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PANRE 2021 - JLI > CARDS > Flashcards

CARDS Flashcards

1
Q

Dressler syndrome

  • what
  • EKG findings
  • sx
A
  • autoimmune pericarditis days to weeks after MI
  • diffuse J point or ST segement elevation is indicative of pericarditis.
  • LG temp, malaise, CP lessened by sitting up
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2
Q

Infective Endocarditis

  • sx
  • cardiac & dx
A
  • fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots.
  • vegetations - TEE
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3
Q

most commonly affected valve in endocarditis in patients with a history of IV drug use

A

tricuspid valve - first one blood hits after injection

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4
Q

Shock

  • definition
  • 3 types of shock
A

Inadequate delivery of oxygen to the tissues

Cardiogenic
Obstructive
Distributive

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5
Q

Shock causes pneumonic

A 
Sepsis
Hypovolemia
Obstructive
Cardiac
Kortisal
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6
Q

Causes of Hypovolemic shock x3

A
  • Hemorrhage
  • Volume loss (diarrhea)
  • Loss of plasma
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7
Q

Causes of Cardiogenic Shock x5

A 
MI 
Arrhythmia 
Heart failure 
Valvular disease 
Massive PE
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8
Q

Causes of Obstructive Shock x4

A

Can’t fill your heart

Tension pneumothorax
Cardiac tamponade
Obstructive valvular disease
Massive PE

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9
Q

Distributive Shock Causes x3

A

Poorly regulated distribution of blood volume

Septic shock
Anaphylactic shock
Neurogenic shock (spinal cord injury)

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10
Q

Syncope definition

A

brief loss of consciousness & postural tone with spontaneous recovery

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11
Q

Orthostatic Hypotension

A

> 20 mm drop in SBP or 10 mm DBP from supine to standing

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12
Q

PDA in utero

A

blood shunted from pulmonary artery to aorta in utero- should close at birth stopping flow from R to L atrium

Functionally closes 15 hours after birth, anatomically by 3 weeks

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13
Q

PDA defect

Risk factors X3

A

As pulm resistance increase&raquo_space; L to R shunt&raquo_space; CHF ( do become cyanotic b/c L- R shunt)

Prematurity, Hypoxia, Congenital Rubella

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14
Q

Describe Fetal circulation

A 
Mom oxygenates blood > placenta
Umbilical vein send blood to placenta
Fetus IVC to RA
RA to FO to LA to LV to aorto 
RA to RV to pulm artery
From PA some goes to oxygenate lungs
From PA, most is shunted thru ductus to aorta to body & back to IVC
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15
Q

PDA murmur

A

Continuous machinery murmur in left upper chest

Bounding pulses with wide pulse pressure

“Slapping 2nd heart sound”

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16
Q

PDA drug for medical management

A

Indomethacin - prostaglandin inhibitor to close duct i premature kids

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17
Q

Venous Hum murmur

A

also continuous murmur (like PDA), but more positional - as you move infants head

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18
Q

Cyantoic Congenital Heart diseases

A 
5 Ts & a P
Tetralogy of Fallot (MC)
Transposition of the Great Arteries
Truncus Arteriosus
Tricuspid Atresia
Total Anomalous Venous Pulmonary Return
Pulmonary Atresia
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19
Q

Tetrology of Fallot

  • 4 components
  • CXR findings x2
A

○ RVH
○ Pulmonic Stenosis (PS) causing RV outflow tract obstruction
○ VSD
○ Overriding aorta (sits atop VSD) which causes blood flow from both ventricles

CXR - Boot-shaped heart, decreased pulmonary vascular markings

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20
Q

Presentation if Large VSD with Tetrology of Fallot

A

If Large VSD
○ Mild PS
○ Presents just like a VSD
○ “Pink tet”

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21
Q

Presentation if Small VSD with Tetrology of Fallot

A

○ Large PS
○ Presents like a cyanotic congenital heart lesion
○ “Blue tet”

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22
Q

Tetrology of Fallot Murmur

A

○ Single second heart sound

○ Systolic ejection murmur at left upper sternal border ± radiation to back

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23
Q

diagnosing cyanotic congenital heart disease

A

Hyperoxia test
○ Give 100% FiO2 for 10 minutes
○ ABG: paO2 <150 mmHg concerning for CCHD

