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IPAP JUNIOR SEM. > CARDIO HIGH NOTES BLOCK I > Flashcards

CARDIO HIGH NOTES BLOCK I Flashcards

1
Q

What are the cardinal S/s of CVD

A 
Dyspnea 
Pain 
Syncope 
Edema 
Palpitations 
Fatigue
Claudication
Fatigue
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2
Q

What does Vindicates stand for

A 
Vascular 
Infection 
Neoplastic 
Drugs/ Degenerative 
Inflammatory/ Idiopathic 
Congenital 
Autoimmune 
Trauma 
Endocrine/ Enviromental 
Something else/ Psychological
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3
Q

What is the earliest and most common S/s of HDz

A

Dyspnea

Think ischemia, HF, Arrhythmia

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4
Q

How does classic cardiac chest pain present

A

Angina, retrosteranal left anterior “crushing” chest pain w/ squeezing, tightness, or pressure.

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5
Q

What is Diamond Criteria

A

Substernal pain
Worse with exertion
relieved by NG

3/3= typical 
2/3= Atypical 
0-1/3= Non Anginal
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6
Q

What does OMI MONA BASH C

A

O2, MONITOR, IV

Morphine, O2, NTG, Aspirin

Beta Blockers, ACE, Statin, Heparin

Clopidogrel

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7
Q

How does Claudication present

A

Pain, burning feelings, in the legs or buttocks when walking

Shiny Hairless blotch foot skin that may get sores

Leg is pale when raised and red when lowered

Impotence in men

Leg pain at night

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8
Q

What are MAjor ASCVD events

A 
Recent ACS within 12 months 
History of MI 
He of Ischemic Stroke 
Symptomatic PVD
Claudication is ABI < 0,85 
Previous revascularization or amputation
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9
Q

What are the Risk Fx for HDz

A 
Age > 65 yrs 
Familial High cholesterol 
Prior Bypass or PCI 
DM 
HTN 
CKD ( GFR 15-59) 
Smocking 
LDL-C above 100 despite statins
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10
Q

How does acute pericarditis present on EKG

A

Diffuse ST elevations with PR depressions in majority of leads

AVR has PR elevation and ST depression

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11
Q

Sympathetic nerves innervate which parts of the heart

A

Sa Node
Atria
AV node
And Ventricles

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12
Q

Parasympathetic nerves innervate which parts of the heart

A

Sa node
Atria
AV node
NO innervation of the Ventricles

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13
Q

What is the major determinant force of cardiac contraction

A

Concentration of Calcium within the cytosol

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14
Q

How do calcium flucutaions effect cardiac contraction

A

Mechanisms that raise intracellular Ca++ concentration enhance force development, whereas factors that lower Ca++ concentration reduce the contractile force.

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15
Q

Absent X waves correspond to..

A

Tricuspid regurgitation

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16
Q

Prominent V waves correspond to …

A

Severe Tricuspid regurgitation

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17
Q

Prominent Y descent waves relate to..

A

Constrictive pericarditis, or restrictive cardiomyopathy
Tricuspid regurgitations
Or ASD

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18
Q

Blunted Y descent waves relate to

A

Cardiac Tamp.
RV ischemia
Or Tricuspid stenosis

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19
Q

What is Kussmals sign

A

Kussmaul’s Sign:
Physical exam finding
-Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity.

  • Kussmaul’s sign is the observation of a JVP that rises with inspiration.
  • The differential diagnosis generally associated with Kussmaul sign is constrictive pericarditis, as well as with restrictive cardiomyopathy
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20
Q

What is hepato-jugular reflex

A

Physical exam technique by which the JVP is observed while pressure is firmly applied to the right upper quadrant, primarily used in patients with subacute right-sided heart failure and/or passive hepatic congestion

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21
Q

High JVP means..

A

Right heart HF, Tricuspid Regurgitation

Tamp.

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22
Q

Low JVP Means

A 
Dehydration 
Bleeding out ( Hypovolemic)
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23
Q

Prominent A waves mean

A

RVH or tricuspid stenosis

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24
Q

Prominent v waves mean

A

Tricuspid Regurgitation

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25
Q

Prominent y waves mean

A

Constrictive pericarditis

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26
Q

What are the fundamental contractile units of the heart

A

Myocardial cells containing myofibirls made of sarcomeres

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27
Q

What does valvular regurgitation lead to

A

Volume overload

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28
Q

What does vulvular stenosis lead to

A

Pressure overload

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29
Q

Murmurs: Harsh/ rumble sound think ..

