Cardiology Flashcards
1
Q
mechanism of syncope
A
ONLY BRAINSTEM stroke can cause syncope (controls sleep/wake in brain)
2
Q
exertional SOB: immigrant, pregnant
A
MS
3
Q
treatment for pericarditis if pain persists after NSAID
A
prednisone
4
Q
diagnostic test for valve rupture
A
echo
5
Q
is pregnancy a contraindication to do balloon valvuloplasty in MS?
A
NO
6
Q
if cardiac exam is ABNORMAL, possible causes could be?
A
structural heart disease:
- aortic or mitral stenosis
- HCM
- mitral valve prolapse (rare)
7
Q
mechanism of increased MS symptoms in pregnancy
A
- 50% increase in plasma volume
- more volume = more pressure, backflow, and symptoms
- ADH levels higher
8
Q
best INITIAL treatment for WPW
A
procainamide
9
Q
MC complaint in MR
A
exertional dyspnea
10
Q
mechanism of S4 gallop
A
atrial systole into a stiff or noncompliant left ventricle
11
Q
possible causes of RESTRICTIVE cardiomyopathy
A
- sarcoidosis
- amyloidosis
- hemochromatosis
- cancer
- myocardial fibrosis
- glycogen storage diseases
12
Q
CHF presentation
A
- SOB, especially on exertion, and…
- edema
- rales
- ascites
- jugular venous distention
- S3 gallop
- orthopnea (SOB when lying flat)
- paroxysmal nocturnal dyspnea (SOB attacks at night)
- fatigue
13
Q
treatment for RIGHT ventricular infarction
A
fluid loading
14
Q
decreases mortality in patients with
- EF 120ms
A
biventricular pacemaker
15
Q
best INITIAL treatment for pericardial tamponade
A
pericardiocentesis
16
Q
- exertional SOB
- S4 gallop
A
hypertrophic cardiomyopathy
17
Q
PARADOXICAL splitting of S2 (P2 delayed) causes
A
- LBBB
- AS
- LVH
- HTN
18
Q
benefit of using aspirin in ACS
A
instant effect of inhibiting platelets
19
Q
what does EKG show in constrictive pericarditis?
A
low voltage
20
Q
Hill’s sign
A
BP gradient much higher in LE’s
21
Q
if etiology of syncope is STILL NOT clear
A
- tilt table test (to diagnose neurocardiogenic (vasovagal) syncope)
- EP testing
22
Q
CXR findings for MS (mitral stenosis)
A
- straightening of left heart border
- elevation of left mainstem bronchus
23
Q
moderate AS pressure gradient
A
30-70mmHg
24
Q
BLS for VF
A
- continue CPR
- defibrillate (UNsynchronized cardioversion)
- IV epinephrine/vasopressin
- defibrillate (UNsynchronized cardioversion)
- IV amiodarone/lidocaine
- defibrillate (UNsynchronized cardioversion)
repeat CPR between each shock
25
exertional SOB: palpitations, atypical chest pain NOT with exertion
MVP
26
possible causes of CHF
1. HTN
2. valvular heart disease
3. MI
27
best treatment for REGURGITANT lesions
VASODILATORS
| ACEIs, ARBs, or nifedipine
28
diagnosis of loss of pulse/VF
EKG
29
when should you answer exercise thallium testing, or stress echocardiography?
EKG is unreadable for ischemia
30
if EKG does not detect VT then
telemetry monitoring
31
best INITIAL test for PAD
ankle-brachial index (ABI)
32
normal aortic valve pressure gradient
ZERO
33
- low-voltage EKG
| - speckled pattern on echo
amyloidosis
34
management of syncope is based on 3 criteria
1. was the loss of consciousness SUDDEN or GRADUAL?
2. was the regaining of consciousness SUDDEN or GRADUAL?
3. is the cardiac exam NORMAL or ABNORMAL?
