Cardiology Flashcards
1
Q
Heart failure type that is due to weakened ventricles and has a reduced EF
A
Systolic heart failure
2
Q
Heart failure type that is due to a stiff heart, hypertrophy and has a normal EF
A
Diastolic heart failure
3
Q
Normal Ejection Fraction
A
50-65%
4
Q
Left or Right HF –> blood backs up into the lungs
A
Left (L = Lungs)
5
Q
Left or Right HF –> blood backs up into the SVC and IVC
A
Right (R = Rest of the body)
6
Q
Left or Right HF –> JVD as a symptom
A
Right
7
Q
Most common type of cardiomyopathy
A
Dilated cardiomyopathy
8
Q
Four drugs that are used to reduce mortality in systolic HF
A
- ACE-I
- BB
- Spironolactone
- Hydralazine + nitrate
(You need to BASH the heart to work harder)
9
Q
Etiologies of Dilated cardiomyopathy
A
6Ds of dilated cardiomyopathy
- Don’t know - idiopathic (50%)
- Drinking alcohol
- Drugs - cocaine
- Disease - Viral infection
- Doxorubicin (Chemo drug)
- Deficiency in Vit B1
10
Q
Physical exam finding common with dilated cardiomyopathy
A
S3 Gallop (3 on its side looks like wide ventricles)
11
Q
Dx test for dilated cardiomyopathy
A
ECHO
12
Q
Echo findings with dilated cardiomyopathy (3)
A
- ventricular dilation
- decreased ventricular wall thickness
- reduced ejection fraction
13
Q
Etiologies of Restrictive cardiomyopathy (3)
A
- amyloidosis (MC)
- sarcoidosis
- hemochromatosis
(AMY HaS restrictive cardiomyopathy)
14
Q
Increased Jugular venous pressure (JVP) with inspiration
A
Kussmaul sign
15
Q
Dx test for restrictive cardiomyopathy
A
ECHO
16
Q
Echo findings for restrictive cardiomyopathy
A
Dilated atrium (MC), also possible ventricular thickening, and diastolic dysfunction
17
Q
Endomyocardial BX showing apple green biofriengence with congo red staining is diagnostic for…
A
amyloidosis
18
Q
autosomal dominant disorder of the heart muscle
A
hypertrophic cardiomyopathy
19
Q
most common symptom of hypertrophic cardiomyopathy
A
dyspnea
20
Q
murmur found with hypertrophic cardiomyopathy
A
harsh systolic murmur best heard at Left sternal border
increased with valsalva or standing
decreased with squatting
21
Q
Dx test for hypertrophic cardiomyopathy
A
ECHO
22
Q
Echo findings in hypertrophic cardiomyopathy
A
left ventricular wall thickening >15 mm
(13mm or greater if they have a FHX)
septum is most common location for thickening
23
Q
First line treatment for hypertrophic cardiomyopathy
A
Beta blockers (decreases the heart rate to give the heart a chance to fill)
24
Q
Second line treatment for hypertrophic cardiomyopathy
A
nondihydropyridine CCB –> Diltazem and verapamil
25
type of CCB that slows AV node conduction (decreases HR)
nondihydropyridine CCB --> Diltazem and verapamil
26
type of CCB that does not affect the AV node
dihydropyridine CCB --> amlodipine
27
Drugs to AVOID in patients with hypertrophic cardiomyopathy
nitrates and diuretics (decreases preload)
28
"lifestyle" choices to AVOID in patients with hypertrophic cardiomyopathy
dehydration, over exertion (sports)
29
Systolic vs Diastolic murmurs: aortic stenosis, mitral regurgitation, pulmonic stenosis, tricuspid regurgitation
systolic
30
