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PANCE > Cardiology > Flashcards

Cardiology Flashcards

1
Q

extra atrial contractions (p waves) that can occur at any time and any rate

A

Premature atrial contraction

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2
Q

Bizarre QRS morphology, T waves in opposite direction, followed by compensatory pause, bad if >3

A

premature ventricular contraction

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3
Q

most common sustained arrhythmias, leading cause of thrombosis

A

Atrial fibrillation

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4
Q

2 drugs you can use for chemical cardioversion for a fib

A

amiodarone, ibutalide

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5
Q

rate lower meds for a fib (3)

A

BB
CCB
digoxin

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6
Q

how do you treat hemodynamically unstable a fib/ flutter?

A

cardioversion

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7
Q

Causes of 1st degree heart block

A

Meds- digoxin, BB< CCB
ischemia/ infarction
lyme dz
calcification

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8
Q

type of heart block where PR interval lengthens then P wave occurs with dropped QRS

A

Type 1 second degree heart block

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9
Q

type of heart block that have a fixed PR interval with some dropped QRs

A

Type 2 second degree heart block

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10
Q

causes of torsades de pointes (3)

A

hypomaganesemia, hypokalemia, diarrhea

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11
Q

Tx for torsades

A

magnesium, antiarrhythmics, defibrillation

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12
Q

Common meds that cause long QT syndrome

A

amiodarone, macrolides (EAC), fluoroquinolones

haloperidol, fluoxetine, citalopram, ondansetron

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13
Q

Tx for long QT syndrome

A

BB, pacmaker, ICD

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14
Q

Class 1 antiarrhythmics (Sodium channels)

A

lidocaine

procainamide

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15
Q

Class II anitarrhythmics (beta blockers)

A

Metoprolol, atenolol, etc

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16
Q

Class III antiarrhthmics (K+ channels)

A

amiodarone, sotalol

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17
Q

Class IV antiarrhythmics (Calcium channel)

A

verapamil, diltiazem

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18
Q

what drugs does amiodarone interact with? (5)

A

simvastatin, digoxin, warfarin, sildenafil, fluoroquinolones

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19
Q

ADRs with amiodarone

A

Hypotension, thyroid issues, pulmonary fibrosis, ocular toxicity

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20
Q

3 meds that can cause secondary HTN

A

steroids
estrogen
ephedrine

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21
Q

what 2 things is the DASH diet high in?

A

potassium and calcium

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22
Q

ADR of loop/ thiazide diuretics

A

decrease potassium

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23
Q

2 ADRs of thiazide diuretics

A

increase uric acid and lipids

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24
Q

What med conserves potassium but can cause gynecomastia in men

A

spironolactone

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25
Q

4 ADRs of beta blockers

A

impotence, fatigue, bradycardia, bronchial constriction (nonselective)

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26
Q

what pregnancy category are ACEIs

A

category X

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27
Q

Does ACEIs cause hypokalemia or hyperkalemia

A

hyperkalemia

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28
Q

3 ADRs of alpha blockers

A

postural HPOTN
improves BPH and urine stream
positive effects on HDL and LDL

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29
Q

2 main causes of HTN in kids?

A

kidney diseae, coarctatin of the aorta

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30
Q

what is a severely elevated BP (>180/110) with symptoms?

A

HTN emergency

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31
Q

BP of >180/110 without symptoms

A

Hypertensive urgency

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32
Q

Tx for HTN urgency or emergency

A

nitroprusside or labetalol

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33
Q

when do coronary artery lesions need to be procedurally treated?

A

lesions >70%

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34
Q

A lesion in what coronary artery needs to be treated if >50%

A

left main

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35
Q

Treatment for stable angina

A

nitroglycerin (0.4 mg SL)

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36
Q

what drug class prolongs life in stable angina

A

beta blockers

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37
Q

CP that occurs w/o precipitating factors and can show ST segment elevation

A

Prinzmetal (variant0 angina (coronary vasospams)

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38
Q

Tx for coronary vasospasm and angina

A

nitrates, CCB

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39
Q

Good biomarker for early detection of an MI

A

myoglobin

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40
Q

best biomarker for early detection of an MI

A

troponin

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41
Q

STEMI complications

A

arrythmias, CHF, pericarditis, mitral regurg, VSD/ left ventricular aneurysm

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42
Q

ST elevation in leads V1-V2 indicate MI where?

