Cardiology Flashcards
Tx for Brugada Syndrome is:
B blockers
and
ICD
Mitral valve stenosis is most frequently preceded by:
Rheumatic fever which causing thickening of the valve leaflet.
Unstable Tachyarrhythmia should be treated with
Cardioversion
Pt with HTN + CFH should be prescribed what HTN drug(s)
Thiazide + B blockers
Pathophysiology of AO dissection:
Tear in the tunica intima
Blood collection b/w tunica intima and tunica media creating false lumen.
Preffered position in patients with pericarditis is
Sitting up, leaning forward.
Tricuspid valve stenosis is usually seen in conjunction with
Mitral valve stenosis
Presentation of AO dissection is:
Sudden onset of tearing chest pain, between scapulas
AO valve regurgitation murmur best heard in what position?
Right sternal border (2nd interspace)
Pt. leaning forward.
Medications that can be used to treat HTN in pregnancy are:
Labetalol
Methyl Dopa (alph 2 agonist)
any Calcium Channel Blocker
Sx of hypertrophic cardiomyopathy are:
Dyspnea on exertion
Syncope/dizziness
Crescendo-decrescendo systolic murmur
S4 gallop
Ventricular stiffness
potassium sparing diuretics and ACE inhibitors used together may produce ________
HyperKalemia
Physical findings associated with Pulmonary valve regurgitation are:
Mild cases are well tolerated and have few or no symptoms Severe cases may have right ventricular hypertrophy Severe cases may have right heart failure Widely split S2 ECG may show right ventricular hypertrophy
Flutter rate is
250-300 bmp
Amyloidosis and Sarcoidosis are known to cause:
Restrictive CM
Treatment for DVT in a pregnant pt is:
Lovenox
Warfarin/coumadin CAN NOT be used at it crosses the placenta!!!
Sick Sinus Syndrome is treated with:
Pacing
Tx of Systolic/Dialated CHF:
ARBs or ACE Inhibitors (vasodilators)
Beta Blockers (lowers mortality)
Digoxin (does not lower mortality)
Which medication is contraidicated in pts with inferior MI:
Nitroglycerin (reduces preload)
inferior MI may be a Rt side MI which are preload dependend
Nitroglycerin may lead to severe drop in blood pressure
Intravenous hydration is indicated in preload depended MI
Normal mean arterial pressure is:
70-100
Valve Locations: Aortic Valve, Pulmonic Valve
Aortic 2nd Rt interspace
Pulmonic 2nd Lt interspace
Waterhammer/ Corrigan’s pulse is associated with
Aortic Valve Regurgitation
Signs of HyperKalemia seen on ECG are:
peaked T waves
QRS widening
p wave flattening
will eventually transform to V tach or V fib if not corrected.
Tx of acute CHF
ACE-I
Loop diuretics
Nitrate
Oxygen
Morphine
The type of ischemia that presents with ST elevation is:
Prinzmetal Angina
LV apical balloning followed by stress and releaes of catacholamines is known as
Taku-Tsubo CM
Systolic (dilated) HF has ______ejection fraction
Diastolic HF has _______ejectin fraction
Reduced EF in Systolic
Preserved EF in Diastolic
Sx of cardiogenic shock are:
Dysrhythmia
caynosis
Hypotentions
Lung crakles
Posterior heart anatomy is best visualized with
Trans Esophageal Echo
HyperParathyroidism produces secondary HTN by means of?
Increased Ca2+ concentration produces increased vasocontriction (contraction) of smooth arterial muscle>increases periferal resistance.
S1 sound is synchronized with ______
Carotid pulse upstroke
Vasodilator that can cause cyanide poisoning is
Nitroprusside
Normal B/P values
<120/80
Best imaging modality or pulmonic valve evaluation is
TEE
WPW syndrome predisposes a pt to develope
A fib
V fib
Symptoms of pericarditis usually include:
- PLEURITIC CHEST PAIN aka pleurisy (aggravated by a deep breath or lying down) 2.Dyspnea
3 Diaphoresis
4 Fever
Tx for Dilated CM:
Promote systolic function by reducing blood pressure:
ACE I
Beta blockers
Diuretics
S1 sound splits into _____ ______ during_______
Mitral valve closure (1st)
Tricuspid closure (2nd)
during inspiration
Imaging modalities for thoracic AO dissection include:
MRI w. IV contrast
CT w. IV contrast
TEE transesophageal echocardiography used in pts with impaired renal function (who can not have IV contrast administered)
ECG with different morphological p waves corresponds to
Multifocal Atrial Tachycardia
Most potent fast HTN reduction medication is:
Labetalol
What is Digoxin classified as?
Digoxin is a positive ionotrope and negative chronotrope.
It augments pumping while decreasing heart rate.
Valvular murmurs will
improve with Valsalva
and become louder with
Leg Raising.
1st degree AV Block
PR interval > 0.2
Regular, narrow QRS
no treatment necessary
Primary management of diastolic HF is:
controlling the HTN (the cause of diastolic HF)
Murmurs grade VI and higher are always associated with
Thrill
Junctiona Rhythm is characterized by:
Rate: 40-60
No P waves
Narrow QRS
Best screening test of Conn’s syndrome/Primary Aldesteronism is:
High [Aldosterone] / Low [renin]
High Aldesterone/Renin ratio
Treatment for bowel edema is
Torsemide (loop diuretic)
Hursh Crescendo-Decresendo ejection/systolic murmur which is heard along the right sternal boarder and may radiate to the carotids bilaterally and the neck:
Aortic Valve Stenosis
Mid diastolic low pitch murmur that is best heard at the apex in LLD position is associated with?
Mitral Stenosis
Temporal artery is a branch of ?
ECA
In patients with true aspirin allergies, ________ should be substituted for aspirin
clopidogrel
Name of the murmur specific to Pulmonic Regurgitation and pulmonary HTN
Graham-Steell murmur
increases with inspiration and dicreases with Valsalva
Most effective step in treating HTN is:
weighth loss
normal PR interval
0.12-0.2
Mid Systolic Click (three words)
Mitral Valve Prolaps (three words)
Tx for A fib is:
1st goal - rate control with B blocker, CCB
2nd goal - cardioverision or ablation
3rd goal - anticoagulation (CHADS2 score)
Mitral valve stenosis produces back up flow into the lungs causing?
Pulmonary congestion
D-dimer test:
Increased D-dimers is indicative of fibrin degradation products.
Negative D-dimers rules out DVT (hight sensitivity)
Positive D-dimers is nonspecific (low specificity)
Sick sinus syndrome
disease of the sinoatrial (SA) node
It is associated with tachycardia-bradycardia syndrome
Diastolic and Systolic Heart failure can be differentiated by?
Echocardiogram
Tx for cardiogenic shock is:
IV fluids
Inotrophic meds (Dopamine - pressor agent)
Stable Sinus Tachycardia can be treated with:
Vagal maneuvers
B-blockers
Radio Frequency ablation
Left Atrial enlargements seen on ECG as:
biphasic p wave in V1
Rigidity of the heart / hiostological damage to the heart muscle is known as:
Restrictive Cardiomyopathy
Digoxin toxicity is monitored by serum ___ levels
Potasium (K)
low K worsens Dig. toxicity
Therapeutic serum K level: 0.5-2
Impairent of the systolic heart function is knowns as
Dilated Cardiomyopathy
Tx of Thrombophlebitis is
NSAIDs if the thrombus is below the knee
Enoxaparin is a low molecular weight heparin if the thrombus above the knee
warm compress
Normal QRS followed by two wide QRS is known as:
Ventricular Couplet
Diminshed contractility of cardiac myocytes is known as:
Dilated CM
Stress Echo finding seen in MI or Ischemia is:
Hypokinetic wall motion.
NSAIDS, corticosteroids and MOA inhibitors are known to _______ b/p
Increase blood pressure
African American pt should not be prescribed what kind of HTN medication provided that there is no end organ damage?
ACE-Inhibitors
(use ARBs instead)
Early diastolic blowing murmur usually corresponds to:
Aortic valve regurgitation.
What enlagement/hypertrophy is seen on this ECG:
Rt. atrial enlargement.
P wave corresponds to
Atrial Contraction / Depolarization
Symptoms of giant cell arteritis include:
Jaw claudication – pain in jaw while chewing
Scalp tenderness
Visual problems including vision loss and diplopia
Fever
Tenderness
Long QT interval is defined as:
greater than 0.45 second
or 11 small squares.
