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Cardiology Flashcards

1
Q

What are the risk factors for Coronary artery disease? (8)

A
  1. diabetes mellitus
  2. hypertension
  3. tobacco use
  4. hyperlipidemia
  5. peripheral arterial disease (PAD)
  6. obesity
  7. inactivity
  8. family history (female relative
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2
Q

A pt presenting with chest pain that does not change with body position or respiration and does not have associated chest wall tenderness, it is dull exertional pain lasting 15-30 minutes located over the substernal area radiating to jaw/ left arm, most likely suffers from …

A

Coronary artery disease (Ischemic heart disease)

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3
Q

A pt presenting with chest pain with associated chest wall tenderness most likely suffers from …

A

Costochondritis

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4
Q

A pt presenting with chest pain that changes with bodily position most likely suffers from…

A

Pericarditis

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5
Q

What is the single worst/ most dangerous risk factor for Coronary artery disease?

A

Diabetes Mellitus

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6
Q

What is the next best step in management of a pt presenting with chest pain associated with epigastric pain, sore throat, bad metallic taste in mouth, and cough?

A

Start proton pump inhibitor (likely GERD)

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7
Q

What is the next best step in management of an alcoholic pt presenting with chest pain associated with nausea, vomiting and epigastric tenderness?

A

Check amylase and lipase (likely pancreatitis)

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8
Q

What is the next best step in management of a pt with chest pain, right upper quadrant tenderness and mild fever?

A

Abdominal Ultrasound (likely gallstones)

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9
Q

What are the four physical exam findings in the cardiovascular exam that could be abnormal in a pt presenting with coronary artery disease?

A
  1. S3 gallop (dilated left ventricle)
  2. S4 gallop (left ventricular hypertrophy)
  3. Jugulovenous distension
  4. Holosystolic murmur (mitral regurgitation)
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10
Q

…. is the sound of rapid ventricular filling during diastole when the left ventricle is dilated

A

S3 gallop

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11
Q

….is the sound of atrial systole into a stiff or non-compliant left ventricle heard just before S1

A

S4 gallop

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12
Q

What is the best initial step in management of a pt presenting with ischemic type chest pain?

A

treat with aspirin, nitrates, oxygen and morphine

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13
Q

What is the best initial diagnostic test for ischemic type chest pain?

A

EKG

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14
Q

What is the most accurate diagnostic test for ischemic type chest pain?

A

CK-MB or troponin

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15
Q

What is the best diagnostic test to detect reinfarction a few days after the initial coronary infarction?

A

CK-MB (because only stays elevated for 1-2 days unlike troponin which is elevated for 1-2 weeks)

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16
Q

What cardiac enzyme rises first after an coronary infarction?

A

myoglobin

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17
Q

What is the next best step in management/ most appropriate further management for a pt presenting with an episode of chest pain that occur a few days ago and has a normal EKG and cardiac enzymes?

A

Stress test (assess for ST segment depression)

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18
Q

What is the next best step in management of a pt with an abnormal stress test showing an area of reversible ischemia after an episode of chest pain?

A

Angiography

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19
Q

What is the best initial test to evaluate valve function or ventricular wall motion?

A

ECHO (echocardiography)

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20
Q

What is the most accurate diagnostic test to evaluate ejection fraction?

A

Nuclear ventriculogram

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21
Q

What is the next best step in management/ most appropriate further management step for a pt presenting with an episode of chest pain that occurred a few days ago and has a normal EKG and cardiac enzymes and cannot exercise to a target heart rate of >85% of maximum?

A

dipyridamole or adenosine thallium stress test or dobutamine ECHO
(sestamibi nuclear stress test used in obese or pts with large breast)

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22
Q

What is the next best step in management/ most appropriate further management step for a pt presenting with an episode of chest pain that occured a few days ago and has normal cardiac enzymes and EKG unreadable for ischemia (LBBB, digoxin use, paccemaker, left ventricular hypertrophy, baseline ST segment abnormalities)?

A

exercise thallium testing or stress ECHO

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23
Q

What is the mechanism of action of P2Y-12 antagonists (clopidogrel, prasugrel, ticagrelor)?

A

blocks aggregation of platelets to each other by inhibiting ADP-induced activation of P2Y-12 receptor

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24
Q

What has the single greatest efficacy in lowering mortality in ST segment elevation myocardial infarction (STEMI)?