35
MOST EFFECTIVE treatment for dissection of thoracic aorta
surgery
36
best INITIAL treatment for pericarditis
NSAID
37
severe AS pressure gradient
> 70mmHg
38
test for ASD
echo
39
which murmurs are LOUDER with handgrip maneuver?
1. AR
2. MR
3. VSD
40
are beta blockers contraindicated with PAD?
NO
41
indications for thrombolytics
1. cannot perform PCI
| 2. chest pain for
42
if cardiac exam is NORMAL, possible cause could be?
ventricular arrhythmia
43
exertional SOB: young female, general population
MVP
44
situations where EKG may be unreadable for ischemia
1. LBBB
2. digoxin use
3. pacemaker
4. LVH
5. baseline ST segment abnormality
45
causes of MR
1. HTN
2. ischemic heart disease
3. any condition leading to dilation of heart
46
- chest pain/syncope
- older
- h/o HTN
AS
47
all LEFT-sided murmurs increase in intensity with
EXhalation
48
Duroziez's sign
murmur heard over femoral artery
49
treatment for myocardial wall rupture
- pericardiocentesis
| - urgent cardiac repair
50
next best step in patient with a-fib, that's rate controlled
warfarin with goal INR of 2-3
51
CHADS2Vasc
| indicates need for warfarin
```
CHF +1
HTN +1
Age
≥ 75 +2
DM +1
Stroke/TIA/Thromboembolism +2
Vascular Disease +1
Age
> 65-74 +1
Female +1
```
52
if return to consciousness onset was GRADUAL, possible causes could be?
neurological etiology (seizures)
53
MORE ACCURATE test for AS
TEE
54
INITIAL treatment for dissection of thoracic aorta
beta blocker, and get EKG/CXR
55
S3 gallop indicates
DILATED left ventricle
56
sudden death
ventricular fibrillation (VF)
57
heart failure is primarily a clinical diagnosis:
name the MAJOR criteria
need either, 2 major criteria, or 1 major and 2 minor
1. paroxysmal nocturnal dyspnea (PND)
2. orthopnea
3. raised jugular venous pressure (JVP)
4. third heart sound
5. increased cardiac silhouette on CXR
6. pulmonary vascular congestion on CXR
58
lower mortality in ACS, but is NOT time critical
beta blockers
59
best long-term management
radiofrequency catheter ablation
60
- SVT that can alternate with ventricular tachycardia
| - WORSENING of SVT after use of CCB or digoxin
Wolff-Parkinson-White syndrome (WPW)
61
MOST ACCURATE test for MS
left heart catheterization
62
best treatment for mitral stenosis
balloon valvuloplasty
63
best INITIAL test for AR
TTE
64
MOST ACCURATE test for PAD
angiography
65
when is lidocaine or amiodarone used for AMI?
- ONLY in Vtach, or Vfib
66
diagnostic tests for MAT
- EKG first
| - if EKG is negative, Holter monitor or telemetry
67
MOA of imamRINONE and milRINONE
- PDE inhibitors
- increase contractility
- vasodilators= decrease AFTERload
68
- pleuritic chest pain (changes with respiration)
- positional chest pain (better when sitting up/leaning forward)
- pain is SHARP, and BRIEF
pericarditis
69
- chest pain radiating to back between scapula
- CP is INITIALLY very severe and "ripping"
- difference in BP between RIGHT and LEFT arms
dissection of thoracic aorta
70
PCI should be done within what timeframe of reaching the ER?
90 MINUTES
71
diagnostic test for VSD
echo
72
only given when angioplasty is done
prasugrel
73
AS is best heard where and radiates where?
