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PANCE Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Heart failure type that is due to weakened ventricles and has a reduced EF

A

Systolic heart failure

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2
Q

Heart failure type that is due to a stiff heart, hypertrophy and has a normal EF

A

Diastolic heart failure

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3
Q

Normal Ejection Fraction

A

50-65%

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4
Q

Left or Right HF –> blood backs up into the lungs

A

Left (L = Lungs)

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5
Q

Left or Right HF –> blood backs up into the SVC and IVC

A

Right (R = Rest of the body)

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6
Q

Left or Right HF –> JVD as a symptom

A

Right

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7
Q

Most common type of cardiomyopathy

A

Dilated cardiomyopathy

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8
Q

Four drugs that are used to reduce mortality in systolic HF

A
  1. ACE-I
  2. BB
  3. Spironolactone
  4. Hydralazine + nitrate
    (You need to BASH the heart to work harder)
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9
Q

Etiologies of Dilated cardiomyopathy

A

6Ds of dilated cardiomyopathy

  1. Don’t know - idiopathic (50%)
  2. Drinking alcohol
  3. Drugs - cocaine
  4. Disease - Viral infection
  5. Doxorubicin (Chemo drug)
  6. Deficiency in Vit B1
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10
Q

Physical exam finding common with dilated cardiomyopathy

A

S3 Gallop (3 on its side looks like wide ventricles)

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11
Q

Dx test for dilated cardiomyopathy

A

ECHO

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12
Q

Echo findings with dilated cardiomyopathy (3)

A
  1. ventricular dilation
  2. decreased ventricular wall thickness
  3. reduced ejection fraction
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13
Q

Etiologies of Restrictive cardiomyopathy (3)

A
  1. amyloidosis (MC)
  2. sarcoidosis
  3. hemochromatosis

(AMY HaS restrictive cardiomyopathy)

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14
Q

Increased Jugular venous pressure (JVP) with inspiration

A

Kussmaul sign

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15
Q

Dx test for restrictive cardiomyopathy

A

ECHO

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16
Q

Echo findings for restrictive cardiomyopathy

A

Dilated atrium (MC), also possible ventricular thickening, and diastolic dysfunction

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17
Q

Endomyocardial BX showing apple green biofriengence with congo red staining is diagnostic for…

A

amyloidosis

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18
Q

autosomal dominant disorder of the heart muscle

A

hypertrophic cardiomyopathy

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19
Q

most common symptom of hypertrophic cardiomyopathy

A

dyspnea

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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

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21
Q

Dx test for hypertrophic cardiomyopathy

A

ECHO

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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

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23
Q

First line treatment for hypertrophic cardiomyopathy

A

Beta blockers (decreases the heart rate to give the heart a chance to fill)

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24
Q

Second line treatment for hypertrophic cardiomyopathy

A

nondihydropyridine CCB –> Diltazem and verapamil

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25
Q

type of CCB that slows AV node conduction (decreases HR)

A

nondihydropyridine CCB –> Diltazem and verapamil

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26
Q

type of CCB that does not affect the AV node

A

dihydropyridine CCB –> amlodipine

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27
Q

Drugs to AVOID in patients with hypertrophic cardiomyopathy

A

nitrates and diuretics (decreases preload)

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28
Q

“lifestyle” choices to AVOID in patients with hypertrophic cardiomyopathy

A

dehydration, over exertion (sports)

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29
Q

Systolic vs Diastolic murmurs: aortic stenosis, mitral regurgitation, pulmonic stenosis, tricuspid regurgitation

A

systolic

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30
Q

Systolic vs Diastolic murmurs: aortic regurgitation, pulmonic regurgitation, mitral stenosis, tricuspid stenosis

A

diastolic

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31
Q

heart sound heard between S1 and S2

A

systolic

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32
Q

heart sound heard between S2 and S1

A

diastolic

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33
Q

systolic murmur heard best at right upper sternal boarder that radiates to carotids and neck

A

aortic stenosis

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34
Q

systolic crescendo-decrescendo murmur heard with an S4 gallop. Patient has a history of syncope

A

aortic stenosis

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35
Q

diastolic decrescendo murmur heard at 2nd ICS of LSB. Patient has a wide pulse pressure

