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Cardiovascular FA > MTB and important from FA 2 > Flashcards

MTB and important from FA 2 Flashcards

1
Q

cardiac sound S3 in normal in

A

children and pregnant

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2
Q

auscultation of the heart - Aortic area (what we hear)

A

systolic murmur (aortic stenosis, flow murmur eg. physiologic murmur, aortic valve sclerosis)

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3
Q

auscultation of the heart - left sternal border (what we hear)

A
  1. diastolic murmur: aortic regurgitation, pulmonic regurgitation
  2. systolic murmur hypertrophic cardiomyopathy
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4
Q

auscultation of the heart - Pulmonic area (what we hear)

A

systolic ejection murmur: pulmonic stenosis, flow murmur (eg physiologic murmur)

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5
Q

auscultation of the heart - mitral valve (what we hear)

A
  1. holosystolic murmur: mitral regurgitation

2. diastolic murmur: mitral stenosis

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6
Q

auscultation of the heart - tricuspid valve (what we hear)

A
  1. holosystolic murmur: tricuspid regurgitation, ventricular septal defect
  2. diastolic murmur: tricuspid stenosis, ASD
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7
Q

ASD auscultation

A

ASD commonly present with a pulmonary flow murmur (increased flow through pulmonary valve) and a diastolic rumble (increased flow across tricuspid). Blood flow across the actual ASD does not cause murmur (no significant P gradient). The murmur later progress to a louder diastolic murmur of pulmonic regurgitation from dilaton of the pulmonary arterey

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8
Q

auscultation of the heart - aortic regurgitation mumur

A

high-pitched early long diastolic decrescendo murmur.

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9
Q

auscultation of the heart - mitral stenosis mumur

A

follows opening snap. Delayed rumbling diastolic murmur

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10
Q

auscultation of the heart - aortic stenosis mumur

A

crescendo - decrescendo systolic ejection murmur

ejection click MAY be present

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11
Q

aortic stenosis pulse

A

pulsus parvus et tardus: weak with delayed peak

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12
Q

aortic stenosis is often related to

A
  1. age related calcification
  2. early onset calcification of bicuspid aortic valve
  3. rarely - Rheumatic heart disease (mitral valve is also involved)
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13
Q

MVP murmur

A

late systolic crescendo murmur with midsystolic click.

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14
Q

acute pericarditis - presentation

A

sharp chest pain, aggravated by inspiration and lying supine, relieved by sitting up and leaning forward

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15
Q

acute pericarditis - ECG

A
  1. ST-segmented
    and/or
  2. PR depression
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16
Q

cardiac tamponade - clinical examination

A
  1. Beck’s triad (hypotension, distended neck veins, distant heart sounds)
  2. increased HR
  3. pulsus paradoxus
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17
Q

most frequent primary cardiac tumor in children

A

Rhabdomyomas

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18
Q

kussmual sign - definition / may be seen in

A
  • increasing in JVP on inspiration instead of normal decreasing
    1. constrictive pericarditis
    2. restrictive cardiomyopathy
    3. right atrial or ventricular tumors
    4. severe right ventricular failure
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19
Q

BNP blood test

A
  1. used for diagnosis of heart failure

2. very good negative predictive value

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20
Q

hypertrophic cardiomyopathy - clinical examination findings

A
  1. S4
  2. Systolic murmur (left sternal border) (loudest with valsava, standing up)
  3. maybe mitral regurgitation due to impaired mitral valve closure
  4. paradoxical splitting
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21
Q

hypertrophic cardiomyopathy - treatment

A
  1. cessation of high intensity athletics
  2. non-didydropyridines Ca2+ channel blockers
  3. β-blockers
  4. Implantable Cardioverter Defibrillator (ICD) if patient is high risk
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22
Q

hypertrophic cardiomyopathy - pulse

A

quick rise arterial pulse

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23
Q

restrictive/infiltrative cardiomyopathy - major causes

A
  1. sarcoidosis
  2. amyloidosis
  3. postradiation fibrosis
  4. endocardial fibroelastosis
  5. Loeffler syndrome
  6. hemochromatosis
  7. scleroderma
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24
Q

