Cardio Flashcards
(322 cards)
1
Q
Three types cardiomyopathy + which is most common?
A
dilated** (MC)
hypertrophic
restrictive
2
Q
Dilated cardiomyopathy:
common cause
prognosis
symptoms same as
A
CAD w/ prior MI (ischemic damage)
death w/in 5 years
CHF symptoms
3
Q
Treatment of Dilated Cardiomyopathy
A
-Dig
-Diuretics
-Vasodilators
+/- anticoagulation
4
Q
HCOM:
- inheritance pattern
- type of dysfunction
A
- AD
- diastolic dysfunction
5
Q
Murmur assc with HCOM?
Worse with?
A
Loud S4 + systolic ejection murmur @ LLSB
worse with Valsalva, standing
6
Q
Initial drug to treat symptomatic HCOM
A
BBers
7
Q
Surgical treatment of HCOM
A
myomectomy
8
Q
Restrictive Cardiomyopathy:
-dysfunction type
A
- impaired diastolic filling
- systolic function variable
9
Q
Causes of Restrictive Cardiomyopathy
A
SASH CC sarcoid amyloid scleroderma hemochromatosis chemo carcinoid ....or idiopathic
10
Q
Echo findings in restrictive cardiomyopathy
A
large atria, normal ventricles
bright myocardium in amyloidosis
11
Q
Definitive diagnosis of restrictive cardiomyopathy
A
biopsy
12
Q
Hemochromatosis treatment
sarcoid treatment
A
hemochromatosis- phlebotomy, deferoxamine
sarcoid- steroids
13
Q
Dig is contraindicated in what type of restrictive cardiomyopathy?
Needed when?
A
amyloid
used in other cases if systolic dysfunction is present
14
Q
Three viral causes myocarditis
A
HHV6
parvo
coxsackie
15
Q
Bacterial causes myocarditis (3)
A
GAS
Lyme
mycoplasma
16
Q
Medication that may cause myocarditis
A
sulfonamides
17
Q
Acute pericarditis most common causes
A
post viral/ coxsackie
18
Q
Complications of acute pericarditis
A
effusion
tamponade
19
Q
How is pericarditis distinguished from MI? (4)
A
pleuritic pain (assc with breathing)
pain relieved when sitting up
friction rub
DIFFUSE STE, PRD
20
Q
Specific EKG finding in pericarditis
A
PRD
21
Q
Treatment of pericarditis
A
NSAIDs
colchicine
22
Q
Fibrous scarring of the pericardium is termed ____.
Dysfunction type is ____.
A
constrictive pericarditis
diastolic dysfunction
23
Q
Constrictive pericarditis auscultation:
EKG:
A
pericardial knock
low voltage QRS, T waves
24
Q
Pericardial effusion clinical findings
A
dull heart sounds
soft PMI
25
Pericardial effusion CXR findings
enlarged heart without pulm vascular congestion
26
When is pericardiocentesis indicated?
evidence of cardiac tamponade
27
What causes cardiac tamponade?
| dysfunction type?
high rate pericardial fluid accumulation, volume irrelevant
diastolic dysfxn
28
Aside from penetration, what conditions lead to tamponade?
post MI
| pericarditis (neoplastic, uremic esp.)
29
(3) clinical features of tamponade
high JVP
narrow pulse pressure
pulsus paradoxus
30
Define pulsus paradoxus
decreased arterial pressure (more than 10) during inspiration
31
Best diagnosis of tamponade
echo
32
EKG finding in tamponade
electrical alternans
33
Mitral Stenosis:
- MCC
- cardiac cascade assc with MS
- RF
| - elevated LAP --> pulm congestion & a fib
34
Unique symptoms of MS (4)
- hemoptysis
- purple/pink cheeks
- emboli
- hoarseness (LAE --> RLN compression)
35
EKG finding assc with MS
broad based notched P waves
36
Murmur assc with MS + severity determinant
S2 --> opening snap --> loud S1
| decreased distance between S2 --> OS= increased severity
37
Treatment of MS
- Diuretics
- BBers
- warfarin
(symptomatic only)
38
Aortic Stenosis:
| cardiac cascade assc
AS --> LVH --> mitral regurg
39
Three causes of AS
- senile calcification (70+)
- bicuspid valve
- RHD
40
Murmur assc with AS
crescendo-decrescendo systolic murmur at RSIS
| radiates to carotids
41
Pulse abnormality assc with AS
parvus et tardus
| diminished pulses, delayed carotid upstrokes
42
Treatment of AS
valve replacement
43
Cause of UE differential BP
supravalvular aortic stenosis
44
Cause of systolic anterior motion of mitral valve
HCOM
45
Cause of Sudden Cardiac Arrest in post-infarct patients
re-entrant ventricular arrhythmia
46
4 Labs in initial evaluation of HTN
- U/A
- chem panel
- lipids
- EKG
47
Aortic Insufficiency (Regurg) PE findings
head bobbing
uvula bobbing
pistol shot sound over femoral arteries
48
Murmur and pulse assc with AI
widened pulse pressure
| diastolic decrescendo murmur
49
Treatment of acute AR
replace valve emergently
50
Medical treatment of chronic AR
diuretics
dig
vasodilators
reduce afterload, limit salt
51
Three acute causes of MR
endocarditis
papillary muscle rupture
chordae tendineae rupture
52
MR:
murmur
common arrhythmia
holosystolic murmur at apex
| afib
53
MR treatment
vasodilation + anticoagulation with afib
54
How common is TR?
