Cardiology Clues (no pharm) Flashcards
Where does a Type A thoracic aortic dissection occur?
Ascending Aorta, (occurs in Cystic medial necrosis and Syphilis)
Where does a Type B thoracic aortic dissection occur?
Descending Aorta, (occurs in trauma and Atherosclerosis)
In what layers does a true aortic aneurysm occur?
Intima, media, and adventitia
In what layers does a pseudo aortic aneurysm occur?
Intima and media layers
What is pulse pressure?
Systolic minus diastolic pressure
What is your maximum heart rate?
220 minus the person’s age
What is stable angina?
Pain with exertion that is relieved with rest (Athersclerosis MCC)
What unstable angina?
Pain at rest (transient clots MCC)
What is Prinzmetal’s angina?
Coronary Artery Spasm
What is Amyloidosis and what stain is used?
Amyloid deposits that stain Congo red: Apple-Green Birefringence (AA-chronic disease)
What is hemochromatosis?
Iron deposits in organs leads to hyperpigmentation, bronze diabetes, and arthritis
What is cardiac tamponade?
- Pressure equalized in all 4 chambers
- quiet Precordium
- no pulse or BP
- Kussmaul’s Sign (paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration)
- Pulsus Pardoxus (Decrease in BP greater than 10 mm Hg with inspiration)
What is transudate?
An effusion with mostly water If too much water: Heart or Renal failure…. Or not enough protein: Cirrhosis (can’t make protein), and Nephritic Syndrome (spilling out protein in urine)
What is exudate?
Effusion of mostly protein Too much protein: Will have — Purulent (from Bacteria), Hemorrhagic (from trauma, CA, PE) Fibrinous (from collagen vascular disease), Granulomatous (non-bacterial)
What is systole?
Ejection of blood from the heart, Decreased blood flow to Coronary arteries, more extraction of Oxygen Phase 1 Korotkoff
What is diastole?
Heart ventricles filling increased blood to Coronary arteries less extraction of oxygen Phase 4 and 5 Korotkoff
What are the only arteries with deoxygenated blood?
Pulmonary and umbilical arteries
What murmur has a water hammer pulse?
Aortic regurgitation
What murmur has Pulsus Tardus?
Aortic stenosis
What cardiomyopathy has Pulsus Alternans?
Dilated cardiomyopathy
What disease has pulsus bisferiens?
IHSS- Idiopathic Hypertrophic Subaortic Stenosis (hypertrophic cardiomyopathy)
HCM!
What murmur has an irregular-irregular pulse?
A fib (no P waves)
What murmur has a regular-irregular pulse?
PVC
What sound radiates to the neck?
Aortic stenosis
What sound radiates to the axilla?
Mitral regurgitation
What sound radiates to the back?
Pulmonic stenosis
Boot-shape on x-ray?
RVH
Banana-shape on x-ray?
IHSS (hypertrophic cardiomyopathy)
Egg-shape on x-ray?
Transposition of the great arteries
Snowman-shape on x-ray?
Total anomalous pulmonary venous return
What disease has a “3” shape on x-ray?
Coarctation of the aorta
What is the Osler-Weber-Rendu?
“A-sler, V-eber, M-endu”
AVM disease also called Hereditary Hemorrhagic Telangiectasia
blanching lesions, recurrent epstaxis: disease of AVM (Atrial-Venous Malformation) in lung, GI, CNS the AVM sequesters platelets and causes acquired Telangiectasia’s
What is VHL?
Predisposes individuals to bnign and malignant tumors, AVM in the head, and retina (AD inheritance in Chromosome 3)
What CA risk does VHL have?
RCC
When do valves make noise under normal physiology?
When the valves close
What valves make noise at the end of diastole?
Mitral and Tricuspid
What murmurs occur during systole?
Holosystolic or pansystolic
What are the Holosystolic murmurs?
Tricuspid Regurg, Mitral Regurg, VSD
What are the Systolic Ejection Murmurs?
Aortic Stenosis, Pulmonic Stenosis, Hypertrophic Cardiomyopathy
What valves make noise at the end of systole?
Aortic and Pulmonic
What are the sounds made from diastolic murmurs?
Blowing and rumbling
What are the Diastolic Blowing murmurs?
Aortic regurgitation, pulmonic regurgitation
What are the diastolic rumbling murmurs?
Tricuspid Stenosis, Mitral Stenosis
What are the continuous Murmurs?
PDA or AVM’s
What has a friction rub while breathing?
Pleuritic
What has a friction rub while holding breath?
Pericarditis
What does a mid-systolic click tell you?
MVP- Mitral valve prolapse
What does an ejection click tell you?
Aortic or Pulmonic Stenosis
What does an opening snap tell you?
Mitral or Tricuspid Stenosis
What does S-2 splitting tell you?
Normal on inspiration Pulmonic valve closing later
What does a wide S-2 split tell you?