A

Urgent/ Primary Angioplasty (add prasugrel)

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25
Q

What is are the indications for thrombolytic therapy for a pt founf to have a ST-segment elevation myocardial infarction (STEMI)?

A
  1. PCI can not be performed within 90 minutes

2. chest pain for

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26
Q

What six treatments are associated with lowering mortality in pts with acute coronary syndrome (acute chest pain)?

A
  1. aspirin
  2. thrombolytics
  3. primary angioplasty
  4. beta blockers (metoprolol)
  5. statins
  6. clopidogrel, prasugrel, ticagrelor
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27
Q

What are the indications for using clopidogrel, prasugrel and ticagrelor in an acute coronoary syndrome pt?

A
  1. aspirin allergy
  2. pt receiving angioplasty and stenting
  3. acute MI (add to aspirin)
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28
Q

What are the indications for using calcium channel blockers in an acute coronary syndrome pt?

A
  1. intolerance to beta blockers (such as has asthma)
  2. cocaine induced chest pain
  3. coronary vasospasm (Prinzmetal’s angina)
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29
Q

What are the indications for lidocaine or amiodarone in an acute coronary sydrome pt?

A

ventricular tachycardia or ventricular fibrillation

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30
Q

What is the diagnostic test and treatment for a pt with cardiogenic shock secondary to myocardial infarction?

A

ECHO or Swan-Ganz catheter; ACE inhibitor and urgent revascularization

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31
Q

What is the diagnostic test and treatment for a pt with valve rupture secondary to myocardial infarction?

A

ECHO; ACE inhibitor, nitroprusside, or intra-aortic balloon pump to bridge to surgery

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32
Q

What is the diagnostic test and treatment for a pt with septal rupture secondary to myocardial infarction?

A

ECHO or right heart catheter (showing step up in saturations from right atrium to right ventricle); ACE inhibitor, nitroprusside or urgent surgery

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33
Q

What is the diagnostic test and treatment for a pt with myocardial wall rupture secondary to myocardial infarction?

A

ECHO; pericardiocentesis or urgent cardiac repair

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34
Q

What is the diagnostic test and treatment for a pt with sinus bradycardia secondary to myocardial infarction?

A

EKG; atropine followed by pacemaker if symptoms continue

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35
Q

What is the diagnostic test and treatment for a pt with third degree heart block secondary to myocardial infarction?

A

EKG or canon “a” waves; atropine and pacemaker is symptoms continue

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36
Q

What is the diagnostic test and treatment for a pt with right ventricular infarction secondary to myocardial infarction?

A

EKG showing right ventricular leads; fluid loading

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37
Q

How long should a pt wait to have sex after a myocardial infarction?

A

2-6 weeks

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38
Q

What medications should all pts with myocardial infarction be discharged home on?

A

aspirin, clopidogrel, beta blocker, statin, ACE inhibitor

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39
Q

What are the three differences in the management of non-ST segment elevation myocardial infarction (NSTEMI) when compared to management of ST-segment elevation myocardial infarction (STEMI)?

A
  1. no thrombolytic use
  2. use Low Molecular Weight Heparin
  3. Glycoprotein IIb/ IIIa inhibitors (eptifibatide, tirofiban, abciximab) to lower mortality
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40
Q

What is the best further office-based management for a patient with chronic angina (chest pain)?

A

aspirin and metoprolol both reduce mortality

add nitrates to relieve pain then add ranolazine

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41
Q

When are ACE inhibitors/ ARBs indicated for further office based management for a pt with chronic angina (chest pain)?

A
  1. congestive heart failure
  2. systolic dysfunction
  3. low ejection fraction
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42
Q

What is the main difference between using saphenous vein grafts and internal mammary artery grafts?

A

venous grafts start to become occluded after 5 years; whereas arterial grafts are often patent at 10 years

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43
Q

What are the indications for treatment of chronic angina with CABG? (4)

A
  1. three coronary vessels with >70 % stenosis
  2. left main coronary artery stenosis > 50-70%
  3. two vessel in a diabetic
  4. two or three vessels with low ejection fraction
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44
Q

What is the next best step in management for a pt with coronary artery disease who is found to have an LDL > 100?

A

start statin

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45
Q

What is the LDL goal for a pt with diabetes?

A

LDL

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46
Q

What are the four coronary artery disease equivalents?

A
  1. diabetes mellitus
  2. peripheral artery disease
  3. aortic disease
  4. carotid disease
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47
Q

What are the side effects of statin therapy?

