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Clerkship Prep > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What CHADS2 score requires anticoagulation?

A

Greater than 2

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2
Q

Apixaban drug class

A

Non vitamin k antagonist oral anticoagulant (NOAC)

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3
Q

Enlarged cardiothoracic ratio could be due to (4)

A

Enlarged heart, pericardial effusion , elevated diaphragm, narrow chest width

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4
Q

Left atrial enlargement signs on CXR

A

Straight left heart border, double bubble right border

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5
Q

Heart perfusion stress testing

A

Exercise, persantine (dipyridamole), dobutamine

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6
Q

S1 sound is caused by

A

Mitral and tricuspid valve closure

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7
Q

S2 heart sound is caused by

A

Aortic and pulmonary valve closure

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8
Q

S1 qualities

A

High frequency, best heart in left lower sternal border or mitral area at apex

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9
Q

S2 best heard at

A

Upper left and right sternal border

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10
Q

S3 heart sound: 1. Pitch. 2. Due to?

A
  1. Low pitched at the apex. 2. Due to increased flow from volume overload
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11
Q

S4 heart sound

A

Atrial kick, at apex and low pitched

Caused by LVH or ischemia, atrium contracts against stiff ventricle

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12
Q

Diastolic murmurs include

A

Mitral stenosis, severe mitral regurgitation, aortic regurgitation

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13
Q

Steth side for each pitch?

A

With high frequency use diaphragm, low frequency use bell

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14
Q

Inspiration increases what murmur

A

A right sided (pulmonary) murmur due to increased venous return during inspiration

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15
Q

Standing increases what murmurs

A

MVP and HOCM

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16
Q

Squatting decreases which murmurs

A

MVP and HOCM

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17
Q

Valsalva changes murmurs

A

By decreasing cardiac filling, accentuating HOCM and MVP

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18
Q

Reguritant murmurs

A

LS - mitral regurg, ventricular septal defect

RS - tricuspid regurg

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19
Q

Triad of symptoms associated with aortic stenosis

A

Angina, syncope, dyspnea

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20
Q

Sustained apex beat can occur due to

A

LVH

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21
Q

Peripheral findings of tricuspid regurg

A

Ascites, pulsatile liver, peripheral edema

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22
Q

Causes of JVP distention PQRST

A

Pericardial effusion, quantity of volume, RS heart failure, SVC obstruction, tricuspid stenosis or regurg

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23
Q

Normal JVP height

A

<4cm

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24
Q

Aortic valve location for auscultation

A

2nd ICS, R sternal border

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25
Q

Tricuspid valve location for auscultation

A

5th ICS, L sternal border

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26
Q

Apex beat, Mitral valve, PMI location for auscultation/palpation

A

5th ICS, mid clavicular line

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27
Q

Things to note on palpation of apex beat (LSAD)

A

Location (5 ICS, MCL), size coin, amplitude, duration

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28
Q

Normal grade of pulse

A

2

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29
Q

JVP demonstrates

A

Fluid status, central venous pressure, right atrial pressure

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30
Q

Eliciting the JVP

A

Patient looks to the left, tangential light between two heads of SCM muscle, look for double waveform

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31
Q

Apixaban, Dabigatran, Rivoroxaban, Edoxaban are all what type of drug?

A

NOAC

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32
Q

Normal JVP distance

A

Less than 4cm

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33
Q

Hepatojugular reflex

A

Apply pressure to liver for 10s, sustained JVP rise after 2 breaths is pathological

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34
Q

S1

A

MT closures

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35
Q

S2

A

AP closures, higher pitched

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36
Q

Type A aortic dessection

A

Ascending aorta and possibly the aortic valve

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37
Q

Type B aortic dissection

A

Descending thoracic distal to the left subclavian

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38
Q

Mainstay of treatment for a type B aortic dissection

A

Medical management with blood pressure and pulse pressure control

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39
Q

Patient with confirmed STEMI should be started on

A

ASA, platelet inhibitor, anticoagulant, and a high dose statin

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40
Q

Give o2 to a patient with a STEMI when stats drop to

A

Below 90

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41
Q

Treating chest pain in a patient with a STEMI

A

Nitroglycerin

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42
Q

When should you measure troponin?

