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Rosh Review > Cardiovascular Disorders > Flashcards

Cardiovascular Disorders Flashcards

1
Q

Types of Brugada Syndrome

A

*Picture from Q1 Exam 3 (154481)

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2
Q

What classic ECG finding is identified in arrhythmogenic right ventricular cardiomyopathy?

A

Epsilon wave - positive ecg deflection after QRS segment in leads V1-V3

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3
Q

Most common bowel site of secondary aortoenteric fistula?

A

Duodenum

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4
Q

Monitoring the progression of AAA (by size)

A

< 5.5 cm - US annually
>/= 4.5cm with greater expansion rate - US every 6 months
Can also use CT or MRI
> 5.5 cm - Surgery

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5
Q

Risk factors for superficial thrombophlebitis

A
  • Intrinsic hypercoagulable states
  • Varicose veins
  • IV catheter use
  • Pregnancy
  • Hx of vein excision or ablation
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6
Q

Differences in diagnosis and management between uncomplicated and complicated superficial thrombophlebitis

A

Uncomplicated:
- Venous segment <5cm
- Remote from saphenofemoral or saphenopopliteal junctions
- Lack of medical risk factors for hypercoagulability
TX: NSAIDs, extremity elevation, compression

Complicated:
- Venous thrombosis >5cm
- Within 5cm of a deep vein
- Recurrent or migratory thrombophlebitis
- Suppurative thrombophlebitis
TX: Anticoagulation, often require antibiotic administration or vein ligation

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7
Q

What test is gold standard to confirm myocarditis?

A

Endomyocardial biopsy

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8
Q

Most common cause of myocarditis worldwide/US

A

T. cruzi (Chagas disease)/viruses such as parvovirus B19

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9
Q

Which is the best sonographic view to assess for cardiac wall motion abnormalities?

A

Parasternal short-axis view

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10
Q

Most common presenting symptom in patients with acute aortic dissection?

A

Chest pain

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11
Q

First step in evaluation of an LVAD patient

A

Auscultate precordium to detect a hum or “whirr” to determine if pump is functioning - absence points to mechanical failure including an interrupted power source or controller malfunction

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12
Q

How to check BP of an LVAD patient

A

With a doppler or arterial line - may not have a pulse if there is no longer innate cardiac contractility

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13
Q

Definitive tx for constrictive pericarditis

A

Paricardiectomy

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14
Q

Symptoms of constrictive pericarditis

A

Similar to heart failure (especially right-sided HF)

  • Fluid overload (dependent edema, anasarca)
  • Diminished cardiac output (fatigue, dyspnea on exertion)
  • Kussmaul sign (increase in JVP during inspiration)
  • “Dip and plateau” LV filling (diastolic) tracing
  • Pericardial knock
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15
Q

Causes of constrictive pericarditis

A
  • Idiopathic
  • Infectious (viral, TB, fungal, parasitic)
  • Postcardiac surgery
  • Postradiation therapy
  • Connective tissue disorder
  • Misc (uremic, malignant, drug-induced, sarcoid)
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16
Q

Constrictive Pericarditis vs. Restrictive Cardiomyopathy

A

CP: results from scarring and consequent loss of elasticity of the pericardial sac

RC: disease of the myocardium that results in restricted ventricular filling

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17
Q

Causes of restrictive cardiomyopathy

A
  • Amyloidosis
  • Sarcoidosis
  • Hemochromatosis
  • Tropical endomyocardial fibrosis
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18
Q

What nerve overlies the pericardium and must be carefully avoided at surgery?

A

Phrenic nerve

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19
Q

What dissection presentation predicts a poorer outcome?

A

In or near the carotid artery resulting in stroke-like symptoms

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20
Q

What is the most frequent site of arterial embolism?

A

Bifurcation of common femoral artery

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21
Q

What is the most common presentation in patients who are diagnosed with an abdominal aortic aneurysm?

