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Cardiology Flashcards

0
Q

What electrolyte is used in repolarization of the heart?

A

K+

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1
Q

What causes fast conduction through the heart?

A

Na+

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2
Q

What effect does parasympathetic stimulation have on the heart?

A

Slows heart rate , slows conduction, decreases force of contraction, caused by cholinergic Ach

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3
Q

What effect does sympathetic stimulation have on the heart?

A

Norepinephrine -adrenergic causes increase rate, increase force of contraction and increase irritability of foci, constricts arteries causing increase in BP

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4
Q

Wandering pacemaker

A

P wave shape varies, atrial rate less than 100, irregular vent rhythm

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5
Q

MAT multifocal atrial tachycardia

A

P wave shape varies, rate over 100’ COPD or dig toxicity

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6
Q

A fib

A

Continuous rapid firing by many atrial foci, continuous atrial spikes, count vent rate — QRS in 6 sec strip x 10

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7
Q

Atrial escape rhythm

A

60-80, atrial foci assumes pacing

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8
Q

Junctional escape rhythm

A

40-60, usually no p wave, but may have retrograde atrial polarization causing Inverted p wave

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9
Q

Ventricular escape rhythm

A

Looks like PVC’s, 20-40, P and QRS do not match

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10
Q

Premature atrial beat

A

Irritable foci, new atrial beat resets the rhythm

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11
Q

Preventricular beat

A

Vent irritability caused by low O2, low K+

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12
Q

V tac

A

A run of three or more PVC, from epi like substances

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13
Q

Paroxysmal atrial tachycardia

A

Different p wave, rate 150-250

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14
Q

PAT with AV block

A

More the one P for every QRS, dig excess

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15
Q

Paroxysmal junction all tachycardia

A

150-250, May have inverted p waves

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16
Q

AV node reentry

A

aVNRT, vicious cycle

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17
Q

SVT

A

Any tachycardia that originates above the ventricles

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18
Q

Torsades de pointes

A

250-350, low K+, long qt syndrome, looks like a twisted ribbon

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19
Q

Atrial flutter

A

250-350, saw tooth,

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20
Q

Ventricular flutter

A

250-350, single foci

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21
Q

V fib

A

Multiple foci, bag of worms

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22
Q

A fib

A

Caused by many irritable parasystolic atrial foci

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23
Q

WPW

A

Bundle of Kent, av conduction pathway causing a reentrent SVT

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24
Q

1degree AV block

A

Retards AV node conduction, PR interval greater than .2 sec or one large square, CONSTANT every cycle

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25
Q

2 degree AV block Wenkebach

A

PR interval gets longer than drops the QRS, still PR interval great than .2 sec

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26
Q

2 degree AV block Mobit

A

AV node total block conduction, no progression just a dropped QRS, regular punctual P wave

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27
Q

3rd degree AV block

A

Total conduction block, usually normal P wave with. Junctional QRS, must have pacemaker

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28
Q

BBB

A

Block produces a delay in the depol of that vent, right chest leads V1-V2, left chest leads V5-V6’ QRS greater than .12 sec or 3 small blocks

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29
Q

How do you determine axis?

A

If QRS in lead 1 and AVF are positive = two thumbs up sign

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30
Q

If QRS in lead one is negative, what is the. Axis?

A

RAD

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31
Q

If the transitional QRS is in V1 or V2 what is the axis?

A

Right shift

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32
Q

If the transitional QRS is in lead V5 or V6, what is the axis?

A

Left shift

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33
Q

How Do you determine atrial hyper trophy in an EKG?

A

V1- dish aspic P wave = AE. The larger P wave is hypertrophied.

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34
Q

How do you determine ventricular hypertrophy in a. EKG?

A

LVH- mm of S in V1 + mm of R in V5 if greater than 35 then LVH

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35
Q

How do you determine ischemia in an EKG?

A

Diminished blood flow, inverted T waves

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36
Q

How do you determine injury in an EKG?

A

ST elevation, acute or recent injury, earliest sign of infarction

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37
Q

What does pericarditis look like on an EKG?

A

ST segment elevation, flat or concave T wave may be off baseline

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38
Q

What is a clue for subendocardial infarction on an EKG?

A

ST depression, no through entire wall thickness

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39
Q

Wat are the signs of necrosis on an EKG?

A

Q wave, significant small box wide or 1/3 the height of the QRS

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40
Q

Which leads would show a lateral infarction?

