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Cardiology Flashcards

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1
Q

What is the first line therapy for Cardiogenic shock?

A

Dobutamine (Beta Agonist) is first line therapy

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2
Q

What is the most common organism involved in Acute pericarditis?

A

Coxsackie B Virus, Hep B, and CMV

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3
Q

What ECG signs are seen with acute pericarditis?

A

ST elevations, PR depression in most leads

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4
Q

WHat is Pulsus Paradoxus?

A

Classic finding in pericardial effusion

Abnormally large decrease in systolic BP (>10 mmHg) and pulse wave amplitude during inspiration

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5
Q

What CXR finding do you see with Acute pericarditis?

A

Water bottle heart, cardiomegaly

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6
Q

What is the gold standard for diagnosing Pericardial effusion? what confirms the dx?

A

Echo-shows fluid between layers of pericardium

Pericardiocentesis: confirms dx

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7
Q

What is cardiac tamponade? what is a common cause?

A

Emergency! Occurs when large pericardial effusion compresses the heart, or greatly reduces CO

common cause: Penetrating trauma to the heart

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8
Q

What are the s/s of cardiac tamponade?

A

Sharp, stabbing CP (worsened by deep breathing or coughing), dyspnea, nonproductive cough

PE: Beck’s Triad-JVD, Arterial hypotension, muffled heart sounds

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9
Q

What is the gold standard for diagnosing Cardiac tamponade?tx?

A

ECHO

Tx: urgen pericardiocentesis!! (by echo guidance)

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10
Q

What is COnstrictive pericarditis? What are the common causes?

A

Diffuse thickening of the pericardium with possible calcifications

Associated with TB, radiation therapy, cardiac surgery, or following viral pericarditis

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11
Q

What are the S/S of constrictive pericarditis? how is it tx?

A

Slowly progressive dyspnea and fatigue, weakness

PE: LE edema, Ascites, elevated JVP, pericardial Knock, + kussmaul sign (evidence of Rt heart failure)

Tx: NSAID, Corticosteroids, Colchicine, Pericardiectomy

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12
Q

What is Dressler syndrome?

A

Postmyocardial infarction Pericarditis

Occurs 2-5 days after infarction due to inflammatory rxn to transmural myocardial necrosis

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13
Q

What are the s/S of infective endocarditis?

A

New systolic murmur, Roth spots, osler nodes, Janeway lesions, splinter hemorrhages

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14
Q

How do you dx Infective endocarditis?

A

Transesophageal Echocardiogram (TEE)-may show vegetations on valves

Blood cultures: 3 sets at least 1 hour apart

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15
Q

What are the most common valves affected in infected endocarditis?

A

Mitral valve most commonly affected

Tricuspid valve most common in IV drug users

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16
Q

What are the most common organisms involved in infective endocarditis?

A

Native valves + IV drug users: Staph aureus

Prosthetic valves: Staph epidermidids

Subacute endocarditis: Streptococcus viridans

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17
Q

Enfective endocarditis: What abx are given while Blood culture is pending? If prosthetic valve? native valve, community? If MRSA?

A
  • Vancomycin + gentamycin
  • Prosthetic valve=Vanco + gentamycin + Rifampin
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18
Q

When does rheumatic fever occur and what are the most common valves involved?

A

Occurs 2-3 weeks following a beta-hemolytic Strep phargyngitis

  • Mitral valve-most common
  • Aortic valve
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19
Q

What are the signs and symptoms of Rheumatic fever?

A
  • Subcutaneous nodues on extensor surfaces
  • Sydenham’s chorea: involuntary movements
  • Erythema marginatum: painless pink rash with well defined edges; central clearing
  • PE: new murmur–mitral regurgitation
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20
Q

HOw do you diagnose Rheumatic fever? How to you treat?

A

Dx: + Antistreptolysin O (90%)

Tx: NSAIDs, beta-lactams, corticosterois

prophylaxis: Benzathine penicillin G q 4 weeks

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21
Q

What is the most appropriate initial diagnostic test in the evaluation of a patient with signs and symptoms consistent with stable angina? Tx?

A

Nuclear stress test

Tx: Sublingual nitroglycerin

(Will reduce effects of GERD and esophageal spasm as well)

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22
Q

What is Printzmetal angina?

A

Occurs in younger patients at rest; Squeezing CP, 2-5 minutes

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23
Q

What leads show an inferior wall MI? what artery is involved?

