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Cards Flashcards

1
Q

fatigue, anorexia, nausea, blurred vision, disturbed color perception, cardiac arrhythmia

A

digoxin toxicity - give digoxin Fab for antidote

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2
Q

bradycardia, AV block, hypotension, diffuse wheezing, hypoglycemia, bronchospasm, neuro dysfunction

A

BB overdose -> give fluid, atropine, and glucagon (increase cAMP)

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3
Q

lungs, liver, eyes, skin, thyroid, nerves

A

AMIODARONE; monitor LFTs and Thyroid; if lung sx, think pneumonitis

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4
Q

retinal hemorrhange + papilledema + HTN

A

malignant HTN

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5
Q

STEMI tx

A 
DAPT (ASA + clopidogrel)
BB
Statin 
Oxygen 
Nitrates
PCI
Anticoag (heparin, LMWH, bivalirudin)
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6
Q

What can happen with RV MI?

A

profound hypotension due to inadequate RV preload – provide NS bolus

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7
Q

electrical alternaans/varying amplitude of QRS + tachycardia + syncope + muffled heart sounds

A

pericardial effusion

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8
Q

SENSITIVITY in diagnosing HF?

A

BNP; physical exam findings are specific (crackles, S3, edema, JVD)

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9
Q

What 10 yr risk % indicates statin initiation?

A

> 7.5%

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10
Q

Causes of acute limb ischemia 2/2 arterial insufficiency?

A

cardiac emboli, thrombosis, trauma

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11
Q

Sources of cardiac emboli causing arterial insufficiency?

A

L ventricle, Thrombus due to afib, aortic atherosclerosis

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12
Q

*** crescendo-decrescendo murmur, increase inspiration, systolic ejection click, widened split of S2

A

Pulmonic valve stenosis

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13
Q

from what do you get pulmonic valve stenosis

A

congenital defect

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14
Q

*** ejection click followed by crescendo-decrescendo systolic murmur over second intercostal space, and widened splitting of S2

A

Pulmonic valve stenosis

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15
Q

Diffuse ST elevations, chest pain worse with breathing relieved with leaning forward, MI one week ago

A

pericarditis in Dressler syndrome, give NSAIDS

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16
Q

4th heart sound

A

LVH - can be 2/2 HTN

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17
Q

inferior notching of ribs, HTN, 4th heart sound, continuous murmur

A

coarctation of the aorta - continuous murmur when there is collateral blood flow

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18
Q

episode of AF but found to have no cardiopulmonary or structural heart disease

A

Lone AF, commonly < 60 and requires no therapy

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19
Q

if AF with mod-severe risk of thromboembolic events by CHADVASC

A

anticoagulate with WARFARIN or Xaban

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20
Q

*** pruritus and flushing on hyperlipidemia control

A

niacin - prostaglandin mediated vasodilation, can be lessened by concomitant aspirin

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21
Q

antiarrhthmic drugs used in rhythm management of paroxysmal a fib

A

amiodarone and flecainide

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22
Q

types of cardioversion

A

electrical or chemical (ibutilide)

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23
Q

Lab panel for new diagnosis of HTN

A

CMP, CBC, UA, TSH, Lipid panel, A1C and EKG

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24
Q

*** two types of mineralcorticoid receptor antagonists (MRAs) that confer longtime survival benefit to patients with LV dysfunction

A

eplerenone, spironolactone

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25
Q

*** Groups of drugs that provide survival benefit to patients with LV dysfunction

A

ARBs, ACEis, BB, MRAs and in African American, Hydralazine + Nitrates

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26
Q

tx for acute decompensated HF with adequate perfusion to end organs

A

supp O2, diuresis (furosemide), vasodilation (nitrates)

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27
Q

Types of nitrates

A

nitroglycerin and nitroprusside

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28
Q

muffled heart sounds, pulsus paradoxus, hypotension, pericardiocentesis

A

tamponande

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29
Q

persistent afib, pneumonitis, blue/grey discoloration of skin, thyroid and liver issues

A

amiodarone (antiarrhythmic; should monitor with LFTs and thyroid labs)

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30
Q

** life prolonging in African Americans with LV dysfunction, SE of salt and fluid retention + edema + palpitations + hypotension + drug induced LUPUS

A

hydralazine

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31
Q

*** two common heart medications that can trigger broncho-constriction and pulmonary symptoms in someone with asthma

A

aspirin and b-blockers

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32
Q

when do you get ACEi SE cough?

A

immediately or months following, depends on individual thresholds for reaction to bradykinin

33
Q

Becks triad

A

3 symptoms of TAMPONADE - hypotension + distended neck veins + muffled heart sounds

34
Q

pulsus paradoxus

A

drop > 10 mm hg in BP with inspiration; seen in tamponade

35
Q

Why does inspiration worsen tamponade?

A

lowers intrathoracic pressure thus increases blood return to RV

36
Q

***Signs of left HF

A

crackles and S3

37
Q

Signs of right HF

A

BEFORE heart - JVD and peripheral edema

38
Q

What increases in the heart during tamponade?

