Cardiology Flashcards
Tx for cardiac tamponade
Massive volume resuscitation and emergent pericardiocentesis
Should you suppress PVCs with antiarrhythmics?
No, this worsens survival.
When to treat patients with PVCs
Only if they are symptomatic, don’t treat asymptomatic PVCs, even if they are regular.
First line treatment for PVCs
Beta-blockers
Second line tx for PVCs
Amiodarone
Amiodarone?
Class III antiarrhythmic. K+ channel blocker. Lengthens QT interval. Useful for treating atrial arrhythmias mostly. Slows down sinus rhythm
Digoxin treats arrhythmias?
Yes, a.fib and a.flutter
Do PVCs affect prognosis.
They make it worse, but you don’t tx if no symptoms
Lidocaine used to tx what
Ventricular arrhythmia (V.tach) with ACS
Lidocaine poor side effect
PPx can increase risk of asystole
Does lidocaine decrease risk of v.fib?
Yes, but increases asystole risk
Radiographic imaging of Coarctation?
3 sign, proximal aortic dilation, constriction, and descending aorta dilatation
Shape of ToF heart
Boot shaped
Depressed CO + Elevated PCWP means
Left ventricular failure
Signs of AV fistula
Shunting of blood leads to increased preload and CO. Leads to widened pulse pressure, strong arterial pulses, and tachycardia.
AV fistula causes essentially
High Output Cardiac Failure
Most common EKG finding with a.flutter
2:1 heart block, less often is 3:1, 4:1, 6:1
Irregularly irregular rhythm
No discernible P waves, a. fib
Neurogenic shock causes what to happen to the MVO2?
Decreased from increased oxygen extraction by hypoperfused tissues
MVO2
Mixed venous oxygen concentration, why is it low in neurogenic shock?
Septic shock presents with
Elevated CO, low SVR, RAP, and PCWP, and frequently normal Mixed Venous Oxygen Concentration
OCPs and BP
Increase in some people, estrogen increases angiotensinogen production in liver.
Common causes of amyloidosis
Multiple myeloma, RA.
Amyloidosis signs
Proteinuria, decreased coag. factors from decreased production in liver. Restrictive cardiomyopathy with thickened ventricles and diastolic dysfunction.
Alcohol causes what CV problem
Dilated cardiomyopathy
Signs of hemochromatosis
Restrictive cardiomyopathy, pancreatic dysfunction, bronzed skin, and hepatomegaly
Sarcoid signs
Restrictive cardiomyopathy, bilar hilar adenopathy, erythema nodosum. No renal involvement typically.
Lasix effects
Diuretic and venodilation decreasing preload
Morphine CV effects
Preload reducer
Beta-blockers with Pulm. edema
Contraindicated
Digoxin and MI
Not used for acute CHF due to an MI
When to use antiarryhthmics like verapamil and amiodarone
???
Best test for AAA
Abd. u/s
Mitral valve prolapse signs
Mid-systolic click over cardiac apex and short systolic murmur if MR is present
Squatting does what to the heart
Increases preload
Squatting and MVP
Decreases the prolapse
What is mitral valve prolapse exactly?
…..
MVP signs
Atypical pain that lasts 5-10 seconds, anxiety, palps, and hyperventilation
Rheumatic heart disease sign
Mostly mitral stenosis, some mitral regurg.
Janeway lesions
Septic emboli in the fingertips
Infective endocarditis presentation
Progressive subacute fevers, chills, malaise, and dyspnea. Arthritis, fingtertip pain. Immune complex phenomena.
Post-strep glomerulonephritis signs
Sore throat/skin infection first, then edema, dark urine, and HTN. No arthritis and fingertip pain.
Most important step with cardiac arrest
Time to defibrillation
Orthostasis and prolonged recumbence
Increased risk of it
ARDS diagnostic criteria
Acute onset, bilateral patchy on CXR, PCWP<200
What is PaO2/FIO2<200
Pretty much means if your FIO2 is 100% (1) and your PaO2 isn’t >200, then it’s a sign that you aren’t oxygenating very well at all.
