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EOR - Emergency Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

classification of bacterial endocarditis

A

acute
subacute

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2
Q

25 yo F w. hx IVDU - previous tx for osteomyelitis - febrile with new systolic murmur best heart at left sternal border

A

bacterial endocarditis

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3
Q

what valve do you think of w. bacterial endocarditis:
IVDU
non IVDU

A

IVDU: tricuspid
non IVDU: mitral

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4
Q

pathogen associated w. acute bacterial endocarditis and drug users:

pathogen associated w. subacute bacterial endocarditis:

A

acute/IVDU: staph aureus
subacute: strep viridans

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5
Q

duke’s criteria

A

2 major
1 major, 3 minor
5 minor

major:
cultures x 2
positive echo findings
new regurgitant murmur

minor:
risk factor
fever 100.5
immunologic signs
positive culture x 1
positive echo not meeting major criteria

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6
Q

vascular phenomena associated w. bacterial endocarditis

A

splinter hemorrhages
janeway lesions

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7
Q

immunologic phenomena associated w. bacterial endocarditis

A

osler node
roth spots

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8
Q

what does from jane stand for

A

classic signs of endocarditis:

fever
roth spots
osler nodes
murmur
janeway lesions
anemia
nail bed hemorrhage
emboli

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9
Q

what are these

A

osler nodes: ouchy nodules

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10
Q

what are these

A

janeway lesions: painless macules

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11
Q

what are these

A

splinter hemorrhages

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12
Q

what are these

A

roth spots

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13
Q

tx for bacterial endocarditis

empiric:
prosthetic valve:

A

empiric: IV vanco OR ampicillin/sulbactam PLUS aminoglycoside

prosthetic valve: add rifampin

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14
Q

prophylactic tx for bacterial endocarditis for high risk pt’s pre procedure

A

amoxicillin

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15
Q

what is this showing

A

clubbing

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16
Q

chest pain/discomfort/heaviness/ pressure/squeezing/tightness that is increased w. exertion or emotion

A

stable angina

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17
Q

stable angina is relieved w.

A

rest
nitro

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18
Q

stress test findings of stable angina

A

-reversible wall motion abnormalities
-ST depressions > 1mm

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19
Q

definitive dx for angina

A

angiography

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20
Q

tx for angina

A

bb
nitro
angioplasty
bypass

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21
Q

previously stable/predictable sx of angina that become more frequent/intense/present at rest

A

unstable angina

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22
Q

tx for unstable angina

A

-IV, O2 monitor
-nitro, morphine
-ASA, bb +/- LMWH
-stress test when stable

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23
Q

4 rf for angina

A

smoking
overweight/obese
DM
HTN

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24
Q

coronary artery vasospasms NOT associated w. clot

A

prinzmetal variant angina

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25
Q

1 rf for prinzmetal angina

A

1. smoking
also cocaine

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26
Q

3 EKG findings of prinzmetal angina

A

U waves
ST elevation
T wave abnormalities

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27
Q

t/f: prinzmetal angina is associated w. preservation of exercise capacity

A

t!

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28
Q

tx for acute prinzmetal angina

A

-stress test w. myocardial perfusion imaging or CTA
-nitro
-ASA, statins, thrombolytics

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29
Q

tx for chronic prinzmetal angina

A

amlodipine
long acting nitrates

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30
Q

what med is contraindicated for prinzmetal angina bc it may exacerbate vasospasms

A

bb

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31
Q

2 common complaints w. arrhythmias

A

SOB
CP

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32
Q

atrial arrhythmias

A

PAC
a fib
a flutter
PSVT: accessory pathway vs AVNR

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33
Q

extra beats from the atria

A

PAC

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34
Q

upper atrial chambers beat out of rhythm
multiple atria foci

A

a fib

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35
Q

atria w. a single foci having multiple p waves before a QRS

A

a flutter

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36
Q

regular, fast arrhythmia btw 160-220 bpm
begins/ends suddently
originates in atria

