Cardio Flashcards
(312 cards)
1
Q
Interchangeable terms with CAD
A
Atherosclerotic heart disease
Ischemic heart disease
2
Q
MCC of CP when source is clearly not cardiac
A
GI
3
Q
Best initial test for CP
A
EKG (regardless of cause)
4
Q
Why are men more at risk for MI under 50
A
Protective effect of Estrogen
This wears off at menopause and the risk becomes equal to males
5
Q
Useful Hx in Ischemia
A
Duration Quality Location Radiation Frequency Alleviating Precipitating
6
Q
Worst RF for CAD
A
DM
7
Q
MC RF for CAD
A
HTN
8
Q
Unmodifiable RFs for CAD
A
Age
Sex
Heredity
9
Q
Clear RFs for CAD
A
DM Smoking - Risk x2 HTN - goal 140/90, 130/80 in DM Hyperlipidemia FHx of premature CAD Age > 45 men, 55 women
10
Q
What is premature CAD
A
Males less than 55
Females less than 65
11
Q
When is FHx of CAD relevant
A
First degree relative
Premature in family
12
Q
Goal for LDL to prevent CAD
A
Less than 100
Less than 70 in DM
13
Q
MCC of death in DM
A
Cardiovascular
14
Q
Weight loss effect on BP
A
1 Kg decreased = 1 mmHg decreased
15
Q
Best way to decrease BP
A
Weight loss
16
Q
Best way to increase HDL
A
Exercise
17
Q
Etiology of Takatsubo cardiomyopathy
A
Massive catecholamine discharge from emotional stress
18
Q
These are NOT RFs for CAD
A
Chlamydia
Elevated CRP
Elevated homocysteine
19
Q
Greatest improvement in risk for CAD
A
Stop smoking
20
Q
Features of non-ischemic CP
A
Pleuritic Positional Tender Knife-like Lasts a few seconds
21
Q
Why are men more at risk for MI under 50
A
Protective effect of Estrogen
This wears off at menopause and the risk becomes equal to males
22
Q
Useful Hx in Ischemia
A
Duration Quality Location Radiation Frequency Alleviating Precipitating
23
Q
When is FHx of CAD relevant
A
First degree relative
Premature
24
Q
MCC of death in DM
A
Cardiovascular
25
Weight loss effect on BP
1 Kg decreased = 1 mmHg decreased
26
Best initial test for all forms of CP
EKG
27
Presentation of ischemic pain
Dull/sore
| Squeezing
28
Features of inferior wall ischemia
Brady
Hypotension
+/- Dizziness
29
Nitrate effect on CP
↑ in GERD
| ↓ in Angina
30
Auscultation findings in MI
```
Wide split S2
LBBB
New S4
S3
New AR - Aortic dissection
New MR - Papillary muscle dysfunction
```
31
What causes wide split S2
RBBB
Pulm HTN
Pulmonic stenosis
RVH
32
What causes paradoxic S2
LBBB
HTN
AS
LVH
33
What causes fixed split S2
ASD
34
What causes S4 gallop
LVH (atrial systole)
| Long standing HTN
35
What causes S3 gallop
Underlying CHF
36
Causes of pleuritic CP
```
PN
PE
Pericarditis - PR depression
PTX
Pleuritis
```
37
CP w/ chest wall tenderness:
| Most accurate test:
Costochondritis
| Physical exam
38
CP w/ radiation to back, unequal BP b/w arms:
| Most accurate test:
Aortic dissection
CXR w/ widened mediastinum
CT, MRI or TEE confirms
39
CP w/ pain worse lying flat, age
Pericarditis
| EKG w/ ST elevation everywhere, PR depression
40
CP w/ epigastric discomfort, pain better w/ eating:
| Most accurate test:
Duodenal ulcer
| Endoscopy
41
CP w/ bad taste, cough, hoarseness:
| Most accurate test:
GERD
| Resonse to PPIs, AlOH, Mg(OH)2, viscous lidocaine
42
CP w/ cough, sputum, hemoptysis:
| Most accurate test:
PN
| CXR
43
CP w/ sudden onset SOB, tachy, hypoxia:
| Most accurate test:
PE
| Spiral CT, V/Q in pregnancy
44
CP w/ sharp pleuritic pain, tracheal deviation:
| Most accurate test:
PTX
| CXR
45
Worst prognostic combination with CP
SOB
46
Best initial test for all forms of CP
EKG
47
When do CKMB and Troponins begin to rise
4hrs
48
When do CKMB and Troponins peak
12-24hrs
49
How long before CKMB resolves
3-4 days - Makes it good to test for re-infarction
50
When to do exercise stress test in setting of CP
Etiology not clear
| EKG not diastolic
51
When to use Prasugrel in ischemic heart disease
Pts undergoing angioplasty and stenting
| NOT in >75 due to risk of hemorrhage and stroke
52
Calculate a pts max HR
220-Age
53
What indicates ischemia on EKG
ST depression
54
What can cause baseline EKG abnormalities
LBBB
LVH
Digoxin - Downsloping ST
Pacer
55
2 ways of evaluating ischemia w/o EKG
Thallium uptake
| Echo - wall motion abnormalities
56
Contraindications to ETT
Cardiac instability - Current CP
| Pt can't exercise
57
MCC ischemic heart disease
Atherosclerosis
58
Calculate O2 delivery
CO x Hb/HCT x O2 sat
59
Why does normal myocardium pick up thallium
Looks like K
60
Differentiate infarct and ischemia on thallium uptake
Ischemia uptake returns to normal at rest
61
Increase myocardium O2 consumption w/o exercise
Dipyridamole or adenosine with Thallium
| Dobutamine with ECHO
62
When to avoid dipyridamole
Asthmatics - Can cause bronchospasm
63
The lower the pretest likelihood of disease
The higher the rate of false positives
64
Why do we do angiography in ischemic heart disease
Determine bypass surgery vs angioplasty
65
Most accurate method of detecting CAD
Angiography
66
When does CABG decrease mortality
3 vessel disease or Left main
2 vessel disease in DM
2-3 vessel with Low EF
LV dysfunction
67
What lowers mortality in CAD
```
Aspirin
BBs
tPA
Angioplasty
Clopidogrel
ACEIs if ↓ EF
Statins if LDL > 100
```
68
What is the purpose of Holter
Rhythm monitoring (A-fib , flutter, premature beats, V-tach)
69
What lowers mortality in ischemic heart disease
Aspirin
BBs
Statins if LDL > 100
70
Best mortality benefit in chronic angina
Aspirin
| BBs
71
When to use clopidogrel in ischemic heart disease
Aspirin intolerance
| Recent angioplasty w/ stenting
72
AE Ticlopidine
Neutropenia
| TTP
73
What do ACEIs/ARBs do in CAD
Decrease EF
74
When to give ACEIs/ARBs in CAD
Regurgitant valvular disease (Decreased LVEF)
75
What to do in hyperkalemia with ACEIs/ARBs
Switch to hydralazine and nitrates
76
What are CAD equivalents (LDL goal
PAD
Carotid disease
Aortic disease
DM
77
MC AE statins
Liver dysfunction (elevated transaminases)
78
Which lipid lowering drugs lower mortality the most in CAD
Statins
79
AE statins
Elevated transaminases
| Myositis
80
AE niacin
Elevated glucose and uric acid
| Pruritis
81
AE fibrate derivatives
Increase risk of myositis when combined w/ statins
82
AE Cholestyramine
Flatus, ABD cramping
83
AE ezetimibe
Nearly useless but well tolerated
84
Effect of CCBs on CAD
May increase mortality
85
ONLY time to use CCBs in CAD
Severe asthma
Prinzmetal
Cocain-induced CP
Max meds don't control pain
86
AE CCBs
Edema
Constipation (verapamil)
Heart block
87
What lowers mortality in CAD
```
Aspirin
BBs
tPA
Angioplasty
Clopidogrel
ACEIs if ↓ EF
Statins if LDL > 100
```
88
Best therapy in acute coronary syndrome
PCI esp w/ ST elevation
89
MCC death in USA
Acute coronary syndrome
90
Only way to determine etiology in acute coronary syndromes
