Cardiovascular

Question 1

Elevation and equalization of RA, RV, and PCWP after cardiac surgery

Answer 1

Cardiac tamponade

Question 2

Causes of pulseless electrical activity?

Answer 2

5 H’s and T’s, + Anaphylaxis
Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hypo/hyperkalemia, Hypothermia
Tension pneumo, Tamponade, Trauma, Thrombosis (MI or PE), Toxins (narcotics, benzos)

Question 3

Immunologic (immune complex) phenomena in endocarditis

Answer 3

1. Osler nodes (painful fingertip nodules)
2. Rosh spots (retinal hemorrhages with pale centers)
3. Glomerulonephritis
4. Positive rheumatoid factor

Question 4

Embolic phenomena in endocarditis

Answer 4

1. Janeway lesions (painless)
2. Splinter hemorrhages
3. Conjunctival hemorrhages
4. Infarcts: stroke, renal infarct, splenic infarcts, digital gangrene

Question 5

Endocarditis with nosocomial UTI

Answer 5

Endocarditis

Question 6

Endocarditis with new AV block

Answer 6

Perivalvular abscess

Question 7

Medications to hold prior to cardiac stress testing

Answer 7

Beta-blockers, CCBs, nitrates for 48 hours prior (caffeine for 12 hours prior)
(Continue ACEIs/ARBs, diuretics, statins, digoxin)

Question 8

Persistent ST elevation well after an MI

Answer 8

LV Aneurysm (late complication, seen 5 days - 3 months after)

Question 9

Type of cause of cardiac arrest in the first 10 minutes after an MI?
10-60 minutes after?

Answer 9

First 10: Re-entry

10-60: Abnormal automaticity

Question 10

Location of MI with ST elevation in precordial leads? Vessel?

Answer 10

Anterior MI due to LAD occlusion

Question 11

Location of MI with ST elevation in I, aVL, V5, and V6? Vessel?

Answer 11

Lateral MI due to circumflex or diagonal artery (off LAD)

May also see ST depression in inferior leads (II, III, aVF

Question 12

Location of MI with ST depression in V1-V3? Vessel?

Answer 12

Posterior MI, usually due to RCA (right dominant, 70%), less commonly circumflex (left-dominant, 20%)

Question 13

Posterior MI with ST depression in V1-V3. How can you tell whether it is RCA or circumflex occlusion?

Answer 13

RCA: ST depression in left lateral limb leads (I and aVL)
Circumflex: ST elevation in left lateral limb leads (I and aVL)

Question 14

Location of MI with ST elevation in II, III, and aVF? Vessel?

Answer 14

Inferior MI, usually due to RCA (80%), sometimes circumflex

Question 15

Signs of right ventricle MI on regular 12-lead EKG? Vessel?

Answer 15

ST elevation in V1 > V2 (or elevation in V1 and depression in V2) and elevation in III > II. (Confirm with ST elevation in V3R-V6R)

Question 16

Vessel obstructed for MI with SA node block?

Answer 16

Either RCA (60%) or LCX (40%)

Question 17

Vessel obstructed for MI with AV node block?

Answer 17

Usually RCA (80%), sometimes LCX (20%)

Question 18

Malignant HTN

Answer 18

Severe HTN with retinal hemorrhage, exudates, or papilledema

Question 19

What can prevent flushing and pruritis due to niacin?

Answer 19

Low-dose aspirin beforehand

Question 20

Initial treatment for symptomatic sinus bradycardia

Answer 20

IV atropine (if fails, can externally pace or use dopamine or epi)

Question 21

Electrophysiological cause of a-fib? Atrial flutter?

Answer 21

A-fib: Ectopic foci around pulmonary veins

Flutter: Reentry around tricuspid valve

Question 22

Treatment for AVNRT

Answer 22

Try vagal maneuvers, then go to adenosine (Gi/Go, leads to transient AV node block)

Question 23

Regular rhythm at 180-200 with retrograde P waves buried in the QRS complex

Answer 23

AVNRT

Question 24

Treatment for sustained v-tac in a hemodynamically stable patient?

Answer 24

IV Amiodarone

But TdP is treated with magnesium sulfate

Question 25

Treatment for Torsades de Pointes in a hemodynamically stable patient?
Hemodynamically unstable?

Answer 25

Stable: Magnesium sulfate
Unstable: Defibrillation (not cardioversion, even if have pulse)

Question 26

Treatment for hereditary long QT syndrome

Answer 26

Beta-blocker, plus pacemaker or AICD if symptomatic or history of syncope

Question 27

Medication that can lead to acquired angioedema

Answer 27

ACEIs (ACE breaks down bradykinin)

Question 28

Antihypertensives that can lead to hyperglycemia and hyperlipidemia

Answer 28

Thiazides

Question 29

Diuretics leading to hypercalcemia? Hypocalcemia?

Answer 29

HyperCa: Thiazides
HypoCa: Loop diuretics

Question 30

Amiloride

Answer 30

Potassium-sparing diuretic that blocks ENaC

Question 31

Atrial tachycardia with AV block

Answer 31

Digoxin toxicity (atrial tachycardia due to ectopic activity, AV block due to vagal tone).
(Also look for N/V/D and vision changes. Can be triggered by other cardiac drugs like amiodarone and verapamil)

Question 32

Treatment for beta blocker overdose

Answer 32

First IV fluids and atropine. If still hypotensive, give IV glucagon (also Gs)

Question 33

What is the big side effect of amiodarone you have to monitor for?

Answer 33

Chronic interstitial pnuemonitis (get CXR and PFTs before starting)
(Others: bradycardia, heart block, thyroid disease, liver toxicity, neurologic symptoms, visual disturbances, blue-gray skin discoloration).

Question 34

Fleicanide and propafenone

Answer 34

Class 1C antiarrythmics (use-dependent K+ block) sometimes used for rhythm control for paroxysmal a-fib

Question 35

Hypertension control in aortic dissection

Answer 35

Beta-blockers, goal is systolic 100-120.
(Nitroprusside can be added if beta-blockers not enough, but don’t give it alone as it can lead to reflex beta stimulation)