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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the first line treatment for Afib

A

Rate control: Metoprolol or Verapamil

if that doesn’t work & duration <48 hours:
Rhythm control: Amioderone or cardioversion

Duration >48hours: Anticoagulation x 21 days BEFORE cardioversion

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2
Q

Common presentation signs of those with Afib

A
  • Elderly, excessive alcohol use
  • Symptoms range from syncope, dyspnea, palpitations to no symptoms
  • Irregularly irregular pulse
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3
Q

How will a left bundle branch block look on EKG

A

Upright bunny ears in V4 - V6

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4
Q

How will a right bundle branch block look on EKG

A

Upright bunny ears in V1-V3

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5
Q

What scoring tool is used to assess the need for anticoagulation

A

CHADS2VASC

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6
Q

What are the scoring parameters for CHADS2VASC score

A

0- No anticoagulation
1- 81mg or 325mg of ASA OR anticoagulation
2+ - Anticoagulation

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7
Q

Which leads are you most likely to see atrial flutter in

A

Leads 2, 3 and aVF

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8
Q

What are the two different types of atrial flutter

A

Type 1: 250-350 bpm
Type 2: Faster (350-450 bpm)

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9
Q

a 68-year-old female with a history of hypertension and hyperlipidemia presents for a routine check-up. She reports feeling generally well but mentions occasional episodes of mild fatigue, which she attributes to aging. She denies any chest pain, shortness of breath, or palpitations. Her medications include lisinopril and atorvastatin. Vital signs are within normal limits. Physical examination is unremarkable. An EKG is performed as part of her evaluation, which reveals a consistent prolongation of the PR interval greater than > 0.2 seconds (200 ms).

What is the likely diagnosis?

A

First degree heart block

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10
Q

a 55-year-old male, with no significant medical history, presents to the clinic complaining of occasional lightheadedness and palpitations, particularly during his morning jogs. He denies any chest pain, shortness of breath, or syncope. On examination, his vitals are stable, but his pulse is irregularly irregular. An ECG is performed, revealing a pattern of progressively lengthening PR intervals followed by a non-conducted P wave.

What is the likely diagnosis

A

Mobitz type 1 –> wenckebach

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11
Q

What pattern/ratio is observed with wenckebach (how often will you see a beat drop)

A

3:2, 4:3, or 5:4 (predictable)

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12
Q

a 68-year-old female with a history of hypertension presents to the emergency department complaining of dizziness and episodes of near-syncope over the past few days. She reports no chest pain, shortness of breath, or palpitations. Her blood pressure is slightly elevated, and her pulse is slow and irregular. An ECG reveals intermittent, non-conducted P waves without progressive prolongation of the PR interval.

What is the likely diagnosis?

A

Mobitz type 2

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13
Q

What is mobitz type 2

A

The impulse is blocked in the bundle of His. Every few beats there will be a missing beat but the PR Interval will not lengthen–> Dangerous to the patient

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14
Q

What is third degree heart block

A

When the atria and ventricles are acting independently of each other. The P waves will be consistent but will not match up with the QRS complexes

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15
Q

An EKG demonstrates a shorter PR interval, a longer QRS segment and a delta wave - what is the likely diagnosis?

A

WPW

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16
Q

What is a delta wave

A

An upward slope at the beginning of a QRS complex

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17
Q

A rapid irregular rhythm >100bpm, with 3 distinct P wave morphologies is indicative of what dx?

A

Multifocal Atrial tachycardia

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18
Q

Which antihypertensive medications can cause bradycardia

A

Dihydropyridine CCB
Beta-blockers

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19
Q

Which calcium channel blockers are non-dyhydropyridines

A

Verapamil
Diltiazem

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20
Q

Which CCB are dyhydropyridines

A

nifedipine
Nicardipine
Amlodipine
felodipine

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21
Q

When are dyhydropyridines preferred?

A

When peripheral vasodilation is needed

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22
Q

When are non-dyhydropyridines preferred

A

When central depression is needed (SA / AV node blockage) - AKA rate control

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23
Q

What type of arrhythmia is most likely to occur with ventricular hypertrophy or ventricular dilation?