- 2nd RIGHT intercostal space
| - carotid arteries
74
ALWAYS lower mortality in ACS
1. aspirin
2. thrombolytics
3. angioplasty
4. metoprolol
5. statins
6. clopidoGREL/ticaGRELor/prasuGREL
75
best INITIAL test for HYPERTROPHIC cardiomyopathy
echo
| shows normal EF
76
treatment for RCMP
1. diuretics
| 2. correct underlying cause
77
diagnostic test for sinus bradycardia
EKG
78
complications of myocardial infarction
1. cardiogenic shock
2. valve rupture
3. septal rupture
4. myocardial wall rupture
5. sinus bradycardia
6. third degree (complete) heart block
7. right ventricular infarction
79
- palpitations
| - REGULAR rhythm
atrial flutter
80
treatment for VF
ALWAYS UNsynchronized cardioversion first
81
VSD murmur description
- holosystolic murmur
| - LLSB
82
what does CXR show in constrictive pericarditis?
calcification
83
mechanism of opening snap earlier in worsening MS
worse MS = higher LA pressure = mitral valve opens earlier
| mitral valve opens when LA pressure > LV pressure
84
if syncope onset was SUDDEN, next question is?
was the regaining of consciousness SUDDEN or GRADUAL?
85
what does CT and MRI show in constrictive pericarditis?
thickening of pericardium
86
diagnostic test for RIGHT ventricular infarction
EKG showing right ventricular leads
87
treatment for syncope
based on etiology
| but most cases lack specific diagnosis
88
calcium channel blockers are used in ACS when
- intolerance to beta blockers (e.g. asthma)
- cocaine-induced CP
- coronary vasospasm/Prinzmetal's angina
89
mechanism of rales
increased HYDROSTATIC pressure in pulmonary capillaries --> transudation of liquid into alveoli --> "popping" sound during inhalation
90
how long do bioprosthetic valves last?
about 10 years
91
what EKG shows in CHF patient
1. sinus tachycardia
| 2. atrial and ventricular arrhythmia
92
if syncope onset was GRADUAL, possible causes could be?
- toxic-metabolic
- hypoglycemia
- anemia
- hypoxia
93
treatment for VT in patient that hemodynamically STABLE
- amiodarone
- lidocaine
- procainamide
- magnesium
94
what echo shows in CHF patient
distinguishes systolic vs diastolic dysfunction
95
treatment for cardiogenic shock
- ACE inhibitor
| - urgent revascularization
96
treatment for VT in patient that hemodynamically UNSTABLE
synchronized cardioversion
97
standard of care for pulmonary edema
1. oxygen
2. furosemide (preload reduction)
3. nitrates
4. morphine
98
- SUDDEN onset loss of pulse and COLD extremity
- painful
- can have h/o AS or atrial fibrillation
acute arterial embolus
99
best INITIAL therapy for MS
diuretics
100
special features of MS
1. dysphagia (LA pressing on esophagus)
2. hoarseness (pressure on recurrent laryngeal nerve)
3. a-fib (stroke)
101
MOST ACCURATE test for valvular heart disease
left heart catheterization
102
mainstay of diagnosis of RCMP
echo
103
treatment of choice for AS
valve replacement
104
ALL post-MI patients should go home on
1. aspirin
2. clopidoGREL, or prasuGREL
3. beta blocker
4. statin
5. ACE inhibitor
105
effect of handgrip on aortic stenosis
SOFTENS murmur
| less blood travels from LV to aorta
106
AR, tricuspid murmurs, and VSD are best heard where?
LLSB
107
treatment for valve rupture
- ACE inhibitor
- nitroprusside
- intra-aortic balloon pump as bridge to surgery
108
MOST ACCURATE for dissection of thoracic aorta
CTA
109
NEXT BEST step in management if vagal maneuvers do NOT work
IV adenosine
| most frequently asked SVT question
110
treatment for ASD
percutaneous or catheter repair
111
do NOT use what in MAT?
beta blockers
112
CAD equivalents
1. DM
2. PAD
3. aortic disease
4. carotid disease
113
exertional SOB: healthy young athlete
HCM
114
MOST EFFECTIVE treatment for constrictive pericarditis
surgical removal of pericardium
115
screening US of abdominal aorta should be done in?
