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[2b] A- step 2 CK > Medicine-Cardio > Flashcards

Medicine-Cardio Flashcards

1
Q

Which pt demographics are most at risk for anaphylaxis 2nd to Latex allergy?-3

image: mottled acute limb ischemia from arterial emboli s/p surgery

A

Health Care Workers

[Abd Surgery pts]

[GU Surgery pts]

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2
Q

Epigastric burning worst with exertion and not relieved with antacids is concerning for ______. Next step?

A

[Atypical Stable Angina]; Exercise Stress EKG

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3
Q

How is SLE associated with CAD

A

SLE accelerates atherosclerosis –> premature CAD

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4
Q

Which EKG leads are Lateral

A

aVL, Lead 1, V5, V6

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5
Q

Which EKG leads are Anterior

A

V2, V3, V4

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6
Q

What Px medication is given to prevent [Coronary Artery Stent Thrombosis]-2?

What’s the biggest predictor of Stent Thrombosis?

A

ASA + [Platelet R Blocker (Clopidogrel,Prasugrel,Ticagrelor)]

DC/noncompliance of this therapy = BIGGEST PREDICTOR of Stent Thrombosis

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7
Q

Initial Mngmt for [Peripheral Arterial Dz]-4

A
  1. Smoking Cessation
  2. Dual Lipid lowering therapy (ASA + Statin)
  3. Mnge DM/HTN
  4. Supervised Exercise (reproduces and reduce sx)
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8
Q

____, ___ and ____ are 3 drugs that should be held ___ hrs prior to [Stress EKG].

When are these drugs actually continued during [Stress EKG]?

A

Beta blockers/CCB/Nitrates; 48 hours

These are continued during [Stress EKG] if the test is determining their efficacy in pts

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9
Q

What is [Pulsus parvus et tardus] and what dz is it related to

A

Delayed and diminished carotid pulse; Aortic Stenosis

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10
Q

PE findings for Aortic Stenosis-3

A
  1. Pulsus parvus et tardus (delayed carotid pulse)
  2. S4 (from LV Hypertrophy)
  3. [Crescendo Decrescendo Systolic murmur w/radiation to Carotids @ R 2nd ICS]
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11
Q

Which Murmur?

(Auscultation Site is attached)

B: Maneuvers that INC (2)

A

Mitral Regurgitation

[Holosystolic High-Pitched Blowing Murmur] w/radiation to axilla

“MR. Hand me a Squat”

B: INC with…

1) Hand Grip
2) Squatting

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12
Q

Which Murmur? (Is Not VSD)

(Auscultation Site is attached)

B: Maneuvers that INC

A

Tricuspid Regurgitation

[Holosystolic High-Pitched Blowing Murmur]

B: INC with… Inspiration

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13
Q

Which Murmur?

(Auscultation Site is attached)

B: Maneuvers that INC (2)

C: Maneuvers that DEC

A

Aortic Stenosis

[Crescendo-Descrescendo Systolic Ejection Murmur]

“Lean forward…& then Squat with that Ass, that’ll turn it up!”

B: INC with…

  1. Leaning Forward
    2) Squatting

C: DEC with…handgrip (INC afterload)

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14
Q

Mitral Valve Prolapse

Murmur

A

“He was MVP…OF COURSE he had a Mid Clique to hang with”

[MidSystolic Click –> Late Systolic Crescendo Mumur] @ Apex

Sound Caused by Tendinae tightening and lips of the valve closing AFTER the preload has been ejected

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15
Q

Which Murmur?

(Auscultation Site is attached)

A

Mitral Valve Prolapse

[Late Systolic Crescendo Murmur + MidSystolic Click]

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16
Q

Which Murmur?

B: Name the Auscultation Site

C: Maneuvers that INC sound

A

Mitral Stenosis

[Delayed Rumbling Diastolic murmur that follows an Opening Snap]

B: [Apex + LLDP (L Lateral Decubitus Position)]

C: Maneuvers that [INC Afterload]

-handgrip

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17
Q

Which Murmur?

(Auscultation Site is attached)

A

Hypertrophic Cardiomyopathy

[Holosystolic Harsh Murmur] auscultated @ [L Sternal 2nd/3rd ICS]

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18
Q

Which Murmur?

(Auscultation Site is attached)

A

Ventricular Septal Defect

[Holosystolic Harsh Blowing Murmur]

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19
Q

Which Murmur?

(Auscultation site is attached)

A

Patent Ductus Arteriosus

[Machinery Continuous Murmur] ausculated over [L infraclavicular region]

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20
Q

In regard to renal arterioles, how do kidneys respond to CHF

A

Constrict Efferent Arterioles –> INC intraglomerular pressure

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21
Q

What are clinical parameters for Orthostatic hypOtension?-3

A
  • ⬇︎ in Systolic BP > 20 when standing
  • ⬇︎ in Diastolic BP > 10 when standing
  • INC HR > 10

insufficient constriction of capacitance blood vessels in LE

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22
Q

Presentation for Aortic Coarctation-2

A
  1. Asx HTN sometimes w/[epistaxis/HA/aortic dissection/cp]
  2. UE HTN with LE hypotension
  3. Delayed femoral pulses
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23
Q

Dx for Aortic Coarctation?-4

A
  1. EKG: L Vt Hypertrophy
  2. CXR: Notching of 3rd-8th enlarged intercostal arteries
  3. CXR: “3” sign from aortic indentation
  4. Echocardiography
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24
Q

What Disorders is Aortic Coarctation associated with?-3

A
  1. Bicuspid Aortic Valve
  2. Vt Septal Defect
  3. Turner Syndrome
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25
Q

Pt with vague chest pain. Dx?

A

Descending Thoracic Aortic Aneurysm

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26
Q

Describe Etiologies for both Thoracic Aortic Aneurysms: Ascending-2 and Descending-2

A
  • Ascending [Cystic medial necrosis from aging] vs [Connective Tissue DO (Ehlers Danlos, Marfan - pts under 40 yo)]*
  • Descending*
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27
Q

What value of BNP indicates CHF dx

A

≥ 100 pg/mL

Note: BNP is excreted by Kidneys = Naturally Elevated in Renal Failure pts!

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28
Q

Describe [Hypertensive Urgency]

A

ONLY HTN ≥ 180/120

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29
Q

Describe [Malignant HTN Emergency] - 2

A

[Hypertensive Urgency (BP>180/120)]

+

Papilledema/Retinal Hemorrhages

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30
Q

Describe [Hypertensive Encephalopathy] - 2

A

[Hypertensive Urgency (BP>180/120)]

+

Cerebral Edema –> General Neuro signs

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31
Q

EKG manifestation for Acute Fibrinous Pericarditis-2

A

DIFFUSE ST elevations + sometimes PR depressions

Pericarditis gave HIM A UTI

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32
Q

What is usually the cause of pericardial effusion

A

recent viral infection –> pericarditis –> pericardial effusion

  • Pericarditis gave HIM A UTI*
  • EKG showing electrical alternans*
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33
Q

Describe Pulsus Paradoxus

A

[Systolic BP] ⬇︎more than 10 during inspiration

“Pulsus for CAPOT”

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34
Q

What conditions cause Pulsus Paradoxus (5)

A

“Pulsus for CAPOT”

  • Croup
  • Asthma
  • Pericarditis
  • Obstructive Sleep Apnea
  • Tamponade
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35
Q

What 2 heart conditions are Marfan pts at risk for

A

AORTIC DISSECTION & [Ascending Aortic Aneurysm]

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36
Q

What should you suspect in an [Aortic Dissection pt] who also has distended neck veins & pulsus paradoxus? Why?

