Cardio Flashcards
(208 cards)
1
Q
What are RF for stable angina?
A
1) DM
2) low LDL
3) HTN
4) family hx
5) age (males >45yo; females > 55yo)
6) family hx
2
Q
How to tx stable angina?
A
lifestyle changes and ASA in all
mild- nitrates + beta blockers (atenolol or metoprolol)
CCB if nitrates + beta blockers don’t help
mod - revascularization via PCI (angioplasty) or CABG
severe - CABG
3
Q
What labs/imaging to run for stable angina?
A
- stress test
- pharmacologic stress test (if cannot do exercise stress test)
- holter
- cardiac catherization w/ coronary angiography
4
Q
What are some beta blockers?
A
atenolol
metoprolol
5
Q
Pt has chest pain upon exertion but goes away with rest?
A
stable angina
6
Q
Pt has chest pain during rest?
A
unstable angina OR non-stemi
7
Q
How to differentiate between unstable angina and non-stemi?
A
cardiac enzymes
if elevated = non-stemi
8
Q
Labs/imaging for unstable anigina?
A
EKG - looks like non-stemi –> get cardia enzymes
coronary angiograph
9
Q
Tx for unstable angina?
A
admit + IV + O2 +/- morphine
1) ASA
2) first line - nitrates + beta blockers
-clopidogrel
-LMWH (low molecular wt heparin) –> Enoxaparin
+/- angioplasty or CABG - use TIMI score
3) discharge: ASA + nitrates + beta blocker
10
Q
Pt has chest pains occasionally at night?
A
variant/prinzmetal angina
11
Q
RF for varient/prinzmetal angina?
A
smoking
12
Q
Hallmark for varient/prinzmetal angina?
A
transient ST segment ELEVATION w/ chest pain
13
Q
What else is associated with chest pains in varient/prinzmetal angina?
A
ventricular dyshythmias
14
Q
Tx for varient/prinzmetal angina?
A
CCB + nitrates
15
Q
Dx for varient prinzmetal angina?
A
coronary angiography - coronary vasopasms w/ chest pains
16
Q
Pt has substernal chest pain for 30min and diaphoresis?
A
MI
17
Q
What EKG findings for MI?
A
peaked T wave - EARLY, usually missed
ST elevation -diagnostic
Q waves - previous MI
ST depression
18
Q
CXR for MI pts?
A
CLEAR lungs
19
Q
What does ST elevation mean?
A
transmural - LARGER
20
Q
What is the gold standard for dx MI?
A
troponin
21
Q
Pt has “crushing” pain that radiates?
A
MI
22
Q
What population has asymptomatic sx w/MI?
A
elderly
DM
women
23
Q
Labs/imaging for MI?
A
EKG
troponin
24
Q
When should troponin be high and normalize?
A
check q8hrs for 24hrs
doubles 5-8hrs then normalize 5-14days later
25
What to do if pt has non-ST elevation?
check troponin - if high --> MI
26
What other lab can be used for MI?
CK MB
27
Tx for MI?
1) admit + IV + O2 + morphine
2) ASA + Beta Blocker + Nitrates + ACE-I + statins + LMWH
3) +/- CABG/stent/angioplasty/tPA (Alteplase)
28
Meds for discharge-MI?
ASA
Beta Blocker
ACE-I
Statins
29
What drug should be avoided in stable angina but used in unstable and MI?
LMWH - enoxaparin
30
When can tPA be used (time)?
w/in 12 hrs
31
When should you NEVER use tPA?
head injury
bleeding (internal)
stroke
surgery
32
Pt has orthopnea and paroxysmal nocturnal dyspnea and diaphoresis?
lef sided CHF
33
What is left sided CHF?
fluid backs up into the lungs
34
What is the biggest cx of CHF?
HTN
35
What is the pathophys behind CHF?
CO is too low --> renin-angiotensin-aldosterone is activated --> increase in preload
36
What are 2 types of CHF?
systolic - problem squeezing
| diastolic - problem filling
37
What is happening in systolic CHF?
cardiomyopathy - too big and won't squeeze effectively
38
Pt has orthopnea and paroxysmal nocturnal dyspnea and diaphoresis -what to expect on PE?
```
dullness on percussion
rales
S3 gallop
displaced PMI
rales
```
39
What is happening in diastolic CHF?
myocardial hypertrophy - too much muscle and will not fill all the way but squeezing is fine
40
What are the NYAH classifications?
