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IM Rotation 2018 > Cardiology Part 1 > Flashcards

Cardiology Part 1 Flashcards

1
Q

At what pulmonary capillary wedge pressure do Kerley B lines appear?

A

18-25 mmHg

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2
Q

What CXR findings are indicative of CHF?

A
  1. Cephalization of flow
  2. Kerley B lines
  3. Batwing appearance = Pulmonary edema*
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3
Q

What are Kerley B lines?

A

Short linear markings at the lung periphery

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4
Q

What is normal pulmonary capillary wedge pressure?

A

6-12 mmHg

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5
Q

What pulmonary capillary wedge pressure will you see Butterfly (Batwing) pattern on a CHF CXR?

A

> 25 mmHg

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6
Q

What is Cephalization?

A

Increased vascular flow to the apices as a result of increased pulmonary venous pressure

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7
Q

What pulmonary capillary wedge pressure will you see Cephalization on a CHF CXR?

A

12-18 mmHg

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8
Q

A patient is having worsening dyspnea and says she has pink frothy sputum when she coughs. CXR reveals pulmonary edema. What could you expect her pulmonary capillary wedge pressure to be? And how do you manage this patient?

A

> 25 mmHg

-LMNOP

Lasix
Morphine: reduces preload
Nitrates: Vasodilators = reduce preload and afterload
Oxygen
Position = place upright to DECREASE venous return

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9
Q

How is the diagnosis of HTN made?

A

Elevated BP > or = 2 readings on > or = 2 different visits

Systolic > or = 140

AND/OR

Diastolic > or = 90

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10
Q

A patient with an isolated elevated systolic blood pressure is at risk for what?

A

A higher risk for cardiovascular disease than isolated diastolic in patients > 50

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11
Q

What is a normal blood pressure?

A

< 120/ <80

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12
Q

What is considered “Pre-HTN”?

A

120-139

80-89

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13
Q

What is considered Stage I HTN?

A

140-159

90-99

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14
Q

What is considered Stage II HTN?

A

> or = 160 Systolic

> or = 100 Diastolic

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15
Q

What is the MC etiology of Primary HTN?

A

Essential/idiopathic

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16
Q

What is the MC etiology of Secondary HTN?

A

Renal artery stenosis

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17
Q

What is the MC etiology of HTN in younger patients?

A

Fibromuscular dysplasia

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18
Q

What is the MC etiology of HTN in elderly patients?

A

Atherosclerosis

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19
Q

When should you suspect secondary HTN?

A

If the patient has refractory HTN to antiHTN agents or if severely elevated

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20
Q

What MC endocrine disorders cause HTN?

A
  1. Primary hyperaldosteronism
  2. Pheochromocytoma
  3. Cushings’s syndrome
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21
Q

What are some random things that cause HTN (5)?

A
  1. Coarctation of the aorta
  2. Sleep apnea
  3. ETOH
  4. Oral contraceptives
  5. COX-2 inhibitors
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22
Q

What is the pathogenesis of HTN?

A

Increased sympathetic activity
Increased angiotensin II activity
Increased mineralocorticoid activity (sodium & water retention)

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23
Q

What is the 2nd most common cause of end-stage renal disease in the US?

A

HTN

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24
Q

What are the grades of Retinopathy?

I.
II.
III.
IV.

A

I. Arterial narrowing
II. A-V nicking
III. I-II + hemorrhages & soft exudates (accelerated)
IV. I-III. + papilledema (malignant HTN)

