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Flashcards in Cardiology Deck (186)
1

Opening snap w/ low pitched diastolic rumble or w/ expiration

Mitral stenosis --> AFIB

2

Most common valve abnormality in RF?

Mitral stenosis --> LA dilation --> AFIB

3

Rheumatic fever, diastolic rumble at apex, AFIB, PND, orthopnea, SOB from CHF, thin cachectic person

Mitral stenosis --> medical management, balloon valvotomy or replace b4 CHF

4

Mid-systolic click w/ Short systolic murmur over apex, dec w/ squatting, 5-10sec chest pain

MVP = myxomatous degeneration

5

High pitched, holosystolic blowing murmur at apex --> axilla, PMI displaced inferolaterally

Mitral regurgitation

6

Endocarditis or infarct, holosystolic murmur at apex

Mitral regurgitation --> replace

7

Inc w/ handgrip

MR (AS dec) & VSD & MVP (but NOT HOCM)

8

Holosystolic murmur INC w/ squatting

VSD

9

Calcification, old men, CP, syncope or CHF, crescendo-decrescendo systolic murmur

Aortic stenosis --> replace w/ gradient >50mmHg

10

Ejection click --> harsh, mid-systolic C-D, radiates to carotids

Aortic stenosis

11

D/T Infection, infarct, dissection, blowing decrescendo, widened pulse pressure, bounding pulse, head bob

Aortic regurg --> replace at 1st LV dilation w/ possible CABG

12

Pounding, racing heart, worse when supine or on left side, 150/55mmHg

Aortic regurg - widened pulse pressure, water hammer pulses

13

Blowing diastolic murmur at LSB, inc/ leaning forward w/ held expiration

Aortic regurg

14

Fixed splitting of 2nd heart sound

ASD

15

Young black male, C-D murmur LLSB, inc w/ valsalva murmur type and mitral valve abnormality

HOCM & systolic anterior motion (SAM) of mitral valve (valsalva dec VR)

16

CP worse w/ exertion, better w/ rest, nitrates

STEMI, Trops w/ NSTEMI, only w/ stress test --> Cath

17

Cath: 1 vessel = stent + plavix, 3+ or includes LAD = CABG

Internal mammary for LAD, saphenous for all other vessels

18

Suspect re-infarct after previous CABG + MI, what enzymes?

CK-MB and myglobin, trops will remain high

19

PCWP after CABG 0-3; >20

More IVFs; ventricular failure

20

T-wave inversion, new RBBB, RVH/strain, acute dyspnea, CP

PE

21

Pulselessness, paresthesia, pallor, pain, paralysis of right hand

AFIB --> limb ischemia = vascular surgery

22

Torsades Tx

Mag sulfate

23

Peaked T waves, long PR, QRS

HyperK --> Ca-gluconate, B2 agonists, insulin, Nabicarb

24

Terminate SVT

Adenosine

25

Narrow complex tach, no P or buried in QRS or inverted

SVT ---> Vagal or Adenosine

26

Young women, tachy b/w 160-220, no heart diease, cold water immersion helps

PSVT = Inc AV node re-entry/conductivity --> vagal & adenosine slow conduction

27

Dig toxicity arrhythmia

Atrial tachy w/ AV block (150-250)

28

Narrow complex tachy, BP 60/30 tx?

DC cardioversion

29

Pulmonary disease arrhythmia

Multifocal atrial tachy

30

Wide complex tachy tx

Amiodarone or Lidocaine

31

Wide complex tachy + 2 fusion beats or AV dissociation

Sustained monomorphic VT ---> IV amiodarone

32

Tx of AFIB in unstable pt (common after CABG)

DC cardioversion

33

#1 ectopic foci for AFIB

Pulmonary veins

34

Tx PEA

Compressions ---> Epi q 3-5min

35

Premature atrial beats next step?

Observation - d/t anxiety, caffeine, CHF, electrolytes (BMP)

36

AFIB/flutter drug

Digoxin

37

Tx symptomatic bradycardia

IV atropine ---> TCP ---> pacemaker

38

Pt w/ WPW and new onset AFIB tx?

Cardioversion or anti-arrhythmic Procainamide

39

New onset AFIB next step?