A

PSVT

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37
Q

additional electrical conduction pathway btw 2 parts of the heart

A

PSVT: accessory pathway tacycardia

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38
Q

mc type of accessory pathway tachycardia

A

WPW

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39
Q

2 EKG findings associated w. WPW

A

shortened PR interval < .20
delta wave

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40
Q

mc type of PSVT

A

AVNR (AV nodal reentrant) tachy

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41
Q

HR associated w. AVNR

A

100-250 bpm

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42
Q

EKG finding of AVNR

A

late p waves that may be hidden w.in QRS

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43
Q

ventricular arrhythmias

A

PVCs
v tach
v fib

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44
Q

early, wide, bizarre QRS
no p wave

A

PVCs

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45
Q

regular, fast, wide QRS
structural heart disease
increased risk of sudden death

A

v tach

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46
Q

-quivering ventricles that do not contract in a coordinated way
-erratic rhythm w. no discernable waves

A

v fib

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47
Q

tx for narrow, tachy arrhythmias

A

rate control:
adenosine
bb
ccb
procainamide

cardoversion

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48
Q

tx for wide, tachy arrhythmias

A

amiodarone
cardioversion

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49
Q

45 yo M presents after MVA - conscious, responsive; chest wall ecchymosis, symmetrical breath sounds; unremarkable cardiac/abd exams - several broken ribs -placed on IV/O2/monitor - 2 hr later: tachy, hypotensive, elevated JVP, distant heart sounds, cool extremities, delayed cap refill

A

cardiac tamponade

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50
Q

buildup of fluid btw pericardial sac and the heart -> heart constricted

A

cardiac tamponade

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51
Q

classification of cardiac tamponade

A

acute
slow onset

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52
Q

causes of acute onset cardiac tamponade:
causes of slow onset cardiac tamponade:

A

acute: trauma, MI, aortic dissection, pericardial effusion

slow onset: cancer, chronic inflammation, uremic pericarditis, hypothyroidism, connective tissue dz

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53
Q

3 d’s of cardiac tamponade

A

distant heart sounds
distended jugular veins
decreased arterial pressure

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54
Q

beck’s triad

A

hypotn
muffled heart sounds
elevated JVD

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55
Q

classic PE finding associated w. tamponade

A

pulsus paradoxus: drop 10 mmHg in SBP on inspiration

narrow pulse pressure

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56
Q

EKG finding associated w. tamponade

A

electrical alternans:
low voltage QRS’s that alternate in height

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57
Q

what is this showing

A

water bottle/canteen shaped heart -> tamponade

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58
Q

tx for tamponade

A

pericardiocentesis

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59
Q

5 causes of acute CP

A

pericarditis
ACS
pulmonary embolism
pneumothorax
thoracic aneurysm/dissection

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60
Q

pericarditis is relieved by

A

sitting
leaning forward

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61
Q

mc symptom of PE

A

dyspnea

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62
Q

best initial test for PE

A

spiral CT

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63
Q

3 PE findings of PTX

A

decreased tactile fremitus
hyperresonance
diminished breath sounds

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64
Q

severe, tearing, ripping, knife-like CP radiating to the back

A

thoracic aneurysm/dissection

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65
Q

typical work up for acute CP

A

ekg
troponin
bnp
cxr
cbc/cmp

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66
Q

ESR is helpful in evaluating what cause of acute CP

A

pericarditis

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67
Q

imaging for thoracic aneurysm

A

CT aortogram

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68
Q

what are the 7 conduction disorders

A

a fib
a flutter
SVT
BBB
v tach
vfib
premature beats

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69
Q

irregularly irregular rhythm with disorganized and irregular atrial activations, absence of p waves

A

a fib

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70
Q

regular, sawtooth pattern
narrow QRS

A

a flutter

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71
Q

narrow complex tachycardia
no discernible p waves

A

SVT

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72
Q

3 or more consecutive VPB’s
wide QRS
tachyarrhythmia

A

v tach

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73
Q

erratic rhythm
no discernable waves

A

v fib

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74
Q

3 types of premature beats

A

PVC
PAC
PJC

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75
Q

early wide bizarre QRS
no p waves

A

PVC

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76
Q

abnormally shaped P wave

A

PAC

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77
Q

narrow QRS
no p wave or inverted p wave

A

PJC

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78
Q

R R’ in V4-V6

A

LBBB

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79
Q

R R’ in V1-V3

A

RBBB

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80
Q

what is this showing

A

afib

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81
Q

what is this showing

A

a flutter

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82
Q

what is this showing

A

SVT

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83
Q

what is this showing

A

v tach

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84
Q

what is this showing

A

v fib

85
Q

what is this showing

A

PVC

86
Q

what is this showing

A

PAC

87
Q

what are these showing

A

PJC

88
Q

what is this showing

A

LBBB

89
Q

what is this showing

A

RBBB

90
Q

3 types of coronary heart dz

A

NSTEMI
STEMI
angina

91
Q

troponin/CK elevation in the absence of acute ST elevation or Q waves

A

NSTEMI

92
Q

NSTEMI’s are _ infarcts

A

subendocardial

coronary artery not completely blocked

93
Q

what EKG findings may be present with an NSTEMI

A

ST depression
T wave inversion

94
Q

3 cardiac markers useful in evaluation of NSTEMI

A

troponin
CK/CK-MB
myoglobin (Mb)

