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IPAP > Cardio Block 3 > Flashcards

Cardio Block 3 Flashcards

1
Q

What are the RFs for DVT?

What are the most common findings?

A 
Hx of DVT
Current CA
Stasis x 6hrs
Endothelium injury
Thrombophilia

Calf pain, Edema, Warmth, Palpable cord

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2
Q

What two tests are sufficient to positively Dx DVT?

When can a DVT be ruled in/out?

A

D-Dimer
Compression US

In: Mod/High probability, Pos compression US
Out: Low probability, Neg D-Dimer

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3
Q

What are the acquired/inherited risk factors of DVTs?

A

Persistent: age, CA, antiphosphoidal Abs, Hx of DVT/PE

Transient: recent surgery/trauma, pregnant, OCP/Hormones, imobile

Inherited: antithrombin 3 deficiency, Protein C/S
Factor 5 Leiden
Prothrombin gene mutaiton

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4
Q

When is a D-Dimer for DVT not recommended?

What blood work up result is considered after a DVT has been Dx’d?

A

Pretest probability is intermediate/high

Factor 5 levels

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5
Q

What is the gray zone of DVT Dx?

What is done to finalize the Dx?

A

Neg US
High probability

CT/MR venography w/ repeat US when D-Dimer is 500ng or higher

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6
Q

What are 5 thrombophilic disorders?

What PE finding is indicative of DVT but unreliable?

A 
OCPs
Hormone replacement
Antiphospholpid Ab syndrome
Protein C/S deficiency
Hyperhormocysteinemia
Factor 5 Leiden

Homan Sign- pain w/ foot dorsiflexion

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7
Q

What is the Gold Standard of DVT Dx?

What are the 3 parts of Virchows triad

A

US

Stasis
Hypercoagulability
Trauma

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8
Q

What Tx med can’t be used in pregnant PTs w/ DVTs?

Define AAA

A

Warfarin, LMWH (Enoxaparin) is preferred

Infrarenal aortic diameter of 3cm or more

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9
Q

What are the RFs for AAA?

What is the underlying pathology?

A 
FamHx
Syphillis
Men (Caucasian)
Atherosclerosis
Smoking
HTN

Oxidative stress
Aortic wall inflammation
Proteolytic degradation of elastin/collagen

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10
Q

When is US screening for AAA conducted?

When are they surgical?

A

Men 65-75 w/ smoking Hx of at least 100 cigarettes

5.5cm or more
Growth of 0.6-0.8cm over 6mon

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11
Q

When are AAAs monitored for growth?

What are they monitored w/?

A

<5.5cm or growth 0.6cm or less per year

Cereal US

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12
Q

What size of AAAs don’t/need screening?

When do these PT need to be referred to vascular specialist?

A

<3cm, no testing
3-4: Q12mon
4-4.5: Q6mon

> 4.5cm

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13
Q

What can be done for PTs w/ AAAs in attempt to reduce their rupture/surgery likelihood?

Aortic dissection involves what 2 events?

A

Tobacco cessation
BP control
LDL <70
PO BB

Intimal tear
Hemorrhagic extravasation into intima-media space

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14
Q

Aortic dissections are characterized by ? pain and the development of ?

What is the first and second line medical therapy given to these PTs after rupture?

A

Ripping/tearing
AI murmur

IV Labetolol, Esmolol
Nitroprusside

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15
Q

What are three genetic d/os that can cause protein abnormalities leading to aortic dissection?

How can dissections be viewed for Dx?

A

Polycystic kidney- polycystin
Marfans- fibrillin
Ehlers- type 3 procollagen

CT- stable
TEE- unstable

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16
Q

What type of shunt is an ASD?

When are most of these Dx’d?

A

L to R

5th decade

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17
Q

Over time, a large enough ASD can lead to what five issues

What is the classic findings of these w/ auscultation?

A 
Pulmonary overcirculation
PHTN
Eisenmenger
R to L shunting
Cyanosis

Wide fixed, split S2

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18
Q

ASDs done affect ? heart structure?

What is the most common and 3 other types of ASD?

A

Coronary artery

Ostium secundum- incomplete adhesion of flap and septum
Ostium primum
Sinus venosus
Coronary sinus septal defect

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19
Q

What is the most common cyanotic congenital heart dz in childhood?

What are the four parts of this d/o?

A

Tetrology of Fallot

PV stenosis- ejection murmur
RVH
VSD, no change w/ respiration
Over riding aorta

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20
Q

What PE finding is characteristic of Tetrology of Fallot?

What makes the Tet spells worse or better?

A

Loud systolic ejection murmur
CXR of boot shaped heart
R sided aortic arch

Worse: worsened pulmonary outflow obstruction
Better: inc systemic vascular resistance

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21
Q

Where does coarctation of the aorta occur?

How can this be identified on PE?

A

Acyanotic narrowing of descending aorta at origin of ductus arteriosus

Dec femoral pulse
Brachial HTN
Systolic ejection at apex
“3 sign” aortic knob on CXR

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22
Q

What does a VSD sound like?

This is considered acyanotic alone but can be seen in ?

A

Harsh murmur louder w/ smaller defects

Tetrology
Transportation of arteries

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23
Q

What causes a PT to become cyanotic from a VSD?