70% normal adults have asx TR
55
TR is secondary to ____.
RVD
| as in heart failure, inferior MI
56
Tricuspid endocarditis cause
IVDA
57
MVP histology
myxomatous degeneration
58
Murmur assc with MVP (+2 maneuvers that increase)
midsystolic click , increased by Valsalva/ standing
59
Treatment of MVP
generally benign, none indicated
60
MC valvular abnormality assc with RF
mitral stenosis
61
Diagnostic requirements RF
2 major or 1 major/2 minor
62
Major criteria RF
JONES
- joints (polyarthritis)
- cadiac involvement
- nodules
- erythema marginatum
- Sydenham chorea
63
How is ARF treated?
NSAIDs, monitor with CRP
| px is penicillin/e-ymcin in GAS pharyngitis
64
New heart murmur + unexplained fever =
endocarditis
65
Acute endocarditis:
bug
valve type
staph, normal valve
66
Subactue endocarditis:
bug
valve type
strep viridans, enterococcus
| diseased valve
67
Culture negative endocarditis bugs
```
HACEK
haemophilus
actinobacillus
cardiobacterium
eikenella
kingella
```
68
Most common bug assc with post op endocarditis
staph epi
69
MC valve + bug assc with IVDA endocarditis
tricuspid, staph
70
Gold standard endocarditis dx
transesophageal echo
71
Major criteria endocarditis
bacteremia , TEE diagnosed endocardial involvement OR new valve regurg
72
Treatment duration of endocarditis
4-6 weeks
| vanc + AG until bug isolated
73
Marantic endocarditis cause + makeup of vegetations
cancer
| fibrin + platelets
74
Treatment for Libman Sacks Endocarditis
anticoagulate
75
Most common type ASD + age at onset
```
ostium secundum (central portion of septum)
age at onset- 40
```
76
ASD murmur + Dx
wide, fixed split S2 - dx with TEE
77
Murmur assc with VSD
blowing, holosystolic
78
Coarctation of the Aorta is assc with what syndrome?
Turners
79
ECG findings in coarctation
LVH --> Left Axis Deviation
80
PDA is assc with what syndrome?
Congenital rubella
81
Murmur assc with PDA
continuous machine like murmur
82
TOF defects
```
IHOP
interventricular septal defect
hypertrophy of RIGHT ventricle
(Right is right answer)
overlying aorta
pulmonic stenosis
```
83
Murmur assc with TOF
LUSB crescendo decrescendo
84
EKG + CXR findings in TOF
RAD
| Boot shaped heart
85
Amiodarone complications + most common
```
pneumonitis **MC
thyroid tox
liver tox
corneal deposits
skin discoloration (blue --> gray)
neuropathy
```
86
Mechanical failure assc with MI at:
day 1
days 3-5
weeks 1-2
day 1: RVF
days 3-5: papillary/ septal defect
weeks 1-2 free wall rupture
87
Definition of HTN emergency?
| urgency?