A

Asymptomatic

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22
Q

How to monitor AAA by size

A

4-4.9cm - US annually
5-5.4cm - US every 6 months
>5.5cm or aneurysms with rapid expansion rate - elective surgery

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23
Q

Screening criteria for AAA

A

One-time screening for AAA by ultrasonography in men aged 65-75 who have ever smoked

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24
Q

Low flow (ischemic) vs. high flow (nonischemic) priapism

A
  • Low flow painful
  • Pathophys of low flow = decreased venous outflow; high flow = increased arterial inflow
  • Shaft rigid and painful in low flow; shaft partially rigid and painless in high flow
  • Glans soft in low flow; hard in high flow
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25
Q

Causes of low flow priapism

A
  • Sickle cell
  • Erectile dysfunction drugs
  • Other medications and drugs
  • Idiopathic
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26
Q

Causes of high flow priapism

A
  • Arterial-cavernosal shunt formation (groin or straddle injury)
  • High spinal cord injury or lesion
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27
Q

Way to distinguish between low flow and high flow priapism

A

Cavernosal blood gas - normal in high flow and with pH <7.25, CO2>60 and O2<40 in low flow

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28
Q

Which type of priapism is urologic emergency?

A

Low flow - requires draining corpora cavernosa blood or injecting phenylephrine into corpora cavernosa

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29
Q

ECG findings indicative of posterior wall MI

A
  • ST segment depressions in leads V1, V2, and V3
  • Tall, broad R waves in V2-V3
  • Dominant R wave in V2 (R/S ratio > 1)

On posterior leads -> elevations in leads V7 and V8

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30
Q

Sgarbossa Criteria

A
  1. Concordant ST elevation > 1mm in leads with a positive QRS (5pts)
  2. Concordant ST depression > 1mm in V1-V3 (3pts)
  3. Discordant ST elevation 5mm in leads with a negative QRS (2pts)
    3pts = STEMI
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31
Q

What medications require increased dose of adenosine?

A
  • Methylxanthines
  • Caffeine
  • Theophylline
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32
Q

What medications require a lower dose of adenosine?

A
  • Carbamazepine
  • Dipyridamole
  • Cardiac transplant
33
Q

What are mycotic aneurysms?

A

Focal arterial dilatations

34
Q

Etiology of mycotic aneurysms?

A
  • Direct bacterial inoculation
  • Bacteremic seeding
  • Contiguous infection
  • Septic emboli
35
Q

Typical presentation of mycotic aneurysm

A
  • Painful, pulsatile, enlarging mass associated with systemic symptoms of infection (fever, malaise, myalgias)
  • At deeper sites, a palpable mass may not be appreciated
  • When in femoral arteries, frequently associated with acute limb ischemia due to thrombosis within the aneurysm
36
Q

Typical microbiology of mycotic aneurysm

A
  • Staph aureus
  • Staph epidermidis
  • Salmonella
  • Strep pneumo
    Occasionally syphilis or Mycobacterium
37
Q

Dx of mycotic aneurysm

A

CTA or MRA

38
Q

Tx of mycotic aneurysm

A

Abx and aggressive surgical debridement

39
Q

Diagnostic criteria for pulmonary hypertension

A

Mean pulmonary arterial pressure greater than 25 at rest or greater than 30 during exertion

Also with decreased cross-sectional area of the pulmonary vascular bed, increased pulmonary blood flow, increased pulmonary venous pressure

40
Q

Physical exam findings of pHTN

A

Initially cyanosis

S1 followed by ejection click
S2 narrowly split
Increased intensity of pulmonary component of S2

As progresses, JVD, hepatomegaly, peripheral edema from RHF

41
Q

What is first line tx for torsades?

A

Mg sulfate

42
Q

Most common causes of prolonged QT

A
  • Drug interactions (procainamide, quinidine, propafenone, flecanide, TCAs, droperidol, phenothiazines, erythromycin, fluoroquinolones, methadone)
  • Myocardial ischemia
  • Electrolyte disturbances (hypomagnesemia, hypokalemia)
43
Q

Other than Mg sulfate and defibrillation, what is another tx for torsades?

A

Increase HR to shorten ventricular repolarization, also known as overdrive pacing

Avoid amiodarone as this can cause QT prolongation itself

44
Q

What is the most common dysrhythmia following commotio cordis?

A

Ventricular fibrillation

45
Q

Risk window on ECG for commotio cordis

A

Upstroke of T wave

46
Q

Medications to avoid in aortic stenosis

A

Nitroglycerin, diuretics, or anything that reduces preload

47
Q

Murmurs

A

Remember to study them and how they increase/decrease with maneuvers

48
Q

What is the initial tx for symptomatic congenital long QT syndrome?

A

beta-blockers - most effective being propranolol and nadolol

49
Q

What conditions can multifocal atrial tachycardia be present?

