Cardiology Flashcards
1
Q
Tx for Brugada Syndrome is:
A
B blockers
and
ICD
2
Q
Mitral valve stenosis is most frequently preceded by:
A
Rheumatic fever which causing thickening of the valve leaflet.
3
Q
Unstable Tachyarrhythmia should be treated with
A
Cardioversion
4
Q
Pt with HTN + CFH should be prescribed what HTN drug(s)
A
Thiazide + B blockers
5
Q
Pathophysiology of AO dissection:
A
Tear in the tunica intima
Blood collection b/w tunica intima and tunica media creating false lumen.
6
Q
Preffered position in patients with pericarditis is
A
Sitting up, leaning forward.
7
Q
Tricuspid valve stenosis is usually seen in conjunction with
A
Mitral valve stenosis
8
Q
Presentation of AO dissection is:
A
Sudden onset of tearing chest pain, between scapulas
9
Q
AO valve regurgitation murmur best heard in what position?
A
Right sternal border (2nd interspace)
Pt. leaning forward.
10
Q
Medications that can be used to treat HTN in pregnancy are:
A
Labetalol
Methyl Dopa (alph 2 agonist)
any Calcium Channel Blocker
11
Q
Sx of hypertrophic cardiomyopathy are:
A
Dyspnea on exertion
Syncope/dizziness
Crescendo-decrescendo systolic murmur
S4 gallop
Ventricular stiffness
12
Q
potassium sparing diuretics and ACE inhibitors used together may produce ________
A
HyperKalemia
13
Q
Physical findings associated with Pulmonary valve regurgitation are:
A
Mild cases are well tolerated and have few or no symptoms Severe cases may have right ventricular hypertrophy Severe cases may have right heart failure Widely split S2 ECG may show right ventricular hypertrophy
14
Q
Flutter rate is
A
250-300 bmp
15
Q
Amyloidosis and Sarcoidosis are known to cause:
A
Restrictive CM
16
Q
Treatment for DVT in a pregnant pt is:
A
Lovenox
Warfarin/coumadin CAN NOT be used at it crosses the placenta!!!
17
Q
Sick Sinus Syndrome is treated with:
A
Pacing
18
Q
Tx of Systolic/Dialated CHF:
A
ARBs or ACE Inhibitors (vasodilators)
Beta Blockers (lowers mortality)
Digoxin (does not lower mortality)
19
Q
Which medication is contraidicated in pts with inferior MI:
A
Nitroglycerin (reduces preload)
inferior MI may be a Rt side MI which are preload dependend
Nitroglycerin may lead to severe drop in blood pressure
Intravenous hydration is indicated in preload depended MI
20
Q
Normal mean arterial pressure is:
A
70-100
21
Q
Valve Locations: Aortic Valve, Pulmonic Valve
A
Aortic 2nd Rt interspace
Pulmonic 2nd Lt interspace
22
Q
Waterhammer/ Corrigan’s pulse is associated with
A
Aortic Valve Regurgitation
23
Q
Signs of HyperKalemia seen on ECG are:
A
peaked T waves
QRS widening
p wave flattening
will eventually transform to V tach or V fib if not corrected.
24
Q
Tx of acute CHF
A
ACE-I
Loop diuretics
Nitrate
Oxygen
Morphine
25
The type of ischemia that presents with ST elevation is:
**Prinzmetal Angina**
26
LV apical balloning followed by stress and releaes of catacholamines is known as
**Taku-Tsubo** CM
27
Systolic (dilated) HF has \_\_\_\_\_\_ejection fraction
Diastolic HF has \_\_\_\_\_\_\_ejectin fraction
Reduced EF in Systolic
Preserved EF in Diastolic
28
Sx of **cardiogenic shock** are:
Dysrhythmia
caynosis
Hypotentions
Lung crakles
29
Posterior heart anatomy is best visualized with
Trans Esophageal Echo
30
HyperParathyroidism produces secondary HTN by means of?
**Increased Ca2+** concentration produces increased vasocontriction (contraction) of smooth arterial muscle\>increases periferal resistance.
31
S1 sound is synchronized with \_\_\_\_\_\_
Carotid pulse upstroke
32
Vasodilator that can cause **cyanide poisoning** is
**Nitroprusside**
33
Normal B/P values
\<120/80
34
Best imaging modality or pulmonic valve evaluation is
TEE
35
**WPW** syndrome predisposes a pt to develope
A fib
V fib
36
Symptoms of pericarditis usually include:
1. **PLEURITIC CHEST PAIN** aka **pleurisy** (aggravated by a deep breath or lying down) 2.Dyspnea
3 Diaphoresis
4 Fever
37
Tx for Dilated CM:
Promote systolic function by reducing blood pressure:
ACE I
Beta blockers
Diuretics
38
S1 sound splits into _____ \_\_\_\_\_\_ during\_\_\_\_\_\_\_
Mitral valve closure (1st)
Tricuspid closure (2nd)
during inspiration
39
Imaging modalities for thoracic AO dissection include:
MRI w. IV contrast
CT w. IV contrast
TEE transesophageal echocardiography used in pts with impaired renal function (who can not have IV contrast administered)
40
ECG with different morphological p waves corresponds to
Multifocal Atrial Tachycardia
41
Most **potent fast** HTN reduction medication is:
**Labetalol**
42
What is Digoxin classified as?
Digoxin is a **positive ionotrope** and **negative chronotrope**.
It augments pumping while decreasing heart rate.
43
Valvular murmurs will
improve with Valsalva
and become louder with
**Leg Raising.**
44
1st degree AV Block
PR interval \> 0.2
Regular, narrow QRS
no treatment necessary
45
Primary management of diastolic HF is:
controlling the HTN (the cause of diastolic HF)
46
Murmurs grade VI and higher are always associated with
**Thrill**
47
**Junctiona Rhythm** is characterized by:
Rate: 40-60
**No P waves**
Narrow QRS
48
Best **screening test** of Conn's syndrome/Primary Aldesteronism is:
High [Aldosterone] / Low [renin]
## Footnote
**High Aldesterone/Renin ratio**
49
Treatment for bowel edema is
Torsemide (loop diuretic)
50
Hursh Crescendo-Decresendo ejection/systolic murmur which is heard along the right sternal boarder and may radiate to the carotids bilaterally and the neck:
**Aortic Valve Stenosis**
51
Mid diastolic low pitch murmur that is best heard at the apex in LLD position is associated with?
Mitral Stenosis
52
Temporal artery is a branch of ?
ECA
53
In patients with true aspirin allergies, ________ should be substituted for aspirin
**clopidogrel**
54
55
Name of the murmur specific to Pulmonic Regurgitation and pulmonary HTN
**Graham-Steell murmur**
increases with inspiration and dicreases with Valsalva
56
Most effective step in treating HTN is:
weighth loss
57
normal PR interval
**0.12-0.2**
58
Mid Systolic Click (three words)
Mitral Valve Prolaps (three words)
59
Tx for A fib is:
1st goal - rate control with B blocker, CCB
2nd goal - cardioverision or ablation
3rd goal - anticoagulation (CHADS2 score)
60
Mitral valve stenosis produces back up flow into the lungs causing?
Pulmonary congestion
61
D-dimer test:
Increased D-dimers is indicative of fibrin degradation products.
Negative D-dimers rules out DVT (**hight sensitivity**)
Positive D-dimers is nonspecific (**low specificity**)
62
Sick sinus syndrome
disease of the sinoatrial (SA) node
It is associated with t**achycardia-bradycardia syndrome**
63
**Diastolic** and **Systolic** Heart failure can be differentiated by?
Echocardiogram
64
Tx for cardiogenic shock is:
IV fluids
## Footnote
**Inotrophic meds (Dopamine - pressor agent)**
65
Stable Sinus Tachycardia can be treated with:
Vagal maneuvers
B-blockers
Radio Frequency ablation
66
Left Atrial enlargements seen on ECG as:
**biphasic** p wave in V1
67
Rigidity of the heart / hiostological damage to the heart muscle is known as:
**Restrictive** Cardiomyopathy
68
**Digoxin toxicity** is monitored by serum ___ levels
**Potasium (K)**
low K worsens Dig. toxicity
Therapeutic serum K level: **0.5-2**
69
70
Impairent of the systolic heart function is knowns as
**Dilated** Cardiomyopathy
71
Tx of Thrombophlebitis is
**NSAID**s if the thrombus is **_below_** the knee
**Enoxaparin** is a low molecular weight heparin if the thrombus **_above_** the knee
warm compress
72
Normal QRS followed by two wide QRS is known as:
**Ventricular Couplet**
73
Diminshed contractility of cardiac myocytes is known as:
**Dilated** CM
74
Stress Echo finding seen in MI or Ischemia is:
**Hypokinetic wall motion.**
75
NSAIDS, corticosteroids and MOA inhibitors are known to _______ b/p
Increase blood pressure
76
African American pt should not be prescribed what kind of HTN medication provided that there is no end organ damage?
ACE-Inhibitors
| (use ARBs instead)
77
Early diastolic blowing murmur usually corresponds to:
Aortic valve regurgitation.
78
What enlagement/hypertrophy is seen on this ECG:
Rt. atrial enlargement.
