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PANRE Review 2016 > Other Heart Problems > Flashcards

Other Heart Problems Flashcards

1
Q

What is found on Echo that is diagnostic for cardiac tamponade?
What is Beck’s Triad?
EKG findings?

A

Large effusion and right heart diastolic collapse.
Hypotension, JVD, muffled heart sound.
Low voltage, tachycardia, Alternans–QRS changing in size (Big, small)

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2
Q

What is sign of pericarditis on EKG?

A

Diffuse ST segment elevation, PR segment depression in some leads

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3
Q

What are major causes Infective endocarditis?
What valve is affected? Murmur?
How to make the Dx of endocarditis?
Special Signs of the infection?

A

IV drug user (Staph aureus) and Prosthetic Valve.
Tricuspid Valve: New regurge murmur changing with time (coming and going).
Dx: new murmur and simultaneous sites of infx (Valve Shoots out septic emboli) so get stroke, pneumonia, change in mental status, renal.
Olsler node, Janeway lesion, splinter hemorrhage.

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4
Q

Causes of pericarditis?
Acute Pericarditis Signs?
Tx?

A

Cause–90% viral or idiopathic. Can also be due to SLE, Isoniazid.
Sharp, positional pleuritic chest pain feeling better when leaning forward, Friction Rub.
Asa, NSAIDs , for 1-3 weeks; colchicine

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5
Q

What is the best initial treatment for acute decompensated heart failure?

A

IV loop diuretic furosemide: initiate without delay to relieve congestion and fluid overload.

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6
Q

What are the etiologies of SHOCK?

A 
Sepsis
Hypovolemia
Obstructive
Cardiac (AMI)
Kortisol deficiency
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7
Q

What is the DX with a CXR showing a widened mediastinum, and EKG showing sinus tach, pain beginning suddenly?
Medical ManagementTreatment?

A 
Aortic dissection.
IV BB (labetalol)
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8
Q

What is a key lab to determine if CHF is decompensating?

A

Increased BNP: <100 unlikely decompensated CHF

>500 likely decompensated CHF

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9
Q

What is the diagnostic study of choice in most disorders of the pericardium?

A

Echo

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10
Q

What does the presence of S3 heart sound suggest?

S4?

A

S3: heart failure; this is due to increased resistance to ventricular filling during passive atrial emptying.
S4: Hypertensive heart disease, CAD, aortic stenosis, cardiomyopathy; occurs when there is increased resistance to ventricular filling during atrial contraction.

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11
Q

What is Tetralogy of Fallot?

A

Think “PROVe”

Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, ventricular septal defect

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12
Q

What is the clinical diagnosis of orthostatic hypotension?

A

> 20 mmHg drop in systolic BP or drop of >10 mmHg in diastolic BP between supine and sitting/standing measurement.
If also a rise in pulse of >15 BPM then depleted circulating blood volume is the probable cause.

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13
Q

What is the finding on ECG for Variant (Printzmetal)Angina?

A

Transient ST segment elevations.

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14
Q

What is the first cardiac marker to rise in an AMI?

A

Myoglobin arises within 1-3 hours.

Troponin rises in 3-12 hours.

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15
Q

What heart sound is the beginning of systole with the tricuspid and mitral valves closing.

A

S1

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16
Q

What heart sound is the end of systole/beginning of diastole with aortic and pulmonic valves closing.

A

S2

17
Q

What is the abnormal heart sound that is heard in early diastole during the passive LV filling?
What condition causes this?

A

S3

Dilated ventricle as in CHF

18
Q

What is the heart sound occurring late diastole during active LV filling and is abnormal. What disease state causes this?

A

S4, stiff ventricle caused by HTN, ischemia

19
Q

What is the first line treatment for chronic angina?
What is the first line treatment for unstable angina especially in heart failure?
What is needed in all angina patients?

A

B Blocker.
ACEI.
Plt inhibiting agents: aspirin, clopidogrel

20
Q

What is the 1st line medication for dissecting aortic aneurysm?

