Cardiology Flashcards
[Diagnosis]
precipitated by exertion, cold, stress
lasting 2-10 minutes, tightness, squeezing, , heaviness,
retrosternal radiating to the neck, jaw, shoulders, arms, epigastric
Stable Angina
[Diagnosis]
Increasing patter or at rest
more than 30 mins
retrosternal radiating to the neck, jaw, shoulders, arms, epigastric
unstable anguna
[Diagnosis]
pleuritic, sharp, retrosternal pain toward the cardiac apex radiating to the left shoulder
relieved by sitting up or leaning forward
Pericarditis
[Diagnosis]
Sudden onset of unrelenting pain
tearing or ripping, knifelike
anterior chest radiating to the back between shoulder blades
loss of peripheral pulses, HPN
Acute Aortic Syndrome
[Diagnosis]
sudden onset pleuritic chest pain, lateral,
dyspnea, tachypnea, tachycardia, hypotension
Pulmonary Embolis,
[Diagnosis]
chest pain, characterized as pressure, substernally located
dyspnea, signs of increased venous pressure
Pulmonary hypertension
[Diagnosis]
sudden onset chest pain, pleuritic
dyspnea, decreased breath sound on one side
Spontaneous pneumothorax
[Diagnosis]
Burning chest pain lasting 10-60 mins, substernal epigastric,
worst by post prandial recumbency, relieved by antacids
GERD
[Diagnosis]
pressure/tightness/burning chest pain lasting 2-30mins, retrosterna
closely mimic angina
esophageal spasm
[Diagnosis]
burning chest pain, 60-90 mins after meals, prolonged, epigastric to substernal relieved with food or antacids
peptic ulcer
[Diagnosis]
aching, colicky, RUQ pain radiating to the back after a fatty meal
GB disease
Chest pain that decreases the likelihood of MI
- Pain that reaches it peak immediately
- Pleuritic
- Positional
- Tender of palpation
[Diagnosis]
53M hypertensive, heavy substernal chest pain on exertion, relieved by rest
radiating to the shoulder,
CSAP
Initial Test: ECG
Next: Stress test
First line: beta blocker and CCB
___ sign
heavy or squeezing, substernal or central
Levine Sign
[CCS Classification for angina]
Slight limitation, emotions, more than 2 blocks, more than 1 flight of stairs
CCS FC II
[CCS Classification for angina]
Marked limitation, 1-2 blocks, more than 1 flight of stairs
CCS FC III
In MI, ECG is needed to assess
- LV function
- Wall motion
- EF
- Thrombus
What drugs can be given for patients who cant exercise
- Dobutamine
- Adenosine
- Dipyridamole
What is the role of beta blockers in managing chronic angina
- Lowers HR, reducing myocardial demand, arterial pressure,
- Blocks catecholamine release
Nicorandil is a 2nd line drug for chronic angina. Its mechanism of action is due to
Dilating the vessels via ATP-sensitive K channels
____ is a drug used in MI that improves myocardial glucose utilization via inhibition of FA metabolism and increasing the availability of ATP
Trimetazidine
What are the indications for PCI?
- Persistent or symptom limiting angina pectoris despite medical management + evidence of ischemia during stress test
What are the indication for CABG
- 3 vessel CAD
2. 2 vessels involving the LAD and LCA
What are the indications for PCI?
- Persistent symptoms of angina despite medical management
2. Evidence of ischemia during stress test
What is the LDL goal in patients with CAD?
LDL <100
What is the LDL goal for patients with CAD and DM?
LDL <70
What accounts for the automaticity of the cardiac action?
SA and AV nodes
What determines the heart rate?
Slope of phase 4 in SA node
[Pacemaker Potential]
opening of hyperpolarization-activated channel permeable to Na and K
Phase 4
[Pacemaker Potential]
Rapid depolarization and overshoot; Ca-mediated action potential
Phase 0
[Pacemaker Potential]
Final repolarization, increase in K efflux
Phase 3
What is the major site of atherosclerotic disease?
