CARDIO HIGH NOTES BLOCK I Flashcards
1
Q
What are the cardinal S/s of CVD
A
Dyspnea Pain Syncope Edema Palpitations Fatigue Claudication Fatigue
2
Q
What does Vindicates stand for
A
Vascular Infection Neoplastic Drugs/ Degenerative Inflammatory/ Idiopathic Congenital Autoimmune Trauma Endocrine/ Enviromental Something else/ Psychological
3
Q
What is the earliest and most common S/s of HDz
A
Dyspnea
Think ischemia, HF, Arrhythmia
4
Q
How does classic cardiac chest pain present
A
Angina, retrosteranal left anterior “crushing” chest pain w/ squeezing, tightness, or pressure.
5
Q
What is Diamond Criteria
A
Substernal pain
Worse with exertion
relieved by NG
3/3= typical 2/3= Atypical 0-1/3= Non Anginal
6
Q
What does OMI MONA BASH C
A
O2, MONITOR, IV
Morphine, O2, NTG, Aspirin
Beta Blockers, ACE, Statin, Heparin
Clopidogrel
7
Q
How does Claudication present
A
Pain, burning feelings, in the legs or buttocks when walking
Shiny Hairless blotch foot skin that may get sores
Leg is pale when raised and red when lowered
Impotence in men
Leg pain at night
8
Q
What are MAjor ASCVD events
A
Recent ACS within 12 months History of MI He of Ischemic Stroke Symptomatic PVD Claudication is ABI < 0,85 Previous revascularization or amputation
9
Q
What are the Risk Fx for HDz
A
Age > 65 yrs Familial High cholesterol Prior Bypass or PCI DM HTN CKD ( GFR 15-59) Smocking LDL-C above 100 despite statins
10
Q
How does acute pericarditis present on EKG
A
Diffuse ST elevations with PR depressions in majority of leads
AVR has PR elevation and ST depression
11
Q
Sympathetic nerves innervate which parts of the heart
A
Sa Node
Atria
AV node
And Ventricles
12
Q
Parasympathetic nerves innervate which parts of the heart
A
Sa node
Atria
AV node
NO innervation of the Ventricles
13
Q
What is the major determinant force of cardiac contraction
A
Concentration of Calcium within the cytosol
14
Q
How do calcium flucutaions effect cardiac contraction
A
Mechanisms that raise intracellular Ca++ concentration enhance force development, whereas factors that lower Ca++ concentration reduce the contractile force.
15
Q
Absent X waves correspond to..
A
Tricuspid regurgitation
16
Q
Prominent V waves correspond to …
A
Severe Tricuspid regurgitation
17
Q
Prominent Y descent waves relate to..
A
Constrictive pericarditis, or restrictive cardiomyopathy
Tricuspid regurgitations
Or ASD
18
Q
Blunted Y descent waves relate to
A
Cardiac Tamp.
RV ischemia
Or Tricuspid stenosis
19
Q
What is Kussmals sign
A
Kussmaul’s Sign:
Physical exam finding
-Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity.
- Kussmaul’s sign is the observation of a JVP that rises with inspiration.
- The differential diagnosis generally associated with Kussmaul sign is constrictive pericarditis, as well as with restrictive cardiomyopathy
20
Q
What is hepato-jugular reflex
A
Physical exam technique by which the JVP is observed while pressure is firmly applied to the right upper quadrant, primarily used in patients with subacute right-sided heart failure and/or passive hepatic congestion
21
Q
High JVP means..
A
Right heart HF, Tricuspid Regurgitation
Tamp.
22
Q
Low JVP Means
A
Dehydration Bleeding out ( Hypovolemic)
23
Q
Prominent A waves mean
A
RVH or tricuspid stenosis
24
Q
Prominent v waves mean
A
Tricuspid Regurgitation
25
Prominent y waves mean
Constrictive pericarditis
26
What are the fundamental contractile units of the heart
Myocardial cells containing myofibirls made of sarcomeres
27
What does valvular regurgitation lead to
Volume overload
28
What does vulvular stenosis lead to
Pressure overload
29
Murmurs: Harsh/ rumble sound think ..
