Cardiovascular Flashcards
Definition of unstable angina
Angina that is new, is worsening, or occurs at rest
Antihypertensive for a diabetic px with proteinuria
ACEI
Beck’s triad for cardiac tamponade
Hypotension, distant heart sounds and JVD
Drugs that slow the heart rate
Beta-blockers, CCBs, digoxin, amiodarone
Hypercholesterolemia tx that leads to flushing and pruritus
Niacin
Murmur - hypertrophic obstructive cardiomyopathy (HOCM)
A systolic ejection murmur heard along the lateral sternal border that increases with a decreasing preload (Valsalva maneuver)
Murmur - aortic insufficiency
Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up; increases with increasing afterload (handgrip)
Murmur - aortic stenosis
A systolic crescendo/decrescendo murmur that radiates to the neck; increases with increasing preload (squatting maneuver)
Murmur - mitral regurgitation
A holosystolic murmur that radiates to the axilla; increases with increasing afterload (handgrip maneuver)
Murmur - mitral stenosis
A diastolic, mid- to late, low-pitched murmur preceded by an opening snap
Tx for atrial fibrillation and atrial flutter
If unstabl, cardiovert. If stable or chronic, rate control with CCBs or beta-blockers
Tx for ventricular fibrillation
Immediate cardioversion
Dressler ‘s syndrome
An autoimmune reaction with fever, pericarditis and increased ESR occurring 2-4 weeks post-MI
IV drug use with JVD and a holosystolic murmur at the left sternal border. Tx?
Treat existing heart failure and replace the tricuspid valve
Diagnostic test for hypertrophic cardiomyopathy
Echocardiogram (showing a thickened left ventricular wall and outflow obstruction)
Pulsus paradoxus
A decrease in systolic BP of >10mmHg with inspiration; seen in cardiac tamponade
Classic ECG findings in pericarditis
Low-voltage, diffuse ST-segment elevation
Definition of HTN
BP >140/90mmHg on 3 separate occasions 2 weeks apart
Eight surgically correctable causes of HTN
Renal artery stenosis (RAS), coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism
Evaluation of a pulsatile abdominal mass and bruit
Abdominal US and CT
Indications for surgical repair of abdominal aortic aneurysm
> 5.5cm, rapidly enlarging, symptomatic or ruptured
Tx for acute coronary syndrome
ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitroglycerin, IV beta-blockers
Metabolic syndrome
Abdominal obesity, high triglycerides, low HDL, HTN, insulin resistance, prothrombic or proinflammatory states
Appropriate diagnostic test?
- 50 yr old man with stable angina can exercise to 85% of maximum predicted heart rate
- A 65 yr old woman with left bundle branch block and severe osteoarthritis has unstable angina
- Exercise stress treadmill with ECG
2. Pharmacologic stress test (eg dobutamine echo)
Target LDL in a px with diabetes
Signs of active ischemia during stress testing
Angina, ST-segment changes on ECG, or decreasing BP
ECG findings suggesting MI
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
Coronary territories in MI
Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal)
A young px with angina at rest and ST-segment elevation with normal cardiac enzymes
Prinzmetal’s angina
Common sx’s associated with silent MIs
CHF, shock, and altered mental status
Diagnostic test for pulmonary embolism (PE)
Spiral CT with contrast
Protamine
Reverses the effects of heparin
Prothrombin time
The coagulation parameter affected by warfarin
A young px with a family history of sudden cardiac death collapses and dies while exercising
Hypertrophic cardiomyopathy
Endocarditis prophylaxis regimens
Oral surgery: amoxicillin for certain situations
GI or GU procedures: not recommended
Virchow’s triad
Stasis, hypercoagulability, endothelial damage
The most common cause of HTN in young women
OCPs
The most common cause of HTN in young men
Excessive EtOH
Figure 3 sign
Aortic coarctation
Water bottle shaped heart
Pericardial effusion; look for pulsus paradoxus
Classic ECG findings in atrial flutter
“Sawtooth” P waves
