USMLE Cardio + internal HY Flashcards
Most common cause of aortic dissection?
Atherosclerosis
What is the immediate treatment for aortic dissection?
Intravenous beta-blockers
and then to the OR
Which type of aortic dissection is treated in the OR?
surgery for type A dissections
blood pressure differences between limbs, and mediastinal widening on chest X-ray.
Which medical emergency this diagnostic clues suggest?
aortic dissection
When is stress testing recommended?
Moderate to high pre-test probability of significant coronary heart disease, with a normal baseline ECG
How is massive pulmonary embolism defined and treated?
Define is Shock
Tx- Fibronolysis
What does long-term treatment of NSTE-ACS include?
Lipid-lowering therapy to achieve LDL-C levels <55, adding ezetimibe if needed.
What defines a positive exercise test?
ST depressions of more than 1 mm, flat or downsloping, lasting more than 0.08 seconds.
What is the most** specific** ECG pattern for PE?
S1Q3T3 pattern.
What are the most common ECG findings in PE?
Sinus tachycardia and T-wave inversions in V1-V4
Which finding can indicate significant global ischemia of the left ventricle during an exercise test?
BP is not increase / BP is drops
During the Test
What lifestyle changes are recommended for hypertension management?
Weight loss, reducing dietary NaCl intake, and increasing potassium intake.
Cardio
What should raise suspicion of cardiac amyloidosis?
Heart failure with hypertrophy on echocardiography and small complexes on ECG.
What does an abdominal aortic aneurysm’s risk of rupture relate to?
The size of the aneurysm.
What ECG changes are seen in acute MI?
ST elevations in the infarcted wall and ST depressions in other walls.
What is often seen accompanying inferior MI?
Right-sided MI in one-third of cases
What are the absolute contraindications to thrombolysis?
- Previous hemorrhagic stroke
- stroke in the past year
- high blood pressure
- and active bleeding
How should stable patients with rapid symptomatic atrial fibrillation be initially treated?
With rate control
What is the indication for treatment in asymptomatic Aortic Stenosis?
Class 1 indication for treatment when the stenosis is severe (Vmax ≥ 4 m/s) and the patient is undergoing cardiac surgery or when EF < 50%.
What is represented on ECG by ST elevations in leads V1-V6, AVL, and I with reciprocal changes?
Anterolateral infarction
What are the most important interventions for STEMI?
Early revascularization by catheterization or thrombolysis
with catheterization preferred.
When is thrombolysis the treatment of choice for STEMI?
When the patient arrives within an hour of symptom onset and catheterization is delayed by at least an hour.
What defines unstable angina?
- Typical pain at rest
- new angina affecting function
- worsening of known angina patterns without elevated troponin and often no changes in the resting ECG.
What determines the need for and timing of coronary catheterization in NSTE-ACS?
Patient’s risk factors for worsening:
* refractory angina,
* acute heart failure
* hemodynamic instability
* ventricular tachyarrhythmias.
What is the initial management of stable AV block?
Ruling out reversible causes, including stopping medications that slow the AV node.
What is the immediate treatment for any unstable arrhythmia?
DC shock
Which AA causes QT prolongation?
Class IA and III antiarrhythmic drugs
What is the clinical presentation of right-sided infarction?
Shock without pulmonary congestion signs, often accompanied by inferior infarction.
What is an effective treatment for SVT in young patients with recurrent episodes?
Ablation
from which Diameter Symptoms in MS usally occur?
typically start below a valve area of 1.5 cm²
What is polymorphic VT due to prolonged QT called?
Torsades de Pointes.
What is the role of beta-blockers in myocardial infarction?
Reduce symptoms, infarct size, risk of ventricular arrhythmias, and play a role in secondary prevention.
What is the general treatment for myocardial infarction?
Antiplatelet, anticoagulant, and anti-ischemic medications, with timing of revascularization depending on the type of MI.
Which medication reduces mortality after STEMI both acutely and long-term?
