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Cardiology > Cardio Test #2 > Flashcards

Cardio Test #2 Flashcards

(121 cards)

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1
Q

NYHA Class I

A

No activity limitations

Ordinary activity causes no fatigue, palpitations, dyspnea, or angina

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2
Q

NYHA Class II

A

Slight activity limitations

Asx @ rest

Ordinary activity causes fatigue, palpitations, dyspnea, angina

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3
Q

NYHA Class III

A

Marked activity limitations

Usually Asx @ rest

Less-than-ordinary activity causes fatigue, palpitations, dyspnea, angina

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4
Q

NYHA Class IV

A

Inability to carry out any physical activity w/o discomfort

Sx @ rest

Increased discomfort w/ any physical activity

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5
Q

ACC/AHA Stage A

A

Patient is high-risk for heart failure development in future

Currently no function/structural heart disorder

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6
Q

ACC/AHA Stage B

A

Structural heart disorder

No sx at this stage

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7
Q

ACC/AHA Stage C

A

Previous/current sx of heart failure w/ underlying structural heart problem

Sx are managed w/ medical treatment

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8
Q

ACC/AHA Stage D

A

Advanced disease

Pt requires hospital-based support, heart transplant, or palliative care

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9
Q

Drugs that improve left ventricular relaxation

A

ACEI

CCB

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10
Q

Drugs that regress LVH

A

ACEI/ARB

Aldosterone antagonists

BB

CCB

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11
Q

Drugs that manage tachycardia

A

BB (preferred)

CCB - 2nd line

Digoxin

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12
Q

Systolic heart failure

A

Heart contraction force decreases/pump function failure

Heart can initially dilate to compensate

Hear S3 w/ this

Get pulmonary and systemic edema

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13
Q

Diastolic heart failure

A

Heart becomes stiff w/ age

Ventricles unable to relax to fill

Pt is more prone to tachycardia

Hear S4 unless pt is in A-fib

Causes elevated pressures/edema

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14
Q

Pulmonary HTN major sign

A

Dry cough

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15
Q

Viral myocarditis causative agent

A

Coxsackievirus most common

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16
Q

Excursion

A

Ejection fraction

Heart can dilate to compensate for contraction

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17
Q

Electromechanical delay

A

Delay between ventricular depolarization and repolarization

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18
Q

Systolic dysfunction causes

A

Impaired contractility

Volume overload

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19
Q

Impaired contractility causes

A

MI

Transient MI

Chronic volume overload - mitral/aortic regurge

Dilated cardiomyopathy

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20
Q

Volume overload causes

A

(increase in preload)

Mitral insufficiency

Aortic insufficiency

Atrial/Ventricular septal defect

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21
Q

Diastolic dysfunction causes

A

Impaired ventricular relaxation

Increased afterload

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22
Q

Impaired ventricular relaxation

A

LVH

Hypertrophic cardiomyopathy

Restrictive cardiomyopathy

Transient MI

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23
Q

Increased afterload

A

(Pressure overload)