Increases Oxygen Increased right ventricular volume Delayed pulmonic vlave opening
What does fixed wide S-2 splitting tell you?
ASD
What does a paradoxical S-2 split tell you?
Aortic Stenosis or LBBB
What is cor-pulmonale?
Pulmonary HTN leads to Right ventricular failure
What is Eisenmenger’s Syndrome?
Physiological shunt from left to right now changes right to left
What is transposition of the great arteries?
Aorticopulmonary septum did not spiral, most common congenital cyanotic heart disease in the first month of life (Neural crest cell migration problem)
What is Tetralogy of Fallot?
Overriding aorta: Aorta sits on intraventricular Septum giving rise to a VSD, this in turn causes Pulmonary Stenosis and ultimately right heart failure (boot shape x-ray)
What is Total Anomalous Pulmonary return?
All pulmonary veins enter into the right atrium (Snowman x-ray)
What is Truncus arteriosus?
Spiral membrane did not develop, there is one Aortic Pulmonary trunk, mixed blood, needs PDA
What is Epstein’s anomaly?
Small right ventricle and very large right atrium (in fetus due to mom taking Lithium during pregnancy)
What Kidney complications can Lithium cause to the person taking the drug?
Destroy the collecting ducts V2 aquaporin receptors, causing Nephrogenic DI
diastolic, low pitched rumbling, opening snap — this valcular condition is intesified by what position?
mitral stenosis - intensified in the left lateral position and mild exercise
holosystolic, decresendo murmur radiating to axilla– this condition is intensified by what, and reduced by doing what?
mitral regurg - intensified by isometric exercise, reduced by straining (doesnt make sense).
late systolic, high pitched crescendo-decrescendo, “whooping” or “honking”- this condition is intensified by what and reduced by doing what?
mitral prolapse
intensified by standing and straining, reduced by squatting and isometric exercises
Midsystolic, low pitched, ocasionally transmitted to apex, paradoxical splitting of S2
Aortic stenosis
mid-to-late diastolic
soft, low pitched rumbling (austin flint)
this condition is intensified by what?
aortic regurg
intensified by strenuous and sustained handgrip
a single heart sound, cyanotic baby
tricuspid atresia
Holosystolic, blowing on left lower parasternal border - intensified by what?
tricuspid regurg - inspiration (carballo sign)
S4 gallop 12-48 hrs after STEMI
acute mitral regurg
Leads and regions corresponding to…
a. right coronary artery
b. left circumflex artery
c. left anterior descending artery
a. RCA: leads
- II, III, avF: inferior wall
- V3R, VR4: right ventricular wall
b. Left circumflex a.
- I, aVL - high lateral wall infarct
c. LAD
- V1+V2 Septal wall
- V3 + V4 Anterior wall
- V5 + V6 Lateral wall
When is a patient sent for coronary artery bypass surgery (CABG)
When is a paitient sent for revascularization surgery
CABG
- 3 vessel disease or 2 vessel + proximal LAD stenosis
- Left ventricular ejection < 50%
- diabetes with L coronary artery dis or multi vessel diz
Revascularization
- anginal symptoms that impair quality of life
indications & contraindications for fibrinolytic therapy
Indications for fibrinolytic therapy:
- acute chest pain suggesting MI
- time to therapy <12 hours
- ST-segment elevation >2-3 mm in the chest leads
- ST-segment elevation 1 mm in the limb leads
Contraindications to fibrinolytic therapy:
- history of intracranial hemorrhage
- acute ischemic stroke within the past 3 months
- cerebrovascular malformation or brain metastasis
- suspected aortic dissection
- active internal bleeding or bleeding diathesis,
- significant head trauma within the past 3 months.
Management of diabetic nephropathy
- the first choice is an angiotensin-converting enzyme (ACE) inhibitor- decreases the progression of diabetic nephropathy and proteinuria.
- In a patient with diabetes and LDL levels 70–189 g/dL, a statin is also recommended to decrease the LDL levels.
Ascending aortic dissections are treated ____
Descending aortic dissections are treated _____
Ascending - treated surgically
Descending - treated medically
- a diagnosis of hypercholesterolemia requires a total cholesterol of ……
- Cardiovascular RFs include…
- In patients with 0-1 cardiovascular risk factor, the target LDL cholesterol level is….
- diagnosis of hypercholesterolemia requires a total cholesterol of > 200 mg/dL on two occasions.
- RFs: Diabetes, smoking, FHx 1st deg relative with HD, obesity, dyslipidemia, HTN, early vascular diz
- In patients with 0-1 cardiovascular risk factor, the target LDL cholesterol level is <160 mg/dL.
To meet the diagnostic criteria for hypertension, it is necessary to have at least _________showing a systolic BP of ______and/or a diastolic BP
To meet the diagnostic criteria for hypertension it is necessary to have at least two blood pressure (BP) measurements (each at least 1 week apart) showing a systolic BP >140 mm Hg and/or a diastolic BP >90 mm Hg.