Beta-blockers
What should be done for a patient with rapid atrial fibrillation that started less than 48 hours ago and is hemodynamically stable?
Anticoagulation and rhythm conversion by drugs or electricity.
How is pulseless VT treated?
Like VF, with unsynchronized electrical shock.
What indicates a positive response during right heart catheterization with adenosine?
Aka positive reactivity test
Decrease in MPAP by more than 10 mmHg to 40 mmHg or less without reducing CO
What is the treatment when the reactivity test is positive?
Calcium channel blockers.
When should a prophylactic defibrillator be implanted in hypertrophic cardiomyopathy?
When two out of six common risk factors are present; sometimes one is sufficient.
risk factors
* sudden death in one or more first-degree relatives
* maximal LV wall thickness ≥30 mm
* recent and unexplained syncopal event
* non-sustained VT on monitor
* Cardiac arrest or susteined VT
* fail to increase /decrease BP during excersice
Sustained ventricular tachycardia is defined as tachycardia that continues for more than 30 seconds or leads to hemodynamic compromise within 30 seconds and requires intervention. On the other hand, non-sustained ventricular tachycardia lasts less than 30 seconds and does not cause hemodynamic instability.
What heart sound will not appear in a patient with atrial fibrillation?
S4
What are absolute contraindications to beta-blockers?
- Significant conduction disorders
- shock
- low blood pressure states
- severe reactive airway disease.
How can pulmonary hypertension be diagnosed?
Echocardiogram, with right heart catheterization as the gold standard.
What phenomenon occurs with the initiation of ACEI treatment?
An increase in creatinine due to a decrease in GFR.
What should raise suspicion of primary pulmonary hypertension?
Sparse clinical findings in early stages and the clinical story.
What is the typical treatment for pericarditis?
NSAIDs and colchicine
What is the first-line treatment for pericarditis?
NSAIDS
. What findings in non-invasive tests require coronary catheterization?
High-risk indicators for coronary events.
How long is colchicine treatment recommended in pericarditis?
3 months
What are the clinical features of tamponade?
Backs Triad
* Hypotension
* Distended Jugular venous
* distant heart sounds
also:
pulsus paradoxsus
electrical alternans on ECG
What effect do aldosterone antagonists have on mortality in heart failure?
reduce mortality in patients with symptomatic systolic heart failure NYHA II to IV.
What are the initial ECG signs of hyperkalemia?
Peaked T waves»_space; flattened P waves, and QRS widening until VF and asystole.
What effect does Sotalol have?
Non-selective beta-adrenergic blocking.
Asthma pt have a relative C/I to __________ drugs
Beta-adrenergic blockers
What are the Class I indications for surgery to correct chronic severe mitral insufficiency?
- Symptoms onset + EF ≤ 60%
- LVESD ≥ 40 mm in asymptomatic patients
What drugs should be avoided in WPW with atrial fibrillation?
Drugs that slow AV node inhibition, like verapamil and digoxin.
How is the need for anticoagulation therapy in patients with atrial fibrillation or atrial flutter determined?
CHA₂DS₂-VASc score
C- CHF
H- HTN
A- age > 75 2 points
D- DM
S- Stroke/ TIA 2 points
V-vascular disease
A- age >65
S- sex (female)
What is the drug treatment of SVT?
IV adenosine
What is the management for an asymptomatic patient with Mobitz Type I 2nd degree AVB?
Monitoring only.
What are some side effects of Amiodarone?
Liver damage, pneumonitis, pulmonary fibrosis, hyperthyroidism, or hypothyroidism.
What are known complications of myocardial infarction that may require pacemaker implantation?
Conduction and rhythm disorders.
What drug has been shown to reduce VT events in Brugada disease?
Quinidine
What is a normal finding in athletes that does not require treatment?
Sinus arrest of up to 3 seconds.
What drugs are commonly used for rate control in atrial fibrillation?