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25
In managing HTN, what is the goal?
< 140/90in general population, diabetics, and chronic renal patients
26
How do you manage uncomplicated HTN?
In Non-African American pts: any of one of 4 can be chosen 1. Thiazide* diuretic 2. ACE inhibitor 3. ARB 4. CCB
27
How do you manage a non-diabetic AA with HTN?
Thiazides | CCB
28
How do you manage a patient with DM/chronic kidney disease and HTN?
ACE I* | ARB
29
How do you manage isolated systolic HTN in the elderly?
Diuretic (+/- CCB)
30
How do you manage HTN in a young caucasian male?
1. Thiazide 2. ACE inhibitor/ ARB 3. BB
31
How do you manage a hypertensive patient with Gout?
CCB or Losartan*
32
How do you manage a patient with BPH and HTN?
Alpha 1 blocker
33
How do you manage a hypertensive patient with systolic HF?
ACEI ARB BB Diuretics
34
How do you manage a hypertensive patient who is post-MI?
BB | CCB
35
How do you manage a hypertensive patient with Afib?
Rate Control: BB CCB (Non-dyhydropyridines: Verapamil; Cardizem)
36
What are the MC causes of Myocardial infarction?
1. Atherosclerosis* MC: caused by a plaque rupture that leads to acute coronary artery thrombosis with platelet adhesion/activation/aggregation along with fibrin formation 2. Coronary artery vasospasm: cocaine-induced; variant (Prinzmetal) angina
37
A patient in the ED is eliciting Levine's sign--what is this?
A clenched fist on the chest
38
A patient in the ED is eliciting Levine's sign. She states her chest pain has been there for longer than 30 min and is not relieved by rest. She also tried taking some of her prescribed sublingual nitrogen, but the pain is persistent. What does her pain at rest indicate in reference to her arteries?
Pain at rest usually indicates > 90% occlusion
39
A patient in the ED is eliciting Levine's sign. She states her chest pain has been there for longer than 30 min and is not relieved by rest. She also tried taking some of her prescribed sublingual nitrogen, but the pain is persistent. What other symptoms would this patient be displaying?
SYMPATHETIC STIMULATION: 1. Anxiety 2. Diaphoresis 3. Tachycardia/palpitations 4. N/V 5. Dizziness
40
What type of patients may present with Silent MIs?
Women Elderly Diabetics Obese patients Atypical sxs: abdominal pain, jaw pain, or dyspnea WITHOUT chest pain
41
A patient complaining of chest pain with bradycardia may be suggestive of what?
Inferior wall MI
42
In a patient with an NSTEMI, what EKG changes may you see?
ST depressions AND/OR T wave inversions; EKG can be normal
43
In a patient with a STEMI, what EKG changes may you see?
ST elevations > or = to 1 mm in 2 or greater anatomically contiguous leads +/- reciprocal changes in the opposite leads
44
What EKG findings is an equivalent to a STEMI?
New left bundle branch block
45
What constitutes a pathologic Q wave?
Q wave > or = 0.03 seconds & 0.1 mV deep | Q wave depth at least 25% of the associated R wave
46
A patient is having ST elevations shown in leads, V1 & V2 what artery is affected?
Proximal LAD
47
A patient is having ST elevations shown in leads V1-V4, what artery is affected?
Left Anterior Descending (LAD)
48
If a patient has a lateral wall infarction, what artery is affected? Where will you see these changes on an EKG?
Circumflex (CFX) I, aVL, V5, V6
49
If a patient is having ST elevations in leads I, aVL, V4, V5, and V6, what type of MI is this?
Anterolateral MI: Mid LAD or CFX
50
A patient is having ST elevations in leads II, III, aVF. What type of MI is this?
Inferior MI: Right Coronary Artery (RCA)
51
If a patient is experiencing a posterior wall MI, what will the EKG look like and what arteries are affected?
EKG: ST depressions V1-V2 RCA, CFX
52
What cardiac marker is most sensitive and specific for MIs?
Troponin I and II Appears: 4-8 hrs Peaks: 12-24 hrs Returns to baseline: 7-10 days
53
Tropins may be falsely elevated in which other conditions?
1. Patients with renal failure 2. Advanced heart failure 3. Pulmonary embolism 4. CVA
54
How are unstable angina and Non-STEMI MI managed?
2 part approach: 1. Antithrombotic approach: Anti-platelet drugs or Anti-coagulants 2. Adjunctive therapy & assess risk factors
55
What Anti-platelet drugs are used in the management of Unstable Angina or an NSTEMI?
1. Aspirin 2. ADP inhibitors 3. GP II/IIIa inhibitors
56
