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[2a] A ⼀ Step 2 OD USLME > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

Which pt demographics are most at risk for anaphylaxis 2nd to Latex allergy?-3

A

Health Care Workers

[GI Surgery pts]

[GU Surgery pts]

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2
Q

Epigastric burning worst with exertion and not relieved with antacids is concerning for ______. Next step?

A

[Atypical Stable Angina]; Exercise Stress EKG

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3
Q

How is SLE associated with CAD

A

SLE accelerates atherosclerosis –> premature CAD

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4
Q

Which EKG leads are Lateral

A

aVL, Lead 1, V5, V6

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5
Q

Which EKG leads are Anterior

A

V2, V3, V4

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6
Q

What Px medication is given to prevent [Coronary Artery Stent Thrombosis]-2?

What’s the biggest predictor of Stent Thrombosis?

A

ASA + [Platelet R Blocker (Clopidogrel,Prasugrel,Ticagrelor)]

DC/noncompliance of this therapy = BIGGEST PREDICTOR of Stent Thrombosis

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7
Q

Initial Mngmt for [Peripheral Arterial Dz]-4

A
  1. Smoking Cessation
  2. Dual Lipid lowering therapy (ASA + Statin)
  3. Mnge DM/HTN
  4. Supervised Exercise (reproduces and reduce sx)
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8
Q

⬜ , ⬜ and ⬜ are 3 drugs that should be held ⬜ hrs prior to [Stress EKG]

________________

When are these drugs actually continued during [Stress EKG]?

A

Beta blockers/CCB/Nitrates; 48 hours

________________

These are continued during [Stress EKG] if the test is determining their efficacy in pts

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9
Q

What is [Pulsus parvus et tardus] and what dz is it related to

A

Delayed and diminished carotid pulse; Aortic Stenosis

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10
Q

PE findings for Aortic Stenosis-3

A
  1. Pulsus parvus et tardus (delayed carotid pulse)
  2. S4 (from LV Hypertrophy)
  3. [Crescendo Decrescendo Systolic murmur w/radiation to Carotids @ R 2nd ICS]
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11
Q

Which Murmur?

(Auscultation Site is attached)

B: Maneuvers that INC (2)

A

Mitral Regurgitation

[Holosystolic High-Pitched Blowing Murmur] w/radiation to axilla

“MR. Hand me a Squat”

B: INC with…

1) Hand Grip
2) Squatting

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12
Q

Which Murmur? (Is Not VSD)

(Auscultation Site is attached)

B: Maneuvers that INC

A

Tricuspid Regurgitation

[Holosystolic High-Pitched Blowing Murmur]

B: INC with… Inspiration

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13
Q

Which Murmur?

(Auscultation Site is attached)

B: Maneuvers that INC (2)

C: Maneuvers that DEC

A

Aortic Stenosis

[Crescendo-Descrescendo Systolic Ejection Murmur]

“Lean forward…& then Squat with that Ass, that’ll turn it up!”

B: INC with…

  1. Leaning Forward
    2) Squatting

C: DEC with…handgrip (INC afterload)

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14
Q

Mitral Valve Prolapse

Murmur

A

“He was MVP…OF COURSE he had a Mid Clique to hang with”

[MidSystolic Click –> Late Systolic Crescendo Mumur] @ Apex

Sound Caused by Tendinae tightening and lips of the valve closing AFTER the preload has been ejected

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15
Q

Which Murmur?

(Auscultation Site is attached)

A

Mitral Valve Prolapse

[Late Systolic Crescendo Murmur + MidSystolic Click]

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16
Q

Which Murmur?

B: Name the Auscultation Site

C: Maneuvers that INC sound

A

Mitral Stenosis

[Delayed Rumbling Diastolic murmur that follows an Opening Snap]

B: [Apex + LLDP (L Lateral Decubitus Position)]

C: Maneuvers that [INC Afterload]

-handgrip

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17
Q

Which Murmur?

(Auscultation Site is attached)

A

Hypertrophic Cardiomyopathy

[Holosystolic Harsh Murmur] auscultated @ [L Sternal 2nd/3rd ICS]

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18
Q

Which Murmur?

(Auscultation Site is attached)

A

Ventricular Septal Defect

[Holosystolic Harsh Blowing Murmur]

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19
Q

Which Murmur?

(Auscultation site is attached)

A

Patent Ductus Arteriosus

[Machinery Continuous Murmur] ausculated over [L infraclavicular region]

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20
Q

In regard to renal arterioles, how do kidneys respond to CHF

A

Constrict Efferent Arterioles –> INC intraglomerular pressure

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21
Q

What are clinical parameters for Orthostatic hypOtension?-3

A
  • ⬇︎ in Systolic BP > 20 when standing
  • ⬇︎ in Diastolic BP > 10 when standing
  • INC HR > 10

insufficient constriction of capacitance blood vessels in LE

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22
Q

Presentation for Aortic Coarctation-3

A
  1. Asx HTN sometimes w/[epistaxis/HA/aortic dissection/cp]
  2. UE HTN with LE hypotension
  3. Delayed femoral pulses
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23
Q

Dx for Aortic Coarctation?-3

A
  1. CXR: Notching of 3rd-8th enlarged intercostal arteries
  2. CXR: “3” sign from aortic indentation
  3. Echocardiography
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24
Q

What Disorders is Aortic Coarctation associated with?-3

A
  1. Bicuspid Aortic Valve
  2. Vt Septal Defect
  3. Turner Syndrome
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25
Q

Pt with vague chest pain. Dx?

A

Descending Thoracic Aortic Aneurysm

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26
Q

Describe Etiologies for [Ascending Thoracic Aortic Aneurysms] - 2

A

Ascending [Cystic medial necrosis from aging] vs [Connective Tissue DO (Ehlers Danlos, Marfan - pts under 40 yo)]

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27
Q

What value of BNP indicates CHF dx

A

≥ 100 pg/mL

Note: BNP is excreted by Kidneys = Naturally Elevated in Renal Failure pts!