A

Concomitant Cardiac Tamponade; dissection can –> blood in pericardial sac –> [Pulsus for CAPOT]

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37
Q

Digoxin toxicity leads to what cardiac arrhythmia?

A

[Atrial Tachycardia(250-350 bpm)] with AV block

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38
Q

Head bobbing with each heart beat or Head pounding is c/w ______

A

Aortic Regurgitation

Head bobbing with each heart beat = de Musset sign and is sign of widened pulse pressure

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39
Q

In Hypertensive Crisis (Urgency & Malignant Emergency), what’s the rate for lowering MAP?-2

A

Normal MAP: 65-110

[10-20% in 1st hour] –> [5-15% over next 23 hours]

Malignant HTN Emergency = [Hypertensive Urgency (BP>180/120)] PLUS Papilledema/Retinal Hemorrhages

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40
Q

What is the normal range for Mean Arterial Pressure (MAP)?

Formula?

A

65-110; formula in pic

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41
Q

What is Nitroprusside commonly used for? Severe SE-3?

A

Rapid BP control (since it’s a vasoDilator);

Cyanide Tox

  1. AMS
  2. Lactic Acidosis
  3. Coma/Death
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42
Q

CP for Exertional Heat Stroke-3 ; What med worsens this?

A

HOT

  1. Head CNS dysfunction (confused/seizure/epistaxis)
  2. Organ Dysfunction (DIC/ARDS/Hemoconcentration/Rhabdo)
  3. Temp > 40C

Worst with antiCholinergics

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43
Q

Compare tx for Exertional-2 heat stoke vs. NonExertional-1 heat stroke

A

Exertional = Ice water immersion + fluid resuscitation

NonExertional (happens in kids & elderly) = Evaporative cooling (spray lukewarm water on pt with fan blowing)

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44
Q

How is Aortic Dissection associated with Aortic Regurgitation ; what’s a possible respiratory complication of this

A

AD may proximally extend into the [aortic valve annulus] and stretch it –> AR which can–> Acute SOB w/lung crackles (since LV will be full and LA can’t dump into it)

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45
Q

Imaging modalities for Aortic Dissection-3

A
  1. TEE-unstable or renal CTX
  2. [Spiral CT Angio] - Stable vitals
  3. [MRI-NonEmergency]

TEE is great because it’s used in renal pts

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46
Q

Name PE finding and what causes it-5

A

Livedo Reticularis;

  1. Atherosclerotic Emboli into periphery s/p cardiac catheterization
  2. SLE
  3. Antiphospholipid Syndrome
  4. Systemic Vasculitis
  5. Amantadine SE

also may see Blue Toes, [Hollenhorst retinal a. plaques]

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47
Q

Fibromuscular Dysplasia etx ; List the manifestation-3

A

Noninflammatory/Nonatherosclerotic abnormal arterial wall cell dysplasia –> Stenosis of 3 arteries…

Renal = ⬇︎renal perfusion–> ⬆︎Renin = HTN

Carotid = amaurosis fugax

Vertebral = stroke

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48
Q

Fibromuscular Dysplasia dx-2

A

[Spiral CT angio Abd] vs. Duplex US

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49
Q

2nd degree AV Block: Mobitz Type 1

Describe where block is, EKG findings and describe QRS

A

[2nd degree AV Block: Mobitz Type 1]

where = AV Node

EKG = Group beating (prolonged PR leading to absent beat/nonconducted P wave)

QRS is Narrow

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50
Q

2nd degree AV Block: Mobitz Type 2

Describe where block is, EKG findings and describe QRS

A

[2nd degree AV Block: Mobitz Type 2]

where = Bundle of His

EKG = Beat Drops Randomly but PR stays constant

QRS is Narrow OR Wide

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51
Q

Name the 4 Medications that Prevent LV Remodeling in HF pts

A

“BANA helps HF pts live Loonger”

Beta Blockers (Metoprolol / Carvedilol)

[ACEk2 inhibitors AND ARBs]

[Nitrates + Hydralazine]

[Aldosterone Blockers (Spironolactone / Eplerenone)]

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52
Q

List 7 Therapies for an Acute MI ; Give brief description of why their used

A

Pts with [Acute MI] Need OBAMAA!

  1. NTG = VasoDilates Veins and Coronary Arteries
  2. Oxygen = Minimizes ischemia
  3. Beta Blockers = DEC HR –> DEC Arrhythmia risk and DEC O2 demand
  4. [ASA and Heparin] = limits thrombosis
  5. Morphine = Pain
  6. ACEk2 inhibitors within 24 hrs= DEC [L Ventricle Dilation/Remodeling]
  7. AtorvaSTATIN - comes later
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53
Q

What therapies are used to treat Unstable Angina?-7

A

Pts with Unstable Angina Need OBAMAA too!

  1. NTG = VasoDilates Veins and Coronary Arteries
  2. Oxygen = Minimizes ischemia
  3. Beta Blockers = DEC HR –> DEC Arrhythmia risk and DEC O2 demand
  4. [ASA and Heparin] = limits thrombosis
  5. Morphine = Pain
  6. ACEk2 inhibitors within 24 hrs= DEC [L Ventricle Dilation/Remodeling]
  7. AtorvaSTATIN - comes later

ASA and Beta blockers can –> asthma exacerbation

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54
Q

Tx for symptomatic Sinus Bradycardia-4

A

1st line: [IV Atropine + Fluids]

2nd line: IV Glucagon (⇪intracell cAMP)

Alternatives: IV Epi / IV DOPAmine / transcutaneous pacing

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55
Q

A pt with what group of sx is most concerning for Cardiac Tamponade

A
  1. Distended Neck Veins
  2. Muffled heart sounds
  3. HypOtension

THIS IS BECK’S TRIAD!

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56
Q

Which demographic should ALWAYS be screened for AAA using _______

A

AAA screening/diagnosis = Abdominal US

Always Screen [65-75 yom who smoke]!!!! for AAA

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57
Q

Which HTN med causes isolated peripheral edema and why? How do you correct for this and why does it work?

A

[Dihydropyridine Ca+ Channel Blockers (Amlodipine/Nifedipine)] preferentially dilate Arterioles –> interstitial extravasation –> isolated peripheral edema

[ACEk2 inhibitors preferentially dilate Veins].

