Cardiology Flashcards by lionel varela

TIP- AGE OF WOMEN WHERE RISK OF CAD IS EQUAL TO MEN

TIP-CAD RISK FACTORS

TIP-CAD RISK FACTORS WITH HIGHEST RATES

TIP- CAD RISK FACTORS FAMILY HAS TO BE HOW CLOSE AND HOW YOUNG

TIP- CAD RISK FACTORS-HYPERLIPIDEMIA ESPECIALLY WHAT LIPID?

TIP- CAD LESS OF A RISK FACTOR/S… MORE ENVIRONMENTAL

TIP- CAD RISK PREVENTION MOST BENIFICIAL

TIP- AKO-TSUBO CARDIOMYOPATHY MECH. AND
TREATMENT

TIP- HOW MUCH DOES SMOKE QUITING REDUCE RISK?

55-60 YEARS

DIABETES, HYPERTENSION, TOBACCO, HYPERLIPIDEMIA, FAMILY HISTORY, AGE MEN 45 WOMEN 55

HYPERTENSION>DIABETES (IS WORSE)

FIRST DEGREE RELATIVES SIBLING AND PARENTS AND AGE=MEN

LDL

PHYSICAL ACTIVITY, ALCOHOL, LOW FRUIT AND VEG., EMOTIONAL STRESS, CARDIAC CT SCAN HIGH IN CA, PET

EXERCISE

CATECHOLAMINE DISCHARGE CAUSES BALLOONING, TREAT AS MI BETA BLOCKERS AND ACE INH.

1 YEAR = 50%, 2 YEARS =90%

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DIAGNOSIS- DULL/SORE/SQUEEZING /PRESSURE-LIKE CHEST PAIN ONGOING/INTERMITTENT

TIP-SHARP/PIN-LIKE/LAST SECONDS PAIN AND CHANGES W/RESPIRATION,POSITION,TOUCH

ISCHEMIC HEART OR CAD

NON ISCHEMIC 95% OF THE TIME

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DIAGNOSIS-CHEST PAIN W/CHEST WALL TENDERNESS

ACC. TEST-

CHOSTOCHONDIRITIS

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DIAGNOSIS-CHEST PAIN W/RADIATION TO BACK UNEQUAL BLOOD PRESSURE BETWEEN ARMS

ACC. TEST-

AORTIC DISSECTION

CHEST X-RAY WITH WIDENED MEDIASTINUM, CHEST CT, MRI, OR TEE CONFIRMS THE DIESEASE

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DIAGNOSIS- PAIN WORSE WITH LYING FLAT BETTER WHEN SITTING UP, YOUNG <40

ACC. TEST-

PERICARDITIS

ELECTROCARDIOGRAM WITH ST ELEVATION EVERYWHERE, PR DEPRESSION

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DIAGNOSIS- EPIGASTRIC DISCOMFORT PAIN BETTER WHEN EATING

ACC. TEST-

DOUDENAL ULCER

ENDOSCOPY

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DIAGNOSIS- BAD TASTE, COUGH, HOARSENESS

ACC. TEST-

GERD

RESPONSE TO PPI, ALUMINUM HYDROXIDE AND MG OH, VISCOUS LIDOCAINE

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DIAGNOSIS-COUGH, SPUTUM, HEMOPTYSIS

ACC. TEST-

PNEUMONIA

CXR

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DIAGNOSIS-SUDDEN ONSET, SHORTNESS OF BREATH, TACHYCARDIA, HYPOXIA

ACC. TEST-

PULMONARY EMBOLUS

SPIRAL CT, V/Q SCAN

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DIAGNOSIS- SHARP, PLEURITIC PIN, TRACHEAL DEVIATION

ACC. TEST-

PNEUMOTHORAX

CXR

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INITIAL TEST- CHEST PAIN OFFICE SETTING DAYS TO WEEKS
INITIAL TEST-CHEST PAIN ER SETTING HOURS
INITIAL TEST- CHEST PAIN WITH EKG NORMAL
TIP- ETT TWO FACTORS TO PERFORM
TIP- MAXIMUM HR FOR EXERCISE AND MIN FOR CARDIO
TIP-ETT CANNOT READ EKG
TIP-EKG BASELINE CANNOT BE READ BECAUSE OF?

