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IM Essentials > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Treatment:

Acute Pericarditis

A

Aspirin or NSAID (e.g. ibuprofen)

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2
Q

What are the signs/symptoms of costochondritis (i.e. musculoskeletal chest pain)?

A
  1. Sharp, chest pain with insidious onset that lasts for hours-weeks
  2. Localizable to a specific area of the chest
  3. Worsened by turning, deep breathing, or arm movement
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3
Q

Treatment:

Panic disorder

A

Selective serotonin reuptake inhibitor

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4
Q

What is the diagnostic test of choice for a patient presenting with pleuritic chest pain, suspicious for pneumothorax?

A

Upright chest radiograph

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5
Q

Treatment:

Noncardiac chest pain

A

Proton pump inhibitor (PPI) BID for 8-10 weeks

“RCTs have shown that a therapeutic trial of twice-daily PPI treatment is effective in 50% to 60% of patients with noncardiac chest pain, indicating that GERD is the underlying cause.”

You should exclude all cardiac causes with a comprehensive cardiac examination first!

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6
Q

What are the signs/symptoms of panic disorder?

A
  1. Sudden panic attacks

2. Acute onset of somatic symptoms (chest pain, palpitations, sweating, nausea, dizziness, dyspnea and numbness)

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7
Q

Your patient complains of sudden onset pleuritic chest pain and dyspnea. What diagnosis MUST be included in your differential?

A

Pneumothorax

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8
Q

Management of:

Chronic stable angina

A
  1. Statin (???)
  2. Aspirin
  3. Beta-blocker (to 55-60 bpm)
  4. Sublingual nitroglycerin PRN
  5. CCB (i.e. Diltiazem)

Routine follow up EKS, exercise stress testing and echocardiography are not indicated.

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9
Q

What test is necessary to diagnose chronic angina?

A

Exercise electrocardiography (i.e. exercise stress test)

Test of choice in patients who have normal findings on baseline EKG and are able to exercise.

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10
Q

How do you evaluate a women with atypical chest pain?

A

Exercise electrocardiography

Exercise stress tests have a higher false positive rate in women, but are still the recommended modality for noninvasive diagnostic testing for women.

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11
Q

Treatment:

Continuing angina in a patient with chronic stable CAD

Current regimen: Metoprolol, Simvastatin, Isosorbide dinitrate, sublingual Nitroglycerin PRN

Vitals: afebrile, 150/85 mmHg, 80bpm, 12 respirations

A

Increase the metoprolol dosage until you reach a resting pulse of 55-60 bpm or angina subsides.

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12
Q

How can you determine when complete beta-blockade has been reached?

A

pulse rate= 55-60 bpm when beta-blockade is optimized

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13
Q

Management:

Chronic stable angina in a patients who is experiencing lifestyle-limiting symptoms despite optimal medical therapy

A

Coronary angiography

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14
Q

Treatment:

ST-elevation MI

Nearest PCI capable hospital is 120 minutes away.

A
  1. Thrombolytic therapy
  2. Aspirin
  3. Heparin
  4. Clopidogrel
  5. IV Nitroglycerin
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15
Q

How does atypical angina present in women and patients with diabetes?

A
  1. fatigue
  2. dyspnea
  3. nausea
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16
Q

Treatment:

ST-elevation MI

What is the preferred treatment

A

Primary percutaneous coronary intervention (PCI)

  • within 90 minutes of presentation
  • within 120 minutes if transfer is necessary

PCI may be beneficial up to 12 hours after symptom onset.

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17
Q

Diagnosis:

Postinfarction ventricular septal defect

A

holosystolic left sternal border murmur presenting days after infarct

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18
Q

Treatment:

unstable angina

A
  1. Dual antiplatelet therapy (aspirin+ clopidogrel, prasurgrel or ticagrelor)
  2. Beta-blocker
  3. Nitrates
  4. Heparin
  5. Morphine for chest pain
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19
Q

Diagnosis:

Sick sinus syndrome

A

Dizziness correlated with episodes of bradycardia.

