc vascular permeability, rapid fluid shift to interstitial space

59
Q

LFTs need to be obtained prior to starting HF/MI PTs on what med?

MOA of Digoxin
PTs w/ digoxin toxicity present w/ ? Sxs

A

Statins

Inc contractility and dec AV conduction by inhibiting Na/K/ATPase
N/V/D, blurry yellow vision

60
Q

Persistent dry cough from ACEI use is due to ?

What is the most serious reaction due to amiodarone use?

A

Bradykinin accumulation

Interstitial lung dz
Presents w/ SoB, dry cough and R side HF

61
Q

AAA

What is the presenting triad?

A

Older male w/ smoking and HTN Hx
US to screen, CT to track progression (>4cm Q6mon, >5cm surgery)

Abd Pain, HOTN, Pulsatile mass

62
Q

What screening is done on all men between 65-75 w/ smoking Hx

What is the first DOC for A-Fib in PTs w/ compensated HF?

A

CT for AAA

Carvedilol

63
Q

What are the 6 P’s of a thromboemblism?

What is the most common site for them to get lodged?

A

Parasthesia, Pallor, Pulselessness, Poikilothemia, Paralysis, Pain OOP

Femoral Artery bifurcation

64
Q

How is thrombophlebitis managed?

How are vericose veins Dx and Tx?

A

US to r/o DVT
Warm compress, NSAID, Elevation, Ambulation

Duplex US
Elevation/compression socks

65
Q

What can cause Symptomatic Bradycardia

What is the sequence of treatment for bradycardia

A

Inc vagal tone, BB/CCBs, Digoxin

Atropine, TC Pacing, Dopamine, Epie

66
Q

What causes V-Fib?

How is it treated?

A

Ischemic heart dz and ventricle dysfunction

Defib w/ max joules 200J biphasic

67
Q

What causes V-Tach

What does it look like on EKG

A

E+ imbalance
Acid-Base change
Hypoxia
MI

HR >100
QRS >120msec
Loss of QS peak

68
Q

How is V-tach treated?

A

Stable- amiodarone, lidocaine, procainamide
Unstable- conversion
Pulseless- Defib

69
Q

What sign is seen w/ DVTs/

What imaging is used and how is it treated?

A

Homans- dorsiflex foot and squeeze calf

Sx w/ duplex, venography is gold standard
Tx w/ Heparin/LMWH
Direct anti-coag w/ Doax

70
Q

What is the TIMI score method

A 
Older than 65
3 or more CAD risk factors
CAD/stenosis 50% or more
ASA in past 7 days
2 or more angina episodes in past 24hrs
ST change 0.5mm or more
Pos cardiac marker
0-2= low
3-4= mod
5-7= high
71
Q

Define Pulsus Bisferiens

Define Pulsus Parvus et Tardus

A

Double wave from AR and AS

Slow uprising of carotid stroke due to severe AS

72
Q

Define Pulsus Alternans

A

Alternation in amplitude w/ cyclic dip in SBP from LV dysfunction

73
Q

HTN emergency criteria and reduction goals

A

Eclampsia/Pheo: SBP <140 in first hour
Aorta Dissection: <120 in first hour

Non compelling condition=
Max 25% in first hour
160/100 in 4-6hrs
Normal within 24-48hrs

74
Q

How is acute HTN pulmonary edema treated?

A

Reduce BP 20-30%
Relieve Sxs
Diuresis

IV nitro first
IV Nicradipine if pregnant/systolic dysfunction

75
Q

How is cocaine/meth induced HTN emergency treated?

What med is NOT used and where else is it not used?

A

IV Benzos: Lorazepam or Diazepam

Labetolol, or in Tx of Decompensated HF induced systolic dysfunction

76
Q

What is the most common form of cardiomyopathy

How does Takotsubo Cardiomyopathy present?

A

Dilated, either idiopathis or alcohol abuse
Tx w/ absenence, ACEI, Diuretics

Apical ballooning on echo w/ ST elevation and abnormal/transient wall motions

77
Q

What are the JNCA8 BP recommendations?

