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x Medicine 200 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Tx for cardiac tamponade

A

Massive volume resuscitation and emergent pericardiocentesis

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2
Q

Should you suppress PVCs with antiarrhythmics?

A

No, this worsens survival.

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3
Q

When to treat patients with PVCs

A

Only if they are symptomatic, don’t treat asymptomatic PVCs, even if they are regular.

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4
Q

First line treatment for PVCs

A

Beta-blockers

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5
Q

Second line tx for PVCs

A

Amiodarone

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6
Q

Amiodarone?

A

Class III antiarrhythmic. K+ channel blocker. Lengthens QT interval. Useful for treating atrial arrhythmias mostly. Slows down sinus rhythm

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7
Q

Digoxin treats arrhythmias?

A

Yes, a.fib and a.flutter

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8
Q

Do PVCs affect prognosis.

A

They make it worse, but you don’t tx if no symptoms

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9
Q

Lidocaine used to tx what

A

Ventricular arrhythmia (V.tach) with ACS

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10
Q

Lidocaine poor side effect

A

PPx can increase risk of asystole

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11
Q

Does lidocaine decrease risk of v.fib?

A

Yes, but increases asystole risk

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12
Q

Radiographic imaging of Coarctation?

A

3 sign, proximal aortic dilation, constriction, and descending aorta dilatation

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13
Q

Shape of ToF heart

A

Boot shaped

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14
Q

Depressed CO + Elevated PCWP means

A

Left ventricular failure

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15
Q

Signs of AV fistula

A

Shunting of blood leads to increased preload and CO. Leads to widened pulse pressure, strong arterial pulses, and tachycardia.

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16
Q

AV fistula causes essentially

A

High Output Cardiac Failure

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17
Q

Most common EKG finding with a.flutter

A

2:1 heart block, less often is 3:1, 4:1, 6:1

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18
Q

Irregularly irregular rhythm

A

No discernible P waves, a. fib

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19
Q

Neurogenic shock causes what to happen to the MVO2?

A

Decreased from increased oxygen extraction by hypoperfused tissues

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20
Q

MVO2

A

Mixed venous oxygen concentration, why is it low in neurogenic shock?

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21
Q

Septic shock presents with

A

Elevated CO, low SVR, RAP, and PCWP, and frequently normal Mixed Venous Oxygen Concentration

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22
Q

OCPs and BP

A

Increase in some people, estrogen increases angiotensinogen production in liver.

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23
Q

Common causes of amyloidosis

A

Multiple myeloma, RA.

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24
Q

Amyloidosis signs

A

Proteinuria, decreased coag. factors from decreased production in liver. Restrictive cardiomyopathy with thickened ventricles and diastolic dysfunction.

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25
Q

Alcohol causes what CV problem

A

Dilated cardiomyopathy

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26
Q

Signs of hemochromatosis

A

Restrictive cardiomyopathy, pancreatic dysfunction, bronzed skin, and hepatomegaly

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27
Q

Sarcoid signs

A

Restrictive cardiomyopathy, bilar hilar adenopathy, erythema nodosum. No renal involvement typically.

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28
Q

Lasix effects

A

Diuretic and venodilation decreasing preload

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29
Q

Morphine CV effects

A

Preload reducer

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30
Q

Beta-blockers with Pulm. edema

A

Contraindicated

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31
Q

Digoxin and MI

A

Not used for acute CHF due to an MI

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32
Q

When to use antiarryhthmics like verapamil and amiodarone

A

???

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33
Q

Best test for AAA

A

Abd. u/s

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34
Q

Mitral valve prolapse signs

A

Mid-systolic click over cardiac apex and short systolic murmur if MR is present

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35
Q

Squatting does what to the heart

A

Increases preload

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36
Q

Squatting and MVP

A

Decreases the prolapse

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37
Q

What is mitral valve prolapse exactly?

A

…..

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38
Q

MVP signs

A

Atypical pain that lasts 5-10 seconds, anxiety, palps, and hyperventilation

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39
Q

Rheumatic heart disease sign

A

Mostly mitral stenosis, some mitral regurg.

