Cardiology Flashcards
(229 cards)
1
Q
cardiothoracic ratio of > 50% can indicate what?
A
- cardiomegaly
- pericardial effusion
2
Q
on the LATERAL view, any increase in the mass of the left ventricle extends the cardiac shadow ____
A
posteriorly and lower – closer to the diaphragm
3
Q
on the LATERAL view, any increase in the mass of the right ventricle extends the cardiac shadow ____
A
anteriorly behind the sternum
4
Q
CXR findings of coarctation of aorta
A
- absence of normal aortic arch
- “3” sign (prominent left subclavian artery, coarctation, poststenotic dilation of descending aorta)
- “reversed 3” sign on barium swallow
- intercostal rib notching
5
Q
CXR findings of heart failure
A
- cardiomegaly
- pulmonary vascular redistribution (visibly thickened upper lobe pulmonary veins)
- Kerley B lines
- pleural effusions (usually right > left)
6
Q
CXR finding of anomalous pulmonary vein that drains into the IVC
A
“scimitar sign” (curvilinear opacity in right lower lung field d/t associated lung hypoplasia)
7
Q
CXR finding of aortic dissection
A
mediastinal widening on PA view
8
Q
CXR finding of pericardial effusion
A
- “WATER BOTTLE” or “water balloon” heart shape
- sometimes significant enlargement of cardiac silhouette
9
Q
areas of CALCIFICATIONS on CXR:
- aortic
A
think DISSECTION if separation between calcification and aortic border, especially if mediastinum appears wide
10
Q
areas of CALCIFICATIONS on CXR:
- myocardial
A
apical aneurysm
11
Q
areas of CALCIFICATIONS on CXR:
- valvular
A
commonly aortic
12
Q
areas of CALCIFICATIONS on CXR:
- annular (ring-shaped)
A
mitral annular calcification
if perfect ring, prosthetic valve likely
13
Q
areas of CALCIFICATIONS on CXR:
- pericardial
A
- think constrictive pericarditis
- or think TB if clinical history suggests exposure
14
Q
CXR finding of ventricular pacemaker
A
single lead in apex of right ventricle
15
Q
CXR finding of implanted defibrillator
A
single lead in apex of right ventricle that is LARGER and WIDER than that of the pacemaker
16
Q
CXR finding of atrioventricular (AV) sequential (dual-chamber) pacemaker
A
2 leads
17
Q
CXR finding of biventricular pacemaker
A
3 leads
18
Q
- left ventricular structure and systolic function
- right ventricular structure and systolic function
- valvular heart disease
- congenital heart disease
- myocardial infarction (including post-MI complications)
- cardiomyopathy (both loss of EF and hypertrophy of myocardium)
- cardiac masses (tumor, thrombus, and vegetation)
- diseases of aorta and pulmonary artery
- estimation of pulmonary pressure
- diastolic function
- cardiac sources of emboli
A
BEST use of echocardiogram
19
Q
echo performed w/ an esophageal probe
A
TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE)
20
Q
HIGHER-RESOLUTION images compared to tranTHORACIC echocardiogram
A
TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE)
21
Q
- valvular structure and function
- left atrium (including left atrial appendage)
- cardiac masses
- intracardiac shunts
- endocarditis
- aortic dissection
A
TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE) provides higher-resolution images than TTE
22
Q
is used to evaluate intracardiac shunts
A
BUBBLE STUDY
23
Q
measures the VELOCITY and DIRECTION of blood flow
A
doppler echocardiography
24
Q
is useful in determining the severity of valvular stenosis or regurgitation, evaluating LV diastolic function, LV outflow tract gradients, and intracardiac shunts
A
doppler echocardiography
25
key factor in use of exercise testing as a diagnostic tool for coronary artery disease (CAD)
INCREASED DEMAND for myocardial oxygen
26
stress tests have an integral role in what 2 ways?