- BP above 220/120
- end organ damage
(urgency= BP above 220/120 w/o end organ damage)
88
```
Effect of severe HTN on:
brain
pulm
cardio
kidneys
```
brain- AMS, ICH
pulm- pulm edema
cardiac- angina/MI/CHF/dissection
hematuria, renal failure
89
PRES- define
Posterior reversible encephalopathy syndrome
90
PREs- radiographic finding
posterior cerebral white matter edema
91
Treatment of HTN emergency
```
hydralazine
nitroprusside
esmolol
labetolol
(IV)
```
92
Ilicit drugs that cause HTN emergency
LSD
meth
cocaine
(+alcohol withdraw)
93
Management of serve H/A and HTN?
antiHTN agent --> CT --> LP
94
Goal reduction of BP in HTN emergency? urgency?
emergency-reduce by 25% in 1-2 hours w/ IV meds
| urgency- reduce BP over 24 hours with oral meds
95
Aortic Dissection:
| causes
- longstanding HTN
- cocaine
- trauma
- CT disorder
- bicuspid aortic valve, coarctation
- third trimester pregnancy
96
Two types of aortic dissection:
```
Type A:
ascending aorta involved, retrograde flow
**surgical**
Type B:
distal to subclavian artery
```
97
Location of pain in dissection
Type A: anterior chest
| Type B: intrascapular
98
Pulse, BP, auscultation abnormalities in AD
pulse asymmetric between limbs
BP usually ^^ but may be low
aortic regurg
99
CXR finding in AD
mediastinal widening
100
Preferred tests in dx of AD
CT
| TEE
101
Medical treatment of AD
- BBer
| - IV nitroprusside until BP under 120
102
Location of most AAAs + MC age/ sex
between renal arteries and iliac bifurcation
| males over 50
103
Signs of impending AAA rupture
flank/umbilical ecchymoses
104
Triad of AAA rupture
hypotension
palpable pulsatile abdominal mass
abdominal pain
105
Dx test of choice for AAA
U/S
106
What AAAs are surgical?
greater than 5 cm or symptomatic
107
Peripheral Vascular Disease is aka?
Chronic Arterial Insufficiency
108
Signs of PVD in lower extremities
- color change
- ulcers
- muscle atrophy
- thickened toenails
- hair loss
109
PVD most important risk factor
smoking
110
MC site of stenosis in PVD
superficial femoral artery
111
Symptoms of PVD
intermittent claudication/ rest pain (severe, poor prognosis)
112
Arteries related to calf claudication? hip?
calf- femoral, popliteal
| hip- aortoiliac
113
Diagnosis of PVD
- ankle to brachial index
- pulse volume
- arteriography (gold standard)
114
Define ankle to brachial index (ABI)
systolic BP in ankle: arm
normal 0.9-1.3
claudication occurs at 0.7
115
Medical treatment PVD
reduce risk factors
symptom control (ASA)
cilostazol (PDEi)
116
Acute arterial occlusion- most common location + common causes
femoral artery
- afib
- aneurysms
- atheromatous plaque
117
Treatment of acute arterial occlusion
- IV heparin
| - surgical embolectomy
118
Cholesterol Embolization Syndrome most common cause + symptoms
triggered by procedure
| small areas of tissue ischemia
119
Treatment of cholesterol embolization syndrome
supportive, no anticoagulation
120
Mycotic aneurysm: cause and location
infection, aortic wall
121
Luetic heart is caused by ____.,
| Location? Sex? Age?
syphilis
aorta (ascending aneurysm)
male: 40s-50s
122
Treatment of luetic heart
IV penicillin + surgery
123
Virchows triad
endothelial injury
venous stasis
hypercoagulability
124
Why are many DVT patients asx?
superficial vein remains patent
125
What is Homans sign?
calf pain on ankle dorsiflexion (DVT sign) I
126
DVT : Dx
d-dimer, Doppler U/S (sensitive not specific)
127
Phlegmasia cerulea dolens:
| define + cause
severe leg edema = caused by extreme DVT
128
Treatment of DVT
Heparin to PTT at 1.5-2x aPTT, INR 2-3.
129
What DVT patients receive tPa/ kinase
massive PE, unstable, no contraindications
130
LMWH:
benefits
downside?
long half life (once daily)
outpatient
no levels
**more expensive
131
Postphlebetic syndrome is aka? Pathogenesis?
chronic venous insufficiency
valve destruction --> ambulatory venous HTN =
fluid accumulation + RBCs into tissue (pigmentation)
eventual tissue death = non-healing ulcers
132
Dig tox- classic EKG finding + cause
a tach with AB block due to increased ectopy and vagal tone
133
CXR finding in perforated ulcer
air under diaphragm
134
PE classic symptoms (four)
dyspnea
pleuritic pain
tachycardia
tachypnea
135
Amlodipine:
MOA
Common ADR?