A

aortic regurgitation

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36
Q

lateral PMI that is hyper-dynamic is found in what type of murmur

A

aortic regurgitation due to the dilated left ventricle

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37
Q

diastolic murmur with an opening snap heard at the apex. described as rumbling

A

mitral stenosis

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38
Q

type of murmur associated with a history of rheumatic fever

A

mitral stenosis

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39
Q

systolic murmur heard at apex and is holosystolic. Has an S3 and a diffuse laterally displaced PMI

A

mitral regurgitation

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40
Q

most common murmur

A

mitral valve prolapse

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41
Q

anxious patient complaining of palpitations that has a midsystolic click and a normal PMI

A

mitral valve prolapse

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42
Q

treatment for mitral valve prolapse

A

none

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43
Q

first valve to be effected by IV drug use

A

tricuspid

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44
Q

Right vs left sided murmurs: increase with inspiration

A

Right

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45
Q

wide fixed split S2 systolic murmur

A

ASD

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46
Q

high pitched harsh holosystolic murmur with a thrill

A

VSD

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47
Q

machine like murmur heard in both systole and diastole

A

PDA

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48
Q

first line treatment for PDA

A

NSAIDs - indomethacin

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49
Q

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

A

coarctation of the aorta

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50
Q

cyanotic congenital heart defect that will have both a VSD murmur and a pulmonic stenosis murmur

A

tetrology of fallot

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51
Q

friction rub is present in which condition

A

pericarditis

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52
Q

symptoms consistent with pericarditis

A

orthopnea, pain with laying down, coughing or deep breathing

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53
Q

EKG findings consistent with pericarditis

A

diffuse ST segment elevation, decreased PR

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54
Q

cardiac sounds beast heard at left sternal boarder when patient is leaning forward

A

aortic regurgitation and friction rub

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55
Q

Beck’s triad is diagnostic for…

A

cardiac tamponade

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56
Q

Beck’s triad includes…

A
  1. JVD
  2. hypotension
  3. muffled heart sounds
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57
Q

EKG finding consistent with cardiac tamponade

A

electrical alternans (QRS changes shape in every lead)

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58
Q

Two diagnosis associated with sudden cardiac death and successful resuscitation

A

hypertrophic cardiomyopathy (associated with exercise), prolonged QT (not exercise induced)

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59
Q

Rhythm strip with PR interval longer than 0.2 seconds. One P wave per QRS

A

First degree AV block

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60
Q

Rhythm strip with progressive lengthening PR interval then a skipped QRS complex

A

Type I second degree AV block (Wenckebach)

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61
Q

Treatment for First degree AV block

A

none

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62
Q

Treatment for Type I second degree AV block

A

None

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63
Q

Rhythm strip with a fixed PR interval and an occasionally dropped QRS

A

Type II second degree AV block (Mobitz)

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64
Q

Treatment for Type II second degree AV block

A

pacemaker

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65
Q

Rhythm strip that shows no association between P and QRS complexes. P waves happening at a regular interval.

A

Third degree AV block

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66
Q

Treatment for Third degree AV block

A

Pacemaker

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67
Q

R and R’ seen in V4-V6

A

Left BBB

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68
Q

R and R’ seen in V1-V3

A

Right BBB

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69
Q

Which type of new onset BBB should you be concerned for an MI

A

Left

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70
Q

Bradycardia alternating with tachycardia

A

Sick sinus syndrome

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71
Q

rhythm strip that does not have P waves visible and has a irregularly irregular rate

A

A. fib

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72
Q

Medications used for rate control in A.fib

A

Metoprolol, diltiazem, verapamil

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73
Q

Rhythm control in A.fib

A

Cardioversion and amioderone

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74
Q

First line treatment in a stable patient with SVT

A

carotid massage or valsalva

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75
Q

medication used to treat SVT

A

adenosine

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76
Q

Medications that can cause Torsades de Pointe

A

zofran, macrolides, TCAs

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77
Q

electrolyte abnormalities that can cause Torsades de Pointe

A

low K and low Mg

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78
Q

Medication used in patients with Torsades

A

Magnesium sulfate

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79
Q

Target INR on Warfarin

A

2.5

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80
Q

Rhythm strip with widened QRS and delta waves

A

Wolff-Parkinson White

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81
Q

Early and wide QRS without a P wave

A

PVC

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82
Q

abnormally shaped P wave

A

PAC

83
Q

narrow QRS with no or an inverted P wave

A

premature junctional complex

84
Q

treatment for V. fib

A

unsynchronized cardioversion (defibrillation)

