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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
Q

A wide QRS with R and R’ waves in leads v4-v6 is characteristic of?

A

Left heart block

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26
Q

Which leads are R and R’ waves seen in in a right heart block?

A

V1-V3

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27
Q

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

A

valsalva

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28
Q

For a symptomatic patient in SVT, what is the treatment?

A

Adenosine

Definitive treatment is ablation

29
Q

How is a PVC distinguished from a PAC?

A

PVC is initiated by ventricles = wide QRS

PAC is initiated by atria = narrow QRS

30
Q

A EKG showing wide QRS and a delta wave is characteristic of what arrhythmia?

31
Q

What is sick sinus syndrome?

A

Dysfunction in the sinus node automaticity and impulse generation.

32
Q

What is the treatment for sick sinus snydrome?

33
Q

What is the treatment for Torsades?

A

IV magnesium sulfate

34
Q

What is the triad of symptoms associated with cardiac tamponade?

A

Becks triad - Muffled heart sounds, JVD, hypotension

35
Q

How do you expect BP to change during cardiac tamponade?

A

Narrowed pulse pressure

36
Q

What EKG finding is consistent with cardiac tamponade?

A

Electrical alternans

37
Q

What is the treatment for cardiac tamponade?

A

Pericardiocentesis

IV fluids to increase preload and prevent RV collapse

38
Q

What medication is the cornerstone of primary prevention of coronary vascular disease?

39
Q

How long after cardiac ischemia does a troponin become positive?
When does it peak?

A

2-4 hours

Peaks at 12-24 hours

40
Q

ST elevation in lead 1, AVL, V2-V6 indicates an MI in what location?

A

Anterior wall

41
Q

ST elevation in leads II, III, and AVF suggest MI in what location?

42
Q

ST elevation in leads I, AVL, V5-V6 suggest MI in what location?

43
Q

What EKG findings are expected in a posterior MI?

A

ST depression in leads V1-V3

44
Q

What EKG findings would you expect in an anterior MI?

A

ST elevation in leads I, AVL, and V2-V6

45
Q

What EKG findings would you expect in an inferior MI?

A

ST elevation in leads II, III and AVF

46
Q

What EKG findings would you expect in a lateral MI?

A

ST elevation in leads 1, AVL, V5-V6, and reciprocal ST depression in inferior leads (III and aVF)

47
Q

What EKG changes would you expect in a posterior MI?

A

ST depression in leads V1-V3

48
Q

What are the symptoms of left ventricular heart failure?

A

SOB + fatigue

49
Q

What are the symptoms of right ventricular heart failure?

A

Peripheral edema and abdominal fluid accumulation

50
Q

Is digoxin indicated for systolic or diastolic heart failure?

51
Q

What is the treatment for heart failure?

A

ACE-I and a beta blocker +/- loop diuretic

52
Q

What qualifies as a hypertensive urgency?

A

SBP >180 or diastolic >100 without end organ damage

53
Q

What is the treatment for hypertensive urgency?

A

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
Q

What qualifies as a hypertensive emergency?

A

SBP >180 and/or DBP >120 with signs of end organ damage (encephalopathy, neuropathy, ICH, aortic dissection, pulmonary edema, unstable angina, MI)

55
Q

What is the treatment for hypertensive emergency?

A

Sodium nitroprusside

56
Q

What qualifies as malignant HTN?

A

DBP >140 with papilledema and either encephalopathy or nephropathy.

57
Q

What is the drug of choice for malignant HTN?

A

hydralazine

58
Q

What is the diagnostic criteria for orthostatic hypotension?

A

Drop of >20mmHg SBP or 10mmHg DBP or 15 bpm increase in pulse 2-5 minutes after change supine to standing

59
Q

Claudication is a symptom of what disease?

A

Peripheral vascular disease (peripheral artery disease)

60
Q

What syndrome is characterized by claudication, erectile dysfunction, and decreased femoral pulses?

A

Leriche syndrome

61
Q

Thigh and upper calf claudication suggests occlusion of what artery?

A

Femoral artery

62
Q

Lower calf claudication suggests occlusion of what artery?

A

Popliteal artery

63
Q

What are the 6 P’s of acute arterial embolism?

A

Pain, pulselessness, pallor, paresthesia, poikilothermy, paralysis

64
Q

What study is the gold standard diagnostic tool for PAD?

A

Arteriography - typically only done if revascularization is planned.

65
Q

What ankle-brachial index is diagnostic of PAD?

66
Q

What medication is used to treat claudication?

A

Cilostazol

67
Q

What are the 4 diastolic murmurs?

A

Aortic regurg
Mitral stenosis
Pulmonary regurg
Tricuspid stenosis

68
Q

What are the 4 midsystolic murmurs (ejection murmurs)?

A

Aortic stenosis
Pulmonic Stenosis
HOCM
Mitral valve prolapse

69
Q

What are the 3 holosystolic (pansystolic) murmurs?

A

Mitral regurg
Tricuspid regurg
Ventricular septal defect

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