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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the ankle brachial index a measurement of? How do you do it, and what is considered abnormal?

A

ABI is is a sensitive test for PAD. You divide systolic of the ankle by the systolic of the arm. Abnormal result is <0.8. A result of <0.5 indicates severe PAD.

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2
Q

Guidelines for lipid-lowering therapy?

A

clinically significant atherosclerosis: high-intensity statin (age 75) LDL >190: high-intensity statin age 40-75 with diabetes: high-intensity statin (ASCVD >7.5) or moderate-intensity statin (ASCVD 7.5: moderate to high-intensity statin

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3
Q

Talk about the pathophys of mitral stenosis

A

Mitral stenosis leads to increased left atrial pressure, which is then transmitted to the pulmonary vasculature. Then, the pulmonary HTN causes congestion (cough, exertional dyspnea, hemoptysis). Pts with mitral stenosis are at risk for developing a. fib due to atrial dilation. This can predispose people to developing thrombi, which can embolize into the cerebral circulation and cause stroke.

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4
Q

what is CHADS-VASC? WHAT IS IT USED FOR?

A

Used to decide when to anticoagulate someone with a. fib for stroke prevention. CHF Hypertension Age >75 (2 points) Diabetes Stroke (CVA or TIA, 2 points) Vascular disease (MI, PVD, etc.) Age >65 Sex (females get 1 point) 2 or more: oral anticoagulant 1: aspirin or oral anticoagulant 0: aspirin or nothing

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5
Q

HASBLED score

A

Hypertension Abnormal kidney/liver function Stroke Bleeding Labile INRs Elderly (age >65) Drug therapy/alcohol 0-1: low risk 2: intermediate risk >/= 3: high risk

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6
Q

Name the inferior, lateral, septal, and anterior EKG leads.

A

inferior: I, III, aVF lateral: I, avL, V4, V6 septal: V1, V2 anterior: V2-V4

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7
Q

EKG findings for pericarditis?

A

Diffuse ST segment elevation, PR depression (usu. mild), with no reciprocal changes in the other leads.

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8
Q

EKG findings for LVH?

A

S wave in lead I + R wave in V5 or V6 = 35 mm (7 boxes) OR R wave in aVL >/= 11 mm

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9
Q

EKG findings for hyperkalemia?

A
  • peaked T waves - loss of P waves, widened QRS, ST elevation - sine wave
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10
Q

normal PR interval?

A

5 boxes

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11
Q

normal QRS?

A
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12
Q

What electrolyte abnormalities does furosemide cause? What can this lead to?

A
  • hypokalemia - hypomagnasemia V. tach
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13
Q

How do you acutely manage a. fib?

A

Hemodynamically unstable: emergency cardioversion Stable patients: beta blocker, diltiazem, digoxin to control the ventricular rate Rhythm control can be considered in patients who are still symptomatic or who need better rate control.

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14
Q

When do you use lidocaine?

A

When treating ventricular arrhythmias. Not effective for a fib.

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15
Q

How do you manage paroxysmal suprventricular tachycardia?

A

adenosine and/or carotid massage. Not effective for long-term rate control.

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16
Q

EKG findings for digitalis toxicity?

A

atrial tachycardia with AV block (ectopy + increased vagal tone)

17
Q

cardiac myxoma clinical findings

A

80% located in the left atrium constitutional symptoms: fatigue, malaise, fever, weight loss, Raynaud’s CV symptoms (heart failure, arrhythmias, heart block, etc.) embolization lung invasion diagnosed via echo needs prompt surgical resection

18
Q

How do you manage cocaine-related chest pain?

A

Benzos for BP and anxiety aspirin nitro and CCBs for pain NO beta blockers, NO fibrinolytics

19
Q

which incidentally found murmurs warrant an echo?

A

Any diastolic or continuous murmur loud (III-IV/IV) systolic murmurs

20
Q

morphology of premature ventricular complexes? when do you treat? with what?

A

widened QRS, bizarre morphology, compensatory pause. more common in patients with cardiac pathology. Do not treat if asymptomatic. If symptomatic, give beta-blockers. Amiodarone is second-line.

21
Q

What are the screening guidelines for AAA? When is surgical repair indicated?

A

Screen men ages 65-75 who have smoked with a one-time abdominal ultrasound.

Screening and repair indicated for AAA 5.5cm or greater

22
Q

Features of restrictive cardiomyopathy? What are some causes?

