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PANCE Review > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

General cause of dilated cardiomyopathy

A

malfunction of myocardium

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2
Q

Most common causes of dilated cardiomyopathy (4)

A

Alcohol abuse (most common)

Idiopathic

Myocarditis

Drugs (doxorubicin)

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3
Q

Sequelae of dilated cardiomyopathy

A

right and left systolic dysfunction, congestive heart failure

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4
Q

Most common first symptom of dilated cardiomyopathy

A

exertional intolerance

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5
Q

In addition to exertional intolerance, other s/sx dilated cardiomyopathy (4)

A

dyspnea

orthopnea

lower extremity edema

chest pain

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6
Q

Physical exam in dilated cardiomyopathy (5)

A

S3 heart sound

JVD

crackles on lungs

mitral regurgitation

lower extremity edema

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7
Q

EKG in dilated cardiomyopathy (3)

A

nonspecific ST and T wave changes, LBBB

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8
Q

CXR in dilated cardiomyopathy (2)

A

cardiomegaly, pulmonary vascular congestion

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9
Q

Echo in dilated cardiomyopathy (4)

A

dilated chambers

thin left ventricular wall

poor wall movement

decreased ejection fraction (often less than 30%)

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10
Q

Non-druggy treatment of dilated cardiomyopathy (3)

A

withdraw offending agents like booze

sodium restriction

maybe heart transplant

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11
Q

druggy treatment of dilated cardiomyopathy (4)

A

Diuretics

maybe digoxin

ACE inhibitors (unless contraindicated)

Beta-blockers in stable heart failure

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12
Q

Most common cause of death in young athletes

A

Ventricular tachyarrhythmias due to hypertrophic cardiomyopathy

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13
Q

Most common cause of hypertrophic cardiomyopathy

A

Autosomal dominant genetic cause

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14
Q

Pathogenesis of hypertrophic cardiomyopathy

A

Hypertrophy of cardiac septum leads to LV outflow obstruction, impaired diastolic filling, this leads to pulmonary congestion.

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15
Q

Most patients with hypertrophic cardiomyopathy have these symptoms:

A

None. Ha. Got you good.

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16
Q

Most common presenting symptoms in hypertrophic cardiomyopathy (3)

A

Dyspnea on exertion (most common)

angina

syncope

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17
Q

Physical exam, hypertrophic cardiomyopathy (3)

A

Mitral regurgitation (increases with valsalva, decreases with handgrip and leg elevation)

S4 sound

Prominent left ventricular impulse

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18
Q

Primary diagnostic test for hypertrophic cardiomyopathy (results)

A

Echocardiogram (septal wall thickness, ejection fraction usually greater than 60%)

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19
Q

EKG in hypertrophic cardiomyopathy

A

LVH

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20
Q

Treatment of symptomatic hypertrophic cardiomyopathy (3)

A

Beta-blockers (propanolol)

Calcium channel blockers (verapamil)

Diuretics for fluid overload

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21
Q

Common causes of restrictive cardiomyopathy (5)

A

Amyloidosis

Sarcoidosis

Hemochromatosis

Post-radiation

Post open-heart surgery

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22
Q

Restrictive cardiomyopathy pathogenesis

A

Myocardial changes lead to diastolic noncompliance with elevated filling pressures, this leads to pulmonary congestion

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23
Q

Most common symptoms in restrictive cardiomyopathy (2)

A

Exertional intolerance

fluid retention

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24
Q

Restrictive cardiomyopathy physical exam

A

elevated JVD

pronounced S4 sound

mitral regurgitation

tricuspid regurgitation

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25
Q

Echocardiogram in restrictive cardiomyopathy (3)

A

ejection fraction between 25% and 50%

Normal LV thickness

Increased atrial size

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26
Q

EKG in restrictive cardiomyopathy (3)

A

Low voltage QRS

Nonspecific ST and T wave changes

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27
Q

Definitive / specific diagnostic test for restrictive cardiomyopathy

A

tissue biopsy

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28
Q

Treatment for restrictive cardiomyopathy (2)