85
Q

treatment for unstable monomorphic V. tach

A

synchronized cardioversion

86
Q

treatment for unstable polymorphic V. tach

A

unsynchronized cardioversion

87
Q

treatment for stable V. tach

A

amioderone

88
Q

most common congenital heart defect

A

VSD

89
Q

most common cyanotic congenital heard defect

A

tetrology of fallot

90
Q

transient cyanotic episodes commonly associated with crying or exertion, improved with squatting or bringing knees to chest

A

tet spells - symptom of tetrology of fallot

91
Q

CXR finding associated with tetrology of fallot

A

Boot shaped heart (upturned apex)

92
Q

treatment of tetrology of fallot

A

surgery, and prostaglandins (alprostadil) until surgery to keep PDA open

93
Q

Genetic disorders associated with tetrology of fallot

A

down syndrome, Digeorge syndrome

94
Q

Two CXR findings consistent with coarctation of the aorta

A
  1. posterior rib notching

2. figure 3 sign

95
Q

congenital heart defect that can be a secondary cause of hypertension

A

coarctation of the aorta

96
Q

cramping of the lower extremities on exertion is a symptom of which congenital heart defect

A

coarctation of the aorta

97
Q

Which congenital heart defect also my have a wide PP

A

PDA

98
Q

most common cause of Right heart failure

A

Left heart failure

99
Q

S3 gallop is found in which type of heart failure

A

systolic HF (and dilated cardiomyopathy)

100
Q

S4 gallop is a abnormal finding that is seen in which type of heart failure

A

Diastolic

101
Q

Symptoms of Left or Right HF: dyspnea, orthopnea, cough, frothy sputum

A

Left

102
Q

Symptoms of Left or Right HF: edema, JVD, N/V, hepatojugular reflux

A

Right

103
Q

NY Heart Association Functional Heart Failure Classes (1-4)

A
  1. NO symptoms
  2. mild symptoms but can do ADLs
  3. only comfortable at rest, cannot do ADLs
  4. Symptoms even at rest
104
Q

Best test to diagnose HF

A

ECHO

105
Q

Best INITAL test for HF

A

CXR

106
Q

Signs of HF on CXR (2)

A
  1. Kerley B line

2. Butterfly/Batwing appearance

107
Q

Lab value important for diagnosing and treatment response of heart failure

A

BNP

108
Q

lifestyle modifications important in HF

A

smoking cessation

Diet: low sodium and fluid restriction

109
Q

Meds used in heart failure that only treat symptoms (have no effect on mortality)

A

Loop diuretics, digoxin

110
Q

ADRs of digoxin

A

visual changes, increased K, arrhythmias

111
Q

Treatment of acute decompensated heart failure

A 
Lasix
Morphine
Nitrates 
Oxygen
Position - sitting up, legs off bed
(LMNOP - Morphine is controversial in practice)
112
Q

most common patient populations to see atypical symptoms of acute coronary syndrome

A

women, elderly, and DM pts

113
Q

patient has chest pain at rest that is not relieved by nitro, they have a negative EKG and troponin - DX?

A

unstable angina

114
Q

patient has chest pain at rest that is not relieved by nitro, they have a negative EKG but positive troponin - DX?

A

NSTEMI

115
Q

patient has chest pain at rest that is not relieved by nitro, they have ST segment elevation on EKG and positive troponin - DX?

