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PANCE > CARDIO > Flashcards

CARDIO Flashcards

1
Q

what are the 4 components of the Tetralogy of fallot

A
  1. right ventricle hypertrophy
  2. pulmonic stenosis
  3. Ventral Septal Defect
  4. Overriding aorta
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2
Q

What is a continuous machinery murmur

A

Pateten Ductus Arterious (PDA)

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3
Q

classic description of mitral stenosis

A

Mid-diastolic rumble or

Crescendo-decrescendo

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4
Q

What type of past medical history will a patient with mitral stenosis have

A

Rheumatic Fever

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5
Q

description of aortic insufficiency?

A

eccentric early diastolic murmur

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6
Q

S3 heart sound should make you think?

A

Fluid Overload like CHF

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7
Q

S4 heart sound should make you think

A

pressure overload such a LVH or stunned Myocardium from an MI

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8
Q

what murmurs are systolic

A 
Mr AsTr
Mitral Regurgitation
Aortic Stenosis
Tricuspid regurgitation
Pulmonic Stenosis
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9
Q

what murmurs are diastolic

A

Mitral Stenosis
Aortic Regurgitation
Tricuspid Stenosis
Pulmonic Regurgitation

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10
Q

where does aortic murmurs radiate to

A

carotids and is high pitched

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11
Q

where does mitral murmurs radiate to?

A

axilla and is low pitched and rumbling

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12
Q

how does squatting affect blood flow

A

increases venous return

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13
Q

what does rising from a squatting position do

A

decreased flow

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14
Q

what does valsalva maneuver do

A

increase intra abdominal pressure decreases flow

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15
Q

what does hand gripping do

A

increases pressure in the aortic root

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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)

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17
Q

Aortic Stenosis symptoms(SAD)

A

syncope
angina
DOE

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18
Q

Aortic stenosis signs

A

harsh loud murmur at the base that radiates to the carotids
LVH
diffuse LV impulse

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19
Q

Aortic Regurgitation causes

A

Infective endocarditis
thoracic aortic aneurysm
congenital valve anomaly
rheumatic fever

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20
Q

Aortic regurg signs

A

diastolic murmur at the base
widened pulse pressure
water hammer pulse (big radial pulse

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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

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22
Q

Mitral stenosis symptoms

A 
Dyspnea
Orthopnea
Pulmonary Edema
Angina
Hemoptysis
Hoarsness
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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

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24
Q

medical treatment of mitral stenosis

A

Afib anticoagulation and dig

surgical valvuloplasty
commussurotomy
replacement

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25
Q

what are osler nodes

A

they are painful raised bumps on the hands and feet and associated with infective endocarditis

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26
Q

what are janeway lesions

A

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

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27
Q

what is the most common cardiomyopathy?

A

dilated cardiomyopathy

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28
Q

Etiology of dilated cardiomyopathy

A

Genetic
Viral myocarditis
Alcoholism
Postpartum

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29
Q

dilated cardiomyopathy signs and symptoms

A 
weakness
SOB
Peripheral Edema
Crackles
S3
JVD
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30
Q

what is the most common cause of right sided heart failure

A

left sided heart failure

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31
Q

what are the classic CXR finding of dilated cardiomyopathy

A

large heart

kerley B lines

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32
Q

dilated cardiomyopathy work up

A

ECG non specific

ECO is most useful will tell you ejection fraction, valve function wall motion

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33
Q

the treatment of Dilated cardiomyopathy

A

try to find reversible cause
treat CHF and dysrhythmias
Anticoagulation

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34
Q

restrictive cardiomyopathy etiology

A

it is a diastolic dysfunction so there is trouble with the filling caused by radiation, fibrosis or amlydosis which results in a small heart

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35
Q

hypertrophic cardiomyopathy

A

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

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36
Q

how to bring out a hypertrophic cardiomyopathy

A

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

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37
Q

a handgrip murmur will accentuate which murmurs

A

aortic regurgitation or insufficiency
mitral regurgitation or insufficiency
VSD

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38
Q

hand grip maneuver will decrease which murmurs

A

aortic stenosis
hypertrophic cardiomyopathy
mitral valve prolapse

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39
Q

valsalva will decrease which murmurs

A

aortic stenosis
pulmonic stenosis
tricuspid regurgitation

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40
Q

valsalva will increase which murmurs

A

MVP and hypertrophic cardiomyopathy

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41
Q

treatment for hypertrophic cardiomyopathy

A

avoid exertion
avoid inoptropes
beta blockers slows contraction and speed of contraction
AICD for ventricular arrhythmias

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42
Q

what is the treatment for dilated cardiomyopathy?

