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Robbins Pathology-Cardio (Chapters 11 and 12) > Cardio-EKGs and Clinical Medicine > Flashcards

Cardio-EKGs and Clinical Medicine Flashcards

1
Q

What is the condition present with a patient bobbing back and forth with the pulse

A

Aka De musset sign

-Aortic regurgitation

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2
Q

How and where is mitral stenosis best heard

A

Diastolic murmur in the apex region (lateral recumbent) with the bell

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3
Q

Multifocal atrial tachycardia is assocaited with which conditions

A

Lung diseases

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4
Q

What is the treatment for mitral stenosis

A
  • Anticoagulant if in afib (risk of emboli)
  • MV replacement
  • Mitral commissotomy (percutaneous ballon valvuloplasty)
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5
Q

Anterior wall infractions tend to have which portion of the ANS response

A

Sympathetic (higher HR and BP)

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6
Q

What is ortner syndrome and which condition is it seen with

A

Hoarseness due to compression of the left recurrent laryngeal nerve due to the increased left atrial size seen with mitral stenosis

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7
Q

Inferior wall MI are associated with which ANS response

A

Parasympathetic (lower BP/HR)

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8
Q

What is usually given to patients with hypovolemic shock

A

Must be given fluids to replenish the lost ones
Crystalloids (sodium, NS) in renal, Gi sweat, burns)
Packed RBC for hemorrhage

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9
Q

ST elevation is indicative of what

A

Injury to the tissue

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10
Q

What is the relation of an S3 gallop with heart failure

A

11x more likely for Heart failure

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11
Q

What is the most common cause of hypovolemic shock

A

Hemorrhage

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12
Q

What is the NYHA classification for a patient with marked limitation on physical activity, less than ordinary activity causes symptoms, asymptomatic at rest

A

Class 3

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13
Q

What is the NYHA classification for a patient with no limitation in physical activity, no symptoms with ordinary exertion

A

Class 1

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14
Q

Dehydration will cause what kind of shock

A

Hypovolemic shock

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15
Q

What is the NYHA classification for a patient with unable to carry out physical activities without discomfort, symptoms as rest

A

Class 4

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16
Q

What are the acute causes of mitral regurgitation

A
  • Rupture of the chordal tendinae
  • Rupture of papillary muscle
  • Papillary muscle dysfunction due to ischemic event
  • Infective endocarditis
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17
Q

What is the condition present with a bounding upstroke, but drops

A

Aka Corrigan’s pulse

-Aortic regurgitation

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18
Q

Which conditions tend to predispose and increase the chances of hyperkalemia

A

Renal failure or kidney diseased patients , acidotic

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19
Q

What is the treatment of an unstable patient with PVCs

A

-Amiofarone,lidocaine, or Procainamide

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20
Q

What is the NYHA classification for a patient with slight limitation of physical activity, ordination activity causes symptoms

A

Class 2

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21
Q

What is the effect of high calcium on the QT

A

Shortened QT

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22
Q

What is the condition present with Capillary flushing in the nailbed

A

Aka Quincke’s pulse

-Aortic regurgitation

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23
Q

Distributive septic shock will have which findings

A
  • Warm, flushed due to vasodilation
  • Fast HR
  • Flat neck veins
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24
Q

What is the most common cause of LV systolic dysfunction

A

Ischemic heart disease

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25
Q

What are the ECG findings of the P wave in left atrial enlargement

A
  • M shaped P wave in lead 1

- Biphasic or negative P wave in V1

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26
Q

What is the condition present with a pistol like sound

A

Aka traube’s sign

-Aortic regurgitation

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27
Q

What is the treatment for a patient with PAC

A

Beta blocker (metoprolol)

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28
Q

What is the condition present with a murmur in the 2nd ICS LSB that radiates to the left shoulder

A

Pulmonary stenosis

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29
Q

What is the appearance of the extremities in the case of distributive or dissociative shock

A

Pink, warm with vasodilation

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30
Q

What are the common causes for low output cardiac failure

A

-Ischemic heart disease

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31
Q

Abnormal T waves are indicative of what

A

Ischemic pattern (especially inverted or tall peaked waves)

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32
Q

What is the presence of paroxysmal nocturnal dyspnea a sign for

A

Cardiac failure, with a 2x increase in risk

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33
Q

Persistent ST elevation for 2 weeks will lead to thought of which condition

A

Ventricular aneurysm

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34
Q

Which patient should never ever reviewed a beta blocker

A

Class 4 HF patient

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35
Q

What is the condition with the finding of a systolic murmur that is harsh and heard at the 2nd ICS RSB that radiates into the suprasternal notch

A

Aortic stenosis

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36
Q

What is usually the finding in the extremities that would lead and support the diagnosis of a Pulmonary emboli

A

-Unilateral edema and pain (not bilateral)

