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Master Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the most common cause of death in the USA?

A

coronary artery disease

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2
Q

What are some risk factors for coronary artery disease?

A
  • diabetes
  • hypertension
  • tobacco use
  • obesity
  • hyperlipidemia
  • PAD
  • inactivity
  • family hx; xx <65 and xy <55
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3
Q

What is the most common cause of chest pain?

A
  • GI
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4
Q

What are characteristics of coronary artery disease?

A
  • chest pain that does not change with body position or respiration
  • dull pain
  • pain lasting 15-30 minutes
  • occurs on exertion
  • substernal chest pain
  • pain radiates to the jaw or left arm
  • not associated with chest wall tenderness
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5
Q

Differential diagnosis with a patient who has pleuritic chest pain (pain that changes with respiration)

A
  • pneumonia
  • PE
  • pleuritis
  • pericarditis
  • pneumothorax
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6
Q

Define costochondritis

A
  • chest pain that occurs when palpating chest wall
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7
Q

Patient is an alcoholic and comes to the ED with nausea, vomiting, chest pain, and epigastric tenderness. What should you check for initially?

A
  • amylase and lipase levels as this patient is suspicious for pancreatitis
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8
Q

Patient comes to the ED with chest pain, right upper quadrant tenderness, and a mild fever. What is the first step in management?

A
  • get an abdominal U/S to check for gallstones; top dx with this info is acute cholecystitis
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9
Q

If you hear an S3 gallop on physical exam, what does that indicate?

A
  • a dilated left ventricle *rapid ventricular filling during diastole
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10
Q

If you hear an S4 gallop, what does that indicate?

A

left ventricular hypertrophy

* atrial systole into a stiff or noncompliant left ventricle

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11
Q

Rales heard on lung examination can be an indication to ?

A

CHF

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12
Q

Holosystolic murmur is consistent with what defect?

A
  • mitral regurgitation
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13
Q

Best initial test for ischemic type chest pain is?

A

EKG

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14
Q

What is the best thing to test for to detect reinfarction a few days after initial MI?

A
  • CKMB
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15
Q

Which cardiac enzyme rises first with ischemia?

A
  • myoglobin
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16
Q

What is the most accurate test for cardiac ischemia?

A
  • cardiac enzymes: troponin or CKMB
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17
Q

MOA of troponin C

A
  • binds to calcium to activate actin:myosin interaction
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18
Q

MOA of troponin T

A
  • binds to tropomyosin
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19
Q

MOA of troponin I

A
  • inhibits actin:myosin interaction
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20
Q

A patient has normal EKG and cardiac enzymes on visit to ED for chest pain. He comes back four days later with the same chest pain. What is the next step?

A
  • do a cardiac stress test
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21
Q

When is a chemical stress test needed?

A
  • when the patient cannot exercise to reach the target heart rate
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22
Q

WHen is it necessary to do a stress echocardiogram?

A
  • left bundle branch block
  • digoxin use
  • pacemaker in place
  • left ventricular hypertrophy
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23
Q

A patient has an abnormal stress test that shows reversible ischemia. What is the next step in management?

A
  • angiography
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24
Q

What is the most accurate method of evaluating ejection fraction ?

A
  • MUGA scan
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25
Q

When is sestamibi nuclear stress testing used?

A
  • obese patients and those with large breasts because of its ability to penetrate tissue
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26
Q

What is the best initial treatment with a patient who has acute coronary syndrome?

A
  • aspirin
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27
Q

What medications are given to those who are undergoing angioplasty and stent placement?

A
  • block aggregation of platelets to each other by inhibiting ADP induced activation of the P2Y12 receptor, such as clopidogrel, ticagrelor, or prasugrel
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28
Q

What is the time frame for when angioplasty should be performed with a patient with a STEMI?

A
  • w/i 90 minutes of ED arrival
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29
Q

When should a patient receive thrombolytics for an MI?

A
  • w/i 30 minutes of ED arrival
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30
Q

ACE inhibitors only lower mortality if?

