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Flashcards in cardiology Deck (214):
1

Acronym for etiology of dilated cardiomyopathy

ABCD-PIG

2

5 components tetralogy of fallot

1. pulmonary valve stenosis
2. VSD
3. over riding aorta
4. right ventricle hypertrophy
5. right sided aortic arch

3

crescendo-decrescendo, with a loud S2, cyanosis

tetralogy fallot

4

when does tetralogy of fallot become a problem

when the PDA closes, 2-10 days

5

tx for neonate coarctation short term/long term

prostaglandins, in tropes, give as little o2 as possible. will need surgery

6

restriction for coarctation

exercise and watch for bacterial endocarditis

7

murmur for ASD

fixed split S2, rumble

8

most common ASD

ostium secundum

9

tx for ASD

most close on own, others will have to be closed surgically

10

VSD murmur

holosystolic or pansystolic

11

heart sound for CHF

parasternal lift, enlarged, diminished first heart sound, S2 gallop

12

Tx of CHF

1. ACE !!!!! (will decrease after load and help renal perfusion) make it easier for weak heart to pump b/c resistance is decreased.
2. ARB
3. BB (decrease catecholamine levels, that predispose to arrythmias)
4. Diuretics

13

best dx test for CHF

ECHO

14

patient with CHF and EJ is less than 35= tx?

Pacer

15

acute pulmonary edema /decompensated CHF

1. decreased L ventricle contractility 2. increase preload, 3. increase after load (resistance)
USE CPAP or BIPAP!!!!

16

Acute exacerbation of CHF acronym

LMNOP (lasix, morphine, nitro, oxygen and position (elevate head of bed)

17

cushing syndrome features

buffalo hump, hyper pigmentation of striated and hypertension!!

18

tx for patient with HTN and chronic kidney dz

ACE (renal protective) until GFR goes bad & creatinine is 2=stop HTN.

19

Tx for HTN emergency

Reduce MAP by 25% in the first couple of hours, then gradually reduce over 24 hours using IV labetolol, Nipride, and Nicardipine, enalaprilat

20

only exception of HTN emergency 24 hour rule?

aortic dissection

21

tx for atherosclerosis

stop smoking, control HTN, DM and dyslipidemia, reduce weight, exercise and diet

22

what is metabolic syndrome

1. abdominal obesity
2. triglycerides >150
3. HDL 110
5. HTN

23

length and tx of stable angina

3 minutes and relieved with nitro

24

EKG finding of stable angina

ST depression and nonspecific t wave changes

25

definitive dx procedure for ischemic heart dz

coronary angiography

26

What two medications should all stable angina patients be on?

Aspirin and BB (ACE or CCB) can also be used for blacks, DM and renal patients

27

What is dressers syndrome

post MI, pericarditis, fever, leukocytosis, and pleural effusion. usually occurs 1-2 weeks after the event

28

define STEMI

ST elevation >1mm in two contiguous leads

29

Posterior leads

V1, V2

30

AnteroLateral leads

V4, V5, V6

31

time frame for coronary angiography PCI

90 mins

32

time frame for thrombolytics

3 hours (some benefit up to 12)

33

absolute contraindication for thrombolytics

stroke in last 3 mont, hemorrhagic stroke ever, acute bleeding, brain cancer, trauma, suspected aortic dissection, major surgery in the last 3 weeks, prolonged CPR, DM retinopathy, prey, and active PUD

34

relative risk of thromolytics

Bp>180 and anticoagulants

35

causes of aortic aneurysm

atherosclerosis is the most common, syphilis, giant cell arteritis, trauma and marfans

36

dx study for abdominal aortic aneurysm

US

37

dx study for thoracic aortic aneurysm

CT or MRI

38

Leriche syndrome

erectile dysfunction (with clogged iliac arteries

39

gold standard to dx peripheral vascular dz

angiography, other tests doppler US, ABI

40

the six Ps may be part of the arterial problem, what are they?

