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Flashcards in Cardiology Deck (126)
1

... is a diastolic decrescendo murmur heard best at the LLSB

aortic regurgitation

2

.... is a triphasic scratchy sound on cardiac auscultation

Pericardial friction rub

3

.... murmur is a pansystolic (holosystolic) murmur obscuring S1 and S2 sounds that is heard best at the apex and radiates to the axilla

mitral regurgitation

4

..... is a decrease of blood pressure of greater than 10 mmHg on inspiration

Pulsus Paradoxus

5

..... murmur is a harsh crescendo-decrescendo systolic murmur best heard at 2nd right intercostal space and radiates to the carotid arteries.

aortic stenosis

6

...... is an increase in jugulovenous pressure (JVP) on inhalation.

Kussmaul sign

(normal decreases b/c inhalation causes blood to be pulled into heart)

7

...... is bounding of jugulovenous wave bouncing up to neck because atrial contraction against closed tricuspid valve

Cannon A waves
(associated with RV infarction and third degree AV block)

8

...... murmur is an opening snap followed by a low-pitched diastolic rumble heard best with patient in lateral decubitus position

mitral stenosis

9

What is periodical splitting of S2 and what does is signify?

P2 before A2

LBBB, HTN, aortic stenosis, LVH

(left ventricular contraction time increases)

10

What results in widening of S2 splitting (A2 before P2)?

RBBB, pulmonary HTN, pulmonic stenosis, RVH

11

What is the only cardiac abnormality that results in fixed in splitting of S2?

Atrial septal defect

12

A pt present with substernal chest pressure/ heaviness, with normal EKG and normal CIPs most likely suffer from ...

Unstable Angina

13

A pt presenting with substernal chest pressure/heaviness, with normal EKG but elevated CIPs most likely suffers from ....

Non-ST elevation MI (NSTEMI)

14

What are features of unstable angina and NSTEMI that suggests progression to STEMI? (5)
(need catherterization)

1. repetitive/ prolonged pain
2. elevated CIPs
3. persistent EKG changes
4. Hemodynamically unstable
5. Sustained V-tach
6. syncope
7. LVEF < 40%
8. prior CABG/ PCI
9. diabetes
10. chronic renal disase

15

What is treatment for unstable angina?

1. aspirin
2. beta blocker
3. heparin
4. nitrates, morphine, oxygen (don't lower mortality)

16

What is treament for NSTEMI?

1. aspirin
2. beta blocker
3. heparin
4. nitrates, morphine, oxygen (don't lower mortality)
5. statin

17

What is treatment for STEMI?

1. tPA (w/in 30 mins)
2. aspirin
3. beta blockers
4. nitrates, morphine, oxygen (don't lower mortality)
5. statin

18

What does an S4 suggest?

atrial systole into stiff left ventricle

(LVH)

19

What does an S3 suggest?

atrial systole into filled ventricle

(CHF)

20

What is the best initial test for chest pain?

EKG

21

What leads represent inferior wall MI?

leads II, III, and avf
(right coronary artery)

22

What is the preferred markers for diagnosis of myocardial injury?

troponins (T and I)

23

A pt presents with pleuritic chest pain with chest wall tenderness in which palpation of chest wall reproduces chest pain most likely suffers from ...

Musculoskeletal chest pain

24

A pt presenting with epigastric pain worse 3 hours after eating most likely suffers from ...

peptic ulcer disease

25

What leads represent anterior wall MI?

V2-V4
(left anterior descending artery)

26

What leads represent lateral wall MI?

I, aVL, V4-V6
(left anterior descending artery)

27

What leads represent septal wall MI?

V1-V3
(left anterior descending)

28

A pt presents with pleuritic, sharp chest pain that is worse with lying down and relieved by sitting up most likely suffers from ...

pericarditis
(diffuse ST elevations; chest pain is positional and pleuritic)

29

A pt presents with sharp tearing chest pain that radiates to back between the scapula most likely suffers from ...

dissecting aortic aneursym

30

What are contraindications for tPA use in STEMI? (7)

1. recent surgery
2. bleeding
3. hypertension (>180/100)
4. suspected aortic dissection
5. hx of hemorrhagic stroke
6. head trauma
7. ischemic stroke w/in 3 months

31

A pt (young female) presents with transient chest pain with midsystolic click murmur most likely suffers from ...

