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cardio and pulm > LA cardiac pt 1 > Flashcards

LA cardiac pt 1 Flashcards

1
Q

dilated CM
-vent wall
-dysfunction
-etio
-EF
-murmur

A

-vent wall: thin, decreased contractility
-dysfunction: systolic
-etio: A B C C D (alcohol, beriberi(thiamine), cocaine, chagas, coxsackie B(enterovirus), doxorubicin
idiopathic most common
-EF: under 40%
-S3 gallop, MR or TR

avoid CCB

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2
Q

kussmaul sign

A

lack of inspiratory decline or increase in JVP.

restrictive CM, pericarditis

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3
Q

HOCM
-vent wall
-dysfunction
Most common sx

-EF
-murmur

A

-vent wall: thick, small ventricle
-dysfunction: diastolic
-most common symptom: dyspnea
-EF: preserved
-murmur: S4 loud, MR, S3, pulsus bisferens

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4
Q

increase LV volume how

A

squatting, leg raise

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5
Q

decrease LV volume how

A

valsalva, standing

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6
Q

what movement will accenuated HOCM

A

standing

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7
Q

3rd degree heart block first line tx

A

transcutaneous pacing

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8
Q

sinus rhythm with inspiration and expiration

A

rhythm increases with inspiration

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9
Q

1st degree AV block

A

PR interval prolonged (>0.20).

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10
Q

wenkebach

A

mobitz 1

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11
Q

mobitz 1 vs 2

A

1: wenkebach: progressive PR lengthening then dropped qrs

2: constant prolonged PR interval then dropped qrs

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12
Q

which av block seen in pts with structural hrt disease

A

mobitz 2

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13
Q

sawtooth pattern on ekg

A

atrial flutter

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14
Q

a flutter
-rate
- ecg picture

A

300 beats/min

sawtooth

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15
Q

most common chronic arrhythmia

A

a fib

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16
Q

afib vs aflutter

A

aflutter has one irritable atrial foci, afib has multiple

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17
Q

4 types of a fib

A

paroxysmal, persistant, permanent, lone

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18
Q

ashman’s phenomenon

A

occasional abberrantly conducted beats (wide QRS) after short R-R cycles

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19
Q

Afib tx

A

stable: rate control with BB or CCD(D/V)

digoxin is BB/CCB contraindicated

unstable: direct current synchronized CV

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20
Q

anticoagulation and cardioversion

A

AF > 48 hours: anticoagulation at least 3 weeks before CV

AF < 48 hours: anticoagulation for 4 weeks after CV

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21
Q

CHA2DS2-VASc

A

chronic oral anticoagulation for score of or higher

CHF, HTN, Age>75(2), DM, Stroke/TIA/Thrombus(2), Vascular disease(prior MI, aortic plaque, PAD), age 65-74, sex(female)

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22
Q

dabigatran

A

direct thrombin inhibitor(binds and inhibits thrombin)

