cardiology uworld Flashcards by danial A

CHADVASC score > 2, what drug do you give to reduce systemic embolic risk?
moa?
why is it better than warfarin?

apixiban or dabiGATRan – long term
direct inhibits factor X (Xiban)
direct thrombin inhibitor (gator)
less risk of hemorrhagic bleeding like warfarin–

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indirect causes of QT prolongation?

antipsychotics: haloperidol

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atrial fibrillation management that ONLY causes QRS prolongation

Flecainide class 1C

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CHA2DS2VASc scoring?

CHF
HTN
Age >75 gets 2, 64-75 gets 1
DM
Stroke or TIA gets. 2
Vascular Dx (PAD, past MI)
Sex Category : FEMALES

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Most common comorbidity with A-fib?
effect on the heart?

chronic HTN
atrial remodeling –> atrial fibrosis & dilation
*will see atrial enlargement, concentric LV hypertrophy
*if paroxysmal you won’t see anything on EKG

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rapid and irregular pulse with no p waves ?
management?

atrial fibrillation with RVR (>100bpm)
rate and rhythm control

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no p-waves where does it originate ?

atrial fibrillation
pulmonary veins

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atrial fibrillation management if greater than ___ >bpm

if greater than 150>bpm –> synchronized cardio version

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atrial fibrillation guidelines for hemodynamically stable patients (<150bpm)

rate control: non-dihydropyridines(diltiazam or verapamil) or b-blockers (metoprolol)

for long term : check CHA2DS2VASc FOR anti-coagulation tx (usually need it)

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Low BP + sinus bradycardia –> next best step?

Atropine

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what causes atrial tachycardia with second degree av block

digoxin )can also cause lots of other arrhythmias

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progressively lengthening of PR interval followed by a drop in QRS ?
next best step?

Mobitz type 1 weinkeback

no further intervention

*also seen in long distance athletes

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what is this? and what’s next best step?

complete AV block, dissociation between P waves and QRS
leads to decreased cardiac output, (thus sxms fatigue, weakness)

next best step cardiac pacing followed by pacemaker

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who do you see this in?
what’s usual sxms?
what’s next step?

mobitz type 1
P-R gets longer longer then drops.

AV node delayed conduction
asymptomatic
can see it in athletes, b-blockers, or structural heart changes

–> observation

vs mobitz 2 constant P-R then sudden drop

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what is this d/t?
what is the best next step and why? (2)

sine wave d/t hyperkalemia

tx with calcium gluconate to stabilize cardiac membranes
and then with insulin and glucose to drive the K back into cells

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young male syncope episode
T-wave inversion on EKG
d/t?
will likely see (2)?
dx?
tx?

cause of death?

HOCM
AD - sarcomere (myosin binding) protein
1) LVOT
2) ischemia induced ventricular tachycardia: O2 supply mismatch (increase in O2 demand d/t more muscle mass & decrease in O2 supply due to myocardial disarray with microvascular dysfunction)
dx: echocardiography
tx: b-blockers or non-di’s (verapamil/diltiazam) to get more LV blood volume

cause of death: ventricular arrhythmia

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syncope vs seizure – tongue biting?

syncope: frontal tongue biting

seizure: lateral tongue biting

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elderly patient
bradycardia or w/ a-fib
ekg: sinus bradycardia, sinus pauses (delayed p waves), sinoatrial nodal exit block ( dropped p waves)
what is it ?
what is it due to?

sick sinus syndrome
age related degeneration of cardiac conduction system w/ fibrosis of sinus node

cardiac conduction system degeneration

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young patient with rapid heart beat and regular**

tx?

AVNRT: (paroxysmal supraventricular tachycardia)
TWO distinct conduction pathways in the atrioventricular node

accessory pathways avoiding AV node: WPW

p waves buried in the complex
narrow QRS

tx: adenosine – interrupts the AV nodal reentry circuit

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any patient with NARROW QRS complex and tachycardia what to give them?

supraventricular tachycardia:
give ADENOSINE

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hemodynamically NOT stable + tachycardia
management?

SYNCHRONIZED CARDIOVERSION

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What is this?
next step?

Ventricular fibrillation

next step: DEFIBRILLATION**

only defibrillation if its in V-fib or pulseLESS v-tachy

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Sudden cardiac death with pt hx of MI or EF <30% is?

VENTRICULAR ARRHYTHMIA

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what is this ? next best step?

