Step 2 High Yield CV Flashcards
What medications improve long term survival in patients with LV systolic dysfunction?
ACEIs/ARBs, BB, Aldosterone agonists, and hydral-Nitrates combo in AA pts
pt taking sotalol. Major SE Risk?
Torsades. Which can present as long QT w syncope. Treat w magnesium sulfate
Tx for stable, wide QRS
Amiodarone
Tx for stable SVT
adenosine
Classic ECG findings for afib. Tx?
absent p-waves. irregularly irregular QRS complexes. Tx= beta blockers or non-dihydropyridine CCBs
Cardiac auscultation findings in Pt w ASD?
- Wide, fixed splitting of S2: Resulting from delayed closure of the pulmonic valve due to enlarged right ventrivle’s rpolonged emptying (widened S2) w no difference betwn inspiration and expiration (fixed)
- Mid-systolic or ejection murmur over the left upper sternal border (due to increased flow across the pulmonic valve. Though the low-velocity left-to-right shunt flow across the ASD itself does not produce any audible murmur
- Mid-diastolic rumble: resulting from an increased flow across the tricuspid valve
New holosystolic murmur 3-5 days after MI. Dx?
Rupture of interventricular septum, causing new VSD (holosystolic murmur heard best at the sternal border)
Bicuspid aortic valve. Murmur?
Most common congenital heart disease in adults. A bicuspid aortic valve w stenosis can lead to exertional syncope but would typically cause a prominent ejection click followed by a midsystolic murmur beast heard over the right second intercostal space.
Young pt w exertional lightheadedness and syncope, with a systolic murmur over the left sternal border that is increased by moving from supine to standing position + with repolarization abnormalities (AKA inverted T waves). Dx?
HOCM. Autosomal dominant. Dx: ECG w LVH + repol abnormalities. TTE: LVH, increased LVOT gradient, motion abnormality of mitral valve, exercise testing, family screening
Tx: avoid volume depletion. BB/CCBs
6 P’s of Amiodarone: action + toxicity
Prolongs action potential Photosensitivity Pigmentation of the skin Peripheral neuropathy Pulmonary alveolitis + fibrosis Peripheral conversion of T3 to T4 inhibited -->hypothyroidism
Aortic Regurg murmur sounds? What if louder on left? what if louder on right?
AR in developed countries=aortic root dilation, which radiates towards Right
AR developing countries due to rheumatic heart disease. valvular AR radiates towards left.
AR overall=early decrescendo diastolic murmur that begins immediately after A2 and is accentuated by the pt sitting up/leaning forward while holding breath after an expiration.
Dobutamine MOA and impact on decompensated HF?
Dobutamine is a beta1-agonist, with weak beta2 and alpha1 activity. Improves inotropy/myocardial contractilit. Leads to improved EF and decreased LVEDV
D&M of acute limb ischemia
Best initial test: arterial and venous Doppler
[shows Diminished or absent Doppler flow signal distal to site of occlusion]
Confirmatory test: angiography (DSA, CTA, MRA)
[Digital subtraction angiography (DSA) is the imaging modality of choice.]
Should only be performed if delaying treatment for further imaging does not threaten the extremity
Depending on the suspected etiology, other tests may be indicated (e.g., echocardiography if an arterial embolism is suspected)
First Tx: IV heparin, second: revasc. procedure, if indicated
Clinical signs, PE, and Dx of mitral stenosis
MS MD OS.
Clin features: dyspnea, orthopnea, PND, hemoptysis, afib, systemic thromboembolism, voice hoarseness due to LAE enlargement compressing recurrent laryngeal
PE: mitral face (pink-purple patches), loud S1, loud P2if pulmonary HTN, OS, mid-diastolic rumble, heard best at apex
Dx: CXR: pulmonary blood flow redistribution to upper lobes, dilated pulmonary vessels, LAE, flattened left heart borders
ECG: “p” mitrale = broad and notched p waves
atrial tachyarrythmias, RVH (tall R waves in V1 and V2)
TTE: LAE, mitral valve thickening, calcification, co-occuring MR
What is the primary mechanism that BB impact angina?
The primary mechanism by which beta-blockers reduce angina is via decreased contractility, which reduces the oxygen demand of the myocardium (which has a constrained supply due to coronary artery disease). Lowering heart rate also helps, but that isn’t one of your choices.
Definition of unstable angina
New or worsening with no increase in troponin
