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Cards Test 3 Flashcards

1
Q

HF most commonly results form what?

A

Conditions of impaired left ventricular failure

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2
Q

At what pressure value does the pulmonary capillary pressure become high enough to force the flow of fluid into the pulmonary interstitium?

A

> 20 mmHg

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3
Q

Would an MI result in systolic or diastolic dysfunction?

A
  • impaired contractility

- systolic

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4
Q

Would chronic volume overload from valvular regurgitation result in systolic or diastolic dysfunction?

A
  • impaired contractility

- systolic

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5
Q

Would a dilated cardiomyopathy result in systolic or diastolic dysfunction?

A
  • impaired contractility

- systolic

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6
Q

Would aortic stenosis result in systolic or diastolic dysfunction?

A
  • Pressure overload

- systolic

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7
Q

Would uncontrolled HTN result in systolic or diastolic dysfunction?

A
  • Pressure overload

- Systolic

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8
Q

2 Primary causes of systolic dysfunction

A
  • Impaired contractility

- Pressure overload

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9
Q

2 Primary causes of diastolic dysfunction

A
  • Impaired ventricular relaxation

- obstruction of left ventricular filling

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10
Q

Would LV hypertrophy result in systolic or diastolic dysfunction?

A
  • Impaired ventricular relaxation

- Diastolic

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11
Q

Would hypertrophic cardiomyopathy result in systolic or diastolic dysfunction?

A
  • impaired ventricular relaxation

- diastolic

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12
Q

Would restrictive cardiomyopathy result in systolic or diastolic dysfunction?

A
  • impaired ventricular relaxation

- diastolic

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13
Q

Would a transient myocardial ischemia episode result in systolic or diastolic dysfunction?

A
  • Either!

- It will impair ventricular relaxation, but it will also impair ventricular contractility. :)

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14
Q

Would mitral stenosis result in systolic or diastolic dysfunction?

A
  • Obstruction of left ventricular filling

- Diastolic

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15
Q

Would pericardial constriction or tamponade result in systolic or diastolic dysfunction?

A
  • Obstruction of left ventricular filling

- Diastolic

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16
Q

Drug that mimics natural natriuretic peptides

A

Nesiritide (given IV)

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17
Q

What causes eccentric hypertrophy?

A

Chronic volume overload

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18
Q

What effect does eccentric hypertrophy have on wall stress?

A

Increases wall stress

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19
Q

What causes concentric hypertrophy?

A

Chronic pressure overload

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20
Q

What effect does concentric hypertrophy have on wall stress?

A

May reduce wall stress substantially

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21
Q

What are some sources of pressure overload that can cause HF?

A
  • aortic stenosis
  • PE
  • HTN
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22
Q

What are some sources of volume overload that can cause HF?

A
  • valvular regurgitation
  • Anemia
  • Thyrotoxicosis
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23
Q

What are some myocardial abnormalities that can cause HF?

A
  • CAD
  • MI
  • Ischemia
  • Cardiomyopathies
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24
Q

What is high output heart failure usually related to?

A

An endocrine disorder

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25
Q

What are some ventricular filling abnormalities that can lead to heart failure?

A
  • mitral stenosis
  • constrictive pericarditis
  • LVH
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26
Q

What are some arrhythmias that can lead to HF?

A
  • Afib
  • SVT
  • marked brayarrhythmia
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27
Q

Top 3 causes of HF in the western world, in order

A
  1. CAD
  2. Hypertension
  3. Dilated cardiomyopathy
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28
Q

Primary complaint of left-sided HF?

A

Dyspnea on exertion

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29
Q

Will the edema of right-heart failure be pitting or non-pitting?

A

Pitting

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30
Q

Gold standard of diagnosing HF

A

Right heart cath

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31
Q

ECHO modality used to assess ventricular wall thickness

A

M-mode

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32
Q

ECHO modality used to assess LV systolic function

A

2-D

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33
Q

ECHO modality used to assess diastolic dysfunction

A

Doppler

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34
Q

ECHO modality that detects regional wall abnormalites

A

2-D

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35
Q

ECHO modality used to estimate pressure gradients

A

Doppler

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36
Q

Mortality increases significantly when the LVEF drops below what?