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37
Q

What is the most likely treatment for a patient with severe sinus bradycardia

A

Atropine

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38
Q

What is Kussmal sign and what is it indicative for

A

-Distention of the jugular vein on inspiration and indicative of RV infarction

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39
Q

Which condition is present if there is a opening snap after S2 and in the case of a short interval between the S2 and opening snap

A

Mitral stenosis, with severe forms having a shorter interval

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40
Q

What is the heart rate usually following an acute inferior MI

A

Sinus bradycardia

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41
Q

Tricuspid stenosis is often assocaited with which condition

A

Rheumatic heart

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42
Q

What is the most common cause of noncardiogenic shock

A

Septic or non-septic/anaphylaxis (vasodilation) shock aka distributive shock

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43
Q

Which patients are ACE inhibitors contraindicated

A
  • Pregnancy
  • Angioadema
  • Bilateral renal artery stenosis
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44
Q

What is the cause of a patient going into shock, yet are still warm and pink in the extremities

A

Cyanide poisoning

45
Q

Multifocal atrial tachycardia (MAT) is commonly seen in which patients

A

Late stage COPD

46
Q

What is the effect of low calcium on the QT

A

Prolonged (leading to torsades)

47
Q

How does lactate relate to mortality

A

The higher the lactate levels, the higher mortality rates

48
Q

Paroxysmal atrial tachycardia with an AV block is associated with which condition

A

Digitalis toxicity

49
Q

What is the order of treatment for a patient with sinus bradycardia

A
  • Atropine
  • Epi
  • Isoproterenol
  • Pacemaker
50
Q

What are the values that are considered to be cardiogenic shock

A

-Decrease in BP, C and urine output

51
Q

Which patients should ACE inhibitors be watched/ given cautiously

A

-Patients with renal insufficiency or potassium >5mEq

52
Q

Wht are the major Jones criteria for rheumatic heart disease

A
  • Inflammation of the heart (endocarditis, pericarditis etc)
  • Migratory polyarthritis of large joints
  • Painless subcutaneous nodules over bones and tendons
  • Sydenham’s chorea (rapids, purposeless movement of the hands and arms)
  • Erythema marginatum (distinct borders of raised erythematous lesions)
53
Q

What test can be ran as a diagnostic when an ultrasound can not be run

A

D-Dimer

54
Q

What condition is present if there is a loud S1, with an increased sound on the second heart sound

A

Mitral stenosis with some pulmonary hypertension

55
Q

J waves are seen in which conditions.

A

Hypothermia

56
Q

What side effect of ACE inhibitors is not seen in Angiotensin receptor blockers

A

The cough, but both classes work the same

57
Q

What stage is ACC/AHA scale for CAD that has the risk factor, no symptoms, LVH or other LV structural defects

A

Class B

58
Q

Anterior wall MI tend to lead to which complication

A

LV wall rupture and cardiac tamponade

LV aneurysm

59
Q

How does the loudness of the mitral regurgitation murmur correlate with severity

A

They are correlated

60
Q

STEMI is usually caused by which event

A

Thrombus leading to a transmural infarction

61
Q

What stage is ACC/AHA scale for CAD that has the risk factor, refractory Heart failure, eligible for specialized treatments such as mechanical support or transplantation

A

Class D

62
Q

What is the ejection fraction in diastolic heart failure

A

The Ejection fraction will remain normal

63
Q

What are the conditions that can cause high output hardback failure

A

High CO despite a low EF:

  • Hyperthyroidism
  • Anemia
  • Pregnancy
  • AV fistula
  • Beriberi
  • Paget’s
64
Q

What are the findings of the ST elevation amounts in a STEMI

A

2 mm at J point in V2, V3 or 1 mm or greater in 2 contiguous chest leads

65
Q

What are the findings and classification for higher amounts of blood loss

A
  • Increased class
  • Increased HR
  • Decreased BP
  • Increased RR
  • Decreased urinary output
66
Q

In a patient with malignancy, which electrolyte imbalance should first be thought to check

A

Calcium (tends to go up)

67
Q

What stage is ACC/AHA scale for CAD that has the risk factor, no symptoms, no structural defects

A

Class A

68
Q

What are the criteria for a sepsis

A

SIRS-systemic inflammatory response syndrome

  • Fever
  • Tachycardia (>90)
  • Tachypnea (>20)
  • Increased WBC (>12,000)
69
Q

Why is an ace inhibitor beneficial in an MI

A

Prevents the remodeling process

70
Q

Patients with mitral stenosis develop which symptoms

A

Cough, pulmonary edema, hemoptysis, Atrial emboli, A fib,

71
Q

What are the signs of accelerated idioventricular rhythm (AIVR)

A
  • Looks like Vtach, but at a rate of 60-100 bpm

- Is benign and signs of reperfusion

72
Q

What is the EKG finding with hypokalemia

A

Prominent U wave with flat T wave

73
Q

What is the most common cause of a pause in the EKC

A

Nonconducted premature atrial contraction (PAC)

74
Q

What are the chronic causes of mitral regurgitation

A
  • Mitral valve prolapse

- Mitral annular calcification

75
Q

What non-MI conditions can have a ST elevation

A
  • Pericarditis
  • LVH with a J point elevation
  • Normal variant of early repolarization
76
Q

What condition is present if there is a Decreased S1, with a click

A

Mitral regurgitation, with the systolic click due to MVP

77
Q

Heart failure can usually result in which change to sodium levels

A

Hyponatremia due to the increased in water consumption and decreased output as a result of decreased renal perfusion.