A

6+ hours after onset of chest pain, and 2 samples 2 hrs apart

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43
Q

What meds should be started in a patient recovering from STEMI? (No longer in danger)

A

Beta blocker (metropolol), ACE inhibitor

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44
Q

Structural defects in tetralogy of fallot

A

VSD, pulmonary stenosis, overriding aorta, and RVH

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45
Q

Natural history for tetralogy of fallot

A

Progression of pulmonary stenosis and cyanosis

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46
Q

Congenital heart diseases in patients with Down syndrome

A

AVSD (45%), VSD(20%), TOF, PDA

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47
Q

Beta blockade and orthostatic hypotension

A

Beta blockade inhibits the baroreceptors response and so there isnt the usual rise in HR you might expect with standing

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48
Q

Sotalol is used to control

A

Rhythm

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49
Q

Stage three pressure ulcer

A

Through dermis, no bone exposed

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50
Q

Orthostatic hypotension testing indicated for

A

Syncope, heart problems in the past

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51
Q

To test for orthostatic hypotension, measure BP

A

Laying down, sitting, standing

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52
Q

Shock is defines as

A

Cellular and tissue hypoxia due to recused oxygen delivery/consumption/utilization

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53
Q

Types of distributive shock

A

Septic, SIRS, neurogenic, anaphylactic, toxic

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54
Q

Cardiogenic shock may be due to

A

MI, arrhythmia, valve or septal rupture, outflow obstruction

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55
Q

Hypovolemic shock can be due to

A

Hemorrhage or other fluid losses

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56
Q

Obstructive shock can be due to

A

PE, pulmonary hypertension, tension pneumothorax, constrictive pericarditis, restrictive cardiomyopathy

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57
Q

Features highly suspicious of shock

A

Hypotension, tachycardia, oliguria, abnormal mentation, tachypnea, cool/clammy/cyanotic skin, metabolic acidosis, high lactate

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58
Q

Absolute hypotension

A

Systolic <90 mmHg, MAP <65 mmHg

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59
Q

Relative hypotension

A

A drop in systolic BP >40 mmHg

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60
Q

Orthostatic hypotension definition

A

> 20 mmHg fall in systolic or >10 mmHg fall in diastolic pressures with standing

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61
Q

Approach to the hypotensive patient very first steps

A

Airway, IV access, breathing and circulation

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62
Q

Hypotensive emergency IV access should be

A

Peripheral venous access with 14 to 18 gauge catheters or intraosseous access

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63
Q

Typical adult dose of epinephrine

A

0.3mg injected every 5-15 minutes as needed

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64
Q

Workup of strongly suspected tension pneumothorax

A

Skip the chest radiograph and go straight for an emergent tube thoracostomy

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65
Q

Cardiac preload

A

The stretch in ventricles just before contraction, estimated by end diastolic volume (immediately after filling)

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66
Q

What is the cardiac afterload? How can we estimate it?

A

Cardiac afterload is the resistance that must be overcome for the ventricle to contract.
It is approximated by the systolic ventricular pressure.

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67
Q

Ejection fraction

A

Fraction of the end-diastolic volume ejected with systole

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68
Q

Normal range for ejection fraction

A

55-75%

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69
Q

Cardiac output calculated by

A

SV x HR

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70
Q

Cardiac output is

A

The volume of blood ejected from the ventricle per minute

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71
Q

Resting cardiac output in men and women

A

Men is about 5.6L/min, women 4.9L/min

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72
Q

The intrinsic ability of the heart to adapt to increasing volumes of inflowing blood is called

A

The frank starling mechanism of the heart

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73
Q

How does increase peripheral resistance affect cardiac output?

A

It decreases the cardiac output

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74
Q

How does decreased peripheral resistance affect cardiac output?

