Cardiology Flashcards
what are the indications for hemodialysis
AEIOU:
- metabolic Acidosis w/ pH 6.5 refractory to medication
- Ingestion: methanol, ethylene glycol, salicylates, lithium, valproate, carbamazepine
- Overload of volume refractory to diuretics
- Uremia causing pericarditis, encephalopathy or bleeding (platelet dysfunction)
symptoms of amyloidosis
- proteinuria/ nephrotic syndrome
- restrictive cardiomyopathy
- hepatomegaly
- peripheral/ autonomic neuropathy
- bleeding diatheses
- macroglossia
- waxy thickening and easy bruising of skin
most sensitive indicator of dehydration or orthostatic hypotension is
BUN/Cr ratio due to decreased GFR and increased urea reabsorption in volume depleted states
major side effects of amiodarone
interstitial pneumonitis,
list lifestyle interventions for hypertension in order of effectiveness
weight loss, DASH diet (high fruits/veggies, low saturated fats), exercise, low sodium (
when can clonic jerks be seen in syncope
prolonged syncope in which there is brain hypoxia (therefore clonic jerks do not necessarily mean seizure)
what does valsalva do to and what murmurs does it accentuate
valsalva decreases preload during strain (increases during release phase); accentuates HCM and MVP murmurs
what does squatting do and what murmurs does it accentuate
squatting increases preload and increases afterload to accentuate AR, MR and VSD murmurs
what does standing do to cardiac hemodynamics
decreases preload; accentuates HCM and MVP murmurs
what does handgrip do to cardiac hemodynamics
increases afterload; accentuates AR, MR and VSD murmurs
name the paroxysymal (abrupt onset and offset) supraventricular tachycardias and how would you manage them in hemodynamically stable patients
AVNRT, AVRT, atrial tachycardia, junctional tachyardia;
in hemodynamically stable patients use vagal maneuvers (carotid massage, eye pressure) or IV adenosine to slow AV conduction to unmask P waves and wave morphology as well as to resolve the tachycardia
if your patient’s EKG shows tachycardia and QRS complexes with varying amplitudes he/she will likely need what treatment
pericardiocentesis (for pericardial effusion/ tamponade)
a hemodynamically stable patient with sustained monomorphic ventricular tachycardia should be treated with…
a ventricular antiarrhythmic (i.e. amiodarone)
treatment for patient with cocaine-associated chest pain; what drug is contraindicated
treat with benzos for lowering BP and anxiety;
beta-blockers contraindicated due to unopposed alpha activitity
what symptoms do you get with cholesterol emboli
livedo reticularis, AKI, GI sx (nausea, abd pain); often seen after vascular procedures
what lab findings suggest cholesterol embolus
eosinophilia (or eosinophiluria), hypocomplementemia, elevated Cr (AKI)
in a patient on alpha1 blockers who wants to take sildenafil for ED, what precaution do you have to take
must take sildenafil and alpha1 blockers at least 4 hours apart to prevent hypotension
does glycemic control improve erectile dysfunction
no
symptoms of Adult Still’s disease
recurrent high fevers (> or =39), maculopapular rash, arthritis
symptoms of infective endocarditis
fever, Osler’s nodes (painful, purple nodules on finger and toes), glomerulonephritis, arthritis
what condition or lab abnormality is associated with breath-holding spells
iron-deficiency anemia (order a CBC and serum ferritin)
diastolic decrescendo murmur at left sternal border is
aortic insufficiency
what are all of the drugs/interventions that should be given for a STEMI
PCI within 90 minutes of arrival, oxygen, nitrates (unless RCA MI), platelet inhibitor, beta blockers (unless hypotensive/bradycardic), full-dose ASA, anticoagulation, statin as soon as possible
what causes pruritus after hot baths in patients with polycythemia vera
increased number of circulating basophils release high levels of histamine
what is the recommended screening for AAA
active or former smokers age 65-75 get a one time abdominal ultrasound
a neonate with cyanotic heart disease and left axis deviation and decreased pulmonary vascular markings on x-ray should make you think of what condition
tricuspid atresia: lack of communication between RA and RV leads to hypoplastic RV (hence left axis deviation), blood flow to the lungs is decreased resulting in underdevelopment of lung vasculature
what risk factor is associated with the highest rate of expansion and rupture of AAA
active smoking
what cardiac defects are associated with hemochromatosis
dilated or restrictive cardiomyopathy (due to iron deposition in myocardial tissue) and conduction abnormalities (due to iron deposition in conduction pathways)
explain the cause and significance of hyponatremia in CHF
hyponatremia occurs due to poor EF leading to increased ADH, renin and norepinephrine promoting water reabsorption and dilutional hyponatremia
hyponatremia is an indicator of CHF disease severity and predicts adverse outcomes
ischemia and chronic hypertension cause what kind cardiomyopathy
dilated cardiomyopathy
patients with what conditions should get prophylactic antibiotics prior to dental surgery
- prosthetic valves
- prior history of infective endocarditis
- unrepaired congenital heart disease
what two imaging modalities could you use in a patient presenting with widened mediastinum on CXR and back pain
chest CT or TEE
note: you cannot use TTE as it does not adequately visualize thoracic aorta
first line for chronic stable angina
beta blockers
then CCB’s, then long-acting nitrates (short acting for acute events)
persistent ST elevations and deep Q waves months out from an MI suggest what complication
ventricular aneurysm
what 3 drugs can you use to treat a hypertensive emergency
labetolol, nitroprusside, nicardipine
signs of constrictive pericarditis
right heart failure (JVD, ascites, hepatomegaly, peripheral edema), pericardial knock (mid diastolic sound), calcifications on heart border, Kussmal’s sign, pulsus paradoxus
a patient with Parkinson’s presents with orthostatic hypotension, impotence, and other autonomic deficits; what is the diagnosis and how do you treat?
Shy-Drager (multisystem atrophy)
fludrocortisone for intravascular expansion, salt, compression stockings, alpha adrenergic agonists
alcohol withdrawl vs. hepatic encephalopathy
both present with agitation and tremor/asterixis; for alcohol withdrawl look for other signs such as fever, tachycardia, HTN
for hepatic encephalopathy check LFT’s and BUN or other signs of decompensated liver failure
blood pressure differential between arms can be what two conditions
aortic dissection, coarctation or subclavian atherosclerosis
at what hemoglobin A1c should you consider starting insulin
Hgb A1c > 8.5%
