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Internal Medicine > Cardiology High Yield > Flashcards

Cardiology High Yield Flashcards

1
Q

What is Aortic Stenosis

A

LV outflow obstruction

Leads to LVH

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2
Q

What murmur is heard with Aortic Stenosis

A

Systolic Ejection Crescendo-Decrescnedo at RUSB

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3
Q

Where does an Aortic Stenosis murmur radiate

A

Carotid Arteries

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4
Q

How can you increase the sound of an aortic stenosis murmur

A

Increase venous return to heart Squatting, Laying Down, Fist Clench
Expiration increases venous return to left side of heart

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5
Q

How can you decrease the sound of an aortic stenosis murmur

A

Decrease venous return to heart with Valsalva and Standing

Inspiration decreases venous return to left side of heart

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6
Q

Tx for Aortic Stenosis

A

Once symptomatic, valve replacement

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7
Q

What is Mitral Regugitation

A

Backflow from LV to LA, usually due to Mitral Valve Prolapse

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8
Q

What type of murmur is heard with Mitral Regurgitation

A

Holostystolic BLOWING murmur heard best at apex

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9
Q

Where does a Mitral Regurgitation murmur radiate

A

Axilla

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10
Q

How can you increase the sound of a Mitral Regurgitation murmur

A

Handgrip

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11
Q

How can you decrease the sound of a Mitral Regurgitation mumrur

A

Amyl Nitrate

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12
Q

Tx for Mitral Regurgitation

A

Vasodilators (Ace-I)

Surgery: Valve Repair

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13
Q

What is Aortic Regurgitation

A

Backflow from Aorta to LV

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14
Q

What type of murmur is heard with Aortic Regurgitation

A

Diastolic Decrescendo BLOWING murmur heard best at LUSB

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15
Q

Where does an Aortic Regurgitation Murmur raidate

A

Along Left Sternal Border

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16
Q

How can you increase the sound of an Aortic Regurgitation murmur

A

Handgrip

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17
Q

How can you decrease the sound of an Aortic regurgitation murmur

A

Amyl Nitrate

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18
Q

Tx for Aortic Regurgitation murmur

A

Vasodilators

Srugery if sx

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19
Q

What is Mitral Stenosis

A

Obstruction of flow from LA to LV

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20
Q

What type of murmur is heard with Mitral Stenosis

A

Diastolic RUMBLE heard at the apex

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21
Q

Where does a Mitral Stenosis murmur radiate

A

No radiation

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22
Q

How can you increase the sound of a Mitral Stenosis murmur

A

Increase venous return to heard with Squatting, Laying Down, Fist Clench
Expiration increases flow through left side of heart, so will increase murmur

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23
Q

How can you decrease the sound of a Mitral Stenosis Murmur

A

Decrease venous return to heart with Valsalva or Standing

Inspiration decreases flow through left side of heart, so will decrease murmur

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24
Q

What is Mitral Valve Prolapse

A

Degeneration of mitral valve

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25
Q

What type of murmur is heard with Mitral Valve Prolapse

A

Midsystolic Ejection CLICK at Apex

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26
Q

Where does a mitral valve prolapse murmur radiate

A

No radiation

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27
Q

Tx for Mitral Valve Prolapse

A

Reassurance

Beta Blockers if autonomic dysfunction

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28
Q

What is Dilated Cardiomyopathy

A

Systolic dysfunction leads to ventricular dilation

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29
Q

What causes dilated cardiomyopathy

A

Viral, usually Enterovirus (Coxsackie)

Alcohol Abuse

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30
Q

Sx of Dilated Cardiomyopathy

A

Systolic HF, signs of Left and Right sided HF

Arrhythmias

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31
Q

Dx of Dilated Cardiomyopathy

A

Echo: See LV enlargement and decreased EF
CXR: Cardiomegaly

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32
Q

Tx of Dilated Cardiomyopathy

A

Diuretics, Ace-I, Beta-Blockers

Implantable Defibrilitaor if EF

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33
Q

What is Restrictive Cardiomyopathy

A

Impaired diastolic function with fairly well preserved contractility
Ventricular rigidity impedes ventricular filling

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34
Q

What causes Restrictive Cardiomyopathy

A

Infiltrative Diseases like Amyloidosis, Sarcoidosis

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35
Q

Sx of Restrictive Cardiomyopathy

A

Right sided HF is more common than Left sided HF

Kussmaul’s sign

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36
Q

Dx of Restrictive Cardiomyopathy

A

Echo: See Ventricles nondilated with normal wall thickness, Dilated of both Atria, amyloidosis
CXR: Enlarged Atria

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37
Q

Tx for Restrictive Cardiomyopathy

A

Diuretics, Vasodilators

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38
Q

What is Pericarditis

A

Acute inflammation of the pericardium

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39
Q

What causes pericarditis

A

Viral: Coxsackie, Echovirus

40
Q

What is the association between pericarditis and an MI

A

Dressler’s Syndrome: Pericarditis 1-2 months after an MI (autoimmune related)

