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Rizk Review > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

62 yo male presents with CP; Labs show NML troponin; EKG shows ST segment depression – diagnosis?

A

Unstable angina

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2
Q

62 yo male presents with CP; Labs show elevated troponin; EKG shows ST segment depression – diagnosis?

A

NSTEMI

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3
Q

When does Troponin T begin to rise in ACS?

A

4-6 hours

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4
Q

How long does Troponin T stay elevated in ACS?

A

10 days

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5
Q

When does Troponin I begin to rise in ACS?

A

4-6 hours

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6
Q

How long does Troponin I stay elevated in ACS?

A

10 days

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7
Q

When does CK-MB begin to rise in ACS?

A

4-6 hours

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8
Q

How long does CK-MB stay elevated in ACS?

A

48-72 hours

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9
Q

Patient recently had MI about 3-4 days ago; Begins to experience CP again – what is best test to evaluate for repeat MI?

A

CK-MB

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10
Q

Metabolic disturbance associated with PE?

A

Respiratory alkalosis

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11
Q

Best management of NSTEMI and Unstable Angina?

A

Anti-ischemic medications; Anti-platelet medication; Anti-coagulant medication

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12
Q

Best management of STEMI?

A

Anti-ischemic medications; Anti-platelet medication; Anti-coagulant medication + Reperfusion therapy

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13
Q

4 anti-ischemic medications?

A

Morphine, O2, NTG, b-blockers

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14
Q

Which anti-ischemic medication has been shown to improve survival in patients with MI?

A

b-blockers

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15
Q

4 anti-platelet + anti-coagulant medications?

A

ASA, Clopidogrel, LMW Heparin, GPIIb/IIIa

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16
Q

Event that will increase morality in patients with Unstable Angina + NSTEMI?

A

Thrombolytic therapy

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17
Q

Which reperfusion drug is contraindicated in patients who are also treated with heparin?

A

Streptokinase

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18
Q

4 absolute contraindications to fibrinolytic therapy in ACS?

A

Hemorrhagic CVA, Active bleeding, Suspected aortic dissection (order CXR), Intracranial tumor

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19
Q

When does post-MI VSD typically occur?

A

3-7 days after MI

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20
Q

When does post-MI papillary muscle rupture typically occur?

A

3-7 days after MI

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21
Q

Test used to distinguish between post-MI VSD and papillary muscle rupture?

A

ECHO

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22
Q

Next step of workup for patient who experiences massive MI, when develops pulseless legs?

A

Angiogram + Embolectomy

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23
Q

Most common cause of death in acute MI?

A

Ventricular fibrillation

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24
Q

Risk of giving lidocaine to patient with ventricular fibrillation in acute MI?

A

Asystole

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25
Q

3 DOC for treatment of CP in patient with HX of cocaine use?

A

Benzodiazepines, NTG, ASA

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26
Q

Which medication should be avoided in treatment of CP in patient with HX of cocaine use?

A

b blockers

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27
Q

2 aspects of clinical presentation for RV infarction?

A

Hypotension, JVD

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28
Q

Best treatment for RV infarction?

A

IV fluids

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29
Q

Which treatment is contraindicated in RV infarction?

A

NTG

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30
Q

Why is NTG contraindicated in patients with RV infarction?

A

Further decreases preload

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31
Q

Alternate name for RV infarction?

A

Inferior wall MI

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32
Q

3 arrhythmias that are common in patients with inferior wall MI?

A

Sinus bradycardia, Prolonged PR, 3rd degree AV block

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33
Q

When may patients resume sexual activity after acute MI?

A

6 weeks after MI

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34
Q

Patient presents with bradycardia; EKG shows no p waves – diagnosis?

A

SA node problem

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35
Q

Patient presents with bradycardia; EKG shows p waves – diagnosis?

A

AV node problem

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36
Q

Appearance of EKG in Sick Sinus Syndrome?

A

Loss of P wave

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37
Q

Clinical presentation for Sick Sinus Syndrome?

A

Syncope

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38
Q

Best treatment for Sick Sinus Syndrome?

A

Pacemaker

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39
Q

How can you differentiate between cardiac and vagal etiologies of syncope?

A

Cardiac = sudden, NO prodrome; Vagal = prodrome (fainting)

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40
Q

Description of 1st degree AV block?

