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Pance Prep Pearls > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Causes of dilated cardiomyopathy (4)

A
  • Idiopathic
  • Infections (viral)
  • Alcohol or drug abuse
  • Metabolic, vitamin B1 deficiency
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2
Q

Standard systolic heart failure treatment

A

ACE inhibitors
Beta blockers (metoprolol or carvedilol)
Symptom control with diuretics

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3
Q

Takotsubo cardiomyopathy

A

Transient regional systolic dysfunction of the LV that can imitate an MI but is associated with absence of significant obstructive CAD or evidence of plaque rupture, often seen in post menopausal women exposed to physical or emotional stress thought to be due to possible catecholamine surge, WILL see EKG findings such as ST elevations in 3 consecutive leads and cardiac enzymes are often positive, but coronary angiography shows absence of plaque rupture or obstruction

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4
Q

Most common cause of restrictive cardiomyopathy

A

Amyloidosis, sarcoidosis, hemochromatosis, metastatic disease

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5
Q

Kussmaul’s sign

A

Lack of inspiratory decline or increase in JVP with inspiration, normally inspiration causes JVP to drop because blood gets sucked in

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6
Q

Definitive diagnosis of restrictive cardiomyopathy is made through ___. Often an ___ is the diagnostic test of choice

A

Endomyocardial biopsy, echocardiogram

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7
Q

Hypertrophic cardiomyopathy has systolic or diastolic dysfunction?

A

Diastolic dysfunction, becomes stiff and unable to relax

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8
Q

All murmurs except HOCM do what with increased venous return (squat, supine, leg raise) or increased afterload (grip)?

A

Increased loudness

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9
Q

HOCM does what with increased venous return?

A

Decrease loudness

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10
Q

What virus is most likely to cause myocarditis?

A

Coxsackievirus B

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11
Q

Rate determination pattern of an EKG if regular rhythm

A

300 150 100 75 60 50

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12
Q

Axis of an EKG is determined by these 2 leads

A

Lead 1 and AVF

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13
Q

Left bundle branch block on EKG

A

Wide QRS***, broad slurred R in V5 or V6

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14
Q

Right bundle branch block on EKG

A

Wide QRS***, RsR’ in V1 or V2

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15
Q

Pathologic Q wave definition

A

A Q wave >1 box in depth or width

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16
Q

3 things that, if present in 2 consecutive leads, indicates heart damage

A
  • Pathologic Q waves
  • ST depression or elevation
  • T wave inversion
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17
Q

Anterior wall infarction corresponding leads and artery involved

A

V1-V4, LAD

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18
Q

Lateral wall infarction corresponding leads and artery involved

A

I, AVL, V5, V6, circumflex

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19
Q

Inferior wall infarction corresponding leads and artery involved

A

II, III, AVF, RCA

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20
Q

What are the 2 nondihydropyridine ca2+ channel blockers

A

Verapamil

Diltiazem

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21
Q

1st line pharmacologic for WPW (narrow complex tachyarrhythmia)

A

Procainamide, opposed to adenosine which is used in others

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22
Q

Unstable bradycardia pharmacologic agent of choice

A

Atropine .5mg bolus every 3-5 min max at 3mg then dopamine if that doesn’t work

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23
Q

Unstable tachycardia treatment

A

Immediate synchronized cardioversion

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24
Q

Stable tachycardia treatment

A

12 lead ekg to assess QRS width, vagal maneuvers

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25
Q

Afib first line pharmacologic option

A

Beta blocker or Ca2+ channel blocker

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26
Q

Narrow QRS stable tachycardia treatment (excluding wpw)

A

Adenosine 6mg iv push

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27
Q

Wide QRS stable tachycardia treatment

A

Amiodarone 150mg

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28
Q

Acute coronary syndrome ACLS steps

A
  • oxygen 94-95%
  • IV access
  • 12 lead EKG
  • 325 mg chewed aspirin unless recent GI bleed or allergy
  • Sublingual nitro (unless BP low, which it may be in the situation of RV infarct, or PDE5 use)
  • Morphine
  • Notify cath lab (if cannot then tPA in 30 min of arrival)
  • CXR
  • Troponin
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29
Q

Stroke ACLS steps

A
  • Facial droop, arm drift, or slurred speech (cincinnati stroke scale)
  • Find last known normal
  • Supportive care
  • CT
  • Perform NIH scale assessmet
  • Ischemic qualities and within 3 hours last known normal tPA fibrolytic therapy
  • Ischemic qualities and non qualifying then aspirin
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30
Q

If AED says shockable, what 2 rhythms could it be?

A

Ventricular fib

Pulseless Vtach

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31
Q

If AED says non shockable, what 2 rhythms could it be?

