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Cardiovascular Flashcards

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1
Q

Normal HR

A

60-100 bpm

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2
Q

Right axis deviation causes (4)

A

Right ventricular hypertrophy

Anterolateral MI

Left Posterior Hemiblock

(also consider PE)

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3
Q

Left Axis deviation causes (4)

A

Ventricular tachycardia

Inferior myocardial infarction

Left ventricular hypertrophy

Left anterior hemiblock

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4
Q

Jervell and Lange-Nielsen syndrome

A

Long QT syndrome due to a defect in K channel conduction.

Associated with sensorineural deafness

Treat with Beta blockers and pacemaker

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5
Q

Left bundle branch block

A

WiLLiaM

V1= W QRS pattern
V6= M QRS pattern

Acute MI

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6
Q

Right bundle branch block

A

MaRRoW

V1= M QRS pattern
V6= W QRS pattern

Rabbit ears (M Shaped) in V1

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7
Q

Right atrial abnormality

A

P pulmonale

causes Peaked P waves

> 2.5 mm in lead II

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8
Q

Left atrial abnormality

A

P mitrale

Mitrale causes M shaped P waves

P wave width in Lead II is > 120 sec

Notched P waves

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9
Q

Right sided murmurs do what

A

Increased with inspiration

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10
Q

Left sided murmurs do what

A

Increased with expiration

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11
Q

JVD measurement

A

> 4 cm above sternal angle

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12
Q

Kussmaul sign

A

Increase in jugular venous pressure (JVP) with inspiration

Seen in constrictive pericarditis

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13
Q

An early decrescendo murmur

A

Aortic regurgitation

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14
Q

A mid to late low pitched murmur

A

Mitral stenosis

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15
Q

S3 gallop

A

Rapid ventricular filling due to fluid overload

A sign of fluid overload

Heart failure, mitral valve disease

Normal in young and pregnancy

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16
Q

S4 gallop

A

Stiff noncompliant ventricle

A sign of decreased compliance

Hypertension, aortic stenosis, diastolic dysfunction,

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17
Q

Hear a “plop” while listening to chest

A

Atrial myxoma

Can develop systemic embolization from breakoff of tumor leading to stroke

Tx: Resection

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18
Q

Wolff-Parkinson White

Tx

A

Abnormal fast accessory conduction pathway from atria to ventricle (Bundle of kent)

Delta wave with widened QRS complex and shortened PR interval

Advise against vigorous activity

Procainamide for arrhythmias

Calcium channel blockers are contraindicated

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19
Q

Management for atrial fibrillation (4)

A

ABCD

Anticoagulate
B-blockers to control rate
Cardiovert/calcium channel blockers
Digoxin (in refractory cases)

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20
Q

Collapsing (“waterhammer”) peripheral pulse

A

Aortic incompetence

AV malformation
Patent ductus arteriosus
thyrotoxicosis
Severe anemia

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21
Q

Pulsus paradoxus

A

Decrease in systolic blood pressure >10 Hg with inspiration

Cardiac tamponade
Pericardial constriction
Tension pneumothorax
Foreign body in airway

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22
Q

Pulsus alternans

A

Alternating weak and strong pulses

Cardiomyopathy
Impaired left ventricular systolic function

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23
Q

Jerky peripheral pulses

A

Hypertrophic obstructive cardiomyopathy

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24
Q

Pulsus bisferiens

A

Bifid pulse/ twice beating

Aortic regurgitation
Combined aortic stenosis and aortic regurgitation
Hypertrophic obstructive cardiomyopathy

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25
Q

What can be used to increase heart rate

A

Atropine

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26
Q

Causes of arrthymias

A

Beta blockers

CCB

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27
Q

No P waves

Variable and irregular QRS response

  • Tx
A

Atrial fibrillation

Tx: Beta blockers, CCB or digoxin
Anticoagualtion w/ warfarin

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28
Q

Causes Atrial fibrillation

A

PIRATES

Pulmonary disease
Ischemia
Rheumatic heart disease
Anemia/ Atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
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29
Q

Estimate stroke risk in atrial fibrillation

A

CHA(2)DS(2)-VASc

CHF (1 point)
HTN (1 point)
Age >= 75 (2points)
Diabets (1 point)
Stroke or TIA history (2 points)
Vascular disease (1 pt)
Age 65-74 (1 pt)
Sex Category (female) 1 point
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30
Q

Ventricular tachycardia tx

A

Amiodarone
Lidocaine
Procainamide
(If stable)

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31
Q

Ventricular fibrillation tx

A

no pulse

Electrical defibrillation

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32
Q

CXR findings for CHF diagnosis (5)

A

ABCDE

Alveolar edema (Bat's wings)
Kerley B lines (interstitial edema)
Cardiomegaly 
Dilated prominent upper lobe vessels
Effusion (pleural)
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33
Q

How to diagnose CHF

A

Echocardiogram ( tarnsthoracic echocardiogram)

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34
Q

Left sided CHF symptoms ( 6)

A 
Dyspnea predominates
Left sided S3/S4 gallop
Bilateral basilar rales
Pleural effusions
Pulmonary edema
Orthopnea, paroxysmal nocturnal dyspnea
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35
Q

Right sided CHF symptoms (6)

A 
Fluid retention predominates
Right sided S3/S4 gallop
JVD
Hepatojugular reflux
Peripheral edema
Hepatomegaly, ascites
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36
Q

Acute CHF management (5)

A

LMNOP

Lasix (furosemide)
Morphine
NItrates
Oxygen
Position (sit upright)
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37
Q

CHF management

A

Loop diuretics

ACEI or ARBS w/ loops

Beta blockers (avoid when decompensated) but started once euvolemic

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38
Q

Loop diuretics (4)

SE (6)

A

Furosemide
Ethacrynic acid
Bumetanide
Torsemide

SE:
ototoxicity
Hypokalemia
Hypocalcemia
Hyeruricemia
Dehydration
Gout
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39
Q

Thiazide diuretics (3)

SE (6)

A

Hydrochlorothiazide
Chlorothiazide
Chlorthalidone

SE:
Hypokalemic metabolic alkalosis
Hyponatremia
HYperGLUC
(hyperglycemia, hyperlipidemia, hyperuricemia, hyperCalcemia)
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40
Q

K sparing agents (4)

SE (3)

Exception

A

Spironolactone
Eplerenone
Triamterene
Amiloride

SE:
Hyperkalemia
Gynecomastia
Sexual dysfunction

Eplerenone does not have antiandrogenic effects that lead to gynecomastia

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41
Q

Carbonic anhydrase inhibitors

SE (4)

A

Acetazolamide

SE:
Hyperchloremic metabolic acidosis
Neuropathy
NH3 toxicity
Sulfa allergy
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42
Q