MEN OVER 65 who are current or were former SMOKERS
116
which murmurs are LOUDER with amyl nitrate?
1. MVP
| 2. HCM
117
in evaluation of syncope, if the neuro exam is FOCAL, or there's h/o head trauma
order CTH
118
Corrigan's pulse
high bounding pulses
| "water-hammer" pulse
119
mechanism of fixed splitting of S2 in ASD
equal pressure between LA and RA = no change in splitting
120
which maneuver increases afterload?
handgrip
121
ONLY 2 murmurs that LOUDER with STANDING/Valsalva
1. MVP
| 2. HCM
122
in evaluation of syncope, if headache is described
order CTH
123
best INITIAL management for STABLE patients
vagal maneuvers
- carotid sinus massage
- ice immersion of the face
- Valsalva
124
diagnostic test for myocardial wall rupture
echo
125
what if PCI cannot be done within 90 minutes?
thrombolytics
126
lower mortality in ACS in CERTAIN CONDITIONS
1. ACE/ARBs inhibitors IF EF is LOW
127
should be given to ALL patients with ACS, but only lower mortality if there is LEFT VENTRICULAR DYSFUNCTION, or SYSTOLIC DYSFUNCTION
ACE inhibitors
128
right heart catheterization findings of pericardial tamponade
EQUALIZATION of ALL pressures in heart during systole
129
treatment for DCMP
1. ACEI/ARB
2. BB
3. spironolactone/eplerenone (decrease work of heart)
130
only pertinent positive PE finding for pericarditis
FRICTION RUB
131
UNSTABLE patient with atrial fibrillation
(unstable = SBP
SYNCHRONIZED electrical cardioversion
132
Musset's sign
head bobbing with pulse
133
best INITIAL therapy for AS
diuretics
| don't improve long-term prognosis
OVERDIURESIS IS DANGEROUS
134
when do you add ranolazine?
persistent chest pain
135
when do you use a pacemaker for AMI?
- 3rd degree AV block
- Mobitz II, second degree AV block
- bifasicular block
- NEW LBBB
- symptomatic bradycardia
136
non-ST segment elevation myocardial infarction treatment
1. no thrombolytics
2. low molecular weight heparin
3. glycoprotein IIb/IIIa inhibitors (lower mortality)
137
MS murmur description
diastolic RUMBLE after OPENING SNAP
| opening snap moves closer to S2 as mitral stenosis worsens
138
all RIGHT-sided murmurs increase in intensity with
INhalation
139
best initial therapy for all cases of ACS
ASPIRIN
140
complaint in VSD
SOB
141
when do you do SURGERY for MR?
| EVEN IF PATIENT IS ASYMPTOMATIC
- LVEF 40mm
142
best INITIAL management for UNSTABLE patients
synchronized cardioversion
143
diagnostic tests for syncope evaluation
- cardiac/neurological exam
- EKG
- chemistries (looking at glucose, and electrolytes)
- oximeter
- CBC (looking for anemia)
- cardiac enzymes
144
MR murmur description and location it's best heard
- holosystolic murmur that obscures S1 and S2
| - apex radiating to axilla
145
MOST ACCURATE test for RCMP
endomyocardial biopsy
146
possible PE findings in valvular heart disease
- peripheral edema
- carotid pulse findings
- gallops
147
atrial fibrillation/atrial flutter WITH:
- borderline hypOtension
digoxin
148
best long-term treatment for WPW
radiofrequency catheter ablation
149
MOST ACCURATE test for pericardial tamponade
echo
150
- claudication (pain in calves on exertion)
- "smooth, shiny skin" with loss of HAIR and SWEAT GLANDS
- loss of pulses in feet
PAD
151
best treatment for STENOTIC lesions
anatomic repair
152
atrial fibrillation/atrial flutter WITH:
- asthma
- migrains
calcium channel blockers (diltiazem)
153
MOA of heparin
potentiates effect of antithrombin
154
handgrip makes it worse/amyl nitrate improves murmur
ACEI indicated
155
which murmurs are SOFTER with handgrip?