- detection of CAD (DIAGNOSTIC tool)
| - stratification of risk (PROGNOSTIC tool)
27
diagnostic testing is MOST VALUABLE when?
pretest probability for CAD is INTERMEDIATE
28
what are the 2 general types of cardiac stress tests?
1. exercise tolerance test (w/o imaging)
2. stress imaging testing
- "STRESS" is induced w/ exercise or pharmacologic stress
29
what is the associated IMAGING done w/ stress testing?
- echocardiography (aka stress echo)
| - myocardial perfusion imaging (MPI; nuclear stress test)
30
is the cornerstone of DIAGNOSTIC testing for ISCHEMIA and FUNCTIONAL CAPACITY and for determining PROGNOSIS (including post-MI)
exercise tolerance test (ETT)
31
level of maximal exercise achieved on the ETT is measured in?
metabolic equivalents (METS)
32
ETT WITHOUT imaging is NOT recommended in which 2 groups?
1. pts unable to exercise sufficiently (MUST ACHIEVE 85% of age-predicted maximum heart rate (PMHR))
2. pts w/ BASELINE ECG ABNORMALITIES
33
what BASELINE ECG ABNORMALITIES can interfere w/ ETT?
- LVH
- LBBB
- WPW
- ventricular pacing
- resting ST depressing
- taking digoxin
34
definition of a POSITIVE ETT
flat or down-sloping ST-segment depression > 1 mm at 80ms after the J-point in THREE consecutive beats
35
is an unusual finding suggestive of marked ischemia (can also be seen w/ coronary artery spasm)
ST elevation during an ETT in 3 contiguous leads w/o Q waves of prior MI
36
- ST elevation > 1 mm in leads w/o Q waves from prior MI and excluding aVR, aVL, and V1
- decrease in SBP > 10 mmHg when accompanied by any other evidence of ischemia or hypoperfusion
- moderate-to-severe angina
- CXS symptoms (ataxia, dizziness, near syncope)
- signs of poor perfusion (cyanosis/pallor)
- sustained 2nd or 3rd degree AV block
- technical difficulties in monitoring ECG/BP
- pt requests to stop
- serious arrhythmia (eg sustained ventricular tachycardia)
absolute indications for termination of an ETT
37
what correlates w/ a good prognosis independent of degree of CAD?
excellent exercise tolerance (> 10 METS)
38
absolute CI to ETT
- acute MI w/i 2 days
- unstable angina not previously stabilized by medical therapy
- uncontrolled arrhythmias causing symptoms or hemodynamic compromise
- symptomatic severe aortic stenosis
- uncontrolled symptomatic HF
- acute PE or infarction
- acute myocarditis or pericarditis
- acute aortic dissection
39
when are stress imaging studies used as the initial diagnostic method?
pt is not a candidate for ETT d/t:
- inability to exercise
- or baseline ECG changes at rest
40
in which pts are stress imaging studies the preferred diagnostic method?
pts w/ prior revascularization
41
do stress imaging studies have greater sensitivity and specificity than regular ETT?
YES
42
when are stress imaging studies used?
to measure EJECTION FRACTION or MYOCARDIAL VIABILITY; in addition to identifying CAD
43
how is the "stress" portion of stress imaging studies done?
- EXERCISE
| - PHARMACOLOGIC agents
44
when is exercise stress imaging NOT used and why?
- pts w/ PACEMAKERS
- LBBB
- can cause false-positive left ventricular anteroseptal perfusion defects
45
pharmocologic agent used for stress imaging that is both iontropic and chronotropic
dobutamine
46
is usually NOT used in stress imaging studies in pts w/ PACEMAKERS
dobutamine
47
dobutamine is used for pts who are not only unable to exercise, but also have what CI's to vasodilators?
- BRONCHOSPASM
| - SEVERE CAROTID ARTERY STENOSIS
48
what are the main coronary vasodilators used in pharmacologic MPI stress tests?
- ADENOSINE
- DIPYRIDAMOLE
- REGADENOSEN
49
vasodilators should be used cautiously in stress imaging studies in pts w/ h/o?