What Anti-coagulant drugs are used in the management of Unstable Angina or an NSTEMI?
1. Unfractionated Heparin 2. LMWH (Enoxaparin/Lovenox) 3. Fondaparinux
57
What is the MOA for Aspirin?
Prevents platelet aggregation/activation | Inhibits COX which decreases Thromboxane A2
58
When are ADP inhibitors indicated for a patient with unstable angina/NSTEMI?
Good to use in patients with aspirin allergy
59
What is the MOA of GP IIb/IIIa inhibitors?
inhibits the final pathway for platelet aggregation
60
When should you consider giving a patient a GP IIb/IIIa inhibitor?
Unstable angina NSTEMI Patients undergoing PCI
61
Why is Metroprolol useful in the management of unstable angina/Non-STEMI?
``` Lowers myocardial O2 consumption Antiarrhythmic effects (titrated to pulse <70 bpm) ```
62
When should Metroprolol not be given in the management of unstable angina/Non-STEMI?
1. Severe bradycardia 2. Hypotension 3. Decompensated CHF 4. 2nd/3rd Heart block 5. Cardiogenic shock 6. Cocaine-induced MI 7. Severe asthma/COPD
63
What is the DOC for patients with Vasospastic disorders (Variant/Prinzmetal angina or cocaine use)?
CCB: Non-dihydropyridines Verapamil Diltiazem
64
How is a STEMI managed?
3 step procedure: 1. REPERFUSION therapy* (most important) 2. Antithrombotics 3. Adjunctive therapy
65
What are the 2 main ways to reperfuse a patient in the management of a STEMI?
1. PCI: Percutaneous Coronary Intervention | 2. Thrombolytic (Fibrinolytic) therapy
66
When is it best to use PCI for the management of a STEMI?
Best w/in 3 hours of sxs onset ``` Especially good for: Cardiogenic shock Large anterior MI Prior CABG If thrombolytics are CI ```
67
When is it best to use thrombolytics (fibrinolytic) therapy in the management of a STEMI?
Used if PCI is not an option, or if unable to get PCI early (w/in 3hrs of onset)
68
In addition to PCI/Thrombolytic therapy what else is given to manage a patient with a STEMI?
Antithrombotic therapy: Aspirin; Heparin, Glycoprotein IIb/IIIa inhibitors Adjunctive therapy: BB, ACE inhibitors, Nitrates, Morphine STATIN therapy
69
What is the MC etiology of myocarditis?
Viral: Enterovirus (Coxackie B)
70
What are some bacterial causes of myocarditis?
Rickettsial (Lyme disease, Rocky Mountain spotted fever, Q fever) Chagas disease (rare in US but seen in South/Central America)
71
What medications can induce myocarditis?
``` Clozapine* Methyldopa Abx: TCN, Amphotericin B, PCN, Isoniazid Cyclophosphamide Acetazolamide Indomethacin Phenytoin Sulfonamides ```
72
Which autoimmune disorders can induce myocarditis?
1. SLE 2. Rheumatic fever 3. RA 4. Kawasaki syndrome 5. Ulcerative colitis
73
What toxic conditions can induce myocarditis?
1. Scorpion envenomation | 2. Diphtheria toxins
74
What is the gold standard in diagnosing myocarditis?
Endomyocardial biopsy
75
In a patient with Myocarditis, what will you see on a patients CXR?
Cardiomegaly (dilated cardiomyopathy)
76
What is the most common finding you will see on a EKG with a Myocarditis patient?
Sinus tachycardia
77
What does an Echo display on a patient with Myocarditis?
Ventricular dysfunction
78
A patient is diagnosed with Myocarditis. How would you expect this patient to present?
Patient will have a viral prodrome: fever, myalgias, malaise then the patient will develop heart failure symptoms (dyspnea at rest, exercise intolerance, syncope, tachypnea, tachycardia, hepatomegaly; impaired systolic function S3-S4) Severe: hypotension, poor pulses and perfusion, altered mental status; Megacolon* +/- concurrent pericarditis: fever, chest pain, pericardial friction rub, pericardial effusion
79
A patient is diagnosed with Myocarditis, how do you manage this patient?
Supportive! Systolic heart failure treatment: diuretics, afterload reduction agents (ACEI), ionotropic drugs if severe (Dobutamine, Dopamine, Milrinone) BB are not used with pediatric pts IVIG
80
A patient is seen in the ED for fever, chest pain, and dyspnea at rest. Patient states he was having flu-like symptoms for several days, then he suddenly felt as if he could not breath. CXR reveals cardiomegaly, and EKG is showing sinus tachycardia. Cardiac CK and troponin are positive. ESR is increased. Based on the information, what is the most likely diagnosis?
Myocarditis

IM Rotation 2018 (5 decks)

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