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USMLE Step 2 CK > Cardiovascular > Flashcards

Cardiovascular Flashcards

To Know The CardioVascular System In the First Aid Book.

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

Normal Heart Rate

A

60 - 100 bpm

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2
Q

Heart Rate < 60 bpm is?

A

Bradycardia

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3
Q

Heart Rate > 100 bpm is?

A

Tachycardia

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4
Q

Rhythm, look for what on tracing?

A

P before every QRS and QRS after every P

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5
Q

Axis: Normal

A

Upright (positive) QRS in leads I and II

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6
Q

Left Axis Deviation

A

Upright (positive) QRS in lead I
&
Downward (negative) QRS in Lead II

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7
Q

Right Axis Deviation

A

Downward QRS in lead I
&
Upright QRS in lead II

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8
Q

What is “unstable” in a patient?

A

Chest Pain
SOB
Hypotension
Confusion (brain not perfusing)

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9
Q

Characteristics of “Stable Angina”

A 
Tightness
Heaviness
Pressure
Sore
Dull
Squeeze
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10
Q

Inferior Wall Ischemia presents?

A

Presents with Vagal Reflexes

Bradycardia
Hypotension
Dizzy
Faint
Sweating
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11
Q

Less Likely to be Ischemic or Infarct with characteristics like?

A

Sharp / knife like pain, easily pinpointed

Pain reproduced on palpation
Or
Change in position

Tender

Respiratory changes

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12
Q

True Infarct has a time that lasts longer than?

A

Pain lasts > 20 - 30 min

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13
Q

Transient Ischemia

Or

Esophageal Spasms

A

Relieved by Nitro

GERD (Worse with Nitro)

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14
Q

To Distinguish between LBBB and RBBB

A

WiLLiaM MaRRoW:

W patter: of QRS in V1-V2 and M pattern of QRS in V3-V6 for LBBB

M pattern: of QRS in V1-V2 and W pattern of QRS in V3-V6 for RBBB

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15
Q

Infarction

ST is elevated or depressed?
T-wave is?

A

ST Elevation

T wave inversion

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16
Q

Systolic Murmurs:

Aortic Stenosis
Mitral Regurgitation
Mitral Valve Prolapse
Flow Murmur

A

AS- Harsh Systolic ejection murmur
- radiation to carotids

MR- Holosystolic murmur
- radiation to axillae or carotids

MVP- Midsystolic Click or Late Systolic Click

Flow Murmur- Common, no disease

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17
Q

Diastolic Murmurs:

Aortic Regurgitation
Mitral Stenosis

A

AR- Early decrescendo murmur

MS- Mid to late, low pitched murmur

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18
Q

Difference of 20 mmHg in Arms with B.P. suggests what?

A

Aortic Disection

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19
Q

Gallops:

S3

S4

A

S3- Volume Issue

- Dilated cardiomyopathy (Floppy ventricle)
- Mitral Valve Disease
- Estrogen effect in early females (normal)

S4- Stiff Ventricle

- HTN
- Diastolic dysfunction (stiff ventricle)
- Aortic Stenosis
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20
Q

Edema, what are causes?

Pulmonary

Peripheral

A

Pulmonary: Left heart Failure

Peripheral: Right heart failure
: Hypoalbuminemia and drugs
: Hepatic Disease

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21
Q

Pulsus Paradoxus

A

(decreased systolic B.P. with inspiration)

Pericardial tamponade
Asthma
COPD
Tension Pneumothorax
Foreign body in airway
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22
Q

Pulsus Alternans

A

(alternating weak and strong pulse)

Cardiac tamponade
impaired left ventricular systolic function
Poor prognosis

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23
Q

Pulsus Parvus et Tardus

A

(weak and delayed pulse)

Aortic Stenosis

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24
Q

Management of Atrial Fibrillation

A

ABCD

Anti-Coagulate
Beta Blockers to control rate
Cardiovert / Calcium Channel Blockers
Digoxin