A

V-tach

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24
Q

What 2 murmurs are associated with atrial fibrillation

A

Mitral stenosis
Mitral regurge

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25
Q

Which type of bundle branch block is always considered to be pathological

A

LBBB –> can be a sign of an MI (Think left = lousy)

*RBBB is NOT always pathological

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26
Q

On an EKG, a QRS complex lasting longer how many seconds is seen in a BBB

A

Longer than 120 ms

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27
Q

What pulmonary disorder is a common cause of RBBB

A

Pulmonary embolism

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28
Q

What acquired infection is a common cause of RBBB

A

Lyme disease

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29
Q

What are the treatment options for SVT

A

1: Valsalva
2: Adenosine
3: Ablation (permanent fix)

*If WPW, do NOT give adenosine of CCB

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30
Q

A faster-than-normal heart rate beginning above the heart’s two lower chambers in the atria, AV junction, or SA node associated with no structural abnormalities is descriptive of what arrhythmia

A

PSVT

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31
Q

a 25-year-old female patient with complaints of sudden onset of a pounding heartbeat, which is regular and “too rapid to count.” She reports that the episodes begin and terminate abruptly and are associated with shortness of breath and chest discomfort. On exam, the patient appears anxious, her heart rate is 170 bpm. EKG demonstrates a shortened PR interval, widened QRS, and delta waves. What is the likely diagnosis?

A

WPW

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32
Q

a 72-year-old man is admitted for exacerbation of COPD. On the third day, he reports dizziness associated with occasional chest pain. His telemetry reveals an irregular rhythm with a pulse of 124/min. The EKG demonstrates an irregularly irregular rhythm, rate of 120 bpm, discrete P waves before every QRS complex with 4 different P wave morphologies. What is the likely diagnosis?

A

MAT

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33
Q

What are the differences between the 3 different types of premature beats in the heart

A

PAC: Abnormal shaped P wave
PVC: Wide QRS
PJC: Narrow QRS of <.1sec

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34
Q

What is the difference between sinus pause and sinus arrest

A

Sinus pause <3sec
Sinus arrest >3sec

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35
Q

a 68-year-old woman with a history of chronic heart failure and recent hospitalization for pneumonia presents to the emergency department complaining of sudden onset dizziness and palpitations. She reports adherence to her medication regimen, which includes a diuretic and an antibiotic she started a week ago. On examination, she appears anxious, her blood pressure is 100/60 mmHg, and her heart rate is irregular and fast. An ECG reveals a polymorphic ventricular tachycardia with a characteristic twisting of the QRS complexes around the baseline and serum K+ and Mg2+ are found to be low. What is the likely diagnosis and how do you treat it

A

Torsades de Pointe
IV mag to prevent vfib

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36
Q

What is the most appropriate treatment in immediate management of a hypertensive emergency

A

nitroprusside

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37
Q

Which of the following ABI values would most likely confirm the diagnosis of PAD in a patient?

A

An ABI of .5

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38
Q

What is the most sensitive and specific method to test for PAD

A

ABI (normal is between 1.4-.9)

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39
Q

What drug class has been shown to improve mortality in patients with systolic heart failure

A

Beta-blockers

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40
Q

What are 3 medications that can help prevent arrhythmia and ease symptoms in those with HOCM

A

Diuretics
Beta-blockers
Non-dyhydrpyridines (verapamil / diltiazem)

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41
Q

What are the signs of HOCM on physical exam

A

S4 gallop
Apical shift
Ejection murmur medial to the apex

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42
Q

What is the treatment for dilated cardiomyopathy

A

Diuretic (loop)
Ace inhibitor
Beta blocker

43
Q

What is the most common cause of non-ischemic dilated cardiomyopathy

A

chronic alcoholism

44
Q

a 58-year-old man complaining of several months of worsening shortness of breath and ankle swelling. He denies palpitations, lightheadedness, syncope, or chest pain. He has a past medical history significant for hereditary hemochromatosis. On physical exam, his temperature is 37 C (98.6 F), pulse is 78, blood pressure is 130/72 mm Hg, and respiratory rate is 16. He has elevated jugular venous pressure, diminished breath sounds at the lung bases, tender hepatomegaly, and bilateral pitting ankle edema. There are no murmurs, rubs, or gallops. EKG shows low-voltage QRS complexes without any signs of ischemia. His chest x-ray shows a normal-sized heart and bilateral pleural effusions. Echocardiography shows symmetrical thickening of the left ventricle, normal left ventricular volume, and mildly reduced systolic function. What is the likely diagnosis

A

Restricted cardiomyopathy

45
Q

What is restricted cardiomyopathy

A

Right sided heart failure in those with a history of an infiltrative process ( Amyloidosis, sarcoidosis, hemochromatosis, scleroderma, fibrosis)

46
Q

What are the NYHA heart failure classifications

A

Class 1: no limitation of physical activity
Class 2: slight limitation in physical activity; comfortable at rest
Class 3: marked physical limitation; comfortable at rest
Class 4: can’t carry on physical activity; anginal syndrome at rest