A

septal wall

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43
Q

ST elevation in V2-V4 indicate a MI where?

A

anterior wall (LAD)

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44
Q

ST elevation in I,aVL (V5-V6) indicate MI where?

A

lateral wall (circumfelx artery)

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45
Q

ST elevation in II, III, aVF indicate an MI where?

A

inferior wall (RCA, PDA)

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46
Q

S1 is the sound of what valves closing?

A

Mitral and tricuspid

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47
Q

S2 is the sound of what valves closing

A

Aortic and pulmonic

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48
Q

What does an S3 gallop indicate?

A

CHF

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49
Q

What does an S4 gallop indicate?

A

Mitral stenosis
LVH
Acute MI

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50
Q

Where is Erb’s point?

A

Third left inetercostal space (left sternal border)

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51
Q

is mitral regurg a systolic or diastolic murmur?

A

systolic

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52
Q

In mitral regur there is ____ cardiac output and _____ volume preload

A

There is decreased cardiac output and increased volume preload

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53
Q

– “floppy” or myxomatous degeneration of mitral valve

– May develop significant mitral regurgitation

A

mitral valve prolapse

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54
Q

What will you hear with mitral valve prolapse?

A

mid-systolic click and possible late systolic murmur

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55
Q

Tx for mitral regurg

A

beta blockers or surgery

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56
Q

holosystolic murmur that radiates to axill and is frequently accompanied by a thrill

A

mitral regurgitation

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57
Q

is aortic stenosis a systolic or diastolic murmur

A

systolic

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58
Q

what causes aortic stenosis?

A

narrowign of the valvue due to dicuspid AS, senile calcific, rheumatic AS

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59
Q

3 common symptoms of aortic stenosis

A

syncope *during exercise), angina (hypertrophied left ventricle), dyspnea (from heart failure)

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60
Q

common signs of aortic stenosis (4)

A

delayed carotid upstroke
systolic ejection murmur
soft, sincle S2 (only hear P2)
S4, sustained and forcefull pmi

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61
Q

description of aortic stenosis

A

crescendo -decrescendo, possible ejection click. radiates to carotids/ neck. heard best in 2nd ICS RSB

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62
Q

What findings will be present on an EKG w/ aortic setnosis

A

LVH

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63
Q

Tx for aortic stenosis

A

diuretics, digoxin. Balloon valvuloplasy (temporary). aortic valve replacement is the gold standard

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64
Q

Aortic valve doesn’t close properly allowing blood
to flow backwards into the left ventricle causing
left ventricular dysfunction and CHF

A

aortic regurgitation

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65
Q

what are some causes of aortic regurgitation

A 
root dilattion (HTN and age)
aortic dissection
infective endocarditits
Marfan syndrome
rheumatic dz
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66
Q

is aortic regurg a systolic or diastolic murmur?

A

diastolic

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67
Q

symptoms of aortic regurg

A

left ventricular failure (dyspnea, orthopnea)
syncope
angina
pulmonary edema (if acute)

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68
Q

: high‐pitched decrescendo blowing
murmur heard along the left sternal border heart
• Radiated to apex

A

aortic regurgitation

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69
Q

: low pitched mid‐diastolic
rumble caused by reverberation of regurgitant flow
against the anterior leaflet of the mitral valve

A

Austin Flint murmur

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70
Q

What is Quincke’s sign and what is it associated with?

A

pulsation of the capillary bed in the nail, aortic regurg

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71
Q

What is Corrigan’s pulse and what is it associated with?

A

Carotid pulse w/ rapid rise and rapid fall, aortic regurg

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72
Q

What is Hill’s signa dn what is it associated with?

