cardio Flashcards
(497 cards)
1
Q
Which type of HTN is more common?
A
primary HTN
2
Q
Who is more at risk for HTN?
A
males
3
Q
According to USPTF, who should be screened for HTN annually (with no risk factors)?
A
adults 18 and over
4
Q
how many high BP readings do you need to make a dx?
A
2
5
Q
What is the goal BP for patients being treated for HTN?
A
<130/80
6
Q
what intervnetion will lower BP the most?
A
DASH diet
7
Q
What tx is the fist line tx for HTN if there is no compelling comorbidities?
A
ACEI
8
Q
What is the first line tc for HTN for a pt with diabetes?
A
ACEI
9
Q
Hypertensive urgency includes what?
A
no end organ damage
10
Q
tx for hypertensive urgency
A
reduce over hours to days
11
Q
Hypertensive emergency includes what?
A
end organ damage
12
Q
what is the most common cause of secondary HTN?
A
renal artery stenosis
13
Q
heart cannot pump (HF)
A
systolic
14
Q
heart cannot fill (HF)
A
diastolic
15
Q
HF with decreased EF
A
systolic
16
Q
best test to evaluate for suspected HF
A
echo
17
Q
What are the tx for chronic heart failure?
A
thiazide diuretics, loop diuretics, fluid restriction
18
Q
What tx is indicated in acute HF?
A
furoseide (Lasix)
19
Q
What is associated with death in young athletes?
A
HCM
20
Q
HCM causes what type of HF?
A
diastolic
21
Q
restrictive cardiomyapthy causes what type of HF
A
diastolic
22
Q
amyloidosis, sarcoidosis are indicative of?
A
restrictive cardiomyopathy
23
Q
What is the best test to assess for any type of cardiomyopathy?
A
echo
24
Q
dilate cardiomyopathy relates in what kind of HF?
A
systolic
25
define sinus bradycardia
rate less than 60
26
an athlete with a HR of 50, no sx
not worrisome
27
an 80 year old with a HR of 50 and mottled skin
worrisome
28
what drug is indicated for symptomatic/unstable bradycardia
atropine
29
consistently long PR interval
1st degreee HB
30
longer, longer, longer drop, then you have
2nd degree HB, type I
31
total block between atria and ventricles
3rd degree HB
32
pacemakers are indicated for what?
conduction disorders
33
tx for AVNRT (AKA SVT)
adenosine
34
what does atrial flutter look like?
sawtooth pattern
35
Most important test for diagnosing an arrhythmia
EKG
36
A fib, unstable patient-hypotension, pulmonary edema, FIRST tx
cardioversion
37
How do you determine if in a fib patient needs ongoing anticoagulation
CHAD score
38
most patients with a fib will receive what medication for anticoagulation?
DOAC
39
what is not a common cause of PVC?
heroin
40
wide monomorphic tachycardia
v tach
41
tx for non sustained v tach, no sx
no tx needed
42
ventricular tachycardia with pulse, hypotension, AMS, chest pain
cardioversion
43
v tach, no pulse
defibrillator
44
Torsades de pointe causes?
Long QT syndrome
45
tx for Torsades
mag sulfate
46
"bag of worms"
v fib
47
chest pain relieved with rest, normal EKG
stable angina
48
stable angina, low probability of CAD
stres test
49
stable angina, high probability of CAD
cardiac cath
50
chest pain during activity and at rest, normal EKG, negative troponin
unstable angina
51
How many sets of troponin are neeed to rule out an MI?
2
52
chest pain, EKG normal, positive troponin
NSTEMI
53
What is the tx for NSTEMI and STEMI (acute)
PCI
54
chets pain, ST elevation on EKG, positive troponin
STEMI
55
vasopastic angina
prinzmetal angina
56
If PCI is not available within 120 minutes for STEMI, what should be done?
fibrinolytics
57
"bad cholesterol"
LDL
58
When should adults start being screening for lipid disorders?
age 40 and over
59
what is the inner most layer of the heart?
endocardium
60
what is the most common cause of(by far) of infective endocarditis
bacteria
61
Abx prophylaxis (before dental/repsiratory procedure) is required for?
endocarditis
61
most common presenting sx of infective endocarditis
fever
61
most cases of infectious endocarditis are caused by?
staph or strep
61
roth spots
endocarditis, retina
61
what is the diagnostic criteris for endocarditis called?
Duke
61
associated with IV drug use
endocarditis
61
janeway lesions
palsm and soles
61
of these, which is the most definitive test for infective endocarditis?
Echo
61
tx for infective endocarditis?
6 weeks IV abx
61
most common cause of pericarditis?
virus
61
pericardial friction rub
pericarditis
61
What is associated with cardiac tamponade?
pericarditis
61
what is the tx for pericarditis?
NSAIDS
61
rheumatic fever is caused by?
strep infection
61
"Beck's Triad"
hypotension, soft heart sounds, JVD
62
tx for cardiac tamponade
pericardiocentesis
63
does either rheumatic fever or heart disease come first?
rheumatic fever
64
JONES criteria
rheumatic fever
65
erythema migrans
rheumatic fever
66
most affected in rheumatic fever
mitral valve
67
most importannt test for rheumatic heart disease
echo
68
prevention for new GABHS infections after rheumatic fever
monthly PCN G
69
narrowing of a heart valve
stenosis
70
insufficiency of a heart valve
regurg
71
best test to assess for valve stenosis or regurgitation
echo
72
lifelong coagulation with Coumadin
mechanical valve
73
DOAC for 3 months
biprosthetic valve
74
AAA associated with?
Marfan syndrome
75
Who should be screened for AAA?
men, 65-75, ever smoked
76
definitive test for AAA
US
77
elective repiar for AAA indicated
>5.5 cm
78
AAA rupture
abdominal pain, hypotension, pulsatile mass
79
pulse discrepancy in extremities
aortic dissection
80
best test for aortic dissection
CT
81
Which class of aortic dissection can usually be managed medically?
standford type B
82
#1 cause of peripheral arterial disease
atherosclerosis
83
all pts with PAD should receive?
anti platelet
83
intermittent claudication
peripheral arterial disease
84
ABI
peripheral arterial disease
85
DVT due to surgery, no previous DVT
anticoagulate 3-6 months
85
best test for extremity for DVT?
US
86
Pt with a _____ should have a D-Dimer if DVT suspected
low pretest probability
87
pain with dorsiflexion of the foot
DVT
88
tx for superficial venous thromboembolism if < 5cm, distal, no risk of
NSAIDS
89
Dx of varicose veins?
clinically
89
chronic venous insufficiency
pulses present, warm limb
90
first line tx of varicose veins
compression therapy
91
type of shock that develops due to profound dehydration?
hypovolemic
92
type of shock that develops due to tension pneumothorax
obstructive
92
type of shock that develops from ventricular tachycardia?
cardiogenic
92
type of shock resulting from sepsis
distributive shock
93
Name 2-3 complications of untreated hypertension?
Stroke, CAD, MI
94
Hypertension is most commonly defined as?
140/90
95
Name the risk factors for primary essential hypertension?
Males, obesity, smoking, family history, race, sodium, excessive alcohol consumption, physical inactivity
96
Name a few meds/drugs that can cause HTN?
NSAIDs, decongestants, meth, bath salts
97
What is the USPSTF hypertension screening recommendation for ages 18-39?
1 every 3-5 years
98
What is the USPSTF hypertension screening recommendation for age 40 and older?
Every year
99
What is required to make a diagnosis of hypertension?