Warfarin/Coumadin
Long term anticoagulant Inhibits vitamin K there by inhibits factors II, VII, IX, X
CAN NOT be used in pregnancy
Warfarin is monitored by INR
Rhabdomyolysis - side effect of statin is monitored/detected by the serum levels of
Creatinine Kianase
Drug of choice to treat arterial thrombosis is:
Cliastazol (antiplatelet)
Pre HTN values
120-139 / 80-89
Tx for Sick Sinus Node Syndrome is
Pacemaker
First line treatment for primary HTN:
BEHAVIORAL MODIFICATIONS
Weight reduction
DASH diet (Dietary Approaches to Stop HTN)
Reduce sodium intake
Increase physical activity
Limit alcohol consumption
chlorothiazide
chlorthalidone
metolazon
are examples of __ diuretics
Thiazide Diuretics
Congenital unicuspid or bicuspid aortic valve may lead to:
Aortic Valve Stenosis
Life threatening arrhythmias that are seen in athletes are caused by:
Hypertrophic Obstructive Cardiomyopathy
Thickened interventricular septum
Outflow obstruction
Small ventricular size
are features of
Hypertrophic Cardiomyopathy
Causes of Tricuspid valve regurgitation are:
RVH
Ebstein’s anomaly
Tricuspid valve prolapse
Pulmonary hypertension (secondary to left hear failure)
Giant “a” waves are seen in
Tricuspid Stenosis
Signs of sx of pulmonary edema:
Increase respiratory rate
Pink, frothy productive cough
Cyanosis
Paroxysma Nocturnal dyspnea
Rales, rhonchi, wheezing
Drugs that increase K
ACE - Inhib
ARBs
Beta Blockers
K sparing diuretics (spirolactone)
have what effect on Digoxin toxicity?
Reduce toxicity associated with Digoxin.
Treatment of long QT syndrome is:
Beta blockers
ECG findings in STEMI include:
ST elevation
new LBBB
evolving Q waves
Most common causes of Dilated CM are:
CAD>Ischemia
Alcoholism
3rd trimester pregnancy
Toxins
P’s of arterial embolism/thrombosis (PAD) include:
Pain
Pallor
Pulselssness
Paresthesias
Poiklothermia (cold feet)
Paralysis
Most commong complicatoin after inferior MI is:
arrhythmia
3rd Degree AV block also known as Complete Block
Dissociated P and QRS complexes
P waves are separated by regular distance
QRS is separated by regular distance
Requires pacing.
Mid Systolic Click
Mitral Valve Prolapse
Machine like murmur (fo and from) is seen in
PDA (Patent Ductus Arteriosum)
Most common valvular disorder is:
Mitral valve regurgitation
Pt has been on hospital telemetry for a while, what is the earliest sign of MI?
Hyperacute T waves
normal QRS lenght is
<0.12
Contraindication for nitroglyceride is
Hypotention
Sildanefil (Viagra)
B blockers side effects include:
Asthma exacerbation
HyperKalemia
N/V
Supraventricular Tachyardia
Increase in pulmonary capillary wedge pressures causes:
Pulmonary edema
HTN emergencies include:
AO dissection
Unstable angine/MI
Ischemic Stroke
Intracrania Hemmorhage
Acute Pulm. Edema.
Definition of the aortic valve regurgitation is:
Failure of the aortic valve to remain closed during ventricular diastole. Failure of the aortic valve to prevent the reverse flow from ascending aorta into left ventricle.
Endocarditis may by caused by:
Bacterial etiology (most common);
postop valve replacement;
IV drug usage
Tx for Kawasaki disease:
High dose Aspirin
Intravenous immunoglobulin (IVIG)
Tx for Diastolic/Hypertrophic CHF
B blockers (verapamil, diltiazem)
Diuretics
Accelerated Ideoventricular Rate
no P waves
wide QRS
Rate 40-100 (higher than typical ventricular rate)
may be seen several days after MI
do not require any intervention
Symptomatic unstable Sinus Tachycardia should be treated with?
Synchronized Cardioversion
Pulmonary congestion causes the following sx:
Paroxysmal nocturnal dyspnea (difficulty breathing in supine position) due to fluid accumulation in the lungs.
HTN emergency/Malignant HTN values:
>220/125 Severe risk of end organ damage (retina, kidneys, lungs, AO)
HTN is the most common cause of ________heart failure
MI is the most common cause of _________heart failure
HTN>Diastolic (Hepertrophic)
MI>Systolic (Dilated)
Long QT is associated with:
Torsade
R on T
V tach or V fib
Romano - Ward
Normal QRS followed by wide QRS is knowns as
Ventricular Bigemeni
Stable angine is relieved by what medication
nitroglycerin
Ductus Arteriousus connects
Aorta to Left Pulmonary Artery
Squatting
handgrip
lying down
straight leg raise
have what effect of ventricular volume
increase ventricular volume
Holosystolic murmur at lower left sternal border that radiates to sternum and xiphoid is associated with
Tricuspid valve regurgitation
AO valve stenosis is a contraindication to undergo what cardiac testing?
Stress Test due to possibility of Syncope (passing out) upon physical exertion.
Digoxin toxicity syndrome can be caused by:
Digoxin overdose
or
Hypokalemia
Most commong etiology of mitral valve stenosis is:
Rheumatic fever which causes leaflet thickening.
Tx for unstable V tach is:
Cardioversion
Idioventricular Rhythm
Rate: 20-40
no P waves
wide QRS (greater than 0.2 sec.)
HypoCalcemia has what effect on ECG?
Prolongates QT interval.
which may lead to Torsade and V fib.
Second degree AV block (Type I) aka
Wenchebach/Mobitz Type I
Progressive lengthening of PR interval until QRS complex drops
Longer, Longer, Drop
Short PR<0.8 is seen in
Wolf Parkinson White Syndrome
pericardial knock on auscultation is associated with
Constrictive pericarditis
Renal Artery Stenosis pathophysiology that produces secondary HTN is:
Hypoperfusion of kendeys activates RAAS which elevates B/P.
Decrease secretion of Na+ also produced hypervolemia > HTN
Giant cell arteritis most often affects which artery?
Temporal artery
Sx of hyperKalemia include:
fatigue or weakness.
a feeling of numbness or tingling.
nausea or vomiting.
problems breathing.
chest pain.
palpitations or skipped heartbeats.
Rheumatic Heart Disease is associated with which valvular pathology?
Mitral Valve Stenosis
Most common cause for pulmonic valve regurgitation is
Pulmonar Hypertention.
Ventricular Systole is between which heart sound?
S1 and S2
“Boot shaped heart” seen on X ray cooresponds to:
Tetrallogy of Fallot
V tach tx:
Unstable V tach > Synchronized Cardioversion
Dead V tach > Unsynchronized Cardioversion
Stable V tach > Lidocaine/Procainamide/Amiodarone
Treatment of choice for HTN emergency is:
Labetalol or Nicardipine
Aortic Valve Stenosis Classical Triad of Sx:
Dyspnea
Angina
Syncope with exertion
Restrictive Cardiomyopathy produces:
diastolic disfunction
U wave after T wave is often seen in
HypoKalemia
Tx of choice for hypetrophic CM is
Beta blockers
increase diastoic filling of ventricles
Loop dieuretics are (two qualities)
Very powerfull
Short acting
Most common location for AAA is:
infrarenal
Sx of Restrictive CM are simular to:
Right Heart Failure:
JVD
Edema
Ascites
Hepatomegaly
Diastolic rumble is associated with
Mitral Stenosis
What cardiac complication is associated with hyperthyroidism?
High-output cardiac failure
tx is Propranalol
Significant risk factors for AAA are:
Atherosclerosis
CAD
Smoking
Hypertensiono
Hyperlipidemia
Medications that prolong QT interval:
macrolides (azithromycin, erythromycin, clarithromycin), fluoroquinolone (ciprofloxacin, ofloxacin, moxifloxacin), trimethoprim-sulfamethoxazole, pentamidine, antifungals (cotrimoxazole, fluconazole, ketoconazole, voriconazole), migraine medications (sumatriptan, zolmitriptan), stimulants (albuterol, epinephrine, dopamine, dobutamine, isoproterenol, methylphenidate, phenylephrine, terbutaline, phenylephrine, pseudoephedrine, cocaine, amphetamine), psychiatric drugs (tricyclics, phenothiazines, citalopram, clozapine, fluoxetine, haloperidol, lithium, methadone, risperidone, quetiapine, sertraline, trazodone, venlafaxine, ziprasidone), class I and III antiarrhythmics, and antihistamines.
