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UWorld Medicine Ultra-HY > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Treatment of primary Raynaud’s syndrome? Secondary?

A

Primary: Trigger avoidance and CCBs if necessary
Scondary: The same, plus aspirin to patients at risk for digital ischemia

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2
Q

Causes of secondary Raynaud’s syndrome (6)

A
  1. Connective tissue disease (lupus, scleroderma)
  2. Occlusive vascular disease
  3. Hyperviscosity syndromes
  4. Sympathomimetic drugs
  5. Birth control pills
  6. Smoking
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3
Q

An ICU patient on pressures has necrosis of distal fingers and toes. Likely cause?

A

Norepinephrine-induced vasospasm (can also caused mesenteric ischemia and AKI)

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4
Q

Clinical signs of cardiac tamponade

A

Beck’s triad: hypotension, elevated JVP, muffled/distant heart sounds
Pulsus paradoxus may also be seen (also seen in constrictive pericarditis, sever asthma/COPD)

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5
Q

Heart sounds in constrictive pericarditis

A

Pericardial friction rub: high-pitched grating/squeaking sound during systole (most common), diastole, or both

Pericardial knock: high-frequency mid-diastolic sound (due to abrupt cessation of diastolic filling)

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6
Q

JVP increases or stays the same with inspiration. Cause?

A

Kussmaul’s sign due to constrictive pericarditis

(Normally JVP decreases during inspiration due to blood being drawn into the chest and heart, but here it cannot take the extra volume)

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7
Q

EKG in acute pericarditis

A

Diffuse ST elevation and PR depression

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8
Q

Treatment for Dressler’s syndrome (post-MI autoimmune pericarditis)

A

High-dose aspirin

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9
Q

Type of pericarditis that does not affect the myocardium

A

Uremic pericarditis (no EKG changes)

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10
Q

Immunologic phenomena in bacterial endocarditis

A
  1. Osler nodes (painful fingertip nodules)
  2. Roth spots (retinal hemorrhage with pale centers)
  3. Glomerulonephritis
  4. Rheumatoid factor

(Janeway lesions, splinter hemorrhages, etc are embolic)

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11
Q

Embolic phenomena in bacterial endocarditis

A
  1. Septic emboli to brain (stroke), fingers (gangrene),etc
  2. Renal or splenic infarcts
  3. Splinter hemorrhages
  4. Janeway lesions (painless)
  5. Conjunctival hemorrahge

(Osler nodes, Roth spots, and glomerulonephritis are immunoloigic)

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12
Q

Subacute endocarditis associated with dental procedure or respiratory tract infection

A
  1. Strep viridans: mostly S. mutans and S. anguis (others are S. mitis and S. oralis)
  2. Less commonly, Eikenella corrodens (one of the HACEK)
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13
Q

Endocarditis associated with IBD and colon cancer

A

Strep gallolyticus (formerly named Strep bovis)

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14
Q

Endocarditis associated with prosthetic valves, implanted devices, and intravascular catheters

A

Staph epi

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15
Q

Endocarditis associated with nosocomial UTIs

A

Enterococcus

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16
Q

Right-sided endocarditis associated with IV drug use

Empiric therapy?

A

Staph aureus most commonly (can also be strep or enterococci)

Empirically treat with vancomycin

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17
Q

Medication for hyperlipidemia that leads to flushing and itching?

What can be given to help?

A

Niacin

Can give aspirin to reduce flushing (flushing is prostaglandin mediated)

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18
Q

Who should be on a statin?

A
  1. All diabetics 40-75
  2. Hyperlipidemia (e.g. LDL >190)
  3. Clinically significant atherosclerotic disease (ACS/MI, angina, stroke/TIA, PAD)
  4. ASCVD risk 7.5% or more
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19
Q

A ventilated patient has decreased CO and low RA pressure - potential cause?

A

Pneumothorax due to barotrauma on PEEP (high pressure leads to elevated intrathoracic pressure, kinda like a tension pneumothorax)

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20
Q

Causes of secondary hypertension (8)

A 
Renal:
1. Renal parenchymal disease
2. Renal artery stenosis
Endocrine
3. Primary aldosteronism
4. Pheochromocytoma
5. Cushing syndrome
6. Hypothyroidism and hyperthyroidism
7. Primary hyperthyroidism
Vascular:
8. Aortic coarctation
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21
Q

Treatment-refractory systemic hypertension with recurrent flash pulmonary edema

A

Consider renal artery stenosis

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22
Q

Definition of pulmonary hypertension

A

PA pressure >25 mm Hg

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23
Q

Treatment options for idiopathic pulmonary hypertension

A
  1. Endothelin receptor blockers like bosentan
  2. PDE5 inhibitors like sildenafil
  3. Prostanoids like epoprostenol
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24
Q

Treatment for pulmonary hypertension due to left heart failure

A

Loop diuretics and ACEI/ARB

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25
Q

Most common cause of aortic regurgitation in young adults in developed countries

A

Congenital bicuspid valve

Other causes: endocarditis, rheumatic heart disease, Marfan syndrome, syphilitic aortitis

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26
Q

What is classic angina pectoris?