A

higher systolic BP in popliteal compared to brachial, aortic regurg

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73
Q

what will you see on EKG with aortic regurg

A

LVH

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74
Q

Treatment for aortic regurg

A

surgery (pain before EF <55%)

medical- diuretics, ACEI, beta blockers

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75
Q

number one cause of mitral stenosis

A

rheumatic fever

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76
Q

2 main symptoms of mitral stenosis

A

Hemoptysis and hoarsness (due to enlarged left atrium iminging on left recurrent laryngeal nerve)

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77
Q

Medical tx for mitral stenosis

A

Diuretics (main one)
digoxin
beta blocks

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78
Q

– Holosystolic murmur with R sided signs
• ↑JVP, hepatomegaly, peripheral edema
• Murmur↑ with inspiraƟon and↓with expiraƟon

A

tricuspid regurgitation

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79
Q

Scratchy, heard better with patient leaning forward

A

pericardial friction rub

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80
Q

Harsh, loudest in late systole

A

PDA

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81
Q

with HOCM (hypertrophic cardiomyopathy) when will the murmur be heard more?

A

standing (heard less when squatting since there is more blood flow)

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82
Q

When is the mitral regurg murmur heard best

A

when patient is squatting

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83
Q

What is the Jones criteria used for?

A

Rheumatic Fever

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84
Q

What are major criteria for the Jones criteria (need 2 of these)

A

carditits, polyarthritits, syndenham chorea, erythema marginatum, subuaneous nodules)

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85
Q

What the minor criteria for Jones criteria (need 2 if there is only 1 major criteria met)

A

fever, arthralgias, prolonged PR interval, increased ESR/CRP

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86
Q

Tx for rheumatic fever

A

Salicylates, corticosteroids, PCN (ro erythromycin)

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87
Q

what condition will present with splinter hemorrhages, painful violaeous raised lesions on hands and fee (Osler’s nodes), painless erythematous lesions (janeway lesions), and retinal hemorrhages (rother’s spots)

A

infective endocarditits

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88
Q

what criteria is used for endocarditits

A

Duke

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89
Q

Decrease in contractile function of either
ventricle in the absence of pressure overload,
volume overload or coronary artery disease
resulting in CHF

A

dilated cardiomyopathy

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90
Q

Tx for dilated cardiomyopathy

A

DAD (diuretics, ACEI, digoxin)

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91
Q

– Systolic ejection murmur that does not usually
radiate to the neck
• Maneuvers to increase the murmur intensity
–Standing up from a squatting position
• Maneuvers to decrease the murmur
intensity
–Squatting maneuver

A

Hypertrophic cardiomyopathy

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92
Q

Tx for hypertrohpic cardiomyopathy

A

Beta blocks
CCB (verapamil)
surgery, alcohol ablation

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93
Q

Myocardium changes and becomes stiffer
causing restriction of left ventricular filling &
reduced stroke output

A

restrictive cardiomyopathy

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94
Q

Causes of restrictive cardiomyopathy

A

infiltrative diseases (amyloidosis, hemochromatosis, carcinoid syndrom, sarcoidosis)

95
Q

Tx for restrictive cardiomyopathy

A

tx underlyign dz, diuretics and beta blockers may be helpful

96
Q

LDL goal for moderate risk factors

A

<130

97
Q

LDL goal for no risk factors

A

<160

98
Q

LDL for lots of risk factors

A

<100

99
Q

what to monitor with statins

A

LFTs and 3 montsh and 6 months then yearly then monitor CPK if myalgias

100
Q

what does niacin help increase

A

HDL

101
Q

contraindications with niacin

A

pregnancy and liver dz

102
Q

how can you minimize flushing with niacin?

A

ASA/NSAIDs and titrate slowly

103
Q

contraindications with fibrates

A

pregnancy, liver and renal disease

104
Q

what do fibrates help lower

A

triglycerides

105
Q

ADR of fibrates

A

cholelithiasis, hepatotoxicity, myositits

106
Q

C/I with bile acid binding resins

A

bowel obstruction and high triglycerides

107
Q

what nerve primarily innervates the heart?

A

Vagus

108
Q

Heart valve closure sequence

A

Mitral, tricuspid, aortic pulmonic (many things are possible)

109
Q

5 Ps of an acute arterial occlusion

A

Pain, pallor, paresthesia, pulselessness, poikliothermia (cold)

110
Q

do coronary veins have valves?

A

No

111
Q

what supplies blood to the AV node?

A

Right coronary artery (posterior descending artery)

112
Q

ADR with aldosterone antagonists?

A

hyperkalemia

113
Q

Drug class that decreases Na and Cl reabsoprtion in the ascending loop of Henle and can cause hypokalemia and hypomagnesemia.