A
  1. liver toxicity (routinely monitor LFTs)

2. rhabdomyolysis (check CPK levels if symptoms)

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48
Q

What medication used in pts with coronary artery disease must be stopped prior to starting sildenafil for erectile dysfunction?

A

nitrates (can result in dangerous hypotension)

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49
Q

A pt presenting with shortness of breath on exertion, edema, rales, ascites, S3 gallop, orthopnea, paroxysmal noctural dyspnea and fatigue most likely suffers from ….

A

congestive heart failure (CHF)

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50
Q

What is the mainstay therapy for acute pulmonary edema (worst manifestation of CHF)?

A

oxygen, nitrates, furosemide, morphine

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51
Q

What diagnostic tests should be performed simultaneously with the initial treatment of acute pulmonary edema?

A
  1. Chest X-ray (pulmonary vascular congestion, cephalization of flow, effusion, cardiomegaly)
  2. EKG (sinus tachycardia, atrial and ventricular arrhythmia)
  3. oximeter or arterial blood gases (hypoxia, respiratory alkalosis)
  4. ECHO (distinguish btw systolic and diastolic dysfunction)
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52
Q

What is the next best step in management of a pt with acute pulmonary edema who is not responding to preload reduction (oxygen, nitrates, furosemide, and morphine)?

A

positive inotropic agents (dobutamine, inamrinone, milrinone)

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53
Q

What is the best therapy for a pt with ventricular tachycardia associated with acute pulmonary edema?

A

synchronized cardioversion

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54
Q

When is unsynchronized cardioversion indicated?

A
  1. ventricular fibrillation without a pulse

2. ventricular tachycardia without a pulse

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55
Q

What are the results on right heart catheter in a pt with pulmonary edema?

A

decreased cardiac output, increased systemic vascular resistance, increased wedge pressure, increased right atrial pressure

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56
Q

What are the results on right heart catheter in a pt with hypovolemic shock (dehydration)?

A

decreased cardiac output, increased systemic vascular resistance, decreased wedge pressure, decreased right atrial pressure

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57
Q

What are the results on right heart catheter in a pt with septic shock (massive cytokine release resulting in vasodilation)?

A

increased cardiac output, decreased systemic vascular resistance, decreased wedge pressure, decreased right atrial pressure

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58
Q

What are the results on right heart catheter in a pt with pulmonary hypertension?

A

decreased cardiac output, increased systemic vascular resistance, decreased wedge pressure, increased right atrial pressure

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59
Q

What are the major side effects of spironolactone? (2)

A
  1. gynecomastia

2. erectile dysfunction

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60
Q

What is the alternative treatment for spironolactone in CHF treatment if side effects occur?

A

eplerenone

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61
Q

What is the further management for a pt with systolic dysfunction with low ejection fraction CHF after acute pulmonary edema has been stabilized?

A

ACE inhibitors/ ARBs, metoprolol/ carvedilol, spironolactone/ eplerenone, diuretics, digoxin

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62
Q

What is the further management for a pt with diastolic dysfunction with normal ejection fraction CHF after acute pulmonary edema has been stabilized?

A

metoprolol/ carvedilol and diuretics

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63
Q

What treatments in the further management of CHF lower mortality? (3)

A
  1. ACE inhibitors/ ARBs
  2. beta blockers (metoprolol, carvedilol)
  3. spironolactone
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64
Q

What treatment is the most beneficial for a CHF pt with an ejection fraction less than 35%?

A

implantable cardioverter/ defibrillator (prevent sudden death from arrhythmia)

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65
Q

What treatment is the most beneficial for a symptomatic CHF pt with an ejection fraction less than 35% and a QRS > 120msec?

A

biventricular pacemaker

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66
Q

What is the absolute contraindication for the use of beta blockers?

A

symptomatic bradycardia

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67
Q

A young female pt presents with shortness of breath worse with exertion, rales and a systolic murmur heard at the apex that radiates to the axilla, decreases with increased venous return and increases with decreased venous return most likely suffers from …

A

mitral valve prolapse

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68
Q

A healthy young athlete presents with shortness of breath worse with exertion, rales, and a systolic murmur that decreases with increased venous return and increases with decreased venous return most likely suffers from …

A

hypertrophic obstructive cardiomyopathy (HOCM)

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69
Q

An immigrant/ pregnant pt presents with shortness of breath worse with exertion, rales, dysphagia, hoarseness, atrial fibrillation and a diastolic rumbling murmur after an opening snap most likely suffers from ….