DHP CCB
| edema
136
Scleroderma renal crisis causes what two phenomena in addition to renal failure?
HTN emergency
| DIC
137
Cardiac amyloidosis:
| EKG and echo findings
EKG: low voltage
Echo: LV wall thickening, normal chamber
138
Common systemic symptoms assc with cardiac amyloidosis
easy bruising
| proteinuria
139
Amyloidosis may be primary or secondary to what ?
chronic inflammatory disoders... IBD, RA etc.
140
Definitive diagnosis of amyloidosis?
tissue biopsy (fat pad)
141
When is sinus brady treated?
below 50 BPM, symptomatic
142
Dosage of atropine for bradycardia?
0.5mg q3-5 min up to 3mg
143
Dosage of dopamine for bradycardia? epi?
dopa: 2-10 uq/lg/min
epi: 2-10 uq/min
144
How might MVP cause holosystolic murmur?
longstanding MVP --> MR (mid systolic click) --> progresses to holosystolic murmur
MVP --> MR MCC MR
145
HyperPTH findings
neuropsych
stones
HTN
146
Shockable Rhythmns
PEA
| Vfib
147
Anterior MI:
STE or STD?
Assc artery?
V1-6 STE, LAD
148
Lateral MI:
STE or or STD?
Assc artery?
STE: I & AvL
STD: II,III,and avF
LCX
149
Right Ventricle MI:
STE or STD?
Assc artery?
STE V4-6
| RCA
150
Posterior MI:
STE or STD?
Assc artery?
V1-3 STD
I&AVL STE-LCX
I&AVL STD- RCA
151
Inferior MI:
STE or STD?
Assc Artery?
II,III,AVF
| LCX or RCA
152
Hypovolemic shock:
```
CO?
CVP?
MVO2?
PCWP?
RAP?
SVR?
```
All low except SVR = ^^^
153
```
Cardiogenic Shock:
CO?
CVP?
MVO2?
PCWP?
RAP?
SVR?
```
CO, MVO2 low
| others high
154
Septic Shock
Hypovolemic shock:
```
CO?
CVP?
MVO2?
PCWP?
RAP?
SVR?
```
CO, MVO2 high
| others low
155
Location of most venous ulcers?
medial malleolus (and less painful than arterial ulcers)
156
Superficial thrombophlebitis:
| common locations
site of IV infusion
| varicose veins in greater saphenous system
157
Common cause of septic thrombophlebitis
infection of IV cannula
158
Most common cardiac tumor
primary tumors rare (usually mets)
| atrial myxoma is most common primary tumor
159
Most common location cardiac myxoma
interatrial septum
160
Murmur assc with myxoma
diastolic "plop" changes with position
161
Signs common to all forms of shock?
```
HOTA
hypotension
oliguria
tachy
AMS
```
162
Effect of neurogenic shock on CO SVR PCWP
all decreased
163
What one sign suggests cardiogenic shock?
| MCC?
JVD
| MI
164
BP/ urine output assc with cardiogenic shock?
systolic under 90
| urine output less than 20ml/hr
165
Intraaortic balloon pump:
| function
pumps during diastole, relaxes during systole
increases ventricular emptying
increases coronary perfusion
166
Pulse + urine output assc with classes I-IV hypodynamic shock
normal, normal
above 100, 20-30 ml/hr
above 120, 20 ml/hr
above 140/ not palpable, none
167
Amount of fluid lost in classes I-IV hypovolemic shock
10-15
20-30
30-40
40+
168
How to monitor treatment success in hypovolemic shock
urine output
169
Clinical progression from SIRS
SIRS --> sepsis --> septic shock --> multiorgan dysfunction
170
Criteria for SIRS
```
2+:
fever/hypothermia
hyperventilation
tachycardia
increased WBC count
```
171
Sepsis criteria
Sepsis:
| SIRS + culture +
172
Septic Shock
Sepsis + hypotension refractory to fluid
173
Multiorgan dysfunction syndrome:
| prognosis
most die
174
Main characteristics of neurogenic shock
peripheral vasodilation/decreased SVR
175
Causes of neurogenic shock
spinal cord/ head injury
spinal anesthesia
pharmacologic
176
Most important lifestyle modifications for lowering BP
```
#1 weight loss
#2 DAG
#3 decrease Na/ alcohol
```
**smoking cessation does not decrease BP
177
Aortic regurg:
worst position?
pulse?
