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Cardio Flashcards

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1
Q

Sudden vs gradual LOC

A

Sudden loss usually has cardiac or neruologic etiology such as arrhythmia or seizure

Gradual Loss usually stems from toxins or metabolic problems such as hypoglycemia, hypoxia or drug intonations

vaso vagal syncope can be sudden or gradual in onset

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2
Q

sudden or gradual regaining of conciousness

A

Sudden regaining usually has a cardiac etiology such as arrhythmia, valve disease or ischemia

gradual usually stems from tonic-clonic generalized seizures (post octal state of confusion for 24hrs

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3
Q

LOC and regaining are both sudden. Next best step (NBS)

A

cardiac evaluation

exam normal: ischemia or arrhythmia - needs EKG, telemetry monitor, and troponin level

exam abnormal: need echocardiogram, exclude AS< HOCM, MS

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4
Q

Abnormal cardiac findings for LOC

A

HOCM: harsh systolic ejection murmur louder with decreased preload (standing) LLsternal

AS: pulses parvus et trades, paradox split S@ systolic crescendo decrecendo

MS: opening snap and mid diastolic murmur, pulmonary edema (sever with split of S2)

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5
Q

CAD risk factors

A 
DM (most serious)
Hypertension (most common)
family history of premature CAD
Hyperlipidemia 
Tabacco Smoking
Age >45 men, >55 women
renal disease
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6
Q

Most likely Dx and Most Accurate test

Chest wall tenderness

A

Costochondritis

Physical exam

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7
Q

Most likely Dx and Most Accurate test

chest pain with radiation to the back unequal BP arms

A

Aortic dissection

Chest X-ray with widened mediastinum, chest CT, MRI or TEE confirms

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8
Q

Most likely Dx and Most Accurate test

Chest Pain worse with lying flat meter with sitting, young (<40)

A

Pericarditis

EKG with ST elevation everywhere, PR depression

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9
Q

Most likely Dx and Most Accurate test

chest pain with Epigastric pain better when eating

A

Duodenal ulcer disease

Endoscopy

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10
Q

Most likely Dx and Most Accurate test

Chest pain with bad taste, cough and horseness

A

GERD

response to PPI, aluminum hydroxide and magnesium hydroxide, viscous lidocaine

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11
Q

Most likely Dx and Most Accurate test

chest pain with cough, sputum and hemoptysis

A

Pneumonia

Chest X ray

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12
Q

Most likely Dx and Most Accurate test

chest pain with sudden onset shortness of breath, tachycardia and hypoxia

A

Pulmonary embolism

Spiral CT, V/Q scan

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13
Q

Most likely Dx and Most Accurate test

Chest pain as sharp pleuritic pain, tracheal deviation

A

Pneumothorax

Chest xray

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14
Q

Best initial test for all Chest pain

A

EKG

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15
Q

Indication and signs of ischemia with exercise tolerance test

A

indication: determine presence of ischemia

ST segment depression

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16
Q

Indication and signs of ischemia with exercise thallium or exercise echo

A

inability to read EKG, baseline ST segment abnormalities

Decreased uptake of nuclear isotope or wall motion abnormalities

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17
Q

Indication and signs of ischemia with dipyridamole thallium or dobutamine echo

A

inability to exercise to target HR.. (stop caffeine before dipyridamole)

Decreased uptake of nuclear isotope or wall motion abnormalities

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18
Q

Exam findings that indicate coronary angiography

A

Normal at least decreased with exercise and then normal at rest again. reversible ischemia and can benefit from angio. No change means irreversible “fixed” defect or dead tissue.

angio is the most accurate method to detect CAD and which intervention is needed

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19
Q

Angioplasty vs CABG

A

angioplasty (precutaneous coronary intervention)- 1-2 vessels the persists past medical therapy. best therapy in acute coronary syndrome, no change in mortality

CABG- 3 vessels, left main or 2 vessels in diabetics, >70% (lowers mortality)

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20
Q

First line stable anginia teraphy

A

Beta Blocker. decrease myocardial contractility, HR, and O2 demand. Decreased HR, prolongs diastole, increased percussion.

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21
Q

Most common adverse effects of statin medications

A

Lyver dysfunction: elevated transaminases. routine AST ALT testing

myositis, and rhabdo soccer in less the 0.1% worsened by gemfibrozil

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22
Q

Clear indications for statin use

A 
acute coronary syndrome
MI/ Stenting 
Any arterial disease
10yr risk of CAD >7.5%
CAD- LDL goal <70
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23
Q

Should yo use calcium channel blockers in CAD?

