Cardiology Flashcards
(156 cards)
1
Q
Coarctation of the aorta presentation
A
Severe upper extremity hypertension with brachial femoral pulse delay and lower extremity claudication due to decreased blood flow
2
Q
Aortic stenosis physical exam
A
Soft single s2
Delayed and diminished carotid pulse also known as Parvis and tardis
Loud and late peeking systolic murmur
3
Q
Echocardiogram features of tamponade
A
Right atrial and right ventricular collapse during diastole which is an indication for pericardiocentesis
4
Q
Pulses paradoxes
A
Drop in systolic blood pressure greater than 10 during inspiration which is an important finding in cardiac tamponade
5
Q
Children with family history of high cholesterol or premature coronary artery disease
A
Should have a lipid profile determined soon after they are two years old
If family member has a total cholesterol greater than 240 order a random cholesterol. If it is less than 170 repeat in five years. If it is greater than 200 order fasting lipid profile.
If family member has a history of premature coronary artery disease, order fasting lipid profile directly.
6
Q
Unstable angina with increased risk of coronary event
A
Need angiogram followed by PCI or CABG
7
Q
Maternal hyperglycemia effect on fetal heart
A
Excessive glycogen deposition in the fetal myocardium which leads to fetal hypertrophic cardiomyopathy and possibly CHF which will resolve spontaneously
8
Q
Purpose of BNP
A
Distinguish between cardiac and non-cardiac causes of dyspnea
9
Q
First step and patient with SVT
A
If they are hemodynamically stable, identify the type with IV adenosine or vagal maneuver’s
If they are hemodynamically unstable, Urgent cardioversion
10
Q
ECG findings in WPW
A
Short PR interval
Delta wave
Widening of the QRS
11
Q
Complications of bicuspid aortic valve
A
Aortic dilation, aortic aneurysm, aortic dissection.
12
Q
SERMs and surgery
A
Discontinue four weeks prior to surgery due to increased risk of venous thromboembolism
13
Q
Statin indications
A
LDL greater then 190 paragraph
Age 40 to 75 with diabetes
Calculated 10 year cardiovascular risk greater than 7.5%
14
Q
Acute infarction pericarditis onset and cause
A
1 to 4 days post transmural myocardial infarction
15
Q
Dressler’s syndrome onset, presentation, and pathophysiology
A
Weeks to months status post MI
Auto immune mediated syndrome
Fever, leukocytosis, pleuritic chest pain, and pericardial rub
16
Q
Acute infarction pericarditis treatment
A
Aspirin
17
Q
Infarction Pericarditis and NSAIDs
A
Thought to increase risk of myocardial rupture following transmural myocardial infarction
18
Q
Dressler’s syndrome treatment
A
NSAIDs
Corticosteroids if refractory to NSAIDs
19
Q
Treatment of DVT
A
Initial treatment consisted of heparin
Warfarin 3 to 6 months in case of a first DVT
20
Q
Chadsvasc score
A
Congestive heart failure Hypertension Age greater than 75 Diabetes mellitus Stroke or TIA Vascular disease Age 65to 74 Female sex
21
Q
Atrial fibrillation score to anticoagulate
A
Greater than two
22
Q
Initial treatment of acute decompensation at heart failure and severe hypertension
A
IV diuretics plus IV vasodilators
Nitro induced vasodilation improves preload and afterload which decreases filling pressures and results in symptomatic relief
23
Q
When to discontinue statin therapy
A
If symptomatic or asymptomatic with a CK level greater than 10 times normal
24
Q
Common arrhythmia resulting from inferior MI and treatment
A
Sinus bradycardia and that usually resolves within 24 hours
Symptomatic bradycardia should be treated with IV atropine and if it persists patient should be treated with transvenous temporary pacing
25
Presentation of constrictive pericarditis
Peripheral edema, JVD, clear lungs
Ascites and hepatic congestion
Pericardial knock
26
Causes of constrictive pericarditis
Idiopathic
Viral pericarditis
Cardiac surgery or radiation therapy
Tubercular pericarditis
27
Most important AAA risk factor
Smoking
28
CRT heart failure guidelines
Ejection fraction less than 35%
NYHA class 2 to 4
LBBB or QRS greater than 15
29
Bicuspid aortic valve genetics and guidelines
Autosomal dominant trait with incomplete penetrance
Recommend screening of first-degree relatives
30
Pathophysiology of bradycardia following inferior myocardial infarction
Right coronary artery he supplies blood to inferior wall and SA node
Infarction leads to SA node ischemia
31
Two categories of mitral regurgitation
Ruptured mitral chordae tendinae which can be secondary to MVP, infective endocarditis, trauma, and rheumatic heart disease
Papillary muscle rupture which can be secondary to myocardial infarction, ischemia, and trauma
32
Adrenal cortical tumors
Secrete steroid hormones such as corticosteroids, mineralocorticoids, and androgens
Examples include Cushing syndrome and aldosteronism
33
Adrenal medullary tumors
Pheochromocytoma
Secrete catecholamines
Present with episodic headaches, Flushing, sweating, tachycardia, hypertension
34
Symptoms of TCA overdose
CNS
Cardiac such as arrhythmias
