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Internal Medicine: PGY-1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which main coronary supplies the following:
1) SA node
2) AV node

A

1) Proximal RCA (65%) or LCx (25%), both (10%)
2) RCA (80%), LCX (10%), both (10%)

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2
Q

Average HR drop during sleep in [1] young healthy adults and [2] elderly?

A

24 bpm
14 bpm

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3
Q

Symptoms of Bradycardia?

A

Asymptomatic
Fatigue
Weakness
Light-headedness
Syncope

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4
Q

Physical findings of bradycardia?

A

Slow pulse rate
Hypotension
Cool extremities
Cannon A waves (in setting of AV dissociation)

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5
Q

What is a junctional escape rhythm?

A
  • Rhythm 40-60bpm
  • No visible P waves before QRS
  • QRS typically <120ms
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6
Q

Causes of sinus bradycardia? (intrinsic vs extrinsic to SA node)

A

1) Intrinsic to SA node
- idiopathic degeneration (aging)
- ischemia (esp. inferior)
- infiltrative (e.g., amyloidosis)
- collagen vascular disease (e.g., SLE)
- infectious (e.g., Chagas, myocarditis, Lyme)
- myotonic dystrophy
- surgical trauma (e.g., valve replacement)

2) Extrinsic to SA node
- meds (e.g., bb, ccb, digoxin, clonidine, amio, opioids)
- lytes (e.g., low/high K+)
- neurally-mediated reflexes (e.g., carotid sinus hypersensitivity)
- hypothyroidism
- hypothermia
- brainstem herniation

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7
Q

Common meds associated with sinus bradycardia?

A
  • bb
  • ccb
  • digoxin
  • clonidine
  • antiarrhythmic agents (e.g., amiodarone, lidocaine)
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8
Q

Typically, infections leads to increase in temperature with corresponding increase in heart rate. Which infections are associated with relative bradycardia?

A
  • Legionella
  • Pscittacosis
  • Q fever
  • Typhoid fever
  • Typhus
  • Babesiosis
  • Malaria
  • Leptosporiasis
  • Yellow fever
  • Dengue fever
  • Viral hemorrhagic fevers
  • Rock Mountain spotted fever
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9
Q

How often is Mobitz II AV block associated with a wide QRS?

A

Wide: 80%
Narrow: 20%

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10
Q

ECG diagnosis of STEMI?

A
  • > 0.1 STE in 2 contiguous leads
  • EXCEPT in V2-3 - must be >0.2 (men) and >0.25 (women)
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11
Q

What is the typical evolution of ECG changes associated with ischemia?

A
  • Hyperacute: tall T waves
  • Acute: STE
  • Hours: STE + reduced R wave + Q wave
  • Day 1-2: TWI, Q-wave deeper
  • Days: ST normalizes, TWI
  • Weeks: ST/TW normal, Q wave persists
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12
Q

Which conditions make ECG interpretation of ischemia unreliable?

A
  • early repolarization
  • LVH
  • LBBB
  • ventricular paced rhythm
  • preexcitation
  • J-point elevation syndromes (e.g., Brugada)
  • pericarditis/myocarditis
  • SAH
  • hyperK+
  • stress CM
  • cholecystitis
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13
Q

Risks associated with acute aortic dissection?

A
  • male
  • age: >60
  • HTN
  • prior cardiac sx (esp AV repair)
  • bicuspid AV
  • connective tissue (eg., marfan)
  • aortitis (eg., GCA, syphilis)
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14
Q

Why do MVP patients who undergo repair can oftenhave persistent episodes of chest pain + palpitations after repair?

A

Autonomic dysfunction that persists after repair

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15
Q

Definitive diagnostic study for pulmonary hypertension?

A
  • Gold: right heart cath
  • Other: TTE, ECG, PFT
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16
Q

S3 vs S4?

A

1) S3
- early diastolic
- r/t rapid ventricualr filling
- DDx: ADHF, DCM, thyrotoxicosis, AR

2) S4
- late diastolic
- r/t late atrial kick against stiff ventricle
- DDx: HTN, AS, cor pulm, ischemic CM, acute MI

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17
Q

Heart failure symptoms: R vs L?

A

1) Right
- tachycardia
- low bp
- high JVP
- RV heave
- right-sided gallop
- ascites
- LE edema

2) Left
- weakness
- crackles, orthopnea, PND
- tachycardia
- low bp
- narrow PP
- left-sided gallop
- laterally displaced apical pulse
- pulsus alternans (end stage)
- cool extremities

18
Q

What is the definition of ischemic CM?

A

LV dysfunction with at least 1 of the following:
- Hx prior MI or PCI
- >75% stenosis of LM or LAD
- 2 vessels or more with >75%

19
Q

What proportion of patients with acute myocarditis will go on to develop chronic heart failure?

A

1/3

20
Q

When does peripartum CM usually present?