A

60 or older= <150/90
Under 60= <140/90
18 w/ CKD= <140/90 w/ ACEI/ARB
18 w/ DM= <140/90

78
Q

How does cardiogenic shock present?

How is it Tx?

A

Lethargy, Confuseion, Somnolence

Dobutamine/Dopamine, NS and O2

79
Q

What is the FROM JANE acronym for endocarditis?

What causes this infection in native valves or IV drug users?

A

Fever, Roth Spots, Osler Nodes, Murmur, Janeway, Anemia, Nail hemorrhage, Emboli

Native= Staph A on TV
IVDA= Strep or Staph on MV
80
Q

How does pericarditis present on EKG?

How is it treated?

A

PR depression, aVR PR elevation, diffuse concave ST elevation

NSAID, Colchicine, Steroids if refractory

81
Q

What causes Pulsus Paradoxus and how does it present?

A

Becks- muffled, JVD, HOTN
EKG w/ low QRS and alternans
Echo shows RV collapse

82
Q

How is A-Fib rate controlled?

How is A-Flutter tx?

A

Rate control- BB
Ventricle rate +100- CCBs
(Metoprolol, Diltiazem)

Unstable= conversion
Rate control- CCB/BB then ablation

83
Q

How is HOCM treated?

How does it present on EKG?

A

No exertion, BB, CCB, activity restriction

Large amplitude QRS, Deep narrow Q in Inf/Lat leads, Tall R in V1,V2

84
Q

How is Prinzmetal treated?

A

Non-DHP CCBs and Nitrates

85
Q

Class 1a Drugs, Uses, S/e, MOAs

A

Quinidine, Procainamide, Disopyramide
SVT, VT
Torsades, Lupus like syndrome
Na channel blocker, slows Phase 0 upstroke, slows conduction

86
Q

Class 1b Drugs, Uses, S/e, MOAs

A

Lidocaine, Mexiletine
VT
Confusion, Seizure
Na blocker that shortens Phase 3

87
Q

Class 1c Drugs, Uses, S/e, MOAs

A

Propafenone, Flecainide, Encainide
SVT, VT
Exacerbates VT, Neg Inotropy, Heart block
Na channel blockage, slows Phase 0 upstroke

88
Q

Class 2 Drugs, Uses, S/e, MOAs

A

Propanolol, Metoprolol
SVT, A-Fib
Bronchospasm, Impotence, Fatigue
Dec Phase 4 and blocks B receptors

89
Q

Class 3 Drugs, Uses, S/e, MOAs

A

Amiodarone, Sotalol Bretylium (IV)
SVT, VT, A-Fib
Photosensitivity, pulmonary/liver toxicity
Sota S/e= Torsades, BB effects
Blocks K channels to prolong Phase 3 and refractory period

90
Q

Class 4 Drugs, Uses, S/e, MOA

A

Verapamil, DIltiazem
SVT, A-Fib
Brady, AV block, HOTN
Slows Phase 4 and AV conduction

91
Q

Which BB are non-selective?

Which ones are B1 specific?

A

Propanolol, Labetolol

Atenolol, Acebutolol

92
Q

Diltiazem and Verapamil are strong ? while DHPs are strong ?

What can cause constrictive pericarditis?

A

Cardiopressants
Vasodilators

TB, Radiation, Post-cardiotomy

93
Q

How does constrictive pericarditis present on exam?

How does it present on EKG?

A

Ascites, Hepato/Spleno megaly, Friedrich sign- prominent Y descent more than X descent

Low voltage, flat T wave

94
Q

How are Constrictive Pericarditis and Cardiac Tamponade different?

A 
Constrictive:
y > x
\+ Kussmaul
1/3 pulsus paradoxus
Pericardial knock
Mod HOTN
Tamponade:
x > y
No JVP
Pulsus paradoxus always
No Knock
Severe HOTN
95
Q

How is constrictive pericarditis treated?

What is the classic quartet of Cardiac Tamponade

A

Diuretics, Na restriction, Pericardiectomy

HOTN, Inc JVP, Tachy, Pulsus Paradoxus
Becks- HOTN, Inc JVP, Muffled heart

96
Q

What meds need to be avoided in cardiac tamponade PTs?

