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cardio and pulm > cardio flash-cards > Flashcards

cardio flash-cards Flashcards

1
Q

what is a hypertensive urgency?

A

over 220 systolic or 125 diastolic

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2
Q

what is a hypertensive emergency

A

diastolic >130

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3
Q

spironolactone

A

aldosterone receptor antagonists, increasingly used in refractory HTN; 2nd line for acute pulm edema or CHF

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4
Q

left sided failure

A

exertional dyspnea, nonprod cough, fatique, orthopnea, paroxsymal nocturnal dyspnea, basilar rales, gallops, exercise intolerance

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5
Q

right sided failure

A

distended neck veins, tender or nontender hepatic congestion, nausea, dependent pitting edema

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6
Q

diastolic failure cardiac sign

A

S4 gallop/hepatomegaly, ascites, JVD

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7
Q

kerley B lines

A

CHF CXR

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8
Q

nocturia, hypotension, narrow pulse pressure

A

CHF

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9
Q

CHF treatment and associated angina

A

loop or thiazide diuretic. Add an ACE. CCB(amlodipine) only to treat associated angina and HTN; LMNOP for pulm congestions

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10
Q

Levine’s sign

A

clenched fist over sternum and clenched teeth: ischemia

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11
Q

angina pectoris

A

midsternal but may radiate to jaw, shoulders, arms, wrists, back of the neck; usually on the left. lasts for 3 min

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12
Q

important marker in atherosclerosis

A

c reactive protein

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13
Q

how to control atherosclerosis

A

manage blood glucose and BP

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14
Q

what if angina pectoris lasts more than 30 min

A

unstable angina, MI, or another dx

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15
Q

EKG in angina

A

horizontal or downsloping ST segment depression. exercise testing will have a depression of 1 mm

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16
Q

definitive diagnostic test in angina

A

coronary angiography

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17
Q

SE of nitrates

A

HA, nausea, lightheadedness, hypoTN

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18
Q

medication for chronic angina

A

Beta blockers first line therapy. it prolongs life of pts with coronary disease

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19
Q

ranolazine

A

prolongs exercise duration and time to angina

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20
Q

CCB does what

A

decrease cardiac muscle oxygen demand but are third line agents

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21
Q

aortic stenosis

A

harsh systolic ejection murmur that radiates to the carotids; narrows the valve opening, impeding the ejection function of the left side of the heart

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22
Q

aortic insuffiency(regurge)

A

early decresendo DIASTOLIC murmur;results in volume overloading of the left ventricle

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23
Q

mitral stenosis

A

mid to late low pitch DIASTOLIC murmur; impedes blood flow between the left atrium and ventricle

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24
Q

mitral insufficiency

A

holosystolic;causes backflow and volume overload of the left atrium

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25
Q

MVP

A

asymptomatic, but it may cause mitral regurge

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26
Q

What does valve related progressive heart failure lead to?

A

pulmonary HTN and congestion

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27
Q

sx in valvular disorder

A

cough, dyspnea, fatigue, decreased exercise tolerance

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28
Q

thready carotid pulses

A

aortic stenosis

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29
Q

widenen pulse pressures

A

aortic insuffiency

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30
Q

MVP characteristics

A

thin females with minor chest wall deformities, midsystolic clicks and late systolic murmur

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31
Q

CXR of aortic valve disorders

A

left sided atrial enlargement and ventricular hypertrophy

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32
Q

CXR in mitral valve disorders

A

atrial enlargement alone

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33
Q

how to check pressure gradient assessment

A

doppler ultrasound

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34
Q

systemic venous congestion sx

A

JVD, peripheral edema, hepatomegaly

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35
Q

Aflutter occurs in what kind of pts

A

COPD, CAD, CHF, atrial septal defect

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36
Q

junctional rhythms occur in what pts

A

nml hearts, mycocarditis, CAD, digitalis toxicity

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37
Q

non pharm tx of PSVT

A

ablation, *synchronized cardioversion(not in dig toxicity)

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38
Q

medicine to treat PSVT

A

IV adenosine, PO verapamil.