A
  • 80% present <3 months of delivery
  • 10% during last month of pregnancy
  • 10% present 4-5 months postpartum
21
Q

What nutritional deficiencies are associated with HFrEF?

A

Thiamine, carnitine, selenium, zinc, copper

22
Q

Which extra heart sound commonly associated with HFpEF?

A

S4 (concentric - stiff ventricle)
S3 (overload - typically HFrEF)

23
Q

Toxic causes of heart failure?

A
  • Alcohol
  • Cocaine
  • Amphetamines
  • Anthracycline (chemo; Doxorubicin)
  • Thyrotoxicosis
24
Q

What threshold of alcohol consumption is associated with the development of cardiomyopathy?

A

Risk increases if consume >90g of EtOH (7-8 drinks) per day for >5 years

25
Q

Which are the main categories that cause HFrEF?

A
  1. Cardiovascular
  2. Toxic
  3. Infectious
  4. Other
26
Q

Sepsis-associated cardiomyopathy typically resolves within? Management specifics?

A
  • 7-10 days
  • Same as sepsis w/o CM, with careful attention to volume status
27
Q

What TTE finding is characteristic of Takotsubo?

A
  • Apical ballooning
  • Basilar hypokinesis
28
Q

How common is idiopathic dilated cardiomyopathy?

A

~1/2 of all dilated CM cases remain idiopathic

29
Q

Quick Answers:
1. “Silent killer”
2. Right-sided heart failure 2/2 lungs
3. Associated with hypertrophic CM
4. Brachial-femoral pulse delay + rib notching on CXR

A
  1. HTN
  2. Cor pulmonale
  3. HOCM
  4. Coarctation of aorta
30
Q

What is the final common pathway of all processes that lead to cor pulmonale?

A

Pulmonary HTN

31
Q

Valvular lesions: which is typically associated with concentric hypertrophy in HFpEF vs. eccentric hypertrophy and HFrEF?
Bonus: right-sided valvular lesions, both stenotic/regurgitant, are generally HFpEF or HFrEF?

A
  • Stenotic
  • Regurgitant
  • HFpEF
32
Q

Describe murmurs:
1. AS
2. MS
3. TR
4. PS
5. TS
6. PR

A
  1. Late-peaking crescendo-decrescendo SEM at RUSB radiating into carotids - musical quality at apex “Gallavardin phenonmenon”
  2. Low-pitched rumbling DEM with presystolic accentuation
  3. Holosystolic murmur at LLSB, increases with inspiration (Carvallo’s sign)
  4. Similar to AS, but (+) Carvallo’s
  5. Late DEM with (+) Carvallo’s
  6. Decrescendo DEM with (+) Carvallo’s
33
Q

TTE criteria for severe AS?

A
  • aortic jet velocity >4.0m/s, or
  • Ao >40mmHg
  • AVA usually <1cm2 (not required)
34
Q

Why is mitral stenosis often associated with embolic events? (eg., stoke, renal infarct)

A
  • Often associated with afib (>50% cases)
  • Risk of embolic events in valvular afib is higher than afib alone
35
Q

Which characteristic finding of IJ waveform associated with severe TR?

A
  • Lancisi’s sign: severe TR causes C wave to fuse with V forming a prominent wave
  • Carvallo’s sign also present (worsen with inspiration)
36
Q

Bullet Q’s - Infiltrative causes of HFpEF:
1. Middle-aged man with macroglossia + large shoulders?
2. Granulomatous disease
3. Infiltration of metallic element
4. Generalized lymphadenopathy + high LDH
5. Infiltration of “acid-loving” cells

A
  1. Amyloidosis
  2. Sarcoidosis
  3. Iron overload
  4. Lymphoma
  5. Eosinophilia
37
Q

How does lymphoma cause heart failure symptoms?

A

Pericardial infiltration + effusion

38
Q

What is Löffler endocarditis?

A

Eosinophilic myocarditis:
- Endocardial fibrosis in association with hypereosinophilic syndrome (HES) [defined as persistent hyperE with eosinophil count >1,500/microL for >6mo with evidence of organ damage

39
Q

What is Fabry’s disease?

A

Genetic cause of HFpEF
- X-linked lysosomal storage disorder releated to deficiency of enzyme a-galactosidase A

40
Q

2 signs that are seen in constrictive pericarditis?

A
  1. Kussmaul’s: paradoxical increase in JVP with inspiration
  2. Friedreich: sharp + deep Y descent
41
Q

How does scleroderma affect the heart and lead to heart failure?

A
  • cor pulmonale from pHTN
  • acute constrictive pericarditis
  • pericardial effusion
  • premature CAD
  • myocarditis
  • nonbacterial thrombotic (marantic) endocarditis
  • conduction system abnormalities

Internal Medicine: PGY-1 (17 decks)

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