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Emergency medicine EOR > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

What is the major criteria for dukes criteria?

A
  1. Positive blood cultures s. auerus, s. virdans, s. bovis or other cultures 12 hours apart.
  2. Vegetation shown on an echocardiogram.
  3. New regurgitant murmur
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2
Q

If they are IV drug users whats the main cause for enfective endocarditis? and if they are non iv drug users?

A
  1. staphylococcus

2. Streptococcus

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3
Q

for an IV drug user where would you first see vegetation for infective endocarditis? how bout non IV drug user?

A

for IV drug user it would be tricuspid valve for non iv it would be mitral valve

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4
Q

What is the minor criteria for the dukes criteria

A
  1. Risk factor
  2. Vascular phenomenon (splinter hemorrhages janeway lesions on palms and soles)
  3. osler nodes
  4. Roth spots
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5
Q

What is the empiric treatment for endocarditis? How bout if they have a prosthetic valve?

A
  1. IV Vancomycin or ampicillin/sulbactam plus an aminoglycoside
  2. Add rifampin
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6
Q

If a patient is high risk for endocarditis and they need a dental procedure, what do you prophylax with?

A

2g of amoxicillin taken one hour before

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7
Q

A person received a stress test because they have pain with exertion that is relieved with rest. What would the stress test show if they have stable angina?

A

Stress test demonstrates reversible wall motion abnormalities/ ST depression >1 mm

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8
Q

What is the definitive diagnoses/test for angina?

A

cardiac angiography

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9
Q

What is the treatment for stable angina?

A

beta blockers or nitrides

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10
Q

Previously stable and predictable symptoms of angina that are now more frequent, increasing or present at rest. This describes what kind of angina?

A

Unstable angina

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11
Q

a patient with perserved exercise capacity presents to the office with chest pain. EKG shows inverted U waves and t-wave abnormalities. They also have a history of smoking. What do they have?

A

Printzmetal angina

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12
Q

What is the treatment for printzmetal angina?

A
  1. Stress testing with myocardial perfusion imaging or coronary angiography
  2. Pharmacotherapy SL, topical, or IV nitrates (initial)
  3. Antiplatelet, thrombolytics, statins, BB
  4. Once diagnosis made—CCB and long-acting nitrates used for long-term prophylaxis (amlodipine)
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13
Q

How do you treat narrow ventricular complex tachycardias?

A

This can be slowed down with CCBs, beta blockers, adenosine, procainamide or cardioversion depending on the scenario

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14
Q

How do you treat wide complex tachycardias from the ventricles?

A

Cardioversion or antiarrythmics like amiodarone

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15
Q

What is becks triad?

A
  1. muffle heart sounds
  2. JVD
  3. hypotension
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16
Q

Treatment for pericardial effusion?

A

pericardiocentisis

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17
Q

What will the heart look like on cxr in someone with a pericardial effusion?

A

water bottle heart

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18
Q

What 5 things do you need to assess for in the acute setting of chest pain?

A
  1. Pneumothorax
  2. PE
  3. MI
  4. Aortic dissection
  5. Pericarditis or boorhaves esophagus (depends on who you talk to)
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19
Q

Typical workup for chest pain in the acute setting?

A
  1. EKG
  2. Troponin
  3. CXR
  4. BNP
  5. CMP/CBC
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20
Q

What cardiac marker is most sensitive? When does it appear? When does it peak? How long does it last?

A

Troponin, appears 2-4 hours, peaks at 12, last 7-10 days

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21
Q

When does CK/CK-MB appear, peak, and then return to normal?

A

appears at 4-6 hours, peaks 12-24, returns to normal around 48-72 hours

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22
Q

just foe fun even though it is less used. When does Myoglobin marker appear, peak and return to normal?

A

appears at 1-4 hours, peaks at 12, returns to normal at 24 hours

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23
Q

treatment for an nstemi includes what?

A
  1. beta blocker
  2. NTG
  3. Clopidogrel and aspirin
  4. statin
  5. ACEi
  6. heparin
  7. reprofusion
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24
Q

what leads will have ST elevation in a lateral infarct?

A

I, AVL, V5-V6

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25
Q

what leads will have ST segment elevation in a lateral wall infarct?

A

I, AvL, V5-V6

can have reciprocal T-wave inversion in inferior leads III and AvF

26
Q

Within what time frame do you want to perform angiography with PCI?

A

within 90 minutes

27
Q

If PCI is not available for 3 hours in someone having an MI what can you do?

A

thrombolytic therapy

28
Q

What are absolute contraindications for thrombolytic therapy?

A

Prior intracranial hemorrhage (ICH)
Known structural cerebral vascular lesion.
Known malignant intracranial neoplasm.
Ischemic stroke within 3 months.
Suspected aortic dissection.
Active bleeding or bleeding diathesis (excluding menses)

29
Q

Treatment for hypertensive emergency? hypertensive urgency? malignant hypertension?

