Cardiology Flashcards
(234 cards)
1
Q
extra atrial contractions (p waves) that can occur at any time and any rate
A
Premature atrial contraction
2
Q
Bizarre QRS morphology, T waves in opposite direction, followed by compensatory pause, bad if >3
A
premature ventricular contraction
3
Q
most common sustained arrhythmias, leading cause of thrombosis
A
Atrial fibrillation
4
Q
2 drugs you can use for chemical cardioversion for a fib
A
amiodarone, ibutalide
5
Q
rate lower meds for a fib (3)
A
BB
CCB
digoxin
6
Q
how do you treat hemodynamically unstable a fib/ flutter?
A
cardioversion
7
Q
Causes of 1st degree heart block
A
Meds- digoxin, BB< CCB
ischemia/ infarction
lyme dz
calcification
8
Q
type of heart block where PR interval lengthens then P wave occurs with dropped QRS
A
Type 1 second degree heart block
9
Q
type of heart block that have a fixed PR interval with some dropped QRs
A
Type 2 second degree heart block
10
Q
causes of torsades de pointes (3)
A
hypomaganesemia, hypokalemia, diarrhea
11
Q
Tx for torsades
A
magnesium, antiarrhythmics, defibrillation
12
Q
Common meds that cause long QT syndrome
A
amiodarone, macrolides (EAC), fluoroquinolones
haloperidol, fluoxetine, citalopram, ondansetron
13
Q
Tx for long QT syndrome
A
BB, pacmaker, ICD
14
Q
Class 1 antiarrhythmics (Sodium channels)
A
lidocaine
procainamide
15
Q
Class II anitarrhythmics (beta blockers)
A
Metoprolol, atenolol, etc
16
Q
Class III antiarrhthmics (K+ channels)
A
amiodarone, sotalol
17
Q
Class IV antiarrhythmics (Calcium channel)
A
verapamil, diltiazem
18
Q
what drugs does amiodarone interact with? (5)
A
simvastatin, digoxin, warfarin, sildenafil, fluoroquinolones
19
Q
ADRs with amiodarone
A
Hypotension, thyroid issues, pulmonary fibrosis, ocular toxicity
20
Q
3 meds that can cause secondary HTN
A
steroids
estrogen
ephedrine
21
Q
what 2 things is the DASH diet high in?
A
potassium and calcium
22
Q
ADR of loop/ thiazide diuretics
A
decrease potassium
23
Q
2 ADRs of thiazide diuretics
A
increase uric acid and lipids
24
Q
What med conserves potassium but can cause gynecomastia in men
A
spironolactone
25
4 ADRs of beta blockers
impotence, fatigue, bradycardia, bronchial constriction (nonselective)
26
what pregnancy category are ACEIs
category X
27
Does ACEIs cause hypokalemia or hyperkalemia
hyperkalemia
28
3 ADRs of alpha blockers
postural HPOTN
improves BPH and urine stream
positive effects on HDL and LDL
29
2 main causes of HTN in kids?
kidney diseae, coarctatin of the aorta
30
what is a severely elevated BP (>180/110) with symptoms?
HTN emergency
31
BP of >180/110 without symptoms
Hypertensive urgency
32
Tx for HTN urgency or emergency
nitroprusside or labetalol
33
when do coronary artery lesions need to be procedurally treated?
lesions >70%
34
A lesion in what coronary artery needs to be treated if >50%
left main
35
Treatment for stable angina
nitroglycerin (0.4 mg SL)
36
what drug class prolongs life in stable angina
beta blockers
37
CP that occurs w/o precipitating factors and can show ST segment elevation
Prinzmetal (variant0 angina (coronary vasospams)
38
Tx for coronary vasospasm and angina
nitrates, CCB
39
Good biomarker for early detection of an MI
myoglobin
40
best biomarker for early detection of an MI
troponin
41
STEMI complications
arrythmias, CHF, pericarditis, mitral regurg, VSD/ left ventricular aneurysm
42
ST elevation in leads V1-V2 indicate MI where?
septal wall
43
ST elevation in V2-V4 indicate a MI where?
anterior wall (LAD)
44
ST elevation in I,aVL (V5-V6) indicate MI where?
lateral wall (circumfelx artery)
45
ST elevation in II, III, aVF indicate an MI where?
inferior wall (RCA, PDA)
46
S1 is the sound of what valves closing?
Mitral and tricuspid
47
S2 is the sound of what valves closing
Aortic and pulmonic
48
What does an S3 gallop indicate?
