Cardiology Flashcards
(200 cards)
1
Q
S1 - S2 heart sound?
A
systoli
2
Q
S2-S1 heart sound?
A
Diastoli
3
Q
s1s2 holosystole murmur?
s1s2 cresendo-decresendo murmur?
s1-s2 late cresendo murmur?
A
mitral regurgitation
aortic stenosis
mitral collapse
4
Q
what is s1?
A
mitral closure
5
Q
what is s2?
A
aortic closure
6
Q
what is s3?
A
rapid ventricular filling blood in HF ventricular overload
7
Q
what ia s4?
A
forcefull atrial contraction due to ventricular stiffness or hypertrophy
8
Q
when can S1 split?
A
RBBB due to delayed mitral closure
9
Q
what is split s2?
A
inspiration decrease pulmonary artery pressure and pulmonary valve stays open longer
10
Q
steps in describing murmurs?
that sound like real proper quality instruments
A
- Timing in heart cycle
- Shape
- Location of max intensity and radiation
- Radiation site
- Pitch (high, medium, low)
- Quality (blowing, harsh, musical, rumbling)
- Intensity (Levine scale)
11
Q
Symptomes of aortic stenosis?
SAD
A
syncope
angina
dyspnea
12
Q
most common cause of aortic stenosis?
A
calcification due to age > 60
13
Q
Most common cause of mitral stenosis?
A
ischemic heart disease: post MI MVP LV dilation Also rheumatic fever and infective endocarditis
14
Q
Describe a mitral prolaps murmur
A
late systolic crescendo starting with a mid systole click
15
Q
what can cause mitral valve prolapse?
A
primary or secondary to Marfan or Ehlers-Danlos syndrome or rheumatic fever
16
Q
describe mitral stenosis murmur?
A
lade diastole, opening snap followed by crescendo murmur
17
Q
how can you asses severity of mitral stenosis when listening to the murmur?
A
the shorter the s1 –> opening snap, the more severe
18
Q
causes of mitral stenosis?
A
mostly a late consequence of RF
19
Q
ortner syndrom is?
A
hoarseness due to left recurrent laryngeal nerve palsy caused by mechanical affection of the nerve from enlarged cardiovascular structures.
20
Q
Define CVD?
give examples
A
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels
- coronary heart disease
- cerebrovascular disease
- peripheral arterial disease
- rheumatic heart disease – damage to the heart
- muscle and heart valves from rheumatic fever,
- caused by streptococcal bacteria;
- congenital heart disease
- deep vein thrombosis and pulmonary embolism
21
Q
primary and secondary CVD prevention?
A
Primary: High risk people prevention - lifestyle
Secondary: already PAD, CHD, TIA - lifestyle and drugs
22
Q
ankle-brachial index value comfirming PVD?
A
< 0.9
23
Q
types of hypertrophic cardiomyopathies?
A
HOCM
HCM
24
Q
The Venturi effect?
A
Due to LVOT obstruction by the septal hypertrophy the increased P during systoli pusher the anterior leaflet of the mitral valve towards the outflow of blood. this causes mitral regurgitation and mimics aortic stenosis murmur upon asculatiton
25
heart sound heard in HOCM?
S4 gallop
26
why should you not give digoxin in HOCM?
decrease N/K ATPase --> decrease Na/ca exchange and increases intracellular Ca --> increased contractility
27
diagnosis of hypertrophic wall thickness?
> 15mm (if above 30mm high risk of sudden cardiac death)
28
Acute heart failure types and definition?
Acute heart failure: rapid onset of new or worsening signs and symptoms of heart failure
Acute decompensated heart failure (ADHF): acute heart failure due to decompensation of preexisting disease/cardiomyopathy (most common)
De novo heart failure: acute heart failure occurring for the first time in a patient without known cardiomyopathy (∼15% of cases)
29
types of CHF
HFrEF
HFpEF
30
normal ejection fraction?
50-70% normal
40-49% moderate
<40% severe
31
what decides of it is a reduced ejection or preserved ejection fraction heart failure?
