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cardio and pulm > cardio misc > Flashcards

cardio misc Flashcards

1
Q

HOCM PE

A

apical lift from LVH, systolic ejection murmur near apex and bisferens carotid pulse

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2
Q

apical lift from LVH, systolic ejection murmur near apex and bisferens carotid pulse

A

HOCM

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3
Q

EF in cardiomyopathies

A

dec in dilated; increase or nml in hypertrophic; nml in restrictive

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4
Q

Paroxysmal supraventricular tachycardia tx

A

adenosine or 2nd line BB or CCB; do valsalva, coughing, leaning, splash ice water

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5
Q

avoid what in aortic dissection

A

diazoxide and hydralazine

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6
Q

pale, hypoTN, angina, syncope

A

v tach; cardiovert if unstable; or do lido, amio, procainamide

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7
Q

syncope, no BP, no pulse

A

v fib; defib and ACLS

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8
Q

orthostatic hypoTN tx

A

hydralazine, nitrates, niacin, CCB

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9
Q

acute sys CHF tx

A

loop with ace. NO BB

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10
Q

chronic sys CHF tx

A

BB with other meds. NO CCB

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11
Q

non prod cough, JVD, PND, exertional dyspnea, S3 maybe S4

A

systolic CHF

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12
Q

diastolic CHF tx

A

diuretics first line then maintain BP. No digoxin

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13
Q

CP in the early morning and tx

A

think prinzmental angina. tx with CCB or nitrates

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14
Q

STEMI and NSTEMI muscle

A

STEMI is transmural and NSTEMI is subendocardial

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15
Q

myoglobin

A

initial elevation at 1-4 h, peaks at 6-7h, and returns to normal with 24 hr

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16
Q

troponin 1

A

initial elevation at 3-12 h, peaks at 24h, and returns to normal with 5-10 days

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17
Q

troponin T

A

initial elevation at 4-8 h, peaks at 12-48h, and returns to normal with 5-14 days

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18
Q

CK-MB

A

initial elevation at 3-12h, peaks at 24h, and returns to normal with 48-72 hr

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19
Q

pulm atresia murmur

A

depends on present of tricuspid regurge; single S1 or single S2, hyperdynamic apical pulse

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20
Q

tetrology of fallot

A

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

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21
Q

hypoplastic lt heart syndrome signs

A

shock, early heart failure, respiratory distress, single S2

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22
Q

transposition of great vessels PE and signs

A 
systolic murmur(VSD) or systolic ejection(pulm stenosis)
 and *cyanosis in newborn; loud S2 if large VSD
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23
Q

ASD murmur; affects what compartment

A

systolic ejection murmur second LICS; wide fixed split S2

*~RBBB, ~RVH

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24
Q

PDA definition, PE, and tx

affects what compartment

A

failure to close or delay in closing channel bypassing the lungs(allowing now placental gas exchange during the fetal state),

PE: machine like murmur, thrill, wide pulse pressure.

tx: NSAID for prostaglandins

LV failure, may have pulm HTN

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25
Q

COA involves what.

PE

CXR

TX

A

narrowing the the proximal thoracic aorta

PE: delayed or weak femoral pulse, harsh systolic murmur

CXR: 3 sign or rib notching

TX: under 50 then surgery; over 50 then stent

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26
Q

medication for aortic/mitral valve d/o

A

(pulm HTN and dysrhythmias)

diuretics and vasodilators for pulm congestion; digoxin and beta blockers for dysrhythmias

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27
Q

torsades medication tx

A

beta blockers, magnesium, temporary atrial or ventricular pacing.

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28
Q

pulsus paroxus

A

decreased systolic BP > than 10 mm hg inspiration

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29
Q

Pulsus parvus et tardus

A

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

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30
Q

Osler nodes and janeway nodes

A

Osler nodes
occur on finger tips. endocarditits
janeway nodes
palms and soles. think endocarditis

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31
Q

Statins

A

lower HDL and TG; inc LFT, myositis, warfarin potentiation

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32
Q

fibrates (lipoprotein lipase stimulators) effect and SE

A

dec Tg and inc HDL; cholelithiasis, myositis, inc LFT, GI upset

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33
Q

cholesterol absorption inhibitors(Ezetimibe) effect and SE

A

dec LDL; diarrhea, abd pain, maybe angiodema

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34
Q

niacin effect and SE

A

inc HDL, dec LDL; flushing that be prevented with aspirin, paraesthesias, pruritis, inc LFT, GI pain

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35
Q

bile acid resins(cholestyramine, colestipol, colesevelam) effect and SE

A

dec LDL; myalgias, constipation, LFT abn, GI upset; can dec absorption of other drugs in small intestine

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36
Q

renal artery stenosis; age/etio
dx how
tx

A

*dx, HTN tx
under 25 y.o(fibromuscular dyplasia); over 50 y.o(atherosclersis); dx with renal artery doppler u/s; tx with ace only in unilateral disease!

