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Emergency Medicine EOR > EM - Cardio > Flashcards

EM - Cardio Flashcards

1
Q

t/f there has to be some type of prior damage to the tissue for bacterial endocarditis to occur

A

T

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2
Q

MC source of bacterial endocarditis

A

oral procedures

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3
Q

MC organism of native valve endocarditis

A

staph aureus

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4
Q

diseases that increase the risk of endocarditis

A

-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease

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5
Q

MC organism for prosthetic valve endocarditis

A

staph epidermis

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6
Q

MC valve affected by IVDU endocarditis

A

tricuspid

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7
Q

s/s of endocarditis

A

-fever, chills, weakness, SOB
-murmur
-petechiae
-splinter hemorrhages
-janeway lesions
-osler nodes
-roth spots

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8
Q

janeway lesions

A

-painless patched on palms or soles caused by emboli

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9
Q

osler nodes

A

painful lesions on pads of fingers or toes caused by vasculitis

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10
Q

diagnosis of endocarditis

A

-CBC
-blood cultures
-echo

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11
Q

major criteria for endocarditis

A

-2+ positive cultures
-evidence on echo
-new regurg murmur

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12
Q

minor criteria for endocarditis

A

-predisposing heart condition or IVDU
-fever
-vascular or embolic sx
-immunologic sx
-1 positive culture

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13
Q

tx of endocarditis
-native valve
-IVDU
-prosthetic valve

A

-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin

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14
Q

patients who get endocarditis prophylaxis

A

-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant

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15
Q

procedures that require endocarditis prophylaxis

A

-dental procedures
-respiratory trat procedures
-I&D

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16
Q

antibiotic for endocarditis prophylaxis

A

-amoxicillin

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17
Q

stable vs unstable angina

A

-stable: typical and predictable that goes away with rest and NTG
-unstable: unexpected and goes not go away with rest and NTG

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18
Q

prinzmetal angina

A

vasospasm resulting in angina that is treated with NTG and CCB

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19
Q

treatment of sinus bradycardia

A

none if asymptomatic, atropine can increase HR, but pacemaker is definitive

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20
Q

sick sinus syndrome

A

recurrent supraventricular arrhythmias and bradycardia

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21
Q

etiology of sick sinus syndrome

A

medications

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22
Q

treatment of sick sinus syndrome

A

pacemaker

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23
Q

treatment of sinus tachycardia

A

beta blockers

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24
Q

heart blocks

A

-first degree: PR interval >0.2 seconds
-second degree type 1: longer, longer, longer, drop
-second degree type 2: randomly dropped beats
-third degree: no correlation between atria and ventricles

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25
Q

treatment of heart blocks

A

-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)

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26
Q

treatment of PAC

A

-beta blockers or CCB

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27
Q

treatment of PVC

A

-BB

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28
Q

treatment of SVT

A

-mechanical measures
-adenosine
-cardioversion if the patient is hemodynamically unstable

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29
Q

treatment of afib

A

-rate control
-rhythm control
-anticoagulation

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30
Q

how to determine who needs anticoagulation with afib?

A

CHADS2-VASc
-CHF
-HTN
-over 75
-DM
-prior stroke
-vascular disease
-between 65-74
-female

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31
Q

CHADS2-VASc score interpretation

A

VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation

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32
Q

afib treatment for patients who cannot have long-term anticoagulation

A

watchman procedure

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33
Q

treatment of atrial flutter

A

-catheter based radiofrequency ablation
-anticoagulation same as afib

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34
Q

etiology of junctional arrhythmias

A

-digoxin toxicity
-electrolyte abnormalities

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35
Q

sustained vs nonsustained Vtach

A

-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds

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36
Q

brugada

A

incomplete right bundle branch block and ST-segment elevations

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37
Q

management of brugada

A

ICD

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38
Q

management of acute sustained VT

A

-if unstable: cardioversion
-stable: amiodarone

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39
Q

Treatment of nonsustained VT

A

-with heart disease: BB
-without heart disease: BB if symptoms

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40
Q

treatment of vfib

A

immediate defibrillation

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41
Q

etiologies of LBBB and RBBB

A

structural heart disease

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42
Q

treatment of LBBB, treatment of RBBB

A

No Specific Tx

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43
Q

s/s of cardiac tamponade

A

-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus

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44
Q

kussmauls sign

A

increase in JVD on inspiration

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45
Q

pulsus paradoxus

A

inspiratory systolic fall in arterial pressure

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46
Q

EKG of tamponade

A

electrical alternans

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47
Q

CXR of tamponade

A

water bottle heart

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48
Q

diagnosis of tamponade

A

echo

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49
Q

treatment of tamponade

A

pericardiocentesis

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50
Q

which arteries feed which parts of the heart?