Beck’s triad is:
Associated with cardiac tamponade
- Hypotension
- Jugular venous distention
- Muffled heart sounds.
Supraventricular Tachycardia
Atrial Flutter
are known collectivelly as:
AV Nodal Re-entry Tachycardia
Harsh, loud, systolic murmur best heard over 2nd or 3rd left interspace is associated with
Pulmonic valve stenosis
Reduced luminal volume of the ventricle is seen in:
Hypetrophic Cardiomyopathy
Propranol is
B1 & B2 blockers that should not be used in pt. with lung disease.
Key radiological feature of thoracic AO dissection:
Double barrel AO consisting of true and false lumens.
Methyldopa and Clonidine are examples of
Alpha agonists
MoA: inhibit NE release
ACE - Inhibitors adverse effects are:
Cough
Angioedema
EKG findings associated with pericardial effusion/Cardiac tamponade:
Electrical alternans- QRS complexes that alternate in hight. example:
Angina in aortic valve stenosis is caused by:
Poor perfusion due to the low pressure in the aorta and diminished blood flow through the coronary arteries.
thyrotoxicosis produces what type of HF
high-output heart failure
Tx of Atrial Flutter are:
B blockers
Digoxin
Ca channel blockers
Loud S3 is associated with?
Mitral valve regurgitation
MoA of loop diuretics is
Inhibit Na/K/Cl pump at the ascending loop of henle thereby preventing reabsorption of water.
ECG Leads anatomy is:
ECG finding of RBBB includes
wide QRS
rabbit ears in V1 and V2
Fibric Acid MoA
Reduce TG levels
Raise HDL
Bradycardia
rate less than 60 bpm
How to determine irregular heart reate on ECG, what is the formula?
6 second rule
of QRS within 30 large boxes x 10
Pericardial effusion/Cardiac Tamponade most often caused by:
Pericarditis
Valve Locations: Tricuspid Mitral
Tricuspid - Left sternal border at the level of 5th interspace
Mitral Apex/Mid clavicular line at level of 5th interspace
Examples of potassium sparing diuretics are:
Spironolactone
Amiloride
Triamtereine
X ray fininds corresponding to Restrictive CM
Pulmonary vascular congestion
Pleural Effusion
Normal heart size
aTrophine
aDenosine
aMiodorone
aTrophine - Tachicardia (increases heart rate)
aDenosine - slows Down the heart
aMiodorone - mellows down (antiarrhythmic)
ACE inhib (MoA) is
blocking the conversion of Angiotensin I to Angiotensin II
Decrease of Aldosterone>reduction of Na reabsorption>reduction of volume
Best imaging modality for AAA diagnosis:
Ultrasound
Definition of cardiac tamponade is
large, rapid or uncontrolled pericardial effusion which reduces cardiac output.
Bisferiens carotid pulse ( a double peak per cardiac cycle is seen in) :
Hypertrophic Cardiomyopathy
Which Beta blocker should be used in pt with CHF and Asthama?
Metoprolol (Beta 1 selective blocker)
Secondary HTN with hypokalemia is indicative of
Conn’s disease/Aldesteronism
low pitched rumbling diastolic apical murmur corresponds to:
Mitral stenosis
Powerfull vascular constrictrors are
Angeotensin II - most potent
Epinephrine
Norepinephrine
Dopamine
Thromboxane
Endothelin
Management of AAA:
Surgical repair if >5.5 cm or expands >0.6 cm per year
Monitor annually if >3 cm.
Monitor every 6 months if >4 cm
Beta blocker
Mitral valve regurgitation can be repaired or replaced?
Repaired. In many case the valve can be repaired rather than replaced.
Buerger’s Disease/Thromboangitis obliterans
Progressive inflammation and thrombosis of arteries and veins of extremities. Strongly associated with smoking.
definition of Cor pulmonale
alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system
closely linked to:
pulmonary embolism
acute respiratory distress syndrome
Roth spots are
Associated with endocarditis;
Retinal hemorrhages with white centers
Nitroglycerin side effects include:
headache
nausea
low B.P
Mid systolic murmur that radiates to carotids corresponds to:
Aortic Valve Stenosis
Locations where S1 and S2 sounds can be heard the best are:
what effect Hypothermia has on ECG:
Bradicardia
J/Osborne wave
Saw Tuth Pattern on ECG corresponds to
Atrial Flutter
Unique ECG feature of hypertrophic obstructive CM is:
exaggerated Q waves corresponding to hypertrophic ventricular septum
CHF Classifications
Class I (mild) corresponds to:
No sx
No limitatons on physical activity
Arterial Flutter
Saw tooth appearance
Causes of mitral valve regurgitation include:
Mitral valve prolapse is the most common cause (thin females are most common for mitral valve prolapse)
Rheumatic fever
Myocardial infarction Endocarditis (regurge will also put a patient at increased risk of endocarditis)
Ruptured chordae tendineae (caused by MI or endocarditis most likely)
Presentation of Aortic valve stenosis include:
Mid systolic murmur
Syncope
Angina
LVH
Paradoxial splitting of S2 sound during expiration (normal splitting occurs during inspiration).
Brain Natriuretic peptide (BNP) is indicative of:
Ventricular Filling Pressure
Downslope ST elevation in V1, V2 and V3
with RBBB are signs of:
Brugada Syndrome
Wells Criteria is used to ascess the risk of
pulmonary embolism
Reduction of ventricular volume will _______worsen symptoms of Hypetrophic Obstructive Cardiomyipathy
Volume reduction with worse/increase sx of HOCM
Damage or prosthetic heart valves most common associated with:
Endocarditis
ACE - Inhibitors ________ breakdown of bradykinin (vasodilator)
decrease breakdown of bradykinin
Most common cause of hypetrophic cardiomyopathy is:
HTN
wide arterial pulse pressure is associated with ?
Aortic valve regurgitation
What is the classic triad of AAA?
Abdominal/back pain,
hypotension and
a pulsatile abdominal mass.
Fibrilation is
heart rate of >350
ECG findings of Restrictive CM are unique for:
Decrased aplitude caused by histological changes that reduce electrical conduction w/i the heart.
Nifedipine
Amlodipine
Nicardipine
Felodipine
are example of:
Dihydropyridine Ca channel blockers.
Tricuspid valve stenosis is usually symptomatic/non symptomatic
Non symptomatic
Vaughn-Williams Antiarrhythmic Drug Classifications:
Class I - Na channel blockers
IA - Quinidine, procainamide
IB-Lidocaine
IC-Flecanide, propafenone
Class II - Beta blockers (Metoprolol)
Class III - Potassium channel blockers (Amiodarone)
Class IV - Calcium channel Blockers
X Ray finding associated with aortic valve stenosis:
Calcified aortic valve.
Mitral valve stenosis produces what type of murmur?
Diastolic low pitch murmur, heard best at the apex in LLD position.
Concentric Hypetrophy corresponds to
Diastolic HF
Severe decreased right atrial compliance is a feature of:
Restrictive CM
Acromegaly causes secondary HTN by means of:
High concentratoin of Ca2+ causes the constriction of arterial smooth muscle which increase periferial resistence.
Viruses that often can cause pericarditis include:
echovirus (enterovirus), coxsackie (hand-foot-and-mouth dz), flu, HIV
Stage II HNT values are
>160/100
Stage II HTN treatment involves:
Combination of two drugs:
Diuretics + ACE inhib, ARBs, Ca channel blockets, B blockers
Sx and signs of PDA are:
Low Diastolic blood pressure
Widended pulse pressure
Machinery like murmur (continuous - both in systole and diastole)
In African American ACE-I should be replaced by:
Hydrochlorothizide
(not ABRS)
absent or weak femoral pulses
HTN in UE with hypotention in LE
3 sign on chest X ray
are all features of:
Coarctation of Aorta
LVH in aortic valve stenosis is caused by:
Excessive force used by left ventricle to pump through stenosed aortic valve.
Diastolic, rumbling murmur heard along lateral left sternal border, increases with insiration, associated with what valvular condition?