A

Stenosis

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30
Q

Murmurs: blowing sound think…

A

Regurgitation

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31
Q

What is the s1 sound

A

Normal closure of the MITRAL and TRICUSPID valves

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32
Q

What is the s2 sound

A

NML closure of the AORTIC and PULMONIC valves

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33
Q

Which heart sound is in sync with the carotid pulse

A

S1

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34
Q

What heart sound is the onset of systole

A

S1

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35
Q

What three things can cause S1 to be louder

A

Shortened PR interval
Mild Mitral Stenosis
High Cardiac output states
(Excercise or Tachy HR)

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36
Q

What can cause diminished S1 sounds

A

AV blocks
Mitral regurgitation
Severe Mitral stenosis
Stiff left ventricle

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37
Q

What sound is at the onset of Diastole

A

S2

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38
Q

What are two common causes of widened split of S2

A

RBBB and Pulm stenosis

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39
Q

What is the cause of S2 splitting

A

ASD

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40
Q

What two things cause Paradoxical splitting of S2

A

LBBB and Aortic stenosis

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41
Q

When does S3 occur and why does it occur

A

During Diastole
( ventricular gallop)

Can be NML in children

in adults in indicated volume overload ( CHF or mitral/ tricuspid regurgitation)

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42
Q

When is S4 heard and what does it mean

A

Late in diastole, atria contracting against a stiff non compliant ventricle

“Atrial gallop”

Means pressure overload

Heard best in L Lat Decubitus

Associated most with HTN

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43
Q

Physiological Split of s2 is accentuated how

A

During inspiration

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44
Q

Paradoxical splitting of S2 is accentuated how

A

audible separation of A2and P2duringexpirationthat fuses into a single sound oninspiration, the opposite of the normal situation.

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45
Q

What is the most common cause of paradoxical splitting of S2

A

LBBB

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46
Q

What is the 1st step for a patient with Dyspnea or Chest pain

A

O2
Monitor
IV

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47
Q

What is the most common cause of R HF

A

L HF

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48
Q

How does anemia effect HR and BP

A

Increases both HR and BP

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49
Q

Clubbing of the nail is a sign of

A

HF, Chronic Lung Dz or Liver Dz

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50
Q

What is pulse pressure and what is considered NML

A

Systolic - diastolic

40 is NML

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51
Q

Increased Pulse pressures indicate

A

Aortic regurgitation

Or increases in SV or Inotropy

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52
Q

Narrow pulse pressures indicate

A

Hypovolemia, severe LVF or mitral stenosis

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53
Q

What Dz is associated with Pulsus tardus

A

Aortic Stenosis

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54
Q

Pulsus bisferiens is associated with what Dz

A

Aortic Regurgitation

And HOCM

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55
Q

What Dz is associated with Pulsus altérnans

A

Severe HF

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56
Q

What Dz is associated with Pulsus paradoxus

A 
Cardiac Tamp 
SVC obstruction 
Pulm Obstruction ( COPD, PE)
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57
Q

Hyperkinetic pulses are associated with what Dz

A

High output states ( PDA, Thryotoxicosis, anemia, fever)

“High volume, bounding pulse”

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58
Q

Hypokinetic pulses are associated with what Dz

A

Low output states ( SHOCK)

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59
Q

Abnormal exaggeration (>10 mm Hg) of the normal decrease in systolic blood pressure during inspiration is called and indiactes what

A

Pulsus Paradoxus

Seen in cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy, hypotensive shock, severe obstructive pulmonary disease, large pulmonary embolism

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60
Q

A thrill corresponds to what grade murmur

A

Grade IV to VI

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61
Q

Heaves or Lifts indicate

A

HF

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62
Q

What three things cause Early Sys Ejection murmur

A

AS, PS, and Pulm HTN

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63
Q

What causes a mid systolic ejection sound

A

Mitral valve prolapse

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64
Q

OS is

A

MS

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65
Q

Mitral Stenosis is best heard in what position

A

Left Lateral Recumbent

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66
Q

What tumor sounds like mitral stenosis

A

Left Atrial Myxoma

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67
Q

What does a pericardial knock mean

A

Severe constrictive pericarditis

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68
Q

Where does Aortic stenosis radiate to

A

The neck

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69
Q

Where does aortic stenosis radiate to

A

Axilla

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70
Q

What are the three holosystolic murmurs

A

VSD, Tricuspid and Mitral regurgitation

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71
Q

Increase in venous return (squatting) increases the sound of all murmurs except which two

A

HOCM and Mitral valve Prolapse

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72
Q

Increasing after load (hand grip) accentuates which murmurs

A

AR, MR, and VSD

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73
Q

Hand grip ( increasing after load) diminishes which murmurs

A

AS MS MVP and HOCM

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74
Q

What effect does Amy NItrate have on Murmurs

A

Increases Stenotic murmurs and decreases regurgitation murmurs

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75
Q

In the role of Cardiac, what is NSAIDs used for

A

Pericarditis

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76
Q

What is the PET scan used for

A

Profusion and myocardial viability

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77
Q

What is the MUGA (SPECT) used for

A

Assessment of Left Vent function

assesses myocardial perfusion, Left Ventricular ejection fraction, and regional wall motion by injected technetium-99m-labeled red blood cells (i.e., Sestamibi or other labeled 99mTc agents)

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78
Q

What is the medication for pharm stress testing

A

Regadenoson

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79
Q

What is the injection used during PET to detect profusion

A

Positively charged rubidium- 82 or nitrogen 13

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80
Q

What is the injection used in PET to asses myocardial viability

A

Positively charged fluorine-18-2-deoxyglucose

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81
Q

What is the 1st non invasive rhythm assessment ordered in pts with frequent daily S/s like palpaciones or unexplained syncope