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20
Q

Treatment:

Asymptomatic complete heart block

A

Pacemaker

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21
Q

Diagnosis:

  • Prolonged P-R interval
  • all P waves conducted
A

First-degree atrioventricular block

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22
Q

Diagnosis:

  • Progressive prolongation of the P-R interval
  • “dropped” ventricular beats
A

Mobitz type I second-degree atrioventricular block

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23
Q

Diagnosis:

  • Normal P-R interval
  • Regularly dropped ventricular beat
A

Mobitz type II second-degree atrioventricular block (Wenckebach)

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24
Q

Treatment:

Mobitz type I second-degree atrioventricular block

A

no specific treatment

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25
Q

Treatment:

Mobitz type II second-degree atrioventricular block (Wenckebach)

A

Pacemaker

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26
Q

How do you diagnose MI in a patient with left bundle branch block on EKG?

A
  1. Chest pain
  2. Elevated biomarkers
  3. New onset LBBB

This constellation is considered an equivalent to STEMI.

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27
Q

Diagnosis:

Left bundle branch block on EKG

A
  1. Large, wide, positive R wave in leads I, aVL and V6 (“tombstone R”)
  2. Absent Q waves in leads I aVL and V6
  3. Prolongation of QRS complex (>.12 seconds)
28
Q

Treatment:

Reversible heart block caused by Lyme carditis

A

IV ceftriaxone

29
Q

Diagnosis:

Lyme carditis

A
  1. acute-onset, high-grade atrioventricular conduction block

2. History of Lyme disease (fever, fatigue, myalgia and erythematous rash)

30
Q

Treatment:

Atrial fibrillation in a hemodynamically stable patient

A

Beta-blocker (i.e. metoprolol) OR Calcium channel blocker (i.e. diltiazem)

31
Q

What is the CHADS2 score used to determine?

A

Thromboembolism risk in patients with atrial fibrillation.

C=Congestive heart failure
H=Hypertension (even if treated)
A=Age >75
D=Diabetes
S=Stroke or previous TIA (2 points)

If < 2 points give aspirin
If >/=2 points give warfarin

32
Q

Diagnosis:

  1. Short PR interval
  2. Delta wave
A

Wolff-Parkinson-White

ventricular preexcitation syndrome

33
Q

Diagnosis:

atrial fibrillation on EKG

A

saw-tooth pattern on EKG most noticeable in the inferior leads (leads II, III & aVF)

34
Q

Diagnosis:

multifocal atrial tachycardia on EKG

A
  1. three or more P wave morphologic patterns

2. Variable P-R intervals

35
Q

How do you diagnosis supraventricular tachycardia?

A

Push adenosine.

Adenosine will terminate a atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT), but will only slow down the ventricular rate in atrial tachycardia, atrial fibrillation and sinus tachycardia.

36
Q

Management:

Asymptomatic hypertrophic cardiomyopathy in a patient with risk factors for sudden cardiac death

A

implantable cardioverter-defibrillator

37
Q

What are the risk factors for sudden cardiac death in patients with hypertrophic cardiomyopathy?

A
  1. FHx of premature sudden death in a first-degree relative
  2. significant left ventricular wall thickening

(look up others)

38
Q

Treatment:

Ventricular tachycardia

A

IV amiodarone (also procainamide or sotalol)

Lidocaine can be used as a second-line therapy

39
Q

Diagnosis:

  1. Wide QRS complex tachycardia
  2. Patient with a history of coronary artery disease or cardiomyopathy
A

Ventricular tachycardia

40
Q

Treatment:

premature ventricular contractions in a patient with severe and disabling symptoms

A
  1. Beta-blockers (i.e Metoprolol)
41
Q

Diagnosis:

  1. Reccurrent syncope triggered by activity
  2. FHx of similar symtpoms
A

Long QT syndrome

Also, consider hypertrophic cardiomyopathy and arrhthymogenic right ventricular dysplasia.

42
Q

Treatment:

Cardiac arrest within the first 48 hours of MI

A

Observation/continue medical therapy (aspirin, clopidogrel, metoprolol, lisinopril and atorvastatin).

Cardioversion is not required.

43
Q

Treatment:

NYHA Class III-IV HR (severe systolic heart failure)

A
  1. ACE inhibitor
  2. Beta-blocker therapy (metoprolol, or carvedilol)
  3. Spironolactone –> associated with a 30% reduction in mortality rate, reduction in hospitalizations and improved NYHA functional class.
44
Q

What conditions or factors increase B-type natriuretic peptide (BNP)?

A
  1. HF
  2. Kidney failure
  3. Old age
  4. Female Sex
  5. PE
  6. Acute MI
  7. Acute tachycardia

Conditions that increase ventricular wall strain will increase the BNP

45
Q

What conditions or factors decrease B-type natriuretic peptide (BNP)?

