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PANRE > cardiology > Flashcards

cardiology Flashcards

1
Q

pr interval

A

0.12-0.20

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2
Q

left atrial enlargmenet

A

m shaped- biphasic p wave in lead II

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3
Q

right atrial enlargement

A

tall p wave in lead II more than 3m

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4
Q

bundle branch block

A

both have wide QRS

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5
Q

acetylcholine

A

regulated by the vagus nerve- decreases force of contractio, decreased SA node

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6
Q

anticholinergics

A

increase heart rate

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7
Q

sick sinus syndreom

A

permanent pacemaker is treatment- or brady with v tach- permanent pacemeaker with automatic implantable cardioverter-defib (AICD)

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8
Q

sinus brady

A

atropine , less than 60

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9
Q

afib

A

no p waves, beta blockers tx
tx: calcium channel blockers: NON DHP!!- diltiazem and verapamil
DIGOXIN- RATE CONTROL IN patient with HYPOTENSION OR CONGESTIVE HEART FAILURE!!
unstable: sycnhorinzed cardioversion

Rhtyhm control: start heparin, cardiovert within 24 hours, and then anticoag for 4 weeks
AMIODRAONE for rhythm control

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10
Q

dabigatran

A

direct thrombin inhibitors

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11
Q

factor XA inhibitors (binds to antithrombin III)

A

rivaroxabana, apixaban, edoxaban

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12
Q

warfarin INR goal

A

2-3

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13
Q

long QT syndrome

A

TCA, macrolides

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14
Q

paroxysmal supraventricular tach

A

more than 100, regularly with narrow QRS complexes
rhtyhm from above ventricles.
WPV is a form- both one accessory pathway is outside the AV node and 1 within the av node

COMMON ONE: both pathways within av node( one slow one fast)- most common

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15
Q

tx for SVT

A 
vagal maneuvers
adenosine- first lien MEDICAL
beta block or calcium channel
dont use adenosin in patients with asma//copd- bronchospasm
amiodarine
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16
Q

TX for WPW

A

PROCAINAMIDE

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17
Q

MAT

A

3 p wav morphologies- SEVERE COPD association

calcium channel blockers or Beta blockers used

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18
Q

WPW

A 
delta waves (slurred QRS upstroke)
WIDE QRS
SHORT PR interval

STABLE:tx: procainamide
Adempsome. BETA. CAlcium, DIGOXIN
unstable:::: SYNCHORNIZED CARDIOVERS
def management: radiofrequency ablation

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19
Q

junctional

A 
p waves inverted, or negative- like I, II, avf leads. 
NARROW QRS
40-60 for junctional
60-100 for accelerated
juctional tacy: more than 100
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20
Q

pvc - premature venticular complex

A

no treatment needed usually

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21
Q

V Tach

A

prolonged QT interval common predisposing condition

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22
Q

TORSADES dE pointes

A

MC due to hypomagnesemia, HYPO kalemia, - twists around baslene

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23
Q

STABLE VT

A

amiodarine

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24
Q

unstable vt with a pulse

A

synchronized cardioversion

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25
Q

VT (no pulse)

A

defib and cpr

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26
Q

trosades de pointes

A

IV MAG

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27
Q

pulsesless electrical activity

A

rhtyhm on monitor but pulseless person- CPR and epi and check for shockable rhythm every 2 mins

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28
Q

acute pericarditisi

A

concave ST elevations in the precordial leads (v1 to v6)

pr depresisons in the same leads iwth ST elevations

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29
Q

phyaiological split

A

inspiration separates S2 into A2 followed by P2.