EKG and Enzymes
91
Features of unstable angina
New pain
Worse pain
Rest pain
92
What is the sequelae of unstable angina
NSTEMI
93
Risk factors for unstable angina to progress to NSTEMI
```
Repetitive/Prolongued Pain
Persistent EKG changes
Hypotension
Elevated cardiac markers
Sustained V-tach
Syncope
EF
```
94
Heart sound in ACS
S4
95
What is associated with constrictive pericarditis
Kussmaul sign
| Increased JVP on inhalation
96
Rx Dressler
NSAIDS and Aspirin +/- steroids
97
Displaced PMI is characteristic of
LVH
| Dilated cardiomyopathy
98
Leads affected in Anterior wall
V2-4
99
Leads affected in Inferior wall
II, III, aVF
100
PR > 200ms associated with
1st degree AV block
101
Leads affected in posterior wall
ST depression in V1-2
102
Most important next step in ACS
Aspirin then Angioplasty then ICU
103
Greatest mortality benefit in ACS
Angioplasty
104
MCC death first several days after MI
Ventricular arrhythmia
105
How is PCI superior to thrombolytics
Survival and Mortality benefit
Fewer hemorrhage complications
Less MI complications
106
When to DEFINITELY do PCI (ie. thrombolytics are contraindicated)
```
Recent surgery
Melena
BP > 180/110
Aortic dissection
Stroke
```
107
When does PCI need to be performed
Within 90min of pt arrival
108
PCI complications
Rupture
Restenosis
Hematoma
109
Most important method of preventing restenosis after PCI
Drug-eluting stent (paclitaxel, sirolimus)
110
When can thrombolytics be administered
Within 12hrs
111
Door to needle time
30min
112
When to do CABG in late presentation MI (>12hrs)
Good anatomy
Cardiogenic shock
Mechanical repair
113
When to do emergency CABG
Failed PCI
| Persistent/Recurrent ischemia refractory to meds
114
ACS, who gets Aspirin
Everyone
| BIT
115
ACS, who gets clopidogrel
Aspirin not tolerated
| Pt undergoing angioplasty and stenting
116
ACS, who gets BBs
Everyone
117
ACS, who gets ACEi/ARBs
Everyone
| Best for EF
118
ACS, who gets statins
Everyone
| Best for LDL>100
119
ACS, who gets O2, nitrates
Everyone
| No mortality benefit
120
ACS, who gets Heparin
After thrombolytics/PCI to prevent restenosis
| Initial therapy w/ ST depression and other NSTE events
121
ACS, who gets CCBs
Can't use BBs
Cocaine
Prinzmetal or vasospastic variant
122
When can you give glycoprotein IIb/IIIa inhibitors
ACS w/ angioplasty and stenting
ST depression
NSTEMI
123
Best for NSTEMI
Heparin
| Glycoprotein IIb/IIIa inhibitors
124
What does "not better" mean in STE ACS
Persistent pain
S3 gallop or CHF
Worse EKG changes or SVT
Rising troponins
125
Next step for pts in STE ACS and are not getting better
Angiography and possible angioplasty
126
Where do you see cannon A waves
3rd degree AV block
127
Rx Symptomatic 3rd degree AV block
Atropine
| Then Pacemaker
128
Most specific finding in Right ventricular infarction
STE in RV4
129
What does the right coronary supply
RV
AV node
Inferior wall
130
Rx RV infarctions
High volume fluid replacement
131
MC complications of MI
V-tach
| V-fib
132
When to look for tamponade/free wall rupture after mI
Sudden loss of pulse
133
Rx v-tach/v-fib
Cardioversion/defibrillation
| Then give BBs
134
Presentation of valve or septal rupture after MI
New onset murmur and pulm congestion
135
Most accurate test for valve or septal rupture
Echo
136