A

loop diuretics

114
Q

does digoxin increase survival?

A

No

115
Q

occlusion of what artery will result in contralateral hemiplegia with hemisensory loss as well as homonymous hemianopia

A

middle cerebral

116
Q

most common type of shock

A

septic

117
Q

what type species most often causes septic shock

A

Gram negative

118
Q

Labs to get on everyone who is in shock

A

CBC, blood type cross-match, coagulation parameters, electrolytes, glucose, UA, serum creatinine, LDH, ECG, cardiac biomarkers

119
Q

What should urine output be?

A

0.5 ml/kg/hr or greater

120
Q

What are inotropes?

A

dobutamine, dopamine, epi

increase CO by increasing HR and contractiligy

121
Q

What are pressors?

A

dopamine, phenylephrine - increase vascular tone

122
Q

Greater than 20 mm Hg drop in systolic BP or a drop greater than 10 mm Hg in diastolic between supine and sitting and /or standing

A

postural hypotension

123
Q

most important factor for HTN

A

genetic predisposition

124
Q

Exacerbations of HTN

A

alcohol, tobacco, lack of exercise, polycythemia, use of NSAIDs, low K+ diet

125
Q

elevated BP associated w/ papilledema and either encephalopathy or nephropathy

A

malignant HTN

126
Q

EKG findings with LVH

A

deep S waves in V1 and V2 and tall R waves in V5 and V6

127
Q

drug classes shown to reduce mrotality after MI and in patients with heart failure

A

beta blockers

ACEI

128
Q

who do beta blockers tend to be more effective in?

A

Younger white patients

129
Q

What do beta blockers do?

A

Decrease heart rate and cardiac output

130
Q

drug class that can help with HTN in black and elderly patients

A

calcium channel blockers

131
Q

drug class that can be used with BPH and HTN

A

alpha blocker

132
Q

what is a renin inhibitor that can be used for HTN

A

aliskiren

133
Q

Why must you not decrease the BP too rapidly in a HTN urgency/ emergency

A

can lead to cerebral ischemia

134
Q

Drugs to give for an aortic dissection

A

nitroprusside, Beta blocker (labetalol, esmolol)

135
Q

preferred HTN agent during pregnancy

A

nitroprusside

136
Q

Oral agents for less severe HTN emergencies

A

clonidine
captopril
nifedipine

137
Q

___ sided heart failure cuases: dyspnea + cough, fatigue, paroxysmal nocturnal dyspnea, gallops, exercise intolerance

A

left

138
Q

____ sided heart failure causes: distended neck veins, heaptic congestion, decreased appetite, dependent pitting edema

A

right

139
Q

In what type of heart failure may an S4 gallop be heard?

A

diastolic heart failure

140
Q

most useful imaging study for CHF

A

echocardiography

141
Q

what lab is typically elevated with CHF?

A

BNP

142
Q

initial therapy for CHF

A

early inititaion o ACEI, beta blocker (improve ejection fraction)

143
Q

When the ejection fraction falls below 35 what is indicated?

A

IMplantable cardioverter-defibrillators (ICDs)

144
Q

what may a fundoscopic retinal exam show for a HTN patient?

A

AV nicking or “copper wire” apperance of vessels

145
Q

2 medication classes that increase BP

A

NSAIDs and OCPs

146
Q

who are thiazide diuretic C/I in?

A

gout, DM, nephrolithiasis (especially calcium based)

147
Q

with HTN emergency what may eye exam show?

A

papilledema, retinal hemorrhages, exudates

148
Q

tx for atherosclerosis

A

smoking cessation, control of HTN, DM, dyslipidemia , weight loss

149
Q

what most commonly causes ischemic heart disease?

A

insufficient oxygen supply to cardiac muscle from atherosclerotic narrowing

150
Q

criteria for metabolic syndrome

A 
Three or more of:
Abdominal obesity
triglycerides >150
HDL 110 
HTN
151
Q

what is the most common presentation of unstable angina?

A

rest angina

152
Q

when is unstable angina suspected?

