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First Aid Step 2 > Rapid Review Cardiovascular > Flashcards

Rapid Review Cardiovascular Flashcards

1
Q

fClassic EKG finding in atrial flutter

A

Sawtooth P waves

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2
Q

Definition of unstable angina

A

Angina that is new, worsening, occurs at rest

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3
Q

Antihypertensive for diabetic pt w/ proteinuria

A

ACEI

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4
Q

Becks triad for cardiac tamponade

A

Hypotension
Distant heart sounds

JVD

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5
Q

Drugs that slow HR

A

Beta blockers

CCB

Digoxin

Amiodarine

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6
Q

Hypercholesterolemia Tx that leads to flushing and pruritis

A

Niacin

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7
Q

Mumur of HOCM

A

Systolic ejection murmur along lateral sternal border that increases with decreased preload (i.e. Valsalva)

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8
Q

Murmur of aortic insufficiency

A

Austin flint murmur:

Diastolic, descrescendo, low pitched, blwing murmur best heard sitting up

Increases with increased afterload (i.e. handgrip)

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9
Q

Murmur of AS

3 cases when valve replacement needed

A

Systolic crescendo-descrescendo radiates to neck

Increases with increased preload

Replace: ACS- angina, CHF, syncope

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10
Q

Murmur of MR

A

Holosystolic mumur that radiates to axilla or carotids

Increases with increased afterload (handgrip)

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11
Q

Mumur of MS

A

Diastolic mid to late low pitched mumur preceded by opening snap

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12
Q

Tx for aflutter and afib

A

Unstable - cardiovert

Stable or chronic- rate control with CCB or Beta blocker

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13
Q

Tx vfib

A

Immediate cardioversion

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14
Q

Dressler’s syndrome

A

AI reaction

Fever, pericarditis, increased ESR 2-4 weeks post MI

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15
Q

IVDU with JVD and holosystolic murmur at left sternal border….Tx

A

Treat existing HF and replace tricuspid valve

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16
Q

Diagnostic test for HCM

A

Echo (shows thickened LV wall and outflow obstruction)

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17
Q

Pulsus paradoxus

A

Decrease in SBP >10 mmHg with inspiration

Seen in cardiac tamponade

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18
Q

Classic EKG in pericarditis

A

Low voltage, diffuse ST segement elevation, PR depression

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19
Q

Definition of HTN

A

BP >140/90 on 3 separate occassions 2 weeks apart

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20
Q

Eight surgically correctable causes of HTN

A
  1. Renal a stenosis
  2. Coarctation of the aorta
  3. Pheochromocytoma
  4. Conn’s syndrome
  5. Cushing syndrome
  6. Unlateral renal parenchymal disease
  7. Hyperthyroidism
  8. Hyperparathyroidism
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21
Q

Evaluation of pulsatile abdominal mass and bruit

A

ABD US and CT

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22
Q

Indications of surgical repair of AAA

A

>5.5 c, rapidly enlarging, symptomatic, ruptured

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23
Q

Tx ACS

A

MONA: morphine, ASA, sublingual nitrogen, O2 +heparin, clopidogrel, IV beta blockers

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24
Q

Metabolic syndrome

A
  1. Abdominal obesity
  2. High TG
  3. Low HDL
  4. HTN
  5. IR
  6. Prothrombotic or proinflammatory states
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25
Q

Dx test for 50 y.o. man with stable angina that can exercise to 85% of max HR

A

Exercise stress treadmill with ECG

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26
Q

Dx test for 65 y.o. woman with LBBB and severe OA with unstable angina

A

Pharmacologic stress test (dobutamine echo)

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27
Q

Target LDL in pt w/ DM

A

<70

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28
Q

Signs of active ischemia during stress test

A
  1. Angina
  2. ST segment changes on EKG
  3. Drop in BP
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29
Q

EKG findings suggesting MI

A

ST segment leevation (depression means ischemia), flattened T waves, Q waves

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30
Q

Anterior wall is suppled by which aa

A

LAD

Diagonal

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31
Q

Inferior wall is supplied by which aa

A

PDA

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32
Q

Posterior wall is supplied by which aa

A

LCA/oblique

RCA/marginal

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33
Q

Interventricular septum supplied by which aa

A

LAD/diagonal

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34
Q

Young pt with angina at rest and ST segment elevation with normal cardiac enzymes