EKG

EKG THEN ENZYMES (TROPONIN, CK-MB)

STRESS TEST (ETT)

READ A EKG, PATIENT CAN EXERCISE

220-AGE, 85% IS MIN. FOR CARDIO

NUCLEAR ISOTOPE: THALLIUM OR SESTAMIBI, OR ECO OF WALL MOTION

BUNDLE BRANCH BLOCK, LEFT VENTRICULAR HYPERTORPHY, PACEMAKER USE, OR DIGOXIN USE

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TIP-HOW DOES THALLIUM TEST WORK?
TIP- ISCHEMIA VS INFARCTION
TIP-ETT CANNOT EXERCISE
INITIAL TEST- CHEST PAIN + POSITIVE EKG AND ENZYMES FOR CAD
TIP- PURPOSE OF ANGIOGRAPH
ACC. TEST- CAD
TIP- STENSOSIS 50% IS?
TIP-STENSOSIS >70% IS?

TAKEN UP LIKE K+ AND READ FOR WALL MOTION

INFARCTION IS IRREVERSABLE SLOW/NO WALL MOTION OF AREA SEEN ON THALLIUM TEST

DIPYRIDAMOLE OR ADENOSINE + NUC. ISOTOPES THALLIUM OR SESTAMIBI/ DOBUTAMINE + ECO WALL MOT. ABNORMALITIES

ANGIOGRAPHY

DETERMINE SURGERY OR ANIOPLASTY (PCI)

ANGIOGRAPHY

IRRELAVENT

RELAVENT

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INITIAL TEST- IRREGULAR EKG BUT NOT ISCHEMIC OR CAD
INITIAL TREAT- CHRONIC CAD
IT/TIP- SUBLINGUAL, PASTE AND IV NITROGLYCERIN ARE FOR?

HOLTER

ASPIRIN, BETA BLOCKERS, NITROGLYCERIN

ACS

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IT/TIP-CAD=CLOPIDOGREL IS USED IN?
IT/TIP- CAD=PRASUGREL WHEN TO USE AND SIDEFFECTS?
IT/TIP-CAD=TICLOPIDINE WHEN TO USE AND SIDE EFFECTS?
IT/TIP-CAD=RANOLAZINE WHEN TO USE AND SIDE EFFECTS?
IT/TIP- CAD/CHF=ACE INHIBITORS/ANGIOTENSIN RECEPTOR BLOCKERS USE AND SIDE EFFECTS?
IT/TIP- CAD/CHF=LOW EF ON ACE INHIBITOR WITH HYPERKALEMIA SWITCH TO?

ASPIRIN INTOLERANCE (ALLERGY) AND RECENT

ANGIOPLASTY WITH STENTING

ANDIOPLASTY AND STENTING, HEMORRHAGIC STROKE IN AGES 75 AND OLDER

ASPIRIN AND CLOPIDOGREL INTOLERANCE (ALLERGY), NEUTROPENIA AND TTP

IF ALL OTHERS FAIL

LOW EF AND REGURGITANT VALVULAR DISEASE, COUGH AND HYPERKALEMIA

HYDRALAZINE AND NITRATES

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P. ASS.- CAD
IT/TIP-CAD=STATINS WHEN TO USE AND SIDE EFFECTS?
TIP-CAD= OTHER LIPID LOWERING DRUGS NOT PROVEN TO DECREASE MORTALITY ALONE BUT HELP STATINS MORE
TIP-CAD=NIACIN SIDE EFFECTS
TIP-CAD=FIBRATES SIDE EFFECTS

CHF, LIPID ATHEROSCLEROSIS, HYPERTENSION

HI LDL (ENDOTHELIAL ANTIOXIDANT), LIVER DYSFUNCTION>RHABDOMYOLYSIS AND RISK OF DIABETES 9%

NIACIN, GEMFIBROZIL, CHOLESTYRAMINE, EZETIMIBE

ELEVATION IN GLUCOSE AND URIC ACID LEVEL, PRURITUS, FLUSH

INCREASE STATIN SIDE EFFECTS IF USED TOGETHER + GALL STONES

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TIP-CAD/HYPERTENSION= CALCIUM CHANNEL BLOCKERS
TIP-CAD/HYPERTENSION= TRUE OR FALSE DIHYDROPYRINDINE INCREASE MORTALITY
TIP-CAD/HYPERTENSION= DIHYDROPYRINDINE SIDE EFFECTS
TIP-CAD/HYPERTENSION=WHEN TO USE CCB
TIP-CAD/REVASCULARIZATION= WHEN TO TREAT WITH BY PASS (CABG)