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25
Q

Definition of CHF

A

Inability of the heart to pump enough blood to maintain luid and metabolic homeostasis

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26
Q

CHF Drugs that Increase Mortality

A 
ACE-I / ARBS
ACE-I + Diuretic
Beta Blocker
Vasodilator
Spironolactone
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27
Q

Acute Atrial Fibrillation Causes (7)

Chronic Atrial Fibrillation Causes (2)

A

PIRATES:

  • Pulmonary Disease
  • Ischemia
  • Rheumatic Heart Disease
  • Anemia / Atrial Myxoma
  • Thyrotoxicosis
  • Ethanol
  • Sepsis

Chronic:

  • HTN
  • CHF
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28
Q

Atrial Flutter has what type of EKG Appearance?

A

Sawtooth

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29
Q

Atrial Flutter has a bpm rate of how much?

A

240 - 320 bpm

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30
Q

Treatment of Atrial Flutter?

A

Anticoagulation and rate Control

Cardiovert according to AF criteria

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31
Q

CHAD2 Score

CHAD2 VASc

A 
C- CHF (1)
H- HTN (1)
A- Age (1)
D- DM (1)
S2- Stroke or TIA (2)
-------------------------
Total = 6
V- Vascular (1)
A- Age (1)
Sc- Sex (1)
----------------
CHAD2 VASc = 9
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32
Q

Atrial Fibrillation use the CHAD2 score to estimate risk of Stroke then treat accordingly

What is the treatments?

A
  • Anticoagulate if >48 hours (prevent CVA)
  • Rate Control (CCB, BB, Digoxin, Amiodarone)

or

  • Initiate Cardioversion if <48 hours
  • Cardiovert if Transesophageal echo (TEE) shows no Left Atrial Clot
  • Cardiovert after 3 - 6 weeks of warfarin treatment with INR 2 -3
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33
Q

Ventricular Tachycardia (VT) Treatment

A

Cardioversion and Antiarrhythmics (Amiodarone, Lidocaine, Procainamide)

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34
Q

Ventricular Fibrillation (VF) Treatment

Syncope, absence of blood pressure, pulselessness

A

Immediate electrial cardioversion and ACLS protocol

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35
Q

Torsades De Pointes Treatment

A
  • Correct HypoKalemia
  • Withdrawl offending drugs
  • Give Magnesium Initally
  • Cardiovert if unstable
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36
Q

New York Heart Association Classificaiton of CHF

(NYHA Classifcation of CHF)

4 classes

A

1- No limit on activity; no symptoms with normal activity

2- Slight limitation of activity, comfortable at rest or with mild exertion

  1. Marked limitation of activity, comfortable only at rest

4- Confined to complete bed rest or chair, physical activity brings on discomfort, symptoms present at rest

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37
Q

Left Sided CHF Symptoms (5)

A 
Left sided S3/S4 gallop
Bilateral Basilar Rales
Pleural Effusions
Pulmonary Edema
Orthopnea, Paroxysmal Nocturnal dyspnea
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38
Q

Right Sided CHF Symptoms (5)

A 
Right-sided S3/S4 gallop
JVD
Hepatojugular reflex
Peripheral Edema
Hepatomegaly, Ascites
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39
Q

Stage Classification and Treatment of CHF (4)

A

A- Patients at high risk of developing CHF
Treatment- Manage risk factors (HTN, Smoking, Hyperlipidemia, obesity, exercise, alcohol)
- ACE-I

B- Structural Heart Disease (MI, Valve Disease), with no symptoms of CHF
Treat- ACE-I, BB

C- Structural Heart Disease with symtoms of CHF (SOB, fatigue, decrease exercise)
Treat- Diuretics, ACE-I, BB, Digitalis, Salt Restrict

D- Marked symtoms of CHF at rest
Treat- Mechanical assist, Heart Transplant, IV inotropic drugs, Hospice

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40
Q

Systolic Dysfunction is defined at what?