BRONCHOSPASM
50
which vasodilator for stress imaging studies is a more selective A2A receptor activator, has less bronchospasm effect, and allows for a faster stress test?
REGADENOSEN
51
pharmacologic agent of choice for stress imaging studies for pts w/ h/o BRONCHOSPASM
DOBUTAMINE
52
unlike ETT, exercise stress echo and stress MPI can be used in which pts?
- resting ECG changes
- WPW syndrome
- on digoxin therapy
53
do pts w/ the following:
- resting ECG changes
- WPW syndrome
- on digoxin therapy
require chemical stress?
NO, if they can exercise, CLASS I indication to do stress echo WITH EXERCISE or MPI WITH EXERCISE
(i.e. they need the IMAGING, not the chemical stress)
54
what is the stress test of choice for pts w/ PACED VENTRICULAR RHYTHM?
MPI w/ vasodilators
55
how is the target heart rate achieved for stress echo?
- EXERCISE, or
| - DOBUTAMINE
56
what does the stress echo evaluate? (3)
- changes in WALL MOTION
- systolic WALL THICKENING
- systolic EJECTION FRACTION w/ stress
57
abnormal wall motion of failure of the wall to thicken (contract) appropriately during a stress echo suggests what?
myocardial ischemia to that region
58
are NOT used for stress echo
vasodilators
59
MPI uses which radioisotopes with single-photon emission computed tomography (SPECT)
- TECHNETIUM-99m (99mTc)
| - THALLIUM-201 (201TI) (less frequently)
60
in MPI the radioisotope tracers distribute in heart tissue in proportion to _____ which is recorded by a gamma camera and compared visually between resting and stressed states
blood FLOW
61
in MPI preserved myocardial perfusion at REST, but decreased during STRESS is suggestive of
ischemia ("REVERSIBLE defect")
62
in MPI matched reduction in perfusion between rest and stress images is suggestive of a
myocardial infarction ("FIXED defect")
63
determining best cardiac stress test:
- resting ECG normal
- able to exercise
ETT
64
determining best cardiac stress test:
- resting ECG normal
- NOT able to exercise
- dobutamine echo
- dobutamine MPI
- vasodilator MPI
65
determining best cardiac stress test:
- > 1 mm resting ST depression
- WPW
- LVH
- on digoxin
- able to exercise
- exercise echo (preferred)
| - exercise MPI (preferred)
66
determining best cardiac stress test:
- > 1 mm resting ST depression
- WPW
- LVH
- on digoxin
- NOT able to exercise
- dobutamine echo
- dobutamine MPI
- vasodilator MPI
67
determining best cardiac stress test:
- LBBB
- able to exercise
N/A
68
determining best cardiac stress test:
- LBBB
- NOT able to exercise
- vasodilator MPI (preferred)
| - dobutamine echo
69
determining best cardiac stress test:
- pacemaker
- able to exercise
N/A
70
determining best cardiac stress test:
- pacemaker
- NOT able to exercise
vasodilator MPI
71
which cardiac stress test is ALWAYS PREFERRED is pt has no limitations and what are the only 2 exceptions?