Tricuspid Stenosis
Bisferiens carotis pulse
loud S4
Systolic murmur
corresponds to
Hypertrophic Cardiomyopathy
S2 sound corresponds to closure of
Aortic and Pulmonic Valves
Complete Heart Block aka 3rd degree AV block
Dry cough that occurs in pt. taking ACE-Inhibitors is caused by:
increased bradykinin
which irritates the lungs
Fluid b/w lung lobules seen in the bases during pulmonary edema are known as:
Kurley B lines.
definitoin: edematous interlobular septa.
Heparin side effect:
HITS: Heparin-induced thrombocytopenia syndrome
What is the most common cardiac cause for cyanosis of children?
Tetralogy of Fallot
Leading cause of Restrictive Cardiomyopathy is:
Amyloidosis
other causes inlclude:
Sarcoidosis, Hemochromatosis, Gaucher’s ds.
Side effect of alpha receptor blockers
Postural hypotension
Syncope
Aortic valve stenosis causes ____ ventricular outflow obstruction and _____ left ventricular hypertrophy
Left Left
Treatment for congenital long QT syndrome is
B blockers
IV drug users are predispose to develop RT or LT endocarditis with Tricuspid or Mitraval valve regurgitation?
RT
Tricuspid Regurgitation.
What medication is contraindicated in the treatment of Prinzmetal’s angina?
Beta-blockers.
Tets spells are:
episodes of cyanosis, hypoxia, SOB seen in kids with Tetralogy of Fallot
releived by squatting.
Major Duke criteria for endocarditis includes:
- Positive blood cultures (S. Aureus, S.Viridins, S Bovis, Enterococci)
- Positive Echo (New regurgitation, Abscess, oscillating mass)
Pathological Opening of the Aortic/Pulmonic will produce
Opening Click (systolic sound)
Mitral valve prolapse is seen mostly in what type of patients?
Young thin females
Tx for Afib concurrent with V tach is:
IV Cardizem (CCB)
Lab work often seen in Giant cell arteritis:
Liver function tests – Alk phos elevated
C-reactive protein is elevated
Sed rate elevated
platelets may be low
Diastolic opening snap following S2 corresponds to:
Mitral valve stenosis (MS=OS)
Cardiological signs of HTN are:
LVH
Displaced PMI
CHF
MS =
(Mitral Stenosis)
OS
(Opening Snap)
Tietze Syndrome
Costochondritis
Serious complication of Giant Cell arteritis:
Blindness
Causes of PAD
Atherosclerosis
Smoking
Furosemide (Lasix)
Torsemide (Bumex)
Bumetanide (Demedex)
are all ____ diuertices
Loop Diuretics
Pulsus Paradoxus
a drop of more than 10 mmHg in systolic blood pressure during inspiration
Seen in pericarditis / cardiac tamponade
Conn’s Syndrome produces secondary HTN by means of?
Aldesterone secreting tumor in the cortex of the adrenal gland.
Produces Na+ retention > hypervolemia.
Digitalis (digoxin effect) can be seen on ECG as:
downsloping ST depression with a characteristic “slurred” appearance;
flattened, inverted, or biphasic T waves;
shortened QT interval.
Digoxin effect is NOT a marker of toxicity
Tx of STEMI includes:
Aspirin or Clopidogrel (if allergic)
TPA (thrombolitics) - must be given w/i first 3 hours
Heparin
INR goal in pt. with A-Fib
2.5
HOCM can cause sudden
death
Classical UA sign of HTN is:
ProteinUrea (frothy urine)
MI and Cardia Arteries:
Inferior>RCA
Lateral>Left Circumflex artery (branch of LCA)
Anterior>L anterior Discending artery (branch of LCA)
Posterior>RCA
STEMI vs NSTEMI
STEMI: total occlusion, transmural (full thickness) MI, tPA are usefull, + enzymes, + ST elevation
NSTEMI: partial vascular occlusion, superficial MI, tPA are not usefull, + enzmems, - ST elevation
Dihydropyridine Ca channell blockers (MoA)
dilate arterioles
What class of diabetes medications are contraindicated in the setting of heart failure?
Thiazolidinediones
Pt with HTN + DM should be prescribed what HTN drug(s)
Thiazide + ACE inhibitors
Causes of aortic valve stenosis include:
- Calcified aortic valve - most common cause
- Congenital valve malformation (bicuspid or unicuspid)
- Hypetrophic obstructive cardio myopathy.
Two normal QRS folled by wide QRS is known as
Ventricular Trigemeni
Low levels of which electrolite prolongates the QT interval is:
Ca
HyporCalcemia
Excentric hypertrophy corresponds to
Dilated HF
B blockers are contraindicated in what AV blocks?
1st AV block
Typical EKG findings associated with pericarditis include (2):
- Diffuse concave-upward ST-segment elevation in multiple leads (exsept in aVR, V1 and III)
- Diffuse PR-segment depression examples:
http: //en.ecgpedia.org/wiki/Pericarditis
What cardiac pathology is often seen in pt with Turner’s syndrome?
aorta coartation
Sinus Tachycardia is often seen in pt’s with:
PE
PE=ST
Pathological opening of the mitral/tricuspid valves produce
Opening Snap (Diastolic sound)
Systolic ejection murmur at pulmonic area that radiates to left neck
Pulmonary valve stenosis
Pharmacological treatment of PAD:
vasodilators and antiplatelet medications
Pentoxifyline Cilostazol
Multifocal Premature Ventricular Contraction
two different wide QRS complexes
Tx for stable V tach
Amiodarone
Lidocaine
R on T phenomenon is
Premature beating occuring during the T wave of the regular rhythm.
May lead to Torsade/VT/VF
1 AV block does / does no require treatement
Does NOT
Kawasaki Disease:
occures in children under 4 y.o
sx: fever x 5 days
erythem of lips / oral mucosa
conjunctivitis
cx lymphadenopathy
edema / erythem of extermieites
complication: coronary artery disease
Management of AO dissection
Type A dissection - Surgical emergency
Type B dissection - Medical therapy (beta blockers) unless complications are present
Prinzmetal angina will produce what ECG changes:
ST elevation
normal enzyme
Bacterial Endocarditits most commonly caused by what pathogens?
Strep Viridans (+), Staph Aureus (+), Enteroccoci (+), Staph Bovis (+)
Increased pulmonary Wedge Pressure is seen in _____ and corresponds to _______
Pulmonary Edema
Left Ventricular Pressure
INR needs to be checked regulary for pt who are on:
Warfarin/Coumadin
S2 splitting occurs during:
During inspiration S2 sound is split into Aortic valve (first) and Pulmonic valve (second)
Junctional Rhythm:
40-60
no p waves
narrow QRS
often caused by:
Digoxin Toxicity
Junctional = Digoxin
Ventricular contractions
Uncoordinated
Rate of 300-600
no pulse
no true QRS
known as:
Ventricular Fibrilation
most common cause of sudden cardian death
Prem. Atrail Contracton
vs.
Prem Junctional Contraction
PAC will have normal p wave (different from other p waves)
PJC will have a missing or inveted p wave
ACE-I actions include:
Block converston of Angiotensin I to Angiotensin II
Dicrease aldosterone mediated water retention
Slow myocardial remodeling and fibrosis.
Giant cell arteritis is best diagnosed with
Temporal artery biopsy
HTN values
>140/90 on two or more readings at two or more separate occasions separated by at least one week.
Cardiac Enzymes
Most common ECG findings in PE is:
Sinus Tachycardia.
Two types of Calcium Channel Blockers are:
Dihydropirodines
Non-dihydropirodines
Stiff ventricle in hypertrophic CM produced ___ sound
Increased diastolic volume in Dialated CM produces ___sound
S4
S3
Beside HTN, hydrochlorothiazide is also used in:
Preventing kidney stones
Osteoporisis (prevent the loss of Ca+)
Target INR range for pt on Warfarin/Coumadin
INR 2.0-3.0
Ventricular rate
20-40
Nitroglycerin MoA is:
reduce oxygen deman
reduct preload and afterload
vasodilation
Several consequative PVC is known as
A run of VT
Pathologic because the heart is not able to fill up due to the fast contraction.
SA node rate
60-100
Definition of mitral valve prolapse:
Superior displacement of mitral valve leaflets into the left atrium.
Signs of HTN retinopathy include
Cotton wool spots
Flame hemmorhages caused by vessel rapture
Papilloedema (indistinct borders of the optic disk)
Arterial thinning (narrowing) / Silver (cupper) wireing
Arterio-venous nicking
sx of Digoxin toxicity are:
N/V (GI sx)
Geynocomastia
Blurred vision with yello halo
Paroxysmal atrial tachycardia
Arterial Septal Defect will be seen on ECG as:
Rt bunlde branch block.