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28
Q

Describe [Hypertensive Urgency]

A

ONLY HTN ≥ 180/120

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29
Q

Describe [Malignant HTN Emergency] - 2

A

[Hypertensive Urgency (BP>180/120)]

+

Papilledema/Retinal Hemorrhages

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30
Q

Describe [Hypertensive Encephalopathy] - 2

A

[Hypertensive Urgency (BP>180/120)]

+

Cerebral Edema –> General Neuro signs

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31
Q

EKG manifestation for Acute Fibrinous Pericarditis-2

A

[DIFFUSE ST ELEVATIONS]

[+/- PR depressions]

________________

Pericarditis gave HIM A UTI

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32
Q

What is usually the cause of pericardial effusion

A

recent viral infection –> pericarditis –> pericardial effusion

  • Pericarditis gave HIM A UTI*
  • EKG showing electrical alternans*
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33
Q

Describe Pulsus Paradoxus

A

[Systolic BP] ⬇︎more than 10 during inspiration

“Pulsus for CAPOT”

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34
Q

What conditions cause Pulsus Paradoxus (5)

A

“Pulsus for CAPOT”

  • Croup
  • Asthma
  • Pericarditis
  • Obstructive Sleep Apnea
  • Tamponade
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35
Q

What 2 heart conditions are Marfan pts at risk for

A

AORTIC DISSECTION & [Ascending Aortic Aneurysm]

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36
Q

What should you suspect in an [Aortic Dissection pt] who also has distended neck veins & pulsus paradoxus? Why?

A

Concomitant Cardiac Tamponade; dissection can –> blood in pericardial sac –> [Pulsus for CAPOT]

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37
Q

Digoxin toxicity leads to what cardiac arrhythmia?

A

[Atrial Tachycardia(250-350 bpm)] with AV block

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38
Q

In Hypertensive Crisis (Urgency & Malignant Emergency), what’s the rate for lowering MAP?-2

A

Normal MAP: 65-110

[10-20% in 1st hour] –> [5-15% over next 23 hours]

Malignant HTN Emergency = [Hypertensive Urgency (BP>180/120)] PLUS Papilledema/Retinal Hemorrhages

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39
Q

What is the normal range for Mean Arterial Pressure (MAP)?

________________

Formula?

A

65-110

________________

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40
Q

What is Nitroprusside commonly used for? Severe SE-3?

A

Rapid BP control (since it’s a vasoDilator);

Cyanide Tox

  1. AMS
  2. Lactic Acidosis
  3. Coma/Death
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41
Q

CP for Exertional Heat Stroke-3

________________

What med worsens this?

A

HOT

  1. Head CNS dysfunction (confused/seizure/epistaxis)
  2. Organ Dysfunction (DIC/ARDS/Hemoconcentration/Rhabdo)
  3. Temp > 40C

________________

Worst with antiCholinergics

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42
Q

Compare tx for Exertional-2 heat stoke vs. NonExertional-1 heat stroke

A

Exertional = Ice water immersion + fluid resuscitation

NonExertional (happens in kids & elderly) = Evaporative cooling (spray lukewarm water on pt with fan blowing)

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43
Q

How is Aortic Dissection associated with Aortic Regurgitation ; what’s a possible respiratory complication of this

A

AD may proximally extend into the [aortic valve annulus] and stretch it –> AR which can–> Acute SOB w/lung crackles (since LV will be full and LA can’t dump into it)

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44
Q

Name PE finding and what causes it-5

A

Livedo Reticularis;

  1. Atherosclerotic Emboli into periphery s/p cardiac catheterization
  2. SLE
  3. Antiphospholipid Syndrome
  4. Systemic Vasculitis
  5. Amantadine SE

also may see Blue Toes, [Hollenhorst retinal a. plaques]

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45
Q

Fibromuscular Dysplasia etx

________________

List the manifestation-3

A

Dysplasia of arterial cell wall –> NONinflammatory NONatherosclerotic Stenosis of 3 arteries…

________________

Renal = ⬇︎renal perfusion–> ⬆︎Renin = [HTN + abd bruit]

Carotid internal = [amaurosis fugax + recurrent HA + subauricular systolic bruit]

Vertebral = stroke

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46
Q

Fibromuscular Dysplasia dx-2

A

[Spiral CT angio Abd] vs. Duplex US

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47
Q

2nd degree AV Block: Mobitz Type 1

Describe where block is, EKG findings and describe QRS

A

[2nd degree AV Block: Mobitz Type 1] (2 and 1)

where = AV Node

EKG = Group beating (progressively elongating PR ➜ dropped QRS)

QRS is Narrow

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48
Q

2nd degree AV Block: Mobitz Type 2

________________

Describe where block is, EKG findings and describe QRS

A

[2nd degree AV Block: Mobitz Type 2] (2 and 2)

where = Bundle of His

EKG = PR stays constant but QRS Drops Randomly

QRS is Narrow OR Wide

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49
Q

Name the 4 Medications that Prevent LV Remodeling in HF pts

A

“BANA helps HF pts live Loonger”

Beta Blockers (Metoprolol / Carvedilol)

[ACEk2 inhibitors AND ARBs]

[Nitrates + Hydralazine]

[Aldosterone Blockers (Spironolactone / Eplerenone)]

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50
Q

What therapies are used to treat [acute MI]? -7

________________

explain why each are used

A

Pts with [acute MI] {Always Need OBAMA}!

  1. [ASA and Heparin] = limits thrombosis
  2. NTG = VasoDilates Veins and Coronary Arteries
  3. Oxygen = Minimizes ischemia
  4. Beta Blockers = DEC HR –> DEC Arrhythmia risk and DEC O2 demand
  5. [ACEk2 inhibitors within 24 hrs] = DEC [L Ventricle Dilation/Remodeling]
  6. Morphine = pain
  7. AtorvaSTATIN - comes later

ASA and Beta blockers can –> asthma exacerbation

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51
Q

Tx for symptomatic Sinus Bradycardia-5

A

1st line: [Atropine IV + IVF]

________________

2nd line: [Glucagon IV (⇪intracell cAMP)]

Alternatives: [Epi IV] / [DOPAmine IV] / [transcutaneous pacing]

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52
Q

A pt with what group of sx is most concerning for Cardiac Tamponade

A
  1. Distended Neck Veins
  2. Muffled heart sounds
  3. HypOtension

THIS IS BECK’S TRIAD!

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53
Q

Which demographic should ALWAYS be screened for AAA using _______

A

AAA screening/diagnosis = Abdominal US

Always Screen [65-75 yom who smoke]!!!! for AAA

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54
Q

Which HTN med causes isolated peripheral edema and why?

________________

How do you correct for this and why does it work?

A

[Dihydropyridine Ca+ Channel Blockers (Amlodipine/Nifedipine)] preferentially dilate Arterioles –> interstitial extravasation –> isolated peripheral edema

__________________

[ACEk2 inhibitors preferentially dilate Venules].