Osmotic agents

SE (2)

CI (2)

A

Mannitol

SE:
Pulmonary edema
Dehydration

CI:
Anuria
CHF

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43
Q

Acute decompensated heart failure tx

A

Inotropic agents (dobutamine) reduces left ventricular end systolic volume for symptomatic improvement

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44
Q

When to place cardiac defibrillator

A

EF < 35%

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45
Q

When to place pacemaker

A

EF < 35
Dilated cardiomyopathy
Widened QRS complex with persistent symptoms

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46
Q

Diuretic taht looses alcium

A

Loops lose calicum

Thiazides take in

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47
Q

College man passes out playing basketball, ECG shows slurred upstroke of QRS

A

Wolff-Parkinson white syndrome

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48
Q

Dilated Cardiomyopathies

Abnormality
Left ventricular cavity size (end diastole)
Left ventricular cavity size (end diastole)
EF
Wall thickness

A

Impaired contractility

Large Increased Left ventricular cavity size (end diastole)

Large Increased Left ventricular cavity size (end diastole)

Decreased EF

Wall thickness decreased

Balloon like heart

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49
Q

Hypertrophic Cardiomyopathies

Abnormality
Left ventricular cavity size (end diastole)
Left ventricular cavity size (end diastole)
EF
Wall thickness

A

Impaired relaxation

Decreased Left ventricular cavity size (end diastole)

Large Decreased Left ventricular cavity size (end diastole)

Increased or normal EF

Wall thickness largely increased

Tx: BB/CCB

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50
Q

Restrictive Cardiomyopathies

Abnormality
Left ventricular cavity size (end diastole)
Left ventricular cavity size (end diastole)
EF
Wall thickness

A

Impaired elasticity

Decreased Left ventricular cavity size (end diastole)

Decreased Left ventricular cavity size (end diastole)

Normal EF

Wall thickness increased

Caused by: amyloidosis, sarcoidosis, hemochromatosis)

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51
Q

Harsh systolic ejection crescendo-decrescendo murmur in the lower left sternal edge that increases with decrease in preload (valsalva, standing) and decreases in increase in preload ( passive leg raise)

Tx

A

Hypertrophic cardiomyopathy

Abnormal mitral leaflet motion= systolic anterior motion of mitral valve

Anterior motion of mitral valve leaflets toward the interventricular septum

Beta blockers (initial therapy) 
Non-dihydropyridine CCB

CI: Digoxin and spironolactone

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52
Q

Prinzmetal angina

A

Young women

Early morning at rest

TX: CCB with or without nitrates

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53
Q

TIMI Risk score for Unstable Angina/ NSTEMI

A

Age >= 65 (1pt)
Three or more CAD risk factors (1 pt)
[ Premature fm hx, DM, smoking, HTN, Increased cholesterol, PAD, abdominal aortic aneurysm]

Known CAD; stenosis > 50% (1 pt)
ASA use in past 7 days (1 pt)

Severe angina (1 pt)
[Two or more episodes within 24 hours]
ST deviation >= 0.5 mm (1 pt)
+ cardiac marker (1 pt)

> = 3 pts benefit more from enoxaparin (vs unfractionate heparin), glycoprotein IIB/II inhibitors (abciximad, tirofiban, eptifibatide) and early angiography

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54
Q

TX MI

A

MOANing Big from MI (MONA-B)

Morphine
Oxygen
ASA+ Additional second antiplatelet agent (NSTEMI)
[Prasugrel or ticagrelor]
Nitrates
B-blockers

IV morphine w/ IV metoclopramide

Heart failure: avoid beta blockers (give ACEI)

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55
Q

Enoxaparin

A

Low molecular weight heparin

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56
Q

STEMI ECG changes

A

1) Peaked T waves
2) ST segment elevation
3) Q waves
4) T wave inversion
5) ST segment normalization
6) T wave normalization over several hours to days

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57
Q

Cardiac enzymes

A

Troponin most sensitive

3-12 hrs to rise (troponin and CK-MB)

Troponin peaks 24-48
CKMB peaks 24 hrs

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58
Q

ST segment elevated leads II, III, aVF

A

Inferior MI

RCA
PDA
LCX

Avoid nitrates and diuretics due to risk for severe hypotension (preload dependent)

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59
Q

ST segment elevations V1-V4

A

Anterior MI

LAD
Diagonal branches

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60
Q

St segment elevations Leads I, AVI, V5-V6

A

Lateral MI

LCA
Diagonal

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61
Q

ST segment depression in V1-V3

ST elevation in leads I and aVL

or

ST depression in leads I and aVL

A

Posterior MI

LCX
RCA

ST elevation in leads I and aVL= LCX

ST depression in leads I and aVL= RCA

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62
Q

Contraindications to thrombolysis (5)

A
  1. Previous intracranial hemorrhage or major GI bleed
  2. Recent major trauma/ surgery/ head injury
  3. Ischemic stroke within the last 6 months
  4. Severe HTN (>180/110)
  5. Known bleeding disorder
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63
Q

Timeline of complications post MI

A

First day: Heart failure

2-4 days: arrhythmia, pericarditis

5-10 days:
1) left ventricular wall rupture (acute pericardial tamponade causing electrical alternans, pulseless electrical activity, JVD)

2) papillary muscle rupture (severe mitral regurgitation, pulmonary edema)
3) Septal rupture (lower left sternal border murmur, increased O2 saturation in the right ventricle)

weeks to months: ventricular aneurysm (CHF, arrhythmia, persistent ST segment elevation, mitral regurg, thrombus formation)

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64
Q

Post MI

2-4 weeks

Fever, pericarditis
pleural effusion
Leukocytosis
Increased ESR

A

Dressler syndrome

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65
Q

Dyslipidemia

A

LDL > 130 mg/dL or

HDL < 40 mg/dL

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66
Q

HMG-COA reductase inhibitors (5)

Effects of lipids

SE (3)

A 
Atorvastin
Simvastatin
Lovastatin
Pravastin
Rosuvastatin

Decrease LDL
Decrease Triglycerides

SE:
Elevated LFT
Myositis
Warfarin potentiation

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67
Q

Lipoprotein lipase stimulators (fibrates)

Effects of lipids

SE (5)

A

Gemfibrozil

Decrease triglycerides
Increase HDL

SE:
GI upset
Cholelithiasis
Myositis (esp in combo w/ statin)
Increased LFT
Pancreatitis
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68
Q

Cholesterol absorption inhibitors

Effects of lipids

SE (3)

A

Ezetimibe

Decrease LDL

SE:
Diarrhea
Abdominal pain
Can cause angioedema

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69
Q

Niacin

Effects of lipids

SE (5)

A

Decrease LDL
Increased HDL

Skin flushing (can be prevented w/ ASA, due to increase in prostaglandins)
Paresthesias
Pruritus
GI upset
Increased LFTs
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70
Q

