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Emma's NPLEX II Dx > CV > Flashcards

CV Flashcards

1
Q

Can abdominal aortic aneurysms be identified with plain film x-rays?

A

50% can be identified with plain film imaging (d/t calcification at the site of a focal bulge) however CT scan should be performed to confirm the diagnosis

US is the best at detecting

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2
Q

What ECG changes are present in pericarditis?

A
  1. ) ST Elevation

2. ) PR Depression

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3
Q

What value designates a high risk in hsCRP?

A

> 3.0mg/L

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4
Q

Describe the different degrees of AV nodal heart block. What ECG findings can be noted?

A

First Degree

 a. ) Consistent, Prolonged PR interval (>0.2 sec)
 b. ) There is a 1:1 ratio of P:QRS waves

Second Degree Mobitz Type-I

   a. ) Progressive PR interval prolongation with each beat until a P wave is not conducted (Wenckebach Phenomenon)
   b. ) Usually asymptomatic

Second Degree Mobitz Type-II

  a. ) Normal P wave intervals with intermittently absent QRS complexes
  b. ) Irreversible, requiring a pacemaker 
  c. ) If left untreated, it may lead to complete heart block

Third Degree, Complete Heart Block

  a. ) No action potential conducts through the AV node
  b. ) Ventricles never see action potentials generated by the atria. The ventricles compensate by making action potentials on their own. However, ventricles are unable to create action potentials fast enough so the ventricular rate (QRS complex) is slow (30-40 per min) in comparison to the atrial (P wave) rate (60-100 per min)
  b. ) AV disassociation. P waves occur at one rate and the QRS complex occurs at another
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5
Q

What is the diagnostic test used for Carotid Stenosis?

A

Carotid Artery Duplex Ultrasonography

However, Carotid Magnetic Resonance Angiography is more specific and sensitive

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6
Q

How can you differentiate Subendothelial MIs from Transmural MIs on an ECG?

A
  1. ) Subendothelial MIs are NSTEMIs demarcated by ST depression
  2. ) Transmural MIs are STEMIs demarcated by ST elevation & the presence of a Q wave
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7
Q

What is the best screening study for vasculitis?

A

Ultrasound

However, MRA is the most sensitive test

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8
Q

How does hyperkalemia and hypokalemia affect an ECG reading?

A 
Hyperkalemia = Wide P, QRS & Peaked T wave
Hypokalemia = Flat T wave & U wave is present
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9
Q

What is a notched p wave on ECG indicative of?

A

Left Atrial Enlargement from Mitral Stenosis

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10
Q

How does hypercalcemia and hypocalcemia affect an ECG?

A 
Hypocalcemia = Long QT
Hypercalcemia = Short QT
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11
Q

What imaging modality is the gold standard in acute intracranial aneurysm identification?

A

CT Scan

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12
Q

What is the most important test for infective endocarditis?

A

Blood Culture

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13
Q

In the first 6 hours what test is the gold standard in identifying an MI?

A

ECG (because troponin I + T do not reach peak concentration until 12 hours)

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14
Q

Endocarditis requires what testing?

A

Blood cultures and echocardiogram (shows vegetations)

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15
Q

What is the best test for detecting an Aortic Dissection?

A

CT

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16
Q

What are the clinical features of DVT?

A
  1. ) Unilateral leg edema, erythema, warmth, and tenderness
  2. ) Palpable cord (thrombosed vein)
  3. ) Phelgmasia cerulea dolens (painful blue edema) occurring with massive thrombosis

NOTE: Homan’s sign (pain with foot dorsiflexion) is unreliable

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17
Q

A systemic vasculitis characterized by the deposition of IgA immune complexes. The condition generally resolves within several weeks.

A

Henoch-Schonlein Purpura

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18
Q

What symptoms are very concerning in a patient with DVT?

A

Change in consciousness and dyspnea

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19
Q

What pressure demarcates pulmonary hypertension?

A

> 25 mmHg

Normal pulmonary pressure is 10 mmHg

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20
Q

What is polyarteritis nodosa?

A

A medium vessel vasculitis causing ischemia of tissues supplied by the respective blood vessels (skin, heart, kidneys).