________________

So [DHP CCB] + [ACEk2 inhibitors] concurrent = ⬇︎peripheral edema

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55
Q

ALPHA 1 RECEPTOR

Tissues - Actions (3)

A

“Gimme an alpha 1 VID”

(1) Most Vascular smooth muscle- contracts (inc. vascular resistance)
(2) Dilator Pupillary muscle- contracts (myDriasis)
(3) Internal Urethral Sphincter- contracts

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56
Q

ALPHA 2 RECEPTOR

Tissues- Actions (4)

A

“You’ll find alpha 2 receptors on a PEAA”

(1) A**drenergic and cholinergic nerve terminals- inhibits NTS release–> [CNS-mediated BP DEC]
(2) *Platelets- stimulates aggregation
(3) *Adipocytes - DEC Lipolysis
(4) Eye - DEC Intraocular pressure

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57
Q

BETA 1 RECEPTOR

Actions (2)

A

(1) Heart- INC rate and force by [INC [Na+ I(f) channels] in phase 0 of AV node] –> shortens PR interval
(2) JGA cells- Stimulates renin release

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58
Q

BETA 2 RECEPTOR

Tissues-Actions (4)

A
  1. ⇪ insulin release
  2. ⇪ lipolysis
  3. ⇪ aqueous humor production
  4. ⬇︎RUV (Resp-bronchoDilates | Uterine relaxation | vasoDilation)
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59
Q

What is [PEA-Pulseless Electrical Activity] ?

________________

how should it first be managed-2?

A

Organized rhythm on cardiac monitor BUT NO Palpable pulse

________________

{ [CPR x 2 min] + [Epi q 3-5 min]} until cause is determined!

Note: [pulseless VT] DOES require defibrillation

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60
Q

What are the causes of PEA (Pulseless Electrical Activity)-10

A
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61
Q

Describe the Approach to [Adult Cardiac Arrest] if pt is in Asystole or PEA-6

A
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62
Q

Describe the Approach to [Adult Cardiac Arrest] if pt is in VFib or pulseless VTach-6

A
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63
Q

What is the normal Jugular Venous Pressure?

(per distance above sternal angle)

A

3-4 cm above sternal angle

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64
Q

Periumbilical Systolic-Diastolic Bruit in [HTN & Atherosclerotic pt] suggest _______

A

Renal Artery Stenosis

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65
Q

[Etx of Amyloidosis (primary AL) vs. (secondary AA)]

________________

[causes of secondary AA]-5

A

Etx of Amyloidosis = Multi-Organ extraceullar deposition of insoluble protein

(primary AL) vs. (secondary AA)

________________

(secondary AA) caused by:

  1. RA
  2. Chronic infection
  3. IBD
  4. CA
  5. Vasculitis
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66
Q

Clinically, what picture makes you suspect Amyloidosis from a cardiac standpoint?-4

A
  1. Unexplained [Diastolic HF] with
  2. echo showing ⬆︎ Vt Wall thickness but normal L Vt Cavity dimensions and
  3. EKG showing low voltage
  4. Proteinuria

Amyloidosis causes Restrictive Cardiomyopathy

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67
Q

RBC 1/2 life

A

120 days

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68
Q

Common Causes of [Constrictive Pericarditis] - 4

Look for the pericardial knock!

A

‘Ur an Idiot to constrict my Radio & T-V”

Idiopathic

Radiation

TB

Viruses

This is a common cause of R HF

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69
Q

The CHA2DS2 VASc score is used to determine ⬜ risk in pts with ⬜

________________

Recite the Criteria

A

determines Thromboemobolism risk in pts with AFib

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70
Q

Afib Pts with CHA2DS2 VASc score ≥ 2 should be Rx managed with what?-2

A

[ASA + Warfarin] OR [ASA + NOAC]

________________

[NOAC = (apixiban,rivaroxaban,dabigatraban)]

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71
Q

Compartment Syndrome and Acute Arterial Occlusion share the same symptomotology

List the sx-6

A

The 6 P’s

Paresthesia-early sign

Pain

Pallor

Poikilothermia (cool to touch)

Paralysis

Pulseless-late sign

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72
Q

[Scleroderma renal crisis] Etx

________________

Sx-2

A

[⇪ Vascular permability] ➜

renin secretion ➜ [Malignant HTN Emergency]

________and________

activation of coagulation cascade ➜ DIC

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73
Q

High Output HF Etx

________________

5 major causes

A

excess blood volume ➜ VERY HIGH Cardiac Output > 70%

  1. Anemia-severe
  2. Hyperthyroidism
  3. Wet BeriBeri
  4. Paget Dz
  5. AV Fistulas

________________

normal Cardiac Output = 55-70%

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74
Q

In which type of HF is ejection fraction preserved

A

Diastolic HF

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75
Q

Causes of Pericarditis-7

image = pericardial effusion 2/2 Pericarditis

A

“Pericarditis gave HIM A UTI”

  • Infection-Viruses (Coxsackie/ echovirus/adenovirus)
  • Acute MI
  • Immune (Dressler vs SLE vs RA)
  • [HMLB CA] - (Hodgkin’s/Mesothelioma/Lung/Breast)
  • Trauma
  • Mediastinal Radiation
  • Uremia (BUN > 60) - TREAT WITH HEMODIALYSIS
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76
Q

What 3 maneuvers INCREASE intensity of Aortic Regurgitation

A

“AR your Hands & Breath [Leaning Forward] ?

  • with Hand Grip
  • when Breath is held after exhalation
  • with Patient leaning forward
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77
Q

Describe the following parameters during hypOvolemic shock:

A: Systemic Vascular Resistance

B: Cardiac Output

C: BP

A

A: Systemic Vascular Resistance = INC

B: Cardiac Output = DEC

C: BP = DEC

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78
Q

Primary PCI (PerCutaneous Intervention) for STEMMI should be administered when in order to restore coronary blood flow? - 3

A
  1. Within 12 Hours of sx onset

+

2A. within 90 min from first medical contact to device at PCI instituition OR

2B. within 120 min from first medical contact to device at NON-PCI instituite (allows transport time)

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79
Q

Biggest RF for Aortic Dissection

A

HTN

Marfan may also cause AD but happens in pts < 40 yo

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80
Q

Arrhythmia is a complication [30 min-4 Hrs] Post MI

List the 2 types of Arrhythmias, when they occur and Etx ;

Which is the most common cause of Sudden cardiac arrest?