Pallor, pain, pulselessness, parenthesis, poikilothermia and paralysis

41

tx of PAD

stop tobacco, control DM, HTN and hyperlipidemia, med=
BB, ACE, antiplatelets

42

tx for temporal art

1-2 month high prednisone steroids, taper and switch to aspirin

43

DVT is associated with

surgery, prolonged bed rest, oral contraceptives and inherited clotting disorder, most commonly =factor V Leiden

44

virchows triad

hypercoagbility, stasis, damage to the vein

45

what is S4

stiff as a board. Rushing blood against a hypertrophic, thick ventricle wall

46

are diastolic or systolic murmurs worse

diastolic are pathological murmurs

47

occurring during ventricle filling

diastolic murmurs

48

name the diastolic murmurs

mitral and triscupid stenosis and aortic/pulmonic regurg

49

what is S3

sack of beans, blood entering a dilated ventricle

50

Mitral stenosis

rumble, mid-diastolic holo

51

rheumatic fever should be linked to what murmur

mitral stenosis

52

widen pulse pressure, b/c blood is going back into the heart, early diasystolic decrescendo murmur

is aortic regurg.

53

most common valvular dz in the US?

Aortic stenosis

54

tx mitral stenosis

do not give fluids, do not give diuretics. GIVE med to help after load CCB, ACEI (prevent remodeling)
Ask the question why is valve stenosis?

55

Tx: Left sided endocarditis

give antibiotics

56

most frequency cause of mitral and aortic valve disorders

congential, rheumatic, connective tissue disorders, and infection

57

tx for aortic regurg?

surgery

58

murmur is described as "blowing"

regurgitation murmur

59

murmur is described as blowing and arterial pulses large and bounding

aortic regurg

60

unstable bradycardia--leading to hypotension tx with?

atropine and positive chronotropic: epi or dopamine

61

unstable tachy

Synchronized cardiovert and adenosine

62

SVT (first try)

1. vagal
2. adenosine
3. synchronized cardiovert

63

a fib treatment

convert for instable pt.
stable pt if in a fib for more than 48 hour anticoagulant for 3-4 weeks. hour if risk of clot

64

medical management of rate control with afib

digoxin and amiodarone

65

chemical conversion of both aflutter and a fib use

ibutilide

66

treat for flutter

similar to fib, electro conversion or medical conversion

67

tx for V tach with hypotension or loss of consciousness

syn cardiovert, medical intervention includes amiodarone, lidocaine and procainamide

68

name the AV blocks

first (prolonged PR), second degree (mobitz one (prolonged until dropped) and two and complete 3rd degree block

69

explain 2 degree heart block type 2

rhythm is regular, but extra p's are present not conducting QRS. The p interval is fixed.

70

osler nodes, janeway lesions, roth spots and splinter hemorrhage are associated with

Endocarditis

71

Dx endocarditis

2 sets of blood cultures 1 hour apart, and echo

72

top three bugs for endocarditis

strep viridan, staph aureus and enterococci

73

tx for endocarditis

gentamicin, vanco, rocephin

74

age range for mechanical vs. bioprostheses valve

younger than 65 get mechanical

75

do mechanical or bioprostheses valves need anticoagulants

mechanical The INR is 2.5-3.5 (they last longer too)

76

do patient's with sustain v-tach have a better or worse survival rate after a CABG?

better, due to revascularization

77

type of fibrolytic that should not be given twice

streptokinanse (antibody build up)

78

both mitral and tricuspid regurg are blowing holosystolic murmurs, describe that difference in location?

tricuspid is best heard left of the sternal border and mitral is best heard at the apex and radiates to the axilla

79

what is the most common primary tumor that metastasizes to the heart?

malignant melanoma

80

What is Thromboangitis obliterans or Buerger dz?

inflammatory dz affecting the small and medium arteries of distal extremities. Common in Asian men and smokers. Venous insufficiency and ulcers are also commonly seen in the LE