Diastolic failure: pEF
Systolic failure: rEF
32
valves mostly effected by endocarditis?
left side of the heart - aortic and mitral
33
intravenous drug use endocarditis mostly effect witch valve?
tricuspid
34
endocarditis janeway lesions?
detached vegitations causing septic emboli in the soles and palms of the hands, also under the nail
35
Endocarditis Osler nodules
Ig complex aggregations causing subcutaneous nodules
36
main difference between viridans, epidermidis and aureus?
1. aureus causes acute IE and attack healthy valves
2. epidermidis causes subacute IE and attack prostetic valves
3. viridans causes subacute IE and attack predamaged valves
37
what valvular disease presents mostly in infectious endocarditis?
Regurgitations
38
If there is a fever of unknown origin and a new heart murmur what should you think?
endocarditis
39
feautures of infectious endacarditis? FROM JANE
Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nail bed hemorrhage, and Emboli.
40
criteria to clinically diagnose infectious endocarditis?
Dukes criteris
2 main
1 main 3 minor
5 minor
41
physiological pericardial fluid?
50ml
42
causes of pericarditis
idiopathic
cocxaci virus
Dresslers syndrom
Uremic pericarditis
43
Ecco in pericarditis?
shows heart dancing in the pericardium
44
what is the name of draining fluis?
centesis
45
ECG in pericarditis?
starts as PR depression with ST elevation
| then progress to flat or inverted T wave
46
what is constrictive pericarditis?
due to fibrin buildup after acute pericarditis it causes decreased CO and increased HR
47
what should you not give in restrictive pericarditis?
Beta blockers and calcium channel blockers should be avoided in constrictive pericarditis, as they may worsen heart failure by slowing a compensatory tachycardia!
48
pharmacology in pericarditis?
NSAIDS (asprin, ibuprofen)
| Prednisone (Glucocorticoid antiinflammatory)
49
normal aortic opening?
3-4 cm2
| Stenosis can be 1cm2
50
difference between mechanical aortic stenosis vs RF stenosis?
commissural fusion where the root of the valves fuse together
51
what type of anemia can aortic stenosis cause?
microangiopathic hemolytic anemia leading to chistocytes and hemoglobinuria
52
what does the heart do when there is decreased SV?
increases heart rate thus shorter diastole, this means less coronary filling time and decreased oxygen to the heart
53
what is pulse pressure?
difference between systolic and diastolic witch is normally 30-40 mmHg (S-D)
54
what can mimic mitral stenosis?
```
endocarditis with mitral vegitations
atrial myxoma (neoplasia)
```
55
normal mitral valve area?
4-6cm2
below 1.5 is severe stenosis
seen on TTE
56
best diagnosis for mitral stenosis?
TTEcco
57
types of hypertention
Primary - no known cause
Secondary - due to underlying cause
58
what is hypertensive crisis?
Systolic > 180
Diastolic > 120
HT emergency (end organ failure)
59
what is defined as Hypertension by 2020 ACC/AHA?
140/90
60
what is resistant hypertension?
hypertension that remains uncontrolled (≥ 130/80 mm Hg) despite treatment with ≥ 3 anti hypertensives OR requires ≥ 4 medications to be controlled
61
what is ambulatory BP management?
The periodic measurement of blood pressure via a portable sphygmomanometer while a patient carries out routine daily activities. Typically obtained across a 24-hour period.
62
what is home BP measurment?
The self-measurement of blood pressure by a patient at periodic intervals outside of a clinical setting. May be used to confirm the diagnosis of hypertension and monitor anti hypertensive treatment.
63
thiazide diuretic?
hydrochlorothiazide
64
dihydropyridin CCB?
Nifedipine
| Amlodipine
65
Non Dihydropyridine CCB?
Verapamil
Diltiazem
66
epithelial sodium channel blocker?
Amiloride
67
aldosteron antagonists?
Spironolactone
| eplerenon
68
Direct peripheral vasodilators? which is good for pregnancy?
Hydralazine (pregnancy)
| Minoxidil
69
causes of secondary hypertension?
```
renal artery stenosis
cushings
Conn's
estrogen
hyperthyroidism
aorta coarctation
```
70
the main drug groups in HT treatments?