Boot shaped heart

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24
Q

Tet spell

A

in older infant with tetralogy of fallot

right-to-left shunting through VSD causing blood to bypass lungs unoxygenated

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25
Q

How to temporize/treat TOF in acute setting

A

reopen ductus with PGE1 @ 0.1 mcg/kg/min

decrease infundibular spasm (beta-blockade)

decrease pulmonary resistance

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26
Q

LT risk of untreated TOF

A

At risk for subacute bacterial endocarditis (SBE) before and after correction

Untreated, paradoxical emboli → stroke

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27
Q

Coartaction of Aorta

A

narrowing of proximal aorta

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28
Q

Coarctation Associations

A 
Bicuspid aortic valve
VSD
Aortic dissection
CHF
SBE
Hypertension
Turner syndrome (15-20%)
Cerebral aneurysms → can cause intracerebral hemorrhage
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29
Q

Coarctation

  • sx (early vs. late)
  • findings on CXR

Murmur

Immediate rx

A

early - shock & CHF

late

  • hypertension (esp UE)
  • UE/LE pulse difference > 20 mm
  • rib notching on CXR

Murmur - systolic L infraclavicular & sub scapular

PGE1 to open ductus

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30
Q

MC type of ASD

Shunt type

A

Ostium secundum: arises from an enlarged foramen ovale (90% of all ASDs)

L to R initially&raquo_space; pulmonary over circulation +/- CHF

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31
Q

ASD murmur

ASD on EKG

A

FIXED widely split S2 (no vary with respiration) 2/2 delayed pulmonary valve closure

RBBB

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32
Q

ASD late presentation

A

Diagnosis often delayed until 5th decade
● Sx: DOE, CP, fatigue, palpitations
● Signs: atrial arrhythmias, right heart failure, ischemic stroke, pulmonary HTN
● Murmur: Fixed split S2, RVOT PS
● Precipitating factors: volume (pregnancy, Mitral Regurgitation), poor left heart compliance

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33
Q

CHF pathophys - initially then over time?

CO vs. Preload vs afterload

A

Low Cardiac Output (CO) → compensatory increased preload, increased afterload, and increased contractility → over time…
○ Low CO + increased afterload decreased renal perfusion → stimulation of RAAS and ADH
system → fluid and sodium retention → fluid overload peripherally and centrally
○ Low CO + increased preload (volume overload) → ventricular dilatation

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34
Q

Left heart failure sx

A

○ Dyspnea, orthopnea, PND ○ Weakness/fatigue

○ Tachy, S3, rales

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35
Q

Right heart failure sx

A

○ JVD (rales if left heart failure also)
○ Peripheral edema
○ RUQ pain, hepatojugular reflex, hepatomegaly
○ Ascites
○ Most common cause is severe Left heart failure

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36
Q

CHF lab abnormalities

A

Anemia
renal insufficiency, elevated LFTs, hyponatremia secondary to excess free fluid, hypo/hyperkalemia
BNP (>500 if acutely decompensated)

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37
Q

What causes mild elevations in BNP

100-500

A

Chronic CHF
severe COPD or RHF,
PE (→ RV dysfunction)
Elderly women, a-fib (→ LV dilatation)

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38
Q

CHF CXR findings in order of progression

A

Cardiomegaly → Cephalization (fluid going to upper lung fields)→ Kerley B lines → Alveolar fluid → Pleural effusion

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39
Q

test of choice for teasing out CHF

A

Echo

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40
Q

2 drugs to improve survival in CHF

2 decrease sx

A

ACEI (reduce after load, Inc renal perfusion)
BB (decrease catecholamine levels & afterload)

nitrates & diuretics

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41
Q

how to treat decompensated HF & cardiogenic pumonary edema (lung = buckets - faucet, pump, emptying hose)

A 
dec preload (nitro & loop diuretic/lasix)
dec afterload (nitro, ACEI)

inc contractility of pump (LV) - inotrope (dopamine, dopamine), only for HoTN/shocky pt:

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42
Q

best therapy for decompensated HF

A

Non-invasive ventilation (improves O2 & gas exchange and dec preload and afterload

43
Q

Prinzmetal angina

  • Phys
  • Rx
A
  • caused by coronary artery spasm, not occlusion

- CCB, such as diltiazem or verapamil are mainstay (nitrates also effective)

44
Q

who to Screen for AAA

  • size
  • MC site
A
  • US Preventative Services Task Force:
    1x screening for AAA by US in men ages 65 to 75 years who have ever smoked
  • > 3cm
  • infrarenal
45
Q

most common drugs that can cause SA node dysfunction or sick sinus syndrome

A

CCB, BB, antiarrythmics, ACh inhibitors

46
Q

Sources of cholesterol

A

All animal based foods contain cholesterol in varying amounts. Major dietary sources of cholesterol include cheese, egg yolks, beef, pork, poultry, fish, and shrimp.

47
Q

phytosterols

  • examples
  • why important
A

cholesterol-like compounds called maufactured by plant-based products

  • avocado, flax seeds, peanuts
  • compete with cholesterol for absorption in the intestines, reducing the absorption of both dietary and bile cholesterol.
48
Q

electrocardiographic findings is classically associated with acute pericarditis?

