Cardiology Flashcards
Murmur associated with Atrial Septal Defect
Systolic ejection murmur
Fixed split S2
2nd and 3rd intercostal space
Murmur associated with Tetrology of Fallot
Crescendo decrescendo holosystolic along left sternal border radiating to back
Murmur of patent Ductus Arteriosus
Machine like with a thrill
Murmur associated with Coarctation of the Aorta
Harsh systolic murmur heard in the back
Treatment of Patent Ductus Arteriosus in a neonate
NSAIDS, by stopping prostaglandin production(prostaglandins keep the shunt open in utero so blood can bypass the lungs)
Coarctation of the Aorta, key physical exam findings
Delayed or weak femoral pulses
Hypertension in upper extremities, hypotension in lower
Treatment of coarctation of the aorta
Pts < 50 open surgical repair
Pts > 50 stenting
Mitral valve stenosis physical exam findings
Opening snap following S2
Low pitched murmur at the apex
Rales secondary to pulmonary congestion
Tachycardia t
Diagnostic test for Mitral Valve Stenosis
ECHO with Doppler
Murmur for mitral valve regurgitation
Pansystolic blowing murmur at the apex radiates to axilla
Loud S3
Aortic stenosis murmur
Harsh crescendo decrescendo systolic murmur along right sternal border
May radiate to carotids
Orthostasis/Postural hypotension definition
Greater than 20mm Hg drop in systolic BP or greater than 10mm Hg drop in diastolic BP between supine and standing measurements
Initial treatment for essential hypertension
Thiazide diuretics ( loop diuretics should be used only in those with renal dysfunction, with close electrolyte monitoring)
What is first line therapy for HTN in those with chronic kidney disease and diabetes?
ACE inhibitors, they help preserve kidney function
ACE inhibitor mode of action
Inhibit bradykinin degradation and stimulate synthesis of vasodilating prostaglandins
Major side effect of ACE inhibitors
Cough
Hyperkalemia is another
Calcium channel blockers are a preferred treatment for HTN in what group of people?
Blacks and elderly patients
Treatment for aortic dissection
Nitroprusside and B-blocker (labetalol Or esmolol) and urgent surgery
Preferred HTN treatment in pregnancy
Hydralazine
Side effects of Beta blockers
Asthma exacerbation Bradycardia Hypoglycemia Nausea/vomiting Not to be used for cocaine induced acute coronary syndrome
Thiazides diuretics side effects
Decrease in Na INCREASE in CA Decrease in K Decrease in Mg Increase in Uric Acid(think gout) Increase in glucose (pay attention in the diabetic pt)
Losartan
Angiotensin Receptor Blocker (ARB)
Reduces vasoconstriction
Reduces aldosterone secretion
Side effects: less cough than ACEI, teratogenicity, hyperkalemia
Dressler Syndrome
1-2 weeks post MI: Pericarditis Fever Leukocytosis Pericardial Effusion Pleural Effusion
Treatment of fibromyalgia
Pregabalin (lyrica)
SSRIs, sSNRIs, TCAs
NSAIDS Do NOT help
Polymyositis treatment
High dose steroids
Methotrexate
Azathioprine
Heart failure and ACE inhibitors both cause this common side effect
Cough
What is pulses alternans?
What condition do you see it in?
Alternating strong and weak pulse force
Seen in heart failure
What is paradoxical pulse?
What conditions is it seen in?
> 10mmHg drop in systolic blood pressure during inspiration
Seen in obstructive lung disease and tamponade
What heart conditions cause a reversed split S2 (split during expiration)?
LBBB
LVH
AS
S4 is best heard in what position?
LL decubitus with the bell
It is never heard in a fib
Mitral valve prolapse causes what murmur?
Midsystolic click
Heard brst at apex and LLSB with diaphragm
Most common holosystolic murmurs?
Mitral and tricuspid regurgitation
VSD
Diastolic rumble is heard in?
Mitral stenosis
Most common continuous murmur?
Patent ductus Arteriosus
“Machinery like”
Meds indicated to prevent recurrent ventricular tachycardia
Sotalol
Amiodarone
Med used during a v tach episode to convert the rhythm
Lidocaine
Side effects of amiodarone
Sinus bradycardia
AV block
Increase in defibrillation threshold
Recommended INR before cardioversion
1.8 for three weeks
Recommended INR for patients with long standing A Fib in which cardioversion has failed?
2.0 to 3.0
What are the ECG findings associated with Wenckebach heart block?
(Type 1 second degree AV block)
Progressive lengthening of the PR interval with a dropped beat
Risk factors for metabolic syndrome include
Trig >150
BP>130/85
Fasting blood sugar>110
Abdominal girth >35 in women and >40 in men
Treatment of unstable bradycardia
Vagolytic (atropine)
Positive chronotropic (epinephrine or dopamine)
Transcutaneous pacing may be indicated
Treatment of unstable tachycardia
Synchronized cardioversion
May also need anti arrhythmic therapy: amiodarone, B Blocker, lidocaine
A regular narrow complex tachycardia is usually from AV node (such as PSVT). What is the treatment?
Adenosine via rapid IV push
Treatment of A flutter in an unstable patient
Electric cardioversion
Treatment of A flutter in a stable patient
First, anticoagulate with heparin, enoxaparin or warfarin
Next, control rate with B Blocker, metoprolol or esmolol ( or diltiazem or verapamil)
Then, cardioversion
What anti arrhythmic drug is first line for chronic A flutter?
Dofetilide
What is Brugada syndrome?
A genetic disorder causing syncope, v fib, and sudden death often during sleep.
Asian men
What are the preferred drugs for acute V tach
Amiodarone
Lidocaine
Procainamide
Treatment of torsades de pointes?
IV magnesium
Correct electrolyte abnormalities (hypomagnesemia or hypokalemia)
Withdrawal of drugs that may have caused it
Isoproterenol infusion and override pacing may then be necessary
What is first degree heart block
All atrial beats are conducted to ventricles, but PR interval is greater than .21 seconds
