cardio Flashcards
smarty pance flash cards
1
Q
A 13 year old boy passes out while
having an argument with his principal.
His examination findings are normal.
What heart conduction condition do you
suspect?
A
Long QT syndrome
2
Q
. A 24 year old has a syncopal event.
EKG demonstrates a short PR interval
with an upswept initial QRS. What
underlying condition caused the
syncope?
A
Wolf Parkinson
White
3
Q
A 30 year old male has a syncopal
event three days after taking an
antibiotic. EKG at the scene reveals
ventricular tachycardia. What disease
condition do you suspect?
A
Acquired long QT
syndrome due to
the antibiotic or
medications
4
Q
A 75 year old patient passes out while
having an argument with his landlord
over money. What three conditions
should you rule out first?
A
Acute coronary
syndrome -
Ventricular
arrhythmia - Aortic
stenosis
5
Q
- Acute Rheumatic fever occurs after
what event?
A
Strep throat
6
Q
adrenal tumor which causes HTN?
A
Pheochromocytoma
7
Q
. After a stent, in addition to ASA, what
oral antiplatelet agent is used?
A
Clopidogrel
8
Q
. After running a mile a 16 year old
suffers chest pain and syncope. He is
asymptomatic in the ER. Examination
is normal. What underlying condition do
you suspect?
A
Anomalous
coronary artery
9
Q
Agent of choice for acute angina
treatment?
A
Nitroglycerine
10
Q
Angina syncope and heart failure in a
child likely represents ____________.
A
HOCM
(Hypertrophic
Cardiomyopathy)
11
Q
Angina syncope and heart failure in an
adult likely represents _____________.
A
Aortic stenosis
12
Q
Aortic stenosis in a 50 year old is
likely due to what abnormality?
A
Bicuspid aortic
valve
13
Q
Austin Flint murmur is associated with
which murmur?
A
Aortic regurgitation
14
Q
Best medication for blood pressure
support in cardiogenic shock?
A
Dobutamine
15
Q
Cancer is an example of what part of
Virchow’s triad?
A
Hypercoagulable
state
16
Q
Can digoxin be used for HTN?
A
no
17
Q
Combination therapy with at least 2
agents is recommended for patients
with which stage of HTN?
A
Stage 2 HTN -
Initiate treatment
with 2 or more
agents
18
Q
Constrictive Cardiomyopathy
occurs by what mechanism?
A
Pericardial sac constricts
19
Q
- Digoxin should never be
used for which type of heart
failure?
A
Diastolic
20
Q
- Does pregnancy fit into the
Virchows triad?
A
Yes - Pregnancy is a
hypercoagulable state
21
Q
- Does renal artery stenosis
cause primary or secondary
HTN?
A
Secondary
22
Q
- During pregnancy what
murmur is commonly first
discovered?
A
Mitral stenosis
23
Q
. First line HTN agent for
Diabetic?
A
Ace inhibitor
24
Q
- First medication to give in a
patient suspected of having
an AMI?
A
Aspirin
25
6. Gallavardin Phenomena is
associated with what
valvulopathy?
Aortic Stenosis
26
. Initial procedure to evaluate
for PVD?
ABI (Ankle brachial index) -
ABI < 0.8 = PAD
27
JVD and clear lung fields
describes what type CHF?
Right Heart Failure
28
List 5 causes of systolic
heart failure.
CAD (ischemia)
- Tako Tsubo
- Cocaine
- Viral illness
- Chemo/radiation
29
30. List 5 side effects of
amiodarone.
Pulmonary HTN
- Elevated
LFTs
- Hypothyroid
- Hyperthyroid
- Iodine allergy
30
List 6 causes of restrictive
cardiomyopathy.
Amyloidosis -
Hemochromatosis -
Sarcoidosis -
Scleroderma -
Fibrosis -
Cancer
31
List the classifications of
blood pressure as per JNC
VII.
Prehypertension = 120-139/80-
90
- Stage 1 = 140-159/90-99
- Stage 2 = >160/100
32
3. List the major systemic
affects of amiodarone
therapy?
Pulmonary fibrosis
- Infiltrative
liver disease
- Hyper OR
hypothyroid state
33
List the NYHA classification
of CHF.
I asymptomatic
- II symptoms
with moderate exertion
- III symptoms with minimal
exertion
- IV symptoms at rest
34
List three medications which
may be used both to prevent
arrhythmia and ease
symptoms with HOCM.
Diuretics - Beta blockers -
Non-dihydropyridine CCB
(verapamil or diltiazem)
35
List two types of surgical
procedures to correct
HOCM.