ECG features of Dilated Cardiomyopathy are:
LVH/RVH
ECG findings corresponding to aortic valve stenosis:
LVH
ECG finding of LBBB include:
Dog ears in V5 and V6
wide QRS
New York Heart Association Classification
Endocarditis caused by poor dental care is often secondary to:
Strep viridans.
Definition of wide arterial pulse pressure is:
the difference between the systolic blood pressure and the diastolic blood pressure is greater than 40 mmHg
Premature Ventricular Contraction (PVC) are treated with:
B blockers
Definition of Thrombophlebitis is:
Inflammation of the wall of the vessel (superficial) secondary to a thrombus.
Autosomal dominant disorder
Sudden death
Common among young athletes
typical of:
Hypertrophic Obstructive CM
Treatment for Patent Ductus Arteriosus is:
Indomethacin (NSAIDS)
New sudden onset of Afib is often related to:
Thyrotoxicosis.
check thyroid labs
ECG finding of Prinzmetal Angina is:
ST-elevation in multiple leads
Syncope is associated with which valvular condition?
Aortic valve stenosis
Congenital valve malformation is usually manifested at what age:
middle age patient
Pathophysiology of AAA includes:
Dilatation of tunica media
Failure of connective tissue (elastin and collagen)
Murmurs in valvular disorders are
reduced with what manuevers
and
increased with what manuevers:
increased with increasing ventricular volume: squating, hand grip, lying down, straight leg raising
reduced with decreaseing ventricular volume: valsalva
Young Asian Men
Sudden Cardian Death
seen in:
Brugada Syndrome
Adverse effect of Nitrates:
Hypotention>Tachyardia>Increased Oxygen demand>ST depression on ECG.
Tx for stable A fib is:
CCB:
Verapamil
Diltaizem
Key radiological feature of AO dissection is
Intimal flap
Treatment of symptomatic V tach is:
Electrical Cardioversion
or
Pharm Cardioversion with amiodarone or lidocaine
Long lasting tx is:
Implantable Cardioverter Defibrillator (ICD)
Tx for A-Fib
Rate Control:
B blockers, Ca channel blockers, Digoxin
Chest pain in kids reliefed by squatting corresponds to:
Tetrallogy of Fallot
Medicaton for Dialted Cardiomyopathy are:
Beta blockers and ACE inhibitors.
Definition of waterhammer/ Corrigan’s pulse is
a pulse that is bounding and forceful, rapidly increasing and subsequently collapsing.
BNP (B-type natriuretic peptide) <100 is indicative of:
rules out CHF
Atrial Septum Defect is caused by:
Osteum Secundum
Foramen ovale fails to close
Respiratory condition that is often seen in pt’s with Arterial Flutter is
COPD
Low K or Mg often caues of kind of arrythmia?
V tach
no p waves
rate of >100
Treatment for WPW is
Amiodarone or Sotalol
or Cardiovertion followed by Radio frequency ablation
upright posture
standing
valsalva
have what effect of ventricular volume?
decrease ventricular volume
Hydralazine is
Arterial vasodilator used in HTN crisis works by releasing Nitric Oxide (NO)
At what time of the day should Statins be taken?
Evening
Peak activity of Statins is at midnight.
INR for prosthetic valves other than mitral valve should be held at
INR 2.0-2.5
warfarin/coumadin
Hypercoagulability state can be induced by:
Oral birth control medications
Pregnancy
Cancer
Factor V Leiden mutation
Smoking
Prolong immobilization
Recent surgery
Homans test:
Dorsiflexion of foot with a straight knee
If + indicate of DVT (accurate only in 50%)
Persisten Sinus Bradycardia in an elderly
with sx of syncope is collectively known as:
Sick Sinus Syndrome
Verapamil
Diltiazem
Non-dihydropyridine Ca channel blockers.
Posterior MI:
ST depression in V1 / V2
Statins MoA is
reduce cholesterol synthesis by inhibiting Hydroxy-methylglutaryl coenzyme (HMG)
Apical ballooning of the LV that occures in response to severe stress is known as:
Taku-Tsubo Cardiomyopathy/Broken Heart Syndrome
Echo feature of Restrictive CM is:
Enlarged atria
Murmur that’s best heard in LLD position at the apex of the heart?
Mitral valve stenosis
what the most common cardiact pathology in pt with Down syndrome?
Atrioventricular septal defect
B blocker that is not contraindicated in pt with COPD/Asthma is:
Metropolol
CHADS2 score of > 2 requirs anticougulation (INR>2)
what is included in the CHADS2
CHF
Hypertension
Age >75
Diabetes
Stroke
multifocal atrial tachycardia if often caused by
COPD
PMI is located at
4/5th interspace at the level of mid clavicular line.
Treatment for RHF symptoms such as ascites, edema is
Loop diuretics
Tx for hyperKalemia is:
Calcium Cloride or Calcium Gluconate
Tx for unstable Paroxysmal Supraventricular Tachycaridia is:
IV adenosis
or
Verapamil, Diltiazem (CCB)
normal QRS is
0.12-0.2
Rt. Atrial Enlargement seen on ECG as
tall p waves (2.5 mm)
in inferior leads (II, III, AVF)
Contraindication for ACE - Inhibitors are:
Pregnancy
Bilateral Renal artery stenosis
Do not work well on African American pts, unless renal disease is also present.
Classic Xray signs of acute CHF (pulmonary congestion/edema)
Butterfly patterns of alveolar edema
Increased interstitial markings
Kerely B lines
Enlarged cardiac silhouette
Effusion (meniscus sign)
Cephalization of flow (vertical distribution of pulm veins)
CVA/TIA
unilateral neck pain / sever headache
Miosis / Ptosis (Horner’s syndrome)
is a classic sign of:
CCA dissection
Diagnostic studies for PAD:
ABI <0.8
Arteriogram is a gold standard
Catochalamines (Epi & NE) bind to
Alpha and Beta receptors.
CT angiogram of the chest with IV contrast is the preferred diagnostic modality in patients with suspected PE unless:
elevated creatinine
use V/Q scan instead
Cause of A-fib include
Thyrotoxicosis
ET(OH) abuse
HTN
CHF
Accurate blood pressure requires:
No smoking or drinking 30min. prior.
Cuff bladder should be 80% or arm diameter
Pharmacological treatment for stage I HTN is
Hydrochlorothiazide
Junctional Rhythm with inverted P waves
First initial therapy in Pulmonary edema (Systolic/Dialated HF) is:
Loop Diuretics (fast acting)
Furosemide
Bumex
Loop Diuretics side effects include:
Hypokalemia
Hyponatremia
Gout (elevated uric acid levels)
Ototoxicity
Bioprothetic valve replacement (bovine/porcine) does / does not require anti coagulation therapy.
does NOT require anti coagulation therapy shorter life span (10-15 years)
Capture beats and fusion beats confirm the diagnosis of which cardiac dysrhythmia
Ventricular tachycardia
What valvular disorder is often seen in young pregnant pt?
Mitral Valve Stenosis
obstruction or delay of conduction b/w SA node and AV node results in
AV nodal Blocks
2nd Degree AV Block Type I is also known as:
Wenchekbach
Mobitz Type I
Definition of Tetrallogy of Fallot is:
PROVe:
Pulmonic stenosis,
Right ventricular hypertrophy,
Overriding aorta,
VSD
Mid systolic click is often seen in
Mitral valve prolapse
Side effects of Ca channel blockers are:
Constipation
Bradycardia
Edema
delta wave on an electrocardiogram is seen in
Wolff-Parkinson-White syndrome
Unique echo feature of Hypertropic Obstructive CM is:
Assymterical ventricular enlargement.
Digitalis effect include:
Inotropic
controls heart rate with Afib
used in CHF concurrent with Afib.
Features of Taku-Tsubo are:
casued by stress/catacholamine release
mimicks amteropr MI
normal coronary arteries
self limiting.
Dressler Syndrome aka Postcardiac injury syndrome is caused by (4):
- MI
- Open heart surgery
- Pericardiotomy
- Trauma to pericardium.
