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my NPLEX II > cardiology > Flashcards

cardiology Flashcards

1
Q

ECG in Supraventricular tachyarrythmia (SVT)

A

narrow QRS

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2
Q

Tx for SVT

A
  • vagal maneuvers (carotid massage) to block AV conduction

- adenosine to block AV conduction (6mg IV push)

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3
Q

untreated SVT can lead to

A

cardiomyopathy (also CHF, hypotension)

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4
Q

SVT pulse rate typically

A

between 100-300 bpm

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5
Q

ECG findings in Dilated Cardiomyopathy

A

Nonspecific ST-T wave changes

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6
Q

ECG in Hypertrophic Cardiomyopathy

A

abnormal and prominent Q waves, short P-R

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7
Q

Imaging (besides ECG) for cardiomyopathy

A
  • 2-D echo-cardiography

- Cardiac MRI (useful in Dx and assessing severity)

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8
Q

Heart sounds in Hypertrophic cardiomyopathy

A
  • Split S2, S4, harsh systolic ejection (crescendo-descrecendo) murmur - best heard along lower left sternal border or apex and best heart during valsalva
  • palpable double apical impuse (@ PMI)
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9
Q

ECG in restrictive cardiomyopathy

A
  • normal, or nonspecific ST-T wave changes

- low QRS voltage

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10
Q

Restrictive cardiomyopathy is caused mostly by

A
  • amyloidosis, sarcoidosis
  • myocardial fibrosis after open-heart surgery
  • radiation
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11
Q

pathophys of hypertrophic cardiomyopathy

A
  • autosomal dominant (chromosome 14)
  • hypertrophy of myocardium (with GREATER hypertrophy of Interventricular Septum than Left ventricular wall)
  • thus, L ventricle outflow may be obstructed
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12
Q

dilated cardiomyopathy is what

A

four chambered hypertrophy, unexplained dilation and impaired systolic function of one or both VENTRICLES

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13
Q

causes of dilated cardiomyopathy

A
  • alcoholism
  • genetic
  • myocarditis
  • drugs (chemo (doxorubicin), cocaine, heroin)
  • organic solvents (“glue sniffers”)
  • peripartum (last trimester or within 6 months postpartum)
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14
Q

Symptoms/signs of Endocarditis

A
  • fever (m/c), weakness, night sweats, weight loss, anorexia
  • SOB, chest pain, regurgitation murmurs
  • Vascular: SPLINTER hemorrhages in nail beds (linear, reddish brown lesion); JANEWAY’s lesions (painless, 5mm pustular, hemorrhagic lesions on PALMS/SOLES); petechiae
  • splenomegaly
  • microscopic hematuria, flank pain
  • immune complex vasculitis (Glomerulonephritis, ROTH’s spot (retinal hemorrhage), OSLER’s nodes (painful nodules on pads of fingers or toes)
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15
Q

what valve is most commonly effected in endocarditis

A

Mitral

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16
Q

what is the most common form of myocarditis

A

viral myocarditis (from parvovirus B19, coxsackie, HIV, polio, influenza, mumps)

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17
Q

What drugs can cause myocarditis

A

doxorubicin, catecholamines, cocaine

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18
Q

systemic diseases that can cause myocarditis

A

collaged vascular disease (SLE, RA), autoimmune, sarcoidosis

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19
Q

Signs of myocarditis

A
  • fever, chest pain, pericardial friction rub, heart failure, elevated JVP, PE, murmurs (usu mitral), sudden death
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20
Q

ECG in myocarditis

A

nonspecific ST-T changes

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21
Q

blood work/imaging in myocarditis

A
  • increased CK-MB and tropinins I and T
  • Antibodies of pathogens
  • LDH and AST (in acute)
  • check WBC, ESR, ANA, RF
  • echo shows dilated, hypokinetic chambers
  • CXR
  • Endomyocardial biopsy
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22
Q

Diagnosis of myocarditis

A

Endomyocardial biopsy (EMB) is the criterion standard for diagnosis

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23
Q

most common viral cause of Acute Pericarditis

A

Coxsackie B virus

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24
Q

Diagnostic triad of acute pericarditis

A
  1. chest pain
  2. friction rub
  3. ECG changes (diffuse ST elevation and PR depression)
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25
Q

Test of choice for detecting pericardial effusion and diagnosing tamponade in acute pericarditis

A

Echocardiography

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26
Q

ECG changes in Acute pericarditis

A
  • PR-segment depression (important, in 80% of cases)

- ST elevation initially

27
Q

major diagnostic Jones criteria for diagnosis of rheumatic fever

A

(requires presence of 2 major or 1 major and 2 minor criteria)
Major diagnostic criteria:
1. carditis
2. polyarthritis (swollen large joints)
3. chorea (rapid movts in face and arms, don’t occur until at least 3 months from onset of infection)
4. subcutaneous nodules (painless, firm collagen on bones/tendons- common at wrist, elbow, knees)
5. erythema marginatum (spares face, begins on trunk or arms, snake like appearance, worse with heat)