A

Contracitility and HR in attempt to increase CO

39
Q

Causes of LV outflow obstruction

A

Severe AS or hypertrophic obstructive cardiomyopathy (HOCM)

40
Q

orthostatic hypotension is ___ change in systolic and ___ in diastolic between laying and standing

A

20 systolic, 10 diastolic

41
Q

*** When may you hear S4

A

S4 indicates DECREASED LV compliance (hypertensive heart disease, AS, hypertrophic cardiomyopathy, acute phase of MI)

42
Q

fixed splitting for second heart sound

A

ASD

43
Q

opening snap, LA enlargement

A

severe mitral stenosis

44
Q

*** recent URI, maximal apical impulse difficult to palpate, dyspnea, JVD, “water bottle” enlarged heart on CXR

A

Pericardial perfusion, before tamponade

45
Q

risk factors for aortic dissection

A

HTN, marfan, cocaine use

46
Q

*** IV drug use, holosystolic murmur that increase with inspiration

A

tricuspid regurgitation

47
Q

diffuse ST elevation, PR depression

A

pericarditis

48
Q

coronary artery re-occlusion

A

acute stent thrombosis

49
Q

3 or more anti-hypertensive medications with inadequate control

A

resistant HTN, think of secondary causes

50
Q

risk factors for AAA

A

age > 60, cigarettes, family history, race, atherosclerosis

51
Q

risk for expansion and rupture of AAA

A

currently smoke, rapid rate of enlargement, large diameter

52
Q

*** when to do defibrillation/unsynchronized shock

A

ventricular fib or pulseless ventricular tachy

53
Q

*** treatment of persistent tachycardia with signs of heart instability/failure (hypotension, cardiogenic shock, signs of ischemia, acute heart failure)

A

immediate synchronized cardioversion

54
Q

*** ST elevation II III and aVF

A

Inferior MI, RCA or Left circumflex

55
Q

*** ST elevation in some/all of anterior leads V1-V6

A

Anterior MI, LAD

56
Q

delayed impulse transmission from atria to ventricles

A

first degree AV block

57
Q

testing for symptomatic patients (dizziness/syncope) suspected to have arrhythmia

A

24 hour holter (constant EKG)

58
Q

*** PR interval > 0.2 seconds/greater than 5 small boxes

A

first degree heart block; delay in conduction from atria to ventricle

59
Q

electrical alternans, recent viral illness, muffled heart sounds, JVD, hypotension

A

pericardial effusion from pericarditis, resultant tamponade

60
Q

patient is asymptomatic but found to have prolonged PR interval on EKG (> 5 small boxes). Is this typical?

A

YES - first degree heart block is typically asymptomatic

61
Q

risk factors for AAA

A

smoking, male, age > 65

62
Q

*** screening recs for AAA

A

one time screening in man who has EVER smoked age 65-75, abdominal US

63
Q

Is AAA screening dependant on pack years and number of years since cessation?

A

NO

64
Q

use of digoxin

A

rate control in tachy of afib and symptom control of CHF

65
Q

are BB contraindicated in setting of pulmonary edema?

A

YES

66
Q

weak diuretic and mortality benefit in CHF

A

spironolactone

67
Q

*** laboratory findings which indicate poor prognosis with systolic heart failure

A

HYPONATREMIA, elevated pro-BNP levels, renal insufficiency

68
Q

hyponatremia is an independent predictor of clinical outcome in CHF - T/F?

A

TRUE

69
Q

*** what is responsible for mediating hyponatremia

A

renin, NE, ADH

70
Q

*** 3 rate control meds for afib

A

digoxin, bb (metoprolol), ccb (diltiazem, verapamil)

71
Q

choices of anticoagulation for pt with a fib and elevated CHADVASC score

A

warfarin, dabigatraban, rivaroxaban, apixaban

72
Q

sudden onset, regular and narrow-complex tachycardia

A

paroxysmal supraventricular tachycardia

73
Q

digitalis toxicity arrhythmia

A

atrial tachycardia with AV block - digitalis increases ectopy and vagal tone

74
Q

*** serum BUN > 60

A

UREMIA - often in setting of renal failure, can cause pericarditis

75
Q

4 types of NSAIDs

A

aspirin, naproxen, indomethacin, ibuprofen

76
Q

tx of idiopathic or acute viral pericarditis

A

NSAID + colchicine

77
Q

3 components of typical angina

A

sub-sternal location + provoked by exercise or emotional stress + relieved with rest or nitroglycerin

78
Q

*** widened pulse pressure, brisk carotid artery upstroke, systolic flow murmur, tachycardia, flushed extremities, LVH, lateralized apical impulse

A

AVF - arteriovenour formation, often secondary to trauma

79
Q

Types of AVF

A

trauma, iatrogenic, cancer, congenital (pulmonary, CNS, angiomas, PDA)

IM (17 decks)

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