CARDIO Flashcards
(110 cards)
1
Q
what are the 4 components of the Tetralogy of fallot
A
- right ventricle hypertrophy
- pulmonic stenosis
- Ventral Septal Defect
- Overriding aorta
2
Q
What is a continuous machinery murmur
A
Pateten Ductus Arterious (PDA)
3
Q
classic description of mitral stenosis
A
Mid-diastolic rumble or
Crescendo-decrescendo
4
Q
What type of past medical history will a patient with mitral stenosis have
A
Rheumatic Fever
5
Q
description of aortic insufficiency?
A
eccentric early diastolic murmur
6
Q
S3 heart sound should make you think?
A
Fluid Overload like CHF
7
Q
S4 heart sound should make you think
A
pressure overload such a LVH or stunned Myocardium from an MI
8
Q
what murmurs are systolic
A
Mr AsTr Mitral Regurgitation Aortic Stenosis Tricuspid regurgitation Pulmonic Stenosis
9
Q
what murmurs are diastolic
A
Mitral Stenosis
Aortic Regurgitation
Tricuspid Stenosis
Pulmonic Regurgitation
10
Q
where does aortic murmurs radiate to
A
carotids and is high pitched
11
Q
where does mitral murmurs radiate to?
A
axilla and is low pitched and rumbling
12
Q
how does squatting affect blood flow
A
increases venous return
13
Q
what does rising from a squatting position do
A
decreased flow
14
Q
what does valsalva maneuver do
A
increase intra abdominal pressure decreases flow
15
Q
what does hand gripping do
A
increases pressure in the aortic root
16
Q
what are the two main causes of aortic stenosis
A
congenital bicuspid value (usually in a young person)
Calcific ( patient >65 yo with HTN,HYPchol, Smoking)
17
Q
Aortic Stenosis symptoms(SAD)
A
syncope
angina
DOE
18
Q
Aortic stenosis signs
A
harsh loud murmur at the base that radiates to the carotids
LVH
diffuse LV impulse
19
Q
Aortic Regurgitation causes
A
Infective endocarditis
thoracic aortic aneurysm
congenital valve anomaly
rheumatic fever
20
Q
Aortic regurg signs
A
diastolic murmur at the base
widened pulse pressure
water hammer pulse (big radial pulse
21
Q
Most common etiology of Mitral Stenosis
A
Rheumatic Fever
affects females more than males
Elevated LA pressure
Murmur can become apparent during pregnancy
22
Q
Mitral stenosis symptoms
A
Dyspnea Orthopnea Pulmonary Edema Angina Hemoptysis Hoarsness
23
Q
Mitral stenosis signs
A
diastolic rumble with opening snap
heard best at the apex and radiates into the axilla
a fib or flutter
24
Q
medical treatment of mitral stenosis
A
Afib anticoagulation and dig
surgical valvuloplasty
commussurotomy
replacement
25
what are osler nodes
they are painful raised bumps on the hands and feet and associated with infective endocarditis
26
what are janeway lesions
are non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are indicative of infective endocarditis
27
what is the most common cardiomyopathy?
dilated cardiomyopathy
28
Etiology of dilated cardiomyopathy
Genetic
Viral myocarditis
Alcoholism
Postpartum
29
dilated cardiomyopathy signs and symptoms
```
weakness
SOB
Peripheral Edema
Crackles
S3
JVD
```
30
what is the most common cause of right sided heart failure
left sided heart failure
31
what are the classic CXR finding of dilated cardiomyopathy
large heart
| kerley B lines
32
dilated cardiomyopathy work up
ECG non specific
| ECO is most useful will tell you ejection fraction, valve function wall motion
33
the treatment of Dilated cardiomyopathy
try to find reversible cause
treat CHF and dysrhythmias
Anticoagulation
34
restrictive cardiomyopathy etiology
it is a diastolic dysfunction so there is trouble with the filling caused by radiation, fibrosis or amlydosis which results in a small heart
35
hypertrophic cardiomyopathy
heart muscle is too big and assymetric where the septum grows bigger and eventually causes blockage of blood out through aortic valve.