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37
Q

pheochromocytoma; definition, symptoms, dx, and HTN tx

A

adrenal gland tumor that secretes epi and norepi; episodic HA, sweating, tachycardia; dx with catecholamine levels, urinary metanephrines; tx with both alpha blockers and BB

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38
Q

Conn Syndrome; definition, how to dx, tx

A

hyperaldosteronism; adenoma; causes: triad of HTN, unexplained hypokalemnia, metabolic alkalosis; check plasma aldosterone and renin; removal of tumor

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39
Q

mnemonic for pericarditis

A

CARDIAC RIND: collagen vascular disorder, aortic dissection, radiation, drugs, infections, acute renal failure, cardiac(MI), rheumatic fever, injury, neoplasm, dressler

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40
Q

STEMI Tx if in heart failure or shock

A

ACE. no BB!

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41
Q

wide split S2 can be what 2 things

A

ASD or PS

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42
Q

harsh systolic murmur can be what 2 things

A

AS(heard best at LSB) or COA

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43
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

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44
Q

LBBB

A

V1 has deep S wave and no R wave;

1, V5, V6 has tall R wave

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45
Q

RBBB

A

V1 has wide RSR wave;

1, V5, V6 has wide S wave

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46
Q

what is preload

A

Volume in ventrical at the end of diastolic

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47
Q

what is afterload

A

pressure required to open aortic valve

48
Q

what slows AV conduction

A

digoxin, BB, CCB; do not give in sick sinus syndrome

49
Q

Narrow QRS means what

A

depolarization of ventricles originates in or above the AV node

50
Q

Wide QRS means what

A

arrhythymia originates in ventricle

51
Q

Rt atrial enlargement

A

P over 2.5mm(tall) in II/III and/or AvF OR

O over 1.5mm in V1(may be biphasic)

52
Q

Lt atrial enlargement

A

P is over 0.04 and deeply neg over 1mm in V1(biphasic) OR

P is over 0.12 sec in I and/or II(maybe notch)

53
Q

peaked vs inverted T wave

A

peaked: hyperkalemia; inverted: early ischemia

54
Q

what is only lead to show ST dep normally

A

Posterior leads

55
Q

Costochondritis

A

young AA females; exacerbated with deep inspirtaion; warmness and redness; left 3/4th ICS

56
Q

kussmaul sign

A

deep inspiration, increased CVP; think pericarditis

57
Q

angina pain

A

visceral pain then becomes somatic

58
Q

good med for HTN assoc with angina pectoris or AFib

A

verapamil

59
Q

smooth muscle dilator and also reverses coronary artery spasm

A

verapamil

60
Q

high vs low pulse pressure

A

40 and 60

61
Q

EKG for rt heart strain

A

inversion t waves in lead II

62
Q

increase handgrip does what

A

increase peripheral resistance and afterload. You hear left sided regurge murmurs louder(AR and MR) and stenosis murmurs softer

63
Q

MR acute vs chronic symptoms

A

acute: dyspnea, pulm edema
chronic: waxing/waning dyspnea

64
Q

good med for HTN assoc with angina pectoris or AFib

A

verapamil

65
Q

smooth muscle dilator and also reverses coronary artery spasm

A

verapamil

66
Q

high vs low pulse pressure

A

40 and 60

67
Q

EKG for rt heart strain

A

inversion t waves in lead II

68
Q

increase handgrip does what

A

increase peripheral resistance and afterload. You hear left sided regurge murmurs louder(AR and MR) and stenosis murmurs softer

69
Q

MR acute vs chronic symptoms

A

acute: dyspnea, pulm edema
chronic: waxing/waning dyspnea

70
Q

assymetric T wave inversions

A

BBB, digitalis

71
Q

symmetric T wave inversions

A

myocardial ischemia

72
Q

chorda tendinae rupture

A

think MR

73
Q

hoarseness, dysphagia, hemoptysis, DOE, orthopnea/PND, pulm edema, angina

A

Elevated left atrial pressure

74
Q

Peaked P wave >2.5mm in lead II

A

P pulmonale(rt atria)

75
Q

ST elevation..