Bile acid resins (3)

Effects of lipids

SE (5)

A

Cholestyramine
Colestipol
Colesevelam

Decrease LDL

SE
Constipation
GI upset
LFT Abnormalities
Myalgias
Can decrease absorption of other drugs from small intestine
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71
Q

Proprotein convertase subtilisin/ kexin type 9 (PSCK9) inhibitors (2)

Effects of lipids

SE (4)

A

Evolocumab
Alirocumab (injectable 2-4 weeks)

Decrease Decrease LDL

Injection site swelling
Rash
Muscle/ limb pain
Backache

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72
Q

HTN non african american tx

A

ACEI/ ARB
Thiazide
CCB

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73
Q

HTN african american tx

A

Thiazide

CCB

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74
Q

HTN w/ CKD tx

A

ACEI/ ARB

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75
Q

HTN

1) uncomplicated
2) CHF
3) Diabetes
4) Post MI
5) CKD
6) BPH
7) Isolated systolic HTN
8) Pregnancy

A

1) uncomplicated: Diuretics, CCB, ACEI
2) CHF: Diuretic, Beta blocker, ACEI, ARB, Aldosterone antagonist
3) Diabetes: Diuretics, ACEIs, ARBs, CCBs
4) Post MI: Beta blocker, ACEI, ARB, Aldosterone antagonist
5) CKD: ACEI, ARBs
6) BPH: Diuretics, alpha adrenergic blockers
7) Isolated systolic HTN: Diuretics, ACEIs, CCB (dihydropyridines)
8) Pregnancy: Methyldopa, beta blockers (labetalol), hydralazine

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76
Q

BP > 180/120

A

Hypertensive crises

IV medications: labetalol, nitropruside, nicardipine)

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77
Q

Pericardial calcifications seen on CXR suggest

A

Constrictive pericarditis due to chronic fibrosis and calcification of the pericardium

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78
Q

Cardiac tamponade tx

A

Aggressive volume expansion with IV fluids

Urgent pericardiocentesis

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79
Q

Ascending aortic aneurysm vs descending aortic aneurysm

A

Ascending
- think cystic medial necrosis or connective tissue disease

Descending aortic aneurysm
- think atherosclerosis

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80
Q

Rapid onset of pulmonary congestion, cardiogenic shock and severe dyspnea

A

Acute aortic regurgitation

[ From infective endocarditis, aortic dissection, chest trauma, MI]

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81
Q

Uncomfortable heart pounding when laying on left side

A

Aortic regurgition (chronic)

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82
Q

Aortic regurgitation

PE (6)

Tx

A

PE:

1) Early blowing diastolic murmur at the left sternal border
2) Mid-diastolic rumble (austin flint murmur)
3) Midsystolic apical murmur

Head bob with heart beat
Water hammer pulse (corrigan sign)
Duroziez sign (femoral bruit)

Tx: Vasodilator therapy (dihydropyridine or ACEI)

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83
Q

Opening snap and mid diastolic murmur at the apex
Pulmonary edema

Tx

A

Mitral valve stenosis

Tx: Antiarrhythmics (Beta blockers, digoxin, CCB) and warfarin

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84
Q

Aortic dissection due to

Aortic aneurysm due to

A

Dissection: HTN

Aneurysm: atherosclerosis

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85
Q

Common site of aortic dissection

A

Above the aortic valve and distal to the left subclavian artery

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86
Q

Hypotension

Severe tearing abdominal pain that radiates to the back

A

Aortic aneurysm

Tx: <5 cm monitor
>5.5 (abdominal) surgery
> 6 cm (thoracic) surgery

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87
Q

Sudden tearing/ ripping pain in the anterior chest with or without radiation fo the back

Hypertensive

Diagnose?

A

Aortic dissection

Anterior chest pain ( ascending)
Back pain (descending)

If stable: CT angiography

Unstable: TEE

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88
Q

Screening AAA

A

men 65-75 who ever smoked

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89
Q

Aortic dissection types

A

Type A: ascending aortia and may progress to involve the arch and thoracoabdominal aorta

[More common]

Type B: descending thoracic or thoracoabdominal aorta distal to the left subclavian artery without involvement of the ascending aorta

[Can be managed medically, IV beta blockers (labetalol) before starting vasodilators (nitroprusside)

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90
Q

Imaging for DVT

Tx DVT

A

Doppler Ultrasound

TX: LMWH or IV unfractionated heparin followed by PO warfarin for 3-6 months

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91
Q

Imaging for PE

Tx PE

A

Spiral CT or V/Q scan

TX: LMWH or IV unfractionated heparin followed by PO warfarin for 3-6 months

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92
Q

Calf claudication=

Buttock claudication=

Buttock claudication+ impotence=

A

Calf claudication= femoral disease

Buttock claudication= iliac disease

Buttock claudication+ impotence= Leriche syndrome (aortoiliac occlusive disease)

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93
Q

Cough
Progressive dyspnea
Orthopnea

Atrial fibrillation with rapid ventricular response

Immigrated to US from India

Recurrent sore throat as child

A

Cough, Progressive dyspnea, orthopnea= pulmonary edema with rapid decompensation due to development of new atrial fibrillation

Recurrent sore throat= rheumatic heart disease

Mitral stenosis is diagnosis

[Rheumatic mitral stenosis can become symptomatic w/ pregnancy]

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94
Q

Elevated jugular venous pressure

Hepatomegaly
Ascites

Peripheral edema

A

Constrictive pericarditis

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95
Q

Peripartum cardiomyopathy (PPCM)

A

Rapid onset of systolic heart failure

Fatigue
Dyspnea
Cough
Pedal edema

at > 36 weeks

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96
Q 
80 y.o
Purulent ulcer
Hypotension
Tachycardic
Tachypnea
Lethargy
Confusion
A

Septic shock

1) Decreased systemic vascular resistance (reduced afterload) due to peripheral vasodilation
2) Decreased pulmonary capillary wedge pressure (left atrial pressure) due to capillary leakage, which causes decreased preload
3) Elevated mixed venous oxygen saturation due to hyperdynamic circulation with an inability of tissues to adequately extract oxygen

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97
Q

Types of shock

Central venous pressure (right sided preload)

PCWP (left sided preload)

Cardiac index (LV output)

SVR (afterload)

SvO2

A

Hypovolemic
- mass hemorrhage
Low CVP, PCWP, CI, SvO2
High SVR

Cardiogenic shock
- decreased cardiac contractility
High CVP, PCWP, SVR
Low CI, SvO2

Obstructive shock
- increased intrapericardial pressure
- pulmonary artery embolism
High: CVP, SVR
Low: PCWP, CI, SvO2
Distributive
- septic shock
- neurogenic shock
High: CI, SvO2
Low: CVP, PCWP, SVR