I - only w/ aggressive activity
II - climbing stairs; little limitation
III - daily activities are affected; mod limitation
IV - sx at rest; BAD
41
Pt has pitting edema, JVD, ascities?
right sided CHF
42
What test/labs to order for CHF?
```
CXR
EKG
cardiac enzymes - r/o MI
CBC - r/o anemia (can cx CHF)
echocardiogram - first line and gold standard
bnp
```
43
What to see on CXR - CHF?
cardiomegaly
| Kerle B lines
44
Tx for CHF-systolic?
```
mild/I-II
-first line: ACE-I
+/-diuretic
mod/II-III
-ACE-I + diuretic + Beta blocker
severe/III-IV
-ACE-I + diuretic + Beta blocker + digoxin
```
45
Discharge drugs for CHF systolic?
ACE-I
| beta-blockers
46
What to use if pt cannot use ACE-I?
ARB
47
What drugs are CONTRAINDICATED in CHF pts?
metformin
| NSAIDs
48
Tx for diastolic CHF?
```
lifestyle changes
beta-blockers
diuretics
digoxin
+/-ACE-I
```
49
Pt comes in with S3 + S4, dyspnea, pitting edema?
dilated cardiomyopathy
50
Cx of cardiomyoptahy?
idiopathic
| CAD
51
How to dx dilated cardiomyopathy?
CXR - cardiomegaly, Kerley B lines , pleural effusion
| echocardiogram - gold standard - dilated chamber
52
How to tx dilated cardiomyopathy?
admit + nitrate + O2 + B blockers + diuretics + ACE-I/ARB
| ASA at discharge
53
Pt suddenly drops dead - literally?
dilated cardiomyopathy
| most likely hypertrophic cardiomyopathy
54
Is hypertrophic cardiomyopathy genetic?
yes - autosomal dominant
55
YOUNG pt has chest pain on exertion, syncope, and palpitations?
hypertrophic cardiomyopathy
56
What is the pathophys of hypertrophic cardiomyopathy?
diastolic problem - overworks during exercise causing increase in HR + contractility
57
How to dx hypertrophic cardiomyopathy?
echocardiogram
| family hx
58
How to tx hypertrophic cardiomyopathy?
AVOID STRENUOUS EXERCISE
B blocker - first line
CCB if B blocker doesnt work
+/- diuretics
59
Young male w/ lyme dz + fatigue, fever, chest pain, pericarditis?
myocarditis
60
How to tx myocarditis?
supportive - usually viral infxn
61
How to monitor myocarditis?
cardiac enzymes - troponin
62
Pt has postviral illness + chest pain when breathing?
acute pericarditis
63
Complications of acute pericarditis?
pericardial effusion
| cardiac tamponade
64
Other cx of acute peridicitis?
```
acute MI OR after MI
usually viral (coxsackivirus, EBV, influenza) or bacterial (TB)
```
65
Pt has chest pain, pericardial friction rub, what to expect on EKG?
diffuse ST elevation + PR depression
66
Pt has acute pericarditis - what temporarily relieves pain? What would you hear on PE?
leaning forward
| pericardial friction rub
67
How to tx acute pericarditis?
self limiting
| NSAIDs
68
Pt has ascities + hepatomegaly + distended neck veins?
cirrhosis
| constrictive pericarditis
69
Pathophys of constrictive pericarditis?
pericarditis becomes very fibrous and scarred --> causes diastolic dsyfxn
70
Cx of constrictive pericarditis?
idiopathic
| TB
71
Pt has muffled heart sounds, dullness at LEFT lung base, soft PMI?
pericardial effusion
72
Pt is SICK, JVD, ascities, and dependent edema?
constrictive pericarditis
73
How to dx constrictive pericarditis?
echocardiogram - increased pericardial thickness
| CT/MRI - increased pericardial thickness
74
Tx of constrictive pericarditis?
