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Cardiology Flashcards

1
Q

Treatment for symptomatic mitral regurgitation from ischemic cardiomyopathy?

A 
Decrease Preload (loop diuretics)
Decrease Afterload (ACEi &/or B-blockers)
Evalute w/ catheritization
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2
Q

Best initial test for CHF?

Most accurate test for CHF?

A

Best initial = Echo
Most accurate = MUGA

MUGA: IV injected 99mTc attaches to patient’s RBCs and retained in vascular space –> it outlines the cardiac chambers, especially LV –> image the isotope in systole and diastole to determine EF accurately w/ visualization of any LV wall abnormality

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3
Q

8 hours after having an acute MI, 50 yo man has a BP of 70/50 and pulse 45. EKG shows normal sinus rhythm. What is most appropriate intervention?

A

IV atropine

Hypotension + bradycardia = vagal response (give anti-ACh)

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4
Q

Finding on EKG in hypothermia?

Common cause of hypothermia?

A

Osborn wave = upward deflection following R wave (lead II)

Check for HYPOGLYCEMIA

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5
Q

What causes diastolic LV dysfunction?

Tx?

A

Long-standing HTN –> cause concentric hypertrophy of LV and leads to a heart that can NOT relax during diastole (filling of the heart chamber) –> this stiff ventricle from hypertrophy causes S4

  • LV volume is reduced (from hypertrophy)
  • End diastole pressure is increased (less chamber space)

*See pulmonary congestion from EXCESS PRELOAD

  • Tx:
    1) decrease HR (B-blocker or CCB) –> increases amt of time for ventricles to fill during diastole
    2) ACEi/ARB –> reduce AFTERLOAD
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6
Q

What anti-HTN also treats Raynaud phenomenon and prophylaxis against migraines?

A

CCBs

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7
Q

Anti-HTN in diabetic patients and CHF?

A

ACEi/ARBs

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8
Q

Anti-HTN in people with coronary artery disease? What condition should they be avoided in?

A

B-blockers

Avoid in ASTHMA

Can be used as migraine prophylaxis, but WORSENS Raynauds!

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9
Q

Hallmark symptom of vertebrobasilar insufficiency causing a TIA?

A

Dizziness/vertigo

Other S/S: diplopia, dysphagia, dyarthria, facial numbness/paresthesia, syncope

These TIAs much shorter than internal carotid TIAs

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10
Q

What condition is seen with shortened PR segment?

What drugs are you NEVER to give?

Med of choice for tx?

A 
WPW syndrome (pre-excitation syndrome) --> short PR segment w/ delta wave (slurred QRS)
    - Accessory connections b/w atrium and ventricle that allows electrical conduction to bypass AV node

**CCB, B-blockers, digoxin –> block conduction at AV node pathway, increasing conduction in the aberrant pathway causing SVT or VT

Tx: procainamide

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11
Q

What body changes are seen in hypokalemia?

What EKG changes are seen with hypokalemia?

A

Weakness –> starts in LE, progresses to trunk & UE

U waves
depressed ST segment
decreased T wave amplitude

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12
Q

After cardiac catheterization, how can you differentiate b/w cholesterol embolism and contrast nephropathy?

A

Cholesterol embolism = look for secondary signs of embolism

* Livedo reticularis
* Cyanosis
* Eosinophilia
* Acute Kidney Failure (high Cr)
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13
Q

Post-MI complication resulting in hypotension and bradycardia?

What artery is affected?

A

Complete (3rd degree) heart block

  • Both SA & AV nodes are infarcted = can’t maintain synchronized rhythm –> this is due to R CORONARY artery blockage
  • Atria and ventricles contract at different rates –> occasionally the atria contract against closed valves –> this back-pressure of venous blood to SVC and jugular veins causes the “canon A waves” on jugulovenous pulse
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14
Q

Anti-HTN with benign essential tremor (worse with movement)?

A

B-blocker (propranolol) - can help control the tremor

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15
Q

Best initial tx for HTN?

A

Thiazide diuretic (HCTZ)

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16
Q

Best initial test for ANY valvular heart lesion?

Most accurate test of ANY valvular heart lesion?

A

Best initial = transthoracic ECHO

Most accurate = cardiac catheterization and angiography ONLY if ECHO results are inconclusive or surgery in the works

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17
Q

S/S of R ventricle MI?

