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Cardiology Flashcards

1
Q

what is the systolic/diastolic level which defines hypertensive emergency?

A

> 180/>110

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2
Q

Which 2 medications are best chosen to RAPIDLY decrease BP in hypertensive emergency?

A

Sodium nitroprusside (Nitropress)

Labetalol

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3
Q

What do you need to be cautious of while rapidly lowering BP during hypertensive crisis?

A

too rapid of decrease can cause cerebral ischemia (brain damage)

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4
Q

Which 3 hypertension medications are safe for pregnancy?

A

Methyldopa

Labetalol

Nifedipine

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5
Q

what finding on Urinalysis is indicative of uncontrolled hypertension?

A

Proteinuria

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6
Q

How should hypertensive urgency (asymptomatic) be handled pharmacologically?

A

ORAL medications with monitoring: Clonidine, Hydralazine, nitrates.

When BP is lowered 20-30 mmHg, send home with longer-acting PO medication and follow up 3-4 days

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7
Q

what are the top 3 medication class choices for treating primary HTN?

A 
Thiazide diuretics (HCTZ)
CCB (long-acting): Amlodipine
ACE/ARB (lisinopril)
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8
Q

which virus commonly causes pericarditis?

A

90% idiopathic, but 10% Coxsackievirus

NOTE: the culprit that causes hand, foot, mouth in kiddos

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9
Q

what is Dressler’s Syndrome?

A

A condition that occurs post-MI, characterized by chest pain with an audible friction rub, commonly a cause of Pericarditis

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10
Q

How does acute pericarditis present?

A

chest pain, worse with lying flat, relieved by leaning forward

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11
Q

What EKG findings will you see with pericarditis?

A

PR depression and DIFFUSE ST ELEVATION (ie you’ll see it in all leads)

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12
Q

Treatment of mild pericarditis (ie NO effusion, Viral in cause)

A

discharge w/ rest + ASA + anti-inflammatory agents (NSAIDs, Steroids)

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13
Q

What is Beck’s Triad?

A

Hypotension + JVD + Muffled Heart sounds

A sign of Cardiac Tamponade

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14
Q

What causes cardiac tamponade?

A

rapid filling of pericardial sac that inhibits venous return and inhibits ventricular filling. Can be FATAL

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15
Q

Treatment Cardiac Tamponade?

A

Pericardiocentesis

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16
Q

which valve is most commonly affected in endocarditis in IV drug users?

A

Tricuspid

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17
Q

Treatment for Staph aureus endocarditis?

A

Amoxicillin for 4-6 weeks

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18
Q

other than IV drug use, what is the underlying risk of contracting endocarditis?

A

Underlying valve disorders: PDA, VSD, prosthetic valve, rheumatic fever, stenosis, regurgitation, congenital heart disease…

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19
Q

what is the most common valve affected by rheumatic fever?

A

Mitral valve

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20
Q

patient presents with joint pain in BOTH hips, shortness of breath, chest pain. Physical exam reveals painless serpiginous rash on trunk. His history reveals illness with sore throat but he never went in to get treatment. What is likely diagnosis?

A

Rheumatic fever

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21
Q

what symptoms may be present in a patient with acute rheumatic fever?

A

symmetrical joint pain, bilateral, large joints

erythema marginatum (rash, snake-like)

chest pain

shortness of breath

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22
Q

what is the JONES criteria used to diagnose

A

rheumatic fever

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23
Q

when to order ABI on a patient?

A
  • when c/o exertional lower extremity pain (intermittent claudication)
  • nonhealing ulcers

(this can r/o nerve impingement vs other vasculitidies)

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24
Q

what is the rate at which the SA node paces?