A

pain is less responsive to NTG, lasts longer, occurs at rest or with less exertion than previous angina

153
Q

what is considered to be a positive stress test

A

ST segment depression of 1 mm

154
Q

what test is the definitive diagnosis of ischemic heart disease

A

coronary angiography

155
Q

ADRs of nitrates

A

HA, anusea, light-headedness, HYPOTN

156
Q

first line therapy for chronic angina, this drug class prolongs life

A

beta blockers

157
Q

when are CCB used w/ unstable angina?

A

beta blockers are C/I or have been maximized

158
Q

what is included in acute coronary syndrome?

A

UA, NSTEMI, STEMI

159
Q

what do patients with an MI die of?

A

V-fib

160
Q

who are more likely to present atypically with a MI?

A

women, patients with DM, elderly

161
Q

Syndrome that develops 1-2 weeks post MI that includes pericarditits, fever, leukocytosis, pericardial or pleural effusion

A

Dressler syndrome

162
Q

Patients with ST segment depression are usually considered to have what?

A

UA or NSTEMI

163
Q

What does a patient with transiet ST segment changes of >0.5 mm that develop during symptomatic episode and resolve suggest?

A

acute ischemia and CAD

164
Q

A new left bundle branch block on ECG is highly suspicious for what?

A

new MI

165
Q

STEMI tx

A

Aspiring + clopidogrel
coronary angiography + PCI w/i 90 minutes
thrombolytic therapy w/i first 3 hours

166
Q

what is the most common congenital structural malformation?

A

congenital heart anomalies

167
Q

4 things in tetraology of fallot

A

VSD, aorta over VSD, pulmonary stenosis, right ventricular hypertrophy

168
Q

most common type of ASD

A

ostium secundum

169
Q

what condition is AV septal defect common in?

A

downs syndrome

170
Q

most common valvular disease in the US

A

aortic stenosis

171
Q

common features of valvular heart disease

A

dyspnea, fatigue, decreased exercise tolerance

172
Q

how are carotid pulses with aortic stenosis?

A

thready

173
Q

how are carotid pulses with aortic insufficiency

A

bounded pulses, widdened pulse pressure

174
Q

congenital heart defect- murmur is srescendo-decrescendo holosystolic at LSB that radiates to back. Infant has cyanosis, clubbing, loud S2

A

tetralogy of fallot

175
Q

congenital heart condition- systolic ejection murmur at 2nd LICS. wide, fixed S2

A

ASD

176
Q

continuous (machinery) murmur , wide pulse pressure, hyperdynamic apical pulse

A

PDA

177
Q

systolic, LUSB and left interscapular area, may be continuous. Infants can present with CHF, older children w/ systolic HTN Or murmur. different BPs in upper and lower extremitites

A

coarctation of the aorta

178
Q

Murmur heard in 2nd RICS, radiates to neck and LSB. Often loud with a thrill.

A

aortic stenosis

179
Q

murmur heard in 2-4 LICS, radiates to apex and RSB. high pitch, blowing

A

aortic regurgitation

180
Q

Murmur heard at apex, low pitch. Heard best with patient in left lateral position, full exhalation. Midiastolic

A

mitral stenosis

181
Q

murmur heard at apex. radiates to left axilla. pansystolic.

A

mitral regurgitation

182
Q

murmur heard at LLSB, holosystolic. radiates to right sternum and xiploid. medium blowing. increases w/ inspiration

A

tricuspid regurg

183
Q

murmur heard at LICS, mid-systolic. crescendo-decrescendo. Radiates to left shoulder and neck.

A

pulmonary stenosis

184
Q

what will happen to INR if someone on warfarin is given amiodarone

A

INR increases

185
Q

does blood from the pericardial sac clot or not clot when put in a tray?

A

not clot

186
Q

tx for thrombophlebitits

A

LMWH for 1 month

187
Q

how does restrictive cardiomyopathy occur?

A

deposition into or near myocardial cells

188
Q

non-cardiac hypoxia (pneumoia, COPD) commonly causes what arrhythmia?

A

a-fib

189
Q

what 2 murmurs are associated with a-fib

A

mitral stenosis, mitral regurgitation

190
Q

what drug can produce blue vision?

A

sildenafil

191
Q

best medication for BP support in cardiogenic shock

A

dobutamine

192
Q

vitamin deficiency that causes igh output cardiac failure

A

thiamine (beri beri)

193
Q

roth spots (retinal hemorrhages) in a drug user are most likely caused by what organism?