28
Q

minor diagnostic Jones criteria for diagnosis of rheumatic fever

A 
(requires presence of 2 major or 1 major and 2 minor criteria)
Minor criteria:
1. fever
2. arthralgia (no swelling)
3. increased ESR or CRP
4. leukocytosis
5. ECG with prolonged PR interval
29
Q

forward heart failure

A
  • inadequate cardiac output

- systemic edema (d/t kidneys not receiving blood and thus conserving salt and water)

30
Q

backwards heart failure

A
  • increased congestion of venous circ
  • results in overfilling of ventricles
  • systemic OR pulmonary edema
31
Q

Which valve is usually effect in L heart failure

32
Q

Which valve is usually effect in R heart failure

33
Q

Types of angina

A
  1. chronic/stable angina (CPain on exertion)
  2. prinzmetal/variant angina (occurs at rest; ST elevation)
  3. unstable angina (an acute coronary syndrome, at rest, increasing CPain)
34
Q

ECG during MI

A

MOST IMPORTANT TEST

  • perform within 10 mins of MI if possible
  • Q waves, ST-segment elevation, T-wave inversion
35
Q

cardiac markers of MI

A
  • CK-MB peak day 1 for 3 days
  • Troponins I and T peak day 1 or 2, stay elevated for up to 2 weeks
  • New CK-MB elevation can be used to diagnose re-infarction
36
Q

What is needed for diagnosis of AFIB

A 
ECG:
- no organized P waves
- irregular R-R intervals
- narrow WRS
blood work: TSH and cardiac markers
37
Q

ECG during PVC (premature ventricular contraction) aka VPB (ventricular premature beats)

A

ECG needed for Dx

  • QRS width > 120 msec, abnormal QRS, no preceding P wave
  • holter monitor
38
Q

3 consecutive VPBs (aka PVCs) create what

A

ventricular tachycardia

39
Q

heart block ECG changes

A

long PR interval that remains constant (>200 msecs), P-wave present

40
Q

Mobitz type 1 heart block ECG

A

QRS does NOT follow each P wave, PR progressively increases

41
Q

Mobitz type 2 heart block ECG

A

QRS does NOT follow each P wave, PR does NOT progressively increase, MULTIPLE irregular P WAVES

42
Q

3rd degree heart block ECG

A

no relationship between P waves and WRS, but consistent P waves

43
Q

ventricular fibrillation ECG

A

erratic, no identifiable waves

44
Q

ventricular tachycardia ECG

A

wide, regular WRS (>140msec), abnormal P-wave pattern

and HR > 100bpm

45
Q

most common arrythmia in cardiac arrest

A

ventricular fibrillation

46
Q

aortic stenosis murmur

A

crescendo decrescendo ejection murmur (heard at right 2nd interspace)

  • radiates to R clavicle, both carotids, musical sound at apex, S4, S3
  • murmur increases with positions that increase LV volume (valsalva, squat)
47
Q

what Tx to avoid in severe aortic stenosis

A

nitrates and ACE-I’s

48
Q

mitral stenosis murmur/ascultation

A
  • mid-distolic rumble (best heard in L lateral decubitus position after exertion)
  • loud opening SNAP - leaflets closing tightly (right after S2)
  • loud S1 and S2
  • palpable diastolic thrill at apex
49
Q

pulmonary stenosis murmur

A
  • midsystolic, crescendo-descrescendo murmur at 2nd L interostal space
    (accentuated by inspiration/valsalva)
  • R side S4
  • pulmonary ejection click
50
Q

what imaging is needed for Dx of pulmonary regurgitation, mitral regurgitation, pulmonary stenosis and tricuspid stenosis

51
Q

most common cause of mitral and tricuspid stenosis

A

rheumatic disease

52
Q

aortic regurgitation murmur

A

early decrescendo, diastolic murmur at Lower left or lower right sternal border
(accentuated by leaning forward/holding breath/squat)
- soft S1, absent S2, late S3

53
Q

pulmonary stenosis etiology is usually

A

congenital

54
Q

mitral regurgitation murmur

A

holosystolic at apex (radiates to axilla)

55
Q

pulmonary regurgitation murmur

A

decrescendo diastolic at Lower left sternal border (LLSB)

accentuated by inspiration and valsalva at 2nd and 3rd L intercostal space

56
Q

tricuspid regurgitation murmur

A

holosystolic at LLSB (accentuated by inspiration)

57
Q

mitral valve prolapse murmur

A

mid-systolic click followed by mid-late systolic murmur at apex
(accentuated by valsalva/squat)

58
Q

Mitral valve prolapse ECG

A

non specific ST-T wave changes

59
Q

orthostatic hypotension - amount systolic and diastolic drops

A

systolic drop of more than 20, diastolic more than 10

60
Q

hypertensive crisis systolic and diastolic

A

Systolic > 180, diastolic > 120 mmHg

61
Q

abnormal ankle-brachial indices is less than what

A

ABI < 0.90

62
Q

what imaging has 100% sensitivity in aortic aneurysm

A

abdominal US

63
Q

bloodwork/imaging in aortic aneurysm

A
  • bloodwork: CBC, electrolytes, urea, creatinine, PTT, INR

- CT, MRI, Abd US, doppler

64
Q

pulmonary embolism imaging

A
  • CXR,
  • pulmonary angiogram (gold standard but invasive, done rarely),
  • ventilation/perfusion scan (V/Q)

my NPLEX II (28 decks)

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