Mitral Valve Prolapse

32

A pt presents with sudden onset of chest pain and SOB with tracheal deviation on CXR and decreased breath sounds most likely suffers from ...

pneumothorax

33

Which thormbolytic should not be given repeated?

streptokinase (b/c provokes allergic reaction)

34

What are modifiable risk factors of ischemic heart disease?

1. LDL
2. smoking
3. HTN
4. inactivity
5. obesity
6. diabetes

35

What is the next best step in the management of a patient with classic ischemic cardiac symptoms that are chronic with a normal EKG?

Stress test (detect ST depression > 2mm suggest inducible ischemia)

36

What are requirements of pt that are going to undergo exercise stress test?

reach 85% max heart (220-age)

37

If stress test post MI is positive, what is the next best step in management?

catherization

(if negative, treat with medical treatment)

38

What treatment are patients with acute coronary sent home on?

1. aspirin
2. plavix
3. beta blocker
4. ACE inhibitors (stop at 6 weeks if EF normal)
5. statins (stop if LDL low)
6. nitrates (pain)

39

What are contraindications to exercise stress test?

1. active symptoms
2. cant exercise (then do pharmacologic stress test)
3. baseline abnormality (do nuclear stress test)

40

When should a pt have a CABG rather than angioplasty for treatment of reversible ischemia?

1. 3 vessel disease
2. left main disease
3. 2 vessel disease in diabetic

41

How do you differentiate septal wall rupture compared to mitral valve rupture prior to echo?

septal has step up increase in saturation when going from right atrium to right ventricle

42

What is the treatment for Dressler syndrome? (pericarditis post MI)

1. asprin and NSAIDs
2. steroids

43

A pt with chest pain at rest with ST segment elevation but the stress test and angiogram are normal most likely suffers from ...

Prinzmetal Angina

44

What is the most accurate test for Prinzmetal Angina?

ergonovine (triggers spasm) on angiogram

45

What is the most common cause of death post MI?

V-tach or V-fib

46

What is the treatment for right ventricular infarction?

fluids

47

What is treatment for Prinzmetal angina?

calcium channel blockers or nitrates

48

What percent of cardiac output is based on atrial contribution?

10-20% in normal pt
(increased if heart condition)

49

A pt presents with tachypnea, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue and weakness most likely suggests ...

congestive heart failure

(pulmonary rales, peripheral edema, ascites, JVD, displaced apical impulse)

50

What is class 1 heart failure?

no limitations of activity; no symptoms from ordinary activities

51

What is class 2 heart failure?

mild limitation of activity; no symptoms at rest or w/ mild exertion

52

What is class 3 heart failure?

marked limitation of activity; no symptoms at rest

53

What is class 4 heart failure?

confined to bed/chair; symptoms at rest

54

A chest x-ray showing cardiomegaly, vascular redistribution, kerley B-lines, and interstitial edema suggests...

Pulmonary edema secondary to ventricular dysfunction (CHF)

55

How is BNP used for diagnosis of cause of dyspnea?

if normal, excludes congestive heart failure

if elevated, suggests congestive heart failure

56

What is treatment of systolic CHF?

1. diuretics (furosemide)
2. beta blocker (metoprolol, carvedilol)
3. ACE inhibitors
4. spironolactone
5. Digoxin

57

What are the effects of potassium on digoxin?

hyperkalemia: deceased digoxin activity

hypokalemia: increased digoxin activity

58

What are the most common side effects of digoxin toxicity?

1. GI (most common)
2. hyperkalemia
3. gynecomastia
4. blurry vision w/ yellow halos
5. arrhythmias

59

What is used for digoxin toxicity involving CNS symptoms or arrhythmias?

stop digoxin and give digiband

60

What is treatment of diastolic heart failure?

1. correct underlying disease
2. diuretics (symptom relief)
3. beta blockers/ calcium channel blockers (slow heart to increase filling)

61

When should a patient receive an automatic implantable cardioverter/defibrillator (AICD)?

pt with dilated cardiomyopathy with ejection fraction< 35%

62

When should a patient receive a biventricular pacemaker?

pt with dilated cardiomyopathy with QRS wider than 120 ms

63

What is the most common cause of mitral stenosis?

rheumatic fever
(immigrant, pregnant pt)

64

What is the treatment for mitral stenosis?