CHF
49
What does an S4 gallop indicate?
Mitral stenosis
LVH
Acute MI
50
Where is Erb's point?
Third left inetercostal space (left sternal border)
51
is mitral regurg a systolic or diastolic murmur?
systolic
52
In mitral regur there is ____ cardiac output and _____ volume preload
There is decreased cardiac output and increased volume preload
53
– "floppy" or myxomatous degeneration of mitral valve
| – May develop significant mitral regurgitation
mitral valve prolapse
54
What will you hear with mitral valve prolapse?
mid-systolic click and possible late systolic murmur
55
Tx for mitral regurg
beta blockers or surgery
56
holosystolic murmur that radiates to axill and is frequently accompanied by a thrill
mitral regurgitation
57
is aortic stenosis a systolic or diastolic murmur
systolic
58
what causes aortic stenosis?
narrowign of the valvue due to dicuspid AS, senile calcific, rheumatic AS
59
3 common symptoms of aortic stenosis
syncope *during exercise), angina (hypertrophied left ventricle), dyspnea (from heart failure)
60
common signs of aortic stenosis (4)
delayed carotid upstroke
systolic ejection murmur
soft, sincle S2 (only hear P2)
S4, sustained and forcefull pmi
61
description of aortic stenosis
crescendo -decrescendo, possible ejection click. radiates to carotids/ neck. heard best in 2nd ICS RSB
62
What findings will be present on an EKG w/ aortic setnosis
LVH
63
Tx for aortic stenosis
diuretics, digoxin. Balloon valvuloplasy (temporary). aortic valve replacement is the gold standard
64
Aortic valve doesn’t close properly allowing blood
to flow backwards into the left ventricle causing
left ventricular dysfunction and CHF
aortic regurgitation
65
what are some causes of aortic regurgitation
```
root dilattion (HTN and age)
aortic dissection
infective endocarditits
Marfan syndrome
rheumatic dz
```
66
is aortic regurg a systolic or diastolic murmur?
diastolic
67
symptoms of aortic regurg
left ventricular failure (dyspnea, orthopnea)
syncope
angina
pulmonary edema (if acute)
68
: high‐pitched decrescendo blowing
murmur heard along the left sternal border heart
• Radiated to apex
aortic regurgitation
69
: low pitched mid‐diastolic
rumble caused by reverberation of regurgitant flow
against the anterior leaflet of the mitral valve
Austin Flint murmur
70
What is Quincke's sign and what is it associated with?
pulsation of the capillary bed in the nail, aortic regurg
71
What is Corrigan's pulse and what is it associated with?
Carotid pulse w/ rapid rise and rapid fall, aortic regurg
72
What is Hill's signa dn what is it associated with?
higher systolic BP in popliteal compared to brachial, aortic regurg
73
what will you see on EKG with aortic regurg
LVH
74
Treatment for aortic regurg
surgery (pain before EF <55%)
| medical- diuretics, ACEI, beta blockers
75
number one cause of mitral stenosis
rheumatic fever
76
2 main symptoms of mitral stenosis
Hemoptysis and hoarsness (due to enlarged left atrium iminging on left recurrent laryngeal nerve)
77
Medical tx for mitral stenosis
Diuretics (main one)
digoxin
beta blocks
78
– Holosystolic murmur with R sided signs
• ↑ JVP, hepatomegaly, peripheral edema
• Murmur ↑ with inspiraƟon and ↓with expiraƟon
tricuspid regurgitation
79
Scratchy, heard better with patient leaning forward
pericardial friction rub
80
Harsh, loudest in late systole
PDA
81
with HOCM (hypertrophic cardiomyopathy) when will the murmur be heard more?
standing (heard less when squatting since there is more blood flow)
82
When is the mitral regurg murmur heard best
when patient is squatting
83
What is the Jones criteria used for?
