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Cardio > MTB 2 > Flashcards

MTB 2 Flashcards

1
Q

Presentation of CHF

A

Dyspnea

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2
Q

Which type of Heart failure is there preserved EF

A

Diastolic

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3
Q

Systolic Dysfunction

MC Causes

A

Dilated Cardiomyopathy + Low EF
Infarction
Cardiomyopathy
Valve disease

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4
Q

MCC of CHF

A

HTN resulting in cardiomyopathy or of myocardial muscle

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5
Q

Presentation of Systolic Dysfnc

A 
Dyspnea (SOB), DOE
Pulmonary Edema = worst form
Orthopnea
Peripheral Edema
Rales 
JVD
Paroxysmal nocturnal dyspnea (PND)
S3 gallop
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6
Q

What is an S3 Gallop

A 
Ken-Tucky
Low frequency
Early Diastolic 
Inflow from LA strikes blood that is already in LV - Reverberation of blood b/t LV walls
Sign of LV Failure
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7
Q

Is S3 ever normal?

A

Can be normal in athletes and young adult

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8
Q

When do we hear S4

A

Late Diastole

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9
Q

Dyspnea + dullness to percussion at bases

A

Pleural Effusion

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10
Q

Dyspnea + recent anesthetic use + brown blood , not improved with oxygen, clear lungs

A

Methemoglobinemia

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11
Q

Most important test for CHF

A

Echo

Only way to differentiate b/c systolic and diastolic

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12
Q

Best initial test for EF

A

TTE

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13
Q

Most accurate test for EF

A

MUGA

Nuclear Ventriculography

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14
Q

Most accurate test for heart valve function

A

TEE

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15
Q

Reduce mortality in Systolic Dysfunction

A 
ACE/ARBs
Beta Blockers
Spironolactone
Hydralazine/nitrates
Implantable defibrillator
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16
Q

First line TX for Systolic Dysfunction

A

Diuretic + Vasodilator

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17
Q

Beta blockers used in Systolic Dysfunction

A

Metoprolol - B1 only
Bisoprolol - B1 only
Carvedilol - non-specific, a-1 antag

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18
Q

Which drugs do we NOT use in Diastolic dysfunction

A

Digoxin
Spironolactone

Uncertain benefit
ACE/ARBs
Hydralazine

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19
Q

Vasodilators used in Systolic Dysfunction

A

ACE, ARBS
Hydralazine
Nitrates

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20
Q

Why are beta blockers used in CHF

A

Antiischemic
Decrease HR = decreased O2 consumption
Antiarrhythmic

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21
Q

MCC death from CHF

A

Arrhythmias

Sudden death

22
Q

Presentation of Beta blocker toxicity

A 
Bradycardia
AV block
HypoTN
Diffuse wheezing
Cardiogenic shock = cold, clammy
Delirium
Seizures
Hypoglycemia
23
Q

TX for Beta blocker toxicity

A 
Glucagon - increases cAMP to increase contractility
Calcium Gluconate 
Epinephrine 
Insulin
Sodium Bicarbonate
24
Q

Spironolactone MOA
Use?
AE?

A

Inhibits Aldosterone
Advanced CHF - Class III, IV
gynecomastia, Hyperkalemia

25
Q

CHF pt develops gynecomastia

A

Switch spironolactone to Eplerenone

26
Q

Presentation of Digoxin Toxicity

A

GI: N/V
Arrhythmia - Atrial Tach w AV block, paroxysmal atrial tachycardia
Blurred vision, yellow halos

27
Q

TX of Digoxin toxicity

A
  1. Stop drug
  2. Administer K+ if needed
  3. Lidocaine + Phenytoin
  4. Digibind = digoxin immune fab only for acute OD
28
Q

Does Digoxin lower mortality in CHF

A

No.

Controls Sx’s

29
Q

When do we use implantable defibrillator

A

Ischemic Cardiomyopathy + EF < 35%

30
Q

When do we use biventricular pacemaker

A

Dilated Cardiomyopathy + EF < 35% + QRS > 120 msec

31
Q

What is Diastolic Dysfunction

A

CHF w Preserved EF

32
Q

Which drugs are clearly beneficial in Diastolic Dysfunction

A

Beta blockers

Diuretics

33
Q

Which drugs are clearly NOT beneficial in Diastolic Dysfunction

A

Digoxin

Spironolactone

34
Q

Does implantable defibrillator lower mortality in diastolic dysfunction?

A

Yes

35
Q

What is Pulmonary Edema

A

Worst, most severe form of CHF

Rapid onset of fluid in lungs

36
Q

Presentation of Pulmonary Edema

A 
Rales
JVD
S3 Gallop
Edema
Orthopnea
Cyanosis
Increased respiratory rate
Productive cough with pink, frothy sputum
Noctural Dyspnea
Ascites, enlarged liver and spleen
37
Q

What does a normal BNP exclude

A

CHF

Pulmonary Edema

38
Q

CXR in Pulmonary Edema

A

Vascular Congestion

Cephalization of flow (filling of blood vessels twds head)

39
Q

ABG in Pulmonary Edema

A

Hypoxia
Respiratory Alkalosis bc of hyperventilation
Increased RR = so CO2 leaves more easily than O2 enters bloodstream

40
Q

Hypoxia v Hypoxemia

A

Hypoxia - inadequate O2 supply in body

Hypoxemia - low arterial O2 supply

41
Q

Management if A fib, A flutter, or V tach are cause of Pulmonary Edema

A

Rapid synchronized cardioversion

42
Q

What tests done in Pulmonary Edema

A

EKG

Echo

43
Q

TX for Pulmonary Edema

A

Preload reduction: MONA
Positive Inotropes
- Dobutamine
- Amrinone and milrinone - PDE inhibitors that increase contractility and decrease afterload
Positive inotrope, increases contractility
Afterload Reduction
- ACE/ARBs

44
Q

TX for chronic Pulmonary Edema

A

Digoxin

ACE/ARBs

45
Q

MCC regurgitant disease

A

HTN

Ischemic heart dz

46
Q

Consequences of infarction

A

Regurgitation -> Dilatation -> CHF

47
Q

Murmurs that increase in intensity/loudness w inhalation

A

Right sided - inhalation increases venous return to right
Tricuspid
Pulmonic

48
Q

Murmurs that increase in intensity/loudness w exhalation

A

Left sided - exhalation squeezes blood out of lungs, into left
Mitral
Aortic

49
Q

Best initial test pulmonary edema

A

TEE

50
Q

Most accurate test pulmonary edema

A

Catheterization

Cardio (6 decks)

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