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Master the Boards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

systolic murmur that is heard in apex, radiates to axilla and increases with grip maneuver and decreases with valsalva

A

mitral regurgitation

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2
Q

sounds heard with acute mitral regurg

A

soft decrescendo systolic murmur
decreased S1
presence of S4

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3
Q

four MCC of acute heart failure

A

papillary muscle rupture
infective endocarditis
rupture of chordae tendinae
chest wall trauma with compromise of valvular apparatus

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4
Q

CF in Ehlers Danlos

A 
pes planus
scoliosis
thin, velvety, fragile skin (cigarette paper)
easy bruisability
past hx of hernias and MVP
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5
Q

cocaine related chest pain - tx.

A

tx early with BDZs

-avoid beta blockers (to avoid causing coronary vasospasm)

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6
Q

Tx. persistent HTN after cocaine use

A

phentolamine

- also decreases coronary vasospasm
alt. nitroglycerin, nitroprusside

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7
Q

valve dz in an immigrant or a pregnant person

A

mitral stenosis

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8
Q

valve dz in Turner’s syndrome pt with coarctation of the aorta

A

bicuspid aortic valve

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9
Q

valve dz in pt presenting with palpitations, atypical chest pain not with exertion

A

MVP

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10
Q

systolic murmurs

A

AS
MVP
MR
HOCM

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11
Q

diastolic murmurs

A

AR

MS

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12
Q

all right sided murmurs increase in intensity with…

A

inhalation

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13
Q

all left sided murmurs increase in intensity with…

A

exhalation

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14
Q

effect of squatting and lifting legs in the air on heart

A

return blood to heart therefore, increase venous return to the heart

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15
Q

effect of Valsalve maneuver and standing up on the heart….

A

decrease venous return to the heart

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16
Q

which murmurs get louder with squatting and leg raise

A

all right sided murmurs

AS, AR, MS, MR

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17
Q

which murmurs get softer with squatting and leg raise

A

MVP
HOCM
- these murmurs INCREASE with valsalva

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18
Q

which murmurs increase in loudness with valsalva/standing

A

HOCM

MVP

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19
Q

Effect of handgrip on heart and which murmurs does it make louder?

A
  1. increases afterload
  2. Worsens VSD, AR and MR murmur
  3. Improves/softens MVP and HOCM
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20
Q

effect of amyl nitrate on heart and murmurs

A
  1. decreases afterload
  2. softens, AR and MR
  3. worsens MVP and HOCM (increases the obstruction and degree of prolapse)
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21
Q

effect of amylnitrate and handgrip on murmur of AS

A

handgrip actually makes AS murmur softer –> creates less of a gradient between LV and aorta. Amyl nitrate increases the gradient and thus, increases murmur of AS

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22
Q

any murmur that improves with amyl nitrate will improve with tx with what med?

A

ACEI

murmurs: AR, MR, VSD

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23
Q

best initial test for valve lesions (1)

most accurate test for valve lesions (2)

A
  1. echo (TTE –> TEE)
  2. left heart catheterization
    - also order EKG and CXR on ccs
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24
Q

best treatment for regurgitant lesions

A

vasodilator therapy - ACEI or ARBs, nifedipine

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25
Q

in which murmurs is diuretic therapy indicated

A

if murmur improves with valsalva (decreased venous return) –> AS, AR, MS, MR, VSD

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26
Q

crescendo-descrescendo systolic murmur, heard best at 2nd intercostal space, radiates to carotid arteries, delayed carotid upstroke

A

AS

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27
Q

how do you assess severity of AS?

A

measure pressure gradient across valve
Normal < 30
Moderate 30-70
Severe > 70 mmHg

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28
Q

best initial therapy for AS (1)

treatment of choice for AS (2)

A
  1. diuretics

2. valve replacement

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29
Q

diastolic descrescendo murmur heard best at left sternal border

A

AR

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30
Q

clinical findings unique to AR

A

Quinke’s pulse - pulsations in fingernails
Corrigan’s pulse - bounding pulses
Musset’s sign: head bobbing up and down with each pulse
Duroziez’s sign - murmur heard over femoral artery
Hill sign - BP gradient high in lower extremities

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31
Q

Tx. aortic regurg

A
  1. ACE, ARBs and nifedipine - best initial
  2. add furosemide
  3. surgery if EF < 55%
32
Q

diastolic rumble murmur with opening snap, best heard at cardiac apex, S1 louder than S2

A

mitral stenosis

33
Q

unique clinical findings in MS

A

dysphagia and hoarseness due to pressure of LA pressing on esophagus and recurrent laryngeal nerve (Ortner’s syndrome)
atrial fibrillation
mitral facies - pinkish-purple patches on cheeks

34
Q

XR findings in MS

A

LA enlargement with flattened left heart border

dilated pulm vessels

35
Q

EKG findings in MS

A

broad, notched P waves

RVH: tall R in V1 and V2

36
Q

Tx. mitral stenosis

A

diuretics
most effective = balloon valvuloplasty
if pregnant - do not hesitate to perform valvuloplasty