QT prolongation --> torsades de pointes next step: MAGNESIUM SULFATE

what is this? next best step in Hemostable vs hemoUnstable?

monomorphic ventricular tachycardia regular wide complex tachycardia stable: amiodarone unstable WITH pulse : synchronized cardio version

intermittent, prominent A waves with high JVP

canon A waves d/t atrioventricular dissociation

WPW hemo unstable hemo stable

unstable: electrical cardio version stable: ibutilide or procainamide

cocaine induced MI next best step?

give benzodiazepines: for agitation anxiety then aspiring for platelet aggregation nitroglycerin and CCB for vasoconstrictive pain

nitrates: ____ preload ____ left ventricular end-diastolic volume ____ myocardial oxygen demand

lowers preload lowers ventricular end diastolic volume lowers myocardial oxygen demand by reducing wall stress

stable angina first line therapy

B-blockers -- decrease myocardial contractility

pt with atypical angina (suspecting stable ischemic heart disease) what is the initial best step?

Exercise EKG

pt <50yo, smoker, recurrent chest pain at rest or sleep, with spontaneous resolution ekg: ST elevation Coronary angio: negative what is it ? best preventative tx? best abortive tx?

vasospastic angina d/t: hyperactivity of intimal smooth muscle causing coronary artery vasospasm tx: prev- Calcium Channel Blocker (diltiazam, verapamil) abortive: sublingual nitroglycerin

acsvd ___ % > start on :

7.5% statin

leads ii, iii, aVF st elevation _____ MI involves the ___ ventricle ____ CONFIRMS R ventricular MI ____ RV preload _____ LV preload ____ SVR

inferior wall MI effects R ventricle V4R confirms RVMI -- right sided precordial EKG increase in RV Preload decrease in LV Preload increase in SVR

pt with MI (ST elevation) with bibasilar crackles in lungs next best step?

pulmonary edema with MI emergency PCI loop diuretic Furosemide (but not with hypotension)

medication management for MI

diffuse ST segment elevation after an MI episode (1mo ago)

post cardiac injury dressler syndrome tx: NSAID in form of high dose aspirin +/- colchicine

what S_ do you hear in acute phase of MI

S 4 d/t left ventricular stiffening and impaired relaxation induced by MI

MI then bibasilar lung sounds with deep Q waves

left ventricular aneurysm

pleuritic chest pain

costochondritis, pericarditis, malignancy, pneumonia, pulmonary embolism

poor heart failure prognosis ?

hyponatremia volume overload + low cardiac output --> decreased renal perfusion --> kidneys think low perfusion is hypovolemia --> activate RAAS --> CAUSING HYPONATREMIA

progressive dyspnea hypoxemia diffuse pulmonary crackles S3 (low pitched, early diastolic sound)

decompensated heart failure

decompensated heart failure + symptoms of cardiogenic shock : medication: effect:

dobutamine B1>b2 positive ionotropic effect: increases contractility --> higher left ventricular stroke volume --> DECREASED LEFT VENTRICULAR END-SYSTOLIC VOLUME--> increase in EF positive chronotropic effect: increases heart rate

heart failure medication: furosemide's effect on renal

reduces central venous and renal venous pressure improving cardiac output increases GFR

initial management of acute decompensated heart failure:

1) clinical stability 2) reduce preload 3) investigate precipitating factors

what sound do you hear with CHF?

S3 gallop

highly SENSITIVE for heart failure ?

serum BNP > 100

pericardial friction rub s/p MI 3 days ago what could prevent it ? tx?

acute pericarditis can also be due to uremic pericarditis bun> 60 early coronary repercussion NSAID and colchicine

fatigue, exertion dyspnea, lower extremity swelling with no pulmonary edema: concentric thickened ventricular walls and diastolic dysfunction

R- sided heart failure restrictive cardiomyopathy can be d/t insoluble protein fibrils amyloid

fatigue, exertion dyspnea, lower extremity swelling with no pulmonary edema: concentric thickened ventricular walls and diastolic dysfunction

R- sided heart failure restrictive cardiomyopathy can be d/t insoluble protein fibrils amyloid

high PCWP low CI low PCWP low CI

cariogenic shock: MI obstructive: pulmonary embolism

causes of high output heart failure how does it effect cardiac output

1) peripheral vasodilation d/t unmet metabolic demand 2) increased # of peripheral vessels 3) bypass of systemic arteriolar resistance d/t enlarged av fistula decrease in SVR leads to Increase in cardiac output and increase in venous return thus increase in preload

difference between R ventricular failure and liver cirrhosis

right ventricular failure resulting FROM pulmonary pathology (COPD, PE) elevate pulmonary artery systolic pressure greater than >____ what do you hear?

cor pulmonale >25 mmHg pulmonary artery systolic pressure loud P2

dyspnea, orthropnea, bibasilar lung crackles, and lower extremity edema with normal EF

heart failure with preserved ejection fraction from DIASTOLIC DYSFUNCITON (impaired relaxation with decreased compliance) concentric hypertrophy d/t chronic hypertension or obesity

pt with Hodgkin's lymphoma, received chemo, now has biatrial enlargement, normal ventricular wall and cavity size

constrictive pericarditis

young pt with viral prodrome dilated ventricles with diffuse hypokinesis

dilated cardiomyopathy (viral myocarditis )

young pt 30s with HTN and bilateral contender upper abdominal masses palpable what is it? next step?

