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Clin Med-Cardio pt 2 > PEARLS Book > Flashcards

PEARLS Book Flashcards

1
Q

ultrasound of the heart, most useful in diagnosing heart failure**, also used in evaluating coronary artery disease

A

Echocardiogram

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2
Q

This type of echocardiogram is:

**primary noninvasive test for assessing cardiac anatomy and function

A

Transthoracic echocardiogram (TTE)

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3
Q

This type of echocardiogram is:
**more invasive but better imaging of structures*, especially posterior cardiac structures, patients w prosthetic valves or aortic disorders (i.e. aneurysms) or atrial abnormalities (i.e. thrombi)

A

Transesophageal echocardiogram (TEE)

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4
Q

GOLD STANDARD FOR DEFINITIVE DIAGNOSIS FOR CORONARY ARTERY DISEASE, PERIPHERAL ARTERY DZ, AND RENAL ARTERY STENOSIS**

A

ANGIOGRAPHY!

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5
Q

What does a positive stress test look like on EKG

A

ST depression

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6
Q

Most useful noninvasive test in evaluating patients w suspected coronary artery disease?

A

Stress test

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7
Q

Benefit of using Myocardial Perfusion Imaging (MPI)..

A

localization of region of ischemia

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8
Q

Adenosine or Dipyridamole

A

Pharmacologic stress test

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9
Q

localizes regions of ischemia***, depicts wall motion abnormalities as well as visualize structure and function of the heart (assess LV and valvular function)

A

Stress echo

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10
Q 
risk factors=
diabetes mellitus
hyperlipidemia
smoking
HTN
males
age over 65
fam hx of CAD
A

Angina

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11
Q

EKG can show:
ST depression with exertion
T wave inversion
poor R wave progression

A

Angina

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12
Q

GOLD STANDARD** outlines coronary artery anatom, determine location and extent of CAD

A

Coronary angiography

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13
Q

Most common cause of an MI?

A

Atherosclerosis

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14
Q

Women, elderly, diabetics, obese have..

A

Atypical MI presentations

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15
Q

With an anterior wall MI, where will the Q waves/ST elevations be seen?

A

v1 through v4

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16
Q

Which artery is involved in an anterior wall MI?

A

LAD

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17
Q

With a lateral wall MI, where will the Q waves/ST elevations be seen?

A

I, aVL, V5, V6

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18
Q

Which artery is involved in a lateral wall MI?

A

Circumflex

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19
Q

With a anterolateral wall MI, where will the Q waves/ST elevations be seen?

A

I, aVL, v4, v5, v6

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20
Q

Which artery is involved in an anterolateral MI?

A

mid LAD or circumflex

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21
Q

With an inferior wall MI, where will the Q waves/ST elevations be seen?

A

II, III, aVF*

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22
Q

Which artery is involved in an inferior wall MI?

A

Right coronary artery

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23
Q

With a posterior wall MI, where will the Q waves/ST elevations be seen?

A

ST DEPRESSIONS IN:
V1-V2
(mirror image!! will be seen)

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24
Q

How often should you test cardiac markers?

A

3 sets Q8 hours

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25
Q

Which cardiac marker is the most sensitive and specific?

A

Troponin

Troponin takes 7-10 days to return to baseline

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26
Q

Post MI pericarditis associated with fever and pulmonary infiltrates

A

Dressler’s syndrome

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27
Q

HF, v fib, cardiogenic shock, papillary muscle, mitral regurg, ventricular wall rupture, pericarditis, mural thrombosis

A

Complications of MI

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28
Q

Average pt goes home on: Aspirin, beta blocker, ACEi, statin, NTG PRN

A

MI pt

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29
Q

EKG shows transient ST elevations (symptoms and ST elevations rapidly resolve w CCB and nitro)

A

Prinzmental angina

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30
Q

Most common cause of HF?

A

Coronary artery disease

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31
Q

most common cause of L sided HF

A

CAD

HTN

32
Q

most common cause of R sided HF

A

L sided HF

also pulmonary dz

33
Q
  1. sympathetic nervous system activation
  2. myocyte hypertrophy/remodel
  3. RAAS activation
    cause: **fluid over load, ventricular remodeling/hypertrophy, all leading to…..
A

CHF!

pulmonary and/or systemic edema

34
Q

Increase pulmonary venous pressure from fluid backing up into lungs:

  • dyspnea
  • pulmonary congestion/edema
A

L sided HF

35
Q

rales, rhonchi, chronic nonproductive cough esp w pink, frothy sputum
wheezing “cardiac asthma” due to airway edema, pleural effusion
Nocturia

A

L sided HF

36
Q

CHF is the most common cause of…

A

transudative pleural effusion

37
Q

HTN, Cheyne Stoke’s breathing

S3 and S4 can be heard

A

L sided HF

38
Q

Dusky pale skin, diaphoresis, fatigue, altered mental status

A

HF

39
Q

Increase systemic venous pressure leading to signs of systemic fluid retention

A

R sided HF

40
Q

Peripheral edema
Jugular venous distention
GI/Hepatic congestion

A

R sided HF

41
Q

most useful test to dx HF?