This usually causes exercise induces syncope
36
how to bring out a hypertrophic cardiomyopathy
if you valsalva it causes the heart to fill with less blood causing the wall to collapse a little making the opening to the aortic valve smaller and producing more turbulence
37
a handgrip murmur will accentuate which murmurs
aortic regurgitation or insufficiency
mitral regurgitation or insufficiency
VSD
38
hand grip maneuver will decrease which murmurs
aortic stenosis
hypertrophic cardiomyopathy
mitral valve prolapse
39
valsalva will decrease which murmurs
aortic stenosis
pulmonic stenosis
tricuspid regurgitation
40
valsalva will increase which murmurs
MVP and hypertrophic cardiomyopathy
41
treatment for hypertrophic cardiomyopathy
avoid exertion
avoid inoptropes
beta blockers slows contraction and speed of contraction
AICD for ventricular arrhythmias
42
what is the treatment for dilated cardiomyopathy?
remove offending agent
diuretics, vasodilators, nitrates
cardiac transplant
anticoagulate because they are at high risk of embolization
43
how to treat restrictive cardiomyopathies
Hemochromatosis- phlebotomy or deferoxamine
Sarcoidosis- glucocorticoids
Amlyoydosis-no treatment
Use diuretics and vasodilators for pulmonary and peripheral edema
44
what is the most common reason for Heart Failure
atherosclerosis which leads to Ischemic heart disease
45
what tests should you order with a patient with new onset CHF
```
CXR
ECG
Cardiac Enzymes
CBC (anemia)
ECHO
```
46
what is the treatment of systolic dysfunction in HF?
| Both Lifestyle and Pharmacological
```
1. Life style modifications:
sodium reduction (less than 4g/day)
weight loss
smoking cessation
restrict alcohol use
exercise
2. Diuretics to provide volume overload relief
Furosemide, HCTZ, 3.Spironolactone
4.ACE
5.ARBs
6.B-blockers
```
47
how to treat mild CHF which encompasses NHYA classes 1-2
sodium restriction and physical activity
loop diuretic
ACE- first line agent
48
how to treat mild to moderate CHF NYHA 2-3
Loop diuretic and ACE
| Add B-blocker if response to standard treatment is suboptimal
49
how to treat moderate to severe CHF NYHA 3-4
add digoxin to loop and ACE
| Digoxin does not improve mortality
50
how to treat diastolic heart failure
patients are treated symptomatically
B-blockers
Diuretics
NO DIG OR SPRINOLACTONE
51
premature atrial complexes
p waves with different morphology
Usually asymptomatic and requires no treatment but if symptomatic beta-blockers maybe helpful
52
what should be done with patients who have frequent PVCs and heart disease
they are at increased risk of death from an arrhythmia so order an Electrophysiology study
53
Atrial Fib causes
```
CAD, MI, HTN mitral valve disease
Pericarditis or pericardial trauma
Hyper or Hypothyroidism
Sepsis, Malignancy
Stress
Alcoholic
Sick Sinus
Pheochromo
```
54
Clinical features of A Fib.
Fatigue
DOE
Palpitations, dizziness, angina, or syncope
Irregularly irregular pulse
55
what is the diagnostic dukes criteria for endocarditis
2 major
1 major 3 minor
or 5 minor
56
what is the major criteria for dukes criteria
1. positive blood culture for endocarditis ( Haemophilus, actinobacillis, cardiobacterium, Eikenlla, kingella, (HACEK), staph aureus)
2. Echo with intracardiac mass on valve or supporting structures
57
what is dukes minor criteria
1. predisposing heart condition or IV drug use
2. temp >38C or 100.4
3. Vascular phenomenon Arterial emboli, pulmonary emboli, conjunctival hemorrhages or janeway lesions
4. osler nodes, roth spots gomerlular nephritis, rheumatoid factor
5. positive blood cultures that do not meet strict definition of major criteria
58
hypertensive urgency is defined as?
