Buzzwords - Cardio

Question 1

TX: tachy, stable (no hypotn, ams, chest pain, acute hf)

w/ ATRIAL FLUTTER

Answer 1

beta blocker or calcium channel blocker 1st line

skip adenosine

Question 2

TX: tachy, stable (no hypotn, ams, chest pain, acute hf)

w/ A-FIB

Answer 2

beta blocker or calcium channel blocker 1st line

skip adenosine

Question 3

TX: tachy, stable (no hypotn, ams, chest pain, acute hf)

w/ WOLFF-PARKINSON-WHITE

Answer 3

PROCAINAMIDE or amiodarone

-avoid adenosine, bb, ccb, digoxin

Question 4

2 “shockable” rhythms using defibrillation (UNsynchronized cardioversion)

Answer 4

VENTRICULAR FIBRILLATION

PULSELESS VENTRICULAR TACHYCARDIA

Question 5

TX: ventricular tachycardia

Answer 5

stable, sustained –> ANTIARRHYTHMICS (AMIODARONE, lidocaine, procainamide)

unstable vt w/ pulse –> CARDIOVERSION (SYNC)

vt w/ no pulse –> DEFIBRILLATION (UNSYNC) + CPR

torsades de pointes –> IV MAGNESIUM

Question 6

TX: ventricular fibriollation

Answer 6

DEFIBRILLATION (UNSYNC) + CPR

Question 7

TX: pulseless electrical activity

Answer 7

organized rhythm on monitor but no palpable pulse (electrical activity not coupled w/ mechanical contraction)

CPR + EPINEPHRINE + CHECK FOR “SHOCKABLE RHYTHM EVERY 2 MINUTES

Question 8

TX: asystole (flat line)

Answer 8

tx like PEA

CPR + EPINEPHRINE + CHECK FOR “SHOCKABLE RHYTHM EVERY 2 MINUTES

Question 9

increased JVP + crackles/rales in lungs

Answer 9

CONGESTIVE HEART FAILURE

Question 10

increased JVP + normal pulm exam

Answer 10

PERICARDIAL (EX TAMPONADE OR CONSTRICTIVE PERICARDITIS)

Question 11

increased JVP + decreased breath sounds

Answer 11

TENSION PNEUMOTHORAX

Question 12

inc aldosterone

Answer 12

inc Na retention

-at expense of K and H (inc secretion of K and H)

Question 13

inc ADH

Answer 13

inc H2O retention

Question 14

LEVINE’S SIGN

Answer 14

clenched fist over chest –> ANGINA

Question 15

C/I in cocaine-induced MI or variant/prenzmetal angina

Answer 15

DONT USE B-BLOCKER (causes unopposed alpha-1 vasoconstriction)

USE CALCIUM CHANNEL BLOCKER

Question 16

acute MI protocol

Answer 16

• ECG w/in 10 minutes
• door to thrombolytics/fibrinolysis w/in 30 min
• door to PCI w/in 90 min (+/- 30m)
• MONA regimen: morphine, oxygen, nitrates, aspirin
• perform hx/exam
• obtain cardiac markers
• O2 at 4L/min

STEMI: BB, NTG, ASA, heparin, ACEI, REPERFUSION (PCI or thrombolytics/fibrinolysis)***

UA or NSTEMI: BB, NTG, ASA, heparin, NO EMERGENT REPERFUSION!

COCAINE INDUCED: ASA, NTG, heparin, benzos (avoid BB bc of vasospasm)

• *R ventricular (inferior wall) MI –> caution w/ nitrates and morphine (may reduce preload) + give fluids
• *if viagra or erectile meds –> NO NITRATES (reduces preload)

Question 17

Dressler syndrome

Answer 17

POST-MI PERICARDITIS + FEVER + PULMONARY INFILTRATES

Question 18

decreased ejection fraction
thin ventricle walls
dilated LV chamber
+S3 gallop

Answer 18

systolic heart failure

Question 19

normal/increased ejection fraction
thick ventricle walls
small LV chamber
+S4 gallop

Answer 19

diastolic heart failure

Question 20

dyspnea
pulmonary congestion (rales, rhonchi)
cheyne-stokes breathing
increased adrenergic activation

Answer 20

left-sided heart failure

inc pulm venous pressure from fluid backing up into lungs

Question 21

peripheral edema
jugular venous distention
GI/hepatic congestion

Answer 21

right-sided heart failure

inc systemic venous pressure –> systemic fluid retention

Question 22

BECK’S TRIAD: DISTANT/MUFFLED HEART SOUNDS, INC JVP, SYSTEMIC HYPOTENSION

Answer 22

PERICARDIAL TAMPONADE

Question 23

viral damage to heart mc cause

Answer 23

ENTEROVIRUSES (COXSACKIE B, echovirus)

-cardiomyopathy, myocarditis, pericarditis

Question 24

ejection click

Answer 24

MITRAL VALVE PROLAPSE - chordae tendinae abruptly pulls mitral valve tight - SYSTOLE

Question 25

opening snap

Answer 25

MITRAL VALVE STENOSIS - diastole

Question 26

harsh/rumble murmur sounds

Answer 26

``` THINK STENOSIS (AS, MS) - abnormal forward flow through stenotic valve that should be open -lead to pressure overload ```

Question 27

blowing murmur sound

Answer 27

``` THINK REGURGITATION (AR, MR) - abnormal backflow of blood through an incompletely closed valve -leads to volume overload ```

Question 28

systolic vs diastolic murmurs

Answer 28

SYSTOLIC: AS, MR DIASTOLIC: AR, MS --> "ARMS REST"

Question 29

murmurs radiate to?

Answer 29

AS --> carotid AR --> left upper sternal border MS --> no radiation MR --> axilla

Question 30

murmur position

Answer 30

AORTIC: sitting up and leaning forward accentuates MITRAL: lying on left side accentuates

Question 31

- JANEWAY LESIONS - red, painless on palms/soles - ROTH SPOTS - retinal hemorrhages w/ pale center - PETECHIAE - conjunctiva, palate - OSLER'S NODES - tender nodules on pads of digits - SPLINTER HEMORRHAGES of proximal nail bed

Answer 31

infective endocarditis

Question 32

VIRCHOWS TRIAD

Answer 32

THROMBI - peripheral venous disease INTIMAL DAMAGE - trauma, infx, inflam STASIS - prolonged sitting >4 h HYPERCOAGUABILITY - factor V leiden, C or S deficient, OCP, malignancy, pregnancy

Question 33

TROUSSEAU'S SYNDROME

Answer 33

MIGRATORY THROMBOPHLEBITIS IS ASSOC W/ MALIGNANCY

Question 34

peripheral VENOUS vs ARTERIAL disease

Answer 34

VENOUS - worse w/ standing, sitting, leg dependency - better w/ walking, elevation - cyanotic leg when dependent ARTERIAL - better when resting, leg dependent - worse with walking, elevation, cold - redness w/ dependency and cyanotic w/ elevation

Question 35

TYPE OF SHOCK, DON'T GIVE LARGE AMOUNTS OF FLUID

Answer 35

CARDIOGENIC SHOCK