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40
Q

Janeway lesions

A

Septic emboli in the fingertips

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41
Q

Infective endocarditis presentation

A

Progressive subacute fevers, chills, malaise, and dyspnea. Arthritis, fingtertip pain. Immune complex phenomena.

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42
Q

Post-strep glomerulonephritis signs

A

Sore throat/skin infection first, then edema, dark urine, and HTN. No arthritis and fingertip pain.

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43
Q

Most important step with cardiac arrest

A

Time to defibrillation

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44
Q

Orthostasis and prolonged recumbence

A

Increased risk of it

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45
Q

ARDS diagnostic criteria

A

Acute onset, bilateral patchy on CXR, PCWP<200

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46
Q

What is PaO2/FIO2<200

A

Pretty much means if your FIO2 is 100% (1) and your PaO2 isn’t >200, then it’s a sign that you aren’t oxygenating very well at all.

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47
Q

Nifedipine and MI

A

Do not use in STEMI, b/c it vasodilates and causes reflex tachycardia which can worsen ischemia

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48
Q

Non-dihydropyridic CCBs like diltiazem and verapamil and STEMIs

A

Can be used after beta-blockers, but don’t improve mortality

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49
Q

Difference between the CCBs

A

Dihydropyridine CCBs like amlodipine and difedipine have little action on the heart. Non-dihydropyridine CCBs like verapamil and diltiazem slow down cardiac conduction.

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50
Q

Drugs that can be used in STEMIs

A

Heparin, ACEIs, Beta-blockers, aspirin

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51
Q

Dihydropyridine CCBs and STEMIs

A

Such as nifedipine, worsen cardiac ischemia

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52
Q

Beta-blockers and STEMIs

A

Decrease oxygen demand of myocardium, prolong diastole (increasing coronary perfusion), reduce ventricular remodeling

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53
Q

Signs of Cushing’s

A

HTN, hyperglycemia, hypoK, proximal muscle weakness, central adiposity, thinning of skin, weight gain, psychiatric problems (sleep, depression, psychosis)

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54
Q

Does hypothyroidism cause hyperglycemia, hypoK and HTN

A

No, but can cause weight gain, fatigue, bradycardia, depression, and skin/hair changes

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55
Q

Adrenal medulla produces

A

Catecholamines: weight loss, tachycardia, HTN, diaphoresis, anxiety

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56
Q

Amiodarone and lungs

A

Don’t use in lung disease. Causes pulm. toxicity: chronic interstitial pneumonitis, organizing pneumonia, and ARDS

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57
Q

Things to slow down ventricular rate

A

Verapamil, digoxin, quinidine

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58
Q

Beta-blockers and lung diseases

A

Don’t use in obstructive like asthma or COPD, but can use for restrictive

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59
Q

Mitral stenosis problems

A

L atrial dilation, a.fib., cardiac emboli. Can cause dyspnea, cough, and hemoptysis from increased pressure in lungs

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60
Q

Beta-blockers and cocaine-vasoconstriction

A

They worsen the vasoconstriction…how???

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61
Q

Beta-blockers and alpha-agonists??

A

????

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62
Q

First line drugs for cocaine ischemia

A

Benzos, nitrates, aspirin

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63
Q

Exertional syncope think of

A

V.tach, L vent. outflow obstruction (Aortic stenosis/HOCM)

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64
Q

Pulsus paradoxus is

A

Exaggerated decrease (>10 mmHg) in systemic arterial BP with inspiration. Seen in cardiac tamponade.

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65
Q

Capillary pulsations are sign of

A

Aortic regurg.

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66
Q

Mitral stenosis sounds

A

Late diastolic murmurs and opening snap

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67
Q

How to get a narrow Ventricular tachycardia

A

???