+/- diuretics
| tx underlying cx
75
What can pericardial effusion lead to?
cardiac tamponade
76
Cause of acute pericarditis?
pericardial effusion
77
How to dx pericardial effusion?
echocardiogram - first line
| CXR - silhouette; water bottle sign
78
How to tx pericardial effusion?
depends on pt's current status
| pericardiocentesis is NOT indicated
79
Pt has stab wound on chest?
cardiac tamponade
80
What is an iatrogenic cause of cadiac tamponade?
central line
pacemaker placement
pericardiocentesis
81
What is important to know about cardiac tamponade?
how FAST fluid is getting in NOT how MUCH
82
Pathophys of cardiac tamponade?
too much fluid on the OUTSIDE of the heart --> problems with filling (diastolic dysfxn)
83
What is the beck's triad?
hypotensive
muffled heart sounds
JVD
84
what is pulses paradoxus?
late decrease of arterial pressure when breathing in
85
How to dx cardiac tamponade?
echocardiogram - diagnostic
| CXR - silhouette; CLEAR LUNGS
86
How to tx if cardiac tamponade is NOT hemorrhagic and pt is stable?
observe with echocardiograms and CXR
87
How to tx if pt is unstable but non hemorrhagic cardaic tamponade?
pericadriocentesis
88
What can mitral stenosis eventually lead to?
pulmonary HTN
| right ventricular failure
89
How to diagnose mitral stenosis?
echocardiogram - diagnostic: big left atrium, thick mitral valve
CXR: large left atrium
90
How to tx mitral stenosis?
mild: diuretics and B blockers
mod to severe: surgery - percutaneous balloon valvuloplasty
a fib: anticoagulant + warfarin
91
Cx of mitral stenosis?
rheumatic fever
92
What is the cx of aortic stenosis?
age
rheumatic fever
congenital
93
What haps to the heart during aortic stenosis?
the left ventricle gets overworked --> big
94
Sx of aortic stenosis?
angina
syncope
HF sx: dyspnea
95
How to dx aortic stenosis?
echocardiogram - diagnostic: big LV and LA; aortic valve is calcified
CXR: calcified valve is late finding
cardiac cath: DEFINITIVE dx test: can exactly measure the valve
96
Tx of aortic stenosis?
valve replacement
97
What is the sx timeline for aortic stenosis and aortic regurgitaiton?
angina --> syncope --> HF
98
Pathophys of aortic regurgitation?
the leaflet valve is not closing all the way so blood is getting leaked back into heart --> LV pushes harder --> overworked --> big
99
What are cx for ACUTE aortic regurgitation?
infective endocarditis
trauma
aortic dissection
100
What are cxs for CHRONIC aortic regurgitation?
valvular - rheumatic fever, bicuspid aortic valve, MARFAN
| aortic - osteogenesis imperfecta, aortic dissection, reiter's sx, HTN
101
What are special PE for aortic regurgitation?
de musset sign - head bobbing
WIDENING PULSE PRESSURE: increased systolic w/ decreasing diastolic
water hammering pulse/ Corrigan's
102
How to dx aortic regurgitation?
CXR - big LV
echocardiogram - big LV
cardiac cath - determine valve damage
103
How to tx aortic regurgitation?
surgery is definitive (replacement)
| mild- observe w/ VASODILATORS, ACE-I/ARB
104
Endocarditis can cause what to the valves?
aortic regurgitaiton
| mitral regurgitation
105
What can rheumatic fever cause to the valve?
mitral stenosis
aortic regurgitation
mitral regurgitation
rheumatic heart dz
106
What can Marfan sx cause to the valve?
aortic regurgitation
mitral regurgitation
mitral valve prolapse
107
Dilated LV on CXR/echocardiogram?
mitral stenosis
aortic stenosis
aortic regurgitation
mitral regurgitation
108
How to tx mitral regurgitation?
vasodilators + surgery
109
Pulsatile liver?
tricuspid valve regurgitation
110
Who are at high risk for tricuspid regurgitation?
IV drug users
111
How to dx tricuspid regurgitation?
echocardiogram only
112
How to tx tricuspid regurgitation?
diuretics (B blockers, ARB-I)
| valve REPLACEMENT IS RARE -just fix the valve
113
Hypertrophic cadriomyopathy increase/decrease with squatting/valsalva?
increase
114
How to dx mitral valve prolapse?
echocardiogram only
115
How to tx mitral valve prolapse?
asymptomatic - nothing
chest pain - beta blocker
surgery is NOT required
116
Pathophys of rheumatic heart dz?
complication of strep A
| occurs after rheumatic fever
117
How to dx rheumatic fever?