A
  • [Immediate Phase 1A Vt Arrhythmia] occurs within 10 min post MI and caused by Reentrant Arrhythmias = MOST COMMON CAUSE OF SUDDEN CARDIAC ARREST
  • [Delayed Phase 1B Vt Arrhythmia] occurs 10-60 min post MI and caused by abnormal automaticity
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81
Q

Post MI evolution

4-12 hours

Complications

A

Arrhythmia

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82
Q

Post MI evolution

1-3 DAYS

Complications

A

[Fibrinous Pericarditis–> [sharp & pleuritic Chest Pain] + friction rub] (only with transmural infarcts)

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83
Q

Post MI evolution

3-7 DAYS

A: Complications (3)

B: Lab

A

Macrophage phagocytosis of dead debris –> weakens cardiac tissue

A: Cardiac Tissue Weakning (Vt Free Wall Rupture-ANTERIOR MI) / (papillary m. rupture-INFERIOR MI) / (interventricular septal rupture)

B: [CkMB] returns to Baseline at Day 3

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84
Q

Post MI evolution

7-10 Days

A: Complications

B: Lab

A

No Complications

B: [Trop I] returns to baseline

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85
Q

Post MI evolution

2 - 8 WEEKS

A: Gross Changes

B: Complications (3)

A

2 - 8 WEEKS

A: White Scar w/[Type 1 Dense Collagen]

B: Aneurysm / [Mural Thrombus] / Dressler’s

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86
Q

Describe the following parameters during hypOvolemic shock:

A: [Pulm Capillary Wedge pressure]

B: [Cardiac Index (Pump Function)]

A

A: [PCWP] = ⬇︎

B: Cardiac Index = ⬇︎

Cardiac Index (pump function) = Cardiac output➗Body Surface area

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87
Q

Define parameters for ISH (Isolated Systolic HTN)

________________

etx?

A

[Systolic > 140] but [Diastolic< 90]

________________

Stiffening of Arterials walls as we age –> inability to dampen systolic pressure –> [INC pulse wave velocity AND reflection during systole]

THIS SHOULD BE TREATED!

88
Q

7 common causes of Dilated Cardiomyopathy

A

“the PIG PAID for Dilated Cardiomyopathy”

  1. Post Viral Myocarditis (Coxsackie B)
  2. Alcohol related (direct toxicity vs. nutritional deficiency)
  3. [Doxorubicin & Daunarubicin Chemo] (dose-dependent)
  4. Peripartum (late in pregnancy vs 5 mo. post partum)
  5. Genetic (affects cytoskeleton)
  6. Iron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
  7. Idiopathic
    * DILATED IS MOST COMMON CARDIOMYOPATHY and CAN BE ACUTE*
89
Q

Name 6 major absolute ctx(contraindications) to Thrombolytic tx

A
  1. Bleeding
  2. Aortic Dissection
  3. Aneurysm
  4. Ischemic stroke within past 6 mo.
  5. Head trauma
  6. Bleeding DO (coagulation abnormality, thrombocytopenia)
90
Q

When should Men start QD ASA for cardiovascular px?
________________
When should Women?

A

Men = 45

________________

Women = 55

91
Q

What all labs should be ordered when concerned for Angina; and why?-6

A
  1. CBC: Anemia contributes to ischemia
  2. BMP: Electrolyte derangement
  3. BUN/Creatinine: Kidney Dz –> Heart Dz
  4. TSH: Hyperthyroidism –> ⬆︎O2 demand of heart
  5. Lipid Panel: Cardiac Risk
  6. ALT/AST: Obtain baseline before starting Statin
92
Q

Criteria for Metabolic Syndrome X -4

A

DIVe –> ASCVD

≥ 3 of the following:

Dyslipidemia (TAG>150 vs HDL<50)

Insulin resistance (Fasting Glucose >110)

Visceral Waist Obesity (Men>102 cm / Women>89 cm)

Hypertension (BP> 130/85)

93
Q

List the main Side Effects of HCTZ-6

A

​HyperGLUC & hypOKN

HYPERGLUC

Glucose

Lipid

Uric acid ➜ gout

Ca+

________and________

hypOKN

k+

[na+ ➜ dehydration

94
Q

6 major causes of Syncope

A

MVC BSD

  1. ⬇︎ Cardiac Output (Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)
  2. Bradyarrhythmia (SA Node dysfunction/AV Block)
  3. VAN - Vasovagal Autonomic Neurocardiogenic
  4. Dehydration
  5. Stroke
  6. Metabolic (⬇︎Glucose vs ⬇︎Na+)

OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!

95
Q

5 major causes of Atrial Fibrillation
________________
which 3 are most common?

A
  1. HTN (1st most common)
  2. CAD (2nd most common)
  3. Valvular dz (3rd most common)
  4. Cardiomyopathy
  5. Hyperthyroidism
96
Q

[HOCM - HyperObstructive CardioMyopathy] MOD-2

A

[Beta myosin heavy-chain mutation] –> Defective cardiosarcomeres–> [Hypertrophied myocytes that are haphazardly arranged]

+

Abnormal [ANT motion of (ANT leaflet mitral valve) toward [Hypertrophied interventricular septum]

97
Q

Major causes of [⬇︎ Cardiac Output]-7

A
  1. Valvular Dz
  2. HOCM
  3. Pulm HTN
  4. PE
  5. Tamponade
  6. myxoma
  7. aFib

⬇︎ Cardiac Output can –> Syncope

98
Q

Nausea, Sweating and Dizziness are preceding sx for what type of syncope?

A

[VAN - Vasovagal Autonomic Neurocardiogenic] only

99
Q

Lactate normal range

A

< 1.7

100
Q

EKG manifestations of hypOcalcemia-2

A

[Prolonged QT] and [shortened PR]

101
Q

Ruptured Popliteal Cyst MOD

A

Popliteal cyst…pops –>fluid extends DISTALLY into POST calf m. –>calf swelling that mimics DVT

Doesn’t involve thigh swelling

102
Q

At what times should Troponin be drawn in pt coming in with cp-3?

A

Now;

And if Now is normal –> 6 hours later; 12 hours later

103
Q

After HF diagnosis, Pt’s functional capacity and volue status should be assessed

________________

How do you do this?

A

NY Heart Association Functional Classification

SYMPTOMS OCCUR :

Class 1: NEVER (No symptoms)

Class 2: with Ordinary Activity

Class 3: with [Less than Ordinary Activity]

Class 4: WITH MINIMAL ACTIVITY

104
Q

How are NSAIDs associated with HF?

A

NSAIDs exacerbate CHF BADLY - it precipitates acute on chronic CHF

105
Q

Name precipitants of Acute on Chronic CHF -8

A
  1. NSAIDs / AKI
  2. [Ischemia / Arrhythmias]
  3. Infection
  4. HTN
  5. PE
  6. Anemia
  7. Thyrotoxicosis
  8. Noncompliance
106
Q

What is the Staging for HF -4

A
  • Stage A: High Risk for HF but no structural dz
  • Stage B: Structural Dz but no sx
  • Stage C: Structural Dz WITH sx
  • Stage D: End-Stage Dz requiring specialized tx
107
Q

What is the W.H.O. definition of MI?