79
P wave corresponds to
Atrial Contraction / Depolarization
80
Symptoms of giant cell arteritis include:
**Jaw claudication** – pain in jaw while chewing
Scalp tenderness
Visual problems including vision loss and diplopia
Fever
Tenderness
81
**Long QT** interval is defined as:
greater than 0.45 second
**or 11 small squares.**
82
Warfarin/Coumadin
Long term anticoagulant Inhibits vitamin K there by inhibits factors II, VII, IX, X
**CAN NOT be used in pregnancy**
Warfarin is monitored by INR
83
**Rhabdomyolysis** - side effect of statin is monitored/detected by the serum levels of
**Creatinine Kianase**
84
Drug of choice to treat arterial thrombosis is:
**Cliastazol** (antiplatelet)
85
Pre HTN values
120-139 / 80-89
86
Tx for Sick Sinus Node Syndrome is
Pacemaker
87
First line treatment for primary HTN:
BEHAVIORAL MODIFICATIONS
Weight reduction
DASH diet (Dietary Approaches to Stop HTN)
Reduce sodium intake
Increase physical activity
Limit alcohol consumption
88
chlorothiazide
chlorthalidone
metolazon
are examples of __ diuretics
**Thiazide Diuretics**
89
Congenital unicuspid or bicuspid aortic valve may lead to:
Aortic Valve Stenosis
90
Life threatening arrhythmias that are seen in **athletes** are caused by:
Hypertrophic Obstructive Cardiomyopathy
91
Thickened interventricular septum
Outflow obstruction
Small ventricular size
are features of
**Hypertrophic** Cardiomyopathy
92
Causes of Tricuspid valve regurgitation are:
RVH
Ebstein's anomaly
Tricuspid valve prolapse
Pulmonary hypertension (secondary to left hear failure)
93
Giant "a" waves are seen in
Tricuspid Stenosis
94
Signs of sx of pulmonary edema:
Increase respiratory rate
Pink, frothy productive cough
Cyanosis
Paroxysma Nocturnal dyspnea
Rales, rhonchi, wheezing
95
Drugs that increase K
ACE - Inhib
ARBs
Beta Blockers
K sparing diuretics (spirolactone)
have what effect on **Digoxin toxicity**?
Reduce toxicity associated with Digoxin.
96
Treatment of long QT syndrome is:
Beta blockers
97
ECG findings in STEMI include:
ST elevation
new LBBB
evolving Q waves
98
Most common causes of Dilated CM are:
**CAD\>Ischemia**
**Alcoholism**
**3rd trimester pregnancy**
**Toxins**
99
P's of arterial embolism/thrombosis (PAD) include:
Pain
Pallor
Pulselssness
Paresthesias
Poiklothermia (cold feet)
Paralysis
100
Most commong complicatoin after inferior MI is:
arrhythmia
101
3rd Degree AV block also known as Complete Block
**Dissociated P and QRS complexes**
P waves are separated by regular distance
QRS is separated by regular distance
Requires pacing.
102
Mid Systolic Click
Mitral Valve Prolapse
103
**Machine like murmur (fo and from)** is seen in
PDA (Patent Ductus Arteriosum)
104
Most common valvular disorder is:
Mitral valve regurgitation
105
Pt has been on hospital telemetry for a while, what is the earliest sign of MI?
**Hyperacute T waves**
106
normal QRS lenght is
\<**0.12**
107
Contraindication for nitroglyceride is
Hypotention
Sildanefil (Viagra)
108
B blockers side effects include:
Asthma exacerbation
HyperKalemia
N/V
109
Supraventricular Tachyardia
110
Increase in **pulmonary capillary wedge pressures causes**:
Pulmonary edema
111
HTN emergencies include:
AO dissection
Unstable angine/MI
Ischemic Stroke
Intracrania Hemmorhage
Acute Pulm. Edema.
112
Definition of the aortic valve regurgitation is:
Failure of the aortic valve to remain closed during ventricular diastole. Failure of the aortic valve to prevent the reverse flow from ascending aorta into left ventricle.
113
Endocarditis may by caused by:
Bacterial etiology (most common);
postop valve replacement;
IV drug usage
114
Tx for Kawasaki disease:
High dose Aspirin
Intravenous immunoglobulin (IVIG)
115
Tx for Diastolic/Hypertrophic CHF
B blockers (verapamil, diltiazem)
Diuretics
116
Accelerated Ideoventricular Rate
no P waves
wide QRS
Rate 40-100 (higher than typical ventricular rate)
may be seen several days after MI
do not require any intervention
117
**_Symptomatic unstable_ Sinus Tachycardia** should be treated with?
**Synchronized Cardioversion**
118
Pulmonary congestion causes the following sx:
Paroxysmal nocturnal dyspnea (difficulty breathing in supine position) due to fluid accumulation in the lungs.
119
HTN emergency/Malignant HTN values:
\>220/125 Severe risk of end organ damage (retina, kidneys, lungs, AO)
120
HTN is the most common cause of \_\_\_\_\_\_\_\_heart failure
MI is the most common cause of \_\_\_\_\_\_\_\_\_heart failure
HTN\>Diastolic (Hepertrophic)
MI\>Systolic (Dilated)
121
Long QT is associated with:
Torsade
R on T
V tach or V fib
Romano - Ward
122
Normal QRS followed by wide QRS is knowns as
**Ventricular Bigemeni**
123
Stable angine is relieved by what medication
nitroglycerin
124
**Ductus Arteriousus** connects
Aorta to Left Pulmonary Artery
125
**Squatting**
**handgrip**
**lying down**
**straight leg raise**
have what effect of ventricular volume
**increase** ventricular volume
126
Holosystolic murmur at lower left sternal border that radiates to sternum and xiphoid is associated with
Tricuspid valve regurgitation
127
AO valve stenosis is a contraindication to undergo what cardiac testing?
Stress Test due to possibility of Syncope (passing out) upon physical exertion.
128
**Digoxin toxicity syndrome** can be caused by:
Digoxin overdose
or
Hypokalemia
129
Most commong etiology of mitral valve stenosis is:
Rheumatic fever which causes leaflet thickening.
130
Tx for unstable V tach is:
**Cardioversion**
131
Idioventricular Rhythm
Rate: 20-40
no P waves
wide QRS (greater than 0.2 sec.)
132
HypoCalcemia has what effect on ECG?
Prolongates QT interval.
which may lead to **Torsade and V fib**.
133
Second degree AV block (Type I) aka
Wenchebach/Mobitz Type I
Progressive lengthening of PR interval until QRS complex drops
**Longer, Longer, Drop**
134
Short PR\<0.8 is seen in
Wolf Parkinson White Syndrome
135
**pericardial knock** on auscultation is associated with
**Constrictive pericarditis**
136
Renal Artery Stenosis pathophysiology that produces secondary HTN is:
Hypoperfusion of kendeys activates RAAS which elevates B/P.
Decrease secretion of Na+ also produced hypervolemia \> HTN
137
Giant cell arteritis most often affects which artery?
Temporal artery
138
Sx of **hyperKalemia** include:
fatigue or weakness.
a feeling of numbness or tingling.
nausea or vomiting.
problems breathing.
chest pain.
palpitations or skipped heartbeats.
139
**Rheumatic Heart Disease** is associated with which valvular pathology?
**Mitral Valve Stenosis**
140
Most common cause for pulmonic valve regurgitation is
Pulmonar Hypertention.
141
142
Ventricular Systole is between which heart sound?
S1 and S2
143
"Boot shaped heart" seen on X ray cooresponds to:
**Tetrallogy of Fallot**
144
V tach tx:
Unstable V tach \> Synchronized Cardioversion
Dead V tach \> Unsynchronized Cardioversion
Stable V tach \> **Lidocaine/Procainamide/Amiodarone**
145
Treatment of choice for HTN emergency is:
**Labetalol or Nicardipine**
146
Aortic Valve Stenosis Classical Triad of Sx:
Dyspnea
Angina
Syncope with exertion
147
**Restrictive** Cardiomyopathy produces:
diastolic disfunction
148
U wave after T wave is often seen in
**HypoKalemia**
149
Tx of choice for hypetrophic CM is
**Beta blockers**
increase diastoic filling of ventricles
150
Loop dieuretics are (two qualities)
Very powerfull
Short acting
151
Most common location for AAA is:
infrarenal
152
Sx of Restrictive CM are simular to:
Right Heart Failure:
JVD
Edema
Ascites
Hepatomegaly
153
Diastolic rumble is associated with
Mitral Stenosis
154
What cardiac complication is associated with **hyperthyroidism?**
High-output cardiac failure
tx is Propranalol
155
Significant risk factors for AAA are:
Atherosclerosis
CAD
Smoking
Hypertensiono
Hyperlipidemia
156
Medications that prolong QT interval:
macrolides (azithromycin, erythromycin, clarithromycin), fluoroquinolone (ciprofloxacin, ofloxacin, moxifloxacin), trimethoprim-sulfamethoxazole, pentamidine, antifungals (cotrimoxazole, fluconazole, ketoconazole, voriconazole), migraine medications (sumatriptan, zolmitriptan), stimulants (albuterol, epinephrine, dopamine, dobutamine, isoproterenol, methylphenidate, phenylephrine, terbutaline, phenylephrine, pseudoephedrine, cocaine, amphetamine), psychiatric drugs (tricyclics, phenothiazines, citalopram, clozapine, fluoxetine, haloperidol, lithium, methadone, risperidone, quetiapine, sertraline, trazodone, venlafaxine, ziprasidone), class I and III antiarrhythmics, and antihistamines.