A

It increases cardiac output

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75
Q

What kind of nervous stimulation increases cardiac output

A

Sympathetic stimulation and parasympathetic inhibition

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76
Q

Beriberi disease is caused by

A

Thiamine (B1) deficiency

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77
Q

How does hyperthyroid affect cardiac output

A

It increased venous return and cardiac output

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78
Q

Low cardiac output is caused by abnormalities that

A

Decrease pumping effectiveness of the heart, or decrease venous return

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79
Q

Low cardiac output can be due to low preload as a result of

A

Hemorrhage, dehydration

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80
Q

Low cardiac output due to obstruction can occur cause of

A

External cardiac compression (pneumothorax, pericardial tamponade)

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81
Q

4 classes of shock

A

Distributive, obstructive, cardiogenic, hypovolemic

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82
Q

Distributive shock differs clinically because

A

Extremities are warm to the touch cx

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83
Q

Initial treatment of narrow-QRS-complex tachycardia

A

IV adenosine

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84
Q

Signs of hemolytic anemia

A

Increased bilirubin, LDH and reticulocytes. Decreased hemoglobin and haptoglobin

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85
Q

Management of delayed hemolytic transfusion reaction

A

Supportive (e.g. fluids)

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86
Q

Onset of delayed hemolytic transfusion reactions occur

A

More than 24 hrs, and up to a month post transfusion

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87
Q

What is a typical iron level for someone with sickle cell disease

A

Iron overload due to frequent transfusions

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88
Q

Why is a patient with sickle cell disease at high risk of delayed hemolytic transfusion reactions?

A

Alloimmunization from frequent transfusions

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89
Q

How can the diagnosis of delayed hemolytic transfusion reaction be confirmed?

A

A newly positive Coombs test

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90
Q

Ascending aortic dissection is type

A

A

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91
Q

Descending aortic dissection is type

A

B

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92
Q

Pulmonary edema in patients with acute decompensated heart failure should be treated with

A

Preload reduction by IV diuretic like furosemide

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93
Q

What percent of people are right coronary artery dominant? (RCA supplies the PDA)

A

> 65% RCA dominant

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94
Q

SA node sets pace at

A

60 BPM

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95
Q

AV node sets pace at

A

40 BPM

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96
Q

AV bundle sets pasce at

A

20 BPM

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97
Q

Sympathetic cardiac nerves increase

A

HR and force of contraction

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98
Q

Tricuspid valve between which two chamber

A

RA to RV

99
Q

Mitral valve between which two chambers

A

LA to LV

100
Q

Anisotropy is

A

The preferential conduction of electricity along certain directions

101
Q

Circle of Willis is an anastomoses

A

Between vertebral artery and internal carotid artery at the base of the brain

102
Q

Fetal circulation bypasses

A

The lungs and liver

103
Q

ECG p wave represents

A

Atrial depolarization

104
Q

QRS complex represents

A

Ventricular depolarization (mostly the left)

105
Q

T waves represent

A

Ventricular repolarization

106
Q

RRIAHI stands for (in ECG)

A

Rate rhythm interval axis hypertrophy and ischemia/infarction

107
Q

NSR ranges from

A

60-100BPM for an adult

108
Q

Rate on ECG can be calc by

A

Number of beats x 6

109
Q

Prolonged PR interval on ECG indicates

A

First degree heart block

110
Q

RBBB looks like

A

Bunny ears

111
Q

Leads I and II positive, what axis

A

Normal

112
Q

Leads I and II negative, what axis

A

RAD or NW

113
Q

Lead 1 negative, what axis?

A

RAD

114
Q

Lead 2 negative, what axis?

A

LAD

115
Q

Tall p waves aka

A

P pulmonale (RAE)

116
Q

M shaped p waves aka

A

P mitrale (LAE)

117
Q

The mitral valve is open during

A

Diastole

118
Q

What heart rate is bad for mitral stenosis

A

Fast ones

119
Q

Aortic valve is open during

A

Systole

120
Q

Aortic regurg is the

A

Leak of blood from aorta back to LV during diastole, we want enough time for the atria to fill before valve opens

121
Q

For someone that has aortic regurg, which speed of heart rates are bad?