A

Diffuse ST segment elevations

49
Q

Causes of ST elevation x4

A

ST elevation MI (STEMI),
early repolarization
pericarditis
left bundle branch block.

50
Q

Pericardial friction rub

  • indicative of?
  • describe
  • enhaced by?
A
  • pericarditis
  • superficial grating or squeaking sound, best heard at the left sternal border, caused by the two layers of the inflammed pericardium rubbing together
  • when the patient is leaning forward.
51
Q

most common immediate complication following surgical repair of an abdominal aortic aneurysm?

A

MI (10%)

52
Q

hypertensive emergency

  • why only lower BP slowly
A

blood pressure is >180/>120 mmHg + signs of acute organ damage

  • leave certain areas of the brain without sufficient bloodflow, resulting in watershed infarcts.
53
Q

Atherosclerotic plaque buildup phys

A

plaques develop in the intima layer of the arteries. The process of plaque formation starts with intimal thickening, then proceeds to intimal xanthoma or fatty streak formation as macrophages accumulate. Building up of extracellular lipids within the intima then occurs, with progression to a fibrous cap atheroma with a lipid-rich necrotic core. When this lesion ruptures, it leads to thrombosis and possible obstruction of blood flow. The lesion can then heal with smooth muscle cells and a collagen-rich matrix.

54
Q

I See All Leads

A

Inferior - II, III, aVf
Septal - V1 V2
Anterior - V3, V4
Lateral - V5, V6, I, aVL, aVR

55
Q

Na restriction in CHF

A

limit their sodium intake to 2-3 grams

56
Q

PE for HTN

A 
PE:
○ Funduscopic exam
○ Presence of S4
○ Presence of carotid or renal bruits
○ Eval of peripheral pulses
57
Q

LVH by EKG

  • why important?
A

deepest R in V1, 2 or 3 + Tallest S in V4, 5 or 6… if 35 or > = LVH

  • indicative of prolonged HTN
58
Q

Secondary HTN

  • when to think about it?
  • causes?
  • MC cause
A

Abrupt onset
○ Age <30
○ Uncontrolled HTN on ≥ 3 meds
○ Excessive end organ damage

Common etiologies:
○ Renal artery stenosis
○ Cushing syndrome
○ Hyperaldosteronism
○ Aortic coarctation
○ Pheochromocytoma
○ Obstructive sleep apnea
○ Drug induced (chronic NSAID use, OCP)

MC renal artery stenosis (2/2 atherosclerosis in older pots)

59
Q

ACEI to treat RAS?

Ultimate Rx

A

yes to unliateral disease
no for BIL

stenting and angio

60
Q

CABG indications

A

> 50% of left main

>70% stenosis LAD, RCA

61
Q

INR recs for mechanical valves

A

aortic 2-3
mitral 2.5-3.5
Aortic & mitral 2.5-3.5

62
Q

indications for AAA repair

A

symptomatic despite size
> 5.5 cm
expansion > 0.5 in 6 mo

63
Q

Aortic dissection Rx

  • Stanford Type A
  • Stanford Type B
A
  • ascending = surgical emergency
  • descending: if HD stable q 6 mo CT
  • both benefit from IV BB & nitroprusside
64
Q

Cor Pulmonale

  • sx
  • on EKG
  • murmur
A

pulmonary HTN & RHF

  • often 2/2 COPD
  • DOE, LE edema, S3 gallop, RUQ tenderness & hepatomegaly
  • RAD, RVH
  • tricuspid reg: holosystolic on L sternal border
65
Q

STEMI

A

STE > 1 mm in 2 continuous leads

66
Q

Venous insufficiency

- sx

A

brawny skin, pitting edema, itching, pain worse with standing, tibial or medial ulcers

67
Q

Claudication

- sx

A

2/2 arterial insufficiency

- dec pulses, hair loss, pallor, thick nails

68
Q

thromoangiitis oblierans
(Beurger’s disease)
- what
- who

A

non- atherosclerotic inflammatory disease in small A & V in extremities

  • pts < 40 with smoking hx
69
Q

EKG changes 2/2 hyperkalemia

  • Mild hyperkalemia
  • K > 7
A
  • peaked T

- prolonged PR, QRS, AV conduction delays and loss of P

70
Q

EKG changes 2/2 hypokalemia x3

A
  • prominent U waves
  • ST depression
  • T wave flattening
71
Q

Best way to dx valvular vegetation

A
  • TEE
72
Q

Murmurs:

  • MVP
  • AS
  • AR
  • MS
  • PDA
  • ASD
  • MR
A
  • mid- late systolic click
  • LATE SEM radiates to carotids & apex
  • high pitched descrecendo in early diastole
  • low-pitched, mid systolic with opening snap
  • continuous, rough, machinery over L pulmonary artery
  • wide, fixed split S2
  • apical holosystolic, radiates to axilla
73
Q

S1
S2
S3
S4

A
  • closing of mitral & tricuspid
  • closing of atrial & pulmonic
  • ventricular gallop (during LV filling, compliant LV), may be seen with SHF
  • atrial gallop (during LV filling in non-compliant LV), may be seen with DHF
74
Q

CAD & Chronic HF med recs X6

A 
statin
BB
ASA
ACEI
diuretic
nitro
75
Q

Splitting of S2

  • physiologic
  • Paradoxical (and MC cause)
  • fixed split
A
  • occurs on inspiration
  • occurs on expiration ( LBBB)
  • ASD and RV failure
76
Q

3 drugs for diabetetic (high risk of CAD)

A

ASA, statin, ACEI

77
Q

3 drugs for secondary prevention of STEMI (had prior MI)

A

ASA, BB, ACEI

78
Q

diastolic dysfunction

A

decreased ventricular COMPLIANCE leads to inabilitiy to draw blood from LA to LV

often in setting of LVH
(normal EF)

79
Q

Beck’s triad

2/2

A

HoTN
Distant heart sounds
JVD

-Cardiac tamponade

80
Q

MC cause of cardiomyopathy worldwide

A

Chagas disease

- 2/2 protozoan parasite Trypanosoma cruzi

81
Q

coxackie B virus

A

RNA enterovirus associated with acute mycoarditis & pericarditis

82
Q

HF Classification I to IV

A

I - no limitation of physical activity
II - mild symptoms with ordinary exertion
III - Marked limitation with activity
IV - Symptomatic at rest

83
Q

drugs x2 to prevent monomorphic VT in pt with cardiac disease (if QT normal)

A

Amiodarone

Sotalol

84
Q

Most toxic SE of Amiodarone

  • less serious SE
A

puomary toxicity

  • corneal deposits, photodermatitis, peripheral neuropathy
85
Q

minimum target INR & duration before cardioversion

A

> 1.8 for 3 weeks

86
Q

First degree Heart Block

A

fixed & prologed PR interval (> .2 sec)

87
Q

Second Degree Heart Block
Type I
Type II

A
  • Wenckebach long, long, drop

- fixed PR and occosainal dropped beat

88
Q

Criteria to dx Metabolic Syndrome in men

Must have Atleast 3 of 5:

A 
BP > 130/85
waist > 40 
HDL < 40
Fasting BS > 100
TG > 150
89
Q

Cilostazol

A

Phosphodiasterase inhibitor used to manage claudication

90
Q

indications for Holter monitoring

A

Suspected tachy inducuced cardiomypathy

Dec systolic function after MI (to determine risk of death)

asymptomatic afib to see about anticoagulant

non- life threatening arrythmias if symptomatic

91
Q

ACLs Rx for symptomatic bradycardia

A

Atropine

Pacing if ineffective

92
Q

Cardiac Syndrome X

A

classic angina CP, treadmill test with ischemia & normal coronaries by cath

93
Q

3 electrolyte abnormalities that increase risk of Dig toxicity

A

hypomag
hypoK
hypercalcemia

Dig increase intracellular Na&raquo_space; drives Calcium into heart&raquo_space; inc contractility

94
Q

Delta wave on EKG

A

slurring of QRS upstroke

Seen in Wolf Parkinson White

95
Q

Most common cause of restrictive cardiomyopathy

A

Amyloidosis

96
Q

Dromotropy

A

Conduction velocity of AV node

97
Q

ACLS for SVT

A
  • carotid massage or vagal
  • then Adensoine
  • then CCB or BB
  • cardiovert if HD unstable
98
Q

symptoms of Dig toxicity

A

PVS, lifethreatening arrhythmia, symptomatic bradycardia

GI - anorexia, N/V, diarrhea
Neuro - lethargy, confusion, dizziness, changes in visual acuity

99
Q

Patients with Congenital Bcuspid aortic valven have increased risk for

  • risk for offspring to have disease
A
  • thoractic aortic aneurysms

- 30%

100
Q

Explain QT interval

A

beginning of QRS (V depol) to end of T (V repol)

101
Q

Torsades

A

Polynmorphic WIDE complex tachycardia with a twisting of the pointes

102
Q

Venous Hum

A

systolic murmur over BIL upper sternal borders that disppears when jugulars compressed (benign condition)

103
Q

Takotsubo cardiomyopathy

A

stress induced - presents like MI but w/o coronary stenosis

  • apical ballooning
  • treat same as MI 2/2 CAD

PANRE 2021 - JLI (12 decks)

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