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Internal Medicine > Cardiology Error List > Flashcards

Cardiology Error List Flashcards

1
Q

When is revascularization indicated for Coronary Artery Disease

A

Sx despite medical therapy
Left MAIN Coronary Artery Stenosis >50%
3-vessel disease with LV dysfunction (EF

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2
Q

What type of revascularization is indicated for Left MAIN coronary artery

A

CABG

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3
Q

When is a Percutaneous Transluminal Coronary Intervention used (PTCA)

A

1 or 2 vessels that are NOT the Left main coronary artery + normal or near normal left ventricular function

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4
Q

What intervention is used for Left Anterior Descending Artery

A

Beta Blockers
Ranolazine
CCB
Ivabradine

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5
Q

What is the gold standard to test for CAD

A

Coronary Angiongraphy (Cath)

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6
Q

What is Heart Failure

A

When the heart can’t pump sufficient blood to meet the metabolic demands of the body at normal filling pressure

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7
Q

What causes left sided HF

A

CAD and HTN

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8
Q

Sx for left sided HF

A

Think Pulmonary back-up

Dyspnea, Pulmonary Congestion/Edema, HTN

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9
Q

What causes right sided HF

A

Left sided HF

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10
Q

Sx for right sided HF

A

Peripheral Edema
JVD
GI/Hepatic Congestion

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11
Q

Dx for HF and what does it measure

A

Echo is most useful, measures EF and wall motility
CXR: See Cephalization of flow, Kerly B lines, Cardiomegaly, Pleaural Effusions
Increased BNP

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12
Q

Tx for HF

A

Ace-I are 1st line
Beta Blockers
Diuretics
Digoxin for short term use in pts. with A.Fib

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13
Q

Which Tx for HF reduce sx vs. improve mortality

A

Improve Mortality: Ace-I, Beta Blockers, Spironolactone (Potassium sparing diuretic)

Treat sx: Loop diuretics (Furosemide, Bumetanide, Torsemide)

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14
Q

If a patient with CHF can’t tolerate beta blocker or Ace-I what is an alternative

A

Hydralize + Nitrates

They do decrease mortality when used together

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15
Q

What valve is most commonly affected in Infective Endocarditis (normal valves)

A

Mitral Valve

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16
Q

What valve is most commonly affected in a person with IV drug use and infective endocarditis

A

Tricuspid Valve

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17
Q

What are the pathogens for Normal Valves, Abnormal Valves, Prosthetic Valves, IV Drug User

A

Normal: S. Aureus
Abnormal: S. Viridans
Prosthetic: Staph. Epidermis
IV Drug Use: MRSA, Pseudomonas, Candida

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18
Q

Sx for Infective Endocarditis

A

Fever, Anorexia, Weight Loss, Fatigue, EKG abnormalities, Regurgitant murmurs
Peripheral Manifestations: Janeway Lesions, Roth Spots, Petechia, Osler Nodes, Splinter Hemorrhages

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19
Q

What is the Duke Criteria for Infective Endocarditis (DX)

A

2 Major or 1 Major + 3 Minor, or 5 Minor
Major: 2 Positive blood cultures, Echo (Vegetations on Valves)
Minor: Predisposing factor like abnormal valves, indwelling catheter, fever, vascular and embolic phenomena (Janeway Lesions, Emboli), Immunologic Phenomena (Osler Nodes, Roth Spots, Positive RF, Acute Glomerulonephritis, Positive blood cultures not meeting major)

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20
Q

Tx for Infective Endocarditis based on valve (Native, Abnormal, Prosthetic, IV drug user, Fungal)

A

Native: Nafcillin + Gentamicin
Abnormal: Penicillin/Ampicillin + Gentamicin
Prosthetic: Vancomycin + Gentamycin + Rifampin
IV Drug Use: Penicillin/Ampicillin + Vancomycin
Fungal: Amphotericin B

Replace Vancomycin in any of those if pt has PCN allergy

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21
Q

What is prophylactic treatment for dental procedure in someone with infective endocarditis history

A

Amoxicillin 2g one hour before procedure. Clindamicin if PCN allergy

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22
Q

What is the reading for HTN

A

> 140/90

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23
Q

Dx for HTN

A

More than 2 abnormal readings on 2 different visits with elevated readings

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24
Q

What are complications of HTN

A

CAD, HF, MI, TIA, Stroke, Retinal Hemorrhages, Blindness, Retinopathy

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25
Q

Sx of HTN

A

Striae, Carotid Bruits, JVD, Pheochromocytoma, Polycystic Kidneys, Bruits over renal arteries

