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PANRE > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define orthostatic hypotension

A

A drop in the systolic BP of > 20mmhg when standing up

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2
Q

Your feel a pulse that seem to be vibrating. What term do you use to describe it?

A

A thrill

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3
Q

What are 3 things in your differential if you have a paradoxical pulse?

A

Cardiac Tamonponade, pericarditis and obstructive lung disease.

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4
Q

On palpation, what size is normal for the aorta?

A

<3cm

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5
Q

A fixed or consistent split S2 sound should make you think of what diagnosis?

A

ASD - atrial septal defect

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6
Q

A pathologic S3 is most commonly associated with what diagnosis>?

A

CHF

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7
Q

A mid systolic click is hear on ausculation of the heart - you immediately think of what diagnosis?

A

MVP - Mitral valve prolapse

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8
Q

An opening snap on asucultation of the heart should make you think of what diagnosis?

A

Mitral stenosis

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9
Q

A continuous murmur most likely involves what area of the heart?

A

most likely it is a septal defect

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10
Q

you hear a continuous machine like murmur. What are you thinking?

A

PDA - patent ductus arteriosis

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11
Q

List 3 medications which may be used for a pharmacological stress test.

A

Adenosine, dobutamine, dipyraidamole and persantine.

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12
Q

What is the gold standard for diagnosing coronary arterial disease?

A

Cardiac catheterization

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13
Q

What is the most common cause of secondary hypertension?

A

chronic kidney disease

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14
Q

What are the treatment parameters for HTN according to JNC 8?

A

< 60 yo, no comorbidities - < 140/90

> 60 yo <150/90

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15
Q

No matter what medications you use, you are having trouble keeping a patient’s blood pressure under control. You also note hyper pigmented skin and truncal obesity. What is the most likely diagnosis?

A

Cushings disease

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16
Q

List 3 sings or symptoms which will likely be included in a description of a patient with a pheochromocytoma?

A

Thin, diaphoretic, tachycardia, agitated and hypertensive.

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17
Q

You have a patient with a diagnosis of a pheochromocytoma. While waiting for surgery should you use an alpha-blocker or beta-blocker?

A

ALPHA!!! never use a pure beta blocker.

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18
Q

A young boy comes into the office. He has an elevated blood pressure in the arms, but no palpable femoral pulses. What is the most likely diagnosis?

A

coarctation of the aorta

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19
Q

According to the CDC, what is the range for a normal BMI?

A

18.5-24.9

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20
Q

What is the first line medical treatment for stage 1 hen according to JNC 8?

A

Thiazide diuretic, ACEI, CCB, ARB

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21
Q

What is the JNC 8 hen goal for a patient with diabetes?

A

<140/90 no matter the race or sex. Initiate ACEI/ARB

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22
Q

If the patient is < 60 and African American - what medication is preferable to start?

A

CCB or thiazide diuretic.

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23
Q

Following a myocardial infarction, what medication should you be using to treat HTN?

A

beta blocker.

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24
Q

Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

A

CHF

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25
Q

What is the most common cause of CHF?

A

Coronary artery diasease

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26
Q

What. ejection fraction is typical for a patient with CHF?

A

35-40%

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27
Q

What is the most likely diagnosis for a young man who experiences sudden death while playing sports?

A

hypertrophic cardiomyopathy

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28
Q

Bat wing vessels or KErley B lines on a CXR should make you think of what diagnosis?

A

CHF

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29
Q

A beta natruirectic peptide below what level rules out CHF?

A

<100

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30
Q

What is the therapeutic range for INR after a mechanical valve replacement?

A

2.5-3.5

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31
Q

What is the first line IV inotropic agent when dealing with cariogenic shock?

A

dopamine

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32
Q

What diagnosis is most likely in an IV drug user with new heart murmur and fever?

A

Endocarditis

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33
Q

List 2 diagnosis which require antibiotic prophylaxis for “ dirty procedures”?