81

prominent U waves on EKG

hypokalemia

82

J point elevation

hypothermia

83

medication that help PAD

cilostazol

84

best study to further investigate PVC after an EKG has been done?

electrophysiology study

85

what is the most efficient way to increase cardiac output?

increase heart rate

86

patients with grade 1 or 2 systolic murmur with no symptoms can be followed with

EKG and Chest x rays

87

patient with diastolic murmur or greater than grade 2 systolic murmur or any grade + symptoms can be followed with

ECHO

88

If a patient has anginal symptoms the best next step is.....

coronary arteriogram or dobutamine stress tests

89

patient has profound bradycardia and tachycardia =SA node dysfunction, another name for this is?

tachybrady syndrome

90

Goal for INR before cardioversion

1.8 for 3 weeks

91

What dysrhythmia can amiodarone cause?

sinus bradycardia and AV block

92

what dysrhythmia can digoxin cause

junctional rhythm

93

what dysrhythmia can adenosine cause

afib

94

name two drugs indicated to prevent recurrent v-tach

Sotalol and amiodarone

95

what is a physiological S2 split?

the ventricles closing at different times

96

a fixed S2 split is heard in patients with ...

ASD

97

a prolonged S2 spilt is heard in patients with

pulmonary embolus and pulmonary valve stenosis

98

patient is on diuretic that is not potassium sparing, what heart arrhythmia can occur

ventricular (tachycardia)

99

venous stasis ulcers are

painless and erythematous

100

arterial ulcers are

painful and pallor

101

what is the difference between a physiological and paradoxical S2 split

paradoxical occurs during expiration phase and is associated with LBBB

102

#'s the define orthostatic hypotension?

drop in 20mmHg systolic and 10mmHg diastolic

103

medication that can be used to control the ventricular rate during rapid atrial fib

BB

104

major side effects of amiodarone are

thyroid, photo dermatitis, liver, CNS

105

What is flecainde?

A big GUN. It potently blocks sodium channel current in the myocardium and is used in life threatening V-tach and V-fib or in refactory SVT

106

what age should you start screen for cholesterol

20

107

3 best meds to prolong life after an MI?

bb, ace, and aspirin.

108

what is preload

ventricular end diastolic volume, it is the pressure that fills the ventricle during diastole

109

how do you decrease preload

dilate veins, which slows the return of blood from the veins (nitrates) or use diuretics

110

how do you increase preload

add intravascular volume

111

what is afterload

think arteries...the resistance that the heart faces during systole.

112

meds that decrease afterload

arterial dilators: ACEI and hydralazine

113

inspiration makes negative pressure in the intrathoracic, how does this affect right atrial and ventricle preloads?

inspiration=increased preload (less pressure for venous return to face means more blood to the heart)

114

you dx pt with pheo and massive HTN, med to use?

phentolamine

115

med for true HTN emergency (encephalopathy)

IV nitroprusside, IV esmolol, they drop BP dramatically and suddenly

116

Hyperkalemia, Lyme dz, MI and lithium can all cause what heart problem

AV block

117

what is ibutilide used for and what is a major SE?

to cardiovert out of a fib or flutter. SE is torsades de pointes

118

tx for constrictive pericarditis

pericardiectomy

119

pt presents with tachycardia, tachypnea, narrow pulse pressure, JVD and pulses paradoxes...you should think

cardiac tamponade

120

Electrical alternans define, this isdpathognomonic for?

alternation of QRS complex amplitude or axis between beats and a possible wandering base-line. EFFUSION

121

big difference between cardiac tamponade and right ventricle infarction?

only right ventricle will have Kussmaul

122

one way to determine tx for pulmonary artery HTN is to do a vasodilator challenge, what med should be used if the PA pressure is reduced?