A

30%

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37
Q

Possible causes of elevated systolic and diastolic PCWP

A
  • LH failure
  • Mitral stenosis or regurg
  • Cardiac tamponade
  • LVH
  • Parenchymal lung disease
  • Pulmonary vascular disease
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38
Q

Good way to estimate LV diastolic pressure

A

PCW pressure

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39
Q

Why might RA pressure be reduced?

A

Intravascular volume depletion

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40
Q

Why might RA pressure be increased?

A
  • RV failure
  • Right side valve disease
  • Cardiac tamponade
41
Q

Why might RV systolic pressure be increased?

A
  • Pulmonary valve stenosis

- Pulmonary HTN

42
Q

Why might RV diastolic pressure be increased?

A

-Volume overload of RH failure

43
Q

Why might diastolic PCWP be elevated

A

-VSD (left-to-right shunt)

44
Q

What should you expect to see on CXR if left atrial pressures are <10mmHg?

45
Q

What should you expect to see on CXR if left atrial pressures are >15 mmHg?

A

Upper-zone vascular redistribution (cephalization)

46
Q

What should you expect to see on CXR if left atrial pressures are > 20mmHg?

A
  • Interstitial edema

- Kerley B lines

47
Q

What should you expect to see on CXR if left atrial pressures are > 25mmHg?

A

Alveolar pulmonary edema

48
Q

What diagnostic workup should be performed in ALL cases of suspected heart failure?

A
  • history
  • EKG
  • PE
  • Echo
  • Labs
  • CAD assessment (stress test, angiogram)
49
Q

Positive inotrope that’s used for palliative care in appropriate Stage D HF patients

50
Q

Arteriolar dilator drug

A

Hydralazine

51
Q

Causes of non-ischemic dilated cardiomyopathy

A
  • viral
  • alcohol
  • genetic mutation
52
Q

How do you confirm a diagnosis of myocarditis?

A

-myocardial biopsy

53
Q

What drug do we need to make sure add to the treatment regimen for dilated cardiomyopathy and why?

A
  • Spironolactone

- Because pts with dilated cardiomyopathies have worsened contractility, which means they’re in worse stages of HF

54
Q

Definitive indications for oral anticoagulation in DCM patient

A
  • Previous thromboembolic event
  • Afib
  • LV thrombus
55
Q

What will happen to the murmur of HOCM with the valsalva maneuver and why?

A
  • Murmur will intensify because preload is decreased
  • Because intrathoracic pressure is increased, which decreases venous return, which allows the mitral leaflet and the hypertrophied septum to come closer together
56
Q

What will happen to the murmur of HOCM when the patient squats and why?

A
  • The murmur becomes quieter

- Because the preload is increased

57
Q

Mainstay of hypertrophic cardiomyopathy tx

A

-Beta blockers

58
Q

What drugs can we use for hypertrophic cardiomyopathy patients that decrease ventricular stiffness?

A

-Calcium channel blockers

59
Q

What kind of drugs do you NOT want to give to a hypertrophic cardiomyopathy patient? Why?

A
  • Inotropic drugs

- because they increase contractility and worsen outflow tract obstruction

60
Q

2 major consequences of the reduced ventricular compliance in restrictive cardiomyopathies

A
  • elevated systemic pulmonic venous pressures

- Reduced ventricular capacity size, decreasing SV and CO

61
Q

Kussmaul Sign

A
  • paradoxical worsening of JVD with inspiration
  • Present in restrictive cardiomyopathy (the stiffened RV can’t accomodate increased venous return)
  • Also present in constrictive pericarditis
62
Q

What might you see on CXR with restrictive cardiomyopathy?

A
  • pulmonary congestion

- but not enlarged heart

63
Q

Most common affliction of the pericardium

A

Acute pericarditis

64
Q

Dressler’s Syndrome

A

-Acute pericarditis occurring 2 weeks to several months after an MI

65
Q

With what type of MI is post-MI pericarditis most closely associated?