A

the patient has left ventricular dysfunction or systolic dysfunction

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31
Q

If the patient cannot have thrombolytics, what is the best way to lower mortality?

A
  • urgent angioplasty or PCI
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32
Q

What is the most common cause of death in both CHF and MI?

A
  • ventricular arrhythmia brought on by ischemia
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33
Q

When do you use prasugrel, clopidogrel, or ticagrelor?

A
  • patient is undergoing angioplasty
  • patient has an aspirin allergy
  • patient with acute MI gets one of these + aspirin
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34
Q

When do you use verapmil or diltiazem?

A
  • patient has intolerance to beta blockers (asthma, cocaine induced chest pain, or coronary vasospasm)
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35
Q

When do you use lidocaine or amiodarone?

A
  • if patient has VTac or VFib
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36
Q

When does a patient need a pacemaker?

A
  • 3rd degree heart block
  • Mobitz II, second degree AV block
  • Bifascicular block
  • New LBBB
  • Symptomatic bradycardia
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37
Q

Prasugrel has a higher efficacy that clopidogrel; however, it increases bleeding in those with which conditions?

A
  • age >75
  • weight < 60kg
  • stroke victims
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38
Q

what is the diagnostic test for cardiogenic shock?

A
  • echo

- swan-ganz catheter

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39
Q

What is the tx for cardiogenic shock?

A
  • ACEi

- urgent revascularization

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40
Q

What is the diagnostic test for valve rupture?

A
  • Echocardiogram
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41
Q

What is the treatment for valve rupture?

A
  • ACEi
  • nitroprusside
  • intra-aortic balloon pump as a bridge to surgery
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42
Q

What is the diagnostic test for septal rupture?

A
  • echocardiogram

- Swan-ganz catheter

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43
Q

Tx for septal rupture

A
  • ACEi
  • nitroprusside
  • urgent surgery
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44
Q

What is the diagnostic test for myocardial wall rupture?

A
  • echocardiogram
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45
Q

Tx for myocardial wall rupture

A
  • pericardiocentesis

- urgent cardiac repair

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46
Q

What is the diagnostic test for sinus bradycardia?

A

EKG

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47
Q

Tx for sinus bradycardia

A
  • atropine followed by a pacemaker if the patient is still having symptoms
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48
Q

How to diagnose third degree heart block?

A
  • EKG

- canon a waves present

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49
Q

Tx for third degree heart block

A
  • atropine and a pacemaker even if the symptoms resolve
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50
Q

How to diagnose right ventricular infarction?

A
  • EKG showing right ventricular leads with the ST segment elevation
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51
Q

Tx for right ventricular infarction

A
  • fluid loading
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52
Q

Which way is the blood shunted in a septal rupture?

A
  • left to right due to the higher pressure in the left ventricle
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53
Q

Post-MI, what medications should a patient be on when going home?

A
  • statin
  • ACEi
  • beta-blocker
  • aspirin
  • clopidogrel
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54
Q

How long should a patient wait to have sex after having an MI?

A
  • 2-6 weeks
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55
Q

What are the special differences when treating an NSTEMI compared to a STEMI?

A
  • no thrombolytic use
  • use low molecular weight heparin
  • use of glycoprotein 2b/3a inhibitors
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56
Q

Name some GP2b/3a inhibitors

A
  • eptifibatide
  • tirofiban
  • abciximab
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57
Q

When are thrombolytics used in MI cases?

A
  • STEMIs
  • new LBBB
  • within 12 hours of the initial symptoms
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58
Q

In what case will heparin not work?

A
  • antithrombin deficient patients
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59
Q

MOA of heparin

A
  • prevents new clots from forming via potentiating antithrombin, which inhibits almost every step of the clotting cascade
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60
Q

When to use an ARB instead of an ACEi?

A
  • patient has cough ADR from the ACEi
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61
Q

Main ADR of both ACEi and ARBs?

A
  • hyperkalemia
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62
Q

What is used to determine who is a candidate for coronary artery bypass grafting?

A
  • angiography
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63
Q

What are the four indications for coronary artery bypass grafting?

