Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Prep Study > PP EM Cardiology > Flashcards

PP EM Cardiology Flashcards

1
Q

How is a 12 lead EKG organized? What are the corresponding major vessels?
Anterior?

A

Anterior

Leads= v3, v4

Vessel= Diagonal branch of the left anterior descending artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is a 12 lead EKG organized? What are the corresponding major vessels?
Septal?

A

Septal

Leads= v1, v2

Vessel= Septal branch of the left anterior Descending Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is a 12 lead EKG organized? What are the corresponding major vessels?
Lateral?

A

Lateral

Leads= Lead I, AVL, V5, V6

Vessel= Left Circumflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is a 12 lead EKG organized? What are the corresponding major vessels?
Inferior?

A

Inferior

Leads= Lead II, III, AVF

Vessel= Right Coronary Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the progression of EKG Changes seen in hyperkalemia?

A

Normal K 3.5 - 5.0

K+ 5.5-6.5
Peaked T waves (V1, V2, AVR)
Short QT

K+ 6.5-8.0
Wide QRS, Long PR, Flat P waves

K+ >8.0
Loss of P waves, Wide QRS,
Interventricular/bundle branch blocks, Sine wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is low voltage defined on an EKG?

A

Adding the QRS measurement of Leads I, II, & III.
Less than 15mm total.

or

Adding the QRS measurements of leads V1, V2, V3.
Less than 30mm Total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes low voltage on an EKG?

A

Decreased ability of EKG leads to detect the signal.

Pericardial effusion
Pleural Effusion
COPD
Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which Electrolyte derangements are associated with a prolonged QTc?

A

Hypokalemia
Hypomagnesemia
Hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is ST Elevation Myocardial infarction (STEMI) Diagnosed?

A

ST Elevation of >1mm in two contiguous leads ina ll leads except V2 & V3.

For Leads V2 and V3:
Women = ST Elevation >1.5mm
Men >40 = ST elevation >2mm
Men <40 = ST elevation >2.5mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some STEMI equivalents?

A

deWinters T Waves

Wellens syndrome

Hyperacute T waves in 2 or more contiguous leads

Sqarbossa criteria present for LBBB

Posterior MI

Isolated T Wave Inversion in AVL

ST elevation in AVR with diffuse ST depression in 6 or more leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are seven conditions that may cause ST elevation on an EKG?

A

STEMI

Pericarditis

Prinzmetal Angina

Hyperkalemia

Early repolarization

LV aneurysm

Hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What Mnemonic is used to show what leads show reciprocal changes in MI?

A

PAILS
AILSP

Posterior MI Results in ST depression in Anterior Leads

Anterior MI Results in ST depression in Inferior Leads

Inferior MI Results in ST depression in Lateral Leads

Lateral MI Results in ST depression in Septal Leads

Septal MI Results in ST depression in Posterior Leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What Is the reciprocal change for a

Posterior MI

A

Anterior Depression

Posterior MI Results in ST depression in Anterior Leads

PAILS
AILSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What Is the reciprocal change for an

Anterior MI

A

Inferior Depression

Anterior MI Results in ST depression in Inferior Leads

PAILS
AILSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What Is the reciprocal change for an

Interior MI

A

Lateral depression

Inferior MI Results in ST depression in Lateral Leads

PAILS
AILSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What Is the reciprocal change for a

Lateral MI

A

Septal Depression

Lateral MI Results in ST depression in Septal Leads

PAILS
AILSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What Is the reciprocal change for a

Septal MI

A

Posterior Depression

Septal MI Results in ST depression in Posterior Leads

PAILS
AILSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the morphology of Wellen’s Syndrome on an ECG?

A

Type A (25% of cases) - Biphasic T wave in leads V2, V3

Type B (75% of cases) - Deep, symmetric T wave inversions in leads V2, V3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the clinical implications of Wellen’s Syndrome?

A

Highly specific for critical stenosis of the LAD

These patients should not undergo stress testing and should instead go for PCI

They do not typically respond to medical management, hence the need for PCI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is Sgarbossa’s criteria applied?