A

-right coronary: inferior wall and RV
-LAD: septum and anterior wall
-left circumflex: lateral wall

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51
Q

angina pectoris

A

used to describe chest discomfort related to ischemia

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52
Q

most sensitive cardiac marker

A

Troponin I

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53
Q

most sensitive early marker for MI

A

myoglobin

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54
Q

positive test for exercise stress test

A

ST depression of 1mm

55
Q

initial management of all ACS

A

-chewable ASA
-NTG
-oxygen if needed
-morphine if pain isn’t managed by NTG

(MONA)

56
Q

STEMI management

A

-re-perfusion via fibrinolytics or PCI
-anti-platelet
-anti-coagulant

57
Q

if using TPA…

A

-plavix
-lovenox

58
Q

if doing PCI…

A

-brilinta
-UFH

59
Q

timeline for STEMI management

A

-30 minutes for fibrinolytics
-120 minutes for PCI

60
Q

presentation of heart failure

A

-DOE
-PND
-orthopnea
-s3 heart sound
-JVD
-peripheral edema
-ascites

61
Q

diagnosis of heart failure

A

-CXR: cardiomegaly, interstitial edema
-BNP
-echo

62
Q

treatment of heart failure

A

-lasix
-ace/arb
-BB
-SGLT2

63
Q

treatment of hypertensive heart failure

A

-NTG
-then lasix

64
Q

treatment of cardiogenic shock

A

-oxygen
-250-500mL of IV fluids
-vasopressors

65
Q

NYHA classification of heart failure

A

Class I: symptoms only occur with vigorous activities
II: symptoms with prolonged or moderate exertion, slight limitation of activities
III: symptoms occur during ADLs, markedly limiting
IV: symptoms occur at rest

66
Q

ACC/AHA classification of heart failure

A

-A: high risk of heart failure
-B: structural heart defect but no symptoms
-C: structural changes and symptoms
-D: advanced disease causing hospitalization

67
Q

management for HFpEF vs HFrEF

A

-HFpEF: lifestyle modifications and diuretics
-HFrEF: combination of multiple meds

68
Q

s/s of acute decompensated HF

A

-pulmonary edema
-pink frothy sputum
-diaphoresis and cyanosis
-inspiratory rales

69
Q

management of acute decompensated HF

A

-stabilize
-IV lasix
-NTG

70
Q

presentation of cardiogenic shock

A

-cool, clammy skin
-tachycardia
-hypotension

71
Q

hypertensive urgency

A

-no symptoms
-225/125
-no evidence of end organ damage

72
Q

Hypertensive Emergency

A

(>220/130) WITH end organ damage.

73
Q

treatment of hypertensive urgency

A

-clonidine
-captopril
-nifedipine

74
Q

Tx Hypertensive emergency

A

BP decreased no more than 25% in first 2 HOURS→ goal BP of 160/100 over next 2-6hrs

BB 1st Line

75
Q

s/s of hypotension

A

-lightheadedness
-syncope
-nausea
-confusion
-fatigue

76
Q

definition of orthostatic hypotension

A

-fall in SBP of 20
-fall in DBP of 10

77
Q

diagnosis of orthostatic hypotension

A

-bedside table tilt test

78
Q

management of orthostatic hypotension

A

-lifestyle modifications
-fludrocortisone
-midodrine

79
Q

POTS s/s (eye roll)

A

-hypotension
-tachycardia
-syncope

80
Q

diagnosis of POTS

A

formal tilt table test
-increase in HR by 30 or to 120 in 10 minutes
-no change in BP

81
Q

strongest risk factors for PAD

A

-diabetes
-smoking

82
Q

presentation of PAD

A

-claudication
-relieved with rest
-decreased pulses
-cool skin
-distal hair loss
-shiny skin

83
Q

pseudoclaudication

A

painful cramps that are not caused by peripheral artery disease, but rather, by spinal, neurologic, or orthopedic disorders such as spinal stenosis, diabetic neuropathy, or arthritis
-occurs with standing and can last up to 30 minute