So [DHP CCB] + [ACEk2 inhibitors] concurrent = ⬇︎peripheral edema

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58
Q

ALPHA 1 RECEPTOR

Tissues - Actions (3)

A

“Gimme an alpha 1 VID”

(1) Most Vascular smooth muscle- contracts (inc. vascular resistance)
(2) Dilator Pupillary muscle- contracts (myDriasis)
(3) Internal Urethral Sphincter- contracts

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59
Q

ALPHA 2 RECEPTOR

Tissues- Actions (4)

A

“You’ll find alpha 2 receptors on a PEAA”

(1) A**drenergic and cholinergic nerve terminals- inhibits NTS release–> [CNS-mediated BP DEC]
(2) *Platelets- stimulates aggregation
(3) *Adipocytes - DEC Lipolysis
(4) Eye - DEC Intraocular pressure

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60
Q

BETA 1 RECEPTOR

Actions (2)

A

(1) Heart- INC rate and force by [INC [Na+ I(f) channels] in phase 0 of AV node] –> shortens PR interval
(2) JGA cells- Stimulates renin release

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61
Q

BETA 2 RECEPTOR

Tissues-Actions (4)

A

(1) Relaxes RUV - (Respiratory, Uterine and Vascular) smooth muscle
(2) Liver- stimulates glycogenolysis
(3) Pancreatic B cells- stimulates insulin release
(4) Somatic motor nerve terminals (voluntary muscle)- causes tremor

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62
Q

What is [PEA-Pulseless Electrical Activity] and how should it first be managed-2?

A

Organized rhythm on cardiac monitor BUT NO Palpable pulse in a cardiac arrest pt; [CPR + Epi] until cause is determined!

Note: VT DOES require defibrillation

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63
Q

What are the causes of PEA (Pulseless Electrical Activity)-10

A
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64
Q

Describe the Approach to [Adult Cardiac Arrest] if pt is in Asystole or PEA-6

A
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65
Q

Describe the Approach to [Adult Cardiac Arrest] if pt is in VFib or pulseless VTach-6

A
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66
Q

What is the normal Jugular venous pressure

A

3-4 cm above sternal angle

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67
Q

Periumbilical Systolic-Diastolic Bruit in [HTN & Atherosclerotic pt] suggest _______

A

Renal Artery Stenosis

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68
Q

[Ex of Amyloidosis (primary AL) vs. (secondary AA)] and [causes of secondary AA]-5

A

Etx of Amyloidosis = Extracell deposition of insoluble protein in organs

(primary AL) vs. (secondary AA)

(secondary AA) caused by:

  1. Inflammatory arthritis (RA)
  2. Chronic infection
  3. IBD
  4. CA
  5. Vasculitis
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69
Q

Clinically, what picture makes you suspect Amyloidosis from a cardiac standpoint?-4

A
  1. Unexplained [Diastolic HF] with
  2. echo showing ⬆︎ Vt Wall thickness but normal L Vt Cavity dimensions and
  3. EKG showing low voltage
  4. Proteinuria

Amyloidosis causes Restrictive Cardiomyopathy

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70
Q

RBC 1/2 life

A

120 days

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71
Q

Common Causes of [Constrictive Pericarditis] - 4

Look for the pericardial knock!

A

‘Ur an Idiot to constrict my Radio & T-V”

Idiopathic

Radiation

TB

Viruses

This is a common cause of R HF

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72
Q

The CHA2DS2 VASc score is used to determine _______ risk in pts with ______. Decsribe the Criteria

A

determines Thromboemobolism risk in pts with AFib

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73
Q

Afib Pts with CHA2DS2 VASc score ≥ 2 should be Rx managed with what?-2

A

ASA + [PO Warfarin vs PO NOAC]

[NOAC = (apixiban,rivaroxaban,dabigatraban)]

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74
Q

Compartment Syndrome and Acute Arterial Occlusion share the same symptomotology

List the sx-6

A

The 6 P’s

Paresthesia-early sign

Pain

Pallor

Poikilothermia (cool to touch)

Paralysis

Pulseless-late sign

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75
Q

[Scleroderma renal crisis] Etx and Sx-2

A

INC vascular permeability–>coagulation cascade activation AND renin secretion –>

  1. DIC
  2. Malignant HTN emergency
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76
Q

High Output HF Etx ; 5 major causes

A

Cardiac output is > than normal (55-70%) due to state of excess blood volume

  1. Anemia-severe
  2. Hyperthyroidism
  3. Wet BeriBeri
  4. Paget Dz
  5. AV Fistulas
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77
Q

In which type of HF is ejection fraction preserved

A

Diastolic HF

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78
Q

Causes of Pericarditis-7

image = pericardial effusion 2/2 Pericarditis

A

“Pericarditis gave HIM A UTI”

  • Infection-Viruses (Coxsackie/ echovirus/adenovirus)
  • Acute MI
  • Immune (Dressler vs SLE vs RA)
  • [HMLB CA] - (Hodgkin’s/Mesothelioma/Lung/Breast)
  • Trauma
  • Mediastinal Radiation
  • Uremia (BUN > 60) - TREAT WITH HEMODIALYSIS
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79
Q

What 3 maneuvers INCREASE intensity of Aortic Regurgitation

A

“AR your Hands & Breath [Leaning Forward] ?

  • with Hand Grip
  • when Breath is held after exhalation
  • with Patient leaning forward
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80
Q

Describe the following parameters during hypOvolemic shock:

A: Systemic Vascular Resistance

B: Cardiac Output

C: BP

A

A: Systemic Vascular Resistance = INC

B: Cardiac Output = DEC

C: BP = DEC

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81
Q

Primary PCI (PerCutaneous Intervention) for STEMMI should be administered when in order to restore coronary blood flow? - 3

A
  1. Within 12 Hours of sx onset

+

2A. within 90 min from first medical contact to device at PCI instituition OR

2B. within 120 min from first medical contact to device at NON-PCI instituite (allows transport time)

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82
Q

When is Carotid Endarterectomy(CEA) indicated in Men-2 vs Women?

A

Men: [> 70% occlusion and Symptomatic] or [> 60% occlusion but Asx]

Women: [> 70% occlusion regardless of sx]

ANY OF THESE –> CAROTID ENDARTERECTOMY

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83
Q

Biggest RF for Aortic Dissection

A

HTN

Marfan may also cause AD but happens in pts < 40 yo

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84
Q

Arrhythmia is a complication [30 min-4 Hrs] Post MI

List the 2 types of Arrhythmias, when they occur and Etx ;

Which is the most common cause of Sudden cardiac arrest?

