Cardiology Flashcards
How do you treat VT?
Can be treated with amiadarone or lido
What is the presentation of restrictive cardiomyopathy?
Usually right heart failure – increased JVP, hepatomegaly, bilateraly ankle edema etc.
o Usually diastolic heart failure
What is the presentation of right ventricular infarct?
Clear lung fields, hypotension, JVD - Kussmaul’s sign (paradoxical rise in JVP on inspiration)
When can digoxin be used in arrhythmia?
hemodynamically stable Atrial flutter, Afib, atrial tachycardia
What is the treatment of choice for tricyclic antidepressent overdose to prevent cardiac arrest
sodium bicarbonate - activates sodium channels to alleviate QRS prolongation
What is the mechanism of dipyridamole?
coronary steal - redistribute coronary blood flow to non diseased areas to diminish perfusion to diseased segments
What are the most common causes of aortic stenosis?
senile calcific, bicuspid aortic valve, rheumatic fever
What are some of the common signs of a massive PE?
right heart strain - elevated JVP, RBBB,
A patient presents with high output heart failure (systolic murmer, flushed extremities) following traumatic injury to the thigh. this is likely due to..
AVF formation at the site of trauma - shunting blood away from extremities resulting in decreased O2 to extremities causing heart failure
What are the causes of high output heart failure?
thyrotoxicosis, Paget disease, anemia, thiamine deficiency
A patient presents with chest pain and dilated eyes. What meds should you give, what meds do you avoid?
drug induced vasospasm - give nitrates and aspirin but don’t give beta blockers
What are the signs on cardiac exam that indicate pulmonary hypertension?
widely split S2, increased intensity of pulmonic component of S2
A patient presents with signs of venous overload, sharp x and y descents on tracing, and pericardial calcifications. What is this/
constrictive pericarditis from TB
A patient has signs of megaesophoagus and cardiomegaly plus arrhythmias and tricuspid regurg. What is this and what causes it?
Chagas disease causes diastolic and systolic heart failure, caused by trypanosoma cruzi
A patient has a midsystolic click over the left apex and a short murmer that decreases with squatting. What is this?
mitral valve prolapse
What are the components of a TIMI score?
age over 65, risk factors for CAD, ST seg deviation, elevated biomarkers, ASA in last week, anginal episodes in last 24 hours,
What is endocardial fibroelastosis?
congenital abnormality characterized by diffuse fibroelastic thickening of left ventricular endocardium
A patient presents with blue toes and elevating creatinine after an acute MI/stent. This is…
cholesterol embolus
When does paradoxical or reversed splitting occur?
pts with fixed left ventricular outflow tract obstruction (aortic valve, subaortic stenosis, LBBB)
What patients are eligible for CEA?
symptomatic with 70-99% lesions, asymptomatic with 60-99% lesions
How can we use CHADS score to decide if a patient needs anticoagulation
if a CHADS-2 score is 1, anticoagulation via aspirin/oral is recommended. If 2, strongly recommended
A patient presents with a decrescendo early diastolic murmer. What is this?
aortic regurgitation
A patient presents with NSTEMI - is this patient a candidate for fibrinolytic therapy
NO!
What is the treatment for pulseless electrical activity?
vascular access, airway stabilization, administration of IV fluids, CPR
What drugs have been shown to improve mortality in patients with heart failure?
ACE-Is, spironolactone for patients in class III or IV
What group of gram negative organisms has been shown to cause endocarditis?
HACEK organisms
Haemophilus aphrophilus, Aggregatibacter actinomycetocomitans, cardiobacterium hominis, E corredens, Kingella kingae
What are the common side effects of amiodarone?
pulmonary toxicity, thyroid dysfunction, hepatotoxicity, corneal deposits, skin changes (blue-gray discoloration)
What medical therapy should be given to a patient with aortic dissection?
beta blockers
What is one of the first things that should be done in a patient with an MI who develops a cold leg and persistent ST elevation 2 days afterwards?
get ECHO to check ventricle for thrombus
What are the signs of digoxin toxicity?
anorexia, nausea, vomiting
How should PVCs post MI be treated?
observe - treating them worsens prognosis
A patient presents with dyspnea, ankle swelling, proteinuria, easy bruising. she has a pericardial effusion and echo shows heart wall thickening. this is..
amyloidosis
What are the findings on echo in patients with hemochromatosis?
dilated cardiomyopathy, impaired systolic function; associated with skin pigmentation, decreased libido, diabetes
What is a classic physical exam finding in patients presenting with MI?
new 4th heart sound
What is the best way to treat venous insufficiency?
frequent leg elevation, exercise and compression
What are the causes of pulsus paradoxus?
asthma, COPD, cardiac tamponade
What medications have been shown to prevent cardiac remodeling in CHF?
