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1
Q

Presentation of sick sinus syndrome and ECG findings

A

Impaired SA node automaticity (degeneration/fibrosis of SA node)

  • fatigue, lightheadedness, syncope, presyncope, palpitations
  • ECG: alternating bradycardia and tachyarrhythmias (tachycardia-bradycardia syndrome); sinus pauses/arrest, SA exit block
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2
Q

Side effects of ACE inhibitors

A

Cough, drug-induced angioedema

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3
Q

Lab work up of new hypertension

A

Renal: Electrolytes, Cr, UA (hematuria/proteinuria), Ur albumin/Cr ratio

Endocrine: fasting glucose, a1c, lipid profile, TSH

Cardiac: ECG (LVH or previous MI), echo (optional)

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4
Q

Which bacteria cause endocartitis after dental manipulation or respiratory tract incision/biopsy?

A

Viridians streptococci (sanguinis, mutans, mitis, milleri)

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5
Q

Tx of torsades de pointe in hemodynamically unstable vs. stable patients

A

Unstable- defibrillation

Stable- IV Magnesium sulfate

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6
Q

Presentation of Pericarditis

A

substernal, pleuritic chest pain- better when leaning forward

  • inflammatory, infectious, or malignant etiology
  • Widespresad ST elevations and PR depressions on ECG
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7
Q

Presentation of endocarditis

A

**staph aureus= acute, viridans= subacute

  • valve dysfunction or vegetations on echo
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8
Q

When do murmurs get louder/softer?

A

Right sided murmurs louder with inspiratoin

  • RINSpiration

Left sided murmurs louder with expiration

  • LEXPiration

Increased preload- more flow over murmur (squatting, leg raise)= LOUDER murmurs

Except: HOCM/MVP

*more blood flow over septum pushes hypertrophied septum back into normal positioning and decreases murmur sound

Decreased preload (less blood across heart)- valsalva= SOFTER murmurs

Except: HOCM/MVP

**less blood= septum not back in position= louder murmur

Increased afterload (more back-pressure on heart)= louder regurgitant murmurs, softer HOCM/MVP

Decreased afterload= louder HOCM/MVP

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9
Q

Aortic Stenosis

A

Crescendo decrescendo systolic murmur, radiates to carotids

  • Old patient - syncope, angina, dyspnea
  • calcified valve
  • bicuspid aortic valve
  • pulsus parvus et tardus (late, weak pulse)
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10
Q

Mitral regurgitation

Tricuspid regurgitation

A

Holostystolic murmur

  • rheumatic fever
  • radiates to axilla

Tricuspid- holosystolic, IVDA

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11
Q

Mitral stenosis

A

Opening snap

  • hx rheumatic fever
  • diastolic
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12
Q

VSD

A

holosystolic HARSH murmur

  • down syndrome, cru di chat, edward syndrome, patau syndrome, TORCH infections
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13
Q

Aortic regurgitation

A

high pitched, blowing early diastolic decrescendo murmur

  • acute= infective endocarditis
  • Chronic= bicuspid aortic valve
  • Valvular AR best heard along left sternal border
  • AR due to aortic root dilation can be heard on left and right sternal borders
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14
Q

Miral stenosis

A

Opening snap with delayed diastolic rumbling murmur

  • SLE, RA, rheumatic fever
  • mimckers= left atrial myxoma, bacterial endocarditis
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15
Q

PDA

A
  • continuous machine like murmur (both systole/diastole)
  • congenital rubella, premature infants (FAS, fetal hydantoin syndrome- phenytoin use)

Keep open with prostaglandins

Close with indomethacin

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16
Q

Constrictuve pericarditis presents with:

A
  • kussmaul sign- increase in JVP with inspiration
  • can also be seen in tamponade
17
Q

Pulsus paradoxus

A

Fall in systolic BP >10 with inspiration

  • Cardiac tamponade or constrictive pericarditis
18
Q

Treatment of:

SVT (narrow complex)

Ventricular tachcardia (wide complex)

A

SVT: adenosine

VT: amiodarone

19
Q

Who should recieve antibiotic prophy for infective endocarditis?

A

Just people with prosthetic heart valves or previous IE

20
Q

Atrial septal defect

A

Left to right shunting

  • Wide and fixed splitting of S2
  • mid-systolic or ejection murmur over LUSB
  • mid-diastolic rumble
21
Q

First line tx for patients with septic shock who do not respond to fluid repletion

A

Norepinephrine

22
Q

First line tx for patients with cardiogenic shock

A

Dobutamine

23
Q

Treatment in acute myocardial ischemia

What treatment decreases the chest pain in acute MI?

A

Morphine, oxygen, nitrates (venous dilatation), aspirin, beta blockers, LMWH, possibly statins

Venous dilation (via nitrates)- decreases LV preload and therefore reduces stress on ventricle- decreased myocardial oxygen demand

24
Q

Tx of hyperkalemic emergency (usually >6.5)

A

IV calcium gluconate or and/or insulin+dextrose

  • can result in heart block
25
Q

Tx of unstable patient with complete heart block

A

1st atropine even if unstable

transcutaneous pacing follows if still unstable

If still refractory, dopamine or dobutamine

26
Q

Presentation of Ruptured Abdominal Aortic Aneurysm

A
  • Sudden onset severe abdominal/back/flank pain (referred pain)
  • hypotension
  • pulsatile abdominal mass
27
Q

Clinical suspicion for blunt thoracic aortic injury– workup for stable vs. unstable patient

A

Stable: CT angiography

Unstable: straight to surgery +/- TEE in operating room

28
Q

Predisposing factors for Torsades de Pointe

Tx of Torsades

A

antiarrhythmics, structural heart diseaes, hypokalemia, hypomagnesima

Tx: magnesium sulfate

29
Q

High Output Heart failure 2/2 Thyroid Storm

A

Decreased SVR–> increased cardiac index (output)–>hyperdynamic circulation–> increased venous return to heart–> LV overwhelmed, fluid back up into lungs–> Increased PCWP

Decreased SVR, increased cardiac index, increased PCWP

30
Q

Viral myocarditis in young person can lead to?

A

Dilated cardiomyopathy

31
Q

Preferred imaging modality for fibromuscular dysplasia? (cause of secondary hyperaldosteronism)

A

computed tomography angiography of abdomen

32
Q

Leriche syndrome (aortoiliac occlusion– bifurcation of aorta)

A
  • claudication of butt, thighs, hip bilaterally
  • absent or diminished femoral pulses
  • impotence
33
Q

Anatomic origin of Afib

A

Pulmonary Veins

Step 2 (13 decks)

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