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PANCE REVIEW > Caridology > Flashcards

Caridology Flashcards

1
Q

Classic EKG findings for pericarditis

A

Diffuse ST elevation in most of the precordial leads, with PR depression in the same lead

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2
Q

Buzz word: mid-systolic click

A

Mitral valve prolapse

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3
Q

Harsh crescendo-decrescendo murmur that radiates to the carotids; heard best with patient leaning forward

A

Aortic Stenosis

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4
Q

Classic EKG finding in ischemic heart disease

A

ST depression

*normal resting EKG in 50%

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5
Q

Formation of an atherosclerotic plaque

A

1) fat streak formation from lipid deposition in white blood cell as
2) LDL+macrophages form foam cells
3) fibrous cap formation

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6
Q

MOA of nitroglycerin

A

1) decrease coronary vasospasm
2) decrease preload by vasodilation

  • take sublingual q5 minutes up to 3 doses
  • remember you need at least an 8 hr nitrate free period to prevent tachyphylaxis
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7
Q

Contraindications to Nitroglycerin

A

1) SBP<90
2) RV INFARCT
3) PDE-5 inhibitors

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8
Q

Classic outpatient regimens for chronic angina lector is

A

Aspirin, BB, statin, prn nitroglycerin

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9
Q

Coronary artery occlusion percentage that typically becomes symptomatic with exertion (stable angina)

A

70%

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10
Q

Coronary artery occlusion percentage that typically becomes symptomatic at rest (unstable angina)

A

90%

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11
Q

Sings of an inferior wall MI

A

Chest pain with bradycardia, possible S4

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12
Q

Dressler Syndrome

A

Post MI pericarditis+ fever+ pulmonary infiltrates

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13
Q

What is a normal ejection fraction?

A

55-60%

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14
Q

MC type of cardiomyopathy

A

Dilated Cardiomyopathy

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15
Q

Cause of dilated cardiomyopathy, including MC

A
  • Viral myocarditis (MC) enterovirus such as Coxsackie B MC, then PB19, Chagas dz
  • alcohol abuse
  • idiopathic (50%)
  • pregnancy
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16
Q

At what ejection fraction is an implantable defibrillator recommended due to the increased risk of arrhythmias?

A

<30-35%

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17
Q

Takotsubo Cardiomyopathy

A

Apical left ventricular ballooning following an event that causes a catecholamine surge

*”broken heart syndrome”

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18
Q

Kussmal’s sign

A

JVP increased with inspiration

*seen in restrictive cardiomyopathy

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19
Q

Echo finding a for restrictive cardiomyopathy

A

1) nondialated ventricles with normal wall tho knees (they are ridged, not hypertrophied )
2) marked dilation of both atria
3) diastolic dysfunction

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20
Q

Hypertrophic cardiomyopathy pathophysiology

A

1) diastolic dysfunction: impaired filling
2) sub aortic outflow obstruction: hypertrophied septum
3) systolic anterior motion of the mitral valve

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21
Q

Hypertensive urgency management

A

Decrease MAP by 25% over 24-48 hours using ORAL agents

  • clonidine: central alpha agonist (rebound HTN If abruptly stopped)
  • captopril: ACEI
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22
Q

What makes a split S2 physiologic?

A

It occurs with inspiration

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23
Q

In what conditions will we see a fixed, split S2?

A

Pulm. HTN
Mitral regurgitation
ASD
VSD

*a paradoxical split s2 May be seen in severe aortic stenosis

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24
Q

What does the S3 sound represent?

A

Passive atrial filling

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25
Q

What does the S4 sound represent? In what conditions is it pathologic?

A

Atrial contraction

-associated with HTN, LVH, Aortic stenosis

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26
Q

Is a harsh murmur indicative of stenosis or regurgitation?

A

Stenosis

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27
Q

Is a blowing murmur indicative of stenosis or regurgitation?

A

Regurgitation

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28
Q

Which murmurs occur during systole?

A

Aortic stenosis and mitral regurgitation

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29
Q

Which murmurs occurring during diastole?

A

Aortic regurge and mitral stenosis

*remember ARMS rest!!

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30
Q

What murmur radiates to the carotids

A

Aortic stenosis

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31
Q

Which murmur radiates to the axilla?

A

Mitral regurge

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32
Q

Which murmur radiates to the L upper sterna border

A

Aortic regurge

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33
Q

Murmurs on Which side of the heart are heard best with inspiration

A

RIGHT

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34
Q

Murmurs on Which side of the heart are heard best with expiration

A

LEFT

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35
Q

Presentation of symptomatic aortic stenosis

A

1) chest pain
2) syncope
3) CHF
4) dyspnea (MC)

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36
Q

Etiologies of aortic regurgitation

A

1) valve dz: rheumatic heart dz, endocarditis

2) aortic root dz: HTN, Marian, RA, SLE

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37
Q

Acute and chronic manifestations of aortic regurge

A

Acute: MI, aortic dissection, endocarditis , pulmonary edema

Chronic: CHF

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38
Q

Pulses in aortic regurgitation

A

BOUNDING with wide pulse pressures

*water hammer pulse

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39
Q

Medical therapy of aortic regurgitation

A

Afterload reduction with vasodilators such as ACEI, nifedipine, hydralazine

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40
Q

Rheumatic heart dz is the MC cause of which heart murmur?