Dressler Syndrome is typically presented by (5):
- Pleuritic chest pain
- Pericarditis
- Pericardial effusion
- Fever
- Pericardial friction rubs
Dressler Syndrome is also known as Postmyocardial infarction syndrome
Digitalis toxicity is associated with what rhythm
Junctional Rhythm.
main treatment for Bradyarrhythmias is:
Atropine
Pharmacological treatment for pulmonary congestion includes:
Diuretics
Vasodilators
Bundle of Kent is associated with
WPW syndrome
Dual antiplatelet therapy consists of:
Clopidogrel(plavix) + apsorin
Decrease risk of coronary artery stent thrombosis.
Treatment for pericarditis is:
Treat the underlying issue. High dose of NSAIDs
Tender cord like structure at affected vein is associated with
Thrombophlebitis
LVH with narrow LVOT is a feature of:
Hypertrophic Obstructive CM
Diagnosis of HTN requires __ seperate readings
3 separate readings.
Non raptured AAA are
Not symptomatic.
V tach
requires Cardioversion
Powerful vasodilators are:
Nitric Oxide (NO)
Prostaglandins
Bradykinin
Mobitz II aka
2nd Degree AV Block type II
Example of Inherited autosomal dominant cardiomyopath
Hypertrophic Obstructive CM
Cushing syndrome has what effect of K concentration
causes HypoKalemia
Supraventricular Tachyarrhythmias include:
Sinus
Atrial
Junctional node
arrhythmias
Eisenmenger’s physiology is:
Large Patent Ductus Arteriousus that produces pulmonary HTN
The drug the decreases mortality in CHF is
ACE-I
Potassium sparing diuretics
B blockets (metaprolol, carvedilol) - efficacy is inversily proportional to the ejectoin fraction. The lower the EF the hight the efficacy (higher decrease of mortality)
Duke Criteria for diagnosis of endocarditis:
Two major findings
or
One major finding + three minor findings
or
Five minor findings
what effect NSAID have on CHF?
Non-steroidal anti-inflammatory drugs are associated with an increased risk of heart failure exacerbation, increased renal dysfunction and impairment of the response of angiotensin converting enzyme inhibitors and diuretics.
Physical findings of Cardiac tamponade include:
Hypotension
Paradoxical pulse pressures –a drop of more than 10 mmHg in systolic blood pressure during inspiration
Jugular venous distension
Tachycardia
Tachypnea
Narrow/low pulse pressure (difference b/w systolic and diastolic blood pressures)
Decreased heart sounds
Water bottle heart on chest X-ray
Typical presentation AAA rapture:
Flank pain,
hypotension,
pulsatile abdominal mass
Tearing pain radiating to the back = AAA RAPTURE
Mitral Valve Prolapse produces
Mid Systolic Click
Systolic Crescendo murmur
preload up > murmur down
preload down > murmur up
Kussmaul sign
paradoxical rise in jugular venous pressure (JVP) on inspiration
signs of right heart dysfunction.
Young Asian Men
Brugada Syndrome
S4 sound is typically seen in what cardiomyopathy?
Hypertropic CM
Cause of aortic valve regurgitation are:
Infective Endocarditis > distruction of the aortic valve
Rheumatic heart disease > enlargement of the valve ring Aortic dissection>propagates and damages the aortic valve
HTN>increased b/p in AO exerts reversed pressure on the aortic valve causing it to regurgitate HTN>cause LV dilatation which stretches the valve ring producing regurgitation
Mafan Syndrome>connective tissue disorder>AO root disease
Conn’s Syndrome/Aldesteronism produces secondary HTN by means of:
increased retention of Na+ and secretion of K+
resulting in hypervolemia and hypokalemia
Prozosin & Terazosin are medications that can be used in
BPH
HTN caused by pheochromocytoma
Ezetimibe MoA
Inhibits intestinal absorption of cholesterol.
features of Supraventricular Tachycardia
very regular
Narrow QRS
p waves may be hiding/missing
rate 140-240
May be caused by SA, AV or Junctional node
CHF with A-fib is indicative for what medication?
Digitalis aka Digoxin
Giant cell arteritis is often seen concurrent with what medical condition?
polymyalgia rheumatica (multiple joint pain)
The target INR for a mechanical mitral valve is ___,
whereas a mechanical aortic valve is ___.
3-3.5 mitral
2.5-3 aortic
ARBs MoA is
Block antiotensin II receptors producing vasodilation
Don not increase bradykinin (like ACE inhib)
Sudden death, seen in young athletes is usually secondary to:
Hypertrophic Obstructive CM and arrhythmia caused by it.
Opening Snap after S2 is associated with
Mitral Stenosis
(MS=OS)
Tx for SVT is:
IV adenosine or
verapamil
Cardioversion for symptomatic SVT
Atrail Flutter definition:
Regular narrow QRS
atrail rate of 250-350
Sawtooth pattern
caused by conduction delay
Physical finding associated with Mitral valve regurgitation?
Pansystolic blowing murmur at the apex and radiating to the axilla
Loud S3 Midsystolic click
Brisk carotid upstroke Rales secondary to pulmonary congestion
A-fib
Left ventricular hypertrophy
Physical findings of Mitral Valve Stenosis include:
Opening snap following S2 sound (MS=OS)
Diastolic low pitch murmur
Pulmonary congestion (back up from left atrium into the lungs).
Lung Rales (secondary to pulm. congestion).
Paroxysmal nocturnal dyspnea.
Tachycardia
Classes of AntiArrhythmics
Digoxin (digitalis) toxicity syndrome is seen on ECG as:
Bradyarrhythmia
PR prolongation
can lead to Torsad De Point
Non-dihydropyridine Ca channel blockers (MoA)
Slows Heart rates
and
Dilate arterioles
Gynecomastia and Hyperkalemia are side effects of:
Aldesterone Antagonists:
spirolactone
epleronone
Angiotensin Receptor Blockers (ARBs) icnlude:
Losartan
Valsartan
Torsades de pointes is
caused often by low Mg
should not be treated with antiarrhythmics
correct electrolyte imbalance
Giant “v wave” is seen in
Tricuspid Regurgitation
Normal BNP in a pt. suspicious of having acute CHF will
exlude CHF.
HTN for pt. with DM, renal or vascular disease is defined as:
BP>130/80
Conn’s syndrome is best seen on:
CT/MR will show adrenal adenoma/hyperplasia
Floppy, myxomatous mitral valve is also known as
Mitral Valve Prolapse
Side effects of thiazide diuretics include
Hyponatremia
Hypokalemia
Hypocloremia
Gout (increase levels of uric acids)
Hyperglycemia
HyperCalcemia
Features of Cardiogenic Shock are:
Decreased CO
Hypoxia
Hypotension
Altered mental status
Cyanotic extrimities
Faint pulses
Oliguria
Low cardiac index (stroke volum x heart rate / body surface are)
Crescendo-decrescendo systolic murmur along the upper left sternal border is seen in what cardiomyopathy?
Hypetrophic Obstructive Cardiomyopathy.
Treatments for Arrhythmias are:
Sinus Brady > Atropine
Sinus Tach >Cardiov (unstable) or B block ( sx)
SVT>adenosine, IV 6 mg
Atrial Flutter > Abutilide
A Fib > B blockers, CCB, warfarin
PVC > B block
V tach > Amiodorone, cardioversion
T fib > defibrilation
S1 sound represents the closure of which valves?
Mitral and Tricuspid valves
With inspiration murmurs associated with which valvular pathologies become louder
Tricuspid valve stenosis and regurgitation.
Pharmacological management of AAA and AO dissections is:
Beta blockers.
Secondary HTN caused by RAS in elderly pt is usually due to:
Renal artery atherosclerosis
Secondary HTN caused by RAS in young pt is usually due to:
Fibromuscular Dysplasia
Pre Hypetension Values are:
120-139 / 80 -89
Echo findings corresponding to aortic valve stenosis:
aortic valve deformity
LVH
what drug is contraindicated in non-STEMI
tpa (Tissue plasminogen activator)
AV rate
60-40
Pathophysiology of wide pulse pressure associated with aortic valve regurgitation is:
This regurgitant flow of blood from Aorta into LV which causes a decrease in the diastolic blood pressure in the aorta, and therefore an increase in the pulse pressure (difference b/w systolic and diastolic pressures)
Hypovolemia, Tachycardia, Valsalva, Arrhythmia, vasodilatatoin drugs will ___________sx of HOCM
worsen/increase sx of HOCM
Adverse effects of B blockers is:
Bronchospasm
Should not be used in COPD/ASTHMA pts.
