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First Aid for Boards > Chapter 2 - Cardio > Flashcards

Chapter 2 - Cardio Flashcards

1
Q

Physical exam findings of Ruptured AAA

A

1) Consider in pt with CP, abdo pain or flank pain especially with hematuria
2) abdo distension and/or pulsatile mass
3) periumbilical and flank ecchymoses
4) Melena and hematemesis
5) Signs of heart failure

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2
Q

Size of thoracic aortic aneurysm

A

defined on CXR as thoracic aorta >4.5cm. Risk of rupture is high when >6cm

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3
Q

Risk factors for aortic dissection

A

1) Uncontrolled HTN
2) Age
3) Connective tissue disorder
4) Congential heart disease (bicuspid aortic valve)
5) Family History
6) Stimulant abuse

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4
Q

Type AAA dissection symptoms

A

1) mostly HTN, but can be hypotensive if tamponade or complete rupture.
2) upper extremity BP difference
3) altered mental status
4) stroke symptoms (due to carotid or vertebral artery dissection)

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5
Q

Type B AAA dissection symptoms

A

asymmetric BP in upper and lower limbs
mesenteric ischemia
refractory HTN (2/2 renin secretion if renal artery involvement)
paraparesis
Peripheral neuropathy (anterior spinal artery involvement)

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6
Q

CXR findings in AAA dissection

A

abnormal in 85% of patients:

1) widened mediastinum
2) loss of aortic knotch
3) “calcium sign” aortic shadow extension >5mm from an aortic calcification

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7
Q

AAA dissection treatment

A

Aim to reduce sympathetic tone via pain control, SBP 100-120 and heart rate <60

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8
Q

6Ps of acute arterial occlusion

A 
Pain
Pallor
Pulseless
Paralysis 
Paresthesia
Polar (cold)
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9
Q

PE CXR signs

A

Hampton hump -> wedge shaped density

Westermark sign -> decreased vessel marking distal to embolus

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10
Q

PE treatment

A

1) anticoagulation with heparin (if contraindicated then use fonda)
2) thrombolysis if massive PE (hypotension, severe hypoxia, cardiac arrest, evidence of R heart strain on ecg). Tpa 100mg over 2 hours
3) Embolectomy -> beneficial if large embolism not resolved with thrombolysis
4) IVC filter

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11
Q

RBBB ecg findings

A

QRS >120
RSR’ in V1-V3 with appropriately discordant T wave
Wide slurred S wave in V5-6

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12
Q

Causes of RBBB

A

Can be normal variant

Can be due to pulmonary HTN, COPD, PE, cariomyopathy

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13
Q

LBBB ecg

A

QRS >120
Dominant S wave in V1 (deep)
Broad monophasic R wave in lateral leads
Prolonged R wave peak time V5-6 (may be M shape)

Due to depolarization issues there will always be repolarization issues: normal to have ST elevation in leads V1-3, ST depression in lateral and V4, Inverted T waves

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14
Q

Scarbosa-Smith criteria

A
  1. STe >1mm in any lead with positive QRS (V4-6, avL, 1)
  2. STd >1mm in V1-3
  3. Abnormal/excessive discordance (T wave opposite to QRS with depth >25% of preceding S wave)
    Total >3 points for 20-36% sensitivity and 90-98% specificity
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15
Q

Hyper K ecg findings

A 
P wave flattening
PR prolonged
QRS widened
Peaked T waves
Sine wave pattern
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16
Q

HypoK ecg findings

A

Flattening T waves
Prominent U waves
ST depression at low levels

17
Q

electrolytes leading to long QT

A

hypoK
hypoCa
hypoMg

18
Q

Heart Failure Treatment

A 
Lasix
Morphine
Nitrates (nitroglycerine and nitroprusside)
Oxygen
Positioning

If hypotensive: correct underlying hypovolemia with fluid challenge first and give norepi (temporary rescue strategy, will increase myocardial demand)

19
Q

Types of cardiomyopathy

A
  1. Dilated -> EtOH, pregnancy, HTN, myocarditis. Treat like CHF and mortality benefit from ACE/ARB
  2. Restrictive -> least common, restricted filling but preserved systolic function. Caused by amyloidosis, srcoid, hemochromatosis etc. Important to differentiate from constrictive pericarditis
  3. Hypertrophic -> often autosomal dominant, average age 30-40 with exertional syncope
  4. Arrhytmogenic R ventricular dysplasia -> autosomal dominant disorder with RV replaced with fibrofatty tissue. Sudden cardiac death or ventricular dysrhythmia. May see RBBB
  5. Unclassified -> Takotsubo, stress cardiomyopathy
20
Q

Causes of myocarditis

A

Viral (Coxsackie, Adeno, Hep B and C, HIV)
Chagas (parasite)
Bacterial (B-hemolytic strep, mycoplasma pneumoniae, diptheria, lyme)
Autoimmune (Kawasaki, SLE, sarcoidosis etc)

21
Q

Myocarditis symptoms

A

flu-like symptoms are common (fever, fatigue, myalgias, GI upset)
Retrosternal CP, dyspnea, palpitations, syncope
Signs of heart failure/CHF

22
Q

Myocarditis treatment

A

Address infectious symptoms

Treat heart failure (ACEi, B-blockers, diuresis)

23
Q

MI treatment

A

Morphine: 0.05-0.1mg/kg IV
Oxygen >90%
NTG 0.4mg SL q5min PRN x3 then IV drip if symptoms persist (contraindicated in hypotension, RV infarct, PDE inhibitors)
ASA + other antiplatlet (clopidogrel 300mg or ticagrelor 180mg)
heparin 60U/kg
PCI with cath lab
Fibrinolysis (TNK or tpa)

24
Q

Pericarditis causes

A 
majority are idiopathic
systemic diseases: SLE, rheumatic fever
Peri-infarct (1-7 days post MI)
Malignancy
Uremia
Post-trauma
25
Q

Pericarditis signs/symptoms

A

retrosternal, pleuritic, sharp CP relieved by leaning forward.
May hear pericardial friction rub
PR depression is specific

26
Q

Pericarditis treatment

A

NSAIDs and colchicine

27
Q

Beck Triad (tamponade)

A

Hypotension
JVP
Muffled heart sounds

28
Q

Tamponade ecg and echo findings

A

ecg: low QRS voltage, alternans
Echo: R ventricular collapse during diastole

29
Q

HTN emergency treatment

A

reduce MAP by 10-20% in 30-60min or reduction in diastolic pressure to about 110 with additional reduction of MAP by 5-15% over next 23 hours. Use IV meds.
Don’t reduce by too much or too fast due to risk of end-organ ischemia 2/2 relative hypotension

30
Q

Triad for symptomatic AS

A

angina
syncope
chf

31
Q

Infective endocarditis pathogens

A
  1. Staph aureus -> new prosthetic valve or IDU (usually R sided)
  2. Strep -> native valve (usually L sided)
  3. Staph epidermidis -> pacemaker or implantable device
32
Q

Endocarditis symptoms

A 
Fever/malaise
Regurg murmur
Osler nodes/Roth spots
Arterial emboli/septic pulmonary emboi
Janeway lesions
Duke Criteria for diagnosis
33
Q

Infective Endocarditis

A

Vancomycin +/- gentamicin

34
Q

Risk factors when presenting with syncope

A
  1. Increasing age
  2. Hx of ventricular dysrhythmia
  3. History of CHF
  4. Abnormal ecg

First Aid for Boards (2 decks)

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