> or equal to 2 readings in a row over two appointments
100
What are the blood pressure categories/stages?
Not specified in the provided text.
101
List 4-5 components of the initial workup for HTN?
CBC, TSH, urinalysis, lipids, ECG, fasting glucose, electrolytes
102
What is the ACC/AHA goal blood pressure for patients being treated with HTN?
<130/80 in the general category
103
What is the initial treatment for hypertension?
ACEI/ARB, beta blocker, monotherapy or lifestyle change, HCTZ
104
What is the definition of resistant HTN?
>180 systolic and or >120 diastolic
105
What is the definition of hypertensive urgency?
Emergency?
106
What is the most common cause of secondary hypertension?
COPD
107
Explain the difference between systolic and diastolic heart failure.
Systolic - too stiff to have a good EF. Diastolic - ventricle can't fill all the way.
108
What is ejection fraction? How is it calculated?
EF = SV/EDV x 100 = the amount leaving the left ventricle
109
Name 4-5 elements of patient history that would indicate HF.
Another disease, needing to sit up to sleep, dyspnea on exertion, past MI
110
Name 3-4 physical exam findings that would indicate heart failure.
Murmurs, rubs, gallops, JVD, lower extremity edema (pitting)
111
What is the MOST important imaging study to assess for HF?
Echo
112
What lab can be done to assess HF?
Elevated BNP
113
Name 8 medications or classes used in treating HF.
ACE, ARB, ARMIs, Beta Blockers, Diuretics - spironolactone, SGL2 inhibitors, Ivabradine, Loop diuretics
114
What is the treatment of choice for acute exacerbation of HF?
Underlying issue, diuretic
115
What patient education is important for HF?
DAILY WEIGHT CHECKS, will need a heart transplant
116
How does hypertension lead to HF?
Leads to inflammation and LVH which then leads to diastolic HF first and then systolic by backing up into the pulmonary trunks and the lungs, and the right ventricle leading to increased fluid retention.
117
List a few causes of sinus tachycardia.
Not specified in the provided text.
118
Describe SVT/AVNRT and what is the treatment algorithm?
Not specified in the provided text.
119
Describe atrial flutter on EKG.
Not specified in the provided text.
120
Describe A fib on EKG. What are the components of A fib?
Not specified in the provided text.
121
List some causes of premature ventricular contractions.
Not specified in the provided text.
122
Describe sustained ventricular tachycardia. What is the treatment?
Not specified in the provided text.
123
Describe polymorphic v-tach. Treatment?
Not specified in the provided text.
124
Describe ventricular fibrillation. Treatment?
Not specified in the provided text.
125
Where is the Aortic valve auscultated?
Right upper sternal border.
126
Where is the Pulmonary valve auscultated?
Left upper sternal border.
127
Where is the Tricuspid valve auscultated?
Left mid-low sternal border.
128
Where is the Mitral valve auscultated?
At the apex.
129
What sound does Systole correspond to?
S1-Lub.
130
What is a characteristic of Open Stenosis?
Radiates to carotids.
131
What is a characteristic of Closed Regurgitation?
Radiates to axilla.
132
What sound does Diastole correspond to?
S2-Dub.
133
What is S3 and when does it occur?
Occurs in early diastole, sounds like a gallop, occurs just after S2, sounds like 'ken-tucky'.
134
What is S4 and when does it occur?
Occurs in late diastole, sounds like a gallop, occurs just prior to S1, sounds like 'tenne-see'.
135
What conditions are associated with S3?
Distended ventricle, dilated cardiomyopathy, heart failure.
136
What conditions are associated with S4?
Stiff ventricle, restrictive cardiomyopathy, HCM, STEMI.
137
What does the murmur rating ⅙ indicate?
Very faint, only careful listening.
138
What does the murmur rating 2/6 indicate?
Audible as soon as stethoscope placed on chest.
139
What does the murmur rating 3/6 indicate?
Louder than 2/6 but not as loud as 4/6.
140
What does the murmur rating 4/6 indicate?
Loud, may be associated with a palpable thrill.
141
What does the murmur rating 5/6 indicate?
Very loud, can be heard with the stethoscope partially off the chest.
142
What does the murmur rating 6/6 indicate?
Audible to the naked ear.
143
What are the two types of heart rhythm interventions?
Defibrillation and Cardioversion.
144
What is Defibrillation used for?
High energy, unsynchronized for V-fib and pulseless V-tach.
145
What is Cardioversion used for?
Lower energy, synchronized to restore sinus rhythm in a-fib or a-flutter, SVT.
146
What is the purpose of Pacing?
To speed things up by delivering electrical impulses via electrodes.
147
What are the indications for an ICD?
Past cardiac arrest, high risk for arrhythmias, long QT syndrome, heart failure.
148
What is Electrophysiology/Ablation?
Disruption of an abnormal pathway in the heart.
149
What are the indications for Electrophysiology/Ablation?
Chronic a-fib, WPW, chronic PVCs, LGL, SVT.
150
What is Atropine used for?
Atropine is an anticholinergic that treats bradycardia and speeds up heart rate.
151
What is the mechanism of Adenosine?
Adenosine works on potassium channels to slow down heart rate at the AV node, primarily used for SVT.
152
What condition does Amiodarone treat?
Amiodarone is used for VFIB.
153
What is the definition of hypertension (HTN)?
Hypertension is defined as a blood pressure greater than 140/90.
154
What are the two types of hypertension?
Primary hypertension is due to a combination of genetic and environmental factors, while secondary hypertension is due to an underlying disease.
155
What are the complications of untreated hypertension?
Complications include heart failure, stroke, kidney failure, aortic dissection, and myocardial infarction (MI).
156
What is Primary Essential Hypertension?
Hypertension characterized by systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg. Most hypertension cases are primary essential.
157
What are the risk factors for Primary Essential Hypertension?
Risk factors include male gender, obesity, sodium intake, excessive alcohol consumption, and physical inactivity.
158
How do the kidneys regulate blood pressure?
The kidneys regulate blood pressure through fluid regulation.
159
What role do baroreceptors play in blood pressure regulation?
Baroreceptors in the heart communicate with the brain and kidneys to help regulate blood pressure.
160
What components contribute to cardiac output?
Cardiac output is determined by heart rate (HR) and stroke volume.
161
What are some causes of impaired renal function leading to hypertension?
Causes include inappropriate activation of hormones regulating salt and water excretion, and excessive activation of the sympathetic nervous system.
162
What are some over-the-counter medications that can cause hypertension?
OTC medications include steroids, NSAIDs, antidepressants, decongestants, St. John's Wort, and contraceptives.
163
What is the recommended amount of exercise for hypertension management?
150 minutes of moderate exercise per week or 70 minutes of rigorous exercise.
164
What is important for proper blood pressure measurement?
Proper technique is crucial for accurate blood pressure readings.
165
What physical examination findings may indicate hypertension?
Findings include carotid bruits, thyroid enlargement, S4 heart sound, abdominal aortic aneurysm (AAA), abdominal bruits, and hepatomegaly.
166
What are the screening recommendations for hypertension?
Screening should occur for individuals >18 years old every 3-5 years, and yearly for those >40 or with multiple risk factors.
167
What defines normal blood pressure?
Normal blood pressure is defined as <120/80 mmHg.
168
What defines elevated blood pressure?
Elevated blood pressure is defined as 120-129 systolic and >80 diastolic.
169
What are the classifications for hypertension?