A

1 and AVL, circumflex

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41
Q

Which leads should show an anterior infarction?

A

V1-V4 from LAD

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42
Q

Which leads would show an inferior infarction?

A

2,3 and AVF, RCA or LCA

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43
Q

Which leads should show a posterior infarction?

A

V1-V2 large R wave plus ST depression

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44
Q

What does a Pulmonary embolism. Look like on EK g?

A

S1, Q3’ inverted T 3….. Large s in lead 1’ large Q in 3 and t wave inversion in 3

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45
Q

What cases the heart sounds S1?

A

Mitral and tricuspid closing

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46
Q

What causes the heart sound S2?

A

Atrial and pulmonic valve closing

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47
Q

Where is each sound heard the best: mitral, tricuspid, pulmonic, aortic?

A

Apex, left lower sternal border, left upper sternal border, right upper sternal border

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48
Q

What can cause widened splitting of S2?

A

RBBB pulmonic valve stenosis

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49
Q

Fixed splitting of S2 is caused by?

A

Atrial septal defect

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50
Q

Paradoxical splitting of the S2 is caused by?

A

LBBB

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51
Q

After S1, the opening of the aortic or pulmonic valves for stenosis is called an?

A

Ejection click

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52
Q

What are the systolic murmurs?

A

Aortic stenosis, pulmonic stenosis, mitral regurgitation and tricuspid regurgitation, VSD, MVP

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53
Q

What murmur begins after S1, May have an ejection click, high frequency, best heard in the RUSB, and radiates to the neck?

A

Aortic stenosis

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54
Q

What murmur begins after S1, May have a click, and is loudest at the left upper sternal border?

A

Pulmonic stenosis

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55
Q

What holosystolic murmur is heard best at the apex, blows, radiates to the axilla and does not change with respiration?

A

Mitral valve regurgitation

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56
Q

What murmur is holosystolic, heard at the left lower sternal border, radiates to the right of the sternum, is blowing and increases with inspiration?

A

Tricuspid regurgitation

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57
Q

What murmur is holosystolic, high pitched, may have a thrill and does NOT change with inspiration or radiate?

A

VSD….. Louder = smaller

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58
Q

Describe the murmur of MVP.

A

Midsystolic click, late systolic murmur heard best at the apex.

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59
Q

List the diastolic murmurs.

A

Mitral valve stenosis, tricuspid stenosis, aortic regurgitation,pulmonic regurgitation,

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60
Q

What is a blowing murmur in early diastole strongest along the left sternal border heard best siting leaning forward and exhaling.

A

Aortic valve regurgitation

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61
Q

What is an early diastolic murmur heard best in the left upper sternal border?

A

Pulmonic regurgitation

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62
Q

This murmur begins after S2, loudest at first, low pitched, heard at apex and in the left lateral decubidis position.

A

Mitral valve stenosis

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63
Q

This murmur is in early diastole, heard best at lower sternum near xiphoid process?

A

Tricuspid regurgitation

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64
Q

This is the only continuous murmur?

A

PDA

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65
Q

How does digoxin therapy look on EKG?

A

ST scooped depression, mild PR prolongation

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66
Q

How does hyper kalmia look on EKG?

A

Peaked T wave

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67
Q

How does severe hyperkalemia look on EKG?

A

Flattened P wave, wide QRS

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68
Q

How does hypojalemia look on EKG?

A

ST depression, flattened T, prominent U

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69
Q

How does hypercalcemia reflect on the EKG?

A

Shortened QT interval

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70
Q

How does hypocalcemia look on the EKG?

A

Prolonged QT interval

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71
Q

Quinidine

A

Use for a fib with WPW. Give with BB.

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72
Q

Quinidine toxicity?

A

Diarrhea, cinchonism, vasodilation, TdP

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73
Q

Procanamide

A

a fib with WPW

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74
Q

Lidocaine cardio use

A

Use for PVC

2nd choice after amiodarone for V tachs

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75
Q

Dilantin

A

Use for arrthymia due to DIG toxins, causes hyperplasia of the gums

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76
Q

Describe what beta blockers do.

A

Use for SVT and PSVT
Useful in suppressing tackyarrhythmias induced by excessive catecholamines (exercise or emotional stress)
Slow vent rage in a fib or a flutter
May terminate Re entrant SVT. Do not prolong QT

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77
Q

Amioderone uses.