- EXERCISE STRESS TEST
- LBBB
- pacemaker
72
which cardiac stress test to choose:
if the pt is simply unable to walk and has no other issues
pharmacologic stress test
73
which cardiac stress test to choose:
if the pt has bronchospasm or severe carotid artery stenosis
DOBUTAMINE
74
which cardiac stress test to choose:
if the pt has severe HTN or prior ventricular tachycardia (VT)
use a VASODILATOR (adenosine, dipyridamole, or regadenoson), NOT dobutamine
75
which cardiac stress test to choose:
if the pt has a paced ventricular rhythm
use a VASODILATOR (adenosine, dipyridamole, or regadenoson), NOT dobutamine
76
is useful in evaluating pts w/ systolic HF, undergoing a pretransplant assessment, and for pts w/ unexplained exertional dyspnea
cardiopulmonary exercise testing (CPX)
77
is the GOLD STANDARD for diagnosis of CAD
coronary ANGIOGRAPHY
78
can also assess EF during coronary angiography
contrast VENTRICULOGRAPHY
79
- noninvasive modality for imaging the heart
- requires IV CONTRAST
- HR must be < 60 BPM and regular
- pts must be able to HOLD their BREATH
coronary computed tomographic angiography (CTA)
80
reasonable diagnostic test for symptomatic pts who are at INTERMEDIATE risk for CAD after initial risk stratification, including pts w/ equivocal stress test results
coronary computed tomographic angiography (CTA)
81
this test's usefulness is reduced in pts w/ pronounced coronary calcification
coronary computed tomographic angiography (CTA)
82
is an excellent test for evaluation of pts w/ congenital coronary anomalies
coronary computed tomographic angiography (CTA)
83
can be used to assess:
- right and left filling pressures
- CO
- RV and PA pressures
- systemic and pulmonary vascular resistance
pulmonary artery catheterization (PAC)
84
what is pulmonary artery catheterization (PAC) used for?
- determine pt's volume status
- causes of shock
- existence of pericardial disease
85
is the dampened LA pressure that reflects left ventricular end-diastolic pressure (LVEDP) in most cases, which reflects LVED volume
pulmonary capillary wedge pressure (PCWP)
86
normal pressures:
RA
< 8 mmHg
87
normal pressures:
RV
15-30/1-7 mmHg
88
normal pressures:
PCWP
4-12 mmHg
89
jugular venous distention in the upright pt which indicates an elevated RA pressure
> 7 cm H2O (5 mmHg)
90
what happens to PCWP w/:
- LV systolic failure
- LV diastolic failure
- mitral stenosis
- aortic insufficiency
- mitral insufficiency
- tamponade
- constrictive pericarditis
INCREASES
91
at what PCWP should LV failure be considered?
> 15-18 mmHg
92
at what PCWP do you have dyspnea on exertion (DOE)?
15-25 mmHg
93
at what PCWP do you have dyspnea at rest, orthopnea, and interstitial edema
25-35 mmHg
94
at what ACUTE PCWP do you have frank pulmonary edema?
> 35 mmHg
95
pulmonary artery catheterization scenarios:
- RA pressure: 0-5
- PA pressure: (13-28)/(3-13)
- PCWP: 3-11
- BP: 110/70
normal
96
pulmonary artery catheterization scenarios:
- RA pressure: 18
- PA pressure: 32/18
- PCWP: 19
- BP: 70/50
tamponade or constrictive pericarditis
97
pulmonary artery catheterization scenarios:
- RA pressure: 15
- PA pressure: 21/11
- PCWP: 10
- BP: 70/50
RV failure to RV infarct
98
pulmonary artery catheterization scenarios:
- RA pressure: 18
- PA pressure: 30/20
- PCWP: 20
- BP: 70/50
biventricular failure
99
pulmonary artery catheterization scenarios:
- RA pressure: 18
- PA pressure: 90/32
- PCWP: 30
- BP: 110/70
mitral stenosis
100
pulmonary artery catheterization scenarios:
- RA pressure: 18
- PA pressure: 90/32
- PCWP: 10
- BP: 110/70
pulmonary HTN
101
diastolic pressure in all 4 chambers is equalized in both ____ and ____
- pericardial tamponade
| - constrictive pericarditis
102
when is endomyocardial biopsy used?