Epicardial arteries
The main stimulus for vasomotion of epicardial arteries is?
Flow
Its role is for transport
The main stimulus for vasomotion of small arteries is?
Pressure
Its role is for regulation
The main stimulus for vasomotion of arterioles is
Metabolites
its role is for exchange
____% stenosis results in a limitation of the ability to increase flow to meet increased myocardial demand
50%
___% stenosis results in limitation of flow at rest
80%
[Pharma]
Irreversible cox1 inhibitor
Aspirin
[Pharma]
P2Y12 inhibitor decreasing platelet aggregation
Clopidogrel
[Pharma]
3-hydroxy-3-methytglutaryl CoA reductase inhibitor
Statins (HMG CoA reductase inhibitor)
SE: Rhabdomyolysis, myopathy, liver disease
[Pharma]
blocks RAAS; can cause hyperkalemia in solitary kidney
ACEI/ARB
[Pharma]
vasodilator of peripheral vessels + nodal inhibition
Verapamil/Diltiazem
[Pharma]
Reduction of peripheral vascular resistance
CCB
-dipines
[Pharma]
What drug is contraindicated in Hypertrophic Obstructive Cardiomyopathy
HOCM
[Pharma]
If channel inhibitor
Ivabradine
[Pharma]
Stimulates K+ adenosine triphosphate channel
Nicorandil
[Pharma]
Anti-ischemic metabolic modulator
Trimetazidine
What are the indications for CABG?
- Left main coronary artery disease
- 3 vessel disease + LVEF <50% or DM
- 2 vessel disease that includes proximal left descending coronary artery
[Diagnose]
52/M smoker HON, severe substernal chest pain radiating to the right arm, diaphoresis
chest pain persist despite sublingual nitrates; 130/90, 90 bpm
Dx: ACS
Initial: ECG
Used to distinguish unstable angina and NSTEMI: cardiac biomarkers
[Diagnose]
new-onset angina or worse in frequency, duration or intensity or at rest <30min
ECG: ST depression or TW inversion or flattening or normal ECG
Trop I: normal
Unstable angina
Tx: Medical + PCI before discharge
[Diagnose]
new-onset angina or worse in frequency, duration or intensity or at rest <30min
ECG: ST depression or TW inversion or flattening or normal ECG
Trop I: elevated
NSTEMI
Tx: Medical + PCI before discharge
[Diagnose]
Angina at rest >30 mins
ST Elevation
Every elevated troponins
STEMI
[Markers]
What cardiac biomarker will first rise in Acute MI?
Myoglobin
what cardiac biomarker is used to determine reinfarction?
CKMB
Dual antiplatelet therapy should last for at least ___ year
1 year
Nitrates cannot be given if the patient took vardenafil for ____ hours
24 hours
Patients cannot take nitrates is they took this PDE5 inhibitor in the past 48 hours
Tadalafil
What is the role of statins in anti ischemic therapy?
Plaque stabilization
[Diagnose]
chest pain heavy, squeezing, crushing, occuring at rest, more severe and lasts longer
sweating, nausea, anxiety, restlessness, sense of impending doom
ST elevation or LBBB or pathologic Q wave
STEMI
The most frequent location of chest pain is beneath ___
xiphoid and epigastrium
[Classification of MI]
spontaneous MI
Type 1
[Classification of MI]
MI secondary to ischemic imbalance
Type 2
[Classification of MI]
MI resulting in death when biomarker values are unavailable
Type 3
[Classification of MI]
MI related to PCI
Type 4a
[Classification of MI]
MI related to Stent thrombosis
Type 4b
[Classification of MI]
MI related to CABG
Type 5
What is the recommended door-to-balloon time to conduct PCI?
within 90 minutes
If you are unable to do PCI in a patient with STEMI within 90 minutes, what is your next step?
administer fibrinolytic therapy within 30 mins of presentation
then transfer for angiography
What are the absolute contraindications in to fibrinolytic therapy?
