Cardio Flashcards
(296 cards)
1
Q
Mid-systolic murmurs:
A
aortic stenosis, pulmonic stenosis
2
Q
Holo-systolic murmurs
A
mitral regurgitation, tricuspid regurgitation
3
Q
Late-systolic murmurs
A
MVP (always showing up late)
4
Q
Early-diastolic murmurs
A
aortic regurgitation, pulmonic regurgitation
5
Q
Mid/late-diastolic murmurs
A
mitral stenosis, tricuspid stenosis
6
Q
What maneuvers increase venous return?
A
Squatting, LR, lying down
7
Q
What maneuvers decrease venous return?
A
Valsalva, standing
8
Q
S1?
A
AV valve closure
9
Q
S1 marks the?
A
beginning of systole
10
Q
S1 is loudest at?
A
Apex
11
Q
Which valve closes first in S1?
A
mitral, then tricuspid
12
Q
S2?
A
Semilunar valve closure
13
Q
S2 marks the?
A
end of systole
14
Q
S2 loudest at?
A
Base
15
Q
Which valve closes first in S2?
A
Aortic, then pulmonic
16
Q
S3?
A
rapid passive ventricular filling
17
Q
S4?
A
atrial contraction into ventricles
18
Q
Elevated BP?
A
120/129/ <80
19
Q
Stage 1 HTN?
A
130-139/ 80-89
20
Q
Stage 2 HTN?
A
> 140/>90
21
Q
HTN urgency?
A
> 180/120
22
Q
Treatment for elevated BP?
A
lifestyle, recheck in 3-6 months
23
Q
Treatment for stage 1 HTN?
A
10 year risk <10% –> lifestyle; >10% –> 1 med, check in one month
24
Q
Treatment for stage 2 HTN?
A
2 meds, recheck in one month
25
Sodium restrictions for HTN?
<2.4 g/d
26
HTN tx: uncomplicated (non-AA)
thiazide diuretics, ACE, ARB
27
HTN tx: a. fib
BB, ND CCB
28
HTN tx: angina
BB, CCB
29
HTN tx: post-MI
BB, ACE
30
HTN tx: systolic HF
ACE, ARB, BB, diuretics
31
HTN tx: DM/CKD
ACE, ARB
32
HTN tx: systolic (isolated) HTN
diuretics +/- CCB
33
HTN tx: osteoporosis
thiazides
34
HTN tx: BPH
alpha blockers
35
HTN tx: AA (non-DM)
thiazides, CCB
36
HTN tx: gout
CCB, losartan (only arb that doesn't cause hyperuricemia)
37
HTN urgency
>180/>120 + no end organ damage
38
HTN urgency treatment
Decreased BP by 25% over 24-48 hours using oral agents --> goal <160/<100
39
HTN emergency
>180/>120 + end organ damage
40
HTN emergency treatment
Decrease BP by no more than 25% within first hour, then by an additional 5-15%, over next 23 hours using IV agents
41
When should you not follow HTN emergency treatment protocol?
-Ischemic stroke: not lowered unless >185/110 in thrombo candidates or >220/120 in non-candidates AND in aortic dissection: rapidly reduce to SBP of 100-120 in 20 minutes
42
Inferior leads:
II, III, aVF
43
II, III, aVF leads?
inferior
44
lateral leads:
I, avL, V5, V6
45
I, avL, V5, V6?
lateral
46
septal leads:
V1, V2
47
V1, V2 leads?
septal
48
V3, V4 leads?
anterior
49
Anterior leads?
V3, V4
50
First degree AV block?
long PR interval (>0.20 sec)
51
First degree AV block treatment?
observe
52
Mobitz Type I (Wenckebach)
long, longer, drop
53
Mobitz Type I treatment
- Symptomatic: atropine, epi, +/- pacemaker
| - Asymptomatic: observe +/- cardiac consult
54
Mobitz Type II
PR constant, random drops
55
Mobitz Type II treatment
atropine, temporary pacing; permanent pacemaker = definitive
56
Third degree AV block:
no relationship between P waves and QRS complexes
57
Third degree AV block treatmnetn
temp pacing --> permanent pacing
58
Pathologic Q wave definition:
>0.04 sec, >2 mm deep, >25% depth of QRS complex
59
Pathologic Q waves may be normal in what leads?