47
Q

How do you diagnose heart failure

A

Dx: BNP, EKG, CXR (Kerley B lines);
** Echocardiography = gold (best to assess size and function of chambers)

48
Q

What are the 3 beta blockers that have been shown to reduce morbidity and mortality in those with heart failure

A

Bisoprolol
Carvedilol
Metoprolol succinate (not tartate)

49
Q

What are the first line agents in those with HEFrEF

A

Entresto (sacubitril/valasartan)
ACE/ARB
Beta-blockers
Aldosterone antagonists
SGLT2 inhibitos
Diuretics

50
Q

a 45-year-old female with a long history of a heart murmur with one week of increasing fatigue and low-grade fevers. She had a dental cleaning two weeks ago. She denies any hematuria, neurological symptoms, or changes in the appearance of her hands and fingernails. Her past medical history is otherwise insignificant. On physical exam, her temperature is 38.1 C (100.6 F), heart rate is 92/min, blood pressure is 118/67, and respiratory rate is 16/min. She appears fatigued but in no acute distress. Cardiac auscultation reveals a grade III/VI holosystolic murmur heard best at the cardiac apex in the left lateral decubitus position. Pulmonary, abdominal, and extremity exams are within normal limits. The patient is admitted and started on empiric IV antibiotics. Three days later, 4/4 blood cultures grow Streptococcus viridans that is highly sensitive to penicillin. What is the likely diagnosis

A

Endocarditis

51
Q

What are signs seen on physical exam that are indicative of infective endocarditis

A

Janeway lesions (painless bumps on the palm)
Osler nodes ( painful bumps on the fingers and toes)
Roth spots (hemorrhages on the retina)
splinter hemorrhages

52
Q

What is the treatment for infective endocarditis

A

IV vancomycin or ampicillin/sulbactam PLUS aminoglycoside

**Prosthetic valve: Add rifampin

53
Q

What murmur is heard with aortic stenosis

A

harsh systolic ejection crescendo-decrescendo at the right upper sternal border with radiation to neck and apex

54
Q

What symptoms will be found with aortic stenosis

A

Dyspnea, angina, syncope with exertion; squatting increases intensity; split S2

55
Q

What type of murmur is heard with aortic regurgitation

A

soft high pitched, blowing, crescendo-decrescendo along left sternal border; loud leaning forward/squatting

56
Q

What type of murmur is heard with mitral stenosis

A

diastolic low-pitched decrescendo rumbling with an opening snap heart best at the apex with pt. lying lateral decubitus position

57
Q

What causes mitral stenosis

A

eaflets of the mitral valve thicken, stiffen from rheumatic fever → valve doesn’t open well in diastolic; cause = rheumatic heart

58
Q

What murmur occurs with mitral regurgitation

A

blowing holosystolic murmur at the apex with split S2 radiating to the left axilla

59
Q

What causes mitral regurge

A

CAD, HTN, MVP, rheumatic, heart valve infection; apical S3 = volume overload on the ventricle

60
Q

What will be heard with mitral valve prolapse

A

midsystolic ejection click heard best at the apex

61
Q

What will be heard with tricuspid stenosis

A

mid-diastolic rumbling murmur at LLSB with opening snap

62
Q

What will be heard with tricuspid regurgitation

A

high-pitched holosystolic murmur at LLSB radiates to the sternum and increases with inspiration

63
Q

What is occurring with tricuspid regurgitation

A

Tricuspid fails to close fully in systole, blood regurgitates from RV → RA = murmur

64
Q

What is heard with pulmonary stenosis

A

harsh, loud, medium pitched systolic murmur heard best at 2nd/3rd left intercostal space that may increase with inspiration

65
Q

What is heard with pulmonary regurgitation

A

high pitched early diastolic decrescendo murmur at LUSB that increases with inspiration

66
Q

what are the screening guidelines for high cholesterol

A

USPSTF recommends screening for patients with NO evidence of CVD and NO other risk factors should begin at 35 years of age

67
Q

What 4 demographics typically benefit from statin therapy

A

Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)

Patients with primary LDL-C levels of 190 mg per dL or greater

Patients WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL

Patients WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%

68
Q

What HDL level is considered protective

A

> 60

69
Q

What is the optimal LDL level

A

<100

70
Q

What is the goal for total cholesterol and what level is considered high

A

<200
>239

71
Q

What is primary hypertension

A

Primary hypertension is defined as a resting systolic BP ≥ 130 or diastolic BP ≥ 80 on at least two readings on at least two separate visits with no identifiable cause.