AR worst in LLD positon
| bounding pulse
178
#1 Study for AAA
AUS
179
Cause of OrthoHTN in elderly
decreased baroreceptor responsiveness
180
Shockable rhythms?
| Rhythms for CPR?
shock: Vfib/ pulseless Vtach
CPR: asystole/ PEA
181
Coarctation buzzword symptoms
epistaxis
| LE claudication
182
BBer OD symptoms & tx
sx: brady, AVB, hypotension
tx: IVF, atropine, glucagon
183
Treatment of stable/unstable afib
stable: BBer/CCB
unstable: SCD
184
Management of Acute MI W/ DHF
NO BBer
| Give diuretics
185
Cause of stenosis post-stenting
early cessation of antiplatelet therapy
| noncompliance
186
Treatment of symptomatic HCOM
Bber --> verapamil/CCBs
187
Drug that prevents post MI remodeling
ACEi + BBer
188
Signs of constrictive pericarditis (3)
- pericardial calcifications
- right heart failure
- pericardial knock (mid-diastolic)
189
Myocarditis findings on echo
all ventricles dilated
| diffuse hypokinesis
190
Afib clot prevention
warfarin or anticoag
| not antiplatelet
191
Cause of syncope + murmur in young person
HCOM
| interventricular septal hypertrophy
192
#1 risk Aortic Dissection
systemic HTN
193
Diagnosis heat stroke
temp 104+
CNS dysfunction
additional organ failure
194
initial diabetic therapy
lifestyle modification + statin
| +metformin if a1c above 7.5
195
Mitral valve abnormality in HCOM
anterior motion mitral valve
| contacts septum in systole= LVOT obstruction
196
MCC constrictive pericarditis outside of US
TB
197
```
Drug class and use for:
Xa inhibitor
P2y12i
colchicine
PDE5i
```
Xa: anticoag, afib
P2y12i: antiplatelet, post MI
colchicine: antitubular, pericarditis
PDE5i: ED
198
Drugs that increase warfarin bleeding
NSAID
amio
abx
199
Foods that decrease warfarin fxn
leafy greens
| ginseng
200
Viral myocarditis can result in _____
decompensated heart failure (DHF)
201
Cause of ascending and descending AD
ascending: cystic medial necrosis (CT disorder)
descending: atherosclerosis
202
Stable angina:
worst risk
most common risk
worst DM
| most common HTN
203
Labs for stable angina
normal EKG & enzymes
| abnormal stress test
204
Treatment of ACS
```
MONA
antiplatelet
BBEr
statin
ACEi
+thrombolytics/PCI
```
205
Drugs that lower mortality post MI
ASA, BBer, ACEi
ACEi+BBer prevent remodeling
206
Pathogenesis prinzmetal angina
| aka?
variant angina
| vasospasm; fixed lesion; ventricular dysrhythmia
207
Prinzmetal:
timing of pain
EKG finding
drug that provokes
night
STE with pain
ergonovine prokokes
208
Treatment of prinzmetal
CCB
| nitrates
209
MI pain radiates to....
L side of body, jaw, arm, epigastrum, back etc.
210
Cause of SCD in first 24 hours following MI
vfib
211
Two signs of RV infarct
JVD
| hepatomegaly
212
EKG changes in MI (broad)
T peaks --> STE --> Q waves
213
Troponins vs CK:
| sensitive? specific?
Troponin more sensitive and specific
| obtain every 8 hours first 24 hours following ACS
214
Marker to rule out second MI
CKMB
215
Treatment of Dressler syndrome
ASA
216
Life threatening causes of chest pain (5)
```
ACS
dissection
PE
tension PTX
esophageal rupture
```
217
7 factors in TIMI score
```
65+
3+ CAD risk factors
known stenosis
2 episodes angina/day
ASA used last 7 days
enzymes
EKG changes
```
218
"Syndrome X" characteristics
stable angina, + stress
- cath
good prognosis
219
Metabolic Syndrome X characteristics
obesity -> insulin resistance --> HTN etc
220
Grading Heart failure I-IV characteristics
I: nearly asx
II: symptoms with mod exertion
III: symptoms with mild exertion
IV: symptoms at rest
221
Auscultation findings in HF
S3 at apex
S4 at LSB
PMI shifted
crackles and rales
222
BNP suggestive of heart failure
above 150
223
First line treatment heart failure
NOT DECOMP.