A

CCB increases mortality in CAD bc of raising heart rate effect.

Only use CCB in CAD if

  • sever asthma (preclude use of BB)
  • prinzmetal angina
  • cocine induced chest pain (BB contraindicated)
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24
Q

Adverse effects of calcium channel blockers

A

Edema
constipation
heart bloak

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25
ADR Niacin
Elevation in glucose anuric acid level, pruritus Aspirin reduces flushing
26
ADR cholestyramine
flatus and abdominal cramping
27
What is an S4 gallop? What is associated with it
S4 gallop is the sound of atrial systole as blood is ejectied into a stiff ventricle. acute coronary syndromes (ACS) are associated with an S4 gallop because of ischemia leading to noncompliance of the left ventricle
28
Kussmaul Sign
increase in JVP on inhalation. | associated with constrictive pericarditis or restrictive cardiomyopathy
29
EKG MI Findings with prognosis
Anterior (worse): V2-V4 ST elevation Inferior: II,III, aVF ST elevation Posterior/ Septal (best): V1-V2 ST depression Lateral: I, VL,VR, V5, V6
30
Most appropriate first step in MI
Aspirin and a second anti-platelet- lowers mortality in ACS - angioplasty (greatest mortality benefit) within 90min - thrombolytics (less mortality benefit)
31
Checking for reinfaction
EKG new ST segment abnormalities | CK-MB- better at detaching reinfection returns to normal in 24-48 hrs
32
Decreasing risk of restenosis after stenting
P2Y12 antiplatelets: Clopidogrel, Prasugrel (best evidence) Drug-eluting stent (paclitacel, sirolimus)- inhibit local T cell response
33
Complications of PCI
Rupture of coronary artery with inflation Restenosis Hematoma at site of entry to artery (femoral artery) Distal cholesterol embolization
34
Symptoms of distal; cholesterol embolization
lived reticularis eosinophilia/eosinophiluria after cath low complement high ESR
35
Contraindications to throb-lyrics
``` major bleeding into bowel or brain recent surgery (2weeks) Severe hypertension (>180/110) Nonhemorrhagic struck within 6mos ```
36
Time of correct answer to thrombolytics
in any patient with chest pain and ST segment elevation within 12hrs of onset of pain. ideal within 30min of ED door, best benefit within 2hours of pain
37
Treatment in chest pain with st segment depression
``` LMW heparin (better than unfrac interns of mortality) prevent clot from growing and closing off artery ``` GP2b3a (abiximab)- best for non st elevlation undergoing pci and stent
38
PCI indication in non ST elevation ACS
``` Not better: -persistent pain S3 gallop of CHF Worse EKG or sustained ventricular tachy rising troponin ```
39
MI Complication Bradycardia
Sinus Brady- insufficiency of SA node 3 AV Block- cannon A waves Atropine pacemaker (if atropine not effective)
40
MI Complications Tachycardia: Right ventricular infaction
inferior was MI and clear lungs ``` treat with high volume fluid replacement avoid nitroglycerin (worsens cardiac filling) ```
41
MI Complications Tachycardia: Tamponad / Free wall rupture
Sevral days sudden loss of pulse lungs are clear PEA Emergency pericariocentesis Repair
42
MI Complications Tachycardia: V Tach/ V fib
monitor MI in ICE for several days defibrillator/ cardioversion
43
MI Complications Tachycardia: Valve or septal rupture
new onset murmur pulmonary congestion Mitral regurgitation- apex and radiation to axila Ventricular septal- LL sternal border, step up oxygenation Most accurate test: Echo
44
MI Complications Tachycardia: extension of the infection/reinfaction
recurrence of pain new rales new bump in CKMB sudden pulmonary edema Redo MI treatment
45
Discharge meds for MI
``` Aspirin (forever) & P2Y12 (12mo) Beta Blocker Statin ACEi (AWMI or EF <40) Spironalactone if EF<40 ``` Prophylactic antiarrythmics increase mortality
46
Causes of CHF
infection cardiomyopathy valvular disease
47
Presentation fo CHF (clinical diagnosis)
``` Orthopnea peripheral edema rales JVD paroxysmal nocturnal dyspnea S3 gallop Pulmonary edema (worst form of CHF) ```
48
Hemodynamic changes in CHF