A

Prolonged PR interval … PR > 0.20

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41
Q

Treatment for 1st degree AV block?

A

Observation

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42
Q

Description of 2nd degree AV block – Type 1?

A

Progressively prolonged PR interval

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43
Q

Treatment for 2nd degree AV block – Type 1?

A

Observation … discontinue digoxin

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44
Q

Condition associated with 2nd degree AV block – Type 1?

A

Inferior MI … affects AV node

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45
Q

Description of 2nd degree AV block – Type 2?

A

Unequal ratio of P waves : QRS complexes

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46
Q

Treatment for 2nd degree AV block – Type 2?

A

Pacemaker

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47
Q

Location of defect in 2nd degree AV block – Type 1?

A

His-Purkinje system

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48
Q

Description of 3rd degree AV block?

A

Complete dissociation between P waves, QRS complexes

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49
Q

Best treatment for 3rd degree AV block?

A

Pacemaker

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50
Q

Location of defect in 3rd degree AV block?

A

His-Purkinje system

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51
Q

DOC for SVT?

A

Adenosine, 6 mg IV … if no response to vagal maneuvers

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52
Q

Appearance of EKG in SVT?

A

Tachycardia, Narrow QRS complex

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53
Q

Definitive treatment of SVT?

A

Catheter ablation of AV node

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54
Q

18 yo female presents for sports physical; Reports occasional palpitation – what should you look for on EKG?

A

Delta wave

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55
Q

In addition to delta wave, what is another EKG finding associated with WPW?

A

Short PR interval

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56
Q

Complication of WPW?

A

V-Fib

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57
Q

Location of accessory pathway in WPW?

A

Connects atria directly with ventricles via conduction across AV groove

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58
Q

DOC for acute management of reentrant tachycardia in WPW?

A

Adenosine

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59
Q

DOC for acute management of atrial fibrillation with rapid ventricular response?

A

Procainamide, Amiodarone

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60
Q

Treatment of choice for WPW patient who is hemodynamically unstable?

A

Emergent cardioversion

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61
Q

Definitive treatment for WPW?

A

Catheter ablation

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62
Q

1st step of treatment for A-Fib?

A

Anticoagulation

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63
Q

2nd step of treatment for A-Fib?

A

Rate control

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64
Q

2 DOC for rate control in patient with A-Fib?

A

b blockers, CCBs

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65
Q

DOC for patient with A-Fib, HX of COPD?

A

CCBs … avoid b blockers

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66
Q

Best treatment for patients with A-Fib lasting more than 48 hours?

A

Anticoagulation for 2-3 weeks, before attempting cardioversion

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67
Q

DOC for atrial flutter?

A

Same as A-Fib … b blockers, CCBs

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68
Q

Additional step of workup for patient with Atrial Flutter?

A

Radiofrequency ablation

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69
Q

In patient with chronic hypoxemia and decompensated COPD – what changes should you expect on EKG?

A

Multifocal atrial tachycardia … P waves all look different

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70
Q

Which drug is typically associated with Multifocal atrial tachycardia?

A

Theophylline

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71
Q

Best treatment for patient with Multifocal atrial tachycardia?

A

Supplemental O2

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72
Q

38 yo male presents for wellness exam; EKG shows PVCs; He is asymptomatic – next step?

A

Reassurance

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73
Q

Torsades de pointes is a type of …

A

Ventricular fibrillation

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74
Q

2 electrolyte imbalances that might lead to Toursade de pointes?

A

Hypo-Mg2+, Hypo-K+

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75
Q

6 medications that may lead to QT prolongation?

A

Fluoroquinolones, Lithium, Azoles, Macrolides, TCA, Methadone

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76
Q

Best treatment for Toursade de pointes?

A

Mg2+ infusion; Defibrillation

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77
Q

Description of Ebstein’s anomaly seen in setting of Lithium use during pregnancy?

A

Atrialization of RV

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78
Q

Change in position of Tricuspid valve in setting of Ebstein’s anomaly?

A

Displaced towards RV

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79
Q

3 additional AE of lithium?

