Cardiology Flashcards by Mattie Nieters

Where is the most common location of the ectopic foci that cause Atrial Fibrillation?

Pulmonary Veins

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An accessory atrioventricular bypass tract is seen in what cardiac syndrome?

Wolff-Parkinson-White Syndrome

Delta waves are seen on EKG.

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What is the most common cause of atrial flutter?

A re-entrant circuit around the tricuspid annulus.

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Interventricular Septum Rupture

Seen 3-5 days post-MI involving the LAD.
Presents with acute cardiogenic shock, JVD, and hepatomegaly.
Harsh, holocystolic murmur with palpable thrill at the LSB.
Diagnosis: pulmonary artery catheterization with step up in oxygenation from the RA to RV or via TTE

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Papillary Muscle Rupture

3-5 days post-MI of the RCA.
Presents with severe, acute mitral regurgitation, sudden-onset hypotension, dyspnea, and pulmonary edema.
Soft, holocystolic murmur without palpable thrill.

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Tennessee

S4 heart sound

Indicates stiff LV and LV hypertrophy from long-standing hypertension or restrictive cardiomyopathy.

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In an adenosine or dypiramidole stress-test that is positive for ischemia, what is the mechanism responsible for the changes seen.

Augmentation of blood flow in non-obstructed vessels. This is because adenosine and dypiramidole both cause dilation of the vessels that is most prominent in non-obstructed vessels.

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What is the mechanism responsible for the changes seen in a dobutamine stress test?

Increase myocardial oxygen demand.

Dobutamine increases HR and myocardial contractility.

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Kentucky

S3 heart sound
Heard in left-sided heart failure.
May be a normal finding in young adults and well-trained athletes without other symptoms.

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Complete AV dissociation

Complete heart block

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For A-Fib with RVR in a patient with WPW, what drug do you use to convert stable patients?

Procainamide (Ibutilide as well)

Electro-cardioversion for unstable patients

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Acute Mitral Regurgitation

Can occur due to papillary muscle displacement secondary to acute MI.
Presents with acute pulmonary edema.
Increase left atrial and ventricular filling pressures.

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Symptomatic Sinus Bradycardia

Initial - IV atropine
No response with atropine - IV epi or dopamine
No response with epi or dopamine - trancutaneous pacing

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Screening for AAA

Men aged 65-75 who have smoked should receive a one-time screening ultrasound.

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ST segment elevations in II, III, and aVF

Inferior wall MI
Reciprocal changes in I and aVL
Involves the RCA or the Left Circumflex (LCX), most commonly the RCA

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ST segment depressions in V1 and V2

Posterior wall MI
RCA if depressions in I and aVL
LCX if elevations in I and aVL

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ST segment depression in V1 and V2 and elevations in II, III, aVF

Occlusion of the right coronary artery (RCA)

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Anterior MI

Occlusion of the LAD

Changes in some or all of V1 - V6

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Lateral MI

Involvement of the LCX or diagonal
ST elevations in I, aVL, V5, and V6
ST depression in II, III, and aVF

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Right Ventricle MI

Occurs in 1/2 of all inferior MI
Involves the RCA
ST elevations in V4-V6R

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Occlusion of the Left Main Coronary Artery

Usually causes sudden death as this supplies the LAD and LCX

Elevations in anterior and lateral leads: I, aVL, V1-V6

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Vasospastic Angina Treatment

CCBs for prevention

Sublingual Nitroglycerin for abortive therapy

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Hyponatremia in Heart Failure

Poor prognostic factor

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New conduction abnormalities in a patient with infective endocarditis:

Perivalvular abscess

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Tricuspid Regurgitation

Holosystolic murmur

Left Ventricular Aneurysm

Etiology: scar tissue following transmural MI Presentation: several months post-MI, heart failure and angina, Ventricular arrhythmia (V-tach), systemic embolization (stroke) EKG: persistent ST elevation, deep Q waves Echo: thin, dyskinetic myocardial wall - impaired EF

Cardiac Index =

Cardiac Output / Body Surface Area | Reduced in HF

Costochondritis

Chest wall tenderness | Most accurate test is physical exam

Pericarditis

Pain worse with lying flat and better sitting up in a young patient <40 years old Most accurate test is EKG with ST elevations in all leads and PR depression

Aortic Dissection

Radiation to the back, unequal blood pressure between arms | Most accurate test is a CXR with widened mediastinum, chest CT, MRI, or TEE to confirm diagnosis

Duodenal Ulcer Disease

Epigastric discomfort, pain relieved with eating | Most accurate test is endoscopy

GERD

Bad taste in mouth, cough, hoarseness | Most accurate test is response to PPIs, aluminum hydroxide, magnesium hydroxide, viscous lidocaine

Pneumonia

Cough, sputum, hemoptysis, chest pain | Most accurate test is CXR

Pulmonary Embolism

Sudden-onset SOB, tachycardia, hypoxia, chest pain | Most accurate test is spiral CT, V/Q scan

Pneumothorax

Sharp, pleuritic chest pain, tracheal deviation | Most accurate test is CXR

Exercise Tolerance Test

Used to determine the presence of ischemia | Shows ST segment depression if ischemia is detected

Exercise thallium

Used if there is an inability to read the EKG or there are baseline ST segment abnormalities Shows decreased uptake of nuclear isotope if ischemia is detected

Exercise Echo

Used if there is an inability to read the EKG or there are baseline ST segment abnormalities Shows wall motion abnormalities if there is ischemia

Dipyridamole Thallium Test

Used if there is an inability to exercise to target heart rate Showed decreased uptake of nuclear isotope if there is ischemia

Dobutamine Echo Test

Used if there is an inability to exercise to target heart rate Shows wall motion abnormalities if there is ischemia

What is the time to becoming abnormal in the setting of an MI for an EKG? What is the duration of the abnormality?

