cardio misc Flashcards
1
Q
HOCM PE
A
apical lift from LVH, systolic ejection murmur near apex and bisferens carotid pulse
2
Q
apical lift from LVH, systolic ejection murmur near apex and bisferens carotid pulse
A
HOCM
3
Q
EF in cardiomyopathies
A
dec in dilated; increase or nml in hypertrophic; nml in restrictive
4
Q
Paroxysmal supraventricular tachycardia tx
A
adenosine or 2nd line BB or CCB; do valsalva, coughing, leaning, splash ice water
5
Q
avoid what in aortic dissection
A
diazoxide and hydralazine
6
Q
pale, hypoTN, angina, syncope
A
v tach; cardiovert if unstable; or do lido, amio, procainamide
7
Q
syncope, no BP, no pulse
A
v fib; defib and ACLS
8
Q
orthostatic hypoTN tx
A
hydralazine, nitrates, niacin, CCB
9
Q
acute sys CHF tx
A
loop with ace. NO BB
10
Q
chronic sys CHF tx
A
BB with other meds. NO CCB
11
Q
non prod cough, JVD, PND, exertional dyspnea, S3 maybe S4
A
systolic CHF
12
Q
diastolic CHF tx
A
diuretics first line then maintain BP. No digoxin
13
Q
CP in the early morning and tx
A
think prinzmental angina. tx with CCB or nitrates
14
Q
STEMI and NSTEMI muscle
A
STEMI is transmural and NSTEMI is subendocardial
15
Q
myoglobin
A
initial elevation at 1-4 h, peaks at 6-7h, and returns to normal with 24 hr
16
Q
troponin 1
A
initial elevation at 3-12 h, peaks at 24h, and returns to normal with 5-10 days
17
Q
troponin T
A
initial elevation at 4-8 h, peaks at 12-48h, and returns to normal with 5-14 days
18
Q
CK-MB
A
initial elevation at 3-12h, peaks at 24h, and returns to normal with 48-72 hr
19
Q
pulm atresia murmur
A
depends on present of tricuspid regurge; single S1 or single S2, hyperdynamic apical pulse
20
Q
tetrology of fallot
A
cyanosis, clubbing, increased RV impulse at LLSB, loud S2
21
Q
hypoplastic lt heart syndrome signs
A
shock, early heart failure, respiratory distress, single S2
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
23
Q
ASD murmur; affects what compartment
A
systolic ejection murmur second LICS; wide fixed split S2
*~RBBB, ~RVH
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
25
COA involves what.
PE
CXR
TX
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
26
medication for aortic/mitral valve d/o
(pulm HTN and dysrhythmias)
diuretics and vasodilators for pulm congestion; digoxin and beta blockers for dysrhythmias
27
torsades medication tx
beta blockers, magnesium, temporary atrial or ventricular pacing.
28
pulsus paroxus
decreased systolic BP > than 10 mm hg inspiration
29
Pulsus parvus et tardus
weak, delayed carotid up stroke, split S2, aortic stenosis
30
Osler nodes and janeway nodes
Osler nodes
occur on finger tips. endocarditits
janeway nodes
palms and soles. think endocarditis
31
Statins
lower HDL and TG; inc LFT, myositis, warfarin potentiation
32
fibrates (lipoprotein lipase stimulators) effect and SE
dec Tg and inc HDL; cholelithiasis, myositis, inc LFT, GI upset
33
cholesterol absorption inhibitors(Ezetimibe) effect and SE
dec LDL; diarrhea, abd pain, maybe angiodema
34
niacin effect and SE
inc HDL, dec LDL; flushing that be prevented with aspirin, paraesthesias, pruritis, inc LFT, GI pain
35
bile acid resins(cholestyramine, colestipol, colesevelam) effect and SE
dec LDL; myalgias, constipation, LFT abn, GI upset; can dec absorption of other drugs in small intestine
36
renal artery stenosis; age/etio
dx how
tx
*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!
37
pheochromocytoma; definition, symptoms, dx, and HTN tx
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
38
Conn Syndrome; definition, how to dx, tx
hyperaldosteronism; adenoma; causes: triad of HTN, unexplained hypokalemnia, metabolic alkalosis; check plasma aldosterone and renin; removal of tumor
39
mnemonic for pericarditis
CARDIAC RIND: collagen vascular disorder, aortic dissection, radiation, drugs, infections, acute renal failure, cardiac(MI), rheumatic fever, injury, neoplasm, dressler
40
STEMI Tx if in heart failure or shock
ACE. no BB!