A

Slow ones, need to pump before it all flows back

122
Q

Kerley B lines on CXR

A

Pulmonary edema

123
Q

Septal leads

A

V1 V2

124
Q

No discernible p waves

A

A fib

`

125
Q

What can hyperkalemia do to the PR interval?

A

Prolong the PR interval

126
Q

T waves in hyperkalemia

A

Peaked

127
Q

Bunny ears V1-V3

A

RBBB

128
Q

The most common ECG abnormality for pulmonary embolism is

A

Sinus tachycardia

129
Q

Atrial tachyarrhythmias include

A

Atrial fibrillation, atrial flutter, atrial tachycardia

130
Q

Losing the atrial kick is extra detrimental in

A

Heart failure

131
Q

Sudden shortness of breath during sleep

A

Paroxysmal nocturnal dyspnea

132
Q

Sensation of breathlessness in recumbent position

A

Orthopnea

133
Q

Hyperkalemia ECG

A

PR prolongation, M shaped p waves, peaked T waves

134
Q

Peaked T waves occur in

A

Hyperkalemia, hyperacute STEMI

135
Q

Negative axis in leads I and II

A

NW or RAD

136
Q

Compensated heart failure occurs when

A

The heart works well enough to compensate without showing systemic symptoms

137
Q

Kerley B lines are indicative of what diagnosis

A

congestive heart failure, pulmonary edema

138
Q

Blunting of costophrenic angles on CXR may indicate

A

Pleural effusion

139
Q

Vascular redistribution to the upper lung zones occurs in

A

Congestive heart failure

140
Q

MONA BASH for ACS treatment

A

Morphine O2 Nitrates ASA

BBlockers, Ace Is, Statins, Heparin (Clopidogrel)

141
Q

Investigating a suspected MI

A

EKG, Troponins stat

142
Q

2 characteristics of sub sternal pain associated with ACS

A

Worse with exertion, relieved by nitroglycerin

143
Q

Treating mitral stenosis

A

Balloon valvuloplasty, replacement

144
Q

Aortic insufficiency treatment

A

Replacement, CABG

145
Q

Mitral insufficiency treatment

A

Replacement

146
Q

Aortic stenosis treatment

A

Replacement, CABG

147
Q

Wide QRS complex indicates what rhythm?

A

Ventricular

148
Q

Narrow QRS complex indicates what kind of rhythm

A

Atrial

149
Q

An arrhythmia with no symptoms should be treated with

A

Nothing - just supportive care (IV, O2, Monitor)