- to monitor cardiac transplant rejection
| - to evaluate the cause of CARDIOMYOPATHY or MYOCARDITIS if cause is unclear or therapy isn't working
103
decreased pulse amplitude w/ INSPIRATION seen as absence of Korotkoff sounds during inspiration
pulsus PARADOXUS
104
can be observed by auscultating BP and listening for an exaggerated decrease in SBP (> 10 mmHg) during inspiration
pulsus PARADOXUS
105
pulsus PARADOXUS is present w/? (4)
- cardiac tamponade (especially)
- constrictive pericarditis
- asthma
- tension pneumothorax
106
what is the paradox in pulsus PARADOXUS?
you can hear a heartbeat, but not feel a pulse during inspiration
107
bifid w/ 2 systolic peaks per cardiac cycle
pulsus BISFERIENS
108
pulsus BISFERIENS is present w/? (2)
- aortic regurgitation (w/ or w/o stenosis!)
| - HCM
109
varying pulse pressure w/ a regular pulse rate
pulsus ALTERNANS
110
what is pulsus ALTERNANS seen w/?
severely depressed systolic function of any cause that leads to DECREASED STROKE VOLUME
111
what is pulsus PARVUS ET TARDUS and when is seen?
- parvus = LOW amplitude
- tardus = slow upswing
- aortic stenosis
112
what is BRACHIOFEMORAL DELAY and when is seen?
- femoral pulse occurs AFTER brachial pulse
| - coarctation of aorta
113
what is pulse ASYMMETRY and when is seen?
- good UE pulses, but diminished or absent LE pulses, OR asymmetry between right and left extremities
- aortic dissection
114
- DECREASED OR ABSENT peripheral pulses
| - possible BRUIT over proximal artery (such as femoral artery)
peripheral artery disease (PAD)
115
maneuvers to differentiate murmurs:
passive straight-leg raise (to 45 degrees, listen after 15 sec)
increases venous return
116
maneuvers to differentiate murmurs:
Valsalva (hold for 20 sec, listen just before end)
decreases venous return
117
maneuvers to differentiate murmurs:
standing (squat for > 30 sec then quickly stand; listen during first 15 sec after standing)
decreases venous return
118
maneuvers to differentiate murmurs:
transient arterial occlusion (BP cuff on both arms, inflated > 20 mm above systolic pressure)
increases systemic vascular resistance
119
maneuvers to differentiate murmurs:
handgrip (isometric; listen at end of 1 min max grip)
increases systemic vascular resistance
120
maneuvers to differentiate murmurs:
squatting
increases venous return and increases systemic vascular resistance, but preload effect is stronger than afterload effect
121
maneuvers for increasing/decreasing specific systolic murmurs:
- for HCM use
- standing (from squat)
(95%) INCREASED murmur
122
maneuvers for increasing/decreasing specific systolic murmurs:
- for HCM use
- Valsalva (if cannot do squat-to-stand)
(65%) INCREASED murmur
123
maneuvers for increasing/decreasing specific systolic murmurs:
- for HCM use
- passive straight-leg raise
(85%) DECREASED murmur
124
maneuvers for increasing/decreasing specific systolic murmurs:
- for HCM use
- handgrip
(85%) DECREASED murmur
125
maneuvers for increasing/decreasing specific systolic murmurs:
- for MVP use
- standing and Valsalva
click-murmur moves EARLIER
126
maneuvers for increasing/decreasing specific systolic murmurs:
- for MVP use
- transient arterial occlusion
(80%) click-murmur moves LATER
127
maneuvers for increasing/decreasing specific systolic murmurs:
- for MVP use
- handgrip
(70%) click-murmur LATER
128
maneuvers for increasing/decreasing specific systolic murmurs:
- for VSD use
- standing and Valsalva
DECREASED murmur
129
maneuvers for increasing/decreasing specific systolic murmurs:
- for VSD use
- transient arterial occlusion
(80%) INCREASED murmur
130
maneuvers for increasing/decreasing specific systolic murmurs:
- for VSD use
- handgrip
(70%) DECREASED murmur
131
maneuvers for increasing/decreasing specific systolic murmurs:
- for AS use
- transient arterial occlusion
DECREASED murmur
132
maneuvers for increasing/decreasing specific systolic murmurs:
- for AS use
- handgrip
DECREASED murmur
133
what happens to the ALL valve murmurs when blood INCREASES across the valve?
INCREASES murmur
134
how does STANDING and the strain phase of VALSALVA effect most most valve murmurs, and what are the 2 exceptions?
