Cardiology Question review Flashcards
ACC 2011 CABG guidelines (CTHSurgery.com)
- => 70% stenosis 2. => 50% left main stem 3. Significant stenosis and unacceptable angina despite medical therapy 4. Significant stenosis and unacceptable angina in patients with medication contraindications or adverse effects, or patient preference 5. In a good candidate, CABG may be considered over PCI for complex three-vessel CAD (eg, STYNTAX score >22) with or without involvement of the proximal LAD artery 6. Transmyocardial laser revascularization (TLR) as an adjunct to CABG may be considered in patients with viable ischemic myocardium that is perfused by coronary arteries that are not amenable to grafting
Indications for CABG to improve survival (CTHSurgery.com)
- LMS ( LEFT MAIN STEM) DISEASE 2. 3VD WITH OR WITHOUT PROXIMAL LAD DISEASE 3. 2VD WITH PROXIMAL LAD DISEASE 4. 2VD WITHOUT PROXIMAL LAD DISEASE (with extensive ischemia) 5. 1VD WITH PROXIMAL LAD DISEASE 6. LV DYSFUNCTION 7. SURVIVORS OF SUDDEN CARDIAC DEATH WITH PRESUMED ISCHAEMIA MEDIATED VT
INR range for pt with mechanical heart valve replacement
2.5 to 3.5
INR for pts with mechanical aortic valve replacement is
2.0 to 3.0
AAA repair recommended for who
- symptomatic (no matter what size) (Substernal abdominal and radiating to the back Tearing pain radiating to the back = rupture Hoarse voice secondary to constriction of the recurrent laryngeal nerve) 2. larger than 5.5 cm in dia with expansion of greater than 0.5 cm in 6 MONTHS
Stanford Type A ascending aortic dissection treatment
Emergent surgical intervention
Stanford Type B descending aortic dissection treatment
Conservative Serial CT scans every 6 mo to follow changes
Pharmacologic management for acute aortic dissections Sanford Type A (ascending) or Sanford Type B (descending)
IV beta-blockade and IV nitroprusside
Cor pulmonale is
right sided heart failure secondary to severe pulmonary disease.
Causes of Core pulmonale include:
- acute respiratory distress syndrome 2. Pulmonary embolism 3. COPD 4. Sarcoidosis 5. Lung trauma
Clinical presentation of pt with cor pulmonale
- Dyspnea 2. Wheezing 3. Wet chronic cough 4. Edema 5. Cyanosis and clubbing may be present
Labs Studies PE findings Cor pulmonale
- Ascites and edema 3. EKG- Tall peaked P waves (R atrial enlargement); R axis deviation (R ventricular hypertrophy)
EKG findings Right sided heart failure
EKG- 1. Tall peaked P waves (R atrial enlargement); 2. R axis deviation (R ventricular hypertrophy)
What is the definition of isolated systolic hypertension?
systolic pressure greater than 140 mm Hg but a diastolic blood pressure less than 90 mm Hg
Renovascular hypertension signs
abdominal bruit in the pressure of elevated blood pressure
Explain differences between tricuspid regurgitation and mitral regurgitation?
TR holosystolic murmur which is best heard at the left lower sternal border (4th interspace) with radiation to the left upper sternal border. Murmur will increase with inspiration due to increased right-sided venous return during inspiration. MR pan systolic (holo systolic) blowing murmur radiating to the axilla if severe. Best heart in L 5th interspace at the Apex. Left lateral decubitus may amplify murmur.
What is the most commonly found microorganism in infectious endocarditis of tricuspid valve
- staph aureus
What are causes of endocarditis in non-IV drug users
The causative agents of infective endocarditis differ depending on host factors. Fungal organisms, such as Candida albicans may cause infective endocarditis in severely immunosuppressed patients, such as those with AIDS. A minority of cases of infective endocarditis are caused by a number of normal commensals in the oral cavity, i.e., the “HACEK” group: Hemophilus Actinobacillus, Cardiobacterium, Eikenella, and Kingella. S. epidermidis and other coagulase-negative staphylococci tend to produce endocarditis in recipients of prosthetic valves. Viridans streptococci are the most frequent agents causing endocarditis in previously abnormal valves, such as those damaged by rheumatic disease, or congenitally abnormal valves. Coagulase-negative staphylococci and viridans (a-hemolytic) streptococci are less virulent than S. aureus and are thus associated with a subacute (more prolonged) clinical course and a better prognosis
Describe mitral stenosis murmur
low pitched diastolic rumbling murmur
Inferior STEMI ECG leads ST segment elevation
II, III, and AVF
Anterior STEMI ECG leads ST segment elevation
V2-V4
Acute posterior STEMI ECG leads ST segment elevation
V1-V3 with relative early R-wave progression in leads V1-V3
Lateral wall STEMI ECG leads ST elevation
V5, V6, I and aVL
Define STEMI
New ST segment elevation in >= 2 contiguous leads and >= 1 mm high. Reciprocal changes of ST segment depression can also be found
Thromboangiitis obliterans (Buerger’s Disease) pathophysiology
Is a recurring progressive inflammation (non-atherosclerotic) and thrombosis of small and medium arteries and veins of the hands and feet. It is strongly associated with use of tobacco products, primarily from smoking, but is also associated with smokeless tobacco.