(systolic?)(diastolic?)
Diuretics + ACEi -- systolic
| BBer + Diuretic-- diastolic
224
Treatment acute decompensated heart failure
diuretics
nitrates
O2/resp support
225
Treatment of symptomatic PVCs
BBers
226
Define couplet/bigeminy/trigemini PVCs
couplet: 2 consecutive
bigeminy: every other
trigeminy: every third
227
Afib EKG findings
no clear P waves
irregularly irregular
a rate 75-175
228
Define "lone afib"
| Management?
lone: no other abnormalities, under 60, asx
| no treatment. observe. low risk.
229
A flutter EKG finding
saw tooth pattern
300 a rate
1/3 a rate = v rate
230
MCC a flutter
CHF
231
MAT:
| EKG appearance + MCC
at least 3 p wave morphologies
rate 60-100
severe pulm disease
232
PSVT
MCC
EKG appearance
AVNRT (assc with ischemia)
| narrow QRS, no P waves
233
Treatment PSVT
vagal
| adenosine
234
WPW:
location of re-entrant path
treatment
Bundle of Kent
procainamide
quinidine
ablation
235
EKG appearance WPW
narrow tachy
short PR
delta wave
236
Drugs to avoid in WPW
dig
| CCB
237
MCC vtach
CAD + MI
238
V tach progression
Vtach --> torsade --> V fib --> death
239
Treatment of v tach
if lasts 30+ seconds
| amio and SCD
240
Vfib appearance
chaotic, irregular, quivering
241
When to treat sinus brady
under 45
| symptomatic
242
sick sinus syndrome appearance
persistent spontaneous bradycardia
243
Which AV blocks get pacers
II/II, III
244
Electrical alternans:
appearance
association
QRS varies each beat
| assc with pericardial effusion
245
How do vagal maneuvers slow PSVT?
decrease AV node activity
246
Aflutter
| -3 findings
"F" waves on EKG
JVD
Hypotension
247
High creatinine + recurrent flash PE=
renovascular HTN
248
Fat embolus symptoms
rash (petechial)
| dyspnea
249
Dig tox symptoms
- N/V/D
- changes in vision
- arrhythmia
250
Easy bruising, waxy skin are assc with what kind of heart failure?
amyloidosis, restrictive
251
Unexplained heart failure (no HTN)
| +LVH + proteinuria =
amyloidosis
252
Findings assc with ventricular aneurysm?
mitral regurgitation
CHF
angina
ventricular arrhythmia
253
Acute limb ischemia following MI is caused by?
LV thrombus
| common in large anterior STEMIs
254
How to Na levels correlate to CHF severity?
Low Na= severe disease
255
MI type that causes hypotension
RV Mi; will need IV bolus
256
MOA class I antiarrythmics
block Na/ phase 0 of depolarization
257
Murmur assc with aortic dissection
ascending dissection --> aortic regurgitation
258
Causes of pulsus paradoxus
tamponade
asthma
COPD
259
Treatment for chest pain assc with cocaine
BDZ
260
Sudden limb ischemia without any previous symptoms=
arterial embolus
261
How does amiodarone effect dig levels?
increases = NVD + vision changes etc
262
Treatment of PHTN in the setting of LV dysfxn
diuretics
| ACEi
263
Treamtent of idiopathic PHTN
endothelin inhibitors
264
How can AV fistula effect cardiac function?
high output heart failure
265
Acquired causes of AV fistula
trauma, cancer, etc
266
Who gets statins?
40-75 year olds with CVD risk about 75%
267
Location of ectopic foci in afib
pulmonary veins
268
Location of re-entry in aflutter
tricuspid annulus
269
WPW EKG findings
delta wave
short PR less than 3 small blocks
ST changes
270
Diagnosis of aortic dissection
stable- CTA
| unstable- TEE
271
Treatment of Dresslers
NSAIDs
| no anticoagulation
272
Aortic stenosis murmur
Right 2nd ICS murmur (systolic)
| soft second heart sound
273
Murmur assc with IVDU endocarditis
Tricuspid regurg (systolic, ^^ with inspiration)
274
Fibromuscular dysplasia:
| in addition to female HTN, what are findings?
neck, abdominal bruits
275
Pericarditis + ^^BUN=
uremic pericarditis
| tx with hemodialysis
276
Who should be screened for AAA?
smokers 65-75 one time
277
MOA statins
inhibits HMG CoA ----> mevalonic acid
increases LDL
decreases CoQ (=statin myopathy)
278
What medications should be held 48 hours before stress test
BBer
CCB
nitrates
+caffeine 12 hours before
279
SLE = risk factor for what heart condition
early CAD
280
NG MOA
systemic vasodilation = decreased LVEDV
281
Peripheral artery disease increases risk for?