95
Q

most sensitive and specific cardiac marker

A

troponin

96
Q

troponin appears at _ hr
peaks at _ hr
and lasts for _ days

A

appears: 2-4 hr
peaks: 12-24 hr
lasts: 7-10 days

97
Q

CK/CK-MB appears at _ hr
peaks at _ hr
and normalizes w.in _ days

A

appears: 4-6 hr
peaks: 12-24 hr
normalizes: 48-72 hr

98
Q

myoglobin appears at _ hr
peaks at _ hr
and normalizes w.in _ hr

A

appears: 1-4 hr
peaks: 12 hr
normalizes: 24 hr

99
Q

tx for NSTEMI

A

bb
nitro
ASA/clopidigrel
heparin
ACEI
statins
reperfusion

100
Q

t/f: reperfusion for NSTEMI’s are less time sensitive than for STEMI’s

A

t!

101
Q

what cardiac markers will be elevated with a STEMI

A

troponin 1 OR troponin T
CK

102
Q

STEMIs are characterized by ST elevations and/or _ waves

A

Q waves

103
Q

immediate tx for STEMI

A

ASA
clopidigrel

104
Q

CTA and reperfusion should be done w.in _ minutes of STEMI onset

A

90

105
Q

_ should be done within _ hours of STEMI onset if PCI is not available

A

thrombolytic therapy w.in 3 hr

106
Q

6 absolute contraindications for fibrinolytic therapy with STEMI

A

prior ICH
structural cerebral vascular lesion
malignant intracranial neoplasm
ischemic stroke w.in 3 months
suspected aortic dissection
active bleeding/bleeding diathesis (excluding menses)

107
Q

dyspnea on exertion should make you think of what 2 etiologies

A

CVD
respiratory

duh

108
Q

6 cardiac causes of dyspnea on exertion

A

coronary heart dz
CHF
myocarditis
pericarditis
MI
ACS

109
Q

8 respiratory causes of dyspnea on exertion

A

asthma
COPD
PNA
pulmonary HTN
obesity/kyphosis/scoliosis
ILD
drugs
psychogenic

110
Q

2 drugs that cause dyspnea on exertion

A

MTX
amiodarone

111
Q

hematologic cause of dyspnea on exertion

A

anemia

112
Q

edema should make you think of what 3 etiologies

A

heart
liver
kidneys
pump failure vs fluid back up

also consider:
pregnancy
drugs
travel

113
Q

main underlying cause of edema

A

Na retention

114
Q

tx for edema (4)

A

reduce Na
lasix
compression socks
elevation

115
Q

2 meds that cause peripheral edema

A

CCB
alpha 1 blockers (ex doxazosin)

116
Q

4 mc causes of HF

A

CAD
HTN
MI
DM

117
Q

pathology of HF

A

LV remodeling -> dilation -> thinning -> mitral valve incompetence -> RV remodeling

118
Q

sx of HF

A

exertional dyspnea -> dyspnea at rest
chronic non productive cough
fatigue
paroxysmal nocturnal dyspnea
night cough
nocturia

119
Q

symptom indicative of late HF

A

orthopnea

120
Q

PE findings of HF (6)

A

cheyne stokes breathing
LE edema
rales (same-same crackles)
S3/S4
JVP > 8 cm
cold extremeties/cyanosis
hepatomegaly/ascites/jaundice