If suspected, what needs to be done to confirm? What are confirmatory findings?

What is treatment?

A

Bradycardia, hypotension, STEMI in leads II, III, avF

**Confirm with R sided EKG –> will see ST elevations in V4, V5

Tx: IV fluids (decreased RV compliance, reduced filling, and reduced R-sided stroke volume –> preload dependent) –> only give fluids if NO signs of fluid overload

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18
Q

What are the 3 different forms of amiodarone toxicity?

What are other side effects of amiodarone?

What is amiodarone used for?

A
  • 1) Organizing pneumonia
  • 2) Chronic intersitital pneumonitis (patchy, alveolar infiltrate w/ NON-productive cough)
  • 3) ARDS

*Other s/e: hypo/hyperthyroidism, liver toxicity

Amiodarone used for AFib and VT

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19
Q

Indication for CABG over angioplasty and stenting?

What is best vessel to use for CABG?

A

1) Significant stenosis of L main coronary
2) 3-vessel disease
3) 2-vessel disease in diabetic patients

Internal mammary artery

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20
Q

Patients with newly diagnosed HTN should have what further testing? Why?

A

To assess secondary causes for HTN

Urinalysis (hematuria/proteinuria)
CMP
Lipid profile
Baseline EKG

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21
Q

Treatment of SVT that is:

  • hemodynamically stable?
  • hemodynamically unstable?
A

Stable = 1) vagal maneuvers, 2) adenosine/CCB

Unstable = sedation w/ DC cardioversion

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22
Q

Most common type of cardiomyopathy?

Most common cause?

Another cause?

A

Dilated

Myocarditis

Alcohol

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23
Q

AAA size 3-4mm - what is criteria for f/u?

Greater than what size = surgery?

Major risk factor for AAA?

A

US screening every year

> 5.5cm

Smoking hx

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24
Q

EKG findings: persistent ST elevations in leads V1-V3 with RBBB appearance (“M” sign) with or without terminal S waves in lateral leads.

Also most common cause of sudden cardiac death in men from Thailand/Laos?

A

Brugada syndrome

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25
Q

Common cause of HTN in young females?

A

OCP use

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26
Q

55 yo man with dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Has a blowing diastolic murmur at the L sternal border with a mid-diastolic rumble. What is the murmur and its special name?

A

Aortic regurgitation –> Austin Flint murmur (blood flows backwards through aortic valve and hits the anterior leaflet of the mitral valve)

*If Austin-Flint is present = valve replacement

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27
Q

What is Druoziez’s sign?

A

Femoral bruit associated w/ aortic regurgitation

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28
Q

Explain why people with prior MIs have increased LVEDV and increased stroke volume?

A

Ischemic cardiomyopathy –> decreased cardiac output due to impaired myocardial contractility –> as a result:

1) SVR increases to maintain overall BP
2) Increased blood volume from activation of RAAS –> increased blood volume and preload = increased LVEDV

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29
Q

Aortic stenosis is associated with what GI pathology?

What is this syndrome called?

A

Angiodysplasia of the colon (R sided usually & bleeds)

Heyde syndrome

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30
Q

IV drug users at risk for what infection?
What murmur will they have?
What intensifies the murmur?

What is seen on imaging (cxr)?

A 
Bacterial endocarditis
Tricuspid regurge (holo systolic)
Louder with inspiration

CXR: scattered masses at lung periphery from emboli

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31
Q

Most common cause of secondary HTN in children?

What is the physical exam finding?

Finding on angiography?

A

Fibromuscular dysplasia

Hum/Bruit in the costovertebral angle due to well-developed collaterals

“String-of-beads” pattern of renal artery

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32
Q

Person with infective endocarditis suddenly develops AV block. What is most common cause of this?

A

Perivalvular abscess extending into the adjacent cardiac conduction tissues

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33
Q

What should be suggested in CHF and ECHO findings of increased ventricular wall thickness with normal LV cavity dimensions in absence of HTN?

A

Amyloidosis

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34
Q

What medications have shown to increase survival in CHF? What medication has NOT shown to increase survival but commonly given?

A

ACEi, ARBs, B-blocker, Spironolactone

Digoxin does NOT increase survival

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35
Q

What is a simple way to assess functional vs pathologic murmur in a child?

