Cardio Conditions Flashcards
Describe the etiology/RF for hypertension
Describe the clinical presentation & PE for hypertension
Describe the range of BP from normal to stage 2 HTN
Describe malignant HTN
Describe the non-pharm treatments for HTN
Describe the 4 main classes of first line antihypertensives
Describe the etiology & RFs for aortic aneurysm
Describe the clinical presentation of aortic aneurysm and aortic aneurysm rupture
Describe the PE for an aortic aneurysm
Describe the testing and screening procedures for aortic aneurysm and rupture
Describe the treatment for aortic aneurysm and rupture
Describe the etiology of aortic dissection
Describe the clinical presentation of aortic dissection
Describe the diagnostic testing for aortic dissection
Describe the treatment for aortic dissection
Stanford A = surgical
Stanford B = medical management
- BP control goal 100-120 systolic (BB, CCB, IV nitroprusside)
- arterial pressure, central venous pressure
What are some contraindications to aortic dissection surgical repair
CVA, severe valve disease, recent MI, pregnancy, advanced age
Describe the etiology of rheumatic heart disease
Describe the clinical presentation and PE of rheumatic heart disease
Describe the diagnostic testing for rheumatic heart disease
Describe the treatment for rheumatic heart disease
Describe the etiology of mitral/tricuspid regurgitation
Describe the clinical presentation of mitral/tricuspid regurgitation
Describe the murmur heard in mitral and tricuspid regurgitation
Mitral best heard at apex, tricuspid best heard at LLSB
Describe the treatment for mitral/tricuspid regurgitation
Describe the etiology of a mitral S3 gallop murmur
Diastolic
Gallop sound in early diastole as a result of extra blood filling back into ventricle & splashing (every 3-4 beats)
Describe the mitral valve prolapse murmur
mid to late systolic click of the valve and late systolic murmur
Describe the etiology of aortic stenosis
Describe the clinical presentation of aortic stenosis
Describe the murmur heard in aortic stenosis
Auscultation:
- ejection click following S1 best heard at left lower sternal border
- systolic crescendo-decrescendo ejection murmur heard at URSB 2nd ICS that radiates to carotid arteries bilaterally
Describe the treatment for aortic stenosis
Describe the etiology of pulmonic stenosis
Describe the clinical presentation of pulmonic stenosis
Describe the murmur for pulmonic stenosis
Describe the etiology of mitral stenosis
Describe the clinical presentation of mitral stenosis
Describe the murmur for mitral stenosis
Describe the treatment for mitral stenosis
Describe the etiology of aortic regurgitation
Describe the clinical presentation of aortic regurgitation
dyspnea, PND, orthopnea
Describe the murmur heard in aortic regurgitation
Early diastolic decrescendo murmur, heard best at 3rd LICS, high pitch blowing, can include S3 sound
Describe the treatment for aortic regurgitation
Describe the etiology of an S4 atrial gallop
Diastolic murmur
L atria contracting against a stenotic L ventricle, often a sign of diastolic HF
Describe the etiology of SVT
can be triggered by stimulants, alcohol, digoxin, MI, pericarditis, valvulopathy, PE, COPD
Describe the treatment for SVT
Describe the etiology of premature atrial contraction
Describe the etiology of premature ventricular contraction
Describe the clinical presentation of PAC and PVC
Describe the treatment for PVCs
beta blocker if symptomatic, to reduce frequency
Describe the etiology of wolff parkinson white syndrome
Describe the clinical presentation of WPW syndrome
Describe the treatment for WPW syndrome
Describe the etiology of idioventricular conduction delay
Describe the RFs for IV conduction delay
Describe the etiology of RBBB
Describe the EKG for RBBB
Describe the etiology of LBBB
Describe the EKG in LBBB
Describe the etiology of tachy/brady syndrome
Describe the clinical presentation of tachy/brady syndrome
Describe the etiology of v-tach
Describe the clinical presentation of V-tach
Describe the treatment for v-tach
Describe the etiology of v-fib
Describe the etiology of acute aortic stenosis
Describe the clinical presentation of acute aortic stenosis
Describe the treatment for acute aortic stenosis
Describe the etiology of long QT syndrome
Describe the etiology of a third degree AV block
Describe the clinical presentation of a third degree AV block
Describe the treatment for third degree AV block
Describe the etiology of a-fib with rapid ventricular response
sxs: palpitations, chest pain, pre/syncope, dyspnea
Describe the treatment for a-fib with rapid ventricular response
Describe the treatment for WPW syndrome
Describe the etiology & RFs for acute MI
Describe the clinical presentation of an acute MI
