NBME MS3 - Cardiology Flashcards
Risk factors a/w development of AAA
- Older age (>60)- Cigarette smoking- Family history of AAA- Atherosclerosis
Risk factors a/w AAA expansion and rupture
- Large aneurysm diameter- Rapid rate of expansion- Current cigarette smoking
Side effects (2) of high-dose niacin therapy to treat lipid abnormalities (hypertriglyceridemia)Mechanism of side effectsTreatment to reduce side effects
Cutaneous flushing and pruritis Niacin causes prostaglandin-induced peripheral vasodilationLow-dose aspirin reduces these side effects
Site of infective endocarditis in IV drug user with systolic murmur?
Tricuspid valve endocarditis Systolic murmur
Site of infective endocarditis in IV drug user with diastolic murmur?
Aortic valve endocarditis Diastolic murmur
Cause of aortic regurgitation (AR) diastolic murmur best appreciated along left sternal border (3rd and 4th intercostal spaces)
Valvular disease (e.g., infective endocarditis)
Cause of aortic regurgitation (AR) diastolic murmur best appreciated along right sternal border
Aortic root disease
IV drug user, diastolic murmur best appreciated at left sternal border, ECG showing evidence of conduction abnormality with 2:1 second-degree AV block
Aortic valve endocarditis complicated by peri-valvular abscess and resulting AV conduction block and syncope
Two primary manifestations of Chagas disease
Megacolon/megaesophagus and cardiac disease (Trypanosoma cruzi protozoal infection)
Signs of congestive heart failure
JVD, S3 heart sound, cardiomegaly
Inciting events of vasovagal (neurocardiogenic) syncope- Age < 60 years- Age > 60 years
Age < 60 years- Emotional/orthostatic stress (venipuncture, prolonged standing, heat exposure, exertion)Age > 60 years- Micturition, cough, defecation
Diagnosis of vasovagal (neurocardiogenic) syncope
- Mainly clinical diagnosis- Upright tilt table testing in uncertain cases
Murmurs that get louder with valsalva/standing
- Hypertrophic cardiomyopathy- Mitral valve prolapse
Murmurs that get softer with squatting
- Hypertrophic cardiomyopathy- Mitral valve prolapse
Murmurs that get softer with handgrip
- Hypertrophic cardiomyopathy
Murmurs that get softer with squatting/handgrip
- Aortic regurgitation- Mitral regurgitation- Ventricular septal defect (VSD)
Treatment of Dressler syndrome
- Dressler syndrome: pericarditis that occurs weeks after an MI believed to be due to immunologic phenomena - Treatment is NSAIDs- Corticosteroids can be used in refractory cases or when NDSAIDs are contraindicated
Complication of treating pericarditis with anticoagulation
Hemorrhagic pericardial effusion
Drug(s) that commonly trigger bronchoconstriction (acute-onset dyspnea with wheezing and prolonged expiration) in patients with asthma, especially those with concurrent chronic rhinitis and nasal polyps
- Aspirin- Beta blockers
Patient with history of recent upper respiratory infection followed by sudden onset of cardiac failure in an otherwise healthy patient
- Dilated cardiomyopathy 2/2 acute viral myocarditis (Coxsackievirus B infection) - Diagnosis of dilated cardiomyopathy is made by echo, which typically shows dilated ventricles with diffuse hypokinesia resulting in low ejection fraction (systolic dysfunction)
Concentric hypertrophy
- Seen following chronic pressure overload- Valvular stenosis, untreated hypertensionCONcentric hypertrophy to CONtract fluid across stenosed valves
Eccentric hypertrophy
- Seen following chronic volume overload
Systolic ejection murmur heard at RUSB
Aortic stenosis
Systolic ejection murmur heart at LUSB
- Pulmonic stenosis- Flow murmur- Atrial septal defect
Systolic ejection click heart at LUSB
Pulmonic stenosis
Systolic ejection murmur heart at LSB
Hypertrophic cardiomyopathy
Early diastolic murmur heart at LSB
- Aortic regurgitation- Pulmonic regurgitation
Holosystolic murmur heart at LLSB
- Tricuspid regurgitation - Ventricular septal defect
Mid/late diastolic murmur heart at LLSB
- Tricuspid stenosis- Atrial septal defect
Holosystolic murmur heart at apex
Mitral regurgitation
Mid/late systolic click heard at apex
Mitral valve prolapse
Mid/late diastolic murmur heard at apex
Mitral stenosis
Signs of chronic mitral regurgitation
Displaced apical impulse, holosystolic murmur, S3
Mitral valve prolapse
Secondary to myxomatous degeneration of the mitral valve leaflets and chordae causing a mid systolic click followed by a mid-to-late systolic murmur
Medical treatment for hypertensive patients with aortic dissection
IV labetalol
Aortic dissections requiring medical/surgical intervention
Type A - involving ascending aorta
Aortic dissections requiring medical intervention only
Type B - involving descending aorta
Digoxin toxicity
- Nausea/vomiting, decreased appetite, confusion, weakness- Visual symptoms of scotoma, blurry vision with changes in color, blindness An inciting event (viral illness, excessive diuretic use) can lead to volume depletion or renal injury that acutely elevates the digoxin levelHypokalemia, often a/w loop diuretic use, increases susceptibility to toxic effects of digoxin
Recurrent fevers (>39C), rash (maculopapular and non-pruritic, affecting the trunk and extremities), and arthritis
Adult Still’s disease
Isolated systolic hypertension (ISH)
- Important cause of HTN in elderly patients- Secondary to decreased elasticity of the arterial wall, which leads to an increased systolic BP without a significant change in diastolic BP
Treatment of isolated systolic hypertension (ISH)
- ISH should always be treated due to its a/w increased risk for cardiovascular events- Initial treatment = monotherapy with a low dose thiazide, an ACE inhibitor, or long-acting Ca channel blocker
Diastolic dysfunction (heart failure with preserved left ventricular ejection fraction)
- Diastolic dysfunction refers to impaired filling of left or right ventricle, either b/c of impaired myocardial relaxation or a stiff, non-compliant ventricle- Contractility (EF) may remain normal but diastolic pressures are elevated, consequently reducing cardiac output - Systemic HTN is the classic cause of diastolic dysfunction- Treatment = diuretics and BP control
ST elevations I, aVL, V2-V6ST depressions II, III, aVF
Anterolateral MI 2/2 occlusion of LAD artery
Initial medical therapy for MI
- Oxygen- Full-dose aspirin (chewed so that it enters the bloodstream quickly)- Adequate pain control with morphine and nitroglycerin (contraindicated in hypotension)- Platelet P2Y12 receptor blocker (clopidogrel)- Beta blocker- AnticoagulationPercutaneous coronary intervention (PCI) > fibrinolytic therapy