A

ST elevation in lead II, III, and aVF

Right coronary artery

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24
Q

What leads show a lateral wall MI? What artery is involved?

A

I, AVL, V5 and V6

LAD, LCA, and CFX

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25
What leads show an anterior wall MI? artery?
V1-V4 LAD
26
What leads and arteries are involved in posterior wall MI?
V1 and V2 RCA, CFX
27
What leads and artery are involved in anterolateral MI?
V4-V6 CFX
28
What leads and artery are involved in Anteroseptal MI?
V1 and V2 LAD
29
What medications should you avoid in Long QT syndrome?
Macrolides and Fluoroquinolones (may prolong QT interval)
30
What med is used to treat HTN in pregancy?
Hydralazine
31
What are the common causes of secondary HTN?
Most common cause: **Renal Parenchymal Disease** CHAPS * Cushings * Hyperaldosteronism (primary) * Coarctation of the Aorta * Pheochromocytoma * Renal artery stenosis
32
What is the clinical defn of renal artery stenosis? what med is contraindicated?
HTN that is resistant to 3 or more medications Renal artery bruit on exam ACE Inhibitors are C/I!!
33
What are the symptoms of pheochromocytoma? how is it dx?
Paroxysms of HA, flushing, sweating, palpitations, and fluctuating BP * Dx: elevated urinary vanilyl mandelic acid (VMA) * A metabolite of catecholamines
34
What is Hypertensive emergency? HOw is it tx?
Diastolic \>130; Situation that requires RAPID (within 1 hour) lowering of BP Increased risk of target organ damage Tx: Nitroprusside sodium IV or IV esmolol
35
What is Hypertensive urgency? How is it tx?
Should be corrected within 24 hours of presentation Systolic \>180, Diastolic \>120 Not associated with target organ damage--\>main diff between urgency and emergency Tx: Oral clonidine
36
What is malignant HTN and how is it tx?
Life threatning secondary to elevated BP resulting in Grade IV hypertensive retinopathy, **papilledema**, cardiovascular or renal compromise and **encephalopathy** \>220/140 TOC: **IV nitroprusside** if HTN encephalopathy; oral **labetolol** if papilledema without encephalopathy Papilledema indicates End organ damage!
37
How do you screen for Abdominal Aortic aneurysm? How do you monitor? How do you dx thoracic aneurysms?
AAA--\>US for screening; MOnitor changes with CT scan\ Thoracic: CT with contrast, Aortography
38
How do you treat Aortic aneurysms?
Tx: Monitor with periodic US if \<5 cm AAA\> 5.5 cm or undergone rapid expansion (\>5 mm in 6 months)--\>Surgery
39
How do you distinguish Stanford A aortic dissections from Standford B dissections?
* Standford A--Ascending Aorta * Tx: Surgical emergency! IV Labetolol and IV nitroprusside * stanford B--\>Distal to Left subclavian * Treat with beta blocker and conservative tx * Followed by serial CT scans every 6 months
40
What are the sxs of Aortic dissection? How do you dx?
Severe chest/flank/back pain-described as "tearing, ripping, or sharp" Presence of unexplained syncope in male pt \>60 y/o should raise possibility PE: variation in BP \>20 mmHg difference between arms Dx: TEE (unstable) or thoracic MRI (stable) CXR: widened mediastinum with enlarged aortic knob
41
What is Giant cell Arteritis? Sxs?
50% also have polymyalgia rheumatica (PMR) Sxs: acute onset of HA, jaw pain, exacerbated by chewing, monocular blindness, visual abnormalities (Amaurosis fugax) PE: enlarged temporal artery, pulseless
42
What is the gold standard of dx Giant cell arteritis? What is the tx?
Gold standard: Superficial temporal artery Bx Elevated ESR (90%) Complication: Blindness seconary to occlusion of central retinal artery Tx: high dose prednisone (60 mg/day) and low dose ASA
43
What is the medical tx and pt ed for peripheral artery dz?
Cilostazol (phophodiesterase Inhibitors): Increases claudication distance by 40-60% Walking recommended because it increases angiogenesis
44
What is the difference in ulcers in Chronic venous insufficiency and Chronic arterial insufficiency?
Chronic venous insufficiency: Painless ulcers most commonly located at the medial malleolus; pigmentation Chronic arterial insufficiency: Painful "punched out" ulcers on pale, necrotic base; Intermittent claudication more common