non vitamin K antagonist oral anticoagulant

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23
Q

rivaroxaban, apixaban, edoxaban

A

factor 10a inhibitors

non vitamin K antagonist oral anticoagulant

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24
Q

pts for warfarin

A

severe CKD, contraindicated to use carbamazepine, phenytoin, cost issue

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25
PSVT most common type
AV node re-entrant tachycardia
26
PSVT common finding on ECG
orthodromic: regular narrow complex tachycardia.
27
PSVT tx -stable(narrow and wide) -unstable -definitive
stable, narrow: adenosine and vagal manuevers stable, wide: amiodarone. Procainimide if WPW suspected. unstable: direct current synchonized CV definitive: radiofrequency catheter ablation
28
multifocal atrial tachycardia classically associated with what. ECG tx
COPD heart rate >100, 3 or more P wave morphologies verapamil or BB
29
WPW what pathway tx avoid what
bundle of kent procainimide preferred. amiodarone lupus like syndrome avoid AV nodal blocking agents
30
Etiologies of myocarditis
Infectious, viral most common, especially in tarot, viruses and coxsackievirus b and toxoplasmosis, Lyme disease Auto immune think of Lupus and rheumatoid arthritis, polymyositis Clozapine
31
Myocarditis symptoms
Fever, myalgia, malaise for a few days, followed by symptoms of systolic dysfunction, ( dilated cardiomyopathy) S3 gallop Megacolon, pericarditis
32
Myocarditis gold standard diagnostic test, and other tests
Gold standard is the endomyocardial biopsy Echo; vent systolic dysfunction
33
Saddle shaped ST elevation
Myocarditis
34
Vent tachycardia is usually due to what
Underlying heart disease, ischemic heart disease
35
V tachycardia treatment Stable Unstable with pulse No pulse
Stable: amio, lido, procainimide Pulse: synchronized cv No pulse: defib, unsynchronized cv + cpr
36
What electrolyte abnormalities can cause VTEC and torsades
Low magnesium, low, potassium, and low calcium
37
V fib, patient presentation and management
Unresponsive, pulse, syncope Un synchronized cardioversion (defib) + cpr
38
Brugada
Rt bbb
39
Prostaglandins PDA and ductus arteriosis
They keep ductus open and close pda
40
Most common innocent murmur
Still murmur
41
Most common innocent murmur
Still murmur
42
Systolic and diastolic pediatric murmurs, which are innocent and concerning
Systolic or innocent and diastolic are pathological
43
Murmur that may develop paradoxical emboli
Asd
44
Describe murmur for ASD
Systolic ejection crescendo de crescendo at pulmonic area Wide, fixed S2 split that does not vary with respirations
45
Systolic ejection crescendo de crescendo at pulmonic area Wide, fixed S2 split that does not vary with respirations
Asd
46
Systolic ejection crescendo de crescendo at pulmonic area Wide, fixed S2 split that does not vary with respirations
Asd
47
Describe the PDA murmur
Continuous machine like murmur loudest at the pulmonic area Wide pulse pressure/bounding, peripheral pulses, S2
48
Continuous machine like murmur loudest at the pulmonic area Wide pulse pressure/bounding, peripheral pulses, S2
Pda
49
pathophys of pda
continued prostanglandin E1 production and low arterial oxygen content promotes patency
50
congenital heart defect often associated with bicuspid aortic valve
coa
51
narrowing occurs where in coa in adult and infants
adult: occurs distal to the ductus arteriosum infants: occurs proximal to ductus arteriosum
52
s/s coa
claudification bilateral, DOE, syncope
53
neonatal presentation of coa
failure to thrive, poor feeding 1-2 weeks after birth
54
describe murmur of coa
systolic murmur radiating to the back, scapula, or chest
55
coa cxr
posterior rib notching; 3 sign
56
failure to thrive, poor feeding 1-2 weeks after birth
coa
56
coa confirmatory test and gold standard
confirmatory test: echo(narrowing of aorta) gold standard: angiography
57
CXR: posterior rib notching; 3 sign
coa
58
systolic murmur radiating to the back, scapula, or chest
coa
59
tetrology of fallot constellation
1. overiding aorta 2. rv outflow obstruction 3. RVH 4. large unrestrictive VSD
60
associated with chromosome 22 deletion
tet of fallot
61
most common cyanotic congenital heart disease
tet of fallot
62
blue baby syndrome
tet of fallot
63
squatting with tet spells do what
decreases the right to left shunting, improving oxygenation
64
tet of fallot murmur
harsh systolic murmur at left mid to upper sternal border, rt ventricular heave.
65
harsh systolic murmur at left mid to upper sternal border, rt ventricular heave.
tet of fallot
66
CXR: boot shaped heart
tet of fallot, prominent rt ventricle
67
tet of fallot test of choice
echo.
68
what to do prior to tet of fallot surgery prophylaxis for what
prostaglandin infusion bacterial endocarditis
69
most common cyanotic heart d/s presenting in neonatal period
TOGA, dextro
70
difference between dextro and levo TOGA
dextro: parallel circuits, most common levo: acyanotic
71
egg on a string CXR
toga
72
TOGA primary means of diagnosis gold standard
echo cardiac cath
73
most common type of congenital heart disease in childhood
vsd
74
congenital heart defect that eisenmenger can occur
vsd
75
most common type of vsd
perimembraneous 80%; hole in the outflow tract near tricuspid valve
76
swiss cheese pattern
vsd
77
s/s of moderate vsd
excessive sweating or fatigue, especially during feeds, lack of adequate growth, frequent respiratory infections
78
excessive sweating or fatigue, especially during feeds, lack of adequate growth, frequent respiratory infections