What to look for in septal rupture
Step-up in O2 sat from RA to RV
| ie. sharp increase in O2 sat
137
Rx stable v-tach
Amiodarone
Procainamide
Lidocaine
138
When to use intraaortic balloon pump
Acute pump failure from anatomical problem fixed in OR
139
What to look for in reinfarction/infarction extension after MI
Recurrence of pain
New Rales
New bump in CKMB
Sudden onset pulm edema
140
Management of reinfarction/infarction extension after MI
EKG
Angioplasty
Aspirin, BBs, Nitrates, ACE, statins
141
Detection of aneurysms/mural thrombus post MI
Echo
142
Rx mural thrombus post MI
Heparin, then warfarin
143
Why do stress test before d/c after MI
Evaluate need for angiography (residual ischemia)
Only if patient is asymptomatic
Done at 5-7 days
144
Postinfarction meds
Aspirin
BBs
Statins
ACEIs (stop at 6wks if EF is NL)
145
Alternate drugs in postinfarction
Clopidogrel - Aspirin intolerance
ARBs - Cough w/ ACEI
Ticlopidine - Aspirin and Clopidogrel intolerance
146
MCC erectile dysfunction post-MI
Anxiety
147
Essential feature of CHF
Dyspnea
148
Difference between systolic and diastolic dysfunction
EF preserved in diastolic dysfunction
| Can really only tell with Echo
149
MCC CHF
HTN causing cardiomyopathy
| Myocardial muscle abnormality
150
Other causes of CHF
Valvular heart disease
| MI
151
Rare causes of CHF
```
Alcohol
Postviral
Radiation
Adriamycin
Chagas
Hemochromatosis
Thyroid disease
Peripartum
Thiamine def
```
152
How to Dx CHF
```
Clinical Dx
Dyspnea
Orthopnea
Rales
JVD
PND
S3
```
153
Sudden onset dyspnea w/ clear lungs
PE
154
Sudden onset dyspnea w/ wheezing, increased expiratory phase
Asthma
155
Slow dyspnea w/ fever, sputum, unilateral rales/rhonchi
PN
156
Dyspnea w/ decreased breath sounds unilaterally, tracheal deviation
PTX
157
Dyspnea w/ circumoral numbness, caffein use, hx anxiety
Panic attack
158
Dyspnea w/ pallor gradual over days to weeks
Anemia
159
Dyspnea w/ pulsus paradoxus, decreased heart sounds, JVD
Tamponade
160
Dyspnea w/ palpitations, syncope
Arrhythmia (any)
161
Dyspnea w/ dullness to percussion at bases
Pleural effusion
162
Dyspnea w/ long smoking hx, barrel chest
COPD
163
Dyspnea w/ recent anesthetic use, brown blood not improved w/ O2, clear lungs, cyanosis
Methemoglobinemia
164
Dyspnea w/ burning building/car, wood burning stove in winter, suicide attempt
CO poisoning
165
Most important test in CHF
Echo
166
Best initial test for CHF
TTE
167
Most accurate test for CHF
MUGA
168
When would you use MUGA for CHF
Test for AE of doxorubicin for lymphoma Rx
169
When would you check BNP in CHF
Acute SOB w/ unclear etiology and cannot wait for echo
| Normal BNP excludes CHF
170
Test if CHF etiology is from MI or heart block
EKG
171
Test if CHF etiology is from dilated cardiomyopathy
CXR
172
Test if CHF etiology is from paroxysmal arrhythmias
Holter
173
Test if CHF etiology is from valve/septal defects
Cath
174
Test if CHF etiology is from Anemia
CBC
175
Test if CHF etiology is from thyroid
T4/TSH
176
Test if CHF etiology is from infiltrative disease
Endomyocardial bx
177
Differentiate between CHF and ARDS
Swan-Ganz (not routine)
178
Decrease mortality in systolic dysfunction
ACEIs/ARBs
BBs
Spironolactone
179
Decrease sx in systolic dysfunction
Diuretics
| Digoxin
180
Only BBs used in systolic dysfunction
Metoprolol
Bisoprolol
Carvedilol