1. MVP
| 2. HCM
156
if return to consciousness onset was SUDDEN, next question is?
is the cardiac exam NORMAL or ABNORMAL?
157
MC adverse effect of statins
LIVER TOXICITY
158
treatment for SYSTOLIC dysfunction (low EF)
1. ACEI or ARB
2. metoprolol/carvedilol/bisoprolol
3. spironolactone/eplerenone
4. diuretic
5. digoxin
159
other PO AC's for a-fib besides warfarin
- dabigatran (direct THROMBIN inhibitor)
- rivaroxaban (factor Xa inhibitor)
- apixaban (factor Xa inhibitor)
160
most common cause of death in US
CAD
161
Valsalva improves murmur
diuretics indicated
162
what is a NORMAL ankle-brachial index (ABI)?
greater than or equal to 0.9
> 10% difference = OBSTRUCTION
163
WIDE splitting of S2 (P2 delayed) causes
- RBBB
- pulmonic stenosis
- RVH
- pulmonary HTN
164
MR is best heard where and radiates where?
- apex (5th intercostal space)
| - axilla
165
diagnosis of WPW
DELTA WAVE on EKG
166
MCC of MS
rheumatic fever
167
best INITIAL test for valvular heart disease
ECHO
168
initial test for atrial fibrillation
- telemetry monitoring as INpatient
| - Holter monitoring as OUTpatient
169
in evaluation of syncope, if murmur is present
order an echo
170
in evaluation of syncope, if seizure is described, OR SUSPECTED
order CTH and EEG
171
MC causes of dilated CMP
- ischemia (MOST COMMON)
- alcohol
- adriamycin
- radiation
- Chagas' disease
172
PAIN + PALLOR + PULSELESS =
ARTERIAL OCCLUSION
173
best INITIAL step in presentation of chest pain
ASPIRIN
174
mechanism of WPW
neutralized cardiac muscle going around AV node creating aberrant pathway
175
Quincke pulse
arterial or capillary pulsations in FINGERNAILS
176
why does high pressure dilate aortic valve?
LaPlace's law
tension = radius x pressure
177
treatment for third-degree (complete) heart block
- atropine
| - pacemaker EVEN IF symptoms resolve
178
MOST EFFECTIVE treatment for pericardial tamponade
pericardial window placement
179
mechanism of thrombolytics
ACTIVATE plasminoGEN into PLASMIN
| chops up fibrin strands into D-dimers
(does nothing if already stabilized by factor XIII)
180
CAD risk factors (8)
1. diabetes mellitus
2. hypertension
3. tobacco use
4. hyperlipidemia
5. peripheral arterial disease (PAD)
6. obesity
7. inactivity
8. family history
181
prognosis of AS
- CAD = 3-5-year average survival
- syncope = 2-3-year average survival
- CHF = 1.5-2-year average survival
182
mechanism of S3 gallop
rapid ventricular filling during diastole
183
mechanism of thallium (nuclear isotope)
decreased uptake = damage
184
causes of PLEURITIC chest pain
1. PE
2. pneumonia
3. pleuritis
4. pericarditis
5. pneumothorax
185
right heart catheter results in acute pulmonary edema
- CO = decreased
- SVR = increased
- wedge pressure = increased
- RA pressure = increased
(wedge pressure = indirect LA pressure measurement)
186
atrial fibrillation/atrial flutter WITH:
- ischemic heart disease
- migraines
- Graves disease
- pheochromocytoma
beta blockers (metoprolol)
187
- palpitations
- IRREGULAR pulse
- h/o HTN, ischemia, or CMP
a-fib
188
CAD + LDL > 100
give statins
189
when do you do SURGERY for AR?
| EVEN IF PATIENT IS ASYMPTOMATIC
- EF 55mm
190
chest pain that changes with RESPIRATION
pleuritic pain
191
MC of post-MI erectile dysfunction d/t medication
beta blockers
192
which medications should only be used in congestive heart failure, systolic dysfunction, or low ejection fraction?