- DECREASES intensity of murmur
| - MVP and HCM
135
how does STANDING and the strain phase of VALSALVA effect right and left cardiac filling?
decreases filling
136
sustained handgrip (20-30 seconds) boosts systemic _____ and _____, and therefore decreases the murmurs of _____ and _____
- systemic vascular resistance
| - HCM and aortic stenosis (AS)
137
sustained handgrip (20-30 seconds) boosts systemic _____, which prolongs the murmur of _____ d/t earlier prolapse of the valve
- systemic vascular resistance
| - MVP (mitral valve prolapse)
138
right-sided murmurs and heart sounds are louder during
- INSPIRATION
| - anything that increases VR
139
left-sided murmurs and heart sounds are louder during
EXPIRATION
140
what is the only semi-exception to right-sided murmurs sounding less loud during inspiration?
right-sided ejection click d/t pulmonic stenosis
141
what happens to S1 intensity when there is:
- prolonged PR interval
- MR
- acute AR (increased LV pressure cause early valve closure)
- severely calcified mitral valve
DECREASES
142
what happens to S1 intensity when there is:
- short PR interval
- mitral stenosis
- hyperdynamic ventricular function
INCREASES
143
what causes S1?
closing of mitral and tricuspid valves
144
what causes S2?
closing of aortic and pulmonic valves at the end of systole
145
when does P2 occur?
right after A2
146
what is PHYSIOLOGIC SPLITTING of S2?
A2 followed by P2
147
when does PHYSIOLOGIC SPLITTING INCREASE, and why?
- during INSPIRATION
| - increased volume of blood in RV, which prolongs systole and delays pulmonic valve closure
148
causes for PERSISTENTLY (or WIDELY) split S2
- pulmonic stenosis
- acute PE
- ectopic or pacemaker beats originating in the LEFT ventricle
- RBBB
149
why do pulmonic stenosis, acute PE, actopic or pacemaker beats originating in the LEFT ventricle, and RBBB cause PERSISTENTLY (or WIDELY) split S2?
they cause DELAYED or PROLONGED CONTRACTION of the RIGHT VENTRICLE
150
cause for FIXED splitting of S2
atrial septal defect (ASD)
151
other cause for fixed splitting of S2 besides ASD
RV failure when SV is unable to increase w/ inspiration
152
cause for PARADOXICAL split S2 w/ P2 coming before A2
- LBBB
- ectopic or pacemaker beats originating in the RIGHT ventricle
- advanced HCM
153
indicates end of rapid ventricular filling; is the first part of diastole
S3
154
when is the S3 gallop normal?
- children
| - high CO, such as pregnant women
155
when is the S3 gallop abnormal?
pts > 40 yoa
156
causes for abnormal S3 gallop
- acute ventricular decompensation
- severe aortic regurgitation
- severe mitral regurgitation
(anything that increases early LV filling rate or volume)
157
S3 in a pt w/ KNOWN left ventricular dysfunction, means what?
POOR prognostic indicator
158
both S3 and S4 are best auscultated how?
left lateral decubitus position using the bell
159
when is S3 heard?
just after S2 (lub-dub-huh)
160
when is S4 heard?
just before S1 (huh-lub-dub)
161
is caused by ventricular filling during atrial contraction
S4
162
is heard in pts w/ decreased ventricular compliance
S4
163
causes for abnormal S4 gallop
- ischemic heart disease
- aortic stenosis
- HCM
- diabetic cardiomyopathy
- hypertensive heart disease w/ concentric hypertrophy
164
when do you NOT hear an S4 gallop?