A

STEMI

116
Q

New LBBB is a _____ until proven otherwise

A

STEMI

117
Q

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

A

troponin

118
Q

this is the first cardiac enzyme to peak (increase)

A

myoglobin

119
Q

this cardiac enzyme may be used for early reinfarction due to it returning to baseline after 72 hours

A

CKMB

120
Q

ST elevation found in these leads in an inferior MI

A

II, III, and AVF

121
Q

artery occluded in a inferior MI

A

right coronary artery

122
Q

treatment for patient with acute coronary syndrome

A 
MOAN BASH 
M-morphine
O- oxygen
A- aspirin
N- Nitro

B- BB
A - ACE-I
S - statin
H - heparin ( or anticoagulation)

123
Q

contraindications to giving nitroglycerin

A

viagra (sidenifil) use within 24 hrs, systolic BP less than 90, or inferior MI with right ventricular involvement

124
Q

First line re-perfusion therapy in acute coronary syndrome

A

PCI - cath and stent

125
Q

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

A

Thrombolytic - TPA (cut off is 90 mins to cath lab)

126
Q

patient with chest pain at rest that is transient, EKG changes when patient is having symptoms - DX?

A

prinzmetal variant angina (or cocaine induced MI)

127
Q

treatment for prinzmetal variant angina

A

CCB (nifedipine) or nitrates (same tx for cocaine induced MI)

128
Q

which medication is contraindicated in patients with prinzmetal variant angina

A

beta blockers (same as cocaine induced MI)

129
Q

Post MI pericarditis

A

Dressler’s syndrome

130
Q

treatment for dressler’s syndrome

A

aspirin or colchicine (avoid NSAIDs)

131
Q

triad of right ventricular infarction

A
  1. increased JVP
  2. Clear lungs
    • Kussmal’s sign (Increased JVP with inspiration)
132
Q

chest pain exacerbated by activity but relieved by rest or nitroglycerine

A

stable angina

133
Q

test of choice to diagnosis stable angina

A

stress test - EKG changes may show down slopping ST segments

134
Q

medication used to treat congenital or stable QT prolongation

A

propranolol

135
Q

ADRs of administering prostaglandins

A

apnea, hypotension, fever

136
Q

taking lithium during pregnancy can cause what cardiac abnormality?

A

Ebstein’s anomaly

137
Q

list risk factors for primary hypertension

A

age, obesity, family history, African American race

138
Q

most common cause of secondary hypertension

A

renal artery stenosis

139
Q

other common causes of secondary hypertension

A

renal artery stenosis, coarctation of aorta, cushing’s syndrome, pheochromocytoma, OSA

140
Q

stage one hypertension

A

systolic of 130-139 or diastolic of 80-89

141
Q

stage two hypertension

A

systolic >140 or diastolic >90

142
Q

what is necessary to make a DX of HTN

A

Two separate readings at two separate events

143
Q

lifestyle modifications used to treat HTN

A

weight loss, DASH diet, decreased ETOH, exercise

144
Q

First line medication in patients with HTN and DM or CKD

A

ACE-I or ARB

145
Q

First line medications in patients with HTN and of African American race

A

Thiazide or CCB (amlodipine)

146
Q

beta blockers should not be used as initial mono therapy to treat HTN except if the patient has which comorbidity?

A

heart failure with reduced EF

147
Q

goal of HTN treatment

A

<140/<90

148
Q

if HTN is refractory to many meds you need to think of ____ and order which test?

A

secondary causes like renal artery stenosis —> order a renal ultrasound

149
Q

Pt with a blood pressure over 180/120 without any symptoms - DX?

A

hypertensive urgency

150
Q

Pt with blood pressure over 180/120 with a headache or chest pain

A

hypertensive emergency (due to them having symptoms of end organ damage)

151
Q

goal of treatment for a HTN emergency

A

reduce MAP by 10-20% in first hour, and then by 5-15% over the next 23 hours

152
Q

treatment for hypertensive urgency

A

oral anti-HTN meds - since end organ damage has not yet occured

153
Q

treatment for hypertensive emergency

A

IV anti-HTN meds (labetolol, nicardipine), admission

154
Q

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?

A

cardiogenic shock

155
Q

pulmonary capillary wedge pressure >15 mm makes which diagnosis?

