Cardiology Flashcards
(187 cards)
1
Q
Tx for cardiac tamponade
A
Massive volume resuscitation and emergent pericardiocentesis
2
Q
Should you suppress PVCs with antiarrhythmics?
A
No, this worsens survival.
3
Q
When to treat patients with PVCs
A
Only if they are symptomatic, don’t treat asymptomatic PVCs, even if they are regular.
4
Q
First line treatment for PVCs
A
Beta-blockers
5
Q
Second line tx for PVCs
A
Amiodarone
6
Q
Amiodarone?
A
Class III antiarrhythmic. K+ channel blocker. Lengthens QT interval. Useful for treating atrial arrhythmias mostly. Slows down sinus rhythm
7
Q
Digoxin treats arrhythmias?
A
Yes, a.fib and a.flutter
8
Q
Do PVCs affect prognosis.
A
They make it worse, but you don’t tx if no symptoms
9
Q
Lidocaine used to tx what
A
Ventricular arrhythmia (V.tach) with ACS
10
Q
Lidocaine poor side effect
A
PPx can increase risk of asystole
11
Q
Does lidocaine decrease risk of v.fib?
A
Yes, but increases asystole risk
12
Q
Radiographic imaging of Coarctation?
A
3 sign, proximal aortic dilation, constriction, and descending aorta dilatation
13
Q
Shape of ToF heart
A
Boot shaped
14
Q
Depressed CO + Elevated PCWP means
A
Left ventricular failure
15
Q
Signs of AV fistula
A
Shunting of blood leads to increased preload and CO. Leads to widened pulse pressure, strong arterial pulses, and tachycardia.
16
Q
AV fistula causes essentially
A
High Output Cardiac Failure
17
Q
Most common EKG finding with a.flutter
A
2:1 heart block, less often is 3:1, 4:1, 6:1
18
Q
Irregularly irregular rhythm
A
No discernible P waves, a. fib
19
Q
Neurogenic shock causes what to happen to the MVO2?
A
Decreased from increased oxygen extraction by hypoperfused tissues
20
Q
MVO2
A
Mixed venous oxygen concentration, why is it low in neurogenic shock?
21
Q
Septic shock presents with
A
Elevated CO, low SVR, RAP, and PCWP, and frequently normal Mixed Venous Oxygen Concentration
22
Q
OCPs and BP
A
Increase in some people, estrogen increases angiotensinogen production in liver.
23
Q
Common causes of amyloidosis
A
Multiple myeloma, RA.
24
Q
Amyloidosis signs
A
Proteinuria, decreased coag. factors from decreased production in liver. Restrictive cardiomyopathy with thickened ventricles and diastolic dysfunction.
25
Alcohol causes what CV problem
Dilated cardiomyopathy
26
Signs of hemochromatosis
Restrictive cardiomyopathy, pancreatic dysfunction, bronzed skin, and hepatomegaly
27
Sarcoid signs
Restrictive cardiomyopathy, bilar hilar adenopathy, erythema nodosum. No renal involvement typically.
28
Lasix effects
Diuretic and venodilation decreasing preload
29
Morphine CV effects
Preload reducer
30
Beta-blockers with Pulm. edema
Contraindicated
31
Digoxin and MI
Not used for acute CHF due to an MI
32
When to use antiarryhthmics like verapamil and amiodarone
???
33
Best test for AAA
Abd. u/s
34
Mitral valve prolapse signs
Mid-systolic click over cardiac apex and short systolic murmur if MR is present
35
Squatting does what to the heart
Increases preload
36
Squatting and MVP
Decreases the prolapse
37
What is mitral valve prolapse exactly?
.....
38
MVP signs
Atypical pain that lasts 5-10 seconds, anxiety, palps, and hyperventilation
39
Rheumatic heart disease sign
Mostly mitral stenosis, some mitral regurg.
40
Janeway lesions
Septic emboli in the fingertips
41
Infective endocarditis presentation
Progressive subacute fevers, chills, malaise, and dyspnea. Arthritis, fingtertip pain. Immune complex phenomena.
42
Post-strep glomerulonephritis signs
Sore throat/skin infection first, then edema, dark urine, and HTN. No arthritis and fingertip pain.
43
Most important step with cardiac arrest
Time to defibrillation
44
Orthostasis and prolonged recumbence
Increased risk of it
45
ARDS diagnostic criteria
Acute onset, bilateral patchy on CXR, PCWP<200
46
What is PaO2/FIO2<200
Pretty much means if your FIO2 is 100% (1) and your PaO2 isn't >200, then it's a sign that you aren't oxygenating very well at all.
