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- Med School Review 🔥 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Electrical alternans

A

Pericardial effusion

(2/2 pericarditis, MI, penetrating trauma, iatrogenic [Central-line placement, pacemaker insertion])

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2
Q

New-onset RBBB

A

Right heart strain

(think PE; usually +JVD)

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3
Q

Symmetric ischemia and necrosis of distal fingers/toes during vasopressor resuscitation

A

NE-induced vasospasm

Can also occur in intestines and kidneys

(mesenteric ischemia; renal failure)

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4
Q

Fingertip pain and pallor triggered by cold or stress

A

Raynaud’s phenomenon

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5
Q

Asymmetrical “blue toe syndrome”

A

cholesterol emboli

(pts with atherosclerosis)

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6
Q

Immigrant + irregular heartbeat

A

Rheumatic MS

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7
Q

Fainting after urinating, coughing, or defecating

A

Situational syncope

(triggers cause a cardioinhibitory, vasodepressor,

or mixed neural alteration in autonomic response)

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8
Q

Postural change-induced fainting

A

Orthostatic syncope

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9
Q

Fainting from prolonged standing, emotional distress, or painful stimuli

A

Vasovagal syncope

(neurally mediated)

  • Tx: Counterpressure maneuvers & trigger avoidance
    • e.g. leg crossing w/ tensing of muscles, handgrip, tensing of arm muscles w/ clenched fists, etc.
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10
Q

Exercise-induced fainting

A
  • HOCM
  • Aortic stenosis
  • Anomalous coronary arteries
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11
Q

Fainting w/ prior hx of CAD, MI, cardiomyopathy,

or decreased EF

A

Ventricular arrhythmias

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12
Q

Fainting in setting of sinus pauses, prolonged PR or prolonged QRS

A

Sick sinus syndrome, bradyarrhythmias, or AV block

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13
Q

Fainting in setting of hypokalemia, hypomag, increased QT meds

A

Torsades de points

(acquired long QT syndrome)

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14
Q

FHx of sudden death, increased QT, syncope w/ exercise/startle/sleeping

A

Congenital long QT syndrome

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15
Q

Micturition

A

Urination

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16
Q

Upper extremity HTN + lower extremity claudication

A

Aortic coarctation

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17
Q

Dilated pupils

A

Cocaine/stimulants

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18
Q

Pinpoint pupils

A

Heroin/Opioids

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19
Q

Avoid ___ in cocaine-induced ACS

A

Beta Blockers

(to avoid risk of unopposed cocaine-induced alpha agonist activity and resultant worsening vasoconstriction)

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20
Q

Digitalis (Digoxin) toxicity

A

CGN

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21
Q

Digoxin

A

Cardiac Glycoside

  • Cardiac (Atrial tachycardia with AV block)
  • GI (anorexia, N/V, abd pain)
  • Neurologic (fatigue, confusion, weakness, color vision alterations)
  • Increased ectopy in atria or ventricles —> Atrial tachycardia
  • Increased vagal tone —> Decreased AV node conduction —> Potential AV block
  • Increased with amiodarone
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22
Q

Pulsus paradoxus

A

Cardiac tamponade or severe asthma/COPD

(Respiratory variation in SBP)

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23
Q

>10mmHg SBP drop during inspiration

A

Pulsus paradoxus

(Cardiac tamponade or severe asthma/COPD)

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24
Q

Post-CABG

A

Think cardiac tamponade ⇒ get echo

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25
Q

Most common location of ectopic foci

that cause AFib

A

Pulmonary veins

(can be disrupted by catheter-based radiofrequency ablation)

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26
Q

S3

A

CHF or Volume Overload:

  • CHF
  • MR (chronic severe)
  • AR (chronic)
  • Pregnancy (due to high CO state)
  • Thyrotoxicosis (due to high CO state)
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27
Q

S4

A

“HHAA”

  • HTN
  • HOCM
  • Aortic Stenosis
  • Acute MI
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28
Q

PCWP

A

LA pressure; LV End-Diastolic pressure

  • Decreased in intravascular volume loss
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29
Q

Increased BNP

A

CHF

  • +S3 sound
  • +/- peripheral edema (less specific for CHF)
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30
Q

Arrhythmia caused by hypokalemia and hypomagnesemia

A

VT

(such as with furosemide)

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31
Q

Tx of beta blocker or CCB toxicity

A

IV Atropine + IVF

(IV Glucagon if refractory)

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32
Q

Prolonged PR interval, normal QRS

A

First-degree AV block due to delayed impulse transmission anywhere from atria to ventricles —> NO FURTHER EVALUATION REQUIRED

(Observation only)