Open heart and excision -
Alcohol ablation done through
cardiac cath
36
Meds for chronic diastolic CHF?
Ace inhibitor plus either a
beta blocker or calcium
channel blocker
37
A military recruit passes out
while standing in formation for a
long period of time. What type of
syncope is this called?
Neurocardiogenic syncope
a.k.a. Vasovagal syncope
38
Most common cause of
cardiogenic shock?
Myocardial Infarction
39
Most common cause of Diastolic
CHF?
Hypertension
40
Most common cause of tricuspid
stenosis?
Rheumatic fever
41
Myocardial damage occurs after
how many minutes of ischemia?
30 minutes
42
. Name the 4 components of
Tetralogy of Fallot.
Pulmonary valve stenosis
-VSD (Ventricular Septal
Defect)
- Overriding aorta
- RVH (Right Ventricular
Hypertrophy)
43
Name the Major Jones criteria.
Carditis
- Migratory
polyarthritis
- Subcutaneous nodules
- Erythema marginatum
- Chorea
44
Non-cardiac hypoxia (e.g.
pneumonia, COPD) commonly
causes what arrhythmia?
a fib
45
Once a patient is diagnosed with
HOCM what family counseling
must be done?
Entire family must be
screened for HOCM
46
Once a patient on a balloon
pump can tolerate a ratio of
___:___ removal may be
considered.
3 : 1 - Once patient only
requires assist every third
beat removal may be
considered
47
Orthostasis is defined as a
change of > __ mmHg systolic
or __ mmHg diastolic BP __
minutes after change from
supine to standing.
> 20 mmHg systolic or 10
mmHg diastolic BP 2-5
minutes after change from
supine to standing
48
. A patient has a cold left arm due
to arterial clot - what is the
most likely valvulopathy?
Mitral stenosis
49
Patient has DVT and unable to
take Coumadin what is next
step?
IVC Filter
50
A patient with pericarditis feels
better in what position?
Leaning forward
51
PVD commonly manifests as
what symptom?
Calf pain with exertion that
relieves with rest
(claudication)
52
Radiologic test of choice in
pregnant woman suspect of
pulmonary embolus?
VQ scan
52
Restrictive Cardiomyopathy occurs by
what mechanism?
Deposition into or
between the
myocardial cells
53
Rheumatic fever affects which valve
first?
Mitral valve
54
. Roth spots in a drug user are most
likely caused by which organism?
staph aureus
55
Should heparin or enoxaparin (Lovenox)
be used for a patient with a CrCl < 15?
Heparin (enoxaparin
is contraindicated
for CrCl < 15)
56
Three meds for acute decompensated
CHF?
Nitroglycerin
- ACE inhibitor
- Loop Diuretic
57
Untreated amaurosis fugax with
temporal arteritis leads to what?
Blindness (High
dose steroids most
be started ASAP to
avoid blindness)
58
Upon auscultation of a patient's carotid
artery they become bradycardic with a
three second pause. What is the
suspected underlying condition?
Carotid sinus
hypersensitivity
59
Use of which antihypertensive
medications is cautioned after cataract
surgery?
Alpha blockers
60
Use of which antihypertensive
medications is cautioned after recent
MI?
Minoxidil - Clonidine
61
Venous insufficiency is differentiated
from right heart CHF in a patient with
lower extremity edema by what exam
finding?
A patient in CHF will
have JVD and
hepatojugular reflux
62
A venous ulcer most often forms
where?
on the inside of the leg, above the ankle and below the calf
63
Vitamin deficiency that causes high
output cardiac failure?
Thiamine - Beriber
64
What are painful lesions on the hands
which occur with endocarditis?
Osler's nodes =
"Ouch"
65
What are painless lesions on the hands
which occur with endocarditis?
Janeway lesions
66
What are the 2 recommended statins
for treatment in acute MI?
Atorvastatin 80 mg
or rosuvastatin 40
mg
67
What are the 3 "D" findings of
pericardial tamponade?
Distant heart
sounds
- Distended
jugular veins
- Decreased arterial
pressure
68
What are the 3 main causes of
mitral and tricuspid regurgitation?
Dilatation (Aneurysm) -
Degeneration of leaflets
- Chordae tendineae
rupture
69
What are the big three meds for
chronic systolic heart failure?
Beta blocker - ACE
inhibitor - Loop diuretic
70
What are the mainstay meds for
chronic diastolic heart failure?