A

Positional body changes

*With decreasing the venous return (Valsalva or standing), this will REDUCE intensity of INNOCENT murmurs

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36
Q

All young patients with systemic HTN should be evaluated for what?

What is seen on ECG? CXR?

A

Coarctation of the aorta

EKG changes: LVH, T-wave changes in precordial leads
CXR: notching of 3-8th ribs from erosion of intercostal arteries (“3” sign)

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37
Q

What heart sound is commonly heard during MI?

Why?

A

Atrial gallop (S4)

*LV stiffening and dysfunction induced by myocardial ischemia

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38
Q

What are complications you must consider with large ANTERIOR lead STEMIs?

What treatments and tests are needed?

A

1) LV thrombus formation
2) Anteroapical aneurysm formation

Immediate anticoagulation
Transthroacic ECHO

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39
Q

Are CCB (dihydroperodine) used in treatment of coronary artery disease?

What are 2 common side effects?

A

NO –> can cause reflex tachycardia on the heart

Edema
Constipation

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40
Q

In a STEMI, after giving aspirin, what is next best treatment?

A

Angioplasty (greatest mortality benefit)

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41
Q

Most common cause of death first several days after STEMI?

A

Ventricular arrhythmia

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42
Q

What is the genetic characteristic of hypertrophic cardiomyopathy?

A

Autosomal dominant –> mutation in genes coding myocardial contractile proteins of cardiac sarcomeres
*Beta-myosin heavy chain gene

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43
Q

Patient has anterior wall MI. 2 yrs later, he is found dead and his heart shows dilated LV with thinning and a scar on the anterior LV. What med could have prevented this?

A

ACEi

*Prevent myocardial remodeling after an MI

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44
Q

What must you look for in association with aortic dissection? How to confirm?

A

Mediastinal widening on CXR

*Pericardial effusion –> confirm with TEE

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45
Q

What is a big risk factor for developing constrictive pericarditis?

What are the s/s?

A

Radiation therapy (esp for Hodgkin lymphoma)

R heart failure = peripheral edema, elevated JVD, enlarged liver, ascites

  • Hepatojugular reflex
  • Kussmaul sign
  • Pericardial knock
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46
Q

What 3 medication classes should be held 48 hours before cardiac stress test? Why?

A

B-blockers
CCBs
Nitrates

*All are anti-anginal and reduce extent and severity of ischemia –> you WANT to assess ischemia in stress test!

47
Q

Most common cause of mitral regurgitation in US?

What can it lead to?

A

Mitral valve prolapse –> myxomatous degeneration of mitral valve leaflets and chordae

- Early finding = mid-systolic click
- As it progresses --> murmur becomes holosystolic and click may disappear
  • It can cause LV dilation –> AFib
  • Also can cause CHF
48
Q

Treatment for premature atrial beats?

A

NONE –> just observation

49
Q

What is the treatment for WPW syndrome?

A

Procainamide

If unstable = cardioversion

50
Q

What side effects must you monitor for with statins?

A
  • Myopathy –> elevated CPK (can progress to renal compromise/failure)
  • Hepatitis –> elevated LFT’s
51
Q

56 yo male complaining of progressively worsening fatigue, difficulty concentrating, and increasingly forgetful. He also has vague RUQ pain and constipation. He has gained 6 lbs unintentionally. His skin appears dry. He has HTN, cardiomyopathy, and persistent AFib. What medication should you conducer as the culprit?

What other side effects are associated with it?

A

Amiodarone

  • *Hypothyroidism –> fatigue, memory loss, constipation, wt gain, dry skin
  • Liver toxicity –> monitor LFTs
  • Pneumonitis –> get CXR
  • Neurologic symptoms
  • Visual disturbances
52
Q

A child has cyanosis and no improvement in SpO2 after being given 100% O2. He has a continuous machine-like murmur. What is the next best step?

A

Prostaglandin E1 –> prevents closure of PDA (helps mix oxygenated blood with deoxygenated blood )

53
Q

What are signs of digoxin toxicity?

How can you get acute episodes of toxicity?