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68
Q

Lidocaine used for

A

Vent. arrhythmias

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69
Q

How does digoxin help a.fib

A

Rate control

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70
Q

How to distinguish syncope from seizure

A

Confusion only occurs after seizures

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71
Q

Risk factors for dissection

A

Bicuspid aortic valve, coarctation of aorta, and Marfan’s syndrome

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72
Q

First step in treating Aortic dissection with HTN

A

Antihypertensive management

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73
Q

What murmurs decrease with greater preload?

A

HOCM and what else….

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74
Q

HOCM genetics

A

Aut. Dom.

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75
Q

Ventricular free wall rupture

A

Happens usually 3-7 days following an MI, leads to PEA from pericardial tamponade

76
Q

Always associate the cardiac findings with the murmur you’d expect to hear

A

….

77
Q

HOCM murmur

A

LLSB interestingly…

78
Q

Papillary muscle rupture causes quick decompensation?

A

Nope

79
Q

Things to hold prior to stress testing

A

Anti-ischemic meds, digoxin, and meds that slow the heart (beta, blockers)

80
Q

When to start ACEIs

A

In diabetics and patients with reduced LV systolic function…

81
Q

Why ACEIs in diabetics??

A

….

82
Q

LIfestyle changes for HTN

A

Lose weight, reduce salt, avoid excess alcohol, stop smoking

83
Q

Pleuritic chest pain in PE

A

From pulm. infarction irritating the pleura

84
Q

What causes orthostasis in old people

A

Decreased baroreceptor sensitivity

85
Q

Hypoglycemia and heart rate

A

Can cause bradycardia, I though it can also cause tachycardia??

86
Q

Treating bradycardia

A

If symptomatic, use IV atropine, decreases vagal input

87
Q

IV adenosine causes what

A

Temporary AV block

88
Q

Amiodarone uses

A

Antiarrhythmic in supraventricular and ventricular tachys, don’t use in brady

89
Q

Transcutaneous pacing use

A

Used after atropine to increase heart rate

90
Q

What causes inferior wall MIs

A

Right coronary artery or L circumflex. Mostly R coronary (5:1)

91
Q

LAD occlusion causes what

A

Anterior wall myocardial infarction

92
Q

Acute inferior wall infarction

A

Right coronary, especially if there is R ventricular infarction.

93
Q

Polycystic kidney disease signs

A

HTN, hematuria, bilateral flank masses.

94
Q

Primary hyperaldosteronism lab finding

A

Elevated aldosterone to renin ratio

95
Q

Can you palpate adrenal masses?

A

Almost never

96
Q

Captopril renal scan

A

Diagnoses renal artery stenosis

97
Q

Polycystic kidney disease genetics

A

Aut. dom.

98
Q

Polycystic kidney disease association

A

Intracerebral aneurysms

99
Q

Oslers nodes/Janeway lesions

A

Osler nodes are painful bumps that turn red-purple in the fingers and toes. janeway lesions are painless hemorrhages in the palms and soles.

100
Q

Coronary steal

A

dipyridamole causes blood flow redistribution to nondiseased vessels in stress test

101
Q

Phamacological stress test drugs

A

Adenosine, dipyridamole, or dobutamine

102
Q

Positive stress test

A

chest pain, st depression, hypotension, or significant arrhythmias

103
Q

What reduces mortality from MI

A

ASA, beta-blockers, and ACEI

104
Q

STEMI tx

A

cath lab for PTCA or CABG!

105
Q

CK-MB lasts for

A

Peaks in 24 hrs and lasts 2-3 days, good for recurrence

106
Q

Troponin I lasts for

A

Peaks in 24 hrs and lasts 1-2 weeks, most specific

107
Q

Dressler syndrome

A

Post-pericardiotomy pericarditis or postMI pericarditis. Treat with colchicine.

108
Q

Prinzmetal (variant) angina

A

Happens at night, inducible by IV ergonovine, women.

