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U World Step 2 > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

Loss of palpable radial pulse on inhalation

A

Example of pulsus paradoxus (large decrease in systolic blood pressure upon inhalation)

Feature of cardiac tamponade

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2
Q
  1. Diagnosis
  2. Treatment
A
  1. Regular wide-complex tachycardia consistent with monomorphic ventricular tachycardia
  2. If stable, treat with IV amiodarone
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3
Q

Ankle brachial index key values

A
  1. 9-1.3 Normal
  2. 4-0.9 Peripheral arterial disease

<0.4 Severe ischemia

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4
Q

Common cause of myocarditis

A

Cocksackie B

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5
Q

Doppler flow tracings acquired from an apical window

A

Aortic stenosis

Blood flow toward the transducer is recorded above the baseline

Blood flow away from the transducer is recorded below the baseline

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6
Q

Agents used for rate control in atrial fibrillation (with RVR)

A

1. Beta adrenergic antagonists

Metoprolol

Esmolol

2. Non-dihydropyridine calcium channel blockers

Diltiazem

Verapimil

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7
Q

Cardiac auscultation in patients with ASD

A

1. Wide and fixed splitting of the second heart sound (S2): Resulting from delayed closure of the pulmonic valve due to englarged RV’s prolonged emptying (widened S2), with no difference between inspiration and expiration (fixed S2).

2. Mid-systolic or ejection murmur over the left upper sternal border: Resulting from increased flow across the pulmonic valve

3. Mid-diastolic rumble: Resulting from increased flow across the tricuspid valve

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8
Q

Ventricular septal rupture

A

3-5 days after MI

Acute hemodynamic instability

Holosystolic murmur at left sternal border

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9
Q

Auscultation of mitral stenosis

A
  1. Loud first heart sound
  2. Opening snap: early diastolic sound after second heart sound
  3. Low pitched diastolic murmur best heard at cardiac apex
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10
Q

Auscultation of mild versus more severe mitral stenosis

A

Mild: Murmur in late diastole

As stenosis progresses: Diastolic murmur is heard earlier in the cardiac cycle (mid-diastolic) and eventually can be heard immediately after the opening snap.

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11
Q

Effect of maneuvers on hypertrophic cardiomyopathy (physiologic effect, change in murmur intensity)

  1. Valsalva (straining phase)
  2. Abrupt standing (from sitting or supine position)
  3. Nitroglycerin administration
  4. Sustained hand grip
  5. Squatting (from standing position)
  6. Passive leg raise
A
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12
Q

Hypertrophic cardiomyopathy

  1. Pathophysiology
  2. Clinical features
  3. Diagnostic evaluation

4. Management

  1. Complications
A

Beta blockers are preferred for initial therapy

Verapimil or disopyramide can be used as additional therapy in patients with persistent symptoms.

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13
Q

How do nitrates relieve chest pain?

A

Venodilation reduces preload, which decreases myocardial oxygen demand

Decrease left ventricular wall stress

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14
Q

Murmur of aortic regurgitation

A

Decrescendo diastolic murmur

  1. Due to congenital bicuspid valve: Left sternal border at the 3rd and 4th interspace with patient sitting up, leaning forward, and holding breath in full expiration.
  2. Due to aortic root dilation: Radiates toward the right side and is best heard along the right sternal border.
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15
Q

Auscultation of chordae tendinae degeneration

A

Mitral valve prolapse: Mid systolic click over cardiac apex

Mitral regurge: Mid to late systolic murmur

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16
Q

Initial treatment for hyperkalemia with EKG changes

A

Calcium gluconate to stabilize cell membrane

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17
Q

Abdominal aortic aneurysm

  1. Risk factors
  2. Symptoms
  3. Screening
  4. Management
A
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18
Q

Diagnosis of aortic rupture

A

Transesophageal echocardiography

CT scan

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19
Q

Medication classes that improve long-term survival in patients with LV systolic dysfunction

A

ACE inhibitors

ARBs

Beta-blockers

Aldosterone antagonists

Hydralazine + nitrates (in African Americans)