- Hemorrhage of the brain
- Other CVD within past year
- Marked hypertension (>180/>110)
- Bleeding internally (exclude menses)
- Aortic dissection is suspected
HOMBA
What are the relative contraindications for fibrinolytic therapy?
- INR >/ 2
- <2 weeks surgery
- > 10 mins CPR
- Bleeding diathesis
- Pregnancy
- Hemorrhagic ophthalmic condition
- Active peptic ulcer disease
- Severe HPN that is controlled
- Streptokinase <50 days to 2 years
What is the most common cause of out-of-hospital death from STEMI?
VFib
What is the most common cause of in-hospital death from STEMI?
Pump failure
[Diagnosis]
29M with PTB, sharp chest pain aggravated by lying relieved by sitting, high pitched rasping sound on cardiac auscultation.
ECG: ST segment elevation with PR-segment depression
Dx: Acute pericarditis
Tx: anti-inflammatory with aspirin
Avoid anticoagulants since it can cause tamponade
What is the pathognomonic character of pericarditis?
pericardial friction rub
What are the SSx of pericarditis?
- Chest pain
- Rub, pericardial
- Effusion
4 ST Elevation - Tamponade
Aside from the diffuse ST segment elevation seen in V2 to V6, what other ECG finding is suggestive of acute pericarditis?
PR-segment depression
What are the ECG changes in acute pericarditis
Stage 1 - widespread elevation of ST segment
Stage 2 - ST segment normal
Stage 3 - T wave inversion
Stage 4 - ECG normal
What antirheumatic drugs can be given to patients with pericarditis?
- Colchicine
- Prednisone
Given 3 months
Colchicine is CI in hepatic and renal dysfunction
[Heart murmur]
Next step for:
Diastolic or continuous murmur
Echocardiography
[Heart murmur]
Next step for:
Grade I + II, midsystolic, asymptomatic murmur
Normal ECG, Normal CXR
No further workup
[Heart murmur]
Next step for:
Grade III murmur
or holosystolic or late systolic
Echocardiography
[Grading or murmur]
Murmur + thrill
Grade IV
[Grading or murmur]
Murmur heard with stethoscope lightly pressed on skin
Grade V
[Grading or murmur]
Murmur heard with stethoscope slightly above the chest
Grade VI
[ECG Changes: Wall involved]
I, aVL, V1-V6
Large anterior wall
Proximal LAD
[ECG Changes: Wall involved]
II, III, aVF
Inferior wall
Distal LAD
[ECG Changes: Wall involved]
V1 to V3
Anteroseptal wall
Distal LAD
[ECG Changes: Wall involved]
V2 to V4
Anteroapical
Distal LAD
[ECG Changes: Wall involved]
V4 to V6
Posterolateral
CircumPlex
[Auscultation]
Atrial septal defect is best heard at ____
pulmonic area
[Auscultation]
Ventricular septal defect is best seen at
tricuspid area
[Murmurs]
Crescendo, midsystolic murmur
Aortic stenosis
[Murmurs]
early diastolic murmur
Aortic regurgitation
[Murmurs]
holosystolic
Mitral regurgitation
Tricuspid regurgitation
[Murmurs]
diastolic murmur after the opening snal
MS
In patients with HOCM, what is the effect of squatting or leg raising to the murmur?
Decreases murmur
Same with MVP
In patients with VSD, what is the effect of squatting or leg raising to the murmur?
increases murmur
same with AS, AR, MS, MR
What is the effect of standing or valsalva in the murmur of HOCM?
Increases
same with MVP
What is the effect of standing or valsalva to the murmur of mitral regurgitation?
decreases murmur
Same with AS, AR, MS, VSD
[Diagnose]
70/M chest pain, exertional syncope 3/6 mid-systolic murmur at 2nd ICS, weak and narrow pulse
Dx: AS
Initial test: Transthoracic echocardiogram
___ effect
murmur transmitted downward confusing with MR
Gallavardin effect
[Diagnosis]
Paradoxical splitting of S2, pulsus parvus et tardus. narrow pulse pressure
AS
What is the echocardiographic finding in AS?