A

Prinzmetal’s angina

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35
Q

Common Sx associated with silent MI

A

CHF

Shock

Altered mental status

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36
Q

Dx test for PE

A

Spiral CT with contrast

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37
Q

Protamine reverses

A

Heparin

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38
Q

PT

A

Coagulation parameter effected by warfarin

Coagulation factors I, II, V, VII, X = EXTRINSIC

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39
Q

PTT

A

Monitor heparin

Factors: I, II, V, VIII, IX, X, XI, & XII- INTRINSIC and COMMON

Does not measure: VII and XIII

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40
Q

Youn pt with FH of sudden death collapses and dies while exercising

A

HCM

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41
Q

Endocarditis prophylaxis regimens

A

Oral surgery: amoxicillin

GI or GU: not recommended

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42
Q

Virchow’s triad

A
  1. Stasis
  2. Hypercoagulability
  3. Endothelial damage
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43
Q

Most common cause HTN in women

A

OCP

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44
Q

Figure 3 sign

A

Aortic coarctation

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45
Q

Water bottle shaped heart

A

Pericardial effision

Look for pulsus paradoxus

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46
Q

Kussmaul’s sign, causes?

A

Increase in JVP with inspiration

RV infarction, postop cardiac tamponade, constrictive pericarditis, TR

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47
Q

Murmur of MVP

A

Midsystolic or late systolic mumur with preceeding click

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48
Q

Murmur of AR

Acute causes?

History of pt in acute AR?

A

Early diastolic descrendo mumur, at left sternal border (Austin Flint murmur)

Acute causes: infective endocarditis, aortic dissection, trauma

Hx: rapid onset pulm congestion, cardiogenic shock, severe dyspnea

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49
Q

Murmur of MS

A

Diastolic mid to late low pitched murmur

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50
Q

S3 gallop - when and why

A

Due to high output states- normal in young kids, and pts

Dilated CMP (floppy ventricle), MV disease

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51
Q

S4 gallop

A

Normal in young and athletes

HTN, diastolic dysfcn (stiff ventricle), AS

52
Q

Pulsus alternans

A

Alternating weak and strong pulses

Cardiac tampnade, asthma, COPD, tension pneumo, FB in airway

53
Q

Pulsus parvus et tardus

A

Weak and delayed pulse

AS

54
Q

When would peripheral pulses be increased?

A

Compensated AR, coarctation (UE>LE), PDA

55
Q

Used to increase HR in bradycardia

56
Q

Causes afib

A

PIRATES = ACUTE

Pulmonary disease

Ischemia

Rheumatic heart disease

Anemia/Atrial myxoma

Thyrotoxicosis

Ethanol

Sepsis

CHRONIC- HTN, CHF

57
Q

Tx acute CHF

A

LMNOP

Lasix

Morphine

Nitrates

Oxygen

Position (upright)

58
Q

Causes dilated CMP

A

Most common 2nd: HTN and ischemia

Idiopathic

Alcohol

Myocarditis

Postpartum

Drugs (doxorubicin, AZT, cocaine)

Endocrinopathies (thyroid, acromegaly, pheo)

Infection (coxsackie, HIV, Chagas, parasites)

Genetics

Nutritional (wet beriberi)

59
Q

Prinzmetal’s angina

A

Mimics angina pectoris

Due to vasospasm of coronary vessels

Young women, at rest, early morning

ST elevation w/o cardiac enzyme elevation

60
Q

Sequence of EKG changes in MI

A

Peak T waves

ST segmenet elevation

Q waes

T wave inversion

ST segment normalization

T wave normalization

61
Q

St segment elevation in II, III, aVF - MI? Vessels?

A

Inferior MI

RCA/PDA and LCA

62
Q

ST segment elevation in V1-V4 - MI? Vessels?

A

Anterior MI

LAD and diagonal

63
Q

ST segment elevation I, aVL, V5-V6 MI? Vessels?

A

Lateral MI

LCA

64
Q

ST segment depression V1-V2

A

Acute transmural infarct in posterior wall

65
Q

CABG indications

A

Unable to perform PCI 2/2 diffuse disease

Left main coronary artery disease

Triple vessel disease

Depressed ventricular function

66
Q

Complicatons of post MI

  1. First day
  2. 2-4 days
  3. 5-10 days
  4. weeks to months
A
  1. heart failure
  2. arrhythmia, pericarditis
  3. LV wall rupture (pericardial tamponade causing electrical alternans and pulseless electrical activity), papillary mm rupture (severe MR)
  4. Ventricular aneurysm (CHF, arrhythmia, persistent ST elevation, MR, thrombus)
67
Q

Rx for HTN

A

ABCD

ACEI/ARB

Beta blocker

CCB

Diuretics- #1

68
Q

Causes 2nd HTN

A

CHAPS

Cushing syndrome

Hyperaldosteronism

Aortic coarctation

Pheo

Stenosis of renal aa

69
Q

Triad of Conn’s syndrome

Labs?

