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Flashcards in Cardio Deck (183):
1

cardio defect seen in turners

coarctation of the aorta

2

signs of coarctation of aorta

weakness lower extremities (from BP discrepency)
rib notching (congestion)
mild continuous murmur all over ( collaterals between HTN and hypoperfused vessels)

3

what causes the narrowing of aorta in coarctation

thickening of tunica media

4

systolic ejection murmur at left inerscapular area

coarctation

5

causes of amyloidosis

inflammatory arthritis
chronic infections
IBD
malignancy
vasculitis

6

CHF Sx with proteinuria and easy bruising

amyloid

7

signs of amyloid

waxy skin, macroglossia, hepatomegaly and periperhal or autonomic neuropathy

8

how to confirm amyloidosis causing cardiomyopathy

tissue biopsy from fat pad, bone marrow, rectum kidney or endomyocardium

9

continuous flow murmur in child

PDA

10

management vfib

defibrillation

11

ischemica reperfusion syndrome

form of compartment syndrome. confied tissue space with edema
need fasciotomy

12

suspect renovascular HTN when

elecation serum Cr after ACEI or ARB
severe HTN with recurrent flash pulm edema
severe HTN with idffuse atherosclerosis
severe HTN after age 65
abdominal bruit
resistent HTN to 3 combined medications

13

risk facotr for aoartic aneurysm

atherosclerosis

14

S4 heard when

acute phase of myocardial infarction from ischemia causing dysfunction and stiffening of left ventricular myocardium

15

acute Tx AF in patients with WPW

unstable- elctrocardioversion
stable- ibutilite or procainamide

16

complication AMI hours-1 week

ventricular septal rupture

17

complication after AMI up to 2 weeks

free wall rupture

18

complication hours to a month post AMI

postinfarction angina

19

When can papillary muscle rupture occur post MI

2 days-1 week

20

when does pericaritis post MI happen

1 day to 3 months

21

when do left ventricular aneurysms occur post mi

5 days to 3 months

22

Signs of ventricular aneurysm psot MI

persistent ST elecation after recent MI with deep Q eaves in same leads

23

sigsn cardiac tamponade

hypotension, tachycardia, distended neck veins and pulsus paradoxus

24

what causes cardiac tamponade

fluid in pericardial sack

25

AS in young adult, cause of chest pain?

increased myocardial oxygen demand

26

innocent murmurs in kids decrease with what maneuever

ones that decrease Venous return like standing up

27

preload increases in what shock

cardiogenic

28

pulmonary capillary wedges pressure increases in what shock

cardiogenic

29

cardiac index increases in what type of schok

septic

30

systemic vascular resistance increases in what shock

hypovolemic and cardiogenic

31

mixed venous oxygen saturation increases in what shock

septic

32

detect VSD in child, next step

echo

33

Afib post CABG patient with low BP, next step?

cardioversion

34

next step for SVT arryhthmia

adenosine to identify origin of arrhythmia

35

when to give statin in new diagnosed DM

if above 40 years old with diabetes, give statin

36

findings on peripheral blood smear in systemic scleroderma

shicstocytes

37

signs primary hyperPTH

hyperCa (polyuria and polydispia)
kidney stones
confusion, depression, psychosis

38

first line antiHTN in pregnancy

methyldopa
labetolol
hydralazine
CCB

39

MVA accident. if PCWP increases after saline IV but BP does not change much

myocardial contusion because there is left ventricular dysfunction

40

patient was having AMI and medically managed, now has pale cold limb. next step?

anticoagulation, vasc surgery consult and a Transthoracic echo to look for left ventricular thrombus

41

dyspnea dry cough and holosystolic murmur

mitral regurg

42

recommended Tx for afib secondary to hyperthyroid

beta blockers

43

cyanotic 1 week old with decreased pulmonary vascular markings and normal size heart.

tricuspid valve atresia

44

EKG findings on tricuspid atresia

left axis deviation
small R waves and tall peaked P waves

45

normal heart deviation in newborn

RAD because right atrium is larger due to PDA

46

explain the murmur in tricuspid atresia

loud holosystolic at Left lower sternal border because there is usually a VSD associated with the defect

47

common heart anomoly with downs

complete AV canal defect. large ventricles

48

what is ebsteins anomaly

displacement of malformed tricuspid valve into right ventricle. causes tricuspid regurg. and Right atrial enlargement. cardiomegaly