AD polycystic kidney disease abdominal ultrasound

HTN medication in pt with gout

losartan avoid diuretics

HTN medication in pt with osteoporoisis

chlorthalidone or any other thiazide

Pt with SOB, tricuspid regurgitation (systolic murmur at lower sternal boarder increases with inspiration), right ventricular dilation + LV dysfunction (ef 30%) and crackles (volume overload) suggestive of : management:

Pulmonary HTN d/t left sided heart failure management: HF combination drug therapy (renin-angiotensin inhibitor, b-blocker, diuretic)

67M with onset of HTN, upper abdominal systolic diastolic bruit dx:

Renal Artery stenosis Doppler U/S, CT-A, MR-A

25F with transient vision loss, onset of HTN, bruit at mandibular angle, renin high, aldosterone:renin high next step:

Fibromuscular dysplasia FMD amauris fugax - either CT-A of abdomen or ultrasound

pounding heart worse with laying on side waterhammer pulse

aortic regurgitation pounding pulse d/t larger left ventricle

diastolic and continuous murmur early gradually decreasing (decrescendo) diastolic murmur that begins immediately after A2 high pitched blowing along the left sternal border at 3/4th intercostal space sitting up leaning forward with full expiration

aortic regurgitation

harsh systolic, crescendo-decrescendo murmur at R upper sternal border with radiation to carotid arteries if young: bicuspid aortic valve if >70y/o senile calcific aortic valve

aortic stenosis

diminished delayed carotid pulses: pulsus parvus et trades late peaking, crescendo-decrescendo systolic murmur soft and single S2 during inspiration

severe aortic stenosis

diminished delayed carotid pulses: pulsus parvus et trades late peaking, crescendo-decrescendo systolic murmur soft and single S2 during inspiration weak and slow rising carotid pulse

severe aortic stenosis

wide splitting of A2 to P2 vs narrow splitting of A2 to P2

pulmonic stenosis pulmonary HTN RBBB, ASD aortic stenosis systemic HTN LBBB, HCM

73M with episodes of dyspnea on exertion, syncope, pre-syncope, LV hypertrophy on EKG what is this? d/t? next step?

aortic stenosis d/t calcific disease do an echocardiography USUALLY d/t coronary artery disease

what indicates severe aortic stenosis

valve area <1cm2

pt with prosthetic heart valve: dental procedure prophylactic abx:

30-60 min prior to procedure oral amoxicillin to reduce strep viridian's if undergoing surgery skin soft tissue: give IV vancomycin for staph bacteremia

holoSYSTOLIC murmur that INCREASES on inspiration

tricuspid regurgitation in infective endocarditis with possible emboli to the lungs s/p IV DRUG USE multiple round nodular opacities w/ or w/o cavitation

Loud S3

Mitral regurgitation dilated heart

concentric LV hypertrophy d/t systemic HTN or aortic stenosis

opening snap with mid diastolic rumble at apex early diastolic sound followed by mid diastolic murmur

mitral stenosis

holosystolic murmur loudest at apex radiates to axilla

mitral regurgitation -myxomatous degeneration of mitral valve can cause MR

ascending aorta dissection and now have bibasilar crackles, S1 is soft, P2 loud, and S3 gallop

d/t aortic valve insufficiency AR

ascending aortic dissection vs descending aortic dissection treatment ?

ascending --> TEE OR CT-A to confirm --> surgery descending --> labetolol and/or nitroprusside if SBP>120

bradycardia, hypotension leading to cariogenic shock (cold/clammy) + hypoglycemia, bronchospasm/wheezing refractory to atropine what next?

b-blocker overdose CCB, digoxin, or cholinergic similar presentation but no wheezing give glucagon (increases cAMP)

AE: weight gain and worsening glucose tolerance (leading to higher insulin secretion from pancreas)

b-blockers

AE: peripheral edema

calcium channel blockers vasodilatory effects leading to increased pressure and capillary permeability

cyanide toxicity (nitroprusside) treatment

management of HOCM

AE: pulmonary infiltrates, or hepatocellular damage

day 4 post MI, pt has harsh loud holosystolic murmur along Left sternal border with palpable thrill

inter ventricular septum rupture

ST elevated in aVF & II III

inferior wall STEMI: RCA

ST elevated aVL & v's

LAD infarct

hypovolemic shock CVP PVWP CI SVR SvO2

CVP -- LOW PVWP -- LOW CI -- LOW SVR -- hiiiiiiighhh* SvO2 -- low

cardiogenic shock

CVP -- HIGH PVWP -- HIGH CI -- LOOOWW* SVR -- HIGH SvO2-- low

biatrial enlargement

constrictive pericarditis -- inelastic pericardium

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cardiology uworld Flashcards

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