A

Features of restrictive cardiomyopathy:

  • normal LV volume
  • primarily diastolic dysfunciton
  • symmetric thickening (in hypertrophic cardiomyopathy, the septum is much thicker)
  • signs of right-sided heart failure (JVD, ankle edema, tender hepatomegaly)

Causes include:

  • hemochromatosis
  • amyloidosis
  • scleroderma
  • sarcoid
23
Q

What is the origin of electrical activity of atrial fibrillation?

A

Pulmonary veins

24
Q

What is the origin of electrical activity in atrial flutter?

A

The tricuspid annulus

25
Q

What is the origin of electrical activity in supraventricular tachycardia?

A

Two separate conducting pathways within the AV node.

26
Q

EKG findings for complete heart block? How would you manage these patients?

A
  • complete AV dissociation: P waves have no relation to QRS complexes
  • ventricular rate is slower than atrial rate (usu. <50 bpm)

Management: symptomatic patients should get temporary pacemaker insertion while evaluating for reversible causes

27
Q

Most comon cause of sudden cardiac arrest in the immediate post-MI period?

A

Reentrant ventricular arrhythmias (e.g. V fib)

28
Q

Presentation of aortic regurg? What are common causes?

A

Causes:

  • Aortic root dilation (Marfan, syphilis)
  • rheumatic heart disease
  • endocarditis
  • congenital bicuspid aortic valve

Presentation:

  • acute awareness of heartbeat in L lateral decubitus position
  • widened pulse pressure
  • water hammer (Corrigan) bounding pulse
  • heart failure symptoms (incr. LVEDV)
29
Q

Presentation of Dressler syndrome? Treatment?

A
  • Weeks post-MI
  • Chest pain relieved when leaning forward
  • malaise, fatigue, elevated ESR
  • diffuse ST elevation with reciprocal changes in aVR
  • treat with NSAIDs. coricosteroids can be an add-on. avoid anticoagulation (can lead to hemorrhagic pericardial effusion)
30
Q

Symptoms of digoxin toxicity?

A

Nausea, diarrhea, fatigue, anorexia, confusion, weakness, visual disturbances.

31
Q

Most appropriate initial intervention for acute aortic dissection?

A

Beta blockade for simultaneous lowering of HR and BP. This minimizes the stress on the aortic wall.

Avoid anticoagulants, as they can impair the body’s ability to contain the dissection.

Avoid vasodilators, which can cause a reflex tachycardia and increase shear stress on aortic wall.

32
Q

What can you do to improve dihydropyridine-associated peripheral edema?

A

Add on an ACE

33
Q

Clinical features and diagnosis of cholesterol embolism?

A
  • Skin: livedo reticularis, blue toe syndrome, ulcers
  • Renal: AKI
  • CNS: stroke, amaurosis fugax
  • Eyes: Hollenhorst plaques
  • GI: ischemia, pancreatitis

Diagnosis:

  • elevated serum Cr
  • Eosinophilia
  • hypocomplementemia
  • possible eosinophiluria
  • Skin/Kidney biopsy: biconvex, needle-shaped clefts in occluded vessels; perivascular inflammation
34
Q

Severe left atrial enlargement can affect which nearby anatomic structures?

A

Compression of recurrent laryngeal nerve

Elevation of left mainstem bronchus

Also huge risk for A. fib

35
Q

Drugs with mortality benefit in CHF?

A

ACEi, ARB, Beta-blocker, spironolactone (or eplerenone).

36
Q

Beck’s triad for cardiac tamponade?

A
  1. Hypotension
  2. Elevated JVP
  3. Muffled heart sounds (non-palpable PMI)

Clear lung fields, enlarged & globular heart silhouette on CXR (water bottle heart)

37
Q

5 Ps of popliteal artery occlusion?

A
  • pain
  • pulselessness
  • pallor
  • poikilothermia (cool temp)
  • paresthesia

definitive treatment is embolectomy or thrombolysis

38
Q

What is a dangerous sequel of myocarditis? What viruses are common offenders?

A
  • Dilated cardiomyopathy
  • Coxackie B, Parvo B19, HHV-6, adeno, etc.
39
Q

Amiodarone toxicity?

A

Hyper/hypothyroidism, hepatotoxicity, bluish skin discoloration, heart block, bradycardia, neuropathy, ocular problems

Internal Medicine (8 decks)

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