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cardiology Flashcards

1
Q

Indications for digoxin

A

Atrial fibrillation

heart failure in tx of resistent cases

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2
Q

Digoxin mechanism of action

A 
Inhibition of Na+/K+-ATPases → higher intracellular Na+ concentration → reduced efficacy of Na+/Ca2+ exchangers → higher intracellular Ca2+ concentration → increased vagal tone
increased contractility (positive inotropic effect); reduced velocity of electric conduction (negative dromotropic effect); reduction of the heart rate (negative chronotropic effect)
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3
Q

what are risk factors for digoxin toxicity

A

hypokalemia
renal failure
Drugs such as verapamil, diltiazem, amiodarone, K+ depleting diuretics

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4
Q

Clinical features of digoxin toxicity

A

Nausea/vomiting, diarrhea, abdominal pain, and anorexia
Blurry vision with a yellow tint and halos, disorientation, weakness
arrthymias

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5
Q

How to tx digoxin toxicity

A

Digoxin-specific antibody (œ) fragments
normalize serum K+ levels
Mg2+

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6
Q

Changes on EKG for STEMI

A

2mm ST elevation or depression or new LBBB

GO to cath lab

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7
Q

ST segment elevation in V1-V4 is STEMI where

A

anterior infarct
Left anterior descending artery
left side of heart and 2/3 front of the IV septum

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8
Q

ST segment elevation in I, aVL, V4-V6 is STEMI where

A

Lateral infarct
Circumflex artery
Supplies the left atrium and side and back of left ventricle

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9
Q

ST segment elevation in II, III, and aVF

A

Inferior infarct
Right Coronary artery
The right coronary artery supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm.

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10
Q

Right ventricular infarct sxs?

What medication do you not give

A

Sxs are hypotension tachycardia, clear lungs JVD, no pulsus paradoxus
DO NOT give nitro

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11
Q

What medications ar indicated in patient with MI

A 
Oxygen
Nitroglycerin (unless right ventricular infarct)
Beta blocker
ASA
Morphine
ACE inhibitor
IV heparin
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12
Q

Dont do a EKG stress test if

A

patient cant exercise
old LBB or baseline ST elevation or pt. is on digoxin do exercise echo instead
if cant exercise do a chemical stress test

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13
Q

Most common cause of death in MI patients

A

Arrhythymia, Vfib

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14
Q

New systolic murmur (mitral regurgitation) 5-7 days s/p MI?

A

Papillary muscle rupture

Obtain echo and emergent surgery for replacement

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15
Q

Tx of Vfib

A

immediate unsynchronized defibrillation and CPR

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16
Q

Acute severe hypotension within 2 weeks s/p STEMI

A

Ventricular free wall rupture

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17
Q

Step up in 02 concentration form RA to RV status post MI

A

ventricular septal rupture

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18
Q

5-10 weeks s/p MI, mild fever, pleuritic CP, tired?

A

Dressler syndrome

Treat with NSAIDS

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19
Q

pt. comes in with chest pain worse with inspiration, better with leaning forward, friction rub and diffuse ST elevation and PR depression?

A

Pericarditis
1st NSAIDS
2nd Colchicine

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20
Q

Young patient complains of CP worse with palpation

A

Costocondritis

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21
Q

patient with chest pain at rest , worse at night, migraine headaches, w/transient ST elevation?

A

Variant Prinzmetal angina

DX with IV ergonovine or acetylcholine
TX CCB or nitrates

22
Q

Varying PR interval with 3 or more more morphologically distinct P waves in the same lead Old person with chronic lung disease in pending respiratory failure

A

Multifocal atrial tachycardia

Tx: improve O2 and ventilation strong association with lung disease
LV fxn preserved–> CCB, BB, amiodarone, digoxin
LV fxn not preserved–> digoxin, diltiazem, or amiodarone

23
Q

Progressive, prolongation of the PR interval followed by a dropped beat

A

Mobitz type 1

Benign requires no treatment

24
Q

Cannon-a waves on physical exam. “regular P-P interval and regular R-R interval

A

3rd degree heart block

TX: pacemaker

25
Q

Three or more consecutive beats w/ QRS <120ms (wide QRS) @ a rate of >120bpm.”