What causes loud/soft S1?

A

Diuretics and vasodilators

Loud: short PR interval, LA pressure, High CO
Soft: 1* Block, calcified mitral valve, High LV diastolic pressure, Occasionally MR

97
Q

Wide fixed splitting S2 is associated with ?

What is widened splitting associated with?

A

ASD

RBBB, PHTN, MR, VSD

98
Q

What is paradoxical splitting associated with?

Pericardial friction rub is due to what 3 events?

A

LBBB, AS, HTN, LV FIb, TR, WPW

Ventricle and Atrial systole, Ventricle Diastole

99
Q

What are the 3 systolic ejection murmurs?

These are AKA ? and caused by ?

A

AS, PS, HOCM

High output murmurs:
Anemia, Thyrotoxicosis, Pregnancy, Fistula, Kids, Fever

100
Q

What are the 2 high pitched diastolic decrescendo murmurs?

What are the low pitched diastolic murmurs/mid-diastolic rumbles

A

AR PR

MS, TS, Severe AR producing Austin Flint

101
Q

What are the 4 high flow murmurs?

What are the continuous murmurs?

A

MR, PDA, VSD, ASD

PDA, Mammary souffle, Coronary AV fistula, Hum

102
Q

What are the normal JVP waveforms and what do the mean?

A

A= atrial contraction, precedes carotid pulse
X= atrial relaxation
C= bulging of TB during RV diastole
X prime= descent of heart base during ventricle diastole
V= atrial filling
Y descent= atrial emptying after carotid pulse

103
Q

What causes Giant A waves?

What causes Cannon A waves?

A

Atrial contraction against resistance

Atrial contraction against closed TV

104
Q

What causes C-V waves?

What causes Sharp Y descents?

A

Regurgitation of blood into venous system, TR

Increased venous pressure, constrictive pericarditis

105
Q

What med is used during UA/NSTEMI as a Xa inhibitor?

What is the other drug that can be used but with different MOA?

A

Bivalirudin

Fondaparinux- indirect Xa inhibitor w/out affecting thrombin

106
Q

What is the possible s/e of lidocaine drips?

What is the most common etiology of V-Tach?

A

Seizures

CAD w/ prior MI?

107
Q

What is a common s/e from taking Enalapril?

What is the primary advantage of using Bivalirudin instead of UFH during UA/NSTEMI?

A

Hyperkalemia

Less chance for bleeding

108
Q

What’s the major difference in Tx between STEMI and NSTEMI?

What does the Left Main supply blood to?

A

Fibrinolytics are only used in STEMIs

LAD= Ant 2/3 septum, Bundles, LV anterior surface

LCX- LatPost LV, LA, SA node in 25%

109
Q

What does the RCA supply blood to?

A 
Inf/Post wall LV
RA/RV
Post 1/3 of septum
SA node in 70%
AV node
PDA in 85%
110
Q

Why does adipose tissue lead to atherosclerosis?

What med do we used for depressed Post-MI PTs?

A

Produced pro-inflammatory cytokines

Sertraline or any SSRI

111
Q

What medication is not indicated for use in UA?

What cardiac conditions is associated w/ Bisferiens pulses?

A

LMWH, 2b/3a inhib, ASA, Clopidorgrel
NOT CCB

AR

112
Q

What is the most common outcome for PTs that develop VSDs post-MI?

Dx test for AAA?

A

HF

Abd US

113
Q

Preferred imaging modality for examining pericardial effusions?

What are the Major Criteria for blood cultures testing for IE?

A

Echo

2 Pos draws 12hrs apart
Persisitant Positive
Single pos w/ Cox Burnetti or IgG AB titer >1:800

114
Q

What’s the most common Sxs of PTs w/ MVP?

What ABX are used to Tx IE?

A

Palpitations

Strep= IV PCN 12-18M units

Staph, O-susc= IV Nafcillin and
Genta/Cefazolin and Genta

Staph, O-resis= IV Vancomycin

PCN Allergy= Ceftriaxone or Vancomycin

IPAP (212 decks)

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