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LMCC > Cardio > Flashcards

Cardio Flashcards

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1
Q

CHF findings on CXR

A 
Kerley B-lines 
Vascular redistribution
Cardiomegaly 
Peribronchial cuffing 
Perihilar infiltrates 
Pleural effusion
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2
Q

Galactin-3-mediated heart failure

A

Galectin-3 instigates fibrosis after cardiac ischemia or MI –> a/w heart remodelling, increased stiffening of heart which reduces cardiac output = heart failure

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3
Q

Pulmonary capillary wedge pressure in cardiogenic pulmonary edema

A

> 25mmHg

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4
Q

Pulmonary capillary wedge pressure in ARDS-induced pulmonary edema

A

<18mmHg

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5
Q

Cheyne-Stokes respirations

A

Triggered by hyperventilation and hypocapnia
Form of periodic breathing in which central apneas and hypopnea alternate with periods of hyperventilation –> waxing and waning of tidal volume

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6
Q

PE on ECG

A 
Sinus tachy 
New RAD 
Complete or incomplete RBBB 
Dominant R wave in V1 (RV dilatation) 
S1Q3T3 pattern
Deep S in lead I 
Q wave in lead III 
Inverted T wave in lead III
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7
Q

Tx for MI

A

B-MONAA + PCI/thrombolysis
Betablocker
Morphine
O2
Nitro (beware in RH infarction ie. inferior or posterior)
Antiplt (ASA 320mg + Clopidogrel for PCI or Ticagrelor if more invasive)
Anticoag (UFH if PCI, LMWH if thrombolysis)
PCI if door to balloon time <90 min and within 12h of symptom onset
Thrombolysis (Alteplase) if no C/I and within 12h of symptom onset

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8
Q

Septal MI

A

V1, V2

LAD

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9
Q

Anterior MI

A

V3, V4

LAD

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10
Q

Anterolateral MI

A

V5, V6

LAD

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11
Q

Inferior MI

A

II, III, aVF
RCA (Lead III ST elevation > Lead II, ST depression in I and AVL)
LCx (ST elevation in II is equal to that in III + ST segment depression in V1-V3)

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12
Q

Lateral MI

A

I, aVL

LCx

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13
Q

Posterolateral MI

A

V7, V8, V9

RCA

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14
Q

Normal QTc length in men and women

A

Men: <450

Women <460

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15
Q

Hypertrophic cardiomyopathy P/E

A

Double apical pulse (forceful LA contraction against highly noncompliant LV)
Carotid bifid pulse (rises quickly b/c increased velocity of blood through LV outflow tract into aorta, then declines in mid-systole as gradient develops)
Increased murmur on Valsalva

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16
Q

HOCM tx

A

Main goal is symptomatic relief
Beta blockers = reduce ventricular contractility, increased ventricular volume, compliance and reduce pressure gdt across LV outflow tract
AVOID drugs that REDUCE preload (ie. ACEi, diuretics, nitrates)

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17
Q

HOCM mostly affects ___ side of heart

A

Left

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18
Q

Left sided murmurs increase by conditions that increase _____ and decrease by conditions that decrease ______

A

Increase by increased preload
Decrease by deccreased preload
Ie. Aortic stenosis murmur is increased by rapid leg raising/squatting, but is decreased by valsalva/standing

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19
Q

3 characteristics of WPW syndrome on ECG

A 
Shortened PR interval (<0.12s) 
Slurred upstroke of R-wave 
Broadened QRS (>100ms)
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20
Q

HOCM characteristics on ECG

A 
T wave inversion
ST segment depression
Pathological Q waves
Conduction delay
LAD
LAE
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21
Q

Debakey aortic dissection classifcation

A

BAD
I = both ascending and descending
II = ascending only
III = descending only

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22
Q

Stanford aortic dissection classification

A 
A = ascending +/- descending 
B = descending only
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23
Q