ACE inhibitors or ARBs
193
MOST ACCURATE test for WPW
electrophysiologic studies
194
what is considered "significant" in the family history of CAD?
- females > 65 years of age
| - males > 55 years of age
195
LDL goal in ACS patient with DIABETES
< 70
196
what oximeter shows in CHF patient
1. hypoxia
| 2. respiratory alkalosis (from tachypnea)
197
mechanism of why CCB don't work in PAD
CCB dilate muscular layer EXterior to atherosclerotic clot which is INterior
198
MC presentation of AR
1. SOB
| 2. FATIGUE
199
clopidoGREL or ticaGRELor is used in ACS when
- aspirin allergy
- patient undergoes angioplasty/stenting
- acute MI
200
which test is best to detect REINFARCTION a few days after initial infarction?
CK-MB
201
which cardiac enzyme rises first?
myoglobin
202
best INITIAL test for MS
TTE
203
mechanism of syncope/angina in AS
blocked flow with increased demand = chest pain
204
added to aspirin for patients with ACUTE MI
clopidogrel or ticagrelor
205
mild AS pressure gradient
< 30mmHg
206
MOA of carvedilol
antagonist of B1, B2, and a1 receptors
1. antiarrhythmic
2. anti-ischemic
3. antihypertensive
207
perform surgical bypass in PAD when
signs of ischemia:
- gangrene
- pain at REST
208
MORE ACCURATE test for MR
TEE
209
effect of amyl nitrate on aortic stenosis
makes it LOUDER
| decreases afterload
210
MOST ACCURATE diagnostic test for VT
electrophysiologic studies
211
used to determine degree of left-to-right shunting
catheterization
212
most effective therapy for MS
balloon valvuloplasty
213
best INITIAL treatment for MR
- ACEI/ARB, or nifedipine
214
heart failure is primarily a clinical diagnosis:
name the MINOR criteria
need either, 2 major criteria, or 1 major and 2 minor
1. B/L LE edema
2. nocturnal cough
3. exertional dyspnea
4. tachycardia
5. presence of pleural effusion
6. hepatomegaly
215
- exertional SOB
| - Kussmaul's sign (increase in jugular venous pressure on inhalation)
restrictive cardiomyopathy
216
role of colchicine in pericarditis
adds efficacy to NSAIDs and prevents recurrent episodes
217
- atrial arrhythmia IN ASSOCIATION WITH COPD/EMPHYSEMA
| - tachycardia (HR > 100)
multifocal atrial tachycardia (MAT)
218
can be given in ACS, but do NOT lower mortality
nitrates and morphine
219
should be given to ALL patients with ACS, regardless of EKG/enzyme levels
statins
220
when is ASD repair most often indicated?
if shunt ratio exceeds 1.5:1
221
causes of AR
- HTN
- rheumatic heart disease
- endocarditis
- cystic medial necrosis
222
clues that chest pain is ISCHEMIC in nature
1. dull pain
2. last 15-30 minutes
3. exertional
4. substernal location
5. radiates to jaw or left arm
223
treatment for HCMP
1. BB
| 2. diuretics
224
if ventricular dysrhythmia is diagnosed as etiology of syncope, what is indicated?
implantable cardioverter/defibrillator
225
MOST ACCURATE test for AR
left heart catheterization
226
AE of ACEI and ARBs
- hyperkalemia with both
| - cough with ACEIs
227
when do you repair AAA?
> 5cm
228
which medications can be given for atrial fibrillation to control the rate?