A
  • three coronary vessels with >70% stenosis
  • left main coronary artery stenosis > 50-70%
  • 2 vessels >70% in a diabetic
  • 2 or 3 vessels with low ejection fraction
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64
Q

You will see a reduced ejection fraction in which type of dysfunction?

A
  • systolic
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65
Q

What is the main difference between saphenous vein graft and internal mammary artery graft?

A
  • Internal mammary artery graft remains open for 10 years
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66
Q

When do most vein grafts start to become occluded?

A
  • in five years
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67
Q

MOA of ranolazine

A
  • inhibits late I(NA) channels, which prevents overload of sodium
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68
Q

When is ranolazine added to the Post-MI regimen?

A
  • when the other medications do not control the pain
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69
Q

MOA of proprotein convertase subtilisin kexin type 9 PCSK9 inhibitors

A
  • reduce LDL by blocking the clearance of LDL by the liver from the blood
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70
Q

What is the most common ADR of a statin?

A
  • liver toxicity
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71
Q

What should be checked routinely in a patient with a statin?

A
  • LFTs since statins increase transaminases
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72
Q

Besides raising the transaminases, what other ADR is less common when using a statin?

A
  • rhabdomyolysis
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73
Q

What is the most important reason why we use statin drugs?

A
  • They have the greatest effect on lowering mortality than any other medication.
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74
Q

What is the risk of the Framingham scale to prescribe a statin?

A

> 7.5% in 10 years

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75
Q

Which two diseases should the LDL be controlled to be under 70 mg/dL?

A
  • those with diabetes and or coronary disease
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76
Q

When do you use PSCK9 inhibitors?

A
  • When patient is on max dose of a statin and still needs their LDL to be lower
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77
Q

Give two examples of a PSCK9 inhibitor

A
  • evolocumab

- alirocumab

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78
Q

What is the most common cause of erectile dysfunction post MI?

A
  • anxiety
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79
Q

What class of medications are contraindicated when a patient is on a medication such as sildenafil?

A
  • nitrates
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80
Q

What are some common characteristics of presenting CHF?

A
  • SOB on exertion
  • edema
  • rales on lung exam
  • ascites
  • JVD
  • S3 gallop
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • fatigue
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81
Q

What causes rales in the lungs?

A
  • Increased hydrostatic pressure develops in the pulmonary capillaries from left heart pressure overload. This causes transudation of liquid into the alveoli.
    During inhalation, the alveoli open with a popping sound–> rales
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82
Q

What is the worst manifestation of CHF?

A
  • pulmonary edema–> can make clinical diagnosis from this
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83
Q

MOA of carvedilol

A
  • same as labetalol: both beta 1 and 2 blocker and alpha-1 receptor
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84
Q

What are four basic things that should be ordered when suspecting CHF?

A
  • CXR
  • EKG
  • oximeter
  • echocardiogram
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85
Q

What is the first line tx for acute pulmonary edema?

A
  • oxygen
  • furosemide
  • nitrates
  • morphine
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86
Q

MOA of inamrinone and milrinone

A
  • phosphodiesterase inhibitors that increase contractility and decrease afterload due to vasodilation
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87
Q

MOA of dobutamine

A
  • beta-1 agonist leading to increased contractility and decreased afterload due to vasodilation
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88
Q

MOA of dopamine

A
  • increases contractility but acts on alpha 1 receptors, leading to vasoconstriction
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89
Q

What can cause respiratory alkalosis in CHF?

A
  • fluid overload causes patient to be hypoxic–> patient then hyperventilates–> decreases PCO2
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90
Q

Tx for those with systolic CHF dysfunction

A
  • ACEi or ARBS
  • beta blockers
  • hydralazine + nitrates if the above three are contraindicated
  • digoxin to decrease symptoms
  • mineralocorticoid receptor antagonists (spironolactone, eplerenone)
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91
Q

Most common ADR of mineralocorticoid receptor antagonists?

A
  • hyperkalemia
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92
Q

ADRs of spironolactone

A
  • gynecomastia

- erectile dysfunction

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93
Q

If a patient is on an ACEi, beta blocker, MRA, digoxin, and diuretic but is still symptomatic, what should you add to their tx?