Check TSH

40

Bradycardia with wide QRS "sine-wave" pattern, hyperK tx?

Calcium gluconate (faster than Kayexelate)

41

Hyperthyroidism, thyroxine induced arrhythmia

Sinus tach, PSVT, Atrial Fib

42

F/C, LUQ pain, fluid in spleen

Infective endocarditis (L) w/ septic emboli to spleen

43

Small petechiae on palate, murmur, microscopic hematuria, 1+ proteinuria

Endocarditis ---> TEE ---> vanco

44

1st step in infective endocarditis

3 blood cultures --> antibiotics, imaging

45

Holosystolic murmur inc w/ inspiration, IVDU

Endocarditis --> Vanco

46

Retrosternal CP worse w/ inspiration, better leaning forward, PR depression, MI 2 weeks ago

Pericarditis = Dressler syndrome (following MI) --> NSAIDs

47

Causes of pericarditis

Viral, SLE, uremia

48

DOE, edema, ascities, pericardial knock, calcified pericardium, prominent x and y waves

Constrictive pericarditis - TB, viral, surgery, radiation

49

Chest pain w/ BUN >60

Uremic pericarditis ---> dialysis

50

Young person, no cardiac risk factors develops CHF sx = cause?

Myocarditis = Coxsackie B virus

51

Runny nose, congestion, RDS, fever, cardiomegaly CXR

Myocarditis = coxsackie B, adeno --> Bx --> diuretics

52

Sore throat, fever, pericarditis, chorea, subcutaneous nodules, arthritis

Rheumatic fever - GAS infection --> PCN G

53

New murmur, low diastolic rumble, 1 yr ago sore throat + arthralgia

Endocarditis --> IM benzathine PCN every 4wks

54

Endocarditis prophylaxis

5yrs or 21 (w/o carditis); 10yrs or 21 (w/ carditis); 10yrs or 40 (w/ valve disease)

55

S/P CABG day 3, pain, fever, leukocytosis, rapid AFIB, cloudy wound drainage, pericardial fluid

Acute mediastinitis --> drain, surgical debridement + abx; AFIB resolves w/in 24hrs

56

Sudden painful, pale, poikothermic, pulseless, paresthetic paralytic LE, AFIB

Arterial embolization --> doppler --> clot bust or embolectomty w/ Fogarty if complete

57

Tearing chest pain to back, unequal pulses, wide mediastinum

TAA --> EKG, troponins, CT --> surgery

58

Diseases assoc w/ aortic aneurysms

Behcet, Takayasu, Giant cell, anklylosing, RA, psoriatic and reactive arthritis

59

Complication of giant cell arteritis

Aortic aneurysm

60

Atherosclerosis, >65 man smoker, pulsatile mass

AAA --> US or CT --> if (+) repeat q6mo

61

Indications for AAA surgery

>5.5cm, expanding >0.5-1cm/yr OR symptmatic/tender/new back pain = immediate

62

#1 risk for expanding AAA

Smoking (Lower w/ DM, statins)

63

POD 1 from AAA, abd pain, bloody diarrhea, tenderness, fever, leukocytosis, intact pulses

Ischemia of bowel

64

Claudication of arm, dizziness, loss of balance

Subclavian steal syndrome --> duplex scan

65

Stridor, crowing resp w/ hyperextension, tracheal compression on bronch

Vascular rings

66

Causes of persistent pulm HTN

Perinatal ASPHYXIA, meconium aspiration --> O2

67

#1 cause of secondary HTN, to-and-fro over CVA

Fibromuscular dysplasia

68

Soft palate injury --> stroke mechanism

Internal carotid artery dissection

69

Palpitations, SVT in healthy adolescent

WPW = accessory AV pathway --> sudden death

70

Congenital deafness, syncopal episodes, no confusion

Jarvell-Lange-Neilson syndrome = Congenital QT = Propanolol

71

Drug for familial HLD >2 y/o

Cholesteryl

72

Congenital heart block cause

Lupus

73

Timeframe for sildenafil and doxazosin dosing

4+ hr interval

74

Tachy, NV, HA, + antibiotic, COPD

Theophylline toxicity

75

Thickened ventricular walls, proteinuria, easily bruised

Amyloidosis

76

DOE, weakness, fatigue --> CP, hoarseness, syncope, edema

Pul HTN

77

Thiazides SEs

HyperGLUC, hypoK, Na

78

Insomnia, weight loss, fine tremor, AFIB tx?