Polyarteritis nodosa can cause glomerulonephritis, MI, thrombosis, and tissue necrosis

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21
Q

What is Virchow’s Triad?

A

Virchow’s Triad describes the three broad risk factors necessary for thrombus formation:

  1. ) Hypercoagulability
  2. ) Hemodynamic changes (stasis, turbulence)
  3. ) Endothelial injury
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22
Q

Intermittent claudication has what brachial to ankle ratio?

A

< 0.6

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23
Q

What are the 3 most common causes of Aortic Stenosis, in order of prevalence?

A
  1. ) Calcific Stenosis later in life
  2. ) Congenital bicuspid valve
    3) Rheumatic Heart Disease
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24
Q

What 3 pathologies increase HDL?

A
  1. ) Alcoholism
  2. ) Nephrotic syndrome
  3. ) Pancreatitis
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25
Q

Describe why cholesterol accumulates with vitamin C deficiency

A

Vitamin C is a cofactor for 7-alpha hydroxylase, the first and commiting step in bile formation.

No Vitamin C = No 7-alpha hydroxylase = No bile formation = No cholesterol excretion

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26
Q

Where is the most common site for a Cerebral Vascular Accident (CVA)?

A

Middle Cerebral Artery (causing contralateral paralysis and aphasia)

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27
Q

What are the causes of non-ANCA associated small vessel vasculitides?

A
  1. ) Paraneoplastic Small Vessel Vasculitis
  2. ) Inflammatory Bowel Disease
  3. ) Immune Complex Small Vessel Vasculitis
    a. ) Henoch-Schonlein Purpura & Cryglobulinemia
    b. ) SLE, RA, Sjogren’s Syndrome
    c. ) Drug or Infection-induced immune complex vasculitis
    d. ) Behcet’s disease
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28
Q
  1. ) What are the primary dermatologic findings associated with vasculitis?
  2. ) What are the primary pulmonary findings associated with vasculitis?
A
  1. ) Palpable Purpura & Urticaria

2. ) Interstitial Lung Disease & Pulmonary hemorrhage

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29
Q

What population group is most likely to experience Primary Pulmonary HTN

A

Young Adult Females

Note: primary pulmonary HTN is idiopathic but believed to be hereditary

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30
Q

Describe differences between Chronic Venous and Arterial Insufficiency

i. ) Pulse
ii. ) Colour
iii. ) Skin Temp
iv. ) Edema
v. ) Skin condition
vi. ) Ulceration
A

i.) CVI = pulses intact
CAI = pulses absent or decreased

ii.) CVI = cyanosis; brown pigmentation
CAI = pale skin (especially when raised)

iii.) CVI = normal temp
CAI = cold to touch

iv.) CVI = Pitting edema
CAI = none or mild

v.) CVI = stasis dermatitis; lichenification
CAI = thin, atrophic, shiny skin with loss of hair

vi.) CVI = medial leg ulceration, painless
CAI = points of trauma can progress to gangrene

31
Q

What are the 2 major signs of Aortic Dissection?

A
  1. ) Severe chest pain that lasts for many hours and is not related to anything
  2. ) Blood pressure is different in both arms
32
Q

An aneurysm of what size infers a 75% risk of rupture?

A

> 7cm

33
Q

An ankle-to-brachial artery index of less than _____ indicates arterial occlusive disease

A

<0.85

34
Q

What is the most common arrhythmia?

A

Premature Ventricular Contractions

35
Q

What fruit is good for vascular integrity because it contains anthocyanidins

A

Blueberries

36
Q

What is the Diagnostic Criteria for Metabolic Syndrome (WHO)

A

Any one of:

i. ) DM-2
ii. ) IFG
iii. ) Insulin Resistance

Plus any 2 of:

a. ) BP >139/89 (stage 1 HTN)
b. ) Dyslipidemia (TG >1.7, HDL <0.9)
c. ) Central Obesity (waist-to-hip >0.85 in women, 0.9 in men)
d. ) Microalbuminuria >20mg/min (ACR>30)

37
Q

What is considered a hypertensive crisis?

