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ABIM > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Draw the six Frontal leads of an EKG

A
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2
Q

Draw the six precordial leads on an EKG

A
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3
Q

What lead on an EKG is best to see a P-wave?

A

Lead 2

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4
Q

Lead 1 shows positive QRS and lead AVF also shows a positive QRS

EKG Axis?

A

Normal axis

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5
Q

Lead 1 shows a positive QRS and lead AVF has a negative QRS

A

Left axis deviation

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6
Q

Lead 1 negative QRS and lead AVF is positive QRS

A

right axis deviation

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7
Q

Lead 1 negative QRS and lead AVF is negative QRS

A

Extreme right axis deviation

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8
Q

Left axis deviation on EKG?

A

Positive Lead 1 QRS and negative lead AVF QRS

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9
Q

RIght axis deviation on EKG?

A

Negative lead 1 QRS and positive AVF QRS

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10
Q

Extreme right axis deviation on EKG?

A

Negative lead 1 QRS and negative lead AVF QRS

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11
Q

What are the causes of left axis deviation?

A

Left anterior hemiblock (aka fascicular block) and is a marker for CAD

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12
Q

What are the pathological causes of right axis deviation? (3)

Are all causes of right axis deviation pathological causes?

A
  1. Normal finding in children and young adults
  2. Pathological causes - left posterior hemiblock, right ventricular hypertrophy, and acute or chronic RV overload syndromes (pulmonary hypertension, PE, pulmonary stenosis)
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13
Q

How is heart rate determined on EKG?

A
  1. 300 divided by number of large boxes between R waves - only works if R-R interval is regular
  2. QRS complexes on strip X 6 - works if R-R interval is irregular or regular
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14
Q

What are three subtypes of neurocardiogenic syncope?

A
  1. Vasovagal syncope
  2. Situational syncope
  3. Carotid sinus hypersensitivity
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15
Q

What are the symptoms of neurocardiogenic syncope?

A

Dizziness, lightheadedness, fatigue, with prodromal features (early symptoms) of diaphoresis, pallor, palpitations, nausea, hyperventilation and yawning.

Myoclonic jerks can occur when the patient is unconscious

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16
Q

What are some triggers of vasovagal syncope?

What symptoms may precede vasovagal syncope?

A

Triggers are intense emotion, pain, prolonged standing, alcohol, or heat exposure.

Vasovagal syncope is preceded by symptoms such as nausea, vomiting, flushing, tunnel vision, and diaphoresis.

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17
Q

What are triggers of situational syncope?

Describe pathogenesis?

A

Situational syncope is brought on by specific scenarios such as cough, micturition, pain, blood draw, strianing, or squatting.

These triggers provoke the vagal nervous system causing reflex vasodilation and bradycardia leading to syncope

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18
Q

Describe carotid sinus hypersensitivity?

A

Pause greater than 3 seconds associated with carotid sinus massage (tight fitting neck collars, shaving, etc)

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19
Q

What are two types of orthostatic hypotension and what are the differences between the two?

A

Volume depletion and autonomic dysfunction.

In volume depletion, the blood pressure drops and the heart rate rises with standing.

In autonomic dysfunction, the blood pressure falls but the heart rate does not rise with standing.

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20
Q

How is autonomic dysfunction orthostatic hypotension treated?

A

Use non-pharmacologic therapy first (support hose, increased dietary salt intake, avoiding hot tubs). Medications include midodrine and fludrocortisone

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21
Q

If the history is typical for vasovagal syncope and this is the first episode in a young patient with no suspected heart disease, is further evaluation needed?

A

No

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22
Q

What are three further tests to workup syncope in patients with risk factors for heart disease and more than one episode of syncope?

A
  1. Carotid sinus massage
  2. Echocardiography
  3. Tilt-table test
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23
Q

What is the most common cause of acute pericarditis and what are some other causes?

A

Most common cause is idiopathic/viral.

Other causes - Autoimmune, neoplasm, metabolic (uremia), drugs (hydralazine), acute MI (Dressler syndrome), after radiation and open heart surgery.

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24
Q

What is the diagnostic criteria for acute pericarditis?

A

2 out of the following four:

  1. Typical chest pain - sharp/pleuritic/positional that improves with sitting up and leaning forward
  2. Pericardial friction rub
  3. Typical EKG changes - diffuse ST elevation and/or PR depression
  4. New or worsening pericardial effusion
25
Q

What distinguishes acute pericarditis ST changes from MI?