``` decreased CO increased PWCP increased LVED volume increased TPR no changes in CVP ```
49
CHF tests
``` Echo (most important- evaluated EF) TTE (best initial exam Nuclear ventriculogram (most accurate- rare use) ```
50
CHF cause tests
``` EKG- MI, heart block Xray- Dilated cardiomyopathy Holter- paroxysmal arrhythmia Cath- valve and septal defect CBC anemia Thyroid function Biopsy- amyloid, sarcoid and most accurate for infections. ```
51
Tx systolic CHF
`ACE/ARB- all patients at any stage `BB (metropolis and carvedilol)- antiarrhythmics not for acute CHF `Spironolactone- first line (eplerenone is gynecomastia develops) `Diuretics- symptomatic control
52
Valvular Disease Diagnostic Tests
Best Initial: Echo (TEE more sensitive) Most Accurate: Catherterization Right sided increase in inhalation left with exhalations murmurs that dont change HOCM and MVP
53
Valvular Disease Treatment
Stenosis: correction of anatomy Regurg: vasodilator therapy (ACE/ARB, nifedipine, hydralazine). Surgical correction before heart dilation.
54
Mitral Stenosis Clues
Pregnant and Immigrant (RF) SOB, CHF - Dysphagia (dilated LA) - Hoarseness (LA pressing laryngeal nerve) - A-fib and stroke from emornouse LA - Hemoptysis
55
Mitral Stenosis Murmur
after s2 with opening snap increased by equating and leg raising
56
Aortic stenosis clues
old or bicuspid valve angina syncope]left ventricular hypertrophy
57
Aortic Stenosis murmur
systolic crescendo decrescendo murmur second right intercostal space standing, handgrip, and valsalva decrease murmur
58
Mitral Regurgitation
Holosystolic radiates to axilla worse with handgrip, equating and leg raise
59
Aortic regurgitation
``` Wide pulse pressure water hammer (bounding) pulse Quincke pulse (nail bed) Hill Sign (BP legs 40 more then arms) Head Bobbing (de Musset sign) Diastolic decrescendo murmur ```
60
Cardiomyopathy Best initial test
Echo. also most accurate
61
Dilated Cardiomyopathy
causes MI and ischemia ``` ABCCCD alcohol beri beri cocaine coxsackie (post viral) chagas Drugs (doxorubicin, radiation) ```
62
Hypertrophic Cardiomyopathy
HF with preserved ejection fracture. heart can't relax to fill in diastole HTN most common cause
63
HOCM
hypertrophic obstructive cardiomyopathy genetic, septum is abnormally shaped. asymmetrical obstruction between septum and valve leaflet blocks blood leaving heart. systolic anterior motion of heart
64
HOCM tx
beta blockers best initial ace and diuretics contraindicated
65
Restrictive cardiomyopathy
``` heart neither contracts nor relaxes. causes: sarcoidosis amyloid hemochromatosis end-myocardial fibrosis scleroderma ```
66
Pericarditis causes and tx
Infection: Coxsackie(mcc), Staph, Strep, fungal Connective tissue: SLE (mcc), Wegener, good pasture, RA, PAN TX: NSAID +Colchicine
67
Pericarditis presentation
sharp chest pain that changes with respiration. worse with laying flat "stretch of pericardium" EKG- defuse st elevation and PR segment depression (more specific)
68
Pericardial Tamponad
Hypotension, Tachycardia Distended Veins Clear Lungs. tx: pericardiocentesis. window
69
Constrictive pericarditis
Kussmaul sign Knock- extra heart sound from filling again pericardium Signs of RHF Xray best initial MRI/ CT most accurate square root sign on cardiac cath
70
PAD "most likely diagnosis"
``` Leg pain walking up or down hills received by rest loss of hair loss of sweat glands loss of sebaceous glands (smooth shinny skin) ```
71
PAD testing and tx
ABI- best initial angiogram- most accurate cilostazol- most effective aspirin or vorapaxar place on statin surgery
72
Peripartum Cardiomyopathy
``` Antibodies against myocardium develops after delivery most cases LV dysfunction (reversible but if not must undergo transplant). will worsen if pregnant again worst cardiac condition in pregnancy ```
73
Peripartum Cardiomyopathy TX
``` ACE/ARB (if after delivery) BB Spironalactone diuretics digoxin ```
74
Eisenmenger syndrome (pregnancy)
development of right to left shunt from pulmonary hypertension. preexisting VSD 2nd worst cardiac condition in pregnancy..

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