A

cardiogenic shock

156
Q

treatment of cardiogenic shock

A

fluids, pressors (dobutamine, norepi), and oxygen

157
Q

drop in blood pressure of >20 mmHg systolic or >10 mmHg diastolic when patient is moved to an upright position

A

orthostatic hypotension

158
Q

orthostatic hypotension without a compensatory increased in heart rate is indicative of which cause

A

autonomic dysfunction

159
Q

treatment of orthostatic hypotension

A

increased Na and Fluids

160
Q

decrease in heart rate and BP that leads to fainting, often associated with a stressful trigger

A

vaso-vagal syncope

161
Q

what test may reproduce symptoms of vaso-vagal syncope

A

tilt-table test

162
Q

According to the USPSTF when should you start screening for cholesterol

A

35 yo

163
Q

Name the two high intensity statins

A

Atorvastatin and Rosuvastatin

164
Q

Most common side effect of statins

A

myalgia (should get CK to rule out rhabdo)

165
Q

An LDL over ____ indicated treatment with statin in a patient with no comorbidities

A

190

166
Q

Triglycerides over _____ put the patient at risk for pancreatitis

A

500

167
Q

treatment for isolated high triglycerides

A

Fibrates (finofibrate, gemfibrozil), second line Niacin, although lifestyle changes can make a big impact on TG

168
Q

Name 2 ADRs associated with Niacin

A

flushing, and hyperglycemia

169
Q

xanthomas are a symptom of…

A

high cholesterol

170
Q

back pain, pulsatile mass, hypotension - DX?

A

abdominal aortic anerurysm

171
Q

severe, tearing/ripping knife like chest pain radiating to back - DX?

A

Aortic dissection

172
Q

screening criteria for aortic aneurysm

A

Male over 65 who has ever smoked

173
Q

size of aortic aneurysm that indicated the need for surgery

A

> 5.5 cm

174
Q

CXR finding indicative of aortic dissection

A

widened mediastium

175
Q

gold standard test for aortic dissection

A

MRI angiography

176
Q

variating in pulses between L and R arms should indicate which DX

A

aortic dissection

177
Q

treatment for ascending dissecting aorta

A

surgical emergency

178
Q

treatment for descending dissecting aorta

A

beta blockers

179
Q

signs and symptoms of arterial occlusion/embolism

A 
6Ps
Pain
paralysis
pallor
paresthesia
polar/poikilothermia
pulselessness
180
Q

gold standard test for diagnosis arterial embolism/thrombosis

A

angiography

181
Q

treatment of arterial thrombosis

A

anticoagulation (heparin), embolectomy within 4-6 hours of symptoms

182
Q

abnormal connection between arteries and veins, bypassing the capillary system

A

arteriovenous malformation (AVM)

183
Q

most common presenting symptom of an AVM

A

intercranial hemorrhage

184
Q

gold standard for diagnosing and treating and AVM

A

angiography

185
Q

giant cell arteritis is most common in this population

A

woman over 50

186
Q

pt with headaches, jaw claudication, amaurosis fugax, and a tender temporal artery – DX?

A

giant cell arteritis

187
Q

studies used to diagnose giant cell arteritis

A

ESR >100, temporal artery BX definitive

188
Q

treatment of giant cell arteritis

A

high dose prednisone

189
Q

dangerous complication of giant cell arteritis

A

blindness

190
Q

patient with claudication, pain with exercise, shiny atrophic skin – DX?

A

peripheral artery disease

191
Q

studies to diagnose PAD

A

ABI

192
Q

treatment of PAD

A

lifestyle changes, smoking cessation, aspirin/plavix, revasculatrization surgery

193
Q

inflammation of the wall of the vein which can lead to clot formation, common after IV insertion

A

phlebitis/thrombophlebitis

194
Q

gold standard diagnostic study for phlebitis/thrombophlebitis

A

venous duplex US

195
Q

treatment for phlebitis

A

elevation, warm compress, NSAIDs

196
Q

treatment for thrombophlebitis

A

heparin - 1 month

197
Q

leg fullness and pressure, pain with exertion, dilated superficial veins visible - DX?

A

varicose veins

198
Q

treatment for varicose veins

A

compression, elevation, surgery

199
Q

stasis dermatitis, non-healing ulcers over medial malleolus are common findings of …

A

venous insufficiency

200
Q

virchow’s triad

A

stasis
hypercoaguable state
trauma

201
Q

homan’s sign is used to test for…

A

DVT

202
Q

woman over 35 who smoke and take OCP are at greatest risk for…

A

DVT

203
Q

studies to diagnose DVT

A

venous duplex, d-dimer if low risk, venography is gold standard

204
Q

treatment for DVT

A

anticoagulation for 3-6 months

PANCE Review (9 decks)

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