A

Mitral stenosis

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41
Q

Clinical manifestations of mitral stenosis

A

1) pulmonary overload: dyspnea, hemoptysis
2) A fib! (Due to atrial enlargement)
3) right sided heart failure
4) mitral facies (flushed and pale)
5) ortner’s syndrome: HOARSENESS, enlarged L atria compresses recurrent laryngeal nerve

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42
Q

A prominent S1 and opening snap is found with what murmur

A

Mitral stenosis

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43
Q

What is the most common cause of mitral regurgitation?

A

Mitral valve prolapse

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44
Q

Management of mitral regurgitation

A

REPAIR PREFERRED OVER REPLACEMENT

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45
Q

MC epidemiology of mitral valve prolapse

A

Women 15-35

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46
Q

Presentation of mitral valve prolapse

A

1) autonomic s/s: anxiety, palpitation, syncope
2) progression s/s: PND, CHF
3) stoke

47
Q

Mitral valve prolapse management

A

REASSURANCE

*only give B.B. if autonomic s/s

48
Q

A mid-late systolic ejection click is associated with what murmur?

A

MVP

49
Q

Pulmonic stenosis radiates where?

A

Neck

50
Q

Xanthoma

A

Lipid plaques on the Achilles’ tendon and a result of hyperlipidemia

51
Q

Xanthelasma

A

Lipid plaques on the eyelids as a result of hyperlipidemia

52
Q

When do we begin screening for hyperlipidemia if they have no risk factors?

A

Makes=35

Females=46

53
Q

When do we begin screening for hyperlipidemia if they have risk factors?

A

Males=20-25
Females
= 30-35

54
Q

How do we determine when to treat hyperlipidemia ?

A

10 year cardiovascular risk calculator

55
Q

What are the criteria for statin initiation ?

A

1) any CAD
2) 40-70y/o with DM
2) anyone over 21 with LDL >190
4) no heart dz, 40-75y/o with 7.5% risk of more

56
Q

Best meds to lower Trigs

A

Fibrates

57
Q

Best meds to increase HDL

A

Niacin

58
Q

Niacin (Vit B3) MOA, SE

A

Increases HDL and delays production of LDL

-SE: flushing pruritus( give with ASA) , hyperuricemia (can cause GOUT) , hyperglycemia (carful in DM)

59
Q

Statin MOA, SE

A

MOA: HMGcoA Reid tase inhibitors … decreases the production of LDL

SE: myositis, rhabdo, hepatitis

60
Q

Fibrates MOA, SE

A

MOA: reduces hepatic triglyceride production

SE: myositis, increased LFTs, gallstones

61
Q

Bile Acid Sequestrants MOA, SE

A

MOA: binds bile acids, removing LDL from the blood

SE: GI effects, increased triglycerides

62
Q

Ezetimibe MOA, SE

A

MOA: inhibits intestinal cholesterol absorption

SE: increased LFTS

63
Q

Management of acute endocarditis

A

Nafcillin + gentamicin x4-6 weeks

64
Q

Management of subacute endocarditis

A

Penicillin or Ampicillin + Gentamicin

65
Q

Management of endocarditis in a patient with a prosthetic valve

A

Vancomycin + Gentamicin + Rifampin

66
Q

Who gets infective endocarditis prophylaxis?

A

1) dental, respiratory, open skin procedures with ….

  • prosthetic valve
  • prosthetic material
  • hz of endocarditis
  • congenital heart dz
67
Q

What valve is MC involved in infective endocarditis?

A

Mitral

*tricuspid valve is found in IVDA

68
Q

Acute bacterial endocarditis

A

No underlying heart dz, often S. aureus

69
Q

Subacute bacterial endocarditis

A

Infection in a patient with abnormal valves

  • often S. Viridans (oral flora)
70
Q

Mc organism causing endocarditis in an IVDA

A

MRSA

71
Q

MC organism causing endocarditis in a patient with a prosthetic valve

A

Staph. Epidermis

72
Q

HACEK organisms of endocarditis

A 
H- haemophilus 
A- actinobacillus
C- cardiobacterium
E- eikenella
K- klingella

*gram negatives causing large vegetation’s and are difficult to culture

73
Q

Clinical manifestations of endocarditis

A

FEVER, weight loss, fatigue

  • Janeway lesions: painless macules on palms and soles
  • Oslar nodes: painful nodules on pads of digits
  • splinter hemorrhage
  • Roth spots: retinal hemorrhage with pale center
  • petechia
74
Q

DUKE CRITERIA for infective endocarditis (major and minor)

A

MAJOR:
1) sustained bacteremia with organism know to cause IE

2) ECHO involvement

MINOR:

1) predisposing condition
2) fever
3) vascular/emboli: janeway leaions, PE
4) immunologic: osler’s nodes, Roth spots
5) blood culture not meeting major
6) echo not meeting major

need 2 major, 1 major + 3 minor, or 5 minor

75
Q

MC cause of myocarditis

A

Enterovirus (Coxsackie)

  • clozapine=MC drug cause
  • SLE, rheumatic fever are common autoimmune causes
76
Q

Presentation of myocarditis

A

Viral prod Rome followed by heart failure symptoms

77
Q

Workup of myocarditis

A

Endoyocardial bx =GOLD STANDARD

CXR=cardiomegaly

Elevated cardiac enzymes

78
Q

Myocarditis tx

A

Heart failure tx

79
Q

What is rheumatic fever?