A

Ejection Fraction <50% and Increased Left Ventricular End-Diastolic Volumes

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41
Q

CHF Diagnosis

A

CHF is Clinical Syndrome

CXR: Cardiomegaly
Pleural Effusions
Vascular Plumpness
Prominent Hila

Echo- Decrease Ejection Fraction
Ventricular dilation

Lab Abnor- BNP >500
Increase Cr
Decrease Sodium

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42
Q

Acute CHF Managment

A

LMNOP

Lasix
Morphine
Nitrates
Oxygen
Position (Upright)
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43
Q

Acute Treatment of CHF

A
  • Correct underlying cause (MI, Drugs, Alcohol, Thyroid and Valvular Disease)
  • Diurese aggressively with loop and thiazide
  • Give ACE-I

Do the LMNOP

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44
Q

Chronic CHF Treatment

A

Control Comorbid Conditions (DM, HTNm Obesity) limit sodium and fluid

  • Long term BB + ACE-I
  • Daily ASA and Statin
  • Chronic diuretic
  • Low Dose Spironolactone
  • Anticoagulate with history of AF
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45
Q

Hypertrophic Cardiomyopathy

What is it?

A

LVH results in Impaireded left ventricular relaxation and filling

involves the interventricular septum, leading to left ventricular outflow tract obstruction and impaired ejection of blood

Congenital Form (Hypertropic Obstructive Cardiomyopathy: HOCM) in Autosomal Dominant)

Most common cause of sudden death in children

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46
Q

Diagnosis of HOCM

A

Echo- shows asymmetrically thickened left ventricular wall and dynamic obstuction of blood flow

ECG- may show LVH

CXR- may reveal left atrial enlargement

47
Q

Treatment of HOCM

A

Initial- BB for symptom relief

2nd line- CCB

48
Q

Restrictive Cardiomyopathy

A

Defined as Decreased Elastic of myocardium

Leads to impaired diastolic filling but has normal EF

Caused- Infiltrative disease (Amyloidosis, Sarcoidosis, Hemochromatosis) or by scarring

49
Q

History or Restrictive Cardiomyopathy

A

Left sided and right side heart failure

Symtoms of Right sided heart failure predominate (JVD, Peripheral edema)

50
Q

Diagnosis and Treatment of Restrictive Cardiomyopathy

A

Echo- Key test
reveals rapid early filling with normal EF

ECG- frequently shows LBBB

Treatment- Limited and Pallative
- Diuretics for fluid overload
- Vasodilators to decease filling
pressure

51
Q

Dilated Cardiomyopathy

A

Most common

Left ventricular dilation
Systolic Dysfunction (Low EF)

both must be present

Most cases idiopathic
2nd cause- Alcohol, myocarditis, Drugs, Endocrinopathies, Infections (Coxsackie, Chags), nutrition (Beriberi) and most common are HTN and Ischemia

52
Q

History of Dilated Cardiomyopathy

A

Gradual symtoms of CHF

Exam shows:

  • displacement of Left Venticular impulse
  • JVD
  • S3/S4 gallop
  • Mitral / Tricuspid Regurg
53
Q

Diagnosis of Dilated Cardiomyopathy

A

Echo- Diagnostic

EKG- non-specific St-T changes

   - Low volte QRS
   - LBBB

CXR- Enlarged balloon-like heart
- Pulmonary congestion

54
Q

Treatment of Dilated Cardiomyopathy

A

Address underlying issues (Alcohol, endocrine)

  • Treat CHF symptoms:
  • Diuretics

Prevent disease pregression:

  • ACE-I
  • BB
  • Aldosterone Antagonists

Consider ICD if EF <35%

55
Q

Coronary Artery Disease (CAD)

Manifestations

A 
Stable and Unstable Angina
SOB
Dyspnea on Exertion
Arrhythmias
MI
Heart Failure
Sudden Death
56
Q

Angina Pectoris

Prinzmetal’s (Variant)

A

Substernal Chest Pain secondary to Myocardial Ischemia (O2 supply and demand mismatch)

Prinzmetal’s- mimics Angina Pectoris but is caused by vasospasms of coronary vessels.

