Cardiology Flashcards
What side effect might make a patient stop taking an ACEI?
Cough
Define orthostatic hypotension.
A drop in systolic pressure of >20mmHg when standing up.
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade
pericarditis
obstructive lung disease
What is a paradoxical pulse?
An abnormally large decrease in systolic BP during inspiration. Normal is less than 10mmHg. PP is more than 20mmHg.
On palpation, what size is normal for the aorta?
Less than 3cm
A fixed or consistent split S2 should make you think of what dx?
Atrial septal defect
A pathologic S3 is most commonly associated with what dx?
CHF
If you hear a mid systolic click you should immediately be thinking about what dx?
Mitral valve prolapse
An opening snap on auscultation of the hear should make you think of what dx?
Mitral stenosis
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect.
You hear a continuous machine-like murmur. What is the most likely dx?
Patent ductus arteriosus(PDA)
List 3 meds which may be used for a pharmacological stress test.
Adenosine
Dobutamine
Dipyridamole
Persantine
What is the gold standard for dx’ing coronary artery disease?
Cardiac catheterization
Define stage 1 hypertension acc to JNC7.
Systolic pressure of 140-159 and diastolic 90-99
What is the tx goal for a diabetic with HTN?
130/80
What is the most common cause of 2ndary HTN?
chronic kidney disease
No matter what meds you use, you are having trouble keeping a pt’s BP under control. You also notice hyper pigmented skin and truncal obesity. What is the most likely dx?
Cushing’s disease
List 3 s/s which will likely be included in the description of a pt with a pheochromocytoma.
Thin diaphoretic tachycardic agitated hypertensive
What is a pheochromocytoma?
(benign) tumor that develops in an adrenal gland. Usually, this type of tumor affects one of your two adrenal glands, but it can affect both.
If you have a pheochromocytoma, the tumor releases hormones that cause either episodic or persistent high blood pressure. Untreated, a pheochromocytoma can result in severe or life-threatening damage to other body systems, especially the cardiovascular system.
Most people with a pheochromocytoma are between the ages of 20 and 50, but the tumor can develop at any age. Surgical treatment to remove a pheochromocytoma usually returns blood pressure to normal.
You have a pt with a dx of pheochromocytoma. While waiting for surgery, should you use an alpha or beta blocker?
Alpha blocker. You should never use a pure beta blocker.
A young boy comes into your office. He has elevated BP when taken in his arm, but no femoral pulses can be palpated. What is the most likely dx?
Coarctation of the aorta
According to the CDC, what is the range for a normal BMI?
18-5-24.9
What is the first line medical tx for stage 1 HTN?
Thiazide diuretic
After a thiazide diuretic, what medication should you start in a HTN pt who also has DM?
ACEI
ARB
Following an MI, what med should you be using to tx HTN?
beta blocker
Paroxysmal nocturnal dyspnea should make you think of what dx?
CHF
What is the most common cause of CHF?
Coronary artery disease
What ejection fraction is typical for a pt c CHF?
35-40%
What is the most likely dx for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
Bat wing vessels or Kerley B lines on CXR should make you think of what dx?
CHF
A beta natriuretic peptide below what level rules out CHF?
<100
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
What dx is most likely in an IV drug user with a new heart murmur and fever?
Endocarditis
List 2 dx which require abx prophylaxis for “dirty procedures”?
Prosthetic valve
Valve repair with any prosthetic material
prior endocarditis
Congenital cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic abx for dental work?
No
What are 3 major criteria for endocarditis?
2 positive blood cultures
a positive transesophageal echocardiography
new murmur
Which are painful and found on the fingers and toes: Osler nodes or Janeway lesions?
Osler nodes (ouch!)
List 4 minor criteria for dx’ing endocarditis.
Fever
embolic event: Janeway lesions or petechiae, splinter hemorrhages
Immunological event (Osler nodes, glomerulonephritis)
1 positive blood culture
What are the 5 components of Tetralogy of Fallot?
Ventricular septal defect Right ventricular hypertrophy right ventricular outflow obstruction (pulmonary valve stenosis) Overriding aorta right sided aortic arch
Sudden death in a young athlete associated with…
hypertrophic cardiomyopathy
Fixed wide splitting of S2
Atrial septal Defect (ASD)
How does coarctation of the aorta present?
Rib notching, absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs
What disorder is associated with a machine like murmur?
patent ductus arteriosus
What dx would you think of in an infant who has cyanosis with crying or feeding?
tetralogy of ballot
A holosystolic murmur suggests…
VSD
A new mitral regurgitant murmur in a pt with a hx of iv drug abuse suggests…..
bacterial endocarditis
How is a pericardial friction rub heard best? Associated c what condition?
With the pt sitting up and leaning forward
acute pericarditis
What is the gold standard for diagnosing myocarditis?
Myocardial bx
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
A pt c/o severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely dx?
pericarditis
What is the first line medical tx for pericarditis?
Aspirin and NSAIDS
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler syndrome
A pt presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely dx?
