Cardiology Flashcards
(90 cards)
1
Q
Physiologic S2 split
A
A2 then P2 on inspiration
2
Q
Paradoxical S2 split
A
AS
HTN
LBBB
3
Q
Early diastolic S3 sound (aka pericardial knock)
A
Constrictive pericarditis
4
Q
Pulsus alternans
A
Severe heart failure
5
Q
Pulsus paradoxus
A
Cardiac Tamponade
SVC obstruction
Pulmonary obstruction
6
Q
Sustained left parasternal lift (heave)
A
RVH
MS, pHTN, PS
7
Q
Sustained apex lift/impulse
A
LVH
Bifid or trifid apical impulse with HOCM
8
Q
Holosystolic murmur
A
MR
TR
VSD
pHTN
9
Q
Mid-systolic murmur
Crescendo-decrescendo
A
AS (more severe with late peak)
pS
ASD
10
Q
Late systolic murmur with mid-systolic click
Crescendo
A
MVP
11
Q
Mid-diastolic murmur
A
MS
TS
ASD
12
Q
Late diastolic murmur
Plop or diastolic sound
A
Atrial myxoma
13
Q
Early diastolic murmur
Decrescendo
A
AR
PR
14
Q
Murmur Inc standing Inc Valsalva Inc Post-PVC Dec hand grip
A
HOCM
15
Q
Murmur Inc standing Inc Valsalva Inc Post-PVC Dec hand grip (duration dec, intensity inc)
A
MVP
16
Q
Murmur Dec standing Dec Valsalva Dec Post-PVC Inc hand grip
A
MR
17
Q
Murmur Dec standing Dec Valsalva Inc Post-PVC Dec hand grip
A
AS
18
Q
Most common murmur in LLSB
A
VSD
19
Q
Strongest modifiable risk factor for MI
A
Dyslipidemia
20
Q
Cardiac stress test with baseline ST-T abnormalities or LVH on EKG
A
Exerciser ECHO
21
Q
Cardiac stress test with LBBB or V-pacing on EKG
A
Vasodilator MPI
SPECT/PET (PET > SPECT if obese or female)
22
Q
Cardiac stress test is patient unable to exercise and has wheezing
A
Dobutamine stress test
23
Q
Cardiac stress test if patient unable to exercise and no wheezing
A
Vasodilator or Dobutamine stress test
24
Q
Indication for MUGA scan
A
Determine LVEF and wall motion abnormalities
25
Management for chronic angina on ASA and nitrates with increasing frequency
Add beta blocker
26
Decrease frequency if anginal episodes and improved exercise tolerance
Ranolazine
| Not shown to decrease mortality
27
Deep T waves in V1 to V4
Myocardial ischemia
| Wellens syndrome/LAD T-wave inversion syndrome
28
Chest pain
EKG normal
Stress test with reversible with reversible ischemia
Coronary arteriography negative
Management
Microvascular angina/Syndrome X
CCB/Beta blockers and nitrates
29
Chest pain
Positive ambulatory EKG
Negative angiogram
Vasospastic angina
30
Syncope. Dizzy after dinner
| EKG with ST depression in II, III, aVF
Postprandial ischemia
31
Lightheaded after meals + syncope
Management
Postprandial hypotension
Small frequent meals
32
Ticagrelor vs Prasugrel vs Clopidogrel
PCI: T and P > C
CABG: C
33
Indications for thrombolysis
CP typical for infarct > 30min w/ LBBB
ST elevation 1mm in 2 cont leads
< 12 hrs post MI
> 2 hrs from PCI center. Not in shock
34
Absolute contraindications to thrombolytic therapy
Previous hemorrhagic stroke
Other CVA events < 1 year
Intracranial neoplasm
Active internal bleed
35
Relative contraindications to thrombolytic therapy
```
CVA > 1 year
Recent internal bleed or major trauma < 2-4 weeks
BP > 180/110
Pregnancy
Active PUD
```
36
Indications for PCI
```
Active STEMI
ST elevation with CP > 12 hrs
MI w/ shock and < 2 hr from PCI center and < 75 yo
tPA contraindicated
Unstable angina
```
37
Management for Vtach or VFib 48 hours after MI
ICD
38
Most specific pericarditis finding on EKG
PR depression
39
Management for acute pericarditis
NSAIDS and colchicine
40
Prophylaxis for pericarditis
Colchicine
41
On GDMT + spironolactone
| Bilateral breast enlargement
D/c spironolactone and start eplerenone
42
Appropriate timing of ICD placement
After optimal GDMT for at least 3 months
43
Hypercontractile base and noncontractile apex
Time of recovery
Takotsubo cardiomyopathy
Recovery within 2-3 months
44
```
Rigid pericardium
Post-cardiotomy, viral, radiation
Mostly normal EKG
BNP < 100
Pericardial calcification
Thickened pericardium
```
Constrictive pericarditis
45
Rigid ventricle
Amyloid, endomyocardial fibrosis, sarcoidosis
Low voltage EKG, repolarization abnormalities
BNP > 400
Cardiomegaly, ventricular wall thickening