A

2 out of 3

EKG changes

Troponin changes

Story

108
Q

When is a post MI pt a candidate for ICD (Implantable Cardioverter Defibrillator)?

________________

Caveat?

A

[EF < 35% post MI]

________________

BUT must wait 40 days after MI

EF = most important prognostic value for pts post MI!!

109
Q

Serum Osmolality Formula and normal range; What does it mean when measured doesn’t = calculated

A

Range = (280 -295); When measured is diff than calculated = something in serum is ⬆︎osmolality (ethanol, PEG)

110
Q

What controls Ventricular rate in afib pts?

A

AV node refractory period controls Vt rate, since SA node is dysfunctional and multile foci in atria are firing

111
Q

List the treatment options for UnStable Afib -3

A

100J CARDIOVERSION

________(unless duration ≥48h) ________ ➜

[Clots on Echo?] ➜

No = [Heparin ➜ 100J Cardioversion STAT]

YES = [Warfarin x 3 wks ➜ Cardioversion when Warfarin therapeutic]

112
Q

In Afib pt, when can you NO LONGER cardiovert?

A

> 2 Days after onset

113
Q

List the 4 treatment options for Stable Afib

A

1ST: BBlockers ( [Metoprolol 10 mg start] v [Esmolol])

________________

2nd: CCB ( [Diltiazem] [0.25 mg/kg bolus] ➜ [0.35 mg/kg DRIP] over 20 min)

________________

3rd: [Amiodarone + Cardio consult]

________________

4th: [digoxin + Cardio consult]

114
Q

Criteria for Lone Atrial Fibrillation-3

________________

tx-2

A

Lone AF (CHA2DS2 VASc of 0) =

  1. <60 yo
  2. no HTN
  3. no Heart Dz = low stroke risk

________________

tx = ASA vs nothing

115
Q

[Direct Current Cardioversion] is 97% successful at restorying atrial NSR

Why is is DC Cardioversion still risky?

A

Most thrombi embolize after [Atrial DC Cardioversion]

116
Q

Absolute CTX for [DC Cardioversion] in aFib -3

A
  1. hypOkalemia
  2. Digitalis Toxicity
  3. > 2 Days after aFib onset
117
Q

Mngmt for [Post-CABG related Afib] -3

A

This type of Afib is common

  1. resolves spontaneously if rate is controlled (Beta Blockers vs Diltiazem in HDS)
  2. Amiodarone in HDS
  3. DC Conversion if Hemodynamically UNSTABLE
118
Q

AV node ablation is most effective for which type of Afib (chronic vs paroxysmal)

A

Paroxysmal

119
Q

Describe Grading System for Heart Murmurs -6

A

F A L T O E

using stethoscope…

1- Faint

2-Audible

3-LOUD

4-[THRILL & LOUD]

5-[Off chest partially murmur heard]

6- [ENTIRELY OFF CHEST MURMUR HEARD]

120
Q

Common Causes of Chest Pain are usually CPGMY

Describe the Cardiac Causes -6

A

CRGMP

  1. ACS (Unstable,Stable,Prinzmetal Vasospastic, MI)
  2. Cocaine
  3. Pericarditis
  4. Aortic Dissection
  5. Valvular
  6. Non-ischemic Cardiomyopathy

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

121
Q

Common Causes of Chest Pain are usually CPGMY

Describe the Pulmonary Causes -5

A

CPGMY

  1. PE
  2. PNA
  3. Pleurisy
  4. PTX
  5. Pulm HTN/Cor Pulmonale

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

122
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Gastrointestinal Causes -5

A

CRGMP

  1. GERD
  2. PUD
  3. Esophageal (dysmotility, inflammation)
  4. Pancreatitis
  5. Biliary (cholecystitis, cholangiits)

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

123
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Musculoskeletal Causes -5

A

CRGMP

  1. Costochondritis
  2. Rib Fracture
  3. Muscular strain
  4. Herpes Zoster
  5. Myofascial syndrome

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

124
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Psych Causes -3

A

CRGMP

  1. Panic DO
  2. Hyperventilation
  3. Somatoform DO

CRGMP= Cardiac/Respiratory/GI/Msk/ Psych

125
Q

Pt with suspected Claudication 2° to [Peripheral Artery Disease]

Dx test? Describe the test

A

ABI (Ankle Brachial Index) = inexpensive/noninvasive measurement of systolic BP Ankle:Brachial

[Peripheral Artery Dz] < [0.90 - 1.3] < [Calcified Vessels]

Alternative is Arterial Duplex US but this is less specific & sensitive

126
Q

What are triggers of VAN (Vasovagal Autonomic Neurocardiogenic) Syncope? -6

A
  1. Pain
  2. Emotional distress
  3. Prolonged Standing
  4. Defecation
  5. Micturition
  6. Coughing

VAN Syncope is preceded by nausea, sweating and dizziness

127
Q

Seizures and Syncope are difficult to differentiate

Name features that help differentiate Seizures from Syncope - 3

A

Seizures has…

  1. Postictal confusion & lethargy
  2. Triggered by flashing lights
  3. Tongue laceration

beware: Clonic jerks can occur during syncope associated w/cerebral hypoxia!!

128
Q

Name the 7 most common manifestations of Marfan Syndrome

etx = mutation of fibrillin 1 gene

A

“Marfan BAATHES a lot! “

  1. Ectopia Lentis
  2. Arm-to-Height Ratio ⬆︎
  3. Heart issues (MVP or [idiopathic Aortic cystic medial degeneration]–> Aortic Dissection and Aneurysm)
  4. Scoliosis vs. Kyphosis
  5. Breastbone structural abnormalities
  6. Arachnodactyly (Steinberg thumb & wrist)
  7. Tall / slender / flat feet

etx = mutation of fibrillin 1 gene

129
Q

Which 2 bedside maneuvers ⬆︎ Intensity of the HOCM mumur?

A

“Val [Stood Up] to Hulk HOCM, the MVP, which ⬆︎ his anxiety intensity”

Valsalva

[Standing Up]

(both ⬇︎ Preload AND Afterload)

130
Q

EKG findings of hypOkalemia - 4

A
  1. ST Depression
  2. Broad Flat T waves
  3. U wave
  4. PVC
131
Q

In respects to old age, what causes Orthostatic hypOtension?-4

A

insufficient constriction of capacitance blood vessels in LE due to

  1. DEC Baroreceptor sensitivity
  2. Arterial stiffness
  3. DEC NorEpi for sympathetics
  4. DEC myocardium to sympathetic stimulation
132
Q

Which demographics typically have Atypical Angina? -3

A
  1. Diabetics
  2. Women
  3. Elderly
133
Q

In addition to smoking, being male, obesity and many others…age > ___ years old is a risk factor for CAD

A

>55 yo

134
Q

Some pts present with SOB as the only sx of cardiac ischemia

What is this called?!

