Cardiology Flashcards
Name two things that would constitute a positive stress test.
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
Are ulcers from venous insufficiency painful or painless?
Painless
A patient 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 treatment for a myocardial infarction?
MONA - morphine, oxygen, mitroglycerin and aspirin
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle brance block
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
Supraventricular tachycardia
An EKG shows a regular heart rate of 200 bps. QRS is narrow. What is the most likely diagnosis?
Supraventricular tachycardia
Acute endocarditis is most commonly caused by what organism?
Staph aureus
List three congenital heart diseases.
Atrial dental defect, ventricular dental defect, coarctation of the aorta, patent ductus arteriosus, tetralogy of Fallot
What is the most common cause of an atrial septal defect?
Patent foremen ovale
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
What side effect might make a patient stop taking an ACEI?
Cough
Define orthostatic hypotension.
A drop in systolic blood pressure of > 20 mmhg 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 and obstructive lung disease
On palpation, what size is normal for the aorta?
Less than 3 cm
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial septal defect
A pathologic S3 is most commonly associated with what diagnosis?
CHF
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral valve prolapse
An opening snap on auscultation of the heart should make you think of what diagnosis?
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 diagnosis?
Patent dusctus arteriosis (PDA)
List three medications which may be used for pharmacological stress test.
Adenosine, dobutamine, dipyridamole and persantine
What is the gold standard for diagnosing coronary artery disease?
Cardiac catheterization
Define stage hypertension according to JNC 7.
Systolic pressure of 140-159 and diastolic of 90-99
What is the treatment goal for a diabetic with hypertension?
130/80
What is the most common cause of secondary hypertension?
Chronic kidney disease
No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most like diagnosis?
Cushing’s disease
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated and hypertensive
You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker?
Alpha blocker. You should never use a pure beta blocker
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis?
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 treatment for stage 1 hypertension?
Thiazide diuretic
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
An ACE or an ARB
Following a myocardial infarction, what medication should you be using to treat hypertension?
Beta blocker
Paroxysmal nocturnal dyson’s should make you think of what diagnosis?
CHF
What is the most common cause of CHF?
Coronary artery disease
What ejection fraction is typical for a patient with CHF?
35-40%
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
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 diagnosis is most likely in an IV drug user with a new heart murmur and fever?
Endocarditis
Lost two diagnoses which require antibiotic prophylaxis for “dirty procedures?”
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mittal valve prolapse from high risk to moderate risk.
What are the 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
List the 4 minor criteria for diagnosing endocarditis.
Fever, embolic event (Janeway lesions or or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 postive blood culture.
What are the five components of tetralogy of Fallot?
Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch
What is the gold standard for diagnosing myocarditis?
Myocardial biopsy
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?
Pericarditis
What is the first line medical treatment for pericarditis?
Aspirin and NSAIDS
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler syndrome
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all the leads. What is the most likely diagnosis?
Pericarditis