Restrictive pericarditis
46
Early systolic murmur at LLSB that increases with decreased flow (standing, Valsalva)
Hypertrophic cardiomyopathy
47
LV wall thickness > 15mm
| LV wall thickness < 15mm
HOCM
Athletes heart
48
1st line Management for HOCM
Beta blocker
49
Severe Aortic stenosis
Gradient > 40
Valve < 1 sq cm
Late peaking murmur
50
Differentiate severe AS from not severe AS
Dobutamine ECHO
51
```
Surveillance:
Asx mild AS
ASx moderate AS
ASx severe AS. LVEF > 50%
ASx severe AS. LVEF < 50%
```
ECHO q 3-5 years
ECHO q 1-2 years
ECHO q 6-12 mo
AV replacement t
52
Management for AR
ESD < 40. EDD < 60
ESD > 50. EDD > 65
ECHO in 6-12 mo
| Surgery
53
Opening snap
Mid diastolic rumble at apex
Straightening of L heart border
Mitral stenosis
54
Management for MS if valve < 1.5 sq cm
Valvuloplasty
55
Management for MR if LVEF < 60% and LVESD > 40
Transcatheter MV repair
56
Incomplete fusion of septum primum
PFO
57
Incomplete covering of foremen ovale by septum primum
Secundum ASD
58
Septum primum does not connect to endocardia cushion
Primum ASD
59
Management for VSD if L to R shunt > 1.7:1
Surgery
60
Wide pulse pressure
PDA
61
Management for Marfan
Early ECHOs
Beta blockers and Losartan
If aorta dilation > 4.5 cm - Repair
62
Surgical indications for TAA and AAA
ASx TAA > 6cm
ASx AAA > 5.5cm
Symptomatic any size
63
AAA screening
And US for males 65-75 with any h/o smoking
64
Frequency of AAA screening
3-3.9cm >> 3 years
4-4.9cm >> 1 year
5-5.4 cm >> 6 mo
65
INR goal for mechanical AV and mechanical MV
AV 2-3 (ASA + Warfarin)
| MV 2.5-3.5 (ASA + Warfarin)
66
Rhythm control for Afib without structural heart disease
Flecainide
| Propafenone
67
Rhythm control for Afib without CAD or CHF
Sotalol
| Amiodarone
68
Rhythm control for Afib with CHF but without CAD
Amiodarone
| Dofetilide
69
CHADS-VASc
```
CHF - 1
HTN - 1
Age > 75 - 2
DM - 1
Stroke/TIA/DVT - 2
Vascular Dz - 1
Age 65-74 - 1
Female - 1
```
70
Peri-op warfarin management with Afib
CHADSVASc < 4 — d/c warfarin 5 days prior to surgery w/o bridging
CHADSVASc > 6 — d/c warfarin 5 days prior and bridge with LMWH
71
Goal INR to clear for surgery
1.5
72
Peri-op DOAC management
Hold 2 days prior and restart 2 days after. No bridge
73
Rate control and AC in Afib compared to cardioversion
Decreased stroke
| Decreased hospitalizations
74
Management for persistent Afib refractory to 2 meds
Ablation of pulmonary vein
75
Drug that will bring Afib into NSR
Ibutilide
76
Intra-atrial macroreentrant tachycardia
250-350/min
Management
Atrial flutter
Slow AV conduction with beta blockers or diltiazem
77
Management for AVNRT
carotid massage
Then Adenosine 6mg
Then Adenosine 12mg
78
Management for WPW
Exercise EKG if asymptomatic
EPS + radioablation if with any arrhythmia or unexplained syncope
79
Management for inappropriate sinus tachycardia
Beta blocker
| Ivabradine
80
> 3 distinct morphological types of p wave
Management
Multifocal atrial tachycardia
(Seen in COPD, theophylline use, CHF)
Oxygen
81
Management for PVC
No heart disease, Asx: no treatment
No heart disease, Sx: beta blocker
Heart disease; low LVEF: ICD
82
QT interval formula
QTc = QT / sq rt (RR)
83
Indications for ICD
Sudden cardiac death: Vtach or VFib
NICM (LVEF < 35%) + 3 mo GDMT
ICM (LVEF < 35%) + 40 days p MI
HOCM w/ NSVT + FHx of sudden death
84
Asian
Cardiac arrest
FHx of young death
Management
Brigades syndrome
ICD
85
Management for 2 deg Type II AV block
If secondary to IW or RV MI — no PPM
If secondary to AWMI — PPM
86
Anorexia
Blurry vision
Yellow appearing objects
Decreased red and green color vision
Digoxin toxicity
87
Best test for familial combined hyperlipedemia
Apoprotein B
88
```
Intensity of statin therapy
ASCVD > 75 yo
ASCVD < 75 yo
LDL > 190
DM 80-189
10 yr ASCVD risk 7.5-20%. >20 %
```
```
Moderate
High
High
Moderate
Moderate. High.
```
89
Muscle biopsy with necrotizing muscle fibers
no inflammation
no vacuoles
Statin induced myopathy
90
Etiology of flushing associated with niacin
PGDE2