Systolic vs Diastolic murmurs: aortic regurgitation, pulmonic regurgitation, mitral stenosis, tricuspid stenosis
diastolic
31
heart sound heard between S1 and S2
systolic
32
heart sound heard between S2 and S1
diastolic
33
systolic murmur heard best at right upper sternal boarder that radiates to carotids and neck
aortic stenosis
34
systolic crescendo-decrescendo murmur heard with an S4 gallop. Patient has a history of syncope
aortic stenosis
35
diastolic decrescendo murmur heard at 2nd ICS of LSB. Patient has a wide pulse pressure
aortic regurgitation
36
lateral PMI that is hyper-dynamic is found in what type of murmur
aortic regurgitation due to the dilated left ventricle
37
diastolic murmur with an opening snap heard at the apex. described as rumbling
mitral stenosis
38
type of murmur associated with a history of rheumatic fever
mitral stenosis
39
systolic murmur heard at apex and is holosystolic. Has an S3 and a diffuse laterally displaced PMI
mitral regurgitation
40
most common murmur
mitral valve prolapse
41
anxious patient complaining of palpitations that has a midsystolic click and a normal PMI
mitral valve prolapse
42
treatment for mitral valve prolapse
none
43
first valve to be effected by IV drug use
tricuspid
44
Right vs left sided murmurs: increase with inspiration
Right
45
wide fixed split S2 systolic murmur
ASD
46
high pitched harsh holosystolic murmur with a thrill
VSD
47
machine like murmur heard in both systole and diastole
PDA
48
first line treatment for PDA
NSAIDs - indomethacin
49
Patient with bounding upper extremity pulses and delayed or weak lower extremity pulses. Murmur heard best on their back and is a mid systolic murmur
coarctation of the aorta
50
cyanotic congenital heart defect that will have both a VSD murmur and a pulmonic stenosis murmur
tetrology of fallot
51
friction rub is present in which condition
pericarditis
52
symptoms consistent with pericarditis
orthopnea, pain with laying down, coughing or deep breathing
53
EKG findings consistent with pericarditis
diffuse ST segment elevation, decreased PR
54
cardiac sounds beast heard at left sternal boarder when patient is leaning forward
aortic regurgitation and friction rub
55
Beck's triad is diagnostic for...
cardiac tamponade
56
Beck's triad includes...
1. JVD
2. hypotension
3. muffled heart sounds
57
EKG finding consistent with cardiac tamponade
electrical alternans (QRS changes shape in every lead)
58
Two diagnosis associated with sudden cardiac death and successful resuscitation
hypertrophic cardiomyopathy (associated with exercise), prolonged QT (not exercise induced)
59
Rhythm strip with PR interval longer than 0.2 seconds. One P wave per QRS
First degree AV block
60
Rhythm strip with progressive lengthening PR interval then a skipped QRS complex
Type I second degree AV block (Wenckebach)
61
Treatment for First degree AV block
none
62
Treatment for Type I second degree AV block
None
63
Rhythm strip with a fixed PR interval and an occasionally dropped QRS
Type II second degree AV block (Mobitz)
64
Treatment for Type II second degree AV block
pacemaker
65
Rhythm strip that shows no association between P and QRS complexes. P waves happening at a regular interval.