Atypical angina?

A

Classic angina has all three of:

  1. Typical location, quality, and duration
  2. Provoked by exercise and/or emotional upheaval
  3. Relieved with nitroglycerin or rest

Atypical angina: two out of three

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27
Q

First-line treatment of stable angina?

Alternate or adjunct?

A

First-line: Beta-blockers

Alternate/adjunct: CCBs

(May also use sublingual nitroglycerin for acute episodes, and may add long-acting nitrates)

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28
Q

Which of these do you hold and which do you continue prior to cardiac stress testing?

  1. ACEI/ARB
  2. Beta blockers
  3. CCBs
  4. Digoxin
  5. Diuretics
  6. Nitrates
  7. Statins
A

Hold beta-blockers, CCBs, and nitrates (these all immediately impact cardiac dynamics)

Continue others (ACEI/ARB, digoxin, diuretic, statins)

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29
Q

Treatment for vasospastic angina

A

CCBs (e.g. diltiazem)

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30
Q

Medications to avoid / be cautious with in vasospastic angina

A

Non-selective beta-blockers (e.g. propanolol): loss of beta2 vasodilation can worsen vasospasm

Aspirin: Inhibiting prostacyclin production can worsen vasospasm

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31
Q

Treatment of patients with MI who have decompensated HF but normal/high BP?

If they have hypotension?

A

Normal BP: Supplemental O2 and a loop diuretic

Hypotension: Supplemental O2 and a vasopressor (e.g. NE), +/- loop diuretic

32
Q

What does S4 indicate?

A

Stiff LV wall (can be seen with MI, hypertension)

33
Q

Treatment of unstable sinus bradycardia during an acute MI

A

IV atropine

34
Q

Location and vessel of MI with ST elevation in V1-V4

A

Anterior MI: LAD

35
Q

Location and vessel of MI with ST elevation in I, aVL, V5, and V6, and ST depression in II, III, and aVF

A

Lateral: LCX or diagonal artery

36
Q

Location and vessel of MI with ST depression in V1-V3

A

Posterior: RCA (if right-dominant, 70%) or L circumflex (if left-dominant, 20%)

(Other 10% are co-dominant)

37
Q

Location and vessel of MI with ST elevation in II, III, and aVF

A

Inferior MI: usually RCA (80%), sometimes L circumflex

38
Q

Location and vessel of MI with ST elevation in V1 > V2 and III > II

A

Right ventricle: RCA occlusion

39
Q

What vessel occlusion(s) can lead to SA node block?

A

RCA (60%) or L circumflex (40%)

40
Q

What vessel occlusion(s) can lead to AV node block?

A

RCA (80%), L circumflex 20%

41
Q

Treatment of pericarditis shortly after MI

A

Aspirin and/or colchicine

Avoid other NSAIDs

42
Q

MI complicated by chest pain, shock, a new holocystolic murmur, and left and right heart failure?
Type of MI seen in?

A

Intraventricular septum rupture. May be seen with LAD or RCA MI

43
Q

MI complicated by chest pain, shock, and distant heart sounds?

A

Free wall rupture. May be seen with LAD MI (the “widowmaker”)

44
Q

Late complication of MI leading to HF, arrhtyhmia, mitral regurgitation, or mural thrombus

A

Ventricular aneurysm

45
Q

Persistent ST elevation well after MI

A

Ventricular aneurysm

46
Q

Medications shown to improve morbidity and mortality in CAD patients

A
  • Dual antiplatelet therapy
  • Beta-blockers
  • ACEIs/ARBs
  • Statins
  • Aldosterone antagonists (e.g. spironolactone) w/ EF <40% and symptomatic HF or DM)
47
Q

Another cause of restrictive cardiomyopathy other than hypertension

A

Amyloid cardiomyopathy

(May also have nephrotic syndrome, hepatosplenomegaly, macroglossia, waxy skin, easy bleeding/bruising, thick LV wall but low voltage EKG)

48
Q

Initial medication for hypertrophic medication

A

Beta blockers

49
Q

Delta wave on EKG

A

WPW syndrome (accessory pathway between atria and ventricles, risk of re-entrant SVT)

50
Q

Treatment of atrial fibrillation in WPW

A

Unstable: cardioversion

Stable: Procainamide (Ia antiarrhythmic that blocks Na+ and K+ channels) (or ibutilide, class III K+ blocker)

(Do not give drugs blocking the AV node as this promotes accessory pathway and increases arrhythmia risk)

51
Q

Treatment of torsades de pointes

A

Unstable: defibrillation
Stable: IV magnesium

52
Q

Initial treatment for pulseless electrical activity

A

ACLS and epinephrine (and look for causes, e.g. with ABG)

53
Q

Reversible causes of pulseless electrical activity

A

5 H’s and T’s:
H’s: Hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyperkalemia, hypothermia
T’s: tension pneumothorax, tamponade, toxins (narcs, benzos), thrombosis (pulmonary or coronary), truma

54
Q

Pharmacologic treatment for stable sustained ventricular tachycardia?