47
Nifedipine and MI
Do not use in STEMI, b/c it vasodilates and causes reflex tachycardia which can worsen ischemia
48
Non-dihydropyridic CCBs like diltiazem and verapamil and STEMIs
Can be used after beta-blockers, but don't improve mortality
49
Difference between the CCBs
Dihydropyridine CCBs like amlodipine and difedipine have little action on the heart. Non-dihydropyridine CCBs like verapamil and diltiazem slow down cardiac conduction.
50
Drugs that can be used in STEMIs
Heparin, ACEIs, Beta-blockers, aspirin
51
Dihydropyridine CCBs and STEMIs
Such as nifedipine, worsen cardiac ischemia
52
Beta-blockers and STEMIs
Decrease oxygen demand of myocardium, prolong diastole (increasing coronary perfusion), reduce ventricular remodeling
53
Signs of Cushing's
HTN, hyperglycemia, hypoK, proximal muscle weakness, central adiposity, thinning of skin, weight gain, psychiatric problems (sleep, depression, psychosis)
54
Does hypothyroidism cause hyperglycemia, hypoK and HTN
No, but can cause weight gain, fatigue, bradycardia, depression, and skin/hair changes
55
Adrenal medulla produces
Catecholamines: weight loss, tachycardia, HTN, diaphoresis, anxiety
56
Amiodarone and lungs
Don't use in lung disease. Causes pulm. toxicity: chronic interstitial pneumonitis, organizing pneumonia, and ARDS
57
Things to slow down ventricular rate
Verapamil, digoxin, quinidine
58
Beta-blockers and lung diseases
Don't use in obstructive like asthma or COPD, but can use for restrictive
59
Mitral stenosis problems
L atrial dilation, a.fib., cardiac emboli. Can cause dyspnea, cough, and hemoptysis from increased pressure in lungs
60
Beta-blockers and cocaine-vasoconstriction
They worsen the vasoconstriction...how???
61
Beta-blockers and alpha-agonists??
????
62
First line drugs for cocaine ischemia
Benzos, nitrates, aspirin
63
Exertional syncope think of
V.tach, L vent. outflow obstruction (Aortic stenosis/HOCM)
64
Pulsus paradoxus is
Exaggerated decrease (>10 mmHg) in systemic arterial BP with inspiration. Seen in cardiac tamponade.
65
Capillary pulsations are sign of
Aortic regurg.
66
Mitral stenosis sounds
Late diastolic murmurs and opening snap
67
How to get a narrow Ventricular tachycardia
???
68
Lidocaine used for
Vent. arrhythmias
69
How does digoxin help a.fib
Rate control
70
How to distinguish syncope from seizure
Confusion only occurs after seizures
71
Risk factors for dissection
Bicuspid aortic valve, coarctation of aorta, and Marfan's syndrome
72
First step in treating Aortic dissection with HTN
Antihypertensive management
73
What murmurs decrease with greater preload?
HOCM and what else....
74
HOCM genetics
Aut. Dom.
75
Ventricular free wall rupture
Happens usually 3-7 days following an MI, leads to PEA from pericardial tamponade
76
Always associate the cardiac findings with the murmur you'd expect to hear
....
77
HOCM murmur
LLSB interestingly...
78
Papillary muscle rupture causes quick decompensation?
Nope
79
Things to hold prior to stress testing
Anti-ischemic meds, digoxin, and meds that slow the heart (beta, blockers)
80
When to start ACEIs
In diabetics and patients with reduced LV systolic function...
81
Why ACEIs in diabetics??
....
82
LIfestyle changes for HTN
Lose weight, reduce salt, avoid excess alcohol, stop smoking
83
Pleuritic chest pain in PE
From pulm. infarction irritating the pleura
84
What causes orthostasis in old people
Decreased baroreceptor sensitivity
85
Hypoglycemia and heart rate
Can cause bradycardia, I though it can also cause tachycardia??
86
Treating bradycardia
If symptomatic, use IV atropine, decreases vagal input
87
IV adenosine causes what
Temporary AV block
88
Amiodarone uses
Antiarrhythmic in supraventricular and ventricular tachys, don't use in brady
89
Transcutaneous pacing use
Used after atropine to increase heart rate
90
What causes inferior wall MIs
Right coronary artery or L circumflex. Mostly R coronary (5:1)
91
LAD occlusion causes what
Anterior wall myocardial infarction
92
Acute inferior wall infarction
Right coronary, especially if there is R ventricular infarction.