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20
Q

Beta blockers that improve symptoms and overall long-term survival in stable patients with heart failure and LV systolic dysfunction (<40%)

A

Metoprolol succinate

Carvedilol

Bisoprolol

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21
Q

Amiodarone indication

A

Preferred antiarrhythmic drug to manage ventricular arrythmias in:

Patients with heart failure

Systolic LV dysfunction

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22
Q

Evaluation of secondary amenorrhea

A
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23
Q

Rapid loss of consciousness without a preceding prodrome

  1. Cause
  2. Predisposing factors
A
  1. Arrhythmia
  2. Use of anti-arrhythmic drugs

Structural heart disease

Hypokalemia

Hypomagnesemia

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24
Q

Treatment for QT prolongation with risk of developing torsades de points

(In a hemodynamically stable)

A

Magnesium sulfate (even if Mg level is normal)

Second line: Temporary pacemaker and/or IV isoproterenol

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25
Q

Amyloidosis

  1. Etiology
  2. Clinical presentation
  3. Diagnosis
A
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26
Q

Treatment of hypertriglyceridemia

A
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27
Q

Treatment for atrial premature beats

A
  1. In asymptomatic patients: Identify and avoid reverse risk factors such as tobacco, alcohol, caffeine, and stress.
  2. In symptomati patients: Consider beta blockers
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28
Q

Retroperitoneal hematoma

A

Local vascular complication of cardiac catheterization

Often presents with sudden hemodynamic instability and ipsilateral flank or back pain.

Non-contrast CT of abdomen and pelvis or abdominal ultrasound to diagnose.

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29
Q

Poor prognostic factors in systolic heart failure

  1. Clinical
  2. Laboratory
  3. EKG
  4. Echo
  5. Associated conditions
A

Hyponatremia in patients with CHF parallels severity of heart failure

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30
Q

Class I antiarrhythmics

A

Block Sodium

Raise the threshold potental of cardiac fast response tissues

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31
Q

Class IV antiarrhythmics

A

Calcium blocking

Raise the threshold potential of cardiac slow response tissues.

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32
Q

Class 1B antiarrhythmic drugs

A

Lidocaine

Tocainide

Mexiletine

Shorten the action potential.

Have mild sodium channel blocking activity and dissociate from the sodium channel more rapidly than other class I drugs

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34
Q

Class IA antiarrhythmics

A

Quinidine

Prolong repolarization and increase the refractory period due to potassium-channel blocking activity

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35
Q

Class III antiarrhythmics

A

Amiodarone

Prolong repolarization and increase the refractory period due to potassium channel-blocking activity

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36
Q

Class I antiarrhythrmic drugs

A

Block voltage-dependent sodium channels during ventricular depolarization

Class 1A (procainamide): Prolong QRS duration and the QT interval due to their moderate potassium channel blocking activity

Class 1B (lidocaine): Have no significant effect on either the WRS duration or QT interval during normal sinus rhythm due to their rapid dissociation from the receptors.

Class IC drugs (e.g., flecainide, propafenone): Prolong QRS duration with minimal effect on the QT interval due to their lack of potassium channel blocking activity.

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37
Q

Procainamide

A

Class 1A antiarrhythmic

Blocks sodium-dependent sodium channels

Prolongs QRS duration and QT interval due to their moderate potassium channel blocking activity

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38
Q

Lidocaine

A

Class 1B anti-arrhythmic

Blocks sodium channels

No effect on either QRS duration or QT interval during normal sinus rhythm due to rapid dissociation from the receptor

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39
Q

Class III antiarrhythmic drugs

A

Amiodarone

Sotalol

Dofetilide

PRedominantly block potassium channels and inhibit the outward repolarizing currents druing phase 3 of the cardiac action potential.

Increaed action potential duration and QT interval prolongation.

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40
Q

Flecainide

Propafone

A

Class IC antiarrhythmic

Block sodium channels

Prolong QRS duration with minimal effect on the QT interval due to their lack of potassium channel blocking activity.