A

mitral stenosis

70
Q

A Turner’s pt or pt with history of coarctation of aorta presents with shortness of breath, rales, and a murmur

A

Bicuspid aortic valve

71
Q

What murmurs increase in intensity with exhalation?

A

left sided murmurs (aortic and mitral valve lesions)

72
Q

What murmurs increase in intensity with inhalation?

A

right sided murmurs (tricuspid valve lesions)

73
Q

What is the effect of squatting and lifting legs in the air on venous return?

A

increase venous return (squatting squeezes veins to push blood to heart)

74
Q

What is the effect of valsalva maneuver and standing up on venous return?

A

decrease venous return (valsalva increases intrathoracic pressure)

75
Q

What are the only two murmurs that decrease with increased venous return (squatting, lifting legs) and increase with decreased venous return (standing, valsalva)?

A
  1. Mitral Valve Prolapse

2. Hypertrophic obstructive cardiomyopathy (HOCM)

76
Q

What is the effect of handgrip on afterload?

A

increases (compressing arteries of the arm by contracting muscles)

77
Q

What murmurs are worsened/ intensified by handgrip? (3)

A
  1. aortic regurgitation
  2. mitral regurgitation
  3. VSD
78
Q

What murmurs are improved/ lessened by handgrip? (3)

A
  1. mitral valve prolapse
  2. hypertrophic obstructive cardiomyopathy
  3. aortic stenosis (smaller gradient across valve)
    (increased afterload -> increased LV size)
79
Q

What is the effect of amyl nitrate and ACE inhibitors on afterload?

A

decreases (dilating peripheral arteries)

80
Q

What murmurs are worsened/ intensified by amyl nitrate?

A
  1. aortic stenosis (larger gradient across valve)
  2. hypertrophic obstructive cardiomyopathy
  3. mitral valve prolapse
81
Q

What murmurs are improved/ lessened by amyl nitrate?

A
  1. aortic regurgitation
  2. mitral regurgitation
  3. VSD
82
Q

The murmur of …. is a crescendo-decrescendo sound heard best at the second right intercostal space and radiates to the carotid arteries

A

aortic stenosis

83
Q

What murmurs are heard at the second left intercostal space?

A

pulmonic valve murmurs

84
Q

What three murmurs are heard best at the lower left sternal border?

A
  1. Aortic regurgitation
  2. tricuspid valve
  3. VSD
85
Q

What is the best initial diagnostic test for suspected valvular lesions?

A

transthoracic ECHO (also include chest X-ray and EKG) then transesophageal

86
Q

What is the most accurate diagnostic test for suspected valvular lesions?

A

Left Heart Catheterization (measure pressure gradients)

87
Q

What is the best initial treatment for regurgitant valvular disease?

A

vasodilators (ACE inhibitors, ARBs, nifedipine decrease afterload) followed by surgery

88
Q

What is the best initial treatment for stenotic lesions?

A

anatomic repair (balloon valvuloplasty- mitral; surgical replacement-aortic) and diuretics

89
Q

What treatment is indicated if valsalva improves/ lessened the murmur?

90
Q

What treatment is indicated if amyl nitrate improves/ lessens the murmur?

A

ACE inhibitor

91
Q

A elderly pt presents with chest pain, history of hypertension, and a crescendo-descrendo systolic murmur best heard at second right intercostal space radiating to the carotids most likely suffers from …

A

aortic stenosis (results in syncope & angina by blocking blood to vertebral & basiliar artery leading to LV hypertrophy and increased demand on heart)

92
Q

What determines the level of severity of aortic stenosis?

A

gradient across valve (mild 70)

93
Q

What is the difference between using a bioprostehtic valve (porcine, bovine) compared to using a mechanical vale for aortic valve replacement?

A

bioprosthetic: only lasts 10 years, no anticoagulation needed
mechanical: lasts 15- 20 years, warfarin with INR 2-3 needed

94
Q

A pt presents with history of hypertension/ rheumatic heart disease/ endocarditis/ cystic medial necrosis, shortness of breath, fatigue and a diastolic decrescendo murmur heard best at the left sternal border most likely suffers from….

