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CC Internal Med > Cardio from QBank > Flashcards

Cardio from QBank Flashcards

1
Q

Which arrhythmia is most specific for digitalis toxicity?

A

Atrial tachycardia with AV block

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2
Q

Chronic protozal disease caused by Trypanosoma cruzi

A

Chagas disease - causes megacolon/megaesophagus and cardiac disease (CHF) - organism common in Latin America

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3
Q

Leading cause of secondary hypertension

A

Renal artery stenosis

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4
Q

In patients with aortic coarctation, which arm has the higher BP?
What is 1 other finding?

A

R > L

Brachial-femoral pulse delay

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5
Q

Next step if premature atrial beats are found in a pt

A

Do not require any follow-up or Tx (benign)

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6
Q

S4 occurs as a result of ______.

A

Left atrial kick against a stiff left ventricle (eg. due to hypertrophy)

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7
Q

3 most common causes of aortic stenosis in general population

A

senile calcific aortic stenosis
bicuspid aortic valve
rheumatic heart disease

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8
Q

Murmur of hypertrophic cardiomyopathy

A

systolic cresc-decresc murmur & S4, best heard at lower L sternal border, no radiation

(aortic stenosis: best heard at upper L sternal border and radiates to carotids)

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9
Q

Mitral stenosis Sx (3)
Often occurs in the context of ____.
Patients are at higher risk of _____.

A

Exertional dyspnea
Nocturnal cough
Hemoptysis (this in particular should raise suspicion of mitral stenosis)

Rheumatic fever

AFib (due to LA dilatation)

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10
Q

Most typical Sx of hypertrophic cardiomyopathy (3)

Type/location of murmur that suggests this Dx in a young person? What causes the murmur?

Another murmur that can occur?

A

Syncope, angina, paliptations

Cresc-decresc murmur that begins after S1, best heard at left lower sternal border, intensifies with Valsalva; caused by hypertrophied IVS and mitral leaflet motion abnormality (“systolic anterior motion”) causing increased outflow obstruction.

Mitral regurg due to dilation of mitral annulus (holosystolic, at apex, radiation to axilla)

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11
Q

Causes of secondary hypertension (8)

A 
Renovascular disease
Renal parencymal disease
Primary aldosteronism
Pheochromocytoma
Cushing's
Hypothyroidism
Primary hyperparathyroidism
Coarctation of the aorta
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12
Q

Traits of primary aldosteronism (3)

A

Easily provoked hypokalemia
Slight hypernatremia
Hypertension with adrenal incidentaloma

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13
Q

Traits of pheochromocytoma (3-5)

A

Paroxysmal elevated BP with tachycardia
Pounding headache, palpitations, diaphoresis
Hypertension with adrenal incidentaloma

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14
Q

Traits of Cushing’s (3-7)

A

Central obesity, facial plethora
Proximal muscle weakness, abdominal striae
Ecchymosis, amenorrhea/erectile dysfnc
Hypertension with adrenal incidentaloma

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15
Q

Hypothyroidiam traits (6)

A

Fatigue, dry skin, cold intolerance

Constipation, weight gain, bradycardia

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16
Q

Primary hyperparathyroidism traits (3)

A

Hypercalcemia (polyuria, polydipsia)
Kidney stones
Neuropsychiatric presentations (confusion, depression, psychosis)

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17
Q

Renovascular disease traits (4-5)

A

Severe hypertension (>180mmHg systolic and/or >120mmHg diastolic) after age 55
Possible recurrent flash pulmoary edema or resistant heart failure
Unexplained rise in serum creat (usually >30%)
Abdominal bruit, asymmetric kidney size

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18
Q

Resistant hypertension is ____

A

Persistent hypertension despite using 3 or more antihypertensive agents of different classes, one being a diuretic. All pts should be evaluated for secondary causes of hypertension; renal artery stenosis is the most common and most correctable cause.

19
Q

Meds/foods to hold prior to stress test:

  • for 48 h (3)
  • for 48h prior to vasodilator stress test (1)
  • for 12h before vasodilator stress test (1)
  • continue (5)
A
  • for 48 h: beta-blockers, Ca channel blockers, nitrates
  • for 48h prior to vasodilator stress test: dipyridamole
  • for 12h before vasodilator stress test: caffeine
  • continue: ACEi, ARB, digoxin, statins, diuretics (but diuretics may cause hypoK leading to ST depression and false positive - ensure K is OK)

Some drugs may be continued in pts undergoing stress testing to evaluate efficacy of antianginal Tx.

20
Q

Atrial septal defects produce a fixed splitting of which heart sound?

A

S2

21
Q

Pulses paradoxis is _____ and is associated with _____.