A

Concave up ST changes in acute pericarditis vs concave down ST changes in MI

26
Q

How is acute pericarditis treated? What should be avoided in cases of idiopathic acute pericarditis and why?

A

NSAIDs/Colchicine

Avoid steroids because there can be a relapse if they are stopped.

27
Q

Describe the pathophysiological cause of constrictive pericarditis?

A

Obliteration of the pericardial cavity with scarring.

28
Q

What happens normally to JVP during inspiration and why?

What happens in Kussmaul sign and what does this indicate?

A

During inspiration, the thoracic cavity expands, leading to negative intrathoracic pressure. This forces air into the lungs but also causes blood to rush into the RV. (Gases move from high pressure to low pressure).

In Kussmaul sign the JVP actually increases with inspiration. Seen in constrictive pericarditis.

29
Q

What distinguishes constrictive pericarditis from restrictive cardiomyopathy? (2)

A

Signs and symptoms of constrictive pericarditis and restrictive cardiomyopathy can be similar - dyspnea, fatigue, and right sided heart failure.

However BNP is less likely to be elevated in constrictive pericarditis. The pericardium is more likely to be thickened with constrictive pericarditis.

30
Q

What is seen in both cardiac tamponade and constrictive pericarditis with cardiac catherization?

A

Shows same pressures during diastole in all four chambers.

31
Q

How is symptomatic constrictive pericarditis treated?

A

Treatment involves open thoracotomy and pericardiectomy.

32
Q

What does pericardial effusion show on EKG?

A

Shows electrical alternans (alternating amplitude of QRS complex from the heart swinging in the pericardium).

33
Q

What happens to the heart in cardiac tamponade?

A

Tamponade occurs when a pericardial effusion leads to critical cardiovascular compromise. There is obstruction to the inflow of blood to the ventricles and equalization of pressures in all four cardiac chambers.

34
Q

What are three hallmarks of cardiac tamponade?

A
  1. Hypotension and distant heart sounds.
  2. Pulsus paradoxus (Systolic BP drops > 10 mm Hg during inspiration)
  3. JVP that doesn’t collapse during diastole
35
Q

Describe the following three signs in terms of Cardiac tamponade and Constrictive pericarditis?

Pulsus paradoxus
Kussmaul sign
Diastolic knock aka pericardial knock
Jugular venous waveforms

A

Tamponade has pulsus paradoxus, but no kussmaul sign and no diastolic knock. Prominent x-descent is seen in cardiac tamponade.

Constrictive pericarditis has mild or absent pulsus paradoxus, present kussmaul sign and present diastolic knock. Prominent x and y descents is seen in constrictive pericarditis.

36
Q

What is pulsus paradoxus and when is it seen? (4)

A

Systolic BP drops > 10 mm Hg during inspiration. It is an exaggeration of the normal decrease in systolic blood pressure with inspiration.

Seen in Cardiac tamponade***/constrictive pericarditis/asthma/tension pneumothorax.

*** KNOW

37
Q

Pulses parvus et tardus is seen in what cardiac disorder?

A

Parvus is low amplitude and tardus is delayed. Seen in Aortic stenosis

38
Q

Brachiofemoral delay is seen in what cardiac disorder?

A

Femoral pulse occurs after the brachial pulse.

Coarctation of the aorta

39
Q

How does pulse asymmetry present and what disorder is it seen in ?

A

Strong upper extremity pulses but delayed or absent lower extremity pulses. Asymmetry can occur between left and right upper extremities.

Seen in Aortic dissection.

40
Q

Pulsus bisferiens is seen in what two disorders? What does pulsus bisferiens mean?

A

Aortic regurgitation and obstructive hypertrophic cardiomyopathy.

Shows two systolic peaks of the aortic pulse per cardiac cycle. In Obstructive cardiomyopathy there is a similar double-peaked pulse known as a bifid pulse.

41
Q

What is pulsus alternans and when is this seen?

A

Varying pulse pressure with regular pulse rate. Seen in severe left ventricular systolic dysfunction.

42
Q

What patient population is thromboangiitis obliterans seen in?

How is it treated?

A

Seen in young male smokers.