Mitral stenosis

Pericardial constriction/tamponade

Aortic stenosis

Uncontrolled HTN

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24
Q

CHF causes

A

*homeostatic imbalances of cardiac output*

Coronary atherosclerosis

Persistent HTN

Dilated cardiomyopathy

Valvular heart disease

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25
Coronary atherosclerosis
fatty buildup clogs coronaries -\> myocardial ischemia Myocardial ischema causes diastolic and systolic dysfunction Get angina pectoris +/- MI
26
Persistent HTN
Increased peripheral pressure cause myocardial hypertrophy and progressive weakening from stress Get concentric or eccentric hypertrophy
27
Dilated Cardiomyopathy (DCM)
Ventricles stretch, become flabby w/ myocardial deterioration Increased workload increases Ca in cardiac cells and causes activation of the heart enlargment gene
28
Right heart failure "backwards failure"
Systemic capillary congestion
29
Left heart failure backwards failure
Pulmonary vasculature congestion
30
Acute decompensation
Immediate goal Nitro, diuretics, NIPPV
31
Head bob w/ each systolic pulsation
deMusset's sign Severe chronic Aortic regurgitation
32
"Pistol shot" pulses over femoral artery
Corrigan's pulses Severe Chronic Aortic Regurgitation
33
Pulsation of the uvula
Mueller's sign Severe Chronic Aortic Regurgitation
34
Systolic/diastolic bruit over femoral artery
Duroziez's sign Severe Chronic Aortic Regurgitation
35
Capillary pulsations seen in the nailbeds
Quincke's pulses Severe Chronic Aortic Regurgitation
36
Pulsation of retinal arteries and pupils
Becker's sign Severe Chronic Aortic Regurgitation
37
Popliteal BP \> Brachial BP by \>60mmHg
Hill's sign Severe Chronic Aortic Regurgitation
38
Systolic murmurs
Aortic stenosis Mitral insufficiency Mitral valve prolapse Tricuspid insufficiency
39
Diastolic murmurs
Aortic Insufficiency Mitral Stenosis
40
CHADS2
CHF HTN Age \>75 Diabetes Stroke (TIA) \>=2 = anticoagulation unless CI Only applies to pts w/o valve dx -\> those get anticoags regardless
41
Class I agents and MOA
Block sodium channels Quinidine Procainamide Disopyramide Lidocaine Mexilitine Flecainide Propafenone
42
Class II agents and MOA
Beta blockers Decrease automaticity Prolong AV conduction Prolong refractory period
43
Class III agents and MOA
Block potassium channels Amiodarone Dronedarone Sotalol Dofetilide Ibutilide
44
Class IV agents and MOA
CCB Decrease automaticity and AV conduction
45
How does digoxin work? Where is it used the most?
Inhibits the sodium/potassium ATPase pump This prolongs AV conduction and refractory period Used to help rate control pts w/ A-fib/flutter
46
When is adenosine indicated and what is the dose? How does it work?
Used for rapid treatment of symptomatic atrial tachycardias 6 mg, then 6 mg, then 12 mg Works by blocking the AV Node
47
PEA causes 6 H's
Hypoxia Hypovolemia Hypoglycemia Hydrogen Ion (acidosis) Hypothermia Hypo/hyperkalemia
48
PEA causes 6 T's
Toxins Tamponade Trauma Tension pneumothorax Thrombosis - cardiac Thrombosis - pulmonary
49
HACEK
Haemophilus sp Actinobacillus Cardiobacterium Eikenella Kingella
50
Osler's Nodes
More specific for infectous endocarditis Painful and erythematous nodules On pulp of fingers and toes More common w/ subactue IE
51
Janeway Lesions
More specific for Infectious endocarditis Erythematous, blanching macules **Not painful** Located on palms and soles
52
Roth spots
More specific for infectious endocarditis Pale retinal lesions surrounded by hemorrhage "target spots" usually near optic disk
53
Major Duke's Criteria
Positive blood cultures w/ appropriate organism Echo finding New valvular regurgitation
54
Minor Duke's Criteria
High risk, hx IVDA Fever Vascular phenomena Immunologic phenomena Serologic studies Blood cultures/echo not meeting major criteria
55
Vascular phenomena
Arterial embolism Septic pulmonary infarct Mycotic aneurysm Intracranial hemorrhage Janeway lesions
56
Immunologic phenomena
Osler's nodes Roth spots Glomerular nephritis Rheumatoid factor
57
Modified Duke's - Definite IE
Microorganisms (culture or histology) in valvular/embolized vegitation or intracardiac abcess Histologic evidence of vegetation/intracardiac abscess
58
Modified Duke's Possible IE
2 major 1 major + 3 minor 5 minor
59
Modified Duke's - Rejected IE
Resolution of illness \<5 days of Abx
60
Empiric Therapy for infective endocarditis
NVE acute - Vanco (staph) Or Nafcillin + gentamycin (no staph) NVE Subacute - PCN + gentamycin PVE - Vanco + gentamycin + Rifampin Fungal - Amphotericin B w/ valve replacement
61
IE prevention w/ proceduce
Dental procedures Tonsillectomy Surgery of GI, Respiratory, Urinary, Gallbladder, I and D Esophageal dilation Cystoscopy/urethral dilation/urethral catheter w/ infection