A
  • hydralazine and nitrates
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94
Q

What is the main treatment management for diastolic CHF dysfunction?

A
  • MRAs (mineralocorticoid receptor antagonists)
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95
Q

A patient with pulmonary edema has V tac. What is the best therapy?

A
  • synchronized cardioversion
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96
Q

A patient with pulmonary edema can have v tac, a fib, a flutter, or SVT, what is the best therapy?

A
  • synchronized cardioversion
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97
Q

When is unsynchronized cardioversion used?

A
  • v fib, v tac without a pulse
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98
Q

When do you use nesiritide?

A
  • when dobutamine, inamrinone, milrinone fail
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99
Q

MOA of nesiritide?

A
  • synthetic version of atrial natriutretic peptide
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100
Q

If BNP levels are normal, it excludes ____ as the diagnosis.

A
  • CHF
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101
Q

A patient with pulmonary edema has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?

A
  • cardiac output= decreased
  • systemic vascular resistance = increased
  • wedge pressure= increased
  • right atrial pressure = increased
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102
Q

A patient with hypovolemic shock has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?

A
  • cardiac output= decreased
  • systemic vascular resistance = increased
  • wedge pressure = decreased
  • right atrial pressure = decreased
103
Q

A patient with septic shock has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?

A
  • cardiac output= increased
  • systemic vascular resistance = decreased
  • wedge pressure = decreased
  • right atrial pressure = decreased
104
Q

A patient with pulmonary hypertension has a right catheter placed. What would be found for cardiac output, systemic vascular resistance, wedge pressure, and right atrial pressure?

A
  • cardiac output= decreased
  • systemic vascular resistance= increased
  • wedge pressure = decreased
  • right atrial pressure = increased
105
Q

Wedge pressure is a measure of which heart chamber?

A
  • left atrial pressure
106
Q

A patient on spironolactone or eplerenone develops hyperkalemia but still needs to stay on these medications. What can you add to the tx regimen?

A
  • patiromer or zirconium
107
Q

ADR of ivabradine?

A
  • transient excess brightness of vision
108
Q

If a patient cannot be on ACEi, what is the next step?

A
  • use sacubitril/valsartan (neprilysin inhibitor + ARB)–> helps to lower mortality in this combo
109
Q

MOA of ivabradine

A
  • SA nodal inhibitor of funny channels that slows the heart rate
110
Q

When is ivabradine used?

A
  • if you cannot use a beta blocker in a patient with systolic dysfunction CHF
  • if the patient’s HR is > 70 with systolic dysfunction CHF
111
Q

When is an implantable cardioverter/defibrillator indicated?

A
  • dilated cardiomyopathy

- those with an ejection fraction <35%

112
Q

When is a biventricular pacemaker indicated?

A
  • ejection fraction <35% AND QRS >120 msec
113
Q

When is warfarin used in a CHF patient?

A
  • if the patient has a metal valve or mitral stenosis
114
Q

What is an ABSOLUTE contraindication for beta blockers?

A
  • symptomatic bradycardia
115
Q

A patient who is young, female, and in the general population most likely has what heart valve abnormality?

A
  • mitral valve prolapse
116
Q

A healthy young athlete most likely has what heart valve abnormality?

A
  • hypertrophic obstructive cardiomyopathy
117
Q

A patient who is an immigrant and pregnant most likely has what heart valve abnormality?

A
  • mitral stenosis
118
Q

Patient with turner syndrome or coarctation of the aorta most likely has what heart valve abnormality?

A
  • bicuspid aortic valve
119
Q

A patient with palpations, atypical chest pain that does not occur during exertion most likely has what heart valve abnormality?

A
  • mitral valve prolapse
120
Q

What are the most common systolic heart murmurs?

A
  • AS
  • MR
  • MVP
  • HOCM
121
Q

WHat are the most common diastolic murmurs?

A
  • AR

- MS

122
Q

All right sided murmurs increase in intensity with?