A

Grand daddy! Decrease SA node firing rate, suppress automaticity, interrupt reentrant circuits, preserves CO,
USE: reentrant tachycardia, a fib, a flutter, SVT with bypass tracts
Tachycardia, fibrillation, more effective than lidocaine

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78
Q

Amiodarone toxicity.

A

Pulmonary toxicity, TdP, hyper/hypo thyroid

Must monitor with EKG, CXR, thyroid, PFT, LFT

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79
Q

Verapamil

A

CCB. DO NOT USE in: wide complex tachycardia, A fib with WPW, SSS, AV block w/o a pacemaker.

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80
Q

Medications used in PSVT treatment.

A

Adenosine 6 mg
Adenosine 12mg
Verapamil
Digoxin

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81
Q

Pacemaker indications.

A

Symptomatic AV node block, mob it’s and type 3.
Long QT syndrome. Recurrent VT. SVT.
Cardiomyopathy. Cardiac arrest. Syncope. NSVT w prior MI

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82
Q

How do you treat a bradyarrhythmias?

A

Increase HR by anti cholinergic drugs (atropine), B receptor agonists (isoproterenol) or a pacemaker

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83
Q

What is the number one cause of dilated cardio myopathy?

A

Idiopathic with coxsackie virus mist common viral

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84
Q

Causes of dilated cardiomyopathy?

A

Idiopathic, HTN, doxorubicin, beri beri, coxsackie virus

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85
Q

Clinical presentation of dilated cardiomyopathy?

A

Exertional intolerance, atypical cp, dyspnea, orhtopnea, edema, crackles on pulm exam

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86
Q

What does the echo show in dilated cardiomyopathy?

A

Dilated thin left vent with low EF

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87
Q

What cardiomyopathy is the MC cause of heart transplant?

A

Dilated

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88
Q

What is an inherited disorder AND a common cause of sudden cardiac death in young athletes?

A

Hypertrophic cardiomyopathy.

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89
Q

What happens in the heart during hypertrophic cardiomyopathy?

A

Hypertrophy leads to left vent outflow obstruction and impaired filling which leads to pulmonary congestion

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90
Q

What does the echo show in HOCM?

A

Septal wall thickness increased and EF of 80-90 %

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91
Q

How to treat hypertrophic cardiomyopathy?

A

No sports, beta blocker to decrease heart rate and improve filling time
CCB to improve ventricle compliance

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92
Q

If you hear an S3 think?

A

CHF

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93
Q

If you hear an S4 think?

A

MI

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94
Q

What causes restrictive cardiomyopathy?

A

An infiltration process like amyloidosis or sarcoidosis . Damage to muscle wall leads to diastolic noncompliance with elevated filling pressure leading to pulmonary congestion

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95
Q

Clinical presentation and dx of restrictive cardiomyopathy?

A

Exertion intolerance, fluid retention, right heart failure with JVD, s3,s4,
Diagnose with echo showing decreased EF 25-50% and normal LV thickness

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96
Q

Treatment for restrictive cardiomyopathy?

A

Diuretics, ACEI, BB or transplant

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97
Q

What is the number one cause of CHF?

A

Ischemic heart disease

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98
Q

What is ventricle volume before contraction?

A

Preload

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99
Q

What is the pressure then ventricle pushing against called?

A

Afterload

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100
Q

Clinical presentation and PE of a patient with CHF?

A

Dyspnea, orthopnea, PND, fatigue, edema, exercise intolerance
JVD, rales, edema, asities

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101
Q

What are the signs of right sided heart failure?

A

Systemic issues like JVD, asities

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102
Q

What are the signs of left sided heart failure?

A

Think pulmonary like orthopnea, dyspnea, rales, PND

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103
Q

What are signs of CHF on X-ray?

A

Cardiomegaly, increased pulmonary vasculature, pleural effusions, kerley b lines

104
Q

What is normal EF?

A

50-70%, below 35 is failure

105
Q

Treatment for CHF?

A

Low sodium diet, loop diuretics #1, ACEI use early to decrease hypertrophy, ARB as needed,

106
Q

What Meds do you avoid in patients with CHF?

A

Steroids, NSAIDs, CCB

107
Q

Normal BP?

A

120/80

108
Q

Stage 1 BP?

A

140-159/90-99

109
Q

Goal for BP treatment? In diabetics and renal failure?