A

Treat underlying cause

Diuretics

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29
Q

Name this rhythm

A

Atrial fibrillation

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30
Q

Most common sustained arrhythmia in adults

A

Atrial fibrillation

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31
Q

Major risk with atrial fibrillation

A

Risk of intra atrial clot formation

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32
Q

QRS rhythm in atrial fibrillation

A

irregularly irregular

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33
Q

3 major goals in a-fib treatment

A

Rate control

Anticoagulation

Rhythm control

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34
Q

Rate control agents in a-fib (3)

A

Beta blockers (metoprolol)

Calcium channel blockers (verapamil, diltiazem)

digoxin

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35
Q

Anticoagulation agents in a-fib (2)

A

heparin acutely

warfarin long term

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36
Q

Rhythm control agents in a-fib (2)

A

Amiodarone is most effective, but side effects are common

Cardioversion may be attempted if no sign of atrial clots

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37
Q

Name this rhythm

A

atrial flutter

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38
Q

Atrial flutter symptoms (4)

A

Dizziness

Palpitations

Chest pain

Dyspnea

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39
Q

Best leads to recognize pattern in a-flutter

A

sawtooth pattern in II, III, aVF

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40
Q

Common ventricular rate in atrial flutter

A

75-150

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41
Q

Common atrial rate in atrial flutter

A

250 to 400

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42
Q

Primary treatment of atrial flutter

A

cardioversion

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43
Q

Acute medication treatments of atrial flutter (2)

A

Beta blockers (metoprolol, esmolol)

Calcium channel blockers (verapamil, diltiazem)

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44
Q

Long-term medication treatments for atrial flutter (4)

A

Amiodarone, sotalol, quinidine or procainamide

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45
Q

Definitive treatment of atrial flutter if reentrant site is known

A

catheter ablation

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46
Q

What the heck is going on here? (ignore those lame arrows)

A

multifocal atrial tachycardia

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47
Q

Common patients that get multifocal atrial tachycardia (2)

A

COPD

severe systemic illness

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48
Q

EKG findings in multifocal atrial tachycardia

A

polymorphic p waves

differing PR intervals

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49
Q

Treatment of multifocal atrial tachycardia (one druggy, one non-druggy)

A

Treat underlying cause

Calcium channel blockers

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50
Q

What the fuck, yo?

A

1st degree AV block

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51
Q

Some people with AV block do this for fun

A

pass out (ok, maybe not so fun)

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52
Q

Definition of first degree AV block

A

PR greater than 200 milliseconds

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53
Q

Name that rhythm

A

Second degree, type 1, Wenckebach

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54
Q

Definition of Wenckebach rhythm

A

progressive increase in PR interval until a P wave is blocked, then the cycle is repeated

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55
Q

What it is?

A

Second degree AV block, type 2

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56
Q

Definition of second degree AV block type 2

A

sudden block of a P wave with no change in PR interval

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57
Q

Whaddaya call this?

A

3rd degree AV block

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58
Q

Third degree AV block definition

A

Atria and ventricles are controlled by different pacemakers, they fire independently

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59
Q

Look at this table

A

because I say so

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60
Q

Three non-druggy considerations for treatment of AV block

A

Asymptomatic patients do not require treatment

Correct any reversible causes

Permanent pacing may be needed

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61
Q

Druggy treatment for symptomatic AV blocks (2)

A

Atropene or isoproterenol

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62
Q

What’s this all about?

A

Right bundle branch block

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63
Q

How bout this one?

A

Left bundle branch block

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64
Q

List some causes for bundle branch blocks (5ish)

A

Acute MI

Cardiomyopathy

Big PE

Aortic stenosis

being a dork

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65
Q

If a bundle branch block gets conduction across an accessory pathway, it’s called ___________ and it can put the patient at risk of __________

A

Wolff-Parkinson-White Syndrome

Other cardiac arrhythmias

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66
Q

What EKG finding will suggest WPW?

