IM Cardio - Rd 2 Flashcards
Acute MR can occur w/acute MI, what does this cause physiologically in the heart?
Increased LV ED pressure (Filling pressure)
What presents w/anorexia, N/V/ADB pain with weakness and confusion?
D/t what?
Digoxin toxicity
Amiodarone interaction
What is isolated systolic hypertension?
D/t what?
Systolic BP > 140 w/diastolic BP < 90
Increased stiffness or dec elasticity of the aortic and arterial walls in elderly pts
Fibromuscular dysplasia MC involves what arteries?
Renal
Carotid
Vertebral
Scleroderma renal crisis presents how?
peripheral blood smear can show what?
Acute RF and Malignant HTN (HA, blurry vision, nausea)
MAHA w/schistocytes and thrombocytopenia
Young woman with recurrent HAs, very high BP, and subauricular systolic bruit has what?
FMD
Cardiac tamponade is d/t what physiologically?
Dec LV preload
Dec SV
Dec CO
Beta blockers are contraindicated in what setting of ACS?
Pulmonary edema (acute decompensated HF)
What murmur is best heard along the Left sternal border at the 3rd and 4th ICS while pt is sitting up, leaning forward, and holding a breath in full expiration?
AR
What are reentrant ventricular arrhythmias?
MC cause of what?
Ventricular fibrillation
Sudden cardiac death
What can cause pulsus paradoxus?
What is it?
Cardiac tamponade, Asthma, COPD
Dec in systolic BP > 10 on Inspiration
What RF is associated with the highest rate of aneurysm expansion and rupture in a pt with enlarged ABD aneurysm?
Cigarette smoking
NOT uncontrolled HTN
What does the ECG show in a LV aneurysm?
Persistent ST elevation, deep Q waves
MOA of dobutamine?
Dec in LV end-systolic volume
Pt that presents w/signs of pericardial effusion should have pericardiocentesis when?
Hemodynamically unstable
Cardiogenic shock
Cardiac tamponade
Pt with a knife injury to the thigh can develop what?
How can this effect the heart?
AV fistula
High-output cardiac failure causing increased preload
What is a synonym for HOCM?
How does the murmur present?
What symptom can manifest early?
Inter Ventricular septal hypertrophy
Crescendo-decrescendo systolic murmur at left sternal border w/out radiation
Syncope
What diseases present with High Output Heart Failure?
Anemia Hyperthyroidism Beriberi Paget disease AV fistula
Pt that has AFib and develops acute arterial occlusion should have been prophylaxed with what?
Apixaban or any anticoagulation
Development of AV block in a pt w/IE should raise suspicion for what?
What symptom do they most likely have?
Perivalvular abscess
Syncope
What arrhythmia is most specific for digitalis toxicity?
Atrial tachycardia w/AV block
Young pt (late 20’s or early 30s) that presents w/very high HTN and symptoms of HA and epistaxis has what?
Coarctation of aorta
Bicuspid aortic valve can cause what uncommon finding in young adult pts?
AR d/t valvular leaflet abnormalities
Pt that has palpable b/L ABD masses with morning HAs, HTN and normal Cr function w/FHx of early death by father has what?
ADPKD
HTN generally PRECEEDS the decline in renal function
Pts with Portal vein thrombosis/compression do NOT have what key feature?
JVD
+ hepatojugular reflex indicates what?
TR
HF d/t non-valvular cause
Constrictive pericarditis
Cardiac tamponade
What has the highest sensitivity for diagnosing CHF?
What has a very high specificity?
BNP
S3
Pulsus parvus et tardus is what?
Seen in what?
Dec pulse amplitude and delayed pulse upstroke
AS
Older pt that has sinus pauses, Inc PR interval and Inc QRS duration that presents w/syncope may have what?
Sick sinus syndrome
Bradyarrhthymia
AV block
What is unsynchronized cardioversion?
Defibrillation
Pt that is on anti-arrhythmic meds and presents w/progressive dyspnea, nonproductive Cough, b/L inspiratory crackles, and CXR showing b/L lung infiltrations primarily involving the middle lung fields has what?
D/t what?
Amiodarone-induced interstitial pneumo it is
too much loop diuretics
Pt that has undergone CABG and the next day presents w/equalization of pressures (RA, RV, PCWP all similar around 20) and HoTN has developed what?
Best next step?
Cardiac tamponade
Echocardiogram
Pt w/LE swelling that is worse in the evening has what?
What treatment is most likely to relieve the pt’s symptoms?
What effect does smoking have?
chronic venous insufficiency
Frequent leg elevation
NONE
What presents w/persistent ST-elevation after a recent MI and deep Q waves?
Ventricular aneurysm
What are the classic sx of pericarditis?
Pleuritic chest pain, fever, pericardial friction rub
Pt that has decompensated HF, what is the body doing to compensate?
Activate RAAS —> constrict efferent arteriole
What pts should have electrophysiology testing done?
1st degree AV block with PROLONGED QRS
How do you treat sustained monomorphic V Tach (SMVT) if the pt is stable?
Unstable?
IV amiodarone
Cardioversion
Young pt that has unexplained HTN should get a detailed H&P, what should the workup be next?
UA —> looking at protein and Cr
CMP
Lipid profile
Baseline EKG
Spotty calcifications along the left heart border indicates what?
Commonly caused by what?
Constrictive pericarditis
Prior cardiac surgery
Pts w/a 10-year atherosclerotic cardiovascular disease risk > what should be treated with statin?
What age group?
> 7.5
40-75
Acute aortic dissection that progresses to syncope can be d/t what complication?
Cardiac tamponade (pericardial fluid accumulation)
What kind of drugs used to treat AFib can cause use dependence leading to widening of the QRS complex?
Class IC —> flecainide
What is a long QT in men?
Women?
> 450 msec
> 470 msec
Amyloid cardiomyopathy is a type of what?
What additional symptoms can be present?
Restrictive cardiomyopathy
CHF, proteinuria, LVH