Stenosis
30
Murmurs: blowing sound think…
Regurgitation
31
What is the s1 sound
Normal closure of the MITRAL and TRICUSPID valves
32
What is the s2 sound
NML closure of the AORTIC and PULMONIC valves
33
Which heart sound is in sync with the carotid pulse
S1
34
What heart sound is the onset of systole
S1
35
What three things can cause S1 to be louder
Shortened PR interval
Mild Mitral Stenosis
High Cardiac output states
(Excercise or Tachy HR)
36
What can cause diminished S1 sounds
AV blocks
Mitral regurgitation
Severe Mitral stenosis
Stiff left ventricle
37
What sound is at the onset of Diastole
S2
38
What are two common causes of widened split of S2
RBBB and Pulm stenosis
39
What is the cause of S2 splitting
ASD
40
What two things cause Paradoxical splitting of S2
LBBB and Aortic stenosis
41
When does S3 occur and why does it occur
During Diastole
( ventricular gallop)
Can be NML in children
in adults in indicated volume overload ( CHF or mitral/ tricuspid regurgitation)
42
When is S4 heard and what does it mean
Late in diastole, atria contracting against a stiff non compliant ventricle
“Atrial gallop”
Means pressure overload
Heard best in L Lat Decubitus
Associated most with HTN
43
Physiological Split of s2 is accentuated how
During inspiration
44
Paradoxical splitting of S2 is accentuated how
audible separation of A2 and P2 during expiration that fuses into a single sound on inspiration, the opposite of the normal situation.
45
What is the most common cause of paradoxical splitting of S2
LBBB
46
What is the 1st step for a patient with Dyspnea or Chest pain
O2
Monitor
IV
47
What is the most common cause of R HF
L HF
48
How does anemia effect HR and BP
Increases both HR and BP
49
Clubbing of the nail is a sign of
HF, Chronic Lung Dz or Liver Dz
50
What is pulse pressure and what is considered NML
Systolic - diastolic
40 is NML
51
Increased Pulse pressures indicate
Aortic regurgitation
| Or increases in SV or Inotropy
52
Narrow pulse pressures indicate
Hypovolemia, severe LVF or mitral stenosis
53
What Dz is associated with Pulsus tardus
Aortic Stenosis
54
Pulsus bisferiens is associated with what Dz
Aortic Regurgitation
| And HOCM
55
What Dz is associated with Pulsus altérnans
Severe HF
56
What Dz is associated with Pulsus paradoxus
```
Cardiac Tamp
SVC obstruction
Pulm Obstruction ( COPD, PE)
```
57
Hyperkinetic pulses are associated with what Dz
High output states ( PDA, Thryotoxicosis, anemia, fever)
“High volume, bounding pulse”
58
Hypokinetic pulses are associated with what Dz
Low output states ( SHOCK)
59
Abnormal exaggeration (>10 mm Hg) of the normal decrease in systolic blood pressure during inspiration is called and indiactes what
Pulsus Paradoxus
Seen in cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy, hypotensive shock, severe obstructive pulmonary disease, large pulmonary embolism
60
A thrill corresponds to what grade murmur
Grade IV to VI
61
Heaves or Lifts indicate
HF
62
What three things cause Early Sys Ejection murmur
AS, PS, and Pulm HTN
63
What causes a mid systolic ejection sound
Mitral valve prolapse
64
OS is
MS
65
Mitral Stenosis is best heard in what position
Left Lateral Recumbent
66
What tumor sounds like mitral stenosis
Left Atrial Myxoma
67
What does a pericardial knock mean
Severe constrictive pericarditis
68
Where does Aortic stenosis radiate to
The neck
69
Where does aortic stenosis radiate to
Axilla
70
What are the three holosystolic murmurs
VSD, Tricuspid and Mitral regurgitation
71
Increase in venous return (squatting) increases the sound of all murmurs except which two
HOCM and Mitral valve Prolapse
72
Increasing after load (hand grip) accentuates which murmurs
AR, MR, and VSD
73
Hand grip ( increasing after load) diminishes which murmurs
AS MS MVP and HOCM
74
What effect does Amy NItrate have on Murmurs
Increases Stenotic murmurs and decreases regurgitation murmurs
75
In the role of Cardiac, what is NSAIDs used for
Pericarditis
76
What is the PET scan used for
Profusion and myocardial viability
77
What is the MUGA (SPECT) used for
Assessment of Left Vent function
assesses myocardial perfusion, Left Ventricular ejection fraction, and regional wall motion by injected technetium-99m-labeled red blood cells (i.e., Sestamibi or other labeled 99m Tc agents)
