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Clinical: Emergency Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Patient presents as a 25yo with fever. hx of IVDU and periously treated for osteomyeloitis. on PE, sheis febrile and heart auscultation reveals a new systolic murmur at the LLSB.
what is the most likely diagnosis?

A

acute bacterial endocarditis

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2
Q

what is the common pathogen associated with acute bacterial endocarditits

A

S. aureus

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3
Q

what pathogen is associated with subacute bacterial endocarditis

A

S. viridans

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4
Q

what is Dukes Criteria

A

endocarditis assessment:
major: BC 2x12 hours apart, Echo with vegitations, new regurgitant murmur
Minor: risk factor, fever 100.5, vascular pehnomena, immunologic phenomena

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5
Q

what are the classic signs of infective endocarditis

A

Oslers nodes
janeway lesions
roth spots
splinter hemorrhages

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6
Q

what are oslers nodes

A

tender “ouchy” nodules

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7
Q

what are janeway lesions

A

painless macules

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8
Q

what is the treatment of infective endocarditis

A

Empiric tx: IV Vanco or Amp/sulbactam + aminoglycoside
prosthetic valve: + Rifampim

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9
Q

what is seen on a stress test with stable angina

A

reversible wall motion abnormalities / ST depression >1 mm

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10
Q

what is the definitive diagnostic test for stable angina

A

angiography

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11
Q

what is the treatment for stable angina

A

Beta blockers and nitroglycerin
if severe: angioplasty and bypass

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12
Q

what is the treatment of unstable angina

A

admit wtih continuous cardiac monitoring (IV + O2)
pain management with NTG and morphine
ASA, clopidogrel, BB (first line), LMWH
replace electroyltes

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13
Q

what are risk factors for prinzmetal variant angina

A

history of smoking (#1)
cocaine abuse

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14
Q

what is seen on EKG with Prinzmetal variant angina

A

inverted U waves, ST-segment or T-wave abormalities

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15
Q

what is the treatment for Prinzmetal

A

stress testing with myocardial perfusion imaging or coronary angiography
Nitrates (Initial)
CCB and long acting nitrates for long-term prophlyaxis

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16
Q

what is atrial fibrillation

A

an irregular heart rate that at a high rate may cause palpitations, fatigue and SOB. occurs when upper atrial chambers of the heart beat out of rhytm and multiple atria foci

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17
Q

what is atrial flutter

A

atria with single foci having multiple P waves before QRS is produced unlike afib which is more chaotic

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18
Q

what is PSVT

A

paroxysmal supraventricular tachycardia
regular, fast (160-220bpm) HR that begins and ends suddently and originates in atria

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19
Q

what is the most common accessory pathway tachycardia

A

wolff-parkinson-white syndrome

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20
Q

What is the most common type of SVT

A

AV node reentrant tachycardia

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21
Q

what are PVCs

A

premature ventricular contractions
extra beats from ventricles
early wide “bizarre” QRS, no p waves seen

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22
Q

what is ventricular tachycardia

A

wide QRS complex that is regular, fast HR that arises from improper electical activity in ventricles

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23
Q

what is ventricular fibrillation

A

ventricles merely quiver and do not contract in coordinated way. No blood is pumped from the heart, very lethal.
erractic rhythm with no discernable waves (P, QRS, or T waves)

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24
Q

how should narrow tachycardic arrhythmias be treated

A

slowed with CCB or BB, adenosine, procainamide or cardioversion

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25
Q

how should wide tachycardic arrhythmias from the ventricles be treated

A

cardioversion or antiarrhythmic such as amiodarone

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26
Q

what is a buildup of fluid between the pericardial sac and the heart causing contriction of the heart called

A

pericardial tamponade

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27
Q

patient presents as a 37yo male brought to the ED after falling off a second-story scaffolding onto his back. PE, HR is 126, BP 80/56, RR 24 and temp 99.0. glasgow coma score is 8, JVD and heart sounds are distant - what is the pateints most likely diagnosis

A

cardiac tamponade

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28
Q

what are the 3Ds associated with cardiac tamponade

A

Distant heart sounds
Distended jugular veins
Decreased atrial pressure

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29
Q

what is Becks Triad

A

cardiac tamponade
- hypotension
- muffled heart sounds
- elevated JVD

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30
Q

what is pulsus paradoxus

A

drop 10 mmHg in systolic pressure on inspiration, narrow pulse pressure

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31
Q

what is seen on EKG with pulsus paradoxus

A

electrical alternanas and low-voltage QRS comple

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32
Q

what is seen on XR with pulsus paradoxus

A

water-bottle heart

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33
Q

how is cardiac tamponade diagnosed

A

Gold standard: ECHO - demonstating diastolic collapse of RV

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34
Q

what is the treatment of cardiac tamponade

A

pericardiocentesis

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35
Q

what is the difference between pericarditis and pericardial effusion and cardiac tamponade

A

pericarditis - inflammation of pericardium
pericardial effusion - accumulation of fluid in pericardium
cardiac tamponade - severe complication of pericardial effusion causing compression of the heart

