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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
Treatment: Mobitz type II second-degree atrioventricular block (Wenckebach)
Pacemaker
26
How do you diagnose MI in a patient with left bundle branch block on EKG?
1. Chest pain 2. Elevated biomarkers 3. New onset LBBB This constellation is considered an equivalent to STEMI.
27
Diagnosis: Left bundle branch block on EKG
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
Treatment: Reversible heart block caused by Lyme carditis
IV ceftriaxone
29
Diagnosis: Lyme carditis
1. acute-onset, high-grade atrioventricular conduction block | 2. History of Lyme disease (fever, fatigue, myalgia and erythematous rash)
30
Treatment: Atrial fibrillation in a hemodynamically stable patient
Beta-blocker (i.e. metoprolol) OR Calcium channel blocker (i.e. diltiazem)
31
What is the CHADS2 score used to determine?
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
Diagnosis: 1. Short PR interval 2. Delta wave
Wolff-Parkinson-White | ventricular preexcitation syndrome
33
Diagnosis: atrial fibrillation on EKG
saw-tooth pattern on EKG most noticeable in the inferior leads (leads II, III & aVF)
34
Diagnosis: multifocal atrial tachycardia on EKG
1. three or more P wave morphologic patterns | 2. Variable P-R intervals
35
How do you diagnosis supraventricular tachycardia?
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
Management: Asymptomatic hypertrophic cardiomyopathy in a patient with risk factors for sudden cardiac death
implantable cardioverter-defibrillator
37
What are the risk factors for sudden cardiac death in patients with hypertrophic cardiomyopathy?
1. FHx of premature sudden death in a first-degree relative 2. significant left ventricular wall thickening (look up others)
38
Treatment: Ventricular tachycardia
IV amiodarone (also procainamide or sotalol) *Lidocaine can be used as a second-line therapy*
39
Diagnosis: 1. Wide QRS complex tachycardia 2. Patient with a history of coronary artery disease or cardiomyopathy
Ventricular tachycardia
40
Treatment: premature ventricular contractions in a patient with severe and disabling symptoms
1. Beta-blockers (i.e Metoprolol)
41
Diagnosis: 1. Reccurrent syncope triggered by activity 2. FHx of similar symtpoms
Long QT syndrome Also, consider hypertrophic cardiomyopathy and arrhthymogenic right ventricular dysplasia.
42
Treatment: Cardiac arrest within the first 48 hours of MI
Observation/continue medical therapy (aspirin, clopidogrel, metoprolol, lisinopril and atorvastatin). Cardioversion is not required.
43
Treatment: NYHA Class III-IV HR (severe systolic heart failure)
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
What conditions or factors increase B-type natriuretic peptide (BNP)?
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
What conditions or factors decrease B-type natriuretic peptide (BNP)?
1. Obesity
46
How can you use BNP to differentiate dyspnea due to heart failure from dyspnea due to pulmonary disease?
BNP<100 excludes decompensated HF from differential. BNP between 100-500 is normal for clinically stable patients with established heart failure.
47
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.
Coronary angiography
48
Treatment: Systolic Heart Failure
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
Treatment: Heart failure with preserved ejection fraction (HFPEF, diastolic heart failure)
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
Treatment: resistant hypertension in a patient with systolic heart failure already receiving optimal multidrug therapy
amlodipine
51
Which antihypertensive drugs should be avoided in patients with systolic HF?
Older-generation CCBs (i.e. Diltiazem, nifedipine and verapamil) *These drugs may precipitate exacerbation of heart failure because of their negative ionotropic effects.*
52
Diagnose: Tricuspid insuficiency
1. Left-sided heart disease 2. systolic murmur at the lower left sternal border 3. Murmur increases with inspiration
53
Diagnose: Prosthetic valve dysfunction
New diastolic murmur or aortic regurgitation (blowing diastolic murmur that is loudest at the third left intercostal space)
54
How do you work up a low-intensity heart murmur (<3/6), without associated findings of valvular or cardiac dysfunction?
Observation, no additional imaging (i.e. echocardiogaphy).
55
Treatment: Aortic stenosis with left ventricular systolic dysfunction
surgical valve repair or replacement
56
Diagnosis: 1. Aortic valve regurgitation 2. PMHx of radiation therapy to the thorax 15 years ago
radiation-induced aortic valve regurgitation Suspect in patients who received radiation therapy to the thorax in the past 10-25 years
57
Management: Asymptomatic bicuspid aortic valve
Annual follow up to monitor for the development of aortic regurgitation or aortic root dilation
58
Diagnose: Mitral stenosis
1. Opening snap followed by a diastolic murmur 2. Murmur accentuated by atrial contraction 3. Loud S1 with variably intense S2.
59
Diagnose: Mitral regurgitation
1. Holosystolic murmur at the apex 2. Radiation to the axilla 3. No variation with respiration
60
Diagnose: Mitral valve prolapse
1. Midsystolic click followed by late systolic murmur | 2. Valsalva or standing from squatting position moves the click-murmur closer to S1
61
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
Hypertrophic cardiomyopathy *Septal hypertrophy causes a dynamic left ventricular outflow tract obstruction.*
62
1. buttock and hip claudication 2. diminished femoral pulses 3. erectile dysfunction
Leriche syndrome; suggestive of atherosclerotic disease in aortoiliac system
63
Where is the site of atherosclerotic disease in Leriche syndrome?
aortoiliac system
64
What is a Stanford type A aortic dissection?
Dissection originating in the the ascending aorta or aortic arch.
65
Treatment: Type A aortic dissection
Emergency surgical intervention
66
Diagnose: 1. Abdominal pain 2. Back pain 3. Syncope
Abdominal aortic aneurysm
67
List two common misdiagnoses for a patient with abdominal aortic aneurysm:
1. Renal colic | 2. Diverticulitis

IM Essentials (4 decks)

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