A

Holter Monitor

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82
Q

What are the postive findings in a cardiac stress test

A

Ischemic ECG findings within 3 minutes of exercise or persist 5 min after stopping exercise
ST Depression > 2mm
Systolic pressure decreases during exercise
high grade ventricular arrhythmias develop
Pt unable to exercise for at least 2 min because of cardiopulmonary limitations

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83
Q

Where would tricuspid regurgitation radiate to

A

right side of the chest

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84
Q

Aortic and Pulm regurgitation are best heard where

A

At Erbs point

Diastolic Murmurs

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85
Q

What systolic murmur is heard at erbs point

A

HOCM murmur

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86
Q

Which grade murmurs will have a thrill

A

Grades IV and above

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87
Q

What murmur is classically a decrescendo murmu

A

Early Diastolic murmur of aortic regurgitation

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88
Q

What murmur is classically a Crescendo-decrescendo “diamond shaped” murmur

A

Aortic Stenosis

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89
Q

Where are stills murmurs heard and what do they indicate

A

Best heard w/ the bell at the L lower sternal border as a crescendo-decrescendo sound in adolescent pts

No therapy is needed as it is not pathological

Indicates increase cardiac output or inotropy in children

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90
Q

What happens to stills murmurs when the pt is upright

A

Less preload and flow when upright causes the murmur to disappear

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91
Q

What distinguishes VSD murmur from Tricupsid or mitral regurgitation

A

It does not increases with inspiration or radiate to the axial

Is head at the tricuspid area/ LLSB

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92
Q

When is Aortic regurgitation best heard vs Pulm regurgitation

A

Leaning forward and exhaling for aortic

Leaning forward and inhaling

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93
Q

Where are Austin flint murmurs best heard

A

Associated with severe aortic regurgitation and best heard at the 5th ICS Midclavicular line

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94
Q

Constant boring pain in the chest indicates..

A

Esophageal rupture or pericarditis

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95
Q

Does PE present with a fever

A

YES

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96
Q

What is the most common presentation for a pt with PE

A

Tachycardia, sudden onset of Dyspnea

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97
Q

Hearing murmurs at the aortic area should make you think of

A

Aortic problems./ dissection or MI

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98
Q

Tachycardia with non specific ST changes, Sometime Right Heart strain sign indiactes

A

PE, sometime S1Q3T3 as well

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99
Q

Right axis deviation is a hint to

A

Right heart problems like PE

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100
Q

Diffuse ST elevations with PR depression indicates

A

Pericarditis

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101
Q

For low risk PE order=

High risk=

A

Low risk D Dimer ‘

High risk Contrast CT

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102
Q

What is the causative agent for Rheumatic fever

A

Strep A pharyngitis

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103
Q

What is jones Criteria for Rheumatic Fever

A 
Migratory poly arthritis 
Pancarditis 
SubQQ nodules 
Erythema marginatum 
Sydenham chorea
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104
Q

Rheumatic fever occurs most in what age pts

A

5-15 years old

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105
Q

What is the Tx approach to Rheumatic fever

A

Anti-inflammatory medication

Prophylaxis with PCN

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106
Q

What is the Dx criteria for Rheumatic fever with Jones Criteria

A

2 Major or 1 major 2 minor

MAJOR-
J: Joints 
O: Carditis/ Murmur 
N: Nodules 
E: Erthyema marginatum 
S: Sydenham chorea 
Minor- 
Arthlagias w/out arthritis 
Fever 101 to 104 
Elevated ESR or CRP 
Prolonged PR Intervals 
Rapid Strep
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107
Q

What valves are most effected by Rheumatic Fever/ Rhematic HDz

A

Mitral valve stenosis in number 1

Aortic Valve Dz is second

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108
Q

What is the 5 step clinical approach

A 
Determine anatomy 
Understand impact of medical history 
Form DDx 
Sick Vs non sick triage 
Life threats 1st
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109
Q

What is the equivalent to angina in the legs

A

Claudication

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110
Q

What does Vindicates stand for

A 
Vascular 
Infectious 
Neoplastic 
Drugs/ Degenerative
Inflammatory/ idiopathic 
Congenital 
Autoimmune
 Trauma 
Endocrine/ Environmental
Something Else/ Psychological
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111
Q

Administration of O2 should start at an SPO2 of ____

A

94 or below

Start with NC 2-4 L/ Titrate to 99 %

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112
Q

What effect does increasing the HOB angle do to preload (Orthopnea)

A

Elevation decreases preload and s/s of heart failure

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113
Q

Pts with pericarditis can find relief in what anatomical position

A

Sitting up and leaning forward , as a pt with with ACS will not find relief by doing this