ACE inhibitors
How is hypertensive urgency differentiated from hypertensive emergency?
in hypertensive emergency, end organ damage is present
A patient from Cambodia presents with progressive exertional dyspnea, nocturnal cough and occasional hemoptysis. She also complains of irregular heart beats. This is..
mitral stenosis secondary to rheumatic fever
A patient presents with palpitations, shortness of breath and irregular heartbeat. Additionally, he has bibasilar crackles and pitting edema and a BP of 170/100. This is..
diastolic dysfunction (heart failure with preserved heart failure)
What are the findings on cardiac exam of pericardial effusion?
diffuse point of maximal impulse
A patient presents with an opening snap. This is likely…
mitral stenosis
A patient presents with fixed splitting of the second heart sound. This is associated with..
atrial septal defects
A patient presents with ST elevations in leads V1-V6 and is at severe risk of sudden death. What vessel is occluded?
LAD (affecting anterior myocardium)
A patient presents with ST elevation in leads II, III and AvF. What vessels are involved?
RCA or LCX - inferior myocardium affected
A patient presents with ST depression in V1-V3 and ST elevation in I and AvL. What vessels are involved?
posterior MI involving LCX
A patient presents with ST depression in V1-V3 and ST depression in I and AvL. What vessels are involved?
posterior MI involving RCA
A patient presents with ST elevation in I, AVL, V5 and V6. What vessels are involved?
LCX
A patient presents with ST elevation in V4-V6, hypotension and a 2:1 block. This is
RCA occlusion. RV infarction – > hypotension. RC occlusion causes AV block
A patient with WPW presents with Afib. What medications should be used to treat?
usually treat afib with medications that act at AV node, but drugs like digoxin, verapamil and adenosine will increase conduction through accessory pathway. Therefore, antiarrhytmic like procainemide should be used
A 20 year old patient presents with a mid diastolic murmer. What should you do next?
EKG - diastolic murmers are abnormal, systolic are usually benign
What are the indications for aortic valve replacement?
symptomatic
What are the side effects of thiazide therapy?
decreased tolerance to glucose
A patient presents with recurrent episodes of pounding and racing worse when lying supine and lying on the left side. What is the cause?
aortic regurgitation
What is the parvus et tardus, exertional angina, syncope and dyspnea associated with? How do you diagnose it?
aortic stenosis - diagnose with echo
A patient presents with midline chest pain, diaphoresis, nausea nad recurrent vomiting. X ray shows a widened mediastinum and moderate left sided pleural effusion with high amylase content. This is..
esophageal rupture - high amylase is due to saliva in esophagus contents
What are the 5 Hs and Ts of reversible PEA?
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypoglycemia, Hypothermia.
Toxins, Tamponade(cardiac),Tension pneumothorax, Thrombosis (coronary and pulmonary), and Trauma.
What are the side effects associated with hydralazine?
salt and fluid retention, peripheral edema, drug indiced lupus syndrome
What are the side effects associated with metoprolol?
bradyarrhythmia, bronchoconstriction, weight gain, depression
What are possible complications of first degree heart block?
higher mortality, heart failure, afib
A patient presents with increased PCWP, increased SVR and cold clammy extremities as well as hypotension. This is..
cardiogenic shock
A patient presents with electrical alternans - this is pathopneumonic for..
pericardial effusion
A patient presents with chest pain radiating to the back and a difference in BP between 2 arms. What is the next step?
TEE for aortic dissection
A patient presents with frequent PACs. What should you do?
nothing, they’re completely normal
An IV drug user presents with aortic regurg and 2:1 2nd degree AV block. This is likely due to..
perivalvular abscess
The most common location of endocarditis (and thus the most common symptom) is..
tricuspid valve - holosystolic murmer
A young patient presents with a Left lower sternal border murmer that decreases with squatting. This is __ and it is inherited in an __ pattern
HOCM, autosomal dominant
What are the common drugs that can increase warfarin’s effect?
acetominophen, antibiotics, omeprazole, thyroid hormone, SSRIs
What are the common drugs that can decrease warfarin’s effects?
Rifampin, carbamazepine, OCPs, ginseng, St. John’s Wort, leafy greens
Why do statins cause myalgias?
inhibit coenyme Q10 synthesis
A patient presents with hypotension, decreased PCWP and increased MvO2. this is..
septic shock (MvO2 high due to improper distribution of cardiac output and inability of tissues to extract O2)
A patient with allergic rhinitis presents with chest pain, is put on aspirin and beta blockers and his chest pain goes away but he presents with difficulty breathing. What happened?
beta blockers exacerbated his athsma, caused bronchoconstriction
A young patient presents with severe htn, headaches, epistaxis and LVH. Suspect.. (and check with)
coarctation of the aorta - check for brachial femoral delay
A patient prevens with symptomatic sinus bradycardia - what is the next step in management?
atropine, followed by transcutaneous pacing
A patient presents with kidney stones, hypertension and hypercalcemia. This is probably due to
primary hyperparathyroidism