- during atrial fibrillation (no atrial contraction!)
| - mitral stenosis
165
which side is the jugular venous pulse assessed?
right
166
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- pulmonary HTN
- elevated a and v waves
| - other physical exam findings of pulmonary HTN
167
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- tricuspid regurgitation
- large v waves
- TR murmur
- pulsatile liver
168
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- constrictive pericarditis
- rapid x and y descents
- Kussmaul sign
- pericardial knock
169
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- tamponade
- rapid x descent
- pulsus paradoxus
- hypotension
170
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- tricuspid stenosis
- slow y descent
| - TS murmur
171
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- restrictive cardiomyopathy
- rapid x and y descents
- low-voltage ECG
- echo
- myocardial bx
172
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- tension pneumothorax
- distended neck veins
- dyspnea
- U/L absent breath sounds
- deviated trachea
- CXR
173
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- superior vena cava syndrome
- U/L distended neck veins
- facial edema and cyanosis
- dx of cancer
174
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- AV dissociation
- irregular cannon a waves
| - ECG
175
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- RV infarction
- elevated a and v waves
- acute inferior MI
- Kussmaul sign
176
venous waveforms in clinical setting:
- neck vein appearance
- other diagnostic features
- ASD
- large v waves and rapid y descent
- fixed split S2
- echo
177
jugular waveform:
- large, RIGHT-SIDED V WAVES
- ventricular septal rupture
| - TR
178
jugular waveform:
- rapid X and Y DESCENTS
constrictive pericarditis
179
jugular waveform:
- ONLY rapid x descent
tamponade (loss of y descent)
180
jugular waveform:
- large, RIGHT-SIDED Y WAVES
- TS
- severe pulmonic stenosis
- severe noncompliant RVH
181
jugular waveform:
- "CANNON" A WAVES
- complete heart block
- ventricular tachycardia
- asynchronous ventricular pacing
- all conditions w/ AV DISSOCIATION (when atrium is contracting against CLOSED tricuspid valve)
182
tall, LEFT-SIDED V WAVES are d/t
severe MR
183
large, LEFT-SIDED A WAVES are d/t
mitral stenosis
184
suspect SECONDARY causes of HTN in which pts?
- onset before 30 yoa or after 55 yoa
- drug-resistant HTN
- development of uncontrolled HTN that was previously well controlled
185
systolic abdominal bruits (w/o a diastolic bruit) suggests
renal vascular HTN
186
what are noninvasive tests to diagnose RAS?
- duplex US
- CTA
- MRA
187
when should you think of primary hyperaldosteronism?
- HTN
- HYPOkalemia
- LOW renin
188
common cardiac medications:
- digoxin
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. +
c. +
d. no
e. no
f. no
g. no
h. systolic HF, arrhythmias
189
common cardiac medications:
- BB
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. +++
b. +++
c. +++
d. no
e. yes
f. yes
g. yes
h. HTN, angina, HF, arrhythmias
190
common cardiac medications:
- carvedilol
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. ++
b. +++
c. +++
d. yes
e. yes
f. yes
g. yes
h. HTN, angina, HF, arrhythmias
191
common cardiac medications:
- nifedipine
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. ++
b. no
c. no
d. yes
e. yes
f. no
g. no
h. HTN, angina
192
common cardiac medications:
- amlodipine
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. +
b. no
c. no
d. yes
e. yes
f. no
g. yes (in DCM)
h. HTN, angina, DCM
193
common cardiac medications:
- diltiazem
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. ++
b. ++
c. ++
d. yes
e. yes
f. no
g. no
h. HTN, angina, arrhythmias
194
common cardiac medications:
- verapamil
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. +++
b. +++
c. +++
d. yes
e. yes
f. no
g. no
h. HTN, angina, arrhythmias
195
common cardiac medications:
- nitrates
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. no
c. no
d. yes
e. yes
f. no
g. yes (w/ hydralazine)
h. angina, HF
196
common cardiac medications:
- ACEIs
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. no
c. no
d. yes
e. no
f. yes
g. yes
h. HTN, HF
197
common cardiac medications:
- ARBs
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. no
c. no
d. yes
e. no
f. yes
g. yes
h. HTN, HF
198
common cardiac medications:
- hydralazine
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. no
c. no
d. yes
e. no
f. no
g. yes (w/ nitrates)
h. HTN, HF
199
common cardiac medications:
- spironolactone
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. no
c. no
d. no
e. no
f. no
g. yes
h. HTN, HF
200
common cardiac medications:
- eplerenone
a. negative inotrope
b. negative chronotrope
c. negative dromotrope
d. vasodilator
e. antianginal
f. prolong survival post-MI
g. prolong survival in HF
h. indications
a. no
b. no
c. no
d. no
e. no
f. yes (w/ HF)
g. yes (post-MI)
h. HF post-MI
201
chest pain d/t "supply-demand" mismatch between coronary perfusion and cardiac workload
angina
202
angina is either classified as
STABLE or UNSTABLE
203
3 characteristics of UNSTABLE angina
1. pain at rest
2. new onset
3. increased frequency
204
most common underlying process triggering ACUTE coronary syndrome
plaque rupture or erosion w/ superimposed thrombus
205
what are causes of INCREASED DEMAND in angina?