A

aortic regurgitation

95
Q

….. is arterial/ capillary pulsations in the fingernails associated with .. murmur

A

Quincke pulse; aortic regurgitation

96
Q

…. is high bounding pulses associated with …. murmur

A

Corrigan’s pulse/ Water-hammer pulse; aortic regurgitation

97
Q

…. is head bobbing up and down with each pulse associated with …. murmur

A

Musset’s sign; aortic regurgitation

98
Q

…. is murmur heard over the femoral artery associated with …. valvular disease

A

Duroziez’s sign; aortic regurgitation

99
Q

…. is blood pressure gradient much higher in the lower extremities associated with … murmur

A

Hill sign; aortic regurgitation

100
Q

What are the indications for surgery in a pt with aortic regurgitation? (2)

A
  1. ejection fraction 55 mm
101
Q

What are the findings on Chest X-ray associated with mitral stenosis? (3)

A
  1. straightening of the left heart border
  2. elevation of the left mainstem bronchus
  3. double density in the cardiac silhouette (left atrial enlargement)
102
Q

A pt with a history of hypertension/ ischemic heart disease/ dilated cardiomyopathy presents with dyspnea on exertion, and a holosystolic murmu that obscures S1 and S2 and is best heard at the apex radiating to the axilla, and S3 may be heard most likely suffers from …

A

Mitral Regurgitation

103
Q

What are the indications for surgery as a treatment for mitral regurgitation?

A
  1. left ventricular ejection fraction 40 mm
104
Q

A pt (who may have shortness of breath) who is found to have a holosystolic murmur at the lower left sternal border that worsens with exhalation, squatting and lef raise most likely suffers from…

A

Ventricular septal defect

105
Q

A pt presents with shortness of breath, parasternal heave and fixed splitting of S2 (no difference between P1 and A1 during respiration) most likely suffers from …

A

Atrial Septal Defect

106
Q

What is the best initial diagnostic test for suspected ventricular septal defect and atrial septal defect?

107
Q

What is the best treatment for atrial septal defects?

A

percutaneous or catheter devices (repair if shunt ratio exceeds 1.5:1)

108
Q

What are the five major causes of dilated cardiomyopathy?

A
  1. Ischemia (most common)
  2. alcohol
  3. adriamycin
  4. radiation
  5. Chaga’s disease
109
Q

What is the treatment for dilated cardiomyopathy?

A

ACE inhibitors, ARBs, beta blockers, spironolactone

110
Q

A pt presenting with shortness of breath, an S4 gallop and a normal ejection fraction on ECHO without a murmur most likely suffers from….

A

Hypertrophic Cardiomyopathy

111
Q

What is the treatment for Hypertrophic Cardiomyopathy?

A

beta blockers and diuretics

112
Q

What is the best initial diagnostic test for dilated cardiomyopathy?

113
Q

What is the most accurate diagnostic test for dilated cardiomyopathy?

A

MUGA or nuclear ventriculography

114
Q

A pt with history of sarcoidosis/ amyloidosis/ hemochromatosis/ cancer/ myocardial fibrosis/ glycogen storage disease presents with shortness of breath, increase in jugular venous pressure on inhalation (Kussmaul’s sign), and low voltage on EKG most likely suffers from….

A

Restrictive Cardiomyopathy (rapid x and y descent on cardiac catheterization)

115
Q

What is the best initial diagnostic test for restrictive cardiomyopathy and what is the most accurate diagnostic test for restrictive cardiomyopathy?

A

ECHO; endomyocardial biopsy

116
Q

A pt presents with sharp, pleuritic chest pain (changes with respiration) that is improved by sitting up and leaning forward and the presence of friction rub on exam most likely suffers from….

A

pericarditis

117
Q

What is the best initial test for suspected pericarditis?

A

EKG showing ST-segment elevation in all leads and possibly PR depression in lead II

118
Q

What is the best initial treatment for pericarditis?

A

NSAIDs (indomethacin, naproxen, aspirin, ibuprofen); if no improvement after 1-2 days, add steroids and if no improvement, add colchicine

119
Q

A pt presents with shortness of breath, hypotension, jugular venous distention and clear lungs most likely suffers from …

A

pericardial tamponade

120
Q

What are characteristic physical exam findings and imaging findings associated with pericardial tamponade?

A
  1. pulsus paradoxus (decreased blood pressure >10 mmHg on inhalation)
  2. electrical alternans (alterations of the QRS complex axis from heart moving in fluid)
  3. low voltage on EKG
  4. equalization of all the pressure in the heart during diastole on right heart catheterization
121
Q

What is the most accurate diagnostic test for pericardial tamponade?