DIHYDROPYRIDINE: NIFEDIPINE, NITENDIPINE,
NICARDIPINE AND NIMODIPINE

TRUE

REFLEX TACHYCARDIA, EDEMA, CONSTIPATION, HEART BLOCK

CANNOT USE BETA BLOCKERS-ASTHMA, PRINZMETAL VARIANT ANGINA, COCAINE USE

THREE VESSELS >70% OCL. LEFT MAIN OCL., TWO VESSELS >70% IN DIABETICS, RECURRENT EVENTS

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TIP-CAD/REVASCULARIZATION= PCI WITH 5YR DURATION AND 10YR DURATION
DIAGNOSIS- CULL/SORE/SQUIIZING /PRESSURELIKE CHEST PAIN ACUTE (HOURS)
DIAGNOSIS-ACS=S4

SAPHENOUS AND INTERNAL MAMMARY

ACS

HYPERTENSION>DIABETES (IS WORSE)

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DIAGNOSIS- >10MMHG SYSTOLIC DROP (DECREASE) WITH INHALATION
DIAGNOSIS-INCREASED JVD ON INHALATION
DIAGNOSIS-TRIPHASIC SCRATCHY SOUND ON AUSCULTATION
DIAGNOSIS- MAXIMAL IMPULSE DISPLACED TO AXILLA (PMI)

P.PARADOX=TAMPONADE

KUSSMAUL SIGN=CONSTRICTIVE PERICARDITIS OR RESTRICTIVE CARDIOMYOPATHY

PERICARDIAL FRICTION RUB (DRESSLER)

LVH OR DIALATED CARDIOMYOPATHY

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P.ASS.- V2 TO V4 ST ELEVATION PROGNOSIS
P.ASS.- II, III, AND AVF LEADS ST ELEVATION
P.ASS.-V1-V2 ST ELEVATION
P.ASS.- RBBB

WORST PROGNOSIS LEFT ANTERIOR WALL (IF UNTREATED MORTALITY 30-40%)
LEFT INFERIOR WALL (IF UNTREATED MORTALITY 5%)
POSTERIOR WALL INFARCTION (READ OPPOSITE)
BENIGN COMPARED TO LEFT

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INITIAL TREAT- ACS
INITIAL TREAT-PVC PREMATURE VENTRICULAR COMPLEXES OR FIRST DEG. AV BLOCK
IT/TIP- IN ACS THINK FIRST ________ THEN ___________ WITH TIME.

MONA-ASPIRIN THEN ANGIOPLASTY ONLY DECREASES MORTALITY WITH TIME CONSTRAINT

NOTHING

DOES IT LOWER MORTALITY THEN MOST IMPORTANT TO DO FIRST

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INITIAL TEST- ACS IMMEDIATELY
INITIAL TEST-ACS 1-4 HOURS
INITIAL TEST- ACS 4-6 HRS AND WHAT LIMITATION???????REALLY
INITIAL TEST- ACS 4-6 HRS MORE ACC. AND WHAT TWO LIMITATIONS?????

EKG

MYOGLOBIN LASTS 1-2DAYS

CK-MB LASTS 1-2DAYS (CHECK FOR REINFARCT AFTER 2 DAYS)

TROPONIN LASTS 10-14DAYS (FALSE POSITIVE WITH KIDNEY INSUFFICIENCY AND CANNOT DETECT REINFARCT)

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DIAGNOSIS- NORMAL ECG ONLY TROPONIN ELEVATED AND HX OF MI OR ANGINA
P.ASS.- MOST COMMON CAUSE OF DEATH WITH MI
INITIAL TREAT- VT OR VF
BEST TREAT- ACS =ANGIOPLASTY VS THROMBOLYTICS

NSTEMI

VT OR VF

CARDIOVERSION OR DEFIBRILLATION

ANGIOPLASTY

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TIP-ACS= ANGIOPLASTY BETTER B.C.
TIP-ACS=ANGIOPLASTY DOOR TIME
P.ASS.- PCI COMPLICATIONS