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42
Q

Amiodarone

Indications and side effects

A

Class III antiarrhythmic

Supraventricular (atrial, nodal, junctional) and ventricular tachyarrhythmia.

One of the broadest spectrum antiarrhythmic drug available.

Side effects:

Photodermatitis

Blue/grey skin discoloration

Pulmonary fibrosis

Hyper- or hypothyroidism

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43
Q

Lidocaine

Indications and side effects

A

Class 1B antiarrhythmic

Ventricular arrhythmias

Overdose or toxicity: neurologic symptoms

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44
Q

Procainamide

Indications and side effects

A

Class 1A antiarrhythmic

Drug-induced lupus

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45
Q

Verapimil (Antiarrhythmic)

Indications and side effects

A

Class IV antiarrhythmic

Most cardioselective of calcium cannel blockers

Potent negative ionotrope

Adverse reactions: Constipation, gingival hyperplasia

Constipation is a major side effect of nondihydropyridine CCBs (verapimil > diltiazem)

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46
Q

Class I (sodium channel-blocking) antiarrhythmics

  1. Specific agents
  2. Inhibition of phase 0 depolarization
  3. Effect on length of action potential
A
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47
Q

Adenosine

Indications and side effects

A

Drug of choice for paroxysmal supraventircular tachycardia (PVST)

PVST comes on suddently and the focus of automaticity lives above the ventricles.

Adenosine is a very rapid acting drug with a half-life <10 seconds.

Slows conduction through the AV node by hyerpolarizing the nodal pacemaker and conducting cells.

Side effects: flushing, chest burning (due to bronchospasm), hypotension, high grade AV block.

Adenosine is used for chemical stress tests

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48
Q

Digoxin/digitalis (antiarrhythmic)

A

Slows conduction through AV node

Positive ionotrope

Toxicity: Fatigue, blurry vision, changes in color perception, nausea and vomiting, diarrhea, abdominal pain, confusion, and delirium

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49
Q

Wolff-Parkinson-White syndrome

A
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50
Q

Mitral stenosis

  1. Clinical features
  2. Physical examination
  3. Diagnosis

Chest X ray
ECG

TTE

A
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51
Q

Acute pericarditis

  1. Etiology
  2. Clinical features & diagnosis
  3. Treatment
A

Uremic pericarditis can occur in patients with BUN >60 mg/dL.

In uremic pericarditis, the classic finding of diffuse ST elevation is typically absent due to lack of myocardial inflammation.

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52
Q

Clinical clues to diagnosis of syncope

  1. Vasovagal or neurally mediated
  2. Situational
  3. Orthostatic
  4. Aortic stenosis, HCM, anomalous coronary arteries
  5. Ventricular arrhythmias
  6. Sick sinus syndrome, bradyarrhythmias, atrioventricular block
  7. Torsades de pointes (acquired long QT syndrome)

Congenital long QT syndrome

A

Situational syncope is a form of reflex (neurally mediated) with specific triggers causing an alteration in autonomic response that is cardioinhibitory, vasodepressor, or mixed.

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53
Q
A

Livedo reticularis

Skin manifestation of systemic atheroembolism

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54
Q

Cholesterol crystal embolism (atheroembolism)

  1. Risk factors
  2. Clinical features

Dermatologic

Renal

CNS

Ocular

GI

  1. Diagnosis

Lab findings

Skin or renal biopsy

A
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55
Q
A

Aortic injury

Suspect in any patient who suffers blunt deceleration trauma (MVA or fall from >10 feet)

56
Q

Hemodynamic measurements in shock (Normal, hypovolemic shock, cardiogenic sock, septic shock)