A

-Transmural MI

66
Q

Pericarditis associated with a thin exudate secreted by mesothelial cells lining the serosal surfaces of the pericardium

A

-Serous pericarditis

67
Q

Most common variation of acute pericarditis

A

Serofibrinous

68
Q

Type of pericarditis in which portions of the visceral and parietal pericardium may fuse

A

Serofibrinous

69
Q

Pericarditis that results from an intense inflammatory response to a bacterial infection

A

Suppurative pericarditis

70
Q

What often causes hemorrhagic pericarditis?

A
  • TB

- Malignancy

71
Q

When and where do you best hear the friction rub of pericarditis?

A
  • When patient is leaning forward

- Over the left lower parasternal edge

72
Q

3 Components of the friction rub of pericarditis

A
  • ventricular contraction
  • ventricular relaxation
  • atrial contraction
73
Q

Evidence of pericarditis on EKG

A
  • Diffuse ST elevation

- PR depression in II, III, and aVF

74
Q

What diagnostic tool is imperative for diagnosing constrictive pericarditis? What will you find?

A
  • Cardiac catheterization

- Elevation and equalization of the diastolic pressures in all 4 chambers

75
Q

What should you think if you find elevation and equalization of diastolic pressures in all 4 chambers on cardiac catheterization?

A

-Constrictive pericarditis

76
Q

Normal pericardial space contains how much fluid?

77
Q

Ewart Sign

A
  • Dullness when percussing over the posterior left lung

- Associated with pericardial effusion

78
Q

Evidence of pericardial effusion on EKG

A
  • Electrical alterans

- Reduced voltage

79
Q

What should you think if you find electrical alterans and reduced QRS voltage on EKG?

A

-Pericardial effusion

80
Q

Good diagnostic tool to determine how much fluid is in the pericardium

81
Q

Pulsus paradoxus

A
  • Decrease of SBP >10mmHg during inspiration

- Associated with cardiac tamponade

82
Q

Definitive diagnostic procedure for cardiac tamponade?

A

-Cardiac catheterization

83
Q

Definition of pulmonary hypertension

A
  • Pulmonary artery systolic pressure > 30mmHg

- Or pulmonary artery mean pressure > 20mmHg

84
Q

What are some cardiac causes of pulmonary HTN?

A
  • VSD/ASD (left-to-right shunts)

- Left atrial hypertension from mitral valve stenosis

85
Q

What might you find upon auscultation of a patient with pulmonary hypertension?

A
  • P2 intensity is increased

- Also a systolic ejection murmur (what you’re hearing is the flow across the pulmonic valve)

86
Q

With pulmonary HTN, would you see right ventricular dilation in early or late stages?

A

-Late stages

87
Q

EKG evidence of a pulmonary embolism

88
Q

Evidence of PTHN on EKG

A
  • RVH (large R wave in V1 and V2)
  • Right atrial enlargement (Increased P wave amplitude)
  • Right axis deviation
89
Q

Gold standard for diagnosis of pulmonary hypertension

A

Right heart cath

90
Q

Drug used to improve exercise capacity in primary PHTN

A

-Sildenafil (viagra)

91
Q

Most common cause of cor pulmonale?

92
Q

What should you think if you see on EKG:

  • Right axis deviation
  • Increase P wave in II, III, and aVF
  • RBBB
  • Low voltage QRS
A

Cor pulmonale (Low voltage QRS indicates underlying COPD

93
Q

Types of neurally-mediated syncope

A
  • Neurocardiogenic
  • Carotid stimulation
  • Situational (reflex) syncope
94
Q

Neurocardiogenic syncope tx

A
  • Beta blockers
  • Liberalize salt/fluid intake
  • Midodrine
95
Q

Direct alpha agonist used to treat neurocardiogenic syncope

A

-Midodrine

96
Q

LOC during or immediately after coughing, micturition, swallowing, or defecation

A

-Situational (reflex) syncope

97
Q

Contraindications for carotid sinus massage

A
  • Recent MI (past 3 months)
  • TIA
  • CVA
  • Presence of Vfib/Vtach
  • Presence of carotid bruits
98
Q

BP change requirements for diagnosis of orthostatic syncope

A

-20mmHg or greater fall in SBP when standing

99
Q

Tilt table contraindications

A
  • pregnancy
  • Positive stress test
  • Men > 45
  • Women > 55

Cardiology (8 decks)

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