Uworld Cardiology 9/22 Flashcards
Incorrect points and Lucky Guesses
Edema in the right ankl, heaviness and cramping in the same leg after a LONG DAY. Its better after sleeping. JVP normal, Lungs are clear, No hepatomsplenomegaly, no thrombosis. Most likely cause?
Venous Valve Incompetence
What could cause edema from LYMPHATIC OBSTRUCTION?
Malignant obstruction of lymph nodes, lymph node resection, trauma, and filiarsis. affects DORSUM of the feet
THINK SURGERY
Where are the ectopic foci that causes atrial fibrillation?
Pulmonary veins, most commonly
What is the mechanism/cause of exertional dyspnea in a person with Cardiac Tamponade?
Decreased Left ventricular preload - the fluid accumulation in the pericardium is restricting venous return and ventricular filling.
JVD, Hypotension, muffled heart sounds
Cardiac Tamponade, meaning fluid in the pericardium
What does Valsalva maneuver do?
Decreases preload, thus increasing intensity of HOCM/MVP, but decreasing everything else
How does squatting help with Tetrollogy of Fallot
Increasing systemic vascular resistance. WIth more afterload, its harder for blood to go forward, thus DECREASING the RIGHT TO LEFT shunting.
Arterial Embolism vs Arterial Thrombosis
Emboli originate from the heart. A Thrombus develops right at the sight of the plaque.
23 year old 29 week pregnant lady has sudden SOB. She woke up with fluttering sensation in her chest, and progressed to dyspnea, dry cough, and cant lie flat. She had recurrent sore throat as a kid, and is an immigrant. ECG shows afib with RVR. What is the diagnosis?
Mitral Stenosis - she alreayd had it from before, and the pregnancy increased the HR and volume of blood, thus precipitating the symptoms.
What is Paripartum Cardiomyopathy, and does it have anything to do with afib?
Rapid onset systolic HF at >36 weeks. Rarely see AF with RVR.
Patient has symptoms of compartment syndrome. Would the cause of symptoms be “Soft tissue swelling” or Venous Thrombosis?
Soft tissue swelling. Venous thrombosis is more in line with DVT, and compartment syndrome is caused by trauma or recent surgery. Basically theres not enough pressure for blood to go UP
Management of Cocaine chest pain?
Benzos, aspirin, Nitro, CCB.
DO NOT USE BB
When do you suspect Chagas disease, and what causes it?
Signs of cardiomegaly and heart failure with TOXIC MEGACOLON. Its a PROTOZOAL disease. not rickettsial.
Cardiac features of Marfans syndrome?
Aortic Dilation, Regurgitation, or dissection.
See MVP - early diastolic murmur
Patient with past history of WPW syndrome and 3 prior episodes of SVT. Now she has Afib. How do you treat?
Procainamide. Treatment is directed towards WPW. If you treat the Afib with the regular antinodals, there would be MORE conduction in the accessory pathway and cause VENTRICULAR TACHYCARDIA
What suggests SEVERE Aortic Stenosis?
Diminished carotid Pulse - Pulsus Parvus and tardus
MID TO LATE PEAKING SYSTOLIC MURMUR
Presence of Soft and single S2***
Why do you get a “sfot single S2 with AS?
The aortic valve leaflets are calcified, thus a softer aortic valve closure.
Clinical Features of atherosclerotic Embolism
- Livedo reticularis, ulcers, gangrene
- Acute Kidney Injury
- Stroke, amurosis fugax
- Hollenhorst Plaques, which are in the retina.
- Intestinal Ischemia
What would you find on CBC for cholesterol embolsim?!?
EOSINOPHILIA and EOSINOPHILURIA
Aortic Dissection - what are the risk factors?
Htn, Marfans, Cocain use
Treatment for FAST and WIDE complex tachy?
IV Amiodarone
What arrythmia do you attempt vagal maneuvers?
PSVT - narrow complex tachycardia thats REGULAR. Since PSVT is generally benign
Conditions associated with Afib?
- HTN, CAD, Rheumatic.Valvular disease, CHF, HOCM,
- Hyperthyroidism
T/F? Aortic Dissection is associated with Afib?
NO.
Patient has an abdominal Aortic Aneurism. What is associated with the highest rate of aneurysm expansion and rupture?
Active Smoking.
RF: Older age, cigarette smoking, family history of AAA, white, and atherosclerosis.