45
What are the values of Ankle-brachial index?
* 1.0 normal, \<0.9 indicates dz * \<1.0 chronic occlusive dz * \<0.7 claudication * \<0.3 pain at rest
46
How do you treat a coronary artery spasm?
Calcium channel blockers (Nifedipine)
47
What are the different classes of Heart failure?
1. Class I: Asymptomatic 2. Class II: Symptomatic with angina with exertion, but no paint at rest 3. Class III: Symptomatic with minimal exertion (ordinary activities cause angina or pain) 4. class IV: Symptomatic at rest
48
What is the most common cardiomyopathy?
Dilated cardiomyopathy
49
What is dilated cardiomyopathy? what is the most common cause?
Impaired contractability; systolic dysfunction Most common cause: chronic alcohol abuse
50
What are the signs of dilated cardiomyopathy? dx? How do you tx?
Signs of LEFT congestive heart failure, S3 gallop Systolic dysfunction and LV dilations are essential for dx dx: Transthoracic Echo Treat CHF; abstinence from alcohol is essential
51
Who does Tako Tsbuo cardiomyopathy commonly affect? What is seen on Echo?
Commonly seen in postmenopausal women after a major discharge of catecholamines ECHO: Left ventricle apical ballooning
52
What is Hypertrophic cardiomyopathy (HOCM)?
Massive hypertrophy of the septum; Impaired relaxation of LV (impaired diastolic filling--\>pulmonary congestion) Most common cause of sudden death in young athletes; exclusively genetic
53
Hypertrophic cardiomyopathy: what are the common signs? How is it dx?
PE: systolic murmur that increases with valsalva maneuver, decreses with squatting (only other murmur that does this besides MVP); JVP with A wave Dx: Echo-interventricular septal hypertrophy CXR- boot shaped heart; ECG: **Long QT syndrome** is the first sign in children; Abnormal Deep Narrow Qs
54
How is HOCM tx?
First line: Beta blockers Second line: CCB May eventually need ablation of hypertrophic septum, or dual chamber pacing
55
What is restrictive Cardiomyopathy? what is the most common cause?
Impaired diastolic filling; Impaired Elasticity Fibrosis--\>stiffness and inabiity of chambers to fill Most common cause: Amyloidosis
56
What are teh s/S of restrictive cardiomyopathy? What is the key to diagnosing restrictive cardiomyopathy? Tx?
sxs of Right sided heart failure Echo is key to diagnosis: Small thickened LV may need endomyocardial biopsy Tx: diuretics
57
What is a common SE from ACE inhibitors?
Angioedema
58
Distinguish the sxs of RHF from LHF
* RHF: Elevated JVP and ankle edema; Dependent edema, hepatomegaly * LHF: Dry cough, exertional dyspnea, Hypotension, perivascular and interstitial edeam, 3-pillow orthopnea, S3 heart sound
59
What are the most common C/I of exercise stress test?
* Aortic stenosis * Unstable angina
60
What are common causes of heart block?
* Hyperkalemia * Lyme dz * MI * Lithium
61
What is first degree AV block?
ECG: prolonged PR\>0.2 seconds, Constant Asymptomatic, no Tx necessary
62
What is Wenckebach AV block?
second degree AV block--Mobitz II ECG: PR intervals progressively lengthen until skipped QRS Tx: no tx unless symtomatic bradycardia--\>pacemaker
63
What is a Mobitz II heart block?
Secondary AV block ECG: randomly skipped QRS without change in PR interval Tx: Permanent dual chamber pacemaker insertion
64
What is a third degree block?
Complete block Occurs when atria and ventricles are controlled by different pacemakers ECG: no relationship btwn P waves and QRS Ventrical rate (QRS) slower than atrial rate (P waves) Tx: Ventricular pacemaker (initially a temporary pacemaker can be inserted until a permanent one can be implanted
65
What is Wolff-Parkinson-White syndrome (WPW)? what drugs are C/I?
Young males, palpitations, SOB, lightheadedness ECG: delta wave in LEad II; Short PR interval Tx: Radiofrequency ablation C/I: digoxin and CCB
66
Who is Paroxysmal supraventricular tachycardia commonly seen in? How is it tx?
Young patients with healthy hearts Tx: DOC: IV adenosine Recurrent episodes: Radiofrequency ablation Prevention: betablocker or verapamil, or diltiazem