Electrical treatment for ventricular tachycardia?

A

Pharmacological: IV amiodarone

Electrical:
Pulseless: Defibrillation
With pulse: Synchronized cardioversion

55
Q

What are capture and fusion beats?

A

Both are signs of ventricular tachycardia

Capture: SA node “captures” rhythm for a beat
Fusion: SA node and ventricular activity simultaneously trigger a beat with a hybrid pattern on EKG

56
Q

Two causes of wide-complex tachycardia

A

Ventricular tachycardia and supraventricular tachycardia with abberency (e.g. WPW, bundle branch block)

57
Q

Most common form of PSVT

A

AV node reentrant tachycardia (may see retrograde P waves, hypotension, regular HR around 180-200)

58
Q

Initial treatment for symptomatic sinus bracycardia

A

IV atropine

59
Q

Effect of TCA overdose on the heart

Treatment?

A

Sodium channel block leads to wide QRS and arrhythmias

Treat with sodium bicarbonate (if long QRS of ventricular arrhythmia)

60
Q

Score to assess thromboembolic risk in atrial fibrillation

A

CHA2DS2-VASc

CHF, HTN, Age>75 (2 pts), DM, Stroke/TIA (2 pts), Vascular disease, Age 65-74), Sex (female)

61
Q

Agent for rhythm control in paroxysmal atrial fibrillation in a structurally normal heart?

A

Class 1C antiarrhythmics like fleicainide or propafenone

(Preferentially block INa at fast heart rates)

(Other agents for rhythm control: amiodarone, sotalol, ibutilide)

62
Q

Blood test to run in all new-onset atrial fibrillation?

A

TSH + free T4 (Hyperthyroidism can lead to a-fib)

63
Q

Drug causing arrhythmia and vision changes

Classic arrhythmia associated with it?

A

Digoxin

Classic arrhythmia is atrial tachycardia with AV block (due to ectopic beats and increased vagal tone)

64
Q

Patient who overdoses on a beta-blocker or CCB remains hypotensive after airway, fluids, and IV atropine. Next step?

A

IV glucagon (stimulates Gs receptors)

65
Q

Beta1 agonist drug

A

Dobutamine

66
Q

Beta blocker and CCB overdose both lead to bradycardia and shock. How do they differ on exam?

A

Beta-blocker OD causes wheezing, CCBs do not.

67
Q

Classic side effect of hydralazine

A

Drug-induced lupus

68
Q

Potential side effect of nitroprusside

A

Cyanide toxicity (especially in CKD): HA, AMS, seizures, flushing, respiratory depression, arrhythmia

69
Q

How do NSAIDs and acetaminophen affect warfarin levels?

A

Increased warfarin levels and bleeding risk (both inhibit the CYP450s that metabolize warfarin)

70
Q

Classic extra-cardiac manifestation of amiodarone

A

Interstitial pneumonitis (restrictive lung disease)

Others: other lung effects, thyroid disease, hepatitis, eye damage (corneal microdeposits, optic neuropathy)

71
Q

Antihypertensives that can lead to peripheral edema

A

Dihydropiridine CCBs (e.g. amlodipine, nifedipine)

72
Q

Indications for carotid endarterectomy

A
  1. Symptomatic >70% stenosis in men and women

2. Asymptomatic >60% stenosis in men only

73
Q

First step in a patient with acute arterial occlusion leading to rest leg pain?

A

IV heparin (prior to any workup)

74
Q

Diagnostic test for aortic dissection

A

CTA (TEE if CTA is CI, like in CKD or contrast allergy)

75
Q

Most common cause of aortic dissection overall? In patients under 40?

A

Overall: HTN

Under 40: Marfan’s

76
Q

Common association with asscending thoracic aortic aneurysm

A

Connective tissue disease (Marfan, Ehlers-Danlos)

77
Q

Hereditary telangiectasia (a.k.a. Osler-Weber-Rendu)

A

AD disease with lip telangiectasias and AVMs of skin, mucus membranes, GI tract, and lungs that lead to nose and GI bleeds as well as pulmonary shunting and hypoxemia

UWorld Medicine Ultra-HY (13 decks)

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