A

Nephrogenic DM, Torsades de pointes, Hypercalcemia

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80
Q

3 AEs of quinidine?

A

Prolonged QT, Tinnitus, Hemolytic anemia

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81
Q

2 AEs of procainamide?

A

SLE, Prolonged QT

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82
Q

1 AE of lidocaine?

A

Seizures

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83
Q

2 AEs of b blockers?

A

Asthma, Decreased libido

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84
Q

5 AEs of Amiodarone?

A

Hyper/hypothyroidism, Corneal deposits, Pulmonary fibrosis, Gray skin, Photosensitivity

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85
Q

5 risk factors for development of coronary atherosclerosis?

A

LDL > 100, BP > 140/90, HBA1c > 7, Low HDL, Homocystinuria

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86
Q

Etiology of Prinzmetal angina?

A

Vasospasm of coronary vessels

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87
Q

Best treatment for Prinzmetal angina?

A

CCBs

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88
Q

EKG change associated with stable angina?

A

ST depression

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89
Q

56 yo male presents with intermittent CP, related to exercise; HX of smoking; Which condition is not considered to be a contraindication to workup with exercise stress test?

A

RBBB

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90
Q

6 conditions that contraindicate exercise stress test?

A

WPW, Pacemaker, LVH, LBBB, Digoxin use, T-wave abnormalities

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91
Q

Alternative workup in patients who cannot undergo exercise stress test?

A

ECHO

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92
Q

3 conditions that might cause resting ST elevation?

A

Acute MI, Pericarditis, LV aneurysm

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93
Q

5 medications that decrease risk of MI in patients with CAD?

A

ASA, ACEIs, b blockers, Statins, Gemfibrozil

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94
Q

Value of giving b blockers to patients with CAD?

A

No mortality benefit for patients with chronic CAD; Beneficial for patients with HTN + stable angina

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95
Q

68 yo male presents with stable CAD, EF = 40%, class 3 angina despite pharmacologic therapy – best therapy to improve survival and decrease need for later revascularization?

A

CABG

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96
Q

Indication for PCI in patients with CAD?

A

Patients with 1- or 2-vessel CAD, NML LV function

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97
Q

3 indications for CABG in patients with CAD?

A

Patients with 3-vessel CAD, decreased LV function, LAD disease

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98
Q

Etiology of acute Mitral Regurgitation murmur?

A

Rupture of papillary muscles post-MI

99
Q

Clinical presentation of acute Mitral Regurgitation murmur?

A

Immediate-onset pulmonary edema in post-MI stage

100
Q

What are the 3 types of holosystolic murmurs?

A

MR, TR, VSD

101
Q

Which medication may be cause of chronic MR murmur?

A

Phen-Fen … used for OB

102
Q

Most common etiology of Mitral Stenosis murmur?

A

Chronic rheumatic fever

103
Q

Change to heart structure in setting of MS murmur?

A

LA dilation

104
Q

Clinical presentation of Mitral Stenosis in pregnant females?

A

Hemoptysis … overload on L heart

105
Q

CXR appearance of Mitral Stenosis murmur?

A

Straightening of L heart border

106
Q

Best treatment of Mitral Stenosis in pregnant females?

A

Balloon valvotomy

107
Q

Most common primary heart tumor?

A

Atrial myxoma

108
Q

Most common location of atrial myxoma tumor?

A

LA

109
Q

Heart sound associated with atrial myxoma?

A

Loud S1

110
Q

Best tool for diagnosis of atrial myxoma?

A

ECHO

111
Q

Best treatment for atrial myxoma?

A

Surgical excision

112
Q

3 most common etiologies of AR murmur?

A

Bicuspid aorta, Syphilis, Marfan

113
Q

Description of Quincke’s Sign in setting of AR?

A

Throbbing nailbed pulses

114
Q

Description of Hill’s Sign in setting of AR?

A

Difference between popliteal-brachial pulses > 20

115
Q

3 steps of treatment for asymptomatic patients with AR?

A

ACEI, Diuretics, Vasodilators (hydralazine)

116
Q

Best treatment for symptomatic AR?

A

Surgery

117
Q

Change to pulses measured in aortic dissection?

A

Good UE pulses; Diminished LE pulses

118
Q

Change to pulses measured in aortic coarctation?

A

High BP in RUE; Low BP in LUE; Diminished pulses in LE

119
Q

Description of pulsus paradoxus?

A

Systolic BP drop > 10 mmHg during inspiration

120
Q

Pulsus paradoxus is associated with which condition?