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36
Q

in an acute settng, what are the 5 causes of chest pain that must be considered when assessing a patient

A
  • pericarditis
  • ACS
  • PE
  • pneumothorax
  • thoracic aneurysm/dissection
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37
Q

what is the typical work up for a patient presenting with chest pain

A

EKG
Troponin I
BNP
CXR
CBC/CMP
(can be included: D-dimer, CT chest, CT angio, CT aortogram)

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38
Q

if you are concerened for ACS or MI what tests should be ordered

A

EKG and troponin

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39
Q

if you are concerened for pericarditis, what test are most important

A

EKG and ESR

40
Q

if you are concerened for CHF what are the most important tests

A

CXR and BNP

41
Q

if you are concerened for Pneumothorax, what are the most important tests

A

CXR and CT

42
Q

if you are concerened for PE what are the most important tests

A

D-dimer and CTA

43
Q

if you are concerened for Thoracic aneurysm what are the most important tests

A

CT aortogram

44
Q

what conduction disorder presents with a regular, sawtooth pattern with narrow QRS complex

45
Q

what conduction disorder presents with narrow, complex tachycardia without discernible p waves

46
Q

what conduction disorder presents with three or more consecutive VPBs displaying a broad QRS complex tacharrhythmia

47
Q

what conduction disorder presents with erractic rhythm with no discernable waves

48
Q

what conduction disorder presents with early, wide, bizarre QRS without P waves

49
Q

what conduction disorder presents with abormal shaped p waves

50
Q

what conduction disorder presents with narrow QRS complex, no p wave or inverted p waves

51
Q

what conduction disorder presents with R and R in V1-V3

52
Q

what conduction disorder presents with R and R in V4-V6

53
Q

what is the most sensite cardiac monitor

when does it appear
when does it peak
how long does it last

A

Troponin

appears at 2-4 hours
peaks at 12-24 hours
lasts for 7-10 days

54
Q

what is the treatment of NSTEMI

A

BB + NTG + ASA + Clopidogral + hepatin + ACEi + Statin + reperfusion (percu intervention)

55
Q

what location of the heart is affected when Q waves and ST elevation in Lead I, AVL and V2-V6

A

anterior wall

56
Q

what location of the heart is affected when Q waves and ST elevation in lead II, III, and AVF

A

inferior wall

57
Q

what location of the heart is affected when ST elevation is in leads I, AVL, and V5-V6. Reciprocal ST depression in leads III and AVF

A

Lateral wall

58
Q

what location of the heart is affected when there is ST depression in V1-V3

A

Posterior wall

59
Q

what are the contraindications for fibrinolytic use in STEMI patients?

A

prior intracranial hemorrhage
known structural cerebral vascular lesion
known malignant intracranial neoplasm
ischemic stroke within 3 months
suspected aortic dissection
active bleeding or bleeding diastesis (excluding menses)

60
Q

what are cardiac causes of dyspnea on exertion

A

coronary heart disease
heart failure
myocardidits
pericarditis
MI
ACS

61
Q

what are pulmonary causes of dypsnea on exertion

A

asthma
COPD
pneumonia
pulmonary HTN
obesity, kyphosis, scoliosis
interstitial lung disease
drugs, radiation therapy, cancer
psychogenic casues

62
Q

what conditions can cause edema

A

CHF
kidney disease
liver disease
chronic venous disease
pregnancy
drugs
travel

63
Q

what are treatment options for edema

A

reduce salt intake
lasix, HTCZ
compression stockings
body position

64
Q

what is cheyne-stokes breathing

A

perioidc, cyclic respiration

65
Q

what lab tests are ordered for heart failure

A

CBC, CMP, U/A, lipids, TSH
Serum BNP
12-lead EKG
CXR
Echo (best test)

66
Q

what is the treatment for systolic left heart failure

A

ACEi + BB + loop diuretic

67
Q

what is the treatment for diastolic heart failure

A

ACEi + BB or CCB

68
Q

what is the drug of choice for hypertensive urgency

69
Q

what is the drug of choice for hypertensive emergency

A

sodium nitroprusside

70
Q

what are common causes of cardiogenic shock

A

acute MI
heart failure
cardiac tamponade

71
Q

what is the treatment of cardiogenic shock

A

fluid resuscitation
pressors (dopamine)
treat the underlying cause

72
Q

a patient presents to the ED and complains of orthopnea. what is the likely cause

A

pulmonay edema

73
Q

what tests are done for the chief complaint of orthopnea

A

CXR
CNF (for CHF)
EKG
Troponin I
ABG

74
Q

64yo female pt presents for 5 weeks of occasional SOB and pain radiating from her shoulder to her chest. pt reports pain is worse with inspiration and lying down and feels better when sitting foward. PE you note distant heart sounds. EKG with low-voltage QRS complexes and electrical alternanas - whats the most likely diagnosis

