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Flashcards in Cardio Deck (322):
1

Three types cardiomyopathy + which is most common?

dilated** (MC)
hypertrophic
restrictive

2

Dilated cardiomyopathy:
common cause
prognosis
symptoms same as

CAD w/ prior MI (ischemic damage)
death w/in 5 years
CHF symptoms

3

Treatment of Dilated Cardiomyopathy

-Dig
-Diuretics
-Vasodilators
+/- anticoagulation

4

HCOM:
-inheritance pattern
-type of dysfunction

-AD
-diastolic dysfunction

5

Murmur assc with HCOM?
Worse with?

Loud S4 + systolic ejection murmur @ LLSB
worse with Valsalva, standing

6

Initial drug to treat symptomatic HCOM

BBers

7

Surgical treatment of HCOM

myomectomy

8

Restrictive Cardiomyopathy:
-dysfunction type

-impaired diastolic filling
-systolic function variable

9

Causes of Restrictive Cardiomyopathy

SASH CC
sarcoid
amyloid
scleroderma
hemochromatosis
chemo
carcinoid
....or idiopathic

10

Echo findings in restrictive cardiomyopathy

large atria, normal ventricles
bright myocardium in amyloidosis

11

Definitive diagnosis of restrictive cardiomyopathy

biopsy

12

Hemochromatosis treatment
sarcoid treatment

hemochromatosis- phlebotomy, deferoxamine
sarcoid- steroids

13

Dig is contraindicated in what type of restrictive cardiomyopathy?
Needed when?

amyloid
used in other cases if systolic dysfunction is present

14

Three viral causes myocarditis

HHV6
parvo
coxsackie

15

Bacterial causes myocarditis (3)

GAS
Lyme
mycoplasma

16

Medication that may cause myocarditis

sulfonamides

17

Acute pericarditis most common causes

post viral/ coxsackie

18

Complications of acute pericarditis

effusion
tamponade

19

How is pericarditis distinguished from MI? (4)

pleuritic pain (assc with breathing)
pain relieved when sitting up
friction rub
DIFFUSE STE, PRD

20

Specific EKG finding in pericarditis

PRD

21

Treatment of pericarditis

NSAIDs
colchicine

22

Fibrous scarring of the pericardium is termed ____.
Dysfunction type is ____.

constrictive pericarditis
diastolic dysfunction

23

Constrictive pericarditis auscultation:
EKG:

pericardial knock
low voltage QRS, T waves

24

Pericardial effusion clinical findings

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