  1. RA pressure (preload)
  2. PCWP (preload)
  3. Cardiac index
  4. SVR (afterload)
  5. MvO2
57
Q

Possible etiologies

A

Cardiac tamponade

Severe ashtma

COPD

58
Q

Murmur associated with PDA

A

Continuous flow murmur

59
Q

Congenital and acquired causes of AV fistulas

60
Q

Cardiac stress tests

  1. Type of stress
  2. Mechanism
  3. Best for
  4. Not for
61
Q

Isolated systolic hypertension

A

Important cause of hypertension in elderly patients

Caused by increased stiffness or decreased elasticity of arterial wall

62
Q

Complication of dual chamber pacemaker placement

A

Tricuspid regurgitation

63
Q

Vasospastic angina

  1. Pathogenesis
  2. Clinical presentation
  3. Diagnosis
  4. Treatment
64
Q

Trisomy 18 (Edwards syndrome)

A

Micrognathia

Microcephaly

Rocker bottom feet

Overlapping fingers

Absent palmar creases

Commonly associated with ventricular septal defect

(Holosystolic murmur best heard at left lower sternal border).

65
Q

Atrial septal defect

A

Commonly occurs in patients with trisomy 21

Systolic ejection murmur at left upper sternal border due to increased blood flow across pulmonic valve

66
Q

Congenital heart block

A

Causes bradycardia

Associated with neonatal lupus (erythemaous, annular rashes on the scalp and periorbital region)

67
Q

PDA

A

Conftinuous flow murur best heard in left subclavicular region

Potential complication of congenital rubella, trisomy 18

68
Q

Cyanotic congenital heart degects

A

Transpostion of the great arteries

Truncus arteriosus

Associated with DiGeorge syndrome

69
Q

Clinical features of aortic dissection

  1. Risk factors/associations
  2. Clinical features
  3. Complications (involved structure)
A

Most important risk factor is systemic hypertension

70
Q

Clinical features of fibromuscular dysplasia

  1. Patients to screen
  2. Clinical presentation
  3. Diagnosis and follow-up
71
Q

Normal renin-to-aldosterone ratio

72
Q

Treatment for ductal-dependent cyanotic heart disease

A

Prostaglandin E1

Vasodilator that maintains flow

73
Q

Congenital heart disease (Clinical features, examples)

  1. Left-to-right shunting
  2. RIght-to-left shunting
  3. Interrupted left ventricular output
74
Q

Diagnostic approach for suspected aortic dissection

75
Q

Medical therapy shown to improve morbidity and mortality

A
  1. Dual antiplatelet therapy with aspirin and P2y12 receptor blockers (clopidogrel, prasugrel, ticagrelor)
  2. Beta blockers
  3. ACE inhibitors or ARBs
  4. HMG-CoA reductase inhibitors (statins)
  5. Aldosterone antagonists (spironalactone, eplenerone) in patients with left ventricular ejection fraction <=40% who have heart failure symptoms or diabetes mellitus.
76
Q

P2y12 receptor blockers

A

Clopidogrel

Prasurgel

Ticagrelor

77
Q

Indications for carotid endarterectomy

  1. Men
  2. Women
78
Q

Cyanotic heart disease in newborns (Diagnosis, Exam, X ray findings)

  1. Transposition
  2. Tetralogy of Fallot
  3. Tricuspid atresia
  4. Truncus arteriosus
  5. Total anomalous pulmonary venous return with obstruction
79
Q

Factors associated with poor outcome after witnessed out-of-hospital arrest

80
Q

What is the most common cause of sudden cardiac arrest in the immediate post-infarction period in patients with acute myocardial infarction?

A

Reentrant ventricular arrhythmias (e.g., ventricular fibrillation)

81
Q
A

Absent thymus

DiGeorge Syndrome

82
Q

DiGeorge Syndrome

  1. Pathogenesis
  2. Clinical features
A

Depending on degree of thymic hypoplasia, patients can have T-cell lymphopenia and increased risk of viral and fungal infections.

Human immunodeficiency can also result from defective T-cell help in B-cell activation for antibody production, increasing susceptibility to bacterial infections as well.