- beta blockers (metoprolol/esmolol)
- calcium channel blockers (diltiazem)
- digoxin
should be given IV
229
STABLE patient with atrial fibrillation
slow ventricular HR if > 100-110
230
do NOT lower mortality in ACS
1. oxygen
2. morphine
3. nitrates
4. calcium channel blockers (actually INCREASE; avoid!)
5. lidocaine
6. amiodarone
231
next diagnostic test to evaluate an abnormal stress test
angiography
232
MOA of clopidoGREL, ticaGRELor, and prasuGREL
inhibit ADP activation of platelets
233
- SOB
- signs of chronic right heart failure (edema, JVD, hepatosplenomegaly, ascites)
- Kussmaul's sign (increase in JVD on INhalation)
- PERICARDIAL KNOCK (extra diastolic sound from heart hitting calcified thickened pericardium)
constrictive pericarditis
234
diagnostic tests for septal rupture
- echo
| - right heart cath showing STEP UP IN SATURATION FROM RIGHT ATRIUM TO RIGHT VENTRICLE
235
FIXED splitting of S2
ASD
236
what does cardiac catheterization show in RCMP?
rapid x and y descent
237
ONLY 2 murmurs that become SOFTER with SQUATTING/leg raise
1. MVP
| 2. HCM
238
treatment for DIASTOLIC dysfunction (normal EF)
1. metoprolol/carvedilol/bisoprolol
| 2. diuretic
239
- FIXED splitting of S2
- SOB
- parasternal heave
ASD
240
treatment for sinus bradycardia
- atropine
| - pacemaker IF there are STILL symptoms
241
MORE ACCURATE test for AR
TEE
242
initial diagnostic tests for CHF patient
1. CXR
2. EKG
3. oximeter (maybe an ABG)
4. echo
243
mechanism for need of synchronization
- T-wave represents refractory period
| - electrical shock delivered during the T-wave can set off a WORSE rhythm; VF, and ASYSTOLE
244
diagnostic test for third-degree (complete) heart block
- EKG
| - canon "a" waves
245
further management of dissection of thoracic aorta
1. order CTA = TEE = MRA
| 2. start nitroprusside
246
best treatment for severe aortic stenosis
aortic valve replacement
247
at what CHADS2Vasc score should a pt be started on warfarin, and should the pt be bridged on heparin?
- 2, or more points
| - NO!
248
best INITIAL diagnostic test for pericarditis
EKG
| GLOBAL ST elevation
(PR segment depression in lead II is pathognomonic)
249
MOA of dobutamine
- increase contractility
| - vasoconstriction= increases AFTERload
250
S3 gallop can be normal in which patients?
age
251
improve mortality of chronic angina
aspirin and metoprolol
252
- palpitations and tachycardia
- occasionally syncope
- NOT associated with ischemic heart disease
- REGULAR RHYTHM WITH VENTRICULAR RATE OF 160-180
supraventricular tachycardia (SVT)
253
- palpitations
- syncope
- chest pain
- sudden death
ventricular tachycardia (VT)
254
VSD treatment
mechanical closure if severe
255
thrombolytics should be done within what timeframe of reaching the ER?
30 MINUTES
256
indications for CABG
1. THREE coronary vessels > 70% stenosis
2. left main coronary artery > 50-70% stenosis
3. TWO vessels in a DIABETIC
4. 2 or 3 vessels with LOW EF
257
if initial EKG and/or enzymes do NOT establish diagnosis of CAD, next step
stress test
258
treatment for septal rupture
- ACE inhibitor
- nitroprusside
- urgent surgery
259
best INITIAL treatment for constrictive pericarditis
diuretic
260
- causes acute chest pain
- can occur with exertion or at rest
- ST segment elevation, depression, or normal EKG
- NOT based on enzyme levels, angiography, or stress test results
- BASED ON h/o chest pain with features suggestive of ischemic disease
definition of acute coronary syndrome (ACS)
261
what CXR shows in CHF patient
1. pulmonary vascular congestion
2. cephalization of flow
3. effusion
4. cardiomegaly
262
AR murmur description and location it's best heard
- diastolic decrescendo murmur
| - LEFT sternal border
263
when do you balloon dilate AS?
