Cardio Flashcards
(183 cards)
1
Q
cardio defect seen in turners
A
coarctation of the aorta
2
Q
signs of coarctation of aorta
A
weakness lower extremities (from BP discrepency)
rib notching (congestion)
mild continuous murmur all over ( collaterals between HTN and hypoperfused vessels)
3
Q
what causes the narrowing of aorta in coarctation
A
thickening of tunica media
4
Q
systolic ejection murmur at left inerscapular area
A
coarctation
5
Q
causes of amyloidosis
A
inflammatory arthritis chronic infections IBD malignancy vasculitis
6
Q
CHF Sx with proteinuria and easy bruising
A
amyloid
7
Q
signs of amyloid
A
waxy skin, macroglossia, hepatomegaly and periperhal or autonomic neuropathy
8
Q
how to confirm amyloidosis causing cardiomyopathy
A
tissue biopsy from fat pad, bone marrow, rectum kidney or endomyocardium
9
Q
continuous flow murmur in child
A
PDA
10
Q
management vfib
A
defibrillation
11
Q
ischemica reperfusion syndrome
A
form of compartment syndrome. confied tissue space with edema
need fasciotomy
12
Q
suspect renovascular HTN when
A
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
Q
risk facotr for aoartic aneurysm
A
atherosclerosis
14
Q
S4 heard when
A
acute phase of myocardial infarction from ischemia causing dysfunction and stiffening of left ventricular myocardium
15
Q
acute Tx AF in patients with WPW
A
unstable- elctrocardioversion
stable- ibutilite or procainamide
16
Q
complication AMI hours-1 week
A
ventricular septal rupture
17
Q
complication after AMI up to 2 weeks
A
free wall rupture
18
Q
complication hours to a month post AMI
A
postinfarction angina
19
Q
When can papillary muscle rupture occur post MI
A
2 days-1 week
20
Q
when does pericaritis post MI happen
A
1 day to 3 months
21
Q
when do left ventricular aneurysms occur post mi
A
5 days to 3 months
22
Q
Signs of ventricular aneurysm psot MI
A
persistent ST elecation after recent MI with deep Q eaves in same leads
23
Q
sigsn cardiac tamponade
A
hypotension, tachycardia, distended neck veins and pulsus paradoxus
24
Q
what causes cardiac tamponade
A
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