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39
Q

pharmacological prevention of PSVT

A

diltiazem verapmil beta blocker

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40
Q

acute A-Fib tx and etio

A

cardiovert. PIRATES

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41
Q

chronic AFIB tx

A

rate control and prevention of thromoembolism

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42
Q

atrial flutter tx/ final

A

chemical conversion with ibutilide or electric cardioversion

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43
Q

chronic atrial flutter tx

A

amiodarone or dofetilide

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44
Q

what is V tach

A

3 or more consecutive ventricular premature beats; sustained/unsustained, frequent complication of acute MI and dilated cardiomyopathy

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45
Q

torsades be pointes

A

Vtach in which QRS complex twists aound the baseline; can happen with hypokalemia, hypomagnesemia, or following drugs that prolong QT

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46
Q

ventricular premature beats tx

A

beta blockers or class I and II

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47
Q

Vfib

A

no effective pumping action; sudden death; occurs in early morning

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48
Q

tx of Vtach with severe hypotension or loss of consciousness

A

synchronized cardioversion if unstable

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49
Q

medication tx of Vtach

A

lidocaine, procainimide, amiodarone. empiric magnesim

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50
Q

brugadas symdrome

A

occurs in asians and males. causes syncope, ventricular fib and sudden death. tx is implantable defibrillator

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51
Q

when is sick sinus syndrome reversible

A

if caused by digitalis, quinidine, beta blockers or aerosols

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52
Q

Describe “silent” MIs

A

1/3 of pts. most likely older people, women, DM

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53
Q

inferior changes will occur in what leads

A

II III aVF

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54
Q

posterior changes occur in what leads

A

V1 V2

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55
Q

anteroseptal changes occur in what leads

A

V1 V2

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56
Q

anteior changes occur in what leads

A

V1 V2 V3

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57
Q

anterolateral changes occur in what leads

A

V4 V5 V6

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58
Q

Cardio PE in ACS

A

nml or JVD, soft heart sounds, mitral regurge, S4 gallop

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59
Q

dresslers syndrome

A

post MI syndrome; pericarditis, fever, leukocytosis, pleural/percaridal effusion; usually 1-2 wks after

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60
Q

ECG changes in MI

A

progression from peaked T waves to ST elevation/depression to Q waves to T wave inversions that occur over hrs to days

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61
Q

doppler studies in MI

A

postinfarction ventricular septal defect or mitral regurge

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62
Q

CXR in MI

A

congestive failure or signs of aortic dissection

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63
Q

most sensitive test to quantify the extent of an infarction

A

MRI with gadolinium

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64
Q

Total CK

A

initial elevation at 3-5 h, peaks at 24h, and returns to normal with 28-72hr

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65
Q

LDH

A

initial elevation at 10h, peaks at 24-28h, and returns to normal with 10-14 days

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66
Q

what should u give ACS pts with ST elevation

A

antiplatelet therapy and anticoagulants

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67
Q

med tx in ACS

A

beta blocker(if not in hrt failure, bradycardic, heart block), CCB(if cannot take bblocker or nitrates )

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68
Q

what does cyanotic heart anomalies involve

A

right to left shunts

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69
Q

tetralogy of fallot description

A

subaortic septal defect, right ventricular outflow obstruction, overriding aorta, right ventricular hypertrophy

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70
Q

tetralogy of fallot murmur

A

crescendo-decrescendo, holosystolic at LSB, radiating to back

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71
Q

pulmonary atresia definition

A

pulmonary valve is closed, atrial septal opening and patent ductus arteriosus are present; emergency tx!