Describe the EKG findings for a STEMI vs NSTEMI
Describe the treatment for STEMI & NSTEMI and some complications
Describe the etiology of PE
Describe the diagnostic testing for PE
Describe the treatment for PE
Describe the etiology of cardiogenic shock
Describe the clinical presentation of cardiogenic shock
Describe the etiology of Kawasaki syndrome
Describe the clinical presentation of kawasaki syndrome
Describe the diagnostic testing for kawasaki syndrome
Describe the treatment for kawasaki syndrome
IVIG & ASA mainstay
Describe the EKG for hypokalemia
Describe the etiology of an anterior MI
describe De Winter T waves seen in anterior MI
Describe which leads show ischemia in septal, anterior, lateral, anteroseptal, anterolateral territories
Describe the etiology for a lateral STEMI
Describe the etiology for an inferior STEMI
Describe the EKG for an inferior STEMI
Describe the etiology of right ventricular infarction
Describe the etiology and EKG for posterior MI
Describe the etiology of subendocardial infarction
Describe the etiology of brugada syndrome
Describe the EKG for brugada syndrome
Describe the etiology of takotsubo cardiomyopathy & EKG findings
Describe the etiology of an anterior fascicular block
Describe the EKG for anterior fascicular block
Describe the etiology of posterior fascicular block
R axis deviation associated with MI, S1Q3
Describe the etiology of a bifascicular block
describe the etiology of atrial septal defect
describe the clinical presentation of atrial septal defect
Describe the murmur & diagnostic testing for atrial septal defect
Describe the etiology of patent foramen ovale
Describe the etiology of ventricular septal defect
Acyanotic
Common, Communication between ventricles (single or multi), shunting L to R
Location class
- peri/membranous
- muscular defects
- outlet defects (subpulmonic)
- inlet defects (AV canal)
Describe the clinical presentation of ventricular septal defect
Symptoms depend on size & pressure differentials
Causes pulmonary HTN if L to R is extreme (Eisenmenger syndrome)
Describe the murmur and diagnostic testing for VSD
Murmur: small 2-3/6 harsh, blowing, holosystolic, heard best at LLSB, sometimes 4/6 thrill,
small defects result in louder murmur, larger can be absent or 1-2/6
EKG may see LVH because of increased workload
CXR - normal or CHF and L hypertrophy
Describe the etiology of patent ductus arteriosus
Describe the clinical presentation of patent ductus arteriosus
Describe the murmur and diagnostic testing for patent ductus arteriosus
Describe the treatment for patent ductus arteriosus
Describe the etiology for coarctation of the aorta
Describe the clinical presentation for coarctation of the aorta
Describe the murmur and diagnostic testing for coarctation of the aorta
Describe the treatment for coarctation of the aorta
Describe the etiology of truncus arteriosus
Describe the murmur and diagnostic testing for truncus arteriosus
Describe the etiology of hypoplastic left heart syndrome
Describe the etiology of tetralogy of fallot
Describe the clinical presentation for tetralogy of fallot
Describe the murmur and diagnostic testing for tetralogy of fallot
Describe the etiology for total anomalous pulmonary venous return
Describe the diagnostic testing for total anomalous pulmonary venous return
echo
Describe the etiology for transposition of great vessels
Describe the diagnostic testing for transposition of the great vessels
Describe the treatment for transposition of the great vessels
Describe the types of heart failure
Describe the clinical presentation of heart failure
Describe the physical exam of heart failure
Describe the diagnostic testing for heart failure
Describe which medications to avoid in heart failure
Describe the treatment for acute decompensated heart failure
Describe the etiology of cor pulmonale
Describe the clinical presentation of cor pulmonale
Describe the diagnostic testing for cor pulmonale
Describe the treatment for cor pulmonale
Describe the etiology of atrial fibrillation
Describe the clinical presentation of the types of atrial fibrillation
Describe the diagnostic testing for atrial fibrillation
Describe the treatment for atrial fibrillation
Describe the causes and RFs for atrial fibrillation
Describe the etiology and risk factors for metabolic syndrome
Describe the clinical presentation of metabolic syndrome
Describe the treatment for dyslipidemia
Describe the treatment for elevated LDL
cholesterol absorption inhibitor (ezetimibe 10mg QD)
Describe the treatment for high triglycerides
Describe the etiology & clinical presentation of stable angina
reversible ischemia
Describe the diagnostic testing for stable angina
Describe the treatment for stable angina
Describe the etiology of unstable angina