What syndrome is defined by PHTN and cyanosis from pulmonary vascular obstruction secondary to large R to L shunt?

A

R to L shunt
PHTN
Dyspnea

Eisenmenger syndrome (irreversible)

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24
Q

Peripheral artery dz can represent atheroscletoic disease w/in the aortoilliac system and is then called?

How does classic claudicaton present?

A

Leriche syndrome- thigh, butt, hip pain w/ ED

Replicated w/ exercise
Relieved w/ rest

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25
Q

What is the most common site for claudication from peripheral artery dz?

What derm changes can be seen on PE?

A

Calf

Cool, shiny skin w/ dec hair

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26
Q

What is a late PE finding of peripheral artery dz?

What measurement can be taken for Dx purposes?

A

Resting pain

Ankle brachial index
<0.9= >50% stenosis
<0.4= ischemia

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27
Q

Pregnant PTs w/ DVTs are usually Tx how?

Although controversal and not recommended, how can these PTs LMWH levels be monitored?

A

Therapeutic anticoag x 6mon
6wks post-partum

Anti-Xa

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28
Q

UFH use requires what lab monitoring?

PTs w/ Coarctation and have the PDA closed may present w/ ?

A

aPTT

Circulatory failure
Shock

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29
Q

In many PTs, coarctation of the aorta occurs ?

What feature does this anomaly allow?

A

Juxtaductal, adjacent to PDA

Widens juxtaducta area of aorta so blood can flow forwards from LV

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30
Q

What are the 3 types of coarctation?

A

Preductal- narrowing proximal to ductus arteriosus, seen in Turners.

Ductal- narrowing at insertion of ductus arteriosus, appears when ducts closes.

Postductal- narrowing distal to ductus arteriosus and most common in adults

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31
Q

What medication can be used to maintain the patency of a ductus arteriosus?

What is the etiology of acquired cases of aortic coarctation?

A

Alprostadil, prostaglandin E1

Takayasu arteritis

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32
Q

PTs w/ Turners and coarctation generally develop what two compensation mechanisms due to the coarctation?

What are the classic PE findings?

A

LVH, collateral flow around lesion

Systolic HTN
Diminished/delayed femoral pulses

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33
Q

How do adults/older kids w/ aortic coarctation present in clinic?

What are the initial diagnostic studies conducted?

A

Chest pain
Cold extremities
Claudication
Continuous murmur over L anterior chest or L midline back

EKG, CXR, Echo

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34
Q

In most PTs w/ coarctation, how is the Dx established?

What further test will adults possibly need?

A

Echo w/ doppler

MRI/CT

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35
Q

What are 3 common complications of aortic coarctation who don’t have surgical correction?

Adults w/ unrepaired coarctation are at increased risk for what other vascular d/os?

A

Accelerated CAD
Dissection
Stroke
HF

Intracranial aneurysm

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36
Q

What is the genetic map of Tuners?

What genetic cardiac differences do Turners present w/?

A

45,XO

Bicuspid aorta
Coarctation

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37
Q

How does coarctation appear on EKG?

What surgical procedure corrects this?

A

LVH- Scott Criteria +35mm

Balloon angioplasty
Stent placement
Surgical correction

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38
Q

What is Well’s Criteria for PE?

What is the PT has a Hx of DVTs?

A 
CIB LTS SPC AD
Cancer
Immobile
Bedridden x 3days/major surgery in past 4wks
Leg tender/swelling >3cm 
Pitting edema
Collateral veins
Alternative Dx (-2pts)
Low= 0
Med= 1-2
High= 3 or more

Given 1pt
DVT likely= 2 or more pts
DVT unlikely= 1 or less

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39
Q

What is the preferred Dx modality for PTs w/ suspected PE?

What is the next best test if PTs kidney can’t handle contrast?

A

CT angiogram of chest

D-Dimer- not needed if mod/high probability exists

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40
Q

Define DeBakey Type 2 dissection?

What is NOT a RF for AAA

A

Dissection in only ascending aorta

Female gender

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41
Q

What systemic Dz may actually be protective against AAA?

If PT receives PGE-1 infusion for PDA maintenance, what are common s/e and two things needed on stand by?

A

DM

Apnea 
Prophylactically intubate 
HOTN
Hyperpyrexia
FPP
Anti-seizure meds
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42
Q

What medication is used to close PDAs in premature infants?

What PO anti-coagulants can be used for PTs w/ A-fib?

A

Indomethacin (prostaglandin inhibitor) or Ibuprofen

Direct thrombin inhibitor
Factor Xa inhibitor

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43
Q

What is the most serious complication that can arise from A-Fib?

What diameter do vessels need to be for veins to be classifed as varicose?

A

Thromboembolism

> 3mm

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44
Q

What is the CHA2DS2VASc criteria?

Peripheral artery dz is associated with 3 RFs?

A

CHF HTN Age >75 DM Stroke
Vascular Dz Age 65-74 Sex, female

Smoking, DM, Age
Atherosclerosis

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45
Q

What are c/i to lower limb vericose vein ablation therapy?

How are vericose veins dx and how are they Tx?

A 
Pregnancy
Thromboembolism
Mod/Sev peripheral artery dz
Joint dz affecting mobility
Congenital venous abnormality

Duplex US
Compression/elevation

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46
Q

What is the most common systemic vasculitis in the US?