III and aVR
60
STEMI EKG definition?
ST elevations 1+ mm in at least 2 anatomically contiguous leads + reciprocal changes in opposite leads
61
STEMI EKG progression?
hyperacute T waves --> ST elevations/depressions --> T wave inversions --> pathologic Q waves
62
Describe QT in hypocalcemia?
prolonged
63
Describe QT in hypercalcemia?
QT shortened
64
Sick sinus syndrome?
brady-tachy syndrome; sinus arrest with alternating paroxysms of atrial tachy and brady
65
Treatment of sick sinus syndrome?
Permanent pacemaker
66
MC chronic arrhythmia?
a. fib
67
Describe P waves in a.fib?
No discernible P waves
68
Paroxysmal A. fib?
self-terminating within 7 days
69
Persistent a. fib?
fails to self-terminate, lasts > 7 days
70
Permanent a. fib?
>1 year; refractory to cardioversion or nerve tried
71
Lone a. fib?
paroxysmal, persistent, or permanent without evidence of heart disease
72
CHADSVASC
```
CHF or LVEF <40% (1)
HTN (1)
Age 75+ (2)
DM (1)
Stroke/TIA/thromboembolism (2)
Vascular disease (1)
Age 65-74 (1)
Sex: Female (1)
```
73
CHADSVASC Score interpretation
2+: mod risk; chronic oral anticoags
1: low risk; clinical judgement
0: no anticoag risk
74
Treatment for unstable a. fib:
DC cardioversion
75
What type of drug is diltiazem?
ND-CCB
76
MCC of atrial flutter
HF
77
Atrial flutter tx: stable
vagal, CCB/BB
78
Atrial flutter tx: unstable
DC
79
Atrial flutter tx:
radiofrequency ablation
80
Long QT can be caused by?
macrolides, TCAs, and electrolyte abnormalities
81
Definitive treatment of long QT?
AICD
82
What type of PSVT is most common?
AVNRT
83
Describe AVNRT?
two pathways within the AV node (slow and fast)
84
Describe QRS of AVNRT?
Narrow w/ no discernible P waves
85
Describe AVRT?
1 pathway in the AV node and a second accessory pathway outside of the AV node
86
Types of AVRT?
orthodromic and antidromic
87
Orthodromic is antegrade via?
AV node
88
Antidromic is antegrade via?
accessory
89
orthodromic is retrograde via?
accessory pathway
90
Antidromic is retrograde via?
AV nod
91
Orthodromic is wide or narrow?
Narrow
92
Antidromic is wide or narrow?
wide
93
Tx of stable orthodromic AVRT?
vagal, adenosine, IV verapamil
94
Tx of unstable orthodromic AVRT?
DC
95
Tx of stable antidromic AVRT?
flecainidine, procainamide, amiodarone
96
What drugs must be avoided in WPW?
digoxin, verapamil, BB
97
Tx for multifocal atrial tachycardia?
CCB, BB
98
Describe EKG of premature ventricular complexes?
T wave opposite direction of QRS
99
Tx of PVCs?
no treatment needed; BB if symptomatic; if frequent, w/u for heart disease
100
Describe ventricular tachycardia?
3+ consecutive PVC at a rate of >100 bpm
101
Where does ventricular tachycardia originate?
Bundle of His
102
MCC of ventricular tachycardia
CAD with prior MI
103
Describe sustained v-tach?
>30 seconds; almost always symptomatic; life threatening; can progress to v. fib
104
Describe non-sustained v-tach?
brief, limited, usually asymptomatic
105
Two types of ventricular tachycardia
monomorphic or polymorphic
106
Tx: sustained, stable v-tach?
amiodarone, procainamide, sotolol (does not respond to vagal or adenosine)
107
Tx: unstable v-tach?
DC, followed by amiodarone
108
Tx: no pulse v-tach?
defib + CPR
109
Name two non-D ccb?
diltiazem, verapamil
110
What rhythm do most ventricular fibrillations start with?