109
Q

When to add digoxin to HF

A

Class IV HF

110
Q

adenosine toxicity

A

HA, flushing, nausea, SOB, chest pressure

111
Q

Nitrate toxicity

A

HA, orthostasis, tolerance, syncope

112
Q

Digoxin toxicity

A

atrial tachycardia with AV block

113
Q

rate control for afib

A

Ca-blockers

114
Q

MCC of Multifocal atrial tachycardia

A

End-stage COPD

115
Q

Tx for torsades

A

IV mag sulfate

116
Q

Tx for sustained Vtach

A

IV amiodarone

117
Q

Mobitz type 2 tx

A

Pacemaker (can convert to third degree w/o tx)

118
Q

Causes of dilated CM

A

MI (MCC), infx, alcohol, doxorubicin (adriamycin), etc.

119
Q

HOCM genetics

A

Aut. Dom. few sporadic

120
Q

Causes of Restrictive cardiomyopathy

A

CASHES: carcinoid, amyloid, sarcoid, hemochromatosis, endocardial fibroelastosis, scleroderma

121
Q

Myocarditis presentation

A

Fever, CP, pericarditis

122
Q

Myocarditis tests

A

Increased cardiac enzymes, incr. esr

123
Q

Myocarditis etiology MCC

A

coxsackie B virus

124
Q

Pericarditis EKG

A

Diffuse ST elevation + PR depression

125
Q

Pericarditis tx

A

NSAIDs

126
Q

Most common cause of pericarditis

A

Coxsackie B virus.

127
Q

Dressler syndrome

A

Post-MI or pericardiotomy pericarditis, tx with NSAIDs

128
Q

constrictive pericarditis pathophys

A

fibrous pericardial scarring leads to increased CVP leading to peripheral edma etc.

129
Q

Constrictive pericarditis xray sign

A

Sqaure root sign

130
Q

Constrictive pericarditis tx

A

Pericardiectomy

131
Q

Pericardial effusion CXR

A

water bottle silhouette

132
Q

Beck’s triad

A

Hypotension, JVD, muffled heart sounds

133
Q

Cardiac tamponade presentation

A

pulsus paradoxus + beck’s triad

134
Q

Pulsus paradoxus

A

A large decrement (>10 mmHg) of BP with inspiration. larger than normal.

135
Q

Most common cause of mitral stenosis

A

Rheumatic heart dz

136
Q

Etiologies of MR

A

ischemic heart dz, LV dilation, MVP

137
Q

Aortic stenosis presentation

A

Parvus et tardus; traid of angina, syncope, dyspnea

138
Q

presentaiton of aortic regurg

A

High pithced blowing diastolic murmur, wide pulse pressure, head bobbing, pulsating uvula, pistol shot over femoral arteries

139
Q

Aortic regrug etiologies

A

bicuspid aortic valve, syphilitic aortitis, rheumatic fever

140
Q

mitral valve prolapse presentation

A

midsystolic click, late systolic crescendo murmur, enchanced with increased SVR

141
Q

Rheumatic fever presentation

A

FEVERSS: fever, erythema marginatum, valvular damage, inc. ESR, red-hot joints (migratory polyarthritis), subq nodules, syndenham chorea

142
Q

Rheum fever dx

A

ASO titers

143
Q

Rheum fever tx

A

PCN or erythromycin for strep throat. Steroids for Rhem fever

144
Q

Most common mumur with Rheum fever

A

MR

145
Q

Rheumatic heart disease murmur

A

Mitral stenosis, from repeated episodes of rheumatic fever

146
Q

Acute infx endocarditis

A

S. aureus on normal valves happens rapidly

147
Q

Subacute Bacterial Endocarditis cause

A

S. viridans for dental procedures (GU/GI procedures is enterococcus) on damaged valves

148
Q

Duke’s criteria

A

Sustained bacteremia, endocardial involvement, fever, immune or vascular phenomena, +bcx, +echo

149
Q

Colon cancer endocarditis

A

Strep bovis, clostridium septicum

150
Q

IV drug abuse endocarditis

A

S. aureus on tricuspid&raquo_space; pseudomonas, candida

151
Q

Prosthetic valve infection

A

s. epidermidis

152
Q

Cx negative endocarditis

A

HACEK group?

