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ToL EM cardiology Flashcards

1
Q

What is the most common valve involved in acute bacterial endocarditis?

A

Mitral valve

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2
Q

What organisms are most commonly involved in acute bacterial endocarditis?

A

HACEK organisms (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

Staph aureus

Viridans streptococci

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3
Q

What diagnostic studies should be preformed on a patient in whom you suspect acute bacterial endocarditis?

A

Blood cultures (before abx initiation)
EKG
Echo
CBC

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4
Q

What criteria can be used to diagnose acute bacterial endocarditis?

A

Duke criteria

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5
Q

How many duke criteria must be positive to diagnose acute bacterial endocarditis?

A 
2 major
OR
1 major + 3 minor
OR
5 minor
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6
Q

What are the major duke criteria?

A 
Bacteremia (2 positive blood cultures)
Endocardial involvement (positive echo showing vegetations, or new valvular regurg)
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7
Q

What are the 6 minor duke criteria?

A
  1. Predisposing condition (IVDE, indwelling cath)
  2. Fever
  3. Vascular/embolic phenomena (janeway lesions, ICH)
  4. Immunologic phenomena (oseler nodes, roth spots, + RF, acute glomerulonephritis)
  5. 1 positive blood culture
  6. Positive echo not meeting major criteria (worsening murmur)
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8
Q

What is the suggested empiric therapy and duration for acute bacterial endocarditis of a native valve in a non-IVDU?

A

Penicillin/ampicillin + gentamycin x 4-6 weeks

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9
Q

What is the suggested empiric therapy and duration for acute bacterial endocarditis of a native valve in an IVDU patient?

A

Vancomycin x4-6 weeks

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10
Q

What is the treatment for acute bacterial endocarditis in a patient with a prosthetic valve?

A

vancomycin + gentamycin + rifampin

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11
Q

What is the #1 risk factor for angina?

A

Smoking

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12
Q

What EKG findings are consistent with stable angina?

A

No changes at rest.

1mm ST depression during episode

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13
Q

What follow up testing should a patient undergo after being diagnosed with stable angina?

A

Exercise stress test

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14
Q

What is the first line therapy for chronic angina?

A

B-blockers

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15
Q

What is prinzmetal angina?

A

vasospastic angina

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16
Q

What medication is contraindicated in treatment of prinzmetal angina?

A

propanolol

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17
Q

What is the treatment for prinzmetal angina?

A

nitrates and CCB

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18
Q

An irregularly irregular rhythm with no discernable P waves is consistent with what dysrhythmia?

A

A fib

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19
Q

What are the components of the CHA2DS2VASc score?

A 
CHF = 1
HTN = 1
Age >74 = 2
DM = 1
Stroke/TIA = 2
Vascular disease = 2
Age 65-74 = 1
Female = 1
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20
Q

A CHADSVASc score of ___ or greater should be anticoagulated

A

2

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21
Q

What rhythm is characterized by a PR interval >.2 without any dropped beats?

A

1st degree AV block

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22
Q

PR intervals that become longer and longer until a beat is dropped is what type of rhythm?

A

Wenckebach (Mobitz I) (Second degree AV block, type 1)

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23
Q

What are the characteristic EKG findings of a mobitz II (second degree AV block, type II)?

A

Consistently long PR interval, with some dropped beats.

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24
Q

How would you describe the EKG findings of a 3rd degree AV block (complete heart block)?

A

P waves and QRS complexes have no correlation to eachother.