Pericarditis
Define paradoxical pulse
There is a large difference in pulse pressure between inhalation and exhalation.
Define pulsus alternans.
EKG waveform changes from beat to beat.
What is the definitive treatment for cardiac tamponade.
Pericardiocentesis
On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely dx?
Aortic stenosis
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what dx?
Aortic regurgitation
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
What 2 abx are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are the first line empiric treatment
What 2 valvular issues do patients with Marfan’s syndrome often have?
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard)
What are the 2 main causes of aortic stenosis?
congenital bicuspid valve
calcification of the valve secondary to coronary artery disease
An elderly pt presents c dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely dx?
aortic stenosis
On auscultation, you hear a harsh, blowing pan systolic murmur at the apex. What is the most likely dx?
Mitral regurgitation
You suspect mitral regurgitation. What is the most accurate way to prove your dx?
Transesophageal echo
A pt c mitral valve prolapse will often have what physical characteristics.
Often a thin female
What is the best pt position to hear aortic regorge and aortic stenosis?
Sitting up and leaning forward
What is Tietze syndrome?
Costochondritis
Are most pulmonary valve problems congenital or acquired?
95% are congenital
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
A 60 yo male presents to the ER with severe dizziness and back pain. His BP is dropping, and you can feel an abdominal pulsatile mass on PE. What is the most likely dx?
Ruptured aortic aneurysm
In a pt c aortic stenosis, will the PMI be medially displaced, normal or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy.
A pt c/o severe crushing chest pain. EKG shows ST segment elevations. All labs including troponin and CK-MB are negative. What is the most likely dx?
Prinzmetal’s angina
A question about Prinzmetal’s angina will often contain what key thing in the pt’s hx?
cocaine use
Name 2 things that would constitute a positive stress test.
A drop in BP.
a new arrhythmia
an increase in angina symptoms
ST depressions
Are ulcers from venous insufficiency painful or painless?
Painless
A pt has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
one year
Where is disease of the mitral valve best heard?
At the apex
What is the initial tx for a myocardial infarction?
MONA: morphine, oxygen, nitroglycerin and aspirin
Clot busting drugs should be used within 3 hrs of which 2 cardiac events?
STEMI & new left bundle brach block
List 3 catastrophic complications of a myocardial infarction.
Papillary muscle rupture
myocardial wall rupture
left ventricular aneurysm
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely dx?
Supra ventricular tachycardia
Acute endocarditis is most commonly caused by what organism?
Staph aureus
List 3 congenital heart diseases.
Atrial septal defect (ASD) Ventricular septal defect (VSD) coarctation of the aorta patent ductus artertiosus (PDA) tetralogy of ballot
What is the most common cause of an atrial septal defect?
Patent foramen ovale
Where on your pt should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
A CXR shows a “3” sign with notching of the ribs. What is the most likely dx?
coarctation of the aorta
What is the appropriate tx for a patent ductus arteriosus?
Indomethacin
A Blalock procedure is used to correct what congenital heart defect?
Tetralogy of Fallot
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely dx?
Ventricular septal defect
Subacute endocarditis is most commonly caused by what organism?
Strep viridans
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
Who is more likely to have an aortic aneurysm: males or females?
Males are 8x more likely to have an aortic aneurysm.
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial but CT is needed for surgery)
List 2 risk factors for an aortic dissection.
Hypertension
Marfan’s syndrome
bicuspid aortic valve
pregnancy
A pt presents to the ER with tearing chest pain radiating to his back. what is the most likely dx?
Aortic dissection
What will a CXR show for a pt with an aortic dissection?
Widened mediastinum
What is the best test to dx an aortic dissection?
CT
List the six P’s of an ischemic limb.
Pain paresthesias pallor pulselessness poikilothermic paralysis
You have a pt with pulsus paradoxus. What 2 dx should you be thinking of?
Pericarditis
pericardial effusion
obstructive lung disease
A pt c/o pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What dx is it associated with?
Intermittent claudication caused by peripheral arterial disease.
Giant cell arteritis is associated with what other dx?
Polymyalgia rheumatica
A sawtooth pattern on EKG should make you think of what dx?
Atrial flutter
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
the bundle of Kent
A biphasic P wave should make you think of what dx?
Left atrial enlargement
What is the gold standard for the diagnosis of giant cell arteritis?
biopsy of the temporal artery
What is the treatment for giant cell arteritis?
High dose prednisone
List the components of Virchow’s triad.
Stasis
vascular injury
hypercoagulability
Calf pain should always make you think of what dx?
DVT
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
What is the most common congenital heart disease?
Ventricular septal defect
Are ulcers from arterial insufficiency painful or painless?
Painful
Give 2 contraindications for using an ACEI.
Bilateral renal artery stenosis
hx of angioedema
pregnancy
Both lead I and AVF have positive QRF complexes. Does this represent normal axis, left axis deviation or right axis deviation?
Normal axis
What med might you switch to if a pt develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
What class of cardiac medications should be avoided in pts c asthma?