VT
111
MCC of ventricular fibrillation?
ischemic heart disease
112
Chronic treatment of f. fib?
amiodarone or ICD (unless within 48 hours of acute MI, then recurrence rate is low; no LT tx needed)
113
What lumen reduction becomes symptomatic?
70%
114
Worst RF for CAD?
DM
115
Most important modifiable RF for CAD?
cigarette
116
MC RF for CAD?
HTN
117
Angina classifications?
I: only with strenuous activities; no limitations
II: with more prolonged or rigorous activities; slight limitations
III: with usual activity; marked limitations
IV: at rest; often unable to carry out any physical activity
118
Most useful non-invasive test for CAD?
stress test
119
If a stress test is positive for CAD, what test should be undergone?
cardiac cath
120
Definitive test for CAD?
cardiac cath
121
Tx for CAD?
nitro, BB (CCB), ASA, statin
122
Definitive tx for CAD
PTCA vs. CABG
123
When is PTCA preferred?
1 or 2 vessel without left main
124
When is CABG preferred?
L main, 3 vessel or critical (70%), LVEF <40
125
When does pain at rest occur with ACS?
90% occlusion
126
What signs indicate an inferior wall MI is likely?
chest pain + bradycardia
127
First cardiac marker detected?
myoglobin
128
Most specific/sensitive cardiac marker?
Troponin I/T
129
What conditions cause falsely elevated troponins?
renal failure, advanced HF, acute PE, CVA
130
What is the exception to the benign upsloping rule?
de Winter's sign (upsloping ST depression with prominent T-waves) --> likely LAD proximal occlusion
131
What types of ST depressions are likely ischemic?
horizontal and down (upsloping benign)
132
What types of ST elevations are likely ischemic?
convex or straight (concave can be non-ischemic)
133
UA and NSTEMI treatment?
ASA + clopidogrel + BB + LMWH
134
STEMI treatment?
immediate and prompt with PCI within 90 minutes of presentation or thrombolysis within 12 hours of symptom onset
-ASA + prasugrel/ticagrelor/clopidogrel + UF heparin + BB + statins + ACE
135
PCI must occur within how long of symptom onset?
12 hours
136
Absolute CI to thrombolytics?
Previous ICH, non-hemorrhagic stroke within 6 months or closed head/facial trauma within 3 months, intracranial neoplasm/aneurysm/AVM, active internal bleeding, suspected aortic dissection
137
What drugs require caution in RV (inferior wall) MI?
nitrates and morphine
138
Tx for cocaine induced MI?
ASA, NTG, heparin, benzos, CCB (! no BB!)
139
Dressler's syndrome:
post-MI pericarditis + fever + pulmonary infiltrates
140
What score is used to estimate mortality in unstable angina and NSTEMI?
TIMI score
141
TIMI score
- Age 65+ (1)
- 3+ CAD RF (1)
- Known CAD (stenosis 50+%) (1)
- ASA use in past 7 days (1)
- Severe angina (2+ episodes in 24 hours) (1)
- EKG ST changes 0/5+ mm (1)
- positive cardiac markers (1)
142
What is a worrisome TIMI score?
3+
143
What does the TIMI score show?
% risk at 14 d of all-cause mortality, new or recurrent MI, severe ischemia requiring urgent revascularization
144
When do you use the HEART score?
Use in 21+ y/o presenting with symptoms of ACS; do not use of ST segment elevation 1+ mm
145
HEART score
-history: slightly suspicious (0), moderately (1), highly (2)
-EKG: normal (0), non-specific repolarization disturbances (1), significant ST deviation (2)
-Age: less than 45 (0), 45-64 (1), 65+ (2)
-RF: none (0), 1-2 RF (1), 3+ (2)
Troponin: less than normal (o), 1-3x normal (1), >3x normal (2)
146
HEART score interpretation
0-3: discharged
4-6: admitted
7+: early invasive measures
147
Definitive test for variant (prinzmetal) angina?
coronary angiography (coronary vasospasm when given IV ergonovine or acetylcholine)
148
Tx of variant (prinzmetal) angina?