Nifedipine and MI
Do not use in STEMI, b/c it vasodilates and causes reflex tachycardia which can worsen ischemia
Non-dihydropyridic CCBs like diltiazem and verapamil and STEMIs
Can be used after beta-blockers, but don’t improve mortality
Difference between the CCBs
Dihydropyridine CCBs like amlodipine and difedipine have little action on the heart. Non-dihydropyridine CCBs like verapamil and diltiazem slow down cardiac conduction.
Drugs that can be used in STEMIs
Heparin, ACEIs, Beta-blockers, aspirin
Dihydropyridine CCBs and STEMIs
Such as nifedipine, worsen cardiac ischemia
Beta-blockers and STEMIs
Decrease oxygen demand of myocardium, prolong diastole (increasing coronary perfusion), reduce ventricular remodeling
Signs of Cushing’s
HTN, hyperglycemia, hypoK, proximal muscle weakness, central adiposity, thinning of skin, weight gain, psychiatric problems (sleep, depression, psychosis)
Does hypothyroidism cause hyperglycemia, hypoK and HTN
No, but can cause weight gain, fatigue, bradycardia, depression, and skin/hair changes
Adrenal medulla produces
Catecholamines: weight loss, tachycardia, HTN, diaphoresis, anxiety
Amiodarone and lungs
Don’t use in lung disease. Causes pulm. toxicity: chronic interstitial pneumonitis, organizing pneumonia, and ARDS
Things to slow down ventricular rate
Verapamil, digoxin, quinidine
Beta-blockers and lung diseases
Don’t use in obstructive like asthma or COPD, but can use for restrictive
Mitral stenosis problems
L atrial dilation, a.fib., cardiac emboli. Can cause dyspnea, cough, and hemoptysis from increased pressure in lungs
Beta-blockers and cocaine-vasoconstriction
They worsen the vasoconstriction…how???
Beta-blockers and alpha-agonists??
????
First line drugs for cocaine ischemia
Benzos, nitrates, aspirin
Exertional syncope think of
V.tach, L vent. outflow obstruction (Aortic stenosis/HOCM)
Pulsus paradoxus is
Exaggerated decrease (>10 mmHg) in systemic arterial BP with inspiration. Seen in cardiac tamponade.
Capillary pulsations are sign of
Aortic regurg.
Mitral stenosis sounds
Late diastolic murmurs and opening snap
How to get a narrow Ventricular tachycardia
???
Lidocaine used for
Vent. arrhythmias
How does digoxin help a.fib
Rate control
How to distinguish syncope from seizure
Confusion only occurs after seizures
Risk factors for dissection
Bicuspid aortic valve, coarctation of aorta, and Marfan’s syndrome
First step in treating Aortic dissection with HTN
Antihypertensive management
What murmurs decrease with greater preload?
HOCM and what else….
HOCM genetics
Aut. Dom.
Ventricular free wall rupture
Happens usually 3-7 days following an MI, leads to PEA from pericardial tamponade
Always associate the cardiac findings with the murmur you’d expect to hear
….
HOCM murmur
LLSB interestingly…
Papillary muscle rupture causes quick decompensation?
Nope
Things to hold prior to stress testing
Anti-ischemic meds, digoxin, and meds that slow the heart (beta, blockers)
When to start ACEIs
In diabetics and patients with reduced LV systolic function…
Why ACEIs in diabetics??
….
LIfestyle changes for HTN
Lose weight, reduce salt, avoid excess alcohol, stop smoking
Pleuritic chest pain in PE
From pulm. infarction irritating the pleura
What causes orthostasis in old people
Decreased baroreceptor sensitivity
Hypoglycemia and heart rate
Can cause bradycardia, I though it can also cause tachycardia??
Treating bradycardia
If symptomatic, use IV atropine, decreases vagal input
IV adenosine causes what
Temporary AV block
Amiodarone uses
Antiarrhythmic in supraventricular and ventricular tachys, don’t use in brady
Transcutaneous pacing use
Used after atropine to increase heart rate
What causes inferior wall MIs
Right coronary artery or L circumflex. Mostly R coronary (5:1)
LAD occlusion causes what
Anterior wall myocardial infarction
Acute inferior wall infarction
Right coronary, especially if there is R ventricular infarction.