A
  • [Immediate Phase 1A Vt Arrhythmia] occurs within 10 min post MI and caused by Reentrant Arrhythmias = MOST COMMON CAUSE OF SUDDEN CARDIAC ARREST
  • [Delayed Phase 1B Vt Arrhythmia] occurs 10-60 min post MI and caused by abnormal automaticity
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85
Q

Post MI evolution

4-12 hours

Complications

A

Arrhythmia

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86
Q

Post MI evolution

1-3 DAYS

Complications

A

[Fibrinous Pericarditis–> [sharp & pleuritic Chest Pain] + friction rub] (only with transmural infarcts)

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87
Q

Post MI evolution

3-7 DAYS

A: Complications (3)

B: Lab

A

Macrophage phagocytosis of dead debris –> weakens cardiac tissue

A: Cardiac Tissue Weakning (Vt Free Wall Rupture-ANTERIOR MI) / (papillary m. rupture-INFERIOR MI) / (interventricular septal rupture)

B: [CkMB] returns to Baseline at Day 3

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88
Q

Post MI evolution

7-10 Days

A: Complications

B: Lab

A

No Complications

B: [Trop I] returns to baseline

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89
Q

Post MI evolution

2 - 8 WEEKS

A: Gross Changes

B: Complications (3)

A

2 - 8 WEEKS

A: White Scar w/[Type 1 Dense Collagen]

B: Aneurysm / [Mural Thrombus] / Dressler’s

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90
Q

Describe the following parameters during hypOvolemic shock:

A: [Pulm Capillary Wedge pressure]

B: [Cardiac Index (Pump Function)]

A

A: [PCWP] = ⬇︎

B: Cardiac Index = ⬇︎

Cardiac Index (pump function) = Cardiac output➗Body Surface area

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91
Q

Define parameters for ISH (Isolated Systolic HTN) and its Etx

A

[Systolic > 140] but [Diastolic< 90]; Stiffening of Arterials walls as we age –> inability to dampen systolic pressure –> [INC pulse wave velocity AND reflection during systole]

THIS SHOULD BE TREATED!

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92
Q

7 common causes of Dilated Cardiomyopathy

A

“the PIG PAID for Dilated Cardiomyopathy”

  1. Post Viral Myocarditis (Coxsackie B)
  2. Alcohol related (direct toxicity vs. nutritional deficiency)
  3. [Doxorubicin & Daunarubicin Chemo] (dose-dependent)
  4. Peripartum (late in pregnancy vs 5 mo. post partum)
  5. Genetic (affects cytoskeleton)
  6. Iron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
  7. Idiopathic
    * DILATED IS MOST COMMON CARDIOMYOPATHY and CAN BE ACUTE*
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93
Q

Name 6 major absolute ctx(contraindications) to Thrombolytic tx

A
  1. Bleeding
  2. Aortic Dissection
  3. Aneurysm
  4. Ischemic stroke within past 6 mo.
  5. Head trauma
  6. Bleeding DO (coagulation abnormality, thrombocytopenia)
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94
Q

EKG findings for [NSTEMI & Unstable Angina]-2

A
  1. ST Depressions
  2. T Wave inversions

MUST OCCUR IN AT LEAST 2 LEADS

95
Q

When should Men start QD ASA for cardiovascular px? When should Women?

A

Men = 45

Women = 55

96
Q

What all labs should be ordered when concerned for Angina; and why?-6

A
  1. CBC: Anemia contributes to ischemia
  2. BMP: Electrolyte derangement
  3. BUN/Creatinine: Kidney Dz –> Heart Dz
  4. TSH: Hyperthyroidism –> ⬆︎O2 demand of heart
  5. Lipid Panel: Cardiac Risk
  6. ALT/AST: Obtain baseline before starting Statin
97
Q

Criteria for Metabolic Syndrome X -4

A

DIVe –> ASCVD

≥ 3 of the following:

Dyslipidemia (TAG>150 vs HDL<50)

Insulin resistance (Fasting Glucose >110)

Visceral Waist Obesity (Men>102 cm / Women>89 cm)

Hypertension (BP> 130/85)

98
Q

List the main Side Effects of HCTZ-5

A
  • Dehydration
  • hypOnatremia
  • hypOKalemia
  • Gout Attack (⬆︎Plasma Uric Acid)
  • Renal dysfunction
99
Q

6 major causes of Syncope

A

MVC BSD

  1. ⬇︎ Cardiac Output (Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)
  2. Bradyarrhythmia (SA Node dysfunction/AV Block)
  3. VAN - Vasovagal Autonomic Neurocardiogenic
  4. Dehydration
  5. Stroke
  6. Metabolic (⬇︎Glucose vs ⬇︎Na+)

OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!

100
Q

5 major causes of Atrial Fibrillation; which 3 are most common?

A
  1. HTN (1st most common)
  2. CAD (2nd most common)
  3. Valvular dz (3rd most common)
  4. Cardiomyopathy
  5. Hyperthyroidism
101
Q

[HOCM - HyperObstructive CardioMyopathy] MOD-2

A

[Beta myosin heavy-chain mutation] –> Defective cardiosarcomeres–> [Hypertrophied myocytes that are haphazardly arranged]

+

Abnormal [ANT motion of (ANT leaflet mitral valve) toward [Hypertrophied interventricular septum]

102
Q

Major causes of [⬇︎ Cardiac Output]-7

A
  1. Valvular Dz
  2. HOCM
  3. Pulm HTN
  4. PE
  5. Tamponade
  6. myxoma
  7. aFib

⬇︎ Cardiac Output can –> Syncope

103
Q

Nausea, Sweating and Dizziness are preceding sx for what type of syncope?

A

[VAN - Vasovagal Autonomic Neurocardiogenic] only

104
Q

Lactate normal range

A

< 1.7

105
Q

EKG manifestations of hypOcalcemia-2

A

[Prolonged QT] and [shortened PR]

106
Q

Ruptured Popliteal Cyst MOD

A

Popliteal cyst…pops –>fluid extends DISTALLY into POST calf m. –>calf swelling that mimics DVT

Doesn’t involve thigh swelling

107
Q

At what times should Troponin be drawn in pt coming in with cp-3?

A

Now;

And if Now is normal –> 6 hours later; 12 hours later

108
Q

What is the criteria for determining functional status in HF pts?-4

A
109
Q

How is NSAIDs associated with HF?

A

NSAIDs exacerbate CHF BADLY - it precipitates acute on chronic CHF

110
Q

Name precipitants of Acute on Chronic CHF -8

A
  1. NSAIDs / AKI
  2. [Ischemia / Arrhythmias]
  3. Infection
  4. HTN
  5. PE
  6. Anemia
  7. Thyrotoxicosis
  8. Noncompliance
111
Q

What is the Staging for HF -4

A
  • Stage A: High Risk for HF but no structural dz
  • Stage B: Structural Dz but no sx
  • Stage C: Structural Dz WITH sx
  • Stage D: End-Stage Dz requiring specialized tx
112
Q

What is the W.H.O. definition of MI?

A

2 out of 3

EKG changes

Troponin changes

Story

113
Q

When is a post MI pt a candidate for ICD (Implantable Cardioverter Defibrillator)? Caveat?

