Cardiovascular Flashcards
1
Q
What CHADS2 score requires anticoagulation?
A
Greater than 2
2
Q
Apixaban drug class
A
Non vitamin k antagonist oral anticoagulant (NOAC)
3
Q
Enlarged cardiothoracic ratio could be due to (4)
A
Enlarged heart, pericardial effusion , elevated diaphragm, narrow chest width
4
Q
Left atrial enlargement signs on CXR
A
Straight left heart border, double bubble right border
5
Q
Heart perfusion stress testing
A
Exercise, persantine (dipyridamole), dobutamine
6
Q
S1 sound is caused by
A
Mitral and tricuspid valve closure
7
Q
S2 heart sound is caused by
A
Aortic and pulmonary valve closure
8
Q
S1 qualities
A
High frequency, best heart in left lower sternal border or mitral area at apex
9
Q
S2 best heard at
A
Upper left and right sternal border
10
Q
S3 heart sound: 1. Pitch. 2. Due to?
A
- Low pitched at the apex. 2. Due to increased flow from volume overload
11
Q
S4 heart sound
A
Atrial kick, at apex and low pitched
Caused by LVH or ischemia, atrium contracts against stiff ventricle
12
Q
Diastolic murmurs include
A
Mitral stenosis, severe mitral regurgitation, aortic regurgitation
13
Q
Steth side for each pitch?
A
With high frequency use diaphragm, low frequency use bell
14
Q
Inspiration increases what murmur
A
A right sided (pulmonary) murmur due to increased venous return during inspiration
15
Q
Standing increases what murmurs
A
MVP and HOCM
16
Q
Squatting decreases which murmurs
A
MVP and HOCM
17
Q
Valsalva changes murmurs
A
By decreasing cardiac filling, accentuating HOCM and MVP
18
Q
Reguritant murmurs
A
LS - mitral regurg, ventricular septal defect
RS - tricuspid regurg
19
Q
Triad of symptoms associated with aortic stenosis
A
Angina, syncope, dyspnea
20
Q
Sustained apex beat can occur due to
A
LVH
21
Q
Peripheral findings of tricuspid regurg
A
Ascites, pulsatile liver, peripheral edema
22
Q
Causes of JVP distention PQRST
A
Pericardial effusion, quantity of volume, RS heart failure, SVC obstruction, tricuspid stenosis or regurg
23
Q
Normal JVP height
A
<4cm
24
Q
Aortic valve location for auscultation
A
2nd ICS, R sternal border
25
Tricuspid valve location for auscultation
5th ICS, L sternal border
26
Apex beat, Mitral valve, PMI location for auscultation/palpation
5th ICS, mid clavicular line
27
Things to note on palpation of apex beat (LSAD)
Location (5 ICS, MCL), size coin, amplitude, duration
28
Normal grade of pulse
2
29
JVP demonstrates
Fluid status, central venous pressure, right atrial pressure
30
Eliciting the JVP
Patient looks to the left, tangential light between two heads of SCM muscle, look for double waveform
31
Apixaban, Dabigatran, Rivoroxaban, Edoxaban are all what type of drug?
NOAC
32
Normal JVP distance
Less than 4cm
33
Hepatojugular reflex
Apply pressure to liver for 10s, sustained JVP rise after 2 breaths is pathological
34
S1
MT closures
35
S2
AP closures, higher pitched
36
Type A aortic dessection
Ascending aorta and possibly the aortic valve
37
Type B aortic dissection
Descending thoracic distal to the left subclavian
38
Mainstay of treatment for a type B aortic dissection
Medical management with blood pressure and pulse pressure control
39
Patient with confirmed STEMI should be started on
ASA, platelet inhibitor, anticoagulant, and a high dose statin
40
Give o2 to a patient with a STEMI when stats drop to
Below 90
41
Treating chest pain in a patient with a STEMI
Nitroglycerin
42
When should you measure troponin?