A

Delta waves

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67
Q

What duration defines a wide QRS

A

Greater than 120 milliseconds

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68
Q

A wide QRS without other signs of BBB is called

A

Intraventricular conduction delay

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69
Q

These 2 medications are contraindicated in WPW

A

Digoxin and CCB’s

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70
Q

Possible presenting symptoms of paroxysmal supraventricular tachycardia

A

palpitations or anxiety

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71
Q

another name for paroxysmal supraventricular tachycardia

A

AV nodal reentry tachycardia

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72
Q

PSVT EKG findings

A

Rate between 150 and 250

Regular rhythm

Typically no atrial activity seen

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73
Q

PSVT treatment (3-6)

A

Vagal maneuver

Antianxiety meds

Drug of choice is adenosine

Other rate slowing meds like CCB, beta-blockers, digoxin, may be helpful

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74
Q

Normal rhythm, then interrupted by a narrow QRS, out-of-rhythm beat

A

Premature atrial contraction

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75
Q

Normal rhythm interrupted by wide-complex QRS

A

premature ventricular contraction

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76
Q

PVC treatment

A

Treat underlying caue

may use antiarrhythmics

use of beta-blockers is common

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77
Q

Class Ia antiarrhytmics (3)

A

Sodium channel blockers like

Quinidine

Procainamide

disopyramide

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78
Q

Class Ib antiarrhythmics (2)

A

Sodium channel blockers like

Lidocaine

mexiletine

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79
Q

Class Ic antiarrhythmics (2)

A

Sodium channel blockers like

Flecainide

propafenone

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80
Q

Class II antiarrhythmics (2)

A

Beta blockers like

Propanolol

Metoprolol

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81
Q

Class III antiarrhythmics (2)

A

Prolonged action potential duration drugs like

Amiodarone

sotalol

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82
Q

Class IV antiarrhythmics (2)

A

Calcium channel blockers like

Verapamil

diltiazem

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83
Q

Class Ia antiarrhytmic side effects

A

Nausea, vomiting

Quinidine: hemolytic anemia, thrombocytopenia, tinnitus

Procainamide: drug induced lupus

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84
Q

Class Ib antiarrhythmic side effects

A

Lidocaine: dizziness, confusion, seizures, coma

Mexiletine: tremor, ataxia, rash

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85
Q

Class Ic antiarrhythmic side effects

A

Flecainide: nausea, dizziness

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86
Q

Class II antiarrhytmic side effects

A

CHF, bronchospasm, bradycardia, hypotension

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87
Q

Class III antiarhythmic side effects

A

Amiodarone: hepatitis, pulmonary toxicity, thyroid disease, peripheral neuropathy

Sotalol: bronchospasm

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88
Q

Class IV antiarrhythmic side effects

A

AV block, hypotension, bradycardia, constipation

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89
Q

Precipitating causes of V-tach (5)

A

electrolyte imbalance

acid-base problems

hypoxemia

MI

drugs

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90
Q

Long QT can lead to this dangerous rhythm

A

Torsades de pointes

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91
Q

Drugs associated with torsades de pointes (9)

A

Tricyclic antidepressants

Erythromycin

Ketoconazole

haloperidol

cisapride

disopyramide

pentamidine

sotalol

Class I antiarrhythmics

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92
Q

Some things that can lead to heart failure (6)

A

Valvular heart disease

Coronary artery disease

arrhythmia

hypothyroidism

High cardiac output syndromes

hypertension

93
Q

Conditions that can precipitate heart failure (6)

A

Reduction of medication

discontinuing medication

increased sodium intake

anemia

infection

PE

94
Q

Presenting symptoms of heart failure (6)

A

dyspnea

orthopnea

paroxysmal nocturnal dyspnea

fatigue

exercise intolerance

edema

95
Q

Physical exam in heart failure (9)

A

restless

dyspnea

JVD

Rales

tachycardia

S3 / S4 heart sounds

displaced PMI

RUQ tenderness / ascites

Peripheral edema

96
Q

Labs in heart failure

A

Elevated LFT’s

Elevated BNP

Check CBC and thyroid to rule out anemia and thyroid disease

97
Q

Imaging in heart failure

A

CXR: cardiomegaly, increase in pulmonary vasculature, pleural effusion, Kerley B lines

Echocardiogram is diagnostic, signs of systolic or diastolic dysfunction, decreased ejection fraction