62
High risk IE lesions
Prosthetic valve Prior IE Cyanotic congenital heart dx Surgical systemic-pulmonary shunt PDA, VSD, coarctation AR/AS/MR/MS w/ MR
63
Antimicrobial prophylaxis
Recommended in high-risk pts Prosthetic valves Previous IE RHD/aquired valve dysfunction Hypertrophic cardiomyopathy MVP (esp w/ murmur)
64
Crawford Classification of TAA
I: L subclavian to renal arteries II: L subclavian to iliac bifurcation III: Midthoracic to infrarenal IV: Distal thoracic to infrarenal
65
6 P's of acute limb ischemia
Pain Pallor Pulselessness Paresthesia Paraparesis (paralysis) Poikilothermia (cold limb)
66
Virchow's triad
Venous stasis Vessel wall injury Hypercoagulable state
67
Systolic dysfunction
Pump function failure Usually from myocardial dysfunction/destruction (MI) Hear S3
68
Diastolic dysfunction
Ventricles are stiffened and cannot relax Inadequate filling causes elevated pressures Pt is prone to bouts of tachycardia (a-fib) Hear S4, but never w/ a-fib
69
Acute decompensation
Immediate goal: reestablish perfusion/oxygenation Tx: Nitro, diuretics, NIPPV
70
Carcinoid syndrome
Carcinoid tumor in small bowel/appendix 1st mets -\> liver, serotonin released straight to the heart 2nd mets -\> lungs, cause left-side abnormalities Commonly causes tricuspid regurge/stenosis
71
Annular dilation
Most common R heart dx in adults Tricuspid regurge w/ anterior and posterior sides dilating while septal side remains the same -\> uneven dilation
72
Causes tricuspid regurge
Aortic dissection Tertiary syphilis Carcinoid syndrome Annular dilation Rheumatic disease Endocarditis Ebstein anomaly
73
Cause tricuspid stenosis
Carcinoid syndrome Rheumatic disease
74
Ebstein's anomaly
Congenital defect Posterior tricuspid leaflet deformed -\> causes TR Usually concomitant w/ ASD/WPW
75
High V wave w/ JVD High-pitched systolic murmur - blowing/coarse/muscial
Tricuspid regurge Usually functional cause - HTN, Chordae malfunction
76
High A wave w/ JVD Low-pitched, rumbling, presystolic murmur w/ loud S1
Tricuspid stenosis
77
Hyperdynamic PMI Visible carotid/nailbed (Quincke) pulsations deMusset's sign Diastolic, blowing, faint murmur right after S2
Aortic regurgitation
78
Sustained PMI w/ palpable heaves Murmur between S1 and S2, harsh rough murmur Prominent S4
Aortic Stenosis
79
Pansystolic, blowing, high-pitched musical murmur Possible mid-systolic clicks Prominent S3 if severe
Mitral Regurgitation
80
Diastolic low-pitched, rumbling murmur Merges w/ loud S1 Palpable S2 @ 2nd intercostals
Mitral stenosis
81
Tricuspid valve disorder treatment
Fluid restriction Diuretics Rhythm disturbances Treat symptoms
82
Pulmonary regurgitation
Treatment is difficult Congenital -\> abnormal cusp number development/complete lack of valve Acquired -\> Pulmonary HTN, Annular dilation w/ structural distortion
83
Pulmonary Stenosis
Congenital - most common Acquired -\> Rheumatic heart dx, Carcinoid syndrome, IE (fungus grows rapidly, occludes opening)
84
Mitral Chordae tertiary stands/head
10 Each papillary muscle has 6 heads
85
Gerbode defect
VSD around AV node Shunt created between LV into RA No pressure abnormalities
86
Mitral stenosis
Usually caused by Rheumatic fever, also congenital, carcinoid, amyloid Progressive, lifelong dx - 20-40 yr onset, 10 yr to disabled Left side failure, A-fib common Orthopnea, PND
87
Mitral stenosis grading and treatment
MVA = 1.5-2.5 cm2 w/ minimal sx = Mild MVA = 1.0-1.5 cm2 w/o sx @ rest = Moderate MVA \< 1.0 cm2 = Severe Tx: Diuretics, BB/CCB (a-fib), Anticoags (a-fib) Balloon valvuloplasty, surgical repair/replacement
88
Mitral Regurgitation
Abnormality to any component of mitral valve Dyspnea, orthopnea, PND, fatigue Can cause A-fib
89
Mitral valve prolapse
Congenital, Marfans, Ischemic sequela Hear a click w/ a late systolic murmur Hemodynamicly unstable if also have MR
90
Chronic Mitral Regurgitation
Monitor if asx Aggressively treat HTN (ACEI) and A-fib (BB, anticoag) Preload reduction: diuretics Afterload reduction: vasodilate
91
Acute mitral regurgitation
Abrupt decline in stroke volume w/ increase in LA volume/pressure =\> drastic increase in pulmonary pressure Pt goes into cardiogenic shock, rapidly fatal Acute severe dyspnea, CHF, HOTN w/ loud S1 Tx: O2, Positive inotrope, DO NOT OVERLOAD W/ FLUID
92
Aortic stenosis
Disruption of LV outflow, increases pressure w/ hypertrophy and diastolic impairment Heart cannot increase stroke volume on demand Cardinal symptoms, sudden death w/ arrhythmias, bruit heard in carotids Tx: All symptomatic until valve replacement
93
Cardinal symptoms of severe aortic stenosis
Dyspnea Angina (increase O2 demand) Syncope (vasodilation w/ fixed C.O.)