A

Less than 140/90, DM and renal less than 130/80

110
Q

Work up for BP should include?

A

Optic fundi, carotids, heart, renal mass, renal artery bruit, pulses, skin
UA, glucose, cholesterol, potassium, EKG

111
Q

What is the first line medication for HTN treatment?

A

Thiazide s

Lifestyle modifications

112
Q

When should you suspect secondary HTN?

A

Onset less than 30 or greater than 50, worsening of controlled HTN, failure to respond to treatment, hypokalemia, liable HTN, headache palpitations and sweating, renal failure after ACEI.

113
Q

Headaches, palpitations and sweating with HTN think?

A

Pheochromocytoma

114
Q

Number one treatment for HTN emergency!

A

IV nitroprusside

115
Q

Clinical dx of cardio genie shock from hypotension.

A

SBP less than 90 or a decrease from baseline from 30

116
Q

Treatment for carcinogenic shock (hypotension)?

A

Dopamine increased cardiac output and BP

Dobutamine increases cardiac output

117
Q

Definition of Orthostatic hypotension?

A

Decrease in SBP of 20 or DBP of 10 when recumbent to standing

118
Q

Etiology eps of Orthostatic hypotension?

A

Antipsychotic Meds, diuretics, alpha blockers, ACEI, ETOH, vasodilators
Parkinson’s disease
Polyneuropathies

119
Q

Modifiable risk factors for MI?

A

Dyslipidemia, smoking, HTN, activity level, obesity, DM

120
Q

Non modifiable mi risk factors.

A

Age, gender, family hx

121
Q

Describe clinical presentation of MI.

A

Pain severe and intolerable, retro sternal may radiate to shoulder or jaw, greater than 20 min, crushing constricting in nature, this is caused by ischemia not infarct

122
Q

Who may have a painless MI?

A

Elderly and women

123
Q

Describe process of creatine kinase in an MI.

A

Increases at 3-6 hrs
Normal at day 2-4
Peaks at 24 hrs
Check every 8 hrs

124
Q

Describe troponin process during MI.

A

Increases at 2/4 hrs.
Peaks at 10-24 hrs.
Persist 5/12 days

Test of choice for people who present late

125
Q

Classic patter of EKG for MI?

A

ST elevation and q waves

126
Q

ST elevation describes what type of injury pattern!

A

Transmural events

127
Q

Injury pattern showing ST depression.

A

Subendocardial ischemia

128
Q

Treatment of MI?

A

M- morphine (pain control, decrease BP)
O- o2
N- nitrates (dilate arteries, improve pre/afterload)
A-ASA
H-heparin
B-bets blockers (control BP and decrease risk of sudden death)

129
Q

Bets blockers contraindicated in whom?

A

2nd and 3rd degree heart block

130
Q

Absolute contraindications for thrombolytics?

A 
Active bleeding
Aortic dissection
Recent head trauma or neoplasm
Hx of CVA
Major surgery or trauma in last 2 wks
131
Q

Define angina.

A

Chest pain that builds rapidly in 30 sec, disappears 5-15 min, produced by activity and relieved by rest

132
Q

Patient presentation of angina?

A

Achy dull, mid sternal discomfort with radiation to left shoulder, neck or arm

133
Q

Diagnostic test for angina?

A

Positive stress test or perfusion test

134
Q

Treatment for angina?

A

Improve risk factors, manage lipids, b blockers, control sx, revascularization with PTCA or CABG

135
Q

What is unstable angina?

A

New onset angina, increasing angina, onset at rest

136
Q

Treatment for unstable angina?

A

ASA, b blocker, ACEI, revascularization

137
Q

Classic triad for acute pericarditis?

A

Chest pain, pericardial friction rub, EKG abnormalities

138
Q

Most common etiology of acute pericarditis?

A

Viral from coxsackie virus

139
Q

Patient presents with retro sternal CP with radiation to left back and trap, coughing and deep breathing increases pain, leaning forward decreases pain.

A

Acute pericarditis.

140
Q

Acute pericarditis on EKG?

A

ST elevation with upright T waves in MOST leads

141
Q

Treatment of acute pericarditis?

A

NSAIDs, steroids, symptomatic tx

142
Q

This is fluid In the pericardial sac and inability to fill chambers in diastole which leads to decreased stroke volume and decreased cardiac output

A

Cardiac tamponade

143
Q

Classic triad of cardiac tamponade?

