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Cardiology Flashcards

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1
Q

Exercise stress test can not be performed

A 
Meds: digitalis, BB, CCB, Amiodarone
Aortic Stenosis (absolute contraindication)

Must use imaging for:
LBBB
LVH with strain pattern
WPW
Pacemaker
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2
Q

Kerly B lines

A

Signs of fluid accumulation in lungs with high blood pressure

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3
Q

Pharmacologic stress test indications

A

Unable to exercise
Aortic Stenosis

Dobutamine-substitution for exercise
Adenosine-vasodilator
Can only dilate “healthy” vessels, causes a “steal effect”

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4
Q

RCA inervates

A

R ventricle, R atrium, SA node, AV node, INFERIOR wall of L ventricle

Leads II, III and AVF

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5
Q

LAD inervates

A

septum, ANTERIOR wall of L ventricle

Leads V1-V4

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6
Q

Circumflex inervates

A

Lateral wall L ventricle

Leads V5, V6, I, aVL

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7
Q

Prinzmetal angina

A 
Resting angina (midnight-8AM)
Caused by focal coronary artery spasm

Treatment: CCB, stop smoking

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8
Q

Acute Coronary Syndrome:

Unstable Angina
NSTEMI
STEMI

A

UNSTABLE ANGINA: chest pain (change from normal), neg Troponin

MSTEMI: chest pain + Ischemic EKG changes (ST depression or T wave inversion), increase in cardiac enzymes. Do stress echo.
Plavix or Heparin (no Thrombolysis)

STEMI: infarct (complete occlusion), ST elevation in 2 consecutive leads.
Right to cath lab (don’t wait for Troponin). PCI within 90 min or Thrombolysis

Treatment: MONAB

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9
Q

Post MI complications

A

Myocardial rupture: new holosystolic murmur. Acute MR (papillary muscle rupture) or VSD

Cardiogenic shock/CHF

Thromboembolism

Pericardial disease: pericarditis, Dressler’s Syndrome

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10
Q

Abnormal heart sounds

A

S3= volume overload (CHF)

S4=pressure overload (longstanding HTN, LVH, acute

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11
Q

Murmur Locations

A 
RUSB: Aortic Stenosis
LUSB: Pulmonic murmurs
Erb's Point(LSB): Aortic Insufficiency, HCM
Tricuspid: TS, TR, ASD, VSD
Mitral/Apex: MS, MR
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12
Q

Murmur Pitch

A 
Low Pitch (bell of stethoscope)-
MS, TS
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13
Q

Murmur Radiation

A

Neck/Carotid=Aortic Stenosis

Back/Axilla=Mitral Regurg

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14
Q

Aortic Stenosis

A

Sx: exertional angina, syncope dyspnea

PE: CHF, narrow pulse pressure, S4 )LVH), sustained PMI

Murmur: crescendo-decrescendo SEM radiating to R clavicle and carotid heard best at RUSB

Ejection click

Rx: avoid exertion, valve replacement

Avoid nitrates, ACE, all vasodilators

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15
Q

Aortic Insufficiency/ Regurg

A

Odd pulses
Stress Test: Hypotension with exercise

Rx: treat CHF, vasodilators to reduce afterload

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16
Q

Mitral Stenosis

A

Etiology: Rheumatic Heart Disease

Sx: DOE, Orthoptera, fatigue, palpitations, peripheral edema

PE: AFib, parastatal lift, crackles

Murmur: mid diastolic RUMBLE heard at apex in LLD position, LOUD S1

Opening snap

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17
Q

Mitral Regurg

A

Etiology: acute-post MI complication
Chronic- MVP

Murmur: holosystolic at apex radiating to back/axilla with an APICAL THRILL

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18
Q

Mitral Valve Prolapse

A

Sx: short lived stabbing chest pain, anxiety, palpitations, fatigue

Heart sound: mid-systolic click

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19
Q

Hypertrophic Cardiomyopathy

A

ECH: LVH in young person, Q waves in V5, V6, I, aVL

Echo: asymmetric hypertrophy of septum

Ex: Exercise restriction & BB

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20
Q

Other Murmurs

A

Tricuspid Regurg: infective endocarditis in IV drug user

Pulmonic Stenosis: congenital, pediatric. Young child with dyspnea

PDA: continuous/ Machinery, LE cyanosis

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21
Q

Acute Pericarditis

A

Most common pathogen: coxsackie
Most common bacterial pathogen= TB
Autoimmune: SLE, RA (female)

Triad of pleuritic chest pain + FRICTION RUB + EKG changes

Pain worse laying flat, better sitting up

EKG: global ST elevation, notched QRS, PR segment depression, tachycardia

Rx: NSAIDS, high dose ASA
DO NOT use steroids ( more complications)

Complications: pericardial effusion, tamponade, chronic pericarditis

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22
Q

Cardiac Tamponade

Triad
Pathognomonic signs
Treatment

A

Effusion large enough to collapse right heart

BECK’s TRIAD: hypotension, JVD, muffled heart tones

Pathognomic: Pulsus parodoxus (drop in systolic BP with inspiration) and electrical alternans (EKG)

Ex: immediate pericardiocentesis (echo guided)

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23
Q

Heart Failure

A

5 years mortality rate=50%

Stage A=at risk (pre HF)
Stage B=asymptomatic
Stage C= Symptomatic
Stage D= Marked sxs at rest (end stage)

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24
Q

Heart Failure

A

Defective pumping mechanism results in accumulation and redistribution of fluids.