```
Thiazides
CCB
ACEI
ARB
B-blockers
```
71
earliest sigh of hypertension on heart?
S4 due to LV hypertrophy
72
mechanical valve drugs?
Warfarin + Aspirin lifelong
73
when is UFH usefull to give a patient?(11)
```
DVT
PE
ACS
artificial valve thrombosis
only drug safe for pregnancy
ECMO
PCI
TAVI
PVI
ASD
Afib
```
74
what must be monitored when giving UFH?
aPTT 25-39s
| this is the intrinsic pathway bleeding time
75
what is PT time?
measure extrinsic pathway time - 12 sec
76
what are NOAC and DOAC?
```
they mean the same
Non-vit K oral anticoagulants
Direct oral anticoagulants
they inhibit F10 and F2
also calles Noval oral anti coagulants
```
77
What is ischemic heart disease?
It's the term given to heart problems caused by narrowed heart arteries.
78
drug used in pharmacological stress test?
Dobutamin
79
Holter montoring?
A continuous, ambulatory, battery-operated ECG recorder worn for 24–48 hours
80
extracardiac provoking factors of angina?
```
anemia
hyperthyroidism
HT
fever
hypoxemia
```
81
cardiac provoking factors for angina?
tachycardia
bradycardia
HOCM
aortic valve disease
82
stable angina treatment?
```
ABCDE
Aspirin / clapidogrel / Nitro
B-blockers
Cigarette stop
Diet
Education and exercise
```
83
what causes stable angina?
plaque blocking more then 75% of CA
84
what causes unstable angina?
| what are the consequence?
plaque rupture - thrombus formation blockage
ischemic damage to heart
if papillary muscle is involved then valvular disease
conduction abnormalities
85
what can you do when AS plaque rupture in coronary artery?
stent implantation
| CABG (coronary artery bypass graft)
86
what to do in prinzmetal angina?
immediate coronary angiography
87
what can cause NSTE-ACS?
-Plaque rupture 95%
- Coronary spasms (prinzmental)
- Coronary embolisms
- Stable coronary stenosi sees in heavy exercise
88
current complaints in NSTE-ACS?
pain retrosternal, interscapula, epigastric radiating to shoulder, chest and arm
89
ECG in a NSTE-ACS?
(acute coronary syndrom)
ST depression
| deep T waves in V2-V4!!!
90
what can be the result of a NSTE-ACS?
Unstable angina
| NSTEMI
91
what is a normal troponin level?
< 14 ng/ml
92
what is the "wash-out"phenomenon?
increase in cardiac biomarkers after re perfusion, indicate success
93
ST segment elevation ACS is the same as STEMI
| what is the treatment pre-hospital?
If chestpain and ECG ST elevation that enough to diagnose MI!!!
1. Morphine
2. Oxygen if SpO2<90
3. Nitrates
4. Aspirin 250mg + clapidogrel 600mg
94
when in a STEMI should Nitrates NOT be given?
if RV infarct due to hypotention
95
STEMI add on treatment at hospital after the pre-MONA treatment
```
BASC
B-blockers
ACEI
Statins
Clopidogrel
PCI within 120 min!!!
```
96
absolutt contraindications for fibrinolysis?
aortic dissection
previous hemmorhagic stroke
active internal bleeding
97
fibrinolysis trearment?
streptokinase
alteplase
reteplase
98
heart cathetirization inlet points?
radial
brachial
femoral
99
steps of inserting cathether into vessle
1. find vessle
2. insert needle
3. insert guide wire
4. take out needle
5. insert catheter sheet tube
6. insert catheter over guiding wire
100
Is a artery or vein used in Right sided heart catheterization?
Femoral vein to reach the right side of the heart!
101
why do we doe heart cathetirization?
```
PCI (stenting)
Coronary angiography
Atherectomy (plaque removal)
Cardiac biopsy
pericardiocentesis (fluis drainage)
valvuloplasty
pressure measurments
```
102
is heart cathetirization a dual form of usage?
Yes, it is both diagnostic and therapeutic
103
complication of Heart cathetirization?