- tachycardia
- fever
- thyrotoxicosis
206
what are causes of DECREASED SUPPLY in angina?
- hypotension
- coronary vasospasm
- anemia
- hypoxia
207
in what conditions can coronary blood flow be impaired, even in the ABSENCE of epicardial CAD?
- severe aortic valve disease w/ LVH
- HTN
- idiopathic dilated CM
- hypertrophic CM
208
what percentage of pts actually have classic angina at the moment of ischemic ST changes?
20%
209
silent ischemia is seen in what pts?
- DIABETICS
| - pts w/ prior ischemic events
210
silent ischemia, MIs, and thrombotic strokes occur at what time during day w/ the highest incidence?
early morning hours
211
what is the MOST IMPORTANT, easily determinable PROGNOSTIC factor in pts w/ CAD?
DEGREE of LV DYSFUNCTION
212
severe LV dysfunction can be a reflection of what?
multi-vessel, or left main/left main-equivalent disease
213
is an excellent, objective way to determine SEVERITY of angina and to determine prognosis
exercise tolerance test
214
what is the 5-year survival rate for pts able to go to stage 4 of Bruce protocol?
nearly 100%
215
what is the 5-year survival rate for pts NOT able to go to stage 1 of Bruce protocol?
only 50%
216
coronary ANGIOGRAPHY is NOT REQUIRED to determine what?
prognostic factor for pt w/ ACS
217
transient ST-elevation that occurs during stress testing
coronary artery SPASM
218
what are causes of RESTING ST-segment elevation?
- acute MI
- coronary artery spasm
- pericarditis
- LV aneurysm
- LBBB
- ventricular pacing
- LVH
- benign early repolarization
219
chronically underperfused myocardium WITHOUT irreversible myocyte injury
hibernating myocardium
220
occurs when severely ischemic myocardium is reperfused after about 1 hour, causing further irreversible microvascular damage to myocytes
reperfusion injury
221
d/t acute ischemia and takes 7-10 days for ventricle to return to normal
stunned myocardium
222
treatment of all angina
modify risk factors and correct aggravating factors (anemia, HTN, smoking, drug abuse, noncompliance)
223
what are the main drugs used to treat angina?
- BB's and nitrates; CCB's can also help
| - ASA +/- clopidogrel (if allergic to aspirin, or if indicated)
224
which pts might benefit from ranolazine (Ranexa)?
pts w/ persistent angina on maximal standard therapy, or as a substitute for BB's
225
these meds ALL decrease myocardial O2 demand, and ALL decrease afterload
BB's, nitrates, and CCB's
226
which meds decrease preload > afterload and can cause severe DECOMPENSATION in acute RIGHT ventricular MI?
nitrates
227
- cause sympathetic reflex tachycardia
- degraded in LIVER
- tachyphylaxis
nitrates
228
how do BB's decrease myocardial O2 demand?
1. decrease HR
2. decrease BP
3. decrease contractility
229
which medication can actually prolong vasospasm in pts w/ variant angina?
nonselective BBs