94
Aortic regurgitation
Leaflet dysfunction/aortic root dilation (Marfans) LV has both pressure and volume load increase, can be chronic or acute Decompensation when LV systolic fails and dilation occurs Wide pulse pressure, bounding pulse, early diastolic murmur Tx: Vasodilate, diuretics, digoxin DO NOT SLOW HR
95
Austin Flint murmur
Mitral valve Mid-late diastole Valve pushed closed by aortic jet (AR)
96
Infective endocarditis
Acute: usually staph on tricuspid, rapidly destructive Subacute: usually Strep, on damaged valve, indolent nature IV drug use: Staph, fungus, pseudomonas
97
Venturi effect
Creation of low pressure sink w/ a jet from valve regurgitation Bacteria tend to settle on opposite side of valve in sink
98
Pediatric IE
Almost all cases occur w/ underlying valve defect Neonate: Staph aureus, coagulase-negative staph, group B strep Older: usually staph or Strep
99
Infectious endocarditis signs
Acute: Toxic, high-grade fever and chills, SOB, arthralgias, Abdominal pain, pleuritic chest pain Subacute: low-grade fever, anorexia, weight loss, fatigue, abdominal pain, nausea/vomiting Fever, heart murmur (not w/ IVDA), splenomegaly, petechia, splinter hemorrhages, clubbing, neuro changes
100
IE diagnostic tests
TTE = 1st line for suspected IE w/ native valves TEE = 1st line for prosthetic, intracardiac complications, inadequate TTE, fungal/staph/bacteremia
101
IE treatment
Parenteral Abx - high concentrations and prolonged therapy Empirical therapy (covers staph) = Vancomycin Viridans = PCN Fungal = Ampho B + replacement/repair Should see fever reduced w/in 7-10 days - think wrong bug or mets if not
102
Acute pericarditis
Sudden inflammation Usually viral, sometimes metastatic, meds, radiation, Dressler's syndrome Pleuritic chest pain w/ fever, Troponin elevated longer Widespread STEMI w/ PR depression Tx: ASA, NSAID, Colchicine
103
Dressler Syndrome
2-3 weeks post-MI Develop necrosis which inflames the pericardium
104
Chronic/Recurrent Pericarditis
6 weeks - 18 months after acute Usually AI Tx: NSAIDS, colchicine, steroids, activity restriction until echo clean Pericardiectomy as last resort
105
Beck's Triad
Sign of cardiac tamponade Hypotension JVD Muffled heart sounds
106
Kussmaul sign
JVD doesn't resolve with inhalation
107
Pericardiocentesis
Supine pt w/ HOB @ 30-60 degrees 1: 5th-6th intercostal space @ LSB @ left lung cardiac notch = Parasternal approach 2: Infrasternal angle = Subxiphoid approach
108
Moenckeberg medial calcific sclerosis
Calcium deposits in tunica media Genetic predisposition Poor prognosis Form of Arteriosclerosis
109
Rheumatic fever
Group A strep - Strep pyogenes/pharyngitis Antibody cross-reactivity Strawberry tongue, petechia, beefy red tonsils w/ exudates Tx: ASA/NSAIDs (kids), PCN/Clarithromycin Also treat heart failure - ACEI, diuretics, BB, steroids
110
Rheumatic fever major criteria
Migratory arthritis Carditis/valvulitis - CHF w/ SOB, pericarditis w/ rub, new onset murmur CNS involvement Erythema Marginatum Syndenham's Chorea
111
Sydenham's Chorea
Rapid arm and face movements without purpose Late stage Rheumatic fever
112
Rheumatic fever minor criteria
Fever 100.8-102 Joint pain w/o swelling Elevated ESR/CRP Leukocytosis EKG: Heart block w/ prolonged PR Previous hx rheumatic fever
113
Buerger's Disease
Thromboangitis Obliterans - finger gangrene Medium vessel Young, male smokers - recurring progressive inflammation Tx: Smoking cessation, CCB for vasospasms
114
Type 1 PAD
Least common Younger/smokers/hyperlipidemia Aorta and common iliacs
115
Type 2 PAD
Aorta, common and external iliacs
116
Type 3 PAD
Most common Multi-level disease Aorta, iliac, femoral, popliteal, tibial
117
PAD diagnosis and treatment
ABI - \<0.8 = claudication, \< 0.4 = severe -not accurate w/ diabetics - no vessel elasticity left Tx: ASA, Cilostazol (stop platelet aggregation), lifestyle, surgery
118
Dilated Cardiomyopathy and treatment
IDC, pregnancy, CHF, alcoholism Tx: Diuretics, ACEI, nitrates, positive inotropes Allow 6 months to heal on its own - then transplant Limit salt intake, digoxin will make them feel better
119
Hypertrophic cardiomyopathy and treatment
Thick septum, aortic valve obstruction Harsh, blowing murmur, resolves w/ Valsalva maneuver Sudden death may occur Tx: BB, vasodilators, diuretics, inotropes
120
Restrictive cardiomyopathy
Looks like constrictive pericarditis Right-side problems, dyspnea, edema, ascites, hepatomegaly, JVD, S3, S4 Tx: perfect volume balance - use diuretics, vasodilators, CCB
121
Constrictive pericarditis history
History of trauma, TB, pericarditis, collagen-vascular disorders

Cardiology (7 decks)

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