```
pericardial temponade
angina
hemorrhage
contrast reaction
arrhythmias
loss of peripheral pulse
```
104
calculate MAP
MAP = DP + 1/3(SP – DP)
105
how do you do a hemodynamic evaluation?
1. feel puls around the body
2. BP measurment
3. MAP calculation
4. dopler flow measurment
5. Arterial pulse pressure
6. CO and SV
106
type of stents?
Bare metal stent (BMS): bare-surfaced, metallic stent that provides a mechanical framework to keep the artery open.
Drug-eluting stent (DES): coated with antiproliferative substances (immunosuppressant drugs, cytostatic drugs) that prevent excessive intimal hyperplasia
107
what is CABG
Coronary artery bypass graft surgery
108
1. anticoagulant therapy in NSTEMI?
2. anticoagulant therapy in PCI?
1. Clopidogrel + Abciximab
2. Clopigdogrel+ Aspirine
109
life threatening causes of chest pain?
MI
PE
perforated ulcer
Aortic dissection
110
cardiopulmonary causes of chest pain?(9)
```
ACS
Angina pectoris
Aortic dissection
aneurysm
PE
Pneumonia
Myocarditis, Pericarditis
Arrhythmias
```
111
PE source?
illiac, femoral or popliteal vein
112
PE and Pulmonary infarction difference?
people have a lot of micro PE that resolve on its own, when the emboli is big enough it causes PI wich is leathal
113
Diagnose PE
```
CT pulmonary angiogram
V/Q lung scan
D-dimer
DVT US
ECG to exclude
```
114
treatmrnt of PE
O2 + IV saline + vassopressor + anticoagulant + morphine
immediatly give 5000 IU heparin + 1000-2000 IU LMWH nd warfaris as long term anticoagulant
115
when do you use the CHADS VAS SCORE?
to determine risk factor and if the patient should be getting anticoagulants in afib state
116
when to do a valvular replacement of aorta?
1. Positive stress test
2. EF < 50%
3. symptomes
117
can we treat Aortic stenosis with drugs?
NO DRUGS HELP
118
what are the two methods used in aortic valve replacement?
1. balloon aortic valvuloplasty
| 2. transcatheter aortic valve replacement (TAVI)
119
why is ballon aortic valvuloplasty not a good option?
50% restenosis within 6 months
120
should we do Balloon aortic valvuloplasty if regurgitation?
No, bec. it makes it worse when there is a backflow
121
organic and functional mitral regurgitation causes?
organic is anatomical abnormalities
| functional is when the leaflets are normal but damaged
122
causes of acute mitral regurgitation?
AMI - ischemia causing chorda or papillari rupture
Endocarditis
123
concequence of acute mitral regurgitation?
no time for adaption - cardiogenic shock
| acute pulmonary edema
124
indication of intervention in mitral reg.
Pulmonary hypertension
Afib
EF < 50%
125
percutaneous mitral valve interventions?
Clip - double orifice
Perc. mitral valve implantation with catheter
Perc. mitral ring implantation
126
aortic regurgitation signs?
Di musset's sign: bobbing of the head
| Muller's sign: uvula budding
127
Endocarditis prophylaxis in high risk AB used?
amoxicillin
Ampicillin
Clindamycin
128
what to use when we want to look at a prostetic valve?
TEE ecco
129
types of vascular grafts?
autograft
allograft
xenogenicgraft
130
symptomes of acute lower extrimity ischemia?
```
6 P
pain
pallor
pulselessness
paralysis
parenthisia
poikilothermia
```
131
aortic dissection classification?
De-bakey
IA: originates in acending aorta extends to at least the arch but often longer
IIA: confined to acending
IIIB: originates in decending and extends peripherally
132
in regards to the De-bakey classification of aortic disecction when to we need surgery?
if class A then surgery ASAP
133
aortic dissection symptomes?
```
sudden chest pain
different BP in different locations
nausea
syncope
dyspnea
weakness
chronic HF, MI
acute limb ischemia
anuria
```
134
imaging for aortic dissection?
MRI angiography
| TTE
135
indication of a CABG?
1. high grade > 50% LM stenosis
2. LAD + 2 or 3 small vessel diseased
3. symptomatic 2-3 vessel
4. non response to PCI
136
how do we stop the heart in open heart surgry?