A

Asystole

PEA

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32
Q

Ventricular fib or pulseless Vtach steps

A
  • administer shock
  • CPR 2 min
  • shockable?
  • If yes cpr 2 min +1 mg epi every 3-5 min IV/IO
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33
Q

Asystole/PEA steps

A
  • CPR 2 min
  • 1 mg epi every 3-5 min IV/IO
  • shockable?
  • If no check for signs of ROSC
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34
Q

You should get an AED if alone with a down adult, but with a kid, you should start ___ first

A

CPR 2 min

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35
Q

Most common cause of sick sinus syndrome (tachy brady sydnrome)

A

Sinus node fibrosis

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36
Q

1st degree AV block

A

Prolonged PR interval, often normal variant asymptomatic in most cases, no treatment needed unless symptomatic then atropine or possibly pacemaker long term

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37
Q

2nd degree AV block Mobitz I

A

Progressive PR interval lenghtening followed by a dropped QRS (wenckebach), no treatment needed in asymptomatic but can do atropine in symptomatic cases

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38
Q

2nd degree AV block Mobitz II

A

Constant PR interval with a dropped QRS, often needs treatment because progression to 3rd degree AV block common so permanent pacemaker definitive treatment***

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39
Q

3rd degree AV block

A

AV dissociation from atrial impulses, requires transcutaneous pacing followed by permanent pacemaker

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40
Q

Treatment of unstable atrial flutter/afib

A

Direct (synchronized) cardioversion (after TEE to ensure no atrial clots preferrably)

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41
Q

3 novel oral anticoagulants

A
  • rivaroxaban (xarelto)
  • dabigatran (pradaxa)
  • apixiban (eliquis)
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42
Q

CHA2DS2-VASc criteria

A 
Congestive heart failure
Hypertension
Age >75 years (2 points)
Diabetes
Stroke or TIA history (2 points)
Vascular disease
Age 65-74
Sex (female)

> or = 2 moderate to high risk so chronic oral anticoag recommended

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43
Q

Therapeutic INR goal for warfarin in patients with afib

A

2-3

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44
Q

PVC definition

A

Premature beat originating from ventricle causing wide bizarre QRS occurring earlier than expected, common finding on EKG that doesn’t usually warrant treatment unless 3 or > in a row then considered ventricular tachycardi

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45
Q

Torsades de pointes treatment

A

IV Mag sulfate

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46
Q

Difference between vtach and vfib

A

V tach still has a pattern while erratic is characteristic of coarse v fib

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47
Q

Long term use adverse effects of aiodarone

A

Thyroid disorders, pulmonary fibrosis, increased LFTS

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48
Q

Drug used to close a patent ductus arteriosus

A

IV indomethacin

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49
Q

Drug used to maintain ductus arteriosus and keep it open

A

Alprostadil

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50
Q

Still murmur

A

Most common pediatric innocent murmur heard up to preadolesence, cooing like a dove or musical/twanging in nature

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51
Q

Cervical venous hum

A

2nd most common pediatric innocent murmur behind a stills murmur, most common continuous benign murmur due to turbulent blood flow returning to heart at junction between jugular vein and superior vena cava

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52
Q

How does a patent foramen ovale present?

A

Often asymptomatic entire life unless causes cryptogenic stroke, treated with surgical PFO closure

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53
Q

Most common type of atrial septal defect

A

Ostium secundum

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54
Q

Eisenmenger syndrome

A

Pulmonary hypertension and cyanotic heart disease occurring when a left to right shunt becomes a right to left shunt causing the patient to develop cyanosis and clubbing in lower extremities

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55
Q

Patent ductus arteriosus murmur description

A

Continuous machine like murmur in the pulmonic area

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56
Q

Physical exam findings of coarctation of aorta

A

Ankle Brachial index, upper extremitiy hypertension and lower extremity hypotension, delayed or diminished lower extremity pulses

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57
Q

Confirmatory test for coarctation of aorta

A

Echocardiogram

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58
Q

Study of choice to diagnose tetralogy of fallot

A

Echocardiogram

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59
Q

Tetralogy of fallot CXR finding

A

Boot shaped heart

60
Q

4 components of tetralogy of fallot

A

RV outflow obstruction
RVH
VSD
Overriding aorta

61
Q

Most common type of congenital heart disease in childhood

62
Q

Diagnostic study for a VSD

A

Echocardiogram

63
Q

Biggest risk factor for CAD

64
Q

4 drugs used in outpatient treatment of angina pectoris

A
  • aspirin
  • b blockers
  • sublingual nitro
  • daily statin
65
Q

Indications for coronary artery bypass graft

A

-Left main coronary artery stenosis, or 3 vessel disesae

66
Q

2 cariac markers most often ordered for ACS

A

CK-MB

Troponin

67
Q

Triad of right ventricular infarct

A
  • Increased JVP
  • Clear lungs
  • Positive Kussmaul sign
68
Q

ST elevations in inferior leads should indicate a…

A

…right sided EKG

69
Q

Cooronary vasospasm treatment

A

Ca2+ channel blockers, avoid B blockers!!!