A

Acute autoimmune multi-system illness in 5-15y/o from a previous GABHS (group A. Beta-hemolytic strep, strep. Pyogenes) infection

80
Q

JONES criteria for rheumatic fever

A 
J- joint; polyarthritis 
O-oh my heart; carditis
N- nodules ; sub Q on extensor surfaces 
E-erythema marginatum; macular, non-pruritic rash on the trunk and extremities 
S-Sydenham’s chorea; jerky movements
81
Q

Rheumatic fever management

A

ASA +Pen G

82
Q

MC presentation of peripheral arterial dz

A

Intermittent claudication

83
Q

6 P’s of Acute arterial embolism

A

Palor, pain, pulselessness, poilkithermia, paresthesias, paralysis

84
Q

Dx of PAD

A

ABI<0.9 (<0.4 is pain at rest)

Arteriography=GOLD STANDARD

85
Q

Management of PAS

A

1) Platelet inhibitors: cilostazol (plital) ; ASA; plavix
2) Revascularization: PTA (percutaneous transluminal angioplasty) or fem-pop
3) supportive : foot care, exercise

86
Q

What is trousseau’s syndrome?

A

Migratory thrombophlebitis associated with malignancy

87
Q

Common causes of superficial thrombophlebitis

A

IV catheter (MC) , pregnancy, varicose veins , factor V Leiden

88
Q

What is bronchiectasis ?

A

Irreversible bronchial dilation and inflammation causing bronchial collapse and impaired clearance of mucus

89
Q

Clinical manifestations of bronchiectasis

A

1) recurrent lung infections

2) hemoptysis * MC cause of massive bronchiectasis

90
Q

What is the most common cause of bronchiectasis in the US?

A

Cystic fibrosis *pseudomonas is the pathogen

91
Q

What is the diagnostic study of choice for bronchiectasis?

A

High resolution CT of the chest!

*”tram-track” bronchial thickening

92
Q

Antibiotic regimen for MAC caused bronchiectasis

A

Clarithromycin + ethambutol

93
Q

Physical exam finding in pericardial effusion

A

Muffled heart sounds

94
Q

What is electric alterans

A

Beat to beat shift in QRS amplitude on EKD coins in pericardial effusion

95
Q

Becks triad of cardiac tamponade

A

1) muffled heart sounds
2) JVP
3) HYPOtension

96
Q

Adults with unrepaired coarctation of the aorta are at increased risk for what other vascular disorder?

A

Intracranial aneurysm

97
Q

What infectious etiology is associated with complete heart block?

A

Lyme Dz

98
Q

What is the treatment for long QTc syndrome in a stable patient?

A

beta blockers such as metoprolol

99
Q

What drugs can increase serum triglyceride concentration?

A

Estrogen replacement, tamoxifen, beta blockers, glucocorticoids, and human immunodeficiency virus (HIV) antiretroviral regimens.

100
Q

Findings of a left bundle branch block on EKG

A

Wide QRS
Large R wave in lead I
Negative wave in VI

101
Q

Findings of a right bundle branch block on EKG

A

Wide S wave in lead I

Triphasic QRS

102
Q

What is the most common cause of heart failure

A

Coronary Artery Dz

103
Q

Long term management of Angina vs long term medical management of HF

A

Angina=BB first line+ ASA

HF=ACE/ARB first line + diuretic

104
Q

Kerley B lines indicate what diagnosis?

A

Congestive Heart failure

105
Q

Treatment of acute pericarditis

A

ASA +NSAIDS, if greater than 48 hrs you can give corticosteroids

106
Q

treatment of hypertrophic cardiomyopathy

A

ICD placement and start patient on BB

107
Q

In what type of shock should you not administer large amounts of fluids

A

cardiogenic shock

108
Q

Treatment of cariogenic shock

A

inotrope-dobutamine

fix the underlying cause..MI

109
Q

Possible etiologies of obstructive shock

A

PE, tamponade, tension pneumothorax, aortic disection

these obstruct the blood flow from the heart or great vessels

110
Q

Etiologies of distributive shock

A
  1. septic shock
  2. neurogenic shock
  3. anaphylactic shock
  4. endocrine shock

**these cause shunting of blood from vital organs to non-vital organs ; there is LOW SVR in this type of shock only

111
Q

in what type of shock will you see BRADYCARDIA along with hypotension

A

neurogenic shock (type of distributive shock)

112
Q

in what type of shock will you see increased pulmonary wedge pressures

A

cardiogenic shock

113
Q

Medication treatment for orthostatic hypotension

A
  1. fludrocortisone

2. Midodrine (vasopressor)

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