Third degree AV block
66
Treatment for Third degree AV block
Pacemaker
67
R and R' seen in V4-V6
Left BBB
68
R and R' seen in V1-V3
Right BBB
69
Which type of new onset BBB should you be concerned for an MI
Left
70
Bradycardia alternating with tachycardia
Sick sinus syndrome
71
rhythm strip that does not have P waves visible and has a irregularly irregular rate
A. fib
72
Medications used for rate control in A.fib
Metoprolol, diltiazem, verapamil
73
Rhythm control in A.fib
Cardioversion and amioderone
74
First line treatment in a stable patient with SVT
carotid massage or valsalva
75
medication used to treat SVT
adenosine
76
Medications that can cause Torsades de Pointe
zofran, macrolides, TCAs
77
electrolyte abnormalities that can cause Torsades de Pointe
low K and low Mg
78
Medication used in patients with Torsades
Magnesium sulfate
79
Target INR on Warfarin
2.5
80
Rhythm strip with widened QRS and delta waves
Wolff-Parkinson White
81
Early and wide QRS without a P wave
PVC
82
abnormally shaped P wave
PAC
83
narrow QRS with no or an inverted P wave
premature junctional complex
84
treatment for V. fib
unsynchronized cardioversion (defibrillation)
85
treatment for unstable monomorphic V. tach
synchronized cardioversion
86
treatment for unstable polymorphic V. tach
unsynchronized cardioversion
87
treatment for stable V. tach
amioderone
88
most common congenital heart defect
VSD
89
most common cyanotic congenital heard defect
tetrology of fallot
90
transient cyanotic episodes commonly associated with crying or exertion, improved with squatting or bringing knees to chest
tet spells - symptom of tetrology of fallot
91
CXR finding associated with tetrology of fallot
Boot shaped heart (upturned apex)
92
treatment of tetrology of fallot
surgery, and prostaglandins (alprostadil) until surgery to keep PDA open
93
Genetic disorders associated with tetrology of fallot
down syndrome, Digeorge syndrome
94
Two CXR findings consistent with coarctation of the aorta
1. posterior rib notching
| 2. figure 3 sign
95
congenital heart defect that can be a secondary cause of hypertension
coarctation of the aorta
96
cramping of the lower extremities on exertion is a symptom of which congenital heart defect
coarctation of the aorta
97
Which congenital heart defect also my have a wide PP
PDA
98
most common cause of Right heart failure
Left heart failure
99
S3 gallop is found in which type of heart failure
systolic HF (and dilated cardiomyopathy)
100
S4 gallop is a abnormal finding that is seen in which type of heart failure
Diastolic
101
Symptoms of Left or Right HF: dyspnea, orthopnea, cough, frothy sputum
Left
102
Symptoms of Left or Right HF: edema, JVD, N/V, hepatojugular reflux
Right
103
NY Heart Association Functional Heart Failure Classes (1-4)
1. NO symptoms
2. mild symptoms but can do ADLs
3. only comfortable at rest, cannot do ADLs
4. Symptoms even at rest
104
Best test to diagnose HF
ECHO
105
Best INITAL test for HF
CXR
106
Signs of HF on CXR (2)
1. Kerley B line
| 2. Butterfly/Batwing appearance
107
Lab value important for diagnosing and treatment response of heart failure
BNP
108
lifestyle modifications important in HF
smoking cessation
| Diet: low sodium and fluid restriction
109
Meds used in heart failure that only treat symptoms (have no effect on mortality)
Loop diuretics, digoxin
110
ADRs of digoxin
visual changes, increased K, arrhythmias
111
Treatment of acute decompensated heart failure
```
Lasix
Morphine
Nitrates
Oxygen
Position - sitting up, legs off bed
(LMNOP - Morphine is controversial in practice)
```
112
most common patient populations to see atypical symptoms of acute coronary syndrome
women, elderly, and DM pts
113
patient has chest pain at rest that is not relieved by nitro, they have a negative EKG and troponin - DX?
unstable angina
114
patient has chest pain at rest that is not relieved by nitro, they have a negative EKG but positive troponin - DX?
NSTEMI
115
patient has chest pain at rest that is not relieved by nitro, they have ST segment elevation on EKG and positive troponin - DX?