181
How do BBs help in systolic dysfunction
Anti-ischemic
Decrease HR therefore decrease O2 consumption
Antiarrhythmic
182
MCC death from CHF
Arrhythmia
183
AE spironolactone
Gynecomastia - switch to eplerenone
| Hyperkalemia
184
When to give diuretics in CHF
Initial therapy w/ low EF along with ACEI/ARB
185
What to do w/ hyperkalemia in CHF treatment
Switch ACEI to hydralazine and nitroglycerin
186
Sx digoxin tox
GI (MC)
CNS
Visual
Hyperkalemia
187
When to give implantable defibrillator in CHF
Ischemic cardiomyopathy w/ EF
188
When to give biventricular pacemaker
DIlated cardiomyopathy w/ EF 120ms
189
Mortality benefit in systolic dysfunction
```
ACEIs/ARBs
BBs
Spironolactone/Eplerenone
Hydralazine/Nitrates
Implantable defibrillator
```
190
Clear mortality benefit in diastolic dysfunction
BBs
| Diuretics
191
Worst form of CHF
Pulmonary edema
192
Presentation of Pulm edema
```
Acute SOB
Pink frothy productive cough
Rales, JVD, S3
Orthopnea
Edema
```
193
What are Kerley B lines on CXR
Fluid in septum
194
When to use BNP in pulm edema
SOB etiology is unclear
| NL rules it out
195
CXR in pulm edema
Vascular congestion
| LVH (chronic)
196
ABG results in pulmonary edema
Hypoxia
197
Most important test to do acutely in pulm edema
EKG
198
Fastest way to fix acute pulm edema from arrhythmia
Cardioversion
199
Contribution of atrial systole to CO
10-20%
200
Contribution of atrial systole to CO in the setting of dilated cardiomyopathy, decreased EF, valvular disease
40-50%
201
Best initial therapy of pulmonary edema
Diuretics to remove large fluid volumes
202
Preload reduction in pulm edema
Loops
O2
Morphine
Nitrates
203
When to use positive inotropes in pulm edema
Pt in ICU and not responding to diuretics
| Dobutamine, Amrinone, Milrinone
204
When to give digoxin in pulm edema
Chronically to increase contractility esp w/ A-fib
205
Acute afterload reduction in pulm edema
Nitroprusside
| IV hydralazine
206
Chronic afterload reduction in pulm edema
ACEIs/ ARBs
207
Main causes of regurgitant diseases
HTN
| Ischemic heart disease
208
Best initial test for any valvular disease
Echo
209
Most accurate test for any valvular disease
Catheterization
210
Endocarditis PPx in valvular disease
Not indicated unless there has been replacement or previous endocarditis
211
MCC of MS
Rheumatic fever
212
Associations w/ MS
Pregnancy
| Immigrants
213
Unique presenting features of MS
Dysphagia
Hoarseness
A-fib and stroke from enlarged LA → systemic emboli
Hemoptysis
214
Murmur in MS
Opening snap in diastole (after S2)
| Loud S1
215
Common EKG findings in MS
A-fib
216
CXR in MS
Straightening of left heart border
Elevation of left main-stem bronchus
Second bubble behind heart
217
Rx MS
Diuretics, Na restriction - preload reduction
Balloon valvuloplasty - refractory/pregnant
Valve replacement - balloon contraindicated or fails
Warfarin for A-fib
Rate control for A-fib - digoxin, BBs, diltiazem/verapamil
218
Is pulm HTN a contraindication for surgery for MS
No
219
MCC AS
Congenital bicuspid
| Calcification from aging
220
Presentation of AS
Angina (MC)
Syncope
CHF - poorest prognosis, 2yr survival
221
Murmur in AS
Systolic crescendo-decrescendo
222
Echo results in AS
Thick aortic leaflets
Decreased excursion
LVH
223
CXR and EKG findings in AS
LVH
224
Only true effective therapy in AS