ONLY when patient can't tolerate surgery
264
how long do mechanical valves last?
15-20 years
need to be on warfarin with INR of 2-3
265
what does EKG show in RCMP?
low voltage
266
best INITIAL test for AS
TTE
267
diagnostic tests for cardiogenic shock
- echo
| - Swan-Ganz (right heart) catheter
268
best INITIAL test for MR
TTE
269
situations where patient won't be able to do an exercise stress test
1. COPD
2. amputation
3. deconditioning
4. weakness/previous stroke
5. LE ulcer
6. dementia
7. obesity
270
exertional SOB: Turner's syndrome, coarctation of aorta
BICUSPID aortic valve
271
treatment for MAT
1. oxygen FIRST
| 2. THEN diltiazem
272
contraindicated with sildenafil (PDI's)
nitrates
273
cause of chest pain that is tender to palpation
costochondritis
274
causes of POSITIONAL chest pain
pericarditis
275
MOST DANGEROUS thing to give a patient with pericardial tamponade
diuretics
276
when should you order a dipyridamole or adenosine thallium stress test, or dobutamine echocardiogram?
patient can't exercise to target HR of > 85% of maximum
277
best INITIAL treatment for PAD
1. aspirin
2. BP control with ACEI
3. exercise as tolerated
4. cilostazol
5. statin with LDL goal
278
mechanism of crescendo-decrescendo murmur of AS
- isovolumetric contraction = no blood moving = no murmur
| - mid-systole = peak flow = peak noise
279
clinical diagnosis of acute pulmonary edema
1. SOB
2. rales
3. S3 (splash)
4. orthopnea
280
- SOB
- hypOtension
- jugular venous distention
- lungs CTA
- PULSUS PARADOXUS (BP decrease > 10mmHg on INhalation)
- ELECTRICAL ALTERNANS (alternating QRS complex heights)
pericardial tamponade
281
pulmonic valve murmurs are best heard where?
2nd LEFT intercostal space
282
AS murmur description and location it's best heard
- crescendo-decrescendo
| - 2nd RIGHT intercostal space radiating to CAROTIDS
283
S4 gallop indicates
left ventricular HYPERTROPHY
284
- holosystolic murmur at LLSB
- SOB
- parasternal heave
VSD
285
best INITIAL therapy for AR
- ACEI/ARB, or nifedipine
| - and loop diuretic
286
MAT EKG finding
POLYMORPHIC P waves
287
MORE ACCURATE test for MS
TEE
288
best INITIAL test for DILATED cardiomyopathy
echo
| check EF and wall motion abnormality
289
best INITIAL test for dissection of thoracic aorta
CXR showing WIDENED MEDIASTINUM
290
other tests to order once atrial fibrillation is diagnosed
1. echo: looking for clots, valve function, LA size
2. TFT: TSH, T4
3. electrolytes: K+, Mag2+, Ca2+
4. troponin/CK
291
which medications decrease afterload?
1. amyl nitrate
| 2. ACEIs
292
MC of post-MI erectile dysfunction
anxiety
293
mechanism of pulsus paradoxus
inhale = big RV = smaller LV = BP drop > 10mmHg
294
further evaluation of syncope if diagnosis is still unclear after INITIAL tests
- Holter monitor as outpatient
- telemetry monitor as inpatient
- repeat cardiac enzymes
- urine/blood toxicology
295
finding on echo in pericardial tamponade
diastolic collapse of RA and RV
296
MOST ACCURATE test for AS
left heart catheterization
297
what LOWER MORTALITY in STEMI and are TIME DEPENDENT?
thrombolytics and PCI