MORTALITY BENEFIT, FEWER HEMORRHAGIC EVENTS, FEWER MI COMPLICATIONS

BALLOON= 90 MIN

RUPTURE, RESTENOSIS (THROMB.), HEMATOMA AT ENTRY

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TIP- MOST IMPORTANT TO DECREASE RESTENOSIS IN PCI
TIP- V&W ANTI-THROMBI
TIP- 4 CONTRAINDICATION FOR THROMBOLITIC TREATMENT IN ACS
TIP- THROMBOLIC ASC DOOR TIME

DRUG ELUTING STENT (PACLITAXEL AND SIROLIMUS)
DECREASE FROM 40 TO 10%

VIENS ANTI THROMBI IS WARFARIN

BLEEDING, RECENT SURGERY(2 WKS), SEVER HYPERTENSION, STROKE IN LAST 6 MONTHS

NEEDLE = 30MIN

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INITIAL TREAT- AFTER ACS THROMBOLICS, ST DEPRESSION OR NSTEMI/ANGINA INITIAL TREAT- AFTER ACS NSTEMI AND PCI AND STENTING

HEPARIN (DECREASES MORTALITY UNDER THESE EVENTS) GII/III INHIBITORS

P.ASS.- BRADYCARDIA, CANON A WAVES | P.ASS. COMPLICATION: BRADYCARDIA (SINUS), HYPOTENSION WITH NITROGLYCERIN

3RD DEG. AV BLOCK RIGHT VENTRICAL MI

INITIAL TREAT- BRADYCARDIA P.ASS.- COMPLICATION: TACHYCARDIA, CLEAR LUNGS, ST ELEVATION AS RIGHT (FLIP EKG) RV4 INITIAL TREAT- INFERIOR WALL MI P.ASS.- COMPLICATION: DAYS AFTER MI, SUDDEN LOSS OF PULSE, LUNGS CLEAR

ATROPINE AND PACEMAKER CHRONIC NEW INFERIOR WALL MI HIGH VOL. FLUID REPLACEMENT, AVOID NITROGLYCERIN (WORSEN CARDIAC FILLING FREE WALL RUPTURE AND TAMPONADE

INITIAL TEST- FREE WALL RUPTURE AND TAMPONADE INITIAL TREAT- TAMPONADE P.ASS.- COMPLICATION V TACHYCARDIA OR V FIBRILLATION INITIAL TREAT- VTACH OR VFIB

ECHO PERICARDIOCENTESIS AND SURGERY MI CARDIOVERION/ DEFIB

P.ASS.- NAME 6 MI COMPLICATION | ACC. TEST- VALVE/SEPTAL RUPTURE

BRADY/TACHYCARDIA, WALL RUPTURE/TAMP, VTACH/FIB, VALVE/SEPTAL RUPTURE, BIGGER INFARCT/REINFARCTION, ANEURYSM/MURAL THROMBUS ECHO

DIAGNOSIS- POST MI STEP UP SATURATION OF O2 FROM R. ATRIUM TO R. VENTRICAL DIAGNOSIS- POST MI PULMONARY CONG. AND MITRAL REGURG. MURMUR INITIAL TREAT- POST MI STRUCTURE COMPLICATION PENDING TO BE FIXED SURGERY

SEPTAL RUPTURE VALVE RUPTURE INTRAAORTIC BALLOON PUMP IABP

DIAGNOSIS- POST MI BUMPUP IN CK-MBS ON DAY 2 + PULMONARY EDEMA INITIAL TEST-

REINFARCT EKG + CK-MB BUMP UP

TIP- MI DISCHARGE MUST DO? BEST TREAT- GO HOME POST MI TIP- NEVER A PROPHYLACTIC IN MI IT/TIP- BETA BLOCKER SIDE EFFECT?

DETECTION OF PERSISTENT ISCHEMIA=STRESS TEST, IF (+) NEW ANGIOGRAGHY ASPIRIN, BETA BLOCKERS, STATINS, ACE INHIBITORS( ANTERIOR WALL MI/ LOW EF) ANTIARRHYTHMIC ERECTILE DISFUNCTION

TIP- HOW LONG BEFORE POST MI SEX? | TIP- HOW LONG BEFORE POST MI EXERCISE?