STEMI
116
New LBBB is a _____ until proven otherwise
STEMI
117
this cardiac enzyme is elevated 2-3 hours after an MI and remains elevated for 10 days, can also be elevated with CKD, PE and trauma
troponin
118
this is the first cardiac enzyme to peak (increase)
myoglobin
119
this cardiac enzyme may be used for early reinfarction due to it returning to baseline after 72 hours
CKMB
120
ST elevation found in these leads in an inferior MI
II, III, and AVF
121
artery occluded in a inferior MI
right coronary artery
122
treatment for patient with acute coronary syndrome
```
MOAN BASH
M-morphine
O- oxygen
A- aspirin
N- Nitro
```
B- BB
A - ACE-I
S - statin
H - heparin ( or anticoagulation)
123
contraindications to giving nitroglycerin
viagra (sidenifil) use within 24 hrs, systolic BP less than 90, or inferior MI with right ventricular involvement
124
First line re-perfusion therapy in acute coronary syndrome
PCI - cath and stent
125
You have a patient having a STEMI but they are 3 hours away from a hospital that does PCI, what medication can you give them for re-perfusion
Thrombolytic - TPA (cut off is 90 mins to cath lab)
126
patient with chest pain at rest that is transient, EKG changes when patient is having symptoms - DX?
prinzmetal variant angina (or cocaine induced MI)
127
treatment for prinzmetal variant angina
CCB (nifedipine) or nitrates (same tx for cocaine induced MI)
128
which medication is contraindicated in patients with prinzmetal variant angina
beta blockers (same as cocaine induced MI)
129
Post MI pericarditis
Dressler's syndrome
130
treatment for dressler's syndrome
aspirin or colchicine (avoid NSAIDs)
131
triad of right ventricular infarction
1. increased JVP
2. Clear lungs
3. + Kussmal's sign (Increased JVP with inspiration)
132
chest pain exacerbated by activity but relieved by rest or nitroglycerine
stable angina
133
test of choice to diagnosis stable angina
stress test - EKG changes may show down slopping ST segments
134
medication used to treat congenital or stable QT prolongation
propranolol
135
ADRs of administering prostaglandins
apnea, hypotension, fever
136
taking lithium during pregnancy can cause what cardiac abnormality?
Ebstein's anomaly
137
list risk factors for primary hypertension
age, obesity, family history, African American race
138
most common cause of secondary hypertension
renal artery stenosis
139
other common causes of secondary hypertension
renal artery stenosis, coarctation of aorta, cushing's syndrome, pheochromocytoma, OSA
140
stage one hypertension
systolic of 130-139 or diastolic of 80-89
141
stage two hypertension
systolic >140 or diastolic >90
142
what is necessary to make a DX of HTN
Two separate readings at two separate events
143
lifestyle modifications used to treat HTN
weight loss, DASH diet, decreased ETOH, exercise
144
First line medication in patients with HTN and DM or CKD
ACE-I or ARB
145
First line medications in patients with HTN and of African American race
Thiazide or CCB (amlodipine)
146
beta blockers should not be used as initial mono therapy to treat HTN except if the patient has which comorbidity?
heart failure with reduced EF
147
goal of HTN treatment
<140/<90
148
if HTN is refractory to many meds you need to think of ____ and order which test?
secondary causes like renal artery stenosis ---> order a renal ultrasound
149
Pt with a blood pressure over 180/120 without any symptoms - DX?
hypertensive urgency
150
Pt with blood pressure over 180/120 with a headache or chest pain
hypertensive emergency (due to them having symptoms of end organ damage)
151
goal of treatment for a HTN emergency
reduce MAP by 10-20% in first hour, and then by 5-15% over the next 23 hours
152
treatment for hypertensive urgency
oral anti-HTN meds - since end organ damage has not yet occured
153
treatment for hypertensive emergency
IV anti-HTN meds (labetolol, nicardipine), admission
154
Patient comes in with JVP, BP of 88/60 and you hear crackles on lung exam. Patient appears pale and had cool skin. What are you concerned about?
cardiogenic shock
155
pulmonary capillary wedge pressure >15 mm makes which diagnosis?
