CARDIOLOGY Flashcards
What is the first line of treatment to reduce angina?
Beta blocker and/or CCB
Chest pain that reaches its peak intensity immediately
- Aortic dissection (look for tall, male w/ hyperextensible joints)
- Pulmonary embolism
- Pneumothorax
MOST frequently CITED Abnormality in PE (in addition to sinus tachycardia)
S1 Q3 T3 Sign AKA McGinn-White Sign
(SPECIFIC, but insensitive)
A large S wave in lead I, a Q wave in lead III and an inverted T wave in lead III together indicate acute right heart strain.
_____ is always the best initial diagnostic test for ischemic-type pain.
ECG
What is the initial test of choice in herat failure?
Echocardiogram
Echocardiography is unquestionably the most important of all tests for heart failure. There is no reliable way to distinguish preserved from reduced ejection fraction. Every patient with heart failure must undergo echocardiography to evaluate EF.
A 30-year-old woman with history of rheumatic fever presents to the emergency room with dyspnea and palpitation. On auscultation, there is an opening snap followed by a low-pitched, tumbling, diastolic murmur at the apex.
Mitral Stenosis
_______ is a selective sinus node inhibitor (If pacemaker current).
Ivabradine
classic findings for Hypertrophic Cardiomyopathy
Septal hypertrophy and systolic anterior motion of the mitral valve
Hallmarks of massive PE
- Dyspnea
- Syncope
- Hypotension
FOUNDATION for successful Treatment of DVT and PE
Anticoagulation
What is the best initial test for AS?
Transthoracic echocardiogram
Almost all PRIMARY cardiac malignancies are
Sarcomas, commonly in right side (but tumors metastatic to heart are more common)
What diagnostic test is used to distinguish unstable angina and NSTEMI?
Cardiac biomarkers
Capillary pulsation at the root of the nail (Quincke’s pulse)
AR
which lipid lowering agent was most likely recently started in a patient who complains of podagra
niacin
Booming “pistol shot” sound over femoral arteries (Traube sign)
AR
Critical narrowing of MS is defined as valve surface area of ___
< 1cm2
MOST common type of PRIMARY cardiac tumor in all age groups, MOST commonly in the 3rd–6th decade, with female predilection
Myxoma (mostly sporadic)
Chest pain, ST depression or normal ECG, normal biomarkers. Diagnosis?
Unstable Angina
_____, an increase in JVP on inhalation, is seen in restrictive cardiomyopathy, constrictive pericarditis, restrictive cardiomyopathy, tricuspid stenosis and RV infarction.
Kussmaul Sign
FUNCTIONAL CLASSIFICATION OF ANGINA
Inability to carry on any physical activity without discomfort
i.e Angina at rest
Class IV
Opening snap is observed in ___
MS
The opening snap (OS) right after S2 is due to high LA pressure and readily audible in expiration.
MOST common cause of DEATH in hypertensive patients
Cardiac
Sildenafil when taken with ______ can result in
large and prolonged decrease in systemic blood pressure and coronary blood flow in vessels with critical stenosis.
Nitrates
Chest pain, ST elevation on ECG, very elevated biomarkers
STEMI
CLASSIFICATION OF MYOCARDIAL INFARCTION
Myocardial infarction secondary to an ischemic imbalance
• Coronary artery spasm, arrhythmias, anemia, respiratory failure, hypotension and hypertension with or without left ventricular hypertrophy
Type 2
This is seen in what condition.
Infective Endocarditis
Roth Spot - white-centered retinal hemorrhages
Osler’s Node - PAINFUL, red papules on the hands and feet
Janeway Lesions - NON-TENDER erythematous macules on palms and soles
BEST known INDIRECT sign of PE on transthoracic
echo
McConnell’s Sign:
hypokinesis of the RV Free Wall with NORMAL motion of the RV Apex
Dihydropyridine calcium channel blocker
(Vascular > Cardiac)
Amlodipine
Nifedipine
Felodipine
Diagnosis of IE is established with certainty
Histologically and microbiologically
What is the best initial therapy for all cases of ACS?
Aspirin
Leg pain + Fever + chills usually indicates
Cellulitis (not DVT)
Chest pain, ST depression or normal ECG, elevated biomarkers. Diagnosis?
NSTEMI
MOST common congenital cardiovascular cause
of hypertension
Coarctation of the Aorta
A 70-year-old man presents with chest pain on exertion and shortness of breath for the past 2 months. His wife recalls that her husband had an episode of syncope a month ago. On examination, there is a 3/6 mid-systolic murmur at the second intercostal space at the right sternal border is auscultated and patient had a weak and delayed pulse.