A

remove offending agent
diuretics, vasodilators, nitrates
cardiac transplant
anticoagulate because they are at high risk of embolization

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43
Q

how to treat restrictive cardiomyopathies

A

Hemochromatosis- phlebotomy or deferoxamine
Sarcoidosis- glucocorticoids
Amlyoydosis-no treatment

Use diuretics and vasodilators for pulmonary and peripheral edema

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44
Q

what is the most common reason for Heart Failure

A

atherosclerosis which leads to Ischemic heart disease

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45
Q

what tests should you order with a patient with new onset CHF

A 
CXR
ECG
Cardiac Enzymes
CBC (anemia)
ECHO
46
Q

what is the treatment of systolic dysfunction in HF?

Both Lifestyle and Pharmacological

A 
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
Q

how to treat mild CHF which encompasses NHYA classes 1-2

A

sodium restriction and physical activity
loop diuretic
ACE- first line agent

48
Q

how to treat mild to moderate CHF NYHA 2-3

A

Loop diuretic and ACE

Add B-blocker if response to standard treatment is suboptimal

49
Q

how to treat moderate to severe CHF NYHA 3-4

A

add digoxin to loop and ACE

Digoxin does not improve mortality

50
Q

how to treat diastolic heart failure

A

patients are treated symptomatically
B-blockers
Diuretics
NO DIG OR SPRINOLACTONE

51
Q

premature atrial complexes

A

p waves with different morphology

Usually asymptomatic and requires no treatment but if symptomatic beta-blockers maybe helpful

52
Q

what should be done with patients who have frequent PVCs and heart disease

A

they are at increased risk of death from an arrhythmia so order an Electrophysiology study

53
Q

Atrial Fib causes

A 
CAD, MI, HTN mitral valve disease
Pericarditis or pericardial trauma
Hyper or Hypothyroidism
Sepsis, Malignancy
Stress
Alcoholic
Sick Sinus
Pheochromo
54
Q

Clinical features of A Fib.

A

Fatigue
DOE
Palpitations, dizziness, angina, or syncope
Irregularly irregular pulse

55
Q

what is the diagnostic dukes criteria for endocarditis

A

2 major
1 major 3 minor
or 5 minor

56
Q

what is the major criteria for dukes criteria

A
  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
Q

what is dukes minor criteria

A
  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
Q

hypertensive urgency is defined as?

A

> 180/>120 in asymptomatic patients

59
Q

what is malignant hypertension

A

hypertensive emergency with papilledema with or without endorgan damage
usually have diastolic bp above 120

60
Q

what is the treatment for malignant HTN

A

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
Q

what agents are used to reduce BP in Malignant HTN

A

IV labetolol, sodium nitroprusside, nicardipine, nitroglycerin

62
Q

what is shock

A

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
Q

what are the clinical feature of shock

A 
low BP
Tachycardia
Peripheral hypoperfusion
Altered mental status
oliguria
64
Q

what are the causes of SHOCK

A 
sepsis
hypovolemia
obstructive causes
cardiac
Kortisol
distributive
65
Q

treatment for septic shock

A

ABC

identify sources, cultures and ABx

66
Q

treatment for hypovolemia

A

causes GI bleed, ruptures AAA or trauma or plasma loss

ABC,IVF, control source and transfuse

67
Q

obstructive causes for shock

A 
Cardiac tamponade
Tension Pneumo
Atrial myxoma
Obstructive valve dz
Aortic dissection
massive pulmonary emboli
68
Q

what is the treatment for obstructive causes of shock

A

ABC, bedside ultrasound, CXR, CT

69
Q

what are the cardiac causes of shock

A

MI
Dysrhythmia
HF
Valve disease

70
Q

treatment of cardiac shock

A

ABC, ECG, monitor, thrombolytics, catheterization

71
Q

diagnosis for acute rheumatic fever requires what?