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26
Q

What are common findings in a person with HTN on a fundoscopic exam

A 
Grades
I: Arterial Narrowing
II: A-V Nicking
III: Hemorrhage, Soft Exudates
IV: Papilledema (Malignant)
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27
Q

What is the goal for someone with HTN. Someone with Diabetes and HTN

A
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28
Q

What is the first line non-medical treatment for someone with HTN

A

Lifestyle modification, sodium restriction, dash diet, exercise

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29
Q

What is the first-line medication used in HTN

A

Hydrochlorothiazides (Diuretics)

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30
Q

What is the strongest diuretic

A

Loop Diuretic: Furosemide, Bumetadine

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31
Q

What do you want to use to treat HTN in someone with diabetes

A

Ace-I (Captopril, Enalapril, Ramipril, Benazepril)

If can’t tolerate Ace-I, use ARB

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32
Q

What do you use to treat HTN in someone with angina

A

CCB (Nifedipine, Amlodipine, Verapamil, Diltiazem)

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33
Q

What do you use to treat HTN in someone with hx of MI or Angina

A

Beta-Blockers (Atenolol, Metoprolol, Esmolol, Propranolol, Labetalol, Carvedilol)

34
Q

What goes under the category of an MI and what do they mean

A

NSTEMI and STEMI

Complete occlusion of vessels that leads to infarction

35
Q

Sx of MI

A

Pain, Dyspnea, Diaphoresis, Nausea, Weakness

Tachycardia, bradycardia, CHF, Hyoptension, new murmur

36
Q

What is a physical exam finding that can be found 24 hours after an MI. What is it called when it happens 1-2 months after an MI

A

24 hours: Pericarditis with friction rub

Dressler’s Syndrome: Pericarditis 1-2 months after MI (autoimmune pathophysiology)

37
Q

What EKG findings do you find with an MI

A

T-Wave Abnormalities
ST-Segment Depression: Ischemia
ST-Segment Elevation: Infarction
Q-Waves: Infarction (could be old or new)

38
Q

What do the locations of the abnormalities tell you about the MI (leads)

A 
V1-V2: Septal or Posterior
V3-V4: Anterior
V5-V6, I, aVL: Lateral
II, III, aVF: Inferior
V1-V2 with DEPRESSION: Posterior
39
Q

What is t gold standard for dx of MI

A

Angiogram

40
Q

What are some biomarkers seen with MI

A

Myglobin rise
CPK-MB
TROPONIN, TROPONIN, TROPONIN (but only after 4 hours)

41
Q

When does Troponin rise, peak, and normalize

A

Rise: 4-6 hours
Peak: 18-24 hours
Normalizes: 7-10 days

42
Q

What are some other imaging/tests you could use to work-up a patient with an MI

A

CXR: Look for CHF or aortic dissection
Echo: Identify wall abnormalities
Stress Test: Low-risk chest pain

43
Q

Tx for MI

A 
MONABASH
M:Morphine
O: Oxygen
N: Nitroglycerin (1st line)
A: ASA (for everyone)
B: Beta-Blocker
A: Ace-I
S: Statin
H: Heparin
44
Q

What tx for MI improve mortality

A

ASA, Beta-Blocker, Ace-I, Statin

45
Q

What is Sick Sinus Syndrome

A

Applied to patients with sinus arrest, sinoatrial exit block, or persistent sinus bradycardia

46
Q

What are the arrhythmias seen with sick sinus syndrome

A

Supraventricular Arrhythmia and Bradyarrhythmia

47
Q

Sx of sick sinus syndrome

A

Most asymptomatic

Syncope, Dizziness, Confusion, Palpitations, HF, or Angina

48
Q

What patient do you see with sick sinus syndrome

A

Elderly with hx of A.Fib

49
Q

Tx for sick sinus syndrome

A

Permanent pacing with dual-chamber pacemaker

50
Q

What is Stable Angina and what causes it

A

A regular pattern of angina exacerbated by physical or emotional stress
Relieved with rest or NTG within minutes
Caused by Fixed Coronary Artery Stenosis

51
Q

Sx of Stable Angina

A

Substernal Chest Pain, Poorly Localized, nonpleuritic, exertional
Radiates to arm, lower jaw, back, shoulder
Lasts

