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ABIM > Cardiology-Basics > Flashcards

Cardiology-Basics Flashcards

1
Q

Base and apex of the heart

A
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2
Q

aortic and pulmonary areas to the ___ and ____ of the sternum

A

aortic and pulmonary areas to the right and left of the sternum

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3
Q

Differences between S1, S2

A
  1. Carotid pulse: S1 just precedes, S2: Follows
  2. Louder at: apex: S1 , base: S2
  3. Lower pitch and longer: S1, Higher pitch and shorter: S2

http://depts.washington.edu/physdx/heart/tech.html

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4
Q

Categories of heart sounds

A
  1. 1st & 2nd Heart Sounds
  2. 3rd & 4th Heart Sounds
  3. Clicks & Snaps
  4. Murmurs
  5. Rubs
  6. Maneuvers
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5
Q

Aortic stenosis

A
  1. Harsh late-peaking crescendo-decrescendo systolic murmur
  2. Heard best- right 2nd ICS
  3. Radiation to the carotids.
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6
Q

A murmur is characterized by:

A
  1. Intensity
  2. Timing
  3. Configuration
  4. Frequency
  5. Location.
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7
Q

Semilunar valves

A

The aortic and pulmonary valves

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8
Q

A mid-systolic murmur associated with a single S2 suggests:

A

Severe aortic stenosis

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9
Q

The most common causes of a mid-systolic murmur are

A

Benign (innocent) flow murmurs,

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10
Q

Types of murmurs

A

Systolic

Diastolic

Continous

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11
Q

Early systolic murmurs

A
  • Mitral regurgitation
  • Tricuspid regurgitation
  • Ventricular septal defect
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12
Q

Midsystolic ejection murmurs

A
  1. Innocent midsystolic murmurs
  2. Increased semilunar blood flow
  3. Aortic valve sclerosis
  4. Aortic outflow obstruction (AS etc)
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13
Q

Holosystolic murmurs

A
  • Mitral regurgitation
  • Tricuspid regurgitation
  • Ventricular septal defect
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14
Q

Late systolic murmur

A
  • Mitral valve prolapse
  • Tricuspid valve prolapse
  • Ischemic mitral regurgitation
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15
Q

Early diastolic murmur

A
  • Aortic regurgitation
  • Pulmonic regurgitation
  • Left anterior descending artery stenosis
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16
Q

Mid-diastolic murmurs

A
  • Mitral stenosis
  • Prosthetic mitral valve
  • Tricuspid stenosis
  • Atrial myxoma
  • Carey-Coombs murmur
  • Austin Flint murmur
  • Left-to-right shunts
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17
Q

Late diastolic murmurs

A
  • Mitral stenosis
  • Tricuspid stenosis
  • Myxoma
  • Complete heart block
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18
Q

CONTINUOUS MURMURS

A

Patent ductus arteriosus

Aortopulmonary window

Shunts

Arteriovenous fistulas

Coarctation of the aorta

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19
Q

Blowing holosystolic murmur

Heard best at the apex

Radiation to the axilla and inferior edge of left scapula.

Possible associated findings:

S2: wide physiologic splitting

S3

A

MR

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20
Q

An apical diastolic rumbling murmur in pure aortic regurgitation

A

Austin Flint

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21
Q

Soft holosystolic murmur

Heard best at the LLSB without radiation

Intensity increases with inspiration or pressure over liver

A

TR

22
Q

Early diastolic

  • high-pitched and “blowing.”
  • decrescendo configuration like that of aortic regurgitation;
  • differentiation is difficult if not impossible by auscultation alone.
  • may increase in intensity during inspiration and can be more localized
  • best heard over the left second and third interspaces.
A

Pulmonic insufficiency

Explanation: Pathologic pulmonic regurgitation is most frequently a result of pulmonic hypertension (Graham-Steell murmur) or residual after Tetralogy of Fallot repair in adults

23
Q

Low frequency rumbling mid-diastolic murmur, with presystolic component possible

Heard best at apex

Accentuated in left lateral decubitus position

A

MS

24
Q

Fixed aortic valve obstruction is distinguished from dynamic subaortic outflow tract obstruction by changes in the murmur with

A

Valsalva: AS goes down, HOCM goes up

Amyl Nitrite: Both go up

Handgrip: AS goes down, HOCM goes down

Squatting: AS goes up, HOCM goes down

25
Q

Differentiate between MR and AS murmur in heart failure

A

MR murmur is pansystolic with radiation to axilla

26
Q

Differentiate: PS and AS

A
  1. Pulmonary stenosis is usually congenital
  2. In adults, associated with carcinoid.
  3. PS murmur is best heard in upper LSB
  4. PS will cause RHF
27
Q

Severe R from AS

A
  1. Severe TR: holosystolic murmur
  2. Best heard: lower sternal borders
  3. TR: V wave
28
Q