See screen shot

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98
Q

Biphasic stridor in child that improves with extension

A

Vascular ring

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99
Q

Orthostatic hypotension caused by

A

Decreased baroreceptor responsiveness

Insufficient constriction of blood vessels in the lower extremities on standing

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100
Q

21 y.o dizziness and palpitations

Provoked by fatigue or strong emotions

Can stop episode by squatting or taking a deep breath

Hypotension
Cool extremities

Regular narrow complex tachycardia

What to do

A

Supraventricular tachycardia (SVT)

Causes hemodynamic instability (hypotension, cool extremities)

Tx: Cardioversion

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101
Q

Diagnosing aortic dissection

A

Hemodynamically stable patients= CT angiography

If Renal insuffiency= tranesophageal echocardiography (diabetes)

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102
Q

Why is K high in CHF

A

Low distal sodium and water delivery in CHF —> reduced potassium excretion and subsequent hyperkalemia

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103
Q

Brain natriuretic peptide (BNP)

A

hormone released from ventricular myocytes in response to high ventricular filling pressures and wall stress in patients

CHF

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104
Q

CHF signs (5)

A

Progressive dyspnea
Fatigue
Elevated BNP

Third heart sound

Peripheral edema

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105
Q

Exertional dyspnea
Orthopnea
Nocturnal cough

Hemoptysis

Emigrated from cambodia 2 years ago

Palpitations and irregular heart rate

A

Rheumatic heart disease

Mitral stenosis

Risk of development of atrial fibrillation —> left atrial thrombus —> systemic thromboembolic complications (stroke)

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106
Q

Syncope while working in garden

HTN
Tachycardia
Widening of mediastinum

Small pericardial effusion

A

Acute aortic dissection

Type A (ascending aorta) into pericardial space

CT angiography

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107
Q

Leg apain
Hx Afib
Smoker

Mottled skin that is cool

Pulses not palpable

Medication to prevent this

A

Embolism of a left atrial thrombus

Anticoagulation therapy

Apixaban: non-vit K antagonist oral anticoagulant (NOAC) directly inhibits factor Xa

[Apixaban, dabigatran, rivaroxaban, edoxaban]

Aspirin and clopidogrel less effective

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108
Q

Harsh crescendo decrescendo systolic ejection murmur over the left upper sternal border

A

Pulmonary stenosis

Tetralogy of fallot

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109
Q

Ring of calcification around the heart

A

Tuberculosis

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110
Q

Initial stabilization of acute ST elevated MI

A

MONA-B

Oxygen
Aspirin
PSY12 inhibitor (clopidogrel)
Nitrates
Beta blocker
Statin
Anticoagulation

If persistent pain, HTN or heart failure= IV nitroglycerin

If persistent severe pain= IV morphine

If unstable sinus bradycardia= IV atropine

If Pulmonary edema= IV furosemide
[If pulmonary edema dont give beta blocker]

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111
Q

Right lung biopsy develop=

Chest pain
Hypotension
Severe dyspnea

Low cardiac index
High PCWP

A

Cardiogenic shock

= Acute MI

112
Q

Maneuvers that increase preload or afterload

A

Squatting
Leg raise
Hand grip
Supine

113
Q

Maneuvers that decrease preload

A

Valsalva

Abrupt standing

114
Q

Syncope while peeing

A

Situational (postmicturition) syncope

Form of vasovagal syncope (neurally mediated)

Triggers: Micturition, defecation, cough

Cardioinhibitory response

115
Q

Patient on digoxin

New medication added

Anorexia
Nausea
Generalized weakness now

  • Also seen features (2)
A

Drug interaction w/ amiodarone

Digoxin toxicity

Can lead to color vision changes

Atrial tachycardia with AV block

116
Q

From Asia

Febrile illness a year ago, with pain and swelling in knees and wrists given NSAIDS

Holosystolic murmur at apex radiates to left axilla

Mitral regurgitation

Tx

A

Rheumatic heart disease

High risk for recurrence

Need antibiotic therapy

Should receive prophylaxis IM benzathine pencillin G every 4 weeks to prevent recurrence

117
Q

On medication for A fib

Treadmill exercise test

Heart rate dramatically increases and QRS complex increases

What medication

A

Class I antiarrhythmic drugs that block sodium channels by inhibiting initial depolarization phase

Flecainide
Propafenone

When patient has faster heart rate drug has less time to dissociate from sodium channels—> higher number blocked channels —> progressive decrease in impulse conduction and widening of QRS complex

“Use dependence”

118
Q

Amlodipine

A

Dihydropyridine CCB

[no QRS effect]

119
Q

Verapamil

Diltiazem

A

CCB

Prolong refractory period of AV node and increase PR interval

120
Q

Uncontrolled HTN
Progessive dyspnea

Lower extremity swelling
JVD

Prominent V waves

Holosystolic murmur at left lower sternal border

A

Decompensated left sided heart failure

Tricuspid regurgitation

Secondary TR results from right ventricular cavity enlargement from chronic right sided volume/pressure overload (right sided heart failure)

Left sided heart failure causes right sided

RV enlargement causes tricuspid annular dilation

Prominent V waves are highly specific for TR

121
Q

Rumbling diastolic murmur at left lower sternal border

no JVP

Prominent A wave

A

Fusion of tricuspid valve commissures

[Rheumatic heart disease]

Tricuspid stenosis

122
Q

Chest pain given medications aspirin, clopidogrel, LMWH, metoprolol, and lisinopril

Hx: Allergic rhinitis
Eczema

Second day: acute onset dyspnea with wheezing and prolonged expieration

A

Bronchoconstriction

Undiagnosed asthma that was exacerbated by aspirin

123
Q

25 y.o
Transient vision loss in right eye

Elevated blood pressure

Bruit below right mandibular angle

High plasma renin

Grandmother stroke at 50

  • Name
  • MOA
A

Fibromuscular dysplasia (FMD)

Transient monoocular vision loss is consistent with amaurosis fugax

Emboli from severe ipsilateral carotid stenosis cause cause ischemia of optic nerve

FMD: noninflammatory and nonatherosclerotic condition caused by abnormal cell developemnt in the arterial wall —> vessel stenosis, aneurysm or dissection

Commonly: renal, carotid and vertebral arteries

Headache
Pulsatile tinnitus
Dizziness

Transient ischemic attack
Stroke
Amaurosis fugax

Dx: CT angiography of abdomen or duplex U/S

FMD decreases perfusion to kidneys which increases both renin and aldosterone levels

124
Q

Preventive medication for anginal episodes

How does it work

A

Beta blockers (first line)