```
mainly MI (20% 5 year risk)
rarely limb amputation (1-2% 5 year risk)
```
282
When do alcohol withdrawal seizures occurs?
12-48 hours after last drink
283
How to decrease BP in HTN emergency
down by 10-20% first hour
| 5-15% next 23 hours
284
Pulm effusion + widened mediastinum=
AD (get CTA or TEE)
285
Left sided neck pain + substernal burning-
MI
286
Risk for AAA rupture
smoking
rapid growth
large diameter
287
When to operate on AAA
more than 5.5 cm
more than 1cm/yea growth
symptomatic
288
Treatment of ADHF with Pulm Edema
vasodilators, diuretics
289
MCC sudden onset afib
hyperthyroid
290
pressor effect on digits
distal ischemia
291
treatment of variant angina
CCB
nitrates
(no BBer, ASA)
292
1mm STE w/ stress test: dx?
nondescript
293
Treatment of PAD
exercise
statins
antiplatelets
294
Common cause of AR + assc murmur
- Bicuspid AV in developed countries
| - LSB diastolic decrescendo murmur
295
Cause of ISH in elderly
arterial wall stiffening
296
Situational (aka ___) syncope:
- caused by?
- occurs during?
reflex
altered autonomic response (cardioinhibitory, vasodepressor)
peeing, pooping, coughing etc
297
Chronic tachycardia may lead to?
```
heart remodeling (dilation, hypokinesis)
=tachycardia mediated cardiomyopathy
```
298
Treatment for tachycardia mediated cardiomyopathy?
rate and rhythm control
299
1st line therapy for stable angina
BBer
| +/-CCB, nitrate
300
Pericardial effusion:
- CXR appearance
- exam findings
- big heart ("water bottle"), clear lung fields
| - diminished heart sounds, hard to find PMI
301
Weight loss, lid lag, tremor, afib= ? tx?
hyperthyroidism, BBer
302
Decreased cardiac index + increased PCWP =
Acute MI
303
Maneuvers that decrease MVP and HCOM
Valsalva
| standing
304
Handgrip decreases what murmurs
HCOM
| AS
305
Post MI ventricular aneurysm:
| clinical findings
heart failure, angina, ventricular arrhythmia
306
Post MI ventricular aneurysm:
ECG findings
echo
persistent Q waves
| thinned myocardial wall
307
Treatment for cardiomyopathy 2/2 alcohol use
abstinence will ^^ LV fxn
308
cholesterol emboli lab findings
eosinophilia
high creatinine/BUN
low complement
309
Meds that increase survivial in LV systolic dysfunction
BBer
ACEi/ ARB
mineralocorticoid antagonists
In AA:
hydral
nitrates
310
Adenosine treats ?
| mechanism?
narrow tachy, can help identify P waves
| slows AV node
311
electrical alternans + sinus tach=
large pericardial effusion --> do pericardiocentesis
312
Cor pulmonale sequence of events
^^Pulm art pressure --> RVP --> RV failure
313
Marfarns murmur
early LSB diastolic murmur
| aortic regurg
314
AV block + infective endocarditis=
perivavular abscess
315
Wells Criteria scoring
```
more than 4= likely PE
3+=
DVT on exam, no other cause likely
1.5+=
hx DVT/ PE
HR above 100
recent sx/ immobilization
1+ =
cancer
hemoptysis
```
316
Any diastolic murmur requires
echo
317
CHF effect on kidney
^^RAAS
efferent constriction
high IG pressure
high GFR
318
Treatment of all persistent tachyarrythmia (narrow and wide)
SCD
| except v fib, pulseless vtach
319
Adult Coarctation:
| symptoms
UE HTN
H/A
epistaxis
brachial femoral delay
320
Adult Coarctation murmur
systolic murmur +/- continuous murmur if there are collaterals
321
Treatment of afib in WPW
cardiovert or antiarrythmics
| cannot use BBer, CCB, dig, adenosine in WPW b/c ^^ accessory conduction
322
Acute inferior MI assc murmur
MR --> pulm edema and ^^LV filling pressure