A

> 180/120 mmHg

38
Q

Premature Atrial Contraction

1. ) What is PAC?   2.) Risk Factors?
3. ) Sequelae?        4.) Prognosis?
A
  1. ) One beat occurs early, irregularly on ECG but other features are normal (PR is variable but QRS is normal)
  2. ) Risk factors = Caffeine intake, Stress, Alcohol/Cocaine/Amphetamine use
  3. ) Sequelae = Atrial fibrillation
  4. ) Prognosis is good - often remains asymptomatic.
39
Q

An aneurysm is a dilation in one segment of an artery that is due to a defect in the ____________, which may lead to a ____________ if ruptured.

A

An aneurysm is a dilation in one segment of an artery that is due to a defect in the tunica media, which may lead to a subarachnoid hemorrhage if ruptured.

It usually occurs at major branching points of arteries

40
Q

What is the main cause of Mitral Stenosis?

A

Rheumatic Heart Disease

41
Q

On auscultation, what is heard in aortic stenosis?

A
  1. ) Systolic ejection murmur (crescendo-decrescendo) at the 2nd right intercostal space
  2. ) Aortic Stenosis murmurs can also often be heard over carotid arteries
42
Q

On auscultation, what is heard in aortic regurgitation?

A

A Diastolic decrescendo mumur heard with the diaphragm at the LLSB with the patient sitting forward and exhaling

43
Q

Describe the signs and symptoms of Left Heart Failure

A

Orthopnea & Dyspnea with Rales & Frequent lung infections

Forward deficit = due to reduced Left ventricular emptying -> kidney hypoxia & brain hypoxia
Backward Deficit = causes fluid buildup in the lungs resulting in orthopnea, dyspnea, and frequent infections. The backload pressure may stress the right ventricle & cause RHF

44
Q
  1. ) Atrial fibrillation is almost always due to?
  2. ) What are the signs and symptoms of atrial fibrillation?
  3. ) What are the sequelae?
A

1.) A Heart pathology

  1. ) Signs & Symptoms
    a. ) Loss of normal atrial contraction with some irregular impulses
    b. ) sawtooth atrial contraction with QRS complexes irregularly spaced but normally configured
    c. ) R-R intervals change all the time

3.) Sequelae: systemic emboli

45
Q

What are the main symptoms of Mitral Stenosis?

A
  1. ) Shortness of Breath & Orthopnea

2. ) Dyspnea on exertion

46
Q

Why do people with a ventricular septal defect have pulmonary hypertension?

A

Blood is shunted from the high-pressure systemic circulatory system into the normally low-pressure pulmonary circulation. This raises the overall pressure and leads to pulmonary hypertension

47
Q

What extra-cardiac symptoms are usually present in endocarditis?

A
  1. ) Petechiae on the conjunctiva or nail beds

2. ) Splinter hemorrhages

48
Q

What heart murmur may cause hemoptysis?

A

Mitral stenosis

Hemoptysis is the second most common presenting symptom of mitral stenosis.

49
Q

On auscultation, what is heard in pulmonic stenosis?

A

1.) A Systolic crescendo-decrescendo murmur heard in 2nd left intercostal space with diaphragm or bell

50
Q

What are the risk factors for pulmonic stenosis?

A
  1. ) Endocarditis

2. ) Pulmonary hypertension

51
Q

What are the 4 findings of tetralogy of fallot?

A

1.) Pulmonary stenosis

  1. ) Right Ventricular Hypertrophy
    a. ) From increased pressure from pulmonary stenosis
  2. ) Overriding aorta
  3. ) Ventricular Septal Defect (right to left shunt)
52
Q
  1. ) What is required for the diagnosis of Rheumatic Fever?

2. ) What is Rheumatic fever?

A
  1. ) Rheumatic Fever is an acute inflammatory complication associated with cross-reactivity of group A beta-hemolytic streptococcus infection (molecular mimmickry)
  2. ) JONES major criteria used (2 positive) plus proof of GAS infection through antistreptolysin O titre or DNAase

Joints - polyarthritis (of large joints)
Carditis - myocarditis that can manifest as CHF with dyspnea or pericarditis with a rub
Subcutaneous nodules - painless, firm collections of collagen fibres over bones or tendons
Erythema marginatum - expanding red macules with central clearing on the trunk or arms
Syndeham’s chorea - rapid movements without purpose

53
Q

What symptoms are associated with right ventricle failure?