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30
Q

pulsus paraoxus

A

more than 10 mm hg decline in SBP with inspiration

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31
Q

treatmill test

A

+ if hypotension or hypertension, arrhytmias, or st elevation,
CI: can’t exercises, LBBB, WPW, baseline ST changes, pacing

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32
Q

pharmaco stress test

A

if patients can’t exericse- do this
ADENOSINE or dipyridamole: CORONARY vasodilators OF ONLY THE NORMAL arterities- used for people with baseline ecg abnromaltieis like LBBB or ventricular pacing
CI: bronchospastic disease

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33
Q

stress echo

A

USES DOBUTAMINE!: stimulates increased hr/ contractiliity

CI: v. arrthytmias, severe aortic stenosis, SBP more than 180, aortic dissection or patients on beta blockers

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34
Q

coronary artery disease

A

ATHEROsclerosis: MC
fatty streak formation: lipid in the white blood cells: then formation of an early plaque, formation of fibrous plaque- narrows coronary arterial lume and calicficiation- uaully more than 70% will cause symptoms

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35
Q

angina pectoris

A

usually short in duration- less than 30 mins, leveines sign, pain relieved with rest,
anginal equivalent: dyspea, epigatric or sholuder pain
ST depression
coronary angiography: definitive diagnosis/gold standard

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36
Q

PTCA

A

1 or 2 vessel disease not involving the lefft main coronary artery and v function is normal- stents

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37
Q

CABGL

A

LEft main coronary artery disease- 3 vessel disease, ejection fraction less than 40% on left

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38
Q

beta blockers (Cardioselective- metoprolol and atenolol)

A

prolongs coronary artery filling times, reduces o2 requirement

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39
Q

ca blockers

A

prevents/terminates ischemia idnuced by coronary vaspospasm- coronary vasodilation

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40
Q

pain at rest for heart disease

A

indicates more than 90% occlusion

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41
Q

inferior wall MI

A

chest pain and BRADYcardia- may be suggestive of an inferior MI , +s4!!!

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42
Q

left anterior descending (LAD)

A

anterior wall-septal v1 through v4

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43
Q

circumflex

A

LATERAL WALL- I, AVL, v5, V6

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44
Q

inferior

A

2, 3, avf- RIGHT CORONARY artery

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45
Q

myoglobin

A

first cardiac marker to increase

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46
Q

adp inhibitors (clopidogrel)

A

good for patients with aspirin allergy- inbhiits aDP mediated platelet ggreagation

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47
Q

GPIIb/iIIA inhibitors

A

inhibits teh final pathway for platelet aggreagatio (eptifbatid, tirofiban, abciximab)

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48
Q

unfractioned heaprin

A

binds to and potentiates antithrombin IIi ability to inactivate factor XA, inactivates thrombin (IIA). Low molectular weight heaprin- more specific to factor XA-

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49
Q

unstable angina or NSTEMI

A
  1. antithrombotic therapy, and adjunctive anti-ischmic therapy
    anti thrombotic: aspirin, clopidogrel, gPIIb/IIIa
    heparin - as anticoag

adjuncts: beta blockers, nitrates, morphine, ca blockers (

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50
Q

St elevations management

A
  1. reperfusion therapy- most important
    DONE WITHIN 12 hours- either PCI or thrombolytics
    pci: best within 3 h of symptoms PCI is better than thrombolytics
  2. thrombolytics: TISSUE plasminogen activateors (alteplase, tenecteplase)- dissolves clot by activating tissue plasminogen to plasmin
    streptokinase: only given once

thromblytics dissolve existing clots

adjunctive: BETA blockers, ACE inhibitors, NITRATES, morphine

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51
Q

ACE

A

slows progression of CHF and decreases VENTRICULAR remodeling

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52
Q

cocaine

A

DONT GIVE BETA blockers

USE CALCIUM channel blockers, benzo, aspirin, heparin

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53
Q

heart failure

A

most common cause is cad

54
Q

systolic failure

A

decresed ejection fraction, thin ventriular walls, dilated LV chamber, +s3

55
Q

diastolic failure

A

increased ejection fraction or normal
thick ventriicular walls
SMALL lv chamber
+s4

56
Q

high output failure

A

severe, anemia, thyrotoxicosis, av shutning, beriberi

57
Q

ejection fraction

A

most important determinant of progrnosis in heart failure

use BNP- to identify CHF as the cause of dyspnea in the ER

58
Q

beta blockers

A

DONT USE during decomponsated HF

59
Q

HF: vasodilators (decrease afterload)