6+ hours after onset of chest pain, and 2 samples 2 hrs apart
43
What meds should be started in a patient recovering from STEMI? (No longer in danger)
Beta blocker (metropolol), ACE inhibitor
44
Structural defects in tetralogy of fallot
VSD, pulmonary stenosis, overriding aorta, and RVH
45
Natural history for tetralogy of fallot
Progression of pulmonary stenosis and cyanosis
46
Congenital heart diseases in patients with Down syndrome
AVSD (45%), VSD(20%), TOF, PDA
47
Beta blockade and orthostatic hypotension
Beta blockade inhibits the baroreceptors response and so there isnt the usual rise in HR you might expect with standing
48
Sotalol is used to control
Rhythm
49
Stage three pressure ulcer
Through dermis, no bone exposed
50
Orthostatic hypotension testing indicated for
Syncope, heart problems in the past
51
To test for orthostatic hypotension, measure BP
Laying down, sitting, standing
52
Shock is defines as
Cellular and tissue hypoxia due to recused oxygen delivery/consumption/utilization
53
Types of distributive shock
Septic, SIRS, neurogenic, anaphylactic, toxic
54
Cardiogenic shock may be due to
MI, arrhythmia, valve or septal rupture, outflow obstruction
55
Hypovolemic shock can be due to
Hemorrhage or other fluid losses
56
Obstructive shock can be due to
PE, pulmonary hypertension, tension pneumothorax, constrictive pericarditis, restrictive cardiomyopathy
57
Features highly suspicious of shock
Hypotension, tachycardia, oliguria, abnormal mentation, tachypnea, cool/clammy/cyanotic skin, metabolic acidosis, high lactate
58
Absolute hypotension
Systolic <90 mmHg, MAP <65 mmHg
59
Relative hypotension
A drop in systolic BP >40 mmHg
60
Orthostatic hypotension definition
>20 mmHg fall in systolic or >10 mmHg fall in diastolic pressures with standing
61
Approach to the hypotensive patient very first steps
Airway, IV access, breathing and circulation
62
Hypotensive emergency IV access should be
Peripheral venous access with 14 to 18 gauge catheters or intraosseous access
63
Typical adult dose of epinephrine
0.3mg injected every 5-15 minutes as needed
64
Workup of strongly suspected tension pneumothorax
Skip the chest radiograph and go straight for an emergent tube thoracostomy
65
Cardiac preload
The stretch in ventricles just before contraction, estimated by end diastolic volume (immediately after filling)
66
What is the cardiac afterload? How can we estimate it?
Cardiac afterload is the resistance that must be overcome for the ventricle to contract.
It is approximated by the systolic ventricular pressure.
67
Ejection fraction
Fraction of the end-diastolic volume ejected with systole
68
Normal range for ejection fraction
55-75%
69
Cardiac output calculated by
SV x HR
70
Cardiac output is
The volume of blood ejected from the ventricle per minute
71
Resting cardiac output in men and women
Men is about 5.6L/min, women 4.9L/min
72
The intrinsic ability of the heart to adapt to increasing volumes of inflowing blood is called
The frank starling mechanism of the heart
73
How does increase peripheral resistance affect cardiac output?
It decreases the cardiac output
74
How does decreased peripheral resistance affect cardiac output?
It increases cardiac output
75
What kind of nervous stimulation increases cardiac output
Sympathetic stimulation and parasympathetic inhibition
76
Beriberi disease is caused by
Thiamine (B1) deficiency
77
How does hyperthyroid affect cardiac output
It increased venous return and cardiac output
78
Low cardiac output is caused by abnormalities that
Decrease pumping effectiveness of the heart, or decrease venous return
79
Low cardiac output can be due to low preload as a result of
Hemorrhage, dehydration
80
Low cardiac output due to obstruction can occur cause of
External cardiac compression (pneumothorax, pericardial tamponade)
81
4 classes of shock
Distributive, obstructive, cardiogenic, hypovolemic
82
Distributive shock differs clinically because
Extremities are warm to the touch cx
83
Initial treatment of narrow-QRS-complex tachycardia
IV adenosine
84
Signs of hemolytic anemia
Increased bilirubin, LDH and reticulocytes. Decreased hemoglobin and haptoglobin
85
Management of delayed hemolytic transfusion reaction
Supportive (e.g. fluids)
86
Onset of delayed hemolytic transfusion reactions occur
More than 24 hrs, and up to a month post transfusion
87
What is a typical iron level for someone with sickle cell disease
Iron overload due to frequent transfusions
88
Why is a patient with sickle cell disease at high risk of delayed hemolytic transfusion reactions?