What are the 6 Ps of compartment syndrome/ peripheral arterial disease
6 P’s: pain, paresthesia, paresis, pallor, pulselessness, poikilothermia. Note 1st 3 are most reliable in compartment syndrome while the last 3 may not hold true in early compartment syndrome.
Lupus pt have increased risk of this cardiovascular abnormality
Pericarditis
Lupus pericarditis signs/symptoms
- Sharp, stabbing chest pain behind the breastbone on the left side of the chest. 2. Pain that worsens when lying down. Pain that improves when sitting up or leaning forward. 3. Shortness of breath. 4. Low-grade fever. 5. Fatigue or feeling of sickness. 6. Dry cough. 7. Abdominal or leg swelling.
Explain how hypothyroidism can lead to heart failure
Hypothyroidism can lead to > Bradycardia > diastolic and systolic dysfunction > low cardiac performance. This can lead to increased systemic vascular resistance > impaired L ventricle diastolic filling > decreased cardiac preload which overall results in reduced systemic perfusion which results in Heart failure.
Name Microvascular complications in diabetes
- Diabetic retinopathy 2. Cotton wool spots and hemorrhages on fundal examination 3. Diabetic nephropathy- leakage of protein and albumin 4. Hyperglycemia, dyslipidemia, insulin resistance, activates the renin-angiotensin system which leads to diastolic dysfunction in dilated cardiomyopathy
Normal serum potassium
3.5 to 5.0 mEq/L
Describe K characteristics of hypo and hyperkalemia on ECG
- Low potassium < 3.5 mEq/L- see depressed ST segment, diphasic T wave and prominent U wave 2. Elevated potassium > 6.0 mEq/L - see tall T wave 3. Elevated potassium > 7.5 mEq/L- see prolonged PR interval, wide QRS Duration and tall T wave 4. Elevated potassium > 9.0 mEq./L - see absent P wave sinusoidal wave
Describe K characteristics of hypo and hyperkalemia on ECG Graphic form
Hypothermia is associated with what finding on ECG
J Waves (aka Osborn waves)
Characteristics of hypermagnesemia on ECG
No distinct features, but severe elevations can lead to prolonged QRS and PR intervals
Normal range of magnesium
1.7 to 2.2 mg/dL
Mitral valve prolapse is a frequent finding in pts with connective tissue disorders such as Marfan’s syndrome. What would you expect to hear on ascultation?
Mid to late-systolic click that may or may not be associated with a murmur.
Mitral valve stenosis sound
associated with a low pitched, mid-diastolic murmur that may be associated with an opening snap
Describe the murmur heard in patent ductous arteriosis
Continuous murmur heard in the pulmonic area (L 2nd intercostal space)
Describe the murmur of aortic stenosis
Systolic ejection murmur at the 2nd R sternal border with radiation to the right neck
Pheochromocytoma patient presentation
(Pt likely young girl)
Sudden, repeated attacks of high blood pressure causing:
Heart palpitations
Sweating
Headache
Anxiety
Other symptoms include:
Nausea
Weakness
Abdomen pain
Tremors
Pale skin
Difficulty breathing
Tetralogy of fallot 4 characterizations
- Overriding aorta
- Ventral septal defect
- Pulmonary stenosis
- R ventricle hypertrophy
Tetralogy of fallot on CXR
Normal sized, boot shaped heart with diminished pulmonary vascular markings
Coarctation of the aorta CXR findings
Rib notching
Ascultory hallmark of ASD
Wide, fixed split S2. Systolic murmur best heard in the upper left sternal border in the pulmonic space (Pulmonary: 2nd left intercostal space.)
What murmurs are best heard in the pulmonic space. 2nd L intercoastal space?
- ASD (Systolic Wide, fixed split S2)
- Pulmonic stenosis (systolic ejection click that increases with inspiration)
- Ventral septal Defect (almost always pansystolic)
Finding of pt with pneumothorax
- Chest pain
- Dyspnea
- Pleural white line on CXR
Calcium channel blockers are not recommended which cardiac diseases?
- CAD
- HF
Negative inotropic effect may further depress cardiac function. Risk is greatest with verapamil, then diltiazem and least risk with dihydropyridines, but use with caution
What is consider physiologic splitting of S2
Splitting of S2 that occurs on inspiration and disappears on expiration
Normal splitting of S2 is caused by (1) increased right-sided heart filling during inspiration because of increased blood volume returning via the venae cavae; and (2) diminished left-sided heart filling because blood is retained within the small blood vessels of the lungs when the thorax expands.
What is paradoxical splitting of S2, and what is the most common cause
1) Paradoxical splitting of S2 occurs on expiration and disappears on inspiration: the opposite of physiologic splitting
2) Left bundle branch block
What is the Definition of orthostasis
- Drop in systolic blood pressure greater than 20 mm Hg OR
- drop of greater than 10 mm Hg of diastolic pressure within 3 minutes of posture change