157
Beck's triad is:
Associated with cardiac tamponade
1. Hypotension
2. Jugular venous distention
3. Muffled heart sounds.
158
Supraventricular Tachycardia
Atrial Flutter
are known collectivelly as:
**AV Nodal Re-entry Tachycardia**
159
Harsh, loud, systolic murmur best heard over 2nd or 3rd left interspace is associated with
Pulmonic valve stenosis
160
**Reduced luminal volume of the ventricle** is seen in:
Hypetrophic Cardiomyopathy
161
Propranol is
**B1 & B2 blockers** that ***_should not be used_*** in pt. with **lung disease.**
162
Key radiological feature of thoracic AO dissection:
Double barrel AO consisting of true and false lumens.
163
**Methyldopa and Clonidine** are examples of
**Alpha agonists**
**MoA: inhibit NE release**
164
ACE - Inhibitors adverse effects are:
**Cough**
**Angioedema**
165
EKG findings associated with pericardial effusion/Cardiac tamponade:
Electrical alternans- QRS complexes that alternate in hight. example:
166
Angina in aortic valve stenosis is caused by:
Poor perfusion due to the low pressure in the aorta and diminished blood flow through the coronary arteries.
167
168
thyrotoxicosis produces what type of HF
high-output heart failure
169
Tx of Atrial Flutter are:
B blockers
Digoxin
Ca channel blockers
170
Loud S3 is associated with?
Mitral valve regurgitation
171
172
MoA of loop diuretics is
Inhibit **Na/K/Cl** pump at the **ascending loop** of henle thereby preventing reabsorption of water.
173
ECG Leads anatomy is:
174
ECG finding of RBBB includes
wide QRS
rabbit ears in V1 and V2
175
**Fibric Acid** MoA
Reduce TG levels
Raise HDL
176
**Bradycardia**
rate less than **60** bpm
177
How to determine irregular heart reate on ECG, what is the formula?
6 second rule
of QRS within 30 large boxes x 10
178
Pericardial effusion/Cardiac Tamponade most often caused by:
Pericarditis
179
Valve Locations: Tricuspid Mitral
Tricuspid - Left sternal border at the level of 5th interspace
Mitral Apex/Mid clavicular line at level of 5th interspace
180
Examples of potassium sparing diuretics are:
Spironolactone
Amiloride
Triamtereine
181
X ray fininds corresponding to Restrictive CM
Pulmonary vascular congestion
Pleural Effusion
Normal heart size
182
a**T**rophine
a**D**enosine
a**M**iodorone
a**T**rophine - **T**achicardia (increases heart rate)
a**D**enosine - slows **D**own the heart
a**M**iodorone - **m**ellows down (antiarrhythmic)
183
ACE inhib (MoA) is
blocking the conversion of **Angiotensin I to Angiotensin II**
## Footnote
**Decrease of Aldosterone\>reduction of Na reabsorption\>reduction of volume**
184
Best imaging modality for AAA diagnosis:
Ultrasound
185
Definition of cardiac tamponade is
large, rapid or uncontrolled pericardial effusion which reduces cardiac output.
186
Bisferiens carotid pulse ( a double peak per cardiac cycle is seen in) :
Hypertrophic Cardiomyopathy
187
Which Beta blocker should be used in pt with **CHF and Asthama**?
**Metoprolo**l (Beta 1 selective blocker)
188
Secondary HTN with hypokalemia is indicative of
Conn's disease/Aldesteronism
189
**low pitched rumbling diastolic apical murmur** corresponds to:
**Mitral stenosis**
190
Powerfull vascular constrictrors are
Angeotensin II - most **potent**
Epinephrine
Norepinephrine
Dopamine
Thromboxane
Endothelin
191
Management of AAA:
Surgical repair if \>5.5 cm or expands \>0.6 cm per year
Monitor annually if \>3 cm.
Monitor every 6 months if \>4 cm
Beta blocker
192
Mitral valve regurgitation can be repaired or replaced?
Repaired. In many case the valve can be repaired rather than replaced.
193
Buerger's Disease/Thromboangitis obliterans
Progressive inflammation and thrombosis of arteries and veins of extremities. Strongly associated with smoking.
194
definition of **Cor pulmonale**
alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system
closely linked to:
**pulmonary embolism**
**acute respiratory distress syndrome**
195
Roth spots are
Associated with endocarditis;
Retinal hemorrhages with white centers
196
Nitroglycerin side effects include:
headache
nausea
low B.P
197
Mid systolic murmur that radiates to carotids corresponds to:
Aortic Valve Stenosis
198
Locations where S1 and S2 sounds can be heard the best are:
199
what effect Hypothermia has on ECG:
Bradicardia
## Footnote
**J/Osborne wave**
200
*Saw Tuth* Pattern on ECG corresponds to
**Atrial Flutter**
201
Unique ECG feature of hypertrophic obstructive CM is:
**exaggerated Q** waves corresponding to **hypertrophic ventricular septum**
202
CHF Classifications
**Class I** (mild) corresponds to:
No sx
No limitatons on physical activity
203
Arterial Flutter
Saw tooth appearance
204
Causes of mitral valve regurgitation include:
Mitral valve prolapse is the most common cause (thin females are most common for mitral valve prolapse)
Rheumatic fever
Myocardial infarction Endocarditis (regurge will also put a patient at increased risk of endocarditis)
Ruptured chordae tendineae (caused by MI or endocarditis most likely)
205
Presentation of Aortic valve stenosis include:
Mid systolic murmur
Syncope
Angina
LVH
Paradoxial splitting of S2 sound during expiration (normal splitting occurs during inspiration).
206
Brain Natriuretic peptide **(BNP**) is indicative of:
Ventricular Filling Pressure
207
Downslope ST elevation in **V1, V2 and V3**
with RBBB are signs of:
**Brugada Syndrome**
208
**Wells Criteria** is used to ascess the risk of
pulmonary embolism
209
Reduction of ventricular volume will \_\_\_\_\_\_\_worsen symptoms of Hypetrophic Obstructive Cardiomyipathy
Volume reduction with **worse/increase** sx of HOCM
210
Damage or prosthetic heart valves most common associated with:
Endocarditis
211
ACE - Inhibitors ________ breakdown of bradykinin (vasodilator)
decrease breakdown of **bradykinin**
212
Most common cause of hypetrophic cardiomyopathy is:
HTN
213
214
wide arterial pulse pressure is associated with ?
**Aortic valve regurgitation**
215
What is the **classic triad of AAA?**
Abdominal/back pain,
hypotension and
a pulsatile abdominal mass.
216
**Fibrilation is**
heart rate of \>**350**
217
ECG findings of **Restrictive CM** are unique for:
**Decrased aplitude** caused by histological changes that **reduce electrical conduction** w/i the heart.
218
Nifedipine
Amlodipine
Nicardipine
Felodipine
are example of:
**Dihydropyridine Ca channel blockers**.
219
Tricuspid valve stenosis is usually symptomatic/non symptomatic
Non symptomatic
220
Vaughn-Williams Antiarrhythmic Drug Classifications:
**Class I** - Na channel blockers
**_IA_** - Quinidine, procainamide
**_IB_**-Lidocaine
**_IC_**-Flecanide, propafenone
**Class II** - Beta blockers (Metoprolol)
**Class III** - Potassium channel blockers (Amiodarone)
**Class IV** - Calcium channel Blockers
221
X Ray finding associated with aortic valve stenosis:
Calcified aortic valve.
222
Mitral valve stenosis produces what type of murmur?
Diastolic low pitch murmur, heard best at the apex in LLD position.
223
Concentric Hypetrophy corresponds to
Diastolic HF
224
Severe decreased right atrial compliance is a feature of:
**Restrictive** CM
225
Acromegaly causes secondary HTN by means of:
High concentratoin of Ca2+ causes the constriction of arterial smooth muscle which increase periferial resistence.
226
Viruses that often can cause pericarditis include:
echovirus (enterovirus), coxsackie (hand-foot-and-mouth dz), flu, HIV
227
Stage II HNT values are
\>**160/100**
228
229
Stage II HTN treatment involves:
Combination of two drugs:
Diuretics + ACE inhib, ARBs, Ca channel blockets, B blockers
230
Sx and signs of PDA are:
Low Diastolic blood pressure
Widended pulse pressure
**Machinery like murmur (continuous - both in systole and diastole)**
231
In **African American** ACE-I should be replaced by:
Hydrochlorothizide
| (**not ABRS**)
232
absent or weak femoral pulses
HTN in UE with hypotention in LE
3 sign on chest X ray
are all features of:
**Coarctation of Aorta**
233
LVH in aortic valve stenosis is caused by:
Excessive force used by left ventricle to pump through stenosed aortic valve.
234
Diastolic, rumbling murmur heard along lateral left sternal border, increases with insiration, associated with what valvular condition?