Decreased myocardial contractility and decrease in HR

125
Q

Coronary artery vasodilation medication

A

Dihydropyridine calcium channel blockers

Amlodipine
Felodipine

They increase myocardial oxygen supply by vasodilation and reduce myocardial oxygen demand through systemic arterial vasodilation and reduction of afterload

126
Q

Decreases cardiac afterload

A

Dihydropyridine calcium channel blockers

Amlodipine
Felodipine

They increase myocardial oxygen supply by vasodilation and reduce myocardial oxygen demand through systemic arterial vasodilation and reduction of afterload

127
Q

Decreases cardiac preload

A

Nitrates

Dilation of venous capacitance vessels and reduction of cardiac preload

128
Q

Tachycardia resolved with cold water immersion

A

Pasroxysmal supraventricular tachycardia

AV nodal reentrant tachycardia

Carotid sinus massage
Cold water immersion
Valsalva
Eyeball pressure
- Increase parasympathetic tone —> temporary slowing conduction of AV node
129
Q

A fib treatment

A

Diltazem

Beta blockers

130
Q

SOB
Abdominal distension

Chemotherapy 18 years ago

JVD
Positive fluid wave
Hepatomegaly
Pitting edema

A

Constrictive pericarditis

Complication of radiation therapy

Pericardial thickening & calcification

Inelastic pericardium

131
Q

Portal vein thrombosis/ compression

A

Decompensated cirrhosis
Hypercoagulable states

NOT JVP

132
Q

Arteriovenous fistula

Afterload
Preload
Cardiac index

A

Forms an enlarged vein

Fistula allows a portion of blood to bypass the high resistancce of the systemic arterioles , systemic vascular resistance (SVR) is decreased (decreased afterload)

Blood through fistula returns to right atrium more quickly—> increased venous return (increased preload)

Both increased venous return and decreased SVR contribute to increased cardiac output

Risk: high-output heart failure
(Increased cardiac preload)

133
Q

Aortic regurg w/ dilated left ventricle why no symptoms

A

Increased left ventricular compliance

134
Q

AR causes

A

Increase LV preload

Increased SV (due to increased preload)

Increase in ventricular contractility

Cardiac output sustained

Total peripheral resistance (TPR) remains unchanged
[TPR increases once decompensation begins]

135
Q

Substernal chest pain
HTN
Diverticular bleed 2 years ago

Cardiac catheterization performed

Heparin drip

Develops weakness, back pain, SOB, nausea, abdominal discomfort

Flat neck veins
Hypotension
Tachycardia

A

Retroperitoneal hematoma

Non-contrast CT scan

136
Q

Chest pain from cocaine tx

A

IV diazepam

137
Q

Digeorge findings

A

Low set ears
Micrognathia
Cleft palate

No thymus

Truncus arteriosus

Hypocalcemia/ Hypoparathyroidism

138
Q

Horseshoe kidney

A

Turner syndrome

139
Q

MOA nitroglycerin

A

Decreased left ventricular wall stress

Systemic vasodilation and decreased preload —> decrease in left ventricular end diastolic and end systolic volume —> reduction in left ventricular systolic wall stress

1) Lowers preload
2) Lowers left ventricular end diastolic volume
3) Reduces wall stress

140
Q

Statins MOA

A

Inhibit HMG-CoA reductase

RL enzyme needed to convert HMG-CoA to mevalonate

Decrease hepatic cholesterol activates cellular signals that increase the number of LDL receptors

[Inhibition of intracellular synthesis pathway]

141
Q

1) Cell surface receptor blockage
2) Extracellular enzyme blockage
3) Inhibition of intracellular synthesis pathway

A

1) Cell surface receptor blockage= beta blockers
2) Extracellular enzyme blockage= ACEI
3) Inhibition of intracellular synthesis pathways= Statins

142
Q

Mitral valve prolapse change with squatting

A

Disappears

Just like HCM

[Other murmurs get louder]

143
Q

Syncopal events triggered by emotion

A

Vasovagal syncope

Tx: Counterpressure maneuver education

144
Q

Progressive dyspnea
Lower extremity edema
JVD
Ascites

Concentric Left ventricular hypertrophy

Non dilated LV cavity

A

Restrictive cardiomyopathy

145
Q

Holosystolic murmur at left lower sternal border with diastolic rumble over the cardiac apex

Poor feeding

A

Ventricular septal defect

146
Q

Harsh systolic ejection murmur at left upper sternal border

A

Tetralogy of Fallot

147
Q

Young
Smoking
Recurrent chest discomfort at rest or when sleeping

Tx

A

Vasospastic angina

CCB
- diltiazem
- amlodipine, felodipine
(preventive)

Sublingual nitroglycerin (abortive)

148
Q

80 y.o man putting on shirt and tie and passing out

A

Carotid hypersensitivity syncope

Baroreceptor hypersensitivity

149
Q

Syncope w/ exertion

A

LV outflow obstruction

150
Q

Leg cramping

Peripheral pulses decreased in left leg

ABI 0.65 in left and 1.1 in right

Next step

A

Atherosclerotic cardiovascular disease

Peripheral artery disease

Tx: Supervised graded exercise program

Low dose aspirin
Statin therapy

151
Q

Hemodynamics in heart failure

Contractility
Cardiac output
Compensatory
SVR
Afterload
A

Decrease contractility —> decrease cardiac output —> Compensatory neurohormonal activation —> increase systemic vascular resistance —> Increase afterload —> Decrease contractility

152
Q

Calf pain after artery embolectomy

Burning sensation in posterior aspect of leg

Swollen
Tense
Exquisitely tender
Pain worse w/ dorsiflexion

Shiny and cool to touch

Patient cant move toes

A

Compartment syndrome

153
Q

Cold 2 weeks ago

Progressive SOB
Swelling of feet

A

Decompensated heart failure from viral myocarditis

—> Dilated cardiomyopathy

Dilated ventricular chambers and diffuse hypokinesis of the ventricular walls

154
Q

Acute coronary syndrome with low risk for aortic dissection give what medication

A

Aspirin

155
Q

Light headedness past month

Syncopal episode

HX HTN

Left ventricular hypertrophy
Ejection fraction 55%

A

Cardiogenic syncope

Bradyarrhythmia

156
Q

Respiratory variation in systolic blood pressure

A

Pulsus paradoxus

Cardiac tamponade

157
Q

Informed consent

A

1) Patient diagnosis
2) Risk and benefits of both proposed tx and tx alternatives
3) Risk of refusing treatment

158
Q

QRS that varies in height

A

Electrical alternans

Cardiac tamponade

Pericardiocentesis

159
Q

HTN cause to consider

A

Oral contraceptives

160
Q

Small face and jaw
No skin creases on palmar aspect

Overlapping fingers

Cardiovascular abnormalities?

