Cardiology Flashcards
ST depressions…
Signs of ischemia
Q waves on leads II, III, aVF
Inferior wall infarct
ECG shows diffuse ST segment elevation, with chest pain relieved by sitting forward
Pericarditis
Most common cause of pericarditis?
Coxsackievirus
Features of unstable angina.
- prolonged chest pain that presents at rest, does not respond to nitroglycerin
- ECG changes (ST depression)
- minimally elevated cardiac enzymes
Treatment of Prinzmetal angina.
Calcium channel blockers
Features of Prinzmetal angina.
- chest pain at rest
- ST-segment elevations on ECG
- Cardiac enzymes are normal
Treatment of achalasia.
pneumatic dilatation or botulism toxin administration
Mitral stenosis murmur characteristics.
Late diastolic blowing murmur (best heard at the apex), with an opening snap.
Aortic stenosis murmur characteristics.
Crescendo - decrescendo systolic ejection murmur
- slow pulse upstroke
- radiates to carotids
- leads to syncope, angina, dyspnea on exertion
Aortic regurgitation murmur characteristics.
Early diastolic decrescendo murmur
- widened pulse pressure
- LVH, LV dilatation
Mitral prolapse murmur characteristics.
Midsystolic click, late systolic murmur
Most common etiology of mitral stenosis.
Rheumatic fever.
Etiologies for Aortic stenosis.
age-related calcification or early onset calcification from bicuspid aortic valve
Etiologies for Aortic regurgitation.
Congenital Rheumatic damage
Endocarditis
Aortic dissection/aortic root dilatation
Marfan syndrome
Virchow’s triad.
Endothelial damage
Venous stasis
Hyper-coagulable state
Homan sign.
Dorsiflexion sign for DVT
Trousseau sign.
Migratory superficial thrombophlebitis, classic marker for pancreatic cancer.
How are the effects of ASA, heparin and warfarin monitored?
Heparin -> PTT
Warfarin -> PT
ASA -> bleeding time
Reversal agent for Heparin and LMW heparin.
Protamine.
Causes for vitamin K deficiency.
- Neonate who did not receive prophylactic vit K
- Malabsorption
- Alcoholism
- Prolonged antibiotic used (kills vit K producing bowel flora)
Cause of cor pulmonale in young woman with no other medical history or risk factors.
Idiopathic pulmonary arterial hypertension.
Treatment for Idiopathic pulmonary arterial hypertension.
Parenteral epoprostenol (prostacyclin) Antiendothilin (bosentan) Heart-lung transplant
Most common kind of cardiomyopathy.
Dilated cardiomyopathy.
Etiologies of dilated cardiomyopathy.
Alcohol abuse Wet Beriberi Coxsackie B virus myocarditis Chronic cocaine use Chagas disease Doxorubicin toxicity Hemochromatosis Sarcoidosis Peripartum cardiomyopathy
What endocrine disorder causes atrial fibrillation?
Hypothyroidism.
Triad for WPW.
- Wide QRS complex
- Short PR interval
- Delta waves
In fetal circulation, highest oxygen content found in:
Umbilical vein (brings blood from mother to baby)
In fetal circulation, lowest oxygen content found in:
Umbilical arteries (brings blood away from baby and back to mom)
“2 measurement rule” of HTN:
BP should be measured 2 times on each of 2 separate office visits before the diagnosis and pharmacologic treatment of HTN
Medications to improve mortality in congestive heart failure:
- ACEI - dose-dependent (limit ventricular remodeling and reduced progression)
- Beta blockers (reduce risk of sudden death/arrhythmia/remodeling)
- ARBS
- Spironolactone (improves survival for Class 3 and 4)
Diabetes and ACEIs
ACE inhibitors reduce progression of nephropathy and neuropathy
Which drugs are used for pregnant woman with HTN?
Labetolol
Hydralazine
alpha-Methyldopa
(Mg2+ sulfate also lowers BP in Preclampsia)
HTN urgency
Severe HTN, SBP >180, DBP >120 WITHOUT sxs.
HTN emergency
1) Malignant HTN: HTN urgency + retinal hemorrhages, exudates or papilledema, or evidence of End-organ-damage
2) HTN encephalopathy: HTN urgency + cerebral edema & non-focal neuro sxs
Tx: IV nitroprusside
Secondary HTN in a young man… most likely cause?
Excessive alcohol intake
Secondary HTN in a young woman… most likely cause?
Birth control pills or renal artery stenosis from Fibromuscular dysplasia (p/w bruit and should be treated with balloon angioplasty)
Screening test for pheochromocytoma:
24-hr urine collection to assess catecholamine products, metephrines, vanillylmandelic acid, homovanillic acid
Older patient with renal artery stenosis, most likely 2/2?
Atherosclerosis
DO NOT give them ACEIs since it precipitates them to acute renal failure
Conn syndrome + HTN
Aldosterone-secreting adrenal neoplasm
Labs: high aldosterone, low renin, hypernatremia, hypokalemia, metabolic alkalosis
Screening test for Conn syndrome (Hyperaldosteronism)?
Plasma aldosterone to Plasma renin activity ratio; ratio greater >30 is indicative of primary hyperaldosteronism
Leriche syndrome
Combination of claudication of buttocks, buttock atrophy, and impotence in men cause by aortoilliac occlusive disease, requiring aortoiliac bypass graft
Management of claudication?
Conservative FIRST cessation of smoking, exercise (develops collateral circulation), weight loss, good control of cholesterol, diabetes and HTN, ASA (or clopidogrel if can’t tolerate ASA)
Features of chronic mesenteric ischemia
Postprandial abdominal pain
Fear of food w/ weight loss
Extensive h/o of atherosclerotic disease
Abdominal bruit
Heme-occult-positive stool
LACK OF JAUNDICE (r/o pancreatic cancer)
CT abdomen is NEGATIVE (raising suspicion for ischemia)
Dx: Angiography of superior mesenteric artery
Features of venous insufficiency
- Deep vein thrombosis
- Varicose veins
- Swelling in the extremity with pain, fatigability or heaviness
- Increased skin pigmentation around the ankles with possible skin breakdown and ulceration
Superficial thrombophlebitis
Pt has a h/o varicose veins, c/o localized leg pain with superficial cordlike induration, reddish discoloration and mild fever.
- NOT A RISK FACTOR for PE
- NO NEED for anticoagulation
Tx: conservative with NSAIDs and warm compresses
Subclavian steal syndrome
Caused by left subclavian artery obstruction proximal to the vertebral artery, particularly when exercising their upper extremity t/f p/w:
-CNS sxs (syncope, vertigo, confusion, ataxia, dysarthria) 2/2 blood being stolen from vertebrobasilar system
-Upper extremity claudication during exercise
Tx: surgical bypass
Thoracic outlet syndrome
Caused by obstruction of nerves or blood vessels that serve the arm as the neurvascular bundle passes from the thoracocervical region to the axilla by CERVICAL RIBS or MUSCULAR HYPERTROPHY (classic is young male weight lifters). P/w:
- Upper extremity paresthesia (nerve impingement)
- Weakness
- Cold extremities (arterial compromise)
- Edema and or venous distention (venous compromise)