Anti-cholinergic side effects
35
Treatment of TCA overdose
Sodium bicarbonate to prevent arrhythmias
Magnesium ore lidocaine for refractory symptoms
36
Presentation and treatment of atrial myxoma
Signs and symptoms of mitral valve obstruction
Heart failure
Atrial fibrillation
Frequently embolize leading to arterial occlusion
Treatment is surgical excision
37
Risks of factor V Leiden
Venus thrombosis such as DVT, PE, cerebral, mesenteric, and portal vein thrombosis
Usually not associated with arterial emboli
38
Most common cause of death and steering wheel injuries
Aortic injury
39
Most important test following blunt chest trauma
ECG
If normal, no further evaluation
If abnormal, FAST or echocardiogram
40
Pathophysiology and treatment of cocaine abuse leading to myocardial ischemia
Vasospasm plus or minus thrombosis
Treatment includes nitrates, aspirin, or benzodiazepines
If symptoms are not reversed with the above regimen, patient will need angiogram
41
Medication to avoid and cocaine users
Beta blockers
42
Pathophysiology of compartment syndrome leading to acute kidney injury
Compartment syndrome may lead to rhabdomyolysis which results in the release of myoglobin in which heme is toxic to the kidneys causing acute kidney injury
43
Diagnosis and treatment of compartment syndrome
Diagnosis by measurement of tissue pressures
Treatment consists of fasciotomy
44
Severe aortic stenosis valve area
Aortic valve area less than 1 cm
45
Most common cause of congestive heart failure
Ischemic heart disease 50 to 70%
46
Abnormal ABI
Less than 0.9
47
Management of PAD
Lipid lowering therapy
Antiplatelet therapy with aspirin or Plavix
Blood pressure control
Screening and treatment of diabetes
Supervised exercise program
Cilostazol, PCI, or surgery
48
Pathophysiology of hyponatremia and CHF
ADH
49
Treatment of hyponatremia in congestive heart failure patients
Water restriction
Tolvaptan for patients with CHF and symptomatic hyponatremia to raise serum sodium above 120 other options of failed
50
Management of cocaine related chest pain
Benzodiazepines
Avoid beta blockers
Phentolamine decreases vasospasm
Nitroprusside and nitroglycerin are also reasonable
51
Most dreaded complication of HOCM
Sudden cardiac death
52
Indications for alcohol septal ablation in HOCM patients
Persistent symptoms despite medical therapy
53
Management of supra therapeutic INR
INR less than five with no bleeding, hold warfarin for 1 to 2 days
INR 5 to 9 with no bleeding, hold warfarin and give one to 2.5 mg of oral vitamin K if there is increased risk of bleeding
INR greater than nine with no bleeding, hold warfarin and give 2.5 to 5 mg of oral vitamin K
Any INR with bleeding, hold warfarin give vitamin K 10 mg, FFP, and it factor VIIa, or prothrombin complex concentrate
54
IV vitamin K risk
Anaphylaxis
55
Subcutaneous vitamin K
Not as effective as oral or IV
56
Initial management of acute decompensated heart failure
Diuretics and or IV vasodilators to decrease preload
57
First line management of hypertension requiring more than one medication
ACEI plus calcium channel blocker's such as amlodipine
58
Treatment of BPH plus hypertension
Alpha blockers such as doxazosin
59
Anti-thrombotic therapy in patients with mechanic heart valves
Aspirin – 75 to 100 mg in all patients with aortic valve or mitral valve replacement, should also take warfarin
Warfarin – goal INR 2-3– Aortic valve replacement if no risk factors are present
Warfarin – goal INR 2.5 to 3.5 – mitral valve replacement or aortic valve replacement plus risk factors
60
Indications for carotid endarterectomy
Men
Asymptomatic – 60 to 99% stenosis
Symptomatic - 50 to 99% stenosis
Women
70 to 99% stenosis
61
Treatment of symptomatic HOCM
Beta blockers or calcium channel blocker's
62
Alcohol septal ablation indications in HOCM
Reserved for patients with persistent symptoms despite medical therapy with calcium channel blocker's or beta blockers
63
Vasodilators in hyper trophic cardiomyopathy
Reduce systemic vascular resistance leading to increased left ventricular outflow tract obstruction and increased symptoms
64
Leading cause of morbidity and mortality and patience with Marfan syndrome
Aortic root disease with progressive aneurysmal dilation, aortic regurgitation, and aortic dissection
65
Imaging indicated in Marfan syndrome
Transthoracic echocardiogram at the time of diagnosis and six-month intervals to assess the aortic root and ascending aorta
66
Pathophysiology of Marfan syndrome
Autosomal will dominant defect in the connective tissue glycoprotein fibrillin 1 that causes abnormalities of the skeleton, eyes, and cardiovascular system
67
Normal right atrial pressure
4
Measurement of preload
68
Normal PCWP
Nine
Measurement of preload
69
Normal cardiac index
2.82 4.2
Measurement of pump function
70
Normal systemic vascular resistance
1150
Management of afterload
71
Normal mixed oxygen saturation
60 to 80%
72
Hemodynamic measurements in hypovolemic shock
Decreased right atrial pressure