A

GI: Nausea, vomiting, diarrhea
Visual: scotoma, blurry vision, halos
Decreased appetite

*RENAL clearance –> if you use any diuretics can cause LOW potassium which will increase the effects and toxicity OR you can have acute kidney damage and will INCREASE digoxin blood levels!

54
Q

Most common EKG finding in cardiac tamponade?

A

Electrical alterans –> beat-to-beat variation of QRS axis and amplitude (from swinging of heart in pericardial cavity)

Sinus tachycardia also

55
Q

Tx in people with unstable AFib?

A

DC cardioversion

56
Q

What is a common cause of HTN in women?

A

OCP use

57
Q

Most important non-pharmacological means of lowering BP?

A

Weight loss –> DASH diet, exercise

58
Q

What heart condition is associated with carotid pulses with dual upstrokes and systolic ejection murmur along L sternal border with strong apical impulse?

A

Hypertrophic cardiomyopathy

**LV outflow obstruction is the cause

59
Q

What maneuvers will INCREASE the murmur in hypertrophic cardiomyopathy?

A

Things that DECREASE chamber size/preload = increase the outflow obstruction
**Valsalva (strain phase), abrupt standing, amyl nitrite

60
Q

What heart problems result from digoxin toxicity?

A

Atrial tachycardia w/ AV block

*Increased ectopy (atrial tachy) and increased vagal tone (hence the AV block)

61
Q

DOC for hypertrophic cardiomyopathy? Why?

What maneuvers worsen this condition?

A

B-blocker (CCB also) –> slow the heart and prolong diastolic filling = less outflow obstruction

*DECREASING preload

62
Q

In someone with acute inferior MI with new holosystolic murmur heard at the apex, what physiologic parameter will be increased?

A

Acute MR –> excessive volume leaking back into the L atrium –> during diastole, there is rapid passive filling of LV augmented by LA contraction at end diastole –> acute MR leads to excessive diastolic volume overload, which causes elevated LVEDP

63
Q

What anti-HTN has side effect of peripheral edema?

What other anti-HTN can help reduce this s/e?

A

CCB (“-dipine”) –> dilate PRE-capillary vessels (arterioles)

ACEi/ARB –> help dilate POST-capillary venules

64
Q

What is treatment of hemodynamically STABLE VT?

What is treatment of hemodynamically UNSTABLE VT?

A

Amiodarone (IV)

Cardioversion (if pulseless, severely symptomatic, or hemodynam unstable)

65
Q

What condition leads to bounding pulses?

3 most common causes of this heart abnormality (1 acquired, 2 congenital)?

A

Aortic regurgitation
Back flow into LV = increased LVEDV

1) Rheumatic heart disease (Acquired)
2) Aortic root dilation
3) Bicuspid aortic valve

66
Q

Which drug has NEVER been proven to lower mortality in CHF?

A

Digoxin

67
Q

What drugs lower mortality in CHF?

A 
ACEi/ARBs
B-blocker
Spironolactone/Epleronone
Hydralazine/nitrates
Implantable defib
68
Q

Best mgmt for regurgitate heart valves?

A

Vasodilators –> reduce afterload

ACEi/ARB, nifedipine, hydralazine

69
Q

What 2 conditions point you towards mitral stenosis?

A

Pregnancy (increased blood volume)

Immigrant (rheumatic fever)

70
Q

Mitral stenosis can result in what 2 GI side effects?

A

Dysphagia (LA presses on esophagus)

Hoarseness (LA presses on laryngeal nerve)

71
Q

LA hypertrophy on EKG?

A

Biphasic P wave in V1

72
Q

Best initial tx for either AR or AS?

A

Vasodilators (ACEi/ARB, nifedipine)

73
Q

Effect of standing or Valsalva?

Effect of handgrip?

Squatting and leg raising?

A

Decrease venous return to the heart

Increases afterload

Increases venous return to the heart

74
Q

What 2 murmurs do NOT increase with expiration?

A

HOCM

MVP

75
Q

What 4 subsets now are recommended to start statin therapy?

A

1) Significant atherosclerotic dx (ACS, MI, angina, revascularization, stroke, TIA, PAD)
2) LDL > 190
3) Age 40-75 with diabetes
4) 10yr ASCVD risk > 7.5

76
Q

How does aging affect arteries and blood pressure?