A

Pericardial tamponade

121
Q

Description of Pulsus biferiens?

A

Pulse with 2 systolic peaks

122
Q

Pulsus biferiens is associated with which condition?

A

Aortic regurgitation

123
Q

Pulsus tardus is associated with which condition?

A

Aortic stenosis

124
Q

Pulsus alternans is associated with which condition?

A

PVCs, Severe LV disease

125
Q

In which 2 conditions does standing/Valsalva increase intensity of murmur?

A

MVP, HCM

126
Q

How can you distinguish between MVP and HCM murmurs?

A

MVP intensifies with hand squeeze; HCM softens with hand squeeze

127
Q

Murmur associated with MVP?

A

Isolated mid-systolic click

128
Q

Should patients with MVP receive endocarditis prophylaxis?

A

No

129
Q

In which 5 conditions is prophylaxis recommended for endocarditis?

A

Prosthetic valves, Previous bacterial endocarditis, Unrepaired cyanotic heart disease, Repaired congenital heart defect (first 6 months), Cardiac transplant patients who develop valvulo-pathology

130
Q

2 types of procedures that require endocarditis prophylaxis?

A

Respiratory, Dental

131
Q

2 heart sounds associated with NML pregnancy?

A

S3, Increased P2 … due to increased blood volume

132
Q

During pregnancy, any ___ murmur is considered pathologic

A

Diastolic

133
Q

2 conditions that decrease intensity of S1?

A

Aortic regurgitation; Mitral stenosis

134
Q

What is the physiologic splitting of S2?

A

A2, then P2

135
Q

Physiologic splitting of S2 is increased with ___

A

Inspiration

136
Q

Physiologic splitting of S2 is decreased with ___

A

Expiration

137
Q

Condition associated with fixed splitting of S2?

A

ASD

138
Q

Which PE finding has the greatest SPECIFICITY to rule out aortic stenosis?

A

Physiologic splitting of S2 … If there is NO splitting of S2, think aortic stenosis

139
Q

Appearance of ASD on CXR?

A

Pulmonary congestion

140
Q

3 conditions associated with paradoxical splitting of S2 (P2, then A2)?

A

Left BBB, Advanced HCM, Pacemaker beats from RV

141
Q

Etiology of S3 heart sound?

A

Tensing of chordae tendinae

142
Q

S3 heart sound is considered normal in which group of patients?

A

Pediatric

143
Q

Condition associated with S3 heart sound?

A

LV systolic dysfunction

144
Q

Etiology of S4 heart sound?

A

Atrial contraction against non-compliant LV

145
Q

3 conditions associated with S4 heart sound?

A

Aortic stenosis, Cardiac ischemia, HCM

146
Q

2 most common infectious causes of dilated cardiomyopathy?

A

Coxsackievirus, Chagas disease

147
Q

Most common hereditary disorder responsible for dilated cardiomyopathy?

A

Hereditary hemochromatosis

148
Q

CTX drug associated with dilated cardiomyopathy?

A

Doxorubicin

149
Q

When can peripartum cardiomyopathy occur?

A

3rd trimester … Up to 6 months postpartum

150
Q

3 DOC for dilated cardiomyopathy?

A

ACEIs, b blockers, Diuretics

151
Q

Patient diagnosed with dilated cardiomyopathy; PE shows no JVD, no leg edema; Labs show BP = 138/79; Currently on terazosin 4 mg for BPH – which drug should be added to regimen?

A

ACEI

152
Q

What causes HCM murmur to intensify?

A

Valsalva

153
Q

What causes HCM murmur to soften?

A

Hand grip, Squat

154
Q

Best diagnostic tool for HCM?

A

ECHO

155
Q

DOC for treatment of HCM?

A

b blockers

156
Q

2 medications that should be avoided in HCM?

A

Diuretics, Nitrates … want to give heart a chance to fill

157
Q

Inheritance pattern for HCM?

A

AD

158
Q

Which group of patients should be screened for HCM?

A

All 1st-degree relatives (AD)

159
Q

Treatment for HCM that reduces the risk of sudden cardiac death/

A

Cardioverter-defibrillator

160
Q

3 contraindications to sports participation?

A

HCM, Infectious mononucleosis (with splenomegaly), Congenital QT prolongation

161
Q

Patient presents with cardiac symptoms; PE shows enlarged + tender liver, neuropathy, petechiae – diagnosis?