1. preload reduction (Na reduction and diuretics)
2. balloon valvulotomy (in pt who remains symptomatic despite medical therapy)

65

What are common complications of mitral stenosis? (4)

1. systemic embolism (due to stagnate blood in enlarged LA)
2. hoarsenss (dilated LA compressing recurrent laryngeal nerve)
3. dysphagia (dilated LA compressing esophagus)
4. a-fib

66

What happens to opening snap of mitral stenosis when the stenosis gets worse?

opening snap happens earlier

67

What are the signs of large left atrium?

1. straightening of left heart border
2. elevation of left mainstem bronchus

68

When should surgery be performed for mitral regurgitation?

1. symptoms persistent despite optimal meds
2. EF < 60%
3. LV ESD > 40 mm

69

What is the best inital test for valvular disease?

ECHO

70

What is the most accurate test for valvular disease?

Catheterization

71

What is the medical treatment for mitral regurgitation?

arteriolar vasodilators (ACE inhibitors, ARBs, hydralazine)

72

What are the symptoms of mitral valve prolapse? (4 P's)

1. pain
2. palpitations
3. panic attacks
4. passing out

(in young women)

73

... is a mid systolic click and late systolic murmur at apex that worsens with valsalva/ standing and improves with squatting/ leg raise

Mitral Valve Prolapse

74

What are the hemodynamic effects of valsalva and standing?

decrease return to heart

left sided murmurs: decreased

(except for MVP and HOCM which increase)

75

What is the hemodynamic effect of squatting and leg raise?

increase return to heart

left sided murmurs: increased

(except for MVP and HOCM which decreases)

76

What are the causes of aortic stenosis? (3)

1. calcification in aging
2. bicuspid aortic valve (young onset)
3. rheumatic

77

What is the treatment for aortic stenosis?

1. valve replacement
2. balloon valvuloplasty (if pt too ill for surgery)

78

What is the most common presentation of aortic stenosis? What is the worse presentation of aortic stenosis?

angina; CHF

79

When should a pt undergo surgery for aortic regurgitation?

1. ejection fraction < 55%
2. left ventricular end systolic diameter > 55mm

80

What is Duroziez sign and what is it associated with?

systolic or diastolic thrill/murmur heard over the femoral arteries; aortic regurgitation

81

What is the best medical treatment for aortic regurgitation?

vasodilators (ACE inhibitors, ARBs, nifedipine)

82

What is the medical treatment for hypertrophic obstructive cardiomyopathy?

Beta blockers

83

What is the medical treatment for mitral valve prolapse?

Beta blockers

84

What is the hemodynamic effect of handgrip on the heart?

increases afterload

regurgitations: increases murmur

stenosis: decreases murmur

85

What is the most common cause of hypertrophic cardiomyopathy?

hypertension

86

What is the hemodynamic effect of amyl nitrate on the heart?

decreases afterload

regurgitations: decreases murmur

stenosis: increases murmur

87

What are the 2 most common causes of dilated cardiomyopathy?

1. ischemic heart disease
2. alcoholics

(peripartum, doxorubicin, chagas disease)

88

What is the treatment for dilated cardiomyopathy?

1. ACE inhibitors
2. beta blockers
3. spironolactone

4. diuretics, digoxin

(like systolic HF)

89

A young pt presents with SOB and syncopal episodes while participating in athletic event most likely suffers from ...

hypertrophic obstructive cardiomyopathy (LV size smaller --> need increased fluid to prevent outflow blockages)

90

What is treatment for hypertrophic obstructive cardiomyopathy?

1.beta blockers or calcium channel blockers (increase filling)
2. septoplasty (surgery if severe)

91

What are causes of restrictive cardiomyopathy?
(systolic & diastolic)

1. sarcoidosis
2. amyloidosis
3. hemochromatosis
4. cancer
5. fibrosis (scleroderma, radiation)

92

An EKG showing diffuse ST segment elevation with PR segment depression is suggestive of ...

Pericarditis

93

What are the 2 diseases that are associated with kussmaul sign?

1. restrictive cardiomyopathy
2. constrictive pericarditis

94

What is treatment for pericarditis?