37
Q

holosystolic murmus that obscures both S1 and S2, heard best at apex that radiates to axilla, S3 gallop often present

A

mitral regurg

38
Q

S3 gallop

A

assoc. with fluid overload states, such as CHF or MR

39
Q

Tx. mitral regurg

A
  1. ACE, ARBs and nifedipine - best initial
  2. add furosemide
  3. surgery if if LVEF < 60% or LVED > 40 mm
40
Q

holosystolic murmur at the LLSB that worsens with exhalation, squatting and leg raise

41
Q

murmur assoc with ASD

A

fixed splitting of S2

42
Q

Tx. ASD

A

percutaneous or catheter devices

- repair indicated when the shunt ratio exceeds 1.5:1

43
Q

causes of wide splitting of S2 with delayed P2

A

RBBB
PS
RVH
pulm HTN

44
Q

causes of paradoxical splitting of S2 with A2 delayed

A

LBBB
AS
LVH
HTN

45
Q

best initial test for cardiomyopathy

46
Q

most accurate method for determining EF

A

MUGA

nuclear ventriculography

47
Q

Tx. dilated cardiomyopathy

A

ACEi/ARBs
BB
spironolactone

48
Q

S4 gallop

A

sign of LVH and decreased compliance or stiffness of the ventricle

49
Q

Tx. HCM

A

beta blockers

diuretics

50
Q

Dx. findings in restrictive evaluation

A

cardiac cath –> rapid x and y descent
EKG –> low voltage
echo = mainstay of diagnosis
single most accurate dx test: endomyocardial biopsy

51
Q

best initial test for pericarditis

A

EKG –> diffuse ST elevation, PR depression

52
Q

best initial therapy for pericarditis

A

NSAID

if the pain persists for > 2 days, add prenisone orally

53
Q

CF in pericardial tamponade

A 
SOB
hypotension
JVD
pulsus paradoxus
EKG: electrical alternans
54
Q

most accurate diagnostic test for tamponade

A

echo –> diastolic collapse of RA and RV

55
Q

results of right heart cath in tamponade

A

equalization of all pressures in the heart during diastole

56
Q

best initial therapy for tamponade

A

pericardiocentesis

57
Q

unique features of constrictive pericarditis

A

sx of chronic RHF -> JVD, hepatomeg, ascites, edema
Kussmaul’s sign: JVD with inspiration
pericardial knock

58
Q

best initial therapy for constrictive pericarditis

59
Q

most effective therapy for constrictive pericarditis

A

pericardial stripping

60
Q

pt presents with severe chest pain that radiates to the back. on exam,he is hypertensive with BP are greater in the right arm vs left arm - dx? best initial test? most accurate test?

A

Dx. thoracic dissection
initial test: CXR shows widening mediastinum
best test: CT angio = TEE = MRA

61
Q

first steps in management if you suspect pt with thoracic dissection

A 
1) start BB
get EKG, CXR --> CT angio or TEE or MRA
2) nitroprusside to control BP
3) place in ICU
4) get surgery consult
62
Q

best initial test for PAD

A

ankle brachial index

normal should be > 0.9

63
Q

best initial therapy for PAD

A
  1. aspirin or clopidogrel (most effective)
  2. ACEI
  3. supervised exercise program
  4. cilastazol - only if severe symptoms
  5. lipid control with statins
64
Q

pentoxyfylline

A

marginally effective therapy for PAD, used only if cilostazol is ineffective

65
Q

for CCS, tests to order once A-fib is found

A
  1. ECHO
  2. TFTs
  3. electrolytes: K+, Mg, Ca
  4. troponin or CK MB
66
Q

Tx. unstable pt with A-fib

A

synchronized cardioversion

- without any TEE or anticoagulation

67
Q

Tx. stable pt with A-fib

A
  1. slow HR with BB (metoprolol or esmolol) or CCB (diltiazem)
  2. anticoagulation with warfarin (INR 2-3) or dabigatran
68
Q

CHADS

A 
CHF
HTN
Age > 75
Diabetes
Stroke/TIA (2)
- score > 2 warrants warfarin
if score < 2, can tx with aspirin
69
Q

causes of multifocal atrial tachycardia

A

secondary to hypoxia (COPD), hypokalemia, hypomag, coronary/valvular dz, meds (theophylline, aminophylline, isoproterenol)

70
Q

Tx. MAT

A

correct underlying cause

if that does not work –> CCBs (verapamil)

71
Q

best initial therapy for unstable pts with SVT

A

synchronized cardioversion

72
Q

best initial therapy for stable pts with SVT

A

Vagal maneuvers

- if vagal maneuvers do not work –> IV adenosine

73
Q

best long term management of SVT

A

radiofrequency catheter ablation

74
Q

pt with history of SVT is treated with a CCB which worsens his/her symptoms - dx?

75
Q

best initial therapy if pt is described as being in SVT or VT from WPW

A

procainamide

76
Q

therapy options for pt who is hemodynamically stable in VT

A

amiodarone
lidocaine
procainamide
Mg

77
Q

acquired QT prolongation

A

hypomagnesemia
hypokalemia
meds - macrolides, antihistamines, psychotropic drugs

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