Tricuspid Stenosis
235
Bisferiens carotis pulse
loud S4
Systolic murmur
corresponds to
Hypertrophic Cardiomyopathy
236
S2 sound corresponds to closure of
Aortic and Pulmonic Valves
237
Complete Heart Block aka 3rd degree AV block
238
Dry cough that occurs in pt. taking ACE-Inhibitors is caused by:
**increased bradykinin**
which irritates the lungs
239
Fluid b/w lung lobules seen in the bases during pulmonary edema are known as:
Kurley B lines.
definitoin: edematous **interlobular septa**.
240
Heparin side effect:
HITS: Heparin-induced thrombocytopenia syndrome
241
What is the most common cardiac cause for **cyanosis of children**?
**Tetralogy of Fallot**
242
Leading cause of Restrictive Cardiomyopathy is:
**Amyloidosis**
other causes inlclude:
Sarcoidosis, Hemochromatosis, Gaucher's ds.
243
Side effect of alpha receptor blockers
Postural hypotension
Syncope
244
Aortic valve stenosis causes ____ ventricular outflow obstruction and _____ left ventricular hypertrophy
Left Left
245
Treatment for **congenital long QT syndrome** is
B blockers
246
IV drug users are predispose to develop RT or LT endocarditis with Tricuspid or Mitraval valve regurgitation?
RT
Tricuspid Regurgitation.
247
What medication is contraindicated in the treatment of **Prinzmetal’s angina**?
**Beta-blockers.**
248
**Tets spells** are:
episodes of cyanosis, hypoxia, SOB seen in kids with **Tetralogy of Fallot**
releived by squatting.
249
Major Duke criteria for endocarditis includes:
1. Positive blood cultures (S. Aureus, S.Viridins, S Bovis, Enterococci)
2. Positive Echo (New regurgitation, Abscess, oscillating mass)
250
Pathological Opening of the Aortic/Pulmonic will produce
Opening **Click** (systolic sound)
251
Mitral valve prolapse is seen mostly in what type of patients?
Young thin females
252
Tx for Afib concurrent with V tach is:
**IV Cardizem (CCB)**
253
Lab work often seen in Giant cell arteritis:
Liver function tests – Alk phos elevated
C-reactive protein is elevated
Sed rate elevated
platelets may be low
254
Diastolic opening snap following S2 corresponds to:
**Mitral valve stenosis (MS=OS)**
255
Cardiological signs of HTN are:
LVH
Displaced PMI
CHF
256
MS =
| (Mitral Stenosis)
OS
| (Opening Snap)
257
Tietze Syndrome
Costochondritis
258
**Serious complication of Giant Cell arteritis:**
**Blindness**
259
Causes of PAD
Atherosclerosis
Smoking
260
Furosemide (**L**asix)
Torsemide (Bumex)
Bumetanide (Demedex)
are all ____ diuertices
**L**oop Diuretics
261
Pulsus Paradoxus
a drop of more than 10 mmHg in systolic blood pressure during inspiration
Seen in pericarditis / cardiac tamponade
262
**C**onn's Syndrome produces secondary HTN by means of?
Aldesterone secreting tumor in the **c**ortex of the adrenal gland.
Produces Na+ retention \> hypervolemia.
263
Digitalis (**digoxin effec**t) can be seen on ECG as:
downsloping ST depression with a characteristic “slurred” appearance;
flattened, inverted, or biphasic T waves;
shortened QT interval.
Digoxin effect is **NOT** a marker of toxicity
264
Tx of STEMI includes:
Aspirin or Clopidogrel (if allergic)
TPA (thrombolitics) - must be given w/i first 3 hours
Heparin
265
INR goal in pt. with A-Fib
**2.5**
266
HOCM can cause **sudden**
**death**
267
Classical UA sign of HTN is:
ProteinUrea (frothy urine)
268
MI and Cardia Arteries:
**Inferio**r\>*RCA*
**Lateral**\>*Left Circumflex artery (branch of LCA)*
**Anterior**\>*L **anterior** Discending artery (branch of LCA)*
**Posterior**\>*RCA*
269
STEMI vs NSTEMI
**STEMI:** total occlusion, transmural (full thickness) MI, tPA are usefull, + enzymes, + ST elevation
**NSTEMI:** partial vascular occlusion, superficial MI, tPA are not usefull, + enzmems, - ST elevation
270
Dihydropyridine Ca channell blockers (MoA)
dilate arterioles
271
272
What class of diabetes medications are contraindicated in the setting of heart failure?
**Thiazolidinediones**
273
Pt with **HTN + DM** should be prescribed what HTN drug(s)
Thiazide **+** ACE inhibitors
274
Causes of aortic valve stenosis include:
1. Calcified aortic valve - most common cause
2. Congenital valve malformation (bicuspid or unicuspid)
3. Hypetrophic obstructive cardio myopathy.
275
Two normal QRS folled by wide QRS is known as
**Ventricular Trigemeni**
276
Low levels of which electrolite prolongates the QT interval is:
**Ca**
HyporCalcemia
277
Excentric hypertrophy corresponds to
Dilated HF
278
B blockers are contraindicated in what AV blocks?
1st AV block
279
Typical EKG findings associated with pericarditis include (2):
1. Diffuse concave-upward ST-segment elevation in multiple leads (exsept in aVR, V1 and III)
2. Diffuse PR-segment depression examples:
http: //en.ecgpedia.org/wiki/Pericarditis
280
What cardiac pathology is often seen in pt with Turner's syndrome?
aorta coartation
281
Sinus Tachycardia is often seen in pt's with:
**PE**
PE=ST
282
Pathological opening of the mitral/tricuspid valves produce
Opening **Snap** (Diastolic sound)
283
Systolic ejection murmur at pulmonic area that radiates to left neck
Pulmonary valve stenosis
284
Pharmacological treatment of PAD:
vasodilators and antiplatelet medications
Pentoxifyline Cilostazol
285
Multifocal Premature Ventricular Contraction
two different wide QRS complexes
286
Tx for stable V tach
**Amiodarone**
**Lidocaine**
287
R on T phenomenon is
Premature beating occuring during the T wave of the regular rhythm.
## Footnote
**May lead to Torsade/VT/VF**
288
1 AV block does / does no require treatement
Does NOT
289
Kawasaki Disease:
occures in children under 4 y.o
sx: fever x 5 days
erythem of lips / oral mucosa
conjunctivitis
cx lymphadenopathy
edema / erythem of extermieites
complication: **coronary artery disease**
290
Management of AO dissection
Type A dissection - Surgical emergency
Type B dissection - Medical therapy (beta blockers) unless complications are present
291
Prinzmetal angina will produce what ECG changes:
**ST elevation**
**normal enzyme**
292
Bacterial Endocarditits most commonly caused by what pathogens?
Strep Viridans (+), Staph Aureus (+), Enteroccoci (+), Staph Bovis (+)
293
Increased pulmonary **Wedge Pressure** is seen in _____ and corresponds to \_\_\_\_\_\_\_
Pulmonary Edema
Left Ventricular Pressure
294
INR needs to be checked regulary for pt who are on:
Warfarin/Coumadin
295
S2 splitting occurs during:
During inspiration S2 sound is split into Aortic valve (first) and Pulmonic valve (second)
296
Junctional Rhythm:
40-60
no p waves
narrow QRS
often caused by:
**Digoxin Toxicity**
***_Ju_***nctional = Di***_go_***xin
297
Ventricular contractions
Uncoordinated
Rate of 300-600
no pulse
no true QRS
known as:
**Ventricular Fibrilation**
most common cause of sudden cardian death
298
Prem. Atrail Contracton
vs.
Prem Junctional Contraction
PAC will have **normal p wave** (different from other p waves)
PJC will have a **missing or inveted p wave**
299
ACE-I actions include:
Block converston of Angiotensin I to Angiotensin II
Dicrease aldosterone mediated water retention
Slow myocardial remodeling and fibrosis.
300
Giant cell arteritis is best diagnosed with
Temporal artery biopsy
301
HTN values
\>**140/90** on two or more readings at two or more separate occasions separated by at least one week.
302
Cardiac Enzymes
303
Most common ECG findings in PE is:
Sinus Tachycardia.
304
Two types of **Calcium Channel Blockers** are:
**Dihydropirodines**
**Non-dihydropirodines**
305
Stiff ventricle in hypertrophic CM produced ___ sound
Increased diastolic volume in Dialated CM produces \_\_\_sound
S4
S3
306
Beside HTN, hydrochlorothiazide is also used in:
Preventing kidney stones
Osteoporisis (prevent the loss of Ca+)
307
Target INR range for pt on Warfarin/Coumadin
INR 2.0-3.0
308
**Ventricular** rate
20-40
309
Nitroglycerin MoA is:
reduce oxygen deman
reduct preload and afterload
vasodilation
310
Several consequative PVC is known as
**A run of VT**
Pathologic because the heart is not able to fill up due to the fast contraction.
311
**SA** node rate
60-100
312
Definition of mitral valve prolapse:
Superior displacement of mitral valve leaflets into the left atrium.