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25
A wide QRS with R and R' waves in leads v4-v6 is characteristic of?
Left heart block
26
Which leads are R and R' waves seen in in a right heart block?
V1-V3
27
What should be the first attempted treatment for a stable patient in SVT?
valsalva
28
For a symptomatic patient in SVT, what is the treatment?
Adenosine | Definitive treatment is ablation
29
How is a PVC distinguished from a PAC?
PVC is initiated by ventricles = wide QRS | PAC is initiated by atria = narrow QRS
30
A EKG showing wide QRS and a delta wave is characteristic of what arrhythmia?
WPW
31
What is sick sinus syndrome?
Dysfunction in the sinus node automaticity and impulse generation.
32
What is the treatment for sick sinus snydrome?
Pacemaker
33
What is the treatment for Torsades?
IV magnesium sulfate
34
What is the triad of symptoms associated with cardiac tamponade?
Becks triad - Muffled heart sounds, JVD, hypotension
35
How do you expect BP to change during cardiac tamponade?
Narrowed pulse pressure
36
What EKG finding is consistent with cardiac tamponade?
Electrical alternans
37
What is the treatment for cardiac tamponade?
Pericardiocentesis | IV fluids to increase preload and prevent RV collapse
38
What medication is the cornerstone of primary prevention of coronary vascular disease?
Aspirin
39
How long after cardiac ischemia does a troponin become positive? When does it peak?
2-4 hours Peaks at 12-24 hours
40
ST elevation in lead 1, AVL, V2-V6 indicates an MI in what location?
Anterior wall
41
ST elevation in leads II, III, and AVF suggest MI in what location?
Inferior
42
ST elevation in leads I, AVL, V5-V6 suggest MI in what location?
Lateral
43
What EKG findings are expected in a posterior MI?
ST depression in leads V1-V3
44
What EKG findings would you expect in an anterior MI?
ST elevation in leads I, AVL, and V2-V6
45
What EKG findings would you expect in an inferior MI?
ST elevation in leads II, III and AVF
46
What EKG findings would you expect in a lateral MI?
ST elevation in leads 1, AVL, V5-V6, and reciprocal ST depression in inferior leads (III and aVF)
47
What EKG changes would you expect in a posterior MI?
ST depression in leads V1-V3
48
What are the symptoms of left ventricular heart failure?
SOB + fatigue
49
What are the symptoms of right ventricular heart failure?
Peripheral edema and abdominal fluid accumulation
50
Is digoxin indicated for systolic or diastolic heart failure?
Systolic
51
What is the treatment for heart failure?
ACE-I and a beta blocker +/- loop diuretic
52
What qualifies as a hypertensive urgency?
SBP >180 or diastolic >100 without end organ damage
53
What is the treatment for hypertensive urgency?
Immediate BP reduction not required but pt should be started on 2-drug oral combination (clonidine, captopril, labetolol, furosemide, nicardipine) with close follow up
54
What qualifies as a hypertensive emergency?
SBP >180 and/or DBP >120 with signs of end organ damage (encephalopathy, neuropathy, ICH, aortic dissection, pulmonary edema, unstable angina, MI)
55
What is the treatment for hypertensive emergency?
Sodium nitroprusside
56
What qualifies as malignant HTN?
DBP >140 with papilledema and either encephalopathy or nephropathy.
57
What is the drug of choice for malignant HTN?
hydralazine
58
What is the diagnostic criteria for orthostatic hypotension?
Drop of >20mmHg SBP or 10mmHg DBP or 15 bpm increase in pulse 2-5 minutes after change supine to standing
59
Claudication is a symptom of what disease?
Peripheral vascular disease (peripheral artery disease)
60
What syndrome is characterized by claudication, erectile dysfunction, and decreased femoral pulses?
Leriche syndrome
61
Thigh and upper calf claudication suggests occlusion of what artery?
Femoral artery
62
Lower calf claudication suggests occlusion of what artery?
Popliteal artery
63
What are the 6 P's of acute arterial embolism?
Pain, pulselessness, pallor, paresthesia, poikilothermy, paralysis
64
What study is the gold standard diagnostic tool for PAD?
Arteriography - typically only done if revascularization is planned.
65
What ankle-brachial index is diagnostic of PAD?
<0.9
66
What medication is used to treat claudication?
Cilostazol
67
What are the 4 diastolic murmurs?
Aortic regurg Mitral stenosis Pulmonary regurg Tricuspid stenosis
68
What are the 4 midsystolic murmurs (ejection murmurs)?
Aortic stenosis Pulmonic Stenosis HOCM Mitral valve prolapse
69
What are the 3 holosystolic (pansystolic) murmurs?
Mitral regurg Tricuspid regurg Ventricular septal defect

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