A

VSD

Trisomy 18 Edwards syndrome

161
Q

27 y.o with bouts of dyspnea on exertion

Ejection type Systolic murmur at lower left sternal border that decreases when squatting

Inheritence?

A

Hypertrophic cardiomyopathy

Autosomal dominant

162
Q

Dark purple legs

Palable pulses

A

Chronic stasis dermatitis due to venous insufficiency

Get Venous doppler U/S

163
Q

Methamphetamine on heart

Given IV medication taht acts primarily stimulating beta 1 adrenergic receptors, what is the MOA

A

Decompensated heart failure
Hypotension
Cool extremities

Low cardiac output state

Dobutamine acts on Beta-1 receptors—> increased production of cAMP in cardiac myocytes —> enhanced calcium mediated binding of actin-myosin to troponin C —>
Increased myocardial contractility (positive inotropic effect)

HR is increased via calcium channel activation (positive chronotropic effect)

Increased myocardial contractility —> ejection of higher volume of blood which results in —> decreased left ventricular end systolic volume

164
Q

Adverse effect of pacemaker

A

Tricuspid regurgitation

Result in right sided heart failure

Pulsation in neck when lies down

Holosystolic murmur at left lower sternal border

165
Q

T wave inversions in V1-V4, Troponin normal

Next step

A

NSTEMI

1) Antiplatelet agents (aspirin, clopidogrel or aspirin and ticagrelor)
2) Anticoagulant therapy (unfractioned heparin, enoxaparin, bivalirudin)
3) Beta blockers (reduce myocardial oxygen demand)
4) Nitrates (reduce oxygen demand and relieve ischemic pain)
5) High intensity statins (stabilize plaques and lower risk of recurrent ACS)

166
Q

Coronary angiogram 5 days ago

Now nausea and abdominal pain

Painless mottling of skin in feet

A

Cholesterol emboli

167
Q

Medication used w/ Beta blocker and ACE I to reduce mortality in MI

A

Eplerenone
Spironolactone

Mineralocorticoid receptor antagonists (MRA)

BLock deleterious effects of aldosterone on the heart

168
Q

Irregular pulse
No P waves

What will resolve ventricular function

A

Afib

Rate or rhythm control

169
Q

Dyspnea
Paroxysmal nocturnal dyspnea
Bibasilar crackles
Hypoxemia

  • Name
  • Due to
  • Tx
A

Pulmonary edema

Acute decompensated heart failure

Tx IV diuresis
Oxygen supplementation
Noninvasive ventilation

170
Q

Afib originates where

A

Pulmonary veins is most frequent location for ectopic foci that cause AF

171
Q

Atrial flutter location

Tx

A

Reentrant circuit around the tricuspid annulus

Anticoagulation (rivaroxaban, apixaban)

172
Q

18 y.o

During expiration that is an extra high pitched sound heard after S1

Systolic crescendo-decrescendo murmur at left upper sternal border

S2 split throughout the respiratory cycle and splitting increases with inspiration

A

Pulmonic stenosis

Ejection click= high pitch sound after S1 best heard during expiration

173
Q

Uveitis 6 months ago

Bradycardia

2:1 AV block and left bundle branch block

Bilateral midfield lung opacities

A

Sarcoidosis

174
Q

Patient < 55 with unexplained second or third degree heart lbock

A

Sarcoidosis

175
Q

Fourth heart sound due to

A

Long standing HTN

176
Q

High amplitude jugular venous pulsations that are seen intermittently at irregular intervals

Wide complex tachycardia

A

Atrioventricular dissociation

Ventricular tachycardia

Cannon A waves: intermittent prominent waves caused by surge in jugular venous pressure —> atrioventricular dissociation

177
Q

Side effect of Amlodipine

A

CCB

Peripheral edema

178
Q

A fib medication that needs pulmonary fxn testing

A

Amiodarone

Pulmonary function and thyroid tests

179
Q

Muffled heart sounds results in

A. Decreased cardiac contractility

B. Decreased left ventricular preload

C. Increased right ventricular compliance

D. Left ventircular outflow obstruction

E. Pulmonary HTN

A

B. Decreased left ventricular preload

Increase intrapericardial pressure restricts venous return to the heart and lowers right and left ventricular filling

Decrease preload
Decrease Stroke volume
Decrease cardiac output

Decreases right ventricular compliance and shifts interventricular septum toward the left ventircular cavity

180
Q

Patient given niacin

1 week later generalized pruritus and flushing

A

Prostaglandin related reaction

Know SE of niacin

Niacin induced peripheral vasodilation

181
Q

9 days of fever

Previous 10 day amoxicillin for streptococcus pharyngitis

No vaccines

Rash on trunk —> extemities

Cervical lymph node palpated

Erythematous strawberry tongue

A

Kawasaki disease

Next step get echo to check for coronary artery aneurysms

182
Q

Benign murmurs

A

Early or mid-systolic

Grade I or II that decrease with standing and Valsalva maneuver

Low pitched
Muscial
Squaky tone

High pitched at LUSB

183
Q

Chest pain, Sharp localized to anterior chest. Exacerbated by deep breathing

Six weeks ago have CABG

Normal wound

100.4 F
144/78
pulse 99/min

Tachycardia nonspecific ST changes

Leukocytosis

Small pericardial effusion

  • Name
  • MOA
  • TX (3)
A

Dressler syndrome

Immune medicated inflammation

NSAIDS + colchicine

Self limited disease

184
Q

Trauma

Hypotension
Tachycardia
JVD

A

Cardiac tamponade

185
Q

Papillary muscle rupture vs interventricular septum rupture vs free wall rupture

A

Papillary muscle rupture

  • 3-4 days
  • RCA
  • Severe pulmonary edema
  • New holosystolic murmur (mitral regurgitation) with flail leaflet

Interventricular septum rupture

  • 3-5 days
  • LAD or RCA
  • Chest pain
  • New holosystolic murmur
  • Biventricular failure
  • Shock

Free wall rupture

  • 5 days to 2 wks
  • LAD
  • Chest pain
  • Shock
  • Distant heart sounds
186
Q

Tx Wide complex tachycardia

A

Sustained monomorphic ventricular tachycardia

Amiodarone

187
Q

Hypovolemic shock

CO
PCWP
SVR
Blood pressure

A

Blood pressure decreases

Loss volume leads to decrease in preload and pulmonary capillary wedge pressure

Consequent decrease in preload—> decrease cardiac output (CO) and BP

Stimulates sympathetic NS which increases HR and peripheral vasoconstriction —> Increase in systemic vascular resistance