Immediately at the onset of pain | Will show ST elevations that progress to Q waves over several days to a week

What is the time to becoming abnormal in the setting of an MI for Myoglobin? What is the duration of the abnormality?

1-4 hours | Resolves in 1-2 days

What is the time to becoming abnormal in the setting of an MI for CK-MB? What is the duration of the abnormality?

4-6 hours | Resolves in 1-2 days

What is the time to becoming abnormal in the setting of an MI for Troponin? What is the duration of the abnormality?

4-6 hours | Resolves in 10-14 days

Treatment indications in the setting of MI: ASPIRIN

Everyone, the best initial therapy

Treatment indications in the setting of MI: | CLOPIDOGREL or PRASUGREL or TICAGRELOR

Those undergoing angioplasty or stenting, second antiplatelet drug with aspirin

Treatment indications in the setting of MI: | BETA BLOCKERS

Everyone, effect is not dependent on time so can be started at any time during the admission

Treatment indications in the setting of MI: | ACEI/ARB

Everyone, benefit best with an EF <40%

Treatment indications in the setting of MI: | STATINS

Everyone, goal LDL <70 mg/dL

Treatment indications in the setting of MI: | NITRATES

Everyone, no clear mortality benefit

Treatment indications in the setting of MI: | HEPARIN

After thrombolytics/PCI to prevent restenosis, initial therapy with ST depression and other non-ST elevation events like unstable angina

Treatment indications in the setting of MI: | CCB's

If a patient can't use B-blockers, in cocaine-induced pain, in Prinzmetal or vasospastic variant angina

What are the absolute contraindications to thrombolytics?

``` Major bleeding (bowel or brain) Recent surgery (<2 weeks) Severe HTN (>180/110) Nonhemorrhagic stroke (<6 months) ```

What medications should every patient be started on after an MI?

Aspirin Beta Blocker Statin ACEI/ARB

What is the most likely diagnosis in the setting of post-MI? | Bradycardia, cannon A waves

Third-degree AV block

What is the most likely diagnosis in the setting of post-MI? | Bradycardia without cannon A waves

Sinus Bradycardia

What is the most likely diagnosis in the setting of post-MI? | Sudden loss of pulse, jugulovenous distention

Tamponade/Wall Rupture

What is the most likely diagnosis in the setting of post-MI? | IWMI in history, clear lungs, tachycardia, hypotension with nitroglycerin

RV infarction

What is the most likely diagnosis in the setting of post-MI? | New murmur, rales/congestion

Valve rupture

What is the most likely diagnosis in the setting of post-MI? | New murmur, increase is oxygen saturation on entering the right ventricle (step-up)

Septal Rupture

What is the most likely diagnosis in the setting of post-MI? | Loss of pulse, need EKG in order to answer this question

Ventricular fibrillation

What is the most likely diagnosis in the setting of Dyspnea? | Sudden onset dyspnea with clear lungs on exam

What is the most likely diagnosis in the setting of Dyspnea? | Sudden onset, wheezing, increased expiratory phase

Asthma

What is the most likely diagnosis in the setting of Dyspnea? | Slow onset dyspnea, fever, sputum, unilateral rales/rhonchi

Pneumonia

What is the most likely diagnosis in the setting of Dyspnea? | Decreased breath sounds unilaterally, tracheal deviation

PTX

What is the most likely diagnosis in the setting of Dyspnea? | Circumoral numbness, caffeine use, hx of anxiety

Panic attack

What is the most likely diagnosis in the setting of Dyspnea? | Pallor, gradual over days to weeks

Anemia

What is the most likely diagnosis in the setting of Dyspnea? | Pulsus paradoxus, decreased heart sounds, JVD

Tamponade

What is the most likely diagnosis in the setting of Dyspnea? | Palpitations, syncope

Arrhythmia of any kind

What is the most likely diagnosis in the setting of Dyspnea? | Dullness to percussion at the bases

Pleural effusion

What is the most likely diagnosis in the setting of Dyspnea? | Long smoking history, barrel chest

COPD

What is the most likely diagnosis in the setting of Dyspnea? | Recent anesthetic use, brown blood, not improved with oxygen, clear lungs, cyanosis

Methemoglobinemia

What is the most likely diagnosis in the setting of Dyspnea? | In a burning building or car, wood-burning stove in the winter, suicide attempt

Carbon monoxide poisoning

Effects of Maneuvers on: | MS and AS

``` Squatting = increase Standing/Valsalva = decrease ```

Effects of Maneuvers on: | MR and AR

``` Squatting = increase Standing/Valsalva = decrease ```

Effects of Maneuvers on: | MVP

``` Squatting = decrease Standing/Valsalva = increase ```

Effects of Maneuvers on: | HOCM

``` Squatting = decrease Standing/Valsalva = increase ```