A

JVD, muffled heart sounds, pulsus paradoxus

144
Q

Treatment of cardiac tamponade?

A

Drain fluid

145
Q

What is a pericardial effusion?

A

Prolonged or severs inflammation leading to fluid accumulation around heart

146
Q

A large pericardial effusion can turn into?

A

Cardiac tamponade.

147
Q

Treatment for pericardial effusion or cardiac tamponade?

A

Pericardialcentesis

148
Q

What is the stretch of myocardial fibers before contraction?

A

Preload, the more fibers are stretched the greater the force of the contraction

149
Q

Symptoms of left sided heart failure are?

A

Dyspnea, orthopnea, PND, fatigue, diaphoresis, rales

150
Q

Sx of right sided heart failure are?

A

Peripheral edema, JVD, RUQ pain

151
Q

What is acute pulmonary edema?

A

Severe acute form of left sided heart failure when elevated capillary pressure pushes fluid into the lungs

152
Q

Tachycardic patient with tachypnea and frothy sputum and rales think?

A

Acute pulmonary edema

153
Q

How does an ACEI work?

A

Blocks the conversion of angiotensin 1 to angiotensin 2 and therefore decreases blood pressure

154
Q

What is the most common cause of heart failure in the first week of life?

A

Hypo plastic left heart syndrome

155
Q

What is hypo plastic left heart syndrome?

A

Underdevelopment of the left side of heart and aorta. Blood from lungs uses PDA and foramen ovale to mix on right side and right vent pushes blood to body.

156
Q

What is transposition of the great vessels?

A

When the aorta comes from the right vent and the pulmonary artery for the left vent

157
Q

X-ray shows absence of pulmonary artery with narrow mediastinum and narrow heart base. What is the disease?

A

Transposition of the great vessels

158
Q

IV med for treatment of HTN emergency?

A

IV nitroprusside

159
Q

Presentation of patient with aortic stenosis?

A

Dyspnea with exertion or syncope

160
Q

Systolic ejection murmur with crescendo de crescendo and radiation to the carotids is?

A

Aortic stenosis

161
Q

Mitral stenosis is common in whom?

A

Adults that had rheumatic fever as a child

162
Q

Harsh mid diastolic murmur heard best at apex is?

A

Mitral stenosis

163
Q

When stimulated this nerve provides blockage in conduction through the AV node and puts the breaks on, can help in PSVT.

A

Vagus nerve

164
Q

Cholesterol panel abnormal… Who do you treat with Meds?

A

Patient t with 2 or more risk factors or LDL over 160.

165
Q

What causes acute rheumatic fever.

A

Inflammatory dz due to group A strep infection

166
Q

Jones criteria for RF… What are major criteria?

A

Carditis, polyarthritis, chorea (rapid purposeless movements), erythema marginatum (macules with central clearing) subcutaneous nodules

167
Q

Jones criteria minor criteria?

A

Arthralgia, fever, increased ESR, increased CRP

168
Q

What is jones criteria to diagnose acute rheumatic fever?

A

Mist have 2 major or 1 major and 2 minor for diagnosis.

169
Q

What is an aortic aneurysm?

A

Dilation of the aorta….. May pop

170
Q

Most common location for aortic aneurysm?

A

Abdominal aorta, 90% below the renal artery

171
Q

Risk factors for aortic aneurysm?

A

Smoking, HTN, age, hyperlipidemia

172
Q

Presentation of hypo gastric or lower back pain, steady gnawing with pulsatile abdominal mass?

A

Aortic aneurysm

173
Q

Screening for AAA?

A

One time ultrasound for men 65-75 who have smoked. If found screen every 4 months if less than 4cm and surgery of greater than 5 cm

174
Q

Most common location for aortic dissection?

A

Ascending aorta #1

Descending sorts distal to left subclavian artery #2

175
Q

Patient presents with severe chest pain with sudden onset, with ripping or tearing pain, difference of BP between arms and decreased loc?

A

Aortic dissection

176
Q

CXR for aortic dissection?

A

Widened mediastinum

177
Q

Gold standard test for aortic dissection?

A

MRI

178
Q

Treatment for aortic dissection?

A

Monitor BP, central line, bets blocker, morphine, surgery consult

179
Q

Arterial embolism causes?

A

A fib/flutter
Mitral stenosis
Infarct
Post one placements

180
Q

What are the 5 P’s of arterial embolism?