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72
Q

cyanosis, clubbing, increased RV impulse at LLSB, loud S2

A

tetralogy of fallot

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73
Q

cyanosis with tachypnea at birth, hyperdyamic apical impulse, single S1 and S2

A

pulm atresia

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74
Q

TET spells

A

cyanosis, hyperpnea, agitation

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75
Q

what is hypoplastic left heart sydrome

A

group of defects with a small left ventricle

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76
Q

transposition of great vessels PE

A

*cyanosis in newborn; loud S2 if large VSD

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77
Q

most common type of ASD

A

ostium secundum

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78
Q

atrial septal defect murmur

A

systolic ejection murmur second LICS; wide fixed split S2

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79
Q

what does right sided overload lead to

A

right sided cardiomegaly, systemic venous congestion, and rt sided heart failure

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80
Q

sx of tricuspid/pulmonic valve d/o

A

JVD, hepatomegaly, peripheral edema

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81
Q

CXR of tricuspid/pulmonic valve d/o

A

prominent rt heart border with dilation of SVC

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82
Q

ECG of tricuspid/pulmonic valve d/o

A

right axis deviation, P wave abnormality associated with right atrial enlargement; or prominent R and deep S waves of right ventricular hypertrophy

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83
Q

Tx of tricuspid/pulmonic valve d/o

A

Na restriction and diuretics to decrease volume filling and right atrial pressure. **surgery

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84
Q

how to treat pulm HTN

A

arterial vasodilators or positive inotrophic agents

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85
Q

aortic stenosis murmur characterisitics

A

2ICS; rad to neck and LSB; loud; best if pt sitting and leaning forward

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86
Q

aortic regurge murmur characteristics

A

2nd-4th LICS; rad to apex and RSB; Loud pitch; best heard sitting, leaning forward, full exhalation

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87
Q

austin flint murmur

A

midsystolic aortic regurge; suggests large flow nad arterial pulses large and bounding

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88
Q

mitral stenosis murmur characteristics

A

heard at apex, no rad, low pitch, heard best in left lateral position with full exhalation.

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89
Q

S1 accenuated; opening snap follows S2

A

mitral stenosis

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90
Q

mitral regurge murmur characteristics

A

heard at apex, rad to left axilla, med to high pitch.

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91
Q

S2 often decreased; apical impulse prolonged

A

mitral regurge

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92
Q

tricuspid regurge murmur characteristics

A

LLSB; holosystolic, rad to rt sternum and xiphoid; increased with inspiration. JVP elevated

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93
Q

2 murmurs with pansystolic timing

A

mitral regurge and tricuspic regurge

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94
Q

murmur with midsystolic timing

A

aortic stenosis

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95
Q

pulm stenosis murmur characteristics

A

2nd-3rd LICS; midsystoic crescendo-decrescendo; rad to left shoulder and neck; medium pitch.

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96
Q

early pulmonary ejection sound

A

pulm stenosis

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97
Q

medication for ventricular premature beats

A

beta blocker(class I and II) if pt is symptomatic

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98
Q

tx for severe V tach with severe hypoTN or loss of consciousness

A

synchronized cardioversion and maybe pacing

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99
Q

medications for Vtach

A

lidocaine, procainamide, amiodarone. empiric magnesium

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100
Q

what to do if in a ventricular arrhythmia with a pt with an identifiable site of arrhythmic origin

A

radiofrequency ablation

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101
Q

what to do in a recurrent sustained Vtach, for congenital long QT syndrome, brugadas syndrome

A

implantable defibrillator

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102
Q

torsades medication tx

A

beta blockers, magnesium, temporary atrial or ventricular pacing.

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103
Q

AV block sx

A

weakness, fatigue, light headedness, syncope

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104
Q

wenckebach

A

mobitz type II 2nd degree heart block

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105
Q

sick sinus sydrome tx

A

most require permanent pacing

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106
Q

AV conduction tx

A

cardiac pacing

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107
Q

common type of cardiomyopathy

A

dilated (affecting left ventricle)

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108
Q

causes of dilated cardiomyopathy

A

excessive ETOH, postpartum state, chemo toxicitiy, endocrinopathies, myocarditis, idiopathic

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109
Q

Takotsubo cardiomyopathy

A

occurs after a major catecholamine discharge; apical left ventricular ballooning with sx of acute MI

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110
Q

major cause of hypertrophic cardiomyopathy

A

genetic; usually asian descent or elderly

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111
Q

what is hypertrophic cardiomyopathy

A

4%; usually of the septum, small left ventricle, systolic anterior mitral motion, diastolic dysfunction