A

ECHO showing diastolic collapse of the right atrium and right ventricle

122
Q

What is the best initial therapy for pericardial tamponade and what is the most effective long term therapy for pericardial tamponade?

A

Pericardiocentesis; pericardial window placement

123
Q

A pt presents with shortness of breath, edema, jugular venous distention, hepatosplenomegaly, ascites, Kussmaul’s sign (increase in jugular venous pressure on inhalation) and a pericardial knock (diastolic sound from heart hitting calcified thickened pericardium) most likely suffers from …

A

Constrictive Pericarditis

124
Q

What are the diagnostic test findings associated with constrictive pericarditis?

A
  1. calcification on chest X-ray
  2. low voltage on EKG
  3. thickening of pericardium on CT/MRI
125
Q

What is the best initial therapy for constrictive pericarditis and what is the most effective therapy for constrictive pericarditis?

A

diuretic; surgical removal of pericardium

126
Q

A pt presents with severe, ripping chest pain radiating to the back between the scapula and is found to have different blood pressures between right and left arms most likely suffers from ….

A

Dissection of aorta (thoracic aorta)

127
Q

What is the best initial test for suspected dissection of aorta?

A

Chest X-ray showing widened mediastinum

128
Q

What is the initial step in management for a pt presenting with suspected dissection of aorta?

A

start beta blockers (if hypertension), order EKG and Chest X-ray

129
Q

What is the next best step in management of pt presenting with suspected dissection of aorta after chest X-ray is inconclusive?

A

order CT angiography/ transesophageal echo/ magnetic resonance angiography; start nitroprusside (to control blood pressure)

130
Q

When should an abdominal aortic aneurysm be repaired?

A

aneurysm diameter is greater than 5 cm

131
Q

A pt presents with pain in the calves with exertion, smooth shiny skin with loss of hair and sweat glands and loss of pulses in the feet most likely suffers from …

A

peripheral arterial disease

132
Q

What is the best initial test for suspected peripheral arterial disease?

A

ankle-brachial index (ABI

133
Q

What is the most accurate test for suspected peripheral arterial disease?

A

angiography

134
Q

What is the best initial therapy for peripheral arterial disease?

A

aspirin, ACE inhibitor (blood pressure control), exercise as tolerate, cilostazol, statins (goal of LDL

135
Q

A pt with history of aortic stenosis/ atrial fibrillation presenting with sudden loss of pulse in the feet, cold lower extremity and severe pain in leg most likely suffers from..

A

acute arterial embolus

136
Q

A pt with history of hypertension/ ischemia/ cardiomyopathy presents with palpitations and an irregular pulse most likely suffers from …

A

atrial fibrillation

137
Q

What is the best initial diagnostic test for suspected atrial fibrillation?

138
Q

What is the next best step in management of a pt with suspected atrial fibrillation and a non-diagnostic EKG?

A

telemetry monitoring (inpatient) or 24 hour Holter monitoring (outpatient)

139
Q

What diagnostic tests should be performed once a pt is diagnosed with atrial fibrillation?

A
  1. ECHO (detect clots, valve dysfunction, left atrial size)
  2. thyroid function testing (TSH and T4)
  3. Electrolytes (K, Mg, Ca)
  4. troponin and CK-MB
140
Q

What is the best initial treatment for an unstable patient (systolic BP

A

immediate synchronized electrical cardioversion

141
Q

What is the best initial treatment for a stable patient with acute atrial fibrillation?

A

rate control medications (IV beta blockers, calcium channel blockers, digoxin) if heart rate is greater than 100-110

142
Q

What is the next best step in management of a patient with atrial fibrillation at rate control?

A

anticoagulation with warfarin/ dabigatran to INR 2-3 for warfarin (if lasting 2 day or longer)

143
Q

What is the CHADS2 score and what disease is it used for?

A

CHADS2: CHF, Hypertension, Age >75, Diabetes, Stroke/TIA
used to determine if anticoagulation is indicated for atrial fibrillation (0-1 means aspirin, 2 or more means warfarin/ dabigatran/apixaban/ rivaroxaban)

144
Q

When should beta blockers be used for rate control in atrial fibrillation and atrial flutter?

A
  1. ischemic heart disease
  2. migraines
  3. graves disease
  4. pheochromocytoma
145
Q

When should calcium channel blockers be used for rate control in atrial fibrillation and atrial flutter?