HTN Stage 1: 130-139 systolic or 80-89 diastolic; HTN Stage 2: >140 systolic or >90 diastolic; HTN crisis: >180 systolic and/or >120 diastolic.
170
What laboratory tests are important in diagnosing hypertension?
Tests include electrolytes (especially calcium), ECG, creatinine (GFR), fasting glucose, urinalysis (proteinuria), CBC, TSH, and lipid profile.
171
What imaging studies may be used to look for secondary hypertension?
Imaging studies include renal ultrasound, MRA, and Doppler ultrasound.
172
What lifestyle modifications are recommended for hypertension management?
Lifestyle modifications include following the DASH diet.
173
What is the blood pressure goal for healthy patients?
The goal for healthy patients is <130/80 mmHg.
174
What is the treatment approach for Stage I and Stage II hypertension?
One medication for Stage I and two medications for Stage II, with rechecks every few months.
175
What are the first-line medications for hypertension?
First-line options include ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and hydrochlorothiazide (HCTZ).
176
What is the recommended treatment for Black patients with hypertension?
Recommended treatments include CCB or HCTZ.
177
What medications are recommended for pregnant patients with hypertension?
Labetalol, nifedipine, and methyldopa are recommended.
178
What medications are indicated for diabetics or patients with kidney disease?
ACE inhibitors are indicated for diabetics or patients with kidney disease.
179
What is the treatment for patients with a history of myocardial infarction or coronary artery disease?
ACEI/ARB and beta-blockers (BBB) are recommended.
180
What factors may necessitate escalating hypertension treatment?
Factors include dosing adjustments, number of drugs used, noncompliance, white coat effect, and incorrect measurement.
181
What is Resistant HTN?
The failure to reach blood pressure control in patients who are adherent to full doses of an appropriate 3-drug regimen. Start to think about secondary HTN.
182
What defines a Hypertension Crisis/Emergency?
Urgency: > 180 and/or >120 with no organ damage, but may have a headache. Should be reduced over hours to days.
Emergency: >180 and/or >120 with end organ damage. Should be reduced within one hour.
183
What are commonly used fast-acting drugs for Hypertension Urgency?
Clonidine, captopril, Nifedipine.
184
What are commonly used drugs for Hypertension Emergency?
Nicardipine, Labetalol, hydralazine, nitroprusside.
185
When should blood pressure be reduced in Hypertension Urgency?
Over hours to days.
186
What is a target for blood pressure reduction in Hypertension Emergency?
Initial target is 25% reduction in 1 hour, then 160/100 in 3-6 hours.
187
What are signs that suggest Secondary HTN?
Severe or resistant hypertension, acute rise or lability in BP, age less than 30, unable to control BP with 3 meds.
188
What are common causes of Secondary HTN?
Renovascular HTN due to renal artery stenosis, sleep apnea.
189
What are less common causes of Secondary HTN?
OCPs, pheochromocytomas, Cushing’s.
190
What diagnostic tests are used for Renovascular disease?
CT or MRA.
191
What diagnostic tests are used for Primary kidney disease?
BUN/creatinine.
192
What tests are used for Pheochromocytoma?
Plasma and urine catecholamines, MRI or CT.
193
What is the treatment for resistant hypertension?
Referral to hypertension specialist.
194
What is CHF?
CHF stands for Congestive Heart Failure, a condition where the heart cannot pump or fill adequately.
195
What are the types of heart failure?
Heart failure can be categorized as systolic, diastolic, left, right, acute, or chronic.
196
What is the most common cause of right-sided CHF?
Right-sided CHF is usually caused by left-sided CHF.
197
What is the most common cause of heart failure in Americans?
Hypertension is the most common cause, affecting 6.2 million Americans a year.
198
What are the risk factors for heart failure?
Risk factors include age, females, obesity, hypertension, smoking, diabetes, coronary artery disease (CAD), valvular heart disease, and atrial fibrillation.
199
What governs systolic function?
Systolic function is governed by contractile myocardium, preload, afterload, and heart rate.
200
What is ejection fraction (EF)?
Ejection fraction is the percentage of blood the left ventricle pumps out with each contraction.
201
What is the normal range for ejection fraction?
The normal range for ejection fraction is 55-70%.
202
What is diastolic heart failure?
Diastolic heart failure occurs when the heart can’t relax enough, leading to decreased stroke volume and cardiac output.
203
What are the causes of diastolic heart failure?
Causes include left ventricular hypertrophy, hypertrophic cardiomyopathy (HCM), infiltrative cardiomyopathies, and ischemic fibrosis.
204
What are common symptoms of heart failure?
Symptoms include dyspnea, orthopnea, palpitations, fatigue, lower extremity edema, cough, abdominal swelling, and pleural effusions.
205
What happens in acute heart failure from myocardial infarction?
Acute heart failure can lead to pulmonary edema due to inadequate blood pumping to the kidneys.
206
What are the cardiac signs of heart failure?
Cardiac signs include jugular venous distension (JVD), lateral PMI, S3 and/or S4 gallop, and mitral regurgitation.
207
What are the non-cardiac signs of heart failure?
Non-cardiac signs include crackles in the lungs, distended or pulsatile liver, and dependent edema.
208
What are the diagnostic tests for heart failure?
Diagnostic tests include echocardiogram for EF, elevated BNP, CBC, serum electrolytes, kidney/liver functions, and chest X-ray.
209
What is the treatment goal for heart failure?
The goal is to relieve symptoms, improve functional status, and prevent death and hospitalizations.
210
What is the evidence for treatment efficacy in heart failure?
Most therapies show clinical benefit primarily in patients with heart failure with reduced LVEF (40% or less).
211
What are common pharmacologic treatments for chronic heart failure?
Treatments include diuretics, ACE inhibitors, ARBs, beta-blockers, vasodilators, and SGLT-2 inhibitors.
212
What is an ARNI?
ARNI (Sacubitril/valsartan) is a newer medication for heart failure introduced in 2015.
213
What lifestyle changes are recommended for heart failure patients?
Lifestyle changes include daily weight checks, fluid/salt restriction, and cardiac rehabilitation.
214
When is a left ventricular assist device indicated?
It is indicated for patients with two or more hospitalizations in the last six months for heart failure or those unable to take medications.
215
What can acute heart failure lead to?
Acute heart failure can lead to pulmonary edema.
216
What are common causes of acute heart failure?
Common causes include discontinuation of meds, excessive salt intake, myocardial ischemia, and tachyarrhythmias.
217
What are the symptoms of acute heart failure?
Symptoms include acute onset or worsening of dyspnea at rest, tachycardia, diaphoresis, pulmonary rales, rhonchi, expiratory wheezing, and pink, frothy sputum.
218
What does a chest X-ray (CXR) show in acute heart failure?
CXR shows interstitial and alveolar edema with or without cardiomegaly, and hypoxemia.
219
What is the treatment for acute heart failure?
Treatment includes addressing the underlying issue and administering diuretics, typically Lasix or Bumetanide.
220
What is HCM?
Hypertrophic Cardiomyopathy (HCM) is a condition where the myocardium becomes thickened and hypercontractile, leading to diastolic heart failure.
221
What is the echocardiogram finding in HCM?
The left ventricular wall is greater than 1.5 cm thick on echocardiogram.
222
What is the most common cause of cardiac death in young athletes?
Hypertrophic Cardiomyopathy (HCM).
223
What are the risk factors for HCM?
Genetics, diabetic mother, and drug-induced factors.
224
What physical exam findings might be present in HCM?
A murmur or an extra heart sound may be heard on auscultation due to the mitral valve rubbing against the wall.