A

Dyspnea, Cough, Edema, and possibly Liver disorders

54
Q

What murmur has a water hammer pulse?

A

Aortic Regurgitation

55
Q

What type of murmur is heard in a ventricular septal defect?

A

Holocystolic crescendo-decrescendo on systole best heard with the diaphragm at the lower left sternal border

56
Q

On auscultation, what is heard in Mitral stenosis?

A

A Diastolic opening snap followed by a low-pitch growling murmur heard at apex with BELL

NOTE: use the BELL because the murmur produces a low-pitch growling sound

57
Q

An S4 heart sound is associated with what finding?

A

Ventricular hypertrophy

The atria are contracting forcefully to overcome an abnormally stiff hypertrophic ventricle

58
Q

What murmur is best heard on inspiration?

A

Tricuspid stenosis

59
Q

What are the main symptoms of Aortic Stenosis?

A
  1. ) Angina
  2. ) Syncope
  3. ) Shortness of Breath
  4. ) Congestive Heart Failure
60
Q

List the two types of Myocardial Infarctions, and their respective differences

A
  1. ) Transmural infarcts (ST elevation & Q Waves = STEMI)
    a. ) Involves the entire thickness of the (generally) left ventricular wall
    b. ) 15-30% of cases involve the right ventricle as well
  2. ) Subendocardial infarcts (ST Depression = NSTEMI)
    a. ) Focal areas of necrosis confined to the inner 1/3-1/2 of the left ventricular wall
61
Q

What age group is most likely to present with pulmonic stenosis?

A

Usually children

62
Q

On auscultation, what is heard in mitral regurgitation?

A

A high-pitched (blowing) Systolic murmur heard at the apex with the diaphragm

63
Q

What are the primary causes of Pericarditis?

A

Infarct, Tumor, Rheumatic fever, Uremia, Bacterial/Viral, SLE, scleroderma

IT RUBS

64
Q

What murmur is heard with the diaphragm at LLSB and the patient sitting forward and exhaling?

A

Aortic Regurgitation

65
Q

What are the most common symptoms associated with pulmonic stenosis?

A

Patients are generally asymptomatic

66
Q

Endocarditis is usually caused by what infectious agent?

A

Staph aureus

Subacute endocarditis is usually caused by streptococcus viridans

67
Q

On auscultation, what is heard in tricuspid stenosis?

A

A Diastolic rumbling murmur heard at the left lower sternal border with the BELL

Note: the murmur is best heard on inspiration

68
Q

Describe the difference between Thrombophlebitis and Phlebothrombosis

A
  1. ) Thrombophlebitis = venous thrombosis occurring secondary to acute inflammation of the vein; thrombi are adherent to vein’s wall; embolism is rare
  2. ) Phlebothrombosis = venous thrombosis occurring in the absence of obvious inflammation; thrombi are loosely attached to the vein wall; embolism is common
69
Q

What murmur increases in sound with valsalva?

A

Mitral Valve Prolapse

70
Q

Describe the signs and symptoms of Right Heart Failure

A

RHF

   a. ) Dilated jugular veins, liver enlargement, Ascites/Edema
   b. ) Tachycardia/tachypnea

Forward Deficit = due to reduced right ventricular emptying -> less blood to lungs
Backward Deficit = portal hypertension (hemorrhoids, caput medusae, esophageal varices, splenomegally)

71
Q

What are the major risk factors of aortic stenosis?

A
  1. ) Age (elderly)
  2. ) History of Rheumatic Fever
  3. ) Congenital bicuspid aortic valves (50% of all cases)
72
Q

What is the classic triad of symptoms related to a worsening aortic stenosis?

A
  1. ) Syncope
  2. ) Angina
  3. ) Dyspnea on exertion
73
Q

On auscultation, what would you expect to hear in an atrial septal defect?

A

Split S2 at the 2nd intercostal

There is a split S2 because blood is being shunted towards the lower-pressured pulmonic circulatory system causing a delayed closure of the pulmonary valve

74
Q

An S3 heart sound is associated with what condition?

A

Congestive Heart Failure

Emma's NPLEX II Dx (10 decks)

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