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114
Q

What is the IV morphine regiment for UA/ STEMI

A

2-4 mg IV PRN, may repeat dose of 2-8 mg q 5-15 min Intervals

115
Q

What is the nitro dose for UA/ STEMI

A

0.3-0.6 sublingual q5min PRN

Max 3 doses witching 15 min

116
Q

What are the cardinal S/s of ACS

A 
Chest pain 
Dyspnea 
Palpitations
Syncope 
Edema
117
Q

Non pitting edema is a a sign of

A

Lymphedema

118
Q

A pt with a shiny hairless blotchy skin on the foot or leg, and the leg is pale when elevated and red when lowered is a sign of

A

Claudication, Vasucalar Dz

119
Q

what is the greatest modifiable risk factor for ACS/ HDz

A

Smoking

120
Q

What is metabolic syndrome

A 
HTN medication or HTN 
Hypertryglyceridema 
HDL less than 50 
Fasting Glucose greater than 100 (DM) 
Fat Waist
121
Q

What are the age cut off numbers for traditional RSK factors for CAD

A

Men 45 women 55

First degree relative at 55 for men
And 65 for women

122
Q

How should you interpret the following CAC scores
CAC=O
CAC 1-99
CAC 100 or over

A

O= Decrease RSK of CVD, no statin required

1-99= favors statin, especially if older than 55

100= Statin therapy required

123
Q

What is the alarm number for a CRP in CVD

A

Greater than 2 mg/L

124
Q

What lipoprotein A number is alarming for CVD

A

Greater than 50 with a FMHx

Normal value is 10mg/dl

125
Q

How is ApoF testing conducted and what is the alarm value

A

Testing is reserved for pts with High Triglycerides >200 mg/dl

Alarm= > 130 mg/L

126
Q

A ApoB of 130 = a LDL of…

A

Greater than 160 ( RSK for CVD)

127
Q

An ABI of less than 0.9 indicates

A

Occlusive arterial Dz

128
Q

Low QRS volatage, Friction Rub, Becks triad, and pulsus paradoxus are all signs of..

A

Pericardial effusion

129
Q

What nerves modulate electrical impulses and conduction to the SA and AV nodes

A

VAgal efferent fibers

130
Q

The SNS inervates the heart via what receptors

A

B1

131
Q

JVP waveforms reflect pressure in what cardiac structure

A

Right atrium

132
Q

How are a waves in AFIB

A

Absent

133
Q

JVP that increases with inspiration is called what and indicates?

A

Kussmal sign, indicates; Pericarditits or restrictive cardiomyopathy’s

134
Q

What is the S1 sound

A

NML closure of the Mitral and tricuspid Valves ( AV valves)

135
Q

What is the S2 sound

A

NML closure of the Aoritc and Pukmonic valves ( semilunar valves)

136
Q

Ejection Clicks indicate

A

Aortic or pulm stenosis, or dilation of the aortic root or plan artery

137
Q

Mid to late clicks indicate

A

Mitral or Tricuspid valve prolapses

138
Q

Openings snap is

A

Mitral stenosis

139
Q

IN adults what does the low pitch S3 sound indicate

A

HF or Volume overload

140
Q

What does the low pitched S4 sound indicate

A

Reduced Vent Compliance

141
Q

What 2 conditions cause a wide split of S2

A

RBBBB and Pulm Stenosis

142
Q

What causes a Fixed S2 split

A

ASD

143
Q

What causes a paradoxical splitting of S2

A

LBBB or Aortic Stenosis

144
Q

Is S3 a diastolic or Systolic sound

A

Diastolic, its rapid filling of the ventricles

145
Q

What position is S4 best heard in

A

Left lateral decub

146
Q

Chronic HTN leads to what pathological heart sound

A

S4 ( atrial gallop)

147
Q

What is the primary means of establishing a specific Dx

A

Physical examination

148
Q

What is the normal pulse pressure

A

40 mmHG ( Sys-Dias)

149
Q

Pulses should Always be examined for what 5 criteria

A 
Rate
Rhythm 
Strength 
Contour 
Symmetry
150
Q

The diacritic notch correlates to what valve closing

A

The aortic valve

151
Q

A slow rising pulse, aka pulsus tardus indicates what Dz

A

Aortic Stenosis

152
Q

A bi or triffid pulse ( Pulsus Bisferines) incidactes what Dz

A

Severe Heart Failure

153
Q

Pulsus paradoxus (change in pulse pressure/amplitude with inspiration) indicates what Dz

A 
Cardiac Tamp
SVC Obstruction
Pulm Obstruction ( PE/ COPD)
154
Q

Hyperkinetic pulses indicate what Dz

A

PDA, Thyrotoxicosis, Anemia, fever

155
Q

How does the apical pulse differentiate with Volume Overload vs pressure overload

A

Volume: Hyperdynamic Apical pulse (S3)

Pressure: Sustained Apical pulse (S4)

156
Q

Pericardial Knock indicated what Dz

A

Constrictive pericarditis

157
Q

Where does the VSD murmur radiate to and what causes it to increase or decrease

A

Murmur intensity does not increase with inspiration or radiate to the axilla, which distinguishes it from tricuspid and mitral regurgitation, respectively.