49

boot shaped heart

tetralogy of fallot

50

what is total anomalous pulmonary venous return

all 4 pulmonary veins fail to connect to left atrium and go to right. (some go to proper place) results in pulmonary overcirculation

51

hemoptysis raises suspicion for what valvular disease

mitral stenosis likely from rheumatic in most cases

52

increase risk for what with mitral stenosis or regurg

afib. increased risk for stroke etc. cardiac emboli

53

5 common side effects of amoidarone

pulmonary fibrosis
thyroid dysfunction (hypo>hyper)
hepatotoxicity (stop if LFT more that 2x high)
corneal deposits
skin changes (blue grey discoloration)

54

risk factor contributing to aortic dissection

systemic HTN longstanding

55

decrescendo diastolic murmur

aortic regurg.

56

risk factor associate with aortic aneurysms

atherosclerosis

57

inspiratory stridor in a child 6 months

6 months most common is croup- laryngotracheobronchitis. barky cough

58

persistent stridor that worsens in supine and improves in prone

laryngomalacia

59

persistent stridor that improves with neck extension

vascular ring

60

Dx of vascular ring causing stridor in infant

barium contrast esophagogram, bronchoscopy or CT or MRIangiogram

61

diagnosis of aortic dissection

stat TEE
if hemodynamically stable and no TEE around then CT or MRI

62

what type of aortic dissection causes pericardial effusion

Acute Type A

63

prinzmental angina is similar to what pathology in extremities

raynauds, vasospasms

64

what cardiac medication cna limit ventricular remodeling post MI

ACEI
start within 24 hours of MI

65

What happens with large AVF

shunting blood decreases SVR and increases cardiac preload and cardiac output

66

signs of large AVF

widened pulse pressure, strong peripheral arterial pulsation and a systolic flow murmur

67

causes of high output cardiac failure

AVF
anemia
thyrotoxicosis
paget disease
anemia
thiamine deficiency

68

change in murmur from hypertrophic cardiomyopathy with valsalva.

increases

69

vascular signs of infective endocarditis

janesway lesions- macular erythematous nodular lesions on palms and soles
mycotic aneurysm
systemic emboli

70

immunologic signs if infective endocarditis

osler nodes- painful violaceous nodules on fingertips and toes
roth spots- edematous, hemorrhagic lesions of the retina

71

what is adults stills disease

inflammatory disorder with recurrent high fevers, rash, and arthritis
rash is maculopapular and nonpruritic, only affecting trunk and extremities

72

what causes hypotension, hyperpigmentation and hyponatremia

adrenal insufficiency

73

most appropriate Tx for a patient with aortic dissection

labetolol- type B (descending) can be managed medically

74

signs of dig toxicity

nausea, vomiting, decreased appetite, confusion and weakness
can also have scotomata, blurry vision with changes in color

75

what other cardiac drug increases risk of dig toxicity

loop diuretics

76

what arrythmia is caused by dig toxicity

Atrial tachy with AV block
slower atrial rate (150-250) with p waves but p waves may look different.

77

most common pathogens for viral myocarditis

coxsackie B and adeno

78

kawasaki

fever x 5 days
cervical lymph node >1.5 cm
rash
bilateral nonexudative conjunctivitis
mucositis
swelling or erythema of palms and soles

79

Indications for urgent dialysis

Acidosis
Electrolyte abnormalities like hyperkalemia
Ingestion ot toxins, lithium, valproate
Overload of volume
Uremia (encephalopathy, pericarditis, bleeding)

80

diagnosis vasovagal syncope

tilt table testing

81

appropriate management of kawasaki

aspirin and IV Ig

82

inability to palpate the point of maximal impulse

large pericardial effusion

83

what causes the outflow obstruction in HCM

hypetrophied interventricular septum and the abnormal motion of the mitral valve leaflets--> "systolic anterior motion"

84

electrical alterans

pericardial effusion

85

what is BUN/Cr in hypovolemic patient

increased ratio like 20:1

86

stable wide complex tachycardia with fusion/capture beats, next step

IV amiodarone

87

what to do for unstable v tach

synchronized cardioversion

88

where do the ectopic foci for AF originate

pulmonary veins

89

most common cause of secondary HTN in children

fibromuscular dysplasia

90

what electrolyte is a good indication of severe heart failure

hyponatremia
from release of renin and ADH. water reabsorption leading to dilutional hyponatremia