78
What is the medication for pharm stress testing
Regadenoson
79
What is the injection used during PET to detect profusion
Positively charged rubidium- 82 or nitrogen 13
80
What is the injection used in PET to asses myocardial viability
Positively charged fluorine-18-2-deoxyglucose
81
What is the 1st non invasive rhythm assessment ordered in pts with frequent daily S/s like palpaciones or unexplained syncope
Holter Monitor
82
What are the postive findings in a cardiac stress test
Ischemic ECG findings within 3 minutes of exercise or persist 5 min after stopping exercise
ST Depression > 2mm
Systolic pressure decreases during exercise
high grade ventricular arrhythmias develop
Pt unable to exercise for at least 2 min because of cardiopulmonary limitations
83
Where would tricuspid regurgitation radiate to
right side of the chest
84
Aortic and Pulm regurgitation are best heard where
At Erbs point
| Diastolic Murmurs
85
What systolic murmur is heard at erbs point
HOCM murmur
86
Which grade murmurs will have a thrill
Grades IV and above
87
What murmur is classically a decrescendo murmu
Early Diastolic murmur of aortic regurgitation
88
What murmur is classically a Crescendo-decrescendo “diamond shaped” murmur
Aortic Stenosis
89
Where are stills murmurs heard and what do they indicate
Best heard w/ the bell at the L lower sternal border as a crescendo-decrescendo sound in adolescent pts
No therapy is needed as it is not pathological
Indicates increase cardiac output or inotropy in children
90
What happens to stills murmurs when the pt is upright
Less preload and flow when upright causes the murmur to disappear
91
What distinguishes VSD murmur from Tricupsid or mitral regurgitation
It does not increases with inspiration or radiate to the axial
Is head at the tricuspid area/ LLSB
92
When is Aortic regurgitation best heard vs Pulm regurgitation
Leaning forward and exhaling for aortic
Leaning forward and inhaling
93
Where are Austin flint murmurs best heard
Associated with severe aortic regurgitation and best heard at the 5th ICS Midclavicular line
94
Constant boring pain in the chest indicates..
Esophageal rupture or pericarditis
95
Does PE present with a fever
YES
96
What is the most common presentation for a pt with PE
Tachycardia, sudden onset of Dyspnea
97
Hearing murmurs at the aortic area should make you think of
Aortic problems./ dissection or MI
98
Tachycardia with non specific ST changes, Sometime Right Heart strain sign indiactes
PE, sometime S1Q3T3 as well
99
Right axis deviation is a hint to
Right heart problems like PE
100
Diffuse ST elevations with PR depression indicates
Pericarditis
101
For low risk PE order=
| High risk=
Low risk D Dimer ‘
| High risk Contrast CT
102
What is the causative agent for Rheumatic fever
Strep A pharyngitis
103
What is jones Criteria for Rheumatic Fever
```
Migratory poly arthritis
Pancarditis
SubQQ nodules
Erythema marginatum
Sydenham chorea
```
104
Rheumatic fever occurs most in what age pts
5-15 years old
105
What is the Tx approach to Rheumatic fever
Anti-inflammatory medication
Prophylaxis with PCN
106
What is the Dx criteria for Rheumatic fever with Jones Criteria
2 Major or 1 major 2 minor
```
MAJOR-
J: Joints
O: Carditis/ Murmur
N: Nodules
E: Erthyema marginatum
S: Sydenham chorea
```
```
Minor-
Arthlagias w/out arthritis
Fever 101 to 104
Elevated ESR or CRP
Prolonged PR Intervals
Rapid Strep
```
107
What valves are most effected by Rheumatic Fever/ Rhematic HDz
Mitral valve stenosis in number 1
| Aortic Valve Dz is second
108
What is the 5 step clinical approach
```
Determine anatomy
Understand impact of medical history
Form DDx
Sick Vs non sick triage
Life threats 1st
```
109
What is the equivalent to angina in the legs
Claudication
110
What does Vindicates stand for
```
Vascular
Infectious
Neoplastic
Drugs/ Degenerative
Inflammatory/ idiopathic
Congenital
Autoimmune
Trauma
Endocrine/ Environmental
Something Else/ Psychological
```
111
Administration of O2 should start at an SPO2 of ____
94 or below
Start with NC 2-4 L/ Titrate to 99 %
112
What effect does increasing the HOB angle do to preload (Orthopnea)
Elevation decreases preload and s/s of heart failure
113
Pts with pericarditis can find relief in what anatomical position