121
Q

S4 indicates _ HF

A

diastolic

122
Q

S3 indicates _ HF

A

systolic

123
Q

which type of HF is associated w. reduced ejection fraction

A

systolic

124
Q

mechanism responsible for S3 in systolic HF

A

rapid ventricular refilling during early systole

125
Q

ejection fraction is usuall normal w. _ HF

A

diastolic

126
Q

3 causes of elevated BNP

A

advanced age
renal impairment
HF

127
Q

what pt pop might have low BNP despite HF

A

obese

128
Q

what is this showing

A

kerley lines -> CHF

129
Q

best test to diagnose and evaluate HF

A

echo

130
Q

NY HF classification

A

class I (<5%): no limitation of physical activity
class II (10-15%): slight limitation of activity, comfortable at rest
class III (20-25%): marked limitation in physical activity, comfortable at rest
class IV (34-40%): discomfort prohibits physical activity, sx of HF or anginal syndrome at rest

131
Q

tx for systolic HF (HFrEF)

A

ACEI
bb
lasix

132
Q

tx for diastolic failure (HFpEF)

A

ACEI
bb OR ccb

133
Q

_ should not be used in stable chronic HFpEF (diastolic)

A

diuretics

134
Q

what 2 drugs used in HF reduces preload O2

A

nitrates

135
Q

what drug used in HF reduces preload

A

morphine

136
Q

5 factors associated w. poor prognosis in CHF

A

CKD
DM
lower LVEF
severe sx
old age

137
Q

3 types of hypertensive emergency

A

emergency: >180/120 w. impending/progressing end organ damage
urgency: >180/120 w.o end organ damage
malignant: DBP > 140

138
Q

malignant HTN is associated w. what 3 sx

A

papilledema
encephalopathy
nephropathy

139
Q

tx for the different types of HTN emergencies

A

emergency: sodium nitroprusside
urgency: clonidine
malignant: hydralazine

140
Q

2 types of hypotensive emergency

A

hypotension
cardiogenic shock

141
Q

3 common causes of cardiogenic shock

A

acute MI
CHF
cardiac tamponade

142
Q

5 PE findings of cardiogenic shock

A

SBP < 90
AMS
cyanosis
cool extremeties
crackles

143
Q

capillary wedge pressure > _ is indicative of cardiogenic shock

A

15

144
Q

tx for cardiogenic shock (3)

A

fluids
pressors (dopamine)
treat underlying cause

145
Q

orthostatic hypotn parameters

A

2-5 min after a change from supine to standing:
SBP drop > 20
DBP drop > 10
pulse increase > 15

146
Q

2 common causes of orthostatic hypotn

A

DM autonomic dysfxn
meds

147
Q

test if you suspect orthostatic hypotn due to DM autonomic dysfxn

A

tilt table

148
Q

PE finding of orthostatic hypotn due to low blood volume

A

HR > 15 bpm

149
Q

what do you think of first when you see orthopnea in the emergency setting

A

pulmonary edema

150
Q

3 causes of orthopnea

A

cardiac
pulmonary
obesity

151
Q

3 cardiac causes of orthopnea

A

CHF
MI
arrhythmias (afib)

152
Q

3 direct causes of pulmonary orthopnea

A

COPD
cor pulmonale
pulmonary HTN

153
Q

2 indirect causes of pulmonary orthopnea

A

kidney failure
liver failure

backed up fluid in lungs

154
Q

ABG finding of orthopnea

A

large A-a gradient

155
Q

pathology behind obesity related orthopnea

A

belly fat pushed up into the chest when lying down

156
Q

ddx for palpitations (lots!)

A

anxiety
lyte abnormalities
hyperthyroidism
ischemic heart dz
stimulants
meds
pheochromocytoma
hypoglycemia
MVP
afib
WPW
SSS
PSVT

157
Q

2 lyte abnormalities associated w. palpitations

A

hypokalemia
hypomagnesemia

158
Q

meds associated w. palpitations

A

bb
ccb
digoxin
diuretics
hydralazine
minoxidil

159
Q

64 yo f w. 5 weeks of intermittent SOB radiating from the shoulder to the chest - pain is worse w. inspiration and lying down, relieved by sitting forward - PE shows distant heart sounds - EKG shows low voltage QRS and electrical alternans

A

pericardial effusion

160
Q

pericardial effusion is a complication of

A

pericarditis

161
Q

PE finding of pericardial effusion

A

distant heart sounds

162
Q

2 ekg findings of pericardial effusion

A

low voltage QRS
electrical alternans

163
Q

xray findings of pericardial effusion

A

water bottle heart

164
Q

tx for pericardial effusion

A

pericardiocentesis

165
Q

what is this showing

A

electrical alternans -> pericardial effusion

166
Q

6 PE findings of PVD

A

lower extremity hair loss
brittle nails
pallor
cyanosis
claudication
hypothermia
ulcers