A
  1. Unexplained hypokalemia
  2. Metabolic alkalosis
  3. HTN

Labs: increased aldo and decreased renin

70
Q

Causes Cushing’s syndrome

A

Cuase: ACTH producing pituitary tumor or ectopic tumor, cortisol secrtion by adrenal adenoma or carcinoma, exogenous steroids

71
Q

Causes pericarditis

A

CARDIAC RIND
Collagen vascular disease

Aortic dissection

Radiation

Drugs

Infections

ARF

Cardiac (MI)

Rheumatic fever

Injury

Neoplasms

Dressler’s

73
Q

Most common risk factor aortic aneurysm vs aortic dissection

A

Aneurysm: atherosclerosis

Dissection: HTN

74
Q

Most common location aortic dissection

A

Above aortic valve or distal to L subclavian

75
Q

Gold standard Dx aortic dissection

76
Q

Stanford system of classification of aortic dissection

A

A: proximal or ascending (ascending is surgical emergency)

B: descending- medically manage

77
Q

6 Ps of acute ischemia

A

Pain

Pallor

Paralysis

Pulse deficit

Paresthesias

Poikilothermia

78
Q

ABI where pain occurs at rest in PVD

79
Q

Hemophilia A

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Inheritance

A

PTT

Low Factor VIII

X-linked

80
Q

Hemophilia B

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Inheritance?

A

PTT

Low factor IX

X linked

81
Q

vWF deficiency

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Inheritance?

A

BT and PTT

Normal or low factor VIII

AD

82
Q

DIC

Which test prolonged: PT, PTT, BT?

Peripheral Smear?

Causes

A

PT, PTT, BT; + D-dimer or FDP

Schistocytes

Infection, postpartum, malignancy

83
Q

Liver Disease

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

A

PT

All low but factor VIII

84
Q

Vit K def

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Cause?

A

PT, PTT (slight)

Factors II, VII, IX, X, Protein C and S

Neonate, malabsorption, alcoholic, prolonged abx use which kills Vit K making bacteria

85
Q

Uremia affects which component of blood?

PT, PTT, BT increased?

Tx?

A

Platelet

BT

Desmopresssin

86
Q

Cor pulmonale

Tx

A

RV enlargement, hypertrophy, or failure due to primary lung disease (can be caused by sleep apnea)

Tx: pulmonary vasodilators -prostacyclins, antiendothelins, PDE5 inhibitors, CCB

87
Q

Differential Dx Chest Pain

A

CHEST PAIN

Cocaine/Costochondritis

Hyperventilation/HSV

Esophagitis/Esophageal spasm

Stenosis of aorta

Trauma

PE/Pnuemo/Pericarditis/Pancreatitis

Angina/Aortic Dissection/ Aortic aneurysm

Infarction (MI)

Neuropsych Disease (depression)

88
Q

Tx VTach

A

Amiodarone

89
Q

When is the greatest risk of sudden death following an MI?

What are the 3 major causes?

A

First few hours

Vtach, Vfib, cardiogenic shock

90
Q

Class IA antiarrhythmic

Drugs?

Use?

Channels?

A

Quinidine, proacinamide

PSVT, Afib, Aflutter, Vtach

Na+- AP prolonged

91
Q

Class IB antiarrhythmic

Drugs?

Use?

Channels?

A

Lidocaine, tocainide

Vtach

Na+ blockers- shorten AP

92
Q

Class IC antiarrhythmic

Drugs?

Use?

Channels?

A

Flecainide, propafenone

PSVT, Afib, Aflutter, PSVT

Na nlockers - no change AP

93
Q

Class II antiarrhythmic

Drugs?

Use?

A

Beta blockers - propranolol, esmolol, metoprolol

PVC, PSVT, Afib, Aflutter, Vtach

94
Q

Class III antiarrhythmic

Drugs?

Use?

Channels

A

Amiodarone, Sotalol, Bretylium

Afib, Aflutter, Vtach (no breytlium)

K blockers

95
Q

Class IV antiarrhythmic

Drugs?

Use?