>180/>120 in asymptomatic patients
59
what is malignant hypertension
hypertensive emergency with papilledema with or without endorgan damage
usually have diastolic bp above 120
60
what is the treatment for malignant HTN
25% reduction in Mean Arterial Pressure in first few hour and gradually decline over 24hours with the exception of Aortic Dissection where you need to get BP down ASASP
61
what agents are used to reduce BP in Malignant HTN
IV labetolol, sodium nitroprusside, nicardipine, nitroglycerin
62
what is shock
inadequate delivery of oxygen to the tissues.
severe cardiovascular failure from poor blood flow or inadequate distributive flow
Involves release of catecholamines, renin, ADH, glucagon, cortisol
63
what are the clinical feature of shock
```
low BP
Tachycardia
Peripheral hypoperfusion
Altered mental status
oliguria
```
64
what are the causes of SHOCK
```
sepsis
hypovolemia
obstructive causes
cardiac
Kortisol
distributive
```
65
treatment for septic shock
ABC
| identify sources, cultures and ABx
66
treatment for hypovolemia
causes GI bleed, ruptures AAA or trauma or plasma loss
ABC,IVF, control source and transfuse
67
obstructive causes for shock
```
Cardiac tamponade
Tension Pneumo
Atrial myxoma
Obstructive valve dz
Aortic dissection
massive pulmonary emboli
```
68
what is the treatment for obstructive causes of shock
ABC, bedside ultrasound, CXR, CT
69
what are the cardiac causes of shock
MI
Dysrhythmia
HF
Valve disease
70
treatment of cardiac shock
ABC, ECG, monitor, thrombolytics, catheterization
71
diagnosis for acute rheumatic fever requires what?
two major criteria or one major and two minor
72
what are the major criteria for rheumatic fever (5)
1. Migratory polyarthritis
2. Erythema marginatum
3. Cardiac involvement (pericarditis, CHF, valve dz)
4. Chorea
5. Subcutaneous nodules
73
what are the minor criteria for rheumatic fever (6)
1. Fever
2. elevated ESR
3. Polyarthralgias
4. Prior Hx of rehumatic heart Dz
5. Prolonged PR interval
6. Evidence of preceding strep infection
74
Rheumatic heart disease is caused by?
streptococcal pharyngitis (group A strep)
75
what is the most common valvular abnormality of rheumatic heart disease?
mitral stenosis but they can have aortic or tricuspid involvement
76
how is rheumatic fever treated?
penicillin for strep pharyngitis
| add NSAID with acute rheumatic fever
77
what is the most common cause of acute endocarditis?
Stap aureus
| occurs on normal heart valves
78
what is the most common cause of subacute endocarditis?
Streptococcus viridans and enterococcus
| occurs on damaged valves
79
what is the most common bacteria in native valve endocarditis?
Streptococcus viridans
80
what is the most common organism in IV drug use related endocarditis?