67
What is seen in both RBBB and LBBB
Prolonged QRS duration (\>.12 sec)
68
What does this show?
Right BBB
69
What is this?
Left BBB
70
What is the most common cause of sudden cardiac death?
V. fib
71
What is this? How is it treated?
V. Fib totally erratic tracing, no P waves or QRS Tx: CPR, immediate cardioversion
72
What is this? How is it treated?
* V. Tach * 3+ PVCs in a row * Regular, wide QRS complexes independent of P waves * Dx: Holter monitor * Tx: **Electrical cardioversion** follwed by antiarrhythmic meds (**Flecainide**)--\>Can quickly deteriorate to V fib. * To prevent recurrent VT: **Sotalol** and **Amiodarone**
73
What can cause Torsades de Pointes?
Can occur spontaneously, with hypokalemia or hypomagnesemia, or drug induced Drugs: TCA, erythromycin, haloperidol, Ibutilide
74
How do you tx Torsades de Pointes?
Magnesium, beta blockers
75
What is the most common chronic arrhythmia?
A fib
76
What is this? How do you treat?
A. fib * Synchronized cardioversion * A min INR of 1.8 (x 3 weeks) is rec. before cardioversion * Anticoagulate with warfarin * Betablocker and Amiodarone should also be used
77
What it is this? How is it tx?
Atrial Flutter Rate control with CCB, BB Long term tx: amiodarone
78
Most common cyanotic congenital Heart disease? what are it's characteristics?
Tetralogy of Fallot * (P.O.S.H) * Pulmonary stenosis, Overriding Aorta, Septal defect (VSD), RVH * R to left shunt * crescendo-decrescendo holosystolic
79
What are TET spells and were are they seen?
Hypercyanotic episodes, seen with Tetralogy of Fallet A medical emergency followed by syncope
80
What is the most common congenital heart disease?
Ventricular Septal Defect (VSD) Harsh, holosystolic murmur; no murmur at birth but appears a few weeks later L to R shunt
81
What is the most common type of Atrial septal defect?
Ostium Secundum
82
What is an important characteristic of ASD? ECG finding? What does the patient need to know about changing altitudes?
Wide Fixed Split S2 ECG: RAD More susceptible to O2 desaturation at high altitudes and decompression sickness during deep sea diving
83
What is the characteristic murmur for PDA? How is it treated?
Continuous, rough, machinery pansystolic murmur Tx: Indomethacin is routinely adminstered to help close a PDA
84
WHat is the main PE finding found with Coarctation of the Aorta?
HTN in the UE and normal or low BP in the LE Weak femoral pulses, exaggerated radial pulses Seen in Turner's syndrome CXR: rib notching and cardiomegaly ECG: LVH
85
What is Mitral stenosis?
Mid-diastolic murmur with an opening snap heard best at apex Echo: Fish mouth Jugular A wave
86
What is mitral regurgitation?
Blowing holosystolic murmur
87
What is the murmur of MVP?
Mid to late systolic murmur; midsystolic click Increased with standing/valsalva Decreased with squatting Thin females with minor chest wall deformities
88
What is the murmur of Aortic stenosis?
* Harsh, midsystolic decrescendo crescendo * Right sternal border, radiates to neck * Narrow pulse pressures * +thready carotids, + thrill * Increases with leaning forward
89
What is Aortic Regurgitation?
* blowing decrescendo diastolic murmur * Widened pulse pressures; Bounding "water hammer" pulses * Chronic: Austin flint murmur * Increases with leaning forward * Tx: Nitroprusside
90
What is the most common Valve disorder of the elderly?
Aortic stenosis
91
What is orthostatic hypotension?
drop in systolic BP (of at least 20 mmhg or \>10 mmHg of diastolic) immediately upon arising from the sitting to standing position If rise in pulse is \>15 bpm: Depleted volume is most likely cause
92
How does Hypercalcemia and hypocalcemia show on ECG?
Hypercalcemia: Shortend QT Hypocalcemia: prolonged QT "Too much too soon, too little too late"
93
What is this?
RVH R wave\>Swave in V1
94
What is this?
Left Ventricular Hypertrophy S wave in V1 + R wave in V5=More than 35 mm
95
What BP meds are best for AA?
CCB or Thiazides ACE Inhibitors tend to not be effective, and AA have higher risk for Angioedema

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