A

Anginal Equivalent

Example of Atypical Angina

135
Q

A complication of Post MI evolution, 3-7 days is Cardiac Tissue Weakning

How can you differentiate Vt Free Wall Rupture vs Papillary muscle rupture vs Interventricular septal rupture?

A

Macrophage phagocytosis of dead debris –> weakens cardiac tissue

  1. Vt Free Wall Rupture = occurs with ANTERIOR MI (
  2. papillary m. rupture= occurs with INFERIOR MI and has systolic murmur @ apex
  3. interventricular septal rupture = systolic murmur @ 2nd/3rd L ICS
136
Q

Why are pregnant patients with mitral stenosis at ⬆︎risk of having exacerbations?

A

⬆︎HR and blood volume –> ⬆︎transmitral gradient and L atrial pressure which can –> aFib

137
Q

When does Peripartum Dilated Cardiomyopathy onset?

________________

What type of sx would you expect?

A

> 36 WG

________________

Systolic HF sx (SOB, pedal edema)

138
Q

Primary Hyperparathyroidism is a rare cause of HTN

What does it mean if you have SEVERE HTN with Primary Hyperparathyroidism

A

Consider Multiple Endocrine Neoplasia 2A - pheochromocytoma

139
Q

Features of Supraventricular Tachycardia on EKG - 4

________________

Tx-2?

A
  1. Narrow and small QRS
  2. tachycardia
  3. P waves are “buried” within QRS
  4. Possibly: Retrograde P waves possibly appearing as spikes at beginning/end of QRS or as inverted P waves

________________

tx = [Adenosine IV] vs [Vagal maneuvers]–>slows/terminates AV node conduction

140
Q

etx of Aortic Coarctation

A

Tunica Media thickening near junction of [ductus arteriosus] and [aortic arch]

141
Q

Common s/s of Mitral Stenosis - 5

A

[Delayed Rumbling Diastolic murmur that follows an Opening Snap]

  1. Progressive SOB (exercise intolerance/fatigue)
  2. Orthopnea
  3. Hemoptysis
  4. Dry Cough
  5. aFib can–>stroke
142
Q

CP of Wolff Parkinson White Syndrome - 2

A
  1. most are asx!
  2. Delta wave (UpSlurring R wave) on EKG!

tx = Procainamide or cardioversion if afib develops

143
Q

Endocardial Cusion Defects are associated with what syndrome?

________________

Describe this defect

A

[Down Syndrome trisomy 21]

________________

CAVSD (Complete AtrioVentricular Septal Defect)–> VSD murmur + Systolic Ejection murmur

144
Q

What are cardiac abnormalities are associated with Williams Syndrome? - 3

A
  1. Aortic Stenosis
  2. Pulmonic Stenosis
  3. Septal Defects
145
Q

Describe S3 gallop. What is it associated with? - 3

A

A: [low-frequency sound JUST after S2]

B: Associated with:

  1. Dilated Vt 2/2 L Systolic HF in pt>40 yo
  2. Dilated Vt 2/2 Mitral Regurgitation–>⬆︎Vt filling rate in pt>40 yo
  3. Normal in [Athletes/Preggos/Pt<40 yo] :-)
146
Q

Auscultation Site for S3 gallop (3)

A

[Apex + (LLDP) + (End Exhalation)]

End Exhalation brings heart closer to chest wall

147
Q

Best indicator for severity of valve Regurgitation?

A

Presence of an additional S3 (indicates Vt Dilitation in addition to regurgitaiton)

148
Q

Aortic Regurgitation

Mumur

A

[Early Diastolic Descrescendo Murmur-High Pitched Blowing noise] auscultated @ [L Sternal 2nd/3rd ICS]

149
Q

Which murmurs are heard at the [L Sternal 2nd/3rd ICS] ? (3)

A
  1. Aortic Regurgitation
  2. Pulmonic Regurgitation
  3. (HOCM) Hypertrophic Cardiomyopathy
150
Q

3 Main Causes of Aortic Regurgitation

A
  • [Aortic Root Dilitation]
  • [Bicuspid Aortic Valve]
  • Endocarditis (i.e. Rheumatic Fever)
151
Q

You hear a Midsystolic murmur in otherwise young, asx adult

Next step?

A

NOTHING!

These are usually benign in young adults and do NOT require further w/u. Diastolic and Continuous should be worked up

152
Q

Why do Class 1C and Class 4 antiarrhythmics work differently in faster heart rates? What is this phenomenon called?

A

drug has less time to dissociate from Na+ chanels –> ⬆︎Blocked Na+ channels–>QRS Widening = Use Dependence

This is why Class 1C is effective against SVT arrhythmias

153
Q

Pathogensis of Aortic Aneurysm

A

[Chronic Transmural Inflammation] of Aortic wall —> [Loss of Elastin and Smooth Muscle] –> [Abnormal Collagen remodeling] –> [progressive Weakening of Aorta] –> Wall Expansion

[Chronic Transmural Inflammation] can come from Atherosclerosis but ⬆︎ risk of rupture comes from smoking!

154
Q

What are the risk factors for AAA?-5

________________

Which RF is most likely to –> aneurysm expansion and rupture?

A
  1. SMOKING which –> AAA RUPTURE!(along with large diameter & expansion rate)
  2. Atherosclerosis
  3. Age > 65
  4. White race
  5. Fam hx of AAA
155
Q

Name 3 EKG Signs of [Atrial Fibrillation]

A

“PIN aFib on an EKG your 1st Try!”

  1. [P wave absent or low amp fibrillation]
  2. [Irregularly irregular R-R intervals (an already irregular R-R interval occurs at an irregular pace also 2/2 atrial electricity chaos)]
  3. [Narrow QRS complex]
156
Q

[Atrial Fibrillation] is the most common tachyarrhythmia
_______________

It is often precipitated by what 4 things?

A

“Smh, SAME Afib as before!”