A
  • inhalation
123
Q

All left sided murmurs increase with intensity with?

A
  • exhalation
124
Q

Why does squatting and lifting the legs increase venous return?

A
  • all the blood from the legs are rushing up into the heart
125
Q
  • Why does valsalva maneuver and standing up decrease venous return?
A
  • it increases intrathoracic pressure, which decreases blood return to the heart
126
Q

Which murmurs increase during a squat with leg raise?

A
  • AS
  • AR
  • MS
  • MR
  • VSD
127
Q

Which murmurs decrease with standing and valsalva?

A
  • AS
  • AR
  • MS
  • MR
  • VSD
128
Q

Which murmurs decrease with squat and then leg raise?

A
  • HOCM

- MVP

129
Q

Which murmurs increase with stand and then valsalva?

A
  • HOCM

- MVP

130
Q

Aortic regurg and mitral regurg are treated with?

A
  • ACEi
131
Q

Name some loop diuretics

A
  • furosemide
  • bumetanide
  • torsemide
  • ethacrynic acid
132
Q

MOA of loop diuretics

A
  • inhibit the Na/K/2Cl pump in the thick ascending limb of the loop of Henle
133
Q

Where does spironolactone act at?

A
  • late distal tubule and early collecting duct
134
Q

MOA of conivaptan and tolvaptan

A
  • block water reabsorption by blocking ADH
135
Q

What test will determine change in care when a patient comes in with chest pain?

A
  • EKG
136
Q

What causes the cough with ACEi?

A
  • ACEi increases bradykinin, which causes cough
137
Q

MOA of ACEi

A
  • inhibits angiotensin converting enzyme, which then blocks aldosterone release
  • this causes increase in potassium
138
Q

If a patient has hyperkalemia due to being on an ACEi or ARB, what is the next step in management?

A
  • take the patient off the acei or arb and add hydralazine and nitrates
139
Q

What is unique about digoxin compared to other cardiac drugs?

A
  • it only decreases symptoms and DOES NOT decrease mortality
140
Q

Which patients should have two anticoagulation drugs on their regimen?

A
  • patients who have had an acute MI–> right after post hospitalization
  • patients who have acute coronary syndrome
  • patients who have unstable angina
141
Q

MOA of CCB

A
  • inhibits the receptor of dihydropyridine
142
Q

Name some thrombin inhibitor drugs

A
  • argatroban

- lepirudin

143
Q

Which chest pain patients should receive TPA?

A
  • STEMI

- new left bundle branch block

144
Q

What happens to the size of the LV chamber if there is increased afterload?

A
  • LV chamber will not empty and thus it will be larger

- a larger LV chamber relieves or lessens the obstruction in HOCM

145
Q

MOA of amyl nitrate

A
  • vasodilator that decreases afterload by dilating peripheral arteries
146
Q

Amyl nitrate worsens which murmurs?

A
  • it decreases the afterload, so HOCM and MVP, AS will WORSEN because afterload is decreased
147
Q

What makes the murmur worse in Aortic stenosis? *what makes the degree of it worse or better

A
  • the gradient between the LV and aorta
  • If the LV pressure exceeds the aorta, then there will be a high gradient
  • the higher the gradient, the louder the murmur
148
Q

Hand grip will increase which murmurs?

A
  • MR

- VSD

149
Q

Where is AS best heard?

A
  • second right intercostal space and radiates to the carotid arteries
150
Q

AS is classically described as?

A
  • crescendo-decrescendo murmur
151
Q

Pulmonic valve murmurs are best heard

A
  • at the second left intercostal space
152
Q

Where are AR, tricuspid, and VSD murmurs best heard

A
  • lower left sternal border
153
Q

MR is best heard?

A
  • at the apex and radiates into the axilla

- the apex is the level of the 5th intercostal space below the left nipple

154
Q

A grade 4/6 murmur indicates?

A
  • a thrill is present
155
Q

best initial test for a valvular lesion?

A
  • echocardiogram
156
Q

Most accurate test for valve lesions?