A

Amyloidosis

162
Q

Change to EKG in setting of Amyloidosis?

A

Reduced voltage … thick walls on ECHO

163
Q

Change to ECHO that is characteristic for Amyloidosis?

A

Speckled pattern on ECHO

164
Q

Drug that should be avoided in Amyloidosis?

A

Digoxin … increased risk of arrhythmias

165
Q

Treatment in hemochromatosis that can improve cardiac function and prolong life expectancy?

A

Phlebotomy

166
Q

3 indications for use of digoxin in CHF?

A

Severely-low EF, S3 gallop, enlarged heart

167
Q

Contraindication to use of digoxin in CHF?

A

AV block

168
Q

5 indications for implantable cardioverter-defibrillator in CHF?

A

EF < 30%, Syncope, Ventricular tachycardia/fibrillation, Cardiac arrest, HCM

169
Q

Indication for cardiac transplant in patients with CHF?

A

End-stage CHF

170
Q

3 examples of L-to-R shunts?

A

ASD, VSD, PDA

171
Q

3 examples of R-to-L shunts?

A

Tetralogy of Fallot, Transposition of Great Vessels

172
Q

L-to-R shunts are associated with ___ heart conditions

A

Non-Cyanotic

173
Q

R-to-L shunts are associated with ___ heart conditions

A

Cyanotic

174
Q

In setting of L-to-R shunts, movement of unoxygenated blood to systemic circulation is called …

A

Eisenmenger Syndrome

175
Q

Alternate name for Eisenmenger Syndrome?

A

Irreversible pulmonary vascular sclerosis

176
Q

Most common ASD etiology?

A

Ostium secundum

177
Q

Location of sinus venosus ASD?

A

Near entrance of SVC

178
Q

What is the most common congenital cardiac malformation at birth?

A

VSD

179
Q

What is the most common congenital cardiac malformation to be first diagnosed in adults?

A

ASD

180
Q

What is the most common cardiac abnormality seen in Down Syndrome?

A

ASD

181
Q

What is the most common etiology of paradoxical embolism?

A

PFO

182
Q

3 systemic manifestations of paradoxical embolism?

A

CVA, Kidney infarction, Acute limb ischemia infarct … embolisms SHOULD be going to the lungs

183
Q

3 conditions associated with VSD?

A

Trisomy 13, Trisomy 18, Cri du Chat

184
Q

Murmur associated with VSD?

A

Holosystolic murmur heard best over L sternal border

185
Q

Congenital PDA is associated with which pathogen?

A

Rubella

186
Q

Description of murmur heard in PDA?

A

Machinery murmur

187
Q

Pattern of cyanosis seen in PDA?

A

LE cyanosis

188
Q

Remnant of PDA that is present after birth?

A

Ligamentum arteriosus

189
Q

What is the most common cyanotic congenital heart disease?

A

Tetralogy of Fallot

190
Q

4 components of Tetralogy of Fallot?

A

RV outflow obstruction; VSD; RV hypertrophy; Overriding aorta

191
Q

Condition associated with Tetralogy of Fallot?

A

DiGeorge Syndrome

192
Q

DiGeorge Syndrome is associated with abnormal development of …

A

Pharyngeal arches 3 and 4

193
Q

When does cyanosis typically develop in baby with Tetralogy of Fallot?

A

Few weeks after delivery

194
Q

Which cardiac defect is always present in viable baby with Transposition of Great Vessels?

A

PDA

195
Q

Best treatment for Transposition of Great Vessels?

A

Prostaglandin E1 … keeps PDA patent

196
Q

When does cyanosis typically develop in baby with Transposition of Great Vessels?

A

Immediately after delivery

197
Q

Appearance of Transposition of Great Vessels on CXR?

A

“Egg on String” heart

198
Q

Maternal exposure that increases risk of baby developing Transposition of Great Vessels?

A

Maternal use of anti-epileptic drugs

199
Q

Clinical presentation of Aortic Coarctation?

A

HTN in UE; Reduced BP in LE

200
Q

In setting of Aortic Coarctation, which vessels maintain circulation in UE?

A

Intercostal arteries

201
Q

CXR manifestation of collateral flow through intercostal arteries in Aortic Coarctation?