Rheumatic Fever
84
What are major criteria for the Jones criteria (need 2 of these)
carditits, polyarthritits, syndenham chorea, erythema marginatum, subuaneous nodules)
85
What the minor criteria for Jones criteria (need 2 if there is only 1 major criteria met)
fever, arthralgias, prolonged PR interval, increased ESR/CRP
86
Tx for rheumatic fever
Salicylates, corticosteroids, PCN (ro erythromycin)
87
what condition will present with splinter hemorrhages, painful violaeous raised lesions on hands and fee (Osler's nodes), painless erythematous lesions (janeway lesions), and retinal hemorrhages (rother's spots)
infective endocarditits
88
what criteria is used for endocarditits
Duke
89
Decrease in contractile function of either
ventricle in the absence of pressure overload,
volume overload or coronary artery disease
resulting in CHF
dilated cardiomyopathy
90
Tx for dilated cardiomyopathy
DAD (diuretics, ACEI, digoxin)
91
– Systolic ejection murmur that does not usually
radiate to the neck
• Maneuvers to increase the murmur intensity
–Standing up from a squatting position
• Maneuvers to decrease the murmur
intensity
–Squatting maneuver
Hypertrophic cardiomyopathy
92
Tx for hypertrohpic cardiomyopathy
Beta blocks
CCB (verapamil)
surgery, alcohol ablation
93
Myocardium changes and becomes stiffer
causing restriction of left ventricular filling &
reduced stroke output
restrictive cardiomyopathy
94
Causes of restrictive cardiomyopathy
infiltrative diseases (amyloidosis, hemochromatosis, carcinoid syndrom, sarcoidosis)
95
Tx for restrictive cardiomyopathy
tx underlyign dz, diuretics and beta blockers may be helpful
96
LDL goal for moderate risk factors
<130
97
LDL goal for no risk factors
<160
98
LDL for lots of risk factors
<100
99
what to monitor with statins
LFTs and 3 montsh and 6 months then yearly then monitor CPK if myalgias
100
what does niacin help increase
HDL
101
contraindications with niacin
pregnancy and liver dz
102
how can you minimize flushing with niacin?
ASA/NSAIDs and titrate slowly
103
contraindications with fibrates
pregnancy, liver and renal disease
104
what do fibrates help lower
triglycerides
105
ADR of fibrates
cholelithiasis, hepatotoxicity, myositits
106
C/I with bile acid binding resins
bowel obstruction and high triglycerides
107
what nerve primarily innervates the heart?
Vagus
108
Heart valve closure sequence
Mitral, tricuspid, aortic pulmonic (many things are possible)
109
5 Ps of an acute arterial occlusion
Pain, pallor, paresthesia, pulselessness, poikliothermia (cold)
110
do coronary veins have valves?
No
111
what supplies blood to the AV node?
Right coronary artery (posterior descending artery)
112
ADR with aldosterone antagonists?
hyperkalemia
113
Drug class that decreases Na and Cl reabsoprtion in the ascending loop of Henle and can cause hypokalemia and hypomagnesemia.
loop diuretics
114
does digoxin increase survival?
No
115
occlusion of what artery will result in contralateral hemiplegia with hemisensory loss as well as homonymous hemianopia
middle cerebral
116
most common type of shock
septic
117
what type species most often causes septic shock
Gram negative
118
Labs to get on everyone who is in shock
CBC, blood type cross-match, coagulation parameters, electrolytes, glucose, UA, serum creatinine, LDH, ECG, cardiac biomarkers
119
What should urine output be?
0.5 ml/kg/hr or greater
120
What are inotropes?
dobutamine, dopamine, epi
| increase CO by increasing HR and contractiligy
121
What are pressors?
dopamine, phenylephrine - increase vascular tone
122
Greater than 20 mm Hg drop in systolic BP or a drop greater than 10 mm Hg in diastolic between supine and sitting and /or standing
postural hypotension
123
most important factor for HTN
genetic predisposition
124
Exacerbations of HTN
alcohol, tobacco, lack of exercise, polycythemia, use of NSAIDs, low K+ diet
125
elevated BP associated w/ papilledema and either encephalopathy or nephropathy
malignant HTN
126
EKG findings with LVH
deep S waves in V1 and V2 and tall R waves in V5 and V6
127
drug classes shown to reduce mrotality after MI and in patients with heart failure
beta blockers
| ACEI
128
who do beta blockers tend to be more effective in?
Younger white patients
129
What do beta blockers do?
Decrease heart rate and cardiac output
130
drug class that can help with HTN in black and elderly patients
calcium channel blockers
131
drug class that can be used with BPH and HTN
alpha blocker
132
what is a renin inhibitor that can be used for HTN
aliskiren
133
Why must you not decrease the BP too rapidly in a HTN urgency/ emergency
can lead to cerebral ischemia
134
Drugs to give for an aortic dissection
nitroprusside, Beta blocker (labetalol, esmolol)
135
preferred HTN agent during pregnancy
nitroprusside
136
Oral agents for less severe HTN emergencies
clonidine
captopril
nifedipine
137
___ sided heart failure cuases: dyspnea + cough, fatigue, paroxysmal nocturnal dyspnea, gallops, exercise intolerance
left
138
____ sided heart failure causes: distended neck veins, heaptic congestion, decreased appetite, dependent pitting edema
right
139
In what type of heart failure may an S4 gallop be heard?
diastolic heart failure
140
most useful imaging study for CHF
echocardiography
141
what lab is typically elevated with CHF?