225
What are the common symptoms of HCM?
Usually asymptomatic; may present with a murmur, abnormal EKG, dyspnea, syncope/presyncope, palpitations, or congestive heart failure (CHF).
226
What are the physical exam findings in HCM?
Nothing or a crescendo-decrescendo murmur at the left sternal border, bifid pulse (biphasic pulse), and S4 heart sound.
227
What are the diagnostic findings for HCM?
EKG may be mostly normal but can show signs of left ventricular hypertrophy (LVH). CXR shows left ventricular enlargement. Echocardiogram shows left ventricle >1.5 cm.
228
What is the first-line treatment for HCM?
Beta blockers, as they decrease the oxygen demand on the heart.
229
What are other treatment options for HCM?
Verapamil or diltiazem to decrease heart rate and force of contraction; septal ablation, implanted cardioverter/defibrillator, or heart transplant.
230
Who should be screened for HCM?
Any first-degree relative, competitive athletes, with genetic testing, EKG, and echocardiogram.
231
What characterizes restricted cardiomyopathies?
The myocardium becomes stiff and less compliant, leading to diastolic heart failure.
232
What are some identifiable diseases causing restricted cardiomyopathies?
Amyloidosis, sarcoidosis, radiation, and hemochromatosis.
233
What are the common symptoms of restricted cardiomyopathies?
Usually presents as heart failure with pulmonary hypertension, dyspnea, and lower extremity edema.
234
What is a physical exam finding in restricted cardiomyopathies?
S4 heart sound.
235
What are the diagnostic findings for restricted cardiomyopathies?
EKG shows small amplitude QRS complexes; echocardiogram shows impaired ventricle filling.
236
What is the treatment for restricted cardiomyopathies?
Reduce pulmonary congestion with diuretics, use beta blockers to slow heart rate, and treat any underlying disease.
237
What happens to the myocardium in dilated cardiomyopathies?
The myocardium gets very weak, resulting in potentially low cardiac output and systolic heart failure, with valves stretching that can cause mitral and tricuspid regurgitations and arrhythmias.
238
How are dilated cardiomyopathies categorized?
They are categorized as ischemic (e.g., CAD, MI) or nonischemic (e.g., idiopathic, myocarditis, alcohol and cocaine abuse, peripartum after birth).
239
What are the symptoms of heart failure in dilated cardiomyopathies?
Symptoms include edema, dyspnea on exertion, and orthopnea. It's important to ask about family history.
240
What physical exam findings are associated with dilated cardiomyopathies?
Findings may include cardiomegaly, S3 heart sound, jugular venous distension (JVD), and rales.
241
What are the diagnostic tools for dilated cardiomyopathies?
Diagnostic tools include echocardiogram (showing left ventricular dilation), chest X-ray (CXR with left ventricular enlargement), and EKG (which may show atrial and/or ventricular hypertrophy and conduction delays like LBBB).
242
What is the treatment for dilated cardiomyopathies?
Treatment involves addressing the underlying condition if possible, using beta blockers, ACE inhibitors, LVAD, and ICD to help prevent sudden death, and may include heart transplant.
243
What are the indications for LVAD in dilated cardiomyopathies?
Indications for LVAD include being a bridge to heart transplant, and all LVAD patients should be evaluated for heart transplant.
244
What are general indications for long-term use of LVAD?
General indications for long-term use of LVAD include patients with severe heart failure who are not candidates for immediate heart transplant.
245
What is Sinus Bradycardia?
Rate <60. P wave for every QRS. Very much related to clinical context.
246
What can cause Sinus Bradycardia?
Can be caused by hypothyroidism, drugs (beta blockers, CCB), myocarditis, hypoglycemia.
247
What are the symptoms of Sinus Bradycardia?
No symptoms or cardiogenic shock, syncope, dizziness, lightheadedness, chest pain, SOB, exercise intolerance.
## Footnote
Ask about comorbidities and history of heart disease.
248
What physical exam findings may be present in Sinus Bradycardia?
Will depend on underlying cause and severity: decreased LOC, cyanosis, peripheral edema, dyspnea, syncope, mottled skin (decreased perfusion to the skin).
249
What are the diagnostic tests for Sinus Bradycardia?
Labs/imaging: EKG, electrolytes (sodium, potassium, calcium, magnesium - only one ordered separately), glucose, thyroid function test (hypothyroidism), toxicology screens, troponin.
250
What is the treatment for stable Sinus Bradycardia?
Treat underlying cause, but do not delay care.
251
What is the treatment for unstable Sinus Bradycardia?
Atropine (binds to and inhibits Ach receptors, anticholinergic receptors), transcutaneous pacing, transvenous pacing, expert consult.
252
What is the general term for heart blocks?
A delay or 'block' somewhere along the conduction system. Usually occur as a result of damage to the conduction system (fibrosis, ischemia), but often idiopathic.
253
What is 1st degree AV block?
Signal is delayed in the AV node. PR interval > 200 ms consistently. Usually asymptomatic.
## Footnote
No treatment unless underlying cause (electrolyte imbalance or due to meds).
254
What is 2nd degree heart block?
Wenckebach: progressive lengthening of the PR interval until a QRS is dropped. Has a consistent P:QRS ratio. Type II: PR interval consistent with intermittent dropped QRS complexes, usually due to ischemia damage.
## Footnote
Requires treatment only if symptomatic (atropine).
255
What is 3rd degree heart block?
Complete heart block between atria and ventricles. Symptoms include fatigue, chest pain, SOB, syncope. May be hemodynamically unstable.
256
What is sinus tachycardia?
Fast/narrow/regular tachycardia with HR > 100 in adults. Almost always due to some underlying issue. Common causes include exercise, pain, fever, hyperthyroidism, heart failure, anemia, alcohol withdrawal, drug use.
## Footnote
There is a P wave before every QRS.
257
What is AVNRT?
AV nodal re-entrant tachycardia, a type of supraventricular tachycardia (SVT). Regular, narrow tachycardia, usually 170-180 bpm, can be as high as 300. Most common in young females.
## Footnote
Treatment includes vagal maneuvers, adenosine, beta-blockers, and cardioversion.
258
What is atrial flutter?
Fast/narrow/regular rhythm with a rate of 300-400. Characterized by a 'saw tooth' pattern with QRS complexes.
259
What are the symptoms of atrial flutter?
May be asymptomatic or present with palpitations and lightheadedness.
260
What is the treatment for stable atrial flutter?
Rate control with diltiazem or verapamil.
261
What is the treatment for unstable atrial flutter?
Anticoagulation and cardioversion.
262
What is atrial fibrillation (A fib)?
'Holiday heart' seen most often in alcoholics; fast/narrow/irregular rhythm. Major preventable cause of stroke.
263
What are the types of atrial fibrillation?
Paroxysmal, Persistent, Long standing persistent.
264
What is paroxysmal atrial fibrillation?
AF that terminates spontaneously or with intervention within seven days.
265
What is persistent atrial fibrillation?
AF that fails to self-terminate within seven days and often requires cardioversion.
266
What is long standing persistent atrial fibrillation?
AF that has lasted for more than 12 months.
267
What are the symptoms of atrial fibrillation?
Asymptomatic or symptoms include palpitations, SOB with HF, lightheadedness, dizziness, focal neuro deficits.
268
What are the diagnostic methods for atrial fibrillation?
EKG, transthoracic echo, transesophageal echo, TSH.
269
What is the treatment for unstable atrial fibrillation?