  1. Acute Systemic Illness (Hyperthyroid / HF / HTN)
  2. Sympathetic Tone ⬆︎
  3. EtOH - excess
  4. Mitral Stenosis
157
Q

When is Transcutaneous pacing used? - 2

A
  1. Symptomatic bradycardia
  2. Complete Heart Block
158
Q

3 classic Clinical Manifestations of [Tetralogy of Fallot]

A

A:

  1. [Systolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [RVOO -R Vt Outflow Obstruction]
  2. Squatting relieves sx (INC afterload–> [DEC amount of R to L shunt]
  3. [Cyanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)

“VOIR is to have See + Sight & Cry”

159
Q

4 anatomic abnormalities associated with [Tetralogy of Fallot]

A

VOIR

(Vt Septal Defect / Overriding Aorta / [Infundibular Pulmonary Stenosis] / [R Vt Hypertrophy with [R –> L shunt] = Boot shaped on CXR ]

“VOIR is to have See + Sight & Cry”

160
Q

List the associated cardiac pathology which each inherited disorder

A: Down Syndrome

B: DiGeorge Syndrome (2)

C: Friedreich’s Ataxia

D: Marfan Syndrome

E: Tuberous Sclerosis

F: Turner’s Syndrome (2)

G: Edwards Syndrome

A

A: “Put the cusions Down” = [Endocardial Cusion CAVSD]

B: [Tetralogy of Fallot] + [Truncus Arteriosus]

C: Hypertrophic Cardiomyopathy (“sweet, big heart”)

D: [Aortic Cystic Medial Dengeration]

E: [Cardiac Rhabdomyomas —> Valvular Obstruction]

F: [Aortic CoArctation] vs. [Biscuspid Aortic Valve]

G: VSD

CAVSD = Complete AtrioVentricular Septal Defect

161
Q

CP of CAVSD (Complete AtrioVentricular Septal Defect)-3 ; When does this present? Demographic?

A
  1. Holosystolic murmur from VSD
  2. Systolic Ejection murmur from ASD
  3. Loud S2 from Pulm HTN

Presents by 6 weeks old

Down Syndrome pts

162
Q

How does [____Stenosis] determine the degree of severity in [Tetrology of Fallot]

A

Degree of [Infundibular Pulmonary Stenosis] determines degree of symptoms since [INC stenosis] –> [INC R–>L Vt Shunt] –> INC [Cyanotic Tet Spells]

“VOIR is to have See + Sight + Cry”

163
Q

1 of the manifestations of Tetralogy of Fallot is Cyanotic lethal Tet Spells

What causes this? ; Tx?-2

A

Sudden spasm of R Vt Outflow during exertion –> Worsening RVOO –> Louder Systolic Ejection HARSH Murmur @ 2/3 LICS & cyanosis

(tx: Knee chest positioning + inhaled O2)

“VOIR is to have See + Sight & Cry”

RVOO = R Vt Outflow Obstruction

164
Q

In cardio world, what is Lidocaine’s indication?

A

Vt Arrhythmias in HDS pts

165
Q

Why is it relatively contraindicated for a HTN pts to take ORAL Contreceptive Pills?

A

OCP –>⬆︎Hepatic Angiotensinogen –> Mild (sometimes severe) ⬆︎ BP

⬆︎Risk in pts who develop HTN during pregnancy or family hx

166
Q

[Tachycardia-mediated LV HF] etx? ; Tx-2?

A

Persistent/Recurrent Tachyarrhythmia (chronic aFib w/RVR) –> [Tachycardia-mediated LV HF];

1st: Rate or Rhythm control

Alt: Coronary Artery Revascularization if vessels occluded

167
Q

What is a clinical predictor of how bad CHF pts are doing?

A

degree of hypOnatremia

168
Q

Afib Pts with CHA2DS2 VASc score of 1 should be Rx managed with what?-2

A

ASA only OR NOAC only

[NOAC = (apixiban,rivaroxaban,dabigatraban)]

169
Q

In HF pts, what process causes the ⬆︎ in SVR?

A

⬇︎Renal A. perfusion –> Release of NorEpi, Renin, ADH –> ⬆︎ SVR and maintainence of BP to vital organs

170
Q

Age group for Senile Calcific Aortic Stenosis

A

> 70 yo (comes from valvular calcification)

171
Q

SE of Niacin-2 ; etx ; tx

A
  1. Cutaneous Flushing
  2. pruritus

Prostaglandin-induced peripheral vasoDilation

tx = Take [ASA 81] 30 min before Niacin

172
Q

atrial flutter etx

A

ReEntry Circuit around tricuspid annulus

173
Q

What amount of EtOH provides coronary heart disease protection in Men? what about Women?

A

Men: 1-2 drinks/day

Women: Only 1 drink/day

> 2 drinks/day can –> HTN

174
Q

Tricuspid valve atresia etx

A

infant with CHD family hx has no formation of Tricuspid valve –> hypoplastic Pulmonary Artery and R Vt –> Left Axis Deviation and ⬇︎CXR Pulmonary markings

175
Q

Ebstein’s anomaly etx

A

Maternal lithium use during [1st trimester pregnancy] –> malformation and displacement of tricuspid valve into R Vt –> Tricuspid Regurgitation –> R Atrial Enlargement and R Axis deviation –> HEART FAILURE

176
Q

In what all situations do you hear an S4? - 2

A
  1. Hypertrophied Ventricle (HTN, Aortic Stenosis, HOCM)
  2. ACUTE Phase of MI (ischemia –> Vt stiffening)
177
Q

Prinzmetal Vasospastic Angina etx ; When do these typically occur?

A

Hyperreactivity of Coronary A. Tunica Intima muscle –> [less than 15 min vasospasm] ; During Sleep

178
Q

Prinzmetal Vasospastic angina tx ; Biggest risk factor?

A

CCB (Diltiazem vs Amlodipine vs Felodipine) ; Smoking

179
Q

Cilostazol MOA-2 ; Indication

A

Phosphodiesterase 3 inhibitor –>

  1. Arterial VasoDilation
  2. ⬇︎Platelet Aggregation

LE Claudication

180
Q

Main causes of Secondary HTN - 12

A
  1. Renal Parenchymal Disease (⬆︎creatinine)
  2. Renal artery stenosis (Systolic > 180, Abd bruit, >55 yo)
  3. Primary Aldosteronism
  4. Pheochromocytoma (HA, diaphoresis, palpitations)
  5. Cushing Syndrome
  6. OSA
  7. hypOthyroidism
  8. Primary HyperParathyroidism
  9. Coarctation of Aorta
  10. Excess EtOH > 2 drinks/day
  11. Stress (via release of NorEpi & Angiotensin 2)
  12. Meds (OCP/Decongestants/NSAIDs/steroids)
181
Q

List the common causes of Restrictive Cardiomyopathy (8)

A

RAMILIES

  1. Radiation Fibrosis
  2. Amyloidosis (heterogenous misfolded proteins)
  3. Sarcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
  4. Metastatic Tumor
  5. Inborn metabolism errors
  6. Endomyocardial fibrosis= Common in [African/Tropic children]
  7. [Loeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
  8. Idiopathic
182
Q

Range for QT

A

250 - 440 (or 460 in Females)

183
Q

What are the electrolytes that cause Prolonged QT when deranged? - 3

A

MKC holds it together

184
Q

What are the Medication-induced causes of Prolonged QT? - 5

A

MKC holds it together

185
Q

What are the inherited causes of Prolonged QT? - 2

A

MKC holds it together

186
Q

What’s the best initial tx for R Vt infarction? Why?