A

Paced ECG and patients with left bundle branch block.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Sgarbossa Criteria?

A

STEMI equivalent if any of the following are present:

Concordant ST segment elevation in any lead
Concordant ST segment depression in V1-V3
Discordant ST segment elevation >5mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What classic ECG pattern can be seen in a patient with cardiac tamponade?

A

Electrical alternans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What ECG Changes can be seen in the setting of an aortic dissection?
Why?

A

ST elevation in inferior leads due to dissection into the right coronary artery.

Signs similar to pericarditis or electrical alternans due to pericardial effusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What ECG finding can be seen in the setting of hypothermia?

A

Osborn Waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the ECG findings in a person with Wolf Parkinson White Syndrome?

A

Delta Waves (slurring upstroke of the QRS)

Short PR Interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the ECG findings in a patient with benign early repolarizations?

A

Diffuse concave ST elevations, mostly in the precordial leads

Notching or slurring of the J point

ST elevation in less than 25% of the T wave amplitude in V6

ST elevation usually <2mm in the precordial leads and <0.5mm in the limb leads

No reciprocal changes

No dynamic changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the common risk factors for ACS?

A 
Diabetes
HTN
HLD
Family history
Male Gender
Obesity
Prior history
Sedentary Lifestyle
Family History of MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which patient population often present with nonclassical symptoms of an MI?

A

Women
Elderly
Diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the atypical symptoms of an acute MI?

A

Sharp, Burning, discomfort or pain free, no radiation, exertional fatigue / SOB, Lightheadedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the typical symptoms of an acute MI?

A

Substernal chest pressure that radiates to the left arm or jaw and worsens with exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the typical symptoms
and
Atypical symptoms
of an acute MI?

A

Typical:
Substernal chest pressure that radiates to the left arm or jaw and worsens with exertion

Atypical:
Sharp, Burning, discomfort or pain free, no radiation, exertional fatigue / SOB, Lightheadedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the first sign of an acute MI on ECG?

A

Hyperacute, wide, tall, T waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the first sign of an acute MI on ECG?

What is the subsequent progression of changes on ECG in an acute MI?

A

First Sign: Hyperacute, wide, tall, T waves

Subsequent Changes: 
Hyperacute T waves, 
ST elevation,
Q Waves with T wave inversion
ST elevations improve
T waves Normalize, Q waves persist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the HEART score?

A

A risk stratification tool for ACS in patients who are presenting with chest pain.

It is composed of:
History
ECG
Age
Risk factors
Troponin value
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What cutoff for the HEART score is safe to discharge?

A

Typically a heart score <4 may go home if they have close outpatient cardiology follow up.

Scores of >4 or with poor outpatient follow up should be considered for admission and further testing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What dosing of aspirin should be administered in a patient with evolving ACS?

A

At least 161mg,

typically 324mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Why is aspirin chewed and not swallowed?

A

Chewing increases surface area for rapid absorption and facilitates faster platelet inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What 2 medications are shown to improve outcomes in patients with acute MI?

A

Aspirin
Beta Blockers
(within first 24 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the most common type of MI?

A

Inferior wall MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is “broken heart Syndrome”

A

STEMI appearance on ECG with possible elevation in troponin but with a clean cath

Echo will show regional wall motion abnormalities

Also know as Takosubo cardiomyopathy, thought to be induced from extreme catecholamine release related to severe emotional stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Does resolution of chest pain after nitro prove ACS?
Does reproducible Chest pain?
Does negative troponin and a normal ECG?