A
  • left heart catheterization
157
Q

Which echo should be ordered first when assessing valvular lesions?

A
  • transthoracic echocardiogram
158
Q

What causes syncope in those with AS?

A
  • a stiff valve proximal to the entry point of coronaries blocks blood flow into the vertebral and basilar arteries and carotids
  • no blood flow to the brain = passing out
159
Q

Delayed carotid upstroke is associated with which murmur?

A
  • AS
160
Q

Normal aortic valve gradient is?

A
  • zero
161
Q

Best initial treatment for AS?

A
  • diuretics
162
Q

What are the two most common symptoms of AR?

A
  • SOB

- fatigue

163
Q

What are some causes of aortic regurg?

A
  • hypertension
  • rheumatic heart disease
  • endocarditis
  • cystic medial necrosis
  • Marfan syndrome
  • ankylosing spondylitis
  • syphilis
164
Q

What is the indication to repair a bicuspid aortic valve?

A
  • when it is >5cm
165
Q

What is the sound of an AR?

A
  • diastolic decrescendo murmur
166
Q

Define quincke pulse

A
  • arterial or capillary pulsations in the fingernails
167
Q

define corrigan pulse

A
  • high bounding pulse “water hammer pulse”
168
Q

define musset sign

A
  • head bobbing up and down with each pulse
169
Q

Define duroziez sign

A

murmur heard over the femoral artery

170
Q

define hill sign

A
  • blood pressure gradient much higher in lower extremities
171
Q

When is surgery indicated for AR?

A
  • EF is <55%

- Left ventricular end systolic diameter >55mm

172
Q

What is the most common cause of mitral stenosis?

A
  • rheumatic fever
173
Q

How does mitral stenosis cause dysphagia?

A
  • large left atrium presses on the esophagus
174
Q

How does mitral stenosis cause hoarseness>

A
  • pressure on the recurrent laryngeal nerve
175
Q

How would you describe the sound of mitral stenosis?

A
  • diastolic rumble with an opening snap
176
Q

What makes mitral stenosis worse?

A
  • the higher the left atrial pressure
177
Q

Best initial therapy for mitral stenosis?

A
  • diuretics
178
Q

Best effective therapy for mitral stenosis?

A
  • balloon valvuloplasty
179
Q

Why does balloon valvuloplasty work in mitral stenosis but not in aortic stenosis?

A
  • Mitral stenosis is most often caused by fibrosis of the valve,which can stretch with a balloon insertion.
  • Aortic stenosis is caused by calcification of the valve, and it will not stretch when a balloon is inserted.
180
Q

When a patient has metal valves, what should be prescribed?

A
  • aspirin and warfarin to prevent clotting
181
Q

Operative criteria for mitral regurgitation

A
  • left ventricular ejection fraction <60%
  • or left ventricular and systolic diameter >40 mm
  • even if the patients are asymptomatic
182
Q

A holosystolic murmur at the lower left sternal border is consistent with?

A
  • VSD
183
Q

In a VSD, what test will determine the degree of left to right shunting most precisely?

A
  • catheterization
184
Q

____ is associated with fixed splitting of S2

A
  • ASD
185
Q

What causes the S2 splitting in an atrial septal defect?

A
  • different pressures on different sides of the heart
186
Q

A wide P2 delayed sound is associated with ?

A
  • RBBB - Pulmonic stenosis - Right ventricular hypertrophy - Pulmonary hypertension
    .
187
Q

What are some common causes of dilated cardiomyopathy??

A
  • ischemia
  • alcohol
  • doxorubicin
  • radiation
  • Chagas disease
188
Q

Tx for dilated cardiomyopathy?

A
  • ACEi or ARBs
  • beta blockers
  • spironolactone
189
Q

What is the main difference between spironolactone and eplerenone?

A
  • spironolactone inhibits testosterone producing an anti-androgenic effect; eplereonone does not inhibit testosterone
190
Q

Common causes of restrictive cardiomyopathy

A
  • sarcoidosis
  • amyloidosis
  • hemochromatosis
  • cancer
  • myocardial fibrosis
  • glycogen storage diseases
191
Q

Define Kussmaul sign

A
  • increase in JVP on inhalation
192
Q

What is the most accurate diagnostic test for restrictive cardiomyopathy?