Alloimmunization from frequent transfusions
89
How can the diagnosis of delayed hemolytic transfusion reaction be confirmed?
A newly positive Coombs test
90
Ascending aortic dissection is type
A
91
Descending aortic dissection is type
B
92
Pulmonary edema in patients with acute decompensated heart failure should be treated with
Preload reduction by IV diuretic like furosemide
93
What percent of people are right coronary artery dominant? (RCA supplies the PDA)
>65% RCA dominant
94
SA node sets pace at
60 BPM
95
AV node sets pace at
40 BPM
96
AV bundle sets pasce at
20 BPM
97
Sympathetic cardiac nerves increase
HR and force of contraction
98
Tricuspid valve between which two chamber
RA to RV
99
Mitral valve between which two chambers
LA to LV
100
Anisotropy is
The preferential conduction of electricity along certain directions
101
Circle of Willis is an anastomoses
Between vertebral artery and internal carotid artery at the base of the brain
102
Fetal circulation bypasses
The lungs and liver
103
ECG p wave represents
Atrial depolarization
104
QRS complex represents
Ventricular depolarization (mostly the left)
105
T waves represent
Ventricular repolarization
106
RRIAHI stands for (in ECG)
Rate rhythm interval axis hypertrophy and ischemia/infarction
107
NSR ranges from
60-100BPM for an adult
108
Rate on ECG can be calc by
Number of beats x 6
109
Prolonged PR interval on ECG indicates
First degree heart block
110
RBBB looks like
Bunny ears
111
Leads I and II positive, what axis
Normal
112
Leads I and II negative, what axis
RAD or NW
113
Lead 1 negative, what axis?
RAD
114
Lead 2 negative, what axis?
LAD
115
Tall p waves aka
P pulmonale (RAE)
116
M shaped p waves aka
P mitrale (LAE)
117
The mitral valve is open during
Diastole
118
What heart rate is bad for mitral stenosis
Fast ones
119
Aortic valve is open during
Systole
120
Aortic regurg is the
Leak of blood from aorta back to LV during diastole, we want enough time for the atria to fill before valve opens
121
For someone that has aortic regurg, which speed of heart rates are bad?
Slow ones, need to pump before it all flows back
122
Kerley B lines on CXR
Pulmonary edema
123
Septal leads
V1 V2
124
No discernible p waves
A fib
| `
125
What can hyperkalemia do to the PR interval?
Prolong the PR interval
126
T waves in hyperkalemia
Peaked
127
Bunny ears V1-V3
RBBB
128
The most common ECG abnormality for pulmonary embolism is
Sinus tachycardia
129
Atrial tachyarrhythmias include
Atrial fibrillation, atrial flutter, atrial tachycardia
130
Losing the atrial kick is extra detrimental in
Heart failure
131
Sudden shortness of breath during sleep
Paroxysmal nocturnal dyspnea
132
Sensation of breathlessness in recumbent position
Orthopnea
133
Hyperkalemia ECG
PR prolongation, M shaped p waves, peaked T waves
134
Peaked T waves occur in
Hyperkalemia, hyperacute STEMI
135
Negative axis in leads I and II
NW or RAD
136
Compensated heart failure occurs when
The heart works well enough to compensate without showing systemic symptoms
137
Kerley B lines are indicative of what diagnosis
congestive heart failure, pulmonary edema
138
Blunting of costophrenic angles on CXR may indicate
Pleural effusion
139
Vascular redistribution to the upper lung zones occurs in
Congestive heart failure
140
MONA BASH for ACS treatment
Morphine O2 Nitrates ASA
| BBlockers, Ace Is, Statins, Heparin (Clopidogrel)
141
Investigating a suspected MI
EKG, Troponins stat
142
2 characteristics of sub sternal pain associated with ACS
Worse with exertion, relieved by nitroglycerin
143
Treating mitral stenosis
Balloon valvuloplasty, replacement
144
Aortic insufficiency treatment
Replacement, CABG
145
Mitral insufficiency treatment
Replacement
146
Aortic stenosis treatment
Replacement, CABG
147
Wide QRS complex indicates what rhythm?
