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Cardiology Flashcards

1
Q

Individuals who should be on mod-high intensity statin

A
  • Clinical ASCVD (ACS, MI, angina, CVA, TIA, PAD)
  • LDL > 190
  • Diabetes Mellitus AND age 40-75
  • 10-year ASCVD risk 7.5% AND age 40-75
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2
Q

Beck Triad

A

Hypotension, distant heart sounds, and distended neck veins

Cardiac Tamponade –> urgent pericardiocentesis

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3
Q

Jones Criteria

A

Acute rheumatic fever (JONES PEACE)
MAJOR: Joints, Heart, Nodules, Erythema marginatum (painless rash), Syndenham chorea
MINOR: Prev RF. EKG w/ PR prolongation, Arthralgias, CRP/ESR elevated, Elevated temp

  • hx of strep infxn + 2 major OR 1 major & 2 minor
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4
Q

Pulsus paradoxus

A

Fall in systolic BP > 10 mmHg with inspiration

*acute pericarditis

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5
Q

Stanford criteria

A

Aortic dissection
A: involves ascending aorta (emergent surgery)
B: distal to left subclavian artery (medical tx)

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6
Q

Endocarditis sx

A
  • Osler nodes (tender nodes on finger and toe pads)
  • Janeway lesions (peripheral petechiae)
  • Splinter hemorrhages (subungual petechiae)
  • Retinal hemorrhages (Roth spots)
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7
Q

Positive hepatojugular reflex

A

apply firm sustained pressure for 10-15 seconds over upper abdomen. + response = sustained elevation of jugular venous pressure >3cm during continued abdominal pressure

  • reflection of failing right ventricle that can’t accommodate for incr venous return
  • *constrictive pericarditis (post TB), right ventricular infarct, restrictive cardiomyopathy
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8
Q

malignant htn

A

> 180/120 associated with retinal hemorrhages, exudates, and/or papilledema

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9
Q

tx for prolonged QT

A

sodium bicarbonate - improves BP, narrows the QRS, and prevents and arrhythmia

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10
Q

Pt with fatigue, dizziness, bradycardia, episodes of 3-6 seconds with no sinus nodal activity

A

Sick sinus syndrome - age related degeneration of the cardiac conduction system with fibrosis to sinus node

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11
Q

Pt with WPW in a-fib with RVR, hemodynamically stable

A

Procainamide or ibutilide

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12
Q

11 month old with fever, rash, conjunctival injection, coronary artery problems

A

Kawasaki disease

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13
Q

Pt with COPD presents with SOB and wheezing. Pulse is 114 and irregular. ECG shows irregular narrow complex tachycardia with 3 different P wave morphologies.

A

Multifocal Atrial Tachycardia

  • exacerbation of pulm dz, electrolyte disturbance (hypokalemia), catecholamine surge (sepsis)
  • correct underlying disturbance & AV nodal blockade (verapamil) if it persists
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14
Q

Pt with a-fib and no palpable carotid or femoral pulses

A

Start chest compressions

- pulseless electrical activity

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15
Q

How to determine if a murmur is innocent in a 5 year old

A

Maneuvers that decrease blood return to the heart (standing, valsalva) typically reduce the intensity of the murmur

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16
Q

Side effects of amiodarone

A 
Chronic interstitial pneumonitis 
sinus bradycardia, heart block
Elevated transaminases, hepatits
corneal microdeposits 
blue grey skin discoloration
peripheral neuropathy
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17
Q

Treatment of acute pericarditis

A

NSAIDs and colchicine

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18
Q

Episodic flushing, secretory diarrhea, cutaneous telangictasias, brochospasm, niacin deficiency (dermatitis, diarrhea, dementia) and tricuspid regurgitation

A

carcinoid syndrome

tx: octreotide

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19
Q

Pt with high BP placed on nitroprusside develops AMS

A

Cyanide toxicity

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20
Q

how to rapidly reduce potassium

A

insulin and glucose
beta 2 agonist
sodium bicarb
(ca stabalizes cardiac membrane)

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21
Q

Retropharyngeal abscess can turn into…

A

acute necrotizing mediastinitis
- retropharyngeal space can drain into superior mediastinum the cross the alar fascia and enter the “danger space” and enter the posterior mediastinum

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22
Q

Causes of anterior mediastinal mass

A

4 T’s: thymoma, teratoma, thyroid neoplasm, terrible lymphoma

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23
Q

Pt with intermittent episodes of dizziness and left arm weakness/heaviness. BP is higher in higher in the right arm than the left.