78
Q

What is the treatment of a stable PVC

A

Metoprolol

79
Q

What is the condition present with diastolic, decrescendo murmur heard in the 3rd ICS LSB

A

Aortic regurgitation

80
Q

How does the prognosis of the patient correlated with ST depression

A

The further the ST depression, the more likely the patient is to die

81
Q

What is the initial medical management of a pt with an MI

A

MONA-B:

  • Morphine
  • Oxygen
  • Nitroglycerin
  • Aspirin
  • betablocker
82
Q

How does treatment of a STEMI and an NSTEMI differs

A

Everything is the same except the thrombolytics dont work

83
Q

What is the treatment of RV infarction leading to heart failure

A

-Fluids to help prime the RV

84
Q

What stage is ACC/AHA scale for CAD that has the risk factor,previous MI, Heart failure, structural defects, decreased exercise tolerance

A

Class C

85
Q

QRS complex changes are indicative of which condition

A

Pattern of necrosis or infarction

86
Q

What is the definition of shock and what are the causes

A

Tissue hypoperfusion and cellular hypoxia caused by:

  • Decreased oxygen delivery or utilization
  • Increased oxygen consumption
  • hypotension<80-90 mmHg or 40 below baseline
  • MAP <60-65
87
Q

Where is a mitral regurgitation best heard

A

Over the apex, radiating to the axilla

88
Q

What is the condition present with a wide pulse pressure

A

Aortic regurgitation

89
Q

If a pt presents with a malar rash similar to lupus, what condition is suspected

A

Mitral stenosis with some pulmonary edema

90
Q

Which MI tends to lead to a second degree AV block and which type is it typically

A

Inferior wall MI, usually leading to Wenchebach

91
Q

What is the condition if the physical finding is narrow pulse pressure with a decreased systolic volume and pressure

A

Aortic stenosis

92
Q

Which condition is present if there are parvis (weak) and tarsus (late) pulses

A

Aortic stenosis

93
Q

What is the condition present with frothing sound heard when compressing the stethoscope of the femoral artery

A

Aka Durozrey’s sign

-Aortic regurgitation

94
Q

What is are the characteristics of the ventricles during diastolic heart failure

A

They can not relax, so there is the tendency to become fibrotic

95
Q

How does septic shock result in vasodilation

A
  • Endothelial damage leading to the release of Nitric oxide
  • Cytokines
  • Increased lactate leads to hypoxia
96
Q

What is the treatment for a mitral valve prolapse

A

Beta blocker for hyperadrenergic state

97
Q

What is the most common cause of mitral regurgitation

A

Mitral valve prolapse due to floppy valve syndrome

98
Q

Which patients are beta blockers contraindicated in

A
  • Class 4 heart failure
  • Anything higher than a class 2 AV block
  • Patients on something causing hypotension
99
Q

If there is a patient older than 65 years old with A fib, what should be checked

A

Thyroid (Free T4, TSH)

100
Q

What is the condition present with the pressure is higher in the legs than the upper extremities

A

Aka Hill’s sign

-Aortic regurgitation

101
Q

What is gallavardin phenomenon and what condition is it found

A

Murmur that radiates to the apex, like mitral stenosis, except it is in aortic stenosis

102
Q

How do you treat Supraventricular tachycardia

A

Adenosine

103
Q

How do you treat multifocal atrial tachycardia (MAT)

A

IV verapamil or diltiazem (calcium channel blocker)

104
Q

What is the usual appearance and state of the extremities in the cause of shock

A

Blue, cold, clammy, due to decreases perfusion and vasoconstriction

105
Q

What is the appearance in the cause of hypovolemic, cardiogenic, or obstructive shock

A

Cool, clammy, pallor, extremities with vasoconstriction

106
Q

What is the most common cause of cardiogenic shock

A

Cardiac pump failure caused by cardiac failure due to an MI

107
Q

Which patients should not be given a beta blocker

A
  • Hypotension
  • Decompensated heart
  • Advanced AV block
108
Q

In the treatment of heart failure, when should fluid be restricted

A

< 126

Robbins Pathology-Cardio (Chapters 11 and 12) (4 decks)

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