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33
Q

Prolonged PR + wide QRS duration

A

Conduction delay likely below the AV node

(often in bundle branches) —> Electrophysiological testing

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34
Q

Causes of HFpEF

A
  • Dilated cardiomyopathy (beriberi/thiamine deficiency)
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy (sarcoidosis, amyloidosis, hemochromatosis, endomyocardial fibrosis)
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35
Q

Lid lag

A

hyperthyroidism

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36
Q

Wt loss + lid lag + hand tremor

A

hyperthyroidism

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37
Q

Indication for Holter monitoring

A

Symptomatic pts w/ intermittent arrhythmias

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38
Q

CHF (diastolic dysfxn) + proteinuria + easy bruising

A

Amyloidosis

(in elderly)

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39
Q

AL amyloidosis

A

primary

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40
Q

AA amyloidosis

A

secondary to RA, IBD, chronic infections

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41
Q

Systolic murmur that increases on inspiration in IV drug user

A

Tricuspid valve endocarditis

42
Q

HF w/ hx of cardiac surgery or radiation

A

Constrictive pericarditis

43
Q

Mid-diastolic sound - Pericardial knock

A

constrictive pericarditis

44
Q

Pericardial calcifications on echo

A

constrictive pericarditis

45
Q

Post-MI acute limb ischemia

A

Arterial embolus from LV thrombus

Tx:

  • IMMEDIATE ANTICOAGULATION
  • Echo to look for LV thrombus & fxn
  • Vascular surgery consult
46
Q

Hepatojugular Reflux (JVP >3cm w/ abd compression)

A

RV Failure

47
Q

Avoid in RVMI

A

Nitrates, Diuretics, Opioids

Due to high sensitivity of RV to intravascular volume depletion leading to profound hypotension (cardiogenic shock) —> Tx: Isotonic saline bolus

48
Q

Upturning of cardiac apex on CXR

A

TOF

(RVH 2/2 pulmonic stenosis—“boot-shaped” heart)

49
Q

Displacement of tricuspid valve w/ enlarged RA

A

Ebstein anomaly

50
Q

Scoliosis + coarctation

A

Turner syndrome (XO)

51
Q

Rib notching on CXR

A

Coarctation of Aorta

(2/2 dilated intercostal arteries)

52
Q

“3” sign on L costal surface in CXR

A

Coarctation of aorta

(Aortic knob —> Actual coarctation —> Post-stenotic dilation of aorta)

53
Q

2:1 AST/ALT

A

Alcoholism

54
Q

Wheals

A

urticaria (allergy or anaphylaxis)

55
Q

Long bone fx + dyspnea, neurological sx, & petechial rash 12-24 hours post-injury

A

Fat embolism

56
Q

Systolic murmur @ apex that radiates to axilla

A

MR

57
Q

Short PR

A

WPW

  • “Ventricular pre-excitation syndrome”
  • Accessory AV conduction pathway not contained within the AV node may cause a short PR interval & a delta wave (slurred upward sloping of QRS due to pre-excitation) on EKG
  • AFib w/ WPW has increased risk of VF →
    • Stable: Procainamide
    • Unstable: Synchronized Cardioversion (DC)
58
Q

Tx for 3rd degree (complete) heart block

A

Temporary cardiac pacing

59
Q

S4

A

HHA: HTN, HOCM, Aortic Stenosis

60
Q

Hyperthermia/HIGH fever post-syncope

A

Exertional heat stroke

61
Q

Exertional heat stroke Tx

A

ICE-WATER IMMERSION

62
Q

Nonexertional heat stroke (elderly) Tx

A

EVAPORATIVE COOLING MEASURES

63
Q

Cyproheptadine

A

Serotonin antagonist used in serotonin syndrome if discontinuation + supportive measures fail.

64
Q

Anterior MI post-MI complication

A

think Free Wall Rupture (LAD) hours-14d

65
Q

Inferior MI post-MI complication

A

think Papillary Muscle Rupture (RCA) 2d-7d

66
Q

Anterior/Posterior MI post-MI complication w/ RHF

A

Interventricular Septum Rupture

(LAD or RCA) 0-5d

67
Q

Inhibits TXA2 production

A

ASA

68
Q

Anti-inflammatory that inhibits mitosis and neutrophil activity

A

Colchicine

(gout, pericarditis, Behcet’s)

69
Q

PEA

A

—> CPR + q4 Epi

70
Q

Asystole

A

—> CPR + q4 Epi

71
Q

VF

A

—> Defibrillation + q2 Epi/Amiodarone

72
Q

Pulseless VT

A

—> Defibrillation + q2 Epi/Amiodarone

73
Q

Chest Pain DDx

A

Cardiac/Pulm/GERD/MSK/Psychogenic/Thyrotox/

Drugs/Pheo/VZV

Pulm - PE/PTX/PNA

74
Q

Pleuritic Chest Pain (PPPC)