A

Echocardiogram

42
Q

What is the most important determinant in prognosis of HF patient?

A

Ejection fraction

43
Q

decreased EF
thin ventricular walls
dilated LV chamber
S3 sound

A

Systolic failure

44
Q

normal/increased EF
thick ventricular walls
small LV chambers
S4 sound

A

Diastolic failure

45
Q

Kerley B lines
Butterfly pattern
Cardiomegaly infiltrates
Pleural effusion

A

CXR of CHF pt

46
Q

increased _____ may identify CHF as the cause of dyspnea in the ER

A

BNP

47
Q

_____ release B-type natriuretic peptides (BNP) during volume overload

A

ventricles

48
Q

calcium channel blockers are helpful for which kind of HF?

A

Diastolic

49
Q

Persistent, pleuritic, postural pain and pericardial friction rub (5 P’s)

A

Acute pericarditis

50
Q

Viral is most common cause (Enteroviruses: Coxsackie and echovirus)

A

Acute pericarditis

51
Q

pericarditis that occurs 2-5 months after an MI

A

Dressler’s syndrome

52
Q

Pleuritic chest pain (sharp and worse w inspiration). Persistent, postural (worse with lying down and relieved by sitting/leaning forward). May radiate to trapezius*, back, neck, shoulder, arm, epigastric area.
Fever usually present

A

Acute pericarditis

53
Q

Best heard at end of expiation with patient upright and leaning forward

A

Pericardial friction rub

54
Q

EKG shows diffuse, ST elevations in precordial leads (concave up in V1 through V6) and associated with PR depression

A

Acute pericarditis

55
Q

First line tx for acute pericarditis

A

Anti-inflammatory drugs- aspirin or NSAIDs

56
Q

Increased fluid in pericardial space

A

Pericardial effusion

57
Q

Causes include: pericarditis**, malignancy infection, radiation therapy, dialysis/uremia, collagen vascular disease

A

Pericardial effusion

58
Q

Exam reveals distant heart sounds bc fluid interferes w sound conduction

A

Pericardial effusion

59
Q

Low voltage QRS complexes suggest…

A

Large effusion (or tamponade)

60
Q

Echocardiogram shows an increase pericardial fluid

A

Pericardial effusion

61
Q

Pericardial effusion causing significant pressure on the heart, which causes a restriction of cardiac ventricular filling, which decreases cardiac output

A

Pericardial tamponade

62
Q
  1. distant (muffled) heart sounds
  2. increased JVP
  3. systemic hypotension
A

Beck’s triad

seen in pericardial tamponade

63
Q

decreased pulses with inspiration

A

Pulsus paradoxus (seen in pericardial tamponade)

64
Q

Echocardiogram may show diastolic collapse of cardiac chambers

A

Pericardial tamponade

65
Q

Tx of pericardial tamponade

A

Immediate pericardiocentesis

66
Q

thickened, fibrotic, calcified pericardium that restricts ventricular diastolic filling

(this causes an increase in venous pressure
decrease in stroke volume
ultimately, a decreased cardiac output)

A

Constrictive pericarditis

67
Q

Dyspnea***
Pulsus paradoxus
R sided HF signs, Kussmaul’s sign: JVD increased during inspiration

A

Constrictive pericarditis

68
Q

Pericardial knock: high-pitched 3rd heart sound due to sudden cessation of ventricular filling in early diastole from thickened inelastic pericardium

A

Constrictive pericarditis

69
Q

Echocardiography shows: pericardial thickening

CXR shows: pericardial calcification

A

Constrictive pericarditis

70
Q

Pericardiectomy is the management for..

A

Constrictive pericarditis

71
Q

What is the most common type of cardiomyopathy

A

Dilated cardiomyopathy (95%)

72
Q

systolic dysfunction leads to ventricular dilation which causes a “dilated, weak heart”

ages 20-60

A

Dilated cardiomyopathy

73
Q

Most commonly idiopathic, can be cause by enteroviruses (Coxsackie B, echovirus), Parovirus B19
*Can be caused by alcohol abuse, cocaine, anthracyclines, pregnancy

A

Dilated cardiomyopathy

74
Q

Echocardiogram shows left ventricular dilation (thin ventricular wall), large ventricular chamber, deceased ejection fraction, regional or global LV hypokinesis

(CXR shows cardiomegaly)

A

Dilated cardiomyopathy

75
Q

You treat dilated cardiomyopathy just like…

A

heart failure

ACEi, diuretics, etc

76
Q

Hallmark= impaired diastolic function with relatively persevered contractility
ventricular rigidity impedes ventricular filling

A

Restrive cardiomyopathy

77
Q

infiltrative disease: amyloidosis is most common cause**, sarcoidosis

A

Restrictive cardiomyopathy

Clin Med-Cardio pt 2 (11 decks)

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