2 major or 1 major + 2 minor
major: polyarthritis, erythmema marginatum, cardiac probs, chorea, subcutaneous nodules
minor: fever, increase ESR, polyarthritis, hx of rheumatic fever, prolonged PR, hx of strep infxn
118
Tx of rheumatic heart dz?
tx strep from the start w/PCN or erythromycin
| rheumatic fever tx w/ NSAIDs
119
Pt has new heart murmur + fever?
infective endocarditis
120
What are the two types of endocarditis?
acute and subacute
121
Bug for acute endocarditis (nosocomial)? What kind of valve?
s aureus
| NORMAL VALVE
122
Bug for subacute (community)? What kind of valve?
strep viridans, enterococcus
| on DAMAGED valves
123
IV drug users are at high risk for?
tricuspid regurgitation
| endocarditis
124
Tx for endocarditis?
culture to find out which abx to use
125
What is the duke criteria used for?
endocarditis
126
Wide fixed splitting of S2?
atrial septal defec
127
What is hap to the heart w/ ASD?
right heart is working hard --> RV gets big
128
Sx of ASD?
if mild may be asymptomatic for life
| if not, 40yo start to feel sx similar to stable angina
129
Right bundle branch block on EKG?
ASD
130
What complication can occur 40yo+ w/ ASD?
pulmonary HTN
131
Tx for ASD?
nothing unless pt is symptomatic (surgery)
132
What sx for VSD?
```
if PVR (pulmonary vascular resistance) is 0 = CHF, lower respiratory infxn
if PVR is high = chest pain, dyspnea
```
133
How to dx VSD?
Echocardiogram
134
How to tx VSD?
if small - nothing
| if big - surgery
135
Who are at risk for coarctation of aorta?
turner sx
136
What are sx of coarctation of aorta?
delayed femoral pulses compared to radial
cold extremities
HA
leg fatigue
137
What dx coarctation of aorta?
CXR-notching of the ribs and "3"
138
Tx of coarctation of aorta?
surgery
139
Machine like murmur?
patent ductus arteriosus
140
Who are at high risk for PDA?
premature babies
141
What can kill pts with PDA?
HF and infective endocarditis
142
How to dx PDA?
echocardiogram
143
How to tx PDA?
surgery unless SEVERE PULMONARY HTN -> surgery is contraindicated
144
What keeps PDA open? close?
open: prostaglandins
closed: indomethacin
in newborns - use prostaglandins until hand off
145
What is tetralogy of fallot?
VSD
right ventricular hypertrophy
pulmonary artery stenosis
overriding aorta
146
Crescendo-decrescendo at left upper sternal border?
tetralogy of fallot
147
What is a tet spell? What is the most common sx?
when pt squats to increase SVR
| cyanotic
148
What is used to dx tetralogy of fallot?
echocardiogram
149
What is found on CXR w/ tetralogy of fallot?
boot shaped heart
150
How to tx tetralogy of fallot?
surgery
151
What organs should be inspected with hypertensive emergency and what will hap to those organs?
```
eyes: papilledema
CNS: altered mental status
kidneys: renal failure
heart: unstable angina, MI, CHF
lungs: pulmonary edema (CHF)
```
152
What could hypertensive emergency lead to?
posterior reversible encephalopathy syndrome
153
Pt has severe HA + HTN - steps to do?
1) lower Bp w/ hydralazine
2) CT scan to r/o bleeding
3) CT is neg --> LP
154
Pt has HA + visual disturbances + altered mental status?
hypertensive emergency
155
Pt has tearing/ripping/stabbing pain in chest, acute?
MI
| aortic dissection
156
What to do when differentiating MI and aortic dissection?
EKG - MI --> may be non stemi --> cardiac enzymes
| CXR - aortic dissection --> WIDENING MEDIASTINUM
157
What two areas can pt have pain for aortic dissection?
ascending - front
| descending - back
158
What is dx for aortic dissection?
CXR- can be used to r/o MI
TEE
CT/MRI
159
How to tx aortic dissection?
MEDICAL EMERGENCY
type A (ascending) - SURGERY
type b (descending) - medicine (B blocker) + morphine
NO TPA
160
Pt has cullen sign?
ecchymoses around umbilicus
| about to rupture AAA
161
What is the triad of ruptured AAA?
abdominal pain
hypotension
pulsatile abdominal mass
162
Who are at high risk for AAA?
Marfan sx
163
How to dx AAA?