41
Q

Sx of Pericarditis

A

Pleuritic chest pain (sharp pain worse with inspiration)
Persistent
Postural (worse with lying down, relieved with sitting/leaning forward)
Radiates to trapezius, back, neck, shoulder, arm
Pericardial friction rub (heard best upright, leaning forward)

42
Q

Dx of Pericarditis

A

Echo is used to assess complications like effusion or tamponade
EKG: Diffuse ST elevations in precordial leads and PR depression

43
Q

Tx of Pericarditis

A

ASA or NSAIDS
Colchicine is 2nd line
Corticosteroids if refractory

44
Q

What is a Pericardial Effusion

A

Increased fluid in the pericardial space

45
Q

What causes a pericardial effusion

A

Pericarditis

46
Q

Sx of Pericardial Effusion

A

Pericarditis sx

Distant heart sounds

47
Q

Dx of Pericardial Effusion

A

Echo: Increased pericardial fluid
EKG: Low voltage QRS comlex, Electric Alternans (shift in QRS amplitude)
CXR: Cardiomegaly

48
Q

Tx of Pericardial Effusion

A

Tx underlying cause, Observation if not big

Pericardiocentesis if tamponade or large effusion

49
Q

What is Pericardial Tamponade

A

Pericardial effusion causing significant pressure on the heart
Leads to restriction of cardiac ventricular filling and decreased CO

50
Q

Sx of Pericardial Tamponade

A

Beck’s Triad: Distant (muffled) heart sounds, Increased JVP, Systemic Hyoptension
Pulsus Paradoxus: >10mmHg decrease in systolic BP with inspiration
Dyspnea, fatigue, peripheral edema

51
Q

Dx of Pericardial Tamponade

A

Echo: See effusion and diastolic collapse of cardiac chambers

52
Q

Tx of Pericardial Tamponade

A

Pericardiocentesis Immediately

53
Q

What is a first degree AV block and tx for it

A

See constant prolonged PR intervals
No loss of beats
No tx

54
Q

What is a Type I second degree block (Mobitz I/Wenckebach) and tx for it

A

PR intervals gradually increase with each beat until a QRS complex is dropped
Tx: Atropine, Epinephrine, +/- Pacemaker if sx
Observation if no sx

55
Q

What is a Type II second degree block (Mobtiz II) and tx for it

A

PR intervals are all the same size, but a QRS is dropped

Tx: PERMANENT PACEMAKER because high risk for it to develop into 3rd degree block

56
Q

What is a third degree block and tx for it

A

None of the P waves are associated with QRS complex

Tx: PERMANENT PACEMAKER is definitive

57
Q

What is Atrial Flutter and tx for it

A

No P waves, rate is regular
Tx: Vagal, CCB, Beta-Blockers
DCC if unstable
Radiofrequency ablation is definitive

58
Q

What is Atrial Fibrillation and tx for it

A

No P-waves
Irregularly Irregular Rhythm
Tx: Vagal, CCB, or Beta-Blockers
DC Cardioversion but you need to give anticoagulants for 3-4 weeks prior

59
Q

What is Wolff-Parkinson-White and tx for it

A

Accessory Pathway that pre-excites the ventricle
See Delta waves
Tx: Vagal, Antiarrhythmics (Procainamide, Amiodarone)
Radiofrequencdy ablation is definitive

60
Q

What is Ventricular Tachycardia and tx for it

A

More than 3 consecutive PVC’s at rate >100 bpm
Prolonged QT interval often is the cause
Tx
If Stable Sustained: Antiarrhythmics (Amiodarone, Lidocaine, Procainamide)
If unstable with pulse: DCC (Cardiovert)
If no pulse: Defibrillator/CPR

61
Q

What is Torsades De Pointes, what causes it and tx for it

A

A type of Ventricular Tachycardia that can lead to V.Fib
Usually due to Hypomagnesia
Tx: IV Magnesium

62
Q

What is Ventricular Fibrillation and tx for it

A

Not compatible with life

Tx: Defibrillation and CPR

63
Q

What is myocarditis

A

Inflammation of the heart muscle

64
Q

What causes myocarditis

A

Viral: Enterovirus (Coxsackie and Echovirus)
Bacteria: Rickettsial
Toxins

65
Q

Sx of Myocarditis

A

Viral Prodome: Fever, Myalgia, Malaise
HF sx: Dyspnea at rest, exercise intolerance, syncope, hepatomegaly
Pericarditis

66
Q

Dx of Myocarditis

A

Gold standard is Endomyocardial Biopsy (see infiltrations of lymphocytes with necrosis)
CXR: Dilated Cardiomyopathy
Biomarkers: CK-MB and Troponin
Echo: Ventricular Dysfunction

67
Q

Tx of Myocarditis

A

Supportive and HF tx

Diuretics, Ace-I, sometimes IVIG

68
Q

What is Rheumatic Fever

A

An acute autoimmune inflammatory multi-system disease affecting children
Usually after a Group A Strep Infection