WHEN SYMPTOM FREE (SEX DOES NOT LAST ENOUGH TO INCREASE OXYGEN DEMAND ON HEART) WHEN SYMPTOM FREE (STRESS TEST MUST BE TOLERATED)

DIAGNOSIS 2 OF 2- DYSPNEA/PULMONARY EDEMA, S3, HX OF CARDIOMYOPATH(HYPERTENSION)/MI/VALVE DISEASE

CHF

TIP- MOST COMMON CAUSES OF CHF? TIP- OTHER CAUSES OF CHF- TRACT PHAP TIP- TYPES OF CHF AND KEY FEATURES

CARDIOMYOPATHY(HYPERTENSION)/MI/VALVE DISEASE THIROID, RADIATION, ALCOHOL, CHAGAS, THIAMINE-- PERIPARTUM, HEMOCHROMATOSIS ADRIAMYACIN, POST VIRAL SYSTOLIC DYSFUNCTION AND EVENTUAL LOW EF, DIASTOLIC DYSFUNCTION AND INABILITY TO RELAX/ HIGH TO NORMAL EF

DIAGNOSIS 1 OF 2- ORTHOPNEA, PAROXYSMAL NOCTURNAL DYSPNEA, S3 GALLOP, PERIPHERAL EDEMA*, RALES, JVD DIAGNOSIS- DYSPNEA, SUDDEN ONSET, CLEAR LUNGS DIAGNOSIS- DYSPNEA, SUDDEN ONSET, WHEEZING, INCREASED EXPIRATORY PHASE DIAGNOSIS- DYSPNEA, SLOWER, FEVER, SPUTUM, UNILATERAL, RALES/RHONCHI

CHF PULMONARY EMBOLUS ASTHMA PNEUMONIA

DIAGNOSIS-DYSPNEA, DECREASED BREATH SOUNDS UNILATERALLY, TRACHIAL DEVIATION DIAGNOSIS-DYSPNEA, CIRCUMORAL NUMBNESS ECAFFEINE USE, HISTORY OF ANXIETY DIAGNOSIS-DYSPNEA, PALLOR GRADUAL OVER DAYS TO WEEKS DIAGNOSIS-DYSPNEA,PULSUS PARADOXUX, DECREASED HEART SOUNDS, JVD

PHEUMOTHORAX PANIC ATTACK ANEMIA TAMPONADE

DIAGNOSIS-DYSPNEA,PALPIATIONS, SYNCOPE DIAGNOSIS- DYSPNEA,DULLNESS TO PERCUSSION AT BASES DIAGNOSIS- DYSPNEA,LONG SOMOKING HISTORY, BERREL CHEST DIAGNOSIS- DYSPNEA, RECENT ANESTHETIC USE, BROWN BLOOD NOT IMPROVED WITH OXYGEN, CLEAR LUNGS ON AUSCULTAITION, CYANOSIS

ARRHYTHMIAS PLEURAL EFFUSION COPD METHEMOGLOBINEMIA

DIAGNOSIS- DYSPNEA, BURNING BUILDING OR CAR, WOOD BURNING IN WINTER, SUICIDE ATTEMPT TIP- THREE SYMPTOMS + DYSPNEA THAT EQUAL CHF

CO POISION S3, ORTHOPNEA, PND

INITIAL TEST- CHF | ACC. TEST- CHF

TRANSTHORACIC ECHO + EF MULTIPLE GATED ACQUISITION SCAN (MUGA) OR NUCLEAR VENTRICULOGRAPHY

ACC. TEST- VALVE PATHOLOGY INITIAL TEST- CHEMO/ CONTROL OF DOXORUBICIN FOR CARDIOMYAPATHY INITIAL TEST- CHF CAUSE WITH MI, HEART BLOCK INITIAL TEST- CHF CAUSE WITH DILATED CARDIOMYOPATHY

TEE VENTRICULOGRAPHY EKG CHEST X-RAY

INITIAL TEST- CHF CAUSE WITH PAROXYSMAL ARRHYTHMIAS INITIAL TEST- CHF CAUSE WITH PERCISE VALVE DIAMETERS, SEPTAL DEFECTS INITIAL TEST- CHF CAUSE WITH ANEMIA INITIAL TEST CHF CAUSE WITH HIGH AND LOW THYROID LEVELS

HOLTER CARDIAC CATHETERIZATION CBC TST/T4

INITIAL TEST- CHF CAUSE WITH EXCLUDES INFILTRATIVE DISEASE SUCH AS SARCOID OR AMYLOID WHEN OTHER SITES FOR BIOPSY IS MOST ACCURATE TEST FOR SOME INFECTIONS INITIAL TEST- CHF CAUSE WITH DISTINGUISHES FROM ARDS