CCB-nifedipine

123

if PAH doesn't respond to vasodilators then what meds can be used?

bosentan, iloprost

124

stage 1-4 heart disease

class 1: symptoms but no affect on physical activity
class 2: angina with activity
class 3 patients must limit activity due to angina
class 4 cannot carry on any physical activity

125

A 70 year old female presents for a routine checkup. On physical exam you auscultate a murmur that radiates from the apex of the heart to the left axilla. Which heart murmur is most often associated with this description?

A murmur that radiates from the apex to the left axilla is consistent with mitral regurgitation.

126

A 56 year old male with severe congestive heart failure is making modifications to his diet plan and asks you about sodium intake. Which of the following is the best advice to give this patient?

CHF patients should be counseled to limit their sodium intake to 2-3 grams or less to properly maintain fluid homeostasis.

127

Although there may be many causes of hypertension, which of the following is the most common cause of secondary hypertension?

renal artery stenosis

128

Which is more potent epi or Isoproterenol positively chronotropic agent?

Isoproterenol

129

He states he has fatigue, shortness of breath, ankle swelling that gets worse during the day, and he sleeps on two pillows at night. He denies syncope or palpitations. Physical examination shows jugular venous distension, S3 gallop, hepatomegaly, and 2+ pitting edema of both legs and ankles. Left ventricular ejection fraction as determined by echocardiography is 35 percent. what Cardiomyopathy is suspected?

Dilated cardiomyopathy may be defined as an ejection fraction of less than 40% in the presence of increased left ventricular dimension (left ventricular end-diastolic size more than 115% of that calculated for age and body surface area).

130

Which of the following is the most important modifiable risk factor for coronary artery disease in patients

smoking

131

What heart rhythm abnormality can be caused by propranolol overdose?

AV block

132

Which of the following is the most common cause of restrictive cardiomyopathy?

Amyloidosis

133

Patients with a diagnosis of Systemic Lupus Erythematosus have a disposition toward acquiring which cardiac abnormality?

pericarditis

134

What is the earliest sign or symptom of congestive heart failure?

Dyspnea on exertion

135

are q waves always present in ST elevation MI?

no

136

tachycardia is a regular, wide-QRS complex tachycardia with only one ("mono") repeating QRS morphology.

monomorphic ventricular tachycardia

137

ECG this morning shows inverted P-waves in the inferior leads. Which of the following would be this patient’s most likely rhythm?

When signals for the heart to contract originate from sources other than the SA node, the p-waves on ECG tend to be inverted. Inverted P-waves should make you think Junctional rhythm first.

138

major criteria for rheumatic fever

The major criteria for rheumatic fever include: polyarthritis, carditis, erythema marginatum, chorea, subcutaneous nodules.

139

Which of the following is the most common immediate complication following surgical repair of an abdominal aortic aneurysm?

MI

140

Which of the following patients would benefit most from a coronary artery bypass graft (CABG) procedure? what disease artery benefits the most from being bypassed

Those patients with proximal LAD involvement, triple vessel disease, or double vessel disease with concomitant diabetes have been shown to benefit most from CABG.

141

the most common finding for a positive stress test?

ST segment depression of greater than 1 mm

142

Which of the following cardiac serum markers will most likely be elevated within 1-3 hours following a myocardial infarction?

Though Troponin levels are more diagnostic of true infarction, myoglobin levels are the first to rise. Myoglobin usually rises within 1-3 hours and is usually the 1st cardiac enzyme marker to be elevated. The other cardiac enzymes begin elevating between 3 and 6 hours.

143

What is the target INR for a patient with a mechanical heart valve?

2.5 to 3

144

what is a normal corrected QT?

a normal corrected QT is generally defined as less than 450 and anything greater than this represents a prolonged QT interval, which increases the risk for ventricular tachycardia (in particular torsades de pointes

145

A 37 year old male presents to the clinic with a red rash in ring form covering his trunk and portions of his lower extremities as well as a fever. He also complains of bumps under the skin of his arms and legs, that you recognize as subcutaneous nodules. Which of following heart murmurs is most commonly noted as a late sequelae of this disease?