A

Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect. NOT MVP

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34
Q

Does a patient with a mitral valve prolapse require prophylactic antibiotics for dental work?

A

No - recent changes move. MVP from high risk to moderate risk

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35
Q

What are 3 major criteria for endocarditis?

A

2 positive blood cultures,
a positive Transesophageal echo,
new murmur

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36
Q

Which are painful and found on the fingers and toes - Osler nodes or Janeway lesions?

A

Osler nodes

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37
Q

List the 4 minor criteria for diagnosing endocarditis

A

fever
embolic event (janeway lesions or petechiae or splinter hemorrhages)
immunological event (Osler nodes, glomerulonephritis)
1 positive blood culture

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38
Q

What are the 5 components of the tetralogy of Fallot>

A 
VSD
RVH
Right ventricular outflow obstruction (pull valve stenosis)
Overiding aorta, 
right sided aortic notch
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39
Q

What is the gold standard for diagnosing myocarditis?

A

Myocardial biopsy

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40
Q

Where of most aortic dissections occur?

A

the ascending or descending thoracic arch

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41
Q

A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis>

A

Pericarditis

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42
Q

What is the first line medical treatment for pericarditis?

A

ASA and NSAIDs

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43
Q

What it set name of the syndrome that involves pericarditis several days - 2 weeks after AMI?

A

Dressler’s syndrome

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44
Q

A patient presents to the ED with chest pain. An EKG shows diffuse ST elevations in almost half the leads - what is the diagnosis?

A

Pericarditis

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45
Q

Define paradoxical pulse

A

There is a large difference in pulse pressure between inhalation and exhalation

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46
Q

Define pulses alternans

A

EKG waveform changes from beat to beat.

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47
Q

What is the definitive treatment for cardiac tamponade?

A

Pericardiocentesis - 2nd ICS MCL

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48
Q

On physical exam, you hear a harsh systolic murmur along the Right sternal border. What is the most likely diagnosis?

A

Aortic stenosis

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49
Q

A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd ICS should make you think of what diagnosis>

A

Aortic regurg

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50
Q

What is the best location to hear problems with the aortic valve?

A

2nd right ICS

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51
Q

Where is disease of the pulmonary valve heard best>

A

2nd LEFT ICS

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52
Q

What 2 antibiotics are used for empiric treatment of endocarditis?

A

Vancomycin and ceftriaxone are first line

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53
Q

What 2 valvular issues do patient with MArfan’s syndrome often have?

A

Aortic regard and MVP

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54
Q

What are 2 main causes of aortic stenosis

A

Congential bicuspid valve

calcification of the valve secondary to CAD

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55
Q

And elderly patient presents with dyspnea, angina, and syncope. The EKG is normal. What is the most likely diagnosis?

A

Aortic stenosis

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56
Q

On auscultation, you hear a harsh, blowing, pansystolic murmur at the apex. What is the most likely diagnosis?

A

Mitral regurg

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57
Q

You suspect mitral regard. What is the most accurate way to prove your diagnosis?

A

Transesophageal echo

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58
Q

A patient with a mitral valve prolapse will often have what physical characteristics?

A

its often a thin female

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59
Q

What is the best patient position to hear aortic regard and aortic stenosis?

A

Sitting up and leaning foraward

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60
Q

What is Tietze syndrome?

A

Costochondritis

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61
Q

Are most pulmonary valve problems congenital or acquired?

A

95% are congenital

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62
Q

What is the therapeutic range for INR following an organic valve replacement?

A

2-3

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63
Q

A 60 yo male presents to the ED with severe dizziness and back pain. His blood pressure is dropping, and you end feel and abdominal pulsatile mass on PE. What is the most likely diagnosis?

A

Ruptured AAA

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64
Q

In a patient with aortic stenosis, the PMI will be medially displaced, normal, or laterally displaced?

A

laterally displaced due to LVH

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65
Q

A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponin and CK-MB are negative. What is the most likely diagnosis?