153
Q

Marantic (thrombotic) endocarditis

A

Metastatic cancer causing clots to form on valves that can embolize, tx with heparin

154
Q

Libman-Sacks endocarditis

A

SLE leads to wart like vegetations on both sides of mitral valve leading to mitral regurg>mitral stenosis. Dx ana, tx underlying SLE and anticoagulate

155
Q

ASD presentation

A

Fixed split S2, low-grade diastolic murmur

156
Q

VSD presentation

A

holosytolic murmur at mid LSB

157
Q

PDA with adults with eisenmenger tx

A

Surgery is contraindicated

158
Q

adults w/o eisenmenger tx

A

surgical ligation

159
Q

Congenital rubella syndrome Triad

A

PDA + deafness + cataracts

160
Q

HTN urgency BP limits

A

> 220/120

161
Q

Tx for HTN urgency vs. emergency

A

Urgency: gradually lower over 24 hrs with PO meds
Emergency: lower 25% with IV nitroprusside in 1-2 hrs, then slowly afterwards

162
Q

Aortic dissection presentation

A

Tearing CP or interscapular back pain, assymetric BP

163
Q

Tx for type A and B aortic dissection

A

A: beta-blockers and surgery
B: beta-blockers

164
Q

When to do surgery on AAA?

A

> 5 cm or sx (synthetic graft)

165
Q

MC pts with AAA

A

old smoking men

166
Q

how does an aortoenteric fistula present

A

small herald bleed followed by massive UGIB s/p aortic graft placement

167
Q

Signs of Ruptured AAA

A

tearing abd. pain, hypotension, pulsatile mass, CUllen sign, grey-turner sign

168
Q

Leriche syndrome

A

PVD of distal aorta above bifurcation leading to bilateral claudication, impotence, and decreased femoral pulses

169
Q

when to amputate after acute arterial occlusion

A

> 6 hrs, most commonly in common femoral artery

170
Q

Mycotic aneurysm cause

A

Bacterial, not fungal infex leading to arotic aneurysm, tx with IV abx and surgical excision

171
Q

Luetic heart

A

tertiary syphilis leading to aortic aneurysm + aortic regurg + coronary artery stenosis, tx with IV PCN G and surgery

172
Q

what to treat superficial venous thrombosis

A

aspiris + warm compresses

173
Q

migratory SVT etiology

A

consider pancreatic cancer (trousseau phenomenon)

174
Q

What is homan’s sign

A

DVT sign calf pain w/ dorsiflexion

175
Q

Tx for PE

A

heparin + warfarin, tx tPa to speed up clot resolution if massive, R heart failure

176
Q

PE on EKG

A

Sinus tach most common, sinus tachy > S1Q3T3

177
Q

Phlegmasia cerulea dolens

A

Venous outflow obstruction causing acute onset leg edema with pain and cyanosis, tx with heparin and venous thrombectomy

178
Q

Post-throbotic syndrome (chronic venous insufficiency)

A

DVT damages valves leading to chronic venous HTN causing severe leg edema and ulceration around ankle area

179
Q

tx for cardiogenic shock

A

Dopamine or IABP instead of IV fluids

180
Q

how to tx neurogenic shock

A

IV fluids + supine or Trandelenburg positioning

181
Q

Cardiac metastases

A

More common than primary tumors (75%)

182
Q

atrial myxoma presentation

A

pedunculated, benign mass that presents like intermittent mitral stenosis

183
Q

cardiac rhabdomyoma

A

MC heart tumor in kids

184
Q

cardiac rhabdomyoma association

A

tubeorus sclerosis.

185
Q

RVH on EKG

A

right axis deviation + Lead V1 R-wave >7 mm

186
Q

LVH on EKG

A

left axis deviation + v1/v2 and V5/V6 overlapping

187
Q

How to determine axis

A

+ in I, and + in II: normal axis
+ in I, and - in II: LAD
- in I, and + in II: RAD

x Medicine 200 (14 decks)

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