Cardio

Question 1

Acute Pericarditis Presentation, Dx, and Tx

Answer 1

Pleuritic chest pain, +/- fever, Pericardial rub on auscultation.

Diffuse ST segment changes on EKG

Echo shows effusion

Tx: NSAIDS + Colchicine, Steroids for contraindications or refractory dz

Question 2

Mitral Stenosis

Answer 2

Opening snap then rumbling mid diastolic murmur

Question 3

Mitral Regurgitation

Answer 3

Holosystolic with Mid-systolic click, apex to axilla, dyspnea, fatigue, heart failure.

Question 4

Pulsus parvus et tardus

Answer 4

“Weak and late pulse” caused by severe aortic stenosis

Question 5

VSD

Answer 5

Harsh holosystolic murmur usually 3/6 or greater, requires echo to evaluate. Most will close spontaneously.

Question 6

Transposition of the Great Vessels

Answer 6

Single loud S2, +/- VSD, egg on a string heart

Question 7

ToF

Answer 7

Harsh pulmonic stenosis murmur, VSD murmur, boot-shaped heart (right hypertrophy)

Question 8

Tricuspid atresia

Answer 8

Single S2, VSD murmur, Minimal pulmonary blood flow

Question 9

Truncus Arteriosis

Answer 9

Single S2, systolic ejection murmur, increased pulmonary blood flow and edema.

Question 10

Total anomalous pulmonary venous return with obstruction

Answer 10

severe cyanosis and resp distress. Pulmonary edema, snowman sign (englarge supracardiac veins & SVC)

Question 11

Constrictive pericarditis

Causes

Presentation

Answer 11

idiopathic, post viral, post radiation, post hodgkins lymphoma, tuberculosis (most common in 3rd world).

Acites, elevated JVP, edema, pericardial knock, pulsus paridoxus, Kussmaul’s sign.

May see pericardial calcifications on xray

Question 12

RV heave

Answer 12

Sign of RV hypertrophy, commonly due to pulmonary arterial hypertension (as seen in SS)

Question 13

papillary muscle rupture

Answer 13

2-7 days post MI, severe MR, RCA associated MI

Question 14

ventricular wall aneurysm

Answer 14

5 days to 3 months, functional MR, mural thrombus, LAD

Question 15

Cardiac effects of thyroid hormone

Answer 15

Increased contractility, increased CO, decreased SVR, increased myocardial O2 demand.

Question 16

Multifocal Atrial Tachycardia

Answer 16

Exacerbation of pulmonary disease, hypokalemia, catecholamine surge (sepsis). 3 or more P-wave forms with an atrial rate greater than 100. Correct underlying disturbance, Verapamil if refractory.

Question 17

Physiology of HCM

Answer 17

Autosomal Dominant, more common in AA Anything that increases the volume of the left ventricle will decrease the murmur by improving the obstruction. -Increasing Afterload or Preload: Handgrip (Preload), Squatting (Preload and afterload), passive leg raise (preload).

Question 18

Intraventricular Septum Rupture

Answer 18

3-5 days post-MI, LAD, chest pain, shock, new holosystolic murmur.

Question 19

PVCs in patients with heart history

Answer 19

BB or CCB

Question 20

Causes of Acute Pericarditis

Answer 20

post Viral, autoimmune (Lupus), Uremia, Postmyocardial infarction (Dressler’s Syndrome)

Question 21

Severe Aortic Stenosis

Answer 21

Aortic Jet velocity >4 m/s

Mean transvalvular pressure gradient >40mmHg

Valve area is usually less than 1cm

Question 22

Indication for AS intervention

Answer 22

Severe stenosis plus one of the following

Symptomatic

LVEF <50%

Undergoing other cardiac surgery

Question 23

Indications for Mitral Valve Repair

Answer 23

LVEF <60% regardless of symptoms

Question 24

Electrical alternans

Answer 24

Changes in QRS complex amplitude from beat to beat

Seen in pericardial effusions

Question 25

Mobitz I

Answer 25

Progressively longer PR interval until a beat is dropped

Question 26

Mobitz II

Answer 26

PR interval constant, random dropped beats.

Question 27

Severe AS

Answer 27

Late peaking systolic murmur Soft single S2 pulsus parvus et tardus

Question 28

Most common heart defect in down syndrome

Answer 28

complete atrioventricular septal defect

Question 29

Thready pulses that disappear with inspiration

Answer 29

Pulsus paradoxus think cardiac tamponade

Question 30

Young person with heart failure after viral illness

Answer 30

Myocarditis --\> Dilated Cardiomyopathy Coxsackie B

Question 31

Infective Endocarditis vs Cardiac tumor

Answer 31

IE: Vegitations + regurg Tumor: Mass + Stenosis

Question 32

S4

Answer 32

Normal older adult Ventricular Hypertrophy Acute MI

Question 33

S3

Answer 33

Children, young adults, pregnancy Heart Failure, Restrictive CM, High output state

Question 34

Suspected Aortic dissection/aneurysm with elevated Cr

Answer 34

TEE

Question 35

Afib after sternotomy

Answer 35

Relatively common, most will go away in less than 24 hours. Rate control. If it persists then you can consider cardioversion and anticoagulation.

Question 36

Mediastinitis

Answer 36

5% of sternotomies Fever, tachycardia, chest pain, leukocytosis Widened mediastinum on xray draining woud Tx: Surgical debridement and abx

Question 37

Old guy, CP, syncope, recent viral illness, markedly enlarged heart

Answer 37

HAVE to consider aortic dissection, even without differences in UE BP.

Question 38

Palpable thrill with harsh, holosystolic murmur Left 4th intercostal space

Answer 38

VSD