A

Pericarditis, PTX, PE, Costochondritis (MSK)

75
Q

Palpable thrill at suprasternal notch

A

AS

76
Q

Bounding pulses

A

—> AR

(+”pounding” heart/heartbeat awareness)

77
Q

“Pounding” heart/Heartbeat awareness

A

AR due to chamber enlargement and myocardial hypertrophy from AR-induced increase in LVEDV, bringing ventricular apex close to chest wall;

(or can be from palpitations from AFib)

78
Q

Peripheral edema side-effect

A

Amlodipine (CCBs)

  • Especially dihydropyridines—amlodipine, nifedipine—due to systemic vasodilation
79
Q

Post-MI Blue toe syndrome

A

Cholesterol embolism

(atheroembolism) - common complication following cardiac catheterization

80
Q

CYP450 Inhibitors

(Increase Warfarin effect; increase bleeding risk)

A

AAA RACKS IN GQ Magazine

  • Acute Alcohol Abuse
  • Acetaminophen
  • Ritonavir
  • Amiodarone
  • Cimetidine/ciprofloxacin - Antibiotics
  • Ketoconazole -antifungal
  • Sulfonamides - Antibiotics
  • INH
  • Grapefruit juice/Cranberry juice
  • Quinidine
  • Macrolides (except azithromycin) - Antibiotics
    • Omeprazole
    • Thyroid hormone
    • SSRIs (e.g. fluoxetine
81
Q

CYP450 Inducers

(Decrease Warfarin effect; decrease bleeding risk):

A

Chronic Alcoholics Steal Phen-Phen &

Never Refuse Greasy Carbs

  • Chronic alcohol use
  • St. John’s wort, Ginseng
  • Phenytoin
  • Phenobarbital
  • Nevirapine
  • Rifampin
  • Griseofulvin
  • Carbamazepine OCPs
82
Q

Acetaminophen + Warfarin

A

Increased bleeding

(CYP450 inhibitor)

83
Q

Theophylline toxicity

A

CGN

(like digoxin toxicity)

  • Cardiac (arrhythmias)
  • GI (N/V)
  • Neuro (CNS Stimulation: HA, insomnia, seizures)
  • CYP450 metabolism; Narrow therapeutic index
84
Q

Pounding heartbeat sensation in L lateral decubitus position

A

AR 2/2 LV enlargement

85
Q

Wide pulse pressure

A

AR

86
Q

Post-cardiac cath AKI

A

Cholesterol emboli vs. CIN (contrast-induced nephropathy)

  • CIN resolves within 3-5d
  • Cholesterol emboli can be immediate or delayed >30d
87
Q

Rheumatic Heart Disease causes AFib due to

A

Mitral stenosis-induced LA dilation

88
Q

Torsades de pointes Tx

A
  • IV Magnesium (stable)
  • Defibrillation (unstable)
89
Q

Subauricular bruit

A

FMD

  • Dx: Duplex US or CTA/MRA
  • Tx: ACE/ARBs, PRTA, or surgery
90
Q

Meds that can trigger bronchoconstriction in

asthma pts

A

ASA & BBs

91
Q

Tx for Torsades de pointes

A

IV Magnesium

92
Q

Tx of bradycardia associated with hypothermia

A

Active external rewarming + warmed IV fluids

(refractory to atropine or cardiac pacing during hypothermia)

93
Q

Post-MI complication up to 3 months out

A
  • Pericarditis (1 d-3mo)
  • LV aneurysm (5d-3mo)
94
Q

Systolic-diastolic abdominal bruit in pt with HTN

A

Renal Artery Stenosis (RAS)

(Renovascular Hypertension)

  • Can be heard in ~40% of RAS pts
  • Other clues: Malignant HTN, Resistant HTN, Severe HTN w/ diffuse atherosclerosis
  • +unexplained atrophic kidney
  • +recurrent flash pulmonary edema
  • +unexplained rise in Cr following ACE-I or ARB
  • Dx: Renal doppler, CT angiography, or MR angiography
95
Q

Why does PCWP ↑ in MI?

A

Failure of Forward Blood Flow

PCWP = Estimate of LA Pressure

96
Q

Failure of ______ to close is PDA

A

Ductus Arteriosus

97
Q

____ closes PDA; ____ opens PDA

A

NSAIDs close PDAs

Prostaglandins keep open PDAs

98
Q

Interventricular calcifications

A

Congenital CMV

99
Q

Periventricular Calcifications at birth

A

Toxoplasma

100
Q

Cholesterol Screening (Lipid Panel)

A

Every 3-5 years beginning at age 40

- Med School Review 🔥 (23 decks)

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