84
Q

diagnosis of PAD

A

-ABI < 0.9
-angiography gold standard

85
Q

treatment of PAD

A

-lifestyle modifications
-ASA or plavix
-statins

86
Q

Mcc of embolus occlusion

A

afibbers

87
Q

S/S of Arterial Occlusion

A

-pain
-pallor
-pulselessness
-paralysis
-poikilothermia
-parasthesias

88
Q

management of arterial occlusion

A

immediate revascularization and IV heparin

89
Q

management of arterial occlusion

A

immediate revascularization and IV heparin

90
Q

thromboangiitis obliterans etiology

A

thrombotic processes

91
Q

s/s of thromboangiitis obliterans

A

-distal ischemic rest pain or ischemic ulcerations

92
Q

management of thromboangiitis obliterans

A

tobacco cessation

93
Q

required workup for syncope

A

-EKG
-cardiac monitoring

94
Q

vasovagal syncope

A

sudden faint due to hypotension induced by response of the autonomic nervous system to abrupt emotional stress, pain, or trauma

95
Q

carotid sinus syncope

A

-reflex syncope due to turning of head, tight collar, or shaving

96
Q

diagnosis of carotid sinus syncope

A

carotid massage
-drop of SBP by 50

97
Q

treatment of carotid sinus syncope

A

none, f/u with pcp :(

98
Q

subclavian steal syndrome

A

stenosis of the subclavian artery which results in decreased perfusion pressure to the distal subclavian leading to arm stealing blood from brain and syncope

99
Q

s/s of subclavian steal syndrome

A

-upper extremity pain and paresthesias
-syncope

100
Q

diagnosis of subclavian steal syndrome

A

-CTA with contrast

101
Q

treatment of subclavian steal syndrome

A

-statins
-antiplatelets and anticoagulants
-smoking cessation

102
Q

basilar artery insufficiency

A

insufficiency causes by a blockage from TIA or stroke

103
Q

s/s of basilar artery insufficiency

A

-n/v
-weakness
-syncope
-dysarthria
-dysphagia

104
Q

diagnosis of basilar artery insufficiency

A

-CT brain without contrast
-HINTS exam

105
Q

treatment of basilar artery insufficiency

A

lipid management
antiplatelets
smoking cessation

106
Q

s/s of aortic stenosis

A

-angina
-syncope
-midsystolic murmur that radiates to the carotids

107
Q

treatment of aortic stenosis

A

surgery

108
Q

Etiologies of aortic regurgitation

A

-rheumatic fever
-infective endocarditis
-marfans
-root dilation

109
Q

s/s of aortic regurgitation

A

-development of CHF sx
-diastolic murmur that radiated to the apex
-widened pulse pressure

110
Q

treatment of aortic regurg

A

-surgery for symptomatic
-vasodilators

111
Q

mcc of mitral stenosis

A

rheumatic fever

112
Q

s/s of mitral stenosis

A

-pulmonary vascular congestion sx
-diastolic murmur at the mitral post
-opening snap

113
Q

treatment of mitral stenosis

A

-BB
-diuretics
-surgery

114
Q

S/S of mitral regurgitation

A

-CHF sx
-systolic murmur at apex that radiated to axilla and back

115
Q

treatment of mitral regurg

A

-vasodilators
-diuretics
-surgery

116
Q

s/s of MVP

A

-CP
-dizziness
-palpitations
-anxiety
-mid-systolic click and late systolic murmur

117
Q

management of MVP

A

-typically none

118
Q

when is it considered a AAA?

A

when it is over 3cm in diameter

119
Q

S&S of Ruptured Aortic Aneurysm

A

-severe mid abdominal pain radiating to lower back
-palpable abdominal mass
-hypotension

120
Q

diagnosis of AAA

A

US

121
Q

screening for AAA

A

men 65-75 who have ever smoked

122
Q

treatment of AAA

A

endovascular repair

123
Q

types of aortic dissection

A

-type A: involves arch proximal to the left subclavian
-type B: beyond the left subclavian

124
Q

presentation of aortic dissection

A

-severe, tearing, CP that radiates to the upper back
-hypertensive

125
Q

diagnosis of aortic dissection

A

-CTA

126
Q

treatment of aortic dissection

A

-labetalol
-morphine
-surgery

127
Q

for aortic dissection, lower BP to…

A

120 SBP

128
Q

surgical indications for aortic dissection

A

-all type A
-type B with end organ damage

129
Q

presentation of superficial venous thrombophlebitis

A

-redness, induration, and tenderness along a superficial vein
-palpable cord

130
Q

management of superficial venous thrombophlebitis

A

-NSAIDs
-compression socks
-elevation
-warm compress
-anticoagulation

131
Q

s/s of lymphangitis

A

-fever and chills
-red streak proximal to lymph node

132
Q

diagnosis of lymphangitis

A

CBC and blood cultures

133
Q

management of lymphangitis

A

-abx
-NSAIDs
-warm compress
-elevate

Emergency Medicine EOR (12 decks)

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