Stanford A aortic dissection tx

A

Medical preferred (HTN mgmt) unless ruptured

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24
Q

Stanford B aortic dissection tx

A

Surgery

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25
CHADS score
``` Stroke risk assessment in AFib pt CHF (1) HTN (1) Age >/=75 (1) Diabetes mellitus (1) Stroke/TIA (2) ``` 1 : OAC needed depends >/=2 : OAC If CHADS 0 and NO CAD OR arterial vascular dz, NO ASA needed
26
Meds used in cardiac arrest algorithm
Epi 1mg IV q3-5min | Amiodarone 300mg IV (for VT/VF that's unresponsive to shock, CPR and vasopressor)
27
1st degree AV block
PR interval >200ms CONSTANT No tx required
28
2nd degree AV block: Mobitz Type 1 (Wenkebach)
PR interval progressively increases until failed conduction | Usually A/W AV node disease
29
2nd degree AV block: Mobitz Type 2
Constant PR, either normal or prolonged with RANDOM failures Usually A/W His Bundle disease Worse than Type I
30
3rd degree AV block
Complete AV dissociation
31
Main medications used in bradycardia algorithm
Atropine 0.5mg IV q3-5min to total of 3mg | If atropine fails --> dopamine 2-20mcg/kg/min OR epi 2-10mcg/min
32
Tx of choice in symptomatic brady pt with poor perfusion
Transcutaneous pacing | Start at 60/min and adjust by pt response
33
Synchronized CV dose if narrow and regular tachycardia
50-100J | Use in atrial flutter, SVT
34
Synchronized CV dose if narrow and irregular
150-200J biphasic or 200J monophasic | Use in afib
35
Synchronized CV dose if wide and irregular
100J | Use in monomorphic VT
36
CV dose if wide and irregular
Defibrillator dose NOT synchronized Pulseless VT/VF
37
Atropine
Blocks vagus nerve --> increased SA node discharge --> increased HR
38
Adenosine
Slows AV node conduction | Tx of choice for regular narrow complex tachy OR monomorphic wide complex, regular tachy
39
Treatment choice for stable, wide QRS tachy?
Antiarrhythmics (Ie. amiodarone, procainamide, sotalol)
40
Diameter of ___cm or greater of thoracic aorta is considered aneurysmal
3
41
Average size of surgically corrected aneurysms
>5cm
42
Central Venous Pressure
AKA RA pressure Pressure in thoracic vena cava near RA Normal = 0-14cm H2O
43
Screening for abdominal aortic aneurysm
Smoking men >60-75yo should have an U/S | If high risk (HTN, Marfan's, Ehlers Danlos syndrome, affected first deg relative), start earlier or at age 60
44
Framingham Risk Score
10y risk of CAD in pt with dyslipidemia
45
Target lipid values for high risk framingham
LDL <2 | TC:HDL <4
46
Target lipid values for mod risk framingham
LDL <3.5 | TC:HDL <5
47
Target lipid values for low risk framingham
LDL <5 | TC:HDL <6
48
Aortic stenosis murmur
Crescendo-descrescendo Ejection click Diminished or absent A2 Paradoxical splitting of S2 (delayed A2 closure) Prominent S4 Decreases with valsalva/standing b/c less blood ejected though aortic valve Increases with squatting b/c increased venous return
49
Waterhammer pulse
Aortic regurg
50
Mitral regurg murmur
High pitched holosystolic murmur
51
Meds for sinus tachy
Beta blocker CCB if BB C/I Ivabrudine
52
Atrial flutter
Reentry tachycardia typically within RA AV block usually occurs, typically 2:1 (reentry at 300bpm --> 150bpm HR) Saw tooth pattern on ECG in inferior leads (II, III, aVF), narrow QRS Tx: electocardioversion if unstable. If stable, rate and rhythm control (BB/CCB/Digoxin + amiodarone/sotalol) Same anticoag parameters as afib
53
Multifocal atrial tachycardia
>/= 3 atrial foci, 3 distinct P waves, some not conducted More common in pts with COPD/hypoxemia Tx: tx underlying cause, may benefit from CCB (BB often C/I becasue of resp disease) NO ROLE for electrical cardioversion, antiarrhythmics or ablation
54
Who should get ASA 81mg?
Pts who have arterial disease (Coronary, aortic or peripheral) but NO CHADS65 risk factors
55
AVNRT tx
1. Vagal maneuvers, carotid sinus pressure 2. Adenosine 3. Metoprolol, digoxin, diltiazem, electrical CV if unstable Long term: BB, CCB, digoxin; 2nd line: flecainide, propafenon; 3rd line: catheter ablation
56
Tx of AFib in WPW
IV procainamide, amiodrone | DO NOT use BB, CCB, Digoxin --> VF
57
Meds post-MI
ASA 81mg Ticagrelor or clopidogrel Beta blocker Nitro PRN ACEi (if high risk, symptomatic CHF, reduced LVEF, anterior MI) Spironolactone (if on ACEi, BB and LVEF <40% and CHF or DM) Statins (atorvastatin 80mg daily)
58
Aortic stenosis murmur
Crescendo/decrescendo systolic murmur radiating to R carotid S4
59
Aortic regurg murmur
Waterhammer pulse | Early decrescendo diastolic murmur
60
Mitral stenosis murmur
Mid-diastolic rumble at apex
61
Mitral regurg murmur
Holosystolic murmur at apex radiating to axilla Loud S2 S3
62
Tricuspid stenosis murmur
Diastolic rumble at 4th left intercostal space
63
Tricuspid regurg murmur
Holosystolic murmur at LLSB
64
Pulmonary stenosis mumur
Systolic murmur at 2nd left intercostal space Pulmonary ejection click Right sided S3
65
Pulmonary regurg murmur
Early diastolic murmur at LLSB
66
Mitral valve prolapse murmur
Mid-systolic click (from billowing of mitral leaflet into LA) mid to late systolic murmur at apex Accentuated by valsalva or squat-to-stand maneuvers
67
Causes high output heart failure
Anemia Thyrotoxicosis AV shunts
68
C/I to statins
Active liver disease | Persistently high AST and ALT
69
Wellen's Syndrome
Deep symmetric T wave inversion in anterior leads | CALL CATH LAB
70
Hallmark P/E finding of aortic regurg
Wide pulse pressure (Sys pressure - dias pressure) Diastolic pressure decreases b/c of decrease flow in aorta
71
Pulsus arternans
Large pulse followed by small pulse | Seen with severe CHF
72
Pulsus paradoxus
Exaggeration of normal fall in systolic pressure with inspiration Normal decrease is <10mmHg Pulsus paradoxus decrease is 15-20mmHg Most commonly a/w constrictive or restrictive disease of heart or pericardium
73
Amiodarone
Similar to thyroxine --> may cause toxic actions Increased risk of interstitial lung dz due to dramatic decrease in diffusion of CO = thyroid function tests and pulmonary function tests should be monitored regularly
74
Receptors a/w dyspnea secondary to pulmonary congestion
J-receptors
75
BNP and BMI
Lower BMI a/w higher BNP

LMCC (22 decks)

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