Beta-blockers, calcium channel blockers
Digoxin can also.
What is pacemaker syndrome?
Symptoms from lack of synchronization between the atrium and ventricle, including fatigue, jugular venous distention, shortness of breath, syncope, dizziness, and heart failure signs.
What are the clinical presentations of severe aortic stenosis?
Chest pain, shortness of breath, and syncope, with a weak or absent S2 indicating severe calcification.
What is the immediate treatment for unstable ventricular tachycardia (VT)?
Unsynchronized electrical shock.
like VF
What characterizes Brugada syndrome?
ST elevations in leads V1-V3,
with arrhythmias during sleep and induced by fever.
What electrolytes conditions can prolong the QT interval?
Hypokalemia, hypocalcemia, and hypomagnesemia
What is the drug of choice for stroke prevention in patients with atrial flutter or atrial fibrillation and moderate or severe mitral stenosis?
Warfarin
What is the likelihood of surviving resuscitation dependent on?
The mechanism of the arrhythmia, with pulseless VT and VF having the best prognosis
How is atrial fibrillation in people with WPW treated?
Procainamide or ibutilide, or electrical cardioversion
What is the effect of adenosine on the QT interval?
not prolong QT but may cause prolonged pauses.
What is the most common persistent arrhythmia?
AF
What characterizes Brugada syndrome and its treatment?
ST elevations in right chest leads and RBBB
requiring AICD implantation in patients with unexplained syncope or after resuscitation.
What is unique about the VT characteristic of digoxin toxicity?
Bidirectional ventricular tachycardia with a 180-degree change in axis between beats.
What is the initial treatment for stable SVT?
Vagal maneuvers or IV adenosine.
What antibiotics are known to prolong QT?
Azitromycin and flueroquinolone
What is the primary treatment for Torsades de Pointes?
IV magnesium
What is the treatment for VT with a pulse even with some hemodynamic compromise?
Synchronized shock
What is an important principle in VF resuscitation?
Early defibrillation
What is paradoxical splitting of the second heart sound (S2)?
A pathological delay in the closure of the aortic valve,
seen in conditions like LBBB, AS, and HOCM
What murmur in young patients usually indicates a functional murmur?
A faint mid-systolic murmur with normal ECG and chest X-ray
heart sounds
What are typical findings of Aortic Stenosis (AS)?
S4
ejection murmur at the heart’s base
and paradoxical splitting in severe cases.
What murmur is classic for Mitral Stenosis (MS)?
Mid-diastolic murmur with an opening snap
What is the most common cardiac tumor?
Myxoma
What should be suspected in a young woman with a “tumor plop” sound?
Myxoma
What is mitral stenosis and its typical findings in pregnancy?
Valvular defect; accentuated first heart sound and an opening snap followed by a diastolic murmur.
How is mitral valve insufficiency generally treated?
Surgical
When should surgery be considered for primary mitral valve insufficiency?
Operate earlier, even without symptoms.
What are the typical findings of severe AS?
Parvus et tardus pulse, weak second sound, and a systolic ejection murmur that weakens when transitioning from lying to standing and during the Valsalva maneuver
What are the main indications for TAVI?
- Severe symptomatic AS
- asymptomatic patients with EF below 50%
- candidates for other cardiac surgery.
אחד מהם
What are the indications for valve replacement in severe aortic stenosis?
Valve area <1 cm²
pressure gradient >40 mmHg
flow velocity >4 m/s
in symptomatic patients, left ventricular dysfunction
or candidates for other heart surgery.
How should severe asymptomatic aortic stenosis be managed?
Periodic evaluation with clinical assessment and echocardiography.
What common toxin causes dilated cardiomyopathy?
Alcohol
What improvement can occur in dilated cardiomyopathy with alcohol abstinence?
Significant improvement within six months.
What combination of medications improves prognosis in systolic heart failure?
Hydralazine and nitrates.
What is the treatment approach for peripartum cardiomyopathy?