A

Multiple fluid boluses ; R Vt infarction are preload dependent

187
Q

What’s the best way to differentiate cardiac tamponade from cardiogenic shock?

A

Cardiac tamponade will have Equalization of intracardiac diastolic pressures (RA, RV and pulm capillary wedge)

Tx = percardiocentesis

188
Q

What are the major causes of arterial emboli?-3 ; Which type of MI predisposes to these emboli?

A
  1. LV cardiac thrombous (GET ECHO!)
  2. LA atrial fibrilattion thrombous (GET ECHO!)
  3. Aortic Atherosclerosis

Large Anterior STEMMIs

189
Q

Tx for Premature Atrial Complexes? ; What are the precipitants of PACs?-4

A

NOTHING unless sx and/or SVT is present

  1. tobacco
  2. EtOh
  3. caffeine
  4. Stress
190
Q

Describe the murmur for VSD- 2

A
  1. Holocystolic murmur at Tricuspid area
  2. Apical Diastolic rumble from ⬆︎ flow acrossed mitral valve when Eisenmenger syndrome occurs

These can cause Failure to Thrive, DOE and HF

191
Q

Why does Squatting ⬇︎ the sound of MVP?

A

Squatting ⬆︎Venous return –> ⬆︎Preload. More preload means it’ll take longer before tendinae and mitra valve lips close –> delays mid-systolic click and shortens the time between it and S2

192
Q

Identify Rhythm

A

aFib with RVR

Tx = Rate control

DONT CONFUSE WITH SVT!

193
Q

Describe how to perform Hepatojugular reflex testing? ; What does a positive result indicate?-3

A

Apply R upper abd pressure for 10 seconds and watch for JVP to increase > 3 cm

  1. R Vt infarction
  2. Constrictive pericarditis (think TB)
  3. Restrictive cardiomyopathy
194
Q

What is the normal Jugular Venous Pressure?

A

6-8 cm H20

195
Q

3 Common signs of CONSTRICTIVE Pericarditis

Ur an idiot to constrict my radio and T-V

A
  1. Pericardial Knock= Sharp sound heard in early diastole
  2. Kussmaul Sign= Paradoxic [⬆︎ JVP during inspiration] since constricted R Vt can accomdate the INC blood
  3. Pulsus Paradoxus
196
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

long standing mitral stenosis –> L atrial enlargement –> L mainstem bronchus elevation or recurrent laryngeal n compression

197
Q

You hear a mumur in a patient

What are the features that indicate it is benign? - 8

A
198
Q

What are the substrates of CYP450 - 4

A

CYP450 Breaks these compounds APART

199
Q

What are the inhibitors of CYP450 - 13

A

AAA RACKSS IN GQ Magazine

  1. Acute alcohol use
  2. Amiodarone
  3. APAP
  4. Ritonavir
  5. Abx (metronidazole)
  6. Cimetidine
  7. Ketoconazole
  8. Sulfonamides
  9. SSRI
  10. INH
  11. NSAIDs
  12. Grapefruit and Cranberry
  13. Macrolides
200
Q

Why should you work up patients with R HF sx who’ve just had an AICD placed?

A

Transvenous lead placement through tricuspid valve can –> tricuspid regurgitation due to leaflet damage

201
Q

What is the most common cause of Chronic Mitral Regurgitation?

A

Mitral Valve Prolapse (myxomatous degeneration of valve)

“He was MVP…OF COURSE he had a Mid Clique to hang with”

[MidSystolic Click –> Late Systolic Crescendo Mumur] @ Apex

Sound Caused by Tendinae tightening and lips of the valve closing AFTER the preload has been ejected

202
Q

what type of EKG would indicate a Right Ventricular Infarction? - 2

A
  1. Inferior STEMMI + V1 STEMI or
  2. V4R STEMMI
203
Q

what type of EKG would indicate a Posterior Ventricular Infarction?

A

V1 reciprocal changes (ST Depression , Tall R)

204
Q

What’s the most non-pharmalogical way to ⬇︎BP

A

Weight Loss (lifestyle modification like DASH and exercise)

205
Q

What percentage of pts with Peripheral Artery Disease end up requiring limb amputation?

A

20%

[Peripheral Artery Dz] < [0.90 - 1.3] < [Calcified Vessels]

Alternative is Arterial Duplex US but this is less specific & sensitive

206
Q

How does Amiodarone interact with Digoxin?

A

Amiodarone ⬆︎serum Digoxin –> toxicity

207
Q

Which pts should be started on statin therapy?

A

pts with 10 year risk of atherosclerotic CVD≥7.5% per the American College of Cardiology tool

208
Q

Side effects of Digoxin - 3

A
  1. Vision changes
  2. NVD
  3. atrial tachycardia with heart block
209
Q

Marfan Syndrome and Ehlers Danlos can present similarly

How do you discern the two?-2 ; What is the etx for Ehlers Danlos?

A

“Marfan BAATHES a lot! “

BUT Ehlers Danlos does NOT have

  1. Ectopia Lentis
  2. Arm-to-Height Ratio that’s INC

Ehlers Danlos etx = defective collagen production

210
Q

Tx for Stable SVT - 2

A
211
Q

Tx for Unstable SVT

A
212
Q

Tx for Stable Ventricular Tachycardia

A
213
Q

Tx for Unstable Ventricular Tachycardia - 2

A
214
Q

Tx for Torsades De Pointe Polymorphic Ventricular Tachycardia - 2

A
215
Q

MOA for Statins?

A

intracellular HmG-CoA reductase inhibitor which –> ⬇︎conversion of HmGCoA to mevalonic acid

216
Q

What are the main features of an innocent mumur - 3

A
  1. Grade 1 or 2
  2. ⬇︎ with standing
  3. early or mid-systolic
217
Q

How should Hypertriglyceridemia be managed?

A

[2a] A ⼀ Step 2 OD USLME (21 decks)

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