Describe the clinical presentation of unstable angina
Describe the diagnostic testing for unstable angia
describe the treatment for unstable angina
Describe the etiology of PAD
Describe the clinical presentation of PAD
Describe the PE & diagnostic testing for PAD
Describe the treatment for PAD
Describe the etiology of critical limb ischemia
Can be a presentation of PAD pts
Significant ischemia that threatens the limb, insufficient arterial flow d/t thrombosis of atherosclerotic artery
Describe the clinical presentation of critical limb ischemia
Pain, paresthesia, pallor, paralysis, pulselessness, poikilothermia (cold)
Rest pain, ischemic ulceration, gangrene
Describe the treatment for critical limb ischemia
Catheter directed thrombolysis or surgical revascularization if limb is salvageable
Amputation if limb is not salvageable
Describe the etiology of venous thromboembolism
Describe the clinical presentation of VTE
Describe the diagnostic testing for VTE
Describe the treatment for VTE
Describe the etiology of buerger’s disease
Describe the clinical presentation of buerger’s disease
Describe the treatment for buerger’s disease
Describe the etiology of varicose veins
Describe the treatment for varicose veins
Describe the etiology of superficial thrombophlebitis
Describe the etiology of chronic venous insufficiency
Describe the clinical presentation of chronic venous insufficiency
Describe the treatment for chronic venous insufficiency
Describe the difference between venous & arterial insufficiency
Describe the etiology of acute infectious pericarditis
Usually initially diagnosed as non-specific chest pain
Infectious
- viral: coxsackie, EBV, HCV, HIV, parvo B19, covid
- Bacterial: pneumo, meningo, gono, staph, strep, coxiella (major concern for TB)
- rare fungal & parasitic
Describe the etiology of non-infectious pericarditis
Non-infectious
- pericardial injury syndromes (post-MI, trauma)
- systemic: SLE, RA, sjogren’s
- malignancy (MC lung, breast, lymphoma)
- metabolic: uremia, hypothyroidism
- traumatic: penetrating or radiation injury (chemo, cardiac meds, isoniazid, phenytoin, PCNs)
Describe the clinical presentation & PE for acute pericarditis
Describe the diagnostic testing for acute pericarditis
Chest pain workup
CXR: typically normal or evidence of effusion
CBC & Inflammatory markers: leukocytosis, elevated CRP, ESR
Troponin not elevated
Consider D-dimer
Echo: usually normal unless large effusion
EKG: classically diffuse ST elevation or PR segment depression (except in aVR & V1 - ST depression), may have no ST changes but have diffuse T wave inversion
Describe the diagnostic criteria for acute pericarditis
Describe the treatment for acute pericarditis
Describe the etiology of constrictive pericarditis
Describe the clinical presentation & diagnostic testing for constrictive pericarditis
Describe the treatment for constrictive pericarditis
Describe the etiology of pericardial effusion
Describe the clinical presentation of pericardial effusion
Describe the diagnostic testing for pericardial effusion
Describe the treatment for pericardial effusion
Describe the etiology for cardiac tamponade
Describe the clinical presentation of cardiac tamponade
Describe the diagnostic testing for cardiac tamponade
Describe the treatment for cardiac tamponade
Define pulsus paradoxus
Describe the etiology of myocarditis
Describe the clinical presentation of myocarditis
Describe the diagnostic testing for myocarditis
Describe the treatment for myocarditis
Describe the etiology of infective endocarditis
Inflammation of endocardium (can lead to regurgitation)
Vegetations on valves/devices
- microorganisms, fibrin, platelets, inflammatory cells, granulomas
Non-infectious is rare (malignancy, hypercoagulable states - can cause embolic stroke)
Causes: rheumatic valvular disease (mitral MC), congenital, MVP, IVDU (tricuspid MC)
MC: staph aureus, epidermidis, viridans (rare oral flora HACEK)
Describe the clinical presentation of infective endocarditis
Fever, chills in 90%, malaise, myalgia, arthralgia, constitutional sxs, highly variable
Acute: sudden onset within a week
Subacute: slower onset (4 weeks)
HF from valvular insufficiency, renal impairment, metastatic infection (osteomyelitis, organ abscess, septic arthritis), systemic embolization
Describe the diagnostic testing/PE for infective endocarditis
Murmur: new or worsening, 85%, regurgitant
Splenomegaly, petechiae, splinter hemorrhages of fingernails, janeway lesions (painless, flat red macule son palms/soles, last longer than Osler), Osler nodes (tender, erythematous nodules on palms/soles/digits), Roth spots (pale retinal patch surrounded by darker ring of hemorrhage from inflammation of small arteries)