Propanolol (Grave's disease)

79

Nosocomial UTI --> IE bug

Enterococci

80

Adjunct tx in MI w/ pulmonary edema

Furosemide

81

Indicator of the severity of CHF

NypoNa & H2O retention --> high renin, aldo, ADH, NE

82

Long-standing HTN, CHF, new PND, dyspnea - drug to relieve sx?

Nitro = dilates veins, red preload & diuretics

83

Old man, awakes at night to pee, fainted while peeing type of syncope?

Situational

84

Female, smoker, NOCTURNAL chest pain 15-20min, transient ST elevations

Prinzmetals angina = CCBs

85

Drugs that prolong QRS

1C (flecainide),

86

Post cardiac cath, intact pulses, blue toes, abd pain, inc Cr, low C3, WBC, eosinophilia

Cholesterol emboli

87

Cardiac cath + blue toes, vision loss ex cause?

Cholesterol embolization

88

Cardiac cath + hypotension, leg hematoma next steo?

CT abd, pelvis

89

Meds to hold 48 hrs b4 cardiac stress test?

BBs, CCBs and Nitrates - they reduce severity of ischemia during test

90

Drugs that improve mortality in CHF

BBs, ACE-I, Spironolactone

91

60 w/ cough, peeing, dizzy, N, sweating

Vasovagal syncope ---> tilt table test

92

Enlarged cardiac shadow, "water-bottle," recent URI, SOB, low voltage EKG, no palpable PMI

Pericardial effusion (malignancy, post-MI, uremia, auto-immune, hypothyroid)

93

4th heart sound

LVH

94

2 strong systolic peaks of aortic pulse w/ mid-systolic dip

Pulsus bisferins (Aortic regurg & HOCM)

95

Chemical stress test w/ dipyramidole mechanism?

Coronary steal - dilated normal vessels steal BF from narrow coronaries

96

CHF, 170/100, stiff left ventricle, EF 55%

Diastolic CHF --> LA dilation --> AFIB

97

Warfarin + weakness, dizziness, anemia, tachycardia, back pain

Suspect bleeding - retroperitoneal hematoma

98

3-7d post MI, new systolic murmur

IV wall rupture or papillary muscle rupture

99

3-7d post MI, tamponade, PEA

Ventricular free wall rupture

100

LAD MI, JVD, distant heart sounds, complication?

5d-2wks = free wall rutpure

101

V1-6 elevation MI

Anterior = LAD

102

II, III, aVF elevation MI

Inferior = RCA or LCX

103

V1-3 depression + I & aVL elevation MI

Posterior = LCX

104

V1-3 depression + I & aVL depression MI

Posterior = RCA

105

Cold leg, no distal pulse post-MI

MI --> stasis --> emboli = get ECHO

106

Cause of stroke w/ fluctuating sx, hx TIA, uncontrolled HTN, DM

Thrombotic (following a cath)

107

Cause of stroke w/ abrupt, maximal sx from start, hx of AFIB, endocarditis, bruits

Embolic

108

Pain, Pulselessness, poikolothermic, paresthesia, pale

Aterial thrombo/embolism --> US doppler, ateriogram --> 6hrs to fix embolectomy or tPA

109

Edema following limb ischemia revascularization, painful, tense

Compartment syndrome --> fasciotomy

110

S/P femoral embolectomy, AFIB + bleeding ulcer, calf swollen, tender, painful, pulses intact

Ischemia-reperfusion injury = compartment syndrome

111

Sudden transient loss of neuro fxn w/o HA

TIA = IC stenosis --> Duplex and surgery

112

Sudden neuro deficits w/o HA, >24hrs

Ischemic stroke --> CT + tPA w/in 3hrs

113

Sudden severe HA, HTN --> neuro deficits

Hemorrhagic stroke --> CT, control HTN

114

Ischemic stroke best Tx for neurological recovery

tPA w/in 3-4.5hrs w/ BP <185/110 - NOT shown to dec mortality

115

When can you start Warfarin after cardioembolic stroke?