A 
Pain
Pallor
Pulseless
Paresthesias
Paralysis
181
Q

How do you diagnose an arterial embolism?

A

Echo or arteriogram

182
Q

Treatment of arterial embolism?

A

Heparin and embolectomy

183
Q

Chronic arterial occlusion is more commen where? What are the risk factors?

A

Lower extremities,

Atherosclerosis #1, smoking, cholesterol, DM, HTN

184
Q

PE of arterial occlusion?

A

Decreased pulse, bruits, ischemic skin changes and ulcers.

185
Q

Arterial insufficiency with foot claudication think?

A

Buergers dz

186
Q

How to diagnose arterial occlusion?

A

Ankle/brachial index
Doppler
Arteriography

187
Q

Treatment for arterial occlusion?

A

Stop smoking!

Decrease cholesterol, ASA or clopidogril, angioplasty

188
Q

What is giant cell arteritis?

A

Granulomatosis vasculitis of the temporal artery

189
Q

A patient presents with headache, jaw claudication, vision loss, fever and fatigue with a painful temporal artery. How do you diagnose and treat?

A

Artery biopsy

And corticosteroids

190
Q

Describe polyarteritis nodosa?

A

Multi system vasculitis of medium sized arteries. Patient presents with fever, malaise, wt loss, anorexia, abdominal pain. Dx by biopsy. Treat with high dose steroids or cyclophosphamide.

191
Q

Describe churg Strauss syndrome.

A

Multi system vasculitis of medium arteries. Typical presentation of asthma, eosinophilia, lung involvement. Middle aged patient with new onset asthma. Dx with biopsy. Tx with high dose steroids or cyclophosphamide.

192
Q

What is thrombophlebitis?

A

Inflammatory thrombosis involving superficial veins of LE. Vein is palpable, tender and red. Dx on clinical findings but must rule out DVT. Tx with warm compress, NSAIDs, LMWH or IV abx if drug user.

193
Q

What is a venous thrombosis?

A

Clot in deep vein of extremities.

194
Q

What is virchows triad?

A

Venous stasis
Vascular damage
Activation of coag system

195
Q

What are the risk factors for venous thrombosis?

A

Immobilization, hyper coag state, post op, trauma, BCP, cancer, obesity, pregnancy, smoking

196
Q

Sx of venous thrombosis?

A

Pain and swelling at site and distal to site

197
Q

How can you diagnose venous thrombosis?

A

Ultrasound, venogram, positive d dimer

198
Q

Who should get DVT prophylaxis?

A

All high risk.
LMWH
Stockings,
Pneumatic leg compression

199
Q

How do you treat venous thrombosis?

A

Heparin
Warfarin 3-6 months
Vena cave filter for recurrent episodes

200
Q

What is a varicose vein?

A

Swelling and pain in superficial veins of the LE from incompetence of the saphenous vein. Treat conservatively, vein striping, sclerosing agent

201
Q

What is endocarditis and what are some predisposing conditions?

A

Infection of valve leaflet

MVP, valvular dz, prosthetic valve, congenital abnormalities, IV drug user

202
Q

MC bacteria in acute endocarditis?

A

Staph aureus, fatal less than 6 wks

203
Q

MC bacteria in subacute endocarditis?

A

Strep viridans, fatal 6 wks to 1 yr

204
Q

In early onset prosthetic valve endocarditis what is the most common pathogen?

A

Less than 60 days post op-staphylococci

205
Q

Late onset prosthetic endocarditis most common pathogen?

A

Greater than 60 days - strep

206
Q

Common presentation of patient with endocarditis?

A

Fever, chills, new onset murmur, janeway lesion, Osler nodes, Roth spots, splinter hemorrhages

207
Q

What is a janeway lesion?

A

Small erythematosus lesions on palms and soles, sign of endocarditis

208
Q

What is an Osler node?

A

Small tender nodules on pulp of digits, common in endocarditis

209
Q

What is a Roth spot?

A

Lesion on retina on one with endocarditis.

210
Q

Dx tool of choice for endocarditis?

A

Transesophageal echo #1
Transthoracic echo #2

If patient has prosthetic valve MUST do TEE

211
Q

How do you treat endocarditis?

A

Abx 4-6 wks minimum

212
Q

Who should get endocarditis prophylaxis?

A

Prosthetic valve or heart transplant, hx of endocarditis, heart defect, mouth procedures, soft tissue, abdominal infections

213
Q

What medications are given for endocarditis prophylaxis?