93
Polycystic kidney disease signs
HTN, hematuria, bilateral flank masses.
94
Primary hyperaldosteronism lab finding
Elevated aldosterone to renin ratio
95
Can you palpate adrenal masses?
Almost never
96
Captopril renal scan
Diagnoses renal artery stenosis
97
Polycystic kidney disease genetics
Aut. dom.
98
Polycystic kidney disease association
Intracerebral aneurysms
99
Oslers nodes/Janeway lesions
Osler nodes are painful bumps that turn red-purple in the fingers and toes. janeway lesions are painless hemorrhages in the palms and soles.
100
Coronary steal
dipyridamole causes blood flow redistribution to nondiseased vessels in stress test
101
Phamacological stress test drugs
Adenosine, dipyridamole, or dobutamine
102
Positive stress test
chest pain, st depression, hypotension, or significant arrhythmias
103
What reduces mortality from MI
ASA, beta-blockers, and ACEI
104
STEMI tx
cath lab for PTCA or CABG!
105
CK-MB lasts for
Peaks in 24 hrs and lasts 2-3 days, good for recurrence
106
Troponin I lasts for
Peaks in 24 hrs and lasts 1-2 weeks, most specific
107
Dressler syndrome
Post-pericardiotomy pericarditis or postMI pericarditis. Treat with colchicine.
108
Prinzmetal (variant) angina
Happens at night, inducible by IV ergonovine, women.
109
When to add digoxin to HF
Class IV HF
110
adenosine toxicity
HA, flushing, nausea, SOB, chest pressure
111
Nitrate toxicity
HA, orthostasis, tolerance, syncope
112
Digoxin toxicity
atrial tachycardia with AV block
113
rate control for afib
Ca-blockers
114
MCC of Multifocal atrial tachycardia
End-stage COPD
115
Tx for torsades
IV mag sulfate
116
Tx for sustained Vtach
IV amiodarone
117
Mobitz type 2 tx
Pacemaker (can convert to third degree w/o tx)
118
Causes of dilated CM
MI (MCC), infx, alcohol, doxorubicin (adriamycin), etc.
119
HOCM genetics
Aut. Dom. few sporadic
120
Causes of Restrictive cardiomyopathy
CASHES: carcinoid, amyloid, sarcoid, hemochromatosis, endocardial fibroelastosis, scleroderma
121
Myocarditis presentation
Fever, CP, pericarditis
122
Myocarditis tests
Increased cardiac enzymes, incr. esr
123
Myocarditis etiology MCC
coxsackie B virus
124
Pericarditis EKG
Diffuse ST elevation + PR depression
125
Pericarditis tx
NSAIDs
126
Most common cause of pericarditis
Coxsackie B virus.
127
Dressler syndrome
Post-MI or pericardiotomy pericarditis, tx with NSAIDs
128
constrictive pericarditis pathophys
fibrous pericardial scarring leads to increased CVP leading to peripheral edma etc.
129
Constrictive pericarditis xray sign
Sqaure root sign
130
Constrictive pericarditis tx
Pericardiectomy
131
Pericardial effusion CXR
water bottle silhouette
132
Beck's triad
Hypotension, JVD, muffled heart sounds
133
Cardiac tamponade presentation
pulsus paradoxus + beck's triad
134
Pulsus paradoxus
A large decrement (>10 mmHg) of BP with inspiration. larger than normal.