Cardioplagia with K+ solution
137
heart failure mechanical suppport?
Aortic balloon pump
ECMO
CentriMag RVAD
Heartmate3 LVAD
138
Large aretry vasculitis
Giant cell arteritis
| Takyashu arteritis
139
medium sized vessle vasculitis
PAD
burgers
Kawasaki
140
small vessle arteritis
Granulomatosis Polyangitis
141
what is used to screen for vasculitis in aorta?
MRI
CT angiography
US
142
treatment of kawasaki vasculitis?
Ig and aspirin
143
Buergers typically?
smoking males
| causes ischemia and autoamputation of toes and fingers
144
polyarteritis nodusa treatment?
corticosteroids and cyclophosphamide
145
churg-strauss syndrom
eosinophilic granulmatosis polyangitis
| asthma, sinusitis, skin nodules, purpura
146
arterial disease risk factors
Major risk factors for PAD include older age, diabetes mellitus, current smoking, high blood pressure, high cholesterol level, obesity, and physical inactivity.
147
screening for peripheral arterial disease
AB index
148
imaging for peripheral arteri disease
Doppler ultrasound if ABI is abnormal
angiography through common illiac artery with contrast
Magnetic resonance angiopraphy
149
messenteric artery disease presents as?
postpradial pain
weightloss
bloody stool
150
treatment for PAD?
| Peripheral artery disease
angioplasty
artherectomy
stenting
151
what is defined as peripheral arteri?
not supplying the heart or brain
152
symptomes of PAD
```
claudication
fatigue, numbness aching
cold
thick nails
shiny skin ( athropy)
hairloss at area
poor wond healing
```
153
what is a normal antebrachial index?
1-1.3
154
Classification for lower limb PAD
Rutherford classification based on level of claudification by cathegory 0-6 where 0 is asymptomatic and 6 is major tissue loss
155
surgical treatment of PVD
```
embolectomy
open endartectomy
eversion endartectomy
end to end anastomosis
vessel reconstruction (bypass or interposition)
stent
```
156
define chronic venous insufficiency
blood pools in veins causing venous hypertension resulting in swelling and ulcers
157
symptomes of CVI
```
varicose veins
chronic swelling
pruritis
hyperpigmentation
lymphedema
venous ulceration
```
158
diagnosing chronic venous insufficiency?
US
| reflex filling time with photophletysmography
159
classification of CVI?
```
CEAP criteria
clinical ethiology anatomy pathophyiology
c0. no symptomes
c1.. telenangiectasia
c2. varicous veins
c3. edema
c4. pigmentation skin changes
c5. healed ulcers and skin changes
c6. skin changes with active ulcers
```
160
signs of DVT (names)
Homan sign: calf pain on dorsiflextion
MEyer sign: compression of calf is painfull
Payr sign: pain when pressure to medial sole
161
scoring system used in DVT to diagnose?
Wells score
1. medical history
2. immobilization
3. clinical symptomes
<2 unlikely
>2 likely
162
DVT treatment
1. UFH heparin 4-5 days
2. warfarin 3 months or rivaroxiban for 3 months
3. thrombolysis
163
most common site of supra-aortic stenosis?
carotid biforcation
| and can cause thromboembolism or TIA
164
carotid stenosis treatment?
endarterectomy
165
Mitral stenosis treatment
Percutaneous balloon mitral commissurotomy (PMBC) is recommended as the first choice of treatment
166
what is subclavian steal syndrom?
stenosis prevertebral a. on one side. upon usage of that arm the vertebral a. blood on the opposite side will redirect blood to the occluded side causing less perfusion to the brain. syncope, dizziness and ischemic symptoms of the arm as well (the arm "steals" blood from brain)
167
What is the difference between vascular and endovascular surgery?
Vascular surgery and endovascular surgery are both modalities to treat vascular disease. Endovascular describes a minimally invasive approach commonly done through needle puncture and a sheath. Traditional vascular surgery is more invasive and involves incisions, which is more surgical in nature
168
treatment for aortic aneurysm, when do we operate?
when the aneurysm is > 5.5 in males and 5.0cm i diameter in females
1. endovascular repair
2. open surgical repair (either valvesparing or also changing valve)
169
when do we choose the open surgery in treatment for AAA?