A

[EF < 35% post MI] BUT must wait 40 days after MI

EF = most important prognostic value for pts post MI!!

114
Q

Serum Osmolality Formula and normal range; What does it mean when measured doesn’t = calculated

A

Range = (280 -295); When measured is diff than calculated = something in serum is ⬆︎osmolality (ethanol, PEG)

115
Q

What controls Ventricular rate in afib pts?

A

AV node refractory period controls Vt rate, since SA node is dysfunctional and multile foci in atria are firing

116
Q

In Afib pt, when can you NO LONGER cardiovert?

A

> 2 Days after onset

117
Q

Afib tx -2

A
118
Q

Criteria for Lone Atrial Fibrillation-3 ; tx-2

A

Lone AF (CHADS VASc of 0) =

  1. <60 yo
  2. no HTN
  3. no Heart Dz = low stroke risk

tx = ASA vs nothing

119
Q

[Direct Current Cardioversion] is 97% successful at restorying atrial NSR

Why is is DC Cardioversion still risky?

A

Most thrombi embolize after [Atrial DC Cardioversion]

120
Q

Absolute CTX for [DC Cardioversion] in aFib -3

A
  1. hypOkalemia
  2. Digitalis Toxicity
  3. > 2 Days after aFib onset
121
Q

Mngmt for [Post-CABG related Afib] -3

A

This type of Afib is common

  1. resolves spontaneously if rate is controlled (Beta Blockers vs Diltiazem in HDS)
  2. Amiodarone in HDS
  3. DC Conversion if Hemodynamically UNSTABLE
122
Q

AV node ablation is most effective for which type of Afib (chronic vs paroxysmal)

A

Paroxysmal

123
Q

Describe Grading System for Heart Murmurs

A
124
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Cardiac Causes -6

A

CRGMP

  1. ACS (Unstable,Stable,Prinzmetal Vasospastic, MI)
  2. Cocaine
  3. Pericarditis
  4. Aortic Dissection
  5. Valvular
  6. Non-ischemic Cardiomyopathy

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

125
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Respiratory Causes -5

A

CRGMP

  1. PE
  2. PNA
  3. Pleurisy
  4. PTX
  5. Pulm HTN/Cor Pulmonale

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

126
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Gastrointestinal Causes -5

A

CRGMP

  1. GERD
  2. PUD
  3. Esophageal (dysmotility, inflammation)
  4. Pancreatitis
  5. Biliary (cholecystitis, cholangiits)

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

127
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Musculoskeletal Causes -5

A

CRGMP

  1. Costochondritis
  2. Rib Fracture
  3. Muscular strain
  4. Herpes Zoster
  5. Myofascial syndrome

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

128
Q

Common Causes of Chest Pain are usually CRGMP

Describe the Psychogenic Causes -3

A

CRGMP

  1. Panic DO
  2. Hyperventilation
  3. Somatoform DO

CRGMP = Cardiac/Respiratory/GI/Msk/Psych

129
Q

When is Angina classified as Unstable -3

A

when chest pain is…

  1. at rest or triggered by low exertion
  2. New
  3. ⬆︎ in frequency
130
Q

Pt with suspected Claudication 2° to [Peripheral Artery Disease]

Dx test? Describe the test

A

ABI (Ankle Brachial Index) = inexpensive/noninvasive measurement of systolic BP Ankle:Brachial

[Peripheral Artery Dz] < [0.90 - 1.3] < [Calcified Vessels]

Alternative is Arterial Duplex US but this is less specific & sensitive

131
Q

What are triggers of VAN (Vasovagal Autonomic Neurocardiogenic) Syncope? -6

A
  1. Pain
  2. Emotional distress
  3. Prolonged Standing
  4. Defecation
  5. Micturition
  6. Coughing

VAN Syncope is preceded by nausea, sweating and dizziness

132
Q

Seizures and Syncope are difficult to differentiate

Name features that help differentiate Seizures from Syncope - 3

A

Seizures has…

  1. Postictal confusion & lethargy
  2. Triggered by flashing lights
  3. Tongue laceration

beware: Clonic jerks can occur during syncope associated w/cerebral hypoxia!!

133
Q

Name the 7 most common manifestations of Marfan Syndrome

etx = mutation of fibrillin 1 gene

A

“Marfan BAATHES a lot! “

  1. Ectopia Lentis
  2. Arm-to-Height Ratio ⬆︎
  3. Heart issues (MVP or [idiopathic Aortic cystic medial degeneration]–> Aortic Dissection and Aneurysm)
  4. Scoliosis vs. Kyphosis
  5. Breastbone structural abnormalities
  6. Arachnodactyly (Steinberg thumb & wrist)
  7. Tall / slender / flat feet

etx = mutation of fibrillin 1 gene

134
Q

Which 2 bedside maneuvers ⬆︎ Intensity of the HOCM mumur?

A

“Val [Stood Up] to Hulk HOCM, the MVP, which ⬆︎ his anxiety intensity”

Valsalva

[Standing Up]

(both ⬇︎ Preload AND Afterload)

135
Q

DDx for T-wave inversion - 5

A
  1. MI
  2. Myocarditis
  3. Myocardial Contusion
  4. OLD Pericarditis
  5. Digoxin OD
136
Q

EKG findings of hypOkalemia - 4

A
  1. ST Depression
  2. Broad Flat T waves
  3. U wave
  4. PVC
137
Q

In respects to old age, what causes Orthostatic hypOtension?-4

A

insufficient constriction of capacitance blood vessels in LE due to

  1. DEC Baroreceptor sensitivity
  2. Arterial stiffness
  3. DEC NorEpi for sympathetics
  4. DEC myocardium to sympathetic stimulation
138
Q

What is Cardiac Syndrome X ; Lab findings?-3

A

Exertional angina-like cp usually in Women ;

  1. Normal coronary angiogram
  2. Normal EKG
  3. Abnormal Exercise Stress test
139
Q

Based on the 3 characteristics of Angina, when is Angina:

Atypical?

NonAngina?

A
  1. Substernal >20 min. PRESSURE
  2. Exertional
  3. relieved with NTG or rest
    * [Atypical = ≥ 2 out of 3 +/- atypical sx] /// [NonAngina = <2 out of 3]*
140
Q

Which demographics typically have Atypical Angina? -3

A
  1. Diabetics
  2. Women
  3. Elderly
141
Q

In addition to smoking, being male, obesity and many others…age > ___ years old is a risk factor for CAD

A

>55 yo

142
Q

Tx for Stable Angina -3

A

Beta Blockers > Calcium Channel Blockers

+

ACE inhibitors

+

ASA

143
Q

Some pts present with SOB as the only sx of cardiac ischemia

What is this called?!

A

Anginal Equivalent

Example of Atypical Angina

144
Q

A complication of Post MI evolution, 3-7 days is Cardiac Tissue Weakning

How can you differentiate Vt Free Wall Rupture vs Papillary muscle rupture vs Interventricular septal rupture?