A

Prinzmetal’s angina

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66
Q

A question about Prinmetal’s angina will often contain what key thing in the patient’s history?

A

cocaine use.

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67
Q

Name 2 things that would constistute a positive stress test.

A

A drop in blood pressure
a new arrhythmia
an increase in angina symptoms
ST depressions

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68
Q

Are ulcers from venous insufficiency painful or painless

A

Painless

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69
Q

A patient has just received a cardiac stent. How long will he be on ASA and Clopidogrel?

A

1 year

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70
Q

Where is the disease of the mitral valve best heard?

A

at the apex

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71
Q

What is the initial treatment for myocardial infarction?

A

MONA - morpine, oxygen, NTG, asa

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72
Q

Clot busting drugs should be used within 3 hours of which 2 cardiac events?

A

STEMI and new left bundle branch blocks

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73
Q

List 3 catastrophic complications of a myocardial infarction

A

Papillary muscle rupture
myocardial wall rupture
left ventricular aneurysm

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74
Q

A EKG sows a regular heart rate of 200bpms. QRS is narrow. What is the most likely diagnosis

A

Supraventricular tachycardia

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75
Q

Acute endocarditis is most commonly caused by what organism?

A

Staph aureas

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76
Q

List 3 congenital heart diseases

A 
ASD
VSD
Coarctation of the aorta
tetralogy of ballot
PDA
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77
Q

What is the most common cause of an partial septal defect?

A

patent foramen ovale

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78
Q

Where on your patient should you listen for the murmur associated with a an atrial septal defect?

A

at the LEFT 2nd or 3rd interspace.

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79
Q

A CXR shows a “3” sign with notching of the ribs. Wha t it the most likely diagnosis?

A

coarctation of the aorta

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80
Q

What is the appropriate treatment for a patient with PDA

A

Indomethacin

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81
Q

A Black procedure is used to correct what congenital heart disease?

A

Tetrology of Fallot

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82
Q

You hear a loud hard pulmonic murmur along the left sternal border. What is most likely diagnosis?

A

VSD

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83
Q

Subacute endocarditis is most commonly caused by what organism>

A

Strep Viridans

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84
Q

What is the most common place for and aortic aneurysm?

A

In the abdomen and below the renal arteries

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85
Q

Who is more likely to have an aortic aneurysm - males of females?

A

males are 8 times more likely to have an aortic aneurysm

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86
Q

The accessory pathway known as the James bundle should make you think of what syndrome?

A

Low - Gaining-Levine syndrome

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87
Q

What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?

A

CT (echoey be used as initial study, but CT is needed for surgery)

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88
Q

List 2 risk factors for an aortic dissection

A

HTN, MArfan’s syndrome, bicuspid aortic valve, pregnancy

89
Q

A patient presents to the ED with tearing chest pain radiating to his back. What is the most likely diagnosis>

A

aortic dissection

90
Q

What will a CXR show for a patient with an aortic dissection?

A

widened mediastinum

91
Q

What it the best test to diagnose an aortic dissection?

92
Q

List the 6 “P’s” of an ischemic limb

A

Pain paraesthesia, pallor, pulselessness, poikilothermia, paralysis

93
Q

you have a patient with pulses paradoxes. What 2 diagnosis should you be thinking of?

A

Pericarditis, pericardial effusion and obstructive lung disease

94
Q

A patient complains of pain in his legs when he walks. it goes away after sitting. What term comes to mind with this symptom? what diagnosis goes along with it?

A

Intermittent claudication caused by peripheral arterial disease (PAD)

95
Q

Giant cell arteritis is associated with what other disease?

A

polymylagia rheumatica

96
Q

a sawtooth pattern on EKD=G should make you think of what diagnosis?

97
Q

What is the accessory pathway associated with Wolf-Parkinson-White

A

The bundle of KEnt

98
Q

A biphasic P wave should make you think of what diagnosis?