98
Q

What’s weird here

A

Kerley B lines, suggestive of heart failure

99
Q

EKG in heart failure

100
Q

Class I heart failure

A

No cardiac symptoms with ordinary activity

101
Q

Class II heart failure

A

Cardiac symptoms with marked activity, but asymptomatic at rest

102
Q

Class III heart failure

A

Cardiac symptoms with mild activity, but asymptomatic at rest

103
Q

Class IV heart failure

A

Cardiac symptoms at rest

104
Q

Non-druggy therapy for heart failure

A

Low sodium diet

Quit smoking, idiot

other obvious things for heart: exercise and weight loss, controlling other comorbidities

105
Q

Drugs that should be avoided in heart failure

A

Aspirin, NSAID’s, CCB’s

106
Q

Goals of druggy therapy for heart failure

A

control fluid retention

control neurohormonal activation

control symptoms

107
Q

Big 2 drugs for heart failure (especially with left ventricular dysfunction and if not contraindicated)

A

ACE and Beta

108
Q

This drug can improve symptoms and exercise tolerance in heart failure by increasing cardiac contractility

109
Q

If a patient can’t use an ACE in heart failure, what are some other options

A

Vasodilators, like hydralazine and nitrates

110
Q

Some possible end organ damage from hypertension (7)

A

LVH

Angina

Heart failure

Stroke

Chronic Kidney Disease

Peripheral artery disease

Retinopathy

111
Q

6 lifestyle modifications for hypertension

A

Weight loss

Limit alcohol intake

Regular aerobic exercise

Quit smoking, dummy

Reduce sodium intake

Reduce saturated fat and cholesterol intake

112
Q

Drug choices for hypertension with angina

A

Beta blockers and CCBs

113
Q

Drug choices for hypertension with diabeetus or hyperlipidemia

A

ACE inhibitors

CCBs

114
Q

Drug choices for hypertension with CHF

A

Diuretics and ACE inhibitors

115
Q

Drug choice for hypertension with previous MI

A

ACE and Beta

116
Q

Drug choice for hypertension with chronic renal failure, or asthma/COPD

A

Diuretics and CCB’s, maybe also ACEi

117
Q

7 common causes for secondary hypertension

A

Renovascular disease

Coarctation of the aorta

Primary aldosteronism

Cushing’s Syndrome

Pheochromocytoma

Obstructive Sleep Apnea

Renal parenchymal hypertension

118
Q

Diagnosing renovascular disease

A

Elevated Cr

MRI of renal arteries

Renogram

119
Q

Diagnosing coarctation of aorta

A

Unequal pulses

Rib notching

Claudication

MRI

120
Q

Diagnosing primary aldosteronism

A

Hypokalemia

Metabolic acidosis

Renin / aldosterone

121
Q

Diagnosing Cushing’s syndrome

A

truncal obesity

cortisol

dexamethasone suppression test

122
Q

Diagnosing pheochromocytoma

A

Tachycardia

Polyuria

Headache

Diaphoresis

Plasma metanephrine and normetanephrine

123
Q

Diagnosing sleep apnea

A

Snoring

Obesity

Sleep study

124
Q

Diagnosing renal parenchymal hypertension

A

Elevated Cr

abnormal UA

24 hour urine for protein

Renal ultrasound

125
Q

Avoid this drug in patients with bilateral renal artery stenosis

A

ACE inhibitors

126
Q

7 etiologies for malignant hypertension

A

Aortic dissection

Post CABG

Acute MI

unstable angina

Eclampsia

Head trauma

Severe burns

127
Q

Some defining symptoms of malignant hypertension (other than elevated blood pressure)

A

headache

confusion

blurry vision

nausea and vomiting

seizures

oliguria

128
Q

Target blood pressure in malignant hypertension

A

170/110 over first 12 or so hours

Normal after that

129
Q

3 meds in malignant hypertension

A

nitroprusside in hypertensive encephalopathy, intracranial bleeding and heart failure

