Cardiology

Question 1

Systolic murmurs

Answer 1

Aortic stenosis-harsh systolic ejection murmurs that radiates to the carotids.
Mitral regurgitation-holosystolic murmur that radiates to the axilla
Mitral valve prolapse- midsystolic, or late systolic murmur with a preceding click

Question 2

Diastolic murmur

Answer 2

Aortic regurgitation-early decrescendo murmur

Mitral stenosis-mid to late, low pitched murmur

Question 3

S3 gallop significance

Answer 3

fluid overload

Question 4

S4 gallop significance

Answer 4

decreased compliance

Question 5

pulsus paradoxus causes

Answer 5

pericaridal tamponade, obstructive lung disease, tension pneumothorax, foreign body in airway

Question 6

CHADVASc

Answer 6

CHF-1
HTN-1
Age >75-2
Diabetes-1
Stroke or TIA-2
Vascular disease-1
Age 65-74-1
Sex (female)-1
***estimate stroke risk in a fib-anti coagulate for a score of 2 or more

Question 7

Afib and Aflutter Tx

Answer 7

1.) Rate control with beta-blockers, CCBs, or digoxin
2.) Anticoagulate with warfarin for pts with CHADVASc greater than or equal to 2
3.) unstable or new onset–> cardiovert
afib for >2 days–> get TEE to r/o clot

Question 8

AVNRT and AVRT Tx

Answer 8

cardiovert if hemodynamically unstable

carotid massage, valsalva, or adenosine

Question 9

torsades de pointes
associations
tx

Answer 9

associated with: prolonged QT syndrome, hypokalemia, congential deafness, alcoholics, and proarrhythmic response to medications
tx: give magnesium, cardiovert if unstable

Question 10

Acute CHF exacerbation management

Answer 10

LMNPO

lasix
morphine
nitrates
oxygen
position (upright)

*don’t give beta-blockers acutely

Question 11

Chronic CHF managment

Answer 11

• low sodium diet
• beta blockers
• ACEi/ARBs
• ASA and statin (if had previous MI)
• spironolactone (if class III or IV heart failure)

Question 12

HOCM murmur

Answer 12

systoic ejection murmur that increases with decreased preload (valsalva maneuver, standing) and decreases with increased preload (passive leg raise)

Question 13

restrictive cardiomyopathy causes

Answer 13

inflitrative diseases (amyloidosis, sarcoidosis, hemochromatosis) or my scarring and fibrosis (secondary to radiation)

Question 14

TIMI

Answer 14

*** pts with a score of 3 or more benefit more from enoxaprin and early angiography
Age >65
3 or more CAD risk factors
known CAD
ASA use in past 7 days
Severe angina ( 2 or more episodes in 24 hrs)
+ cardiac markers

Question 15

post MI complications timeline

Answer 15

first day: heart failure
2 to 4 days: arrhythmia, pericarditis
5 to 10 days: left ventricular wall rupture, papillary muscle rupture
weeks to months: ventricular aneurysm, dressler syndrome

Question 16

Dressler syndrome

Answer 16

Autoimmune process occuring 2 to 10 weeks post MI

Sx: fever, pericarditis, pleural effusion, leukocytosis, and increased ESR

Question 17

Signs of HTN in the eye

Answer 17

cotton wool spots and hemorrhage

Question 18

causes pf secondary HTN

Answer 18

CHAPS
Cushing syndrome
Hyperaldosteronism (Conn syndrome)
Aortic coarctation
Pheochromocytoma (Dx with urinary metanephrines, catecholamine levels, or plasma metanephrine)
Stenosis of renal arteries