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Internal Medicine EOR > Cardio > Flashcards

Cardio Flashcards

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1
Q

Angina Pectoris Path

A

Exertional chest pain d/t increased demand and decreased supply

Typically caused by fixed plaque

Pain lasts LESS THAN 30 minutes and is relieved by rest and/or Nitro

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2
Q

Classes of Angina

A

I: only with unusally strenuous activity, no limitations

II: with more prolonged/rigorous activity, slight limit

III: with usual daily activity, marked limts

IV: at rest, unable to do activity

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3
Q

Dx of Ischemic Heart Disease

A

EKG: ST depression
Stress test: most useful noninvasive tool
Myocardial Perfusion imaging
Coronary angiography: GOLD STANDARD

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4
Q

Surgical Tx of ischemic heart disease

A

PTCA: not involving the left main coronary artery, vent function is near normal

CABG: for left main coronary or critical stenosis

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5
Q

Nitro and ischemic heart disease

A

Increases O2 and increases collateral blood flow, reducing coronary vasospasm and increasing dilation.
If no relief with first dose give a 2nd and 3rd evert 5 minutes. If still not relief ā€“ ACS!!!

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6
Q

Contraindications to Nitro

A

SBP <90
RV infarction
PDE-5iā€™s

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7
Q

BBs

A

increase diastolic timing, first line drug of choice for ischemic heart disease management

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8
Q

CCBs

A

used by patients that cannot use BBs, Prinzmetal angina

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9
Q

Prinzmetal angina

A

almost ALWAYS occurs at rest, usually between midnight and early morning

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10
Q

ASA and ischemic heart

A

prevents progression of stable angina to ACS

CAUTION in pts with PUD or increased bleeding risk

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11
Q

Sinus Arrhythmia

A

Same as NS except irregular

HR increases during inspiration and decreases with expiration

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12
Q

Since sinus syndrome

A

ā€œBrady-Tachyā€
Combo of sinus arrest with alternating paroxysms of atrial tach and brady. Commonly caused by sinoatrial node disease

NEED PACER

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13
Q

AV block

A

Interuption of normla impulse from SA to AV

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14
Q

A Flutter

A

Saw tooth waves @ 250-350 BPM with no P waves.
Rate: regular

Stable: vagal, BB, CCB
Unstable: cardiovert
Cure: ablation

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15
Q

Afib

A

Rhythm: Irregular
Narrow QRS
No p wave
80-140bpm

Can lead to ischemic stroke

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16
Q

Ashmens Phenomenon

A

occasional aberrantly conducted beats and short R-R cycles

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17
Q

AFIB MANAGEMENT of stable patients

A

rate control

BB: metoprolol but be careful in pts with reactive airway disease

CCB Diltiazem

Digoxin: Preferred in pts with hypotension or CHF

Rhythm Control: cardiovert, flecinide, sotalol, amiodarone, ablation

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18
Q

Afib management o Unstable patients

A

Cardiovert

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19
Q

Anticoags for Afib

A

Warfarin w/ goal INR 2-3

Dual Antiplatelet: ASA + clopidogrel

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20
Q

Long QT syndrome

A

d/t congenital or macrolides/TCAs and electrolyte abnormalities. Can lead to sudden cardiac death

Tx: d/c offending med and correct abnormalities

Congenital: AICD

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21
Q

PSVT

A

HR>100
Regular, narrow QRS, P waves hard to see

Paroxysmal: sudden onset and termination

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22
Q

PSVT types

A

AV nodal reentry: 2 pathways both within AV node ā€“> MC

AV reciprocating Tach: 1 pathway in AV and second outside AV

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23
Q

PSVT tx

A

Stable: vagal, adenosine 1st line, BB/CCB

Unstable: cardiovert
Cure: ablation

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24
Q

Wandering atrial pacemaker/ Multifocal Atrial Tach

A

WAP: <100 BPM >/= 3 P waves

MAT: >100 BPM >/= 3 P waves ā€“> SEVERE COPD

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25
Wolff Parkinson White
Bundle of Kent excites ventricles DELTA waves Wide QRS Short PR Tx: vagal, antiiarhythmics, procainamide AVOID ABCD: adenosine, BBs, CCBs, Digoxin
26
Lown Ganong Levine Syndrome
Short PR with normal QRS Bundle of James connects with His
27
PVC
Premature beat from ventricle WIDE bizarre QRS earlier than expected with a pause T wave is opposite direction
28
Ventricular Tach
>/= 3 PVCs at a rate of >100bpm No pulse: defib/CPR
29
Torsades De Pointes
MC d/t Hypomagnesemia, hypokalemia, V Tach that twists around baseline Tx: IV mag
30
V Fib Tx
Unsynchronized cardiovert and CPR
31
PEA
NSR without a pulse | CPR/Epi
32
Dilated Cardiomyopathy etiology (95% of cases)
Post viral, MC is enterovirus Also: chagas, ETOH, prego, cocaine TAKE A GOOD Hx
33
Dilated Cardiomyopathy Sx
Systolic heart failure sx S3 Laterally displaced PMI Mitral/Tricuspid Regurg
34
Dilated Cardiomyopathy Dx/ Tx
Echo -> LV dilation, decreased EF Tx: ACEi, Diuretics, BBs
35
Restrictive Cardiomyopathy etiology
Impaired disatolic function with preserved contractility Amyloidosis MC cause Also: sarcoidosis and infiltrative disease
36
Restrictive cardiomyopathy Sx/ PE
``` Right sided failure sx Kussmauls sign (JVP increases with inspiration) ```
37
Restrictive Cardiomyopathy dx/ tx
CXR: atrial enlargement, pulm congestion Tx: tx sx and underlying issue
38
HOCM etiology
Genetic disorder of LV and/or RV hypertrophy | Subaortic outflow obstruction
39
HOCM Sx
Dyspnea MC CC, angina, syncope, arrythmias, sudden cardiac death
40
HOCM PE
HARSH systolic Cresendo-Decresendo murmur heard at lower left sternal border, similar to AS except HOCM decreases with squatting
41
HOCM Dx and TX
Echo: >15mm wall thickness Tx: BB is 1st line, the myomectomy, and alcohol septal ablation
42
CHF L vs R
L: MC causes CAD and HTN R: MC causes is left sided failure
43
CHF systolic vs diastolic
``` Systolic: decreased EF S3 MC form Etiology: post MI, dilated cardiomyopathy, myocarditis ``` Diastolic: normal EF S4 Stiff ventricle Etiology: HTN, LVH, Elderly
44
High Output CHF
metabolic demands of hte body exceed normal cardiac fxn Thyrotoxicosis, wet beriberi, severe anemia, AV shunting
45
Low output CHF
Inherent problem of myocardial contraction, ischemia, chronic HTN
46
NY heart CHF Classificaiton
I: no sx/ limits II: mild sx, slight limits III: sx cause marked limits with activity, comfy at rest IV: sx at rest, severe limits
47
Sx of L CHF
Increased pulmonary pressure from fluid backup Dyspnea, Pulm edema/congestion (rales, rhonchi) Productive cough, Transudative pleural effusions HTN, S3/S4, cheyne stokes breathing, dusky pale skin, diaphoresis, sinus tachy, cool extremities
48
Sx of R CHF
Peripheral edema, JVD, GI/Hepatic congestion | N/V, RUQ t, Anorexia
49
CHF Dx
Echo for EF CXR: kerley B lines, butterfly pattern, cardiomegaly, Pulm Edema, Pleural Effusions CEPHALIZATION: increased vascular flow to apices Increased BNP
50
CAD
Inadequate perfusion d/t imbalance between decreased coronary blood supply and increased demand MC etiology: artherosclerosis, AS,AR, Pulm HTN Rsk: DM, Sm, HTN, HLD, Male, >45, Fam hx
51
CAD PE
Sx only with >70% reduction in lumen ABI<0.9 Delayed cap refull, cool limbs, pale on elevation, lateral malleolar ulcers
52
CAD tx
Cilostazol, ASA
53
CVD
Atherosclerosis MC DM (worst rsk factor) Sm, HLD, HTN , Males, Age, Hx
54
ACS
UA, NSTEMI, STEMI Retrosternal pressure not relieved by rest or nitro a/w diaphoresis and n/v
55
UA/ NSTEMI tx
ASA, GPIIb/IIa i's, BBs, Nitrates, CCBs
56
STEMI Tx
PCI within 3 hours of onset. Alteplase if no PCI
57
Exceptions to STEMI Tx
Cocaine: NO BBs R vent infarct: give IVF, no nitrates or morphine Viagra: no nitrates
58
Lateral leads
I, aVL, V5-V6
59
Inferior Leads
II, III, aVF
60
Anterior/Septal leads
V1-V4
61
Endocarditis
Mitral valve MC | IVDA --> tricuspid MC
62
Types of endocarditis
Acute bacterial (S. Aureus) Subacute Bacterial (S. Viridans) IVDA: MRSA Prosthetic: S. Epidermis
63
HACEK
Haemophlius, Actinobacillus, Cardiobacterium, Eikenella, Klingella Gram Neg organisms a/w large vegetations and hard to culture
64
Endocarditis | FROM JANE
``` Fever Roth Spots Osler Nodes Murmur Janeway Lesions Anemia Nailbed Hem Emboli ```
65
Duke Criteria
Blood Cx: 3 sets at least 1 hour apart EKG: arrythmias Echo: TTE first, consider TEE Labs: Leukocytosis, anemia, increased EST/rheumatoid factor
66
Tx of Endocarditis | Surgery indication
Refractory CHF, persistent infection, invasive, prosthetic valve, fungal
67
Tx of endocarditis acute/subacute
Native valve: Naficillin and Gentamicin 4-6 weeks Subacute: PCN or Ampicillin and Gentamicin OR Vanc in IVDA
68
Tx of Endocarditis Prosthetic Valve
Vanc and Genta micin and Rifampin
69
PPX abx for endocarditis
Prosthetic valves, heart repairs with prosthetic material, prior hx of endocarditis, congenital heart disease Procedures: dental, respiratory, infected skin
70
PPX regimen
Amoxicillin 2g 30-60 minutes prior to procedure
71
Hyperlipidemia Etiology
Hypercholesterolemia: hypothyroidism, pregnancy, kid failure Hypertriglyceridemia: DM, ETOH, Obesity, Estrogen, Steroids
72
HLD Sx
Xanthomas, Xanthelasma, usually asx
73
Statin therapy guidelines
DM 40-75 y/o CVD 40-75 y/o w/ >7.5% risk >21 y/o w/ LDL >190 ANY ASVCD
74
Lipid medications
Lower LDL: statins Lower Triglycerides: Fibrates Increase HDL: Niacin Type II DM: Fibrates/Statins
75
HTN
>2 readings on >2 visits of >140 SBP and/or >90 DBP
76
Primary vs Secondary HTN
Primary: d/t idiopathic cause, onset 25-55, Fam hx Secondary: d/t an outside cause
77
HTN sx
Papilledema, renal artery bruits, decreased femoral pulses, presence of S4
78
Goal BP
<140/90 for general population <150/90 if > 60yo
79
Chlorthialidone
Prevents Kidney NA/H2O reabsorption SE: hyponatremia, hypokalemia, hypercalcemia, hyperglycemia
80
Furosemide Loop Diuretic
Ihibits H2O transport SE: Water depletion, hypokalemia/calcemia, hyperglycemia, acidosis, ototoxicity
81
Spirnolactone, amiloride
K sparing Inhibits aldosterone mediated H2O and NA absorption SE: hyperkalemia, gynecomastia
82
ARB
Contraindicated in Pregnancy
83
ACEi
Decreases preload/afterload Good for DM, nephropathy, CHF, post MI SE: azotemia, hyperkalemia, cough
84
CCB: Nifedipine, Amlodipine, Verapamil, Diltiazem
DHP> non DHP SE: HA, flushing Contraindicated in CHF 2/3 heart block
85
BBB Atenolol, metoprolol, esmolol, propanolol
SE: Fatigue, depression, impotence Contraindicated in Heart block, CHF, Asthma, COPD, Raynauds, Hypotension
86
Prazosin/Terazosin
Good for HTN w/ benign prostatic hypertrophy SE: Syncope, HA, Dizziness
87
Myocarditis
Inflamm of heart muscle MC d/t viral infection or post viral immune mediated cardiac damage
88
Myocarditis Sx
Viral prodrome: fever, malaise, myalgias, heart failure Dyspnea at rest, exercise intolerance, syncope, tachy, AMS
89
Myocarditis Dx
CXR: cardiomegaly Cardiac Enzymes: elevated CK-MB and troponin, and ESR GOLD STANDARD: endomyocardial biopsy
90
Myocarditis Tx
Supportive mainstay of T, standard systolic heart failure tx: diuretics, ACEi, IVIG, no BBs in peds
91
Acute pericarditis
Fibrinous inflammation of the pericardium Enterovirus
92
Pericarditis Sx
Chest pain pleuritic persistent and postural Fever Pericardial friction rub at end of expieration whilte upright
93
Pericarditis Dx
EKG: ST elevations in precordial leads with PR depressions Echo: assess for complications of pericarditis like effusion or tamponade
94
Pericarditis tx
NSAIDS/ASA for 7-14 days | Colchicine is 2nd line
95
PVD
Superficial Deep Perforating
96
Superficial Thrombophlebitis
Thrombus in superficial vein, d/t IV cath, trauma, preg, varicose veins
97
Superficial thrombophlebitis Dx/ Tx
Dx: venous duplex US Tx: Supportive, elevation, warm compress, NSAIDS, stockings
98
Trousseau's Malignancy
Migratory Thrombophelbitis associated with malignancy (Pancreatic CA)
99
DVT
U/L swelling of lower extremity >3cm is most specific sign Dx: Venous Duplex is 1st line, VENOGRAPHY gold standard Tx: Antigoag --> Heparin, IVC filter
100
Rheumatic fever
Autoimmine inflammatory multi systemic illness found in 5-15 y/o MC: mitral complications
101
Rheumatic Fever PE
JONES criteria - Joint pain - Oh my heart - Nodules - Erythema Marginatm - Sydenhams Chorea Also: fever, elevated ESR/CRP, Positive throat culture of Group A strep
102
Rheumatic Fever Tx
ASA 2-6 weeks with taper, steroids | Pen G abx of choice
103
Aortic Stenosis Etiology
1: Degenerative heart disease 2: Congenital heart disease 3: Rheumatic heart disease
104
Aortic stenosis sx
Angina Syncope Congestive Herat Failure SYSTOLIC CRES-DECRESEND MURMUR RAD TO CAROTID Narrow pulse pressure
105
Aortic stenosis tx
AoV replacement, balloon pump
106
Aortic Regurg Etiology
1: Rheumatic heart disease 2: Endocarditis 3: Aortic root dilation
107
Aortic Regurg sx
CHF, Bounding pulses, Wide pulse pressure | DIASTOLIC DECRESENDO BLOWING MURMUR
108
Aortic regurg tx
ACEi/ARB/Nifedipine, surg is definitive
109
Mitral Stenosis etiology
Rheumatic Heart Disease MC
110
Mitral Stenosis sx
Dyspnea, hemoptysis, cough, pulm HTN, Afib, R sided HF, Flushed cheeks PROMINENT S1 OPENING SNAP, MID DIASTOLIC
111
Mitral stenosis tx
Surgery | can use diuretics for congestion or BB for afib
112
Mitral regurg etiology
Prolapse MC 2: Ischemia/infarct 3: Ruptured chordae tendinae
113
Mitral regurg sx
Acute pulm edema, hypotension, dyspnea, chronic afib, CHF BLOWING HOLOSYSTOLIC
114
Mitral regurg tx
Surgery (repair>replacement) OR ACEi, hydralazine, nitrates
115
Mitral valve prolapse
Palpitations, syncope, fatigue, dyspnea, mostly ASX MID-LATE SYSTOLIC EJECTION CLICK Tx: none
116
Pulm Stenosis etiology
congenital
117
Pulm Stenosis sx
harsh misystolic ejection crescendo decrescendo murmur radiates to neck
118
Pulm Regurg etiology
pulm htn, TOF, endocarditis, rheumatic heart disease
119
Pulm Regurg Sx
brief decrescendo early diastolic murmur with inspiration TX: none
120
Tricuspid stenosis sx
mid diastolic murmur Tx: diuretics/ Na restriction
121
Tricuspid regurg sx
holosystolic blowing high pitched murmur CARVALLOs SIGN: increased with inspiration Tx: diuretics, HF therapy

Internal Medicine EOR (8 decks)

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