A

Amoxicillin/ampicillin

If allergy clindamycin

214
Q

Describe aortic stenosis.

A

Due to left vent outflow obstruction, leads to increase left vent pressure and hypertrophy.

215
Q

A systolic murmur that radiates to neck and increased when leaning foreword?

A

Aortic stenosis

216
Q

A cardiac stress test is contraindicated ins patient with a symptomatic murmur of?

A

Aortic stenosis

217
Q

What is aortic insufficiency and the acute and chronic causes?

A

Due to abnormal leaflets or proximal aortic root
Acute -endocarditis or dissection
Chronic-HTN, marfans

218
Q

What has a diastolic blowing murmur on LSB? With weakens pulse pressure and hammer pulses?

A

Aortic insufficiency

219
Q

What med is give given to a patient with symptomatic bradycardia post MI?

A

Atropine 0.5mg every 5 min up to 3 mg total

220
Q

IV drug user with pleuritic chest pain, fever, Roth spots, janeway lesion and Osler nodes?

A

Endocarditis caused by staph aureus.

221
Q

Valve affected by IV drug users?

A

Tricuspid

222
Q

Oval, pale retinal lesion surrounded by hemorrhages?

A

Roth spot. Infective endocarditis

223
Q

Hemorrhagic painless macular plaques on palms and soles?

A

Janeway lesions

224
Q

Small painful modular lesions on pads of fingers?

A

Osler nodes

225
Q

Renal arteries emerge from?

A

Abdominal aorta

226
Q

Blood supply to the colon?

A

Celiac trunk

227
Q

What supplies blood to the lower extremities?

A

Common iliac artery to the internal and external iliac arteries

228
Q

Occlusion to this can cause acute bowel ischemia.

A

Inferior mesenteric artery

229
Q

No beta blockers in a patient with?

A

Peripheral vascular disease, reactive airway dz or heart block!

230
Q

Four findings in tetralogy of fallot?

A

Pulmonary stenosis, VSD, overriding aorta, RVH. Blue squatting smurf

231
Q

Best med for HTN with heart failure?

A

BB, ACEI

232
Q

Best med for HTN with post MI?

A

BB, then ACEI

233
Q

Best HTN med for diabetes?

A

ACEI, ARB

234
Q

Best HTN med for renal dz?

A

ACEI, ARB

235
Q

Best HTN med for recurrent stroke?

A

Thiazides, ACEI

236
Q

Contraindications to thiazides?

A

Gout

237
Q

Contraindications to potassium sparing diuretics?

A

Hyperkalemia

238
Q

Contraindications to ACEI/ARB?

A

Prego, renal artery stenosis, hyperkalemia

239
Q

Contraindications to nondihydropine CCB?

A

Heart block, heart failure

240
Q

Contraindications to BB?

A

Heart block, asthma, depression, cocaine abuse

241
Q

Contraindications to. Alpha blocker?

A

Orthostatic hypotension, heart failure

242
Q

Sharp chest pain, worse lying down, better sitting up

A

Pericarditis

243
Q

Systolic ejection murmur in LUS border

A

Aortic stenosis

244
Q

Troponin appearance and duration?

A

2-4 hrs, 5-10 days good for late presenters

245
Q

CK-MB appearance and duration?

A

3-6 hrs 2-4 days peaks at 24 hrs

246
Q

ST depression?

A

Subendocardial ischemia

247
Q

ST elevation?

A

Transmural ischemia

248
Q

EKG change in II, III, aVF?

A

Inferior, RCA

249
Q

EKG changes in I, aVL, V5, V6?

A

Lateral, circumflex

250
Q

EKG changes in V2-V4

A

Anterior, LCA

251
Q

EKG changes in V1-V2?

A

Posterior, RCA or circumflex

252
Q

EKG changes in V3-V6?

A

Apical,

LAD or circumflex

253
Q

EKG changes in I, aVL, V4-V6?

A

Anteriolateral, LAD or circumflex

254
Q

EKG changes in V1-V3?

A

Anterioseptal, LAD

255
Q

Pericardial friction rub?

A

Acute pericarditis

256
Q

What causes diffuse ST elevation and upright T waves on EKG?

A

Acute pericarditis

257
Q

Foot drop is from compression of what nerve?

A

Paroneal

Panre (18 decks)

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