158
Q

Non specific ST changes, w/ Right axis deviation should think..

A

PE

159
Q

What does HEART stand for in the HEART score

A 
History 
ECG 
AGE 
RSK Fxs 
Troponins
160
Q

What are the primary indications for CT in Cardiac PTs

A

1) aortic aneurysm or dissection suspected and 2) differentiating diseases of the pericardium

161
Q

What are electron beam CRT scanners main use

A

To evaluate pericardial Dz and Cardiac tumors

162
Q

Metallosis, amyloidosis, and sarcoidosis are best seen with what kind of imaging study?

A

MRI

163
Q

Are Marfans pt would best benefit from what kind of cardiac imagining

A

MRI

164
Q

What are the indications for Echocardiograms

A

Valvular lesions, Ventricualr assessment
CAD
Cardiomyopathy
Pericardial Dz

165
Q

What is the bubble study

A

simultaneous venous saline agitation in order to identify an intracardiac shunt in a TTE

166
Q

What are the absolute contras to stress tests

A

Recent STEMI < 2 days
High risk ACS ( perform coronary angiogram)
Active Heart Failure (decompensated)
Active endocarditis
Severe Aortic Stenosis, Symptomatic HOCM
Acute myocarditis or pericarditis
Physical disability that precludes safe and adequate testing

167
Q

What is the Duke Treadmill criteria

A

Duke Treadmill Score = Minutes of Exercise (Bruce protocol) - (5xmax ST deviation in mm)-(4xexercise angina)

168
Q

What is Regadenoson

A

An adenosine receptor agonist used in the SPECT scan , (VASODILATOR)

169
Q

What probability of CAD is a pt with typical angina (male over 40 or female over 60)
W/ DM, smoker, or hyperlipidemia

A

HIGH RISK take straight to catch lab or admit

170
Q

What probability of CAD is a pt with typical angina ( younger than 40 male or 60 female)

A

Intermediate risk, Order a stress test

171
Q

Reliable stress test results require that the pt reach what level of the predicted maximum HR

A

85 percent

172
Q

How do you calculate a duke treadmill score

A

Minutes of exercise- (5x max ST deviation in mm)- (4x exercise angina)

173
Q

What are the markedly postive findings of a cardiac stress test

A

Ischemic ECG findings within 3 minutes of exercise or persist 5 min after stopping exercise
ST Depression > 2mm
Systolic pressure decreases during exercise
high grade ventricular arrhythmias develop
Pt unable to exercise for at least 2 min because of cardiopulmonary limitations

174
Q

What are the 5 major Jones Criteria for Rheumatic Fever

A 
Migratory Poly Arthritis 
Pancarditis 
SubQ nodules 
Erthyema marginatum 
Sydenham chorea
175
Q

What does the JONES neumoníc stand for

A 
Joint ( migratory) 
O- Carditis 
N- nodules 
E- Erthyema marginatum 
S- Sydenham Chorea
176
Q

What is the causative agent of Rhematic Fever

A

Group A strep including pharyngitis assoc w/ scarlet fever

177
Q

Rheumatic fever leads to Rhuematic HDz which effects which valves the most

A

Mitral VAlve the most

Second is Aoritc Vavle

178
Q

What does the HEARTFAILED neuronic stand for

A 
Hypertension 
Endocarditis 
Anemia 
Rheumatic Heart 
Thyrotoxicosis 
Failure to take meds 
Arrhythmia 
Infection/ Ishcemia/ infarct 
Lung Problems 
Endocrine 
Dietary indiscretion
179
Q

A pt with Progressive Dyspnea on exertion and hemoptysis likely has what valvular heart Dz

A

Mitral stenosis

180
Q

On palpitations of the pericordium, a Right ventricular heave suggests

A

Mitral stenosis

181
Q

A patient with Severe MS ( MVA< 1.5 cm) symptomatic stage D a pliable valve, no clots, and a <2+ MR are candidates for what Tx of Rhumenatic Heart MS

A

Percutaneous Mitral balloon
Commissurotomy

IF they have severe HF symptoms and are a surgical candidate then they get MV surgery

182
Q

What is the TX approach for a pt with VHD and Afib

A

IF the have Rhematic MS then Long term Vitmain K antagonist ( HEPARIN)

183
Q

A PT that presents with a new murmur and fever you should suspect

A

Endocarditis

Also may present with Janeway lesions

184
Q

Non infective endocarditis can be caused by..