This Dz almost never presents before ? age

A

GCA

50y/o

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47
Q

How do PTs w/ GCA present?

How is it Tx?

A

Amaurosis Fugax
Claudication in jaw
HA

No vision loss- pred
Vision loss- Methylpred

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48
Q

What PO anti-coag is similar to Warfarin but doesn’t require monitoring?

Define Kussmaul sign

A

Dabigatran

Inc of CVP rather than decrease from R sided HF

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49
Q

Kussmaul signs are frequently seen in PTs w/ ? two issues

Periodic BP measurements should be a part of routine preventative health assessments starting at age ?

A

Constrictive pericarditis
RV infarction

3y/o

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50
Q

What is the most appropriate initial medication for Diabetics w/ HTN?

What is the most common cause of Secondary HTN?

A

ACEI

Renal parenchymal Dz

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51
Q

HCM is characterized by ?

What movement reduces/increases AS?

A

Medium pitch, mid-systolic murmur decreasing w/ squatting/inc w/ straining

Dec w/ Straining
Inc w/ Squatting

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52
Q

How is MR characterized?

What is this type of murmur rarely associated w/?

A

Blowing systolic murmur radiating to axilla

Syncope

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53
Q

How is PS characterized?

Acute MI frequently presents w/ what 2 Sxs and rarely w/ what 2?

A

Widely split S2
Not changed w/ maneuvers

Frequent: Chest pain, SoB
Rare: Fever, Myalgia

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54
Q

Restrictive pericarditis is most commonly from ? and shows ? on Echo

What study is useful for establishing Dx/pathway of complex arrhythmias including SVT?

A

Amyloidosis
Impaired diastolic

Electrophysiology

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55
Q

Thiazide diuretics are most likely to cause ? E+ disturbance?

What medication needs to be avoided in PTs w/ WPW?

A

Hypokalemia

Digoxin/CCBs- dec refractory, inc AV node refractory causing faster ventricular rates

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56
Q

What are two findings seen in central retinal artery occlusions?

What is seen in chronic HTN PTs?

A

Cherry red fovea
Boxcar segmentation

AV nicking

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57
Q

What is the first finding that can indicate worsening CHF?

What is the major predisposing risk factor to the development of A-Fib?

A

Inc in weight during daily checks

MS

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58
Q

What drugs are most likely to cause a Lupus-like reactions and pericarditis?

What are examples of causes of high output HF?

A 
Procainimide
Hydralazine
Methyldopa
Isoniazid
Phenytoin
Reduced systemic vascular resisitance in:
Thyrotoxicosis
Animia
Pregnancy
BeriBeri
Pagets Dz
AV malformation
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59
Q

What is the most common cause of acute arterial occlusion in the upper extremities in adults over 40y/o?

PTs w/ Marfans frequently/rarely have what 2 cardiac conditions?

A

Thoracic outlet syndrome

Common: MVP, AR
Rare: RAE, PS, VSDs

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60
Q

What are the major criteria for the Dx of Marfans?

What are the absolute c/i to giving thrombolytic therapies?

A

Ectopia lentis
Aortic root dilation
Aortic dissection

Hermorrhagic stroke
Stroke in past 1yrs
Intracranial neoplasm
Internal bleeding, actively
Suspected dissection
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61
Q

How is renal artery stenosis identified?

How does primary aldosteronism affect E+ balances?

A

Abnormal radionuclide uptake in affected kidney

High Na
Low K

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62
Q

What is the only E+ loss that effects Digoxin metabolism?

Revascularization of the Left Main artery is indicated when stenosis is greater than ?

A

K loss

50%

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63
Q

What type of ventricular arrhythmia leads to death?

What is the TOC for these PTs?

A

VT

Inplanted Defib

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64
Q

What type of physiological cahnge/shift can predispose Pts to skin ulcers?

A

Leaking fibrinogen/GF into interstitial space
Leukocyte aggregation/activation
Loss of cutaneous lymphatic network

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65
Q

What is the definitive Tx to correct MR from papillary muscle rupture?

What PT population has the highest risk for HTN?

A

MV replacement

Black, non-hispanic

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66
Q

AHA recommends what PTs receive ABX prophylaxis?

PTs w/ prosthetic MV or AV should keep INR between ?

A

Prosthetic heart valves
Heart transplant w/ valve dz
Un/repaired cyanotic CHD

MV: 2.5-3.5
AV: 2-3

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67
Q

What heart measurement is an indirect measurement of the left atria filling pressure?

What is a classic finding of cardiac tamponade?

A

Pulmonary capillary wedge pressure

Pulsus paradoxus

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68
Q

What is the last in sequence of events to occur in peripheral artery dz?

What Sx usually precedes this finding?

A

Arterial ulcers, usually in feet/areas of pressure

Claudication

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69
Q

When do venous ulcerations typically develop?

What is the most common location for these to develop?

A

Secondary to venous incompetence/chronic edema

Medial ankle

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70
Q

What trifecta leads to diabetic ulcers?

HPV is commonly associated with ? but not ?

A

Atheroscleorsis
Arterial insufficiency
Diabetic neuropathy

Venereal warts
Myocarditis

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71
Q

What 2 viruses are most commonly associated with myocarditis?

What two are most likely to cause pericarditis?