Ventricular
148
Narrow QRS complex indicates what kind of rhythm
Atrial
149
An arrhythmia with no symptoms should be treated with
Nothing - just supportive care (IV, O2, Monitor)
150
Characteristics of an unstable heart rhythm
Chest pain, SOB, altered mental status, hypotension
151
How to treat an unstable arrhythmia
Electricity
152
A patient with stable arrhythmia can be treated with
Pharmacotherapy
153
If an arrhythmia is fast and unstable treat with
Shock
154
If an arrhythmia is slow and unstable treat with
Pacemaker
155
Stable arrhythmia that is fast and narrow (atrial arrhythmia), medication
Adenosine
156
Stable arrhythmia thats fast and wide (ventricular) treat by
Amiodarone
157
Stable arrhythmia that is slow is treated with
Atropine
158
Afib/flutter is treated with
Rate control via beta blocker, CCB
159
SVT is narrow and fast with a loss of p waves, its treated by
Adenosine
160
Ventricular tachycardia is wide and regular, it can be treated by
Amiodarone
161
Cardioverting an AFIB that’s lasted >48 hrs runs the risk of
Embolism and stroke
162
Sinus bradycardia responds to drug
Atropine
163
2nd degree heart block type II, and 3rd degree heart block are treated by
Pacing
164
Total AV node dissociation is called
3rd degree AV block
165
Shocking the heart is indicated only in
VTac/Vfib arrest
166
VT/Vfib treatment
Epi + 2 min CPR, shock, REPEAT
167
Symptoms of hypertrophic cardiomyopathy are
Shortness of breath, angina, sudden death in athletes
168
Medical treatment for restrictive cardiomyopathy includes
Gentle diuresis and heart rate control
169
Bad cholesterol
LDL
170
Good cholesterol
HDL
171
Vascular disease (stroke, CAD, PVD, carotid stenosis) or LDL >190 should be treated with
High intensity statins (atorvastatin or rosy a statin)
172
High intensity statin examples
Atorvastatin or rosuvastatin
173
If a patient has LDL 70-190, 40-75YO, and diabetic or high risk they get
Statins
174
Myositis presents with
Soreness, weakness, muscle pain
175
Hepatitis presents with
RUQ pain, jaundice
176
Risk factors for coronary artery disease
Diabetes, smoking, hypertension, dyslipidemia, >55YO woman, >45 YO men
177
A1C should be monitored
Every 3m in diabetics
178
Statin myositis treatment
Stop it and start a lower dose
179
Statin hepatitis treatment
Stop statin and start a lower dose
180
Statins decrease
LDL and triglycerides
181
Side effects of statins
Myositis, increased LFTs
182
Second line meds to statins are
Fibrates
183
Statin alternative that causes flushing
Niacin
184
Treat niacin flushing with
Aspirin prophylaxis
185
Stable vs unstable angina
Stable has pain with exercise and relief with rest and nitrates
Unstable has pain at rest, no relief with meds
186
Risk factors for all vascular diseases are
Diabetes, smoking, hypertension, dyslipidemia, obesity, age, FHx
187
Identification of STEMI goes to
Emergent cath
188
Identification of NSTEMI goes to
Urgent cath
189
Prinzmetals angina is
Clean coronary arteries producing ischemia as a product of vasospasm
190
Prinzmetals angina is treated with
Calcium channel blockers
191
3 types of reflex syncope
Vasovagal, situational, carotid hypersensitivity
192
Syncope with a trigger, and prodrome
Vasovagal
193
Syncope with micturition, defecation, swallow, cough
Situational reflex syncope
194
Tactile stimulation of the carotid sinus plus syncope is called
Carotid hypersensitivity reflex syncope
195
Medications that can cause orthostatic syncope
Vasodilators (alpha1 blockers, antihypertensives), ionotropic/chronotropic blockade (beta blockers)
196
3 main causes of orthostatic syncope
Medications, hypovolemia, autonomic dysfunction
197
3 main causes of cardiac syncope
LV outflow obstruction, ventricular tachycardia, conduction impairment
198
Increased afterload worsens which murmur?