Affects young women at rest in early morning

  • ST-Elevation in absence of Cardiac Enzyme elevation
57
Q

Angina Pectoris:

Diagnosis

A
  • Rule out: Pulmonary, GI and Cardiac causes
  • Women and diabetic classically experience “silent” ischemic events. Keep Suspicous high
  • St segment change with stress test is diagnostic of CAD
58
Q

Angina Pectoris:

Treatment

Acute

Chronic

A

Acute Symptoms: (MONA)

  • ASA
  • 02
  • Nitro IV
  • IV Morphine
  • Consider IV BB

Chronic:

  • Nitrates
  • ASA
  • BB (CCB are second line)

Initiate risk reduction:

  • Smoking
  • Cholesterol
  • HTN
59
Q

Unstable Angina / Non-Elevation MI (NSTEMI)

Unstable Angina Description

A

Unstable Angina- chest pain that is

  • New Onset
  • Accelerating
  • Occurs at rest

NSTEMI

  • Elevation of:
    • Troponin I
    • Troponin T
    • CK-MB
60
Q

Unstable Angina / NSTEMI

Diagnosis

A

Pt should be risk stratified by TIMI (Thrombosis in Myocardial Infarction Study)

  • Unstable Angina doesn’t have elevated cardiac Markers, but ST changes seen on EKG
  • NSTEMI- serial cardiac enzymes and EKG
61
Q

Unstable Angina / NSTEMI

A

Tx same as for Stable Angina

  • Clopidogrel
  • Unfractionated Heparin or Enoxaparin
  • Glycoprotein IIB/IIIA

TIMI >3

  • Troponin elevation or St changed >1mm
    - Given Heparin
    - Angiography
    - Revascularization
62
Q

TIMI

A
  • AGE (>65)- 1
  • > 3 CAD risk factors (Family, DM, Smoke, HTN)- 1
  • Known CAD (stenosis >50%) - 1
  • ASA use in past 7 days- 1

Presentation

  • Severe Angina >2 episodes in 24hr- 1
  • St deviation >0.5mm - 1
    • Cardiac Marker - 1

Risk Score = 0-7

Score >3 = Enoxaparin and Angiography

63
Q

ST-Elevation MI (STEMI)

Definition

A

St- Elevation and Cardiac Enzyme release secondary to prolonged cardiac ischemia and necosis

64
Q

STEMI Hx

A

Acute onset substernal chest pain

Described as:

  • pressure or tightness
  • radiates to left arm, next, jaw

Associated symptoms

  • Diaphoresis
  • SOB
  • Lightheaded
  • Anxiety
  • N/V
  • Syncope

Physical

  • Arrhythmias
  • Mitral Regurg (rupture papillary muscle
  • Hypotension
  • CHF new (rales, S3 gallop)

Best predictor of survival - left ventricular EF

65
Q

STEMI Diagnosis

A

ST Elevation
New LBBB

ST Depression in leads V1-V2 means infarction of posterior wall

T wave inversions
peak T waves

Cardiac Enzymes

  • Troponin I (most sensitive)
  • CK-MB (specific)
66
Q

STEMI Tx

A

Six Meds Consider:

  • ASA
  • BB
  • Clopidorgrel
  • Morphine
  • Nitrates
  • O2

Emergent Angiography and PCI

67
Q

Indications for CABA

A

DUST

Depressed ventricular Function
Unable to do PCI
Stenosis of left main coronary artery
Triple vessel disease

68
Q

Complications of STEMI

A

Arrhythmia most common

Dressler’s happen 2-10 weeks Post MI

Timeline of complications:
1st day- Heart failure
2-4- arrhythmias
5-10- left ventricular wall rupture
Weeks-Months- Ventricular aneurysms
69
Q

HyperCholesterolemia

A

Total Cholesterol >200 mg/dL
LDL >130 mg/dL
Triglycerides >500 mg/dL
HDL <40 mg/dL