Treated with smoking cessation, and calcium channel blockers. Revascularization is usually not an option.

43
Q

Lumbar stenosis is relieved by what? What position exacerbates lumbar stenosis?

A

Lumbar stenosis is relieved by sitting down but not by standing still.

44
Q

Any body movement that flexes the spine worsens lumbar stenosis?

A

False, anything that EXTENDS the lumbar spine worsens lumbar stenosis

45
Q

How are vascular claudication symptoms differentiated from lumbar stenosis?

A

Vascular claudication is relieved by rest such as sitting down or standing still.

Lumbar stenosis is worsened by standing (does not relieve symptoms).

46
Q

What is a normal ABI level?

What ABI level indicates noncompressible calcified arteries?

What ABI indicates abnormal PAD?

A

Normal ABI is 1.0 - 1.4

ABI > 1.4 indicates noncompressible calcified arteries.

ABI < 0.9 is considered abnormal

47
Q

If resting ABI is normal, but history is concerning for PAD, what are next steps?

A

Perform exercise tolerance test

48
Q

If initial testing for PAD is abnormal, what are next steps?

A

Define arterial anatomy with imaging studies like contrast angiography (gold standard, needs to be done in cath lab) , CT angiography, or MR Angiography

49
Q

Treatment for all PAD patients? (3)

What is not used for as treatment in PAD patients?

A
  1. Smoking cessation
  2. Statins
  3. Antiplatelet therapy (either aspirin OR Plavix)

DON’T USE WARFARIN - no benefit

50
Q

When is dual antiplatelet therapy used in PAD patients?

What is the primary benefit of cilostazol in PAD patients and when is it contraindicated?

A

Use DAPT in patients who develop critical limb ischemia or receive stenting of peripheral arteries.

Cilostazol is used to increase walking distance. It is contraindicated in patients with heart failure.

51
Q

What are the six P’s of Acute Limb Ischemia?

A

Pain
Pallor
Pulselessness
Paresthesias
Poikilothermia (coolness)
Paralysis

52
Q

Why is heparin indicated in acute limb ischemia?

What complication is a concern after revascularization of acute limb ischemia?

A

Heparin protects collateral circulation during evaluation by preventing further thrombus formation around the clot that caused ALI.

Worry about compartment syndrome after revascularization of acute limb ischemia. Compartment syndrome occurs due to tissue edema following reperfusion therapy.

53
Q

What is a pericardial knock and what disease process is it seen in? What disease process is it not seen in?

A

Pericardial knock is an early diastolic sound that occurs when the unyielding pericardium results in a sudden arrest of ventricular filling.

Seen in constrictive pericarditis.

NOT seen in cardiac tamponade.

54
Q

Which of these adverse cardiovascular events is most likely to occur in a patient with atherosclerosis of the carotid artery: MI/Stroke/TIA

A

Patients with atherosclerotic carotid artery stenosis are more likely to have an MI than a TIA or Stroke

55
Q

What are some symptoms of carotid artery atherosclerosis?

What is best initial diagnostic test to detect carotid stenosis?

A
  1. Weakness or numbness of the face
  2. Weakness or numbness of an extremity contralateral to stenosis
  3. Dysarthria
  4. Vision loss ipsilateral to stenotic vessel (amaurosis fugax)
  • diagnosis test of choice is carotid duplex US
56
Q

Carotid artery stenosis % cutoff for CEA in both symptomatic or asymptomatic carotid stenosis patients?

A

CEA is indicated if stenosis is > 70%

57
Q

What are some recommended tests to be done in all patients with CVA (Cerebral embolic disease)? (4)

A
  1. Perform Carotid artery US and transthoracic echocardiogram in all patients with CVA to exclude cardiac and carotid artery abnormalities
  2. EKG to evaluate for AFib. Patients may need telemetry or extended cardiac monitoring because paroxysmal atrial fibrillation may be the cause of an emboli.
  3. CT angiography of the vessels of the carotid and brain (minority of CVAs are due to obstructive disease of the intracranial vessels)
58
Q

Treatment regimens for TIA if no history of stroke, patient does not have Afib, and cause is likely atherosclerosis. (4)

A
  1. Aspirin monotherapy
  2. Plavix monotherapy
  3. Aspirin + dipyridamole
  4. Short term course of DAPT followed by monotherapy.

ABIM (7 decks)

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