Mitral regurg
199
Grading scale for diastolic murmurs
1-4
200
Grading scale for systolic murmurs
1-6
201
Mitral stenosis murmur is
Diastolic
202
Aortic stenosis murmur is
Systolic
203
Chronic, severe tricuspid regurg presents with
Right sided heart failure
204
Which rhythms are shockable?
Ventricular fibrillation and pulseless ventricular tachycardia
205
In a tachycardic emergency if the rhythm is regular with narrow complexes consider
Adenosine
206
What is the dosage of adenosine for tachyarrhytmia
6mg IV rapid push
207
If a patient is in ventricular tachycardia with wide complexes on the heart monitor, what steps should the provider take?
Establish IV access, obtain ECG, consider using adenosine
208
In vtac, if the complexes are narrow
Try vagal maneuvers, adenosine 6mg IV rapid push if rhythm is regular
209
Synchronized cardioversion dose for regular and irregular rhythms are
50-100J, 100-200J
210
Adenosine first and second dose
First dose 6mg IV followed by saline flush, second dose 12mg IV rapid push
211
Greatest BP decrease by lifestyle change is seen with
DASH diet
212
Preferred anti hypertensive for patients with gout
Losartan (mild uricosuric effect)
213
Best antihypertensive for LVH
ARBs
214
Target diastolic BP for a diabetic
Less than 80
215
Two drug types important in chronic heart failure
ACE inhibitors and beta blockers
216
Diagnosing hypertension
At least 3 readings 140/90 or higher
217
Treating hypertension with DMT1
ACE inhibitor preferred
218
Treating HTN in heart failure
ACE inhibitors and diuretics
219
Treating hypertension in MI
Beta blockers and ACE inhibitors
220
Treating hypertension in someone with kidney disease
ACE inhibitors and ARBs
221
Which antihypertensives are not okay in pregnancy
ACE inhibitors because they are teratogenic
222
Treating hypertension in migraine patients
Beta blockers can be helpful
223
1st line medical treatment for hypertension in someone with osteoporosis
Thiazide diuretics - can help increase calcium reabsorption
224
Labetalol drug class is
Combination alpha beta blocker
225
Most common side effect of ace inhibitors is
Cough bradykinin induced
226
Some patients who are allergic to sulfonamides are also allergic to
Hydrochlorothiazide
227
Thiazide diuretics can have 6 metabolic side effects
High glucose, uric acid, lipids
| Low magnesium, sodium, potassium
228
What antihypertensive should be avoided in asthmatics
Beta blockers - bronchoconstriction and wheezing
229
Why is HCTZ contraindicated in gout
May raise uric acid levels
230
Treatment of atrial premature beats
No treatment - just investigate the cause
231
Treatment for PSVT when the patient is stable
Vagal maneuvers and adenosine
232
Pulmonary embolism is suggested by the triad of
Cough, hemoptysis, and pleuritic chest pain
233
Patients with VTE and contraindication to anticoagulation should get
IVC filter
234
Crescendo decrescendo systolic murmur, left upper sternal border
Pulmonary stenosis
235
What CHADS2 score requires anticoagulation?
Greater than 2
236
What CHADS2 score requires anticoagulation?
Greater than 2
237
What CHADS2 score requires anticoagulation?
Greater than 2
238
Apixaban drug class
Non vitamin k antagonist oral anticoagulant (NOAC)
239
Apixaban, Dabigatran, Rivoroxaban, Edoxaban are all what type of drug?
NOAC
240
Stable patients should recieve packed red blood cell transfusion for Hgb less than
7g/dL
241
Managing variceal bleeding
Somatostatin analogs like octreotide
242
Treatment of AF in patients with WPW who are hemodynamically unstable require
Electrical cardioversion
243
Treatment of AF in patients with WPW who are stable require
Anti-arrhythmic drugs like IV ibutilide or procrainamide
244
Adenosine, beta blockers, calcium channel blockers all block which electrical pacemaker in the heart?
AV node