Acute Mitral Regurgitation is oftern caused by:
MI
possibel mechanism is:
rupture of the chordae tendineae, papillary muscle, or valve leaflet
Murmurs in HOCM are
reduced with what manuevers
and
increased with what manuevers:
reduced with increasing ventricular volume: squating, hand grip, lying down, straight leg raising
inrcreased with decreaseing ventricular volume: valsalva
Nitroprusside
Arterial and Venous vasodilator works by releasing Nitric Oxide (NO)
CK-MB returns back to normal after MI in __days while Troponin returns in ___ days.
CK-MB retuns in few days
Triponins returns in a week
(if repeated MI is suspected within a week of the original, check CK-MB)
What are some anticholinergic side effects?
Dry mouth,
blurred vision,
constipation, urinary retention
drowsiness, sedation
red flashes, hyperthermia.
Best initial test for pt suspected of having endocarditis is:
Blood cultures
Causes of pericardial effusion:
viral myopericarditis (simultaneous infection of heart muscle and pericardial tissue)
metastatic malignancy (lung and breast)
autoimmune disease (lupus)
renal failure
bleeding (hemopericardium)** commonly considered a separate syndrome
Premature Ventricular Contraction
Diastolic B/P is determined by
Peripheral arterial resistance.
multifocal atrial tachycardia is often seen in pt with
COPD
Murmur that’s best heard in pt. leaning forward?
AO valve regurgitation
Endocarditis is mostly of __________ origin while Pericarditis is usually ____________ origin.
Bacterial Viral
Mitral valve regurgitation cause back flow of blood into __ atrium during systole or diastole?
Left
Systole
Blood volume in the system is determined by:
Na+ concentration
Mineralcorticoids
Atrial natriuretic peptide (ANP)
Physical findings associated with endocarditis (6)
1 New or changed murmur
2 Splinter(nail) hemorrhages
3 Janeway lesions
4 Osler nodes
5 Roth spots
6 Petechia (purple spots)
Gynecomastia is a side effect of which medication?
Spironolactone (Aldosterone Antagonist)
Treatment for Giant Cell arteritis:
High dose of oral prednisole (40-60 mg daily)
Sick Sinus Syndrome
(bradycardia, syncope, palpitation)
tx is:
Pacemaker.
Endocarditis prophylactic treatment for high risk patients undergoing procedures is
Amoxicillin
Definition of PANSSTOLYC/HOLOSYSTOLIC murmur is?
Systolic murmur that starts at S1 and continues through S2 sound.
Tx for A fib is:
CCB
B blockers
Digoxin
DM produces secondary HTN by means of?
Hyperglycemia damages arterial wall making is less complient.
Tricuspid valve stenosis produces ___murmur
Diastolic
Nitroglyceride is
venous vasodilator
Risk factors for AAA are (syndromes):
Marfan’s syndrom
Ehlers-Danlos type IV
Pseudoaneurysm
Localized tear in arterial wall.
Abnormal blood work in endocarditis is:
Low complement level
DVT anticoagulation protocol:
Heparin to Warfarin/coumadin bridge:
Start with Low Molecular Weight Heparin
Continue with Warfarin for up to 12 month
Mose common cause of mortality in pt with CHF is:
Ventricular arrhythmia
Crescendo-Decrescend Diastolic Murmur head at 3rd or 4th left interspace is associated with?
Pulmonic Regurgitation
Types of AO dissection
Ascending AO dissection - type A
All other dissections - type B
Type A is more common than type B.
Burning disproportional pain after trauma is known as:
Reflex Sympathetic Dystrophy / Complex Regional Pain syndrome
tx for Digoxin toxicity includes:
Administer K
Digibind (if SNS or ECG sx are present)
Essential HTN is usually diagnoses in what ages?
b/w 25 and 55 y.o.
Apixaban is anticoagulatn that is used in
Pregnancy
If giant artery cell arteritis is suspected the next step is:
High-dose corticosteroids
Hyper or Hypo Thyroidism produces secondary HTN by means of:
HyperThyroidism produces increased expression of adrenergic receptors>vasoconstricution; also causes increased cardiac output.
HypoThyroidsim produced Na+ retention>hypervolemia.
Causes of secondary HTN include:
Drugs Chronic kidney disease
Primary aldosteronism
RAS
Cushing’s or long term corticosteroid use –one cause here is from retained salt and fluid
Pheochromocytoma –Epinephrine secreting tumor.
Coarctation of the aorta
Thyroid or parathyroid disease
Pregnancy
Carcinoid Syndrome
Hormone Replacement Therpy
Sleep Apnea
Lead poisoning
Porphyria
Mechanical valve replacement does / does not require anti coagulation therapy.
does not require anti coagulation therapy
Dyspnea on exersion
Paroxysmal Nocturnal Dyspenea
SOB
are signs of which CHF
Left side
Sinus Bradycardia may be caused by what medication?
Beta Blockers
Cardiac Stenting requires what medications:
Aspirin
and
Clopidogrel
Wide Pulse Pressure is defined as
and associated with
Large diference b/w systolic and diastolic pressures
Aortic Valve Regurgitation
Cardiogenic shock (diminished hear CO) is usually due to:
MI
CHF
CM
Cardiac tamponade
ARBS bind to which receptors
AT 1
Mitral valve has __leaflets?
Two
Short PR interval w/o delta waves seen on ECG corresponds to:
Lown-Ganong-Levine Syndrome
causes A fib or V tach
same tx as WPW
Junctional Rhythm is often caused by what medicatoin?
Digitalis
Symptomatic Sinus Bradycardia should be treated with?
Atropine
Bilat hip and buttuck claudication
Erectile disfunction
absent femoral pulses
known as:
Leriche’s syndrome
Aortic valve stenosis is very similar to what coronary condition?
Atherosclerosis. Calcification of the aortic valve leaflet lead to Aortic valve stenosis (most common cause)
Physiological Sinus Arrhythmia is
caused by vagus activation/deactivation
Inspiration > increases HR
expiration > decreaes HR
Most common cause for Mitral Valve Stenosis is
Rheumatic heart disease
Location of PMI/apex is
Level of 5th inerspace Mid clavicular line
Osler nodes
Associated with endocarditis;
Painful, raised lesions on the pads of fingers and toes;
Depositions of immune complexes;
Spirolactone MoA
Inhibits Aldosterone>Increase Na extretion
causes hyperKalemia
S wave in lead I
q wave in lead III
inverted T in lead III
Sinus Tachycardia
are all features of:
PE
Empiric endocarditis treatment is
IV vancomycin OR ampicillin/sulbactam (unasyn) PLUS aMinoglycoside (gentoMicin, streptoMicin)
Second Degree AV Block Type II / Mobitz II
features:
Normal PR intervals
Intermitten dropped QRS
associated with syncope
requires pacing
Causes of Pulmonary valve regurgitation
Pulmonary hypertension
Endocarditis
Rheumatic
heart disease
MI
Plaqueo
Iatrogenic
Axis deviation is determined by looking at which leads?
Lead I
and
AVF
Physical findings that are typical of Tricuspid valve regurgitation are:
Jugular venous distention with v waves
Peripheral edema
Ascites
Pulmonic valve murmurs decrease/increase with inspiration?
decrease
pulmonary artery wedge pressure is measured?
A Swan-Ganz catheter
Endocarditis sec. to post op valve replacement is caused by:
Staph aureus;
Fungi;
Negative bacteria
Causes of Tricuspid Valve Regurgiation include:
RVH
Pulmonar Hypertension
Ebstein’s anamoly
Pacemaker leads
Tricuspid endocarditis
Myocarditis is caused by:
Coxsackie B virus
arvovirus B12
Echovirus
S1 souund is ______ frequency best heard with ____
S2sound is _______ frequency best heard with____
Low, bell
Hight, diaphragm
Beta blockers effects are:
Reduces heart rates
allows more time for diastolic fillings
MoA: inhibits Na/K-ATPase
Ebstain Anomaly
defect in which the tricuspid leaflets attach to the right ventricular wall, leading to a larger than normal right atrium and smaller than normal right ventricle. Ebstein’s anomaly is also commonly associated with an atrial septal defect, patent foramen ovale and the pre-excitation, re-entrant conduction defect of Wolff-Parkinson-White syndrome.