A
  • endomyocardial biopsy
193
Q

Define takotsubo cardiomyopathy

A
  • rare, sudden systolic dysfunction brought on by extreme emotions
  • sudden psychological stress
  • presents like an acute MI with ventricular dysfunction
  • coronary arteries are normal
194
Q

What is the only pertinent positive finding for pericardial disease?

A
  • friction rub
195
Q

What does an EKG show in a patient with pericarditis?

A
  • ST segment elevation in all leads
196
Q

Tx for pericarditis

A
  • NSAIDs
197
Q

What will be found on EKG in a patient with pericardial tamponade?

A
  • electrical alternans
198
Q

Triad for cardiac tamponade

A
  • Beck’s triad

- hypotension, jvd, muffled heart sounds

199
Q

Right heart catheterization will show what in cardiac tamponade?

A
  • equalization of all the pressures in the heart during diastole
200
Q

Tx for cardiac tamponade

A
  • short term: pericardiocentesis

- long term: pericardial window placement

201
Q

Constrictive pericarditis will involve signs of right heart failure. Name some signs of right heart failure

A
  • edema
  • JVD
  • hepatosplenomegaly
  • ascites
202
Q

Define a pericardial knock

A
  • extra diastolic sound from the heart hitting a calcified, thickened pericardium
203
Q

If a pericardial knock is present, what is the diagnosis?

A
  • constrictive pericarditis
204
Q

Tx for constrictive pericarditis

A
  • short term: diuretics

- long term: surgical removal of the pericardium aka pericardial stripping

205
Q

Name some characteristics of aortic dissection

A
  • chest pain radiating to the back
  • difference in blood pressure between the right and left arms
  • sudden and severe pain
206
Q

Best initial test for aortic dissection

A
  • CXR
207
Q

Most accurate test for aortic dissection

A
  • CT angiogram
208
Q

Most effective therapy for aortic dissection

A
  • surgical correction
209
Q

Who should be screened for an abdominal aortic aneurysm?

A
  • men age 65-75 who are current or former smokers
210
Q

When are abdominal aortic aneurysms repaired?

A
  • > 5cm in size
211
Q

Presentation of peripheral arterial disease

A
  • claudication aka pain in the calves on exertion
  • smooth, shiny skin due to hair loss
  • loss of pulses in feet
212
Q

Best initial test for PAD

A
  • ABI
213
Q

Most accurate test for PAD

A
  • angiogram
214
Q

Pain, pallor, and pulseless is associated with?

A
  • arterial occlusion
215
Q

Tx for PAD

A
  • aspirin
  • ACEi
  • exercise as tolerated
  • cilostazol
  • statins
  • vorapaxar to add to aspirin or clopidogrel
  • beta blockers if needed for ischemic disease
216
Q

Hemodynamically stable patients who may have a fib should undergo?

A
  • 24 hour holter monitoring
217
Q

What are some other tests to order once a fib is found on ekg?

A
  • echo
  • TSH
  • CMP
  • troponins and or CKMB
218
Q

Tx for hemodynamically unstable individuals with a fib *first line?

A
  • synchronized electrical cardioversion
219
Q

Stable patients who have a fib tx?

A
  • beta blockers, CCBs, or digoxin
220
Q

After a patient goes back into normal rhythm from a fib, what other medication should they be placed on?

A
  • anticoagulation with NOACs, such as dabigatran, rivaroxaban, edoxaban, apixaban
  • similar or better efficacy to warfarin but do not need to monitor INR
221
Q

If bleeding occurs with warfarin, it is reversible by giving?

A
  • prothrombin complex concentrate
222
Q

Bleeding with dabigatran is reversible with?

A
  • idarucizumab
223
Q

If bleeding occurs with Xa inhibitors, it is reversible with?

A
  • andexanet
224
Q

What is the scoring system used to indicate if a patient needs anticoagulation?