167
Q

hallmark symptom associated w. PVD

A

intermittent claudication

168
Q

ABI < _ indicates PVD

A

0.9

169
Q

describe ulcers associated w. PVD (4)

A

pale to black
well circumscribed
painful
lateral/distal

170
Q

gs dx for PVD

A

arteriography

171
Q

definitive tx for PVD

A

arterial bypass

172
Q

pharm for PVD

A

antiplatelets: ASA, clopidigrel, cliostazol
statins

173
Q

transient LOC/postural tone 2/2 to acute decrease in cerebral blood flow

A

syncope

174
Q

t/f: syncope is associated w. rapid recovery of consciousness w.o intervention

A

t!

175
Q

2 mc cause of syncope

A

vasovagal
idiopathic

176
Q

red flags for syncope (6)

A

during exertion
multiple recurrences in short time
murmur/structural heart dz
old age
significant injury during event
fam hx unexpected deat/exertional syncope

177
Q

types of syncope (5)

A

vasovagal
cardiac
orthostatic hypotn
cerebral vascular dz
noncardiogenic

178
Q

neurocardiogenic syncope is same same

A

vasovagal

179
Q

3 causes of cardiac syncope (5)

A

AV block
SSS
aortic stenosis
HOCM
massive MI

180
Q

3 meds that can cause syncope

A

bb
nitrates
antiarrhythmic agents

181
Q

work up for syncope

A

EEG
glucose
pulse ox
tilt table
rarely imaging

182
Q

flowchart for syncope work up

A
183
Q

valvular diseases Smarty PANCE wants us to know

A

aortic stenosis
aortic regurgitation
mitral stenosis
mitral regurgitation

184
Q

harsh systolic ejection crescendo-decrescendo murmur at right USB

A

aortic stenosis

185
Q

aortic stenosis murmur radiates to the _ (2) and is heard best with _ (2)

A

radiates: neck/apex
heard best: leaning forward/expiration

186
Q

soft, early diastolic blowing murmur along LSB

A

aortic regurgitation

187
Q

aortic regurgitation murmur is best heart with the patient

A

leaning forward/exhaling

188
Q

what is erb’s point
what murmur does it make you think of

A

left third intercostal space close to the sternum

mitral regurgitation

189
Q

diastolic low pitched descrescendo rumbling murmur w. opening snap heart

A

mitral stenosis

190
Q

mitral stenosis murmur is heard best at _
with the pt in _ position

A

apex

lateral decubitus

191
Q

holosystolic high pitched blowing murmur

A

mitral regurgitation

192
Q

mitral regurgitation murmur is heard best at the _
and radiates to the _

A

apex

axilla

193
Q

heart sound associated w. mitral regurgitation

A

S2

194
Q

3 vascular dz’s to know

A

aortic aneurysm/dissection
arterial embolism/thrombosis
phlebitis/thrombophlebitis

195
Q

3 sx of aortic aneurysm

A

flank pain
hypotn
pulsatile abdominal mass

196
Q

tx for aortic aneurysm based on size

A

> 5.5 cm OR expands > 0.6 cm/year: surgery
3 cm: monitor annually
4 cm: monitor q 6 mo

197
Q

pharm for aortic aneurysm

A

bb

198
Q

sudden onset tearing CP between scapulas
diminished pulses

A

aortic dissection

199
Q

what is this showing

A

widened mediastinum -> aortic dissection

200
Q

2 types of aortic dissection and tx for each

A

-ascending OR descending w. complications: emergent surgey
-descending w.o complications: bb

201
Q

6 p’s of arterial emboli

A

pain
pallor
pulselessness
paresthesia
paralysis
poikilothermia

202
Q

2 common causes of thrombus formation

A

a fib
mitral stenosis

203
Q

gs for dx of embolism/thrombosis

A

angiography

204
Q

tx for acute arterial embolism

A

IV heparin
angioplasty
graft
endarterectomy

205
Q

3 common causes of phlebitis/thrombophlebitis

A

trauma
IV/PICC lines
spontaneous

206
Q

4 sx of phlebitis/thrombophlebitis

A

dull pain
erythema
induration of vein
palpable cord

207
Q

gs dx for thrombophlebitis

A

duplex US

208
Q

tx for thrombophlebitis

A

NSAIDs
warm compress

EOR - Emergency Medicine (13 decks)

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