Loeffler syndrome

A

endomyocardial fibrosis with prominent eosinophilic infiltrate

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25
endocardial fibroelastosis
thick fibroelastic tissue in endocardium of young children
26
restrictive cardiomyopathy - type of dysfunction
diastolic
27
hyperlipidemia signs
1. xanthomas 2. tendinous xanthoma 3. corneal arcus
28
lipid-lowering agents groups
1. HMG-CoA reductase inhibitors (statins) 2. Bile acid resins 3. Ezetimibe 4. Fibrates 5. Niacin
29
statins side effect
hepatotoxicity (increased LFTs) | myopathy (especially when used with fibrates or niacin)
30
bile acid resins drugs
cholestyramine colestipol colesevelam
31
bile acid resins mechanism of action
prevent intestinal reabsorption of bile acids SO the liver must use cholesterol to make more
32
bile acid resins side effects
1. GI upset | 2. decreased reabsorption of other drugs and fat-soluble vitamins
33
Ezetimibe mechanism of action
prevent cholesterol absorption at small intestine brush border
34
Ezetimibe side effects
1. increased LFT (rare) | 2. diarrhea
35
Fibrates drugs
-FIBRATES clofibrate, bezafibrate, fefenofibrate AND GEMFIBROZIL
36
fibrates mechanism of action
1. upregulate LPL --> increased TG clearance | 2. Activates PPAR-α to induce HDL synthesis
37
fibrates side effecrs
1. myopathy (increased risk with statins) | 2. cholesterol gallstones
38
niacin mechanism of action
1. inhibits lypolyisis (hormone sensitive lipase) in addipose tissue 2. reduces hepatic VLDL synthesis
39
3 agents able to stabilize the atherosclerotic plaques
1. Beta blocker 2. ACE inhibitor 3. statins
40
increased of TG leves - agent
bile acid resins (SLIGHTLY)
41
LDL levels calculation
LDL ch = TOTAL ch - HDL - (TG/5) (no if tg more than 400)
42
niacin side effects
1. hyperglycemia 2. Hyperuricemia 3. Red, flashed face, which is decreased by NSAID or long term use
43
MI: complications at 0-4hr
1. arrhythmia 2. HF 3. cardiogenic shock
44
MI: complications at 4-24hr
1. arrhythmia 2. HF 3. cardiogenic shock
45
MI: complications at 1-3 days
postinffraction fibrinous pericaridtis
46
MI: complications at 3-14 days
1. Free wall rupture: a. tamponade b. papillary muscle rupture (mitral regurgitation) c. interventricular septal rupture ( leads to shunt) due to macrophage-mediated structural degradation 2. LV pseudoaneurysm (risk of rupture)
47
MI: complications at 2weeks to several months
1. Dressler syndrome 2. HF 3. True ventricular aneurysm (RISK OF MURAL THROMBUS)
48
Diagnosis of MI - ECG localization of STEMI and vessel - ANTEROSEPTAL
LAD | V1-2
49
Diagnosis of MI - ECG localization of STEMI and vessel - | ANTEROAPICAL
DISTAL LAD | V3-4
50
Diagnosis of MI - ECG localization of STEMI and vessel - | ANTEROLATERAL
LAD or LCX | V5-6
51
Diagnosis of MI - ECG localization of STEMI and vessel - | LATERAL
LCX | I, aVL
52
Diagnosis of MI - ECG localization of STEMI and vessel - | INFERIOR
RCA | II, III, aVF
53
Myocardial infraction complication - Interventricular septal rupture, papillary muscle rupture, ventricular pseudoaneurysm, ventricular free wall rupture - time
Interventricular septal rupture --> 2-3 d papillary muscle rupture --> 3-7 d ventricular pseudoaneurysm --> 3-14 d ventricular free wall rupture --> 5-14 d
54
Diagnosis of MI - ECG localization of STEMI and vessel - | posterior
PDA | V7-V9, ST depression in V1-V3 with tall R waves
55
causes of sabacute endocarditis
viridans streptococci (low virulence)
56