A

Macrophage phagocytosis of dead debris –> weakens cardiac tissue

  1. Vt Free Wall Rupture = occurs with ANTERIOR MI (
  2. papillary m. rupture= occurs with INFERIOR MI and has systolic murmur @ apex
  3. interventricular septal rupture = systolic murmur @ 2nd/3rd L ICS
145
Q

Why are pregnant patients with mitral stenosis at ⬆︎risk of having exacerbations?

A

⬆︎HR and blood volume –> ⬆︎transmitral gradient and L atrial pressure which can –> aFib

146
Q

When does Peripartum Cardiomyopathy onset? What type of sx would you expect?

A

> 36 WG ; Systolic HF sx (SOB, pedal edema)

147
Q

Primary Hyperparathyroidism is a rare cause of HTN

What does it mean if you have SEVERE HTN with Primary Hyperparathyroidism

A

Consider Multiple Endocrine Neoplasia 2A - phenochromocytoma

148
Q

Features of Supraventricular Tachycardia on EKG - 4 ; Tx-2?

A
  1. Narrow and small QRS
  2. tachycardia
  3. P waves are “buried” within QRS
  4. Possibly: Retrograde P waves possibly appearing as spikes at beginning/end of QRS or as inverted P waves

tx = [IV Adenosine] vs [Vagal maneuvers]–>slows/terminates AV node conduction

149
Q

etx of Aortic Coarctation

A

Tunica Media thickening near junction of [ductus arteriosus] and [aortic arch]

150
Q

Common s/s of Mitral Stenosis - 7

A

[Delayed Rumbling Diastolic murmur that follows an Opening Snap]

  1. Progressive SOB
  2. Exercise intolerance
  3. Fatigue
  4. Orthopnea
  5. Hemoptysis
  6. Dry Cough
  7. aFib can–>stroke
151
Q

CP of Wolff Parkinson White Syndrome - 2

A
  1. most are asx!
  2. Delta wave (UpSlurring R wave) on EKG!

tx = Procainamide or cardioversion if afib develops

152
Q

Endocardial Cusion Defects are associated with what syndrome? Describe this defect

A

Down Syndrome ; CAVSD (Complete AtrioVentricular Septal Defect)–> VSD murmur + Systolic Ejection murmur

153
Q

What are cardiac abnormalities are associated with Williams Syndrome? - 3

A
  1. Aortic Stenosis
  2. Pulmonic Stenosis
  3. Septal Defects
154
Q

Describe S3 gallop. What is it associated with? - 3

A

A: [low-frequency sound JUST after S2]

B: Associated with:

  1. Dilated Vt 2/2 L Systolic HF in pt>40 yo
  2. Dilated Vt 2/2 Mitral Regurgitation–>⬆︎Vt filling rate in pt>40 yo
  3. Normal in [Athletes/Preggos/Pt<40 yo] :-)
155
Q

Auscultation Site for S3 gallop (3)

A

[Apex + (LLDP) + (End Exhalation)]

End Exhalation brings heart closer to chest wall

156
Q

Best indicator for severity of valve Regurgitation?

A

Presence of an additional S3 (indicates Vt Dilitation in addition to regurgitaiton)

157
Q

Aortic Regurgitation

Mumur

A

[Early Diastolic Descrescendo Murmur-High Pitched Blowing noise] auscultated @ [L Sternal 2nd/3rd ICS]

158
Q

Which murmurs are heard at the [L Sternal 2nd/3rd ICS] ? (3)

A
  1. Aortic Regurgitation
  2. Pulmonic Regurgitation
  3. (HOCM) Hypertrophic Cardiomyopathy
159
Q

3 Main Causes of Aortic Regurgitation

A
  • [Aortic Root Dilitation]
  • [Bicuspid Aortic Valve]
  • Endocarditis (i.e. Rheumatic Fever)
160
Q

You hear a Midsystolic murmur in otherwise young, asx adult

Next step?

A

NOTHING!

These are usually benign in young adults and do NOT require further w/u. Diastolic and Continuous should be worked up

161
Q

Why do Class 1C and Class 4 antiarrhythmics work differently in faster heart rates? What is this phenomenon called?

A

drug has less time to dissociate from Na+ chanels –> ⬆︎Blocked Na+ channels–>QRS Widening = Use Dependence

This is why Class 1C is effective against SVT arrhythmias

162
Q

Pathogensis of Aortic Aneurysm

A

[Chronic Transmural Inflammation] of Aortic wall —> [Loss of Elastin and Smooth Muscle] –> [Abnormal Collagen remodeling] –> [progressive Weakening of Aorta] –> Wall Expansion

[Chronic Transmural Inflammation] can come from Atherosclerosis but ⬆︎ risk of rupture comes from smoking!

163
Q

What are the risk factors for AAA?-5 ; Which RF is most likely to –> aneurysm expansion and rupture?

A
  1. SMOKING which –> AAA RUPTURE!(along with large diameter & expansion rate)
  2. Atherosclerosis
  3. Age > 65
  4. White race
  5. Fam hx of AAA
164
Q

Which arteries are affected by Fibromuscular Dysplasia? - 2

A

Renal

+

Internal Carotid –> Recurrent HA

165
Q

CP of Fibromuscular dysplasia - 4

A
  1. RECURRENT HA (from Internal Carotid stenosis)
  2. HTN 2/2 Secondary Hyperaldosteronism from Renal A. Stenosis
  3. Subauricular Systolic Bruit (from Internal Carotid stenosis)
  4. Abd Bruit possibly
166
Q

Dx for Fibromuscular Dysplasia

A

Vascular imaging (Duplex US, CT angio, MRI angio)

167
Q

Name 3 EKG Signs of [Atrial Fibrillation]

A
  1. [irregularly irregular R-R intervals] (the already irregular R-R interval will occur at an irregular pace since atrial electrictivity is chaotic)
  2. Absent or [low-amp fibrillatory] P-waves
  3. Narrow QRS Complexes
168
Q

[Atrial Fibrillation] is the most common tachyarrhythmia. It is often precipitated by what 4 things?

A

“Smh, SAME Afib as before!”