Mycotic aneurysm or infected graft
Persistent endoleak and aneurysm sac growth following EVAR
Anatomical contraindications for EVAR
| endovascular repair of abdominal aneurysm
170
most common site of peripheral aneurysms?
popliteal artery
171
most common visceral aneurysm sites?
spleenic
hepatic
renal
172
types of aneurysms?
saccular
fusiform
psaudosaccular
173
acute aortic syndromes?
aortic dissection
intramural hematoma (IMH)
perforated aortic ulcer
174
vascular imaging methods?
duplex US
MRA
CTA
175
what does a pulmonary AVM show on US, MRI, CT
US: enlarged arteries/dilated veins, high flow
| MRI, CT: Large arteries, draining veins, rapid AV shunt
176
what is a hemangioma?
it is a AVM benign tumor of the vessles. The most common form is infantile hemangioma, known as a "strawberry mark", most commonly seen on the skin at birth or in the first weeks of life. A hemangioma can occur anywhere on the body, but most commonly appears on the face, scalp, chest or back.
177
AV fistulas why? most common?
we do this to make the wall of a vein stronger to withstand multiple punctures due to hemodialysis. most common is the radial artery to the cephalic vein. after 4-6w the wall of the vein becomes thicker due to increased pressure.
178
VA ECMO sites?
femoral vein to femoral artery
179
VV ECMO sites?
Right femoral vein to the right IJV and advanced through the SVC into the RA
180
ECMO complications
coagulation disorders and bleeding
hemolysis
thrombocytopenia
infections, sepsis
181
what is the difference between the cannula sites of CPBM and ECMO?
ECMO is peripherally not in the heart
182
what is important with extracorporal circulation in regards to temperature?
the patient needs to be thermoregulated down to 28-32C to slow the bodies BMR decreasing oxygen demand
183
when to do a endovascular vs open surgeru in aortic dissection?
Type A: immediate open surgery with graft inplant
Type B: endovascular with stent
184
causes of acute aortic regurgitation?
endocarditis and aortic dissection
185
when do we need to do acute heart surgery?
acending aorta aneurysm
AMI CABG
acute aortic regurgitation
acute mitral regurgitation with no adaption
cardiac temponade
abdominal aneurysm larger then 8cm in diameter.
186
when do we operate the valves in endocarditis?
1. significant stenosis or regurgitation
2. elevated end diastolic volum
3. increased LV atrial pressure and PH
4. recurrent septic emboli
5. vegitations > 10mm
6. persistent bloodculture despite AB
7. relapsing infections
8. abscess formation
187
drug in cardioversion?
amiodoran
188
when can we not do a cardioversion?
throbus in the heart
189
drugs inhibiting remodeling of heart in HF?
ACEI
ARB
B-blockers
spironolacton
190
hypertension mediated organ damage HMOD
```
brain
eyes
heart
kidney
arteries
```
191
if you see ST elevation and chestpain after a intervention what can it be?
stent thrombosis
192
abnormal ventricular wall motion?
Akinesis: lack of wall motion
Dyskinesia: outward movement of a wall segment during systole (transmural infarct)
hypokinesis: movements with decreased amplitude
193
contrastagent in MRI heart?
Gadolinium
194
pericarditis on ECG?
depressed PR intervall
195
tripple rule out
Triple-rule-out (TRO) CT angiography is a recent technique for evaluation of:
Coronary arteries
Aorta
Pulmonary arteries
Adjacent intrathoracic structures
Done simultaneously for patients with acute chest pain.
196
what do you have to give if patient is on aspirin?
PPI due to gastric ulcers
197
why do we have to do syncronized cardioversion in supraventricular arrhythmias?
if you give shock at the wrong time you can start Vfib
198
why is it better to use thoracic artery then saphenous vein in CABG?
veins collapse after about 10 years, arteries dont
199
why is radial artery the 3rd choice in CABG?
bec. tends to get spasms faster
200
in ECMO what is the time difference between VV and AV
AV week
| VV months