A
  1. asthma

2. migraine

146
Q

When should digoxin be used for rate control in atrial fibrillation and atrial flutter?

A

borderline hypotension

147
Q

A COPD/ emphysema pt presents with tachycardia and an EKG showing polymorphic P waves most likely suffers from …

A

Multifocal atrial tachycardia

148
Q

What is the treatment for multifocal atrial tachycardia?

A

Oxygen followed by diltiazem (avoid beta blockers)

149
Q

A pt presents with palpitations, tachycardia,a regular rhythm with a ventricular rate of 160-180 and possible history of syncope most likely suffers from …

A

supraventricular tachycardia

150
Q

What is the best initial step in management for a unstable pt with supraventricular tachycardia?

A

synchronized cardioversion

151
Q

What is the best initial step in management for a stable pt with supraventricular tachycardia?

A

vagal maneuvers (carotid sinus massage, ice immersion of face, valsalva)

152
Q

What is the next best step if vagal maneuvers do not work for a stable pt with supraventricular tachycardia?

A

IV adenosine

153
Q

What is the best long term management for supraventricular tachycardia?

A

radiofrequency catheter ablation

154
Q

A pt presents with palpitations, tachycardia and is found to be in supraventricular tachycardia that alternates into ventricular tachycardia/ worsening of supraventricular tachycardia after calcium channel blockers or digoxin most likely suffers from…

A

Wolff-Parkinson-White syndrome

155
Q

What is the characteristic finding on EKG associated with Wolff-Parkinson-White syndrome?

A

delta wave

156
Q

What is the best initial therapy for someone in SVT/ VT from Wolff-Parkinson-White syndrome?

A

Procainamide

157
Q

What is the best long term therapy for Woldd-Parkinson-White syndrome?

A

Radiofrequency catheter ablation

158
Q

What is the most accurate diagnostic test for ventricular tachycardia and Wolff-Parkinson- White syndrome?

A

electrophysiologic studies

159
Q

What is the best treatment for hemodynamically unstable ventricular tachycardia?

A

synchronized cardioversion

160
Q

What are the treatment options for hemodynamically stable ventricular tachycardia?

A

amiodarone, lidocaine, procainamide, magnesium

161
Q

What should always be given to a pt presenting with torsade de pointes (ventricular tachycardia with an undulating amplitude)?

162
Q

What is the best treatment for ventricular fibrillation?

A

unsynchronized cardioversion (also use for pulseless ventricular tachycardia)

163
Q

What are the 7 steps to unsynchronized cardioversion?

A
  1. CPR
  2. defibrillate
  3. administer IV epinephrine/ vasopressin
  4. reattempt defibrillation
  5. administer IV amiodarone/ lidocaine
  6. reattempt defibrillation
  7. repeat several cycles of CPR between shocks
164
Q

A pt presenting with gradual syncope most likely suffers from …

A

toxic-metabolic, hypoglycemic, anemic, hypoxic etiology

165
Q

A pt presenting with sudden syncope and gradual return of consciousness most likely suffers from ..

A

neurologic etiology (seizures)

166
Q

A pt presenting with sudden syncope, sudden return of consciousness and has a normal cardiac exam most likely suffers from …

A

ventricular arrhythmia

167
Q

A pt presenting with sudden syncope, sudden return of consciousness and has an abnormal cardiac exam most likely suffers from..

A

structural heart disease (aortic/mitral stenosis, hypertrophic obstructive cardiomyopathy, mitral valve prolapse)

168
Q

What are the initial diagnostic tests that should be performed for a syncopal patient? (7)

A
  1. cardiac and neuro exams
  2. EKG
  3. electrolytes and chemistries (including glucose)
  4. oximeter
  5. CBC
  6. cardiac enzymes (CK-MB, troponin)
  7. ECHO (if murmur), head CT (if history of head traumu or focal neuro deficit)
169
Q

What diagnostic test should be performed if the etiology of syncope is not clear from the initial tests results? (3)

A
  1. holter monitor (outpatients) or telemetry monitoring (inpatient)
  2. repeat CK-MB and tropinin levels 4 hours later
  3. urine and blood toxin screen
170
Q

What is the final diagnostic tests that should be performed in a syncopal pt if etiology is still unclear?

A
  1. tilt table testing (vasovagal syncope)

2. electrophysiological testing

STEP 3 (19 decks)

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