70
Q

Most common cause of HF

A

CAD (post MI)

71
Q

BNP > __ inidcates CHF

72
Q

Most common cause of right sided heart failure

A

Left sided heart failure

73
Q

Hydralazine

A

Vasodilator used to treat hypertension

74
Q

Hydroxyzine

A

1st gen antihistamine used for anxiety, allergies, vomiting, and anesthesia (sedation)

75
Q

ACE inhibitors/ARBS do what to k+?

A

Can precipitate hyperkalemia

76
Q

Spirinolactone and other k+ sparing diuretics do what to k+?

A

Can precipitate hyperkalemia

77
Q

Loop diuretics side effects

A

Can cause decreased electrolytes, hyperuricemia (precipitate gout), hyperglycemia

78
Q

Most effective medications that decrease mortality in heart failure with reduced EF? what medications have no mortality benefit?

A 
#1 ACE inhibitors
B blockers

Ca2+ channel blockers

79
Q

CXR findings associtaed with congestive HF

A

Kerley B lines

80
Q

Most common secondary cause of hypertension?

A

Renal artery stenosis

81
Q

Most common cause of end stage renal disease in the US

82
Q

Why is it recommended to limit beta blocker use in diabetic patients?

A

It may mask tachycardic symptoms of hypoglycemia in DM

83
Q

Drug used to treat hypertension + BPH

A

Prazosin, doxazosin

84
Q

Hypertensive urgency and emergency definition

A

SBP >180 and or DBP >120 without evidence of end organ damage and with evidence of end organ damage respectively

85
Q

Hypertensive urgency treatments (2)

A

clonidine

Captopril

86
Q

Hypertensive emergency treatment

A

sodium nitroprusside

87
Q

What’s part of the work up for postural hypotension

A

tilt table test

88
Q

What is the only type of shock which agressive IV fluids are NOT given?

A

Cardiogenic

89
Q

Massive PE finding on EKG

90
Q

SIRS criteria

A

2 of the following

  • temp >100.4 or <96.8
  • Pulse >90bpm
  • RR >20
  • WBC >12,000
91
Q

How long should a patient be observed after anaphylactic shock episode

A

4-6 hours in case of biphasic phenomenon

92
Q

Best meds to lower LDL, triglcyerides, increase HDL

A

statins, fibrates, niacin

93
Q

Statin contraindication

A

Pregnancy or breastfeeding

94
Q

Most common valve to become infected NOT from IV drug use?

A

Mitral valve

95
Q

Most common valve to become infected from IV drug use

A

Tricsupid valve

96
Q

Strep viridans can cause infective endocarditis from dissemination during a….

A

….dental procedure (patient’s with dental caries)

97
Q

What are HACEK organisms?

A

Haemophilus aphrophilus, actinobacillus, cardiobacterium homminis, Eikenella corrodens, Kingella kingae, gram negative organisms that are hard to culture and should be suspected in patients with endocarditis but NEGATIVE blood cultures

98
Q

3 key physical exam findings in infective endocarditis

A
  • Osler nodes - painful or tender nodules on pads of digits and the palms
  • Janeway lesions - painless erythematous macules on palms and soles
  • Roth spots - retinal hemorrhages with central clearing
99
Q

Diagnositc studies for infective endocarditis

A
  • Blood cultures (before antibiotic initiation) 3 sets 1 hour apart each
  • Echocardiogram
100
Q

Modified Duke Criteria

A

Determines clincial criteria for infective endocarditis, includes 2 major criteria (sustained bacteremia in 2 + cultures) or Endocardial invovlement documented by + eechocardiogram and 5 minor criteria including fever, predisposing condition, vascular and embolic phenomena such as janeway lesions, immunologic phenomena, requires 2 major or 1 major + 3 minor or 5 minor criteria

101
Q

If antibiotics cannot clear an infected prosthetic heart valve, then what is needed to treat?

A

Surgery to remove and replace the infected artificial valve

102
Q

Infective endocarditis native valve treatment

A

Nafcillin or Oxacillin plus either ceftriaxone or gentamicin

103
Q

Infective endocarditis prosthetic valve treatment

A

Vancomycin + gentamicin + rifampin

104
Q

Regimen for endocarditis prophylaxis in patients that have conditions that warrant prophylaxis

A

Amoxicillin

Clindamycin

105
Q

Dressler syndrome is treated different from acute pericarditis how?