A

No

Unstable angina is part of the spectrum of ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

HFrEF Treatment (Sarah)

A 
BB
Entresto
Spironalacto
SGLT2
Statin (likely)

Ivabradine for tachycardia
Loop for fluid/edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

HFpEF Treatment (Sarah)

A

Spiro
Loop
SGLT2

Treat symptoms/ conditions ie HTN, DM, AFIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Post Stent Treatment (Sarah)

A

Aspirin (DAPT)
Plavix
BB
Statin (Atorvastatin)

Nitro
<40EF Entresto (can use ACE/ARB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Asymptomatic <40 EF (Sarah)

A

Use ACE/ARB over Entresto

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

AFIB (symptomatic) (Sarah)

A

Dilt drip over night
if don’t convert

TE Cardiovert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

AFIB with high chads vasc (Sarah)

A

DOAC
Metoprolol or Dilt (first line metoprolol)

No CCB if bad EF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

ATTR Amyloidosis Treatment (Sarah)

A

Tafamidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What biomarkers are elevated in the presence of an MI?

A

Myoglobin (First)
CK-MB
Troponin I
Troponin T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What biomarker elevates in the presence of an MI First?

A

Myoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is stable vs unstable angina?

A

Stable angina =
Predictable cardiac chest pain that occurs with exertion and resolves with rest

Unstable angina =
Cardiac chest pain in the absence of elevated cardiac markers or ST elevation on ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Stable angina

A

Stable angina =

Predictable cardiac chest pain that occurs with exertion and resolves with rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Unstable angina

A

Unstable angina =

Cardiac chest pain in the absence of elevated cardiac markers or ST elevation on ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is an NSTEMI?

A

Non ST elevation myocardial infarction

Cardiac chest pain with elevation of troponin in the absence of ST elevation of ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the normal pulse pressure at rest?

A

30-40mmhg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are some etiologies of a narrow pulse pressure?

A 
Significant blood loss
Aortic stenosis
Tachycardia
Pericardial effusion
Constrictive pericarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are some etiologies of a wide pulse pressure?

A 
Systolic HTN
Aortic regurgitation
Severe anemia
Thyrotoxicosis
Pregnancy
AV fistula
Thiamine deficiency
Congenital anomalies (PDA, COA)
58
Q

What happens to a pacemakers function when a magnet is placed on it?

A

Turns off the sensing capability and resets pacemaker to a fixed rate.

59
Q

What happens to the defibrillator function when a magnet is placed on an AICD?

A

Turns defibrillator function off

60
Q

What are some indications for pacemaker insertion?

A 
CHF with EF <25%
Symptomatic sinus bradycardia
Mobitz Type II (second degree AV block)
Third degree AV Block
Sick sinus syndrome
Frequent episodes of V-Tac
61
Q

What are pacemaker codes?

A

There are 5 of them but the first 3 are the most important in the ED.

Informs which chambers are paced
Which chambers are sensed
and the response of the sensing

62
Q

What are some complications most commonly seen during the first 6 weeks of pacemaker placement?

A 
Hemopneumothorax
Bleeding
Venous in the SVC/Subclavian veins
Air embolism
Post-operative infection
Lead displacement
63
Q

What is failure to capture?

A

The pacemaker sends a signal

but the myocardium does not depolarize

64
Q

What is failure to pace?

A

Pacemaker does not send the signal to the myocardium

65
Q

What is failure to sense?

A

Pacemaker does not recognize the the myocardium has depolarized

66
Q

What does it mean to interrogate a pacemaker?

A

A special device is placed over the pacemaker and electronically connects to the pacemaker

The machine prints out when the pacemaker fired and why.
It will detect if overdrive pacing has occurred in an AICD
It will tell you if any shocks were delivered
It can also tell you about what rhythms the patient has been in and when

67
Q

What is the treatment of a patient who gets on shock form their AICD?

A

HPI to assess for repetitive arm movement that might have falsely triggered AICD

Interrogate the AICD to determine why it went off

Observe in the ED and then close outpatient follow up with EP

68
Q

What is the treatment for a patient who gets repeated shocks from an AICD?

A

Typically these patients are admitted

(Same as single shock)
HPI to assess for repetitive arm movement that might have falsely triggered AICD

Interrogate the AICD to determine why it went off

Observe in the ED and then close outpatient follow up with EP

69
Q

What is the definition of an electrical storm?