A

Non bacterial thrombi
Systemic Lupus
Pancreatic adenocarcinoma

185
Q

How are Oslers Nodes different than Janeway lesions

A

Oslers nodes are painful and caused bu bacterial AG-Ab complexes

Janeways are non tender and caused by thrombic emboli

186
Q

What is the criteria to Dx endocarditis

A

2 major Dukes
1 major and 3 minor dukes
Or 5 minor dukes criteria

187
Q

What are the major dukes criteria

A 
Blood cultures (positive) 
Echocardiogram
188
Q

What are the 5 minor Dukes criteria for endocarditis

A

Cardiac lesion/ PHx of IV drug use

Fever

Evidence of septic emboli
( Janeway lesions, Pulm Infarcts, Conjunctival Hemorrhages)

Auto immune conditions
(Glomerulonephritis, Oslers nodes, Roths spots, Rhuematoid)

Serological evidence

189
Q

When inspecting for endocarditis ( valvular) when would you go straight to TEE

A

In pts with prosthesis valves, implantable cardiac devices, prior valve ABNMLS, obese or have chest wall deformities

190
Q

What is the most common affected valves of endocarditis

A

Mitral (most) or bicuspid aortic valves

191
Q

In a pt with endocarditis and IV drug use what is the most common effected valve

A

Tricuspid

192
Q

In a pt with Endocarditis caused by Viridians strep or Strep Sanguiins what is the most likely causes (dental procedures)

A

Older pts with native valve dz develop endocarditis after dental procedures

193
Q

Endocarditis from Staph Epi effects what valves the most

A

Prosthetic valves ( Dirty IV)

194
Q

Endocarditis from genital urinary catheretiers is caused by what agent

A

Group D Enerococcal Endocarditis

195
Q

Pseudomonas/ Candida (IV drug use) effects what valves most during endocarditis

A

Tricuspid Valves

196
Q

Patients with Q fever and endocarditis most likely got it from what

A

Coxiella Burnetti ( Sheep, COWS, Goats)

197
Q

Streptococcus Gallolyticus endure endocarditis is associated with what type of cancer

A

Colorectal cancer (needs colonoscopy screening)

198
Q

BArtonella endcuced endocarditis ( Cat infection) effects what valves most

A

Tricuspid Valves

199
Q

What bacteria is associated with Endocarditis, old people and dental procedures

A

Viridans strep

200
Q

Pts with endocarditis that have vegetation’s greater than 10mm, abcesses, severe valve damage, Dehiscence, heartfauliure or Recurrent septic emboli are candidates for..

A

Surgery

201
Q

HRpEF is equal to

A

60% and greater

202
Q

HRrEF is equal to

A

40% and less

203
Q

What is the relationship between left ventricular dysfunction and BNP

A

Its more specific to LV Dysfunction in HEART Failure States

204
Q

Aldosterone has what effect

A

Increases Na retention in exhcannge for potassium (increases fluid level)

205
Q

Angiotensin II has what effect

A

Leads to Peripheral vasoconstriction

206
Q

What is PRO BNP used to discriminate against

A

Cardiogenic vs non cardiogenic pulmonary edema

207
Q

What are the cutoff values for PRO BNP for cardiogenic pulm edema in 50 yo, 50-75 yo, and older than 75 yo

A

50 and younger : 450 pg/nl;
50-75: 900
Older than 75: 1800

208
Q

What is eccentric hypertrophy

A

Increased ventricular chamber radius and wall thickness

209
Q

What is concentric hypertrophy

A

Increases wall thickness without proportional chamber dilation

210
Q

A pt with Dyspnea, orthopnea, nocturnal Dyspnea and fatigue, Diaphoretic, Tachypnea and Tachycardia, Pulmonary Rales and a S3/S4 gallop is what sided HF

A

Left Sided

211
Q

A pt with peripheral edema, JVP, RUQ discomfort, Hepatic enlargement, Ascites is what sided HF

A

Right Sided

212
Q

HIGH YEILD NUEMONIC

HEARTFAILED

A 
HTN 
Endocarditis 
Anemia 
Rhuematic HDz 
Thyrotoxicosis 
Failure to take meds 
Arrhythmias 
Infection/ MI, Ishcemia 
Lung Problems ( COPD, PE, Pneumo) 
Endocrine D/o 
Dietary indiscreción
213
Q

S3 is pathological for what

A

HF in adults

214
Q

What are the top three causes of HFrEF

A

CAD, Valvulr D/o, HTN

215
Q

What is Framingham Criteria

A

Dx made with 2 major or 1 major 2 minor criteria

MAJOR: 
Acute Pulm Edema 
Cardiomeg 
Hepatojux reflex 
JVD 
Orthopnea or Nocturanl 
Rales 
S3 
Minor: 
Ankle Edema 
Dyspnea 
Heptmeg 
Nocturnal cough 
Pleural Effusion 
Tachycardia
216
Q

S3 vs S4 is common with which form of cardiomyopathies

A

S3 dilated

S4 Hypertrophioc Cardiomypthies

217
Q

High output HF is associated with what S/s

A

Tachycardia

218
Q

What are the #1 and #2 most common Causes of sudden cardiac death

A

Cardiomyopathy is the 2nd most common cause of sudden death

(** Ischemic heart disease is #1**)

219
Q

What cancer drug can cause Cardiomyopthy

A

Doxicirubicin

220
Q

Pts with dilated cardiomyopathies are most likey to die from what abnormalities

A

Arrhythmic D/o ( VTACH, VFIB)

221
Q

Cossackie B virus is heavily associated with…

A

Myocarditis and Pericarditis

222
Q

An EKG with LVH/ LAD, prominent q waves in II, III, and AvF, I AVL, V5-V6, and septal Qs

A

Hypertrophioc Cardiomyopathy

223
Q

What is the 1st line Tx for HCM

A

BB and alternative CCB (Verapamil) and Amioderone

Myomectomy,

224
Q

PTs with EF less than 35 and with 1 year prognosis, 40 days after MI, should get..