RAAS:
Renal hypo perfusion causes release of renin-A-AI-AII

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25
angiotensin II
Potent vasoconstrictor-causes increase in BP Stimulates kidney to release aldosterone-mediates renal Na+ and H20 retention-increases arterial pressure-increase in BP
26
Heart Failure Signs
Dyspnea with minor activity, cyanotic, cold extremities, diaphoresis Vitals: normal or tachy, hypotn, reduced pulse pressure PE: crackles, dullness to percussion, exp wheeze/rhonchi, enlarged liver, edema ``` Key cardiac PE findings: Parasternal lift=pulmonary HTN Enlarged, sustained LV impulse Diminished S1 (impaired contractility) S3 gallop S4 (diastolic heart failure) ```
27
Cor Pulmonale
Prolonged HBP in pulmonary artery If acute, think PE If chronic, think COPD Labored respiratory effort with retractions, hyperresonance, diminished breath sounds, wheeze, distant heart sounds
28
Dilated Cardiomyopathy
Most common Poor EF, large heart, pulmonary congestion. Thin, dysfunctional LV wall, LV dilation/dysfunction
29
Restrictive Cardiomyopathy
``` Pulmonary HTN, dyspnea Usually caused by Amyloidosis -sarcoidosis -scleroderma Right HF ```
30
Hypertrophic Cardiomyopathy
Early adulthood, athletes-sudden cardiac death
31
Heart Failure Prevention
Underlying causes, control Systolic HTN, prevent first MI Initial rx= *diuretic+ ACE Early addition of BB Digitalis
32
Abdominal Aortic Aneurysm
``` >3cm diameter Typically involve bifurcation Rarely ruture until diameter > 5cm abdominal US Mid-abdominal pain radiating to back ```
33
Thoracic Aortic Aneurysm
Pressure on trachea/esophagus/SVC: dyspnea, stridor, cough, dysphasia Stretching of laryngeal nerve: hoarseness Study of choice= CT
34
Giant cell arteritis
Most frequently involves temp artery 50% also have polymyalgia rheumatica Sxs: HA, scalp tenderness, amaurosis fugax, diplopia ESR>50mm/h Temporal artery bx =gold standard Rx: prednisone 60 mg/d x 1 month before tapering Screen for thoracic aneurysm
35
PAD
Aorto-iliac segment: extreme limb fatigue/weakness, weak/absent distal pulses, thigh/buttock pain ``` Femoral-popliteal: foot pain at rest, relieved by dependency Dependent rumor (purplish), legs blanch with elevation, distal atrophic changes ``` Tibial segment: thin skin on foot, hairless, cool, absent pulses ABI
36
Virchow's Triad
Venous stasis, vascular injury, hypercoagulanility Increased risk of DVT Main/serious complication is PE
37
DVT
``` Increased calf circumference by > 3cm Measured 10cm below tibial tuberosity Duplex US is study of choice Spiral CT chest to R/o PE Treatment: anti coagulation *LMWH or Lovenox Bridge to Warfarin for prolonged rx ```
38
Arterial Disease Pearls
``` Claudication Cool, thin, hairless skin Muscle atrophy Atrophic nails Ulcerations-painful, shallow, round, dry Gangrene ```
39
Venous Disease Pearls
``` Varicose ties Tough, thick, fibrous skin Hemosiderin deposits Pitting edema Stasis ulcerations: painless, large, irregular, wet, slow to heal ```
40
Lipid risk factors
Smoking HTN HDL 60
41
Metabolic Syndrome
``` Risk Factors: Waist circumference TG > 150 Low HDL Increased BP (>130/85) Fasting BG > 100 ``` 3+ risk factors or DM= Metabolic Syndrome
42
Lipid Treatment
Statins= DOC in most cases Niacin-most effective for low HDL Fibrates-DOC for high TG Bile Acid Binders-pedis and Pregnancy (Welchol)
43
Supra ventricular Tachycardia
``` Regular narrow tachycardia Usually no P waves Commonly caused by congenital accessory pathway (AV node) Treatment= Vagal maneuvers Drug of choice= Adenosine Use CCB/BB following cardioversion ```
44
First Degree AV block
Long PR interval Pathological causes: Acute rheumatic fever, Lyme carditis (hallmark), secondary syphilis
45
Second Degree AV Block Type I | Wenckebach
Varied PR interval (normal, long, longer, dropped)
46
Second Degree AV Block type II | Mobitz
Randomly dropped QRS complexes (extra P waves) Treatment-stop new med Pacemaker
47
Third Degree AV Block
PP interval and QRS intervals constant but not communicating Treatment-pacemaker
48
V Fib
CPR Defibrillated Epinephrine followed by Amiodarone
49
V Tach
Sawtooth pattern Treat stable pt with Amiodarone Unstable pt with cardioversion
50
Torsades de Pointes
Sine wave pattern Stop meds that prolong QT interval
51
Left Axis Deviation
Up in I, down in AVF | Causes: inferior wall MI
52
Right Axis Deviation
Down in I, up in AVF Causes: RVH, COPD, ant/lay MI, PE Normal variant in kids
53
Right BBB
Wide QRS Bunny ears Causes: RVH, PE, Ischemia
54
Left BBB
Wide QRS with ski slopes | Causes: HTN with LVH, AS, dilated cardiomyopathy, fibrosis, acute NI
55
Pericarditis
ST elevation in all leads
56
Ejection click
Aortic Stenosis
57
Opening Snap
Moral Stenosis
58
Mid-systolic click
MVP
59
Fixed split S2
ASD
60
Continuous/machinery
PDA

PANRE (4 decks)

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