135
Most common cause of mitral stenosis
Rheumatic heart dz
136
Etiologies of MR
ischemic heart dz, LV dilation, MVP
137
Aortic stenosis presentation
Parvus et tardus; traid of angina, syncope, dyspnea
138
presentaiton of aortic regurg
High pithced blowing diastolic murmur, wide pulse pressure, head bobbing, pulsating uvula, pistol shot over femoral arteries
139
Aortic regrug etiologies
bicuspid aortic valve, syphilitic aortitis, rheumatic fever
140
mitral valve prolapse presentation
midsystolic click, late systolic crescendo murmur, enchanced with increased SVR
141
Rheumatic fever presentation
FEVERSS: fever, erythema marginatum, valvular damage, inc. ESR, red-hot joints (migratory polyarthritis), subq nodules, syndenham chorea
142
Rheum fever dx
ASO titers
143
Rheum fever tx
PCN or erythromycin for strep throat. Steroids for Rhem fever
144
Most common mumur with Rheum fever
MR
145
Rheumatic heart disease murmur
Mitral stenosis, from repeated episodes of rheumatic fever
146
Acute infx endocarditis
S. aureus on normal valves happens rapidly
147
Subacute Bacterial Endocarditis cause
S. viridans for dental procedures (GU/GI procedures is enterococcus) on damaged valves
148
Duke's criteria
Sustained bacteremia, endocardial involvement, fever, immune or vascular phenomena, +bcx, +echo
149
Colon cancer endocarditis
Strep bovis, clostridium septicum
150
IV drug abuse endocarditis
S. aureus on tricuspid >> pseudomonas, candida
151
Prosthetic valve infection
s. epidermidis
152
Cx negative endocarditis
HACEK group?
153
Marantic (thrombotic) endocarditis
Metastatic cancer causing clots to form on valves that can embolize, tx with heparin
154
Libman-Sacks endocarditis
SLE leads to wart like vegetations on both sides of mitral valve leading to mitral regurg>mitral stenosis. Dx ana, tx underlying SLE and anticoagulate
155
ASD presentation
Fixed split S2, low-grade diastolic murmur
156
VSD presentation
holosytolic murmur at mid LSB
157
PDA with adults with eisenmenger tx
Surgery is contraindicated
158
adults w/o eisenmenger tx
surgical ligation
159
Congenital rubella syndrome Triad
PDA + deafness + cataracts
160
HTN urgency BP limits
>220/120
161
Tx for HTN urgency vs. emergency
Urgency: gradually lower over 24 hrs with PO meds
Emergency: lower 25% with IV nitroprusside in 1-2 hrs, then slowly afterwards
162
Aortic dissection presentation
Tearing CP or interscapular back pain, assymetric BP
163
Tx for type A and B aortic dissection
A: beta-blockers and surgery
B: beta-blockers
164
When to do surgery on AAA?
>5 cm or sx (synthetic graft)
165
MC pts with AAA
old smoking men
166
how does an aortoenteric fistula present
small herald bleed followed by massive UGIB s/p aortic graft placement
167
Signs of Ruptured AAA
tearing abd. pain, hypotension, pulsatile mass, CUllen sign, grey-turner sign
168
Leriche syndrome
PVD of distal aorta above bifurcation leading to bilateral claudication, impotence, and decreased femoral pulses
169
when to amputate after acute arterial occlusion
>6 hrs, most commonly in common femoral artery
170
Mycotic aneurysm cause
Bacterial, not fungal infex leading to arotic aneurysm, tx with IV abx and surgical excision
171
Luetic heart
tertiary syphilis leading to aortic aneurysm + aortic regurg + coronary artery stenosis, tx with IV PCN G and surgery
172
what to treat superficial venous thrombosis
aspiris + warm compresses
173
migratory SVT etiology
consider pancreatic cancer (trousseau phenomenon)
174
What is homan's sign
DVT sign calf pain w/ dorsiflexion
175
Tx for PE
heparin + warfarin, tx tPa to speed up clot resolution if massive, R heart failure
176
PE on EKG
Sinus tach most common, sinus tachy > S1Q3T3
177
Phlegmasia cerulea dolens
Venous outflow obstruction causing acute onset leg edema with pain and cyanosis, tx with heparin and venous thrombectomy
178
Post-throbotic syndrome (chronic venous insufficiency)
DVT damages valves leading to chronic venous HTN causing severe leg edema and ulceration around ankle area
179
tx for cardiogenic shock
Dopamine or IABP instead of IV fluids
180
how to tx neurogenic shock
IV fluids + supine or Trandelenburg positioning
181
Cardiac metastases
More common than primary tumors (75%)
182
atrial myxoma presentation
pedunculated, benign mass that presents like intermittent mitral stenosis
183
cardiac rhabdomyoma
MC heart tumor in kids
184
cardiac rhabdomyoma association
tubeorus sclerosis.
185
RVH on EKG
right axis deviation + Lead V1 R-wave >7 mm
186
LVH on EKG
left axis deviation + v1/v2 and V5/V6 overlapping
187
How to determine axis
+ in I, and + in II: normal axis
+ in I, and - in II: LAD
- in I, and + in II: RAD