52
Q

Non-Med Tx for Stable Angina

A

Modify RF, low fat, low cholesterol diet

53
Q

Medication Tx for Stable Angina

A

Nitrates are 1st line for acute management
Beta-Blockers are 1st line for chronic management
CCB used in patients not able to tolerate beta-blockers (NOT Nifedipine because it causes reflex tachycardia)

54
Q

What is Unstable Angina

A

New onset of angina
Increased intensity of stable angina
Increased frequency of stable angina

55
Q

Sx of Unstable Angina

A

Retrosternal chest pain not relieved by rest or NTG, radiates to arms, neck, back, shoulders, epigastrum, lower jaw
Pain at rest usually means >90% occlusion
Anxiety, diaphoresis, tachycardia, N/V, palpitations, dizziness

56
Q

Dx for Unstable Angina

A

EKG: T-wave Inversion/ST Depression

57
Q

Tx for Unstable Angina

A 
MONABASH (same as MI)
Nitrates for all
Antiplatelets: ASA, Clopidogren (Plavix)
Beta-Blockers for all
Anticoagulants: Heparin
Statins if elevated LDL
58
Q

What is Coarctation of the Aorta

A

Narrowing of the descending aorta

59
Q

What is Coarctation of the Aorta associated with

A

Bicuspid valve

60
Q

Sx of Coarctation of Aorta

A

Different blood pressures between upper and lower extremities
Weak and delayed femoral pulses
Systolic murmur that radiates to back or scapula

61
Q

Dx of Coarctation of Aorta

A

Angiogram is gold standard
CXR: see Rib notching
EKG: LVH
Echo

62
Q

Tx of Coarctation of Aorta

A

Balloon Angioplasty or surgical correction, PGE

63
Q

What causes a Venous Stasis Ulcer

A

Vascular Incompetence of either deep or superficial veins

Usually after DVT, trauma, or thrombophlebitis

64
Q

Sx of Venous Stasis Ulcer

A

Leg pain, worse with prolonged sitting, improved with walking or leg elevation
Edema, Stasis Dermatitis

65
Q

Where you see a Venous Stasis Ulcer

A

Medial Malleolus

66
Q

Tx of Venous Stasis Ulcer

A

Compression: Leg elevation, stockings, exercise
Ulcer: Wet to dry dressings, skin grafting, hyperbaric O2
Venous valve transplant

67
Q

What is Left Ventricular Hypertrophy

A

Thickened ventricles with components of both systolic and diastolic dysfunction
Septum is big and thick, portion under the aortic valve is big and thick

68
Q

Sx of Left Ventricular Hypertrophy

A

Exercise induced syncope, SOB, Murmurs

69
Q

How do you decrease the sound of a murmur in ventricular hypertrophy

A

Squatting, Laying Down, Fist Clench, Inspiration
To decrease the sound, you increase the venous flow to the heart
This is because the septum covers the aortic outlet as blood enters the heart chambers

70
Q

How do you increase the sound of a murmur in ventricular hypertrophy

A

Valsalva and Standing
To increase the sound, you decrease the venous flow to the heart
This allows the septum to relax and move away from aortic outlet, allowing flow through and the murmur to be heard

71
Q

What is the first choice for Dx ventricular hypertrophy

A

Echo

72
Q

What are other imaging/tests you can do for ventricular hypertrophy

A

CXR: Normal Heart Size
EKG: LVH, Large QRS, Non-Specific T-waves
Angiography

73
Q

Tx for Ventricular Hypertrophy

A

Beta Blockers
Avoid strenuous exercise
No Inotropes

74
Q

What is Aortic Regurgitation

A

Backflow from aorta to LV

It leads to LV volume overload

75
Q

Sx of Aortic Regurgitation

A

Left Sided HF

76
Q

What murmur is heard with Aortic Regurgitation

A

Diastolic Descrescendo BLOWING murmur heard best at LUSB

77
Q

How can you increase the sound an Aortic Regurgitation murmur

A

Handgrip

It increases backward flow

78
Q

How can you decrease the sound of an Aortic Regurgitation murmur

A

Amyl Nitrate

79
Q

Where does an Aortic Regurgitation murmur radiate to

A

Left Sternal Border

80
Q

Tx of Aortic Regurgitation

A

Vasodilators, Surgery

Internal Medicine (16 decks)

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