Sx of chronic venous insufficiency are often relieved by:
leg elevation
clenched fist held over the chest is known as
Levine’s signs of MI
S3 sound is produced when
overfilled ventricle (hight diastolic pressure) is filled during diastole
Janeway lesions
Associated with endocarditis; Painless, macular (spot) lesions on palms and soles
Symptoms of mitral valve prolapse are:
Palpitations
Chest pain
Anxiety Dizziness
Nicotinic Acid / Niacin MoA
Decrease productioin/release of VLDL
cause flushing
INR for mechanical mitral vavle should be held at
INR 2.5-3.5
warfarin/coumadin + aspirin 81 mg.
Digoxin and Dobutamine are:
Positive Inotrophes
Increase heart contractility/force of myocardial contraction
Used in Systolic HF
Preserve intracellular Ca
MoA of Paradoxical/Pathological S2 splitting
No splitting during Inspiration
Expiration produces paradoxical splitting:
Pulponic component first
Aortic compoent second
X ray presentation of thoracic AO dissection is:
widening of the aortic silhouette
Elevated JVP with giant a waves are seen in what valvula disorder
Tricuspid Valve Stenosis
HTN emergency needs to be corrected w/i:
one hour
b/p should be lowered by no more than 25%
Tx for long QT includes:
correcting electrolites
B blockers
ICD
pacers
Aorta Coartation is depicted on chest X-ray by:
Fifure 3 sign.
MoA Thiazide Diuretics is
Acts on distal convoluted tubule by inhibiting Na/Cl transporter thereby reducing reabsorption of water.
MoA of potassium sparing diuretics is:
acts on collectiong duct, inhibits Na/K exchanger
Takayasu’s Arteritis
Pulseless Disease
Seen in young asian females
Affect aortic arch and great vessels
Tx: corticosteroids
Which drug is contraindicated in pt who is under the influence of cocaine and experiences chest pain with ECG changes?
B blockers.
Electrolite that is often low in pt. with Prinzmetal angina is:
Mg
ECG findings corresponding to LVH:
R wave in V5 or V6 + S wave in V1 >35 mm
infants born to diabetic mothers often have what cardiac pathology?
Transposition of great vessels.
Prozosin
Terazosin
are examples of what drugs?
Alpha Receptor blockers
used for HTN caused by pheochromacytoma; BPH
Positive finding for myocardial ischemia during an exercise stress test is:
2 mm downslopping ST-segment depression
WPW ECG features are:
Wide QRS
PR interval is short
Wave Delta
q waves seen on ECG are often idicative of:
Old MI
HTN emergency treatments are:
Labetalol (alpha and beta blocker)
Nicardipine (CCB)
Esmolol (beta blocker)
Clevidipine (CCB)
Cushing syndrome produces secondary HTN by means of?
Petiutary tumor that
best initial choice for treating hypertension in African-American patients is:
calcium-channel blocker
thiazide-type diuretic
Virchow triad:
Associated with DVTs
- Venous injury
- Hypercoagulability
- Venous statis
Hypetrophic Cardiomyopathy causes:
diastolic disfunction
Dobutamine (positive ionotrop) is used in CHF under what circumstences?
When initial therapy (oxygen, loop diuretics, morphine) does not improve the sx.
MoA: dilate peripheral arteries and decrease afterload
a new LBBB is equivalent to:
STEMI
Boot shaped heart seen on X ray is a sign of:
Tetralogy of Fallot
Stage I HTN values are
140-159/ 90-99
Standing Valsalva will increase ___________ and ___________ in what valvular conditon?
Mid systolic click and late systolic murmur in Mitral valve prolapse
Definitation of Pramature Atrial Contraction is:
premature different p wave that comes together with normal QRS and followed by compensatory pause
S4 seen in Hypertrophic Obstrictive CM
will ____ with valsalva and ______with squatting
increase with valsalva
decrease with squatting
Lead I -
AVF +
corresponds to which axis deviation
Right Axis Deviation
seen in: RVH, Lt MI, tall think poeple (Marfan)
Tx for Pulm Edema
O2 - first step
Diuretics (Lasix/furosemide)
Morphine
Dobutamine (ionotrop - increases contractility)
Clonidine important side effect is
Rebound HTN if discountinued abruptly.
Heparin MOA:
Fast onset
Amplifies antithrombin III which inhibits factor Xa of coagulation cascade.
Heparin is monitored by aPTT
MoA of Clonidine is:
Alpha 2 agonist
Presentation of Thrombophlebitis is:
Tender cord like structure at affected vein.
Pain Erythema
Loop Diuretics are contrainidcated in pt with what drug allergy?
Sulfa
Medications that are known to prolong QT are:
Clarithromycin
Erythromycin
Chloroquine
Pentamidine
Haloperidol
Chlorpromazine
Wide S2 split is associated with
Pulmonic Stenosis
and
Pulmonic Regurgitation
what effect B blockers have on CHF?
Slow heart rate
Decrease HTN > decrease afterload
Decrease stress on the hears
Rise the EF
Reduct LV size
Fluid Retention
Ascites
Edema
Hepatic congestion
are signs of what CHF?
Right sided heart failure.
Side effects of potassium sparing diuretics are
HyperKalemia
Ototoxiicty
Gout
MI blood markers are:
Troponins I - most specific test. Elevates 3-12 hours.
Creatine kinase (CK-MB)
Lead I +
AVF -
corresponds to which axis deviation?
Left Axis Devation
seen in: LVH, HTN, HF, Obesity
What effect NSAIDs have on pt with CHF
Worsen the sx.
Mitral valve regurgitation produces what kind of murmur?
Pansystolic/holosystolic blowing murmur best heard at the apex radiating to the axilla.
Mirtal valve Prolapse and HOCM
will become louder with Valsalva
and less evident with
leg raising.
Adenosine is usually given to treat __
Supraventricular Tachycardia
Aortic valve stenosis corresponds to ___ murmur Aortic valve regurgitation correspond to ___ murmur
Crescendo-Decresendo MILD SYSTOLIC ejection
Early DIASTOLIC blowing
Normal SA rhythm on the top
A fib rhythm on the bottom
Compensatory pause on ECG is seen in
PAC
Irregularly irregular corresponds to
Atrial Fibrilation
Heparin-induced thrombocytopenia syndrome:
Plateletes become activated and stick to each other resulting in:
Thromboses
Platelete consumption leading to thrombocytopenia
Hemorrhage
Hypetrophic CM is caused by__________while hypertrophic Obstructive CM is caused by ___________
HTN > hypertrophic
Genetic predisposition > hypertrophic obstructive
RV lift
RBBB
RVH
split and fixed S2
systolic ejection murmur (2nd and 3rd interspace)
are features of:
Atrail Septal Defect
side effects of Nitrates is:
Throbbing headaches sec to arterial dialation in the head.
Treatment for aortic valve stenosis include:
- Aortic valve replacement
- Ballon valvuloplasty
- Ross procedure (aortic valve is replaced with pulmonary valve; pulmonary valve is replaced with cadaver’s valve).
Sx of PAD
Claudication
Tingling
Numbness
Ulcers
Hair loss on the affected extermity.
Week PT and DP pulses
Definition of Ejection Fraction is
Stroke Volume (volume of ejected blood) /
end diastolic volume
Mitral Valve Prolapse is associated with what type of mumur?
Late systolic murmur
Lead I +
AVF +
corresponds to which axis deviation?
No axis deviation.
Junctional Rhythm with missing P waves
Systolic B/P is determined by
Cardiac Output
Color change in digits in response to cold temp is called:
Raynaud’s dz
Location of the AO valve stenosis murmur is
Rt. sternal border (level of the 2nd intespace)
On ECG WPW syndrome can be recognized by seeing
Delta waves (slurred upstroke)
Short PR interval seen in WPW syndrome and higher contractility will have what effect on S1 sound?
S1 will be louder
Cardiogenic shock requires what tx:
Vassopressors or ionotrophic agents
Not fluid
Orthostatis hypotention without increase in heart rate is caused by:
Autonomic Insufficiency - impared sympathetic nervous system
Orthostatis hypotention with increase in heart rate is caused by:
Hypovolemia caused by either exsessive diuressis or addrenal insuffeciency.
tx for Hyperkalemia is:
nebulized albuterold
calcium gluconate
glucose solution
sodium bicarbonate
side effect of IV lidocaine?
neurological toxicity
including siuzeres
Diltiazem and verapamil are contraindicated in:
systolic heart failure
acute MI
Beta blocker is indicated for chronic or acute cardiac problems?
Chronic only
contraindicated in Acute