I
Criteria for statin therapy (4)
- atherosclerotic diz
- LDL-C = or > 190 mg/dl
- DM + LDL-C between 70-189, in pts 45-75
- estimated atherosclerotic risk > 7.5% in pts 45-70
Dilated cardiomyopathy (DCM): helpful mnemonic
DCM may be precipitated by an acute event such as a viral illness, which disrupts the normal physiology of the heart’s lining and causes symptoms of congestive heart failure.
DCM comprises close to 90% of all cardiomyopathies.
A helpful mnemonic for the “ABCDEs” of DCM is:
- Alcohol abuse
- wet Beriberi
- Coxsackie B, Cocaine, Chagas disease
- Doxorubicin
- Everything else (Zidovudine, toxicity, hemochromatosis, sarcoidosis, peripartum cardiomyopathy).
For a young, otherwise healthy patient with recent viral infection and new-onset heart failure, what should be at the top of your differential?
myocarditis
Diagnosing Chest Pain steps 1-5
- Rule out STEMI or LBBB with EKG: if present–> Emergent cath lab
- If EKG negative, rule out STEMI or LBB with troponin-I
- NSTEMI –> Urgent cath lab
- if EKG and troponin I are all negative –> exercise stress test
- if exercise stress test is (+) –> elective cath
CHA2DS2-VASc score
- CHA2DS2-VASc score is used to determine stroke risk: higher the score, higher the risk of stroke.
- The score is also used to determine the need for oral anticoagulation.
- Oral anticoaguluation is indicated when CHA2DS2-VASc is >1 point (0-1 needs aspirin but no therapy)
CHA2DS2-VASc: scoring
- Congestive HF: 1 point
- Hypertension: 1 point
- Age > 75: 2 points
- Diabetes: 1 point
- Stroke/TIA/Thromboembolism: 2 points
- Vascular diz: 1 point
- Age 65-74: 1 point
- Sex catgegory: female: 1 point
ANP vs BNP
BNP: As the name suggests, BNP was initially discovered in the brain but is mainly secreted by stretch of the cardiac ventricles, not the atria.
ANP: Atrial natriuretic peptide is secreted by the cardiac atria.
The drug of choice for treating torsades de pointes
Magnesium sulfate
Criteria for the diagnosis of metabolic syndrome in 2004.
- waist circumference ≥102 in men
- waist circumference ≥88 cm in women
- PLUS any two of the following:
- Triglycerides >150 mg/dL
- HDL cholesterol <40 mg/dL
- Fasting plasma glucose >100 mg/dL
- Blood pressure >130/85 mm Hg or drug treatment for hypertension.
side effects of thiazides mnemonic
hyperGLUC: hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia.
causes of hyperkalemia mnemonic
“MACHINE”
Medications (ACE-I, ARBs, K sparer’s, NSAIDs)
Acidosis
Cellular destruction (burns, trauma, tumor lysis)
Hypoaldosteronism, hemolysis
Intake (excessive)
Nephrons (renal failure)
Excretion impaired
atrial fibrillation mnemonic
PIRATES
- Pulmonary disease, Post-op
- Ischemia
- Rheumatic heart disease
- Age, Anemia
- Thyroid
- Ethanol
- Sleep apnea
- Sepsis
Beck triad
Beck triad (hypotension, distant heart sounds, and distended neck veins) is pathognomonic for cardiac tamponade
Central hallmark of hypertrophic obstructive cardiomyopathy
Dynamic outflow obstruction caused by septal hypertrophy and systolic anterior motion of the anterior leaflet of the mitral valve.
Squatting leads to an increase in preload and afterload and thus increases the LV chamber, thereby _decreasing the intensity of the murmu_r.
The most common valvular disease caused by rheumatic heart disease.
Mitral stenosis: murmur of mitral stenosis is an opening snap with a mid-diastolic rumble.
At what LDL level does the National Cholesterol Education Program guideline recommend giving patients pharm treatment?
above 190
Dilated cardiomyopathy diagnosis requires evidence of what?
Dilated cardiomyopathy diagnosis requires evidence of left ventricular dilation and systolic dysfunction with a left ventricular ejection fraction <40% on echocardiography.
Symptomatic bradycardia and the drug of choice for symptomatic bradycardia.
Symptomatic bradycardia exists when the following three criteria are present
- the heart rate is slow (usually <50/min)
- the patient has symptoms
- the symptoms are due to the slow heart rate.
in an elderly patient, symptomatic bradycardia is most likely caused by an inferior wall myocardial infarction or sick sinus syndrome.
medications like nitroglycerin, β-blockers, angiotensin-converting enzyme inhibitors or barbiturates can mimic a shock-like state. A
Atropine, a competitive antagonist of the muscarinic acetylcholine receptors, is the drug of choice for symptomatic bradycardia.