A

Use of aspirin or colchicine but avoid NSAIDS as this may interfere with myocardial scar formation

106
Q

Pulsus paradoxus

A

Exaggerated decrease in systolic blood pressure with inspiration seen in cardiac tamponade

107
Q

Increasing venous return does what to all murmurs except HOCM?

A

Increases intensity

108
Q

What increases venous return (3)

A

Supine position
Squatting
Leg elevation

109
Q

What decreases venous return (2)

A

Standing

Valsalva

110
Q

Inspiration increases intensity of (right or left) sided murmurs? What about the other side?

A

Right, decreases

111
Q

What does handgrip do to the outflow?

A

Decreases it, thus decreasing an outflow murmur (AS or HOCM)

112
Q

What 3 murmurs increase with handgrip?

A

Aortic regurg or Mitral regurg or mitral stenosis

113
Q

Diastolic blowing decrescendo murmur heard at the left upper sternal border

A

Aortic regurgitation

114
Q

Quincke’s pulse and interpretation

A

Fingernail bed pulsations, Aortic regurg

115
Q

De Musset’s sign and interpretation

A

Head bobbing with each heart beat, aortic regurg

116
Q

Watter hammer/corrigan’s pulse and interpration

A

Swift upstroke and rapid fall of radial and carotid pulse, respectively, aortic regurg

117
Q

Most common cause of mitral stenosis

A

Rheumatic heart disease

118
Q

Opening snap indicates…

A

…forceful closure of mitral valve, mitral stenosis

119
Q

Management of mitral stenosis in a younger patient with symptoms?

A

Percutaneous balloon valvuloplasty

120
Q

Blowing holosystolic murmur heard best at the apex with radiation to the axilla

A

Mitral regurg

121
Q

Most common cause of mitral regurgitation

A

Mitral valve prolapse

122
Q

Mid late systolic ejection click

A

Mitral valve prolapse

123
Q

Pulmonic stenosis etiologies

A

Almost always congenital and disease of the young!!!

124
Q

Pulmonic stenosis treatment

A

Balloon valvuloplasty

125
Q

Pulmonic regurgitation causes

A

Almost always congenital, most clinically insignificant, well tolerated

126
Q

Mid diastolic murmur at the left lower sternal border

A

Tricuspid stenosis

127
Q

Holosystolic, blowing, high pitched murmur at the subxyphoid area, left mid sternal border

A

Tricuspid regurgitation

128
Q

Carvallo’s sign

A

Increased murmur intensity with inspiration distinguishing tricuspid regurgitation from mitral regurgitation

129
Q

Most common site of AAA formation and main modifiable risk factor

A

Infrarenal, smoking

130
Q

AAA diagnosis if stable and symptomatic? If unstable?

A

CT scan with IV contrast, bedside ultrasound

131
Q

AAA initial test in asympomtatic patients

A

Abdominal ultrasound

132
Q

How is AAA screened for?

A

1 time abdominal ultrasound inmen 65-75 who have ever smoked

133
Q

What size of AAA requires surgery

A

> or =5.5 cm or >0.5 cm expansion in 6 months

134
Q

Aortic dissection can be split into 2 categories, type A and type B. What is the difference between them and how are they managed?

A

Type A is the ascending aorta, B involves the descending aorta, type A requires surgery while type B can have medical management

135
Q

ABI is considered positive for PAD if value is < or =

136
Q

First line therapy for peripheral artery disease?

137
Q

Most common primary cardiac tumor that can mimick mitral stenosis

A

Atrial myxoma, identified with TEE as pedunculated mass with ball valve obstruction and requires surgical removal

138
Q

Giant cell arteritis treatment

A

HIGH dose corticosteroids

139
Q

Trousseau sign in superficial thrombophlebitis

A

Migratory thrombophlebitis associated with malignancy

140
Q

In a patient with MODERATE risk for DVT, positive D dimer but negative initial ultrasound, what is recommended?

A

Serial ultrasounds

141
Q

DVT treatment

A

Anticoagulation with lovenox plus warfarin, or other anticoagulants, if recurrent can to an IVC filter, or thrombectomy in severe cases

142
Q

Heparin antidote

A

Protamine sulfate

143
Q

Treatment for kawasaki disease (2)

A

IVIG and high dose aspirin, even in children

144
Q

Contraindications to aspirin

A

Renal injury
Gastric mucosal injury
Children use (post viral reye’s sydrome)

145
Q

Aspirin overdose treatment (2)

A

IV sodium bicarb and activated charcoal to prevent absorption

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