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112
Q

Sx for dilated cardiomyopathy

A

*dyspnea. S3 gallop, rales, increased JV pressure

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113
Q

Sx of hypertrophic cardiomyopathy

A

*dyspnea and angina. also maybe asymptomatic or sudden death

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114
Q

PE for hypertrophic cardiomyopathy

A

sustained point of maximal impulse or triple apical impulse, loud S4 gallop, variable systolic murmur, bisferens carotid pulse, JV pulsations with a prominent “a” wave

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115
Q

bisferens carotid pulse, JV pulsations with a prominent “a” wave

A

hypertrophic cardiomyopathy

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116
Q

restrictive cardiomyopathy Sx

A

decreased exercise tolerance; pulmonary HTN; in advanced disease will have right sided congestive failure

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117
Q

ECG in dilated cardiomyopathy

A

nonspecific ST and T wave changes, PVC(vent ectopy)

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118
Q

ECG in hypertrophic cardiomyopathy

A

nonspecific ST and T wave changes, exagerated Q waves, LVH

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119
Q

CXR in dilated cardiomyopathy

A

pulmonary congestion and cardiomegaly

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120
Q

CXR in hypertrophic cardiomyopathy

A

not remarkable

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121
Q

hrt studies show high diastolic pressures and low cardiac output

A

dilated hypertrophy

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122
Q

cardiac studies show LVH, asymmetric septal hypertrophy, small left ventricle, diastolic dysfunction

A

hypertrophic cardiomyopathy

123
Q

Key test for restrictive cardiomyopathy

A

echocardiography! cardiac MRI is distinctive, cath shows reduced mildly left ventricular function.

124
Q

tx for the cardiomyopathies

A

dilated(no ETOH, treat underlying cause, CHF); hypertrophic(beta blockers, CCB; disopyramide for negative inotrophic effects, ablation of hypertrophic septum); restrictive(diuretics)

125
Q

percarditis common in who

A

men and those under 50 yrs old

126
Q

what is cardiac tamponade

A

fluid compromises cardiac filling and impairs cardiac output

127
Q

Sx of acute pericarditis

A

pleuritic substernal radiating chest pain relieved by sitting upright and leaning forward. *friction rub

128
Q

sx of constrictive pericarditis

A

slowly progressing dyspnea, fatigue, weakness, accompanied by edema, hepatomegaly, ascites

129
Q

sx of cardiac tamponade

A

tachycardia, narrow pulse pressure, pulsus paradoxus

130
Q

ECG changes in pericardial disorders

A

nonspecific T wave changes and low QRS voltage.

131
Q

what is pathognomonic for a pericardial effusion

A

electrical alternans

132
Q

organism in prosthetic valve endocarditis

A

staph, gm neg, fungi in first 2 months; strep or staph later on

133
Q

a changing murmur

A

rare but diagnostically significant in endocarditis

134
Q

sx in endocarditis

A

none in elderly; fever and nonspecific sx

135
Q

classic features on endocarditis

A

25% pts have this. palatal, conjunctival, subungal petechiae, splinter hemorrages, osler nodes, janeway lesions, and roth spots

136
Q

roth spots

A

exudative lesions in the retina

137
Q

common sx in endocarditis

A

pallor and splenomegaly; strokes and emboli may occur

138
Q

pulm infiltrates on CXR

A

right side of hrt has endocarditis

139
Q

antibiotic choice for endocarditis prophylaxis

A

amoxicillin

140
Q

empiric antibiotic for endocarditis

A

vanco ply ceftriaxone

141
Q

surgery for endocarditis?