A

Labetalol

21
Q

In a patient with acute STEMI and BP of 90/56 despite aggressive fluid resuscitation, what pressor agent is most appropriate?

A

Dobutamine

22
Q

What is variant (Printzmetal) angina?
Describe the ST-Segment
What is the treatment of choice(after nitrates)?

A

Vasospastic angina. Episodes of rest angina that promptly responded to nitrates due to coronary artery vasospasm. Assoced with ST-segment elevation.
Calcium Ch Blocker.

23
Q

What is stable angina?

Describe the ST-segment.

A

Effort angina

assoced with ST-segment depression.

24
Q

What is unstable angina?
Describe the ST-segment?
Do nitrates help?

A

Closely related to non-ST-segment elevation MI. Less responsive to nitrates. Angina lasting >30 minutes. MC presentation is at rest. Also, new onset of angina sxs, or increasing pattern of pain in previously stable patients.

25
Q

What do you check for in any elderly patient who faints even without associated chest pain?

A

Evaluate for acute MI with serum creatinine kinase and troponin levels.

26
Q

Antibiotics are no longer needed as prophylaxis for which type of Heart/valve disease?

A

Bicuspid aortic valve, acquired mitral or aortic valve disease including patient’s who have undergone valve repair, hypertrophic cardiomyopathy.

27
Q

When do you need antibiotic prophylaxis in heart/valve disorder patients?

A

Prosthetic heart valves, Hx of endocarditis, unrepaired cyanotic congenital heart disease, repaired congenital heart defects with prosthetic material or device during 1st 6 mos after procedure,

28
Q

What is cor pulmonale?
What is a common manifestation?
Signs?
What is seen on the EKG?

A

An alteration in the structure and function of the R. Ventricle of heart caused by a primary disorder of the respiratory system.
Pulmonary HTN that leads to R. Ventricular heart failure.
Elevated jugular venous pressure, congestive hepatomegaly, ascites, peripheral edema.
EKG: Right Ventricular Hypertrophy

29
Q

What is the MC congenital heart disease?

A

VSD

30
Q

What do you see on the EKG with hypocalcemia?

What do you see with hypokalemia?

A

Prolonged QT interval.

Flattening of T waves.

31
Q

What does the Valsalva maneuver do?
What type of murmurs does it increase?
What type of murmurs does it decrease?

A

Diagnoses hypertrophy, regurgitation, prolapse, stenosis.
Increases the murmur in hypertrophic cardiomyopathy and mitral valve prolapse.
Decreases murmurs in stenosis and regurgitation.

32
Q

An increased size of the cardiac silhouette on CXR is characteristic of what disorder?

A

Pericardial effusion

33
Q

What is the #1 RF for aortic dissection?

A

HTN

34
Q

What is the diagnosis: trauma(car accident) causing sxs of hypotension, muffled heart sounds, distended neck veins, tachycardia

A

Cardiac tamponade: accumulation of blood in the pericardial cavity.

35
Q

What conditions are associated with acute pericarditis?

A
  • 90% idiopathic or due to viral infection
  • Isoniazid therapy
  • Systemic Lupus Erythematous: suspect this in a female of any age who has acute pericarditis.
  • Uremia(high levels of waste product in the blood
36
Q

What is a clinical symptom associated with atherosclerotic stenosis of a carotid artery?

A 
Transient visual loss in one eye.
Amaurosis fugax(painless temporary loss of vision) lasts only 1-2 mins:  anyone with this needs a duplex US of carotid artery.
37
Q

What is the HTN treatment of choice in a patient with gout?

What is the HTN treatment of choice for HTN with angina or AFIB?

A

Verapamil as thiazide diuretics increase serum uric acid levels.
Verapamil.

38
Q

What is cardiogenic shock?

Tx:

A

The heart suddenly can’t pump enough blood usually after a severe AMI.
Dobutamine(to increase cardiac output) and volume replacement.

39
Q

What med used in treatment of CHF is most effective for decreasing the patient’s mortality?

A

ACEI

PANRE Review 2016 (22 decks)

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