- reduced systolic opening of the valve leaflet with thickening
- LV hypertrophy
What is the role of statins in Aortic stenosis?
Slow down leaflet calcification
[Diagnosis]
62M, HPN
Diastolic murmur, high pitched, blowing, on the left sternal border, wide pulse pressure
murmur heard over femoral artery
Dx: AR
Initial tes: transthoraci echocardiogram
Drug that should not be given in acute condition: beta blocker
____ sign murmur heard over the femoral artery. Can be suggestive of AR.
Duroziez sign
What is the associated murmur in syphilis?
AR
What is the associated murmur in patients with ankylosing spondylitis?
AR
____ murmur heard in severe AR; early diastolic rumbling murmur
austin flint
AT
____ sign
bobbing motion of the head
De musset sign
AR
___ sign
bounding and forceful pulse, rapidly increasing and subsequently collapsing
Water-Hammer sign or Corrigan’s pulse
AR
___ sign
pulsation at the root of the nail
Quicke pulse
AR
___ sign
booming pistol shoot sound over the femoral arteries
Traube sign
___ sign
pulsating popliteal artery
Lincoln sign
What is the treatment of choice for AR with an EF <55%
Surgery within 24 hours
Also if the Left ventricular end systolic diameter goes above 55mm
[Diagnosis]
30M with RHD
opening snap, low-pitched, tumbling, diastolic murmur at the apex
Dx: mitral stenosis
Treatment of choice: percutaneous transmitral commisurotomy
What is the earliest CXR finding of mitral stenosis
straightening of the upper left border of the cardiac silhouette
What is the cut-off value to say that there is critical valve narrowing in mitral stenosis?
Valve surface area <1cm2
The opening snap right after S2 in patients with mitral stenosis is best heard upon?
Upon expiration
the opening snap is due to high LA pressure
What is the hemodynamic hallmark of mitral regurgitation?
elevated left atrioventricular pressure gradient
___ sign
high functional tricuspid murmur
carvallo sign
Aside from SOB and heart failure, patients with MS also present with ___
- Dysphagia
- Hoarseness
- AFib and stroke
What are the DOC for patients with MS?
- Beta blockers, digoxin, NDHP CCB to slow down HR
2. Warfarin if with AF (INR 2-3
What is the best initial therapy for MS?
Diuretics
What is the most effective treatment for MS?
Percutaneous mitral balloon valvotomy or valvuloplasty
[Heart Failure]
What is the EF for HFrEF?
<40%
due to decreased pumping ability
[Heart Failure]
What is the EF for HFpEF
> 40-50%
due to decreased ventricular compliance/relaxation
___ respiration signifies advanced HF
Cheyne-stokes
[Right/Left CHF]
bibasal rales
pleural effusions
pulmonary edema
orthopnea, PND
Dyspnea
LSHF
[Right/Left CHF]
Fluid retention
Hepatojugular reflux, peripheral edema
hepatomegaly
ascites
RSHF
[HFrEF vs HFpEF]
displaced PMI, S3 gallop
Q waves, decreased EF
HFrEF
[HFrEF vs HFpEF]
sustained PMI, S4 gallop
LVH, normal preserved
EF (>55%) abnormal LV diastolic indices
HFpEF
[NYHA]
Symptoms with ordinary activity
2 flights of stairs
Stage II
[NYHA]
marked limitation in less than ordinary activity
<1 flight of stairs
Stage III
[Stage of heart failure]
Structural heart disease with no symptoms
Stage B
[Stage of heart failure]
Structural heart disease with prior or current symptoms
Stage C
[Stage of heart failure]
Refractory HF; occurs at rest
Stage D
Drug class with mortality benefit in HF
- ACEi in HFrEF
2. Beta blockers - Carvedilol, Bisoprolol, Metoprolol succinate
[Pharma for HF]
angiotensin receptor-neprilysin inhibitor
Sacubitril/Valsartan
[Diagnosis]
Dyspnea, orthopnea, cyanosis, elevated JVP, Hepatomegaly
ECG: tall p-waves, RAD, RVH
CXR: enlarged pulmonary artery
Echo: RA/RV enlargement
Cor pulmonale
What is the best initial test for cases of cardiomyopathy?