A

Rib notching

202
Q

Appearance of Aortic Coarctation on CXR?

A

Figure 3 sign

203
Q

Description of Figure 3 sign seen in Aortic Coarctation on CXR?

A

Dilation of aorta above/below coarctation

204
Q

More than 50% of patients with Aortic Coarctation also have which cardiac abnormality?

A

Bicuspid aorta

205
Q

Which genetic condition is associated with Aortic Coarctation?

A

Turner’s Syndrome

206
Q

Patients with Aortic Coarctation have greater risk of developing …

A

Berry aneurysm … Higher pressure above heart

207
Q

Condition associated with Pulmonary Stenosis?

A

Noonan Syndrome

208
Q

1 clinical manifestation of Noonan Syndrome?

A

Neck webbing

209
Q

What type of coagulopathy is associated with Noonan Syndrome?

A

Hemophilia C

210
Q

Hemophilia C results from deficiency in …

A

Factor XI

211
Q

Clinical manifestation of Pulmonary Stenosis?

A

Prominent JVD

212
Q

On JVD mapping, which portion of curve is prominent in setting of Pulmonary Stenosis?

A

a wave

213
Q

Appearance of EKG in setting of Pulmonary Stenosis?

A

RA enlargement

214
Q

Treatment of choice for Pulmonary Stenosis?

A

Balloon valvuloplasty

215
Q

Description of cardiac changes seen in setting of Ebstein anomaly?

A

Atrialization of RV

216
Q

Exposure associated with Ebstein anomaly?

A

Lithium

217
Q

2 cardiac abnormalities associated with Marfan Syndrome?

A

Aortic dissection, AR

218
Q

What causes aortic dissection in setting of Marfan Syndrome?

A

Cystic medial necrosis

219
Q

1 cardiac abnormality associated with Ehler-Danlos Syndrome?

A

Aortic dissection

220
Q

1 cardiac abnormality associated with Ehler-Cystic Fibrosis?

A

Aortic stenosis

221
Q

1 cardiac abnormality associated with maternal rubella?

A

PDA

222
Q

Electrolyte abnormality that might cause QT prolongation?

A

Hypocalcemia

223
Q

DOC for atrial flutter?

A

Diltiazem

224
Q

BP that should be diagnosed as HTN?

A

Sustained BP > 140/90

225
Q

Best treatment for Conn Syndrome?

A

Spironolactone

226
Q

Thyroid condition that causes HTN?

A

Hypothyroidism

227
Q

Parathyroid condition that causes HTN?

A

Hyperparathyroidism … increased Ca2+ causes vessel constriction

228
Q

Most common case of HTN in young females?

A

OCP use

229
Q

EKG findings associated with acute pericarditis?

A

Diffuse ST elevations

230
Q

Most common cause of acute pericarditis?

A

Viral infection

231
Q

Which treatment for Dressler Syndrome should be avoided?

A

Corticosteroids

232
Q

Best treatment for acute pericarditis?

A

NSAIDs, Corticosteroids

233
Q

Best treatment for recurrent pericarditis?

A

Colchicine

234
Q

Characteristic of pericardial effusion that can cause symptoms?

A

Rapid accumulation

235
Q

Triad of symptoms seen in pericardial tamponade?

A

Pulsus paradoxus, Hypotension, JVD (jugular venous distension)

236
Q

Change to EKG in setting of pericardial tamponade?

A

Decreased voltage

237
Q

When should you collect samples of pericardial aspirate in setting of pericardial effusion?

A

Suspected TB

238
Q

Appearance of pericardial tamponade on PA cath?

A

Equalization of pressure in RA, RV, Pulmonary artery

239
Q

Change to JVD curve in pericardial tamponade?

A

Attenuated Y descent

240
Q

Heart sound associated with constrictive pericarditis?

A

Pre-systolic knock

241
Q

In setting of constrictive pericarditis, when does pericardial knock occur?

A

Just after S2

242
Q

Change to JVD curve in constrictive pericarditis?

A

Sharp Y descent

243
Q

Change to JVD appearance on PE in setting of constrictive pericarditis?

A

Kussmaul sign … Increased JVD during inspiration

244
Q

Best treatment for constrictive pericarditis?

A

Pericardiectomy

Rizk Review (19 decks)

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