Cardiology Flashcards
1
Q
Causes of dilated cardiomyopathy (4)
A
- Idiopathic
- Infections (viral)
- Alcohol or drug abuse
- Metabolic, vitamin B1 deficiency
2
Q
Standard systolic heart failure treatment
A
ACE inhibitors
Beta blockers (metoprolol or carvedilol)
Symptom control with diuretics
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
4
Q
Most common cause of restrictive cardiomyopathy
A
Amyloidosis, sarcoidosis, hemochromatosis, metastatic disease
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
6
Q
Definitive diagnosis of restrictive cardiomyopathy is made through ___. Often an ___ is the diagnostic test of choice
A
Endomyocardial biopsy, echocardiogram
7
Q
Hypertrophic cardiomyopathy has systolic or diastolic dysfunction?
A
Diastolic dysfunction, becomes stiff and unable to relax
8
Q
All murmurs except HOCM do what with increased venous return (squat, supine, leg raise) or increased afterload (grip)?
A
Increased loudness
9
Q
HOCM does what with increased venous return?
A
Decrease loudness
10
Q
What virus is most likely to cause myocarditis?
A
Coxsackievirus B
11
Q
Rate determination pattern of an EKG if regular rhythm
A
300 150 100 75 60 50
12
Q
Axis of an EKG is determined by these 2 leads
A
Lead 1 and AVF
13
Q
Left bundle branch block on EKG
A
Wide QRS***, broad slurred R in V5 or V6
14
Q
Right bundle branch block on EKG
A
Wide QRS***, RsR’ in V1 or V2
15
Q
Pathologic Q wave definition
A
A Q wave >1 box in depth or width
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
17
Q
Anterior wall infarction corresponding leads and artery involved
A
V1-V4, LAD
18
Q
Lateral wall infarction corresponding leads and artery involved
A
I, AVL, V5, V6, circumflex
19
Q
Inferior wall infarction corresponding leads and artery involved
A
II, III, AVF, RCA
20
Q
What are the 2 nondihydropyridine ca2+ channel blockers
A
Verapamil
Diltiazem
21
Q
1st line pharmacologic for WPW (narrow complex tachyarrhythmia)
A
Procainamide, opposed to adenosine which is used in others
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
23
Q
Unstable tachycardia treatment
A
Immediate synchronized cardioversion
24
Q
Stable tachycardia treatment
A
12 lead ekg to assess QRS width, vagal maneuvers
25
Afib first line pharmacologic option
Beta blocker or Ca2+ channel blocker
26
Narrow QRS stable tachycardia treatment (excluding wpw)
Adenosine 6mg iv push
27
Wide QRS stable tachycardia treatment
Amiodarone 150mg
28
Acute coronary syndrome ACLS steps
- 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
29
Stroke ACLS steps
- 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
30
If AED says shockable, what 2 rhythms could it be?
Ventricular fib
| Pulseless Vtach
31
If AED says non shockable, what 2 rhythms could it be?
Asystole
| PEA
32
Ventricular fib or pulseless Vtach steps
- administer shock
- CPR 2 min
- shockable?
- If yes cpr 2 min +1 mg epi every 3-5 min IV/IO
33
Asystole/PEA steps
- CPR 2 min
- 1 mg epi every 3-5 min IV/IO
- shockable?
- If no check for signs of ROSC
34
You should get an AED if alone with a down adult, but with a kid, you should start ___ first
CPR 2 min
35
Most common cause of sick sinus syndrome (tachy brady sydnrome)
Sinus node fibrosis
36
1st degree AV block
Prolonged PR interval, often normal variant asymptomatic in most cases, no treatment needed unless symptomatic then atropine or possibly pacemaker long term
37
2nd degree AV block Mobitz I
Progressive PR interval lenghtening followed by a dropped QRS (wenckebach), no treatment needed in asymptomatic but can do atropine in symptomatic cases
38
2nd degree AV block Mobitz II
Constant PR interval with a dropped QRS, often needs treatment because progression to 3rd degree AV block common so permanent pacemaker definitive treatment***
39
3rd degree AV block
AV dissociation from atrial impulses, requires transcutaneous pacing followed by permanent pacemaker
40
Treatment of unstable atrial flutter/afib
Direct (synchronized) cardioversion (after TEE to ensure no atrial clots preferrably)
41
3 novel oral anticoagulants
- rivaroxaban (xarelto)
- dabigatran (pradaxa)
- apixiban (eliquis)
42
CHA2DS2-VASc criteria
```
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
43
Therapeutic INR goal for warfarin in patients with afib
2-3
44
PVC definition
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
45
Torsades de pointes treatment
IV Mag sulfate
46
Difference between vtach and vfib
V tach still has a pattern while erratic is characteristic of coarse v fib
47
Long term use adverse effects of aiodarone
Thyroid disorders, pulmonary fibrosis, increased LFTS
48
Drug used to close a patent ductus arteriosus
IV indomethacin
49
Drug used to maintain ductus arteriosus and keep it open
Alprostadil
50
Still murmur
Most common pediatric innocent murmur heard up to preadolesence, cooing like a dove or musical/twanging in nature
51
Cervical venous hum
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
52
How does a patent foramen ovale present?