Use nitroprusside with propanolol for dissecting aneurysm

Oral clonidine for hypertensive urgency

130
Q

3 causes of hypovolemic shock

A

Hemorrhage

Volume depletion

Extravascular spacing

131
Q

2 causes of cardiogenic shock

A

Myocardial dysfunction

Valvular defects

132
Q

4 causes of obstructive noncardiogenic shock

A

Pericardial tamponade

Tension pneumothorax

Severe pulmonary embolism

Left ventricular outflow obstruction

133
Q

Symptoms of cardiogenic shock

A

Altered mental status

cyanosis

oliguria

cool clammy extremities

134
Q

Vasopressor agents used in cardiogenic shock

A

Dopamine can increase systemic pressure and cardiac output

Dobutamine can increase cardiac output, but not systemic blood pressure

135
Q

Definition of orthostatic hypotension

A

Fall in systolic of 30 mm Hg or more

Fall in diastolic of 10 mm Hg or more

between recumbent and upright

136
Q

10 causes of orthostatic hypotension

A

Antipsychotics

Diuretics

Alpha blockers

ACE inhibitors

Alcohol

Tranquilizers

Vasodilators

Methyldopa

Neuropathies

Parkinson’s

137
Q

Most MI deaths occur within ________ of onset of symptoms

138
Q

10 Risk factors for coronary atherosclerosis

A

Hyperlipidemia

Hypertension

Oldness

Fatness

Family history

Stress

Diabeetus

Having a penis

Being lazy

Smoking like a goddamn idiot

139
Q

Who tends to have painless MI’s?

A

Old folk

Diabeetuses

140
Q

In addition to chest pain, list some other associated symptoms of MI

A

Nausea

Vomiting

Diaphoresis

Dyspnea

Weakness

141
Q

How long does troponin stay elevated after an MI?

How about CKMb?

Myoglobin?

A

troponin 5-10 days

CKMb 2-4 days

Myoglobin less than 1 day

142
Q

How long after the start of an MI is Troponin elevated?

CKMb?

Myoglobin?

A

Troponin 2-6 hours

CKMb 3-6 hours

Myoglobin 1-2 hours

143
Q

ST elevation in II, III, aVF

Location?

Artery?

A

Inferior

RCA

144
Q

STE in I, aVL, V5, V6

Location?

Artery?

A

Lateral

Circumflex

145
Q

STE in V1-V4, I, aVL

Location?

Artery?

A

Anterior

LCA

146
Q

ST Depression v1, v2

Location

Artery

A

Posterior

RCA circumflex

147
Q

STE v3-v6

Location

Artery

A

Apical

LAD / RCA

148
Q

STE I, aVL, v4-v6

Location

Artery

A

Anterolateral

LAD / circumflex

149
Q

STE V1-V3

Location

Artery

A

Anteroseptal

LAD

150
Q

4 absolute contraindications to thrombolytic therapy in MI

A

Active bleeding / bleeding disorder

Prior hemorrhagic stroke / other stroke within 1 year

Intracranial or spinal cord cancer

Suspected / known aortic dissection

151
Q

4 relative contraindications to thrombolysis in MI

A

Severe / uncontrolled hypertension

Anticoagulation: therapeutic or elevated INR

Old ischemic stroke

Recent major surgery / trauma / pregnancy

152
Q

Only way to exclude coronary artery disease with certainty. (used in angina)

A

Coronary angiography

153
Q

4 general treatment considerations for angina

A

Quit smoking

control BP

control diabeetus

exercise

154
Q

3 major meds for angina

A

ACE

Beta

Nitrates

155
Q

3 things that would make angina unstable

A

New onset

Worsening

Occurs at rest

156
Q

Treatment of unstable angina (5)

A

ACE

Beta

Aspirin / heparin / clopidogrel

Nitro

Revascularization (CABG / angioplasty)

157
Q

2 other conditions that may be associated with Prinzmetal angina

A

Raynaud

Migraines

158
Q

Treatment of Prinzmetal angina

A

nitrates

CCB’s

NO Beta Blockers!

159
Q

5 Major Jones Criteria of acute Rheumatic Fever

A

Carditis

Polyarthritis

Chorea

Erythema Marginatum

Subcutaneous nodules

160
Q

4 minor Jones Criteria for Rheumatic Fever

A

Arthralgia

Fever

Long PR

Lab (ESR, CRP)

161
Q

Rheumatic fever treatment

A

Bed rest

Antibiotics to prevent, but they don’t help once you have RF

Anti-inflammatories can help (aspirin up to steroids)