A

Coxsacie
Echovirus

Coxsackie
CMV

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72
Q

How does LVH present on EKG?

Is coarctation cyanotic or acyanotic?

A

Tall R in Lead 1, aVL
Deep S waves
Poor R wave progression
Scotts criteria- 35mm

Acyanotic

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73
Q

What is the NYHA HF classifications?

What is the College of Cardiology staging crtieria?

A

1: ASx
2: Sx w/ normal activity
3: Asy only at rest
4: Sxs at rest

A: high risk, no Sx/Dz
B: Dz w/out Sxs
C: Dz w/ Sxs
D: refractory heart failure

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74
Q

What medication could be given to PTs w/ coarctation and HTN?

How would COPD w/ cardiac strain present on EKG?

A

ARB- protects kidneys

Tall R waves
Deep S waves
RAD
Tall P waves

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75
Q

What is a normal pulmonary artery systolic pressure value?

Define Cor Pulmonale

A

25mmGH

HF secondary to lung Dz

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76
Q

Lung Dzs are a cause of ? sided HF

What strong CCBs are used in PTs w/ Raynauds?

A

R

Verapamil
Diltiazem

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77
Q

How does an atrial myxoma present?

What heart issue does this mimic?

A

Inducible diastolic murmur w/ bending over, disappears w/ sitting up

MS

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78
Q

Loud P2 is always indicative of ?

What are the 5 categories of PHTN?

A

PHTN

1: idiopathic, CT Dz, CHD, pulmonary arterial HTN
2: result of L sided HDz
3: lung dz/dec O2
4: occlusion of pulmonary vasculature
5: unclear mechanism

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79
Q

Which categories of PHTN can be Tx with meds?

What has to be done prior to conducting CT angiogram, what is the f/u exam if PT is ineligible for this?

A

1 and 4

CrCl/BUN
VQ scan

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80
Q

PHTN causes ? looking feature seen on pulmonary angiography?

What meds are used to treat PHTN?

A

“Pruned tree” vasculature

Endolthelium blockers- prevents dilation
Prostacyclin- causes dilation
PD-5 inhibs- Sildenafanil (viagra/cialis)

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81
Q

Sildenafil can’t be used within 24hrs of ?

What are two risks of femur Fx?

A

Nitro

Fat embolism
Blood loss

82
Q

Sympathetic responses to the CV system travel through ? vertebral structures?

Contusions of the heart are Tx like?

A

From medulla to T1-5

Myocarditis

83
Q

What would the troponin levels be if they’re from a PE etiology?

What drugs are used for triglyceride lowering therapy?

A

1-10

Fibrate- Gemfibrozil

84
Q

Diabetics w/ HTN should be put on one of what two ACEIs?

PTs that are cold/clammy, confused, HOTN, and tachy have ? type of shock?

A

Enalapril
Lisinopril

Cardiogenic

85
Q

What would be two hallmark findings of a PT suffering from anterior wall MI?

What would be seen if they were having an inferior wall MI?

A

Tachy, HOTN

Brady, HOTN

86
Q

What drug is used in intubated PTs that are suffering from HOTN?

What is the best way to monitor cardiogenic shock resuscitation?
What drug can be added to inc one of these monitored indicators?

A

Dobutamine

Ins and Outs, especially outs
NorEpi

87
Q

What is the most common cause of the development of a prominent S4?

What type of genetic issue is HOCM that usually causes mutations in the development of ?

A

HTN

Autosomal dominant
Myocardial contractile apparatus

88
Q

What are the only two holosystolic, blowing murmurs over the sternum w/out radiation?

What drug is given to PTs Dx’d w/ MRSA IE?

A

TR, VSD
VSD won’t change w/ inspiration

IV Vancomycin

89
Q

What microbe is the most common cause of IE in the US?

What is given to PTs as a endocarditis prophylaxis prior to dental procedures?

A

Strep Viridians

Amoxocillin

90
Q

What is the most likely Dx for PTs w/ wide pulse pressure?

AVRT= ?

A

AR

WPW

91
Q

What type of lesion is Hypoplastic Left heart Syndrome?

What would be heard on PE?

A

Cyanotic, no LV

Loud P2
Hyperactive precordium from large RV

92
Q

What drug can be used to keep PDA open in PTs w/ Hypoplastic Left Heart Syndrome?

What can be given to inc their BP?

A

Alprostadil older than 12mon surgery repair

Dopamine

93
Q

Normally, PDA connects ? to ?

What treatment needs to be avoided in PDA PTs?

A

Aorta
Pulmonary artery

O2

94
Q

What EKG abnormality is associated w/ ADS?

ASDs smaller than ? close sponataneously

A

RBBB- rabbit ears

<8mm

95
Q

What is the most common cardiac congenital abnormality in adults?

What is the most common one in infants?

A

ASD- acyanotic

VSD, membranous

96
Q

What are the 4 types of VSDs?

VSDs that don’t are Sx and cause CHF receive ? med?

A

Membranous
Muscular
AV canal
Outlet septum

Furosemide

97
Q

What is the most common cardiac issue seen in Down’s?

Define Hyperoxia test

A

A-V Canal

ABG is drawn
>200g- Cardiac Dz unlikely
50-150- mixing lesion (truncus, tricuspid atresia)
<50- two circuits w/ mixing

98
Q

What are the two cyanotic lesions that will be on the test?