91

how does cold water immersion affect PSVT

decreases conduction through the AV node

92

managemetnt third degree heart block

temporary pacing

93

which murmur maneuvers decrease preload

valsalva
abrupt standing
nitroglycerin

94

which murmur maneuvers increase afterload

hand grip
squatting

95

which mrumur maneuver increase preload

passive leg raise and squatting

96

if patient has chronic rhinitis and nasal polyps and just put on beta blocker

watch for dyspnea and bronchoconstriction

97

signs of edwards

micrognathia, microcephaly, rocker bottom feet, overlapping fingers and absent palmar creases

98

common heart defect in edwards

VSD

99

basic workup for HTN

UA, chem panel, lipid profile, baseline EKG

100

kid with congenital QT syndrome

propanolol and pacemaker

101

what electrlyte abnormalities can cause long QT

hypoK
hypoCa
hypoMg

102

what drugs increase warfarin's effect (CYP450 inhibitors)

acetominophen, NSAIDs
antibiotics/antifungals
amiodarone
cimetidine
cranberry juice, binko, vit E
omeprazole
thyroid hormone
SSRIs

103

what drugs decrease warfarin's effect (CYP450 inducers)

carbamazepine
ginseng
green vegetables (spinach) (Vitamin K)
oral contraceptives
phenobarbital
rifampin
St johns wort

104

after arterial puncture, within 12 hours become hypotensive

suspect retroperitoneal hemorrhage and order CT non contrast

105

how does knee to chest help with tetralogy

increase sysmteic resistance

106

4 parts of tetralogy

right ventricular outflow tract obstruction from pulm stenosis or atresia)
right ventricular hypertrophy
overriding aorta
VSD

107

when to definitely anticoagulate for Afib

CHAD score 2-6

108

CHADS2 score

CHF
HTN
Age >75
DM
Stroke or TIA

109

murmur with acute aortic dissection in marfanoid patient

early diastolic murmur

110

pulsus parvus et tardus

aortic stenosis

111

clopidogrel is what R blocker

P2y12

112

Malignant HTN criteria

severe HTN with retinal hemorrhages, exudates or papilledema

113

systemic arterial P that falls >10mmHg with inspiration

asthma- pulsus paradoxus

114

Mitral valve prolapse occurs due to what

myxomatous degeneration of leaflets

115

murmurs with complete AV septal defect

loud S2 due to pulmonary HTN
systolic ejection murmur
hososystolic murmur of VSD

116

bradycardia, AV block, hypotension and diffuse wheezing. OD on what drug

beta blocker

117

management of beta blocker OD

secure ariway and give isotonic fluid and IV atropine
glucagon IV

118

common side effect of CCB in women

peripheral edema from dilation of precapillary vessels

119

combine what drug with CCB to decrease edema

ACEI

120

at what degree stenosis do you do surgery for carotid stenosis

60-99% if asymptomatic
>50% is sypmtomatic

women >70% surgery!

121

strongest predictor for stent thrombosis within 12 months of placement

is medical noncompliance

122

what murmur is best heard during expiration

aortic regurg

123

PAD patients are greatest risk to suffer what in 5 years

MI

124

initial Tx of chronic venous disease

leg elevation, exercise and compression stockings

125

murmur in tetralogy

harsh systolic ejection murmur in left upper sternal border and a single S2 from poor pulmonary blood flow

126

constrictive pericarditis causes

idiopathic or viral
cardiac surgery or radiation
TB pericardiitis (endemic areas)

127

Tx for prinzmetals angina

diltiazem

128

what happens to preload in cardiac tamponade

decreases

129

treatment and management for acute arterial occlusion

IV heparin

130

complication of nitroprusside for HTN emergency

can cause cyanide toxicitiy which can cause lactic acidosis and seizures

131

PCI for STEMI patients in what time

12 hours since onset
90minutes with contact personnel

132

most likely impact on high BP non pharmacologic

weight loss then dietary modification to DASH

133

what happens to RAAS system with CHF

RAAS is activated and causes vasoconstriction of the efferent renal arterioles increasing intraglomerular pressure to maintain GFR