A

maybe necessary, especially aortic valve

142
Q

what is rheumatic fever

A

a systemic immune response occurring usually 2-3 wks following a beta hemolytic streptococcal pharyngitis

143
Q

common people rheumatic hrt disease occurs in

A

recent immigrants; kids 5-15 years of age

144
Q

perivascular granuloma lesion with vasculitis

A

rheumatic valve disease

145
Q

valve most commonly involved in rheumatic heart disease

A

mitral(75-80%) then aortic(30%). aortic and tricuspid rarely occurs in isolation

146
Q

medication tx for rheumatic heart disease

A

IM PCN, if allergic then emycin

147
Q

Leriche’s syndrome

A

ED occurring with iliac artery disease

148
Q

ankle brachia index for PAD

A

less than 0.9 indicates significant disease

149
Q

tests to order for PAD

A

CT or magnetic resonance angiography

150
Q

drug for PAD

A

cilostazol; sildenafil for ED.

151
Q

brodie-trendelenburg test

A

differentiates saphenofemoral valve incompetence from perforator vein incompetence

152
Q

Virchows triad

A

stasis, vascular injury, and hypercoagulability

153
Q

what is thrombophlebitis

A

involve partial or complete occlusion of a vein and inflammatory changes. virchows triad

154
Q

palpable cord in long saphenous vein

A

thrombophlebitis

155
Q

what is d-dimer

A

fibrin degradation product that is elevated in presence of thrombus

156
Q

skin changes in chronic venous insufficiency

A

shiny, thin, itchy, atrophic with dark pigment and subcutaneous induration

157
Q

how to treat stasis dermatitis

A

wet compresses, hydrocortisone cream. chronic forms may also need zinc oxide with ichthammol and antifungal cream

158
Q

1st degree AV block

A

PR interval constant and >200/asymptomatic/no treatment; can occur with increased vagal tone or with a bb or ccb

159
Q

mobitz 1

A

PR progressively lengthens until QRS drops; asymptomatic or palp/no tx; can be from bb or ccb or increased vagal tone or coronary ischemia/infarction

160
Q

mobitz 2

A

from fibrotic disease of the conduction system from an MI/occasional syncopeQRS beats are intermittently dropped w/out PR prolongation/asymp or palp/tx: pacemaker

161
Q

3rd degree AV block

A

dissociation of P and QRS/no electrical communication between atria and ventricles/syncope,dizziness,hrt fail,hypoTN/ tx: pacemaker

162
Q

L BBB

A

QRS >120;deep S wave and no R wave in V1;wide, tall R waves in 1, V5, V6

163
Q

R BBB

A

QRS >120; RSR complex;wide R wave in V1, QRS pattern with wide S wave in 1, V5, V6

164
Q

BBB causes and sx

A

CAD, Cardiomyopathy, valve disease/asymp, syncope, presyncope

165
Q

q wave

A

septal depolarization

166
Q

r wave

A

apical and early depolarization

167
Q

s wave

A

late ventricular depolarization

168
Q

t wave

A

ventricular repolarization;

corresponds to the period when the lower heart muscle chambers are relaxing and preparing for the next muscle contraction

169
Q

p wave

A

atrial depolarization/record of movement of electrical activity through atria and recorded when they contract

170
Q

qrs complex

A

record of movement of electrical impulses through ventricles and recorded when they contract

171
Q

ST segment

A

elevated or lowered means heart muscle damaged or not receiving enough blood

172
Q

T wave

A

corresponds to the period when the lower heart muscle chambers are relaxing and preparing for the next muscle contraction

173
Q

inferior leads and arteries

A

I, II, avF/ rt coronary arter circumflex branch, and post descending branch

174
Q

posterior leads and arteries

A

V1 and V2/ LCA to circumflex branch and RCA to post descending branch

175
Q

anteroseptal leads and artery

A

V1 and V2 / LAD plus septal branch

176
Q

anterior leads and artery

A

V1 V2 V3; Lt Ant Descending

177
Q

anterolateral leads and lateral arteries

A

V4 V5 V6/ lt coronary artery, circumflex branch

178
Q

PSVT causes and risks

A

dig too high, WPW/ risks: etoh,caffeine,drugs, smoking

179
Q

test for aortic dissection

A

CT angiography

180
Q

secondary HTN causes

A

CHAPS: cushing, hyperaldosterone, aortic coarctation, pheochromocytoma, stenosis renal artheries