A

V tach

if sustained–> hemodynamically stable –> IV amidoarone, procainamide or sotalol

if sustained–> hemodynamically unstable –> DC cardioversion then IV amidarone

if EF is normal consider long term amiodarone
if EF is reduced consider ICD placement

26
Q

Short PR interval followed by QRS >120ms with a slurred initial deflection representing early ventricular activation via the bundle of Kent

A

WPW

TX: radiofrequency catheter ablation or procainamide quinidine

27
Q

Regular rhythm with a ventricular rate of 125-150 bpm and atrial rate of 250-300 bpm

A

Atrial flutter

Rate control with BB or CCB
similar to Afib

28
Q

Prolonged QT interval leading to undulating rotation of the QRS complex around the EKG baseline” In a
pt w/ low Mg and low K. Lithium or TCA OD

A

Torsades de pointes

29
Q

Regular rhythm w/ a rate btwn 150-220bpm.” Sudden onset of palpitations/dizziness
narrow QRS complexes

A

supra-ventricular tachycardia

Tx: Valsalva maneuver, carotid sinus massage, head immersion in cold water
Acute tx: IV adenosine, verapamil
if unstable and drugs dont work DC cardioversion
Recurrent sxs. –> ablation

30
Q

Renal failure patient/crush injury/burn victim w/ “peaked T-waves, widened QRS, short QT and prolonged PR.”

A

Peaked T wave, hyperkalemia

Tx: IV calcium (be cautious in pts. on digoxin can cause toxicity)
IV glucose and insulin
or hemodialysis

31
Q

Alternate beat variation in direction, amplitude and duration of the QRS complex” in a patient w/ pulsus paradoxus, hypotension, distant heart sounds, JVD

A

Cardiac tamponade= electrical alternans

Tx if not stable–> pericardiocentesis

32
Q

Undulating baseline, no pwaves appreciated, irregular R-R interval” in a hyperthyroid pt, old pt w/ SOB/dizziness/palpitations w/ CHF or valve dz

A

A fib
hemodynamically stable pt.–> rate control with beta-blockers
hemodynamically unstable–> immediate electrical cardioversion

33
Q

When to anticoagulate with warfarin for chronic a-fib pt.?

A

Afib in with nothing else and under 60 DONOT

but over 60 and or have CVD risk factors or heart disease DO

34
Q

Systolic Ejection murmur
crescendo decrescendo
louder with squatting, softer with valsalva
refers to a weak (parvus) and delayed (tardus) carotid upstroke

A

Aortic stenosis

35
Q

Systolic ejection murmur louder with valsalva, softer with squatting or handgrip

A

HOCM

36
Q

Late systolic murmur with click louder with valsalva and handgrip, softer with squatting

A

MVP

37
Q

Holosystolic murmur radiates to axilla with LAE

A

Mitra regurgitation

38
Q

Holosystolic murmur with late diastolic rumble

A

VSD

39
Q

Wide fixed and split S2

A

ASD

40
Q

Continuous machine like murmur

A

PDA

41
Q

Rumbling diastolic murmur with an opening snap, LAE

A

Mitral Stenosis

42
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade (collapsing pulse)

A

Aortic Regurgitation

43
Q

Pt comes in SOB with a murmur and hx of CHF

A

Echo

44
Q

What tx do you give acute pulmonary edema?

A

nitrates, lasix, morphine

45
Q

young patient with sxs of CHF with prior hx of viral infection?

A

Myocarditis (coxsackie B)

46
Q

systolic CHF causes

A

Ischemic cardiomyopathy HTN, DM, valvular disease

dilated (viral, etoh, cocaine, Chagas, idiopathic), hemochromatosis, thyroid

47
Q

diastolic CHF causes

A

HTN most common cuase
valvular disease AS, MS, AR
Restrictive cardiomyopathy (Amyloidosis, sarcoidosis, hemochromatosis)

48
Q

What type of dilated cardiomyopathy is reversible?

A

Alcoholic if you stop

49
Q

What type of restrictive cardiomyopathy is reversible?

A

Hemochromatosis with phlebotomy

50
Q

CHF treatment

A

Diuretics (Lasix, HCTZ) sxs control
ACE Inhibitors (reduce mortality)
B-Blockers (metoprolol, bisoprolol, carvedilol) reduce moraltity
Spironolactone improves survival in severe CHF
Digoxin for pts with EF<40 who are sxs. despite use of ACE, BB, Aldosterone antagonist, and Diuretic) –> for sxs relief

51
Q

Most common arrhythmia of digoxin toxicity?

A

Atrial tachycardia with AV block

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