A

ICD

225
Q

What are the major IND for ICD placement

A

Unexplained syncope
LV wall thickness greater than 30 mm

Or non sustained VTACH

226
Q

Apple green biference is hallmark for

A

Amyloidosis, and Restricitive Cardiomyopathy

227
Q

What is a aldosterone antagonist

A

Spirinolactone (Potassium Keeping) diuretics

useful in Stage C HFrEF pts with good CrCL and Adequate K+

228
Q

Pts in Stage C HFrEF on a ACEI or ARB with no Contra to ARB or Sacubitril what is the Standard HF treatment

A

ARNI (Sacrubitril + Valsartran)

229
Q

A black pt in Stage C HFrEF gets what meds

A

Nissoprusside

230
Q

A pt with Stage C HFeRF with a EF less than 35, 1 year survival and 40 days post MI is a candidate for what intervention

A

ICD

231
Q

A pt with LVEF less than 35%, NSR and LBBB is a candidate for what intervention

A

CRT (Pacing)

232
Q

A Group 1 pulm HTN pt due to scleroderma presents with what 5 conditions

A 
Calcinosis 
Raynauds Syndrome 
Esophageal Dysmotility 
Sclerodactily 
Telangiectasia
233
Q

What is an infection to the endocardia surface, that particularly impacts prosethitc valves, damaged native valves, and native valves.

A

Endocarditis

234
Q

What are the two types of endocarditis

A

Infectious and non infectious

235
Q

What are the RSK Fxs for infective endocarditis

A 
Dental Surgery, Wounds 
IV Drug use 
IV Catheters 
Immunocomp pts 
Valvular or congenital HDz 
Previous Hx of endocarditis, pacemaker, or prosethic valve
236
Q

What are the conditions that promote non infectious endocarditis

A

Hypercoag states ( Cancer, pregnancy)

Ag-Ab complex ( systemic lupus)

237
Q

A pt with a fever and a new heart murmur presents with Septic emboli or type III hypersensitivity reaction (Ag-Ab complex, aka lupus).. what is the heart condition that should be suspected

A

Endocarditis

238
Q

Endocarditis of the left valves in the heart, can create septic emboli that can lead to

A

Stroke

239
Q

Endocarditis of the right valves of the heart can create septic emboli that can lead to

A

PE

240
Q

Describe splinter hemorrhages and what are they a S/s of

A

Splinter hemorrhages are longitudinal red brow hemorrhages under the nail that look like splinters

It is a S/s of septic embolus from Endocarditis

241
Q

Describe Janeway lesions and what are they a S/s of

A

Jane way lesions are NON TENDER, small macular or nodular lesions of the palms or toes

They are a S/s of septic emboli from endocarditis

242
Q

Septic emboli from endocarditis can effect the eyes how..

A

Conjunctival hemorragias

243
Q

How will infective endocarditis present on an EKG

A 
Heart Blocks
Conduction Delays (effecting the valves) 
Isolated prolonged PR Intervals

Can also present with Cardiac ischemia from septic emboli in the coronary circulation

244
Q

What is the first branch off the aorta

A

Coronary circulation

245
Q

Bacterial Ag-Ab complexes from infectious endocarditis can effect the skin, the kidney, and the eyes in what three specific ways

A

Skin: Oslers nodes - PAINFUL tender lumps on the fingers or toes. They are red-purple, raised, and often with a pale center.

Kidneys: Glomerulonephritis

Eyes: Roths Spots- seen most commonly in acute bacterial endocarditis. A red spot caused by a hemorrhage, with a characteristic pale white center.

246
Q

Describe an Oslers Node

A

Osler nodes are red-purple, slightly raised, tender lumps, often with a pale center.

Pain often precedes thedevelopmentof the visiblelesionby up to 24 hours.

They are typically found on the fingers and/or toes.

247
Q

Explain Roths spots

A

A Roth spot, seen most commonly in acute bacterial endocarditis is a red spot (caused by hemorrhage) with a characteristic pale white center.

This white center usually representsfibrin-platelet plugs

248
Q

Duke criteria is specific to what Dz process

A

Endocarditis

249
Q
  1. Cardiac lesions or Hx of Rec. Drug use
  2. Fever
  3. Evidence of Septic Emboli
  4. Autoimmune Conditions (Ag-Ab complexes)
  5. Serological Evidence

There are what criteria

A

5 minor Dukes Criteria

250
Q

In endocarditis, how many sets of blood cultures need to be collected

A

3

1 aerobic, 1 anaerobic, 1 fungi

251
Q

How will endocarditis present on Echocardiography

A

Presents with valvular vegetations,

Valular regurgitation, MVP, or stenosis.