Aortic Stenosis
MOST common clinical presentation of myxomas
Mimics mitral valve disease
MAJOR indication for Surgery in IE
Moderate to severe CHF due to valve dysfunction
Identify the associated murmur:
- crescendo, midsystolic murmur
- early diastolic murmur
- holosystolic
- diastolic murmur after the opening snap
- AS
- AR
- MR/TR
- MS
STAGES OF HEART FAILURE
Structural heart disease with prior or current symptoms
i.e Patients with abnormal cardiac structure with exertion dyspnea, fatigue, etc.
Stage C
Murmur heard over the femoral artery is known as ______
Duroziez sign.
MOST common acquired cause of thrombophilia
and associated with venous / arterial thrombosis
Antiphospholipid-antibody syndrome
FUNCTIONAL CLASSIFICATION OF ANGINA
Ordinary physical activity, (walking and climbing stairs), does not cause angina
i.e. Angina with strenuous or rapid or prolonged exertion at work or recreation.
Class I
What is the most important step in the diagnosis of endocarditis?
Serial blood cultures are the most important step in the diagnosis of endocarditis
The ONLY FDA-approved indication for PE fibrinolysis
Massive PE
What risk factors are associated with increased incidence of Infective endocarditis?
Structural heart disease (RHD, VHD), IV drug use, Prosthetic heart valves
In its MOST SEVERE form, Postphlebitic Syndrome
causes
Skin ulceration (especially in medial malleolus of leg)
Narrowed pulse pressure
AS
STRONGEST risk factor for stroke
Elevated BP
FUNCTIONAL CLASSIFICATION OF ANGINA
Marked limitation of ordinary physical activity.
i.e. Walking one to two blocks on the level and climbing more than one flight of stairs in normal conditions.
Class III
The best empiric therapy for infective endocarditis.
Vancomycin and Gentamicin
This will cover the most common organisms, which are S. aureus, MRSA, and viridans Streptococci.
MCC of Systolic HF or HF with reduced EF (HFrEF)
CAD
FUNCTIONAL CLASSIFICATION OF ANGINA
Slight limitation of ordinary activity
i.e. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, or when under emotional stress or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of stairs at a normal pace and in normal conditions.
Class II
Non-dihydropyridine calcium channel blockers
(Cardiac > Vascular)
Verapamil
Diltiazem
If a patient with acute MI presents with new murmur, think of 2 potential conditions: _____ and _____
free or septal wall rupture and acute mitral regurgitation
The two most common autosomal dominant
genetic mutations for prothrombotic states
- Factor V Leiden: causes resistance to activated protein-C (which inactivates factors V and VIII)
- Prothrombin gene mutation: increases prothrombin
Avoid combining _____ and _____ due to risk of heart block, heart failure, and symptomatic bradycardia.
non-dihydropyridine CCB (Verapamil and Diltiazem) and beta blockers
MOST common primary malignant pericardial tumor
Mesothelioma
reversing agent for warfarin
Vitamin K, FFP, 4-factor prothrombin complex concentrate
SECOND MOST frequent cause of DEATH in the
world
Stroke
The maximum protection against combined
cardiovascular endpoints is achieved with:
- SBP <135-140 mmHg
- DBP <80-85 mmHg
Definition of resistant HPN
BP persistently >140/90 mmHg despite taking three or more antihypertensive agents, including a diuretic
(+) Lung Pathology + Right sided heart failure
Cor Pulmonale
Ruled out if there is Left sided HF
What is the best initial test and often most accurate test for all types of cardiomyopathy?
Echocardiography
Sudden, severe calf discomfort suggests…
Ruptured Baker’s cyst
2D Echo finding of pulmo embolism
McConnell’s sign (hypokinesis of the RV free wall)
What is the mainstay of treatment of hypertrophic cardiomyopathy?
Beta blockers and diuretics
reversing agent of Heparin, Enoxaparin, Dalteparin, Fondaparinux
Protamine:
100% reversal of UFH
70-80% reversal of LMWH
No effect on Fondaparinux
MOST frequent SIGN of PE
Tachypnea
Most common symptom for PE
• Unexplained breathlessness
MOST common tumor of the pericardium
Malignant neoplasms from the mediastinum (bronchus, breast, lymphoma, melanoma)
The only absolute contraindications to the use of
nitrates are ______
hypotension or the recent use of PDE-5 inhibitors, Sildenafil or Vardenafil (w/in 24 hours) or Tadalafil (w/in 48 hours)
Most common type/ characteristics of myxoma
Sporadic, solitary, located in the left atrium, often pedunculated
first line of treatment for severe hypertriglyceridemia.
Fibrates
Remember “CREST” in acute pericarditis:
C – Chest pain
R – Rub (85% of patients)
E – Effusion
S – ST elevation
T – Tamponade (a potential complication of pericarditis)