A

pericardial effusion

75
Q

how is pericardial effusion diagnosed

A

EKG
ECHO
CXR

76
Q

63yo male presents complainin gof bialteral leg pain, which has been increasing gradually over the past several months. worsens when walking and improves with rest. PMH and surgical hx is significant for HTN, hyperlipidemia, and coronary artery bypass graft 5 years ago. he has a 60 pack year smoking hx. vitals are: temp 37C, HR 70, BP 143/89, and RR 18. PE of LE reveals palpable but weake posterior tibial and dorsalis pedis pulses bilaterally; warm and well-profused and ABI on 0.7 and 0.8.
What is the likely diagnosis

A

peripheral vascular disease

77
Q

how is PVD diagnosed

A

doppler US
ABI
Angiography = gold standard

78
Q

what are medical treatment options for PVD

A

antiplatelet
antilipids
manage risk factors
Cilostazol
ASA and plavix

79
Q

what is the definitive treatment for PVD

A

aterial bypass

80
Q

a patient presents after a syncopal episode to the ED, what test should be ordered

A

ECG
glucose
pulse ox
ECHO
tilt table
CNS imaging (rare)

81
Q

59yo male presents with chest pani, dyspnea, and presyncope. The symptoms ocurred after he climbed a flight of stairs. he has a late systolic-ejection murmur heard at the RUSB with radiation to the carotids and apex.
what is the most likely diagnosis

A

Aortic stenosis

82
Q

59yo male presents with chest pain, dyspnea, and presyncope. The symptoms ocurred after he climbed a flight of stairs. he has a late systolic-ejection murmur heard at the RUSB with radiation to the carotids and apex.
what makes the murmur decrease?

83
Q

59yo male presents with chest pain, dyspnea, and presyncope. The symptoms ocurred after he climbed a flight of stairs. he has a late systolic-ejection murmur heard at the RUSB with radiation to the carotids and apex.
What is the EKG suggestive of given the suspected diagnosis?

A

LV hypertrophy

84
Q

aortic stenosis presents with what murmur

A

systolic ejection crescendo-decrescendo at RUSB
split S2
increases with squatting and espiration
decreases wtih valsalva, hand grip and standing

85
Q

61yo male presents with recent hx of increased fatigue with mildly increased exertional dyspnea. the pt denies any sigificant PMH but states that he had some heart problems as a child but he was never clear as to what the problem was. on cardiac exam you hear a early diastolic, soft-blowing decrescendo murmur with a high-pitch quality.
what is the likely diagnosis?

A

aortic regurgitation

86
Q

61yo male presents with recent hx of increased fatigue with mildly increased exertional dyspnea. the pt denies any sigificant PMH but states that he had some heart problems as a child but he was never clear as to what the problem was. on cardiac exam you hear a early diastolic, soft-blowing decrescendo murmur with a high-pitch quality.
what increases this murmur?

A

squatting, sitting, leaning forward and hand grip.

87
Q

what type of murmur is heard with aortic regurgitation

A

soft high pitched, blowing diastolic murmur heartd along the LLSB
increases with squatting, sitting, leaning foward and hand grip
decreases with valsalva and satnding

88
Q

pt is a 72yo female presenting to the office for routine check up. while she otherwise feels well, it has been a long time since she recieved medical care. on exam you note an apical, rumbling diastolic murmur with a split S1 that occurs following an opening snap. this is heard best at LLSB and apex.
no other PE findings or PMH.
what is the most likely diagnosis

A

Mitral stenosis

89
Q

pt is a 64yo obese pt with hx of hyperlipidemia and poorly controled T2DM who underwent percutaneous transluminal coronary angioplasty of the posterior descending artery 3 days ago for ST elevation MI. He has so far been stable since the procedure, but overnight, you are called to his bedside. he is mallid and breathing laboriously. notable vitals include a BP of 85/45, and HR of 125bpm. his lung exam is notable for bibasilar crackles. on cardiac exam you note a hyperactive precordium with new II/VI blowing holosystolic mumur at apex with a split two radiating to axilla.

What is the most likely diagnosis?

A

Mitral regurgitation

90
Q

at what measurement does a AAA need to be surgically repaired

A

> 5.5cm or expands >0.6cm per year

91
Q

what is seen on CXR wtih aortic dissection

A

widened mediastium

92
Q

what are common cardiac causes for thrombus formation

A

afib and mitral stenosis

93
Q

what is the gold standard test to diagnose aterial embolism/thrombus

A

angiography

94
Q

what is the treatment of acute arterial occlusion

A

IV heparin if not limb-threatening then call vascular for angioplasty, graft or endartectomy

95
Q

what is the presentation of phlebitis/thrombophlebitis

A

dull pain, erythema, induration of vein and a palpable cord

96
Q

what diagnostic tests are used for phlebitis/thrombophlebitis

A

venous duplex is the gold standard

97
Q

what is the treatment of phlebitis/thrombophlebitis

A

symptomatic: NSAIDS and warm compress

Clinical: Emergency Medicine (13 decks)

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