313
Signs of HTN retinopathy include
Cotton wool spots
Flame hemmorhages caused by vessel rapture
Papilloedema (indistinct borders of the optic disk)
Arterial thinning (narrowing) / Silver (cupper) wireing
Arterio-venous nicking
314
sx of **Digoxin toxicity** are:
**N/V (GI sx)**
Geynocomastia
Blurred vision with yello halo
Paroxysmal atrial tachycardia
315
**Arterial Septal Defect** will be seen on ECG as:
**Rt bunlde branch block.**
316
ECG features of **Dilated** Cardiomyopathy are:
LVH/RVH
317
ECG findings corresponding to aortic valve stenosis:
LVH
318
ECG finding of LBBB include:
Dog ears in V5 and V6
wide QRS
319
**New York Heart Association Classification**
320
Endocarditis caused by poor dental care is often secondary to:
***Strep viridans.***
321
Definition of wide arterial pulse pressure is:
the difference between the systolic blood pressure and the diastolic blood pressure is greater than 40 mmHg
322
Premature Ventricular Contraction (PVC) are treated with:
B blockers
323
Definition of Thrombophlebitis is:
Inflammation of the wall of the vessel (superficial) secondary to a thrombus.
324
Autosomal dominant disorder
Sudden death
Common among young athletes
typical of:
Hypertrophic Obstructive CM
325
Treatment for Patent Ductus Arteriosus is:
**Indomethacin (NSAIDS)**
326
327
New sudden onset of **Afib** is often related to:
**Thyrotoxicosis.**
**_check thyroid labs_**
328
ECG finding of Prinzmetal Angina is:
**ST-elevation** in multiple leads
329
Syncope is associated with which valvular condition?
Aortic valve stenosis
330
Congenital valve malformation is usually manifested at what age:
middle age patient
331
Pathophysiology of AAA includes:
Dilatation of tunica media
Failure of connective tissue (elastin and collagen)
332
Murmurs in **valvular** disorders are
reduced with what manuevers
and
increased with what manuevers:
**increased** with increasing ventricular volume: **squating, hand grip, lying down, straight leg raising**
**reduced** with decreaseing ventricular volume: **valsalva**
333
Young Asian Men
Sudden Cardian Death
seen in:
Brugada Syndrome
334
Adverse effect of Nitrates:
Hypotention\>Tachyardia\>Increased Oxygen demand\>ST depression on ECG.
335
Tx for stable A fib is:
CCB:
## Footnote
**Verapamil**
**Diltaizem**
336
Key radiological feature of AO dissection is
Intimal flap
337
Treatment of symptomatic V tach is:
Electrical Cardioversion
or
Pharm Cardioversion with **amiodarone or lidocaine**
Long lasting tx is:
**Implantable Cardioverter Defibrillator (ICD)**
338
Tx for A-Fib
Rate Control:
**B blockers, Ca channel blockers, Digoxin**
339
Chest pain in kids **reliefed by squatting** corresponds to:
**Tetrallogy of Fallot**
340
Medicaton for Dialted Cardiomyopathy are:
Beta blockers and ACE inhibitors.
341
Definition of waterhammer/ Corrigan's pulse is
a pulse that is bounding and forceful, rapidly increasing and subsequently collapsing.
342
**BNP** (B-type natriuretic peptide) \<100 is indicative of:
rules out CHF
343
Atrial Septum Defect is caused by:
**Osteum Secundum**
**Foramen ovale fails to close**
344
Respiratory condition that is often seen in pt's with **Arterial Flutter** is
**COPD**
345
Low K or Mg often caues of kind of arrythmia?
**_V tach_**
**no p waves**
**rate of \>100**
346
Treatment for WPW is
Amiodarone or Sotalol
or Cardiovertion followed by Radio frequency ablation
347
**upright posture**
**standing**
**valsalva**
have what effect of ventricular volume?
**decrease** ventricular volume
348
**Hydralazine** is
Arterial vasodilator used in HTN crisis works by releasing Nitric Oxide (NO)
349
At what time of the day should Statins be taken?
Evening
Peak activity of Statins is at midnight.
350
INR for prosthetic valves other than mitral valve should be held at
**INR 2.0-2.5**
warfarin/coumadin
351
Hypercoagulability state can be induced by:
Oral birth control medications
Pregnancy
Cancer
**Factor V Leiden mutation**
**Smoking**
Prolong immobilization
Recent surgery
352
**Homans test:**
Dorsiflexion of foot with a straight knee
If + indicate of DVT (accurate only in 50%)
353
**Persisten Sinus Bradycardia** in an elderly
with sx of syncope is collectively known as:
**Sick Sinus Syndrome**
354
Verapamil
Diltiazem
Non-dihydropyridine Ca channel blockers.
355
Posterior MI:
**ST depression in V1 / V2**
356
**Statins** MoA is
**reduce cholesterol synthesis** by inhibiting **Hydroxy-methylglutaryl coenzyme (HMG)**
357
Apical ballooning of the LV that occures in response to severe stress is known as:
**Taku-Tsubo** Cardiomyopathy/Broken Heart Syndrome
358
Echo feature of Restrictive CM is:
**Enlarged** atria
359
Murmur that's best heard in LLD position at the apex of the heart?
Mitral valve stenosis
360
what the most common cardiact pathology in pt with **Down syndrome**?
Atrioventricular septal defect
361
B blocker that is not contraindicated in pt with COPD/Asthma is:
**Metropolol**
362
**CHADS2** score of \> 2 requirs anticougulation (INR\>2)
what is included in the **CHADS2**
**C**HF
**H**ypertension
**A**ge \>75
**D**iabetes
**S**troke
363
multifocal atrial tachycardia if often caused by
COPD
364
PMI is located at
4/5th interspace at the level of mid clavicular line.
365
Treatment for RHF symptoms such as ascites, edema is
Loop diuretics
366
Tx for hyperKalemia is:
Calcium Cloride or Calcium Gluconate
367
Tx for unstable Paroxysmal Supraventricular Tachycaridia is:
**IV adenosis**
or
Verapamil, Diltiazem (CCB)
368
normal QRS is
0.12-0.2
369
Rt. Atrial Enlargement seen on ECG as
tall p waves (2.5 mm)
in inferior leads (II, III, AVF)
370
Contraindication for ACE - Inhibitors are:
Pregnancy
Bilateral Renal artery stenosis
Do not work well on African American pts, unless renal disease is also present.
371
Classic Xray signs of acute CHF (pulmonary congestion/edema)
Butterfly patterns of alveolar edema
Increased interstitial markings
Kerely B lines
Enlarged cardiac silhouette
Effusion (meniscus sign)
**Cephalization** of flow (vertical distribution of pulm veins)
372
CVA/TIA
unilateral neck pain / sever headache
Miosis / Ptosis (Horner's syndrome)
is a classic sign of:
**CCA dissection**
373
Diagnostic studies for PAD:
ABI \<0.8
Arteriogram is a gold standard
374
Catochalamines (Epi & NE) bind to
**Alpha** and **Beta** receptors.
375
376
CT angiogram of the chest with **IV contrast** is the preferred diagnostic modality in patients with suspected PE unless:
elevated creatinine
use **V/Q** scan instead
377
Cause of A-fib include
Thyrotoxicosis
ET(OH) abuse
HTN
CHF
378
Accurate blood pressure requires:
No smoking or drinking 30min. prior.
Cuff bladder should be 80% or arm diameter
379
Pharmacological treatment for stage I HTN is
Hydrochlorothiazide
380
Junctional Rhythm with inverted P waves
381
First initial therapy in Pulmonary edema (Systolic/Dialated HF) is:
Loop Diuretics (fast acting)
## Footnote
**Furosemide**
**Bumex**
382
Loop Diuretics side effects include:
Hypokalemia
Hyponatremia
**Gout (elevated uric acid levels)**
**Ototoxicity**
383
Bioprothetic valve replacement (bovine/porcine) does / does not require anti coagulation therapy.
does NOT require anti coagulation therapy shorter life span (10-15 years)
384
**Capture beats** and **fusion beats** confirm the diagnosis of which cardiac dysrhythmia
**Ventricular tachycardia**
385
What valvular disorder is often seen in young pregnant pt?
Mitral Valve Stenosis
386
obstruction or delay of conduction b/w SA node and AV node results in
AV nodal Blocks
387
**2nd Degree AV Block Type I** is also known as:
**Wenchekbach**
**Mobitz Type I**
388
Definition of **Tetrallogy of Fallot** is:
**PROVe**:
**P**ulmonic stenosis,
**R**ight ventricular hypertrophy,
**O**verriding aorta,
**V**SD
389
**Mid systolic click is often seen in**
**Mitral valve prolapse**
390
Side effects of **Ca channel blockers** are:
Constipation
Bradycardia
Edema
391
**delta wave** on an electrocardiogram is seen in
**Wolff-Parkinson-White** syndrome
392
Unique echo feature of Hypertropic Obstructive CM is:
**Assymterical** ventricular enlargement.
393
Digitalis effect include:
Inotropic
controls heart rate with Afib
used in CHF concurrent with Afib.
394
Features of **Taku-Tsubo** are:
casued by stress/catacholamine release
mimicks amteropr MI
normal coronary arteries
self limiting.
