Cardiology Flashcards
1
Q
… is a diastolic decrescendo murmur heard best at the LLSB
A
aortic regurgitation
2
Q
…. is a triphasic scratchy sound on cardiac auscultation
A
Pericardial friction rub
3
Q
…. murmur is a pansystolic (holosystolic) murmur obscuring S1 and S2 sounds that is heard best at the apex and radiates to the axilla
A
mitral regurgitation
4
Q
….. is a decrease of blood pressure of greater than 10 mmHg on inspiration
A
Pulsus Paradoxus
5
Q
….. murmur is a harsh crescendo-decrescendo systolic murmur best heard at 2nd right intercostal space and radiates to the carotid arteries.
A
aortic stenosis
6
Q
…… is an increase in jugulovenous pressure (JVP) on inhalation.
A
Kussmaul sign
normal decreases b/c inhalation causes blood to be pulled into heart
7
Q
…… is bounding of jugulovenous wave bouncing up to neck because atrial contraction against closed tricuspid valve
A
Cannon A waves
associated with RV infarction and third degree AV block
8
Q
…… murmur is an opening snap followed by a low-pitched diastolic rumble heard best with patient in lateral decubitus position
A
mitral stenosis
9
Q
What is periodical splitting of S2 and what does is signify?
A
P2 before A2
LBBB, HTN, aortic stenosis, LVH
(left ventricular contraction time increases)
10
Q
What results in widening of S2 splitting (A2 before P2)?
A
RBBB, pulmonary HTN, pulmonic stenosis, RVH
11
Q
What is the only cardiac abnormality that results in fixed in splitting of S2?
A
Atrial septal defect
12
Q
A pt present with substernal chest pressure/ heaviness, with normal EKG and normal CIPs most likely suffer from …
A
Unstable Angina
13
Q
A pt presenting with substernal chest pressure/heaviness, with normal EKG but elevated CIPs most likely suffers from ….
A
Non-ST elevation MI (NSTEMI)
14
Q
What are features of unstable angina and NSTEMI that suggests progression to STEMI? (5)
(need catherterization)
A
- repetitive/ prolonged pain
- elevated CIPs
- persistent EKG changes
- Hemodynamically unstable
- Sustained V-tach
- syncope
- LVEF < 40%
- prior CABG/ PCI
- diabetes
- chronic renal disase
15
Q
What is treatment for unstable angina?
A
- aspirin
- beta blocker
- heparin
- nitrates, morphine, oxygen (don’t lower mortality)
16
Q
What is treament for NSTEMI?
A
- aspirin
- beta blocker
- heparin
- nitrates, morphine, oxygen (don’t lower mortality)
- statin
17
Q
What is treatment for STEMI?
A
- tPA (w/in 30 mins)
- aspirin
- beta blockers
- nitrates, morphine, oxygen (don’t lower mortality)
- statin
18
Q
What does an S4 suggest?
A
atrial systole into stiff left ventricle
LVH
19
Q
What does an S3 suggest?
A
atrial systole into filled ventricle
CHF
20
Q
What is the best initial test for chest pain?
A
EKG
21
Q
What leads represent inferior wall MI?
A
leads II, III, and avf
right coronary artery
22
Q
What is the preferred markers for diagnosis of myocardial injury?
A
troponins (T and I)
23
Q
A pt presents with pleuritic chest pain with chest wall tenderness in which palpation of chest wall reproduces chest pain most likely suffers from …
A
Musculoskeletal chest pain
24
Q
A pt presenting with epigastric pain worse 3 hours after eating most likely suffers from …
A
peptic ulcer disease
25
What leads represent anterior wall MI?
V2-V4
| left anterior descending artery
26
What leads represent lateral wall MI?
I, aVL, V4-V6
| left anterior descending artery
27
What leads represent septal wall MI?
V1-V3
| left anterior descending
28
A pt presents with pleuritic, sharp chest pain that is worse with lying down and relieved by sitting up most likely suffers from ...
pericarditis
| diffuse ST elevations; chest pain is positional and pleuritic
29
A pt presents with sharp tearing chest pain that radiates to back between the scapula most likely suffers from ...
dissecting aortic aneursym
30
What are contraindications for tPA use in STEMI? (7)
1. recent surgery
2. bleeding
3. hypertension (>180/100)
4. suspected aortic dissection
5. hx of hemorrhagic stroke
6. head trauma
7. ischemic stroke w/in 3 months
31
A pt (young female) presents with transient chest pain with midsystolic click murmur most likely suffers from ...