Echocardiography
What is the best initial therapy for HOCM?
beta blockers
[Types of cardiomyopathy]
Impaired systolic function
EF <30%
Dilated LV wall
Dilated CM
[Types of cardiomyopathy]
Impaired ventricular filling
EF 25 to 50%
normal to decreased LV wall dimension
+ RH failure
Restrictive CM
[Types of cardiomyopathy]
Septum hypertrophy
EF >60%
Decreased LV wall dimension, LV is thick
+ angina, syncope
Hypertrophic CM
What is the leading cause of sudden death in young healthy athletes
hypertrophic CMP
[Diagnosis]
septal hypertrophy + systolic anterior motion of the mitral valve
HOCM
[Diagnosis]
chest pain, progressive dyspnea, distended jugular veins, muffled heart sounds, pulsus paradoxus, bp 70/50
Dx: Cardiac tamponade
How will you say that it is a paradoxical pulse?
> 10mmHg inspiratory decline in systolic arterial pressure
Pathognomonic CXR for cardiac tamponade?
Water bottle sign
ECG finding in cardiac tamponade?
electrical alternans
[Diagnosis]
65/M smoker, pain on both calves after walking a few blocks, resolves with rest.
femoral and dorsalis pedis are diminished bilaterally, cool to touch, shiny
Dx: PAD
Initial test: ABI
Pain + pallor + pulselessness = arterial occlusion
What is the ABI cut off value in duplex UTZ to say its PAD?
<0.9
Severe ischemia - <0.5
What is the most accurate test to diagnose PAD?
Arteriography
What is the first line drug for symptom improvement in PAD?
Cilostazol
Second line - pentoxifylline
[Diagnosis]
50F, leg swelling and sudden onset dyspnea with pain on inspiration. previous surgery < 2 weeks,
110/70 110 bpm RR 30
Dx: Pulmonary Embolism
Most appropriate test: chest CT with contrast
Virchow’s triad is composed of ___
- Endothelial Injury
- Venous stasis
- Hypercoacuable state
What are the variables in Well’s score for PE?
- DVT SSx
- Alternative dx less likely PE
- HR > 100
- Immobilization 3 days, surgeru withint 4 weeks
- Prior PE or DVT
- Hemoptysis
- Cancer
What are the variables in Well’s score for DVT?
- Active CA
- Paralysis
- Bedridden > 3 days; major surgery <12 weeks
- Tenderness along deep veins
- Entire leg swelling
- Unilateral calf swelling >3cm
What is the rule out test in PE?
D-dimer
[CXR Finding in PE]
Focal oliemia
Westermark sign
[CXR Finding in PE]
enlarged RDPA
Palla sign
[CXR Finding in PE]
wedge-shape opacity at lung periphery
Hampton hump
What are the ECG findings in PE?
- Sinus tachycardia
- S1Q3T3
- T wave inversion in V1 to V4
McConnell sign in 2DE for PE means there is
Hypokinesis of the RV free wall
[Pharma: Dyslipidemia]
Cholesterol absorption inhibitor
Ezetimibe
[Pharma: Dyslipidemia]
Bile acid sequesteran
Cholestyramine
[Pharma: Dyslipidemia]
upregulates lipoprotein lipase to increase breakdown of VLDL and chylomicrons
Fibrates (gemfibrozil, fenofibrate)
[Pharma: Dyslipidemia]
CPK levels must be checked in patients taking this drug combination due to rhabdomyolysis as most common adverse effect
Rhabdomyolysis
Statin + fibric acid derivative (Gemfibrozil)
What are the 4 statin benefit groups
- Clinical ASCVD
- LDL-C > 190mg/dL without secondary cause
- Primary prevention with DM
- Primary prevention without DM by ASCVD risk >/ 7.5%
[Pharma: Dyslipidemia]
PCSK9-inhibitor
Evolocumab
[Pharma: Dyslipidemia]
CETP-inhibitor
Torcetrapib
[Pharma: Dyslipidemia]
first line treatment for severe hypertriglyceridemia
Fibrates
[Pharma: Dyslipidemia]
What is the contraindication for cholestyramine
TG > 500
[Hypertension]
What medications should be avoided in patients with gout?