395
Dressler Syndrome aka Postcardiac injury syndrome is caused by (4):
1. MI
2. Open heart surgery
3. Pericardiotomy
4. Trauma to pericardium.
396
**Dressler Syndrome** is typically presented by (5):
1. Pleuritic chest pain
2. Pericarditis
3. Pericardial effusion
4. Fever
5. Pericardial friction rubs
**Dressler Syndrome is also known as Postmyocardial infarction syndrome**
397
**Digitalis toxicity** is associated with what rhythm
**Junctional Rhythm.**
398
main treatment for Bradyarrhythmias is:
**Atropine**
399
Pharmacological treatment for pulmonary congestion includes:
Diuretics
Vasodilators
400
**Bundle of Kent** is associated with
WPW syndrome
401
**Dual antiplatelet therapy** consists of:
**Clopidogrel(plavix)** + apsorin
Decrease risk of coronary artery **stent thrombosis.**
402
Treatment for pericarditis is:
Treat the underlying issue. High dose of NSAIDs
403
**Tender cord** like structure at affected vein is associated with
Thrombophlebitis
404
LVH with narrow LVOT is a feature of:
Hypertrophic Obstructive CM
405
Diagnosis of HTN requires __ seperate readings
**3** separate readings.
406
Non raptured AAA are
Not symptomatic.
407
V tach
requires **Cardioversion**
408
Powerful vasodilators are:
Nitric Oxide (NO)
Prostaglandins
Bradykinin
409
Mobitz II aka
2nd Degree AV Block type II
410
Example of Inherited **autosomal dominant** cardiomyopath
Hypertrophic **Obstructive** CM
411
Cushing syndrome has what effect of K concentration
causes HypoKalemia
412
Supraventricular Tachyarrhythmias include:
Sinus
Atrial
Junctional node
arrhythmias
413
**Eisenmenger's physiology** is:
Large Patent Ductus Arteriousus that produces pulmonary HTN
414
The drug the **decreases** mortality in CHF is
ACE-I
Potassium sparing diuretics
B blockets (metaprolol, carvedilol) - efficacy is inversily proportional to the ejectoin fraction. The lower the EF the hight the efficacy (higher decrease of mortality)
415
Duke Criteria for diagnosis of endocarditis:
Two major findings
or
One major finding + three minor findings
or
Five minor findings
416
what effect NSAID have on CHF?
Non-steroidal anti-inflammatory drugs are associated with an increased risk of heart failure exacerbation, increased renal dysfunction and impairment of the response of angiotensin converting enzyme inhibitors and diuretics.
417
Physical findings of Cardiac tamponade include:
Hypotension
Paradoxical pulse pressures –a drop of more than 10 mmHg in systolic blood pressure during inspiration
Jugular venous distension
Tachycardia
Tachypnea
Narrow/low pulse pressure (difference b/w systolic and diastolic blood pressures)
Decreased heart sounds
Water bottle heart on chest X-ray
418
Typical presentation AAA rapture:
Flank pain,
hypotension,
pulsatile abdominal mass
**Tearing pain radiating to the back = AAA RAPTURE**
419
Mitral Valve Prolapse produces
Mid Systolic Click
Systolic Crescendo murmur
preload up \> murmur down
preload down \> murmur up
420
**Kussmaul sign**
paradoxical rise in jugular venous pressure (JVP) on inspiration
signs of right heart dysfunction.
421
Young Asian Men
Brugada Syndrome
422
S4 sound is typically seen in what cardiomyopathy?
**Hypertropic** CM
423
Cause of aortic valve regurgitation are:
**Infective Endocarditis** \> distruction of the aortic valve
**Rheumatic heart disease** \> enlargement of the valve ring Aortic dissection\>propagates and damages the aortic valve
**HTN**\>increased b/p in AO exerts reversed pressure on the aortic valve causing it to regurgitate HTN\>cause LV dilatation which stretches the valve ring producing regurgitation
**Mafan Syndrome**\>connective tissue disorder\>AO root disease
424
Conn's Syndrome/Aldesteronism produces secondary HTN by means of:
increased retention of **Na+** and secretion of **K+ **
resulting in hypervolemia and hypokalemia
425
**Prozosin & Terazosin** are medications that can be used in
BPH
## Footnote
**HTN caused by pheochromocytoma**
426
**Ezetimibe** MoA
Inhibits intestinal absorption of cholesterol.
427
features of **Supraventricular Tachycardia**
**very regular**
**Narrow QRS**
**p waves may be hiding/missing**
rate 140-240
May be caused by SA, AV or Junctional node
428
CHF with A-fib is indicative for what medication?
Digitalis aka Digoxin
429
Giant cell arteritis is often seen concurrent with what medical condition?
polymyalgia rheumatica (multiple joint pain)
430
The target INR for a mechanical mitral valve is \_\_\_,
whereas a mechanical aortic valve is \_\_\_.
**3-3.5 mitral**
**2.5-3 aortic**
431
ARBs MoA is
Block **antiotensin II receptors** producing vasodilation
Don not increase bradykinin (like ACE inhib)
432
Sudden death, seen in **young athletes** is usually secondary to:
Hypertrophic **Obstructive** CM and arrhythmia caused by it.
433
Opening Snap after S2 is associated with
Mitral Stenosis
| (MS=OS)
434
Tx for SVT is:
**IV adenosine** or
verapamil
***Cardioversion*** for symptomatic SVT
435
**Atrail Flutter** definition:
**Regular narrow QRS**
atrail rate of 250-350
**Sawtooth** pattern
caused by conduction delay
436
Physical finding associated with Mitral valve regurgitation?
Pansystolic blowing murmur at the apex and radiating to the axilla
Loud S3 Midsystolic click
Brisk carotid upstroke Rales secondary to pulmonary congestion
A-fib
Left ventricular hypertrophy
437
Physical findings of Mitral Valve Stenosis include:
Opening snap following S2 sound (MS=OS)
Diastolic low pitch murmur
Pulmonary congestion (back up from left atrium into the lungs).
Lung Rales (secondary to pulm. congestion).
Paroxysmal nocturnal dyspnea.
Tachycardia
438
Classes of AntiArrhythmics
439
**Digoxin (digitalis) toxicity syndrome** is seen on ECG as:
Bradyarrhythmia
PR prolongation
can lead to Torsad De Point
440
**Non-dihydropyridine Ca channel blockers** (MoA)
Slows Heart rates
and
Dilate arterioles
441
**Gynecomastia** and Hyperkalemia are side effects of:
Aldesterone Antagonists:
## Footnote
**spirolactone**
**epleronone**
442
Angiotensin Receptor Blockers (ARBs) icnlude:
Losar**tan**
Valsar**tan**
443
Torsades de pointes is
caused often by **low Mg**
should not be treated with antiarrhythmics
**correct electrolyte imbalance**
444
Giant "v wave" is seen in
Tricuspid Regurgitation
445
Normal BNP in a pt. suspicious of having acute CHF will
**exlude** CHF.
446
HTN for pt. with DM, renal or vascular disease is defined as:
BP\>**130/80**
447
Conn's syndrome is best seen on:
CT/MR will show **adrenal adenoma/hyperplasia**
448
Floppy, myxomatous mitral valve is also known as
Mitral Valve Prolapse
449
Side effects of thiazide diuretics include
Hyponatremia
Hypokalemia
Hypocloremia
Gout (increase levels of uric acids)
Hyperglycemia
**HyperCalcemia**
450
Features of **Cardiogenic Shock** are:
Decreased CO
Hypoxia
Hypotension
Altered mental status
Cyanotic extrimities
Faint pulses
Oliguria
Low cardiac index (stroke volum x heart rate / body surface are)
451
Crescendo-decrescendo systolic murmur along the upper left sternal border is seen in what cardiomyopathy?
Hypetrophic Obstructive Cardiomyopathy.
452
Treatments for Arrhythmias are:
Sinus Brady \> Atropine
Sinus Tach \>Cardiov (unstable) or B block ( sx)
SVT\>**_adenosine, IV 6 mg_**
Atrial Flutter \> Abutilide
A Fib \> B blockers, CCB, warfarin
PVC \> B block
V tach \> **Amiodorone, cardioversion**
T fib \> **defibrilation**
453
S1 sound represents the closure of which valves?
Mitral and Tricuspid valves
454
With **inspiration** murmurs associated with which valvular pathologies become **louder**
Tricuspid valve stenosis and regurgitation.
455
Pharmacological management of AAA and AO dissections is:
Beta blockers.
456
Secondary HTN caused by RAS in elderly pt is usually due to:
Renal artery atherosclerosis
457
Secondary HTN caused by RAS in young pt is usually due to:
**Fibromuscular Dysplasia**
458
Pre Hypetension Values are:
120-**139** / 80 -**89**
459
Echo findings corresponding to aortic valve stenosis:
aortic valve deformity
LVH
460
what drug is contraindicated in **non-STEMI**
**tpa** (Tissue plasminogen activator)
461
**AV** rate
60-40
462
Pathophysiology of wide pulse pressure associated with aortic valve regurgitation is:
This regurgitant flow of blood from Aorta into LV which causes a decrease in the diastolic blood pressure in the aorta, and therefore an increase in the pulse pressure (difference b/w systolic and diastolic pressures)
463
Hypovolemia, Tachycardia, Valsalva, Arrhythmia, vasodilatatoin drugs will \_\_\_\_\_\_\_\_\_\_\_sx of HOCM
**worsen/increase** sx of HOCM
464
Adverse effects of B blockers is:
Bronchospasm
Should not be used in COPD/ASTHMA pts.