69
Q

Dx of Rheumatic Fever

A

Jones Criteria
Recent Group A Strep Infection AND
2 Major or 1 Major + 2 Minor

70
Q

What are the major criteria for Rheumatic Fever

A 
MAJOR JONES
J: Migratory Polyarthritis
O: Carditis
N: Sydenham's Chorea
E: Erythema Marginatum (Macular, erythematous, non-pruritic annular rash with rounded, sharply demarcated edges)
S: Subcutaneous Nodules
71
Q

What are minor criteria for Rheumatic Fever

A

Fever, Arthrlagias, Increased ESR/CRP/Leukocytosis, EKG shows prolonged PR intervals

72
Q

Tx for Rheumatic Fever

A

Penicillin G or Erythroycin if PCN allergy

ASA

73
Q

What is Peripheral Artery Disease

A

Atherosclerosis of lower extremities

74
Q

Sx of Peripheral Artery Disease

A

Intermittent Claudication (pain brought on by exercise/walking and relieved with rest)
Resting leg pain (advanced disease)
Parasthesias, Pian, Pallor, Pulselessness, Paralysis, Poikilothermia
Livedo Reticularis (rash)
Gangrene
Ulcers at points of trauma (Lateral Malleolus, toes)

75
Q

Dx of Peripheral Artery Disease

A

Gold Standard is Arteriograph

AnkleBrachial Index: + if

76
Q

Tx of Peripheral Artery Disease

A

Platelet Inhibitors: Cilostazol, ASA, Clopidogrel
Revascularization: PTA, Bypass Grafts, Endarterectomy
Supportive: Exercise, foot care
Amputation if gangrene

77
Q

What is an Abdominal Aortic Aneurysm

A

Dilation of aortic diameter

Usually infrarenal

78
Q

Sx of Aortic Anuerysm

A

Usually asymptomatic until rupture

Pulsating abdominal mass, abdominal pain with syncope or hypotension

79
Q

Dx of Aortic Aneurysm

A

Gold Standard: Angiography
1st Choice: Abdominal Ultrasound
CT is 1st choice for Thoracic aneurysm

80
Q

Tx for Aneurysms

A

3-4cm: Ultrasound every year
4-4.5cm: Ultrasound every 6 months
>4.5: Refer to vascular surgeon
>5.5cm: Immediate surgical repair

81
Q

What is an Aortic Dissection

A

A tear in the innermost layer of the aorta (intima)

82
Q

What is the #1 RF for aortic dissection

A

HTN

83
Q

Sx of Aortic Dissection

A

Sudden onset of severe, tearing (ripping, knife-like) chest pain that radiates to the back
Decreased peripheral pulses
Variation in pulses between left and right arm
HTN
New onset Aortic Regurgitation murmur

84
Q

Dx of Aortic Dissection

A

Gold Standard: MRI Angiography
1st Choice: CT scan with contrast
TEE
CXR: Widening of mediastinum

85
Q

Tx of Aortic Dissection

A

Surgery if Type A

Beta-Blockers if Type B

86
Q

What is Giant Cell Arteritis

A

Autoimmune vasculitis

Systemic, granulomatous, chronic vasculitis mostly of extracranial arteries

87
Q

Sx of Giant Cell Arteritis

A 
Headache (unilateral, temporal, throbbing)
Scalp Tenderness
Jaw Claudication with Mastication
Visual Loss
Thick temporal artery
88
Q

Dx of Giant Cell Arteritis

A

Biopsy: see Mononuclear lymphocyte infiltration and multinucleated giant cells
Clinical dx

89
Q

Tx of Giant Cell Arteritis

A

High Dose Corticosteroids

90
Q

What rheumatological condition is associated with Giant Cell Arteritis

A

Polymalgia Rheumatica

  • Aching/Stiffness of shoulders, hips, neck
  • Difficultly combing hair, putting on coat, getting out of chair
  • No severe muscle weakness
91
Q

What are Varicose Veins

A

Dilated, tortuous superficial veins secondary to defective valve structures and function of superficial veins

92
Q

Sx of Varicose Veins

A

Dull ache or pressure sensation worsened with prolonged standing and relieved with elevation
Venous stasis ulcers

93
Q

Tx of Varicose Veins

A

Leg Elevation, Compression Stockings

Sclerotherapy, Radiofrequency or Laser ABlation

94
Q

What is Chronic Venous Insufficiency

A

Vascular incompetency of either deep or superficial veins

95
Q

Sx of Chronic Venous Insufficiency

A 
Leg Pain
Worse with prolonged standing, warm
Better with walking and leg elevation
Leg Edema
Ulcers found at Medial Malleolus
Brownish Hyperpigmentation
96
Q

Dx of Chronic Venous Insufficiency

A

Ankle/Branchial Index
Ultrasound
Trandelenburg Test

97
Q

Tx of Chronic Venous Insufficiency

A

Compression stockings, Leg Elevation, Exercise
Ulcer: Wet to dry dressings, skin grafting, hyperbaric oxygen
Venous valve transplant

Internal Medicine (16 decks)

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