Staph aureus
most common valve affected is the tricuspid valve
81
when is endocarditis antibiotic prophylaxis required
patients with know valvular heart disease or prosthetic valves under go oral, GI or GU surgery
82
how is endocarditis treated
PCN+gentamicin for NVE
Naficillin+gentamicin for IV drug use
Vancomycin+gentamicin for MRSA
if prosthetic valve add rifampin
treatment is from 4-6weeks
83
what is the most common cause of pericarditis
infectious
It can also be caused by malignancy from lung and breast mets
drug induced from procainamide or hyddralizine
MI or Heart surgery
Autoimmune
Chemo
84
Pericarditis clinical features
sharp chest pain, pleuritic and positional better with leaning forward worse when laying supine
friction rub which increases when patient leans forward
tachycardia
85
ECG findings with pericarditis
ST elevation and PR depression
86
what is the treatment for pericarditis
high dose ASA or NSAIDS (naproxen or Ibuprofen) for 1-3 weeks
treat underlying infection
Cholchicine
87
what is becks triad
for pericardial tamponade
| HYPOtension, JVD and muffled heart sounds
88
what is the best test for pericardial effusion
ECHO
89
ECG triad for pericardial tamponade
low voltage
tachycardia
QRS changes in size beat to beat
90
treatment for pericardial tamponade
pericardiocentesis vs pericardiotomy to drain fluid
91
predisposing factors for aortic dissection
```
Long standing HTN (70% of patients)
Cocaine
Trauma
Marfans, ehlers danlo
Bicuspid aortic valve
coarctation of the aorta
```
92
what is a type A dissection?
involves the ascending aorta and moves towards the descending aorta
93
what is a type B dissection
limited to the descending aorta distal to the take off of the subclavian artery
94
what is the clinical presentation of an aortic dissection?
```
severe tearing,ripping,stabbing typically abrupt onset either in the anterior or back of chest.
Diaphoresis
most are HTN
Pulse or BP asymmetry between limbs
aortic regurg
```
95
How is a dissection diagnosed
CXR will show a widened mediastinum
TEE is a very high sensitivity and specificity
CT and MRI are both accurate
Aortic angio is invasive but best test to determine the extent of dissection for surgery
96
Treatment of aortic dissections
IV Betablockers to lower heart rate and diminish left ventricle ejection
IV nitroprusside to get bp below 120
For type A surgical management
TYPE B dissections
medical management first line drugs include IV beta blockers like labetalol, esmolol, propranolol
pain control with morphine or dilaudid
97
what are the clinical features of a AAA like
pay may or may not be present
pulsatile mass and throbbing
Grey turner sign which is ecchymoses on back and flanks
Cullen sign which is ecchymoses around umbilicus
98
what is the test of choice to evaluate AAA
Ultrasound
Can use CT but only indicated in stable patients
99
what is the treatment of a AAA
AAA >5cm in diameter or symptomatic surgical resection
| AAA
100
general characteristics of PAD
superficial femoral artery is the most common site
risk factors are smoking by far the most common
CAD, Hyperlipidemia, HTN
101
PAD symptoms
intermittent claudication
| rest pain, often awakens them at night. hanging foot over side of bed helps relieve pain
102
PAD signs
diminished or absent pulses, muscular atrophy, decreased hair growth, thick toenails, cool skin, pallor of elevation and dependent rubor
103
how is PAD diagnosed
ABI
Normal is .9-1.3
ABI>1.3 indicates noncompressible vessel which is severe disease
ABI
104
what is the treatment of PAD
```
STOP SMOKING
exercise program
foot care
control HTN,weight, diabetes
Aspirin along with clopidogrel
Ciloztazol
Surgery
```
105
what is virchows triad?
endothelial injury venous stasis and hypercoaguability for DVT
106
what are risk factors for DVT
```
age>60
malignancy
prior HX of DVT,PE, or vericose veins
Hypercoagulable state (factor V, protein c and s deficiency, antithrombin III def)
cardiac disease
Obesity, immobilization
trauma
surgery,
pregnancy or estrogen use
```
107
what are the signs of DVT
lower extremity pain and swelling better with elevation
Homans signs
palpable cords
fever
108
how is a DVT diagnosed
Doppler and duplex ultrasound
venography
d-dimer
109
when should you use a d-dimer
has high sensitivity but low specificity can be used to rule our DVT when combined with doppler and clinical suspicion
110
what is the treatment for DVT
anticoagulation heparin bolus followed by a constant infusion and titrated to maintain the PTT of 1.5-2 times aptt
thrombolytic therapy
prophylatic inferior vena cava filter placement