Polycystic kidney disease signs
HTN, hematuria, bilateral flank masses.
Primary hyperaldosteronism lab finding
Elevated aldosterone to renin ratio
Can you palpate adrenal masses?
Almost never
Captopril renal scan
Diagnoses renal artery stenosis
Polycystic kidney disease genetics
Aut. dom.
Polycystic kidney disease association
Intracerebral aneurysms
Oslers nodes/Janeway lesions
Osler nodes are painful bumps that turn red-purple in the fingers and toes. janeway lesions are painless hemorrhages in the palms and soles.
Coronary steal
dipyridamole causes blood flow redistribution to nondiseased vessels in stress test
Phamacological stress test drugs
Adenosine, dipyridamole, or dobutamine
Positive stress test
chest pain, st depression, hypotension, or significant arrhythmias
What reduces mortality from MI
ASA, beta-blockers, and ACEI
STEMI tx
cath lab for PTCA or CABG!
CK-MB lasts for
Peaks in 24 hrs and lasts 2-3 days, good for recurrence
Troponin I lasts for
Peaks in 24 hrs and lasts 1-2 weeks, most specific
Dressler syndrome
Post-pericardiotomy pericarditis or postMI pericarditis. Treat with colchicine.
Prinzmetal (variant) angina
Happens at night, inducible by IV ergonovine, women.
When to add digoxin to HF
Class IV HF
adenosine toxicity
HA, flushing, nausea, SOB, chest pressure
Nitrate toxicity
HA, orthostasis, tolerance, syncope
Digoxin toxicity
atrial tachycardia with AV block
rate control for afib
Ca-blockers
MCC of Multifocal atrial tachycardia
End-stage COPD
Tx for torsades
IV mag sulfate
Tx for sustained Vtach
IV amiodarone
Mobitz type 2 tx
Pacemaker (can convert to third degree w/o tx)
Causes of dilated CM
MI (MCC), infx, alcohol, doxorubicin (adriamycin), etc.
HOCM genetics
Aut. Dom. few sporadic
Causes of Restrictive cardiomyopathy
CASHES: carcinoid, amyloid, sarcoid, hemochromatosis, endocardial fibroelastosis, scleroderma
Myocarditis presentation
Fever, CP, pericarditis
Myocarditis tests
Increased cardiac enzymes, incr. esr
Myocarditis etiology MCC
coxsackie B virus
Pericarditis EKG
Diffuse ST elevation + PR depression
Pericarditis tx
NSAIDs
Most common cause of pericarditis
Coxsackie B virus.
Dressler syndrome
Post-MI or pericardiotomy pericarditis, tx with NSAIDs
constrictive pericarditis pathophys
fibrous pericardial scarring leads to increased CVP leading to peripheral edma etc.
Constrictive pericarditis xray sign
Sqaure root sign
Constrictive pericarditis tx
Pericardiectomy
Pericardial effusion CXR
water bottle silhouette
Beck’s triad
Hypotension, JVD, muffled heart sounds
Cardiac tamponade presentation
pulsus paradoxus + beck’s triad
Pulsus paradoxus
A large decrement (>10 mmHg) of BP with inspiration. larger than normal.
Most common cause of mitral stenosis
Rheumatic heart dz
Etiologies of MR
ischemic heart dz, LV dilation, MVP
Aortic stenosis presentation
Parvus et tardus; traid of angina, syncope, dyspnea
presentaiton of aortic regurg
High pithced blowing diastolic murmur, wide pulse pressure, head bobbing, pulsating uvula, pistol shot over femoral arteries
Aortic regrug etiologies
bicuspid aortic valve, syphilitic aortitis, rheumatic fever
mitral valve prolapse presentation
midsystolic click, late systolic crescendo murmur, enchanced with increased SVR
Rheumatic fever presentation
FEVERSS: fever, erythema marginatum, valvular damage, inc. ESR, red-hot joints (migratory polyarthritis), subq nodules, syndenham chorea
Rheum fever dx
ASO titers
Rheum fever tx
PCN or erythromycin for strep throat. Steroids for Rhem fever
Most common mumur with Rheum fever
MR
Rheumatic heart disease murmur
Mitral stenosis, from repeated episodes of rheumatic fever
Acute infx endocarditis
S. aureus on normal valves happens rapidly
Subacute Bacterial Endocarditis cause
S. viridans for dental procedures (GU/GI procedures is enterococcus) on damaged valves
Duke’s criteria
Sustained bacteremia, endocardial involvement, fever, immune or vascular phenomena, +bcx, +echo
Colon cancer endocarditis
Strep bovis, clostridium septicum
IV drug abuse endocarditis
S. aureus on tricuspid»_space; pseudomonas, candida
Prosthetic valve infection
s. epidermidis
Cx negative endocarditis
HACEK group?