A

subclavian artery occlusion

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24
Q

Pt passes out in the grocery store. Right before she passed out she felt an overwhelming sense of warmth and nausea. Her pulse was 40 bpm

A

Neurocardiogenic or vasovagal syncope

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25
Q

Pt develops right calf pain, swelling following embolectomy of right femoral artery. Extremity is cool and shiny. Distal pulses are palpable. Pt has loss of sensation and is unable to move his toes.

A

Compartment syndrome

- ischemia-reperfusion syndrome

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26
Q

Man develops severe left sided chest pain 5 days after an LAD infarction. He develops PEA and shock

A

free wall rupture

  • occurs 5 days - 2 weeks after
  • LAD involved
  • echo shows pericardial effusion with tamponade
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27
Q

3-5 days after MI, patient develops chest pain, new holosystolic murmur, biventricular failure, and shock

A

interventricular septum rupture

  • LAD, RCA
  • left to right ventricular shunt
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28
Q

3-5 days after MI patient develops severe pulmonary edema and new holosystolic murmur

A

Papillary muscle rupture

  • RCA
  • echo: severe mitral regurg with flail leaflet
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29
Q

Patient presenting with right-sided heart failure following pace-maker implantation is due to

A

Tricuspid regurgitation

- due to lead placement causing direct leaflet damage or inadequate leaflet coaptation

30
Q

Effects of digoxin toxicity

A

nausea, vomiting, diarrhea, vision changes (yellow/green), and arrhythmias

31
Q

Isolated systolic hypertension

A

systolic >140 and diastolic <90

  • seen in old men
  • due to increased stiffness and decreased elasticity in aortic and arterial walls
32
Q

Initial management of left ventricular systolic or diastolic dysfunction

A

ACEi (or ARB) and loop diuretic

33
Q

Cardiovascular changes in Turner syndrome

A

Bicuspid aortic valve, coarctation of the aorta, aortic root dilation –> can lead to dissection

34
Q

Tx for person with DVT and elevated homocysteine

A

Folate and B6 (pyridoxine)

35
Q

endocarditis after nosocomial UTIs

A

Enterococci

36
Q

Most common valvular abnormality in IE

A

MVP with mitral regurgitation

37
Q

arrhythmia associated with digoxin toxicity

A

Atrial tachycardia with AV block

- increased vagal tone slowing conduction to the AV node

38
Q

3-5 days after LAD infarct pt develops complications

A

Interventricular septum rupture

39
Q

Medications used to prevent thromboembolic events in a fib patient

A

Warfarin and non-vitamin-K antagonists (apixaban, dabigatran, rivaroxaban)

40
Q

Pt with palpable purpura on the LE, peripheral neuropathy (hyporflexia), liver involvement, arthralgias, fatigue, glomerulonephritis, previous hep C infection

A

Mixed cyroglobulinemia

  • IC deposition in small and medium sized vessels
  • assay for cryoblogulins that classically contain RF
41
Q

Long term amiodarone use can lead to

A

pulmonary toxicity

42
Q

indication for MVP repair

A

LVEF less than or equal to 60 with or without sx

43
Q

How to inhibit beta blockers in an overdose

A

Glucagon

44
Q

When is an endarterectomy indicated

A

symptomatic pt with 70-99% stenosis

45
Q

Pt ODs on a drug and EKG show wide QRS and prolonged QT. What do you do next?