IV beta blockers or CCB, anticoagulation, electrical cardioversion if severe hypotension or pulmonary edema.
270
What is the treatment for stable atrial fibrillation?
Get an echo first; if no thrombus, give anticoagulation and rate control. If thrombus, anticoagulate for 4 weeks prior to meds.
271
What is the CHAD score used for?
It is specific to anticoagulation with atrial fibrillation.
272
What is the goal of rate control in chronic atrial fibrillation?
Resting heart rate of <80 in symptomatic patients.
273
What anticoagulation is recommended for a CHAD score greater than 2?
DOACs for most patients; Warfarin for mechanical heart valves, rheumatic heart disease, severe chronic kidney disease.
274
What should be done if symptoms persist despite rate control in atrial fibrillation?
Consider cardioversion and/or ablation.
275
What causes Premature Ventricular Contraction (PVC)?
Ventricular irritability causes a beat (or several) that originate in the ventricle (ectopic foci). Can be caused by: epinephrine released by the adrenal glands, stimulants, hyperthyroidism, low O2, hypokalemia.
276
What is the treatment for Premature Ventricular Contraction?
In general, self-limited. Usually followed by 'compensatory pause'.
277
What characterizes Ventricular Tachycardia?
A 'run of PVCs' with wide monomorphic tachy. Can be sustained (3-30 in a row) or unsustained. Patients may or may not have a pulse.
278
What are the risk factors for sustained Ventricular Tachycardia?
Coronary artery disease (most common), cardiomyopathies, cardiac sarcoidosis. Most patients will have a history of underlying heart disease.
279
What are the early symptoms of sustained Ventricular Tachycardia?
Early symptoms may include SOB/dyspnea, chest pain, palpitations, and syncope.
280
What are the symptoms of Ventricular Tachycardia?
Depends on sustained vs unsustained. May have palpitations, lightheadedness, or may be asymptomatic and discovered accidentally.
281
How is Ventricular Tachycardia diagnosed?
Evaluate for underlying heart disease, history/physical exam, EKG, transthoracic echo, exercise stress testing, Holter monitor.
282
What is the treatment for unsustained Ventricular Tachycardia?
Asymptomatic and no heart disease → no treatment. Symptomatic and no heart disease → rate control with beta blocker or ablation. Underlying heart disease → evaluate and treat underlying disease.
283
What is the treatment for sustained Ventricular Tachycardia?
Stable, minimally affected → procainamide. Stable but compromised with hypotension, AMS, chest pain → cardioverter with sedation. Cardiac arrest → chest compressions and defibrillation. Chronic/recurring → treat underlying heart disease, catheter ablation, implantable cardioverter defibrillator.
284
What is Polymorphic Ventricular Tachycardia?
Torsades, where the shape of contractions from each beat changes as the signal begins in a different area of the ventricles. Usually a sequelae of long QT syndrome.
285
What are the causes of long QT syndrome leading to Polymorphic Ventricular Tachycardia?
Acquired: drugs (some anti-infective, antipsychotics, antiemetics), electrolyte abnormalities, starvation. Congenital: rare genetic syndromes, females, age of onset 14 years, should avoid QT prolongation drugs.
286
What is the treatment for Polymorphic Ventricular Tachycardia?
IV magnesium sulfate.
287
What does CAD stand for?
CAD refers to a spectrum of conditions that cause decreased blood flow to the myocardium due to varying degrees of atherosclerosis.
288
What is the progression of CAD?
Asymptomatic → stable angina → unstable angina → NSTEMI → STEMI.
289
How many adults in the U.S. have CAD?
About 18 million adults aged 20 and over have CAD.
290
How many heart attacks occur annually in the U.S.?
Every year, 805,000 Americans have a heart attack.
291
What are the risk factors for CAD?
Tobacco, physical inactivity, obesity, hypertension, dyslipidemia, insulin resistance, metabolic syndrome, family history, males, nephrotic syndrome, high lipoprotein A, hypothyroidism.
292
What is atherosclerosis?
Chronic inflammatory disorder of medium and large arteries characterized by the buildup of cholesterol plaques within the arterial lumen.
293
What causes endothelial cell injury in atherosclerosis?
Endothelial stress from hypertension and smoking.
294
What happens when the endothelium is injured?
LDL particles leak into the intimal layer, where they are oxidized, leading to an immune response and inflammation.
295
What is a 'fatty streak'?
A 'fatty streak' is formed in the lumen due to the immune response and inflammation after LDL oxidation.
296
What occurs if a lipid-filled plaque ruptures?
More platelets adhere, forming a thrombus, which can occlude the vessel.
297
What is the occlusion percentage in the LAD artery?
The top one is almost 100% occluded, while the bottom is about 60% occluded.
298
What is Stable Angina?
Chest pain relieved by rest, described as tightness, squeezing, burning, or indigestion. Pain is typically in the mediastinum or slightly to the left and may radiate to the left shoulder or arm. Duration is less than 30 minutes.
299
How can Stable Angina pain be relieved?
Pain can be relieved with nitroglycerin.
300
What are the signs of underlying disease in Stable Angina?
Increased blood pressure, diaphoresis, and risk factors for cardiac ischemia.
301
Which groups present atypically for Stable Angina?
Women, diabetics, and people over 65.
302
What is the diagnostic approach for Stable Angina?
Clinical assessment; labs to check for underlying causes (lipids, kidneys). EKG is usually normal at rest but may show ST elevation with activity.
303
What does ST segment depression indicate in Stable Angina?
It is often the first symptom, followed by ST segment elevation.
304
What to do if there is low probability of CAD?
Conduct a noninvasive stress test.
305
What to do if there is high probability of CAD?
Perform cardiac catheterization.
306
What is the treatment for Stable Angina?
Risk factor modification and follow-up every 6-12 months, anti-anginal therapy, and acute treatment with short-acting nitrates.
307
What is the preventive treatment for Stable Angina?
Beta blockers, coronary artery revascularization if >70% stenosis in 1 vessel, and anti-platelet therapy.
308
What medications are used for anti-platelet therapy?
Aspirin (ASA) or clopidogrel if allergic.
309
What is the lipid-lowering therapy for Stable Angina?
Statins.
310
When should ACEI/ARB be used?
In patients who are diabetic or have chronic kidney disease (CKD).
311
What is Unstable Angina?
Pain during and at rest, usually due to a ruptured plaque leading to ischemia and high risk for myocardial infarction (MI). Not distinguishable from NSTEMI until cardiac enzymes are obtained.
312
What are the symptoms of Unstable Angina?
Chest pain is constant. Levine sign. Vital signs are variable.
313
What is the diagnosis for Unstable Angina?
EKG may show ST segment changes; cardiac enzymes should be negative x2. If stable, observe for 24-48 hours, then perform a stress test. If unstable or high risk, may require immediate cardiac catheterization with PCI.
314
What is the treatment for Unstable Angina?
Acute: aspirin, antiplatelet therapy (P2Y12 inhibitor), anticoagulation (heparin if invasive therapy). Ongoing: ASA, antiplatelet therapy, nitroglycerin, beta blocker, ACEI, lipid reduction, glucose control.
315
What is NSTEMI?
Unstable angina with elevated cardiac enzymes (elevated troponin) and no ST elevations on EKG (likely ST segment depression).
316
What is the treatment for NSTEMI?
Consult cardiology; treated like STEMI but with less urgency. PCI is the preferred treatment.
317
What is STEMI?
Time is critical (get an EKG in 10 mins). Average age is 68 years old.
318
What are the risk factors for STEMI?