Sitting up and leaning forward , as a pt with with ACS will not find relief by doing this
114
What is the IV morphine regiment for UA/ STEMI
2-4 mg IV PRN, may repeat dose of 2-8 mg q 5-15 min Intervals
115
What is the nitro dose for UA/ STEMI
0.3-0.6 sublingual q5min PRN
Max 3 doses witching 15 min
116
What are the cardinal S/s of ACS
```
Chest pain
Dyspnea
Palpitations
Syncope
Edema
```
117
Non pitting edema is a a sign of
Lymphedema
118
A pt with a shiny hairless blotchy skin on the foot or leg, and the leg is pale when elevated and red when lowered is a sign of
Claudication, Vasucalar Dz
119
what is the greatest modifiable risk factor for ACS/ HDz
Smoking
120
What is metabolic syndrome
```
HTN medication or HTN
Hypertryglyceridema
HDL less than 50
Fasting Glucose greater than 100 (DM)
Fat Waist
```
121
What are the age cut off numbers for traditional RSK factors for CAD
Men 45 women 55
First degree relative at 55 for men
And 65 for women
122
How should you interpret the following CAC scores
CAC=O
CAC 1-99
CAC 100 or over
O= Decrease RSK of CVD, no statin required
1-99= favors statin, especially if older than 55
100= Statin therapy required
123
What is the alarm number for a CRP in CVD
Greater than 2 mg/L
124
What lipoprotein A number is alarming for CVD
Greater than 50 with a FMHx
Normal value is 10mg/dl
125
How is ApoF testing conducted and what is the alarm value
Testing is reserved for pts with High Triglycerides >200 mg/dl
Alarm= > 130 mg/L
126
A ApoB of 130 = a LDL of…
Greater than 160 ( RSK for CVD)
127
An ABI of less than 0.9 indicates
Occlusive arterial Dz
128
Low QRS volatage, Friction Rub, Becks triad, and pulsus paradoxus are all signs of..
Pericardial effusion
129
What nerves modulate electrical impulses and conduction to the SA and AV nodes
VAgal efferent fibers
130
The SNS inervates the heart via what receptors
B1
131
JVP waveforms reflect pressure in what cardiac structure
Right atrium
132
How are a waves in AFIB
Absent
133
JVP that increases with inspiration is called what and indicates?
Kussmal sign, indicates; Pericarditits or restrictive cardiomyopathy’s
134
What is the S1 sound
NML closure of the Mitral and tricuspid Valves ( AV valves)
135
What is the S2 sound
NML closure of the Aoritc and Pukmonic valves ( semilunar valves)
136
Ejection Clicks indicate
Aortic or pulm stenosis, or dilation of the aortic root or plan artery
137
Mid to late clicks indicate
Mitral or Tricuspid valve prolapses
138
Openings snap is
Mitral stenosis
139
IN adults what does the low pitch S3 sound indicate
HF or Volume overload
140
What does the low pitched S4 sound indicate
Reduced Vent Compliance
141
What 2 conditions cause a wide split of S2
RBBBB and Pulm Stenosis
142
What causes a Fixed S2 split
ASD
143
What causes a paradoxical splitting of S2
LBBB or Aortic Stenosis
144
Is S3 a diastolic or Systolic sound
Diastolic, its rapid filling of the ventricles
145
What position is S4 best heard in
Left lateral decub
146
Chronic HTN leads to what pathological heart sound
S4 ( atrial gallop)
147
What is the primary means of establishing a specific Dx
Physical examination
148
What is the normal pulse pressure
40 mmHG ( Sys-Dias)
149
Pulses should Always be examined for what 5 criteria
```
Rate
Rhythm
Strength
Contour
Symmetry
```
150
The diacritic notch correlates to what valve closing
The aortic valve
151
A slow rising pulse, aka pulsus tardus indicates what Dz
Aortic Stenosis
152
A bi or triffid pulse ( Pulsus Bisferines) incidactes what Dz
Severe Heart Failure
153
Pulsus paradoxus (change in pulse pressure/amplitude with inspiration) indicates what Dz
```
Cardiac Tamp
SVC Obstruction
Pulm Obstruction ( PE/ COPD)
```
154
Hyperkinetic pulses indicate what Dz
PDA, Thyrotoxicosis, Anemia, fever
155
How does the apical pulse differentiate with Volume Overload vs pressure overload
Volume: Hyperdynamic Apical pulse (S3)
Pressure: Sustained Apical pulse (S4)
156
Pericardial Knock indicated what Dz
Constrictive pericarditis
157
Where does the VSD murmur radiate to and what causes it to increase or decrease
Murmur intensity does not increase with inspiration or radiate to the axilla, which distinguishes it from tricuspid and mitral regurgitation, respectively.
158
Non specific ST changes, w/ Right axis deviation should think..