A

*Normally, the elastic properties of arteries allow them to absorb energy from systole –> they then recoil and this is what maintains diastole when the heart relaxes

As you age, the elastic properties decrease (lower compliance) and arteries can’t absorb the energy from systole –> have a higher systolic pressure (become like rigid pipes) and can’t maintain the diastolic pressures

Have wider pulse pressure

77
Q

Most sensitive cardiac marker for MI?

Most useful for assessing re-occlusion after a recent MI?

A

Troponin T (takes 10 days to return to normal)

CK-MB (1-2 days to return to normal)

78
Q

What other cardiac drug will cause digoxin toxicity if given together?

What are the acute s/s of digoxin toxicity?

A

Amiodarone

GI: anorexia, nausea, vomiting, abd pain + weakness/confusion

**If given together –> need to decrease digoxin dose by 25-50% because the amiodarone will increase digoxin levels

79
Q

In hemodynamically stable patient with SVT, what are the 2 treatments?

A

Adenosine

Vagal maneuvers

80
Q

What EKG finding in neonates is NEVER normal?

What is it an indication of?

What other signs are associated with this disease?

A

L axis deviation (the RV should be larger b/c of ductus arteriosis in utero)

Tricuspid valve atresia

  • L axis deviation on EKG
  • Decreased pulmonary markings on CXR (hypoplasia of RV and pulm outflow tract)
81
Q

What is the most likely anatomic site for the origin of atrial fibrillation?

A

Absent P waves & irregularly irregular R-R intervals

**Pulmonary veins

82
Q

Best treatment for torsades?

A

Magnesium sulfate

83
Q

Person with knife-injury can develop what abnormality?

How does this affect heart physiology?

A

Arteriovenous malformation
- Blood bypasses capillaries

Decreases systemic vascular resistance
Increases cardiac preload
Increases cardiac output

*Causes high output cardiac failure

84
Q

What is the mechanism of nitroglycerin in reducing anginal pain?

A

*Nitroglycerin –> dilation of veins (capacitance vessels)

Increased venous capacitance –> venous pooling –> big DECREASE IN PRELOAD + decrease in heart size –> O2 requirement of heart greatly decreases

85
Q

Family hx of sudden death, congenital sensorineural deafness, and QT prolongation (> 600ms) - what is this?

Tx?

A

Jervell and Lange-Nielsen syndrome (congenital long QT syndrome)

Tx: maintain normal levels of Ca, K, Mg

 * B-blockers
 * Pacemaker
86
Q

Common drug-induced causes of prolonged QT interval?

A 
Macrolides
Fluoroquinolones
Antipsychotics
TCAs
SSRIs
Opioids (methadone, oxycodone)
Aniemetics (ondansetron)
Antiarrhythmics (qunidine, procainamide, amiodarone, sotalol)
87
Q

Person with hx of MI has deep Q waves in leads I, aVL, and V2-V5 with a 4-mm ST-segment elevation, which is unchanged from readings at discharge 2 months ago. what is the following cause of this?

A

Ventricular aneurysm
*Persistent ST-segment elevation after a recent MI + deep Q waves in same leads

Usually see LV enlargement with heart failure

88
Q

Current guidelines for AAA screening?

A

Men 65-75yo with (+) smoking hx

89
Q

Most common mechanism of PSVT?

How do vagal maneuvers help break PSVT?

A

Re-entry into AV node

*Increase vagal tone –> decreases conduction through the AV node

90
Q

What signs are seen in acute limb ischemia?

Tx?

A

5 P’s: pain, pulseless, paresthesia, poikilothermia, pallor

TX: IV heparin + embolectomy

91
Q

Why is a single S2 heard in transposition of the great vessels?

A

The aorta is now anterior to the pulmonary artery

*Aorta is out of RV and pulm artery is out of LV

92
Q

Most important risk factor for strokes?

A

HTN

93
Q

Previously healthy 32 yo woman recently returned from a trip to Texas. She has been having progressive dyspnea on exertion and now has dyspnea at night. She has B/L pitting ankle edema and her liver is enlarged. She has decreased breath sounds B/L at the bases with an enlarged cardiac silhouette and B/L pleural effusions on CXR. What is the cause?