Mitral Valve Prolapse
32
A pt presents with sudden onset of chest pain and SOB with tracheal deviation on CXR and decreased breath sounds most likely suffers from ...
pneumothorax
33
Which thormbolytic should not be given repeated?
streptokinase (b/c provokes allergic reaction)
34
What are modifiable risk factors of ischemic heart disease?
1. LDL
2. smoking
3. HTN
4. inactivity
5. obesity
6. diabetes
35
What is the next best step in the management of a patient with classic ischemic cardiac symptoms that are chronic with a normal EKG?
Stress test (detect ST depression > 2mm suggest inducible ischemia)
36
What are requirements of pt that are going to undergo exercise stress test?
reach 85% max heart (220-age)
37
If stress test post MI is positive, what is the next best step in management?
catherization
| if negative, treat with medical treatment
38
What treatment are patients with acute coronary sent home on?
1. aspirin
2. plavix
3. beta blocker
4. ACE inhibitors (stop at 6 weeks if EF normal)
5. statins (stop if LDL low)
6. nitrates (pain)
39
What are contraindications to exercise stress test?
1. active symptoms
2. cant exercise (then do pharmacologic stress test)
3. baseline abnormality (do nuclear stress test)
40
When should a pt have a CABG rather than angioplasty for treatment of reversible ischemia?
1. 3 vessel disease
2. left main disease
3. 2 vessel disease in diabetic
41
How do you differentiate septal wall rupture compared to mitral valve rupture prior to echo?
septal has step up increase in saturation when going from right atrium to right ventricle
42
What is the treatment for Dressler syndrome? (pericarditis post MI)
1. asprin and NSAIDs
| 2. steroids
43
A pt with chest pain at rest with ST segment elevation but the stress test and angiogram are normal most likely suffers from ...
Prinzmetal Angina
44
What is the most accurate test for Prinzmetal Angina?
ergonovine (triggers spasm) on angiogram
45
What is the most common cause of death post MI?
V-tach or V-fib
46
What is the treatment for right ventricular infarction?
fluids
47
What is treatment for Prinzmetal angina?
calcium channel blockers or nitrates
48
What percent of cardiac output is based on atrial contribution?
10-20% in normal pt
| increased if heart condition
49
A pt presents with tachypnea, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue and weakness most likely suggests ...
congestive heart failure
| pulmonary rales, peripheral edema, ascites, JVD, displaced apical impulse
50
What is class 1 heart failure?
no limitations of activity; no symptoms from ordinary activities
51
What is class 2 heart failure?
mild limitation of activity; no symptoms at rest or w/ mild exertion
52
What is class 3 heart failure?
marked limitation of activity; no symptoms at rest
53
What is class 4 heart failure?
confined to bed/chair; symptoms at rest
54
A chest x-ray showing cardiomegaly, vascular redistribution, kerley B-lines, and interstitial edema suggests...
Pulmonary edema secondary to ventricular dysfunction (CHF)
55
How is BNP used for diagnosis of cause of dyspnea?
if normal, excludes congestive heart failure
if elevated, suggests congestive heart failure
56
What is treatment of systolic CHF?
1. diuretics (furosemide)
2. beta blocker (metoprolol, carvedilol)
3. ACE inhibitors
4. spironolactone
5. Digoxin
57
What are the effects of potassium on digoxin?
hyperkalemia: deceased digoxin activity
hypokalemia: increased digoxin activity
58
What are the most common side effects of digoxin toxicity?
1. GI (most common)
2. hyperkalemia
3. gynecomastia
4. blurry vision w/ yellow halos
5. arrhythmias
59
What is used for digoxin toxicity involving CNS symptoms or arrhythmias?
stop digoxin and give digiband
60
What is treatment of diastolic heart failure?
1. correct underlying disease
2. diuretics (symptom relief)
3. beta blockers/ calcium channel blockers (slow heart to increase filling)
61
When should a patient receive an automatic implantable cardioverter/defibrillator (AICD)?
pt with dilated cardiomyopathy with ejection fraction< 35%
62
When should a patient receive a biventricular pacemaker?
pt with dilated cardiomyopathy with QRS wider than 120 ms
63
What is the most common cause of mitral stenosis?
rheumatic fever
| immigrant, pregnant pt
64
What is the treatment for mitral stenosis?
