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PANCE/EOC > Cardiology #3 > Flashcards

Cardiology #3 Flashcards

1
Q

Mitral Valve Prolapse Murmur

A

Mid-late systolic ejection click best heard at apex.

  • Standing and Valsalva make click earlier
  • Squatting and supine make click delayed
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2
Q

Mitral Regurgitation Murmur

A

Blowing holosystolic murmur heard at apex with radiation to axilla

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3
Q

MCC of mitral regurgitation in the US

A

Mitral Valve Prolapse

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4
Q

What are some common complications of cardiac catheterization?

A
  • Hematoma/Retroperitoneal Bleeding
  • AV Fistula
  • Dissection
  • Myocardial Infarction
  • Infection
  • Allergic Reaction to Contrast Dye
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5
Q

Treatment for anterior and lateral wall MI

A
  • MONA

- Heparin, BB, Clopidogrel

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6
Q

Treatment for Inferior or Posterior Wall MI

A
  • Aspirin/Heparin, IVF, Oxygen, Clopidogrel

- Avoid Nitroglycerin and Morphine in these types

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7
Q

What is Dressler Syndrome?

A

-Post-MI Pericarditis

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8
Q

MCC of Heart Failure

A

CAD

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9
Q

Mechanism of action of Ace Inhibitors

A
  • Decreased preload, decreased afterload, decreased aldosterone production
  • Decreases ventricular remodeling
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10
Q

What do all Ace Inhibitors end with?

A
  • Pril

- Lisinopril, Captopril, Enalapril, Quinapril

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11
Q

Ace inhibitors are first-line therapy for heart failure. (Most effective singular medication for mortality benefit.) What are the common adverse effects of Ace Inhibitors?

A
  • Hyperkalemia
  • Angioedema
  • Cough

HAC

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12
Q

True or False: Ace Inhibitors are not safe in pregnancy?

A

True

They should be avoided in pregnancy, hypotension, renal insufficiency, and bilateral renal artery stenosis.

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13
Q

What medications should be used first in African Americans with hypertension?

A

-Hydralazine + Nitrates

Diuretics and CCB

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14
Q

Regarding lipid medications:

  • Best meds to lower elevated LDL levels: ______
  • Best meds to lower elevated triglycerides: _____
  • Best meds to increase HDL: ______
  • With type II DM: ______, ______
A

Statins
Fibrates
Niacin
Statins, Fibrates

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15
Q

What are five times a statin should be started?

A

1) Patients with DM between 40-75
2) People > 21 with LDL > 190
3) Any patient with any form of atherosclerotic CVD
4) Patients < 19 with familial hypercholesterolemia
5) Patients 40-75 with no CVD but 7.5% risk for stroke within 10 years

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16
Q

Mechanism of action of statins

A

-Inhibit the rate-limiting step in hepatic cholesterol synthesis via inhibition of enzyme HMG-CoA reductase

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17
Q

Adverse effects of statins

A
  • Muscle damage (myalgias, rhabdomyolysis)
  • Increased liver function tests
  • Hepatitis (MC)
  • GI symptoms
  • Diabetes mellitus
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18
Q

Side effects of Niacin

A
  • Flushing, warm sensation, pruritus (give NSAIDs or Aspirin beforehand)
  • Hyperglycemia (take with meals)
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19
Q

What are 4 cardiac conditions that are indications for endocarditis prophylaxis?

A
  • Prosthetic heart valves
  • Heart repairs using prosthetic material (not including stents)
  • Prior history of endocarditis
  • Congenital heart disease
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20
Q

What is given as prophylaxis for dental or respiratory procedures against endocarditis?

A
  • Amoxicillin 2g 30-60 min before procedure

- Clindamycin 600 mg if PCN allergy

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21
Q

What is the treatment for Dressler Syndrome?

A

Aspirin or Colchicine

22
Q

Amyl Nitrate ________ and, therefore, murmurs like AR and MR are decreased with amyl nitrate

A

Decreases afterload

23
Q

Describe the murmur for Aortic Regurgitation

A

Diastolic blowing decrescendo murmur best heard at the LUSB

24
Q

Unique symptoms/signs of widened pulse pressure in AR/AI

A
  • Water Hammer Pulse: swift upstroke and rapid fall of radial pulse accentuated with wrist elevation
  • Hill’s Sign: Popliteal artery systolic pressure > brachial artery by 60 mmHg (MOST SENSITIVE)
  • De Mussett’s Sign: Head bobbing with each heartbeat
  • Quincke’s Pulse: Visible fingernail bed pulsations with light compression of fingernail bed
25
Q

What is the definitive diagnostic for Aortic Regurgitation?