  1. Acute Systemic Illness (Hyperthyroid / HF / HTN)
  2. Sympathetic Tone ⬆︎
  3. EtOH - excess
  4. Mitral Stenosis
169
Q

When is Transcutaneous pacing used? - 2

A
  1. Symptomatic bradycardia
  2. Complete Heart Block
170
Q

3 classic Clinical Manifestations of [Tetralogy of Fallot]

A

A:

  1. [Systolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [RVOO -R Vt Outflow Obstruction]
  2. Squatting relieves sx (INC afterload–> [DEC amount of R to L shunt]
  3. [Cyanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)

“VOIR is to have See + Sight & Cry”

171
Q

4 anatomic abnormalities associated with [Tetralogy of Fallot]

A

VOIR

(Vt Septal Defect / Overriding Aorta / [Infundibular Pulmonary Stenosis] / [R Vt Hypertrophy with [R –> L shunt] = Boot shaped on CXR ]

“VOIR is to have See + Sight & Cry”

172
Q

List the associated cardiac pathology which each inherited disorder

A: Down Syndrome

B: DiGeorge Syndrome (2)

C: Friedreich’s Ataxia

D: Marfan Syndrome

E: Tuberous Sclerosis

F: Turner’s Syndrome (2)

G: Edwards Syndrome

A

A: “Put the cusions Down” = [Endocardial Cusion CAVSD]

B: [Tetralogy of Fallot] + [Truncus Arteriosus]

C: Hypertrophic Cardiomyopathy (“sweet, big heart”)

D: [Aortic Cystic Medial Dengeration]

E: [Cardiac Rhabdomyomas —> Valvular Obstruction]

F: [Aortic CoArctation] vs. [Biscuspid Aortic Valve]

G: VSD

CAVSD = Complete AtrioVentricular Septal Defect

173
Q

CP of CAVSD (Complete AtrioVentricular Septal Defect)-3 ; When does this present? Demographic?

A
  1. Holosystolic murmur from VSD
  2. Systolic Ejection murmur from ASD
  3. Loud S2 from Pulm HTN

Presents by 6 weeks old

Down Syndrome pts

174
Q

How does [____Stenosis] determine the degree of severity in [Tetrology of Fallot]

A

Degree of [Infundibular Pulmonary Stenosis] determines degree of symptoms since [INC stenosis] –> [INC R–>L Vt Shunt] –> INC [Cyanotic Tet Spells]

“VOIR is to have See + Sight + Cry”

175
Q

1 of the manifestations of Tetralogy of Fallot is Cyanotic lethal Tet Spells

What causes this? ; Tx?-2

A

Sudden spasm of R Vt Outflow during exertion –> Worsening RVOO –> Louder Systolic Ejection HARSH Murmur @ 2/3 LICS & cyanosis

(tx: Knee chest positioning + inhaled O2)

“VOIR is to have See + Sight & Cry”

RVOO = R Vt Outflow Obstruction

176
Q

In cardio world, what is Lidocaine’s indication?

A

Vt Arrhythmias in HDS pts

177
Q

Why is it relatively contraindicated for a HTN pts to take ORAL Contreceptive Pills?

A

OCP –>⬆︎Hepatic Angiotensinogen –> Mild (sometimes severe) ⬆︎ BP

⬆︎Risk in pts who develop HTN during pregnancy or family hx

178
Q

[Tachycardia-mediated LV HF] etx? ; Tx-2?

A

Persistent/Recurrent Tachyarrhythmia (chronic aFib w/RVR) –> [Tachycardia-mediated LV HF];

1st: Rate or Rhythm control

Alt: Coronary Artery Revascularization if vessels occluded

179
Q

What is a clinical predictor of how bad CHF pts are doing?

A

degree of hypOnatremia

180
Q

Afib Pts with CHA2DS2 VASc score of 1 should be Rx managed with what?-2

A

ASA only OR NOAC only

[NOAC = (apixiban,rivaroxaban,dabigatraban)]

181
Q

In HF pts, what process causes the ⬆︎ in SVR?

A

⬇︎Renal A. perfusion –> Release of NorEpi, Renin, ADH –> ⬆︎ SVR and maintainence of BP to vital organs

182
Q

Age group for Senile Calcific Aortic Stenosis

A

> 70 yo (comes from valvular calcification)

183
Q

SE of Niacin-2 ; etx ; tx

A
  1. Cutaneous Flushing
  2. pruritus

Prostaglandin-induced peripheral vasoDilation

tx = Take [ASA 81] 30 min before Niacin

184
Q

Name the location in the heart where ectopic foci that causes aFib are found

A

Pulmonary Veins

Myocardial sleeves extends around PVs and are supposed to be a sphincter to prevent reflux during atrial systole

185
Q

atrial flutter etx

A

ReEntry Circuit around tricuspid annulus

186
Q

What amount of EtOH provides coronary heart disease protection in Men? what about Women?

A

Men: 1-2 drinks/day

Women: Only 1 drink/day

> 2 drinks/day can –> HTN

187
Q

Tricuspid valve atresia etx

A

infant with CHD family hx has no formation of Tricuspid valve –> hypoplastic Pulmonary Artery and R Vt –> Left Axis Deviation and ⬇︎CXR Pulmonary markings

188
Q

Ebstein’s anomaly etx

A

Maternal lithium use during [1st trimester pregnancy] –> malformation and displacement of tricuspid valve into R Vt –> Tricuspid Regurgitation –> R Atrial Enlargement and R Axis deviation –> HEART FAILURE

189
Q

In what all situations do you hear an S4? - 2

A
  1. Hypertrophied Ventricle (HTN, Aortic Stenosis, HOCM)
  2. ACUTE Phase of MI (ischemia –> Vt stiffening)
190
Q

Prinzmetal Vasospastic Angina etx ; When do these typically occur?

A

Hyperreactivity of Coronary A. Tunica Intima muscle –> [less than 15 min vasospasm] ; During Sleep

191
Q

Prinzmetal Vasospastic angina tx ; Biggest risk factor?

A

CCB (Diltiazem vs Amlodipine vs Felodipine) ; Smoking

192
Q

Cilostazol MOA-2 ; Indication

A

Phosphodiesterase 3 inhibitor –>

  1. Arterial VasoDilation
  2. ⬇︎Platelet Aggregation

LE Claudication

193
Q

Ranolazine MOA ; Indication

A

inhibits late-phase Na+ influx –> ⬇︎myocardial Ca+ –> treats Stable Angina

Stable Angina 2/2 Atherosclerotic CAD

194
Q

Main causes of Secondary HTN - 12

A
  1. Renal Parenchymal Disease (⬆︎creatinine)
  2. Renal artery stenosis (Systolic > 180, Abd bruit, >55 yo)
  3. Primary Aldosteronism
  4. Pheochromocytoma (HA, diaphoresis, palpitations)
  5. Cushing Syndrome
  6. OSA
  7. hypOthyroidism
  8. Primary HyperParathyroidism
  9. Coarctation of Aorta
  10. Excess EtOH > 2 drinks/day
  11. Stress (via release of NorEpi & Angiotensin 2)
  12. Meds (OCP/Decongestants/NSAIDs/steroids)
195
Q

Pt just had a stroke recently and now wants px

What are the therapy regimens for prevention of stroke? - 3

A
  1. Give ASA vs [ASA + Clopidegrel] vs Warfarin after first stroke
  2. START WARFARIN FOR SURE after second stroke (if warfarin contraindicated, use only ASA)
  3. Give WARFARIN vs NOAC if pt has aFib after ANY stroke

Also make sure pt is on a Statin

196
Q

List the common causes of Restrictive Cardiomyopathy (8)

A

RAMILIES

  1. Radiation Fibrosis
  2. Amyloidosis (heterogenous misfolded proteins)
  3. Sarcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
  4. Metastatic Tumor
  5. Inborn metabolism errors
  6. Endomyocardial fibrosis= Common in [African/Tropic children]
  7. [Loeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
  8. Idiopathic
197
Q

Range for QT

A

250 - 440 (or 460 in Females)

198
Q

What are the electrolytes that cause Prolonged QT when deranged? - 3

A

MKC holds it together

199
Q

What are the Medication-induced causes of Prolonged QT? - 5

A

MKC holds it together

200
Q

What are the inherited causes of Prolonged QT? - 2

A

MKC holds it together

201
Q

What’s the best initial tx for R Vt infarction? Why?