ENDOMYOCARDIAL BIOPSY SWAN-GANZ RIGHT HEART CATH

INITIAL TREAT- 5 TYPES OF PHARM FOR LOW EF CHF INITIAL TREAT- 3 TYPES OF PROCEEDURE TREATMENT FOR CHF INITIAL TREAT- CHF DIASTOLIC DYSFUNCTION NORMAL/HIGH EF NON-HOCM INITIAL TREAT- CHF DIASTOLIC DYSFUNCTION NORMAL/HIGH EF HOCM

ACE INH., BETA BLOCKERS(ONLY METROPOLOL,BISOPROLOL, CARVEDILOL), SPIRANOLACTONE (ONLY CHF III/IV NON-DIURETIC EFFECT), DIURETICS (LOOPS), DIGOXIN (ONLY HELPS WITH SYMPTOMS) IMPLANTABLE DEFIBRILLATOR (EF

DIAGNOSIS- DYSPNEA+RALES,JVD,S3,EDEMA ORTHOPNEA, ACITES

P.EDEMA FULL CHF

INITIAL TEST- P. EDEMA | INITIAL TREAT- ACUTE P.EDEMA/ TEMP. AND SEC. CHOICE FOR ACUTE/ CHRONIC P.EDEMA ADD?

BNP,CXR,OXIMETRY, EKG,ECHO PRELOAD REDUCTION: (O2,DIURETIC,MORPHINE, NITRATES)/ INOTROPE: DOBUTAMINE/ AFTERLOAD RED.: ACE INH

TIP- MURMURS: INCREASE LOUDNESS WITH INSPIRATION/CVR TIP-MURMURS: INCREASE LOUDNESS WITH EXPIRATION/ INITIAL TEST- VALVE DIESEASE ACC. TEST-VALVE DIESEASE

RIGHT SIDE OF HEART VALVES LEFT SIDE OF HEART VALVES TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO) CATHETERIZATION

INITIAL TREAT- VALVE DIESEASE TIP- INCREASE LOUDNESS LEAN FORWARD OR LEFT DECUBITUS POSSITION (WITH BELL) TIP- HOLOSYSTOLIC MURMUR RADIATS TO AXILA TIP-IF END-SYSTOLIC DIAMETER EXPANDS? >40MM

DIURETICS (ALL CAUSE LUNG FLUID OVERLOAD), STENOSIS=NO PHARM(BALLOON (MS), SURGICAL(AS)),REGURG:VASODILATOR(ACE INH, NIFEDIPINE,HYDRALAZINE)+SURG. DIASTOLIC MURMUR MITRAL REGURGITATION REPLACE REGURG VALVE

TIP-COMMON ETIOLOGY OF MITRAL STENOSIS AND 1 OTHER/ COMMON AGE TIP-MS CRITICAL NARROWING IS VALVE AREA OF? P.ASS.-DYSPHAGIA, HOARSENESS, ATRIAL FIBRILLATION, HEMOPTYSIS,EKG(V1,2): BIPHASIC P WAVE TIP- NAME AND DESCRIBE TWO DIASTOLIC MURMURS AND CHARACTORISTIC

RHEUMATIC FEVER, PREGNANCY INDUCED CARDIOMYOPATHY/ YOUNG ADULT IMMIGRANT PATIENTS 1CM SQUARD MS MS/AR, OPEN SNAP/DECRESIENDO, HEARD BEST ON APPEX/HEARD BEST ON LOWER LEFT STERNAL B. AND INC. WITH HANDGRIP AND BETTER WITH VALSAVA AND STANDING

P.ASS.-CXR STRAIGHTENING OF THE LEFT HEART BORDER,ELEVATION OF THE LEFT MAIN STEM BRONCHUS,SECOND BUBBLE BEHID HEART P.ASS.-ANGINA,SYNCOPE,CHF, OLD OR CONGENITAL TIP- DESCRIBE AS MURMUR

MS AS HEARD BEST SECOND R. INTERCOSTAL AND RATIATES TO CAROTID, (VALSAVA, HANDGRIP AND STANDING IMPROVE)