A

Left partial enlargement

99
Q

What is the gold standard for the diagnosis of giant cell arteritis

A

temporal artery biopsy

100
Q

What is the treatment for giant cell artertitis

A

High dose prednisone

101
Q

List the components of Virchow’s triad

A

Stasis
vascular injury
hepercoagualbility

102
Q

Calf pain should always make you think of what diagnosis?

103
Q

Where is the disease of the tricuspid valve heard best:

A

along the left lower sternal border

104
Q

What is the most common congenital heart disease?

105
Q

Are ulcers from arterial insufficiency painful or pain less?

106
Q

give 2 contraindications for using ACEI

A

bilateral renal artery stenosis
history of angioedema
pregnancy

107
Q

Both leads I and AVF have a positive QRS complexes; Does this represent normal, right or left axis deviation?

A

normal axis

108
Q

What medication might you witch a patient to if they develop and intolerable cough?

109
Q

What class of cardiac medications should be avoided in patients with asthma?

A

Beta blockers

110
Q

A boot shaped heart on CXR should make you think of what congenital heart defect?

A

Tetrology of Fallot

111
Q

An RSR prime in leads V1 and V2 should make you think of what diagnosis>

112
Q

Which lab should be more tightly monitored in a patient taking and aldosterone antagonist?

A

Potassium - they may develop hyperkalemia

113
Q

What is the best test for diagnosing CHF

A

echocardiogram

114
Q

Which cardia medications is used to help with cardiac contractility after you have optimized most of the other cardiac medications?

115
Q

A blockage of which artery causes an anterior walll MI

A

Left anterior descending

116
Q

What lab will result in increased the risk of digoxin toxicity?

A

hypokalemia or hypercalcemia

117
Q

A patient presents to the ED in CUTE CHF - WHAT dRUG CLASS WILL LIKELY BE THE FIRST CHOICE FOR TREATMENT?

A

Loop diuretics

118
Q

A patient has a GFR of 25 and HTN. Which class of diuretic should you use - loop of thiazide?.

A

Loop will work no matter how low the GFR is, a Thiazide will only work if GFR >30

119
Q

Which EKG leads are used to diagnose an anterior wall MI?

A

V1, V2, and V3

120
Q

Do loop diuretics cause hypekalemia or hypokalemia?

A

hypokalemia

121
Q

Statins are the drug of choice to treat what type of dysplipidemia?

A

Elevated LDL

122
Q

A patient recently started taking Lipitor. HE is now complaining of aches and pains. What lab test should be ordered?

A

Creatinine Kinase looking for rhabdomylolisis

123
Q

How does Ezetimbe work?

A

Decreases the intestinal absorption of cholesterol

124
Q

Which hyperlipidemia agent may cause flushing?

125
Q

Name 3 classes which are used to reduce LDL

A

Statins, Ezetimibe, niacin, nicotinic acid

126
Q

Name 2 fabric acid deriviatives

A

Fenofibrate and gemfibrozil

127
Q

List 3 class 1a antiarrhythmics

A

disopyramide, quinidine, procainamide

128
Q

you are counting boxes from the Peak of a QRS wave on an EKG in order to determine the heart rate. What would be the heart rate if the next QTS wave peak were 3 boxes away? what are the numbers associated with the first 5 boxes?>

A 
3 boxes - 100beats/min
1 box = 300
2 = 150
3=100
4=75
5=60beats per miniute
129
Q

A U wave on an EKG should make you think of what diagnosis?

A

Hypokalemia

130
Q

What will the heart rate be if the AV node is pacing the heart?

A

40-60 beats / minute

131
Q

Which cardia medication has gynecomastia in its side effect profile?

A

Spironolactone

132
Q

Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal, left or right axis?

A

left axis deviation

133
Q

An Osborn or J wave on EKG should make you think of what diagnosis?

A

hypothermia

134
Q

What is the first line medication for a patient with symptomatic bradycardia?