PE
159
What does HEART stand for in the HEART score
```
History
ECG
AGE
RSK Fxs
Troponins
```
160
What are the primary indications for CT in Cardiac PTs
1) aortic aneurysm or dissection suspected and 2) differentiating diseases of the pericardium
161
What are electron beam CRT scanners main use
To evaluate pericardial Dz and Cardiac tumors
162
Metallosis, amyloidosis, and sarcoidosis are best seen with what kind of imaging study?
MRI
163
Are Marfans pt would best benefit from what kind of cardiac imagining
MRI
164
What are the indications for Echocardiograms
Valvular lesions, Ventricualr assessment
CAD
Cardiomyopathy
Pericardial Dz
165
What is the bubble study
simultaneous venous saline agitation in order to identify an intracardiac shunt in a TTE
166
What are the absolute contras to stress tests
Recent STEMI < 2 days
High risk ACS ( perform coronary angiogram)
Active Heart Failure (decompensated)
Active endocarditis
Severe Aortic Stenosis, Symptomatic HOCM
Acute myocarditis or pericarditis
Physical disability that precludes safe and adequate testing
167
What is the Duke Treadmill criteria
Duke Treadmill Score = Minutes of Exercise (Bruce protocol) - (5 x max ST deviation in mm) - (4 x exercise angina)
168
What is Regadenoson
An adenosine receptor agonist used in the SPECT scan , (VASODILATOR)
169
What probability of CAD is a pt with typical angina (male over 40 or female over 60)
W/ DM, smoker, or hyperlipidemia
HIGH RISK take straight to catch lab or admit
170
What probability of CAD is a pt with typical angina ( younger than 40 male or 60 female)
Intermediate risk, Order a stress test
171
Reliable stress test results require that the pt reach what level of the predicted maximum HR
85 percent
172
How do you calculate a duke treadmill score
Minutes of exercise- (5x max ST deviation in mm)- (4x exercise angina)
173
What are the markedly postive findings of a cardiac stress test
Ischemic ECG findings within 3 minutes of exercise or persist 5 min after stopping exercise
ST Depression > 2mm
Systolic pressure decreases during exercise
high grade ventricular arrhythmias develop
Pt unable to exercise for at least 2 min because of cardiopulmonary limitations
174
What are the 5 major Jones Criteria for Rheumatic Fever
```
Migratory Poly Arthritis
Pancarditis
SubQ nodules
Erthyema marginatum
Sydenham chorea
```
175
What does the JONES neumoníc stand for
```
Joint ( migratory)
O- Carditis
N- nodules
E- Erthyema marginatum
S- Sydenham Chorea
```
176
What is the causative agent of Rhematic Fever
Group A strep including pharyngitis assoc w/ scarlet fever
177
Rheumatic fever leads to Rhuematic HDz which effects which valves the most
Mitral VAlve the most
| Second is Aoritc Vavle
178
What does the HEARTFAILED neuronic stand for
```
Hypertension
Endocarditis
Anemia
Rheumatic Heart
Thyrotoxicosis
Failure to take meds
Arrhythmia
Infection/ Ishcemia/ infarct
Lung Problems
Endocrine
Dietary indiscretion
```
179
A pt with Progressive Dyspnea on exertion and hemoptysis likely has what valvular heart Dz
Mitral stenosis
180
On palpitations of the pericordium, a Right ventricular heave suggests
Mitral stenosis
181
A patient with Severe MS ( MVA< 1.5 cm) symptomatic stage D a pliable valve, no clots, and a <2+ MR are candidates for what Tx of Rhumenatic Heart MS
Percutaneous Mitral balloon
Commissurotomy
IF they have severe HF symptoms and are a surgical candidate then they get MV surgery
182
What is the TX approach for a pt with VHD and Afib
IF the have Rhematic MS then Long term Vitmain K antagonist ( HEPARIN)
183
A PT that presents with a new murmur and fever you should suspect
Endocarditis
Also may present with Janeway lesions
184
Non infective endocarditis can be caused by..