ACE inhibitor - Beta
blocker or calcium
channel blocker
(diltiazem or verapamil)
71
5. What are the mainstay meds of
acute decompensated heart
failure?
NTG - ACE inhibitor -
Loop diuretic
72
What are the modifiable cardiac
risk factors?
Smoking - DM -
Cholesterol - Blood
pressure - Obesity
73
What are the most common side
effects of dihydropyridine calcium
channel blockers (amlodipine
felodipine)?
Lower extremity edema
and headache
74
What are the signs of HOCM on
exam?
Apical lift - S4 gallop -
Ejection murmur medial
to apex
75
What are the three main symptoms
of Aortic stenosis?
ASH (Angina - Syncope
- Heart Failure)
76
What are the three main symptoms
of Mitral stenosis?
PHD (Palpitations -
Heart Failure - Dyspnea
on exertion)
77
What are the two main causes of
aortic and pulmonic regurgitation?
Dilatation (Aneurysm) -
Degeneration of leaflets
78
What are two CXR findings in
pulmonary embolus?
Hamptons hump -
Westermark sign
79
What arm does anginal pain tend to
radiate toward?
left
80
What arrhythmia can occur with
structural changes such as
hypertrophy or dilatation of the
ventricle?
Ventricular tachycardia
81
What arrhythmia is associated
with arterial embolism?
Atrial fibrillation
82
What balloon pump setting would
be best for initial treatment of the
acute patient in cardiogenic
shock?
1 : 1 Balloon pump
assists with every beat
83
What blood pressure medication
can make peripheral artery
disease symptoms worse?
Beta blockers
84
What blood pressure medicine is
commonly associated with
impotence in men?
Beta blockers
85
What cardiac abnormality is
associated with a bicuspid aortic
valve?
Coarctation of aorta
86
What cardiac drug can cause hypo
or hyperthyroidism?
Amiodarone
87
What cardiac drug can produce
yellow vision?
Digoxin
88
What causes the sudden cardiac
death in a HOCM patient?
Ventricular tachycardia
that degenerates into
ventricular fibrillation
89
What characteristic will be seen in
blood which is drawn from with in
the pericardial sac during
pericardial centesis?
Blood does not clot
when put into tray (+
clotting = not in the
pericardial space)
90
What class of medication should
you think of when you see the
suffix "azosin"?
Alpha blockers -
example doxAZOSIN
91
What class of medication should
you think of when you see the
suffix "dipine"?
Dihydropyridine
calcium channel
blockers - example
amloDIPINE
92
What condition is right ventricular
collapse on echocardiogram
pathognomonic for?
Pericardial tamponade
93
What condition occurs when
congenital cyanotic heart murmurs
cause right heart failure?
Eisenmenger
syndrome
94
What congenital abnormality should
be considered with a child who
frequently squats?
Tetralogy of Fallot
95
What disorder is most likely in a
patient with calf pain with walking
that improves with rest?
Peripheral Artery
Disease
96
What diuretic can be used if
furosemide is not available?
What diuretic can be used if
furosemide is not available?
Bumetanide
97
What does a Beta blocker do for a
post AMI patient?
Prevents arrhythmia
and reduces cardiac
work load
98
what does a BP> 180/120 with end
organ dysfunction define?
Hypertensive
emergency
99
What does an ACE
inhibitor/ARB do for a post
AMI patient?
Decreases afterload to rest
myocardium and
prevents/decreases remodeling
100
What do low ejection
fraction and hypertrophic
(HOCM) heart have in
common?
Sudden death due to VT
101
what drug can produce
blue vision?
Sildenafil
102
What EKG changes are
seen in a patient during a
Prinzmetal attack?
ST elevations which resolve
after attack (Persistent
elevations suggest MI)
103
What EKG changes are
seen with a ring abscess
of the mitral valve?
Variable heart block
104
What finding is
pathognomonic for
Rheumatic fever?
Aschoff bodies (Subcutaneous
nodules)
105
What happens to renal
function during cardiogenic
shock?
Reduced cardiac flow =
reduced kidney perfusion this
leads to pre-renal failure then
ATN if not corrected
106
What heart sound will
likely be present with
HOCM?
S4
107
What heart valve murmur
rarely causes a
symptomatic problem?
Pulmonary regurgitation
108
What HTN med classes can
cause bradycardia?
Beta Blockers - Central agents
(clonidine) - Verapamil and
Cardizem
109
What hypertension agent is
commonly associated with
edema in the lower
extremities?
Calcium channel blockers
110
What is a complication of
cardiac cath that causes
Grey-Turner's sign?
