Chap 1 - Cardiovascular Flashcards
Treatment for viral pericarditis?
NSAID (+3 months colchicine)
Classic findings of pericarditis?
Pleuritic chest pain, friction rub, diffuse ST-segment elevations
How to diagnose costochondritis?
Insidious onset, lasts hours to days, pain reproducible, worse with turning/twisting/etc.
Treatment for costochondritis?
NSAIDs and rest
Characteristics of panic disorder?
Chest pain but in a young, low-risk individual lasting 5-60 minutes, often with agoraphobia
Treatment for panic disorder?
SSRI
Common history in secondary spontaneous pneumothorax?
COPD
Work-up for secondary spontaneous pneumothorax?
Upright CXR
Work-up of non-cardiac chest pain?
Exclude cardiac causes => empiric PPI therapy 8-10 weeks => endoscopy, manometry, or ambulatory pH monitoring
When to revascularize in chronic angina?
If optimal medical therapy does not improve symptoms
Indicated diagnostics in chronic stable angina?
Routine ECG, exercise stress testing, and echo are NOT recommended
Indication for exercise stress test?
Diagnose CAD in patients with normal ECG at baseline but anginal symptoms. Use ONLY when pre-test probability is intermediate
Gender pitfalls of ECG exercise stress test?
Higher false-positive rate in women
How to optimize medical therapy in chronic stable CAD with anginal symptoms?
Increase B-blocker until resting HR is 55-60, add nitrates, then add CCB, then ranolazine, then coronary angiography
Manage acute chest pain in ED?
If intermediate suspicion of ACS, admit to telemetry unit with serial ECGs and troponins
Treating STEMI?
PCI if < 2 hours away
Thrombolytic therapy: ASA, clopidogrel, heparin, intravenous nitrates, thrombolytics
Indication for cardiac catheterization in NSTEMI?
Serial troponins => if rising with evolving ECG, then go to catheterization
How long after symptom onset do patients benefit from PCI?
Up to 12 hours
90 minutes door-to-balloon time at PCI facility
120 minutes to balloon time from non-PCI facility
New holosystolic murmur at left lower sternal border s/p anterior wall MI?
Either acute mitral valve regurgitation (papillary muscle dysfunction) or ventricular septal defect (has palpable thrill)
Anatomic defect associated with inferior wall MI?
Aortic dissection
Presentation of left ventricular free wall rupture?
Hemopericardium => muffled heart sounds, RHF, no murmur
Medical therapy for unstable angina?
ASA, clopidogrel, LMWH, nitrate, B-blocker
Contraindication for treatment with B-blocker?
Bronchospastic disease => use CCB instead
Contraindicated CCB in unstable angina?
Nifedipine => causes increased HR
Indication for cardiac catheterization in STEMI?
Go to PCI if within 90 minutes of presentation and 12 hours of symptoms
DO NOT wait for troponins
Diagnose Sick Sinus Syndrome?
Sinus bradycardia correlated with dizziness
Pathologic findings: sinus arrest, sinus exit block, sinus bradycardia
Treatment for asymptomatic complete heart block?
Permanent pacemaker
ECG difference between First-/Third-degree heart block and 2nd-degree?
2nd-degree does not have consistent R-R intervals
LBBB characteristics on ECG?
Absent Q waves and wide, positive R waves in I, aVL, V6, prolongation of QRS > 0.12 sec
Management of new LBBB with anginal symptoms?
Consider equivalent to STEMI even though no ST elevations
Consistent and non-consistent characteristic in Mobitz type I?
PP interval constant, PR interval increasing
Similarity between atenolol and diltiazem conduction system side effect?
Decrease conduction through AV node
Lyme carditis manifestations?
Acute onset, high grade AV conduction deficits rapidly leading to 3rd degree AV block. Administer IV ceftriaxone until resolution of symptoms then 21 days oral therapy
Management of A-fib?
Hemodynamically stable: B-blocker or CCB
Hemodynamically unstable: Cardioversion
CHADS2 guidance of treatment?
0 => no ASA
1 => ASA, consider anti-coag if other RFs
>=2 => long-term anticoagulation on warfarin
A-fib patient with contraindication to warfarin?
Use ASA + clopidogrel
Indication for A-fib ablation therapy?
Failure of at least one antiarrhythmic agent
ECG characteristics of WPW syndrome (ventricular preexcitation syndrome)?
Short PR interval, prolonged QRS, slurred QRS onset (delta wave).
Paradoxically split S2
ECG characteristics of A-flutter?
Sawtooth appearance most noticeable in inferior leads, clearly defined p-waves (vs. a-fib), atrial conduction rate approaches 250-300/min
ECG characteristics of MAT?