BNP
142
initial therapy for CHF
early inititaion o ACEI, beta blocker (improve ejection fraction)
143
When the ejection fraction falls below 35 what is indicated?
IMplantable cardioverter-defibrillators (ICDs)
144
what may a fundoscopic retinal exam show for a HTN patient?
AV nicking or "copper wire" apperance of vessels
145
2 medication classes that increase BP
NSAIDs and OCPs
146
who are thiazide diuretic C/I in?
gout, DM, nephrolithiasis (especially calcium based)
147
with HTN emergency what may eye exam show?
papilledema, retinal hemorrhages, exudates
148
tx for atherosclerosis
smoking cessation, control of HTN, DM, dyslipidemia , weight loss
149
what most commonly causes ischemic heart disease?
insufficient oxygen supply to cardiac muscle from atherosclerotic narrowing
150
criteria for metabolic syndrome
```
Three or more of:
Abdominal obesity
triglycerides >150
HDL 110
HTN
```
151
what is the most common presentation of unstable angina?
rest angina
152
when is unstable angina suspected?
pain is less responsive to NTG, lasts longer, occurs at rest or with less exertion than previous angina
153
what is considered to be a positive stress test
ST segment depression of 1 mm
154
what test is the definitive diagnosis of ischemic heart disease
coronary angiography
155
ADRs of nitrates
HA, anusea, light-headedness, HYPOTN
156
first line therapy for chronic angina, this drug class prolongs life
beta blockers
157
when are CCB used w/ unstable angina?
beta blockers are C/I or have been maximized
158
what is included in acute coronary syndrome?
UA, NSTEMI, STEMI
159
what do patients with an MI die of?
V-fib
160
who are more likely to present atypically with a MI?
women, patients with DM, elderly
161
Syndrome that develops 1-2 weeks post MI that includes pericarditits, fever, leukocytosis, pericardial or pleural effusion
Dressler syndrome
162
Patients with ST segment depression are usually considered to have what?
UA or NSTEMI
163
What does a patient with transiet ST segment changes of >0.5 mm that develop during symptomatic episode and resolve suggest?
acute ischemia and CAD
164
A new left bundle branch block on ECG is highly suspicious for what?
new MI
165
STEMI tx
Aspiring + clopidogrel
coronary angiography + PCI w/i 90 minutes
thrombolytic therapy w/i first 3 hours
166
what is the most common congenital structural malformation?
congenital heart anomalies
167
4 things in tetraology of fallot
VSD, aorta over VSD, pulmonary stenosis, right ventricular hypertrophy
168
most common type of ASD
ostium secundum
169
what condition is AV septal defect common in?
downs syndrome
170
most common valvular disease in the US
aortic stenosis
171
common features of valvular heart disease
dyspnea, fatigue, decreased exercise tolerance
172
how are carotid pulses with aortic stenosis?
thready
173
how are carotid pulses with aortic insufficiency
bounded pulses, widdened pulse pressure
174
congenital heart defect- murmur is srescendo-decrescendo holosystolic at LSB that radiates to back. Infant has cyanosis, clubbing, loud S2
tetralogy of fallot
175
congenital heart condition- systolic ejection murmur at 2nd LICS. wide, fixed S2
ASD
176
continuous (machinery) murmur , wide pulse pressure, hyperdynamic apical pulse
PDA
177
systolic, LUSB and left interscapular area, may be continuous. Infants can present with CHF, older children w/ systolic HTN Or murmur. different BPs in upper and lower extremitites
coarctation of the aorta
178
Murmur heard in 2nd RICS, radiates to neck and LSB. Often loud with a thrill.
aortic stenosis
179
murmur heard in 2-4 LICS, radiates to apex and RSB. high pitch, blowing
aortic regurgitation
180
Murmur heard at apex, low pitch. Heard best with patient in left lateral position, full exhalation. Midiastolic
mitral stenosis
181
murmur heard at apex. radiates to left axilla. pansystolic.
mitral regurgitation
182
murmur heard at LLSB, holosystolic. radiates to right sternum and xiploid. medium blowing. increases w/ inspiration
tricuspid regurg
183
murmur heard at LICS, mid-systolic. crescendo-decrescendo. Radiates to left shoulder and neck.