A

60-100 bpm

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25
what is the rate at which the AV node paces?
40-70 bpm
26
how do you treat SVT in a stable, asymptomatic patient?
IV Adenosine 6 mg
27
How do you treat SVT in an unstable, hypotensive patient?
cardiovert
28
heart auscultation: low, diastolic rumble with an opening SNAP after s2
mitral stenosis
29
high pitched blowing, pansystolic murmur that radiates into the axilla. Heard best at apex
Mitral regurgitation
30
BNP >800 is concerning for heart failure or COPD?
heart failure
31
heart auscultation: mid-to-late systolic click
Mitral Valve Prolapse
32
what is the criteria used to diagnose Endocarditis?
Duke's | must see vegetation on TEE, serum culture positive for gram + cocci
33
what is the Treatment and duration for treating endocarditis?
Amoxicillin 4-6 weeks
34
What is Dressler's Syndrome?
pericarditis that occurs after an MI (chest pain w/ audible friction rub)
35
patient presents with chest pain that is relieved by leaning forward. What is at the top of your differential
Pericarditis/pericardial effusion
36
what can pericardial effusion progress to if not treated?
cardiac tamponade (pulsus paradoxus on ekg, or "wandering ekg")
37
you see a "water bottle heart" on CXR. Based on your diagnosis, what might EKG show?
diffuse ST elevation, PR depression pericarditis/pericardial effusion
38
what is both diagnostic and therapeutic treatment of pericardial effusion?
pericardiocentesis
39
Tx pericarditis without effusion?
Aspirin + NSAIDs (or steroids)
40
What makes up Beck's Triad of cardiac tamponade
hypotension + JVD + Muffled heart sounds
41
What is the criteria used to diagnose Rheumatic fever?
``` JONES J-joint pain <3 - carditis N-nodules E - erythema marginatum S - Sydenham chorea ```
42
Patient presents with hypertension and c/o tearing/ripping pain in his back. What is at the top of your DDX
aortic dissection
43
what might you see on CXR of a person with aortic aneurysm?
widening of the medastinum
44
What are the 2 narrow QRS fast arrythmias
SVT and A.fib
45
What is the pharmacological treatment for SVT
Adenosine 6 mg, 12 mg, 12 mg if unstable: shock
46
What is the pharmacological tx a.fib
Beta blockers or CCBs if unstable - shock
47
pharmacological treatment for Torsades de pointes
IV Mg + shock
48
pharmacological treatment for VTACH?
IV Amiodarone if unstable: shock
49
what is the tx for Wolff-Parkinson-white arrhythmia?
IV Procainamide
50
what is the "thumbprint" sign on EKG and what is it indicative of?
PR elevation in lead AVR. Acute pericarditis
51
what is the FIRST step in managing aortic dissection
LOWER BP immediately; use labetalol or sodium nitroprusside
52
what non-emergent injury is often misdiagnosed as DVT?
ruptured bakers cyst - no tx required
53
an Ankle Brachial Index score of ____ indicates severe peripheral vascular disease
>1.3 | normal is 0.9-1.3
54
what is the treatment for confirmed Giant Cell ARteritis?
Immediate Steroids (prednisone po if no vision loss) (IV methylprednisolone if vision symptoms)
55
what are the large cell arteritis's?
Giant cell arteritis Takayasu
56
patient presents with hemoptysis, bloody nasal discharge. Labs show glomerulonephritis (kidney failure) and he is c-ANCA positive. What is his disease?
Wegener's Vasculitis affects lungs and kidneys - Dx is p-ANCA and lung biopsy
57
which immunoglobulin (Ig_) is associated with Henoch-schonlein purpura
IgA
58
what is the most common form of systemic vasculitis in kids?
Henoch-schonlein purpura
59
your patient is taking HCTZ and Beta blocker for CHF, statin, metformin, NSAIDs, flexiril for hyperlipidemia, DM, and chronic back pain. which of these medications should be discontinued due to risk of exacerbating heart failure.
NSAIDs can exacerbate acute HF
60
patient presents with hemoptysis and glomerulonephritis (proteins and red cell casts in urine). Serum ELISA is positive for anti-GBM antibodies. What is his Dx?
Goodpasture's syndrome
61
what differentiates polyarteritis nodosa from Goodpastures?
no lung involvement in polyarteritis nodosa they both have skin rash, GI and kidney involvement
62
Takayasu Arteritis commonly affects this major artery; what is the diagnostic imaging study of choice to confirm dx?
Aortic arch arterogram (sees stenosis or arch and major arteries)
63
coronary artery stenosis >____% produces angina?
>70%
64
What findings render a stress test positive?
any symptoms during exam: chest pain, ST elevation, hypotension, arrhythmias. (NEED CATH)
65
Treatment of stable angina (3 meds)
Nitro for prn + Beta blocker + ASA
66
what determines NSTEMI if there is no ST elevation?
cardiac enzymes are still elevated (Troponin, CK-MB)
67
what is the difference in regard to symptoms of stable vs unstable angina?
stable angina: symptoms with exertion Unstable angina: symptoms at rest
68
what will EKG show if there is "old" or "late" MI?
Q waves
69
for MI, door-to-balloon time for PCI is ___ minutes
90 min from door to balloon
70
if patient is experiencing chest pain as potential for Mi, how much Aspirin should they be given/take at home?
325 mg, CHEW IT
71
what are the 2 treatments for confirmed MI
Fibrinolysis PCI (percutaneous coronary intervention)
72
door-to-needle time for fibrinolysis is _____ minutes
30 minutes
73
ST elevation in leads II, III and aVF correlate to an MI in which artery?
Right coronary artery (Inferior MI)
74
ST elevation in leads I, aVL, V4-V6 correlates to an MI in which artery?
Lateral circumflex artery (LATERAL MI)
75
ST elevation in leads V1-V4 correlates to MI in which coronary artery?
Left anterior descending (Anterior MI)
76
Reciprocal changes in leads V1-V3 correlates to MI in which coronary artery?
Right coronary artery (Posterior MI)
77
what is a Delta wave and what condition is this seen in
upslurring of the QRS complex. Seen in Wolff-Parkinson white
78
where is the conduction coming from in wolff Parkinson white syndrome?
Bundle of Kent
79
patient is experiencing SVT, but is stable. What is the treatment of choice?
IV Adenosine 6 mg, 12 mg, 12 mg. | unstable = cardiovert
80
T or F: treatment for stable VTACH is adenosine
FALSE - this does not respod to vagal maneuvers or adenosine Treatment is IV Amiodarone
81
what is the pharmacologic tx for torsades?
IV Mg THEN shock!
82
what do the letters of the CHADS2 score stand for and what is it used for?
``` C - CHF H - HTN A - Age >75 D - DM S - stroke S - stroke (Gets 2 points) ``` assesses need for anticoagulation in person with A fib score >2 requires anticoagulation
83
Your patient has "old" (>48 hours) A fib, and you decide to cardiovert her due to being overall healthy with no comorbidities. Can you cardiovert right away?
NO! must anticoagulate for 3 weeks before cardioversion. TEE during procedure to look for clot in atrium, THEN cardiovert. continue anticoag for 1 month after cardioversion
84
which medication should be given for reduced EF (seen in MI and CHF) that prevents Left ventricular remodeling?
ACE-Inhbitor
85
how do you manage a patient with hemodynamically UNSTABLE a fib?
immediate cardioversion
86
Is oral or electric conversion of A fib preferred?
electrical
87
What 2 meds are preferred for converting A fib?
Propafenone, flecainide
88
pharmacological treatment of VTACH
IV Amiodarone

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