What are 3 others that will be distractors?

A

Transposition
Tetralogy

Truncus arterious
Tricuspid atresia
Anomalous pulmonary venous

99
Q

What is the timeline from Dx to fixing of transposition of the vessels or death will occur?

How do you ID transposition on an x-ray?

A

6hrs

“Egg on a string” w/ Pt being cyanotic

100
Q

Kids w/ tricuspid atresia usually also have ?

RV failure is also associated w/ ? finding on PE?

A

VSD

Heave

101
Q

What is the whole issue of Tetralogy?

What is the condition called if an ASD is added to the tetrology?

A

PS

Pentology of Fallot

102
Q

How does uremic pericarditis present?

How is it Tx?

A

High Cr/BUN
EKG- ST elevation, PR depression in multiple

Dialysis

103
Q

PT w/ HOTN/Tachy is in ? shock

PT w/ HOTN/Brady is in ? shock

A

Cardiac

Neurogenic

104
Q

Where does PHTN show on EKG?

What changes this to Cor Pulmonale

A

Large P-waves on Lead 2

Edema
JVD
Loud P2

105
Q

Why would a 30 year old PT who smokes already have COPD?

What needs to be looked for on PE for obstructive sleep apnea?

A

Alpha-1 trypsin Dz

Mallampati score of 3
1- complete visualization of soft palate
2- complete visualization of uvula
3*- visualization of only base of uvula
4- soft palate not visible at all
Polysomnograpy
106
Q

PT experiencing pain around an IV site w/ not streaks/heat has a ?

How is it Tx?

A

Thrombophlebitis

Warm compression
NSAIDs

107
Q

Where are acute thrombo embolisms created and thrown from?

PT w/ CTA showing numerous PEs would be classified as ?

A

A-fib, Left atria

Group 4

108
Q

Restrictive pericarditis will have ? EF and is usually caused by ?

How does Takosubo’s look on Echo?

A

Preserved
Sarcoidosis

Apical ballooning

109
Q

How do you Dx Rheumatic heart Dz?

PT w/ calf pain when walking can have an expected ankle brachial index below ?

A 
JONES
J- large
O- carditis
N- nodules
E- erythema marginatum
S- synchorea

0.9

110
Q

PT w/ low brachial ankle index needs to have ? issue r/o

Examining new born who is cyanotic, palpation of the chest produces heave, what needs to be done for ? issue

A

CAD

Bring knees to chest
Tetrology

111
Q

PT w/ CA, abdominal ascites, significant LE edema, no change of JVP w/ inspiration. CXR reveals calcified ring around heart is ?

What is the most important initial therapy for vericose veins?

A

Constrictive pericarditis

Compression

112
Q

What is the difference in available studies for PTs w/ suspected dissections?

All STEMI PTs get ?

A

HTN- CT
HOTN- no scans

Caths

113
Q

What drug is most associated w/ causing TR?

What other cardiac anomaly is associated w/ TR?

A

Lithium

Epstein anomaly

114
Q

PT w/ brachial index of 1 and claudication needs to have what 2 steps done for Tx?

A

Statin

Low ABI= Exercise stress test to rule CAD in/out

115
Q

An vessel needs to be stenosis _% in order to be symptomatic?

What drug is used for, and only for, peripheral artery dz?

A

71%

Pletal (Cilostazol)
Vasodilator

116
Q

BNP will be artificially low for what two issues?

PT w/ bilateral claudication in thighs/calf/feet will most likely have occlusion in what area?

A

Body fat
Pericarditis

Thighs: abdomen
Calf: popliteal
Feet: tibial artery

117
Q

What is the criteria for using Dobutamine?

What are the most common causes of cardiogenic, neurogenic, hypovolemic shock and criteria?

A

HOTN
Cardiogenic shock
Exhausted all other options

Volemic- fluid

118
Q

How does pericarditis present on EKG?

What drugs do are used to Tx and prevent reoccurence?

A

Diffuse ST elevation (+1mm)
PR depression
Concave ST upslope
Pathognomonic for pericarditis

Tx: NSAID (Indomethacin) if viral
Prevent: Colchicine
ASA if acute/Dressler’s
Steroids- refractory to NSAID, Colchicine, ASA (anaphylactic reaction to ASA= straight to steroid)

119
Q

What is the sequence of changes seen on EKG during a MI?

What happens with a prolonged QT interval?

A

Hyper acute T waves
ST depression
ST elevation
Q wave development

Torsades

120
Q 
What leads are high lat?
What leads are inferior?
What leads are septal?
What leads are anterior?
What leads are lateral?
A 
1, aVL- diagonal
2, 3, aVF (RCA)
V1, V2- (LAD), posterior= RCA
V3, V4- LAD
V5, V6 (LCX)
121
Q

What is more common, NSTEMI or STEMI?

What are 3 things that can cause an ST depression?

A

NSTEMI- 70% of MIs in US

Digoxin
Ischemia
Hypo-K

122
Q

Inferior MI in 2, 3, aVF will have reciprocal changes where?

What is the next step after these are confirmed?

A

1, aVL

R sided EKG

123
Q

What two medications can be given during brady/instable PTs?

What is the TOC for confirming/Dx dilated cardiomyopathy?