Retroperitoneal hematoma
111
What is calf pain with walking
that improves with rest called?
Claudication
112
What is first-line treatment for
varicose veins?
Compression stockings
113
What is most common cause of
right heart failure?
Left heart failure
114
What is most common genetic
hypercoagulable state?
Factor V deficiency
115
9. What is most common
pathogen causing of subacute
endocarditis?
Strep. viridans
116
What is the diameter of an
aortic aneurysm at which
surgical intervention is
recommended?
> 5.4 cm
117
What is the first medication to
be given to a patient with an
acute arterial emboli?
Heparin
118
What is the first step and
evaluation of a patient with calf
pain when he walks that is
relieved with rest?
Ankle brachial index
119
What is the gold standard to
evaluate peripheral artery
disease?
Angiography
120
What is the initial dose of
clopidogrel (Plavix) in acute
MI?
300 mg
121
What is the INR goal for a
patient on warfarin for a
mechanical heart valve?
2.5 - 3.5
122
What is the likely cause of HTN
in a 30 year old female who is
still poorly controlled after 3
medications?
Renal Artery Stenosis
123
. What is the medical treatment
of patent ductus arteriosus
(PDA)?
Indomethacin
124
8. What is the medication
suggested by JNC VII for a
patient who has no compelling
indications?
Diuretic
(Hydrochlorothiazide is the
most common)
125
What is the most common
cause of constrictive
cardiomyopathy?
Radiation therapy
126
. What is the most common skin
manifestation seen in
endocarditis?
Petechiae are not specific
for infective endocarditis
but are its most common
skin manifestation
127
What is the most likely cause
of orthostatic hypotension in
which there is no reflex
increase in heart rate?
Autonomic dysfunction
(examples: age diabetes)
128
What is the most likely cause of
syncope in an older adult which
occurs during an argument?
Myocardial ischemia
129
What is the most likely cause of
syncope which occurs after a
period of prolonged motionless
standing?
Neurocardiogenic
(vasovagal)
130
What is the most likely cause of
syncope which occurs while
shaving and has an associated
bradycardia?
Carotid sinus
hypersensitivity
131
What is the most likely disorder in
a patient with apical ballooning on
echo and a presentation similar to
MI?
Tako Tsubo
132
What is the pathognomonic
echocardiogram finding in
pericardial tamponade?
Collapse of the right
ventricle
133
What is the recommended initial
treatment for a Stanford type A
aortic dissection?
Surgical management
134
What is the recommended initial
treatment for a Stanford type B
aortic dissection?
Medical treatment
135
What is the rise in jugular pressure
which occurs with inspiration in a
patient with pericardial tamponade
called?
Kussmaul sign
136
What is the Stanford classification
of an aortic dissection of the
descending aorta?
Type B
137
What is the term for a hoarse voice
caused by mitral stenosis?
Ortner's syndrome
138
What is the treatment for angina in
a patient who is allergic to
nitrates?
Calcium channel
blockers
139
What is the treatment for a nonsurgical cyanotic heart disease
causing polycythemia?
Phlebotomy
140
What is the treatment for
constrictive cardiomyopathy?
Pericardial stripping
141
What is the treatment for dilated
cardiomyopathy?
Same as systolic heart
failure - (Beta blocker -
Loop Diuretic - ACE
inhibitor)
142
What is the treatment for mitral
valve prolapse?
Reassurance and beta
blockers
143
What is the treatment for
phlebitis due to an IV?
Elevation - Warm
compress - NSAIDs
144
What is the treatment for
Prinzmetal angina?
Calcium channel blockers
145
What is the treatment for
thrombophlebitis?
One month of low
molecular weight heparin
146
What is Virchows triad?
Stasis
- Hypercoagulable
state
- Trauma (= risk of venous thrombus)
147
What lab most sensitive for
AMI?
Troponin
148
What leads represent anterior
wall?
V3 V4
149
What leads represent lateral
wall?
V5 V6 I AVL
150
What maneuver makes the
HOCM murmur louder?
Valsalva or standing
151
What mechanical intervention
can improve coronary perfusion
and work load of heart?
Aortic Balloon Pump
152
What medication can assist in
closing an open PDA (Patent
Ductus Arteriosus)?
Indomethacin
153
What medications are
recommended for a patient with
CAD?
Beta blocker and ACE
inhibitor
154
What murmur has a continuous
machinery quality?
PDA (Patent Ductus
Arteriosus)
155
What murmur has a Left
parasternal lift pulmonic area
ejection murmur and fixed
splitting of S2?