Often asymptomatic entire life unless causes cryptogenic stroke, treated with surgical PFO closure
53
Most common type of atrial septal defect
Ostium secundum
54
Eisenmenger syndrome
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
55
Patent ductus arteriosus murmur description
Continuous machine like murmur in the pulmonic area
56
Physical exam findings of coarctation of aorta
Ankle Brachial index, upper extremitiy hypertension and lower extremity hypotension, delayed or diminished lower extremity pulses
57
Confirmatory test for coarctation of aorta
Echocardiogram
58
Study of choice to diagnose tetralogy of fallot
Echocardiogram
59
Tetralogy of fallot CXR finding
Boot shaped heart
60
4 components of tetralogy of fallot
RV outflow obstruction
RVH
VSD
Overriding aorta
61
Most common type of congenital heart disease in childhood
VSD
62
Diagnostic study for a VSD
Echocardiogram
63
Biggest risk factor for CAD
DM
64
4 drugs used in outpatient treatment of angina pectoris
- aspirin
- b blockers
- sublingual nitro
- daily statin
65
Indications for coronary artery bypass graft
-Left main coronary artery stenosis, or 3 vessel disesae
66
2 cariac markers most often ordered for ACS
CK-MB
| Troponin
67
Triad of right ventricular infarct
- Increased JVP
- Clear lungs
- Positive Kussmaul sign
68
ST elevations in inferior leads should indicate a...
...right sided EKG
69
Cooronary vasospasm treatment
Ca2+ channel blockers, avoid B blockers!!!
70
Most common cause of HF
CAD (post MI)
71
BNP > __ inidcates CHF
100
72
Most common cause of right sided heart failure
Left sided heart failure
73
Hydralazine
Vasodilator used to treat hypertension
74
Hydroxyzine
1st gen antihistamine used for anxiety, allergies, vomiting, and anesthesia (sedation)
75
ACE inhibitors/ARBS do what to k+?
Can precipitate hyperkalemia
76
Spirinolactone and other k+ sparing diuretics do what to k+?
Can precipitate hyperkalemia
77
Loop diuretics side effects
Can cause decreased electrolytes, hyperuricemia (precipitate gout), hyperglycemia
78
Most effective medications that decrease mortality in heart failure with reduced EF? what medications have no mortality benefit?
```
#1 ACE inhibitors
B blockers
```
Ca2+ channel blockers
79
CXR findings associtaed with congestive HF
Kerley B lines
80
Most common secondary cause of hypertension?
Renal artery stenosis
81
Most common cause of end stage renal disease in the US
Diabetes
82
Why is it recommended to limit beta blocker use in diabetic patients?
It may mask tachycardic symptoms of hypoglycemia in DM
83
Drug used to treat hypertension + BPH
Prazosin, doxazosin
84
Hypertensive urgency and emergency definition
SBP >180 and or DBP >120 without evidence of end organ damage and with evidence of end organ damage respectively
85
Hypertensive urgency treatments (2)
clonidine
| Captopril
86
Hypertensive emergency treatment
sodium nitroprusside
87
What's part of the work up for postural hypotension
tilt table test
88
What is the only type of shock which agressive IV fluids are NOT given?
Cardiogenic
89
Massive PE finding on EKG
S1Q3T3
90
SIRS criteria
2 of the following
- temp >100.4 or <96.8
- Pulse >90bpm
- RR >20
- WBC >12,000
91
How long should a patient be observed after anaphylactic shock episode
4-6 hours in case of biphasic phenomenon
92
Best meds to lower LDL, triglcyerides, increase HDL
statins, fibrates, niacin
93
Statin contraindication
Pregnancy or breastfeeding
94
Most common valve to become infected NOT from IV drug use?
Mitral valve
95
Most common valve to become infected from IV drug use
Tricsupid valve
96
Strep viridans can cause infective endocarditis from dissemination during a....
....dental procedure (patient's with dental caries)
97
What are HACEK organisms?
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
3 key physical exam findings in infective endocarditis
- 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
Diagnositc studies for infective endocarditis
- Blood cultures (before antibiotic initiation) 3 sets 1 hour apart each
- Echocardiogram
100
Modified Duke Criteria
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
If antibiotics cannot clear an infected prosthetic heart valve, then what is needed to treat?