181
Q

orthostatic hypoTN

A

greater than 20 mm Hg drop in systolic or 10 diastolic. if pulse increase by 15 beats, depleting circlulating blood volume

182
Q

pericarditis sx, PE,

A

pleuritic CP, dyspnea, cough, FEVER; CP worsens in supine and inspiration(sits and leans); friction rup, inc JVP, pulsus paroxus

183
Q

pericarditis imaging and tx

A

ekg: diffuse st seg elev and PR seg dep followed by t wave inv; tx: underlying cause; asa/NSAIDS for viral;no corticosteroids

184
Q

pulsus paroxus

A

decreased systolic BP > than 10 mm hg inspiration

185
Q

beck triad

A

jvd, hypoTN, distant heart sounds: cardiac tamponade

186
Q

acute cardiac tamponade

A

beck triad, pulsus paradoxus, kussmaul, electrical alternans, (water bottle heart), EKG: rt atrial and rt vent diastolic collapse

187
Q

WPW EKG and tx

A

DELTA WAVE; procainamide or arrhythmics

188
Q

S3

A

early sign of heart failure; ventricular gallop, fluid overload, disappears when pt gets up

189
Q

S4

A

atrial gallp, decreased compliance- HTN, diastolic dysfunction

190
Q

Pulsus parvus et tardus

A

weak, delayed carotid up stroke, split S2, aortic stenosis

191
Q

blowing diastolic murmur and tx

A

aortic regurge; tx: vasodilators

192
Q

opening snap and mid diastolic murmur at apex an tx

A

mitral stenosis; rheumatic fever; antiarhythmics

193
Q

under 65 y/o, EF under 50%, *exertional dyspnea, parasternal lift, S3 S4, JVD, BNP >500

A

systolic CHF- do loop. no ccb

194
Q

tx for pulm congestion

A

LMNOP: lasix, morphine, nitrates, O2, position

195
Q

murmur heard best in left lateral position in full exhalation

A

mitral stenosis

196
Q

high pitch, blowing murmur; heard best sitting and leaning forward, full exhalation

A

aortic regurge

197
Q

harsh and medium pitch murmur, heard best sitting and leaning forward

A

AS

198
Q

murmur radiation

1)axilla 2)rt sternum/xyphoid 3)lt shoulder/neck

A

1) AR 2) TR 3) PS

199
Q

anti-arrhythmic class 2 drugs

A

beta blockers slow AV conduction for SV tachycardia, may prevent vent fibrillation

200
Q

anti-arrhythmic class 3 drugs

A

K++ channel blockers:prolong action potential; for refractory V tach, SV tach; amiodarone,sotalol,dofetilide,ibutilide

201
Q

anti-arrhythmic drugs class IV

A

slow CCB for SV tachycardia

202
Q

anti-arrhythmic class V drugs

A

Adenosine and Digoxin for SV tachycardia

203
Q

Sodium channel blockers

A

Class 1 drugs; Quinidine, procainamide, disopyramide,lidocaine

204
Q

med for variant/atypical/prinzmental angina

A

CCB

205
Q

how do nitrates work

A

venodilation to decrease preload and O2. also coronary artery dilation to increase blood flow.

206
Q

how do Beta blockers work

A

decrease O2 demand. watch out for hypoglycemia

207
Q

which CCB causes flushing and which ones cause constipation

A

nifedipine. diltiazam and verapamil

208
Q

which CCB can cause worsening angina

A

nifedipine

209
Q

anteroseptal leads

A

V1 V2. LAD

210
Q

MONA

A

ACS tx. Morphine/merperadine O2 Nitrates, asa

211
Q

post ACS complications mneumonic

A

PFARTS. pericarditis, failure, arrhythmia/aneursym, ruptrue, thromboembolism, septal perf