72
Q

What are the AHA classifications of hypertension

A

Normal: < 120/80 mmHg
Elevated: 120–129 mmHg and < 80 mmHg
Stage 1: 130–139 mmHg or 80-89 mm Hg
Stage 2: ≥ 140 mm Hg or ≥ 90 mm Hg

73
Q

What is considered a hypertensive crisis

A

Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems or immediate hospitalization if there are signs of organ damage.

74
Q

What medications are better for managing blood pressure in black adults

A

Thiazide-type diuretics and/or calcium channel blockers are more effective in black adults at lowering BP alone or in multidrug regimens

75
Q

Which patients are beta blockers contraindicated in

A

Those with asthma

76
Q

When are alpha blockers beneficial

A

With BPH and HTN issues

77
Q

What is a side-effect occasionally seen with hydralazine and when is hydralazine used

A

-Lupus like symptoms and pericarditis
- Hydralazine can be used for chronic HTN

78
Q

In a hypertensive emergency, how quickly does the blood pressure need to be reduced in order to prevent the start of end organ damage

A

Within an hour it needs to be. reduced by 10-20%

79
Q

What are the signs and symptoms of hypertensive encephalopathy

A

the insidious onset of headache, nausea, and vomiting, followed by nonlocalizing neurologic symptoms such as restlessness, confusion, and, if the hypertension is not treated, seizures and coma.

80
Q

What is the drug of choice to treat hypertensive urgency

A

Nitroprusside

81
Q

What is the drug of choice to treat hypertensive emergency

A

Nitroprusside

82
Q

What is the drug of choice to treat malignant hypertension (hypertensive retinopathy)

A

Clevedipine / nitroprusside

83
Q

What leads in a EKG look at the anterior/ septal` wall of the heart

A

V1 - V4

84
Q

What leads in an EKG look at the lateral walls of the heart

A

I, aVL, V5, V6

85
Q

What leads on an EKG look at the inferior portion of the heart

A

II, III, aVF

86
Q

What is the gold standard to diagnose myocarditis

A

end-myocardial biopsy

87
Q

What is the most common cause of myocarditis

A

viral enterovirus 
(Coxsackie), EBV, HIV, VZV


88
Q

a 45-year-old male with type I diabetes mellitus and end-stage renal disease currently on hemodialysis presents to the emergency department with dyspnea, cough and chest pain. He describes the pain as worse during inspiration and when he is lying on his back. What is the likely diagnosis

A

Pericarditis

89
Q

What are signs of pericarditis

A
  • chest pain that is relieved by sitting or leaning forward
  • pericardial friction rub
  • Dressler’s syndrome
90
Q

What is Dressler’s syndrome

A

Pericarditis within 1 month following
an MI, trauma, or surgery

91
Q

Where is Erb’s point and what is the significance

A

It is the middle left sternal border when listening to the heart–> Where you will hear a pericardial friction rub

92
Q

How do you diagnose pericarditis

A

An EKG which will demonstrate diffuse, ST-segment elevations in the precordial leads (V1-V6)

93
Q

What is the most common presentation of peripheral artery disease

A

intermittent claudication (Thigh and upper calf are most common locations)

94
Q

What is Leriche syndrome

A

Leriche syndrome refers to a buildup of plaque in the iliac arteries → claudication, impotence, decreased femoral pulses

95
Q

What are the 6 P’s to look for with an acute arterial embolism

A

Pain
Pulslessness
pallor
Paresthesia
poikilothermia (inability to regulate temperature)
Paralysis

96
Q

What is the mainstay treatment for PAD and why

A

Cilostazol (anti platelet) because it also helps with the intermittent claudication

97
Q

What is homans sign and when is it seen

A

Pain in the calf when the foot is dorsiflexed
- Will occur with phlebitis

98
Q

How do you diagnose phlebitis

A

Duplex US

99
Q

What is the mainstay treatment for those with ARF and do not have carditis

A

Antistreptococcal prophylaxis should be maintained continuously after the initial episode of ARF to prevent recurrences - PENICILLIN G - for 5 years or until they turn 21 (if that is before the 5 yr tx is complete)

100
Q

Which valve is most commonly effected by ARF

A

Mitral
- will see regurge unless it is in late stage then you will hear mitral stenosis

101
Q

How do you dx rheumatic heart

A

Clinical presentation and echo
*Labs: ↑ anti-streptolysin O (ASO) titers

102
Q

What type of prophylaxis is given to those with rheumatic heart and are allergic to penicillin

A

sulfadiazine

103
Q

What is amaurosis Fugax and when is it seen

A

Sudden temporary monocular blindness that occurs with giant cell arteritis

Internal Medicine (8 decks)

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