A

3 or more appropriate shocks in a 24 hour period

70
Q

What is Twiddlers syndrome?

A

Dislodgment of pacemaker wires and malfunction of the pacemaker from external manipulation by the patient

71
Q

When analyzing tachycardiac rhythms, what are common ways to categorize them?

A

Wide vs Narrow

Stable vs unstable

72
Q

A narrow complex tachycardia indicates that the rhythm is originating in which part of the heart?

A

Supraventricular (above the ventricle)

73
Q

In which cases will supraventricular tachycardia (SVT) appear to be a wide complex rhythm?

A

SVT with underlying bundle branch block or WPW

74
Q

What etiologies of a wide QRS need to be considered?(Tachy or not)

A

Hyperkalemia
Acidosis
NA+ channel blockers

75
Q

How is Torsades de Pointes Treated?

A

IV Mag

If refractory to Mag:
Overdrive pacing
Consider Isoproterenol
Cardioversion used in the unstable patient
Defibrillation used in the pulseless patient

76
Q

What treatment should be attempted first in a stable patient with SVT?

A

Vagal maneuvers

REVERT Procedure (modified valsalva)

77
Q

What medication (including dosage) is used in a stable patient with SVT?

A

Adenosine 6mg
2nd dose is 12mg

Push it fast then follow with a fast flush push

78
Q

How is SVT in the unstable patient treated?

A

Synchronized cardioversion

79
Q

What is happening when the synchronization function is turned on?

A

T Waves are detected to prevent delivering a shock during repolarization

80
Q

Why is hitting the synchronized function so important when cardioverting?

A

Prevents R on T phenomenon which leads to ventricular fibrillation

81
Q

If unable to determine if the rhythm is V tach or SVT with Wide QRS, how should it be approached?

A

Treat as V Tach

82
Q

What is atrial fibrillation?

A

Irregular and uncoordinated atrial electrical activity

No discernable P waves

Can be narrow or wide complex

83
Q

What term is used to describe an atrial fibrillation rhythm?

A

Irregularly irregular

84
Q

What is atrial fibrillation with rapid ventricular Response?

A

A FIB with RVR

Tachycardic atrial fibrillation where the ventricle is hypersensitive to the irregular atrial electrical activity, resulting in rates >120bpm

85
Q

Treatment of A FIB with RVR should be focused on what two priorites?

A

Identifying underlying causes of A FIB with RVR to focus treatment

Restoring a normal rate or rhythm (depends on time of onset)

86
Q

A patient with previously undiagnosed atrial fibrillation should be evaluated for what potential endocrine etiology?

A

Hyperthyroidism

87
Q

If a patient with atrial fibrillation, with or without RVR, is unstable due to the rhythm, what is the preferred treatment?

A

Synchronized cardioversion

88
Q

Why is rhythm control (synchronized cardioversion or medication) not always used to treat A FIB?

A

After 48hrs of continuous A FIB, an atrial thrombus can develop

May result instroke if rhythmically converted

89
Q

What two classes of medications are used for rhythm control in A FIB?

What determines which medication is used for rate control?

A

Medications: CCB, BB

Choice depends on:
Provider preference
Patients current medications…
(If already on one, try more of it)

Beta Blockers preferred in CHF Patients

90
Q

What scores are used to help determine the need for anticoagulation in a patient with atrial fibrillation?

A

CHA2DS2-VASc

HAS-BLED

91
Q

What is the preferred oral anticoagulant per the American College of Cardiology?

A

DOAC’s

Direct Oral Anticoagulants

  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
92
Q

If the patient has mechanical valves, what anticoagulant is used?

A

Warfarin

Goal INR of 2.5-3.5

93
Q

What is the path of the cardiac conduction system?

A 
SA Node
AV Node
Bundle of His
Bundle Branches
Purkinje Fibers
94
Q

What causes a bradycardic rhythm?