134

presentation late aortic coarctation

chest pain, claudication, HA, epistaxis, heart failure and aortic dissection

135

exam for aortic coarctation

brachio femoral delay
check BP in upper and lower extremities

136

what happens to ribs in longstanding coarctation of aorta

notching ribs 3-8 from enlarged intercosals

137

aortic stenosis murmur

mid late peaking systolic murmur with soft and single second heart sound

138

smoking cessation or weight loss for HTN

weight loss

139

furosemid causes what abnormalities for electrolytes

hypoMg and kypoK

140

mild persistent HTN in young woman on OCP

switch to different birth control

141

vasodilation is what type related reaction

prostaglandin related reaction

142

heart defect with turners

bicuspid aortic valve

143

bloody diarrhea and fever after surgery correcting infrarenal AAA

bowel ischemia

144

fatigue, cough dyspnea with hemoptysis and early diastolic sound

myxoma tumor
do a TEE or TTE

145

DiGeorge

Catch 22
cotruncal cardiac defects
abnormal facies
thymic aplasia
cleft palate
hypocalemia

146

eisenmenger syndrome

cyanosis and dyspnea from right to left shunting through large VSD

147

management of cocaine overdose

IV benzos for BP and anxiety
aspiring
nitro and CCB for pain
NO NO beta blockers

148

situational syncope

autonomic dysregulation

149

narrow complex tachycardia causing hypotension
next step

synchronized cardioversion

150

CHA2DS2VASc

CHF
HTN
Age>75 2 pts
DM
Stroke/TIA/DVT 2 pts
Vascular disease
Age 65-74
Sex (female)

maximum 9

151

S4 heart sound

corresponds with left ventricular hypertrophy most likely secondary to long standing HTN

152

Water hammer pulse

aortic regurg

153

Pulseless electrical activity management

CPR and vasopressor therapy

154

reversible causes of pulseless electrical activity

Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
hypo or hyperK
hypothermia
Tension pneumo
tamponade
toxins
thrombosis
trauma

155

type 1 HIT vs type 2

type 1 is in first 2 days
type 2 is from Ab to platelet factor 4 and presents 5-10 days after initiation heparin

156

what is the effect of dipyridamole and adenosine in cardiac stress testing

cause coronary steal
the obstructed coronary aa are already maximally dilated

157

Tx for hypertrophic cardiomyopathy

Beta blockers

158

what murmurs get louder with squatting

AR MR and VSD

159

what murmurs get softer with squatting

MVP and HCM

160

what murmurs get louder with standing

HCM and MVP

161

what murmurs get louder with valsalva

HCM and MVP

162

what murmurs get louder wtih handgrip

AR MR and VSD

163

what murmrs get softer with handgrip

HCM and AS

164

rhemuatic fever is from what infection

GAS

165

management of rheumatic fever in child with recurrent pharyngitis

IM penicillin q4 weeks

166

pericalcular abscess indications

aortic valve endocarditis causing AR and a AV conduction block with syncope

167

tricuspid regurg murmur

holosystolic that is accentuated with inspiration

168

features of cholesterol emboli

levedo reticularis, ulcers, gangrene, blue toe syndrome
renal injury
CNS like stroke and amaurosis fugax
ocular involvement
GI like ischemia and pancreatitis

169

lab studies in cholesterol emboli

eosinophilia, hypocomplementemia

170

abnormal Ankle brachial index

171

ABI of >1.30

calcified uncompressible vessels

172

Tx for sinus bradycardia

IV atropine 0.5 mg bolus every 3-5 minutes for up to 3.0 mg

173

Tx for hemochromatosis

phlebotomy

174

early onset HTN with bilateral upper abdominal masses

PKD auto dominant so do abdominal US

175

secondary effects of fibromuscular dysplasia

decrease perfusion kidneys causing increased renin and aldosterone
the ratio is

176

inheritance of HCM

auto dominant

177

common anatomical cause of aortic stenosis

bicuspid valve

178

what is kussmaul

increase JVD with inspiration

179

Tx for endocarditis susceptible to penicillin

IV penicillin G or IV ceftriaxone

180

mid diastolic sound and signs of R side CHF

constrictive pericarditis because there is mid diastolic sound

181

rupture of left ventricular wall results in what

pericardial tamponade

182

ventricular septal rupture results in what murmur

pansystolicand is best heard at left sternal border with a thrill and does not radiate

183

papillary muscle wall rupture murmur

mitral regurug
and has pansystolic murmur loudest at apex and radiates to axilla