465
Acute Mitral Regurgitation is oftern caused by:
MI
possibel mechanism is:
rupture of the chordae tendineae, papillary muscle, or valve leaflet
466
Murmurs in **HOCM** are
**reduced** with what manuevers
and
**increased** with what manuevers:
**reduced** with increasing ventricular volume: **squating, hand grip, lying down, straight leg raising**
**inrcreased** with decreaseing ventricular volume**: valsalva**
467
Nitroprusside
Arterial and Venous vasodilator works by releasing Nitric Oxide (NO)
468
CK-MB returns back to normal after MI in \_\_days while Troponin returns in ___ days.
CK-MB retuns in few days
Triponins returns in a week
**(if repeated MI is suspected within a week of the original, check CK-MB**)
469
What are some anticholinergic side effects?
Dry mouth,
blurred vision,
constipation, urinary retention
drowsiness, sedation
red flashes, hyperthermia.
470
Best initial test for pt suspected of having endocarditis is:
Blood cultures
471
Causes of pericardial effusion:
**viral myopericarditis** (simultaneous infection of heart muscle and pericardial tissue)
**metastatic malignancy** (lung and breast)
**autoimmune disease** (lupus)
**renal failure**
bleeding (hemopericardium)\*\* commonly considered a separate syndrome
472
Premature Ventricular Contraction
473
474
Diastolic B/P is determined by
Peripheral arterial resistance.
475
**multifocal atrial tachycardia** is often seen in pt with
**COPD**
476
Murmur that's best heard in pt. leaning forward?
AO valve regurgitation
477
Endocarditis is mostly of __________ origin while Pericarditis is usually ____________ origin.
Bacterial Viral
478
Mitral valve regurgitation cause back flow of blood into __ atrium during systole or diastole?
Left
Systole
479
Blood volume in the system is determined by:
Na+ concentration
Mineralcorticoids
Atrial natriuretic peptide (ANP)
480
Physical findings associated with endocarditis (6)
1 New or changed murmur
2 Splinter(nail) hemorrhages
3 Janeway lesions
4 Osler nodes
5 Roth spots
6 Petechia (purple spots)
481
Gynecomastia is a side effect of which medication?
**Spironolactone** (Aldosterone Antagonist)
482
Treatment for Giant Cell arteritis:
High dose of oral prednisole (40-60 mg daily)
483
**Sick Sinus Syndrome**
(bradycardia, syncope, palpitation)
tx is:
Pacemaker.
484
Endocarditis prophylactic treatment for high risk patients undergoing procedures is
Amoxicillin
485
Definition of PANSSTOLYC/HOLOSYSTOLIC murmur is?
Systolic murmur that starts at S1 and continues through S2 sound.
486
Tx for A fib is:
CCB
B blockers
Digoxin
487
DM produces secondary HTN by means of?
Hyperglycemia damages arterial wall making is less complient.
488
Tricuspid valve stenosis produces \_\_\_murmur
**Diastolic**
489
Nitroglyceride is
**venous** vasodilator
490
Risk factors for AAA are (syndromes):
Marfan’s syndrom
Ehlers-Danlos type IV
491
Pseudoaneurysm
Localized tear in arterial wall.
492
Abnormal blood work in endocarditis is:
Low complement level
493
DVT anticoagulation protocol:
Heparin to Warfarin/coumadin bridge:
Start with Low Molecular Weight Heparin
Continue with Warfarin for up to 12 month
494
Mose common cause of mortality in pt with CHF is:
**Ventricular** arrhythmia
495
Crescendo-Decrescend Diastolic Murmur head at 3rd or 4th left interspace is associated with?
Pulmonic Regurgitation
496
Types of AO dissection
Ascending AO dissection - type A
All other dissections - type B
Type A is more common than type B.
497
Burning disproportional pain after trauma is known as:
Reflex Sympathetic Dystrophy / Complex Regional Pain syndrome
498
tx for Digoxin toxicity includes:
Administer K
Digibind (if SNS or ECG sx are present)
499
Essential HTN is usually diagnoses in what ages?
b/w 25 and 55 y.o.
500
**Apixaban** is anticoagulatn that is used in
Pregnancy
501
If giant artery cell arteritis is suspected the next step is:
**High-dose corticosteroids**
502
Hyper or Hypo Thyroidism produces secondary HTN by means of:
**HyperThyroidism** produces increased expression of adrenergic receptors\>vasoconstricution; also causes increased cardiac output.
**HypoThyroidsim** produced Na+ retention\>hypervolemia.
503
Causes of secondary HTN include:
Drugs Chronic kidney disease
Primary aldosteronism
RAS
Cushing’s or long term corticosteroid use –one cause here is from retained salt and fluid
Pheochromocytoma –Epinephrine secreting tumor.
Coarctation of the aorta
Thyroid or parathyroid disease
Pregnancy
Carcinoid Syndrome
Hormone Replacement Therpy
Sleep Apnea
Lead poisoning
Porphyria
504
Mechanical valve replacement does / does not require anti coagulation therapy.
does not require anti coagulation therapy
505
Dyspnea on exersion
Paroxysmal Nocturnal Dyspenea
SOB
are signs of which CHF
Left side
506
**Sinus Bradycardia** may be caused by what medication?
**Beta Blockers**
507
**Cardiac Stenting** requires what medications:
**Aspirin**
and
**Clopidogrel**
508
Wide Pulse Pressure is defined as
and associated with
Large diference b/w systolic and diastolic pressures
Aortic Valve Regurgitation
509
**Cardiogenic shock (diminished hear CO)** is usually due to:
MI
CHF
CM
Cardiac tamponade
510
**ARBS** bind to which receptors
**AT 1**
511
Mitral valve has \_\_leaflets?
Two
512
Short PR interval w/o delta waves seen on ECG corresponds to:
**Lown-Ganong-Levine Syndrome**
**causes A fib or V tach**
**same tx as WPW**
513
**Junctional Rhythm** is often caused by what medicatoin?
**Digitalis**
514
Symptomatic Sinus Bradycardia should be treated with?
**Atropine**
515
Bilat hip and buttuck claudication
Erectile disfunction
absent femoral pulses
known as:
Leriche's syndrome
516
Aortic valve stenosis is very similar to what coronary condition?
Atherosclerosis. Calcification of the aortic valve leaflet lead to Aortic valve stenosis (most common cause)
517
**Physiological Sinus Arrhythmia** is
caused by vagus activation/deactivation
Inspiration \> increases HR
expiration \> decreaes HR
518
Most common cause for Mitral Valve Stenosis is
Rheumatic heart disease
519
Location of PMI/apex is
Level of 5th inerspace Mid clavicular line
520
Osler nodes
Associated with endocarditis;
Painful, raised lesions on the pads of fingers and toes;
Depositions of immune complexes;
521
**Spirolactone** MoA
Inhibits Aldosterone\>Increase Na extretion
## Footnote
**causes hyperKalemia**
522
S wave in lead I
q wave in lead III
inverted T in lead III
Sinus Tachycardia
are all features of:
**PE**
523
Empiric endocarditis treatment is
IV vancomycin OR ampicillin/sulbactam (unasyn) PLUS aMinoglycoside (gentoMicin, streptoMicin)
524
Second Degree AV Block Type II / Mobitz II
features:
Normal PR intervals
Intermitten dropped QRS
**associated with syncope**
**requires pacing**
525
Causes of Pulmonary valve regurgitation
Pulmonary hypertension
Endocarditis
Rheumatic
heart disease
MI
Plaqueo
Iatrogenic
526
Axis deviation is determined by looking at which leads?
**Lead I**
and
**AVF**
527
Physical findings that are typical of Tricuspid valve regurgitation are:
Jugular venous distention with v waves
Peripheral edema
Ascites
528
Pulmonic valve murmurs decrease/increase with inspiration?
decrease
529
**pulmonary artery wedge** pressure is measured?
**A Swan-Ganz catheter**
530
Endocarditis sec. to post op valve replacement is caused by:
Staph aureus;
Fungi;
Negative bacteria
531
Causes of Tricuspid Valve Regurgiation include:
RVH
Pulmonar Hypertension
Ebstein's anamoly
Pacemaker leads
Tricuspid endocarditis
532
Myocarditis is caused by:
Coxsackie B virus
arvovirus B12
Echovirus
533
S1 souund is ______ frequency best heard with \_\_\_\_
S2sound is _______ frequency best heard with\_\_\_\_
Low, bell
Hight, diaphragm
534
Beta blockers effects are:
Reduces heart rates
allows more time for diastolic fillings
MoA: inhibits Na/K-ATPase
535
Ebstain Anomaly
defect in which the tricuspid leaflets attach to the right ventricular wall, leading to a **larger than normal right atrium and smaller than normal right ventricle.** Ebstein’s anomaly is also commonly associated with an **atrial septal defect,** **patent foramen ovale** and the pre-excitation, re-entrant conduction defect of **Wolff-Parkinson-White syndrome**.