A

ACe inhibitors, ARBs, beta blockers, hydralazine and nitrates)

60
Q

decrease preload during HF

A

diuretics, potassium sparing diuretics, hydrochlorthiazides

61
Q

sympathomimetics

A

SHORT TERM IN SEVERE ACUTE CHF: dobutamine, digoxine and dopamine: positive ionotropes

62
Q

digoxin

A

double/blurred vision/green yellow halos around lights), seizures, dizziness,

63
Q

DECOMPENSATED HEart failure

A

LASIX, morphine, nitrates, oxygen, position

reducing preload

64
Q

acute pericarditis

A

aspirin or NSAIDS for 7-14 days

Dressler: ASPOIRIN or colchicine

65
Q

pericardial effusion

A

low voltage Qrs complex, electric alternans

66
Q

pericardial tamponade

A

pulsus paraodxus: more than 10 mmhg decrease in systolic blood pressure with inspiration!!
HYPOTENSION, JVP , muffled heart sounds

67
Q

constrictive pericardi

A

:thickened, fibrotic, calicfied pericardium- restricts diastolic filling- percardiectomy is tx

68
Q

acute pericarditis

A

mc idiopathic

virus: enterovirus: coxackie

69
Q

myocarditis

A

C viral: enteroviruses like coxsackie, parvo too
gold standard: endoyocardial biopsy-
CXR: dilated cardiomyopathy!
+cardiac enzymes

70
Q

restrictive cardiomyopathy

A

amyloisodosis MC cause
sarcoidsosis
diastiolic function imparied
kussmaul’s sign: jvp increses with INSPIRATION

71
Q

hypertrophic cardiomyopathy

A

SYSTOLIC crescendo-descredo murmur
handgrip, INCREASED VENOUS return by squatting or lying supine- DECREASES mURMUR

DECREASED VenOUS return such as valsalva and standing- increases murmur intesnsity- assymettriacal wall thickeness- esp septal

TX : beta blockers, CCB

72
Q

rheuamtic fever

A 
migratory polyarthritis
active carditis
nodules (subcutaneous)
erythema marginatum
syndenham's chorea

plus recent strep infection

73
Q

tx for rheumatic fever

A

antiinflammatory: aspirin, and penicillin G

if pcn allergic: erythromycin

74
Q

ejection clinck

A

mitral valve prolapse

75
Q

harsh rumble sounds

A

THINK STENOSIS

76
Q

bllowing sound

A

think REGURG

77
Q

aortic stenosis

A

congenital heart disease (bicuspid aov)
angina, syncope, congestive heart failure
systolic ejection!

78
Q

aortic regurg

A

Endocaritis, MARFAN syndrome, syphillis, aortic dissesction,

AUSTIN flint murmur
bounding pulse
wide pulse pressure
water hammer pulse: radial pulse upstroke and rapid fall
corrigans’ pulse: carotid artery
de musset’s : head bobbing
traube’s sound: pistol shot femoral artery
quinke’s pulse: fingernail bed pulsations

PULSUS bisferins: double pulse carotid upstroke

a

79
Q

tx of aortic regur

A

afterload reduction with ace, arbs, nifiedipine, surgical

80
Q

mitral stenosis

A

mc rheumatic heart disease
pulm symptoms: pulmonary htn, dyspnea, atrial fib, OPENING SNAP!!!!
left atrial enlargement +Afib

percutaneous blaloon valvulopasty

81
Q

mitral regurg

A

most common cause: mitral valve prolapse, or ISCHEMIA/infarction

82
Q

mitral valve prolapse

A

MC in young women
most asymptomatic
mid late systolic EJECTION CLICK!

83
Q

pulmonic stenosis

A

congenital and disease of the young

84
Q

htn

A

sysotlic more than 140
diastolic more than 90

95% primary- idiopathic etiology
secondary: mc reason is renovascular mc- renal artery stenosis

goal is less than 140 /90 for diabetecs and chronic renal disease!