pulmonary stenosis
184
what will happen to INR if someone on warfarin is given amiodarone
INR increases
185
does blood from the pericardial sac clot or not clot when put in a tray?
not clot
186
tx for thrombophlebitits
LMWH for 1 month
187
how does restrictive cardiomyopathy occur?
deposition into or near myocardial cells
188
non-cardiac hypoxia (pneumoia, COPD) commonly causes what arrhythmia?
a-fib
189
what 2 murmurs are associated with a-fib
mitral stenosis, mitral regurgitation
190
what drug can produce blue vision?
sildenafil
191
best medication for BP support in cardiogenic shock
dobutamine
192
vitamin deficiency that causes igh output cardiac failure
thiamine (beri beri)
193
roth spots (retinal hemorrhages) in a drug user are most likely caused by what organism?
staph aureus
194
Tx for mitral valve prolapse
reassurance and beta blockers
195
austin flint murmur (low pitched rumbling murmur heart best at apex) is associated with which murmur
aortic regurgitation
196
pathognomonic finding for rheumatic fever
aschoff bodies (subcutaneous nodules)
197
Major Jones criteria (rheumatic fever) 5
```
Carditits
migratory polyarthritits
subq nodules
erythema marginatum
chorea
```
198
what cardiac abnormality is associated with bicuspid aortic valvue
coarctation of the aorta
199
an ABI less that what indiates PAD?
ABI
200
HTN agent associated with edema in lower extremitites
CCB
201
size an aortic aneurysm can get before surgery si needed
5.5 cm
202
becks traid (pericardial tamponade)
distant heart sounds, JVD and hypotension
203
what cardiac enzyme peaks first?
CKMB
204
stroke + fever=
endocarditits
205
preferred medication for endocarditits prophylaxis
ampicillin
206
what BP med causes blood levels of lithium to increase?
HCTZ
207
AV narrowing and venous nicking are associated with what condition
HTN
208
cotton wool patches and neovascularization is associated with what condition
DM
209
most common EKG changes with hypothyroidism
low voltage and sinus bradycardia
210
MOA of thrombolytic medication
activates plasminogen to plasmin. the plasmin disolves the fibrin in a thrombus
211
tx for viral pericarditits
NSAIDS
212
what is the initial symptom of diastolic heart failure?
dyspnea
213
diastolic heart failure is associated with what?
is a stiff, non-compliant left ventricle
214
a diastolic rumbling murmur heard best at the left lower sternal margin and the xiphoid. augmented during inspiration
tricuspid setnosis
215
a low pitched, blowing decrescendo diastolic murmur, heard best at the left intercostal space along the left sternal border
aortic regurgitation
216
what produces permanent fibrosis in small veins and relieves all symptoms of vericose veins
compression sclerotherapy
217
2 antibiotic classes to be avoided in individuals with long QT syndrome
macrolides and fluoroquinolones
218
drug with alpha and beta blocking action that is good to rapidly lower BP
labetalol
219
symptoms of aotic stenosis
Syncope, angina, dyspnea
220
loud crescendo-decrescendo systolic murmur, radiates to carotids.
aortic stenosis
221
low pithced mid siastolic murmur w/ opening snap.
mitral stenosis
222
loud holosystolic murmur radiating to the axilla
mitral regurgitation
223
Fixed split 2nd heart sound, may ahve RBBB
ASD
224
cause of bacterial endocarditits in non-drug useds
strep viridans
225
criteria for endocarditits
Duke's
226
tx for endocarditits from strep viridans
PCN G or ceftriaxone
227
Tx for bacterial endocarditits from staph aureus
nafcillin/ oxacillin (vanco if MRSA)
228
4 main causes of restrictive cardiomyopathy
amyloidosis, hemochromatosis, sarcoidosis, carcinoid
229
systolic ejection murmurs that decreases with squatting and increases with standing or dehydration
hypertrophic cardiomyopathy
230
Bp med that can cause cyanide toxicity and high anion gap acidosis
nitroprusside
231
Tx for WPW
procainamide
232
Tx for Vtach (w/ and w/o pulses)
with pulses- synchronized cardioversion. Without pulses- unsynchonized cardioversion
233
who are diuretics more potent in?
african americans, the elderly, and obese patients
234
how does atherosclerosis develop?
fatty streak (accumulation of lipis and macrophages) --> subendothelial space and take up lipid (foam cells) --> fibrous cap