Similar to heart failure: beta-blockers, ACE inhibitors/ARBs, Aldactone.
How can diuretics affect HOCM?
Worsen obstruction due to hypovolemia
What other side effects can niacin cause?
Increased blood sugar, uric acid levels, and liver enzyme disturbance.
Should patients with heart failure receive beta-blockers and ACE inhibitors even if asymptomatic?
Yes, if no contraindications.
What is BNP and what does it diagnose?
BNP is a natriuretic peptide that diagnoses left and right heart failure.
When is primary prevention ICD implantation recommended?
- EF of 35% or less and NYHA class 2-3,
- post-MI with an EF of 30% or less regardless of NYHA class.
How is malignant hypertension manifesting as hypertensive encephalopathy treated?
Lower blood pressure with IV labetalol or nitroprusside to around 160/100 or up to 25% of MAP.
What is the treatment for most cases of renal artery stenosis?
Medical treatment, with vascular intervention only for advanced kidney failure or uncontrolled blood pressure.
What is the primary treatment for amyloid cardiomyopathy?
loop diuretics like furosemide
What is the primary treatment for alcohol-related DCM?
Abstinence
What is thiazide’s mode of action in hypertension treatment?
diuretic and vasodilator
What drugs form the basis of HFrEF treatment?
RAAS blockers
beta-blockers
aldosterone antagonists
SGLT2 inhibitors.
What is recommended for patients who remain symptomatic despite ACEI/ARB treatment in HFrEF?
ARNI treatment.
What are conditions that cause heart failure due to high cardiac output?
Metabolic conditions like thyrotoxicosis, chronic anemia, and arteriovenous shunt in conditions like Beriberi disease
What does treatment with Candesartan achieve in heart failure with preserved ejection fraction?
Reduces hospitalizations but does not reduce mortality.
What are known side effects of nifedipine?
Leg edema and headaches
What is Aldactone’s role in HFrEF treatment?
Used when beta-blocker and ACEI/ARB treatment does not achieve balance.
What is a risk factor for heart failure with preserved ejection fraction?
Systemic hypertension
How is hemochromatosis classified, and how is it diagnosed?
restrictive cardiomyopathy; diagnosed by MRI or heart biopsy with iron staining.
What is the effect of digoxin on heart failure hospitalizations?
Reduces hospitalization rates
What supportive treatment of right-sided infarction include?
IV fluids to improve right ventricular function.
How is unstable angina diagnosed?
Clinical diagnosis- course of progressive severe chest pain
* Normal resting ECG
* Normal Troponin
Definition: Typical pain at rest, new angina affecting function, or worsening of known angina patterns without elevated troponin and often no changes in the resting ECG.
What risk does DKA pose on potassium levels?
Risk for Hypokalemia
What is pulse pressure?
The difference between systolic and diastolic blood pressure.
In which conditions is a wide pulse pressure expected?
3 conditions
Atherosclerosis
thyrotoxicosis
aortic regurgitation (AR).
What mainly determines the treatment of hypertensive crises?
Severity of target organ damage, not absolute blood pressure values.
How should blood pressure be reduced in malignant hypertension?
Moderately, by up to 25% in MAP over two hours or more.
MAP = 1/3 X SBP + 2/3 DBP
Which emergency is microangiopathic hemolytic anemia associated with?
Emergencies related to malignant hypertension.
What is the treatment of choice for microangiopathic hemolytic anemia in hypertensive emergencies?
Rapid blood pressure reduction with intravenous medications.
What should be suspected in elderly patients with treatment-resistant hypertension and an abdominal bruit?
Renal artery stenosis (RAS).
What is the standard treatment for most cases of acute pericarditis?
High-dose NSAIDs or aspirin (first line) for 3 months
+- colchicine
if not worked- steroids
How is the diagnosis of pulmonary hypertension confirmed?
Swan gantz Cathether
What are the differential diagnoses for Kussmaul sign?