US
| CT
164
How to tx AAA?
surgery
165
Pt has leg off the end of the bed and foot feels better?
peripheral vascular disease
166
What are other PE for dangerous peripheral vascular disease?
no hair
thick toenails
decreased skin temp
no pulses
167
Which peripheral vascular disease has good prognosis? Why?
intermittent claudication
| pain goes away w/ rest
168
Where does the pain occur the most in peripheral disease? Why?
distal metatarsals b/c it has the smallest arteries
169
Highest RF for peripheral disease? Most people have what as cx?
smoking
| underlying cardio prob - CHF, CAD
170
What is normal ABI? What is bad ABI?
0. 9-1.3
| 1. 3 - severe dz
171
What is the gold standard for peripheral disease?
arteriography
172
Who has the highest risk for peripheral disease?
DM
173
Tx for peripheral dz?
```
lifestyle changes
PDE inhibitor (vasodilator)
surgery -angioplasty, bypass IF pt has pain w/ rest and affects life activties
```
174
Where it is likely for a clot to occur in LE?
femoral artery
175
What are the 6 P's for acute arterial occlusion? What else can this be used for?
```
Pain
Pallor
Pulseless
Paresthesias
Paralysis
Polar (Cold)
can also be used for compartment sx
```
176
Tx for acute arterial occlusion?
anticoags
| surgery
177
What is the virchow triad?
injury to vessel
stasis
hypercoagulability
178
Pt has swollen leg after taking OCP?
DVT
179
First line imaging for DVT?
doppler
180
If doppler is positive for DVT - next step?
anitcoagulation
181
How to tx and manage DVT?
heparin bolus then warfarin
| manage w/ PTT and INR
182
If pt has right sided CHF + DVT - how to tx?
tpa
183
Hx of DVT can cause...?
destruction of valves
| does not allow blood to pass from superficial to deep
184
What does hx of DVT lead to?
ambulatory venous HTN --> edema d/t increase interstitial fluid accumulation --> weeping of skin --> brown color of the skin
185
How to tx chronic venous insufficiency? Complications? and how to tx complications?
stockings
avoid long standing time
elevate leg
ulcers can occur - dressing/unna boot
186
Pt has hypotension. oliguria, tachycardia, and altered mental status?
shock!
187
Pt has fever? Type of shock?
septic
188
Pt has trauma, GI bleeding, vomiting/diarrhea? Type of shock?
hypovolemic shock
189
Pt has leg swelling and skin color changes but relieved when leg is elevated?
chronic venous insufficiency
190
Pt has JVD? Type of shock?
cardiogenic
191
Pt has MI, angina, heart disease? Type of shock?
cardiogenic
192
Pt has spinal cord injury? Type of shock?
neurogenic shock
193
What is the first step to tx shock?
fluids-make sure pt is hemodynamically stable
| vasopressors (dopamine/norepinepherine)
194
What to keep in mind for cardiogenic shock pts when tx?
fluids can overexert the heart --> use diuretics if LV is too high
195
What are some causes for hypovolemic shock?
hemorrhage - trauma
| nonhemorrhagic- severe dehydration
196
What is pre HTN?
120/80+
197
What is stage I and stage II HTN?
>140/90 and >160-/100
198
What is OK for 80yo - HTN?
150
199
What is HTN ER?
220/125
200
What is malignant HTN?
HTN + sx
201
How to tx stage I HTN? stage II?
over 60yo: CCB/ diuretic + ACE/ARB
| younger 60: ACE/ARB + CCB/diuretic
202
ATP III - cholesterol: norm, borderline, high?
norm: 200
borderline: 240
high: 240+
203
ATP III - LDL: norm, borderline, high, very high?
norm: 130
borderline 160
high 190
very high 190+
204
ATP III - HDL: low, high?
low: less than 40
high: more than 60
205
ATP IIII - triglyceride: norm, borderline, high, very high?
norm: 150
borderline: 200
high: 500
very high: 500+
206
ATP IV - mod statin?
clinical ASVCD + 75yo OR cannot use high statin
LDL is lower than 190 + DM1/2+40-75yo
7.5% ASCVD + 40-75yo
207
ATPIV - severe statin?
clinical ASVCD + less than 75yo
LDL greater than 190
LDL less than 190 + 7.5% ASCVD + DM1/2
208
Dressler's sx?
low grade fever + pleuretic chest pain + pericardial effusion AFTER injury to heart (2wks post MI)