Thiazide diuretics
[Hypertension]
What is the most common cause of secondary hypertension
primary renal disease
[Hypertension]
In BP measurement, the length and width of the cuff should be _____ of the arms circumference
80%, 40%
released at a rate of 2-3mmHg
inflate to 30mmHg above expected SBP
[Pharma: Hypertension]
Can cause sexual impotence, diabetes, gout, hyperuricemia
Thiazide diuretics
can cause hypokalemia
[Pharma: Hypertension]
Can cause hypokalemia, hypocalcemia, hypomagnesemia, metalbolic alkalosis
Loop diuretics
[Pharma: Hypertension]
can cause gynecomastia
Spironolactone
[Pharma: Hypertension]
contraindicated in sick sinus syndrome
beta blocers
[Pharma: Hypertension]
beta blocker with NO potentiating effect
Nebivolol
[Pharma: Hypertension]
can cause sedation, xerostomia, CNS side effects
rebound HPN on withdrawal
Clonidine
Methydopa
Reserpine
[Diagnosis]
Hematuria, urinary symptoms, elevated crea, cast on UA,
abdominal mass
Renal parenchymal disease
[Diagnose]
Abrupt onset hypertension or worsening or difficult to control
flash pulmonary edema, early onset HPN
abdominal bruits
renovascular disease
[Diagnose]
hypertension with spontaneous hypokalemia; adrenal mass
primary hyperaldosteronism
[Diagnose]
Resistant HPN, snoring, apnea, day-time sleepiness, obesity
OSA
[Hypertension]
SBP > 180
DBP >120
No TOD
Hypertensive Urgency
[Hypertension]
SBP >180
DBP >120
With TOD
Hypertensive emergency
Admit to ICU
What is the target SBP for patients with Hypertensive emergency + aortic dissection?
<120
What is the target SBP for patients with hypertensive emergency + compelling condition
<140
What is the target DBP for patients without compelling condition
- Not more than 25% in the 1st hour, then if stable
- 160/100 mmHg in the next 2 to 6 hours
- Then to normal following 24 to 48 hours
What is the most common sustained arrythmia
AF
What is the ECG finding in AF?
- Absence of discrete P wave
2. Irregularly irregular ventricular contraction
What are the components of the CHA2DS2-VASc risk score?
CHF - 1 HPN - 1 Age >/75 -2 DM - 1 Stroke or TIA - 2 Vascular disease - 1 Age 65 to 75 - 1 Sex - Female -1
What is the estimated annual stroke score in CHA2DS2VASc 2?
2.2%
What is the estimated annual stroke score in CHA2DS2VASc 4?
4.0%
What is the estimated annual stroke score in CHA2DS2VASc 4?
3.2%
What is the DOC for pharmacologic cardioversion in patients with AF and with structural heart disease?
Amiodarone
What is the DOC for pharmacologic cardioversion in patients with AF without structural heart disease?
- Flecainide
- Ibutilide
- Propafenone
When will you do an electrical cardioversion in patients with AF?
Recent onset AF (<48 hours)
What is the antidote of Dabigatran?
Idarucizumab
What is the most important step in the diagnosis of endocarditis?
Serial blood cultures
What are the components of Duke’s Criteria?
