Cardiology Flashcards
What side effect might make a patient stop taking an ACEI?
Cough
Define orthostatic hypotension
A drop in systolic BP 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, obstructive Lung disease
On palpating, what size is normal for the aorta?
Less than 3cm
A fixed consistent split S2 should make you think of what diagnosis?
Atrial septal defect
A pathological S3 is most commonly associated with what diagnosis?
CHF
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral stenosis
An opening snap on auscultation should make you think of what diagnosis?
Mitral stenosis
A continuous murmur most likely involves what area of the heart?
Most likely a septal defect
You hear an continuous machine-like murmur, why is the most likely diagnosis?
Patent ductus arteriosus
List three medications which may be used for pharmological stress test
Adenosine, dobutamine, dipyridamole, Persantine
What is the gold standard for diagnosing CAD?
Cardiac catheterization
Define stage I HTN according to JNC 7
Systolic: 140-159
Diastolic: 90-99
What is the treatment goal for a diabetic with HTN?
130/80
What is the MCC of secondary HTN?
CKD
No matter what medicaitons you use you are having trouble keeping a patient’s BP under control. You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
Cushing’s Disease
List three S/S which will likely be included in a description of a patient with a pheochromocytoma
thin, diaphoretic, tachycardic, agitated, hypertensive
You have a patient with a diagnosis of pheochromocytoma, while waiting for surgery, should you use an alpha or beta blocker?
Alpha blocker, NEVER use pure beta blocker
A young boy comes to you office. He has an elevated BP 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 medication treatment for stage I HTN?
Thiazide diuretic
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has DM?
ACEI or ARB
Following an MI, what medication should be prescribed to treat HTN?
Beta Blocker
paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF
What is the most common cause of CHF?
CAD
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 links on a CXR should make you think of what diagnosis?
CHF
a BNP 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 nre heart murmur and fever
Endocarditis
List two diagnoses which require antibiotic prophylaxis for “dirty procedures”
prosthetic valve, valve repair with any prosthetic material, prior endocarditis, congenital cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, recent change move mitral valve prolapse from high risk to medium risk
What are the three major criteria for endocarditis
2 positive blood cultures, positive transesophageal echo, 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 enodcarditis
fever, embolic event, immunological event, 1 positive blood culture
What are the 5 components of tetralogy of fallot?
overriding aorta, RVH, ventricular septal defect, pulmonary stenosis, 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 CP that is relived 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 MI?
Dressler syndrome
A patient presents to the ED with CP, an EKG shows diffuse ST elevations in almost all of the leads, what is the most likely diagnosis?
Pericarditis
Define paradoxical pulse
there is a large difference in pulse pressure between inhalation and exhalation
define pulses alternans
EKG waveform changes from beat to beat
What is the definitive treatment for cardiac tamponade?
Pericardiocentesis
On physical exam, you hear a harsh systolic murmur along the right sternal border, what is the most likely diagnosis
aortic stenosis
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
aortic regurgitation
what is the best locations to hear problems with the aortic valve?
2nd right intercostal space
where is disease of the pulmonary valve best heard?
2nd left intercostal space
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are first line empiric Tx
What two valvular issues do patients with Marfan’s syndrome often have?
Aortic regurgitation and Mitral prolapse
What are the two main causes of aortic stenosis?
congenital bicuspid valve and calcification of the valve secondary to CAD
An elderly patient presents with dyspnea, angina, and syncope on exertion. The EKG is normal, what is the most likely diagnosis?
Aortic stenosis
On auscultation you hear a harsh, blowing, pansystolic murmur at the apex, what is the most likely diagnosis?
mitral regurgitation
You suspect mitral regurgitation, what is the most accurate way to prove your diagnosis?
tranesophageal echo
a patient with Mitral prolapse will often have what physical characteristics?
often a thin female
What is the best patient position to hear aortic regurge and aortic stenosis?
sitting up and leaning forward
What is Tietze syndrome?
costochondritis
Are most pulmonary valve problems congenital or acquired?
95% congenital
What is the therapeutic range for INR following an organic valve replacement?
2-3
a 60 year old male presents to the ER with severe dizziness and back pain. his BP is dropping and you can feel and abdominal pulsatile mass on physical exam. what is the most likely diagnosis?
ruptured aortic aneurysm
In a patient with aortic stenosis, how will the PMI be displaced?
laterally d/t LVH
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. all labs including troponins and CK-MB are negative. what is the most likely diagnosis?
Prinzmetal’s angina
a questions about prinsmetal’s angina will often contain what key thing in the patient’s history?
cocaine use
name two things that would constitute a positive stress test
a drop in BP, 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?
1 year
Where is disease of the mitral valve best heard?
at the apex
What is the initial treatment for a MI?
MONA > morphine, oxygen, nitroglycerin, aspirin
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new LBBB
List three catastrophic complications of a MI
Papillary muscle rupture, myocardial wall rupture, left ventricular aneurysm
an EKG shows a regular heart rate of 200 BPM, QRS is narrow, what is the most likely diagnosis?
SVT
Acute endocarditis is most commonly cauased by what organism?
staph aureus
list three congenital heart diseases?
Atrial septal defect, ventricular septal defect, coarctation of the aorta, patent ductus arteriosus, tetralogy of fallot
what is the most common cause of an atrial septal defect
patent foramen ovale
Where on your patient should you listen for the murmur associated with an atrial septal defect?
at the second or third interspace
a CXR shows a “3” sign with notching of the ribs, what is the most likely diagnosis?
coarctation of the aorta
what is the appropriate treatment for a patent ductus arteriosus?
indomethacin
a Blalock procedure is used to correct what congenital heart condition?
tetralogy of fallot
You hear a loud, harsh pulmonary murmur along the left sternal border, what is the most likely diagnosis?
ventricular septal defect