A

ischemia, pericarditis(diffuse leads); transmural; do thrombolytics

76
Q

ST depression

A

think ACS, LVH, Dig; subendocardial wall; could be significant atherosclerosis, avoid thrombolytics

77
Q

avoid what is QT prolongation

A

emycin and procainimide

78
Q

PVC- give what in the 1st 24 hours

A

lido

79
Q

organism, ages, valves in rheumatic fever

A

betahemolytic strep; kids 5-15, fever 1-3 weeks later, mitral 75-80% and aortic 30%

80
Q

Jones criteria(major) rheumatic fever

A

2 major or 1 of major/minor: carditis, polyarthralgia, chorea, erythema marginatum, sub-q nodules

81
Q

minor Jones criteria

A

arthralgia, increased ESR and CRP, fever, increased PR interval

82
Q

leriche syndrome

A

impotence, bil butt and thigh claudication

83
Q

trosseau sign

A

1st sign of pancreatic cancer; superficial thrombophlebitis

84
Q

left coronary artery suppies what part of heart

A

anterior (left ventricle) or septal

85
Q

right coronary artery suppies what part of heart

A

posterior inferior, septal, or rt ventricle

86
Q

left circumflex artery suppies what part of heart

A

antero and posterolateral

87
Q

Lower extremity arteries

A

distal aorta-common iliac artery-external iliac-

common femoral artery-superficial femoral artery

88
Q

pain in calf

A

superficial femoral artery

89
Q

pain in thigh

A

commom femoral artery or ext iliac

90
Q

pain in butt

A

distal aorta or common iliac

91
Q

impotence

A

distal aorta

92
Q

constant pain vs acute pain in claudication

A

occlusion is constant; emboli is acute

93
Q

danger of VSD, describe murmur

A

can cause CHF by 6 months; systolic murmur LLSB; and audible in infants 1 month

94
Q

isenmenger syndrome

A

VSD; left to right

95
Q

presentation of symptoms of COA and order what test

A

failure to thrive, CP, lightheadness, SOB, heart failure in infant, HBP; get echo

96
Q

what electrolyte abnormalities can cause long QT syndrome

A

hypocalemia and hypomagnesiumia

97
Q

phenothiazine, haldol, risperidone, and TCA can all cause what

A

long QT syndrome

98
Q

when to avoid thrombolytics(4)

A

intracranial neoplasm, uncontrolled HTN(170/110), recent signficant trauma, active internal bleeding

99
Q

what to do in Afib with high risk of thrombus

A

anticoagulate, control rate; all prior to cardioversion

100
Q

rate control in Afib with heart failure

A

*amiodarone, digoxin, or dronedarone

101
Q

rate control in Afib with no heart failure

A

BB or CCB(verapamil or diltiazem)

102
Q

paroxysmal Afib tx

A

BB or CCB; digoxin 2nd line

103
Q

cardioversion meds in Afib

A

*amiodarone, propafenone, ibutilide; 2nd line is flecanide

104
Q

when to cardioversion vs defib vs pacing

A

cardiovert in tachy and alive pt; defib in unconscious(no C.O, vfib or v tach); pace in brady(heart block)

105
Q

3 BB known to reduce mortality in CHF

A

carvedolol, metoprolol, bisprolol

106
Q

CHA2 DS2 VASc ( 2 or higher)

A

CHF, HTN, Age >75, DM, Stroke/TIA, Vascular d/s, Age 65-74, female gender

107
Q

most common endocarditis pathogens

A

strep viridans, staph aureus, enterococci

108
Q

damaged heart valves in endocarditis murmurs

A

MR or AS

109
Q

post op valve replacement endocarditis organisms

A

staph aureus, fungi, gm neg bacteria

110
Q

IV drug use endocarditis organism

A

staph aureus

111
Q

dx endocarditis

A

3 positive blood cultures, new murmur, transesophageal echo

112
Q

duke criteria for dx

A

2 major, one major/3 minor, 5 minor

113
Q

empiric tx for endocarditis

A

start vanco and ceftriaxone after 1st positive blood culture; treat for 4-6 weeks IV tx

114
Q

prophylactic antibiotic for endocarditis

A

oral amoxicillin 1 hour before procedure

115
Q

Bradycardia in adults, child, infant

A

60
70
90

116
Q

dilated vs HOCM

systolic ?
tx meds
gallop

A

dilated: systolic, tx with ace and BB

HOCM: diastolic, BB and CCB. NO Ds or ACE

cardio and pulm (22 decks)

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