The mitral valve is most commonly affected in rheumatic heart disease, the late sequelae of acute rheumatic fever. Mitral stenosis is the classic valvular complication associated with rheumatic heart disease, which is noted to have a low-pitched diastolic rumble, possibly with opening snap early in the course of the disease

146

Which of the following ECG changes indicates that transmural ischemia is occurring?

ST elevation

147

the test of choice in this unstable patient presenting with likely acute thoracic aortic dissection.?

Gated CT chest angiography i

148

what is worse a fib or atrial flutter?

Atrial flutter generally has a rate of 250-350 bpm, has the risk of transferring that rate to the ventricles, sending the patient into ventricular tachycardia. A fib, with the rate well over 350 bpm, generally does not transfer that high a rate to the ventricles, and therefore is the most common chronic sustained arrythmia.

149

Which characteristics is classically associated with monomorphic ventricular tachycardia?

Monomorphic ventricular tachycardia is a regular rhythm, wide-QRS complex tachycardia with only one ("mono") repeating QRS morphology.

150

treatment of choice for recurrent cases of Rheumatic fever

Monthly injections of benzathine penicillin

151

what test is used to evaluate the excitability of the myocardium, and may also reproduce the tachycardia. good for patient who most likely has a diagnosis of Wolff-Parkinson-White syndrome. WPW is a syndrome of excitability in which re-entry pathways lead to tachyarrhythmias.

Electrophysiology study

152

what is Thromboangiitis obliterans, or Buerger’s disease,

is a rare vasculitis in which inflammation causes obstruction of blood vessels in the hands and feet resulting in the listed symptoms, often associated with smoking. Raynaud's phenomenon is similar in presentation to Buerger's disease and may be difficult to initially distinguish.

153

best drug for patient with cardiogenic shock. There are multiple causes for cardiogenic shock which result in pump failure.

Dobutamine is a vasopressor that enhances myocardial contractility and decreases the cardiac workload, and therefore is the drug of choice in this condition

154

At times congestive heart failure patients are placed on dopamine to yield diuretic effects. Dopamine, however produces different peripheral responses depending on the dose administered. At what dosing level does dopamine exert the desired effect of diuresis?

2-5 ug/kg/min administered intravenously

155

does Digoxin help with mortality or symptoms of CHF

symptoms

156

In coronary artery bypass grafting, which vessel has been shown to yield the greatest longevity after the procedure?

internal mammary

157

Which of the following drugs is used to modify the heart rate in a patient who presents with an irregularly irregular rhythm on ECG?

Diltiazem

158

Which of the following medications is most important when treating a patient with dilated cardiomyopathy and an ejection fraction of 50%?

ACE

159

Diffuse ST segment elevation is indicative of

pericarditis.

160

This ECG finding is characteristic of Prinzmetal’s angina.

Transient ST segment elevations

161

True or False, Serial Troponins that are negative rule out all causes of acute coronary syndrome.

False

162

Total occlusion of a coronary artery is a characteristic of ST elevation MI?

Yes

163

A 55-year old male presents with acute onset right flank pain radiating to his periumbilical area for the past 2 hours. He states his pain causes urinary urgency but he cannot urinate. He has had several episodes of nonbilious vomiting. BP 165/87, P 105, RR 22, O2Sat 99% room air, T 98.7F. Abdomen is nontender. Urine dipstick reveals only large hematuria. Which of the following is the next best step in diagnosing this patient's condition?

possible kidney stones get a KUB

164

What type of valvular disease can rheumatic fever cause?

mitral STENOSIS

165

how do you increase the hypertrophic cardiomyopathy murmur?

valsalva

166

Bumetanide (Bumex)

strong loop diuretic, used in moderate to severe CHF

167

What heart rhythm abnormality can be caused by propranolol overdose?