A

Sodium bicarbonate

-TCA overdose

46
Q

Ischemic eval testing for a patient with LBBB or paced rhythm

A

COPD: dobutamine perfusion imaging

no COPD: persantine/regadenoson myocardial perfusion imaging

47
Q

MOA and SE of digoxin

A

slows the conduction through the SA and AV nodes by inhibiting the Na+/K+ ATPases of the cardiac myocytes

SE: abdominal pain, yellowing vision, heart block. *give immune Fab antibody

48
Q

Restrictive cardiomyopathy with fibrosis and prominent eosinophilic infiltrate

A

Loffler syndrome

49
Q

Debakey Classification

A

Type I involves the ascending aorta, arch, and descending thoracic aorta.
Type II is confined to the ascending aorta.
Type IIIa involves the descending thoracic aorta distal to the left subclavian artery and proximal to the celiac artery.
Type IIIb dissection involves the thoracic and abdominal aorta distal to the left subclavian artery.

50
Q

Most common cause of aortic dissection

A

hypertension

51
Q

Hypertensive crisis tx

A

nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam

52
Q

Medication CI in WPW and A-fib

A

digoxin - blocks the AV node and shortens the pathway needed for depolarization down the accessory pathway increasing the risk of v-fib

53
Q

chest pain with diaphoresis. ECG findings of ST elevation in leads V1-V3 and ST depression in leads II, III and aVF

A

Anteroseptal infact (see reciprocal changes in II, III and aVF)

54
Q

Prinzmetal angina

A

transient narrowing of the coronary vessels by the contraction of the smooth muscle in the vessel

  • EKG: transient ST elevations
  • tx: CCB, sublingual NTG to relieve vasospasm
55
Q

EKG in hypercalcemia

A

shortened QT interval

56
Q

EKG in hypomagnesemia

A

nonspecific T wave changes and a prolonged QT interval. As the deficit progresses, Torsades de pointes, a polymorphic ventricular tachycardia, may result
- common in alcoholics

57
Q

posterior MI EKG

A

a posterior STEMI presents as ST depression (reciprocal ST elevation) and R-waves (reciprocal Q-waves) in leads V1-V3.

58
Q

Endocarditis and conduction abnormality on EKG

A

perivalvular abscess

59
Q

Pt with recent URI develops increasing SOB. CXR shows enlarged cardiac silhouette and she has clear lung sounds on PE with jugular vein distension

A

Cardiac tamponade

- nonpalpable PMI on exam

60
Q

pulsus paradoxus

A

cardiac tamponade, asthma, copd

61
Q

synchronized cardioversion

A

a-fib, a flutter, VT with a pulse

62
Q

defibrillation

A

v-fib and pulseless VT

63
Q

meds shown to prolong survival in left ventricle dysfunction

A

ACEi, ARBs, BB, mineralcorticoid receptor antagonist (aldosterone), hydralazine and nitrates in AAs

64
Q

Why do you give sodium bicarb in TCA overdose

A

increases serum pH and sodium level, alleviating the cardio-depressant action on sodium channels

65
Q

Triptans and ergot derivatives are avoided in patients with

A

CAD - can cause vasospasm

66
Q

Pt complains of transient, rapid, painless monocular vision loss. States it appears as if a curtain is being drawn down over his visual field

A

Amaurosis fugax - retinal ischemia due to atherosclerotic emboli from internal carotid
- get duplex US of neck

67
Q

medication contraindicated in prinzmetal angina

A

propanolol - can exacerbate vasospasm

68
Q

left main artery is occluded greater than or equal to 50%

A

bypass surgery

69
Q

Brugada syndrome

A
  • most common cause of sudden death among young men of Asian descent without known underlying cardiac disease (possible mutation with Na channels in myocytes)
  • die in their 40s
  • die from ventricular tachycardia (VT)/ventricular fibrillation.
  • persistent ST elevations in the V1–V3 leads with a right bundle branch block appearance, with or without terminal S waves in the lateral leads
  • tx: ICD
70
Q

indications for valve replacement in endocarditis

A
  1. prosthetic valve endocarditis especially when associated with valve dysfunction or Staphylococcus aureus or Gram-negative rod bacteremia;
  2. uncontrolled infection leading to conduction abnormalities, periannular suppuration, and fistula despite appropriate antibiotic treatment for at least 1 week;
  3. repeated systemic embolizations despite appropriate antibiotic treatment;
  4. severe valvular disease resulting in refractory congestive heart failure.

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