Cardiology Flashcards Preview

PANCE > Cardiology > Flashcards

Flashcards in Cardiology Deck (234):
1

extra atrial contractions (p waves) that can occur at any time and any rate

Premature atrial contraction

2

Bizarre QRS morphology, T waves in opposite direction, followed by compensatory pause, bad if >3

premature ventricular contraction

3

most common sustained arrhythmias, leading cause of thrombosis

Atrial fibrillation

4

2 drugs you can use for chemical cardioversion for a fib

amiodarone, ibutalide

5

rate lower meds for a fib (3)

BB
CCB
digoxin

6

how do you treat hemodynamically unstable a fib/ flutter?

cardioversion

7

Causes of 1st degree heart block

Meds- digoxin, BB< CCB
ischemia/ infarction
lyme dz
calcification

8

type of heart block where PR interval lengthens then P wave occurs with dropped QRS

Type 1 second degree heart block

9

type of heart block that have a fixed PR interval with some dropped QRs

Type 2 second degree heart block

10

causes of torsades de pointes (3)

hypomaganesemia, hypokalemia, diarrhea

11

Tx for torsades

magnesium, antiarrhythmics, defibrillation

12

Common meds that cause long QT syndrome

amiodarone, macrolides (EAC), fluoroquinolones
haloperidol, fluoxetine, citalopram, ondansetron

13

Tx for long QT syndrome

BB, pacmaker, ICD

14

Class 1 antiarrhythmics (Sodium channels)

lidocaine
procainamide

15

Class II anitarrhythmics (beta blockers)

Metoprolol, atenolol, etc

16

Class III antiarrhthmics (K+ channels)

amiodarone, sotalol

17

Class IV antiarrhythmics (Calcium channel)

verapamil, diltiazem

18

what drugs does amiodarone interact with? (5)

simvastatin, digoxin, warfarin, sildenafil, fluoroquinolones

19

ADRs with amiodarone

Hypotension, thyroid issues, pulmonary fibrosis, ocular toxicity

20

3 meds that can cause secondary HTN

steroids
estrogen
ephedrine

21

what 2 things is the DASH diet high in?

potassium and calcium

22

ADR of loop/ thiazide diuretics

decrease potassium

23

2 ADRs of thiazide diuretics

increase uric acid and lipids

24

What med conserves potassium but can cause gynecomastia in men

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