135
Q

On an EKG, there is an early but other wise normal
PQRS complex. After that beat there is a slight pause and then a normal rhythm continues what is the term for this one beat>

A

Premature atrial complex.

136
Q

What is the management of a patient in supra ventricular tachycardia?

A

vagal maneuvers, carotid massage, adenosine

137
Q

How do you treat PMR (polymylagia rheumatic)?

A

low dose prednisione

138
Q

how do you treat temporal (giant cell) arteritis?

A

high dose prednisone

139
Q

What is the definitive treatment for atrial flutter?

A

radio frequency ablation

140
Q

The EKG shows irregularly irregular narrow QRS waves. What should you be thinking of?

141
Q

An EKG shows a regular rate of 50 ppm. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?

A

junctional rhythm

142
Q

Name a commons cause of junctional rhythm

A

Digoxin toxicity

143
Q

An EKG shows two premature ventricular contractions. There two QRS waves look very different. What is the term for this?

A

Multifocal premature ventricular contractions.

144
Q

What is the most common cause of suffer cardiac death?

145
Q

Pa patine tin the ED has no pulse. But on EKG there are wide irregular “complexes” which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?

A

He is in V Fib - defibrillate!!!

146
Q

Tall Peaked T waves should make you think of what diagnosis?

A

Hyperkalemia

147
Q

How do you define 1st degree Av block?

A

PR interval is longer than 0.2 seconds (1 block) on EKG

148
Q

What is the other term for Mobitz type 1

149
Q

What is the most important complication of giant cell arteritis

150
Q

What 2 labs do you monitor on a patient on a ACEI?

A

creatinine and potassium

151
Q

The heart rate is irregular, so you can’t count boxes between QRS waves to determine heart rate. What is anothe meths you can use to determine rate on an EKG?

A

Count QRS waves in a 6 second strip and multiply by 10 to get beats per minute.

152
Q

What is the treatment for a patient with Mobitz type 2 AV block?

153
Q

On an EKG - you see regular P waves and regular QRS waves but they do not seem to have any correlation to each other. What is this?

A

3rd degree AV heart block

154
Q

Name 1 aldosterone antagonist.

A

Spironolactone, eplerenone

155
Q

You see a short PR interval and a delta wave on EKG what is the most likely diagnosis?

A

Wolf Parkinson White

156
Q

What 2 leads on and EKG do you use to determine the axis of the heart?

157
Q

An RSR prime in lead V5 and V6 should make you think of what diagnosis?

158
Q

Which finding requires immediate attention - LBBB or RBBB

A

new LBBB - is a STEMI equivalent.

RBBB is usually not an issue

159
Q

What medication class is used to lower triglycerides?

A

fibric acid derivatives (fenofibrate/gemfobrazil)

160
Q

Tall Peaked P waves should make you think of what diagnosis?

A

Right atrial enlargement

161
Q

List 2 causes of right atrial enlargement

A

Pulmonary HTN, severe lung disease, pulmonary valve stenosis

162
Q

which EKG leads are used to diagnosis anterolateral MT

163
Q

which leads are used to diagnosis a lateral MI

164
Q

A blockage of which artery can cause a lateral wall MI

A

Left circumflex

165
Q

What is represented by ST segment depressions greater than 1mm on EKG?

166
Q

Rheumatic fever commonly effects which valve?

167
Q

What is the only cyanotic congenital heart disease on the NCCPA blueprint?

A

tetralogy of Fallot nonP wave.

168
Q

In EKG there is an early wide QRS complex withAfter the treat there is a slight pause, then a normal rhythm continues. What is the term for this one bea

A

PVC (premature ventricular contraction)

169
Q

What is the definitive treatment for a patient with recurrent ventricular tachycardia?

