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
2
Q
MC source of bacterial endocarditis
A
oral procedures
3
Q
MC organism of native valve endocarditis
A
staph aureus
4
Q
diseases that increase the risk of endocarditis
A
-rheumatic fever
-congenital heart diseases
-MVP
-degenerative heart disease
5
Q
MC organism for prosthetic valve endocarditis
A
staph epidermis
6
Q
MC valve affected by IVDU endocarditis
A
tricuspid
7
Q
s/s of endocarditis
A
-fever, chills, weakness, SOB
-murmur
-petechiae
-splinter hemorrhages
-janeway lesions
-osler nodes
-roth spots
8
Q
janeway lesions
A
-painless patched on palms or soles caused by emboli
9
Q
osler nodes
A
painful lesions on pads of fingers or toes caused by vasculitis
10
Q
diagnosis of endocarditis
A
-CBC
-blood cultures
-echo
11
Q
major criteria for endocarditis
A
-2+ positive cultures
-evidence on echo
-new regurg murmur
12
Q
minor criteria for endocarditis
A
-predisposing heart condition or IVDU
-fever
-vascular or embolic sx
-immunologic sx
-1 positive culture
13
Q
tx of endocarditis
-native valve
-IVDU
-prosthetic valve
A
-native valve: pen G + gent
-IVDU: nafcillin + gent
-prosthetic valve: vanc + gent + rifampin
14
Q
patients who get endocarditis prophylaxis
A
-prosthetic heart valves
-prior endocarditis
-congenital heart disease
-heart transplant
15
Q
procedures that require endocarditis prophylaxis
A
-dental procedures
-respiratory trat procedures
-I&D
16
Q
antibiotic for endocarditis prophylaxis
A
-amoxicillin
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
18
Q
prinzmetal angina
A
vasospasm resulting in angina that is treated with NTG and CCB
19
Q
treatment of sinus bradycardia
A
none if asymptomatic, atropine can increase HR, but pacemaker is definitive
20
Q
sick sinus syndrome
A
recurrent supraventricular arrhythmias and bradycardia
21
Q
etiology of sick sinus syndrome
A
medications
22
Q
treatment of sick sinus syndrome
A
pacemaker
23
Q
treatment of sinus tachycardia
A
beta blockers
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
25
treatment of heart blocks
-first degree and mobitz 1: none
-mobitz 2 and 3rd degree: pacemaker
Also, Atropine? (2nd and 3rd)
26
treatment of PAC
-beta blockers or CCB
27
treatment of PVC
-BB
28
treatment of SVT
-mechanical measures
-adenosine
-cardioversion if the patient is hemodynamically unstable
29
treatment of afib
-rate control
-rhythm control
-anticoagulation
30
how to determine who needs anticoagulation with afib?
CHADS2-VASc
-CHF
-HTN
-over 75
-DM
-prior stroke
-vascular disease
-between 65-74
-female
31
CHADS2-VASc score interpretation
VASc score interpretation
-0: no antithrombotic therapy needed
-1: ASA or oral anticoagulation
-2: full anticoagulation
32
afib treatment for patients who cannot have long-term anticoagulation
watchman procedure
33
treatment of atrial flutter
-catheter based radiofrequency ablation
-anticoagulation same as afib
34
etiology of junctional arrhythmias
-digoxin toxicity
-electrolyte abnormalities
35
sustained vs nonsustained Vtach
-nonsustained: less than 30 seconds
-sustained: greater than 30 seconds
36
brugada
incomplete right bundle branch block and ST-segment elevations
37
management of brugada
ICD
38
management of acute sustained VT
-if unstable: cardioversion
-stable: amiodarone
39
Treatment of nonsustained VT
-with heart disease: BB
-without heart disease: BB if symptoms
40
treatment of vfib
immediate defibrillation
41
etiologies of LBBB and RBBB
structural heart disease
42
treatment of LBBB, treatment of RBBB
No Specific Tx
43
s/s of cardiac tamponade
-JVD
-muffled heart sounds
-hypotension
-kussmauls sign
-pulsus paradoxus
44
kussmauls sign
increase in JVD on inspiration
45
pulsus paradoxus
inspiratory systolic fall in arterial pressure
46
EKG of tamponade
electrical alternans
47
CXR of tamponade
water bottle heart
48
diagnosis of tamponade
echo
49
treatment of tamponade
pericardiocentesis
50
which arteries feed which parts of the heart?