Blood cultures before abx (3 samples from different sites), echo will show vegetations (TEE better)
Duke Criteria (2 major, 1 major & 3 minor, or 5 minor)
Describe the treatment for infective endocarditis
Inpatient, ABCs
IV abx (4-6 weeks)
Remove devices if indicated
+/- surgical debridement if refractory to abx, valve replacement
Repeat blood cultures until negative for 1-2 days in a row
IV fluid resuscitation, antipyretics, empiric anticoag NOT recommended dt risk of ICH
Prophylactic abx prior to dental procedures w/ hx of endocarditis
Describe the etiology of dilated cardiomyopathy
Describe the clinical presentation of dilated cardiomyopathy
Describe the diagnostic testing & murmur for dilated cardiomyopathy
Describe the treatment for dilated cardiomyopathy
Describe the etiology of restrictive cardiomyopathy
Describe the clinical presentation of restrictive cardiomyopathy
Describe the diagnostic testing/heart sounds for restrictive cardiomyopathy
Describe the treatment for restrictive cardiomyopathy
Describe the etiology of amyloidosis
Describe the clinical presentation of amyloidosis
Describe the diagnostic testing for amyloidosis
Describe the etiology of hypertrophic cardiomyopathy
Diastolic failure
Heart muscle becomes bulky, large, and impairs adequate pumping leading to fatal arrhythmias
Historical indicators: low exercise tolerance, SOB with exertion, dizziness with exercise, fatigue, hx syncope with exercise
RF: genetic (autosomal dom)
Patho: physiologic response or inherited inability for cardiac muscle to contract properly, ventricular spaces shrink, SV/CO reduced - intermittent outflow obstruction can develop obstructing mitral valve
Describe the clinical presentation of hypertrophic cardiomyopathy
Describe the murmur & diagnostic testing for hypertrophic cardiomyopathy
Auscultate sitting, lying, valsalva
- high pitched crescendo-decrescendo midsystolic ejection murmur at LLSB exacerbated with valsalva, S4
Echo: gold standard, shows septal thickness, LV wall thickness > 1.3
Confirmatory tests: genetic testing, cardiac biopsy will show myofibril disarray (not parallel)
Describe the treatment for hypertrophic cardiomyopathy
Identify the leads where Q waves/ST elevation will be seen for the following areas of infarction & associated arteries
Identify the valvular dysfunctions/causes of the following systolic/diastolic murmurs
Describe the etiology/RF for RBBB
Describe the clinical presentation for RBBB
Describe the EKG for a RBBB
Describe the etiology/RF for a LBBB
Describe the clinical presentation of a LBBB
Describe the EKG for a LBBB
Describe the treatment for a RBBB & LBBB
treat underlying condition, pace if symptomatic
Describe the etiology for a left anterior fascicular block
Describe the EKG for a left anterior fascicular block
Describe the etiology of a left posterior fascicular block
Describe the EKG for a left posterior fascicular block
Describe the etiology of sick sinus syndrome
Describe the clinical presentation of sick sinus syndrome
Describe the EKG findings in sick sinus syndrome
Describe the treatment for sick sinus syndrome
treat underlying condition or pace
Describe the etiology of cardiogenic shock
Describe the clinical presentation of cardiogenic shock
Describe the diagnostic testing for cardiogenic shock
Describe the treatment for cardiogenic shock
Describe the most common cause of cardiogenic shock
Describe some of the mechanical circulatory supports for cardiogenic shock treatment
- intra-aortic balloon pump
- impella device
- VA-ECMO (veno-arterial extracorporeal membranous oxygenation)
- LVAD (left ventricular assist device - HeartMate3)
Describe how an intra-aortic balloon pump works for cardiogenic shock
- short term support following MI
- balloon inserted via femoral artery & synced to EKG
- inflates during diastole to back-fill the coronary arteries
- deflates during systole to suction blood forward
Describe how an impella device works in cardiogenic shock
- percutaneous ventricular assist device
- increases blood flow in line with aortic circulation via femoral artery into left ventricle
- encourages continuous forward flow (like a jetski motor)
- risk of hemolytic anemia
Describe how VA-ECMO treats cardiogenic shock
- temporary cardiopulmonary bypass via femoral vein & artery
- deoxygenated blood is pulled from the right atrium, passes through gas exchange membrane, and is injected into iliac artery
- allows adequate tissue perfusion while greatly reducing cardiac preload/afterload
Describe how an LVAD treats cardiogenic shock
- surgically inserted impellor
- blood pulled froom apex of LV, spun through impellor, injected into aortic root
- continuous flow support
- numerous complications (infection, suction events, thrombus, hemolytic anemia, battery failure)