CCB, nitrates, +/- ASA, heparin, benzos (no BB!)
149
MCC of HF?
CAD
150
Systolic or diastolic MC HF?
systolic
151
Is EF increased or decreased in systolic HF?
decreased
152
Is EF increased or decreased in diastolic HF?
Normal or increased
153
Left HF MCC?
CAD
154
Right HF MCC?
left-sided heart failure
155
pink frothy sputum is associated with?
hF
156
MCC of transudative pleural effusion?
CHF
157
What breathing pattern is associated with HF?
Cheyne-Strokes: deeper, faster breathing with gradual decrease and periods of apnea
158
HF initial test?
echo
159
Tx HF?
ACE (1)/ARb (2) +/- BB + diuretics (symptoms)
160
Tx of HF + a. fib?
digoxin
161
What drugs are CI in HF?
metformin and NSAIDs
162
MCC of pericarditis?
viral and idiopathic
163
Mneumonic for pericarditis?
pleuritic, persistent, postural (relieved with leaning forward)
164
What is heard on auscultation with pericarditis?
pericardial friction rub
165
EKG of pericarditis?
ST elevation --> pseudo-normalization --> T wave inversion --> resolution (no reciprocal changes)
166
What EKG sign is seen with pericarditis?
knuckle sign: ST elevation with PR depression in same lead
167
Treatment of pericarditis?
ASA or NSAIDs x 7-14 days; second line colchicine
168
Cause of constrictive pericarditis?
chronic pericarditis; idiopathic/viral
169
MC symptom of constrictive pericarditis
dyspnea
170
Sign seen with constrictive pericarditis?
Kusmmaul's sign: increased JVD during inspiration
171
What is heard on auscultation with pericarditis?
pericardial knock
172
What condition shows a square root sign on cardiac cath?
constrictive pericarditis
173
Definitive treatment of constrictive pericarditis?
pericardiectomy
174
MCC of myocarditis?
Viral specifically enteroviruses (coxsackie)
175
What may be seen on x-ray with myocarditis?
cardiomegaly
176
What may be seen on EKG with myocarditis?
sinus tachy (MC)
177
Gold standard for dx myocarditis?
biopsy
178
Tx of myocarditis?
diuretics, ACE, IVIG
179
What rash is seen with Lyme disease?
erythema migrans
180
Mneumonic for rheumatic fever (just say the menumonic)
JONES CAFE PAL
181
JONES CAFE PAL: major criteria
```
Joint involvement: polyarthritis 2+ joints; lower to upper; medium large joints MC
O looks like a heart: myocarditis
Nodules
Erythema marginatum (MC on trunk)
Sydenham chorea
```
182
JONES CAFE PAL: minor criteria
CRP
Arthralgias
Fever 101.3 +
ESR
Prolonged PR interval
Anamnesis of rheumatism
Leukocytosis
183
Diagnostic criteria for rheumatic fever
throat cultures growing GABHS or ASO pos + 2 major OR
| 1 major and 2 minior
184
Rheumatic fever is assoc with what valve dz?
mitral stenosis
185
Tx of rheumatic fever?
ASA 2-6 weeks with taper +/- corticosteroids; pen G in acute phase
186
MC site of PAD?
superficial femoral artery (hunter canal)
187
MC RF for PAD
smoking
188
Leriche's syndrome:
claudication (buttocks, thigh), impotence, decreased femoral pulses
189
Dependent rubor is seen with?
PAD
190
Hanging foot over bed helps with pain?
PAD
191
Painful ulcers at LM with clean margins?
PAD
192
Test for PAD?
ABI
193
Gold standard test for PAD?
arteriography
194
ABI is + for PAD at?
<0.90
195
Tx for PAD?
Cilostazol is mainstay
196
Acute arterial occlusion MC location?
common femoral artery
197
MCC of acute arterial occlusion?
a. fib
198
Skeletal muscule can tolerate x of ischemia?
6 hours
199
Tx of acute arterial occlusion?
IV heparin, emergency embolectomy
200
Chronic venous insufficiency MC occurs after?
superficial thrombophlebitis, after DVT, or trauma to leg
201
Which type of LE deficiency has edema?
chronic venous insufficiency
202
Which type of LE deficiency has decreased pulses?
PAD
203
Improves with walking/elevation; worse with sitting/standing?
chronic venous insufficiency
204
Uneven, medial mallelolus, less painful ulcers?
chronic venous insufficiency
205
Stasis dermatitis is seen with?
chronic venous insufficiency
206
Atrophic skin changes are seen with?
PAD
207
Atrophie blanch is seen with?
chronic venous insufficiency
208
Dx of chronic venous insufficiency
trendelenburg test
209
Tx of chronic venous insufficiency
stockings, leg elevation
210
AAA: focal dilation of aortic diameter at least x diameter at level of renal arteries; typically >
1-1.5 x
| >3 cm (normal 2 cm)
211
MC location of AAA
infra-renal (between renal arteries and iliac bifurcation)
212
AAA tx: 3-4 cm
US every year
213
AAA tx: 4-4.5
US every 6 months
214
AAA tx: 4.5-5.5
vascular surgery referral
215
AAA tx: 5.5+ or >0.5 growth in 6 months
immediate surgery
216
AAA criteria for: US every year
3-4 cm
217
AAA criteria for: US every 6 months
4-4.5 cm
218
AAA criteria for: vascular surgery referral
4.5-5.5 cm
219
AAA criteria for: immediate surgery
5.5+ or >0.5 growth in 6 months
220
AAA I:
l. subclavian to renal
221
AAA II:
L. subclavian to aortic bifurcation
222
AAA III:
mid-descending to aortic bifurcation
223
AAA IV:
upper abdominal aorta and all or none of infrarenal
224
CM of AAA:
fullness, throbbing pain in hypogastrium and lower back
225
Symptoms of impending rupture AAA?
sudden onset of severe pain in back and lower abdomen, radiating to groin, buttocks, legs; grey-turner and cullen sign
226
Acute leakage/rupture AAA?
1) severe back pain/abdominal pain
2) syncope or hypotension
3) tender, pulsatile mass
+/- flank ecchymosis
*** no further testing --> emergent lapartomy
227
Acute GI bleed in patients who underwent prior aortic grafting?
-Aortoenteric fistula
228
Initial test in suspected AAA?
US
229
Test for pre-op planning in AAA?
CT scan
230
Gold standard AAA?
angiography
231
MC site for aortic dissection?
ascending
232
Stanford A:
proximal AD
233
Stanford B:
distal AD (not involving ascending)
234
DeBakey I:
ascending + descending
235
DeBakey II:
confined to ascending
236
DeBakey III:
not involving ascending
237
Most important predisposing RF to aortic dissection?
HTN
238
CM of ascending AD?
anterior chest pain
239
CM of aortic arch AD?
neck/jaw pain
240
CM of descending AD?
interscapular pain
241
Describe vascular symptoms of AD?
decreased peripheral pulses; variation in pulse/BP
242
Dx of aortic dissection?
CT with contrast
243
Gold standard aortic dissection?
MRI angio
244
Type A AD tx?
surgical emergency; open!
245
Type B AD tx?
medical management; lower BP as quickly as possible with IV BB --> SBP 100-120
246
Stanford A CM?
new onset aortic regurgitation
247
Stanford B CM?
HTN
248
Most specific sign for DVT?
> 3 cm calf difference
249
Initial test for DVT?
US
250
gold standard for DVT?
venography
251
Wells Criteria for DVT?
active cancer (1)
bedridden >3 days or major sx in 4 weeks (1)
calf swelling >3 cm (1)
collateral superficial veins (1)
Entire leg swollen (1)
Localized tenderness to deep venous system (1)
Pitting edema, one leg (1)
Paralysis, paresis, or recent plaster immobilization (1)
Previously documented DVT (1)
alt. diagnosis as likely or more likely (-2)
252
wells criteria dvt: (-2) to 0:
d-dimmer
- If + --> US (if negative r/o)
- If (-) --> r/0
253
wells criteria DVT: 1-2
```
d-dimer
-If - --> r/o
-If + US ----->
If (-) r.o
If non-diagnostic, repeat US q 2-3 d for 2 weeks
if (+) anticoag
```
254
Wells criteria DVT 3
```
All get US; d-dimer to risk stratify
(-) us and dimer --> r/o
(+) d-dimer:
(+): US anticoag
(-) US repeat in one week
```
255
If patient has DVT with coagulation problems? tx?
lifetime anti-coag
256
1st DVT with reversible RF?
3 months
257
1st DVT with idiopathic cause: proximal
LT
258
1st DVT with idiopathic cause; distal
3 months if severely symptomatic; US surveillance if asymptomatic
259
Anticoag used in pregnancy?
LMWH
260
MC predisposing condition for PE?
Factor V Leiden
261
MC symptom of PE
Dyspnea
262
MC sign of PE
tachy
263
PERC criteria:
-Age 50+
-HR 100+
SaO2 <95
-Unilateral leg swelling
-Hemoptysisi
-Recent surgery, trauma (4 weeks)
-Prior PE/DVT
-Hormone use
264
Wells criteria: PE
Signs/symptoms of DVT (3)
PE # diagnosis (3)
HR >100 (1.5)
Immobilization at least 3 days or surgery in 4 weeks (1.5)
Previous DVT/ PE (1.5)
Hemoptysis (1)
Malignancy with treatment in 6 months (1)
265
Wells Criteria: <2 (PE)
d-dimer
266
Wells criteria: 2-6 (PE)
high sensitivity d- dimer
267
Wells criteria: >6 (PE)
CT angio
268
Best initial test for PE
Helical CT
269
Gold standard test for PE
pulmonary angio
270
CXR: PE
westermark's sign; hamptom's hump
271
Westermark:
avascular markings distal to embolus
272
Hamptoms hump
wedge shaped infiltrate
273
EKG finding in PE
S1Q3T3
274
S1Q3T3
PE
275
Describe S1Q3T3
wide deep S in lead I, isolated Q and T wave inversion in lead III
276
ABG PE
resp alk --> resp acidosis
277
Tx PE
heparin --> warfarin
278
MC valve affected in non-IVDA in endocarditis?
Mitral valve
279
MC valve affected in IVDA in endocarditis?
Tricuspid
280
MCC of sub-acute endocarditis?
strep viridans
281
MCC of acute endocarditis?
staph aureus
282
MCC of endocarditis in IVDA?
staph aureus
283
MCC of endocarditis in men 50 y/o with a history of GI/GU procedures?
enterococcus
284
MCC of endocarditis in prosthetic valve within 60 days of surgery?
staph epidermis
285
MCC of endocarditis in prosthetic valve >60 d of surgery?
strep viridans
286
Painless lesions on soles/palms seen in endocarditis?
Janeway
287
Retinal hemorrhages seen in endocarditis?
Roth
288
Tender spots on pads of digits seen in endocarditis?
Osler's nodes
289
Dx of endocarditis
Blood cultures x 3;
| Echo: TTE, then if non-diagnostic TEE (if prosthetic valve, do TEE first)
290
Endocarditis prophylaxis is required for those who have:
- prosthetic heart valve
- Heart repairs using prosthetic cardiac valve
- Prior hx of endocarditis
- Congenital heart disease (unrepaired cyanotic, repaired congential heart dz with prosthetic material during first 6 months)
- Cardiac valvulopathy in transplanted heart
291
Endocarditis prophylaxis is required for these procedures?
- dental: manipulation of gums, root of teeth, oral mucosa perforation
- respiratory: surgery on respiratory mucosa, rigid bronchoscopy
- Procedures involving infected skin/MSK (including I&D)
* Not needed for GI/GU
292
Endocarditis prophylaxis
amox 2 g 30-60 minutes prior
| -Clinda 600 mg if PCN allergic
293
Endocarditis (acute; native)
nafcillin + gent x 4-6 weeks
| or vanco + gent
294
Endocarditis (subactue, native)
PCN or amp + gent
| -Vanco in IVDA
295
Fungal endocarditis
amphotericin B x 6-8 weeks
296
Prosthetic endocarditis
Vanc + gent + rifampin