85
Q

spirinolactone

A

Side effect: hyperkalemia and gyenocmastia

86
Q

hydrochlorthiazides

A

side effect: hypercalcemia, hyperglycemia, hypercalcemia, hyperuricemia, hypokaemia

87
Q

alpha blockers

A

used tfor BPH-

se: dizzines, headache-

88
Q

calcium channel

A

dont give for CHF or 2/3rd heart block

89
Q

african americans

A

do well with thiazides, cCB

90
Q

DM

A

do well with ACEI, ARB

91
Q

htn urgency

A

increased bp , but no acute organ damage- oral agents used - clonidine, captopril, furosemide, labetalol, nicardibine

92
Q

htn emergency

A

with acute end organ damage- usually more than 180 and diastolic more than 120

neuro /cardiac. renal /
if its retial damage: malignant htn- papilledema

93
Q

INIATE statin therapy

A

type 1 or type 2 between 40-75 with LDL-C levels of 70 to 189 mg per dL
cardiovasc disease 40-75 and 7.5 % risk of heart attack or stroke in 10 years
peaople more than 21 with ldl levels of more than 190
any form of clinical atherosclerotic cardiovasc disease

94
Q

increase hdl

A

niacin0 best drug- increases HDL

se: hyperuric, hyperglycemia

95
Q

lower elevated trigliceride

A

fibrates - decreases hepatic production of tiglyceride

seE: myositis, and yalgias esp with statin, gall stones

96
Q

lower ldl

A

statins: increases ldl receptions
se: myositis/.myagias, hepatitis

97
Q

bile acid sequestrants

A

used for pruritis associated with biliary obstruction
ONLY MED SAFE IN PREGNANCY!!!!
removes LDL from the blood
-sE: causes increased trigly

98
Q

endocarditis

A

MC valve: MITRAL valve

IN IV drug users: TRICUSPID VALVE

99
Q

acute bacterial endocard

A

s. aureus- for normal valves

100
Q

subacute bacterial endocard

A

ABNORMAL VALVES- s. viridans

101
Q

endocarditis in IV drug users

A

MRSA

102
Q

prosthetic valve endocarditis

A

STAPH epidermis MC- early

late: staph aureus

103
Q

hacek organizesm

A

hemophilus, actinobaci, cardiobacterium, eikenella, klingella- gram neg organizesm- large vegetables

104
Q

janeway

A

painless macules on palms and soles (endo)

105
Q

roth spots

A

retinal hemorrhages with pale centers

106
Q

osler’s nodes

A

tender on pads of the digits

107
Q

blood culture for endcard

A

3 sets at least 1 hour apart, use TEE- more sesntiive.

108
Q

acute (native valve )Endocard

A

naficillin and genta X 4-6 weeks, vanco for mrsa and genta

109
Q

subacute (native valve)

A

pen or ampi, plus genta, VANCO in IVDA

110
Q

protsthetic valve

A

VANCO+genta, +rifampin (staph aureus)

111
Q

fungal (Endocard)

A

amphotericin B

112
Q

prophylaxis for endocarditis

A

prosthetic, heart repairs, prior history of endcard, congenital heart disease, cardiac valvulopathy

DENTAL- gums, roots of teeth, oral mucosa
respir: rigit dbronchoscopy , respiratory mucosa surgery
INFECTED SKIN/musculoskeleta tissue : abscess incision and draining
AMOX 30-60min sbefore surgery
clinda if penc allergy

113
Q

leriche’s syndrome

A

claudication (buttock, thigh pain), impotence, and decreased femoral pulses

114
Q

acute arterial emoblism

A

paresthsais, pain, pallor, pulseless, paralysis, poikilothermia

115
Q

PAD

A

lateral malleolar ulcers, atrophic skin changes,
USE ABI +pad if less than 0.90
arteriorgraphy: gold standard
CILOSTAZOL tx