A

staph aureus

194
Q

Tx for mitral valve prolapse

A

reassurance and beta blockers

195
Q

austin flint murmur (low pitched rumbling murmur heart best at apex) is associated with which murmur

A

aortic regurgitation

196
Q

pathognomonic finding for rheumatic fever

A

aschoff bodies (subcutaneous nodules)

197
Q

Major Jones criteria (rheumatic fever) 5

A 
Carditits 
migratory polyarthritits
subq nodules
erythema marginatum
chorea
198
Q

what cardiac abnormality is associated with bicuspid aortic valvue

A

coarctation of the aorta

199
Q

an ABI less that what indiates PAD?

A

ABI

200
Q

HTN agent associated with edema in lower extremitites

A

CCB

201
Q

size an aortic aneurysm can get before surgery si needed

A

5.5 cm

202
Q

becks traid (pericardial tamponade)

A

distant heart sounds, JVD and hypotension

203
Q

what cardiac enzyme peaks first?

A

CKMB

204
Q

stroke + fever=

A

endocarditits

205
Q

preferred medication for endocarditits prophylaxis

A

ampicillin

206
Q

what BP med causes blood levels of lithium to increase?

A

HCTZ

207
Q

AV narrowing and venous nicking are associated with what condition

A

HTN

208
Q

cotton wool patches and neovascularization is associated with what condition

A

DM

209
Q

most common EKG changes with hypothyroidism

A

low voltage and sinus bradycardia

210
Q

MOA of thrombolytic medication

A

activates plasminogen to plasmin. the plasmin disolves the fibrin in a thrombus

211
Q

tx for viral pericarditits

A

NSAIDS

212
Q

what is the initial symptom of diastolic heart failure?

A

dyspnea

213
Q

diastolic heart failure is associated with what?

A

is a stiff, non-compliant left ventricle

214
Q

a diastolic rumbling murmur heard best at the left lower sternal margin and the xiphoid. augmented during inspiration

A

tricuspid setnosis

215
Q

a low pitched, blowing decrescendo diastolic murmur, heard best at the left intercostal space along the left sternal border

A

aortic regurgitation

216
Q

what produces permanent fibrosis in small veins and relieves all symptoms of vericose veins

A

compression sclerotherapy

217
Q

2 antibiotic classes to be avoided in individuals with long QT syndrome

A

macrolides and fluoroquinolones

218
Q

drug with alpha and beta blocking action that is good to rapidly lower BP

A

labetalol

219
Q

symptoms of aotic stenosis

A

Syncope, angina, dyspnea

220
Q

loud crescendo-decrescendo systolic murmur, radiates to carotids.

A

aortic stenosis

221
Q

low pithced mid siastolic murmur w/ opening snap.

A

mitral stenosis

222
Q

loud holosystolic murmur radiating to the axilla

A

mitral regurgitation

223
Q

Fixed split 2nd heart sound, may ahve RBBB

A

ASD

224
Q

cause of bacterial endocarditits in non-drug useds

A

strep viridans

225
Q

criteria for endocarditits

A

Duke’s

226
Q

tx for endocarditits from strep viridans

A

PCN G or ceftriaxone

227
Q

Tx for bacterial endocarditits from staph aureus

A

nafcillin/ oxacillin (vanco if MRSA)

228
Q

4 main causes of restrictive cardiomyopathy

A

amyloidosis, hemochromatosis, sarcoidosis, carcinoid

229
Q

systolic ejection murmurs that decreases with squatting and increases with standing or dehydration

A

hypertrophic cardiomyopathy

230
Q

Bp med that can cause cyanide toxicity and high anion gap acidosis

A

nitroprusside

231
Q

Tx for WPW

A

procainamide

232
Q

Tx for Vtach (w/ and w/o pulses)

A

with pulses- synchronized cardioversion. Without pulses- unsynchonized cardioversion

233
Q

who are diuretics more potent in?

A

african americans, the elderly, and obese patients

234
Q

how does atherosclerosis develop?

A

fatty streak (accumulation of lipis and macrophages) –> subendothelial space and take up lipid (foam cells) –> fibrous cap

PANCE (14 decks)

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