536
Sx of **chronic venous insufficiency** are often relieved by:
**leg elevation**
537
clenched fist held over the chest is known as
**Levine's** signs of MI
538
S3 sound is produced when
overfilled ventricle (hight diastolic pressure) is filled during diastole
539
Janeway lesions
Associated with endocarditis; Painless, macular (spot) lesions on palms and soles
540
Symptoms of mitral valve prolapse are:
Palpitations
Chest pain
Anxiety Dizziness
541
Nicotinic Acid / Niacin MoA
Decrease productioin/release of VLDL
## Footnote
**cause flushing**
542
INR for mechanical mitral vavle should be held at
**INR 2.5-3.5**
warfarin/coumadin + aspirin 81 mg.
543
**Digoxin** and **Dobutamine** are:
Positive Inotrophes
**Increase heart contractility/force of myocardial contraction**
Used in Systolic HF
Preserve intracellular Ca
544
MoA of Paradoxical/Pathological **S2** splitting
No splitting during Inspiration
Expiration produces paradoxical splitting:
**Pulponic component first**
**Aortic compoent second**
545
X ray presentation of thoracic AO dissection is:
widening of the aortic silhouette
546
Elevated JVP with giant a waves are seen in what valvula disorder
Tricuspid Valve Stenosis
547
HTN emergency needs to be corrected w/i:
**one hour**
b/p should be lowered by no more than 25%
548
Tx for long QT includes:
correcting electrolites
B blockers
ICD
pacers
549
Aorta Coartation is depicted on chest X-ray by:
Fifure 3 sign.
550
MoA Thiazide Diuretics is
Acts on **distal convoluted tubule by inhibiting Na/Cl transporter** thereby reducing reabsorption of water.
551
MoA of potassium sparing diuretics is:
acts on collectiong duct, inhibits **Na/K exchange**r
552
Takayasu's Arteritis
Pulseless Disease
Seen in young asian females
Affect aortic arch and great vessels
Tx: corticosteroids
553
Which drug is contraindicated in pt who is under the influence of **cocaine and experiences chest pain with ECG changes**?
**B blockers.**
554
Electrolite that is often low in pt. with Prinzmetal angina is:
**Mg**
555
ECG findings corresponding to LVH:
R wave in V5 or V6 + S wave in V1 \>35 mm
556
infants born to **diabetic mothers** often have what cardiac pathology?
Transposition of great vessels.
557
Prozosin
Terazosin
are examples of what drugs?
Alpha Receptor blockers
## Footnote
**used for HTN caused by pheochromacytoma; BPH**
558
Positive finding for myocardial ischemia during an exercise stress test is:
**2 mm downslopping** ST-segment depression
559
**WPW** ECG features are:
**W**ide QRS
**P**R interval is short
**W**ave Delta
560
q waves seen on ECG are often idicative of:
Old MI
561
HTN emergency treatments are:
**Labetalol** (alpha and beta blocker)
**Nicardipine** (CCB)
**Esmolol** (beta blocker)
**Clevidipine** (CCB)
562
Cushing syndrome produces secondary HTN by means of?
Petiutary tumor that
563
best initial choice for treating hypertension in African-American patients is:
calcium-channel blocker
thiazide-type diuretic
564
Virchow triad:
Associated with DVTs
1. Venous injury
2. Hypercoagulability
3. Venous statis
565
Hypetrophic Cardiomyopathy causes:
**diastolic** disfunction
566
**Dobutamine** (positive ionotrop) is used in CHF under what circumstences?
When initial therapy (oxygen, loop diuretics, morphine) does not improve the sx.
MoA: dilate peripheral arteries and decrease afterload
567
a new LBBB is equivalent to:
**STEMI**
568
**Boot shaped** heart seen on X ray is a sign of:
Tetralogy of Fallot
569
Stage I HTN values are
140-**159**/ 90-**99**
570
Standing Valsalva will increase ___________ and ___________ in what valvular conditon?
Mid systolic click and late systolic murmur in Mitral valve prolapse
571
Definitation of Pramature Atrial Contraction is:
premature **different *p*** wave that comes together with **normal *QRS*** and followed by *_compensatory pause_*
572
**S4** seen in Hypertrophic Obstrictive CM
will ____ with valsalva and \_\_\_\_\_\_with squatting
increase with valsalva
decrease with squatting
573
Lead I -
AVF +
corresponds to which axis deviation
**Right Axis Deviation**
seen in: RVH, Lt MI, tall think poeple (Marfan)
574
Tx for Pulm Edema
**O2 - first step**
Diuretics (Lasix/furosemide)
Morphine
Dobutamine (ionotrop - increases contractility)
575
**Clonidine** important side effect is
Rebound HTN if discountinued abruptly.
576
Heparin MOA:
Fast onset
Amplifies antithrombin III which inhibits factor **Xa** of coagulation cascade.
Heparin is monitored by aPTT
577
MoA of Clonidine is:
Alpha 2 agonist
578
Presentation of Thrombophlebitis is:
**Tender cord** like structure at affected vein.
Pain Erythema
579
**Loop Diuretics** are contrainidcated in pt with what drug allergy?
**Sulfa**
580
Medications that are known to **prolong QT** are:
Clarithromycin
Erythromycin
Chloroquine
Pentamidine
Haloperidol
Chlorpromazine
581
Wide S2 split is associated with
Pulmonic Stenosis
and
Pulmonic Regurgitation
582
583
what effect B blockers have on CHF?
Slow heart rate
Decrease HTN \> decrease afterload
Decrease stress on the hears
Rise the EF
Reduct LV size
584
Fluid Retention
Ascites
Edema
Hepatic congestion
are signs of what CHF?
Right sided heart failure.
585
Side effects of potassium sparing diuretics are
**HyperKalemia**
Ototoxiicty
Gout
586
MI blood markers are:
**Troponins I** - most specific test. Elevates 3-12 hours.
## Footnote
**Creatine kinase (CK-MB)**
587
Lead I +
AVF -
corresponds to which axis deviation?
**Left Axis Devation**
seen in: LVH, HTN, HF, Obesity
588
What effect NSAIDs have on pt with CHF
Worsen the sx.
589
Mitral valve regurgitation produces what kind of murmur?
Pansystolic/holosystolic blowing murmur best heard at the apex radiating to the axilla.
590
Mirtal valve Prolapse and HOCM
will become louder with Valsalva
and less evident with
leg raising.
591
**Adenosine** is usually given to treat \_\_
**Supraventricular Tachycardia**
592
Aortic valve stenosis corresponds to ___ murmur Aortic valve regurgitation correspond to ___ murmur
Crescendo-Decresendo MILD SYSTOLIC ejection
Early DIASTOLIC blowing
593
Normal SA rhythm on the top
A fib rhythm on the bottom
594
**Compensatory pause** on ECG is seen in
PAC
595
**_Irregularly irregula_**r corresponds to
_Atrial Fibrilation_
596
Heparin-induced thrombocytopenia syndrome:
Plateletes become activated and stick to each other resulting in:
Thromboses
Platelete consumption leading to thrombocytopenia
Hemorrhage
597
Hypetrophic CM is caused by\_\_\_\_\_\_\_\_\_\_while hypertrophic Obstructive CM is caused by \_\_\_\_\_\_\_\_\_\_\_
HTN \> hypertrophic
Genetic predisposition \> hypertrophic **obstructive**
598
RV lift
RBBB
RVH
**split and fixed S2**
systolic ejection murmur (2nd and 3rd interspace)
are features of:
**Atrail Septal Defect**
599
side effects of Nitrates is:
Throbbing headaches sec to arterial dialation in the head.
600
Treatment for aortic valve stenosis include:
1. Aortic valve replacement
2. Ballon valvuloplasty
3. Ross procedure (aortic valve is replaced with pulmonary valve; pulmonary valve is replaced with cadaver's valve).
601
Sx of PAD
Claudication
Tingling
Numbness
Ulcers
Hair loss on the affected extermity.
Week PT and DP pulses
602
Definition of **Ejection Fraction** is
Stroke Volume (volume of ejected blood) /
end diastolic volume
603
Mitral Valve Prolapse is associated with what type of mumur?
Late systolic murmur
604
Lead I +
AVF +
corresponds to which axis deviation?
No axis deviation.
605
Junctional Rhythm with missing P waves
606
Systolic B/P is determined by
Cardiac Output
607
Color change in digits in response to cold temp is called:
**Raynaud's** dz
608
Location of the AO valve stenosis murmur is
Rt. sternal border (level of the 2nd intespace)
609
On ECG WPW syndrome can be recognized by seeing
Delta waves (slurred upstroke)
610
Short PR interval seen in WPW syndrome and higher contractility will have what effect on S1 sound?
S1 will be louder
611
Cardiogenic shock requires what tx:
Vassopressors or ionotrophic agents
Not fluid
612
Orthostatis hypotention **without increase in heart rate** is caused by:
**Autonomic Insufficiency** - impared sympathetic nervous system
613
614
Orthostatis hypotention **with** increase in heart rate is caused by:
Hypovolemia caused by either **exsessive diuressis** or **addrenal insuffeciency.**
615
616
tx for Hyperkalemia is:
nebulized albuterold
calcium gluconate
glucose solution
sodium bicarbonate
617
side effect of **IV lidocaine**?
neurological toxicity
including siuzeres
618
619
**Diltiazem and verapamil** are contraindicated in:
systolic heart failure
acute MI
620
Beta blocker is indicated for chronic or acute cardiac problems?
Chronic only
contraindicated in Acute