188
Q

Decrescendo early diastolic murmur at left sternal border

Patient leaning forward

A

Aortic regurgitation

Bicuspid aortic valve

189
Q 
HTN
Depression
Poor sleep
Headaches
Muscle weakness

Kidney stones

Hypercalcemia

A

Hyperparathyroidism

190
Q

Spontaneous or easily provoked hypokalemia

HTN

A

Primary aldosteronism

191
Q

Recent catheterization

Vague abdominal pain

Tender in periumbilical area

Bluish discoloration of right great toe and all toes of left foot

Mottling of leg

A

Atheroembolism (cholesterol embolism)

192
Q

What should be given to diabetic over age 40

A

Statin

193
Q

Sudden cardiac arrest

A

Ventricular fibrillation

Reentrant ventricular arrhythmias

194
Q

Kussmaul

JVD

A

RV failure

STEMI with right ventricular myocardial infarction (acute inferior wall MI)

195
Q

Left side

Early diastolic heart sound followed by diastolic rumble

Hemodynamic findings

Pulm A Sys pressure
Pulm A dis pressure
LV diastolic pressure

A

Mitral stenosis

Rheumatic heart disease

Restricted diastolic filling of LV —> increase left atrial pressure —> left atrial dilation—> increase pulm artery pressure (systolic and diastolic)

196
Q

Early diastolic sound followed by mid-diastolic murmur

Seen on Echo?

A

Mitral stenosis

Left atrial dilation

197
Q

Pericarditis tx

A

NSAIDS

198
Q 
Fatigue
Confusion
Constipation
Weight gain
Dry skin

Medication that causes this

A

Hypothyroidism

Amiodarone

199
Q

ABI

A

Peripheral artery disease

200
Q

Afib tx

A

Warfarin

201
Q

Scratchy sound at left sternal border before S1

A

Pericarditis

Tx: NSAID
Colchicine (ibuprofen)

202
Q

Hyperextensible

Easy bruising, poor healing

A

Ehlers-Danlos

MVP

203
Q

High sensitivity for Congestive heart failure

A

BNP

204
Q

Diastolic dysfunction

A

Heart failure with preserved ejection fraction

Heart cant relax fast enough after each beat

Choking sensation
Dry cough
Palpitations
Progressive SOB
HTN
Bibasilar crackles
Afib
Pitting edema
normal EF
205
Q

Medication associated with weight gain and worsening glucose tolerance

A

Beta adrenergic blockers

206
Q

Regular Narrow complex tachycardia

Tx

A

Superventricular tachycardia

IV adenosine

207
Q

Aortic Stenosis what you hear

A

late peaking crescendo-decrescendo systolic murmur

Soft single S2

208
Q

Family Hx sudden death

QT interval prolong

Congenital sensorineural deafness

Tx:

A

Jervell and Lange-Niesen syndrome

AR

Risk of torsades de pointes

Tx: Beta blocker and pacemaker

209
Q

Cor pulmonale

A

RV hypertrophy

Tricuspid regurgitation w/ right atrial enlargement

Elevated pulmonary artery systolic pressure

210
Q

BP 165/75

A

Isolated systolic hypertension

MOA: increased stiffness or decreased elasticity

211
Q 
Pain in leg
Numbness
Palpitations in leg
Hair is sparse
Absent pulses of left, diminished on right
Sensation to light touch decreased
Weaker dorsiflexion
A

Acute limb ischemia

6 Ps
Pain
Pallor
Paresthesia
Pulselessness
Poikilothermia (cool extremity)
Paralysis (late)

Tx: Anticoagulation (heparin)
Thrombolysis vs surgery

212
Q

Greatest impact on lowering HTN

A

Dietary modification to DASH diet

213
Q

pharmacologic stress test

A

Adenosine

Coronary vasodilation and increased myocardial blood flow in non obstructed coronary arteries

214
Q

Infective endocarditis with conduction abnormalities on ECG

A

Perivalvular abscess

215
Q

INR mechanical valve

A

2-3

216
Q

TX ventricular fibrillation

A

Defibrillation

217
Q

MI 2 weeks ago

Persistant ST elevations

A

Ventricular aneurysm

218
Q

Infective endocarditis finding

A

Tricupsid valve involvement

Holosystolic murmur increases with inspiration

219
Q

MVP

A

Early diastolic murmur (Decrescendo)

220
Q

HTN emergency

Given IV furosemide and nitroprusside

Next morning, Confused and agitated with tonic clonic seizures

A

Cyanide toxicity

221
Q

Aortic dissection can progress to

A

Acute aortic regurgitation

[Aortic valve insufficiency]

Dont want to lay flat
Hypotension
pulmonary edema

222
Q

Diastolic collapse with elevated right ventricular pressure

A

Cardiac tamponade

223
Q

Dilated left ventricle with apical hypokinesis

A

Cardiogenic shock

224
Q

Engorgement of the inferior vena cava

A

Cardiogenic shock

225
Q

Right ventricular dilation and hypokinesis

A

Massive pulmonary embolism

226
Q

Hx of aortic aneurysm what drugs to avoid

A

Fluroquinolones

  • levofloxacin
  • Moxifloxacin
  • Ciprofloxacin
227
Q

Antihypertensive for diabetic patient with proteinuria

A

ACE inhibitor

ARB

228
Q

Drugs that slow heart rate

A

Beta blockers
Calcium channel blockers
Digoxin
Amiodarone

229
Q

Systolic ejection murmur heard along lateral sternal border

Increases with Valsalva maneuver

A

Hypertrophic obstructive cardiomyopathy

Increases with decrease in preload

230
Q

Diastolic decrescendo low pitched blowing murmur

Best heard sitting up

Increases with hand grip maneuver

A

Aortic insufficiency

Increases with increase in afterload

231
Q

Systolic crescendo/decrescendo murmur

Increases with squatting

A

Aortic stenosis

Increase with increase in preload (squatting)

232
Q

Holosystolic murmur that increases with hand grip

A

Mitral regurgitation

Increases with increase in after load

233
Q

Diastolic mid to late low pitched murmur preceded by opening snap

A

Mitral stenosis

234
Q

ECG for pericarditis

A

Low voltage

Diffuse ST segment elevations

235
Q

Metabolic syndrome (6)

A 
Abdominal obesity
High triglycerides
low HDL
hypertension
insulin resistance
prothrombotic or proinflammatory states
236
Q

Anterior wall MI

Inferior wall MI

Posterior wall MI

Septum MI

A

Anterior wall: LAD/ diagonal

Inferior wall: PDA

Posterior: left circumflex/ oblique, RCA/ Marginal

Septum: LAD/ diagonal

237
Q

Reverses effects of heparin

A

Protamine

238
Q

What parameter is effect by warfarin

A

Prothrombin time

239
Q

Water bottle shaped heart

A

Pericardial effusion

240
Q

Gradual prolongation of PR interval till dropped beat

A

Mobitz type II

241
Q

Third degree or complete AV block

A

P waves are entirely unrelated to QRS complexes

242
Q

PR intervals > 0.20 second

Constatn PR interval

A

First degree AV block

243
Q

Displace apical impulse

Holosystolic murmur

Third heart sound

A

Chronic severe mitral regurgitation

Mitral valve prolapse more common in developed countires

244
Q

Rheumatic heart disease causes what heart abnormalities

A

Mitral stenosis
MR
Aortic regurgitation

245
Q

Tx asymptomatic bilateral carotid artery stenosis

A

Antiplatelet agent (aspirin)

