cardiology Flashcards
VSD - murmur?
holosystolic murmur w/palpable thrill
sign of coarctation of aorta on exam?
brachial-to-femoral ulse delay
PDA - exam finding?
continuous murmur in L infraclavicular area
most common cyanotic congenital heart defect?
tetralogy of fallot
characteristic anomalies of tetralogy of fallot?
- RV outflow obstruction
- overriding aorta
- RV hypertrophy
- VSD
what defect causes wide, fixed S2 split?
- ASD
- large R-to-L shunts (ASD, ventricular defect, PDA)
newborn decompensates after PDA closes - dx?
hypoplastic LV
Ebstein anomaly - what causes it?
Lithium during pregnancy
Ebstain anomaly - what is it?
atrialized RV (presents w/tricuspid regurg + cyanosis)
fetal hypertrophic cardiomyopathy - caused by what?
maternal hyperglycemia (deposits of glycogen in myocardium)
TIMI score - variables?
1 point for each
- age >= 65
- > = 3 risk factors for CAD
- known CAD w/ >50% stenosis
- use of ASA in past 7d
- > = 2 anginal episodes in past 24 hours
- elevated cardiac biomarkers
- ST segment deviation >0.5 mm on admission EKG
TIMI low risk 0-2 - next step?
stress test
TIMI intermediate (3-4) or high risk (5-7) - next step?
early coronary angio (w/in 24h)
indications for immediate coronary angio?
- HD instability
- HF or new MR
- recurrent CP
- ventricular arrhythmia
mitral stenosis murmur
diastolic low pitched rumble
manuever to bring out mitral stenosis?
exhale, lay in left lateral decub
EKG findings diagnostic of STEMI?
- new ST elevation at the J point in >= 2 natomically contiguous leads w/threshold:
- – >1mm in all leads except V2/V3
- –>= 1.5mm in women, >=2mm in men in leads V2/V3
- NEW LBBB w/clinical presentation of ACS
acute pericarditis - EKG findings?
- diffuse ST elevation
- PR depression
coronary revascularization is indicated for who?
- pts w/refractory angina despite max medical tx
- pts in whom revasc will improve long term survival
- – those w/LM coronary stenosis
- – those w/multivessel CAD (Esp prox LAD) and w/LV systolic dysfunction
what is ranolazine?
anti-anginal agent
pt develops cardiogenic shock after STEMI and tx w/nitro + morphine - where is MI?
right ventricle
what to do w/pt w/acute inferior MI and RV systolic failure + hypotension?
bolus with IVF if JVP is normal/low
which type of MI can cause transient bradycardia or AV block 2/2 increased vagal tone?
inferior MI
which medication decreases vagal tone?
atropine
after which type of MI might you need to use an intra-aortic balloon pump?
LV dysfunction (LAD, LCx)
RVMI w/persistent hypotension despite fluid resuscitation - what do you use?
- dopamine (1st choice)
- dobutamine (@nd choice 2/2 lowering of peripheral vascular resistance)
indications for ICD for primary prevention (5)
- fam hx of sudden cardiac death
- syncope (recurrent or assoc w/exertion)
- nonsustained VT on Holter
- hypoT BP response to exercise
- extreme LVH (>3cm septal wall thickness)
indications for ICD for secondary prevention (2)?
- survivors of cardiac arrest
- sustained spontaneous ventricular arrhythmias
when perform alcohol septal ablation?
pts w/symptoms of HCM refractory to medical therapy
what things can impair conduction across AV node?
- ischemia
- electrolyte abnrmality
- medications
- infiltrative dz
- age-related fibrosis
mobitz type 1 - what happens w/PR?
progressively prolongs, then drop beats
mobitz type 2 - what happens with PR?
normal PR, intermittently drop beats
mobitz type 1 and 2 - which has higher rate of progression to CHB?
type 2
sign of pHTN on exam?
- L para-sternal lift, RV heave
- loud P2, r-sided S3
- tricuspid regurg
- JVD, ascites, peripheral edema, hepatomegaly
5 groups of pHTN
1) pulmonary arterial htn
2) 2/2 L-sided heart dz
3) 2/2 chronic lung dz
4) 2/2 chronic PE
5) 2/2 other (sarcoid, MCTD)
diagnostic criteria for pHTN?
RHC w/mean pulm aterial pressure >25mmHg
How rule out pHTN 2/2 L heart failure?
pulmonary capillary wedge pressure <18
how treat idiopathic pulm arterial htn?
- endothelin receptor antagonists (bosentan, ambrisentan)
- PDEs (sildenafil, tadalafil)
- prostacyclin antagonists (epoprostenol, treprostinil, iloprost)
beck triad - what does this refer to?
cardiac tamponade
beck triad - what are the components?
- hypotension
- JVD
- decerased heart sounds
pulsus paradoxus - definition / which phase of respiration does pressure change?
SBP decreases >10 mmHg with inspiration 2/2 bowing of RV into LV during inspiration
cardiac tamponade - physiology?
impaired diastolic filling of RIGHT SIDE of heart
on TTE - what see in cardiac tamponade?
early diastolic collapse of RV and RA
Kussmaul sign - what is it?
abnormal increase (or lack of decrease) in JVP during inspiration
Kussmaul sign - when do you see it?
- constrictive pericarditis
- restrictive CMP
TIMI risk score components?
- age > 65
- > =3 risk factors for CAD
- known CAD w/>50% stenosis
- use of ASA in past 7d
- > =2 anginal episodes w/in preceding 24h
- elevated trop
ST-segment deviation >05mm on admission EKG
TIMI - what is low risk score?
0-2
TIMI intermed or high risk score - what is recommendation?
cath within 24h
inferior wall MI - what see on EKG?
ST elevations in II, III, aVF
stent thrombosis - most events happen how soon after stenting?
30 days
hypertrophic CMP w/LVOT obstruction - murmur?
systolic murmur
who should be on a statin?
- clinically sig. athero
- – ACS, MI
- – stable or unstable angina
- – coronary stent/CABG
- – stroke, TIA, PAD
- LDL > 190
- DM ages 40-75
- ASCVD risk >7.5
if pt w/very high triglycerides (>1000) what give them?
fibrate
niacin
fish oil
inotropic agents used in heart failure?
- dobutamine
- milrinone
which class of chemo agents leads to dose-dependent decline in EF –> dilated CMP?
anthracyclines
routine testing for initial dx of essential htn?
- CBC
- BMP
- UA
- 12 lead EKG
- lipids
when do workup for secondary htn?
- non-obese non-black pts <30 yo w/ fam hx htn
- htn starting before puberty
- severe/refractry htn
- acute-onset htn