212
Q

marker for heart failure

A

BNP

213
Q

EKG changes in pericarditis

A

ST segment elevation in 2 or 3 limb leads

214
Q

acute occlusion S/S

A

paresthias, pallor, pulseless, pain, paralysis

215
Q

heart sounds locations

A

A then P, below is T. to the right is M

216
Q

sternal lift

A

RVH

217
Q

enlarged, displaced PMI

A

LVH

218
Q

systole valves

A

A/P open

219
Q

diastole valves

A

M/T open

220
Q

S1 is what valves

A

M/T close

221
Q

S3

A

early diastolic sound. think heart failure

222
Q

S4

A

think chr HTN. its late diastolic

223
Q

high pitched murmur

A

M/T valve

224
Q

cresendo

A

think A/P

225
Q

inspiration does what to a murmur

A

increase venous return

226
Q

left lateral decubitus affects murmurs how

A

makes mitral valve murmurs easier to hear

227
Q

sitting and leaning forward

A

increases AR murmur

228
Q

valsalva/standing

A

decrease venous return

229
Q

squatting

A

increases venous return

230
Q

wide pulse pressure

A

AR

231
Q

narrow pulse pressure

A

AS

232
Q

marfans

A

AR

233
Q

tachycardia

A

with infections

234
Q

bradycardia

A

with AV blocks

235
Q

JVP

A

reflects RA pressure.

236
Q

large A wave

A

TS

237
Q

large V wave

A

TR

238
Q

bounding pulses

A

AR

239
Q

pulsus alternans

A

with left ventricular failure

240
Q

slow and delayed carotid pulse

A

severe AS

241
Q

roth spots on retina

A

endocarditis

242
Q

clubbing

A

hypoxia

243
Q

petechiae, splinter hemorrhages

A

endocarditis

244
Q

S4

A

AS

245
Q

rheumatic fever

A

MS

246
Q

radiate to left neck

A

PS

247
Q

rt sided S3 S4

A

PS

248
Q

murmur with inspiration

A

PS

249
Q

heard at aortic region, no radiation. softer with squatting, louder with valsalva/standing

A

IHSS

250
Q

how to hear hypertrophic cardiomyopathy

A

over lower sternum; louder with standing/valsalva; softer with squatting

251
Q

3 holosytolic murmurs

A

MR, TR, VSD

252
Q

MR heard best at

A

apex

253
Q

TR heard best at

A

LLSB

254
Q

MR

A

LL deb positiion. radiates to left axilla. blowing

255
Q

TR

A

inspiration decreases intensity. blowing

256
Q

diastolic murmurs: nml flow through valves

A

mitral and tricuspid stenosis

257
Q

diastolic murmurs: backward flow through valves

A

aortic and pulmonic regurge

258
Q

MS

A

decresendo-cresendo. heard best at apex. rumbling, S2 accentuated. think rheumatic fever

259
Q

AR

A

decresendo. S4, PMI enlarged. head bobbing. increase intensity with leaning forward with expiration.

260
Q

machine like murmur

A

PDA

261
Q

continuous murmur

A

venous hum. stops with compression of jugular vein

262
Q

systolic murmurs

A

AS, PS, MR, TR, VSD, MVP

263
Q

IV drug use affects

A

right heart valves

264
Q

murmur heard best at pulmonic area and increases with inspiration

A

likely PS

265
Q

hypoxia, electrolyte abnormalities, HYPERthyroidism; dx and tx

A

PVC, give BB

266
Q

systolic dysfunction: defintion, age, EF, cardiomyopathy, PMI, gallop, CXR, ekg

A

inadequate vent contractility, under 65 y.o, EF under 40%, dilated CM, PMI displaced, S3, Cardiomegaly on CXR, q waves

267
Q

non systolic dysfunction: definition, age, EF, cardiomyopathy, PMI, gallop, CXR, ekg

A

impaired relaxation- cannot fill; over 65 y.o, EF over 55%, Hypertrophic and restrictive CM, PMI sustained, S4, CXR pulm htn, LVH

268
Q

tx for systolic and non systolic dysfunction CHF.

avoid what in each. (3)

A

Systolic: 1) acute: loop with ACE (avoid BB)

2) chronic: loop, ACE, BB. (avoid CCB)

Diastolic: diuretics first line(avoid digoxin)

269
Q

loop

1) effects

2) use in what

3) SE

4)disadvantage

A

1) hypokalemia, hypocalcemia,hypomagnesium,hyperruricemia.

