Cardiology Flashcards
Young woman with history of migraines, chest pain, St segment elevation. Dx?
Coronary vasospasm
Young person with chest pain following a party. Dx?
Cocaine
Tall, thin person with long arms with acute chest and back pain., normal EKG, aortic diastolic murmur. Dx?
Marfan syndrome and aortic dissection
Person who recently traveled or with immobility, Sharp, Pleuritic Chest Pain, Nondiagnostic EKG. Dx?
PE
Tall., thin young man who smokes with sudden pleuritic, chest pain and dyspnea. Dx?
Spontaneous pneumothorax
Post menopausal women with substernal chest pain following severe emotional stress with St elevation, an unremarkable coronary angiography. Dx?
Stress induced cardiomyopathy. Look for characteristic apical ballooning on ventriculogram
Young man with substernal chest pain, deep T wave inversions and a harsh systolic murmur that increases with Valsalva. Dx?
Hypertrophic cardiomyopathy
Abrupt pulmonary edema or hypotension and a loud holosystolic murmur and thrill s/p mi. Dx?
VSD Or papillary muscle rupture
Sudden hypotension or cardiac death associated with pulseless electrical activity. S/p mi Dx?
LV Free wall rupture
Coronary vasospasm Dx and tx?
Echocardiography, long acting nitrate, calcium channel blocker
Marfan syndrome and aortic dissection. Dx and tx?
MRA, CTA, TEE, immediate surgery for type a dissection
PE Dx and tx?
CTA, heparin
Spontaneous pneumothorax Dx?
CXR
Stress induced cardiomyopathy. Look for characteristic apical ballooning on ventriculogram Tx?
Beta blocker, Ace inhibitor
Hypertrophic cardiomyopathy dx and tx?
Echocardiography, beta blocker
Strong family history of premature heart disease + patient has a low HDL. What level is likely to be elevated?
Lipoprotein a or Lp(a)
Aortic aneurysm, abdominal associated w/what dz?
Atherosclerosis
Aortic aneurysm, ascending or arch associated w/what dz?
3º syphilis (syphilitic aortitis), vasa vasorum destruction
Aortic aneurysm, thoracic associated w/what dz?
Marfan syndrome (idiopathic cystic medial degeneration)
S3 heart sound
↑ ventricular filling pressure (eg, mitral regurgitation, HF), common in dilated ventricles
S4 heart sound
Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)
Rapid fire txt: Arrhythmia in damaged cardiac tissue
Class IB antiarrhythmic (lidocaine, mexiletine)
Cardiac manifestation of lupus?
Marantic/thrombotic endocarditis (non-bacterial)
Constrictive pericarditis MCC?
TB (developing world); idiopathic, viral illness (developed world)
Cardiac tumor (adults)? “Tumor plop” on auscultation
Metastasis, myxoma (90% in left atrium; “ball and valve”)
Rapid fire assoc: Electrical alternans (alternating amplitude on EKG)
Pericardial tamponade
Rapid fire assoc: “Delta wave” on EKG, short PR interval, supraventricular tachycardia
Wolff-Parkinson-White syndrome (Bundle of Kent bypasses AV node)
What cardiac condition has a loud holosystolic murmur w/ palpable thrill along left sternal border over 3rd or 4th intercostal space?
Ventricular septal defect(VSD)
What condition does a patient likely have if on physical exam you hear a loud systolic ejection murmur at the right 2nd intercostal space?
Aortic stenosis
What degree of stenosis is an indication for carotid endarterectomy in female patients?
70-99% stenosis
What degree of stenosis is an indication for carotid endarterectomy in male patients who are symptomatic? And asymptomatic?
50-99% in symptomatic. 60-99% in asymptomatic
Rapid fire assoc: Cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
Rapid fire assoc:Rib notching (inferior surface, on x-ray)
Coarctation of the aorta
Rapid fire assoc: “Boot-shaped” heart on x-ray
Tetralogy of Fallot (due to RVH)
What is the best management in an individual who has overdosed on TCAs and has widened QRS on EKG?