A

Common in elderly patients with chronic lung disease

Also seen in heart failure and sepsis

50
Q

Time troponin is detectable from onset of ischemia

A

3-12 hours

51
Q

Peak of troponin after ischemia

A

24-48 hours

52
Q

Time for troponin to return to baseline

A

5-14 days

53
Q

Time CK is detectable from onset of ischemia

A

3-12 hours

54
Q

Peak of CK after ischemia

A

24 hours

55
Q

Time for CK to return to baseline after ischemia

A

48-72 hours

56
Q

What is the role of beta-adrenergic blocking agents in acute MI?

A

Given within 24 hours of presentation reduce risk of developing ventricular dysrhythmias

57
Q

What cardiac biomarker has highest sensitivity and specificity?

A

Troponin

58
Q

When is the cardiac biomarker CK useful?

A

Useful for diagnosis of reinfarction

59
Q

Absolute contraindications to anticoagulation

A
  • NSGY within past 10 days
  • Active bleeding
  • Severe bleeding diathesis
  • Platelet count <20,000
  • Severe allergy
60
Q

Relative contraindications to anticoagulation

A
  • Mild-moderate bleeding diathesis
  • Platelet count >20,000 but less than normal
  • Brain mets
  • Recent major trauma
  • Major abdominal surgery in last 2 days
  • GI or GU bleeding in past 14 days
  • Endocarditis
  • Severe hypertension
61
Q

When anticoagulating a patient with DVT with enoxaparin and warfarin, when is it safe to have the patient stop enoxaparin

A

When INR is greater than 2.0 for 2 consecutive days

62
Q

Etiology of acute MR

A

ISCHEMIC:

  • Acute MI with papillary muscle displacement
  • Trauma

NONISCHEMIC:

  • Ruptured mitral chordae tendineae (flail leaflet) due to myxomatous disease (MVP)
  • Infective endocarditis
  • Blunt chest trauma
  • Rhematic heart disease
  • Spontaneous
63
Q

Clinical presentation of acute MR

A
  • Sudden onset and rapid progression of pulmonary edema, hypotension, and s/s of cardiogenic shock
  • Systolic murmur is often soft, harsh, low-pitched, and decrescendo, often ending well before A2; best heard along left sternal border and base of heart
64
Q

Types of Wellens Syndrome

A 
Really a continuum, but need to recognize both
In leads V1-V2...
Type A: Biphasic T wave
Type B: Deeply inverted T wave
Q143890
65
Q

What is the most common symptom of cardiac ischemia in patients older than 85 years?

A

Dyspnea

66
Q

What initial anti-hypertensive should be initiated in African American population (including those with diabetes)?

A

Thiazide or CCB

67
Q

What is the most likely cardiac arrest rhythm in someone who arrests in public (as opposed to at home)?

A

Vfib

68
Q

What diagnostic test has the highest sensitivity for diagnosing a DVT?

A

Venography (Duplex US still first-line imaging)

69
Q

What antibiotic is recommended as prophylaxis for high-risk patients undergoing a dental extraction?

A

Amoxicillin (2g by mouth)

70
Q

What affect will atropine have on third degree heart block?

A

It alters conduction ratios without changing the appearance of the ventricular escape rhythm

71
Q

What entities may cause a falsely large E-point septal separation?

A

Mitral stenosis and aortic stenosis

72
Q

Mechanism of action of atropine

A

Competitively inhibits acetylcholine at the AV node from the vagus nerve

73
Q

What medication should be avoided in myocarditis

A

NSAIDs (can exacerbate disease and increase mortality)

74
Q

What medication is contraindicated in the tx of a child younger than 12 months old with SVT? In what other situations is this medication contraindicated?

A

CCB due to poor calcium reserves in the sarcoplasmic reticulum in infants
(Also contraindicated in children with heart failure, suspected WPW, or wide QRS complex)

75
Q

What is the most common significant dysrhythmia in pediatrics?

A

SVT

76
Q

What is the most common cause of tricuspid valve stenosis?

A

Rheumatic heart disease

77
Q

Murmur with VSD

A

Harsh, holosystolic murmur heard best at left lower sternal border
Murmur may no longer be present later due to reversal of shunting and a loud S2 caused by pulmonary hypertension

78
Q

What is an epsilon wave?

A

Small positive deflection at end of QRS complex that is most specific finding for arrhythmogenic right ventricular dysplasia

Rosh Review (22 decks)

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