-right coronary: inferior wall and RV
-LAD: septum and anterior wall
-left circumflex: lateral wall
51
angina pectoris
used to describe chest discomfort related to ischemia
52
most sensitive cardiac marker
Troponin I
53
most sensitive early marker for MI
myoglobin
54
positive test for exercise stress test
ST depression of 1mm
55
initial management of all ACS
-chewable ASA
-NTG
-oxygen if needed
-morphine if pain isn't managed by NTG
(MONA)
56
STEMI management
-re-perfusion via fibrinolytics or PCI
-anti-platelet
-anti-coagulant
57
if using TPA...
-plavix
-lovenox
58
if doing PCI...
-brilinta
-UFH
59
timeline for STEMI management
-30 minutes for fibrinolytics
-120 minutes for PCI
60
presentation of heart failure
-DOE
-PND
-orthopnea
-s3 heart sound
-JVD
-peripheral edema
-ascites
61
diagnosis of heart failure
-CXR: cardiomegaly, interstitial edema
-BNP
-echo
62
treatment of heart failure
-lasix
-ace/arb
-BB
-SGLT2
63
treatment of hypertensive heart failure
-NTG
-then lasix
64
treatment of cardiogenic shock
-oxygen
-250-500mL of IV fluids
-vasopressors
65
NYHA classification of heart failure
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
ACC/AHA classification of heart failure
-A: high risk of heart failure
-B: structural heart defect but no symptoms
-C: structural changes and symptoms
-D: advanced disease causing hospitalization
67
management for HFpEF vs HFrEF
-HFpEF: lifestyle modifications and diuretics
-HFrEF: combination of multiple meds
68
s/s of acute decompensated HF
-pulmonary edema
-pink frothy sputum
-diaphoresis and cyanosis
-inspiratory rales
69
management of acute decompensated HF
-stabilize
-IV lasix
-NTG
70
presentation of cardiogenic shock
-cool, clammy skin
-tachycardia
-hypotension
71
hypertensive urgency
-no symptoms
-225/125
-no evidence of end organ damage
72
Hypertensive Emergency
(>220/130) WITH end organ damage.
73
treatment of hypertensive urgency
-clonidine
-captopril
-nifedipine
74
Tx Hypertensive emergency
BP decreased no more than 25% in first 2 HOURS→ goal BP of 160/100 over next 2-6hrs
BB 1st Line
75
s/s of hypotension
-lightheadedness
-syncope
-nausea
-confusion
-fatigue
76
definition of orthostatic hypotension
-fall in SBP of 20
-fall in DBP of 10
77
diagnosis of orthostatic hypotension
-bedside table tilt test
78
management of orthostatic hypotension
-lifestyle modifications
-fludrocortisone
-midodrine
79
POTS s/s (eye roll)
-hypotension
-tachycardia
-syncope
80
diagnosis of POTS
formal tilt table test
-increase in HR by 30 or to 120 in 10 minutes
-no change in BP
81
strongest risk factors for PAD
-diabetes
-smoking
82
presentation of PAD
-claudication
-relieved with rest
-decreased pulses
-cool skin
-distal hair loss
-shiny skin
83
pseudoclaudication
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
diagnosis of PAD
-ABI < 0.9
-angiography gold standard
85
treatment of PAD
-lifestyle modifications
-ASA or plavix
-statins
86
Mcc of embolus occlusion
afibbers
87
S/S of Arterial Occlusion
-pain
-pallor
-pulselessness
-paralysis
-poikilothermia
-parasthesias
88
management of arterial occlusion
immediate revascularization and IV heparin
89
management of arterial occlusion
immediate revascularization and IV heparin
90
thromboangiitis obliterans etiology
thrombotic processes
91
s/s of thromboangiitis obliterans
-distal ischemic rest pain or ischemic ulcerations