Risk factors for CAD

70
Q

Hypercholesterolemia Hx

A

Most have no signs or symptoms

Extremely high triglycerides or LDL levels may have
- Xanthomas (nodules in skin over the tendons

  • Xanthelasmas (yellow fatty deposits in the skin around the eyes)
  • Lipemia Retinalis (creamy appearance of retinal vessels)
71
Q

Hypercholesterolemia Dx

A

Fasting lipid profile >20 years old
Repeat every 5 years

Total Serum Cholesterol >200 mg/dL on 2 occasions is diagnostic

72
Q

Dyslipidemia

A

LDL >130

HDL <200 is diagnostic of dyslipidemia

73
Q

Hypercholesterolemia Tx

A

1st intervention- Diet / Exercise for 12 weeks

Then do Statins

74
Q

HTN Definition

A

Systolic >140
Diastolic >90

based on 3 measurements separated in time

75
Q

Diabetic HTN range

A

<130/80

76
Q

Essental HTN Dx

A

Conduct:

  • Cardio
  • Neuro
  • Ophthalmologic
  • Abdominal exams

Obtain:

  • UA
  • BUN/CR
  • Electrolytes

To assess organ problems

77
Q

HTN Tx

A

ABCD

ACE-I / ARBS
BB
CCB
Diuretics

78
Q

Causes of 2 HTN

A

CHAPS

Cushings
Hyperaldosteronism (Conns)
Aortic Coarctation
Pheochromocytoma
Stenosis of Renal Arteries
79
Q

HTN Emergencies

> 200

A

IV Meds:

  • Labetalol
  • Nitroprusside
  • Nicardipine

Goal is to lower no more than 25% over first 2 hours to prevent cerebral hypoperfusion

80
Q

Pericarditis

A

Pain sharper and worse when lying down (due to stretch on pericardium)

Pain worsens with inspiration

Relieved when sitting up

81
Q

Pericarditis

Looks on EKG and Tx

A

PR Depression

Treat- Start NSAIDS then give steroids if no better in 2 days

82
Q

Pericarditis Diagnosis

A

CXR, EKG and Echo to rule out MI

EKG changes include ST segment Elevation

PR depressions

T wave inversion

83
Q

Cardiac Tamponade

A

Excess fluid in the pericardial sac

compromises ventricular filling and decrease cardiac output

84
Q

Risk factors for Cardiac Tamponade

A 
Pericarditis
Malignancy
SLE
TB
Trauma (Stab wound medial to the left nipple)
85
Q

Cardiac Tamponade

What is Becks Triad

A

JVD
Hypotension
Distant Heart Sounds

86
Q

What Causes Pericarditis

A

CARDIAC RIND

Collagen Disease
Aortic Disection
Radiation
Drugs
Infections
Acute Renal Failure
Cardiac (MI)
Rheumatic Fever
Injury
Neoplasms
Dressler Syndrome
87
Q

Treatment of Tamponade

A

Aggressive Volume Expansion with IV fluid

Pericardiocentesis (aspirate will be non clotting blood)

Decomprensation may warrent balloon pericardiotomy and pericardial window

88
Q

Aortic Aneurysms

A

Associated wit Atherosclerosis

Most Abdominal

> 90% originate below renal arteries

89
Q

Aortic Aneurysm HX

Risk factors?
Look for?

A

Usually asymptomatic

Risks- HTN

     - Hypercholesterolimia
     - Males > Females

Exam- Pulsitile abdominal mass or abdominal bruits

90
Q

Diagnosis Aortic Aneurysms

A

Abdominal Ultrasound

91
Q

Treatment of Aortic Aneurysms

A

Asymptomatic- Monitor lesions 5.5 cm Abdominal

                               >6cm thoracic

Surgery if ruptured

92
Q

Aortic Dissection

A

Most commonly 2nd to HTN

Creates false Lumen (intima and adeventia) are affected not true rupture

Occurs at 40-60

M>F

93
Q

Aortic Dissection HX

A

Sudden tearing / ripping pain in anterior chest in ascending dissection

Interscapular back pain in descending disection

Pt is typically HTN

Asymmetric pulses and B.P. measurments (20 mmHg difference between arms)

94
Q

Aortic Dissection Dx

A

EKG
CXR- widening of the mediastinum, cardiomegaly or new left pleural effusion.