Statin

Careful blood pressure control

246
Q

When to do carotid endarterectomy

A

Symptomatic patients with high grade carotid stenosis > 70%

247
Q

Worsening fatigue
Exertional dyspnea
Lower extremity swelling

Bruising easily
Proteinuria

Smoker

JVD
Small pericardial effusion

Concentric thickening of the ventricular walls with diastolic dysfunction

A

Amyloidosis

Fatigue, exertional dyspena, lower extremity swelling in absence of pulmonary edema= right side heart failure

Manifestation of restrictive cardiomyopathy (thickened ventricular walls)

248
Q

Bradycardia
AV block
Hypotension
Wheezing

A

Beta blocker overdose

Tx IV atropine
IV glucagon

249
Q

Intense holosystolic murmur best heard at cardiac apex

A

Severe mitral regurgitation

S3 gallop

Sudden cessation of blood flow into a dilated LV

250
Q

Atherosclerotic CV disease tx

A

High intensity statin therapy

251
Q

Evaluation of HTN (4)

A

Chemistry panel (electrolytes and creatinine)

Hemoglobin/ hematocrit

Urinarlysis (to exclude hematuria and proteinuria)

ECG for LV hypertrophy or prior MI

252
Q

Loud midsystolic murmur heard at first right intercostal space

Palpable thrill at suprasternal notch

Differential blood pressure between upper extremities

A

Supravalvular aortic stenosis

[Congenital left ventricular outflow tract obstruction]

Develop LV hypertrophy over time

—> Increased myocardial oxygen demand= pain

253
Q

Systolic anterior motion of the mitral valve

A

Hypertrophic obstructive cardiomyopathy

Exertional angina
Dyspnea
Dizziness
Presyncope
Syncope

Systolic murmur with maximal intensity along the lower left sternal border

254
Q

MI that result in LV systolic dysfunction

Resulted in thinned walls and evidence of scaring, dilated left ventricle

A

Eccentric hypertrophy

Due to ischemic heart disease

[Deleterious cardiac remodeling —> risk for fatal cardiac arrhythmia (ventricular tachycardia or fibrillation]

Cardiac remodeling driven by RAAS pathway

Prevented by ACE inhibitor

255
Q

Tx Torsades de pointes

A

Stable: IV Magnesium sulfate

Unstable: defibrillation

Polymorphic ventricular tachycardia

256
Q

Adenosine

A

Tx Paroxysmal supraventricular tachycardia

257
Q

Amiodarone

A

Artrial and ventricular tachycardia

258
Q

Atropine

A

Symptomatic sinus bradycardia

AV nodal block

259
Q

Tx torsades de points with quinidine use

A

Sodium bicarbonate

260
Q

Preventing pericarditis after MI

A

Early coronary reperfusion

[Minimizes myocardial necrosis]

261
Q

Passing out while in crown or giving blood due to

See on ECG

A

Vasovagal syncope

Bradycardia and sinus arrest

262
Q

32 y.o with HTN

Father dies suddenly at 54

BP 175/103

Bilateral nontender uper abdominal masses palpated

Hemoglobin elevated

A

ADPKD

Get abdominal US

263
Q

NE used to tx

A

Severe hypotension and shock

264
Q

HTN
Headaches

Fourth heart sound

Continuous murmur through out the thorax in multiple areas

A

Coarctation of the aorta

Erosions of the inferior costal surfaces

265
Q

“Pounding” heart

150/45

Exertional SOB

Heart murmur?

A

Aortic regurgitation

266
Q

Syncope when waking up to urinate

Due to

A

Peripheral vasodilation

267
Q

37 y.o Weakness and dizziness

Two episodes of syncope

Vague mid-chest discomfort and left sided neck pain

Two ago had sore throat and dry cough

He has thready pulses over both radial arteries that disappear with deep inspiration

A

Cardiac tamponade

Due viral pericarditis

Pulsus paradoxus is a typical feature of pericardial tamponade, large decrease in systolic blood pressure on inspiration.

Loss of palpable radial pulse during inspiration

268
Q

Afib

Weakness and slurred speech for 15-20 min

How to prevent future episodes

A. Amiodarone
B. Aspirin
C. Clopidogrel
D. Long-acting nitrates
E. Metoprolol succinate
F. Rivaroxaban
G. Strict blood glucose control
A

F. Rivaroxaban

Give warfarin or NOAC

269
Q

Ventricular tachycardia tx

A

Amiodarone

270
Q

Young patient

URI 2 weeks ago

Chest pain
Arrhythmias
Fatigue
SOB
Choking sensation when falling asleep

PMI displaced

A

Myocarditis —> Dilated cardiomyopathy

271
Q

Atrial fibrillation
Unintentional WL
HTN

Best initial test?

A

TSH and free T4

Hyperthyroidism can cause both

272
Q

Tx Atrial fibrillation

A. Quinidine
B. Clonidine
C. Metoprolol
D. Hydroclorothiazide
E. Amlodipine
A

C. Metoprolol

273
Q

Increased left ventricular end diastolic pressure

A

Heart failure

Hypoxia
Hypotension

274
Q

Tx of chest pain in MI

A

Venous dilation
Nitrates

[Not coronary artery dilation]

275
Q

Soft murmur starts after the second heart sound and declines in intensity until disappearing suddenly before the first heart sound

Murmur heard along with left and right sternal borders

Accentuated when patient sits up, leans forward and puts hands in head

A

Aortic root dilation

Aortic regurgitation

Decrescendo diastolic murmur

276
Q

59 y.o sudden onset of syncope

Twice in two hours while sitting

No confusion afterwards

Recent placed on Sotalol for sinus rhythm

Tx

A

Torsades de pointes

Ventricular Arrhythmia

Sotalol —> prolong QT —> torsades de pointes

Tx Magnesium sulfate
(Hypomagnesemia)

277
Q

CHF put on loop diuretics

What other medication for long term outcomes

A. Amiodarone
B. Amlodipine
C. Atenolol
D. Chlorthalidone
E. Digoxin
F. Diltiazem
G. Metoprolol succinate
H. Propafenone
A

Metoprolol succinate

[ACE-I, ARB, beta blockers, aldosterone antagonists]

Beta blockers

  • Metoprolol succinate
  • Carbedilol
  • Bisoprolol

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