A

Multiple fluid boluses ; R Vt infarction are preload dependent

202
Q

What’s the best way to differentiate cardiac tamponade from cardiogenic shock?

A

Cardiac tamponade will have Equalization of intracardiac diastolic pressures (RA, RV and pulm capillary wedge)

Tx = percardiocentesis

203
Q

What are the major causes of arterial emboli?-3 ; Which type of MI predisposes to these emboli?

A
  1. LV cardiac thrombous (GET ECHO!)
  2. LA atrial fibrilattion thrombous (GET ECHO!)
  3. Aortic Atherosclerosis

Large Anterior STEMMIs

204
Q

Tx for Premature Atrial Complexes? ; What are the precipitants of PACs?-4

A

NOTHING unless sx and/or SVT is present

  1. tobacco
  2. EtOh
  3. caffeine
  4. Stress
205
Q

Describe the murmur for VSD- 2

A
  1. Holocystolic murmur at Tricuspid area
  2. Apical Diastolic rumble from ⬆︎ flow acrossed mitral valve when Eisenmenger syndrome occurs

These can cause Failure to Thrive, DOE and HF

206
Q

Why does Squatting ⬇︎ the sound of MVP?

A

Squatting ⬆︎Venous return –> ⬆︎Preload. More preload means it’ll take longer before tendinae and mitra valve lips close –> delays mid-systolic click and shortens the time between it and S2

207
Q

Identify Rhythm

A

aFib with RVR

Tx = Rate control

DONT CONFUSE WITH SVT!

208
Q

Describe how to perform Hepatojugular reflex testing? ; What does a positive result indicate?-3

A

Apply R upper abd pressure for 10 seconds and watch for JVP to increase > 3 cm

  1. R Vt infarction
  2. Constrictive pericarditis (think TB)
  3. Restrictive cardiomyopathy
209
Q

What is the normal Jugular Venous Pressure?

A

6-8 cm H20

210
Q

3 Common signs of CONSTRICTIVE Pericarditis

Ur an idiot to constrict my radio and T-V

A
  1. Pericardial Knock= Sharp sound heard in early diastole
  2. Kussmaul Sign= Paradoxic [⬆︎ JVP during inspiration] since constricted R Vt can accomdate the INC blood
  3. Pulsus Paradoxus
211
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

long standing mitral stenosis –> L atrial enlargement –> L mainstem bronchus elevation or recurrent laryngeal n compression

212
Q

You hear a mumur in a patient

What are the features that indicate it is benign? - 8

A
213
Q

What are the substrates of CYP450 - 4

A

CYP450 Breaks these compounds APART

214
Q

What are the inhibitors of CYP450 - 13

A

AAA RACKSS IN GQ Magazine

  1. Acute alcohol use
  2. Amiodarone
  3. APAP
  4. Ritonavir
  5. Abx (metronidazole)
  6. Cimetidine
  7. Ketoconazole
  8. Sulfonamides
  9. SSRI
  10. INH
  11. NSAIDs
  12. Grapefruit and Cranberry
  13. Macrolides
215
Q

Why should you work up patients with R HF sx who’ve just had an AICD placed?

A

Transvenous lead placement through tricuspid valve can –> tricuspid regurgitation due to leaflet damage

216
Q

What is the most common cause of Chronic Mitral Regurgitation?

A

Mitral Valve Prolapse (myxomatous degeneration of valve)

“He was MVP…OF COURSE he had a Mid Clique to hang with”

[MidSystolic Click –> Late Systolic Crescendo Mumur] @ Apex

Sound Caused by Tendinae tightening and lips of the valve closing AFTER the preload has been ejected

217
Q

what type of EKG would indicate a Right Ventricular Infarction? - 2

A
  1. Inferior STEMMI + V1 STEMI or
  2. V4R STEMMI
218
Q

what type of EKG would indicate a Posterior Ventricular Infarction?

A

V1 reciprocal changes (ST Depression , Tall R)

219
Q

What’s the most non-pharmalogical way to ⬇︎BP

A

Weight Loss (lifestyle modification like DASH and exercise)

220
Q

What percentage of pts with Peripheral Artery Disease end up requiring limb amputation?

A

20%

[Peripheral Artery Dz] < [0.90 - 1.3] < [Calcified Vessels]

Alternative is Arterial Duplex US but this is less specific & sensitive

221
Q

How does Amiodarone interact with Digoxin?

A

Amiodarone ⬆︎serum Digoxin –> toxicity

222
Q

Why should you use ____ to treat afib from Wolff Parkinson White Syndrome instead of beta blockers, calcium blockers or digoxin?

A

Procainamide ; the others are AV nodal blockers and may ⬆︎condution through the accessory pathway

223
Q

Which pts should be started on statin therapy?

A

pts with 10 year risk of atherosclerotic CVD≥7.5% per the American College of Cardiology tool

224
Q

Side effects of Digoxin - 3

A
  1. Vision changes
  2. NVD
  3. atrial tachycardia with heart block
225
Q

Marfan Syndrome and Ehlers Danlos can present similarly

How do you discern the two?-2 ; What is the etx for Ehlers Danlos?

A

“Marfan BAATHES a lot! “

BUT Ehlers Danlos does NOT have

  1. Ectopia Lentis
  2. Arm-to-Height Ratio that’s INC

Ehlers Danlos etx = defective collagen production

226
Q

Tx for Stable SVT - 2

A
227
Q

Tx for Unstable SVT

A
228
Q

Tx for Stable Ventricular Tachycardia

A
229
Q

Tx for Unstable Ventricular Tachycardia - 2

A
230
Q

Tx for Torsades De Pointe Polymorphic Ventricular Tachycardia - 2

A
231
Q

MOA for Statins?

A

intracellular HmG-CoA reductase inhibitor which –> ⬇︎conversion of HmGCoA to mevalonic acid

232
Q

What are the main features of an innocent mumur - 3

A
  1. Grade 1 or 2
  2. ⬇︎ with standing
  3. early or mid-systolic
233
Q

How should Hypertriglyceridemia be managed?

A

[2b] A- step 2 CK (16 decks)

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