83
Q

Anaphylaxis

  1. Triggers
  2. Clinical manifestations

3. Treatment

84
Q

Conditions associated with atrial fibrillation

  1. Cardiac
  2. Pulmonary
  3. Miscellaneous
85
Q

Clinical features of acute decompensated heart failure

  1. Clinical presentation
  2. Treatment
86
Q

Hypertensive complications

  1. Hypertensive urgency
  2. Hypertensive emergency
87
Q

Differential diagnosis and features of chest pain

  1. Coronary artery disease
  2. Pulmonary/pleuritic
  3. Aortic
  4. Gastrointestinal/esophageal
  5. Chest wall/musculoskeletal
88
Q

Initial stabilization of acute ST - elevation MI

89
Q
A

Vascular ring

Results from abnormal development of the aortic arch

Presents with respiratory (e.g., biphasic stridor, wheezing, coughing) and esophageal (e.g., dysphagia, vomiting, difficulty feeding) symptoms. Stridor typically improves with neck extension

90
Q

Differential diagnosis of stridor (Acute, chronic)

  1. Acute
  2. Chronic
91
Q

Diastolic murmur

Continuous murmur

A

Usually due to an underlying pathologic cause

Follow up with transthoracic echo

Midsystolic murmurs in otherwise young, asymptomatic adults are usually benign and do not require further evaluation

92
Q

Constrictive pericarditis

  1. Etiology
  2. Clinical presentation
  3. Diagnostic findings
A

Kussmaul’s sign: Lack of the typical inspiratory decline in central venous pressure

Pericardial knock: Early heart sound after S2

93
Q

Major side effects of amiodarone

  1. Cardiac
  2. Pulmonary
  3. Endocrine
  4. Gastrointestinal/hepatic
  5. Ocular
  6. Dermatologic
  7. Neurologic
A

Class III antiarrhythmic drug often used for management of ventricular arrhythmias in patients with CAD and ischemic cardiomyopathy

94
Q

Cardiac tamponade

  1. Etiology
  2. Clinical signs
  3. Diagnosis
A

Tamponade is a rare but important complication of CABG

Urgent echo in patients with suspected cardiac tamponade for definitive diagnosis and management

95
Q

Clinical features of compartment syndrome

  1. Common
  2. Uncommon
  3. Diagnosis
A
  1. Compartment pressure >30 mm Hg is diagnostic
96
Q

Clinical features of pulmonary hypertension

  1. Classification
  2. Symptoms
  3. Signs
  4. Treatment
97
Q

Treatment of pulmonary hypertension due to LV systolic or diastolic dysfunction

A

Loop diuretics + ACE inhibitors

98
Q

Treatment of pulmonary hypertension due to chronic lung disease

A

Oxygen and/or bronchodilators

99
Q

Treatment of pulmonary hypertension for symptomatic idiopathic pulmonary hypertension

A
  1. Endothelin receptor antagonists: bosentan
  2. Phosphodiesterase-5 inhibitors: sildenafil
  3. Prostanoids: epoprostenol
100
Q

Treatment of pulmonary hypertension due to chronic thromboembolic occlusion of pulmonary vasculature

A

Long-term anticoagulation

101
Q

Coarctation of the aorta

  1. Pathophysiology
  2. Clinical features
  3. Treatment
102
Q

Treatment of supraventricular tachycardia

A

Adenosine (or vagal maneuvers)

Slows the sinus rate, increases AV nodal conduction delay, or can cause a transient block in AV node condution.

103
Q

Gastroesophageal reflux disease

  1. Etiology
  2. Clinical presentation
  3. Initial treatment
104
Q

Valve abnormality in HOCM

A

Systolic anterior motion of the mitral valve leads

Contract between the mitral valve and the thickened septum during systole leads to left ventricular outflow tract obstruction.