NOT HTN. The administration of BB and ACEis have not been shown to reduce the rate.
Alcohol’s effect on CAD?
associated with DECREASED incidence of coronary heart disease and cardiovascular mortality
Findings of a congenital bicuspid aortic valve?
Diastiolc Decrescendo Murmur, widened pulse pressure.
Most commone heart defect in a baby with overlapping fingers, absent palmar creases, small face and jaw with a prominence on the back of the head?
VSD. the child has Trisomy 18 aka Edwards. See rocker bottom feet as well.
When and how do you screen for AAA?
men between 65-75, SMOKER, one time screen with US. if no smoke, no screen
Ptnt has crushing midsternal chest pain ten days after coronary angiography and surgery from a everlimus eluting stent. ECG shows 2mm ST segment elevation in leads I, aVL, and V1 to V4. What happened?
Medication noncompliance. His new symptoms are consistent with a NEW Myocardial infarction just 10 days after already having an MI and a stent put in.
What medications would a patient be on after having a stent put in?
Aspirin and Clopidogrel (or Prasugrel, ticagrelor)
25 year old woman has transient right eye vision loss. Her BP is 164/103. Her BMI is 26 She has a bruit below the right mandibular angle. Labs show a borderline low -normal K, a HIGH RENIN activity, and a PAC/PRA of 10. Next step? and what is her vision loss?
CT Angio of the abdomen. She has fibromuscular dysplasia, most likely in the renal arteries, so need to check for that.
The vision loss is from “Amaurosis fugax”
When do you use Adrenal Vein sampling with unusually high BP?
when you suspect adrenal hyperplasia and adenoma. See a plasma aldosterone of >15, hypokalemia, a SUPRESSED renin activity, thus a ratio of >20.
Young woman has chest pain for the past 3 weeks, thats episodic and sharp. She has a systolic murmur at the apex that shortens with squatting. What is the DX?
MVP.
Remember, anything that decreases a murmur by adding more blood to the heart, its MVP or HOCM.
What would decrease a murmur from Rheumatic Heart Disease
This leads to Mitral Stenosis, so a decrease in preload would decreased preload. Valsalva and standing.
What murmurs get softer with Handgrip?
HCM, MVP, and AS
Old man has syncope while walking. He’s had light headedness twice over the past month. He has a pulse of 64. He has a prolonged PR interval and prolonged QRS complex, normal QTc, with occasional Premature Ventricular Contractions. Cause?
Bradyarrhythmia.
What is another phrase for “autonomic dysfunction”
Postural Hypotension
Causes of Dialated Cardiomyopathy?
HTN, Alcohol, and VIRAL - parvo B19, HHV8, coxsackievirus, adenovirus, influenza, and HIV.
Old man has LE swelling, JVD when now lying down, but no chest pain. He has a permanent pacemaker in. Has a 3/6 holosystolic mumur over the LSB. The liver is enlarged and tender. DX?
Tricuspid Regurgitation due to the pacemaker, explaining the Right sided HF.
Holosystolic may lead you into MR, VSD, but none of those have symptoms of right heart failure.. VSD not associated with pacemaker.
Indication for Statin Therapy
LDL of over 190, past MI, Stroke, or if they have a estimated 10 year risk.
What is the function of IV Adenosine in chemical stress test?
Augments blood flor in nonobstructive coronary arteries. Blood flow is increased in the stenosed coronary arteries, but to a lesser extent.
When do you used Dobutamine instead of Adenosine/Dypyridamole in pharmacological stress test
Reactive airway disease, or patients already on dipyridamole or theophylline
When would a Papillary Muscle Ruputre happen post MI>
Acute or within 3-5 days. RCA. See severe pulmonary edema, new holosystolic murmur. Here Severe mitral regurg with flail leaflet.
Interventricular septum rupture?
Acute or within 3-5 days. LAD. New holosystolic murmur, biventricular failure, shock
Free wall rupture?
Within 5 days to 2 weeks - LAD, see pericardial effusion with tamponade
Left Ventricular Aneurysm?
Up to several months, LAD. see subacute HF, stable angina.
Blocked vessel for STE in V1-6?
LAD
STE in II, III, aVF?
INFERIOR - RCA (see aditional DEPRESSION in V1 and 2) or LCX
STE in I, aVL, V5 and 6?
LATERAL - LCX, with DEPRESSION in leads II, III, and aVF