A

CHF –> likely from viral myocarditis (Coxsackie B)

94
Q

Patient comes to ER with episode of syncope. He recently got over an URI 1 week ago. Vitals are stable. Neck veins are distended and heart sounds are distant. LCAB. CXR shows b/l pleural effusions and enlarged cardiac silhouette. What EKG finding is specific for this condition?

A

**Electrical alterans –> beat-to-beat variations in QRS complexes (heart’s swinging back and forth within increased quantity of pericardial fluid)

*Prior URI is clue –> pericardial effusions are often secondary to viral pericarditis

95
Q

Treatment of choice for acute aortic dissection (Type A or B)?

A

B-blocker (labetalol)

*Lower HR + BP = minimize stress on aortic wall

96
Q

24 yo with sudden onset syncope has crescendo-drescendo murmur @ L sternal border with NO radiation to carotids. What is the cause?

A

HOCM

97
Q

What is uremic pericarditis?

What is tx?

A

Form of pericarditis seen in people with renal failure and BUN > 60.

Tx: hemodialysis

98
Q

Person has enlarged liver, prominent abdominal fluid, and dilation of jugular vein with manual compression of abdomen. There is B/L LE edema. He has barrel-shaped chest w/ B/L end-expiratory wheezes. What is the cause of his edema?

A

Cor pulmonale

*Pulmonary HTN (elevated pulm systolic pressure >25)

99
Q

Only type of restrictive cardiomyopathy that is reversible?

A

Hemochromatosis –> phlebotomy

100
Q

Differentiation b/w restrictive and hypertrophic cardiomyopathy?

A

SYMMETRIC thickening of LV = restrictive

INTERVENTRICULAR septum thickest = hypertrophic

101
Q

What can trigger vasovagal syncope?

How to test?

A

Standing
Emotional distress
Painful stimuli
Prodrome of dizziness, nausea, pallor, diaphoresis

*Upright tilt table test

102
Q

Person with IV drug history - what is most common bug and valve affected by endocarditis?

Complications?

A

S. aureus

Tricuspid valve

*Pulmonary septic emboli –> causing pulmonary infiltrates, abscesses (multiple) –> located in lung periphery

103
Q

What is the mechanism behind muscle weakness of statin drugs?

A

Decrease coenzyme Q10 synthesis –> involved in muscle cell energy production and possibly contributes to statin-induced myopathy

104
Q

Features of constrictive pericarditis?

Causes?

A
  • R heart failure (progressive peripheral edema, JVD, ascites, hepatomegaly)
  • Kussmaul respirations
  • Pericardial thickening + calcification
Causes:
   *Prior cardiac surgery
    Irradiation
    Tuberculosis
    Malignancy
    Uremia
105
Q

Cardiac complication of Marfan?

A

Acute aortic dissection –> can progress to aortic root regurgitation (early decrescendo diastolic murmur)

106
Q

What is potential complication of Lidocaine administration in person with acute coronary syndrome?

A

Asystole

107
Q

Common findings in elderly women with diabetes who are having acute MI?

A

Dyspnea
Epigastric pain
Nausea/Vomiting

108
Q

Treatment for Viridans group strep (Strep mutans)?

A

IV penicillin G OR IV ceftriaxone for 4 weeks

109
Q

What is pulsus paradoxus?

What 3 conditions is it commonly seen in?

A

When systemic arterial pressure drops MORE than 10mmHg during INSPIRATION

1) Cardiac tamponade (during inspiration, the increased preload to R heart causes IV septum to shift into the LV, reducing its LVEDV = decreased stroke volume and reduced systolic BP)
2) Severe asthma
3) COPD (more negative intrathoracic pressure causes pooling of blood in pulmonary vasculature = less return to the heart)

110
Q

Most common heart defect in Down children?

A

Complete atrioventricular septal defects

111
Q

Common cause of pericardial effusion?

Complication?

Exam findings?

A

Recent viral URI

Cardiac tamponade

Diminished heart sounds
*Difficult to palpate maximal apical impulse
Clear lung sounds
JVD
Hypotension
112
Q

This physical exam finding is indicative of R-heart failure?

A

Hepatojugular/abdominojugular reflex

*Failing RV can’t accommodate an increase in venous return –> JV distends

113
Q

How to use sildenafil with a-blockers?

A

Need 4 hour interval between phosphodiesterase (-) and a-blocker

Step 2 (19 decks)

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