1. preload reduction (Na reduction and diuretics)
| 2. balloon valvulotomy (in pt who remains symptomatic despite medical therapy)
65
What are common complications of mitral stenosis? (4)
1. systemic embolism (due to stagnate blood in enlarged LA)
2. hoarsenss (dilated LA compressing recurrent laryngeal nerve)
3. dysphagia (dilated LA compressing esophagus)
4. a-fib
66
What happens to opening snap of mitral stenosis when the stenosis gets worse?
opening snap happens earlier
67
What are the signs of large left atrium?
1. straightening of left heart border
| 2. elevation of left mainstem bronchus
68
When should surgery be performed for mitral regurgitation?
1. symptoms persistent despite optimal meds
2. EF < 60%
3. LV ESD > 40 mm
69
What is the best inital test for valvular disease?
ECHO
70
What is the most accurate test for valvular disease?
Catheterization
71
What is the medical treatment for mitral regurgitation?
arteriolar vasodilators (ACE inhibitors, ARBs, hydralazine)
72
What are the symptoms of mitral valve prolapse? (4 P's)
1. pain
2. palpitations
3. panic attacks
4. passing out
(in young women)
73
... is a mid systolic click and late systolic murmur at apex that worsens with valsalva/ standing and improves with squatting/ leg raise
Mitral Valve Prolapse
74
What are the hemodynamic effects of valsalva and standing?
decrease return to heart
left sided murmurs: decreased
(except for MVP and HOCM which increase)
75
What is the hemodynamic effect of squatting and leg raise?
increase return to heart
left sided murmurs: increased
(except for MVP and HOCM which decreases)
76
What are the causes of aortic stenosis? (3)
1. calcification in aging
2. bicuspid aortic valve (young onset)
3. rheumatic
77
What is the treatment for aortic stenosis?
1. valve replacement
| 2. balloon valvuloplasty (if pt too ill for surgery)
78
What is the most common presentation of aortic stenosis? What is the worse presentation of aortic stenosis?
angina; CHF
79
When should a pt undergo surgery for aortic regurgitation?
1. ejection fraction < 55%
| 2. left ventricular end systolic diameter > 55mm
80
What is Duroziez sign and what is it associated with?
systolic or diastolic thrill/murmur heard over the femoral arteries; aortic regurgitation
81
What is the best medical treatment for aortic regurgitation?
vasodilators (ACE inhibitors, ARBs, nifedipine)
82
What is the medical treatment for hypertrophic obstructive cardiomyopathy?
Beta blockers
83
What is the medical treatment for mitral valve prolapse?
Beta blockers
84
What is the hemodynamic effect of handgrip on the heart?
increases afterload
regurgitations: increases murmur
stenosis: decreases murmur
85
What is the most common cause of hypertrophic cardiomyopathy?
hypertension
86
What is the hemodynamic effect of amyl nitrate on the heart?
decreases afterload
regurgitations: decreases murmur
stenosis: increases murmur
87
What are the 2 most common causes of dilated cardiomyopathy?
1. ischemic heart disease
2. alcoholics
(peripartum, doxorubicin, chagas disease)
88
What is the treatment for dilated cardiomyopathy?
1. ACE inhibitors
2. beta blockers
3. spironolactone
4. diuretics, digoxin
(like systolic HF)
89
A young pt presents with SOB and syncopal episodes while participating in athletic event most likely suffers from ...
hypertrophic obstructive cardiomyopathy (LV size smaller --> need increased fluid to prevent outflow blockages)
90
What is treatment for hypertrophic obstructive cardiomyopathy?
1. beta blockers or calcium channel blockers (increase filling)
2. septoplasty (surgery if severe)
91
What are causes of restrictive cardiomyopathy?
| systolic & diastolic
1. sarcoidosis
2. amyloidosis
3. hemochromatosis
4. cancer
5. fibrosis (scleroderma, radiation)
92
An EKG showing diffuse ST segment elevation with PR segment depression is suggestive of ...
Pericarditis
93
What are the 2 diseases that are associated with kussmaul sign?
1. restrictive cardiomyopathy
| 2. constrictive pericarditis
94
What is treatment for pericarditis?