Men, prior MI, CAD (tobacco, physical inactivity, HTN, dyslipidemia, DM, family history), cocaine use.
319
What are the symptoms of STEMI?
Pain starts in the retrosternal area, may radiate, occurs at rest or with minimal exertion, lasts ≥10 mins, may be new onset or increased intensity angina, unrelieved within 5 mins of rest or nitroglycerin. Atypical symptoms include arm, shoulder, back, neck, jaw, epigastric pain, and anginal equivalents like new onset dyspnea, N/V, diaphoresis, abdominal pain, syncope, unexplained fatigue.
320
What is the diagnosis for STEMI?
EKG and repeat at 15 min intervals if not diagnosed; cardiac biomarkers (troponin-high sensitivity); other tests: CXR, echo, PT/PTT/INR, BNP.
321
What is the treatment for STEMI?
PCI within 90 mins of arrival if available; within 120 mins if transfer needed. If PCI unavailable within 120 mins, pharmacologic reperfusion (fibrinolysis) with plans for PCI ASAP. Ongoing treatment: ASA, antiplatelet therapy, nitroglycerin, beta blocker, ACEI, lipid reduction, glucose control, evaluate EF with echo, stress test for residual ischemia.
322
What is Prinzmetal Angina?
Vasospastic angina characterized by chest pain at rest and transient ST segment elevation due to focal spasm of the coronary artery.
323
What are the typical patient characteristics for Prinzmetal Angina?
Younger patients with fewer risk factors.
324
How is Prinzmetal Angina diagnosed?
Coronary angiography with acetylcholine provocation.
325
What is the treatment for Prinzmetal Angina?
Nitrates and calcium channel blockers (CCB). Usually resolves in about 6 months.
326
What are lipid disorders?
Disorders of lipoprotein metabolism associated with abnormal levels of total, HDL, LDL, and cholesterol.
327
What is dyslipidemia?
Lipid values associated with disease or increased risk that may require lipid-altering therapy.
328
What is hyperlipidemia?
Elevation of serum total or LDL cholesterol, or triglycerides.
329
What are the risk factors for lipid disorders?
Family history, type 2 diabetes mellitus (T2DM), age, male gender, and obesity.
330
When should lipid screening begin according to AHA/ACC?
Start at age 20 and repeat every 5 years if no risk factors; more often with risk factors (1-2 years).
331
What is the AAP recommendation for lipid screening?
Screen at age 9-11 years; age 2-9 if high risk.
332
What are common symptoms of lipid disorders?
Usually asymptomatic; inquire about family history, activity levels, medication use, and diet.
333
How is a lipid profile conducted?
Fasting for 8 hours to measure HDL, LDL, triglycerides, and VLDL.
334
Who are the four groups most likely to benefit from statin therapy?
1. Patients with any form of clinical ASCVD. 2. Patients with LDL levels of 190 mg/dL or greater. 3. Patients with diabetes aged 45-75 with LDL levels of 70-189 mg/dL. 4. Patients without diabetes aged 40-75 with an estimated 10-year ASCVD risk of 7.5% or greater.
335
What is familial hypercholesterolemia?
An inherited disorder of low-density lipoprotein cholesterol metabolism.
336
What are the diagnostic criteria for familial hypercholesterolemia?
Family history, early onset (before age 50), and extreme hypercholesterolemia (310-1000 mg/dL).
337
When should children with familial hypercholesterolemia begin medication?
Around age 8, as they may have measurable atherosclerosis by age 12.
338
What is bacterial endocarditis?
Infection of the endocardial surface of the heart, most often the heart valves, particularly prosthetic heart valves.
339
What are the common causes of bacterial endocarditis?
Majority of cases are caused by staph or strep (80%).
340
What is the in-hospital mortality rate for bacterial endocarditis?
In hospital mortality is 18%.
341
What is the 4-year mortality rate among IV drug users with bacterial endocarditis?
4-year mortality among IV drug users is 33%.
342
What are the risk factors for bacterial endocarditis?
Prosthetic valves, cardiac devices, history of endocarditis, IV drug use, prolonged bacteremia, congenital heart disease, poor dental hygiene, HIV, long-term hemodialysis.
343
What underlying condition is required for endocarditis to occur?
Underlying structural heart abnormality causing turbulent blood flow leading to fibrin deposition.
344
What can introduce microbes into the bloodstream leading to endocarditis?
Medical procedures, abscess, IV drug use, open wounds, dental infections.
345
What is native valve endocarditis?
Endocarditis of the valve you were born with, commonly caused by strep (CA) or staph (HCA).
346
What is the common cause of right-sided endocarditis in IV drug users?
Staphylococcus.
347
What is the common cause of prosthetic valve endocarditis?
Staphylococcus epidermidis.
348
What are the HACEK organisms associated with infective endocarditis?
Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella.
349
What are common symptoms of infective endocarditis?
Fever (persistent in 90%), anorexia, malaise, weight loss.
350
What are the diagnostic criteria for infective endocarditis?
Modified Duke Criteria: 2 major and 1 minor criteria, or 1 major and 3 minor criteria, or 5 minor criteria.
351
What constitutes major criteria in the Modified Duke Criteria?
Positive blood culture of typical organism (2 cultures) or evidence of endocardial involvement.
352
What are examples of minor criteria in the Modified Duke Criteria?
Predisposing heart condition or IV drug use, fever, vascular phenomenon, immunologic phenomenon, microbiologic criteria.
353
What are some physical exam findings in infective endocarditis?
Fever, Roth's spots, new or worsening heart murmur, splenomegaly, splinter hemorrhages, Janeway lesions, Osler nodes.
354
What complications can arise from infective endocarditis?
Cerebral complications such as cerebral embolism, intracranial hemorrhage, cerebral abscess.
355
What tests are included in the Modified Duke Criteria?
Blood cultures x 2, ESR, CBC, EKG, Echo, Brain CT if neuro deficits.
356
What is the initial treatment for patients with acute symptoms of infective endocarditis?
Empirical treatment with vancomycin.
357
What is the long-term treatment for infective endocarditis?
6 weeks of IV antibiotics with a PIC line for patients who are not IV drug users.
358
What prophylaxis is required for certain patients with infective endocarditis?
Amoxicillin, unless they cannot take oral meds or are allergic.
359
What procedures require prophylaxis for infective endocarditis?
Some dental work, invasive respiratory procedures, skin/soft tissue procedures over infected skin, cardiac surgery with prosthetic material.
360
What is acute infective endocarditis?
Develops suddenly and may become life-threatening within days.
361
What is subacute infective endocarditis?
Develops gradually over weeks to months but can also be life-threatening.
362
What is noninfective endocarditis?
Blood clots that do not contain microorganisms form on heart valves and adjacent endocardium.
363
What is pericarditis?
Inflammation of the pericardium, often causing chest pain.
364
What are the common causes of pericarditis?
Infectious (viral, bacterial, TB), systemic diseases (autoimmune, neoplasms), radiation, drug toxicity, and idiopathic cases.
365
What percentage of hospital admissions does pericarditis account for?
0.2% of hospital admissions and about 5% of patients with nonischemic chest pain in the ER.
366
What are the symptoms of pericarditis?
Pleuritic chest pain, fever, malaise, myalgia, and severe sharp chest pain that may radiate.
367
What is Beck's triad in cardiac tamponade?
Hypotension, soft or absent heart sounds, and jugular venous distension.
368
What is the diagnostic method for cardiac tamponade?
Ultrasound, with supportive tests including chest X-ray and EKG.