A

two major criteria or one major and two minor

72
Q

what are the major criteria for rheumatic fever (5)

A
  1. Migratory polyarthritis
  2. Erythema marginatum
  3. Cardiac involvement (pericarditis, CHF, valve dz)
  4. Chorea
  5. Subcutaneous nodules
73
Q

what are the minor criteria for rheumatic fever (6)

A
  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
Q

Rheumatic heart disease is caused by?

A

streptococcal pharyngitis (group A strep)

75
Q

what is the most common valvular abnormality of rheumatic heart disease?

A

mitral stenosis but they can have aortic or tricuspid involvement

76
Q

how is rheumatic fever treated?

A

penicillin for strep pharyngitis

add NSAID with acute rheumatic fever

77
Q

what is the most common cause of acute endocarditis?

A

Stap aureus

occurs on normal heart valves

78
Q

what is the most common cause of subacute endocarditis?

A

Streptococcus viridans and enterococcus

occurs on damaged valves

79
Q

what is the most common bacteria in native valve endocarditis?

A

Streptococcus viridans

80
Q

what is the most common organism in IV drug use related endocarditis?

A

Staph aureus

most common valve affected is the tricuspid valve

81
Q

when is endocarditis antibiotic prophylaxis required

A

patients with know valvular heart disease or prosthetic valves under go oral, GI or GU surgery

82
Q

how is endocarditis treated

A

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
Q

what is the most common cause of pericarditis

A

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
Q

Pericarditis clinical features

A

sharp chest pain, pleuritic and positional better with leaning forward worse when laying supine
friction rub which increases when patient leans forward
tachycardia

85
Q

ECG findings with pericarditis

A

ST elevation and PR depression

86
Q

what is the treatment for pericarditis

A

high dose ASA or NSAIDS (naproxen or Ibuprofen) for 1-3 weeks
treat underlying infection
Cholchicine

87
Q

what is becks triad

A

for pericardial tamponade

HYPOtension, JVD and muffled heart sounds

88
Q

what is the best test for pericardial effusion

A

ECHO

89
Q

ECG triad for pericardial tamponade

A

low voltage
tachycardia
QRS changes in size beat to beat

90
Q

treatment for pericardial tamponade

A

pericardiocentesis vs pericardiotomy to drain fluid

91
Q

predisposing factors for aortic dissection

A 
Long standing HTN (70% of patients)
Cocaine
Trauma
Marfans, ehlers danlo
Bicuspid aortic valve
coarctation of the aorta
92
Q

what is a type A dissection?

A

involves the ascending aorta and moves towards the descending aorta

93
Q

what is a type B dissection

A

limited to the descending aorta distal to the take off of the subclavian artery

94
Q

what is the clinical presentation of an aortic dissection?

A 
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
Q

How is a dissection diagnosed

A

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
Q

Treatment of aortic dissections

A

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
Q

what are the clinical features of a AAA like

A

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
Q

what is the test of choice to evaluate AAA

A

Ultrasound

Can use CT but only indicated in stable patients

99
Q

what is the treatment of a AAA

A

AAA >5cm in diameter or symptomatic surgical resection

AAA

100
Q

general characteristics of PAD

A

superficial femoral artery is the most common site
risk factors are smoking by far the most common
CAD, Hyperlipidemia, HTN

101
Q

PAD symptoms

A

intermittent claudication

rest pain, often awakens them at night. hanging foot over side of bed helps relieve pain

102
Q

PAD signs

A

diminished or absent pulses, muscular atrophy, decreased hair growth, thick toenails, cool skin, pallor of elevation and dependent rubor

103
Q

how is PAD diagnosed

A

ABI
Normal is .9-1.3
ABI>1.3 indicates noncompressible vessel which is severe disease
ABI

104
Q

what is the treatment of PAD

A 
STOP SMOKING
exercise program
foot care
control HTN,weight, diabetes
Aspirin along with clopidogrel
Ciloztazol
Surgery
105
Q

what is virchows triad?

A

endothelial injury venous stasis and hypercoaguability for DVT

106
Q

what are risk factors for DVT

A 
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
Q

what are the signs of DVT

A

lower extremity pain and swelling better with elevation
Homans signs
palpable cords
fever

108
Q

how is a DVT diagnosed

A

Doppler and duplex ultrasound
venography
d-dimer

109
Q

when should you use a d-dimer

A

has high sensitivity but low specificity can be used to rule our DVT when combined with doppler and clinical suspicion

110
Q

what is the treatment for DVT

A

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

PANCE (8 decks)

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