cardiogenic shock
156
treatment of cardiogenic shock
fluids, pressors (dobutamine, norepi), and oxygen
157
drop in blood pressure of >20 mmHg systolic or >10 mmHg diastolic when patient is moved to an upright position
orthostatic hypotension
158
orthostatic hypotension without a compensatory increased in heart rate is indicative of which cause
autonomic dysfunction
159
treatment of orthostatic hypotension
increased Na and Fluids
160
decrease in heart rate and BP that leads to fainting, often associated with a stressful trigger
vaso-vagal syncope
161
what test may reproduce symptoms of vaso-vagal syncope
tilt-table test
162
According to the USPSTF when should you start screening for cholesterol
35 yo
163
Name the two high intensity statins
Atorvastatin and Rosuvastatin
164
Most common side effect of statins
myalgia (should get CK to rule out rhabdo)
165
An LDL over ____ indicated treatment with statin in a patient with no comorbidities
190
166
Triglycerides over _____ put the patient at risk for pancreatitis
500
167
treatment for isolated high triglycerides
Fibrates (finofibrate, gemfibrozil), second line Niacin, although lifestyle changes can make a big impact on TG
168
Name 2 ADRs associated with Niacin
flushing, and hyperglycemia
169
xanthomas are a symptom of...
high cholesterol
170
back pain, pulsatile mass, hypotension - DX?
abdominal aortic anerurysm
171
severe, tearing/ripping knife like chest pain radiating to back - DX?
Aortic dissection
172
screening criteria for aortic aneurysm
Male over 65 who has ever smoked
173
size of aortic aneurysm that indicated the need for surgery
>5.5 cm
174
CXR finding indicative of aortic dissection
widened mediastium
175
gold standard test for aortic dissection
MRI angiography
176
variating in pulses between L and R arms should indicate which DX
aortic dissection
177
treatment for ascending dissecting aorta
surgical emergency
178
treatment for descending dissecting aorta
beta blockers
179
signs and symptoms of arterial occlusion/embolism
```
6Ps
Pain
paralysis
pallor
paresthesia
polar/poikilothermia
pulselessness
```
180
gold standard test for diagnosis arterial embolism/thrombosis
angiography
181
treatment of arterial thrombosis
anticoagulation (heparin), embolectomy within 4-6 hours of symptoms
182
abnormal connection between arteries and veins, bypassing the capillary system
arteriovenous malformation (AVM)
183
most common presenting symptom of an AVM
intercranial hemorrhage
184
gold standard for diagnosing and treating and AVM
angiography
185
giant cell arteritis is most common in this population
woman over 50
186
pt with headaches, jaw claudication, amaurosis fugax, and a tender temporal artery -- DX?
giant cell arteritis
187
studies used to diagnose giant cell arteritis
ESR >100, temporal artery BX definitive
188
treatment of giant cell arteritis
high dose prednisone
189
dangerous complication of giant cell arteritis
blindness
190
patient with claudication, pain with exercise, shiny atrophic skin -- DX?
peripheral artery disease
191
studies to diagnose PAD
ABI
192
treatment of PAD
lifestyle changes, smoking cessation, aspirin/plavix, revasculatrization surgery
193
inflammation of the wall of the vein which can lead to clot formation, common after IV insertion
phlebitis/thrombophlebitis
194
gold standard diagnostic study for phlebitis/thrombophlebitis
venous duplex US
195
treatment for phlebitis
elevation, warm compress, NSAIDs
196
treatment for thrombophlebitis
heparin - 1 month
197
leg fullness and pressure, pain with exertion, dilated superficial veins visible - DX?
varicose veins
198
treatment for varicose veins
compression, elevation, surgery
199
stasis dermatitis, non-healing ulcers over medial malleolus are common findings of ...
venous insufficiency
200
virchow's triad
stasis
hypercoaguable state
trauma
201
homan's sign is used to test for...
DVT
202
woman over 35 who smoke and take OCP are at greatest risk for...
DVT
203
studies to diagnose DVT
venous duplex, d-dimer if low risk, venography is gold standard
204
treatment for DVT
anticoagulation for 3-6 months