41
wide split S2 can be what 2 things
ASD or PS
42
harsh systolic murmur can be what 2 things
AS(heard best at LSB) or COA
43
S2 S3 S4 with
AS, AR, PS, MR, MS,
AS and AR S4
PS S3 and S4
MR S2 and S3
MS S2
44
LBBB
V1 has deep S wave and no R wave;
| 1, V5, V6 has tall R wave
45
RBBB
V1 has wide RSR wave;
| 1, V5, V6 has wide S wave
46
what is preload
Volume in ventrical at the end of diastolic
47
what is afterload
pressure required to open aortic valve
48
what slows AV conduction
digoxin, BB, CCB; do not give in sick sinus syndrome
49
Narrow QRS means what
depolarization of ventricles originates in or above the AV node
50
Wide QRS means what
arrhythymia originates in ventricle
51
Rt atrial enlargement
P over 2.5mm(tall) in II/III and/or AvF OR
| O over 1.5mm in V1(may be biphasic)
52
Lt atrial enlargement
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
peaked vs inverted T wave
peaked: hyperkalemia; inverted: early ischemia
54
what is only lead to show ST dep normally
Posterior leads
55
Costochondritis
young AA females; exacerbated with deep inspirtaion; warmness and redness; left 3/4th ICS
56
kussmaul sign
deep inspiration, increased CVP; think pericarditis
57
angina pain
visceral pain then becomes somatic
58
good med for HTN assoc with angina pectoris or AFib
verapamil
59
smooth muscle dilator and also reverses coronary artery spasm
verapamil
60
high vs low pulse pressure
40 and 60
61
EKG for rt heart strain
inversion t waves in lead II
62
increase handgrip does what
increase peripheral resistance and afterload. You hear left sided regurge murmurs louder(AR and MR) and stenosis murmurs softer
63
MR acute vs chronic symptoms
acute: dyspnea, pulm edema
chronic: waxing/waning dyspnea
64
good med for HTN assoc with angina pectoris or AFib
verapamil
65
smooth muscle dilator and also reverses coronary artery spasm
verapamil
66
high vs low pulse pressure
40 and 60
67
EKG for rt heart strain
inversion t waves in lead II
68
increase handgrip does what
increase peripheral resistance and afterload. You hear left sided regurge murmurs louder(AR and MR) and stenosis murmurs softer
69
MR acute vs chronic symptoms
acute: dyspnea, pulm edema
chronic: waxing/waning dyspnea
70
assymetric T wave inversions
BBB, digitalis
71
symmetric T wave inversions
myocardial ischemia
72
chorda tendinae rupture
think MR
73
hoarseness, dysphagia, hemoptysis, DOE, orthopnea/PND, pulm edema, angina
Elevated left atrial pressure
74
Peaked P wave >2.5mm in lead II
P pulmonale(rt atria)
75
ST elevation..
ischemia, pericarditis(diffuse leads); transmural; do thrombolytics
76
ST depression
think ACS, LVH, Dig; subendocardial wall; could be significant atherosclerosis, avoid thrombolytics
77
avoid what is QT prolongation
emycin and procainimide
78
PVC- give what in the 1st 24 hours
lido
79
organism, ages, valves in rheumatic fever
betahemolytic strep; kids 5-15, fever 1-3 weeks later, mitral 75-80% and aortic 30%
80
Jones criteria(major) rheumatic fever
2 major or 1 of major/minor: carditis, polyarthralgia, chorea, erythema marginatum, sub-q nodules
81
minor Jones criteria
arthralgia, increased ESR and CRP, fever, increased PR interval
82
leriche syndrome
impotence, bil butt and thigh claudication
83
trosseau sign
1st sign of pancreatic cancer; superficial thrombophlebitis
84
left coronary artery suppies what part of heart
anterior (left ventricle) or septal
85
right coronary artery suppies what part of heart
posterior inferior, septal, or rt ventricle
86
left circumflex artery suppies what part of heart
antero and posterolateral
87
Lower extremity arteries
distal aorta-common iliac artery-external iliac-
| common femoral artery-superficial femoral artery
88
pain in calf
superficial femoral artery
89
pain in thigh
commom femoral artery or ext iliac
90
pain in butt
distal aorta or common iliac
91
impotence
distal aorta
92
constant pain vs acute pain in claudication
occlusion is constant; emboli is acute
93
danger of VSD, describe murmur
can cause CHF by 6 months; systolic murmur LLSB; and audible in infants 1 month
94
isenmenger syndrome
VSD; left to right
95
presentation of symptoms of COA and order what test
failure to thrive, CP, lightheadness, SOB, heart failure in infant, HBP; get echo
96
what electrolyte abnormalities can cause long QT syndrome
hypocalemia and hypomagnesiumia
97
phenothiazine, haldol, risperidone, and TCA can all cause what
long QT syndrome
98
when to avoid thrombolytics(4)
intracranial neoplasm, uncontrolled HTN(170/110), recent signficant trauma, active internal bleeding
99
what to do in Afib with high risk of thrombus
anticoagulate, control rate; all prior to cardioversion
100
rate control in Afib with heart failure
*amiodarone, digoxin, or dronedarone
101
rate control in Afib with no heart failure
BB or CCB(verapamil or diltiazem)
102
paroxysmal Afib tx
BB or CCB; digoxin 2nd line
103
cardioversion meds in Afib
*amiodarone, propafenone, ibutilide; 2nd line is flecanide
104
when to cardioversion vs defib vs pacing
cardiovert in tachy and alive pt; defib in unconscious(no C.O, vfib or v tach); pace in brady(heart block)
105
3 BB known to reduce mortality in CHF
carvedolol, metoprolol, bisprolol
106
CHA2 DS2 VASc ( 2 or higher)
CHF, HTN, Age >75, DM, Stroke/TIA, Vascular d/s, Age 65-74, female gender
107
most common endocarditis pathogens
strep viridans, staph aureus, enterococci
108
damaged heart valves in endocarditis murmurs
MR or AS
109
post op valve replacement endocarditis organisms
staph aureus, fungi, gm neg bacteria
110
IV drug use endocarditis organism
staph aureus
111
dx endocarditis
3 positive blood cultures, new murmur, transesophageal echo
112
duke criteria for dx
2 major, one major/3 minor, 5 minor
113
empiric tx for endocarditis
start vanco and ceftriaxone after 1st positive blood culture; treat for 4-6 weeks IV tx
114
prophylactic antibiotic for endocarditis
oral amoxicillin 1 hour before procedure
115
Bradycardia in adults, child, infant
60
70
90
116
dilated vs HOCM
systolic ?
tx meds
gallop
dilated: systolic, tx with ace and BB
HOCM: diastolic, BB and CCB. NO Ds or ACE