A

Atropine/Isoproterenol

Trans thoracic echo

124
Q

What are the 3 types of restrictive cardiomyopathy?

What will be seen on CXR and how is it Dx?

A

Amyloidosis
Sacroidosis
Hemchromatosis

Normal x-ray
Biopsy

125
Q

What can be given to PTs w/ sarcoidosis induced cardiomyopathy?

What is the most and second most common location for hypertrophy to occur in HCM?

A

Steroids

Septum
LV

126
Q

What will be seen on CXR of HCM?

What is the TOC for Dx?

A

Normal heart

Doppler Echo

127
Q

What 3 things are avoided in PTs w/ HCM?

What can be used?

A

Digoxin
Dilators
Exertion

CCBs, BBs, amiodarone for arrhythmias
Improve diastolic function

128
Q

Normal sinus rhythm has upright P-waves in what leads?

What is a normal sinus, junctional and ventricular rate?

A

1, 2, 3, aVF

Sinus: 60+
Junction: 40-60
Ventricle: 20-40

129
Q

How do you figure out max tachy rate?

What is a common cause of tachy, narrow complex rhythms?

A

220-age

Hypovolemia

130
Q

How is A-Fib Tx?

How is A-flutter Tx?

A

Vagal, Adenosine, CCB/BB, conversion

A1 meds- Procainamide/Quinidine
Amiodarone
Conversion

131
Q

What med is used for Torsades if the Qc is normal?

What is used if the QTc is prolonged?

A

Lidocaine

Mg Sulfate

132
Q

Sequence of drugs for wide complex V-Tach

When are PDAs necessary for life?

A

Procainamide
Amiodarone
Lidocaine

Tetrology
Transposition of vessels

133
Q

What do different BNP levels mean”

What is the sequence of Tx of HF?

A

<1000: unlikely decompensated CHF
>500: likely decompensated
100-500: uncertain

Ventilation
Tx dysrhthmias
Reduce PL- nitro, loop, morphine
Reduce AL- nitro, ACEI, prussie

134
Q

What are the 3 parts of HF?

A

Inc PL
Inc AL
Dec contractility

135
Q

JNC8 BP goals

A

60+ <150/90
59- <140/90
DM/CKD: <140/90

White: Thiazide, ACEI/ARB, CCB
Black: Thiazide, CCB
CKD: ACEI/ARB

136
Q

What causes 95% of HTN?

What are the causes of Secondary HTN?

A

Essential HTN- no identifiable cause

Renal/VascularDz
Obstructive sleep apnea
Pheo
Estrogen
Steroids
Drugs
Coarctation- kids*
Cushings
Hyperaldosteronism
137
Q

What are the first two meds given for HTN control?

What is the last resort?

A

ACEI- first in CKD/DM
CCB- amlodipine

BB

138
Q

DOC for neurologic HTN

DOC for dissections

A

Nicardipine/Clevidipine
Labetalol

Esmolol
Nitroprusside
Metoprolol

139
Q

DOC for acute MI HTN

DOC for acute HF

A

Nitro
Esmolol
Metoprolol

Nitro
Furosemide
Nitroprusside

140
Q

DOC for renal HTN

DOC for pregnancy HTN

A

Nicardipine/Clevidipine
Labetolol
Fenoldopam

Hydralazine
Labetolol
Mg sulfate- pre/eclampsia

141
Q

What does the acronym SHOCKD mean

What is the Metabolic Syndrome

A 
Causes of shock
Sepsis
Hypovolemia
Obstructive
Cardiac
Kortisol
Distributive
Inc risk for atheroscleortic Dz, having 3 of:
Obesity
TG >150
HDL <40/<50 in female
Fastin glucose >110
HTN- BP >140/90
142
Q

Old person exercising and has syncope is most likely due to ?

What if they’re young?

A

AS

WPW, HCM

143
Q

What 4 systemic factors increase Metabolic Syndrome risks for dz?

Time for rise, peak and normal for myoglobin, CK-MB and troponin

A

Lupus RA HIV CKD

M: 1-3h, 6-8h, 12-18h
C: 3-6h, 18-24hr, 48-72hr
T: 4-6h, 18-24h, 7-10day

144
Q

Difference Type A/B dissection

Chart on

A 
A= proximal/ascending aorta, surgery
B= distal aorta, medical therapy

Pg 64

145
Q

What Txs are given to PTs w/ venous thrombosis?

When is a D-Dimer ordered?

A

LMWH, Coumadin

Low risk DVT
Mod/High= US

146
Q

Rheumatic fever is associated with ? valve issue?

Define Austin Flint murmur

A

MS

Early diastolic decrescendo from AR
Wide PP, hypoperfusion (HOTN)
Thick LV on CXR

147
Q

What does IVDA do to the TV?

What drug is added for IE from a Gram Neg organism but can’t be given alone?

A

TS

Gentamicin

148
Q

What’s the difference of areas affected between myocarditis and pericarditis?

What is Beck’s Triad?

A

Myo: transmural
Per: only pericardium

Tamponade:
Muffled sounds
JVD
HOTN

149
Q

ASD is common w/ ? type of block?

VSD is common w/ ? type of block?