Channels

A

Verapamil, Diltiazem

PSVT, Afib, Aflutter, MAT

Ca blockers

96
Q

Functions of Angiotensin II

A

Vasoconstriction (arterial smooth mm)

Increase Aldo (at adrenal gland - increase Na reabsorption in kidney)

Increase NE release (SNS)

Stimulate thirst and vasopressin (brain)

Increase contractility and ventricular hypertrophy of heart

97
Q

Valsalva effect on AS and HOCM

A

AS: decrease murmur

HOCM: increase murmur

98
Q

Specific gravity and causes of transudate vs exudate of pericardial effusion

A

Exudate >1.020- high in protein; think neoplasm, fibrotic disease, TB

Transudate <1.020 - low in protein

99
Q

Causes myocarditis

A

Drugs: doxorubicin, chloroquine, penicillins, sulfonamides, cocaine, radiation

Infection

  • Virus: coxsackie, parvovirus B-19, HHV-6, adenovirus, echovirus, EBV< CMV, influenza
  • Bacteria
  • Rickettsia
  • Fungi
  • Parasites
100
Q

Cause myocarditis in S America, common assocaition

A

Chagas- Trypanosoma crzui

Achalasia

101
Q

H/P GAS infection- acute rheumatic fever

A

Migratory arthritis, hot swollen joints, fever, sub1 nodules on extensor surface, Sydenham chorea, erythema marginatum (painless)

102
Q

JONES criteria for Rheumatic Heart Disease

A

Jones Peace

Major:
Joints (polyarticular, hot and swollen)
Heart: carditis
Nodules
Erythema marginatum
Sydenham Chorea

Minor:
Previous rheumatic fever
ECG with prolonged PR
Arthralgias
CRP and ESR elevated
Elevated T

Need 2 major or 2 minor and 1 major

103
Q

Bugs that would result in negative culture endocarditis

A

HACEK

Haemophilus
Actinobacillus
Cadiobacterium
Eikenella
Kingella

104
Q

Bugs common on prosthetic valve

A

Staph epidermidis

Staph aureus

105
Q

Acute vs subacute bugs that cause endocarditis

A

Acute: Staph aureus, Strep pyogenes/pneumo, Neisseria gonorrhoeae

Subacute: strep viridians, Enterococcus, fungi, Staph epi

106
Q

Tx bacterial endocarditis

A

4-6 weeks IV abx

Beta lactam + aminoglycoside

penicillin, cephalosporins, monobactams, and carbapenems

amikacin, arbekacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, rhodostreptomycin,[2] streptomycin, tobramycin, and apramycin

107
Q

DM

Best antiHTN Rx?

Worst?

A

Best: ACEI for kidneys

Worst: Thiazide (impair glc tolerance) and beta blocker (mask hypoglycemia)

108
Q

CHF

Best antiHTN Rx?

Worst?

A

Best: ACEI/ARB; Aldo antag; Beta blockers

Worst: CCB - reduce rate/contractility- make HF worse

109
Q

Post MI

Best antiHTN Rx?

Worst?

A

Best: Beta blocker, ACE/ARB, Aldo antag

Worst???

110
Q

BPH

Best antiHTN Rx?

Worst?

A

Best: selecative alpha 1 blocker

Worst:??

111
Q

Migraine

Best antiHTN Rx?

Worst?

A

Best: Beta blocker

Worst: ??

112
Q

Osteoporosis

Best antiHTN Rx?

Worst?

A

Best: thiazide- maintain normal/high serum Ca

113
Q

Asthma/COPD

A

BEst???

Worst: Nonselective Beta blocker- bronchoconstriction

114
Q

Pregnancy

Best antiHTN Rx?

Worst?

A

Best: Hydralazine, methyldopa, labetaolol. nifedipine

Worst: thiazide ( increased bv during pregancy should be maintained), ACE and ARB are teratogens

115
Q

Gout

Best antiHTN Rx?

Worst?

A

Best??

Worst: Diuretic - increase uric acid in serum

116
Q

Depression

Best antiHTN Rx?

Worst?

A

Best???

Worst: beta blockers - worsen Sx

117
Q

BP of HTN urgency/ emergency

Emergency vs urgency

A

> or = 180/120

Emergency: evidence of end organ damage - progressive renal failure, pulm edema, aortic dissection, encephalopathy, papilledema

118
Q

Tx HTN emergency

A

Reduce DP to 100 using IV nitroprusside, labetolol, nicardipine, fenoldopam

Then use Beta blocker or ACEI orally to reduce BP

Use diuretics for pulm edema

119
Q

Meds used in PVD to help slow occlusion (2)

A

Pentoxifylline

Cilostazol

120
Q

Nitroprusside dilates?

121
Q

Nitroglycerin dilates

122
Q

Hydralazine dilates

123
Q

Alpha 1 antagonist dilates

124
Q

CCB dilates

125
Q

Secondary causes HLD

A

Uncontrolled DM

Hypothyroidism

Nephrotic syndrome

Obstructibe liver diseae

Excessive EtOH (raise TG)

Obesity

Meds (OCP, isotretinoin, glucocorticoids, thiazides, beta blockers)

First Aid Step 2 (22 decks)

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