2 weeks

116

When are aspirin and clopidogrel NOT ok w/ use of tPA

1st 24hrs after tPA is given

117

Stroke antiplatelet therapy to reduce risk of recurrence

Aspirin - give ASAP in 1st 24hrs (clopidogrel if ASA intolerant)

118

Stroke + already on aspirin --> tx?

Aspirin + dipyrimadole or clopidogrel

119

Stroke + AFIB --> tx?

LT anti-cogaluation (warfarin, dabigitran, rivaroxaban)

120

Cause of stroke w/ focal neuro, HA, N/V, brady, AMS, slow progression, HTN, drug use, coagulopathy

Intracranial hemorrhage

121

Cause of stroke w/ pure motor, pure sensory, mix, dysarthria w/ clumsy hand, no speech problems

Lacunar = HTN --> small vessel hyalinosis

122

UL motor, dysarthria, no sensory loss

Lacunar - posterior internal capsule

123

UL sensory loss of face, arm, leg, trunk

Lacunar - VPL of thalamus

124

> LE weakness + IL arm & leg incoordination

Lacunar - anterior internal capsule

125

Hand weakness, mild motor aphasia, no sensory loss

Lacunar - pontine base

126

C/L sensory & motor, eye deviation TO side, homonymous hemianopsia, aphasia, hemineglect

MCA

127

C/L LE sensory & motor, emotional, urinary incontinence, lack of will

ACA

128

C/L hemiplegia & IL CN involvement, ataxia

Vertebrobasilar

129

Occipital HA, gaze palsy, facial weakness

Cerebellar hemorrhage

130

Hemiparesis, sensory, Upgaze, non-reactive pinpoint, eye Toward lesion

Thalamus

131

#1 cause B/L LE swelling

Venous insufficiency

132

Tenderness + swelling DDx

DVT, lipidema

133

Pitting edema DDx

Venous, DVT, CHF, early lymphedema

134

Brown hemosiderin, dry dermatitis, skin ulceration Dx

Venous insufficiency

135

Warm tender moist skin Dx

Complex regional pain syndrome/reflex sympathetic dystrophy

136

S/P 2mo crush injury, burning, agonizing pain, cold, moist cyanotic extremity

Reflex sympathetic dystrophy (Causalgia) --> symp block dx + sympathectomy

137

Brawny induration, warty texture w/ papillomatosis, can't pinch skin of dorsum 2nd toe

Lymphedema (malignancy, surgery, infection)(Kaposi-Stemmer sign)

138

Edema + jaundice, spider hemangioma, ascites

Liver disease

139

Edema + JVD, lung crackles Dx

CHF

140

Labs if etiology unclear

CBC< BMP, albumin, UA, TSH, EKG, BNP, CXR, D-dimer, sleep study (pul HTN)

141

Morning weight gain >0.7kg Dx

Idiopahic edema - 65% recumbent, assoc w/ obesity, depression

142

Tumors assoc w/ edema

Prostate, ovarian, lymphoma = CT scan

143

Tx idiopathic edema

Intermittent laying, avoid heat, low Na, dec fluid intake, weight loss, spironolactone

144

Tx venous insufficiency

Compression socks, horse chestnut seed, loop diuretics ST use

145

Tx lymphedema

Exercise, elevation, pneumatic device, manual drainage, surgery, Abx for cellulitis

146

Tx DVT

LMWH or warfarin --> INR 2-3, IVC filter

147

Dermal edema secondary to inc CT/mucopolysaccharides

Myxedema = thyroid disease

148

JVP, hepatomegaly, ascities, edema, no pulmonary edema

R heart failure = Cor pulmonale - #1 is COPD > pul fibrosis,

149

Leg pain w/ walking, relieved by rest

Ateriosclerosis/Caludication --> stop smoking, exercise, Cilostazol

150

Disabling claudication work-up

Doppler --> sig pressure gradient --> angiogram --> angioplasty or bypass grafts

151

B/L hip, thigh, buttock pain w/ walking, smoker, poor LE pulses

Leriche syndrome/claudication --> impotence

152

Patient can't sleep d/t leg pain, better sitting and dangling legs --> pale --> purple, atophic skin

Claudication soon --> ulceration and gangrene

153

Peripheral vascular disease precipitant?