162
Q

AAA screening, how and who

A

Ultrasound, males 65-75 who have ever smoked

163
Q

AAA treatment

A

Beta blockers

Imaging q6mo

surgery if greater than 5.5cm or rapidly changing

164
Q

Definitive treatment for aortic dissection

A

surgery, duh

165
Q

Embolus / thrombus physical exam

A

5 P’s

Pain

Pallor

Pulselessness

Paresthesia

Paralysis

166
Q

What’s the awesome name for temporary loss of vision in one eye, frequently due to ophthalmic artery occlusion

A

amaurosis fugax

167
Q

3 methods for diagnosis of peripheral arterial occlusion

A

Ankle/brachial index

Ultrasound doppler

Arteriography

168
Q

5 treatments for peripheral arterial occlusion

A

Pentoxifylline (decreases blood viscosity)

Aspirin

Ticlopidine (inhibits platelet aggregation)

Thromboendarterectomy

Stop Fucking Smoking

169
Q

Most common symptom of giant cell arteritis

A

New onset of temporal headache

170
Q

Definitive diagnosis of giant cell arteritis

171
Q

Giant cell arteritis treatment

A

Corticosteroids

172
Q

Phlebitis treatment

A

Warm moist compresses

NSAIDS

Abx to cover staph if septic thrombophlebitis

173
Q

9 risk factors for DVT

A

Prolonged immobilization

Postoperative

Pelvic or extremity trauma

Birth control pills

Cancer

Hypercoagulable state

Preggers

Obesity

Smoking

174
Q

DVT diagnosis

A

ultrasound

D-dimer may be useful to rule out in low probability patients

175
Q

DVT treatment

A

Bridge heparin to warfarin

Warfarin, INR 2-3

IVC filter

176
Q

Aortic stenosis symptoms

A

angina, syncope, CHF

177
Q

Physical exam in Aortic stenosis

A

Delayed carotid upstroke

Strong apical impulse

Narrowing pulse pressure

Loud, rough, diamond-shaped systolic murmur with ejection click (best heard at base of heart, with radiation to neck)

178
Q

Imaging in aortic stenosis

A

CXR: dilatation of ascending aorta, pulmonary congestion, boot shaped heart

Echo shows thickening of LV wall, valvular calcifications

179
Q

Aortic stenosis treatment

A

Avoid strenuous activity

Treat CHF with diuretics and sodium restriction

Valve replacement

180
Q

This awesome drug is contraindicated in aortic stenosis

181
Q

6 causes of aortic regurgitation

A

Rheumatic fever

Infectious endocarditis

Hypertension

Syphilis

Collagen vascular disease

Marfan

182
Q

Symptoms of aortic regurgitation (4)

A

Dyspnea on exertion

syncope

chest pain

CHF

183
Q

Physical exam in aortic regurgitation (6)

A

Wide pulse pressure

Bounding pulses

S3 heart sound

Displaced apical impulse

Decrescendo, blowing diastolic murmur on left sternal border

Low-pitched apical diastolic murmur (austin-flint murmur)

184
Q

Imaging in aortic regurgitation

A

CXR: LVH

Echo: left ventricular enlargement

185
Q

Druggy treatment for aortic regurgitation

A

Cover CHF sith digoxin, diuretics, ACEi, salt restriction

186
Q

Definitive treatment for aortic regurgitation

A

surgical valve replacement should be performed before ejection fraction is less than 55%

187
Q

Symptoms of mitral stenosis (3)

A

exertional dyspnea

orthopnea

paroxysmal nocturnal dyspnea

188
Q

Mitral stenosis is most common in this population

A

Women between 25 and 45

189
Q

Mitral stenosis physical exam

A

Prominent jugular A wave (sure)

Opening snap in early diastole

Soft, low pitched diastolic rumble heard best at apex in left decubitus postition

Palpable right ventricular heave at left sternal border

190
Q

EKG in mitral stenosis

A

left atrial enlargement, atrial fib

191
Q

CXR in mitral stenosis

A

left atrial enlargement, prominent pulmonary arteries

192
Q

2 major diagnostic tests for mitral stenosis

A

echocardiogram

cardiac cath

193
Q

Mitral stenosis treatment

A

Control a fib and CHF

Valve replacement or percutaneous transvenous mitral valvotomy

194
Q

6 causes of mitral regurgitation

A

Rheumatic fever

Papillary muscle rupture

Chordae tendineae rupture

Calcification

Mitral valve prolapse

Lupus

195
Q

Mitral regurgitation symptoms

A

fatigue

dyspnea

orthopnea

CHF

196
Q

Mitral regurgitation physical exam (4)