Non bacterial thrombi
Systemic Lupus
Pancreatic adenocarcinoma
185
How are Oslers Nodes different than Janeway lesions
Oslers nodes are painful and caused bu bacterial AG-Ab complexes
Janeways are non tender and caused by thrombic emboli
186
What is the criteria to Dx endocarditis
2 major Dukes
1 major and 3 minor dukes
Or 5 minor dukes criteria
187
What are the major dukes criteria
```
Blood cultures (positive)
Echocardiogram
```
188
What are the 5 minor Dukes criteria for endocarditis
Cardiac lesion/ PHx of IV drug use
Fever
Evidence of septic emboli
( Janeway lesions, Pulm Infarcts, Conjunctival Hemorrhages)
Auto immune conditions
(Glomerulonephritis, Oslers nodes, Roths spots, Rhuematoid)
Serological evidence
189
When inspecting for endocarditis ( valvular) when would you go straight to TEE
In pts with prosthesis valves, implantable cardiac devices, prior valve ABNMLS, obese or have chest wall deformities
190
What is the most common affected valves of endocarditis
Mitral (most) or bicuspid aortic valves
191
In a pt with endocarditis and IV drug use what is the most common effected valve
Tricuspid
192
In a pt with Endocarditis caused by Viridians strep or Strep Sanguiins what is the most likely causes (dental procedures)
Older pts with native valve dz develop endocarditis after dental procedures
193
Endocarditis from Staph Epi effects what valves the most
Prosthetic valves ( Dirty IV)
194
Endocarditis from genital urinary catheretiers is caused by what agent
Group D Enerococcal Endocarditis
195
Pseudomonas/ Candida (IV drug use) effects what valves most during endocarditis
Tricuspid Valves
196
Patients with Q fever and endocarditis most likely got it from what
Coxiella Burnetti ( Sheep, COWS, Goats)
197
Streptococcus Gallolyticus endure endocarditis is associated with what type of cancer
Colorectal cancer (needs colonoscopy screening)
198
BArtonella endcuced endocarditis ( Cat infection) effects what valves most
Tricuspid Valves
199
What bacteria is associated with Endocarditis, old people and dental procedures
Viridans strep
200
Pts with endocarditis that have vegetation’s greater than 10mm, abcesses, severe valve damage, Dehiscence, heartfauliure or Recurrent septic emboli are candidates for..
Surgery
201
HRpEF is equal to
60% and greater
202
HRrEF is equal to
40% and less
203
What is the relationship between left ventricular dysfunction and BNP
Its more specific to LV Dysfunction in HEART Failure States
204
Aldosterone has what effect
Increases Na retention in exhcannge for potassium (increases fluid level)
205
Angiotensin II has what effect
Leads to Peripheral vasoconstriction
206
What is PRO BNP used to discriminate against
Cardiogenic vs non cardiogenic pulmonary edema
207
What are the cutoff values for PRO BNP for cardiogenic pulm edema in 50 yo, 50-75 yo, and older than 75 yo
50 and younger : 450 pg/nl;
50-75: 900
Older than 75: 1800
208
What is eccentric hypertrophy
Increased ventricular chamber radius and wall thickness
209
What is concentric hypertrophy
Increases wall thickness without proportional chamber dilation
210
A pt with Dyspnea, orthopnea, nocturnal Dyspnea and fatigue, Diaphoretic, Tachypnea and Tachycardia, Pulmonary Rales and a S3/S4 gallop is what sided HF
Left Sided
211
A pt with peripheral edema, JVP, RUQ discomfort, Hepatic enlargement, Ascites is what sided HF
Right Sided
212
HIGH YEILD NUEMONIC
HEARTFAILED
```
HTN
Endocarditis
Anemia
Rhuematic HDz
Thyrotoxicosis
Failure to take meds
Arrhythmias
Infection/ MI, Ishcemia
Lung Problems ( COPD, PE, Pneumo)
Endocrine D/o
Dietary indiscreción
```
213
S3 is pathological for what
HF in adults
214
What are the top three causes of HFrEF
CAD, Valvulr D/o, HTN
215
What is Framingham Criteria
Dx made with 2 major or 1 major 2 minor criteria
```
MAJOR:
Acute Pulm Edema
Cardiomeg
Hepatojux reflex
JVD
Orthopnea or Nocturanl
Rales
S3
```
```
Minor:
Ankle Edema
Dyspnea
Heptmeg
Nocturnal cough
Pleural Effusion
Tachycardia
```
216
S3 vs S4 is common with which form of cardiomyopathies
S3 dilated
| S4 Hypertrophioc Cardiomypthies
217
High output HF is associated with what S/s
Tachycardia
218
What are the #1 and #2 most common Causes of sudden cardiac death
Cardiomyopathy is the 2nd most common cause of sudden death
(** Ischemic heart disease is #1**)
219
What cancer drug can cause Cardiomyopthy
Doxicirubicin
220
Pts with dilated cardiomyopathies are most likey to die from what abnormalities
Arrhythmic D/o ( VTACH, VFIB)
221
Cossackie B virus is heavily associated with…
Myocarditis and Pericarditis
222
An EKG with LVH/ LAD, prominent q waves in II, III, and AvF, I AVL, V5-V6, and septal Qs
Hypertrophioc Cardiomyopathy
223
What is the 1st line Tx for HCM
BB and alternative CCB (Verapamil) and Amioderone
Myomectomy,
224
PTs with EF less than 35 and with 1 year prognosis, 40 days after MI, should get..