AV block
Propranolol is a beta blocker. Due to the ability of this drug class to slow the heart, an overdose could cause an AV block or sinus bradycardia.

168

"Tet spells" are presumed to be due to acute increase in pulmonary vascular resistance, clinically manifesting as acute episodes of systemic cyanosis followed by syncope, which may result in hypoxia and death. The treatment of a "tet spell" is to increase systemic vascular resistance to allow for temporary reversal of the shunt. name a vasopressor

Phenylephrine is a vasopressor that increases systemic vascular resistance.

169

what is the most common cause of CHF?

coronary artery disease

170

a bnp below what level rules out CHF

171

2 dx that need prophylactic antibiotics

prosthetic valve, prior endocarditis, cyanotic heart defect

172

what are the three major criteria for endocarditis

2 positive blood cultures
positive ECHO
new murmur

173

what are the minor criteria for endocarditis

Fever
Embolic event (janeway)
Immunological event (osier)
Positive blood culture

174

gold standard for dx myocarditis

myocardial biopsy

175

what is the first line tx for pericarditis

aspirin and nsaids

176

normal BMI

18.5-24.9

177

3 dx when paradoxical pulse is mentioned

pericarditis, pleural effusion, and cardiac tamponade and obstructive lung dz.

178

a pathologic S3 is most often associated with?

CHF

179

mid systolic click, you should think

mitral valve prolapse

180

name 3 medications used for pharmacological stress test

adenosine, dobutamine, and dipyridamole

181

two valve disorders common with marfans

aortic regurgitation and mitral valve prolapse

182

2 most common causes of aortic stenosis

bicuspid valve + calcification and CAD

183

Elderly person presents with dypnea, angina, syncope, but EKG is normal. What is the dx

aortic stenosis

184

aortic valve is best heard when pt is in what position?

sitting up and leaning forward

185

what is tietze syndrome

costochondritis

186

James bundle, think

lown-ganong-levine syndrome

187

subacute endocarditis is most often what bug

strep viridans

188

A blalock procedure corrects what congenital heart condition

tetralogy of fallot

189

a "3" sign and rib notching =

coarctation of the aorta

190

name 4 things that constitute a positive stress test

a drop in blood pressure, a new arrhythmia, an increases in angina symptoms, ST depression

191

can you use clot busting drugs in a new LBBB

yes within 3 hours

192

RSR prime in leads V1 or V2, you should think

RBBB

193

patient is taking aldosterone antagonist (aka spirolactone )what labs must to watched

K+ (may become hyperkalemic)

194

what does digoxin do?

helps with cardiac contractility

195

Inferior MI what artery is blocked

RCA

196

Anterior MI what artery is blocked

LCA

197

Posterior MI what artery is blocked

posterior descending artery off the RCA

198

Bundle of kent : think?

WPW

199

biphasic P wave, should make you think of

left atrial enlargement

200

U waves

hypokalemia

201

spironlactone SE

gynecomastia

202

Lead 1 has a positive QRS and AVF has a negative QRS, what is the axis?

left axis deviation

203

when taking statins measure the creatinine kinase due to

rhabdomyolysis

204

what is ezetimibe

lowers LDL by decreasing intestinal absorption of cholesterol

205

counting rate on an EKG what are line values

300, 150, 100, 75, 60

206

what two leads determine the axis of the heart

Lead 1 and AVF

207

RSR prime in V5 or V6

LBBB

208

what meds lower trigycerides

fibrin acid derivatives

209

Lateral wall MI is caused by the blockage of what artery?

LEFT CIRCUMFLEX artery

210

describe junctional rhythm

50 beats per minute, QRS is narrow and no P wave

211

most common cause of sudden cardiac death

v-fib

212

patient is taking ACE, must watch

serum creatinine and potassium

213

what does ST depression represent

ischemia

214

You note a tachycardic rhythm with three different P-wave morphologies, and R-wave progression across the precordial leads. name the rhythm

Multifocal atrial tachycardia