- Fever
- Roth Spot
- Osler node
- Murmur
- Janeway lesions
- Anemia
- Nail-bed hemorrhage
- Emboli
Based on Duke’s criteria, how will you say that the patient has endocarditis?
- 2 major
- 1 major + 3 minor
- 5 minor
What are the major criteria in Duke’s?
- Sustained bacteremia
- Endocardial involvement
- New valvular regurgitation
What are the minor criteria in Duke’s?
- Abnormal valve/risk of bacteremia
- fever
- Vascular phenomena
- Immune phenomena
- Positive blood culture not meeting the major criteria
- Positive echocardiogram
What is the best empiric therapy for endocarditis?
vancomycin and gentamicin
Serial blood cultures to diagnose endocarditis should be taken ___
- 3 two bottle blood set
- Separated by at least 2 hours
- Different sites
[Most commons]
myocardial perfusion occurs during this time
Diastole
[Most commons]
anterior chest MSK pain
costochondral and chondrosternal syndrome
[Most commons]
presenting complaint of aortic dissection
Sudden onset of severe sharp pain
[Most commons]
preventable cause of death among hospitalized patients
PE
[Most commons]
most severe form of postphlebitic syndrome
Skin ulceration
[Most commons]
autosomal dominant genetic mutations for prothrombotic states
- Factor V Leiden
2. Prothrombin gene mutation
[Most commons]
acquired cause of thrombophilia and associated with venous/arterial thrombosis
APAS
[Most commons]
gas exchange abnormality in PE
arterial hypoxemia and increased A-a gradient
[Most commons]
usual cause of death from PE
Progressive right heart failure
[Most commons]
symptom of DVT
charley horse or cramp
[Most commons]
most common symptom for PE
Unexplained breathlessness
sudden, severe calf discomfort suggests
Ruptured Bakers cyst
[Most commons]
frequent symptom of PE
dyspnea
[Most commons]
sign of PE
tachypnea
leg pain, fever, chills
Cellulitis
Tachycardia, low grade fever, neck vein distention
PE
Dyspnea, syncope, hypotension
massive PE
[Most commons]
frequently cited ECG abnormality in PE
S1Q3T3 sign
[Most commons]
abnormality in PE on ECG
T wave inversion in leads V1 to V4
principal imaging test for the diagnosis of PE
CT with IV contrast
second-line diagnostic test for PE
lung scanning
Best known indirect sign of PE
mcConnell sign
Definitive diagnosis of PE
Pulmonary angiography
Foundation for successful treatment of DVT and PE
anticoagulatin
Major advantage of UFH
short half life
Warfarin embryopathy most common exposure during ___ AOG
6th to 12th week AOG
Two principal indications for IVC filters
- Active bleeding that precludes anticoagulation
2. Recurrent venous thrombosis despote anticoagulation
Two determinants of arterial pressure
- Cardiac output
2. Peripheral resistance
Strongest risk factor for stroke
elevated BP
Indicative of primary renal disease
Proteinuria > 1000 mg/day
active urine sediment
Gold standard for evaluation and identification of renal artery lesions
Contrast arteriography
most common congenital cardiovascular cause of hypertension
CoA
what is the definition of resistant hypertension?
BP >140/90 despite more than 3 antihypertensive agents
Prototypic lesions in IE
vegetation
IE in drug users usually affect ____ valve
tricuspid valve
Optimal method for diagnosis of prosthetic valve endocarditis, valve perforation or fistula
transesophageal echocardiography
Test of choice to detect perivalvular abscess
TEE with color doppler
Most common valve affected in perivalvular infection
aortic valve infection
most common tumor of the pericardium
malignant neoplasm from the mediastinum
Most common primary malignant pericardial tumor
mesothelioma
most common primary cardiac tumor in age groups
myxoma
most common clinical presentation of myxoma
mimic MV disease
most common cardiac tumors in infants and children?
rhabdomyoma and fibroma
Most often involved in metastasis to the heart
pericardium > myocardium> endocardium or valves