TFS-2.0 Flashcards
A U wave on EKG should make you think of what diagnosis?
Hypokalemia
In heart failure with preserved EF, the EF is greater than what %?
50%
Why can’t you lower blood pressure too quickly in the setting of hypertensive crisis?
Hypoperfusion
In terms of major and minor criteria what combinations are necessary for diagnosis of endocarditis when using the modified Duke Criteria?
2 major
1 major and 3 minor
5 minor
What is the name of the syndrome that involves pericarditis several days after an MI?
Dressler syndrome
Treat with ASA and colchicine
What is the accessory pathway associated with Wolff-Parkinson-White syndrome
The Bundle of Kent
What are the three inferior leads?
II, III, AVF
Define pulse pressure
The difference between systolic and diastolic pressure
An opening snap is an indication of what valvular disease?
Mitral valve stenosis
MONA is a common mnemonic used to remmeber treating acute coronary syndrome. What does it stand for?
Morphine, oxygen, nitroglycerin, aspirin
Define orthostatic hypotension
A drop in systolic blood pressure of >20 when standing up.
Or
diastolic blood pressure drop >10 when standing up.
An aortic aneurysm typically does not rupture below what size?
5cm
Which lab should be tightly monitored in a patient when taking an aldosterone antagonist? (Spironolactone)
Potassium for hyperkalemia
What is the definitive treatment for a patient with recurrent ventricular tachycardia?
Implanted defibrilattor
What are we so concerned about DVT?
50% progress to PE
Diffuse ST elevation on a 12 lead ECG should make you think of what diagnosis?
Pericarditis
Using the JNC8 what blood pressure do you begin treating a patient over the age of 60 with medication?
150/90
What is the most common type of cardiomyopathy?
Dilated cardiomyopathy
What causes the second heart sound? (s2)
Closure of aortic and pulmonic valves
Calf pain should always make you think of what diagnosis?
DVT
Diminished peripheral pulses may indicate what diagnosis?
Atherosclerosisi
What percentage of HTN is esstential HTN?
> 90%
Patients with what medical history should consider prophylaxis before dirty procedures for endocarditis?
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis, congential cyanotic heart defect
Mitral stenosis patients will usually go on to develop what other cardiac issue?
Afib
Why do you get pulsus paradoxus with cardiac tamponade?
The heart is squeezed by the tampoande. Its squeezed more with inspiration and left ventricle can’t fill.
An elderly patient presnets with dyspnea, angina, and syncope on exertion but EKG is normal. what is the most likely dx?
Aortic stenosis
List two RF for aortic dissection
HTN, Marfan’s syndrome, bicuspid aortic valve, pregnancy
List three congential heart diseases
ASD, VSD, coarctation of aorta, patent ductus arteriosus, tetralogy of Fallot
Following an MI what medication should you use to be treating HTN?
B-Blocker
What are two reasons you can get a cough in the cardiology section?
Heart failure, ACE-i
What diagnostic tool is used to look for an embolism in an extremity?
Doppler
On PE you hear a harsh systolic murmur along the right sternal border. what’s the most likely dx?
Aortic stenosis
A diastolic rumble should make you think of what diagnosis?
Mitral valve stenosis
What is the association between pericarditis, pericardial effusion, and cardiac tamponade.
Pericarditis may lead to pericardial effusion which can lead to tamponade
What medication do you use to treat dig toxicity?
Digi-bind or Atropine
List 5 minor Duke criteria for the diagnosis of endocarditis
Predisposing condition, fever of 100.4, vascular phenomenon, immunologic phenomenon, positive blood culture that doesn’t meet major criteria.
Name three complications of endocarditis we need to be worried about?
Embolization, abscess, acute regurgitation
What is the most common cause of HF with preserved EF
HTN
What imaging needs to be done before taking the pt to the OR for aortic aneurysm?
CT (echo may be initial study but CT is necessary for surgery)
What are the first-line medications for cardiogenic shock?
Norepinephrine or dobutamine
A patient with mitral valve prolapse will often have what physical charactersitc?
often a thin female
Which of the two of the four first line medication classes are preferred in African American pts with uncomplicated HTN?
Thiazides or CCB
What is the imaging of choice to diagnose an abdominal aortic aneursym
Ultrasound
No matter what medications you use you are having trouble keeping a blood pressure under control. You notice hyperpigmented skin and truncal obesity with thin extremities. Whats the most likely Dx?
Cushing’s disease
What are Roth spots and what diagnosis do they indicate?
Exudates in the retina, endocarditis
Where are conditions of the mitral valve best heard?
apex and left lower Sternal border.
IS the murmur associated with pulmonic pulmonary regurgitation diastolic or systolic?
Diastolic
An elevated BNP is an indicative of what disease process?
Heart failure
Name 4 important components of education when discharging a pt with heart failure
Monitor blood pressure
preform daily weights
2 g sodium restriction
2L fluid restriction
What is the most common presenting symptom of heart failure?
Shortness of breath
What is the first line medical treatment for cardiomypathy without other comorbidities
B-blocker and Ace-i
How long before troponins and CK-mb are elevated after an MI?
4-6 hours
Are murmurs on the left or the right side side of the heart more common?
Left
What are the two main causes of aortic stenosis?
Congenital/bicuspid/unicuspid valve and calcification of valve secondary to CAD
Give 4 characteristics that should make you consider secondary HTN
HTN begins before age 25
No family history of HTN
HTN first develops after age 50
Previously controlled HTN can no longer be controlled
HTN which is controlled on three or more medications
Treatment for pericarditis post MI?
ASA and colchicine
Whats the difference between hypertensive urgency and emergency?
Urgency > 180 without signs of end organ damage
Emergency - elevated BP with signs of end organ damage
Give two characteristics of angina pectoris (stable agina)
Brought on by stress either physical or emotional. Relieved by rest or nitrates
Electrical alternans on EKG is pathognomonic for what condition?
Cardiac tamponade
When listening to the murmur of aortic regurg and aortic stenosis what position should be the patient be in?
Sitting up, leaning forward and exhaling
MCC of sudden death of people under 35 in North america?
HOCM
What is the management of a patient in SVT?
Vagal maneuvers, carotid massage, adenosine
Shock if unstable
What is the best way to listen to aortic stenosis?
Right second intercostal space with the patient leaning forward on expiration
Radiates to the neck
List 3 vessels that can be used in CABG
internal mammary artery, saphenous vein, radial artery
What heart condition is associated with pulsus alternans?
heart failure
Is the murmur of aortic stenosis systolic or diastolic
Systolic
Continuous machine - like murmur makes you think of what dx??
Patent ductus arteriosus
Name three ACEi’s
Catopril, benazepril, enalapril, lisinopril
On EKg there is an early but otherwise normal PQRS complex, after that beat there is a slight pause and then an normal rhyhtm continue. What is the term for this beat?
Premature atrial contraction
Elevated JVP with a giant wave should make you think of what diagnosis?
Tricuspid stenosis or pulmonic stenosis
When do hyperacute t waves occur?
Immediately after an MI
Paroxsymal nocturnal dyspnea should make you think of what dx?
Heart failure
A patient in the ER has no pulse, but on EKG there are wide irregular ocmplexes which are at an irregular rate. They all appear very different from one another. What is the treatment?
V fib- treatment is defibrilaation