Marantic (thrombotic) endocarditis
Metastatic cancer causing clots to form on valves that can embolize, tx with heparin
Libman-Sacks endocarditis
SLE leads to wart like vegetations on both sides of mitral valve leading to mitral regurg>mitral stenosis. Dx ana, tx underlying SLE and anticoagulate
ASD presentation
Fixed split S2, low-grade diastolic murmur
VSD presentation
holosytolic murmur at mid LSB
PDA with adults with eisenmenger tx
Surgery is contraindicated
adults w/o eisenmenger tx
surgical ligation
Congenital rubella syndrome Triad
PDA + deafness + cataracts
HTN urgency BP limits
> 220/120
Tx for HTN urgency vs. emergency
Urgency: gradually lower over 24 hrs with PO meds
Emergency: lower 25% with IV nitroprusside in 1-2 hrs, then slowly afterwards
Aortic dissection presentation
Tearing CP or interscapular back pain, assymetric BP
Tx for type A and B aortic dissection
A: beta-blockers and surgery
B: beta-blockers
When to do surgery on AAA?
> 5 cm or sx (synthetic graft)
MC pts with AAA
old smoking men
how does an aortoenteric fistula present
small herald bleed followed by massive UGIB s/p aortic graft placement
Signs of Ruptured AAA
tearing abd. pain, hypotension, pulsatile mass, CUllen sign, grey-turner sign
Leriche syndrome
PVD of distal aorta above bifurcation leading to bilateral claudication, impotence, and decreased femoral pulses
when to amputate after acute arterial occlusion
> 6 hrs, most commonly in common femoral artery
Mycotic aneurysm cause
Bacterial, not fungal infex leading to arotic aneurysm, tx with IV abx and surgical excision
Luetic heart
tertiary syphilis leading to aortic aneurysm + aortic regurg + coronary artery stenosis, tx with IV PCN G and surgery
what to treat superficial venous thrombosis
aspiris + warm compresses
migratory SVT etiology
consider pancreatic cancer (trousseau phenomenon)
What is homan’s sign
DVT sign calf pain w/ dorsiflexion
Tx for PE
heparin + warfarin, tx tPa to speed up clot resolution if massive, R heart failure
PE on EKG
Sinus tach most common, sinus tachy > S1Q3T3
Phlegmasia cerulea dolens
Venous outflow obstruction causing acute onset leg edema with pain and cyanosis, tx with heparin and venous thrombectomy
Post-throbotic syndrome (chronic venous insufficiency)
DVT damages valves leading to chronic venous HTN causing severe leg edema and ulceration around ankle area
tx for cardiogenic shock
Dopamine or IABP instead of IV fluids
how to tx neurogenic shock
IV fluids + supine or Trandelenburg positioning
Cardiac metastases
More common than primary tumors (75%)
atrial myxoma presentation
pedunculated, benign mass that presents like intermittent mitral stenosis
cardiac rhabdomyoma
MC heart tumor in kids
cardiac rhabdomyoma association
tubeorus sclerosis.
RVH on EKG
right axis deviation + Lead V1 R-wave >7 mm
LVH on EKG
left axis deviation + v1/v2 and V5/V6 overlapping
How to determine axis
+ in I, and + in II: normal axis
+ in I, and - in II: LAD
- in I, and + in II: RAD