ICD
225
What are the major IND for ICD placement
Unexplained syncope
LV wall thickness greater than 30 mm
Or non sustained VTACH
226
Apple green biference is hallmark for
Amyloidosis, and Restricitive Cardiomyopathy
227
What is a aldosterone antagonist
Spirinolactone (Potassium Keeping) diuretics
useful in Stage C HFrEF pts with good CrCL and Adequate K+
228
Pts in Stage C HFrEF on a ACEI or ARB with no Contra to ARB or Sacubitril what is the Standard HF treatment
ARNI (Sacrubitril + Valsartran)
229
A black pt in Stage C HFrEF gets what meds
Nissoprusside
230
A pt with Stage C HFeRF with a EF less than 35, 1 year survival and 40 days post MI is a candidate for what intervention
ICD
231
A pt with LVEF less than 35%, NSR and LBBB is a candidate for what intervention
CRT (Pacing)
232
A Group 1 pulm HTN pt due to scleroderma presents with what 5 conditions
```
Calcinosis
Raynauds Syndrome
Esophageal Dysmotility
Sclerodactily
Telangiectasia
```
233
What is an infection to the endocardia surface, that particularly impacts prosethitc valves, damaged native valves, and native valves.
Endocarditis
234
What are the two types of endocarditis
Infectious and non infectious
235
What are the RSK Fxs for infective endocarditis
```
Dental Surgery, Wounds
IV Drug use
IV Catheters
Immunocomp pts
Valvular or congenital HDz
Previous Hx of endocarditis, pacemaker, or prosethic valve
```
236
What are the conditions that promote non infectious endocarditis
Hypercoag states ( Cancer, pregnancy)
Ag-Ab complex ( systemic lupus)
237
A pt with a fever and a new heart murmur presents with Septic emboli or type III hypersensitivity reaction (Ag-Ab complex, aka lupus).. what is the heart condition that should be suspected
Endocarditis
238
Endocarditis of the left valves in the heart, can create septic emboli that can lead to
Stroke
239
Endocarditis of the right valves of the heart can create septic emboli that can lead to
PE
240
Describe splinter hemorrhages and what are they a S/s of
Splinter hemorrhages are longitudinal red brow hemorrhages under the nail that look like splinters
It is a S/s of septic embolus from Endocarditis
241
Describe Janeway lesions and what are they a S/s of
Jane way lesions are NON TENDER, small macular or nodular lesions of the palms or toes
They are a S/s of septic emboli from endocarditis
242
Septic emboli from endocarditis can effect the eyes how..
Conjunctival hemorragias
243
How will infective endocarditis present on an EKG
```
Heart Blocks
Conduction Delays (effecting the valves)
Isolated prolonged PR Intervals
```
Can also present with Cardiac ischemia from septic emboli in the coronary circulation
244
What is the first branch off the aorta
Coronary circulation
245
Bacterial Ag-Ab complexes from infectious endocarditis can effect the skin, the kidney, and the eyes in what three specific ways
Skin: Oslers nodes - PAINFUL tender lumps on the fingers or toes. They are red-purple, raised, and often with a pale center.
Kidneys: Glomerulonephritis
Eyes: Roths Spots- seen most commonly in acute bacterial endocarditis. A red spot caused by a hemorrhage, with a characteristic pale white center.
246
Describe an Oslers Node
Osler nodes are red-purple, slightly raised, tender lumps, often with a pale center.
Pain often precedes the development of the visible lesion by up to 24 hours.
They are typically found on the fingers and/or toes.
247
Explain Roths spots
A Roth spot, seen most commonly in acute bacterial endocarditis is a red spot (caused by hemorrhage) with a characteristic pale white center.
This white center usually represents fibrin-platelet plugs
248
Duke criteria is specific to what Dz process
Endocarditis
249
1. Cardiac lesions or Hx of Rec. Drug use
2. Fever
3. Evidence of Septic Emboli
4. Autoimmune Conditions (Ag-Ab complexes)
5. Serological Evidence
There are what criteria
5 minor Dukes Criteria
250
In endocarditis, how many sets of blood cultures need to be collected
3
| 1 aerobic, 1 anaerobic, 1 fungi
251
How will endocarditis present on Echocardiography
Presents with valvular vegetations,
Valular regurgitation, MVP, or stenosis.
252
When would transesophageal echo be done first as opposed to transthoracic ?