92
management of thromboangiitis obliterans
tobacco cessation
93
required workup for syncope
-EKG
-cardiac monitoring
94
vasovagal syncope
sudden faint due to hypotension induced by response of the autonomic nervous system to abrupt emotional stress, pain, or trauma
95
carotid sinus syncope
-reflex syncope due to turning of head, tight collar, or shaving
96
diagnosis of carotid sinus syncope
carotid massage
-drop of SBP by 50
97
treatment of carotid sinus syncope
none, f/u with pcp :(
98
subclavian steal syndrome
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
s/s of subclavian steal syndrome
-upper extremity pain and paresthesias
-syncope
100
diagnosis of subclavian steal syndrome
-CTA with contrast
101
treatment of subclavian steal syndrome
-statins
-antiplatelets and anticoagulants
-smoking cessation
102
basilar artery insufficiency
insufficiency causes by a blockage from TIA or stroke
103
s/s of basilar artery insufficiency
-n/v
-weakness
-syncope
-dysarthria
-dysphagia
104
diagnosis of basilar artery insufficiency
-CT brain without contrast
-HINTS exam
105
treatment of basilar artery insufficiency
lipid management
antiplatelets
smoking cessation
106
s/s of aortic stenosis
-angina
-syncope
-midsystolic murmur that **radiates to the carotids**
107
treatment of aortic stenosis
surgery
108
Etiologies of aortic regurgitation
-rheumatic fever
-infective endocarditis
-marfans
-root dilation
109
s/s of aortic regurgitation
-development of CHF sx
-diastolic murmur that radiated to the apex
-widened pulse pressure
110
treatment of aortic regurg
-surgery for symptomatic
-vasodilators
111
mcc of mitral stenosis
rheumatic fever
112
s/s of mitral stenosis
-pulmonary vascular congestion sx
-diastolic murmur at the mitral post
-opening snap
113
treatment of mitral stenosis
-BB
-diuretics
-surgery
114
S/S of mitral regurgitation
-CHF sx
-systolic murmur at apex that radiated to axilla and back
115
treatment of mitral regurg
-vasodilators
-diuretics
-surgery
116
s/s of MVP
-CP
-dizziness
-palpitations
-anxiety
-mid-systolic click and late systolic murmur
117
management of MVP
-typically none
118
when is it considered a AAA?
when it is over 3cm in diameter
119
S&S of Ruptured Aortic Aneurysm
-severe mid abdominal pain radiating to lower back
-palpable abdominal mass
-hypotension
120
diagnosis of AAA
US
121
screening for AAA
men 65-75 who have ever smoked
122
treatment of AAA
endovascular repair
123
types of aortic dissection
-type A: involves arch proximal to the left subclavian
-type B: beyond the left subclavian
124
presentation of aortic dissection
-severe, tearing, CP that radiates to the upper back
-hypertensive
125
diagnosis of aortic dissection
-CTA
126
treatment of aortic dissection
-labetalol
-morphine
-surgery
127
for aortic dissection, lower BP to...
120 SBP
128
surgical indications for aortic dissection
-all type A
-type B with end organ damage
129
presentation of superficial venous thrombophlebitis
-redness, induration, and tenderness along a superficial vein
-palpable cord
130
management of superficial venous thrombophlebitis
-NSAIDs
-compression socks
-elevation
-warm compress
-anticoagulation
131
s/s of lymphangitis
-fever and chills
-red streak proximal to lymph node
132
diagnosis of lymphangitis
CBC and blood cultures
133
management of lymphangitis
-abx
-NSAIDs
-warm compress
-elevate