ASD (Atrial Septal Defect)
156
What murmur is heard with MVP
(Mitral Valve Prolapse)?
Midsystolic click
157
What murmur is pansystolic and
is best heard mid sternal
border?
vSD (Ventricular Septal
Defect)
158
What must be ruled
out in a Marfan patient
with chest pain
radiating to the back?
Aortic dissection
159
What physical sign is
easily seen with
tricuspid stenosis?
JVD (Jugular Venous Distension)
160
What secondary cause
of HTN will present
with abdominal
bruits? What is the
first diagnostic test?
Renal artery stenosis - Renal artery
doppler is the initial test
161
What sign
distinguishes mitral
regurgitation from
tricuspid
regurgitation?
Carvallo s sign (The murmur of
tricuspid regurgitation increases in
intensity during held deep
inspiration)
162
What test can be
performed to evaluate
neurocardiogenic
syncope?
Tilt table test
163
5. What test should be
ordered for a patient
with suspected
pheochromocytoma?
Urine for VMA (Vanillylmandelic acid)
164
What three criteria
define a heart attack?
EKG changes - Chest pain -
Elevated cardiac enzymes
165
What three tests are
recommended before
starting amiodarone?
Thyroid panel - Pulmonary function
testing - Liver function test
166
What two murmurs
are most associated
with atrial
fibrillation?
Mitral stenosis - Mitral regurgitation
167
What two populations
more commonly have
diastolic heart
failure?
Elderly women and black patients
168
1. What type of heart
failure may
pericardial tamponade
initially present like?
Right heart failure: Tamponade looks
like right heart failure because the
right ventricle is the weakest of the
two and collapses first due to the
fluid around the heart
169
What underlying disease state is
likely in a patient with a malar
rash and recurrent DVT?
Systemic Lupus
Erythematosus(SLE) with
antiphospholipid
syndrome
170
What valvular abnormality is
most commonly associated with
a peripheral arterial emboli?
Mitral stenosis
171
What valvulopathy increases
afterload?
Aortic stenosis
172
What will most likely happen to
the INR of a patient on warfarin
when they are given
amiodarone?
INR increases
173
7. When treating a patient with
hypertensive urgency the goal is
not to reduce the BP more than
__% in __ hours?
Goal is to reduce blood
pressure no more than
25% every 1-2 hours
174
Which antihypertensive
medications are contraindicated
with asthma and isolated PAD?
Beta blockers
175
Which antihypertensive
medications are contraindicated
with bradycardia or heart block?
Beta blockers - Nondihydropyridine CCB -
Central agents (clonidine)
176
. Which antihypertensive
medications are contraindicated
with pregnancy?
ACE inhibitors -
Angiotensin II receptor
blockers - Thiazide
diuretics - Direct renin
inhibitors
177
Which antihypertensive
medications are contraindicated
with renal artery stenosis?
ACE inhibitors and
Angiotensin II receptor
blockers (Note: caution
with direct renin inhibitors)
178
Which antihypertensive
medications can cause
angioedema?
ACE inhibitors -
Angiotensin II receptor
blockers (ARBs) - Direct
renin inhibitors
179
Which antihypertensive
medications can cause AV
block?
Non-dihydropyridine CCB -
Central agents (clonidine)
180
4. Which antihypertensive
medications can cause
bradycardia?
Beta blockers - Nondihydropyridine CCB -
Central agents (clonidine)
181
5. Which antihypertensive
medications can cause
constipation?
diarrhea?
Verapamil - Central
agents (clonidine)
Direct renin inhibitors
182
. Which antihypertensive
medications can cause
depression?
edema
Beta blockers - Central
agents (clonidine)
Dihydropyridine CCB (e.g. amlodipine nifedipine) - Benzothiazepine CCB
(diltiazem) - Minoxidil
183
Which antihypertensive medications can cause
hyperkalemia?
hyperuricemia
hypokalemia
ACE inhibitors - Angiotensin II receptor blockers (ARBs) - Direct renin
inhibitors - Aldosterone antagonists (spironolactone)
Thiazide
Thiazide
184
Which electrolyte disorder can increase the chance of
digoxin toxicity?
Hypokalemia
185
. Which lab value must be obtained before initiating ACE
inhibitor therapy
Potassium
186
Why are post menopausal women more prone to heart
disease?
Estrogen is cardio protective
187
You have performed pericardial centesis. How do you
ensure you are in the pericardial space?
Blood evacuated from the pericardial space does not clot