Valve replacement when area
225
When to do balloon valvuloplasty in AS
Surgery contraindicated due to instability or fragility of pt
226
Cause of MR
Dilation of the heart
- HTN
- Endocarditis
- MI
- Papillary muscle rupture
227
Only unique physical finding in MR
Pan(holo)systolic murmur
| Rest looks like CHF
228
Radiation of MR murmur
Axilla
229
Rx MR
Vasodilators - ACEIs/ARBs
Digoxin/diuretics
Valve replacement - LVSED >45 or EF
230
MCC AR
HTN
231
Causes of AR
Dilation of heart or aorta
- HTN
- MI
- Endocarditis
- Marfan, cystic medial necrosis
- Aortic dissection
- Ankylosing spondylitis/Reiter
- Syphilis
232
Unique PE findings in AR
```
Wide pulse pressure
Watter hammer pulse
Pulsating nail beds
BP in legs > BP in arms
Head bobbing
```
233
Murmur in AR
Diastolic decrescendo best heard at left lower sternal border
234
EKG/CXR findings in AR
LVH
235
Rx AR
Vasodilators - ACEIs/ARBs
| Valve replacement - LVESD > 55, EF
236
Causes of MVP
Normal variant W>M
| Marfan, Ehlers-Danlos
237
MC presentation of MVP
Atypical CP
Palpitations
Panic attack
Syncope
238
Murmur in MVP
Midsystolic click
239
Rx MVP
BBs if symptomatic
| Valve repair
240
Endocarditis PPx in MVP
Not indicated
241
Murmurs increased w/ more blood to heart (Leg raise, squat)
MS, AS
| MR, AR
242
Murmurs increased w/ less blood to heart (valsalva, standing)
MS, AS
| MR, AR
243
Murmurs decreased w/ more blood to heart (Leg raise, squat)
HOCM
| MVP
244
Murmurs decreased w/ less blood to heart (valsalva, standing)
HOCM
| MVP
245
Murmurs that do NOT increase with expiration
HOCM
| MVP
246
Rx for all types of cardiomyopathies
Diuretics
247
MCC dilated cardiomyopathy
Previous MI and ischemia
248
Other causes of dilated cardiomyopathy
```
Alcohol - 2nd MCC
Postviral myocarditis
Radiation
Toxins
Chagas
Peripartum
```
249
Dx dilated cardiomyopathy
Echo then EKG, CXR
| Shows decreased EF
250
Rx dilated cardiomyopathy
ACEIs/ARBs, BBs, spironolactone
Diuretics, digoxin
Biventricular pacemaker if QRS > 120ms
251
MCC hypertrophic cardiomyopathy
HTN
252
What is HOCM
Genetic disorder w/ abnormal shape of heart septum
253
Features specific to HCM
S4
| Fewer RHF signs
254
MCC presentation of HOCM
Dyspnea
255
Other sx in HOCM
CP
Syncope
Sudden death
256
What worsens sx in HOCM
```
Anything increasing HR
Anything decreasing LV size
- ACEIs/ARBs
- Digoxin
- Hydralazine
- Valsalva
- Standing suddenly
```
257
Best initial test for HCM
Echo
258
Best initial therapy for HCM and HOCM
BBs
259
Most accurate test for HCM
Cath
260
Common EKG changes in HOCM
Septal Q waves
261
What to give in HOCM w/ syncope
Implantable defibrillator
262
Ultimate therapy in HOCM
Surgical myomectomy
| Only after septal ablation is tried and meds fail
263
Hand grip increases
AR, MR
264
Hand grip decreases
AS
MVP
HOCM
265
Problem in restrictive cardiomyopathy
Heart doesn't contract or relax normally
266
Causes of restrictive cardiomyopathy
```
Sarcoidosis
Amyloid
Hemochromatosis
Endomyocardial fibrosis
Scleroderma
Cancer
```
267
MC complaint in restrictive cardiomyopathy
Dyspnea w/ RHF signs
268
Where do you see kussmaul's sign
Restrictive cardiomyopathy
| Constrictive pericarditis
269
Best initial test for restrictive cardiomyopathy
Echo
270
Most accurate test for restrictive cardiomyopathy
Endomyocardial Bx
271