A
  1. nitroprusside
  2. Clonidine
  3. Hydralazine
30
Q

What is malignant hypertension?

A

blood pressure greater than 140 with papilledema, and either encephalopathy or nephropathy

31
Q

Cardiac causes for DOE?

A
  1. CAD
  2. Heart failure
  3. myocarditis
  4. pericarditis
  5. MI
  6. ACS
32
Q

pulmonary causes for DOE?

A
  1. asthma
  2. COPD
  3. pneumonia
  4. pulmonary hypertension
  5. interstitial lung disease
  6. obesity, kyphosis, scoliosis
33
Q

What meds should you keep in mind about peripheral edema?

A
  1. CCBs

2. Alpha 1-blockers

34
Q

What are the most common causes of heart failure?

A
  1. CAD
  2. MI
  3. HTN
  4. DM
    LV remodeling: thinning, dilation, mitral valve incompetence,
35
Q

An S4 is a sign of what kind of CHF?

A

diastolic heart failure, EF is usually preserved

36
Q

an S3 is usually a sign of what kind of heart failure?

A

systolic heart failure.

37
Q

What causes the S3 heard in systolic heart failure?

A

rapid filling of the ventricles during early diastole

38
Q

Class 1 heart failure is (with or without) physical limitations?

A

without, 5% of patients

39
Q

class II heart failure have slight limitation of physical activity, are the (comfortable or uncomfortable) at rest?

A

comfortable

40
Q

Class III heart failure has a marked limitation of physical activity. Are they comfortable or uncomfortable at rest?

A

They are also comfortable

41
Q

Then you have class IV heart failure. Are these patients capable of any physical activity? and do they have symptoms of anginal syndrome at rest?

A

They cant do any physical activity without issues and have symptoms even at rest

42
Q

Tx for systolic heart failure?

A

Acei + beta blocker + loop diuretic

43
Q

Tx for diastolic heart failure?

A

Acei + beta blocker or CCB

do not use diuretics in stable chronic diastolic heart failure

44
Q

An ABI less than 0.9 is a sign of what?

A

peripheral vascular disease/ intermittent claudication

45
Q

gold standard for diagnosing peripheral vascular disease?

A

arteriography

46
Q

What is the Tx for PVD?

A
  1. anti-platlets
  2. cholesterol drugs
  3. cilostazole
47
Q

medical definiton of syncope?

A

loss of postural tone/transient loss of consciousness secondary to an acute decrease of cerebral blood flow.

48
Q

What are some red flags of syncope?

A
  1. syncope during exertion
  2. multiple recurrences in short time
  3. heart murmur / structural heart disease
  4. old age
  5. significant injury during syncope
  6. family hx of unexpected death/exertional/unexplained recurrent syncope
49
Q

Aortic stenosis is heard where? is it systolic or holosystolic? does it radiate anywhere? how is it best heard?

A
  1. RUSB
  2. Systolic
  3. Radiates to the neck and apex
  4. With the patient leaning forward with expiration
50
Q

aortic regurgitation is heard where? systolic? diastolic? holosystolic? soft or harsh? best heard how?

A
  1. at erbs point so left sternal border
  2. diastolic
  3. soft
  4. leaning forward after exhaling
51
Q

Mitral stenosis is best heard where? systolic? diastolic? holosystolic? best heard how?

A
  1. at the apex
  2. Diastolic
  3. lateral decubitus position

Low pitched decrescendo murmur with opening snap

52
Q

mitral regurg is best heard where? systolic? diastolic? holosystolic? radiate anywhere?

A
  1. at the apex
  2. holosystolic
  3. to the axilla with split S2
53
Q

symptoms of abdominal aortic aneurysm?

A

flank pain, hypotension, pulsatile abdominal mass

54
Q

what size abdominal aortic aneursym do you perform surgery on?

A

anything greater than 5.5cm or expands greater than 0.6cm per year

55
Q

how often do you monitor an abdominal aortic aneurysm if its >3cm? and >4cm

A

annually for 3cm, every 6 months for 4cm

56
Q

tx for abdominal aortic aneurysm

A

beta blockers

57
Q

symptoms of aortic dissection?

A

sudden onset tearing chest pain, between scapulas diminished pulses

58
Q

difference between tx if its on the ascending aorta vs the descending

A

if its ascending then immediate surgical repair

if descending then medical tx with beta blockers

59
Q

what are two very common causes of thrombus formation?

A

a-fib and mitral stenosis

60
Q

gold standard to diagnose arterial thrombus?

A

angiography

61
Q

gold standard for dx phlebitis/thrombophlebitis?

A

Venous duplex ultrasound

62
Q

tx for Phlebitis/thrombophlebitis?

A

supportive with NSAIDs warm compress

Emergency medicine EOR (5 decks)

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