A
  1. Obesity
46
Q

How can you use BNP to differentiate dyspnea due to heart failure from dyspnea due to pulmonary disease?

A

BNP<100 excludes decompensated HF from differential.

BNP between 100-500 is normal for clinically stable patients with established heart failure.

47
Q

What test would you use to evaluate for ischemia in a patient with new-onset heart failure and a high pretest probability of coronary artery disease.

A

Coronary angiography

48
Q

Treatment:

Systolic Heart Failure

A

Beta-blocker (metoprolol, carvedilol, or bisoprolol if they have significant pulmonary disease)

Give beta-blocker regardless of symptoms status, and even if they have significant pulmonary disease

49
Q

Treatment:

Heart failure with preserved ejection fraction (HFPEF, diastolic heart failure)

A
  1. Angiotensin receptor blocker (candesartan)
  2. ACE inhibitors
  3. Nondihydropyridine calcium channel blockers (verapmil, diltiazem)
  4. Beta-blockers

Avoid medications that decrease preload (i.e. nitrates, dihydropyridine CCB/amlodipine). These drugs cause ventricular underfilling and decrease the cardiac output.

There is no role for digoxin in diastolic heart failure.

50
Q

Treatment:

resistant hypertension in a patient with systolic heart failure already receiving optimal multidrug therapy

A

amlodipine

51
Q

Which antihypertensive drugs should be avoided in patients with systolic HF?

A

Older-generation CCBs (i.e. Diltiazem, nifedipine and verapamil)

These drugs may precipitate exacerbation of heart failure because of their negative ionotropic effects.

52
Q

Diagnose:

Tricuspid insuficiency

A
  1. Left-sided heart disease
  2. systolic murmur at the lower left sternal border
  3. Murmur increases with inspiration
53
Q

Diagnose:

Prosthetic valve dysfunction

A

New diastolic murmur or aortic regurgitation (blowing diastolic murmur that is loudest at the third left intercostal space)

54
Q

How do you work up a low-intensity heart murmur (<3/6), without associated findings of valvular or cardiac dysfunction?

A

Observation, no additional imaging (i.e. echocardiogaphy).

55
Q

Treatment:

Aortic stenosis with left ventricular systolic dysfunction

A

surgical valve repair or replacement

56
Q

Diagnosis:

  1. Aortic valve regurgitation
  2. PMHx of radiation therapy to the thorax 15 years ago
A

radiation-induced aortic valve regurgitation

Suspect in patients who received radiation therapy to the thorax in the past 10-25 years

57
Q

Management:

Asymptomatic bicuspid aortic valve

A

Annual follow up to monitor for the development of aortic regurgitation or aortic root dilation

58
Q

Diagnose:

Mitral stenosis

A
  1. Opening snap followed by a diastolic murmur
  2. Murmur accentuated by atrial contraction
  3. Loud S1 with variably intense S2.
59
Q

Diagnose:

Mitral regurgitation

A
  1. Holosystolic murmur at the apex
  2. Radiation to the axilla
  3. No variation with respiration
60
Q

Diagnose:

Mitral valve prolapse

A
  1. Midsystolic click followed by late systolic murmur

2. Valsalva or standing from squatting position moves the click-murmur closer to S1

61
Q

Diagnosis:

  1. systolic murmur along the left lower sternal border accentuated with Valsalva and decreased with the handgrip maneuver
  2. left ventricular hypertrophy with septal hypertrophy on echocardiogram
A

Hypertrophic cardiomyopathy

Septal hypertrophy causes a dynamic left ventricular outflow tract obstruction.

62
Q
  1. buttock and hip claudication
  2. diminished femoral pulses
  3. erectile dysfunction
A

Leriche syndrome; suggestive of atherosclerotic disease in aortoiliac system

63
Q

Where is the site of atherosclerotic disease in Leriche syndrome?

A

aortoiliac system

64
Q

What is a Stanford type A aortic dissection?

A

Dissection originating in the the ascending aorta or aortic arch.

65
Q

Treatment:

Type A aortic dissection

A

Emergency surgical intervention

66
Q

Diagnose:

  1. Abdominal pain
  2. Back pain
  3. Syncope
A

Abdominal aortic aneurysm

67
Q

List two common misdiagnoses for a patient with abdominal aortic aneurysm:

A
  1. Renal colic

2. Diverticulitis

IM Essentials (4 decks)

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