150
Q

Characteristics of an unstable heart rhythm

A

Chest pain, SOB, altered mental status, hypotension

151
Q

How to treat an unstable arrhythmia

A

Electricity

152
Q

A patient with stable arrhythmia can be treated with

A

Pharmacotherapy

153
Q

If an arrhythmia is fast and unstable treat with

A

Shock

154
Q

If an arrhythmia is slow and unstable treat with

A

Pacemaker

155
Q

Stable arrhythmia that is fast and narrow (atrial arrhythmia), medication

A

Adenosine

156
Q

Stable arrhythmia thats fast and wide (ventricular) treat by

A

Amiodarone

157
Q

Stable arrhythmia that is slow is treated with

A

Atropine

158
Q

Afib/flutter is treated with

A

Rate control via beta blocker, CCB

159
Q

SVT is narrow and fast with a loss of p waves, its treated by

A

Adenosine

160
Q

Ventricular tachycardia is wide and regular, it can be treated by

A

Amiodarone

161
Q

Cardioverting an AFIB that’s lasted >48 hrs runs the risk of

A

Embolism and stroke

162
Q

Sinus bradycardia responds to drug

A

Atropine

163
Q

2nd degree heart block type II, and 3rd degree heart block are treated by

A

Pacing

164
Q

Total AV node dissociation is called

A

3rd degree AV block

165
Q

Shocking the heart is indicated only in

A

VTac/Vfib arrest

166
Q

VT/Vfib treatment

A

Epi + 2 min CPR, shock, REPEAT

167
Q

Symptoms of hypertrophic cardiomyopathy are

A

Shortness of breath, angina, sudden death in athletes

168
Q

Medical treatment for restrictive cardiomyopathy includes

A

Gentle diuresis and heart rate control

169
Q

Bad cholesterol

A

LDL

170
Q

Good cholesterol

A

HDL

171
Q

Vascular disease (stroke, CAD, PVD, carotid stenosis) or LDL >190 should be treated with

A

High intensity statins (atorvastatin or rosy a statin)

172
Q

High intensity statin examples

A

Atorvastatin or rosuvastatin

173
Q

If a patient has LDL 70-190, 40-75YO, and diabetic or high risk they get

A

Statins

174
Q

Myositis presents with

A

Soreness, weakness, muscle pain

175
Q

Hepatitis presents with

A

RUQ pain, jaundice

176
Q

Risk factors for coronary artery disease

A

Diabetes, smoking, hypertension, dyslipidemia, >55YO woman, >45 YO men

177
Q

A1C should be monitored

A

Every 3m in diabetics

178
Q

Statin myositis treatment

A

Stop it and start a lower dose

179
Q

Statin hepatitis treatment

A

Stop statin and start a lower dose

180
Q

Statins decrease

A

LDL and triglycerides

181
Q

Side effects of statins

A

Myositis, increased LFTs

182
Q

Second line meds to statins are

A

Fibrates

183
Q

Statin alternative that causes flushing

A

Niacin

184
Q

Treat niacin flushing with

A

Aspirin prophylaxis

185
Q

Stable vs unstable angina

A

Stable has pain with exercise and relief with rest and nitrates
Unstable has pain at rest, no relief with meds

186
Q

Risk factors for all vascular diseases are

A

Diabetes, smoking, hypertension, dyslipidemia, obesity, age, FHx

187
Q

Identification of STEMI goes to

A

Emergent cath

188
Q

Identification of NSTEMI goes to

A

Urgent cath

189
Q

Prinzmetals angina is

A

Clean coronary arteries producing ischemia as a product of vasospasm

190
Q

Prinzmetals angina is treated with

A

Calcium channel blockers

191
Q

3 types of reflex syncope

A

Vasovagal, situational, carotid hypersensitivity

192
Q

Syncope with a trigger, and prodrome

A

Vasovagal

193
Q

Syncope with micturition, defecation, swallow, cough

A

Situational reflex syncope

194
Q

Tactile stimulation of the carotid sinus plus syncope is called

A

Carotid hypersensitivity reflex syncope

195
Q

Medications that can cause orthostatic syncope

A

Vasodilators (alpha1 blockers, antihypertensives), ionotropic/chronotropic blockade (beta blockers)

196
Q

3 main causes of orthostatic syncope

A

Medications, hypovolemia, autonomic dysfunction

197
Q

3 main causes of cardiac syncope

A

LV outflow obstruction, ventricular tachycardia, conduction impairment

198
Q

Increased afterload worsens which murmur?

A

Mitral regurg

199
Q

Grading scale for diastolic murmurs

A

1-4

200
Q

Grading scale for systolic murmurs

A

1-6

201
Q

Mitral stenosis murmur is

A

Diastolic

202
Q

Aortic stenosis murmur is

A

Systolic

203
Q

Chronic, severe tricuspid regurg presents with

A

Right sided heart failure

204
Q

Which rhythms are shockable?

A

Ventricular fibrillation and pulseless ventricular tachycardia

205
Q

In a tachycardic emergency if the rhythm is regular with narrow complexes consider

A

Adenosine

206
Q

What is the dosage of adenosine for tachyarrhytmia

A

6mg IV rapid push

207
Q

If a patient is in ventricular tachycardia with wide complexes on the heart monitor, what steps should the provider take?