1. NSAIDs
| 2. steroids
95
What is the treatment for pericardial effusion?
fluid aspiration
96
.... is a life threatening condition in which a pericardial effusion has developed so rapidly or become so large that it compresses heart
Cardiac tamponade
97
A pt presents with pulsus paradoxus, JVD, hypotension and decreased/ muffled heart sounds most likely suffers from ...
Cardiac tamponade
98
What is the most accurate diagnosis for cardiac tamponade?
cardiac catheterization shows equal left and right atrial pressures
99
What is the treatment for cardiac tamponade?
1. pericardiocentesis (followed by pericardial window)
| 2. subxiphoid surgical drainage
100
What can be seen on EKG in the setting of cardiac tamponade?
electrical alternans (small complexes alternating with large complexes)
101
A pt presenting with exertional dyspnea, pericardial knock, signs/ symptoms of right heart failure, kussmaul sign, distant heart sounds most likely suffers from ...
Constrictive pericarditis
102
What is the most accurate diagnostic test for constrictive pericarditis?
Chest CT/MRI show thickened/ calcified pericardium
103
What is the treatment for constrictive pericarditis?
pericardiectomy (remove pericardium)
104
What is the treatment for symptomatic sinus bradycardia?
1. atropine (acute)
| 2. pacemaker (chronic)
105
.... is constant, prolonged PR interval (>.2 sec)
First Degree AV block
| no tx
106
... is progressively prolongation of PR interval until dropped ventricular beat
Second Degree AV block type 1 (Wenckebach)
| no tx
107
.... is normal PR interval or fixed prolonged PR interval associated with dropped ventricular beat
Second Degree AV block type 2 (Mobitz)
108
What is treatment for second degree AV block type 2 (Mobitz) and why do we treat?
pacemaker; prevent progression to third degree AV block
109
.... is atrial and ventricular beating separately without correlation
Third degree AV block
110
What is treatment for symptomatic third AV block (Adams-Stoke attacks -> sudden loss of consciousness)?
1. atropine (acute)
| 2. pacemaker
111
What is the treatment for supraventricular tachycardia?
1. carotid sinus massage (increase vagal tone)
2. adenosine/ verapamil
3. synchronized external conversion (if unstable)
112
... is an EKG with 3 different P waves from beat to beat followed by normal QRS
Multifocal atrial tachycardia
113
What disease is associated with multifocal atrial tachycardia?
COPD (chronic lung disease)
114
... is characterized as saw-tooth wave on EKG in which atrial rate is 250-300 and ventricular rate is (125-150) resulting in 2:1 or 3:1 ration
Atrial flutter
115
What is the treatment for multifocal atrial tachycardia?
1. diltiazem/ verapamil
2. digoxin
(avoid beta blockers)
116
... is characterized by no P-wave and irregularly irregular ventricular contraction on EKG
atrial fibrillation
117
What is the treatment for atrial flutter?
1. beta blockers
2. calcium channel blockers
3. digoxin
118
What characterizes unstable arrhythmia?
1. confusion
2. chest pain
3. SOB
4. hypertension
(synchronized cardioversion is all but )
119
What is CHADS score and what is it used for?
```
score system to determine stroke risk in pts with a-fib and need for anticoagulation
CHF (1)
HTN (1)
Age > 75 y/o (1)
Diabetes (1)
Stroke/TIA prior (2)
if 0: no tx
if 1: aspirin or warfarin
if 2 or more: warfarin
```
120
What is treatment for a-fib?
rate control
1. beta blocker
2. calcium channel blockers
3. digoxin
(rhythm conversion:
amiodarone)
121
What should you do before synchronized cardioversion in a pt with a-fib?
anticoagulation to be sure not to dislodge clot when shocked
122
... is characterized by short PR interval and delta wave (slurred initial deflection of QRS) on EKG
Wolff Parkison White Syndrome
| aberrant electrical pathway around AV node
123
What is treatment for WPW?
1. radiofrequency catheterization ablation (long-term)
2. synchronized cardioversion (unstable)
3. procainamide (stable)
124
What is treatment for pulseless V-tach and V-fib?
asynchronized cardioversion
125
What tests should be done in pt on amiodarone?
1. PFTs
2. LFTs
3. TFTs (thyroid)
126
What are common side effects of amiodarone?
1. pulmonary fibrosis
2. blue-gray discoloration of skin
3. blurry vision with halo
4. hypothyroid
5. hepatotoxicity