Beta blockers (blocks receptors for bronchodilators)
A boot shaped heart on CXR should make you think of what congenital heart condition?
Tetralogy of ballot
An RSR prime in leads V1 or V2 should make you think of what dx?
Right bundle branch block
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyperkalemia
What is the best test for dx’ing CHF?
Echo
Which cardiac medication is used to help cardiac contractility after you have optimized most of the other cardiac meds?
Digoxin
A blockage of which artery causes an anterior wall MI?
left anterior descending artery
Which lab result will increase the risk of digoxin toxicity?
Hypokalemia or hypercalcemia
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
A pt has a GFR of 25 and HTN. Which class should you use–a loop or thiazide diuretic?
a loop will work no matter how long the GFR is. thiazides will only work with a GFR>30.
Which EKG leads are used to dx anterior wall MI?
V1, V2, V3
Do loop diuretics cause hyperkalemia or hypokalemia?
hypokalemia
Statins are the drug of choice to tx what type of dyslipidemia?
Elevated LDL
A pt recently started taking Lipitor. He is now c/o aches and pains. What test should you order?
Serum creatinine kinase: you are looking for rhabdomyolysis
How does ezetimibe work?
Decreases intestinal absorption of cholesterol
Which hyperlipidemia med may cause flossing?
Niacin
Name 3 medication “classes” which are used to reduce LDL?
Statins
ezetimibe
niacin
nicotinic acid
Name 2 fibric acid derivatives.
Fenofibrate
gemfibrozil
List 3 class 1a antiarrhythmics.
Disopyramide
quinidine
procainamide
You are counting boxes from the peak of a QRS wave on an EKG IOT determine the heart rate. What would the heart rate be if the next QRS were 3 boxes away? What numbers are associated with the first five boxes?
The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.
An U wave on EKG should make you think of what dx?
Hypokalemia
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
Which cardiac medication has gynecomastia in its side effect profile?
spironolactone
Lead I has a QRS that is up and the AVF lead has a QRF complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?
Left axis deviation
An Osborn or J wave on EKG should make you think of what dx?
Hypothermia
What is the first line medication for a pt c symptomatic bradycardia?
Atropine
What is the heart rate for tachycardia? How about bradycardia?
Tachy >100
Brady<60
On EKG there is an early but otherwise 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?
Premature atrial contraction
How do you treat polymyalgia rheumatica?
Low dose prednisone
What is the management of a patient in supra ventricular tachycardia?
Vagal maneuvers
carotid massage
adenosine
What is the definitive treatment for atrial flutter?
Radio frequency catheter ablation
An 82 yo pt c/o HA and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
The EKG shows irregularly irregular narrow QRS waves. What dx should you be thinking of?
Atrial fibrillation
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely dx?
Junctional rhythm
Name a common cause of a junctional rhythm.
Digoxin toxicity
An EKG shows two premature ventricular contractions. These 2 QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
A pt in the ER 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 tx of this pt?
He is in ventricular fibrillation. The tx is defibrillation.
Tall peaked T waves should make you think of what diagnosis?
Hyperkalemia
How do you define 1st degree AV block?
the PR interval is longer than 0.2 seconds or one block on EKG
What is the other term for Mobitz type I?
Wenckebach
What is the most important complication of giant cell arteritis?
Blindness
What 2 labs do you want to monitor in a pt on an ACEI?
Serum creatinine
serum potassium
The HR is irregular, so you can’t count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute.
What is the treatment for a patient with a Mobitz II AV block?
pacemaker
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the dx?
Third degree AV block
Name one aldosterone antagonist.
Spironolactone, eplenerone
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
What two leads do you use to determine the axis of the heart?
Lead I and AVF
An RSR prime in leads V5 or V6 should make you think of what dx?
left bundle branch block
Which finding requires immediate attention: left bundle branch block or right bundle branch block?
New left bundle branch block is a STEMI equivalent. right bundle branch block is usually not a problem.
What medication is used to lower triglycerides?
Fibric acid derivatives
Tall peaked P waves should make you think of what dx?
Right atrial enlargement
List 2 causes of right atrial enlargement.
Pulmonary HTN
severe lung disease
pulmonary valve stenosis
Which EKG leads are used to dx an anterolateral MI?
V5 and V6
What are the 3 inferior leads?
II, III, aVF
A blockage of which artery causes a lateral wall MI?
left circumflex artery
What is represented by ST segment depressions greater than 1mm on EKG?
Ischemia
Rheumatic fever most commonly affects which valve?
The mitral valve
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of ballot
On EKG, there is an early wide QRS complex with no associated P wave. After that beat, there is a slight pause, and then a normal rhythm continues. What is the term for this one beat?
premature ventricular contraction
What is the definitive treatment for a patient c recurrent ventricular tachycardia?
Implanted defibrillator
On an EKG, you notice a pt has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?
Mobitz I or Wenckebach
List 3 SE of digoxin.
Nausea/vomiting anorexia confusion arrhythmia (sinus brady, AV block) fatigue vision disturbances
What is the first line medical tx for torsades de pointes?
Magnesium sulfate
