CARDIO Flashcards
(114 cards)
1
Q
Murmur of MVP
A
Late systolic murmur with a
Mid SYSTOLIC click
2
Q
Opening Snap
A
Mitral stenosis
3
Q
Fixed splitting
A
ASD
4
Q
Loud P2, split S2
A
Pulmonary HTN
5
Q
Paradoxical Split/ Reverse splitting/ P2 closes earlier than A2
A
AS, LBBB, HTN
6
Q
Pericardial friction rub/ pericardial knock
A
Constrictive Pericarditis
*Sharp early diastolic sound
7
Q
Physiologic Split
A
A2 comes before P2
8
Q
Pulsus Tardus et parvus
A
Aortic stenosis
9
Q
Pulsus Bisfiriens
A
HOCM
10
Q
Pulsus Alternans
Cheyne-Stokes Respiration
A
Severe heart failure
11
Q
Pulsus Paradoxus
A
Cardiac tamponade
SVC syndrome
Pulmonary Obstruction
12
Q
Late diastolic murmur with a “plop”
A
Atrial Myxoma
13
Q
Continuous murmur, 3rd L ICS
A
PDA
14
Q
What happens to murmurs with handgrip/phenylephrine?
A
All murmurs will increase (due to increased afterload) EXCEPT HOCM, MVP, AS
15
Q
What happens to murmurs with amyl nitrite?
A
All murmurs will decrease (due to decreased afterload) EXCEPT MVP, HOCM, AS
16
Q
Post PVC what happens to murmur of HOCM, MVP, AS?
A
HOCM, AS - increase
MVP- decrease
17
Q
Increased neck vein distention on inspiration?
A
Kussmaul’s sign
Found in constrictive pericarditis, cardiac tamponade, RV infarct, pulmonary (BA, COPD), abdominal compartment syndrome
18
Q
RCA supplies what
A
Inferior, posterior, RV
19
Q
LAD supplies what
A
Anteroseptal, apicolateral
20
Q
L circumflex supplies what
A
Apicolateral
21
Q
Post descending artery supplies what
A
Apical
22
Q
Diagonal branch supplies what
A
High lateral
23
Q
When to use MUGA scan
A
To det EF in pxs with wall motion ab(N); EF poor prognosticating factor for MI
24
Q
When is Exercise stress test +
A
ST elevation
ST dep > 1mm for > 0.08 sec
25
When to stop stress test
Symptomatic (CP/SOB)
Vtach
ST dep > 2 mm
SBP drops > 15 mmHg
26
When to do cardiac cath?
Poor prognostic factor on stress test
Post infarct angina
UA still symptomatic despite tx or becomes NSTEMI (+ ekg, cardiac enz)
27
Findings in Microvascular Angina
CP, EKG neg, Stress test reversible ischemia, cath neg
TX: BB, nitrates, CCB
28
Wellens Syndrome
ST dep in V2-V4
29
Indications for PCI
- STEMI > 12hrs
- TPA contraindicated
- 75 years
30
Indications for thrombolysis
-STEMI
31
T/F in pxs going for PCI, clopidogrel should be used
True
32
T/F in pxs going for cabg, clopidogrel should be used
False
33
When is CABG better than PCI
L main dse
DM w/ CAD
3V dse with dec EF
2V dse with Involvement of proximal LAD & low EF
34
Dressler's syndrome
Post-MI pericarditis
Tx: high dose ASA (6-8g/d) or ibuprofen 800 mg TID
35
T/F Mortality benefit of ICD > 40 days post-MI, warfarin in large ant wall MI x 3-6mos
T
36
T/F Vtach & Vfib within 48hrs postMI need long term therapy
F
37
Mech of reperfusion arrhythmias
Change in frequency fr accumulated Ca
38
What to do if px has sustained Vtach 48hrs after MI?
Treat with amio (if stable), defibrillate if unstable, then place ICD
*Vtach > 48h post MI is a predictor of mortality after discharge
39
Vtach post MI, with recurrent discharges from ICD?
Start amiodarone
If persistent, radiofrequency ablation
40
How many mos after MI should you do elective surgery?
After 6 mos
41
Treatment for recurrent pericarditis
Colchicine
42
Most common cause of constrictive pericarditis?
Post CABG
43
Square root sign
Constrictive pericarditis
Also with:
Pericardial knock (early 3rd heart sound)
Pericardial friction rub
Heart pressures are within 5mmHg of each other
44
Treatment of constrictive pericarditis
Surgical stripping
45
Most common cause of CHF
Ischemic
Also caused by:
Dilated CMP, valvular dse, congenital heart dse
46
Drug shown to be of most benefit in HFpEF
Candesartan
47
ACE-I with mortality benefit in MI
Ramipril (fr studies)
48
ACE-I with mortality benefit in TIA
Perindopril
49
Most common cause of decompensated CHF
Inc Na intake
50
If px with CHF becomes hyperkalemic on ACE-I what to do?
D/C Ace-I and start hydralazine-isordil
51
Flow of drugs in CHF
Diuretics for acute decompensation -> ACE-I -> BB -> +/- spironolactone
52
When to put ICD in CHF?
After 3 mos of maximal medical therapy (non-ischemic cause),40 days after MI (ischemic)
53
Unilateral gynecomastia on spironolactone?
Biopsy
54
Bilateral gynecomastia on spironolactone?
D/C spiro and start eplerenone
Alternative to eplerenone?