369
What is rheumatic fever?
A systemic immune process following beta-hemolytic streptococcal infection of the pharynx.
370
What are the major symptoms of rheumatic fever?
Fever, carditis, arthritis, chorea, subcutaneous nodules, and erythema marginatum.
371
What is the diagnostic criteria for rheumatic fever?
2 major criteria or 1 major and 2 minor criteria.
372
What is the treatment for rheumatic fever?
Symptomatic relief with NSAIDs, eradication of GABHS with penicillin, and prophylaxis against future infections.
373
What are the long-term risks of rheumatic fever?
It can lead to rheumatic heart disease, which increases the risk for endocarditis.
374
What are valvular disorders?
Heart valves can become diseased, leading to abnormal valve movement and blood flow, causing murmurs.
375
Which side of the heart is most effective?
The left side of the heart is most effective due to increased pressure of systolic circulation.
376
Is pulmonic valve disease common?
Pulmonic valve disease is rare.
377
What is regurgitation in valvular disorders?
Regurgitation is when blood flows the wrong way and can occur with prolapse.
378
What is mitral stenosis?
Mid diastolic with mitral valve opening snap, best heard at apex. Presumed to be caused by rheumatic heart disease (unusual in the US).
379
What are the symptoms of mitral stenosis?
Symptoms worsen with exertion and can lead to heart failure.
380
How is mitral stenosis diagnosed?
Diagnosis is made via echocardiogram.
381
What are the treatment options for mitral stenosis?
Treatment options include balloon valvuloplasty and valve replacement.
382
Mitral regurgitation
Systolic heart failure heard at the apex and radiates to axilla
## Footnote
DX: Echo, TX: Valve replacement
383
Aortic stenosis
Crescendo-decrescendo murmur heard at the right sternal border, 2nd ICS, radiates to carotids. Occurs due to calcification
## Footnote
SX: Angina, syncope, dyspnea, fatigue; DX: Echo, TX: Balloon valvuloplasty, valve replacement
384
Aortic regurgitation
Early diastolic decrescendo murmur with HTN is a common cause
## Footnote
SX: HF, dyspnea; DX: Echo, TX: Valve replacement
385
Tricuspid Stenosis
Late diastolic murmur, very rare. Caused by rheumatologic disease, endocarditis/IV drug use
## Footnote
SX: Right sided HF w/ hepatomegaly, ascites, dependent edema; DX: Echo, TX: Valve replacement
386
Tricuspid Regurgitation
Pansystolic murmur. Mild is common, severe is rare. Caused by infective endocarditis, trauma
## Footnote
SX: Right sided heart failure with hepatomegaly, ascites, dependent edema; DX: Echo, TX: For mild - diuretics, for moderate/severe - repair or replacement
387
Anticoagulation for mechanical valves
Lifelong anticoagulation with COUMADIN is indicated - target INR 2.5-3.0
## Footnote
All pts on lifelong ASA
388
Anticoagulation for bioprosthetic valves
Anticoagulation for 3 months (Coumadin or DOAC)
## Footnote
Pts with bioprosthetics - no need for lifelong anticoagulation, but shorter durability and higher reoperation rates.
389
What is AAA?
AAA refers to abdominal aortic aneurysm, a full thickness dilation of the aorta resulting in a diameter > 3 cm or exceeding normal vessel diameter by > 50%.
390
What is the normal aortic diameter?
Normal aortic diameter varies based on age, sex, body size, and blood pressure, but the infrarenal aortic diameter is typically 2.7 cm for most older men and slightly less for women.
391
What are the risk factors for AAA?
Risk factors include smoking, male sex, family history of AAA, age, hypertension, hyperlipidemia, and genetics (e.g., Marfan syndrome).
392
What causes AAA?
AAA is caused by failure of structural proteins (elastin and collagen), inflammation and immune responses (smoking), biomechanical wall stress (hypertension), and atherosclerosis.
393
What is the screening recommendation for men aged 65-75 who have ever smoked?
Men aged 65-75 who have ever smoked have a screening rating of B.
394
What is the screening recommendation for men aged 65-75 who have never smoked?
Men aged 65-75 who have never smoked have a screening rating of C.
395
What is the screening recommendation for women who have never smoked?
Women who have never smoked have a screening rating of D.
396
What is the screening recommendation for everyone else?
Everyone else has an I rating for screening.
397
What is the follow-up for AAA found on screening?
If AAA is found, follow-up depends on size:
- >2.5 cm but <3.0 cm: rescreening after 10 years
- 3.0-3.9 cm: imaging at 3 year intervals
- 4.0-4.9 cm: imaging at 12 month intervals
- 5.0-5.4 cm: imaging at 6 month intervals.
398
What are the symptoms of AAA?
AAA is usually asymptomatic. When symptomatic without dissection or rupture, it shows as chronic abdominal pain or discomfort, low back pain, and flank pain. With dissection/rupture, symptoms include sudden onset abdominal, back, or flank pain with syncope or shock.
399
How is AAA diagnosed?
AAA is often asymptomatic and usually discovered incidentally by physical exam, abdominal ultrasound, CT, or other imaging. Ultrasound has high accuracy for diagnosing AAA.
400
What is the treatment for AAA?
Treatment includes risk reduction (quit smoking, increase physical activity), elective repair for AAA > 5.5 cm, or rapid expansion or symptomatic cases. Options include endovascular vs open repair.
401
When is endovascular repair preferred?
Endovascular repair may be preferred in patients who are at a high level of perioperative risk.
402
When is open surgical repair preferred?
Open surgical repair may be preferred for younger patients who have a low or average perioperative risk.
403
What is the mortality rate for ruptured AAA?
An aneurysm or dissection can rupture, with a 90% mortality rate.
404
What is the classic triad of symptoms for AAA rupture?
The classic triad includes abdominal pain, hypotension, and a pulsatile mass.
405
What is a thoracic aneurysm?
A permanent dilation of a segment of the thoracic aorta to greater than or equal to 150% normal diameter usually caused by atherosclerosis.
406
What percentage of thoracic aneurysms are asymptomatic?
Usually 90% are asymptomatic and found on imaging done for other purposes.
407
What conditions can cause thoracic aneurysms?
Marfan syndrome, Ehler’s Danlos syndrome (EDS), Turner’s syndrome, autosomal dominant polycystic kidney disease.
408
What are the symptoms of a thoracic aneurysm?
Usually asymptomatic until dissection or rupture; can cause dyspnea, stridor, brassy cough, dysphagia, and edema in the neck and arms.
409
How is a thoracic aneurysm diagnosed?
Seen incidentally on imaging (CT or US) or as abnormalities in aortic size/contour on CXR.
410
When is surgery indicated for a thoracic aneurysm?
If symptomatic, if rapidly growing, if ascending, if aortic arch, or if descending.
411
What is an aortic dissection?
A tear in the intima, allowing blood to separate the intima and media.
412
What are the symptoms of an aortic dissection?
Sudden searing chest or abdominal pain with radiation to back, abdomen, or neck in a hypertensive patient.
413
How is an aortic dissection diagnosed?
CT will show widened mediastinum on X-ray.
414
What is the treatment for an aortic dissection?
Aggressive lowering of BP with beta blockers; surgical vs medical management.
415
What is peripheral arterial disease (PAD)?
Refers to stenosis, occlusion, or aneurysmal dilation of lower extremity arterial branches, primarily caused by atherosclerosis.
416
What are the risk factors for PAD?
Age, diabetes, history of smoking, hypertension, hyperlipidemia.