Surgery to remove and replace the infected artificial valve
102
Infective endocarditis native valve treatment
Nafcillin or Oxacillin plus either ceftriaxone or gentamicin
103
Infective endocarditis prosthetic valve treatment
Vancomycin + gentamicin + rifampin
104
Regimen for endocarditis prophylaxis in patients that have conditions that warrant prophylaxis
Amoxicillin
| Clindamycin
105
Dressler syndrome is treated different from acute pericarditis how?
Use of aspirin or colchicine but avoid NSAIDS as this may interfere with myocardial scar formation
106
Pulsus paradoxus
Exaggerated decrease in systolic blood pressure with inspiration seen in cardiac tamponade
107
Increasing venous return does what to all murmurs except HOCM?
Increases intensity
108
What increases venous return (3)
Supine position
Squatting
Leg elevation
109
What decreases venous return (2)
Standing
| Valsalva
110
Inspiration increases intensity of (right or left) sided murmurs? What about the other side?
Right, decreases
111
What does handgrip do to the outflow?
Decreases it, thus decreasing an outflow murmur (AS or HOCM)
112
What 3 murmurs increase with handgrip?
Aortic regurg or Mitral regurg or mitral stenosis
113
Diastolic blowing decrescendo murmur heard at the left upper sternal border
Aortic regurgitation
114
Quincke's pulse and interpretation
Fingernail bed pulsations, Aortic regurg
115
De Musset's sign and interpretation
Head bobbing with each heart beat, aortic regurg
116
Watter hammer/corrigan's pulse and interpration
Swift upstroke and rapid fall of radial and carotid pulse, respectively, aortic regurg
117
Most common cause of mitral stenosis
Rheumatic heart disease
118
Opening snap indicates...
...forceful closure of mitral valve, mitral stenosis
119
Management of mitral stenosis in a younger patient with symptoms?
Percutaneous balloon valvuloplasty
120
Blowing holosystolic murmur heard best at the apex with radiation to the axilla
Mitral regurg
121
Most common cause of mitral regurgitation
Mitral valve prolapse
122
Mid late systolic ejection click
Mitral valve prolapse
123
Pulmonic stenosis etiologies
Almost always congenital and disease of the young!!!
124
Pulmonic stenosis treatment
Balloon valvuloplasty
125
Pulmonic regurgitation causes
Almost always congenital, most clinically insignificant, well tolerated
126
Mid diastolic murmur at the left lower sternal border
Tricuspid stenosis
127
Holosystolic, blowing, high pitched murmur at the subxyphoid area, left mid sternal border
Tricuspid regurgitation
128
Carvallo's sign
Increased murmur intensity with inspiration distinguishing tricuspid regurgitation from mitral regurgitation
129
Most common site of AAA formation and main modifiable risk factor
Infrarenal, smoking
130
AAA diagnosis if stable and symptomatic? If unstable?
CT scan with IV contrast, bedside ultrasound
131
AAA initial test in asympomtatic patients
Abdominal ultrasound
132
How is AAA screened for?
1 time abdominal ultrasound inmen 65-75 who have ever smoked
133
What size of AAA requires surgery
> or =5.5 cm or >0.5 cm expansion in 6 months
134
Aortic dissection can be split into 2 categories, type A and type B. What is the difference between them and how are they managed?
Type A is the ascending aorta, B involves the descending aorta, type A requires surgery while type B can have medical management
135
ABI is considered positive for PAD if value is < or =
.90
136
First line therapy for peripheral artery disease?
Exercise
137
Most common primary cardiac tumor that can mimick mitral stenosis
Atrial myxoma, identified with TEE as pedunculated mass with ball valve obstruction and requires surgical removal
138
Giant cell arteritis treatment
HIGH dose corticosteroids
139
Trousseau sign in superficial thrombophlebitis
Migratory thrombophlebitis associated with malignancy
140
In a patient with MODERATE risk for DVT, positive D dimer but negative initial ultrasound, what is recommended?
Serial ultrasounds
141
DVT treatment
Anticoagulation with lovenox plus warfarin, or other anticoagulants, if recurrent can to an IVC filter, or thrombectomy in severe cases
142
Heparin antidote
Protamine sulfate
143
Treatment for kawasaki disease (2)
IVIG and high dose aspirin, even in children
144
Contraindications to aspirin
Renal injury
Gastric mucosal injury
Children use (post viral reye's sydrome)
145
Aspirin overdose treatment (2)
IV sodium bicarb and activated charcoal to prevent absorption