A

RBBB (rabbit ears)
Fixed split S2
Mid systolic ejection murmur

LBBB (Deep S in V1, High R in V6)
Constant machinery

150
Q

What microbe is likely to cause pericarditis in ImmComp PTs around the world?

Dressler’s can appear up to _wks after MIs

A

TB

12wks

151
Q

What two drugs can cause pericarditis but w/out Lupus like syndrome?

What is the pathological process behind pericarditis?

A 
Anthracycline antineoplastics (Doxorubicin, Daunorubicin)
Minoxidil

Dilation, inc permeability, leukocyte exudation, fibrin deposit, inflammation, dec space

152
Q

What type of pericarditis has the highest mortality of almost 50%?

What are 4 types of acute pericarditis?

A

Purulent

Serous- thin exudate
Serofibrinous- bread/butter
Suppurative- bacterial, inflammation
Hermorrhagic- TB, cancer

153
Q

What medication is c/i during acute pericarditis?

How long does this med stay in circulation after d/c?

A

Warfarin

5 days

154
Q

What are four things that can cause friction rubs on exam?

10% of PTs w/ pericarditis can present with a normal ?

A

Pericarditis
Tamponade
Myocarditis
Pleuritis

EKG

155
Q

All pericarditis PTs get what three things?

What labs are ordered?

A

CXR, EKG, Echo

CBC, ESR/CRP, Enzymes
Fever= culture
PPD/HIV- if not done
ANA/RF- suspected rheumatoid d/o

156
Q

Transition from effusion to tamponade occurs around __mL of fluid

What are three conditions that can cause pericardial effusion?

A

> 250mL

Inc permeability: hypothyroid
Inc hydrostatic press: CHF
Dec oncotic press: cirrhosis

157
Q

How long after an MI can a free wall rupture occur and cause an effusion?

What does pericardial effusion do to JVP?

A

3-5 days

Inc w/ dominant x-descent

158
Q

Hiccups longer than ? are pathological for ?

How do pericardial effusions look on EKG?

A

6wks
Effusion from irritation of phrenic nerve

Flat T, low voltage

159
Q

What is the first Dx/TOC for pericardial effusions?

Pulsus paradoxis is more indicative of a ?

A

Echo

Tamponade

160
Q

Pathophysiology of tamponades cause what two events?

What does a tamponade do to the JVP?

A

Inc atrial pressure, dec venous return
Inc ventricle pressure, dec diastolic filling

Loss of Y descent

161
Q

What findings make you think of a tamponade from malignant effusion?

A

Tamponade w/out inflammatory signs

162
Q

What is the difference in lab results for pericardial effusion from exudate or from transudate?

A 
Ex: malignant, infection, CT d/o (external)
SpecGrav >1.015
Protein >3
Serum/protein >0.5
Serum/LDH >0.6
Serum/glucose<1.0

Trans: hypothyroid uremia radiation trauma
Opposite of Exudate

163
Q

How can you Tx cardiac tamponade?

What drug is used to prevent recurrence of constrictive pericarditis?

A

Inc fluids to stretch heart
Pericardiocentesis

Colchicine

164
Q

Constrictive pericarditis mimics ?

What is the initial and definitive way to Dx?

A

R sided HF

TTE
Biopsy
CMR to determine constrictive vs restrictive

165
Q

What PE findings would be seen in PTs w/ constrictive pericarditis?

How does this present on EKG/CXR?

A

Precordial knock before S3

EKG: ST/T-wave changes
Tachy, Low voltage, A-Fib
CXR: calcifications, minimale silhouette enlargement

166
Q

What image is ordered to assess pericardial thickness?

What is ordered to differentiate effusion from scarring?

A

CT

MRI

167
Q

What does cardiac cath allow for PTs w/ constrictive pericarditis?

What is the only effective Tx for severe/chronic cases?

A

Biopsy
Definitive distinction between constrictive/restrictive

Pericardectomy

168
Q

All CA PTs are hyper-?

What is HF from pericarditis?

A

Coagulable

Myocarditis

169
Q

The more ? a thrombus is, the more dangerous it is

Define Phlegmasia Cerulea dolens
Define Phlegmasa alba dolens

A

Proximal

PCD: cyanotic hue
PAD: pallor w/ edema

170
Q

What labs are ordered for DVT work ups?

What test has the highest sensitivity/specificity for DVTs, but which one is 100% accurate?

A 
PT and PTT
CBC w/ platelet
Renal/LFT
UA
D-dimer

Doppler US
Venography but invasive

171
Q

Venous thromboembolism is ?+?

What is the Tx of choice of VTEs?

A

PE + DVT

LMWH* (Lovenox)
UFH (needs PTT monitoring)
Xa inhib- Fondaparinux*
PO Factor Xa inhib- Rivaroxaban

172
Q

LMWH/Fonda use overlapped w/ Coumadin has to occur for at least ? days

When can you d/c one of the meds?

A

5 days, remains for 5 days after use

D/c LMWH/Fonda on day 5/6 if INR is in range for two days

173
Q

What platelet level indicates HIT and need to stop heparin?

What are the only two issues with using Rivaroxaban?

A

<100K/microl

Similar to warfarin but,
BID dosing for 3wks then one/day (don’t give to forgetful/incompetent PTs, use Coumadin)
$

174
Q

What is the reversal agent for Rivaroxaban?

Embolic strokes can only occur in the ?