Differntiate: AS from aortic sclerosis

A
  1. No symptoms
  2. Brief, not loud
29
Q

Aortic stenosis murmur conducted to the apex with a musical quality

A

Gallavardin murmur

30
Q

Harsh quality midsystolic murmur

Heard best LSB

Increases with decreased venous return

Possible associated findings:

  1. Sustained apical beat to palpation
  2. S4 (50% of the time)
A

HOCM

31
Q

Differentiating SEM from a regurgitant murmur

A

Hand grip: decreases the intensity of the ejection murmur

Amyl nitrite: increases the intensity of the ejection murmur

32
Q

Late systolic murmurs are most commonly caused by

A

MVP

33
Q

Early diastolic murmur is usually due to

A

Aortic or pulmonic regurgitation

34
Q

Timing of the Mitral stenosis murmur

A

mid-diastolic, late diastolic murmur, or both.

35
Q

Causes of a continuous murmur include

A
  1. PDA
  2. Aortopulmonary window (rare, confusingly also refers to radiologic term)
  3. Some shunts
  4. AV fistulas
  5. Coarctation
36
Q

Low-frequency diastolic sounds that appear to originate in the ventricles

A

S3, S4

37
Q

S3, S4 are best heard with:

A

bell

38
Q

Aortic, Pulmonary, Tricuspid and Mitral areas

A
  1. Aortic: 2 RICS
  2. Pulmonary: 2 LICS
  3. Tricuspid: 4 LICS
  4. Mitral: Apex
39
Q

Beginning of the middle third of diastole, approximately 0.12 to 0.18 seconds after S2. “Kentucky” with the final syllable (“-CKY”) representing

A

S3

40
Q

Significance of S3

A
  1. Normal under 40 years
  2. Normal in some trained athletes
  3. Should disappear before middle age.
  4. Re-emergence later: heart failure.
41
Q

Significance of S4

A

Decreased left ventricular distensibility.

Thus, S4 is common in hypertensive heart disease, AS, and HOCM

42
Q
A
43
Q

Rx: blood pressure lowering in hypertensive emegency with CHF

A

IV nitroglycerine

44
Q
A
45
Q

Antihypertensives in pregnancy

A
  1. Methyldopa
  2. Labetalol
46
Q

CAD.LipidMx

Patient with CAD+myalgias, mildly elevated CK

A
  1. Switch statin OR
  2. lower dose
47
Q

CHB+Cardiomyopathy+clean coronary+ventricular tachycardias

Most likely Dx

A

Sarcoidosis

48
Q

Ascending aorta aneurysm: size requiring surgery

A

5.5 cm

49
Q

A 26-year-old woman with a history of hypertension characterized as difficult-to-control and depression is admitted to the hospital to mental health services for treatment of suicidal ideation. Before hospital admission, she was taking amlodipine, 10 mg daily; chlorthalidone, 25 mg daily; methyldopa, 500 mg twice daily; and sertraline, 100 mg daily. All of these medications have been continued during her hospitalization. She has now been hospitalized for 2 weeks, her mental health has stabilized, and she is ready for discharge. However, her systolic blood pressure has been approximately 150 to 170 mm Hg during most of her stay in the inpatient psychiatric unit. She has no physical complaints.

Her available outpatient records reveal similar blood pressure readings over the previous year. Other than the elevated blood pressure, her physical examination findings are normal. Her pulse rate is 70 beats/min, respiratory rate is 12 breaths/min, and BMI is 23.5 kg/m2.

Laboratory data, including serum sodium, potassium, creatinine, and TSH measurements, are normal.

In addition to arranging for an outpatient follow-up appointment in 4 weeks, which of the following is the best course of action for this patient who is being discharged from the hospital?

A. Discontinue sertraline and begin citalopram, 20 mg daily

B. Begin lisinopril, 10 mg daily, and measure serum renin and aldosterone levels

C. Begin losartan, 25 mg daily, and perform duplex Doppler ultrasonography of the renal arteries

D. Begin fosinopril, 10 mg daily, and order an outpatient polysomnography test

E. Begin metoprolol succinate, 25 mg daily, and measure plasma metanephrine levels

A

Begin losartan, 25 mg daily, and perform duplex Doppler ultrasonography of the renal arteries

Rationale: FMD is a “common” cause of secondary hypertension in young women. There is no hypokalemia to suggest hyperaldosteronism (choice C).

50
Q

this class of drugs should be considered for patients whose blood pressure remains elevated after treatment with a 3-drug regimen to maximal or near maximal doses. Resistant hypertension may be associated with secondary causes of hypertension includin

A

spironolactone

An increasing body of evidence has suggested benefits of mineralocorticoid receptor antagonists, such as eplerenone and spironolactone, in improving blood pressure control in patients with resistant hypertension, regardless of circulating aldosterone levels.

ABIM (36 decks)

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