3 different p-wave morphologies best seen in II, III, V1 with varying P-P, P-R, and R-R intervals
ECG characteristics of AVNRT?
Lost P-waves, narrow QRS, Regular rhythm
ECG characteristics of AVRT?
Short R-P tachycardia with P wave in ST-segment, regular rhythm
What are the paroxysmal SVTs?
AVNRT, AVRT, ATach
Treatment of paroxysmal SVTs?
IV adenosine push => slow rate in AVNRT and AVRT, but not in ATach
Treatment of asymptomatic HOCM?
Implantable defibrillator
If not feasible, use amiodarone
Treatment of wide complex tachycardia with history of CAD/cardiomyopathy?
Assume it is a ventricular tachycardia
IV amiodarone
What are premature ventricular complexes?
Spontaneous depolarizations from ventricles
Treatment of PVCs?
B-blockers => RF ablation if refractory
What is long QT syndrome?
Familial condition with long QT interval predisposing patients to syncope and cardiac arrest due to TdP, especially during exertion
Why does one become unresponsive during STEMI?
Ventricular fibrillation arrest => immediate cardioversion
Indication for pacemaker placement?
SA node dysfunction (sinus brady, intra-nodal block, exit block), symptomatic 2nd or 3rd degree block
Indication for ICD placement?
If ventricular arrhythmia occurs >48 hours s/p MI, patients with EF < 30%
Baseline medications for CHF?
ACE inhibitor and B-blocker
Additional medication for NYHA III-IV CHF?
Spironolactone
What makes BNP falsely low in CHF patients?
Obesity
New onset heart failure with evidence of ischemia?
Coronary angiography if high pretest probability of CAD
Indications for biventricular pacing?
NYHA Class III-IV CHF, EF < 35%, ventricular dyssynchrony (QRS > 120 msec)
dCHF medications?
Furosemide and ACE inhibitor/ARB
Do not use preload reducing meds: CCB and nitrates
Digoxin good for sCHF, not dCHF
Optimal medical therapy for sCHF class III-IV?
ACE inhibitor, B-blocker, spironolactone
Treatment of concurrent hypertension and sCHF?
Loop diuretic, max out doses of B-blocker and ACE inhibitor, then add CCB - new dihydropyridine class (amlodipine)
CCB that have negative inotropic effects and can exacerbate sCHF?
Nifedipine, verapimil, diltiazem
Tricuspid regurg murmur?
Early systolic murmur at left lower sternal border that increases with inspiration, does not radiate
Progression of heart disease from chronic lung disease?
Chronic lung disease => pulmonary hypertension => right ventricular overflow => tricuspid insufficiency => cor pulmonale
Most prominent physical exam finding for dysfunctional prosthetic aortic valve?
Blowing diastolic murmur at left sternal border = aortic regurgitation
Murmur heard in LBBB?
Expiratory splitting of S2
TTE indications?
Diagnosing >=3/6 systolic murmurs, diastolic murmurs, continuous murmurs, holosystolic murmurs, late systolic murmurs, ejection clicks, murmurs radiating to back or neck
Physical exam findings of AR?
Carotid pulse rapid upstroke and decline (Corrigan pulse), widened pulse pressure, diastolic murmur
Cardiac consequences of radiation therapy?
Valvular regurgitation, constrictive pericarditis (RVF symptoms), restrictive cardiomyopathy (RVF symptoms)
Bicuspid aortic valve associated anatomic difference?
50% have aortic root dilation
Mitral stenosis murmur characteristics?
Opening snap followed by diastolic murmur accentuated by atrial contraction => loud S1
Prominent parasternal impulse?
Right ventricular hypertrophy
Prominent pulmonic component of S2?
Pulmonary hypertension
Characteristics of MVP murmur?
Late systolic murmur with click at apex, Valsalva and sit-to-stand will move click to early systole but not decrease intensity of murmur
Effects of preload and afterload on HCM?
Decrease preload => intensify murmur
Increase afterload => decrease murmur
What is Leriche syndrome?
Aortoiliac arterial disease => characterized by erectile dysfunction, hip and buttock pain when walking, diminished femoral, popliteal, and DP pulses
Acute AAA management
Sudden, severe low back pain associated with syncope
Low BP, infraumbilical and suprapubic tenderness
CT scan and repair emergently
Management of renovascular hypertension 2/2 fibromuscular dysplasia?
Percutaneous transluminal kidney angioplasty
Fibromuscular dysplasia angiogram finding?
String of beads
Management of anticoagulation in setting of acute venous thromboembolism?
5-7 days of LMWH with warfarin with target INR of >2.0 for 24 hours
Treatment of DVT in kidney insufficient patients post-operative?
IV unfractionated heparin
Unfractionated heparin cleared by reticuloendothelial system
LMWH cleared by kidneys