A

Impaired conduction at the SA or AV node
Can be intrinsic or extrinsic

Impaired conduction through the His-Purkinje system

95
Q

What are soe extrinsic causes of bradycardia?

A 
MI
Hypothermia
Electrolyte imbalance (ie Hyperkalemia or hypoglycemia)
Infection (ie sepsis)
Intracranial hemorrhage

Medications
BB, CCB, Digoxin, Clonidine, Opiates, ethanol, anticholinesterase meds (ie aricept)

96
Q

What initial determination needs to be made in a patient presenting with a heart rate of 38 bpm?

A

Hemodynamically stable?

Check mental status
BP (ie hypotension)

97
Q

Why can bradycardia lead to hemodynamic instability?

A

Bradycardia can lead to reduced cardiac output

Cardiac output (CO) = 
Heart Rate (HR) x Stroke Volume (SV)

CO = HR x SV

98
Q

What medication can be used to increase the heart rate in bradycardia?

A

Atropine

99
Q

If atropine does not increase the HR, what other medication could be considered in bradycardia?

A

Epinephrine

100
Q

What is a common electrolyte abnormality that causes bradycardia and often makes the rhythm difficult to treat until the imbalance is addressed?

A

Hyperkalemia

Often presenting as a bradycardic high degree block

101
Q

What is the treatment alternative to atropine for a patient that is hemodynamically unstable patient?

A

Cardiac Pacing

102
Q

What are the typical presenting symptoms of a patient experiencing heart failure?

A

Dyspnea
Edema (pulmonary or peripheral)
Fatigue

103
Q

Which race has the highest incidence of heart failure?

A

African American

104
Q

What is one method to characterize heart failure that is determined with an echocardiogram?

A

Ejection Fraction (EF)

Impaired ejection fraction <40% = HFrEF

Preserved ejection fraction >50% = HFpEF

105
Q

What symptoms result from left sided heart failure?

A

Pulmonary edema
Hepatomegaly
Vascular congestion

106
Q

What is the most common cause of right sided heart failure?

A

Left sided heart failure

107
Q

What is acute heart failure?

What causes acute heart failure?

A

An acute event that causes inadequate cardiac output

Causes:
Acute myocardial infarction
Valvular rupture
Infection
Dysrhythmia
108
Q

How does acute heart failure typically present?

A

Flash pulmonary edema

Hypotension (cardiogenic shock)

109
Q

What triggers a patient with chronic heart failure to have an acute exacerbation?

A

Triggers:
Non compliance (meds and diet)
Infection, anemia, cardiac ischemia

Presentation
Worsening dyspnea (often exertional)
Lower extremity edema
Orthopnea
fatigue 
Weight gain
110
Q

What physical exam findings are often present in a patient with heart failure exacerbation?

A 
Tachycardia
Increased work of breathing
Presence of rales, rhonchi
diminished lung sounds
JVD
Hepatojugular reflex (due to hepatic congestion)
111
Q

What is cardiogenic shock?

A

End organ damage caused by inadequate perfusion secondary to decreased cardiac function

112
Q

Are patients with cardiogenic shock fluid overloaded?

A

Possibly, but they may also be intravascularly depleted with interstitial edema

113
Q

When performing a lung Ultra Sound on a patient with concerns for heart failure, what finding indicates pulmonary edema?

A

B lines

114
Q

What are some x ray findings in someone who has decompensated congestive heart failure?

A 
Cardiomegaly
Pulmonary congestion
Pleural Effusion
Kerley B Lines
Alveolar edema (Bat wing Opacities)
115
Q

What are initial treatment measures for decompensated congestive heart failure?

A

IV, O2, Monitor

Sublingual Nitroglycerin

NIPPV (non invasive positive pressure Ventilation)

Furosemide

116
Q

If a decompensated heart failure patient is hypotensive, what type of shock are they in?

A

Cardiogenic shock (Pump Problem)

117
Q

What is the approach to managing a patient in cardiogenic shock?