Bicarbonate
What is the best next step in a patient with aspirin allergy who will be undergoing elective coronary angioplasty?
Aspirin desensitization. Pts undergoing elective angioplasty should be pre-treated with aspirin and clopidogrel.
Systolic ejection murmur (crescendo-decrescendo)
Aortic stenosis
Muffled heart sounds, distended neck veins, hypotension
Beck triad of cardiac tamponade
What is the ideal LDL goal in CAD patients or CAD equvialent patients?
Less than 70 mg/dl
What is the leading cause of sudden cardiac death in young athletes?
Hypertrophic cardiomyopathy
Chest pain, pericardial effusion/friction rub, persistent fever following MI Dx?
Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)
Chest pain with ST depression on EKG
Unstable angina (- troponins) or NSTEMI (+ troponins)
Which two murmurs decrease in intensity with leg raising and squatting?
Hypertrophic obstructive cardiomyopathy (HOCM) and Mitral valve prolapse (MVP)
Which type of beta blockers are okay to give to patients with hypertension and asthma? BAMN
Cardioselective beta blockers (metoprolol, atenolol, bisoprolol, nebivolol)
Which congestive heart failure medication is used for symptomatic relief but does not decrease mortality?
Furosemide (Lasix)
What two conditions are associated with bisferiens (biphasic pulse) pulse in the carotids?
Aortic regurgitation and hypertrophic cardiomyopathy
What is the valvular abnormality that can result from dissection of the ascending aorta?
Aortic regurgitation
What is the valvular condition most commonly associated with pulsus tardus in the carotids?
Aortic stenosis
What is the treatment of choice for unstable pt with wide complex tachycardia?
Immediate synchronized cardioversion
Within what age range does USPSTF recommend one-time screening for AAA in men with a smoking history?
65 to 75 years
Achilles tendon xanthoma Dx?
Familial hypercholesterolemia (decreased LDL receptor signaling)
Bounding pulses, widening pulse pressure, diastolic heart murmur, head bobbing
Aortic regurgitation
What is the classic echo finding in hypertrophic cardiomyopathy?
Systolic anterior motion of mitral valve.
What drug class is contraindicated in multifocal atrial tachycardia MAT?
Beta blockers
What is the most common mutation seen in patients with HOCM?
Beta myosin heavy chain mutation
How is sudden death prevented in patients with HOCM?
ICD implantation
Calcifications of pericardium on chest imaging
Dx?
Constrictive pericarditis
You must treat asymptomatic LV systolic dysfunction with ejection fraction less than 40% with what two medications?
Ace Inhibitors and beta blockers
What drug toxicity causes patients to present with GI disturbances, neurologic dysfunction, vision changes, electrolyte imbalances & cardiac arrhythmia?
Digoxin
What is the earliest and most sensitive sign of cardiac tamponade?
Right atrial collapse
What is mcconnell sign and what is it suggestive of?
Right ventricular dilation and free wall hypokinesia with sparing of the Apex. Acute pulmonary embolism
Murmur?
Systolic murmur best heard at right upper sternal border
Aortic stenosis
murmur? Diastolic murmur best heard at L upper sternly border
aortic regurg
Murmur? Opening snap followed by low pitched diastolic murmur at apex best heard in L lat decubitus
mitral stenosis
pansystolic murmur w/palpable thrill
VSD
Fixed,,split second heart sound
ASD
dx? RV heave, wide, fixed splitting of 2nd sound, midsystolic pulm flow or ejection murmur, R axis Deviation and incomplete R bundle branch block
ASD
What are the EKG findings of ASD?
R axis Deviation and incomplete R bundle branch block
What are the 3 components of Beck’s triad? What diagnosis is this classic of?
Hypotension, Distended neck vv, muffled heart sounds. Cardiac Tamponade
What medication needs to be added to DAPT in pts >65, w/hx of UGI bleed, PUD, active h pylori?
PPI
What drug is absolutely contraindicated in atrial fibrillation?
Digoxin