P.ASS.- CXR RIGHT VENTRICULAR HYPERTROPHY, EKG: S WAVE IN V1 AND R WAVE IN V5 >35MM TIP- COMMON ETIOLOGY OF MITRAL REGURG TIP-DESCRIBE MR MURMUR TIP- MURMUR INCREASES WITH HANDGRIP

AS HYPERTENSION, MI OR DILATED HEART(CHF SYSTOLIC DYSFUNCTION), ENDOCARDITIS PAN/HOLOSYSTOLIC, RADIATES TO AXILLA HANDGRIP WORSENS AR AND MR

TIP- LEFT MURMUR THAT DOES NOT INCREASE WITH EXPIRATION | INITIAL TREAT- MR LVESD ABOVE 40MM OR EF

MVP OR HOCM SURGICAL VALVE REPAIR OR REPLACMENT AR

DIAGNOSIS- WIDE PULSE PRESSURE, WATER HUMMER PULSE, QUINCKE PULSE,HILL SIGN, HEAD BOBBING

TIP- DESCRIBE AR MURMUR | TIP- 2-5% HAVE WHAT ANATOMICAL VALVE?

DIASTOLIC DECRESIENDO MURMUR, HEARD BEST LOWER LEFT STERNAL BOARDER, INCREASES WITH HANDGRIP MVP

DIAGNOSIS- CHEST PAIN, PALPITATIONS, PANIC ATTACK, MURMUR: MIDSISTOLIC CLICK TIP- WHAT INCREASES AND DECREASES MVP SOUND?

MVP VALSALVA AND STANDING (DECREASE RETURN) AND HANDGRIP AND SQUAT (INCREASE PRE AND AFTERLOAD)

DIAGNOSIS- DYSPNEA, EDEMA, RALES, JVD, INITIAL TEST- CARDIOMYOPATHY INITIAL TREAT- CARDIOYOPATHY TIP- MURMURS THAT DO NOT INCREASE WITH EXPIRATION/MORE BLOOD

CARDIOMYOPATHY TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO) DIURETICS NEVER WITH HOCM HOCM AND MVP

P.ASS.- ALCOHOL, POSTVIRAL,TADIATION, TOXINS, CHAGAS | INITIAL TREAT- DILATED CARDIOMYOPATHY

DILATED CARDIOMYOPATHY SAME AS SYSTOLIC DYSFUNCTION CHF

DIAGNOSIS- YOUNG CHEST PAIN WITH EXERCISE, INC. HR, DEC. LEFT VENT. CHAMBER SIZE, LIKE AS TIP- WHAT DECREASES LEFT VENTRICULAR CHAMBER SIZE?

HOCM ACEI, ARB, DIGOXIN, HYDRALAZINE, VALSALVA, AND STANDING SUDDENLY

DIAGNOSIS- HYPERTENSION, S4 GALLOP, NO R. CHF SIGNS

HCM

INITIAL TREAT- HOCM OR HCM INITIAL TREAT- HOCM SPECIFIC TIP- PHARM QUANTITY FOR DILATED VS HYPERTROPHY CARDIOMYOPATHY TIP- ETIOLOGY OF RESTRICTIVE CARDIOMYOPATHY?

BETA BLOCKERS, NEG. INOTROPS, NEVER DIURETICS IN HOCM IMPLANT DEFIB AND ABLATION OF SEPTUM W/ CATH ALCOHOL INDUCED INFARCT OR MYOMECTOMY 5 VS 2 INFILTRATED MUSCLE CAUSES BOTH EFFECTS OF DILATED AND HYPERTROPHIED HEART DUE TO IMMOBILITY.

P.ASS.- SARCOIDOSIS, AMYLOID, HEMOCHROMATOSIS, ENDOMYOCARDIAL FIBROSIS, SCLERODERMA, EKG:LOW VOLTAGE DIAGNOSIS- DYSPNEA + R.CHF SIGNS, KUSSMAUL SIGN, PULMONARY HYPERTENSION

RESTRICTIVE CARDIOMYOPATHY | RESTRICTIVE CARDIOMYOPATHY

TIP- WHAT IS KUSSMAUL SIGN? | INITIAL TEST- RESTRICTIVE CARDIOMYOPATHY

INSPIRATION INCREASES JVD TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)