A

NIPPV (non invasive positive pressure Ventilation)
First,
Intubation as a last resort after resuscitation

Caution: can result in decreasing preload due to increased intrathoracic pressure

Gentle resuscitation of 250-500cc boluses

Early Vasopressors: Norepi or Epi

Inotrope: Dobutamine if additional support is needed after vasopressor

118
Q

A patient is sent to the ED due to concerns for elevated BP discovered at an employee health screening. The patient is asymptomatic, how should they be worked up?

A

Consider ECG, If asymptomatic follow up with PCP, Patient does not need ED, Consider initialization of a low dose BP med to bridge until PCP follow up, (HCTZ or ACE)

119
Q

What determines ED treatment for hypertension?

A

Profound elevation (>180 systolic and/or 120 diastolic) with signs of end organ damage.

120
Q

What is the term used to describe the patient with hypertension and end organ damage?

A

Hypertensive emergency, ***(the term Hypertensive urgency is no longer used??)

121
Q

Does the degree of BP elevation correlate to the severity of symptoms?

A

No the severity of symptoms does not correlate with level of BP

122
Q

If a patient requires emergent treatment of their BP, what is the target reduction in the first hour?

A

25%

123
Q

JNC 8 (joint national committee) defines normal blood pressure as what?

A

120/80

124
Q

When can a patient with hypertensive emergency be transitioned from IV medication to Oral medication?

A

After 12-24 hours of successful BP control

125
Q

What is endocarditis?

A

Infection with associated vegetations of cardiac valves, native or prosthetic, or indwelling cardiac devices

126
Q

What is the common scoring tool that is used to help diagnose endocarditis?

A

Duke Criteria

127
Q

What is the most common presenting symptom in patients with endocarditis?

A

Fever, Seen in 90% of acute cases

128
Q

What imaging modality is best to determine the presence of a valvular vegetation?

A

Cardiac echo (TEE is more sensitive, TTE is more available)

129
Q

What physical exam finding is observed in 85% of patients with endocarditis?

A

Cardiac murmur

130
Q

What are some non cardiac exam findings that are concerning for endocarditis?

A

Janeway lesions (Painless Hands/feet), Osler nodes (Painful nodules on tips of fingers and toes), Roth’s spots (Retinal hemorrhages with pale center)

131
Q

What is a significant pulmonary complication seen in endocarditis?

A

Septic Pulmonary Emboli

132
Q

What is the most common site for metastatic infection from endocarditis?

A

CNS (up to 20% of patients)

133
Q

What organisms are commonly involved with endocarditis?

A

Staph > Strep, (Consider MRSA)

134
Q

In patients with prosthetic valves undergoing an invasive procedure, what prophylaxis medication is indicated?

A

Amoxicillin (i.e. Cephalexin if PCN allergy)

135
Q

What is pericarditis?

A

Inflammation of the pericardium (two layers of sac like tissue surrounding the heart), (there is normally a small amount of fluid naturally between the 2 layers to decrease friction)

136
Q

How is acute pericarditis diagnosed?

A

Clinical diagnosis that includes at least 2 of the following criteria: Chest pain - typically pleuritic, worse when lying flat and improved when sitting upright. ECG abnormalities - (diffuse ST elevation, PR depression). Pericardial friction Rub, Pericardial effusion (acute or acute on chronic)

137
Q

What alternative etiology must often be considered in a patient with suspected pericarditis?

A

STEMI

138
Q

What ECG characteristics can help differentiate between STEMI and pericarditis?

A

Pericarditis will not have reciprocal changes and will have PR segement depression, STEMI should have reciprocal depression, will often be dynamic, and ST elevation in lead III > Lead II

139
Q

Will a patient with pericarditis have an elevated troponin?

A

No, does not have any effect on myocardium

140
Q

What is the treatment for pericarditis?

A

NSAIDS and Colchicine

141
Q

How long should a patient be on NSAIDs to prevent recurrence of pericarditis?

A

At least 6 months

Prep Study (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions