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Flashcards in Cardio from Prep Book Deck (173):
1

Name the NYHA classification: no limitation of physical activity, ordinary physical activity does not cause fatigue, dyspnea, or anginal pain

Class I

2

Name the NYHA classification: marked limitation of physical activity; comfortable at rest, but less than ordinary activity causes symptoms

Class III

3

Name the NYHA classification: Slight limitation of physical activity, ordinary physical activity results in sx

II

4

Name the NYHA classification: Unable to engage in any physical activity w/o discomfort; sx may be present even at rest

IV

5

___________ may be related to reduced CO, paroxysmal cardiac dysrhythmias, low blood volume, meds, and various endocrine/metabolic disorders

Postural hypotension

6

Postural hypotension is > ______mmHg drop in SBP b/t supine and sitting and/or standing measurements

20

7

What can exacerbate HTN?

excessive ETOH, smoking, lack of exercise, polycythemia, NSAIDs, low K intake

8

What are causes of secondary HTN?

sleep apnea, estrogen, pheochromocytoma, coarctation of aorta, pseudotumor cerebri, parenchymal renal disease, renal artery stenosis, chronic steroid therapy, Cushing's, thyroid/parathyroid disease, primary hyperaldosteronism, pregnancy

9

Stage 1 HTN

SBP 140-159
DBP 90-99

10

PreHTN

SBP 120-139
DBP 80-99

11

Stage 2 HTN

SBP >160
DBP >100

12

What is a hypertensive urgency?

reflects BP that must be reduced w/in hours; SBP>220, DBP >125

13

What is hypertensive emergency?

Reflects BP that must be reduced w/in 1 hour to prevent progression to end-organ damage or death; DBP >130; optic disc edema indicates end organ damage; complications include HTN encephalopathy, nephropathy, intracranial hemorrhage, aortic dissection, preeclampsia, eclampsia, pulmonary edema, unstable angina, MI

14

What is malignant HTN?

Elevated BP associated with papilledema and encephalopathy or nephropathy; if untreated, progressive renal failure occurs

15

End organ damage in untreated HTN

HF, RF, stroke, dementia, aortic dissection, atherosclerosis, retinal hemorrhage

16

What will EKG show for HTN?

LVH or HF; strain failure if poor prognosis

17

HTN Treatment

DASH diet, diuretics, Beta blockers, ACEI, ARB, CCB, Renin inhibitor

18

When should loop diuretics be used?

Only in those with renal dysfunction and when close electrolyte monitoring is assured

19

What is the initial HTN DOC for diabetics?

ACEI

20

What HTN drug is used for men with symptomatic prostatic hyperplasia?

alpha adrenergic antagonists

21

What is preferred agent to treat hypertensive urgencies or emergencies?

sodium nitroprusside

22

CHF results from changes in 1 of what 3 areas

contractile ability of heart muscle
preload and afterload of ventricle
heart rate

23

Characteristics of left sided heart failure

exertional dyspnea plus nonproductive cough, fatigue, orthopnea, paroxysmal noctural dyspnea, basilar rales, gallops, exercise intolerance

24

Characteristics of right sided heart failure

Distended neck veins, tender or nontender hepatic congestion, N, dependent pitting edema, hepatomegaly, edema

25

Cardiac PE signs of CHF

Parasternal lift, enlarged apical impulse, diminished first heart sound, S3 gallop

26

What is a common nightime sx of CHF?

nocturia

27

CXR of CHF

cardiomegaly and b/l or right sided pulmonary effusions, perivascular or interstitial edema (Kerley B lines), venous dilation, alveolar fluid

28

What lab may be elevated with heart failure?

BNP

29

Treatment of CHF

stress reduction, aerobic exercise, low sodium, diuretic

Initial therapy: thiazide (or loop diuretic) + ACEI

30

What is the most common cause of cardiac related death and disability?

Atherosclerotic heart disease

31

What is an important marker of atherosclerosis?

C-reactive protein

32

Treatment of atherosclerosis

Smoking cessation; exercise, dietary modifications, treatment of dyslipidemias

33

What is the usual cause of ischemic heart disease?

atherosclerotic narrowing

34

Risk factors of ishemic heart disease

male, age, low estrogen, smoking, Fhx, HTN, DM, abdominal obesity, inactivity, dyslipidemias, increase ETOH, low intake of fruits/veggies

35

What is stable angina?

exacerbated by physical activity and is relieved by rest

36

What is variant angina (or Prinzmetal's)?

Vasospasm at rest, with preservation of exercise capacity

37

What is unstable angina?

Increasing pattern of pain in previously stable patients. Less responsive to meds, lasts longer, occurs at rest or with less exertion

38

What is it called when a patient has a clenched fist over their sternum and clenched teeth when describing chest pain? Seen in ischemia patients

Levine's sign

39

If angina pectoris lasts longer than 30 minutes what does it suggest?

unstable angina, MI, or another dx

40

_______ is relieved by sublingual or spray nitroglycerin

Acute Anginal attacks

41

During an exercise test, an ST segment depression of 1mm is considered a positive test for what?

ischemic heart disease

42

What is first line therapy for chronic angina?

Beta blockers

43

Conditions classified simply as ST-elevated or non-ST elevated events rather than unstable angina, q-wave infarction, or non-q wave infarction

ACS

44

Causes of MI

prolonged myocardial ischemia, prolonged vasospasm, reduced myocardial blood flow, excessive metabolic demand, embolic occlusion, vasculitis, aortitis, coronary artery dissection, cocaine use

45

Who are more likely to present atypically with MI?

Elderly, women, diabetics

46

Patient develops increasingly severe, prolonged (>30min) anterior CP at rest, usually during early morning hours

MI

47

Other common symptoms of MI

diaphoresis, weakness, anxiety, restlessness, light-headedness, syncope, cough, dyspnea, orthopnea, N/V, abdominal bloating

48

What is Dressler's syndrome? (post-Mi syndrome)

pericarditis, fever, leukocytosis, pericardial or pleural effusion; usually 1-2 weeks post-MI

49

What serial cardiac enzymes are elevated in MI?

creatine kinase, troponin T, and troponin I

50

MRI with gadolinium contrast is one of the most sensitive tests to quantify the extent of _______

infarction

51

What should all patients with suspected ACS receive?

IV fluids, oxygen, nitroglycerin, pain management

52

If a patient with ACS WITHOUT STEMI what should they get?

antiplatelets (ASA and clopidrogel);
Anticoagulant (heparin, enoxaparin, fondoparinux, bivalriduin)

53

What is the drug that is started in most patients with ACS?

Beta Blockers

54

Patients with ACS and acute STEMI tx

ASA and clopidrogel = immediately; Within 90 minutes, coronary angiography, primary PCI; Within 3 hours, thrombolytic therapy (alteplase, reteplase, tenecteplase)

55

What are absolute C/I to thrombolytic therapy?

previous hemorrhagic stroke, any stroke in last year, known intracranial neoplasm, active internal bleeding, suspected aortic dissection

56

_____ types of congential heart anomalies are R--> L shunt

Cyanotic (Tetralogy of Fallot, Pulmonary atresia, hypoplastic left heart syndrome, transposition of great vessels)

57

_____ types of congential heart anomalies are L--> R shunt

Noncyanotic (ASD, VSD, AV septal defect, PDA, Coarctation of aorta)

58

Occurs with an intact ventricular septum; pulmonary valve is closed; an open atrial septal opening and PDA are present

Pulmonary atresia

59

Subaortic septal defect, right ventricular outflow obstruction, overriding aorta, right ventricular hypertrophy

Tetralogy of Fallot

60

What is the most common ASD?

ostium secundum

61

Due to incomplete fusion of endocardial cushions; common in Down syndrome

AV septal defect

62

Failure to close or delay in closure of the channel bypassing the lungs, which allows placental gas exchange during the fetal state

PDA

63

What are the most frequent causes of mitral and aortic valve disorders

congenital defects

64

What are the common sx's of valvular disorders?

Dyspnea, fatigue, decreased exercise tolerance

65

Thin females with minor chest wall deformities, midsystolic clicks, late systolic murmur

mitral valve prolapse

66

Is ECG useful in diagnosing valvular disorders?

No

67

Murmur heard in 2nd-4th left intercostal space; radiates to apex and RSB; Grade 1-3; High pitch, blowing; Better heard when patient sits and leans forward on full exhalation; murmur is systolic and diastolic decrescendo

Aortic regurg

68

Murmur heard at apex with little or no radiation; Grade 1-4; Low pitch; Can be heard better in left lateral position on full exhalation; S1 accentuated; opening snap follows S2; Mid-diastolic

Mitral Stenosis

69

Murmur heard at apex that radiates to left axilla; murmur is soft to loud and is medium to high pitch; blowing; S2 often decreased; Pansystolic

Mitral Regurg

70

Murmur found in 2nd Right intercostal space that radiates to neck and LSB; It is loud with a THRILL; Medium pitch and harsh; Can be heard better if patient is sitting and leaning forward; Midsystolic

Aortic Stenosis

71

With aortic valve disorders, CXR may show?

left sided atrial enlargement, ventricular hypertrophy

72

With mitral valve disorders, CXR may show?

atrial enlargement

73

What are the only definitive methods for identifying structural and functional abnormalities of the heart?

Echocardiography, cardiac catheterization

74

In all cases of tricuspid and pulmonic valve disorders, right sided pressure overload leads to ?

right-sided cardiomegaly, systemic venous congestion, right-sided heart failure

75

How do patients with tricuspid and pulmonic valve disorders typically present?

Exercise intolerance

76

How to treat tricuspid and pulmonic valve disorders ?

Sodium restrction and diuretics to decrease fluid volume and right atrial filling pressures

77

Murmur at LLSB that is holosystolic and radiating to right sternum and xiphoid area; Variable intensity; Pitch/Quality is medium and blowing; Increases slightly with inspiration; JVP often elevated; Pansystolic

Tricuspid regurg

78

Pulmonic Stenosis Murmur:
Location
Radiation
Intensity
Pitch/Quality
Associated findings
Timing

Heard: 2-3rd left intercostal space, midsystolic crescendo-decrescendo murmur; Radiations to left shoulder and neck; Intensity soft to loud; Pitch/Quality: Medium/harsh; Early pulmonic ejection sound common; Timing: systolic

79

What are risk factors for developing an arrhythmia?

electrolyte abnormalities, hormonal imbalances, hypoxia, drug effects, MI

80

Heart Rate <60bpm; normal in athletes, usually represents SA node pathology, increased risk for ectopic rhythms

Sinus Bradycardia

81

HR >100bpm occurs with fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, HF, use of many drugs

Sinus Tachycardia

82

What is the most common paroxysmal tachycardia?

Paroxysmal supraventricular tachycardia

83

What class of antiarrhythmic drug includes beta blockers that slow AV conduction?; esmolol, propranolol, metoprolol

Class II

84

What class of antiarrhythmic drug includes drugs that slow calcium channel blockers?; verapamil, diltiazem

Class IV

85

Digoxin and Adenosine are in what class?

Class V

86

This drug slows the conduction time through the AV node and interrupts reentry pathways

Adenosine

87

This drug directs action on cardiac muscles and indirect action on cardiovascular system via ANS

Digoxin

88

What class of antiarrhythmics prolongs action potential?; amiodarone, sotalol, dofetilide, ibutilide

Class III

89

What class of antiarrhythmics blocks sodium channels? They also depress phase 0 depolarization, slow conduction, and prolong repolarization. Quinidine, procainamide, disopyramide, moricizine

Class Ia

90

What class of antiarrhythmics shortens depolarization?; lidocaine, mexiletine

Class IIB

91

What class of antiarrhythmics depress phase 0 repolarization and slows conduction?; flecainide, propafenone

Class Ic

92

What is the most common chronic arrhythmia?

A fib

93

Who does A flutter typically occur in?

COPD, CHF, ASD, CAD

94

What mechanical measures can be used to interrupt acute PSVT?

Valsalva maneuver, coughing, breath holding, stretching, putting head b/t knees, applying cold water to face, U/L carotid sinus massage

95

What is treatment of choice for chronic A flutter?

amiodarone, dofetilide

96

Three or more consecutive ventricular premature beats

V tach

97

What is Brugada's syndrome?

Syncope, v fib, sudden death common in Asians and men

98

What is preferred pharmacologic interventions for acute V tach?

lidocaine, procainamide, amiodarone

99

When is implantable defibrillator indicated?

Chronic recurrent sustained V tach w/o reversible causes, congenital long QT syndrome, Brugada's syndrome

100

Often occurs in elderly; usually asymptomatic, but may have syncope, dizziness, confusion, heart failure, palpitations, angina; can be exacerbated by digitalis, CCB, BB, sympatholytic agents, antiarrhythmic drugs

Sick Sinus syndrome

101

How do you treat sick sinus syndrome?

permanent pacing

102

What are the most common type of cardiomyopathy?

Dilated cardiomyopathy

103

What are causes of dilated cardiomyopathy?

genetic abnormalities, excessive ETOH, postpartum state, chemo toxicity, endocrinopathies, myocarditis

104

What is Takotsubo cardiomyopathy?

Occurs after major catecholamine discharge and is an apical left ventricular ballooning with sx indistinguishable from acute MI

105

Results from fibrosis or infiltration of ventricular wall b/c of collagen-defect disease, most commonly amyloidosis, radiation, postop changes, diabetes, endomyocardial fibrossi

Restrictive cardiomyopathy

106

Dilated cardiomyopathy sx/PE

Left or biventricular congestive failure; most common presentation is dyspnea; S3 gallop, rales, increased JVP

107

Hypertrophic cardiomyopathy s/sx

Dyspnea and angina; syncope and arrhythmias; sudden death may be initial presentation

108

Hypertrophic cardiomyopathy PE

sustained PMI, loud S4 gallop, variable systolic murmur, bisferiens carotid pulse, JVP with prominent "a" wave

109

Restrictive cardiomyopathy s/sx

Decreased exercise tolerance; in advanced dz: right sided congestive failure; pulmonary HTN

110

Tx of dilated cardiomyopathies

Abstinence of ETOH, underlying disease tx

111

Tx of hypertrophic cardiomyopathies

BB or CCB; surgical or nonsurgical ablation of hypertrophic septum possibly; dual chamber pacing, implantable defibrillators, mitral valve replacement may be indicated

112

What may help pts with restrictive cardiomyopathies?

Diuretics

113

Occurs as result of infx, autoimmune or connective tissue disease, neoplasms, RT, chemo, cardiac surgery, myxedema, TB

Pericarditis

114

Cardiac tamponade occurs when _____ compromises cardiac filling and impairs CO

Fluid

115

What is primary presenting sx of acute pericarditis?

pleuritic substernal radiating CP relieved by sitting upright and leaning forward; friction rub characteristic

116

Presents with slowly progressive dyspnea, fatigue, weakness, edema, hepatomegaly, ascites

Constrictive pericarditis

117

Presents with tachycardia, tachypnea, narrow pulse pressure, pulsus paradoxus

Cardiac tamponade

118

What organisms typically cause infective endocarditis?

Staph. aureus (most common in IV drug users), Group D strep, enterococci, HACEK organisms

119

Presentation of infective endocarditis

Fever, nonspecific sx (cough, dyspnea, arthralgias, back/flank pain, GI complaints); stable murmur

120

What classic features of infective endocarditis occurs in 25%?

Palatal, conjunctival, subungual petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots

121

How do you diagnose infective endocarditis?

3 sets of blood cultures at least 1 hour apart preferable before starting ABX

122

CXR on infective endocarditis

underlying cardiac abnormality or reveal pulmonary infiltrates if right side of heart is involved

123

_______ criteria are used to establish DX of infective endocarditis

Duke criteria

124

What is the common ABX for infective endocarditis?

Vancomycin + ceftriaxone

125

A systemic immune response occuring usually 2-3 weeks following a Beta hemolytic strep pharyngitis infection

Rheumatic fever

126

_______ criteria are used to establish DX of rheumatic fever

Jones (Need 2 major or 1 major and 1 minor)

127

What are the major Jones criteria for RF?

Carditis, erythema marginatum, subQ nodules, chorea, polyarthritis

128

What are minor Jones criteria for RF?

Fever, polyarthralgias, reversible prolongation of PR interval, rapid ESR, C-reactive protein

129

Common age range of RF

5-15y/o

130

What valve is most affected in RF?

Mitral

131

Recommended tx of RF

Strict bed rest, salicylates, corticosteroids, IM penicillin for strep infix, prevention (early tx of strep pharyngitis)

132

Lower leg pain with exercise (relieved by rest), weak or absent femoral/distal pulses; possible aortic, iliac, femoral bruit; if severe: numbness, tingling, ischemic ulcers (leads to gangrene);

PAD

133

What is Leriche's syndrome?

ED when PAD in iliac artery disease

134

In PAD, extremity occlusion results in the 6 Ps. What are they?

pain, pallor, pulselessness, paresthesias, poikilothermia, paralysis

135

An ABI of <____ indicates significant PAD

0.9

136

What is main drug tx of PAD?

Cilostazol

137

What are nonpharmacologic tx of PAD?

Stop smoking; progressive exercise

138

Risk factors of Varicose veins

Pregnancy, Fhx, prolonged sitting/standing, hx of phlebitis

139

What test differentiates saphenofemoral valve incompetence from perforator vein incompetence?

Brodie-Trendelenburg

140

Are lab studies necessary for varicose veins?

No

141

Tx of varicose veins

Graduated elastic stockings, leg elevation and exercise for sx, endovenous radiofrequency or laser ablation, compression sclerotherapy, surgical stripping

142

Partial or complete occlusion of vein and inflammatory changes

Thrombophlebitis

143

Virchow's triad

stasis, vascular injury, hypercoagulability

144

Presents with dull pain, erythema, tenderness, induration of involved vein or with no sx; common in long saphenous vein; palpable cord

Superficial thrombophlebitis

145

Preferred study for DVT

Duplex US

146

What is most accurate method for definitive diagnosis of DVT?

venography

147

What is preferred pharmacologic tx of DVT?

LMWH; heparin followed by warfarin

148

Loss of wall tension in veins which results in stasis of venous blood and is associated with hx of DVT, leg injury, or varicose veins

Chronic venous insufficiency

149

Sx of chronic venous insufficiency

progressive edema starting at the ankle followed by skin and subQ changes; itching, dull pain w/ standing and pain with ulceration is common; skin is shiny,thin, atrophic with dark pigment changes and subQ induration

150

Stasis dermatitis tx

wet compresses, hydrocortisone cream; chronic dermatititis add zinc oxide with ichthammol and an antifungal cream

151

Causes of aortic aneurysm

Atherosclerosis (#1); syphillis, giant cell arteritis, vasculitis, trauma, Marfan's syndrome, Ehlers-Danlos syndrome

152

Classic person with aortic aneurysm

Elderly male smoke with CAD, emphysema, renal impairment

153

Thoracic aortic aneurysms presentation

Substernal, back, neck pain; dyspnea, stridor, cough, dysphagia, hoarseness, sx of superior vena cava syndrome

154

Study of choice for abdominal aneurysms

abdominal US, followed by contrast enhanced CT

155

Tx for Aortic aneurysm

endovascular or open surgical repair

156

What are 2 impt features of aortic dissection?

unequal blood pressure between arms; widened mediastinum on CXR

157

Q waves in 2 or more leads means?

previous MI

158

ST depression >1mm means?

ischemia

159

ST elevation means?

acute MI or pericarditis (which will show involvement in all leads and PR depression)

160

LBBB means

suggests underlying heart disease (ischemia, HTN)

161

RBBB means

may indicate right heart strain (as in pulmonary embolus)

162

Substernal pressure, heaviness, burning, squeezing, or choking; rarely well localized

angina pectoris

163

Xanthomas may appear in what?

hyperlipidemia (fat build up under skin)

164

The __________ prediction model tallies point for the major known cardiac risk factors: age, gender, diabetes, smoking, LDL, HDL, BP

Framingham

165

When should you stop an exercise stress test?

Moderate to severe CP or dyspnea, dizziness, greater than 2mm ST segment depression, fall in SBP of >10mmHg (seen in ischemia), sustained ventricular tachycardia

166

What are causes of false ST depressions?

LBBB, LVH, WPW, digoxin use

167

Gold standard of diagnosing coronary artery disease

Coronary angiography

168

Treatment of Stable Angina (Acronym: ABCDE)

A: ASA, ACEI, antianginals
B: BB and BP
C: cholesterol and cigarettes
D: diet and diabetes
E: Education and exercise

169

Patients with CHD should have LDL of _______

<90

170

Are pathologic Q waves present in NSTEMI?

No

171

The evolution of the ECG during a STEMI

1. T wave increases in amplitude (several minutes after vessel occlusion)
2. ST-segment elevation (minutes to hours)
3. Development of Q waves (hours to days)
4. Resolution of ST segment elevation (hours to days)

172

What is Wellen's sign?

deep inverted T waves in leads V1-V4 associated with severe disease in left anterior descending artery

173

TIMI Risk Score (7 point system for evaluating UA or NSTEMI) components

Age >65
At least 3 risk factors for coronary artery disease
Known coronary artery disease with at least 50% coronary stenosis
ST segment changes
At least 2 episodes of angina in past 24 hours
ASA used in past week
Elevated CK-MB or troponin