A

Fall in systemic arterial BP by >10mmHg during inspiration, often assoc with cardiac tamponade.

22
Q

Common causes of aortic regurg (3)

A

Aortic root dilation (e.g. Marfan, syphilis)
Post-inflammatory (e.g. rheumatic heart disease, endocarditis)
Congenital bicuspid aortic valve

23
Q

Clinical features of aortic regurg (4)

A

Diastolic decrescendo murmur
Widened pulse pressure (increased SBP, decreased DBP)
Collapsing/water hammer pulse
Heart failure signs/Sx

24
Q

Initial empiric Tx of infective endocarditis (after obtaining cultures)

A

IV vancomycin (covers Staph, Strep, enterococci)

25
Q

Tx of infective endocarditis if cultures are found to be penicillin-sensitive (2)

A

IV aqueous penicillin G q4-6h for 4wks, OR

IV ceftriaxone DIE for 4wks (easier since DIE)

26
Q

Alcoholism has what cardiac manifestations?

A

Alcoholic cardiomyopathy = Dilated cardiomyopathy secondary to alcoholism, causes CHF

27
Q

Myxomatous degen of mitral valve and chordae tendinae can lead to ____; causes what sound?

A

Mitral prolapse; midsystolic click at apex

28
Q

5 Ps that point toward Dx of embolic occlusion

A 
pain
pulselessness
paresthesia
poikilothermia (coldness)
pallor
29
Q

Cilostazol mech and use

A

Inhibits platelet aggregation, causes vasodilation; sometimes used to Tx chronic claudication

30
Q

Drug of choice in pts presenting with hypertension and benign essential tremor

A

propanolol

31
Q

Essential tremor is ______.

A

Postural tremor (not a resting tremor like in Parkinson), usually disturbs fine motor tasks, typically inhibited by small amount EtOH, usually familial, unclear pathophysiology.

32
Q

ANP is released from ____ and BNP is released from ____.

A

ANP - atria

BNP - ventricles (in response to volume overload)

33
Q

Most common mechanism underlying paroxysmal supraventricular tachycardia is _____.

A

Re-entry into the AV node. (Tx: decrease AV node conductivity, eg. vagal maneuvers increase vagal tone and decrease conduction through AV node; adenosine).

34
Q

The most effective nonpharmacologic Tx to decrease BP in overweight pts: weight loss or stop smoking?

A

> 10% weight loss

35
Q

When aortic regurg is due to valvular disease, the murmur is best heard at _____, but when it is due to aortic root disease, it is best heard at _____.

A

left sternal border (3-4th interspaces)

right sternal border

36
Q

How can infection cause AV block or other conduction abnormalities?

A

Perivalvular abscess (e.g. complicated aortic valve endocarditis)

-new conduction abnormality in pts with known infective endocarditis should raise suspicion of perivalvular abscess

37
Q

Digoxin toxicity typically presents with ___ (5-6).

A 
nausea
vomiting
decreased appetite
confusion
weakness
maybe visual Sx (scotomata, blurry vision)
38
Q

Acute dyspnea in hospitalized pt DDx (7)

A 
Arrhythmia
Bronchoconstriction (acute-onset dyspnea with wheeze and prolonged expiration - can be exacerbated by ASA or B-blockers in asthmatics)
CHF / hypervolemia
Infection / pneumonia / aspiration
Pleural effusion
PE
Anxiety
39
Q

1st line Tx for stable chronic angina Sx

A

Beta-blocker - except if hypotensive or bradycardic; can later combine with Ca channel blocker (diltiazem, felodipine) or long-acting nitrates (isosorbide dinitrate, isosorbide mononitrate)

Short-acting nitrates (amlodipine) are indicated in ACUTE angina

40
Q

Amiodarone causes which side FX? (2 groups)

A

Amiodarone-induced hypothyroidism (fatigue, memory loss, constipation, weight gain, dry skin, …) and hepatocellular injury

41
Q

Beck’s triad? What is it associated with?

A

Hypotension, distended neck veins, muffled heart sounds

Cardiac tamponade

(Pulsus paradoxus is also a common finding)

42
Q

Variant angina (Prinzmetal’s): cause? Tx?

A

Due to coronary vasospasm; usually young females, greatest risk factor is smoking; lack other cardiovascular risk factors; typically occur at night (midnight-8am), can be assoc with transient ST elevations

Tx: stop smoking; Ca channel blockers or nitrates

43
Q

In AFib with rapid ventricular response, rate control should be attempted initially with ______ (2).

In hemodynamically unstable patients with rapid AFib, ______ is indicated.

A

Beta blockers or calcium channel blockers.

Immediate synchronized electrical cardioversion

44
Q

Aortic dissection CXR finding

A

Mediastinal widening

CC Internal Med (6 decks)

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