MCC of endocariditis in drug users
1. S aureus 2. Candida 3. pseudomons
57
Olser nodes vs Janeway lesions
Osler: tender raised lesions on finger or toe pads | Janeway lesions: small painless erythematous lesions on palm or sole
58
culture negative infective endocarditis
1. Coxiella burnetti 2. Bartonella 3. HACEK 4. prior treatment with antibiotics
59
rheumatic fever - major criteria
1. migratory polyarthritis 2. carditis 3. Nodules on skin (subcotaneous) 4. Erythema marginatum 5. Sydenham chorea
60
systemic inflammatory response syndrome
>=2: 1. fever/hypothermia 2. tachycardia 3. tachypnea 4. leukocytosis/leukopenia
61
Ischemic heart disease manifestations - types
1. angina (stable, unstable, variant) 2. Coronary steal syndrome 3. MI 4. sudden cardiac death 5. Chronic ischemic heart disease
62
Sudden cardiac death: definition
death from cardiac causes within 1 hour of onset of symptoms most commonly sue to lethal arrhythmia (eg ventricular fibrillation)
63
antiarrhytmics Class IA drugs
1. Quinidine 2. Procainamide 3. Disopyramide
64
antiarrhytmics Class IA - clinical use
Both atrial and ventricular arrhythmias | esp re-entrant (eg WPW), ectopic SVT (eg atrial fibrillation) and VT
65
antiarrhytmics Class IA - toxicity
1. Cinchonism (headache, tinnitus, psychosis) - quinidine 2. reversble SLE-like syndrome - procainamide 3. heart failure - disopyramide 4. thrombocytopenia 5. torsades de pointes due to increased QT interval
66
antiarrhytmics Class IB -drugs
1. Lidocaine 2. Mexiletine 3. phenytoin
67
antiarrhytmics Class IB - clinical use
1. acute ventricular arrhythmias (esp post MI) | 2. digitalis-induced arrhythmias
68
antiarrhytmics Class IB - toxicity
1. CNS stimulation/depression | 2. cardiovascular depression
69
antiarrhytmics Class IC - drugs
1. Flecainide | 2. Propafenone
70
antiarrhytmics Class IC - toxicity
proarrhythmic (esp in post-MI)
71
antiarrhytmics Class IC - contraindicated
1. ischemic heart disease (post-MI) | 2. stractural ischemic heart disease
72
antiarrhytmics Class IC - clinical use
1. SVT (including atrial fibrillation) | 2. Only last resort in refractory VT
73
treat β-blockers overdose
saline, atropine, glucagon
74
anthiarrhythmics class II - clinical use
SVT (ventricular rate control for atrial fibrillation and flutter)
75
anthiarrhythmics class II - toxicity
1. impotence 2. exacerbation of COPD/athma 3. cardiovascular effects (bradycardia, AV block, HF) 4. CNS effects (sedation, sleep alterations) 5. may mas hypoglycemia signs 6. dyslipidemia (metoprolol) 7. exacerbate vasospasm in prinzmetal (propranolol)
76
anthiarrhythmics class III - drugs
1. Amiodarone 2. Ibutilide 3. Dofetilide 4. Sotalol
77
anthiarrhythmics class III - clinical use
1. atrial fibrillation 2. atrial flutter 3. ventricular tachycardia (amiodarone, soloatol)
78
solatol toxicity
1. torsades de pointes | 2. excessive β blockage
79
ibutilide toxicity
torsades de pointes
80
amiodarone toxicity
1. pulmonary fibrosis 2. hypo/hyperthyroidism 3. hepatotoxicity 4. act as hapten 5. neurological defects 6. comstipation 7. cardiovascular effects (bradycardia, heart block, HF)
81
antiarrhythmics IV - drugs
verapamil, diltiazem
82
other antiarrhythmics drugs
1. adenosine | 2. Mg2+
83
Mg2+ as antiarrhythmic
effective in torsades de pointes and digoxin toxicity
84
adenosine as antiarrhythmic - clinical use
drug of choice in diagnosing/abolishing SVT

Cardiovascular FA (8 decks)

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