When the pt is obese, has a chest wall deformity, has a prosethic valve, implanted cardiac device, or prior valve abnormalities
253
An older pt with native valve Dz ( endocarditis) post dental procedure is likely caused by what bacterial agent
Sterp Sanguinis or Viridans Strep
254
Endocarditis in IV drug abusers effects what valve? From what agents?
Tricuspid Valve
And if it’s Methicillin Senstitive ( MSSA) this its Staph, Aureus.
If its not Staph then its Psuedomonas or Candida
255
IV drug users are at risk of developing Endocardits from what agents
```
Staph Aureus (MSSA)
Psuedomonas
Candida
```
256
Endocardits acquired in the hospital or from surgery are likely caused by what agent
MRSA
257
What is the agent that is most likely to cause endocarditis in a prosthetic valve
Staph Epi.
| Think dirty catheters, valve surgery, biofilm
258
A pt with a foley or post GI surgery is likely to develop Endocardits from what agent
Enterococcal ( Group D)
259
What pts are at most risk to developing endocarditis from Coxiella burnetti
Farmers (Cows, sheep, goats)
Immuno comp or preg pts
(These pts develop Q fever)
260
Q fever is associated with
Coxiella burnetti
261
Pts that develop Endocardits from Strep Gallolyticus, must also be screened from what associated conditions
Colorectal cancer ( need colonoscopies after endocarditis Tx)
262
What is the agent associated with endocarditis from a cat infection and what valve does it infect most
Bartonella and the tricuspid valve
263
What is the Tx approach to infective endocarditis
Suspected?
Dukes? (2 major? 1 Major 3 minor? 5 minor?)
Stable? What for cultures
Unstable?
-Then Tx 2-6 weeks
(Prevention is Amoxicillin/ Ampicillin 1 hr before procedures)
264
What is the protein in Rheumatic fever that looks/ mimics protiens on the myocardium, heart valves, joints, skin, and brain…
In short what is the protein that is the cause of Rhuematic fever turning into Rhuematic heart Dz
The M protiens on GROUP A sterp infections
265
Jones criteria is specific to what Heart Dz
JONES!!
| Remember dukes is Endocarditis
266
What are the S/s of Rhuematic fever ( Aka jones criteria)
```
Migratory Polyarthritis
Pancarditis
SubQ nodules
Erthyema Marginatum
Sydenham Chorea
```
267
Chronic Rheumatic HDz presents with what valvular abnormalities
Regurgitation or stenosis of the Mitral or Aortic Valves
268
Does group A strep cause Endocarditis or Rhuematic Fever
RHeumatic Fever!!
269
What stage of VHD is symptomatic
Stage D
270
What stage of VHD meet criteria but are asymptomatic
Stage C
271
What stage is “ pts with progressive VHD yet asymptomatic”
Stage B
272
What stage of VHD is “at risk”
Stage A
273
What are stages A, B, C, and D of VHD
```
A; At risk
B: Progressive
(Mild to moderate severity, asymptomatic)
C: Severe VHD, Aysmptomotis
-C1: LV/RV compensated
-C2: LV/RV decompensated
D: symptomatic severe
```
274
MS leads to what major LV problems
LA dilation, Increased pressure in the LA and Increased pressure in the pulmonary vessels, which can lead to hemoptysis, and eventually Corpulmonale HF
275
What physical exam finding is indicative of MS
Right Vent Heave (with Pulm HTN), PMI may also be decreased
276
What atrial arrhythmia is associated with MS
A fib from a dilated L atria
277
This valve replacement requires life long Anticoagulant, last q-years, and has an audible click
Mechanical prosthetic valve
278
This valve replacement last 8-10 years, does not require anticoagulant, and has no audible click
Biological prosthetic valve
279
When would you do a Percutaneous Mitral balloon for RH mitral stenosis
A pt with Sever MS (MVA less tha 1.5 cm), Stage D VHD, has a pliable valve, with out clots, and Less than 2+ MR.
280
Tx approach for RHDz MS in a pt with Class D VHD, MVA less than 1.5cm, with a pliable valve, no clots and less than 2+ MR
PerC Mitral Ballon Commissure
281
When would a pt need MV surgery in RHDz MS
Severe MS (MVA less than 1.5 cm)
Stage D with out a Pliable Valve,
+presence of clots
And greater than 2+ MR
NYHA III-IV and is a surgical candidate
282
Tx A pt with VHD and AFib +RHDz s
Long Tterm VKA (Anticoagulant)
283
Pts with Afib require what medication
Anticoagulant