A

Cardiac catheterization

26
Q

Treatment for AR/AI

A

Medical therapy: afterload reduction (ACEi, ARB, Hydralazine)
Surgical therapy: definitive management

27
Q

MC type of Aortic Dissection

A

-Ascending = high mortality

28
Q

Risk Factors for Aortic Dissection

A
  • HYPERTENSION (MOST IMPORTANT)
  • Age > 50
  • Marfan Syndrome
  • Men
  • Pregnancy
  • Turner Syndrome
29
Q

Symptoms of Aortic Dissection

A
  • Chest Pain: sudden onset of severe, tearing, ripping chest/upper back pain radiating between scapula
  • Unequal blood pressure in both arms
  • Decreased peripheral pulses
  • New onset of aortic regurgitation
30
Q

Diagnostics for Aortic Dissection

A
  • CT angiogram and TEE (MC first-line imaging)

- CXR: widened mediastinum

31
Q

Treatment for both types of Aortic Dissection

A
  • Surgical: Proximal/Ascending

- Medical: Descending/Distal. Nonselective BB (Labetalol) with Sodium Nitroprusside if needed

32
Q

What is Leriche’s Syndrome in regards to PAD?

A

Claudication + Impotence + Decreased femoral pulses

33
Q

Treatment for PAD

A
  • Exercise (fixed distance walking)
  • Smoking cessation (greatest benefit)
  • Foot care
  • Cilostazol most effective medical therapy
  • Revascularization: Percutaneous transluminal angioplasty, bypass grafts
34
Q

With an acute arterial occlusion, this is a vascular emergency. What type of occlusion is the most common?

A

Thrombotic occlusion in superficial femoral or popliteal artery

35
Q

Symptoms of acute arterial occlusion

A
  • Paresthesias
  • Pain
  • pallor
  • Pulselessness
  • Poikilothermia
  • Paralysis
36
Q

Workup for acute arterial occlusion

A
  • Bedside arterial doppler to assess for pulses

- CT angiography (quicker)

37
Q

What is the mainstay of treatment for acute arterial occlusion?

A

Reperfusion: surgical bypass, surgical or catheter based thromboembolectomy
-Supportive: pain control, fluid resuscitation, unfractionated Heparin

38
Q

With a DVT, what are the symptoms?

A
  • Unilateral swelling and edema of lower extremity > 3 cm (most specific)
  • Calf pain and tenderness
  • Homan sign: deep calf pain with foot dorsiflexion while squeezing the calf
39
Q

First-line imaging for DVT

A

-Venous Duplex US

40
Q

However, the definitive diagnostic for DVT is

A

Contrast venography

-Invasive, difficult to perform, and rarely used though

41
Q

When can a D-dimer exclude a DVT

A

-Negative D-dimer with a low-risk for DVT can exclude DVT as the diagnosis

42
Q

Management of DVT

A
  • Anticoagulation: first line
  • IVC filter: if recurrent, stable patients whom anticoagulation is contraindicated, or right ventricular dysfunction with enlarged RV on echo
43
Q

What are the anticoagulation options for patients with a DVT

A

1) LMWH + Warfarin
2) LMWH + Dabigatran/Edoxaban
3) Monotherapy: Rivaroxaban or Apixaban

44
Q

In pregnancy, what is the preferred anticoagulation for patients with a DVT?

A

LMWH as initial and long-term therapy

45
Q

LMWH potentiates antithrombin III. Explain this.

A

Works more on factor Xa than thrombin (Factor IIa)

46
Q

Contraindications of LMWH

A
  • Renal failure

- Thrombocytopenia

47
Q

For Peripheral Venous Disease, what does the leg pain feel like?

A
  • Worse with leg dependency, standing, prolonged sitting
  • Improved with walking, elevation of leg
  • Cyanotic leg with dependency
48
Q

Where are ulcers associated with peripheral venous disease located?

A

Medial malleolus, uneven ulcer margins

49
Q

For Peripheral arterial disease, what does the leg pain feel like?

A
  • Better with leg dependency, rest
  • Worse with walking, elevation of leg, cold
  • Redness leg with dependency
  • Dependent rubor and cyanotic leg with elevation
50
Q

Where are ulcers associated with PAD located?

A

Lateral malleolus, clean margins

PANCE/EOC (63 decks)

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