A

Left ventricular lift or apical thrill

Holosystolic murmur at apex with radiation to base or left axilla

s3 heart sound

laterally displaced apical impulse

197
Q

EKG with mitral regurgitation

198
Q

Diagnostic test for mitral regurgitation

A

echocardiogram

199
Q

Mitral regurgitation treatments

A

Treat CHF with digoxin, diuretics, ACEi and salt restriction

Valve replacement must be performed early and is the only definite treatment

200
Q

Symptoms of mitral valve prolapse

A

chest pain

palpitations

201
Q

Physical exam in mitral valve prolapse

A

mid to late click at apex

crescendo, mid to late systolic murmur

202
Q

diagnostic test for mitral valve prolapse

A

echocardiogram shows valve leaflets bulging backwards in systole

203
Q

mitral valve prolapse treatment

A

Avoid stimulants

Maybe some beta blockers

204
Q

2 causes for tricuspid regurg

A

Pulmonary hypertension

Endocarditis

205
Q

Symptoms of tricuspid regurgitation (3)

A

Ascites

Edema

RUQ pain

206
Q

Physical exam in tricuspid regurgitation (4)

A

Hepatic enlargement

JVD

Parasternal lift

Holosystolic murmur, left sternal border

207
Q

Treatment for tricuspid regurg

A

treat underlying cause (endocarditis, pulmonary hypertension)

208
Q

Pulmonary stenosis physical exam

A

early systolic opening ejection click

systolic ejection murmur, radiates to base

209
Q

Spend some time with this table

210
Q

This table is really good too, look at it a bunch

A

I like looking at tables

211
Q

5 predisposing factors for endocarditis

A

Mitral valve prolapse

Degenerative valvular disease

IV drug abuse

Prosthetic valve

Congenital abnormalities

212
Q

3 bugs for community acquired endocarditis

A

Staph aureus

Strep viridans

Enterococcus

213
Q

4 bugs for nosocomial endocarditis

A

Staph aureus

Staph epidermidis

Enterococcus

Funguses

214
Q

3 bugs for prosthetic valve endocarditis

A

Staph epidermidis

Staph aureus

Enterococcus

215
Q

6 symptoms for endocarditis

A

Fever

Fatigue

Malaise

Weight loss

Arthritis

Myalgias

216
Q

7 physical exam findings in endocarditis

A

Petechiae

Osler’s nodes (palmar surface of fingers and toes)

Janeway lesions (palms and soles)

Splinter hemorrhages

Roth’s spots (retinal hemorrhage)

Murmur

Splenomegaly

217
Q

Labs in endocarditis

A

Leukocytosis

ESR elevation

Hematuria

218
Q

2 major and 4 minor Duke criteria for endocarditis

A

Major: positive blood culture, murmur or echo showing a thing

Minor: predisposing condition, fever, vascular pneumonia, immunologic stuff

219
Q

Empiric abx, community acquired endocarditis

A

nafcillin, penicillin, gentamicin

220
Q

Empiric abx, hospital acquired endocarditis (or pcn allergy)

A

vanco, gentamycin

221
Q

Empiric abx, endocarditis with prosthetic valve

A

vanco, genta, rifampin

may need to replace valve

222
Q

symptoms of pericarditis

A

chest pain worsens with deep breathing or lying down

pain improved by sitting and leaning forward

223
Q

pericarditis physical exam

A

friction rub

224
Q

EKG in pericarditis

A

STE in all precordial leads, with no reciprocal depression

225
Q

cardiac tamponade symptoms

A

Hypotenson

tachycardia

dyspnea on exertion

226
Q

physical exam in cardiac tamponade (4)

A

JVD

indistinct heart sounds

narrow pulse pressure

pulsus paradoxus

227
Q

Hey look, another table!

A

bask in it’s tabley goodness

228
Q

pericardial effusion CXR

A

large water bottle shaped heart

PANCE Review (3 decks)

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