A

Implanted defibrillator

170
Q

on an EKG you notice a patient has a gradual lengthening of the PR interval and then misses a QRS complex. the pattern repeats again. What type of AV block is this

A

Mobitz 1 or Wenkeback

171
Q

List 3 side effects of digoxin

A 
N/V,
Anorexia
confusion
arrthymias (sinus Brady/AV block)
fatigue
visual distrubances
172
Q

What is the fist line treatment of torsades de pointes

A

Mg sulfate

173
Q

What are symptoms of LEFT sided heart failure?

A 
described as low output with increased venous pressure
SOB
DOB
Orthopnea
paroxysmal nocturnal dyspnea
174
Q

What are symptoms of right sided heart failure

A 
caused by left ventricular dysfunction
Edema
Hepatic conjestion
JVD
loss of appetites
nausea
175
Q

Describe cardiac PRELOAD

A

how full the heart is before it squeezes

176
Q

Describe cardiac AFTERLOAD

A

what is the ventricle pushing against?

177
Q

Describe heart Contractility

A

the force the heart muscle can exert

178
Q

how does heart rate effect the cardiac performance?

A

gages the demand - fast - slow

179
Q

What are 4 factors that determine cardiac performance

A

Preload
Afterload
contractility
rate

180
Q

What is “broken heart syndrome”

A

Acute CP and SOB similar to acute MI caused by LV apical ballooning following a high catecholamine stress
Normal arteries on a cardiac cath
“Taku-Tsubo” cardiomyopathy

181
Q

how do beta blockers work

A

They interfere with cahanges caused by catecholamine release
decrease heart rate
decreased after load/BP
decrease cardiac output

182
Q

how do diuretics such as LASIX work

A

Decrease peripheral vascular resistance
decrease plasma volume
decrease excess NA and fluid
decrease volume overload

183
Q

Why do we do an echocardiogram evaluation

A

determines EF
evaluate LV function and wall motion
assess valve function
diagnosis cardiomyopathies

184
Q

What Ejection fracture would you ex[pect in a normal patient?
one with CHF

A

50-70% is normal
35-40% can form CHF
<35% life threatening

185
Q

How would you treat acute CHF

A 
loop diuretic (LAsix)
SL/IV Nitroglycerin
O2/CPAP
ACEI
treat underlying cause
186
Q

What are the classic signs of Infective Endocarditis

A

Petechiae of palate, conjucntiva, sublingual
Subungual splinter hemorrhages
Osler nodes (PAINFUL) finges / toes/feet
JAneway lesions (PAINLESS) palms and soles
Roth spots - exudative retinal hemorrhages

187
Q

IS the pleural effusion in CHF transudative or exudative

A

Transudative Glucose >60, protein <3 LDH >200

188
Q

What procedures require prophylaxis ( for those patient that need prophylaxis)?

A

Oral: extraction/root canal/ tonsils
GI: surgery/ERCP/colonoscopy with biopsy
GU: Prostate surgeyr/cystoscopy

189
Q

Who needs antibiotic prophylaxis for procedures?

A

HIGH risk: prosthetic heart valve
Prior infective endocarditis
Cyanotic congenital heart disease
MODERATE : Rheumatic valvular heart disease with regard
HOCM
Mitral valve prophase with regurg
MVP NO LONGER REQUIRES PROPHYLAXIS

190
Q

Dukes criteria for infective endocarditis

2 major. OR. 5 minor. OR1 major and 3 minor.

A

MAJOR: 2 + BLC. TEE showing endocarditis new Murmur
MINOR:
fever/ vascular phenomenon 1+ BLC h/o IV drug use immunologic change

191
Q

What is the gold standard test for myocarditis?

A

myocardial biopsy.

192
Q

What is myocarditis?