Constrictive pericarditis
restrictive cardiomyopathy
right ventricular MI (RVMI)
tricuspid valve stenosis.
Increased jugular venous pressure with inspiration is commonly referred to as Kussmaul’s sign
What are the initial ECG signs of hyperkalemia?
peak T waves»_space; Flattent P wave»_space; QRS widening»_space; VF + asystole
What characterizes Accelerated Idioventricular Rhythm (AIVR)?
A ventricular arrhythmia with a rate up to 100 bpm, common around MI, usually not requiring specific treatment.
What often complicates viral illness?
Acute/subacute myocarditis
What contributes to the development of myocarditis and clinical heart failure syndrome in viral illness?
The virus himself and immune response.
What complication of uremia indicates dialysis?
Pure Pericarditis, no Ecg changes
What are the clinical features of pericarditis?
- Chest pain
- Friction rub
- diffuse ST elevations + PR depressions
- elevated inflammatory markers
- pericardial effusion
What is the test of choice for the initial evaluation of heart function?
Echocardiography
What is postcardiac injury syndrome and its treatment?
Pericarditis due to myocardial injury, treated with aspirin or NSAIDs combined with colchicine.
What is the test of choice for monitoring abdominal aortic aneurysm in men over 65 who smoked?
Abdominal US
When should symptomatic or large abdominal aortic aneurysms be repaired?
> 5.5-6 cm
What syndrome is associated with aortic aneurysms and aortic insufficiency?
Marfan syndrome
also MVP
What tests should be performed for every patient diagnosed with hypertension?
Urinalysis and protein test.
How is pulmonary hypertension initially assessed?
Echocardiography
What is linked to isolated systolic hypertension and increased pulse pressure in primary hypertension?
Arterial wall stiffness.
What condition can ACE inhibitors and ARBs exacerbate, and when should they be avoided?
Hyperkalemia
What is the initial evaluation method for suspected RAS (renal artery stenosis)?
Renal artery Doppler ultrasound.
What is the main cause of Dilated Cardiomyopathy?
Idiopathic, diagnosed after ruling out other known causes.
What indicates a rapid lowering of blood pressure in hypertensive emergencies?
Signs of encephalopathy (headache, papilledema).
What defines a hypertensive emergency?
Systolic BP >180 or diastolic BP >120 with evidence of target organ damage.
What are thiazides known for in hypertension treatment?
Reliable antihypertensive drugs
What is the most common etiology of renal artery stenosis?
Atherosclerosis
What is a common cause of secondary hypertension and blood pressure imbalance?
Renal artery stenosis
What is a common side effect of thiazide diuretics?
Hyponatremia
What lifestyle changes are recommended for hypertension management?
Weight loss
reducing dietary NaCl intake
increasing potassium intake.
Which type of toxicity cause Adriamycin (chemotherapy)?
Cardiotoxic, potentially causing cardiomyopathy
What receptors does Aldactone bind to, and what are the side effects?
Binds- Progesterone + androgen receptors
Side effects- gnycomastia, impotence, ammneorhea
How is Eplerenone different from Aldactone?
** selective aldosterone blocke**
Not causing Gnycomastia in mans (10% gnycomastia in mans under aldactone) + ammneorhea
Where is a myxoma typically located?
Left atrium, attached to the septum
What systemic symptoms can a myxoma present with?
Fever, weight loss
Which diuretics are potassium-sparing?
Amiloride and Eplerenone
What type of repair may reduce perioperative mortality in abdominal aortic aneurysm?
Endovascular repair.
Tx for Peripherial artery disease (PAD)?
- Smoking cessation
- physical activity
- antiplatelet therapy
- hypertension treatment
- statins
- possibly low-dose rivaroxaban (Prevent DVT, PE)
What does ECG show in Cor pulmonale?
RVH
R in V1 > 7 mm tall or V1 R/S ratio > 1 mm. Right axis deviation