Smoking --> inc atherosclerosis

154

Atherosclerosis, smoking, calf pain w/ walking interferes w/ life

PAD --> ABI --> US doppler --> ateriogram

155

Calf pain at rest, scaly skin, shiny, no hair, purple and improve w/ legs down

PAD --> single lesion = angioplasty w/ stent or fem-fem or fem-pop bypass

156

ABI index

0.9-1.2 normal; 0.8-0.9 mild; 0.5-0.8 mod; <0.5 severe

157

PVD diffuse disease tx

Anti-platelets like clopidogrel + cilostazol --> amputation as last resort

158

Persistent HTN, inc Cr w/ ACE, recurrent pul edema, >55 y/o, abdominal bruit

Renovascular HTN

159

Persistent HTN, hypoK, hyperNa, aldo:renin >20:1

Primary hyperaldosteronism

160

Persistent HTN, inc urine cortisol, central obesity, proximal muscle weakness, ED

Cushing syndrome

161

Persistent HTN, rib-notcing, delayed femoral pulse, UL SBP > LL, machine murmur over back

Coarctation of aorta

162

CP radiating to back, severe HTN, early diastolic decrescendo murmur RSB, widened mediastinum

Aortic dissection ---> TEE, CT - cause = HTN

163

Asymmetric BP Left:Right, HTN, tall, long fingers, syphilis

Aortic dissection ---> CXR, CTA --> MRI, TEE, TTE

164

Tx ascending dissection = surgery, TEE for aortic replacement?

Tx descedning dissection = control BP

165

#1 risk factor for stroke

HTN

166

HTN cause w/ inc Cr, proteinuria, RBC casts

Renal parenchymal

167

HTN cause w/ pounding HA, tachy, diaphoresis

Pheo

168

HTN cause w/ kidney stones, hyper Ca, depression, fatigue, confusion, psychosis

Parathyroid - (80% adenoma)

169

Cyanosis, harsh systolic murmur, breathe fast after feeding

Tetrology of fallot --> knee-chest, O2--> surgery b4 6mo

170

Knee-to-chest mechanism

Inc systemic vascular resistance --> dec R-->L shunt

171

DiGeorge, tetrology, recurrent sinusitis, fever, morning HA + seizures cause?

Tetrology --> brain abscess

172

Left axis dev, absent R waves in precordium, peaked t-waves, cyanotic

Tricuspid valve atresia

173

Cyanotic at birth, PaO2 38 no improvement with 100% O2

Cyanotic heart defect --> PGE1 to maintain PDA

174

Cyanosis, NO MURMUR, loud single S2, no improvement with O2

Transposition --> PGE1 to maintain PDA

175

Cardiac vs. Resp cyanosis

100% O2, <10-15mmHg Inc PaO2 = tetrology, 15-20 = Truncus

176

#1 congenital heart defect

VSD --> L-->R = dyspnea HF

177

Dyspnea, holosystolic LLSB and at apex, FTT

VSD --> ECHO w/ bubble study OR surveillance as most close spontaneously

178

Split fixed S2, Hx frequent colds

ASD

179

Inc femoral pulses, continuous "machinery murmur"

PDA --> Indo "Ends"

180

Dec femoral pulses, murmur b/w scapulae

Coarctation

181

*COPD*, OSA --> DOE, syncope, tricuspid regurg, JVD, peripheral edema, hepatomegaly, ascities, distant heart sounds, RBBB, RVH, no pulmonary congestion

Cor pulmonale (RHF d/t pulm HTN)
- R heart cath --> pulm artery pressure >25
---> O2, diuretics

182

2months s/p MI --> DOE, fatigue, crackles, holosystolic murmur at apex --> axilla, unchanged ST elevation and deep Q waves on EKG

Ventricular aneurysm --> LVH --> MR

183

When to do dobutamine stress test

Underlying EKG abn, pacemaker
Physically unable

184

When to do exercise EKG stress test

Pt w/ exertional chest pain
1mm depression = +
2mm = severe

185

When to do stress ECHO

Valvular, HOCM, pulm HTN, EKG abn

186

When to do myocardial perfusion imaging

Active chest pain w/o EKG abn
Wall motion abn during echo