A
  • CHA2DS2-VASc
225
Q

What does CHA2DS2-VASc check for ?

A
  • CHF
  • Hypertension
  • > 75 y/o
  • Diabetes
  • S2- stroke or TIA
  • Vascular disease
  • 65-74 y/o
  • sex category
  • age >75 is 2 points
  • stroke or TIA is 2 points
226
Q

What is the score for CHAD2S2VASc?

A
  • score 0 or 1 use aspirin or nothing

- score >2: use apixaban, dabigatran, edoxaban, or rivaroxaban

227
Q

define multifocal atrial tachycardia

A
  • atrial arrhythmia in association with COPD
  • EKG will show polymorphic P wave
  • reveals different atrial foci for the QRS complexes
    0 >100 HR
228
Q

Tx for multifocal atrial tachycardia

A
  • oxygen and then diltiazem
229
Q

Best management for unstable patients with SVT

A
  • synchronized cardioversion
230
Q

Best initial tx for stable patients with SVT

A
  • vagal maneuvers
231
Q

If vagal maneuvers do not work in a stable patient with SVT, what is the next step?

A
  • give adenosine 6 mg
232
Q

Best long term management for SVT

A
  • radiofrequency catheter ablation
233
Q

A delta wave will be found on EKG in patients with?

A
  • Wolff-Parkinson-White syndrome
234
Q

Most accurate test for WPW syndrome

A
  • electrophyisological study
235
Q

Patients with WPW syndrome with SVT or VT, should be given?

A
  • either procainamide, sotalol, or amiodarone
236
Q

Long term therapy for WPW syndrome

A
  • radiofrequency catheter ablation
237
Q

Why do CCBs or digoxin worsen WPW syndrome?

A
  • CCBs and digoxin block conduction more in the normal AV node- forcing the conduction down the abnormal conduction tract in those with WPW syndrome
238
Q

Tx for hemodynamically unstable individual with VT?

A
  • synchronized cardioversion
239
Q

Tx for hemodynamically stable patients with VT

A
  • amiodarone, lidocaine, procainamide, or magnesium
240
Q

First line tx for v fib?

A
  • unsynchronized cardioversion
241
Q

Why should you not deliver a shock during the T wave or refractory period?

A
  • Doing it during this time can set off a worse rhythm, such as asystole or v fib.
242
Q

Those with sudden loss of conscious should be placed on a holter monitor for how long?

A

24-72 hours

243
Q

If a patient presents with syncope what should be ordered?

A
  • EKG
  • CMP
  • glucose
  • troponins/CKMB
  • echo
  • head CT
244
Q

What is the mechanism of rate control in a fib or a flutter?

A
  • inhibition of conduction of the AV node
245
Q

What causes the majority of SVTs?

A
  • abnormal conduction pathway at the AV node
246
Q

Define Brugada syndrome

A
  • genetic disorder leading to syncope and sudden death in association with right bundle branch block; common in Asians
247
Q

What is important to note about the accessory bundle of Kent seen in WPW syndrome?

A
  • It conducts faster than the AV node, so the PR interval is less than 120 msec
248
Q

A patient decompensating from cardiogenic shock should have what intervention tried first to increase blood pressure?

A
  • normal saline boluses
249
Q

If normal saline boluses do not increase the patient’s blood pressure who has cardiogenic shock, then what do you try to bring it up?

A
  • pressors
250
Q

An inferior wall MI is associated with?

A
  • AV nodal block and symptomatic bradycardia
251
Q

Which artery supplies the AV node?

A
  • right coronary artery
252
Q

What causes wide QRS complexes in a patient with a pacemaker?

A
  • Pacer impulses do not go down the normal HIS-Purkinje fiber pathway. They travel slow from myocyte to myocyte
253
Q

30-40% of patients with an inferior MI will experience a ?

A
  • right ventricular infarction (due to the same blood supply=right coronary artery)
254
Q

MOA of cilostazol

A
  • phodiesterase inhibition; increases cAMP

- prevents platelet aggregation and has vasodilating effects

Master Review (4 decks)

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