417
What are the primary sites of involvement in PAD?
Iliac arteries (30%), femoral and popliteal arteries (80-90%), tibial and peroneal arteries (40-50%).
418
What are the symptoms of PAD?
Intermittent claudication, atypical leg pain, nonhealing ulcers, or limb ischemia.
419
How is PAD diagnosed?
Measure ankle-brachial index (ABI), systolic pressure in upper extremities, and CTA or MRA.
420
What is the treatment for chronic PAD?
Risk modification, antiplatelet (ASA or clopidogrel), cilostazol, revascularization (endovascular and bypass surgery).
421
What is acute limb ischemia (ALI)?
A condition lasting less than 2 weeks requiring systemic anticoagulation (heparin).
422
What are the categories of ALI?
Viable (urgent revascularization), threatened (emergency revascularization), irreversible (amputation).
423
What is the clinical presentation of Arterial Embolism/Thrombosis?
Sudden pain in an extremity with absent distal pulses, usually accompanied by neuro dysfunction such as numbness, weakness, and complete paralysis.
424
What are the common causes of emboli in Arterial Embolism/Thrombosis?
Emboli from the heart can occlude proximal arteries in lower extremities, often due to atrial fibrillation. Emboli from peripheral circulation are usually smaller and affect distal extremities.
425
What are the symptoms of Arterial Embolism/Thrombosis?
Sudden onset pain, coolness of extremity, loss of peripheral pulses by Doppler, pallor, and skin mottling.
426
What diagnostic methods are used for Arterial Embolism/Thrombosis?
CTA or MRA to localize occlusion, catheter-based angiography with fluoroscopy.
427
What is the treatment for Arterial Embolism/Thrombosis?
Revascularization within 3 hours is critical to prevent irreversible ischemia. Heparin and either endovascular or surgical revascularization are used.
428
What does VTE stand for?
VTE refers to Venous Thromboembolic disease, which includes conditions like PE/DVT and SVT.
429
What is Virchow’s triad?
Virchow’s triad consists of alterations in blood flow, endothelial injury, and alterations in blood constituents.
430
Where does DVT usually occur?
DVT usually occurs in the lower extremities, particularly in the iliac, femoral, and popliteal veins.
431
What are the symptoms of DVT?
Cramps, heaviness in the calf, increased visible skin veins, cyanotic discoloration, swelling or pitting edema, unilateral leg tenderness, Homan’s sign, and possible palpable cord in the calf.
432
What is the role of the liver in DVT?
The liver filters the blood and may play a role in the development of DVT.
433
What diagnostic tests are used for DVT?
D-dimer, Compression US, Contrast venography, and CT with IV contrast for splanchnic DVT.
434
What is the treatment for DVT?
No treatment needed for distal DVT if symptomatic and low risk for extension; all proximal DVT requires treatment. Anticoagulation for 3-6 months if provoked, indefinite if unprovoked.
435
What is Superficial Venous Thromboembolism?
Thrombosis and inflammation of a superficial vein.
436
What are the symptoms of Superficial Venous Thromboembolism?
Painful, warm, red, tender, palpable cord-like structure usually found in lower extremities.
437
What diagnostic method is used for Superficial Venous Thromboembolism?
Ultrasound to assess the extent and check for DVT.
438
What is the treatment for Superficial Venous Thromboembolism?
Compression stockings and ambulation. NSAIDs if less than 5 cm and no medical risk for DVT; anticoagulation required if greater than 5 cm or at risk for DVT.
439
What are varicose veins?
Dilated, palpable, often tortuous subcutaneous veins > 3 mm in diameter involving saphenous veins, saphenous tributaries, and/or superficial leg veins.
440
What are the risk factors for varicose veins?
Age, pregnancy, females, family history, upright position/prolonged standing, increased height, chronic constipation, DVT.
441
What is the primary physical exam finding for varicose veins?
Reflux through incompetent valves.
442
What are the symptoms of varicose veins?
Cosmetically unappealing superficial veins of lower extremities (often asymptomatic). If symptoms present, may consist of localized pain, burning, itching, tingling, general achiness, heaviness, tiredness, cramping, throbbing, restlessness, and/or swelling in leg.
443
What is the physical exam finding for varicose veins?
Dilated, tortuous veins of the thigh and calf seen better with patient standing.
444
What is the diagnostic method for varicose veins?
Clinical if presence of varicosity > 3 mm on physical exam in upright position. Duplex US to assess severity (looks for reflux).
445
What is the first-line treatment for varicose veins?
Try compression therapy first. Avoid long periods of standing.
446
What are the potential treatments if varicose veins do not improve?
Endovascular thermal ablation, endovascular chemical ablation (sclerotherapy), or surgery.
447
What is chronic venous insufficiency?
Incompetent venous valves and the presence of venous hypertension, which may be caused by primary venous disease, secondary to venous disease (DVT), or congenital abnormality.
448
What are the symptoms of chronic venous insufficiency?
Lower limb symptoms including burning/tingling, nocturnal leg cramping, chronic ulcerations of the medial or anterior aspect of the ankle, hyperpigmentation, and stasis dermatitis.
449
What is the diagnostic method for chronic venous insufficiency?
Duplex US.
450
What is the treatment for chronic venous insufficiency?
Compression, treatment of underlying issues, and wound care for ulcerations.
451
What is an arteriovenous malformation?
Congenital defect in the vascular system consisting of tangles of abnormal blood vessels where arteries and veins are connected without a capillary bed.
452
Where can arteriovenous malformations occur?
Can occur anywhere in the body, but brain and spinal cord are at high risk of hemorrhage.
453
What drug is given as a rapid IV push over 1-3 seconds?
Adenosine
454
Identify the axis: QRS negative in 1, positive in aVF?
RAD
455
What do you use after resuscitation of V tach to control the rate?
Amiodarone
456
EKG: inverted P waves, not junctional?
Ectopic atrial rhythm
457
How long of pause is considered a syncope risk?
6 secs
458
What are lateral leads?
I, aVL, V5, V6
459
26 y/o pregnant at 19 weeks- what med do you avoid?
Lisinopril
460
Your patient has diabetes insipidus, what medication are you putting them on?
Vasopressin
461
Patient was in a fib with RVR, what medication are you going to give them?
Diltiazem
462
Migraine headache prophylaxis?
Verapamil
463
BB WARNING: fluid and electrolyte depletion?
Lasix
464
MOA of vasopressin saving water?
Promotes aquaporins in the collecting ducts
465
Delta wave and decreased PR interval?
WPW
466
Medication for ventricular arrhythmias that has a BBW for proarrhythmic effects?
Procainamide
467
EKG shows monomorphic wide complexes?
V tach
468
Diffuse ST elevations across almost all leads?
Pericarditis
469
Diabetic female (60s) has hypertension, what medications can we put her on?
ACE inhibitor
470
Most common finding in large PE?
Sinus tach
471
Med to give if atropine doesn't work on symptomatic bradycardia?
Epinephrine
472
EKG shows asystole, what ALS medication is used for this?
Epinephrine
473
Your patient has vasospastic angina, what medication are you going to give them?
Amlodipine
474
Take 325 mg aspirin 30 min before which med?
Niacin to reduce or prevent flushing
475
MI in anterior leads, which artery is occluded?
LAD
476
Your patient has decompensated heart failure, what med can we prescribe?
Dobutamine
477
What medication is contraindicated in pregnancy (fetal toxicity)?
ARBs
478
Atrial septal defect finding?
RBBB