1. NSAIDs
2. steroids

95

What is the treatment for pericardial effusion?

fluid aspiration

96

.... is a life threatening condition in which a pericardial effusion has developed so rapidly or become so large that it compresses heart

Cardiac tamponade

97

A pt presents with pulsus paradoxus, JVD, hypotension and decreased/ muffled heart sounds most likely suffers from ...

Cardiac tamponade

98

What is the most accurate diagnosis for cardiac tamponade?

cardiac catheterization shows equal left and right atrial pressures

99

What is the treatment for cardiac tamponade?

1. pericardiocentesis (followed by pericardial window)
2. subxiphoid surgical drainage

100

What can be seen on EKG in the setting of cardiac tamponade?

electrical alternans (small complexes alternating with large complexes)

101

A pt presenting with exertional dyspnea, pericardial knock, signs/ symptoms of right heart failure, kussmaul sign, distant heart sounds most likely suffers from ...

Constrictive pericarditis

102

What is the most accurate diagnostic test for constrictive pericarditis?

Chest CT/MRI show thickened/ calcified pericardium

103

What is the treatment for constrictive pericarditis?

pericardiectomy (remove pericardium)

104

What is the treatment for symptomatic sinus bradycardia?

1. atropine (acute)
2. pacemaker (chronic)

105

.... is constant, prolonged PR interval (>.2 sec)

First Degree AV block
(no tx)

106

... is progressively prolongation of PR interval until dropped ventricular beat

Second Degree AV block type 1 (Wenckebach)

(no tx)

107

.... is normal PR interval or fixed prolonged PR interval associated with dropped ventricular beat

Second Degree AV block type 2 (Mobitz)

108

What is treatment for second degree AV block type 2 (Mobitz) and why do we treat?

pacemaker; prevent progression to third degree AV block

109

.... is atrial and ventricular beating separately without correlation

Third degree AV block

110

What is treatment for symptomatic third AV block (Adams-Stoke attacks -> sudden loss of consciousness)?

1. atropine (acute)
2. pacemaker

111

What is the treatment for supraventricular tachycardia?

1. carotid sinus massage (increase vagal tone)
2. adenosine/ verapamil
3. synchronized external conversion (if unstable)

112

... is an EKG with 3 different P waves from beat to beat followed by normal QRS

Multifocal atrial tachycardia

113

What disease is associated with multifocal atrial tachycardia?

COPD (chronic lung disease)

114

... is characterized as saw-tooth wave on EKG in which atrial rate is 250-300 and ventricular rate is (125-150) resulting in 2:1 or 3:1 ration

Atrial flutter

115

What is the treatment for multifocal atrial tachycardia?

1. diltiazem/ verapamil
2. digoxin

(avoid beta blockers)

116

... is characterized by no P-wave and irregularly irregular ventricular contraction on EKG

atrial fibrillation

117

What is the treatment for atrial flutter?

1. beta blockers
2. calcium channel blockers
3. digoxin

118

What characterizes unstable arrhythmia?

1. confusion
2. chest pain
3. SOB
4. hypertension
(synchronized cardioversion is all but )

119

What is CHADS score and what is it used for?

score system to determine stroke risk in pts with a-fib and need for anticoagulation
CHF (1)
HTN (1)
Age > 75 y/o (1)
Diabetes (1)
Stroke/TIA prior (2)
if 0: no tx
if 1: aspirin or warfarin
if 2 or more: warfarin

120

What is treatment for a-fib?

rate control
1. beta blocker
2. calcium channel blockers
3. digoxin

(rhythm conversion:
amiodarone)

121

What should you do before synchronized cardioversion in a pt with a-fib?

anticoagulation to be sure not to dislodge clot when shocked

122

... is characterized by short PR interval and delta wave (slurred initial deflection of QRS) on EKG

Wolff Parkison White Syndrome
(aberrant electrical pathway around AV node)

123

What is treatment for WPW?

1. radiofrequency catheterization ablation (long-term)
2. synchronized cardioversion (unstable)
3. procainamide (stable)

124

What is treatment for pulseless V-tach and V-fib?

asynchronized cardioversion

125

What tests should be done in pt on amiodarone?

1. PFTs
2. LFTs
3. TFTs (thyroid)

126

What are common side effects of amiodarone?

1. pulmonary fibrosis
2. blue-gray discoloration of skin
3. blurry vision with halo
4. hypothyroid
5. hepatotoxicity