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int med exam 0828 > cardiology 1: General > Flashcards

cardiology 1: General Flashcards

1
Q

define the x-ray findings

A
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2
Q

define x-ray findings lateral view

A
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3
Q

Describe the sign?

A

this is the scimitar sign, which is a curvilinear opacity in the right lower lung field due to associated lung hypoplasia. It is an anomalous pulmonary vein

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4
Q

Describe the cxr finding

A

This is pericardial effusion, “water bottle” sign.

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5
Q

what are teh two types of cardiac stress tests?

A

exercise tolerance test and stress imaging test

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6
Q

what are the groups that you should not perform an exercise tolerance test?

A
  1. unable to achieve 85% of age-predicated max HR
  2. patients with baseline ECG abnormalities
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7
Q

what is the definition of a positive Exercise tolerance test?

A
  • flat or down-sloping ST-segment depression >1mm and 80ms after J-point in 3 consecutive beats.
  • ST depression does not correlate with anatomic location unlike ST elevation
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8
Q

what are the absolute indications for termination of ETT? (7)

A
  1. ST elevation >1mm in leads without q waves from prior MI excluding aVR, aVL, and V1
  2. the decrease in SBP >10mm Hg when accompanied by other evidence of ischemia or hypoperfusion
  3. moderate to severe angina
  4. CNS symptoms
  5. Sustained 2/3rd AV block
  6. Signs of poor perfusion (cyanosis/pallor)
  7. serious arrhythmia
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9
Q

what are the stress imaging studies you can do?

A

stress echo and myocardial perfusion imaging (MPI)

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10
Q

what is the general sensitivity/specificity of ETT?

A

60% sensitive, 70% specific

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11
Q

when are stress imaging tests done instead of ETT?

A

cannot exercise or ECG changes at rest

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12
Q

why is exercise tolerance tests not used in patietns that have pacemakers or LBBB?

A

produces false-positive left ventricular anteroseptal perfusion defects

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13
Q

what agents are used in cardiac imaging studies? How do they work?

A
  • Dobutamine acts as an inotropic/chronotropic and acts similarly as exercise
  • Vasodilatation increases blood flow but does not increase heart rate. They increase blood flow to normal vessels while doing no change to stenotic vessels. Thus, steal blood from stenotic vessels causing perfusion defects as seen on EKG.
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14
Q

what are the specific agents used for vasodilatation in cardiac stress testing?

A

Adenosine, dipyramadole, and regadenoson (nonselective A2 receptor activator)

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15
Q

what agent can you use for chemical stress test in patient w/history of bronchospasm?

A

dobutamine. Regadenoson has less effect.

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16
Q

when are exercise stress echo and MPI indicated instead of ETT? (5)

A
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17
Q

what cardiac test is indicated for patients with paced ventricular rhythm?

A

MPI with vasodilators

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18
Q

when do you use cardiopulmonary exercise testing?

A
  • patients with systolic heart failure
  • pre-transplant assessment
  • unexplained exertional dyspnea
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19
Q

what are the requirements prior to doing a coronary Computed tomographic angiography?

A
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20
Q

when do you choose CTA diagnostic test? when should you not use this test?

A
  • symptomatic patients who are at intermediate risk for CAD after initial risk stratification.
  • Patient with congenital coronary anomalies
  • It should not be used in asymptomatic patients or symptomatic patients with low/high probability for CAD.
  • Usefulness is reduced patients with pronounced coronary calcification
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21
Q

why do you use Coronary computed angiogrpahy in intermediate CAD risk?

A

high negative predictive value in excluding significant CAD

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22
Q

what is coronary artery calcium scoring?

A
  • use to scan for atherosclerosis and does not use IV contrast
  • Used to further risk stratification in asymptomatic, intermediate-risk patients
  • CAC score 0 is low
  • CAC score>400 indicates 3 fold risk for CAD
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23
Q

what is a cardiac MRI used for?

A

can be used for everything but the mainstay is infiltrative diseases, post-MI tissue viability

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24
Q

what is PCWP?