2) 1st line for CHF, also can use in acute pulm edema

3) dehydration, gout, ototoxicity

4) short acting

270
Q

SE for K sparing agents

A

hypokalemia, gynecomastia, sexual dysfunction

271
Q

most common cause of young healthy athletes in US; etio

A

hypertrophic obstructive CM; inherited as an autosomal dominant trait

272
Q

echo shows rapid early filling and normal EF; EKG LBBB. which CM?

A

restrictive

273
Q

7 major risk factors in CAD

A

male, inc LDL, dec HDL, smoking, HTN, FH, age(male over 45 and woman over 55),

274
Q

tx for chronic stable angina

A

BB, aspirin, and nitro

275
Q

Xanthelasma, xanthomas, lipemia retinalis; indicates what

A

yellow deposits in skin around eyes, eruptive nodules in skin over tendons, creamy appearance of retinal vessels; think dyslipidemia

276
Q

When to conduct a fasting lipid profile

A

pts over 35 y.o or over 20 y.o with CAD risk factors; repeat every 5 years.

277
Q

dyslipidemia dx

A

LDL over 130 or HDL under 40

278
Q

mnemonic for HTN tx

A

ace/arb, bb, ccb, diuretics

279
Q

tests for end organ complications(kidney and heart)- HTN

A

creatinine, BUN, urine protein to creatinine ratio, EKG to look for hypertrophy

280
Q

primary renal disease HTN tx

A

ace

281
Q

diuretic SE

A

hypokalemina; HYPER glycemia, lipemia, uricemia; azotemia

282
Q

BB SE

A

bronchospasm, bradycardia, CHF exacerbation, impotence, fatigue, depression

283
Q

ACE SE

A

angiodema, rash, leukopenia, HYPERkalemia

284
Q

ARB SE

A

leukopenia, rash, HYPERkalemia

285
Q

screening in aortic aneurysm

A

screen all men 65-75 with hx of smoking once by ultrasound.

286
Q

when to repair and when to monitor a AAA

A

under 5 cm -monitor

over 5 cm- surgery

287
Q

what is a AAA and origination

A

greater than 50% dilatation of all 3 layers of the aortic wall; most are abdominal and over 90% below renal arteries

288
Q

AAA commonly associated with what

A

atherosclerosis

289
Q

what is aortic dissection

A

transverse tear in the intima of a vessel that results with blood entering the media, creating a false lumen and leading to a propagating hematoma

290
Q

aortic dissection commonly linked to what

A

HTN

291
Q

common site for aortic dissection; age, gender

A

above aortic valve and distal to left subclavian artery. age 40-60 and greater in females

292
Q

imaging of AAA and aortic dissection

A

AAA: abd ultrasound; aortic dissection is CT angiography

293
Q

BP classification

(3)

A

over 60 y/o: 150/90(no CKD, DM,or HTN)

under 60 y/o: 140/90

over 18 y/o with CKD or DM: 140/90

294
Q

spironolactone SE and uses

A

hyperkalemia, gynecomastia

2nd line for acute pulm edema and CHF

295
Q

meds to reduce mortality in CHF

A

BB with ACE

296
Q

first test to order for CHF.

A

echo. look at EF

297
Q

medication for CHF to add if angina present

A

amlodipine

298
Q

most specific and sensitive cardiac enzyme

A

troponon 1

299
Q

wide split S2 can be what 2 things

A

ASD or PS

300
Q

harsh systolic murmur can be what 2 things

A

AS(heard best at LSB) or COA

301
Q

S2 S3 S4 with

AS, AR, PS, MR, MS,

A

AS and AR S4

PS S3 and S4

MR S2 and S3

MS S2

302
Q

S2 S3 S4 with

AS, AR, PS, MR, MS,

A

AS and AR S4

PS S3 and S4

MR S2 and S3

MS S2

303
Q

pansystolic murmur heard best at apex and rad to left axilla

A

MR

304
Q

rib notching or 3 sign

A

COA

cardio and pulm (22 decks)

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