Rx restrictive cardiomyopathy
Treat underlying cause
| Diuretics may help
272
Which valvular diseases do diuretics help
MS, AS
| MR, AR
273
MC infection causing pericarditis
Viral
274
MC connective tissue disease causing pericarditis
SLE
275
Presentation of pericarditis
Sharp CP changing in intensity w/ respiration and body position
Worse lying down
276
EKG in pericarditis
PR depression
| ST elevation in all leads
277
Rx pericarditis
Treat underlying cause
278
Rx pericarditis if idiopathic cause
Presumed to be coxsackie B
NSAIDS - Steroids if they don't work
Colchicine reduces recurrence
279
Any cause of pericarditis can cause
Pericardial tamponade
280
Common features of pericarditis
Hypotension
Tachy
Distended neck veins (not in PE)
Clear lungs
281
Physical finding in tamponade
Pulsus paradoxus
282
What is pulsus paradoxus
>10mmHg decrease in BP on inspiration
283
Why should echo be done over EKG in tamponade
EKG commonly only shows tachy
284
EKG feature in tamponade
Electrical alternans
285
CXR feature in tamponade
Water bottle heart
286
Echo feature in tamponade
RA and RV diastolic collapse
287
Rx tamponade
Pericardiocentesis
IVF
Subxyphoid window in pericardium for recurrence
288
What is constrictive pericarditis
Any cause of pericarditis leading to calcification and fibrosis (can be from TB)
289
Sx indicating constrictive pericarditis
Signs of RHF
- Edema
- Ascites
- Hepatosplenomegaly
- JVD
290
Physical findings in constrictive pericarditis
Kussmaul sign - Increased JVD on inhalation
| Knock - extra heart sound in diastole
291
Best initial test for constrictive pericarditis
CXR showing calcification and fibrosis
292
Rx Constrictive pericarditis
Diuretics FIRST
| Surgical removal of pericardium
293
Causitive factors for PAD
DM
Hyperlipidemia
HTN
Smoking
294
Key sx in PAD
Leg pain in calves on exertion (intermittent claudication)
| Pain walking up and down hills
295
Differentiate PAD from spinal stenosis in Hx
Stenosis is pain waling down hills only
296
Severe PAD is associated with loss of
Hair follicles
Sweat glands
Sebaceous glands
Skin looks smooth and shiny
297
Best initial test for PAD
ABI
298
Most accurate test for PAD
Angiogram
299
Best initial therapy for PAD
Aspirin
Stop smoking
Cilostazol
300
Single most effective medication for PAD
Cilostazol
301
Sx description in aortic dissection
Severe, Sharp, Tearing
| Radiating through to back
302
Key points of aortic dissection
Loss of pulses +/- aortic insufficiency
BP difference b/w arms
Pain between scapulae
303
CXR feature in aortic dissection
Widened mediastinum
304
Most accurate test for aortic dissection
Angiography
| However MRA = CTA = TEE
305
Best initial test for aortic dissection
CXR
306
Rx aortic dissection
Control BP
- BBs
- Nitroprusside
- Surgical correction
307
Most appropriate screening for aortic aneurysm
Surgical/Catheter repair when AAA > 5cm
308
Who doesn't get screened for AAAs
Non-smokers
| Women
309
Worst form of heart disease in pregnancy
Peripartum cardiomyopathy
- Abs against myocardium in pregnancy
If this isn't a choice then Eisenmenger
310
Rx if LV dysfunction doesn't improve
Cardiac transplant
311
Medical therapy of peripartum cardiomyopathy
```
ACEIs/ARBs
BBs
Spironolactone
Diuretics
Digoxin
```
312
Eisenmenger syndrome
R to L shunt from pulm HTN in people w/ VSD