A

dampened LA pressure that reflects LV-EDP, which reflects LV-EDV

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25
what are normal Right atrial, right ventricular and pcwp pressures?
26
In what conditions does PCWP elevate?
27
in what conditions are diastolic pressures equal in all 4 chambers?
pericardial tamponade and constrictive pericarditis
28
what is pulsus paradoxus?
* decreased pulse amplitude with inspiration seen as absence of korotkoff sounds during inspiration * Can be observed clinically bu auscultating BP and listening for exaggeration of normal inspiratory decrease in SBP\>10mm Hg * you can heart a heart beat but not a feel a pulse during inspiration
29
when do you see pulsus paradoxus?
* cardiac tamponade * constrictive pericarditis * asthma * tension pneumothorax
30
what is pulsus bisferiens?
bifid with 2 systolic peaks during cardiac cycle
31
when do you see pulsus bisferiens?
* AR * HCM
32
what is pulsus alterans?
varying pulse pressure with a regular pulse rate
33
when do you see pulsus alterans?
any cause pf decreased systolic function that leads to decreased stroke volume
34
what is pulsus parvus et tardus? condition seen?
* parvus = low amplitude * tardus - slow upswing * aortic stenosis
35
what is and where do you see branchiofemoral delay?
this is femoral pulse occurring after brachial pulse see this in coarctation of the aorta
36
what does standing do to valve murmurs?
* decrease right and left cardiac filling and cause the sound of most murmurs to decrease * increase murmurs of MVP and HCM
37
what does strain phase of valsalva do to cardiac murmurs?
* decrease right and left cardiac filling and cause the sound of most murmurs to decrease * increase murmurs of MVP and HCM
38
what does squatting do to cardiac murmurs?
* increase cardiac volume * increase volume and after load * increase intensity of all murmurs except MVP and HCM
39
what does lying down or supine passive straight leg raise?
* increase cardiac volume * increase volume and after load * increase intensity of all murmurs except MVP and HCM
40
what does sustained handgrip do?
* boosts SVR and LV volume * decreases murmurs of HCM and aortic stenosis
41
what maneuever can you do to distinguish HCM and MVP?
handgrip prolongs murmur of MVP due to earlier prolapse of MV.
42
what maneuver can you use to differentiate between AS and MVP?
* AS murmur decreases * MVP murmur increases in duration
43
what does inspiration/expiration do to heart murmurs?
inspiration increases right-sided sounds Expiration increases left-sided sounds.
44
S1 is caused by?
closing of mitral and tricuspid valves
45
S1 is decreased when?
* prolonged PR interval * Mitral regurgitation * acute aortic regurgitation (Increased LV pressure causes early LV closure) * severely calcified mitral valve
46
S1 intensity is increased when?
* (mitral valve slams shut) * short PR interval * mitral stenosis * hyperdynamic ventricular function
47
what is S2 caused by?
closing by the aortic and pulmonic valves (A2 then P2)
48
why do you have a physiologic split?
* this is when P2 occurs after A2 * Caused by the increased volume of blood in the RV prolonged RV systole, delays closure of the pulmonic valve. * Disappears during expiration
49
what is a persistent/wide split S2? causes?
* vary with respiration but does not disappear on expiration * anything that cause delay or prolonged contraction of the right ventricle * pulmonic stenosis, PE, RBBB,
50
what is the classic presentation of a fixed split S2?
also see patient with systolic ejection murmur, ASD, and pulmonary vascular congestion on CXR
51
what is paradoxical split S2?
* P2 occurs before A2 * hear split with expiration instead of inspiration
52
what conditions do you see paradoxical split S2?
* LBBB * pacemaker beat from RV
53
what does a S3 indicate?
indicates end of rapid ventricular filling
54
what conditions do you see a S3?
kids, patients with poor LV dysfunction.
55
what is S4?
* ventricular filling during atrial contraction * hear it in patients with decreased ventricular compliance * ischemic heart disease, aortic stenosis, HCM,
56
what pathological conditions do you not hear a S4?
* atrial fibrillation * mitral stenosis (ventricular inflow obstruction)
57
when do you see large right sided v waves?
* ventricular septal rupture * Tricuspid regurgitaiton
58
when do you left sided v waves?
severe MR
59
what do you see with constrictive pericarditis?
rapid x and y descents
60
what do you see with tamponade?
rapid x descent only
61
what do you see with mitral stenosis?
large, left sided a-waves
62
when do you see cannon a waves?
anything with AV disassociation (times when atrium is contracting gainst a close TV)
63
when do you see a slow y descent?
delayed atrial emptying as in from tricuspid stenosis
64
what waveforms are seen during diastole?
* A wave (atrium contracting, tricuspid valve open) * Y descent (atrium emptying, tricuspid open)