116
Q

AAA

A

mc risk factor, atherosclerosis, smoking!!!, marfan’s, syphillis, HTN
_tender, pulsatile abdominal mass, syncope or hypotension
more than 5 cm is rupture risk
ultrasound: imagin study of choice

CT SCAN: test of choice for THORACIC aneurysm
ANGIOGRAPHY: gold standard

117
Q

Aortic dissection

A

TEAR IN THE INNERMOST LAYER OF AORTA (INTIMA)
65% ascending, ascending- high mortality
HYPERTENSION- RISK FACTOR! MOST IMPORTANT!
variation in pulse between right and left arm
acute NEW onset- AORTIC REGURG
GOLD STANDARD: MRI angiography!
CT scan with contrast- test of choice??
XR: widening mediastinum
surgical management for debakey I or II/stanford A
medical: descending without complications

118
Q

debakey

A

type I: aortic arch and beyond it distally
type II: ascending aorta- confined
type III: descending aorta

119
Q

buerger’s disease (THROMBOANGIITS OBLITERANS)

A

superficial migratory thrombophlebitis, ischemic ulcers or gangrene finger/toe ischemia, raynaud’s phenomena

ABNORMAL allen test: assesses patency of radial and ulnar arteries

tx: CCB, STOP SMOKING!

120
Q

DVT

A

virchow triad: venous stasis, endothelial damage, hypercoagulability
VENOUS DUPLEX ULTRASOUND- first line
D dimer - for low risk patients- can rule it out
venography: gold standard

tx: heparin and then WARFARIN!

121
Q

warfarin

A

inhibits protein C and S, 2,7,9,10

122
Q

postural hypotension (orthostatic)

A

impaired autonomic reflexes or reduced intravascular volume

fall in the systolic blood pressure of more than 20 mm or fall of the diastolic blood pressure more than 10 mm with changes in position
if due to hypovolemia: increase in pulse rate of more than 15

123
Q

ciruclatory shock

A

low cardiac output OR low systemic vascular RESISTANCE
inadequate tissue perfusion, autonomic nervous sytem activation- increases SVR and contracitilyt when NE, DOPAMINE and cortisol relesed, RAAS activation- decreased urine output
systemic effects of shock: ATOP depletion, metabolic acidsosi, lactic acid, multisystemic organ failure

124
Q

hypovolemic shock

A

vasoconstriction, increased SVR, hypotension, decreased CO, and decreased pulmonary capillary pressure

tX: crystalloids, normal saline, control hemorrahge

125
Q

cardiogenic shock

A

increased pulmonary capillary wedge pressure, increased SVR (Vasoconstrict), hypotension, decreased CO

ONLY SHOCK WHERE LARGE AMOUNTS OF fluids aren’t given
ionotopic support: DOBUTAMINE, epinephrine, treat underlying

126
Q

obstructive shock

A

MASSIVE PE: ECG: S1Q3T3
perciardial tamponande
tension pneumo
aortic DISSECTION!

127
Q

Distributive shock

A

maldistribution of blood and vasodilation- shunt of blood away from vital to nonvital organs!
decreased cardiac output , decreased SVR (this is diff from other shocks), decreased pulmonary wedge pressure
But if warm extremities: increased CO, decreased SVR- early septic shock
(septic shock, anaphylactic shock, neurogenic shock, endocrine shock)

128
Q

septic shock (distributive shock)

A

infectiev organism activates immune system: host produces systemic inflammatory response
SIRS: temp, pulse high, RR high, wbc high or too low
sepsis: incresed lactate, and sirs
severe sepsis: sirs and multi system organ failure
septic shock: sepsis and refractory hypotension
- BROAD SPECTRUM abx
iv fluid resusciationt,
VASOPRESSORS if no response to iv fluids

129
Q

anaphylactic shock

A

ige mediated severe systemic hypersens reactivity

epinephrine, air way management, antihistamines, iv fluids

130
Q

neurogenic shock

A

acute spinal cord injury- brady and hypotens- wide pulse pressure

131
Q

endocrine shock

A

adrenal insufficiency - tx with hydrocortisone

PANRE (18 decks)

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