TIP- ECHO SPECKLING SEPTUM ACC. TEST- RESTRICTIVE CARDIOMYOPATHY TIP-STANDING AND VALSALVA

RESTRICTIVE CARDIOMYOPATHY ENDOMYOCARDIAL BIOPSY DECREASE BLOOD RETURN TO HEART

TIP- TRUE OR FALSE? STANDING AND VALSAVA = DIURETIC USE TIP- TRUE OR FALES? HANDGRIP = FULLER LEFT VENTRICLE TIP- TRUE OR FALSE? AMYL NITRATE=ACEi= EMPTIER LEFT VENTRICLE TIP-REGURG VALVE SOUNDS BEST FULLER AND ALL REST SOUND BEST EMPTY (L.VENTRICAL) TIP-PERICARDIAL DISEASE: CHRONIC FLUID LEADS TO FIBROSIS/CALCIFICATION= CONSTRICTIVE PERICARDITIS TIP-PERICARDIAL DISEASE: ACUTE LOTS OF FLUID LEADS TO TAMPONADE

TRUE

DIAGNOSIS- SHARP PAIN INCREASED INTENSITY WITH RESPIRATION AND POSITION(FLAT), EKG: ST ELEVATION AND PR DEPRESSION

PERICARDITIS

TIP- ETIOLOGY OF PERICARDITIS TIP- AMOUNT OF FLUID IN TAMPONADE INITIAL TEST- CARDIAC TAMPONADE

ANY INFLAMATION NEAR THE HEART: MAINLY VIRAL OR SYSTEMIC DISEASE 50ML TO 2000ML ECHO

DIAGNOSIS- EKG: ELECTRICAL ALTERNANS( DIFF. HIGHT QRS),CXR:GLOBULAR HEART,COLLAPSE DIASTOLIC R. ATRIAL AND VENT DIAGNOSIS- R. HEART CATHETER: EQUALIZATION OF PRESSURES IN DIASTOLE

TAMPONADE | TAMPONADE

INITIAL TREAT- TAMPONADE

PERICARDIOCENTESIS, IV FLUIDS AND WINDOW

DIAGNOSIS- R. HEART FAILURE SIGNS +CHRONIC INFLAMATORY DISEASE P.ASS.- KNOCK HEART SOUND AND KUSSMAUL SIGN INITIAL TEST- ACC. TEST- INITIAL TREAT-

CONSTRICTIVE PERICARDITIS CONSTRICTIVE PERICARDITIS CXR-SHOWS CALCIFICATION FIRST THEN CT/MRI THEN ECHO (TO RULE OUT MYOPATHY) CT AND MRI DIURETICS THEN SURGICAL REMOVAL

DIAGNOSIS- LEG PAIN IN CALVES ON EXERTION, LOSS:HAIR FOLLICLES, SWEAT GLANDS, SEBACEOUS GLANDS, SKIN SHINY TIP- PAIN WHEN WALKING UP HILL OR DOWN INITIAL TEST- INITIAL TREAT-

PAD PERIPHERAL ARTERY DISEASE PAD PERIPHERAL ARTERY DISEASE ANKLE-BRACHIAL INDEX (ABI) LESS THAN .90 IS + FOR DISEASE CONTROL CAUSE, ASPIRIN, STOP SMOKING, CILOSTAZOL THEN SURGERY IF ALL FAILS

DIAGNOSIS-PAIN IN BETWEEN SCAPULAE AND BP DIFF. BETWEEN ARMS INITIAL TEST- AORTIC DISSECTION ACC. TEST- AORTIC DISSECTION INITIAL TREAT- AORTIC DISSECTION

AORTIC DISSECTION CXR- WIDE MEDIASINUM ANGIOGRAM CONTROL BP: BETA BLOCKERS, NITROPRUSSIDE, SURGICAL CORRECTION TIP- ACCURACY IS MRA=CTA=TEE

DIAGNOSIS- BACK PAIN, PULSADING ABDOMIN

AORTIC ANEURYSM

TIP- SCREENING TEST FOR AORTIC ANEURISM AND WHO TIP- WHEN TO SURGICALLY/CATHETER REPAIR AORTIC ANEURYSM? TIP- WORST CARDIAC DISEASE IN PREGNANT WOMEN AND TREAT

ULTRASOUND AND SMOKERS OVER 65YEARS OVER 5CM IN DIAMETER PERIPARTUM CARDIOMYOPATHY TX: LIKE DILATED CHF, THEN EISENMENGER SX. FROM VSD

Cardiology Flashcards

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