s/s of moderate vsd
79
large vsd pressure in ventricles
no differences
80
vsd murmur
high pitched harsh holosystolic murmur best heard at the LLSB
81
vsd testing
echo finds location and size echo usually preferred over cath
82
congenital cyanotic heart diseases
5 Ts truncus arteriosus TOGA tricuspid atresia tet of fallot total anomalous pulm venous return
83
hypoplastic left heart syndrome is often associated with what
mitral valve and/or aortic valve atresia
84
pulm atresia def
complete obstruction to rt ventricular outflow; blood if unable to flow from the rt ventricle into pulm artery and lungs
85
pulm atresia s/s improved survival ...
cyanosis improve survival if there is a PDA single heart sound(due to semilunar valve-aortic valve) systolic murmur of TR
86
tricuspid atresia incidence leads to what s/s
2% leads to hypoplastic rt ventricle. single heart sound S2
87
tricuspid atresia CXR and ECG
nml or enlarged cardiac silhouette with DECREASED pulm flow LVH ECG
88
single heart sound(due to semilunar valve-aortic valve) systolic murmur of TR
pulm atresia
89
nml or enlarged cardiac silhouette with DECREASED pulm flow LVH ECG
tricuspid atresia
90
what is hypoplastic left heart syndrome incidence
failure of the development of the mitral valve, aortic valve, or aortic arch then small ventricle unable to supply the nml systemic circulation requirements. 1% of all congenital heart diseases
91
failure of the development of the mitral valve, aortic valve, or aortic arch then small ventricle unable to supply the nml systemic circulation requirements.
hypoplastic left heart syndrome
92
CAD and angina def
inadequate tissue perfusion due to imbalance between increased demand and decreased coronary artery blood supply
93
CAD major risk factors
DM worst, smoking modifiable.
94
classic EKG for angina
ST depression
95
angina initial test of choice most important non-invasive testing definitive diagnostic test
angina initial test of choice: EKG most important non-invasive testing: stress testing definitive diagnostic test: coronary angiography
96
angina tx
4 drugs: asa qd, bb, nitro, qd statin ccb if bb contraindicated
97
4 classes of angina
1. angina only with strenuous activity. no limitations. 2. angina with more prolonged or rigorous activity. s.ight limitations with activity. 3. angina with usual daily activity. marked limitation of physical activity. 4. angina at rest. often unable to carry out any physical activity.
98
most useful non-invasive test in CAD
stress testing
99
definitive diagnosis/gold standard in CAD
coronary angiography
100
ACS silent MI pt population atypical S/s
women, elderly, DM, obese abd pain, jaw pain, dyspnea without CP
101
what artery supplies the AV node
RCA
102
triad of rt ventricular infarction (ACS)
increased JVP, clear lungs, positive kussmaul sign
103
CK/CK-MB marker
appears 4-6 hours peaks 12-24 hours baseline 3-4 days
104
troponin 1 and T
appears 4-8 hours peaks 12-24 hours baseline 7-10 days
105
Myoglobin
appears 2-4 hours peaks 4-6 hours baseline 1 day
106
quickest cardiac enzyme
myoglobin
107
most sensitive and specific cardiac enzyme
troponin
108
STEMI tx
BB, nito, asa, heparin, ACE, reperfusion
109
avoid what in cocaine induced MI
BB do CCB, MONA, heparin
110
O2 in NSTEMI and STEMI
NSTEMI: low O2 STEMI: no O2
111
proximal LAD
V1 and V2 anterior and septal wall
112
LAD
V1 -V4 anterior wall
113
circumflex artery
lateral wall
114
RCA
inferior wall
115
leads in anterior wall/septal wall
V1-V4
116
leads in lateral wall
1, avL, V5, V6
117
leads in anterolateral wall
1, avL, V4-V6
118
leads in inferior wall
11, 111, avF
119
posterior wall leads
ST depressions in V1-V2
120
avoid what in inferior/posterior MI
nitro and morphine
121
dressler syndrome
post MI pericarditis + fever + pulm infiltrates
122
to form a clot, factor __
factor Xa converts prothrombin II to thrombin(IIa). Thrombin activates fibrinogens to fibrin clot.
123
cheap and least chance of intracranial bleeding:
streptokinase
124
MOA of rTPA
dissolves clot by activating tissue plasminogen to plasmin
125
initial tests of choice for suspected CHF
CXR, BNP
126
Kerley B lines
linear lucencies in the peripheral lung fields
127
most common cause of pleural effusions
CHF
128
BNP in CHF
over 100
129
cheyne stokes breathing
deeper, faster breathing in gradual decrease and periods of apnea, cyanosis
130
cephalization
increased vascular flow to the apices as a result of increased pulmonary venous pressure. occurs with PCWP of 12-18.
131
bat wings
PCWP over 25
132
HTN urgency tx medications
clonidine, captopril, furosemide, labetalol, nicardipine
133
avoid cerebral hypoperfusion if ischemic list bps
>220/120 (not a thrombotic candidate) >185/110 ok
134
avoid what in acute HF
hydralazine and BB
135
when to not use nitro
if suspected right ventricular infarction
136
orthostatic hypoTN workup tx avoid what
tilt table test: BP reduction at a 60 degree angle fludrocortisone avoid flat position, sleeping with the head of the bed raised to 30-45 degrees
137
left BBB EKG
WILLIAM wide qrs rsr in V5,6 deep S wave in V1 ST elevations in V1-V3
138
Extra cranial branches of carotid artery
Temporal, occipital, opthalmic, posterior ciliary artery
139
Temporal arteritis R/F Triad symptoms
Women, >50 yo, NE Europeans Ha, jaw clarification with mastication, visual changes . Poss scalp tenderness
140
Right BBB
MARROW wide qrs rsr in V1, 2 wide S wave in V6
141

cardio and pulm (24 decks)

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