252
Q

When would transesophageal echo be done first as opposed to transthoracic ?

A

When the pt is obese, has a chest wall deformity, has a prosethic valve, implanted cardiac device, or prior valve abnormalities

253
Q

An older pt with native valve Dz ( endocarditis) post dental procedure is likely caused by what bacterial agent

A

Sterp Sanguinis or Viridans Strep

254
Q

Endocarditis in IV drug abusers effects what valve? From what agents?

A

Tricuspid Valve

And if it’s Methicillin Senstitive ( MSSA) this its Staph, Aureus.

If its not Staph then its Psuedomonas or Candida

255
Q

IV drug users are at risk of developing Endocardits from what agents

A 
Staph Aureus (MSSA) 
Psuedomonas 
Candida
256
Q

Endocardits acquired in the hospital or from surgery are likely caused by what agent

A

MRSA

257
Q

What is the agent that is most likely to cause endocarditis in a prosthetic valve

A

Staph Epi.

Think dirty catheters, valve surgery, biofilm

258
Q

A pt with a foley or post GI surgery is likely to develop Endocardits from what agent

A

Enterococcal ( Group D)

259
Q

What pts are at most risk to developing endocarditis from Coxiella burnetti

A

Farmers (Cows, sheep, goats)

Immuno comp or preg pts

(These pts develop Q fever)

260
Q

Q fever is associated with

A

Coxiella burnetti

261
Q

Pts that develop Endocardits from Strep Gallolyticus, must also be screened from what associated conditions

A

Colorectal cancer ( need colonoscopies after endocarditis Tx)

262
Q

What is the agent associated with endocarditis from a cat infection and what valve does it infect most

A

Bartonella and the tricuspid valve

263
Q

What is the Tx approach to infective endocarditis

A

Suspected?
Dukes? (2 major? 1 Major 3 minor? 5 minor?)

Stable? What for cultures
Unstable?
-Then Tx 2-6 weeks

(Prevention is Amoxicillin/ Ampicillin 1 hr before procedures)

264
Q

What is the protein in Rheumatic fever that looks/ mimics protiens on the myocardium, heart valves, joints, skin, and brain…

In short what is the protein that is the cause of Rhuematic fever turning into Rhuematic heart Dz

A

The M protiens on GROUP A sterp infections

265
Q

Jones criteria is specific to what Heart Dz

A

JONES!!

Remember dukes is Endocarditis

266
Q

What are the S/s of Rhuematic fever ( Aka jones criteria)

A 
Migratory Polyarthritis 
Pancarditis 
SubQ nodules 
Erthyema Marginatum 
Sydenham Chorea
267
Q

Chronic Rheumatic HDz presents with what valvular abnormalities

A

Regurgitation or stenosis of the Mitral or Aortic Valves

268
Q

Does group A strep cause Endocarditis or Rhuematic Fever

A

RHeumatic Fever!!

269
Q

What stage of VHD is symptomatic

A

Stage D

270
Q

What stage of VHD meet criteria but are asymptomatic

A

Stage C

271
Q

What stage is “ pts with progressive VHD yet asymptomatic”

A

Stage B

272
Q

What stage of VHD is “at risk”

A

Stage A

273
Q

What are stages A, B, C, and D of VHD

A 
A; At risk 
B: Progressive 
(Mild to moderate severity, asymptomatic) 
C: Severe VHD, Aysmptomotis 
-C1: LV/RV compensated 
-C2: LV/RV decompensated 
D: symptomatic severe
274
Q

MS leads to what major LV problems

A

LA dilation, Increased pressure in the LA and Increased pressure in the pulmonary vessels, which can lead to hemoptysis, and eventually Corpulmonale HF

275
Q

What physical exam finding is indicative of MS

A

Right Vent Heave (with Pulm HTN), PMI may also be decreased

276
Q

What atrial arrhythmia is associated with MS

A

A fib from a dilated L atria

277
Q

This valve replacement requires life long Anticoagulant, last q-years, and has an audible click

A

Mechanical prosthetic valve

278
Q

This valve replacement last 8-10 years, does not require anticoagulant, and has no audible click

A

Biological prosthetic valve

279
Q

When would you do a Percutaneous Mitral balloon for RH mitral stenosis

A

A pt with Sever MS (MVA less tha 1.5 cm), Stage D VHD, has a pliable valve, with out clots, and Less than 2+ MR.

280
Q

Tx approach for RHDz MS in a pt with Class D VHD, MVA less than 1.5cm, with a pliable valve, no clots and less than 2+ MR

A

PerC Mitral Ballon Commissure

281
Q

When would a pt need MV surgery in RHDz MS

A

Severe MS (MVA less than 1.5 cm)
Stage D with out a Pliable Valve,
+presence of clots
And greater than 2+ MR

NYHA III-IV and is a surgical candidate

282
Q

Tx A pt with VHD and AFib +RHDz s

A

Long Tterm VKA (Anticoagulant)

283
Q

Pts with Afib require what medication

A

Anticoagulant

IPAP JUNIOR SEM. (43 decks)

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