105
Q

Renin-angiotensin-aldosterone system

106
Q

Clinical features of cocaine use

  1. Clinical features
  2. Complications

3. Managment of chest pain

107
Q

Guidelines for lipid-lowering therapy

  1. Indication
  2. Recommended therapy
108
Q

Medications that can trigger bronchoconstriction in patients with asthma

A

Aspirin

Beta blockers

109
Q
A

Thoracic aortic aneurysm

110
Q
A

Hiatal hernia

111
Q
A

Hilar mass

Unilateral masses near the hilum are usually malignancies

112
Q

Dihydropyridine calcium channel blockers

SIde effect

A

End with -pine, e.g., amlodipine

Smooth muscle selective

Cause peripheral edema

113
Q

Non-dihydropyridine calcium channel blockers

A

Diltiazem

Verapimil

114
Q

Amyloid cardiopmyopathy

A

Unexplained congestive heart failure

Proteinuria

Left ventricular hypertrophy in the absence of a history of hypertension

115
Q

Ausculation of severe aortic stenosis

A
  1. Soft second heart sound
  2. Mid to late systolic murmur with maximal intensity at second right intercostal space
116
Q

Mechanical complications of acute MI (Time course, Coronary artery involved, Clinical Findings, Echo)

  1. RV failure
  2. Papillary muscle rupture
  3. Interventricular septum rupture/defect
  4. Free wall rupture
117
Q

Acute pericarditis

  1. Etiology
  2. Clinical features & Diagnosis
  3. Treatment
A

Anti-inflammatories are avoided in peri-infarction pericarditis, because anti-inflammatories can disrupt collagen deposition

118
Q

Coarctation of the aorta

  1. Etiology
  2. Clinical features
  3. Diagnostic studies
  4. Treatment
A

Coarctation of the aorta is a potential cause of secondary hypertension in younger adults

119
Q

Tetralogy of Fallot

A

Most common cyanotic congential heart defect

  1. Right ventricular outflow tract obstruction (pulmonary stenosis or atresia)
  2. Right ventricular hypertrophy
  3. Overriding aorta
  4. Ventricular septal defect (VSD)
120
Q

Development of atrioventricular block in a patient with infective endocarditis

A

Perivalvular abscess with infection extending into adjacent cardiac conduction tissues

121
Q

Wolf-Parkinson White syndrome

EKG abnormalities

122
Q

Guidelines for lipid-lowering therapy

  1. Indication
  2. Recommended lipid-lowering therapy
123
Q

Lone atrial fibrillation

A

Patients with atrial fibrillation and a CHA2DS2-VASc score of 0

Low risk of systemic embolization and anticoagulant therapy is not indicated

124
Q

Treatment of hypertension with lifestyle modifications (Modification, recommended plan, approximate reduction in systolic BP)

  1. Weight loss
  2. DASH diet
  3. Exercise
  4. Dietary sodium
  5. Alcohol intake
A

Weight loss is the most effective nonpharmacologic measure to reduce blood pressure in overweight individuals

125
Q

Inferior wall MI

A

II, III, aVF

Due to occlusion of the right coronary artery promixal to the origin of the RV branches

126
Q

Managment of STEMI

127
Q
A

Cardiomegaly

Cardiothoracic ratio > 50% (Abnormal in a child > 1 year)

>60% is abnormal in a child < 1 year

128
Q

Pediatric viral myocarditis

  1. Etiology
  2. Clinical presentation
  3. Diagnostic studies
  4. Prognosis
129
Q

Common complications of acute myocardial infarction

  1. Complication
  2. Time course
A

Ventricular aneurysm: ECG shows persistent ST-segment elevation along with deep Q waves

130
Q

Causes of left heart failure with preserved left ventricular function

131
Q

strongest predictor of stent thrombosis after intracoronary stent implantation

A

Premature discontinuation of antiplatelet therapy.

Long-term dual antiplatelet therapy with aspiring and platelet P2Y12 receptor blpcker is recommended to reduce rate of stent thrombosis after intracoronary drug-eluting stent placement.

132
Q

Basic testing for patients diagnosed with hypertension

A
  1. Urinalysis for occult hematuria and urine protein/creatinine ratio
  2. Chemistry panel
  3. Lipid profile
  4. Baseline electrocardiogram
133
Q

Initial treatment for sinus bradycardia

134
Q

Most common etiology of atrial fibrillation

A

Ectopic foci within the pulmonar veins

U World Step 2 (22 decks)

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