Amiloride
55
Poor prognostic factors in CHF
```
S3
HypoNa
PCWP > 12
PAP > 50
peak O2 uptake
```
56
Which coxsackie virus causes viral myocarditis?
B
57
Never drugs in CHF
NSAIDs
Glitazones & Metformin (in advanced CHF)
Cilostazol
CCB
58
Symmetrical hypertrophy on echo
Athlete's heart
DM
Obesity
59
Poor prognostic factors for HOCM
Familial, FHx of sudden cardiac death
Age 3cm
Failure to inc SBP by 20mmHg during exercise
60
Echo definition of severe AS
Gradient > 40mmHg, valve area
61
Asymptomatic Mild AS, echo frequency?
3-5yrs
62
Asymptomatic moderate AS, frequency of echo?
1-2 yrs
63
Asymptomatic severe AS, frequency of echo?
6-12 mos
64
T/F compared to surgery, complications w/ TAVR are increased
T
65
Criteria for repair in AS
Severe AS w/ symptoms
If asymptomatic, do serial echo depending on valve area
66
Criteria for repair in AR
EF
67
When to do echo for AR with LVED 60-70
Echo every 12mos
68
When to do echo for AR with LVED 70-75
Every 3-6mos
69
What to do for AR with LVED >75
Surgery
70
Criteria for MS repair
Valve area
71
Criteria for MR repair
symptoms
| EF
72
When to repair PDA
Percutaneous repair is beneficial at all times
73
When to repair ASD/VSD
When L to R shunt is > 1.7:1
74
Pathology in septum primum defect
Septum primum did not connect w/ endocardial cushion
-assoc w/ MR
75
Pathology in septum secundum defect
Incomplete covering of foramen ovale by septum primum
Associated w/ MVP
76
Pathology in patent foramen ovale
Incomplete fusion of septum primum
77
Right to left shunt
Eisenmenger syndrome
78
The most common presentation of eisenmenger syndrome
Cyanosis
79
3 sign is seen in?
Coarctation of the aorta
80
Most common associated congenital anomaly in coarctation of the aorta
Bicuspid aortic valve
81
How often is echo done in Marfan's?
Yearly until aortic dilatation is 4.5 cm then every 6 mos til 5.5 cm then repair
82
Best way to prevent aortic dissection in Marfan's?
```
Beta blockers
Then losartan (shown to dec risk of dissection)
```
83
Screening age for AAA
Men w/ hx of smoking age 65-75
84
Thoracic aneuryms are repaired at what size?
> 6 cm
85
AAA are repaired at what size?
> 5 cm
86
What to give for HTN in dissecting aneurysm?
Beta blocker then nitroprusside
87
If found to have small AAA how often is US repeated?
Every 6 mos
88
Best test for dissection?
TEE
If not available, CT w/ contrast
89
Anticoagulate porcine valves?
No
90
In AF rate control + anticoagulation compared to cardioversion has shown
Decreased stroke & hospitalizations
91
Drugs for chemical cardioversion of AF
```
Amiodarone
Dronedarone- only med shown to dec hospitalization
Quinidine
Procainamide- for WPW
Ibutilide
Dofetilide
```
92
AF + CAD + CHF, which drug?
Amiodarone
93
AF + CAD, no CHF, which drug?
Sotalol, amiodarone, dronedarone, dofetilide
94
AF no CAD which drug?
Flecainide, propefenone
95
CHADS2
| CHAD Vasc
```
CHF
HTN
Age > 75, in chad vasc, age 65-74
DM
Stroke/TIA/embolism
Vascular dse
Female
```
Also high risk, MS, HOCM, prosthetic valve
96
For elective major surgery on pxs with AF on warfarin, if risk factor
D/C warfarin 5 days before surgery, no bridging
97
For elective major surgery on pxs with AF on warfarin, if risk factor > 3
D/C warfarin 5 days before and bridge with lovenox BID with last dose 24hrs before surgery; or lovenox OD with last dose 1/2 dose on AM of surgery
98
AF refractory to medical treatment
AV ablation w/ pacemaker insertion
99
Young px with AF refractory to medical treatment
Circumferential pulmonary vein ablation
100
Target HR for AF control
101
Mgt if atrial flutter?
Same as AF
- rate control
- cardioversion
- EPS w/ ablation
102
Wheezing px w/ SVT, what to give?
Ca channel blocker
103
Delta wave and short PR interval
WPW
104
Tx for MAT
O2, Mg, bronchodilators
105
If w/ multiple PVCs, look for organic heart disease, then?
If neg, no sx -- no tx
If neg, w/ sx -- beta blocker
If pos, low EF -- ICD
106
2nd deg type 2 fr inf wall MI, what to do?
May be transient, wont require pacing
107
2nd deg type 2 fr ant wall MI, what to do?
May require pacing
108
Indications for pacing
SA node ab(N): HR 3 sec
2nd deg AV block type 2
3rd deg AV block
Pause dependent vtach
CHF w/ prolonged QRS (biventricular)
109
Quinidine toxicity
Prolonged QT, dec platelets
110
Procainamide toxicity
Drug induced lupus
111
Lidocaine toxicity
Seizures
112
Amiodarone toxicity
Hypo/hyperthyroidism, pulmonary fibrosis, corneal deposits
113
Drugs which inc digoxin level
```
Amiodarone
Quinidine
Verapamil
Spironolactone
Chlothalidone
HCTZ
```
114
Inc incidence of what valvular disorder in septum secundum defect?
MVP
