Medicine- Cardiology Flashcards
General indications for surgical treatment of infective endocarditis and the treatment of choice?
congestive heart failure, uncontrolled infection, systemic embolization, a prosthetic valve, or fungal endocarditis.
Tx: Mechanical valve replacement is the treatment of choice in a young (< 65 years old)
Diastolic murmur + sharp sound after S2 (Opening snap)
Mitral stenosis
Otherwise healthy male, with high cholesterol on examination for pre-employment… next best step?
Serum lipid studies while fasting
What is the normal jugular venous pressure
less than <3 cm H2O above the sternal angle at 30-45 degrees recumbency
What drugs should be avoided in RVMI (Right ventricular Myocardial infarction)
Nitrates, diuretics and opiods
Clinical presentation of cardiac outflow obstruction
progressive dyspnea on exertion, fatigue and exertional syncope
Clinical presentation of Beta blocker overdose
bradycardia and hypotension leading to cardiogenic shock
Aortic regurgitation murmur
Early diastolic murmur
Vasovagal syncope pathophysiology
Response to from increased parasympathetic activity leading to bradycardia and asystole due to sinus arrest
Holosystolic murmur that increases in intensity with inspiration
Tricuspid regurgitation
What are the most important factors improving patient survival in cardiac arrest
- Prompt effective resuscitation with adequate bystander cardio-pulm resuscitation
- Promt rhythm analysis and defibrillation in a shockable rhythm (eg. V-fib)
Physical Characteristics of a patient with Pericarditis
Pleaurtic chest pain that can radiate to bilateral trapezius ridges
Triphasic pericardial friction rub
ECG findings in a patient with sick sinus syndrome
Sinus bradycardia
Sinus pauses (delayed P waves)
SA nodal exit block (dropped P waves)
Clinical features of sick sinus syndrome
Elderly patients
Bradycardia (fatigue, dyspnea, syncope, dizziness)
bradycardia-tachycardia syndrome (A-fib, palpitations)
Treatment of sick sinus syndrome
- Pacemaker
2. +/- rate control meds eg. BB (if tachyarrhythmias)
Best modalities for diagnosing of Aortic Dissection
TEE (Preferred in patients with renal insufficiency)
CT Angio (preferred study in hemodynamically stable pts)
MRA
What is the next best step in a Asx patient with a diastolic murmur
Transthoracic echo (these type of murmurs are almost always pathological)
ECG findings that are consistent with LV Hypertrophy
High voltage QRS
Lateral T wave inversions
Lateral ST segment depressions
Symptoms of Coartation of the aorta in an adult
Headaches
Epixtasis
Lower extremity claudication
Initial evaluation of coarctation of the aorta
- Simultaneous palpitaion of brachial and femoral pulse to look for delay
- UE and LE BP difference by measuring UE supine and LE in prone position
Prolonged infusion of Nitroprusside especially in renal failure patients can lead to what?
Cyanide Toxicity
Dilated cardiomyopathy that begins in the last month of pregnancy or within 5 months of delivery and what murmur is it associated with?
Peripartum Cardiomyopathy associated with mitral regurg
Intermittent prominent A waves caused by surge in JVP and why this happens
Cannon A waves (right atrial contraction against a closed tricuspid valve)
What pathology are cannon A waves associated with
Atrioventricular dissociation (eg. V-tach)
What is the net result of a cardiac tamponade
Decrease preload, cardiac output and stroke volume
What is the most common endocrine disorder associated with A-fib
Hyperthyroidism
Transient loss of consciousness along with loss of postural tone or motor tone during micturition
Situational syncope (cardioinhibitory or vasodepressor or mixed)
It typically presents as a high-frequency, mid-systolic click combined with a high-frequency, mid-to-late systolic murmur heard best at the apex.
MVP
What is given to keep the PDA open
PGE1
In the context of a serious motor vehicle collision, this patient’s hypotension and tachycardia refractive to fluid resuscitation, including vasopressors, combined with atrial fibrillation on EKG and a negative FAST, are highly suspicious for what?
Cardiac contusion
The patient has acute aortic regurgitation and left-sided CHF from infective endocarditis, which together are an indication for what type of intervention.
Surgical Mechanical valve replacement is the treatment of choice in a young (< 65 years old) patient with no contraindications for anticoagulation.
What is the treatment of choice in a patient who is >65 yrs or has contraindications for anticoagulation with severe Aortic regurgitation with CHF symptoms
Porcine valves
Do patients with HOCM have abnormal mitral leaflet motion
YES.. they have a systolic anterior motion