A

Andexxa

Brain

175
Q

Why is LMWH superior to UFH on inpatient settings?

What criteria must be met inorder for PTs w/ VTE to be Tx on outpatient basis?

A

Reduces mortality and bleeding risks

Stable/normal VS
Low bleeding risk
No severe renal insufficiency- normal Chem 7
System in place for LMWH use and monitoring
Surveilance/Tx of recurrent VTEs

176
Q

What is the Chem panel set up and data inputs?

A

Na Cl BUN
K HCO3 Cr
At the end= Glucose

177
Q

How long is Coumadin used when Tx DVTs?

When is an IVC filter used?

A

3-6mon

Anticoags are c/i
Recurrent embolism w/ anticoag therapy
Recurrent embolism w/ PHTN
Urgent surgery w/out time for anticoag

178
Q

What is done for PTs suffering from a TIA?

What med has the highest effect on lowering TGs?

A

Give ASA, Dipyridamole
Admit to stroke unit

Fibrinates- Gemfibrozel

179
Q

Strep infections lead to ? and will present w/ ? murmur

PT getting dental Tx and has to stop Warfarin, what is the next step?

A

MR- diastolic decrescendo murmur at apex

No bridging is necessary

180
Q

Old PT w/ lower extremity skin changes and discomfort relieved w/ elevation will have what PE finding?

Fist Sx/complain of AS

A

LE edema

Dyspnea

181
Q

Tx for V-Fib

What is the most common congenital heart Dz?

A

Defib

VSD

182
Q

Who is classified as a medical PT and can be Tx for DVTs on outpatient basis?

A

Previous VTE
Ca
Immobility
Inherited/acquired hypercoag

183
Q

What DVT prophylaxis drug can be taken PO w/out inc bleed risk?

Arterial thromboembolism will present w/ ? Sxs

A

Rivaroxaban

Pain
Paresthesis
Pallor
Absent pulses

184
Q

Suppurative phlebitis w/ fevers and chills is called ?

Define Trousseau Syndrome

A

Suppurativel thrombophlebitis

Migratory superficial thrombophlebitis associated w/ adenocarcinomas

185
Q

Most common location for superficial thrombophlebitis to occur?

What PT population gets lipodermatosclerosis?

A

Great saphenous vein

DM

186
Q

What is the difference between pulse/no pulse in veins/arteries that are varicosed?

Varicose vein Tx is best with ?

A

Pulse= problem in vein
No pulse= problem in artery

Sclerotherapy

187
Q

What is the most common vascular d/o

If vascular pain is better w/ walking then its ? where if it’s worse w/ walking then its ?

A

Chronic lower extremity venous dz

Better- vein
Worse- arteries

188
Q

What can PTs w/ chronic venous insufficiency do to improve their Sxs?

What is pruritus in the LE indicative of?

A

Limb elevation
Walking

Chronic venous insufficiency

189
Q

All PTs w/ chronic venous insufficiency/ulcers need to be on ? med

What causes lymphedema?

A

ASA

Primary: High protein content
Secondary: Filarisis (MC)

190
Q

What is the only issue we’ve covered that has non-pitting edema?

What has to be avoided with this condition?

A

Lymphedema

Limb injury

191
Q

What happens to untreated lymphedema?

What is Beurger’s Dz

A

Resistant to Tx due to subcutaneous fibrosis

Vascular Dz in chronic smoking involving both arteries and veins leading to foot claudication
Triad: ???

Thromboangitis obliterans

192
Q

? heart murmur isn’t pathological in early life?

MOA of Gemfibrizil

Aortaenteric fisutal

A

Systolic

Activates lipoprotein lipase to increase VLDL clearance

MC seen on duodenum from AAA complication

193
Q

What are the three processes leading to peripheral artery dz?

What causes plaque?

A

Structure changes
Lumen narrowing
Spasm

Tear, macrophages, foam cells

194
Q

What is the time frame from arterial occlusion to surgical management?

What type of injury starts the peripheral artery disease etiology?

A

<6hrs or irreversible ischemia

Endothelial dysfunction

195
Q

What PE finding would be seen if the popliteal artery is occluded 90%?

What questionnaire is used for peripheral artery disease screening?

A

Muscle atrophy
Ulcer

Edinburghs

196
Q

What are the 6 Ps of PADzin order?

What is the time frame to correct it?

A

Pain Pallor Paresthesia Paralysis Poikilothermia Pulselessness

6hrs

197
Q

Aortailiac occlusive dz

Common femoral artery

A

Butt hip thigh

Thigh and/or calf

198
Q

Superficial femoral artery

Popliteal artery

A

Upper 2/3 calf

Lower 1/3 calf

199
Q

What are the 4 acyanotic lesions?

What is the only type of ASD that does not have RAD?

A

ASD
PFO
VSD
PDA

Ostium primum- LAFB

200
Q

What is the Dx test for ASD?

PTs w/ ASDs can’t do what recreational activity?

A

Echo- primary test for Dx
Bubble study

Scuba dive

201
Q

Why do infants w/ VSD have failure to thrive?

If PT w/ VSD has a new diastolic murmur, what is it?

A

Large heart pressing on esophagus interferes w/ feeding

R to L shunt from increasing pulmonary pressure

IPAP (212 decks)

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