CT angiography is gold standard of imaging

TEE- provide details of thoracic aorta

95
Q

Aortic Dissection Tx

A

Monitor and medically manage B.P. and HR necessary

Don’t give Thrombolytics

Dissection of Ascending Aorta- MEDICAL EMERGENCY

Dissection of DECENDING AORTA- Manage with B.P. and HR control

96
Q

Deep Venous Thrombosis (DVT)

what is the Virchow’s Triad

A

Clot formation in the large veins of the extremities or pelvis

Virchow’s- Hemostasis, trauma, hypercoagulability

97
Q

DVT Hx

A

Unilateral lower extremity pain, erythema and swelling

Homan’s Sign- Calf tenderness with passive foor dorsiflexion

98
Q

DVT Dx

A

Doppler ultrasound

Spiral CT or V/Q scan- evaluate for pulmonary embolism

99
Q

DVT Tx

A

IV unfractionated heparin
or
SQ low molecular weight heparin

followed by warfarin for 3-6 months

CONSIDER IVC Filter for contraindications to anticoagulation

100
Q

Lymphedema

A

Disruption of lymphatic circulation results in peripheral edema and chronic infection of extremities

Complication of surgery or node dissection

101
Q

Lymphedema Hx

A

PostMasectomy has upper extremity

Immigrants present with progressive swelling of lower extremities bilateraly

Children present progressive, bilateral swelling

102
Q

Lymphedema Dx

A

Diagnosis is clinical

Rule out other causes of edema- Cardiac and Metabolic disorders

103
Q

Lymphedema Tx

A

NO CURATIVE TX Exists

Diuretics are ineffective

Exercise, massage and pressure garments to mobilize and limit fluid may help

104
Q

Peripheral Artery Disease

A

Occulsion of blood supply to the extremities by atherosclerotic plaque

Lower extremities are most commonly affected

105
Q

PID Hx

A

Intermittent claudication (reproducible leg pain that occurs with walking and ALAYS relieved by rest)

Disease preogresses, pain occurs at rest and affect distal extremities

Foot ulcerations develop due to poor perfusion

FEMOROPOPLITEAL DISEASE- Calf Claudication, pulses below femoral artery absent

106
Q

PID Dx

A

Measure Ankle and Brachial Systolic BP (Ankle-brachial index ((ABI)))

Normal ABI >1

Pain at rest occcurs with ABI<0.4

107
Q

PID Tx

A

Control underlying conditions (smoke, dm)
Exercise best

Drugs:
ASA, cilostazol, thromboxane inhibits may improve symptoms

Angioplasty / stents have variable success rate

Amputation if conservation tx fails

Avoid BB in PID due to B2 mediated peripheral vasoconstriction

108
Q

Syncope

A

Sudden temporary less of consciousness and postural tone secondary to cerebral hypoperfusion

Etiologies are either Cardiac or Non-Cardiac

109
Q

Syncope

Cardiac reasons

A 
Valvular lesions
Arrhythmias
Pulmonary Embolisms
Cardiac Tamponade
Aortic Dissection
110
Q

Syncope

Non-Cardiac

A 
Orthostatic / Hypovolemic Hyptotension
Neurologic (TIA / Stroke)
Metabolic Abnormalities
Neurocardigenci syndromes (Vasovagal)
Psychiatric
111
Q

Syncope Dx

A

Depends on suspected etiology

Holter Monitor
Echocardiogram
Stress Test

112
Q

Syncope Tx

A

Tailored to the etiology

113
Q

Stable Angina

And Unstable Angina

A 
Stable
---------
EKG Negative
Stress test + - ST depression
Increase 02 demand
Releaved by rest
Unstable
----------
New
Worse pattern
Pain @ rest

USMLE Step 2 CK (5 decks)

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