65
what wave forms are seen during systole?
* C notch * X descent (atrium relaxing then filling, tricuspid closed) * V wave (atrium tense and full, tricuspid close)
66
what waveforms do you see in pulmonary HTN?
elevated A and V waves
67
what waveforms are seen in tricuspid regurgitation?
large V waves
68
what waveforms do you see with tricuspid stenosis?
slow y descent
69
what waveforms do you see with restrictive cardiomyopathy?
rapid x and y descents
70
what waveforms do you see with RV infarction?
elevated A and V wave
71
what waveforms do you see with ASD?
large V waves and rapid y descent
72
when should you suspect secondary HTN?
* age\<30 * drug resistant HTN * people who develop uncontrolled HTN that was previously well controlled
73
physical exam finding that suggests renal vascular HTN?
systolic abdominal bruit without a diastolic bruit
74
primary hyperaldosteronism basic script?
hypertension patient with hypokalemia and low renin
75
which common cardiac medications prolong survival post - MI?
* beta blockers * carvedilol * ACe/ARB * Epleronone
76
which common cardiac medications prolong survival in HF?
* Beta blockers * carvedilol * nitrates (with hydralazine) * Ace/ARb * spirinolactone * Epleronone
77
what is a dromotrope?
affects the speed of the electrical impulses (SA node to purkinjie fibers)
78
what is a inotrope?
affects the strength of contraction (ability to squeeze)
79
what is chronotropic?
affects the heart rate
80
what time of day does the highest incidence of spontaneous ischemic cardiac events occur?
circadian pattern with the highest incidence in the early morning hours.
81
what type of cardiac medication is digoxin?
negative chronotropic and negative domotropic
82
what type of cardiac medication are beta blockers?
negative inotropic negative chronotropic negative domotropic anti-anginal prolongs survival post - MI prolongs survival in HF Only coreg is a vasodilator
83
generally, non-dihydropiridine CCB is what type of cardiac medication?
* these are verapamidl and diltiazem * negative inotrope * negative chronotrope * negative dromotrope * vasodilator * antianginal * vasodilator * does not prolong survival
84
generally, dihydropidine CCB is what type of cardiac medication?
* These are nifedipine, amlodipine * negative inotrope * no chrono/dromotropic effects * vasodilator * anti-anginal * only amlodipine prolongs survival in DCM
85
what type cardiac medication is ACE/ARB?
* vasodilator * prolongs survival post mi and hF
86
what type of cardiac medication do nitrates do?
vasodilator anti-anginal prolongs survival in HF with hydralazine
87
what causes resting ST segment elevation?
* acute MI * pericarditis * LV aneurysm * LBBB * LVH * ventricular pacing * benign early repolarization
88
define hibernating myocardium?
* chronically underperfused myocardium without irreversible myocyte injury * when perfusion restored to normal, contractility should return to normal
89
define reperfusion injury?
* severely ischemic myocardium is reperfused after 1 hour * causes further irreversible microvascular damage and myocardial cell damage
90
define stunned myocardium?
* result of acute ischemic * from time to reperfusion, takes 7-10 days for the ventricular function to return to normal
91
what does ST-segment elevation suggest on an exercise ECG test?
suggest spasms of the coronary arteries
92
what are the main drugs to treat angina?
* beta-blockers and nitrates are staples * CCB can also help by decreasing coronary artery vasodilation, peripheral vasodilation, and negative chronotropic effect.
93
which patient would benefit from ranexa?
* maximal standard therapy or substitute for beta-blockers * inhibits late sodium current in cardiac myocytes reducing sodium and calcium overload that follows ischemia * improves myocardial relaxation and reduces LV diastolic stiffness, enhancing myocardial contractility and perfusion
94
which antianginal drugs decrease preload?
nitrates decrease preload\>afterload,
95
which antianginals decrease afterload?
* nitrates * beta blockers * CCB
96
wat anti-anginal drugs do you NOT give to a patient with RV infarct?
Nitrates because acute preload reduction can cause severe decompensation
97
what drugs decrease preload in general?
* nitroglycerin * ACE/ARB * Morphine * Aldosterone blockers
98
which drugs decrease afterload?
* nitroprusside * milironine * CCB (pines) * ACE.ARB
99
which drugs decrease heart rate?
* beta blockers * CCB * Digoxin * adenosine * antiarrhythmics
100
what 3 components make up SV?
* preload * afterload * contractility
101
what are the two pathologies of thoracic aortic aneurysms?
102
when is surgery indicated for chronic thoracic aortic aneurysms?
103
how to manage AAA?
104
what is coarctation of the aorta?
105

int med exam 0828 (24 decks)

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