A

Establish IV access, obtain ECG, consider using adenosine

208
Q

In vtac, if the complexes are narrow

A

Try vagal maneuvers, adenosine 6mg IV rapid push if rhythm is regular

209
Q

Synchronized cardioversion dose for regular and irregular rhythms are

A

50-100J, 100-200J

210
Q

Adenosine first and second dose

A

First dose 6mg IV followed by saline flush, second dose 12mg IV rapid push

211
Q

Greatest BP decrease by lifestyle change is seen with

A

DASH diet

212
Q

Preferred anti hypertensive for patients with gout

A

Losartan (mild uricosuric effect)

213
Q

Best antihypertensive for LVH

A

ARBs

214
Q

Target diastolic BP for a diabetic

A

Less than 80

215
Q

Two drug types important in chronic heart failure

A

ACE inhibitors and beta blockers

216
Q

Diagnosing hypertension

A

At least 3 readings 140/90 or higher

217
Q

Treating hypertension with DMT1

A

ACE inhibitor preferred

218
Q

Treating HTN in heart failure

A

ACE inhibitors and diuretics

219
Q

Treating hypertension in MI

A

Beta blockers and ACE inhibitors

220
Q

Treating hypertension in someone with kidney disease

A

ACE inhibitors and ARBs

221
Q

Which antihypertensives are not okay in pregnancy

A

ACE inhibitors because they are teratogenic

222
Q

Treating hypertension in migraine patients

A

Beta blockers can be helpful

223
Q

1st line medical treatment for hypertension in someone with osteoporosis

A

Thiazide diuretics - can help increase calcium reabsorption

224
Q

Labetalol drug class is

A

Combination alpha beta blocker

225
Q

Most common side effect of ace inhibitors is

A

Cough bradykinin induced

226
Q

Some patients who are allergic to sulfonamides are also allergic to

A

Hydrochlorothiazide

227
Q

Thiazide diuretics can have 6 metabolic side effects

A

High glucose, uric acid, lipids

Low magnesium, sodium, potassium

228
Q

What antihypertensive should be avoided in asthmatics

A

Beta blockers - bronchoconstriction and wheezing

229
Q

Why is HCTZ contraindicated in gout

A

May raise uric acid levels

230
Q

Treatment of atrial premature beats

A

No treatment - just investigate the cause

231
Q

Treatment for PSVT when the patient is stable

A

Vagal maneuvers and adenosine

232
Q

Pulmonary embolism is suggested by the triad of

A

Cough, hemoptysis, and pleuritic chest pain

233
Q

Patients with VTE and contraindication to anticoagulation should get

A

IVC filter

234
Q

Crescendo decrescendo systolic murmur, left upper sternal border

A

Pulmonary stenosis

235
Q

What CHADS2 score requires anticoagulation?

A

Greater than 2

236
Q

What CHADS2 score requires anticoagulation?

A

Greater than 2

237
Q

What CHADS2 score requires anticoagulation?

A

Greater than 2

238
Q

Apixaban drug class

A

Non vitamin k antagonist oral anticoagulant (NOAC)

239
Q

Apixaban, Dabigatran, Rivoroxaban, Edoxaban are all what type of drug?

A

NOAC

240
Q

Stable patients should recieve packed red blood cell transfusion for Hgb less than

A

7g/dL

241
Q

Managing variceal bleeding

A

Somatostatin analogs like octreotide

242
Q

Treatment of AF in patients with WPW who are hemodynamically unstable require

A

Electrical cardioversion

243
Q

Treatment of AF in patients with WPW who are stable require

A

Anti-arrhythmic drugs like IV ibutilide or procrainamide

244
Q

Adenosine, beta blockers, calcium channel blockers all block which electrical pacemaker in the heart?

A

AV node

Clerkship Prep (34 decks)

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