A 
sudden onset of heart failure
echo: dilated cardiomyopathy
EKD nonspecific
Edmea and S3 on PE
Sx SOB and pleuritic CP
193
Q

What are the primary causes of Myocarditis

A

Coxsackie B virus (measles/flu/varicella)

Kawasakis

194
Q

Where would you hear an aortic murmur

A

2nd right ICS

195
Q

where would you hear mitral murmur

196
Q

where would you hear pulmonic murmur

A

2nd LEFT ICS

197
Q

where would you hear tricuspid murmur

A

Left Lateral sternal border/ LLSB

198
Q

Systolic murmurs

A

Aortic stenosis

Mirtal regurg

199
Q

Diastolic murmurs

A

Aortic regurg

Mitral stenosis

200
Q

Causes of Aortic stenosis

A

Congential bicuspid valve (presents 50-60yo)

degenerative - calcification due to atherosclerosis

201
Q

describe the murmur in aortic stenosis

A

systolic ejection, harsh and low, heart best right 2nd ICS and leaning forward and exhale

202
Q

treatment of aortic stenosis

A

most common surgical valve replacement
Replace if CHF/ angina/syncope
Ross procedure (young patient ) mechanical/ TAVR (trans catheter aortic valve replacement)
bioprosthetic (porcine/bovine) good for elderly

203
Q

murmur of aortic regurg

A

soft blowing diastolic murmur along LSB best with sitting forward and expire (also called Austin flint murmur)

204
Q

S/Sx of aortic regurg

A

SOB
Widened pulse pressure
Waterhammer pulse (also called corrigans)
hyperactive enlarged LV

205
Q

Who would get aortic regurg?

A

Rheumatic fever in elderly/foreigners
infective endocarditis/marfans syndrome(aortic root disease)
Inflammatory

206
Q

Treatment of aortic regurg`

A

treat infective endocarditis - immediate surgery
Chronic: ACEI/ARB to decrease SOBand improve EF
valve replacement

207
Q

causes of mitral stenosis

A

thickened leaflets (thick/stiff leaflet on echo)
fusion of the chord
Calcium deposits
(can see initial onset A Fib/ pregnancy)

208
Q

describe the Murmur of mitral stenosis

A

mid-diastolic rumble heard best at apex with bell

also can hear an opening snap with S2

209
Q

Who gets mitral stenosis?

A

h/o rheumatic fever

sx: orthopnea/PND.exertional dyspnea

210
Q

treatment of mitral stenosis

A
  • if asymptomatic - monitor, can be precipitated by pregnancy
    treat underlying afib
    Surgery: percutaneous balloon valuloplasty
211
Q

What occurs with mitral regard?

A

increases preload and reduces after load, eventually enlarging LV which weakens it and the EF drops

212
Q

Describe the murmur of mitral regurg

A

harsh blowing pan systolic murmur at apex that radiates to the axilla

213
Q

Discuss MVP

A

thin young female with a floppy mitral valve - hear a Mid Systolic Click (MSC) heard best with standing or valsalvea
Confirmed by echo, treat with b-blocker
doesn’t need prophylaxis
Usually asymptomatic

214
Q

How is a HTN emergency classified and treated?

A

Diastolic pressure >130
requires substantial reduction in 1 hour to avoid morbidity and mortality
Could result in intracranial hemorrhage/pumonary edema/unstable angin/MI

215
Q

Define malignant HTN

A

Sustaine BP >200/130 with present of encephalopathy/nephrolathy/pappiledema

216
Q

Treatment for HTN emergency

A

LAbetolol IV (both alpha and beta blocker)
nicardipine IV
Esmolol IV

Goal to reduce BP 25% in 1-2 hours then decrease lower than 160/100 over next 2-6 hours

217
Q

describe a paradoxical pulse

A

> 10mmhg drop in systolic BP during inspiration

Seen in COPD and cardiac tamponade

218
Q

Describe the S1S2 heart sounds

A

S1 “lub” - clsoure of the mitral/tricuspid valves
S2 “dub” - closure of aortic/pulmonic valves.- can split with inspiration
S3 - early rapid LV filling - associated with CHF
S4 - rigorous atrial contraction with stiff LV - LVH/MI

PANRE (12 decks)

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