Decreased pulmonary capillary wedge pressure
Decreased cardiac index
Increased systemic vascular resistance
Decreased mixed oxygensaturations
73
Hemodynamic measurements in cardiogenic shock
Increased right atrial pressure
Increased pulmonary capillary wedge pressure
Decreased cardiac index
Increased systemic vascular resistance
Decreased mixed oxygen saturations
74
Hemodynamic measurements in septic shock
Decreased or normal right atrial pressure
Decreased or normal pulmonary capillary wedge pressure
Increased cardiac index
Decreased systemic vascular resistance
Increased mixed oxygen saturations
75
Prodrome a vasovagal syncope
Nausea, lightheadedness, pallor, diaphoresis
76
Precipitating events of vasovagal syncope
Standing, needles, exertion, pain
77
Mitral valve prolapse's murmur
Mid to late systolic click followed by a late systolic murmur
78
Mitral regurgitation murmur
Apical holosystolic murmur
79
Pulmonic stenosis murmur
Crescendo decrescendo ejection murmur in the left upper sternal border
80
Mitral stenosis murmur
Low pitched, rumbling diastolic murmur heard best over the apex
81
Heart sounds of cardiac tamponade
Muffled heart sounds
82
Prolonged QT interval
Men greater than 450
Women greater than 470
83
Side effects of calcium channel blocker's
Headache, Flushing, dizziness
Arteriolar dilation leads to increased capillary hydrostatic pressure leading to peripheral edema
ACEI leads to venodilation which decreases peripheral edema
84
WPW pathophysiology
Preexcitation syndrome caused by accessory pathway that directly connects the atria to the ventricles and bypasses the AV node
The accessory pathway conducts faster than the AV node and excites the ventricles prematurely, leading to short PR interval and delta wave
QRS is prolonged
85
Arrhythmia to avoid in patients with WPW
Atrial fibrillation which can lead to ventricular fibrillation and cardiac arrest
86
Treatment of symptomatic WPW
Catheter ablation therapy
87
Treatment of TDP
IV magnesium sulfate
If no response, temporary transvenous pacing
88
Initial medical therapy for acute coronary syndrome
Oxygen, aspirin, morphine, nitroglycerin
Plavix
Beta blocker
Anticoagulation
Statin therapy
89
ICD placement guidelines in patients with hypertrophic cardiomyopathy
Prior history of cardiac arrest or VT
Family history of sudden death
Recurrent or exertional syncope
Nonsustained VT
Hypotension with exercise
Extreme left ventricular hypertrophy
90
Murmur of VSD
Holosystolic murmur heard best over the left third and fourth intercostal spaces accompanied by a palpable thrill
91
Causes of left to right shut
Atrial septal defect
Ventricular septal defects
Patent ductus arteriosus
92
Murmur of PDA
Continuous murmur heard best in the left infraclavicular area
93
For characteristic features of TOF
RVOT obstruction
Overriding aorta
Right ventricular hypertrophy
VST
94
Common findings in Ehlers Danlos syndrome
Hyperextensible skin
Velvet skin
Joint hypermobility
Mitral valve prolapse's
Development of hernias
95
Pathophysiology of Ehlers Danlos syndrome
COL5A mutations
Autosomal dominant
96
Common findings in Marfan syndrome
Joint hypermobility
Increased arm span to height ratio
Aortic root dilation
Mitral valve prolapse's
Lens dislocation
Spontaneous pneumothorax
97
Murmur of ASD
Wide and fixed splitting of the second heart sound
Mid systolic ejection murmur resulting from increased flow across the pulmonic valve
Mid diastolic rumble resulting from increased flow across the tricuspid valve
98
Trastuzumab cardiotoxicity
May lead to congestive heart failure but is often reversible with discontinuation of the medication
99
Most common cause of mitral stenosis
Rheumatic heart disease with symptoms presenting 10 to 20 years after initial rheumatic fever
100
Management of acute limb ischemia
Anticoagulation and emergent surgical revascularization
101
Use of target specific oral anticoagulants
Not intended for nonvalvular atrial fibrillation , prosthetic heart valves, or end stage renal disease
102
Preferred agent's for rate control in patients with atrial fibrillation
Beta blockers or calcium channel blockers
103
Characteristics of multifocal atrial tachycardia
Three or more P waves of different morphologies
QRS complexes are narrow
PR segments in the ER or intervals are variable
Heart rate can reach 200 bpm
104
Causes of multifocal atrial tachycardia
Hypoxia
COPD
Hypokalemia
Hypomagnesemia
105
Treatment of multifocal atrial tachycardia
Treat the underlying cause such as hypoxia or electrolyte abnormalities
Beta blockers can be used if other therapy does not correct MAT
Verapamil is the drug of choice in patients with asthma or COPD
106
The most effective nonpharmacologic measure to decrease blood pressure
Weight loss
107
Goal of aortic dissection treatment
Adequate pain control
Lowering systolic blood pressure to 100 to 120
Decreasing left ventricular contractility reduce aortic wall stress
108
Treatment of aortic dissection
IV beta blockers such as esmolol, propranolol, or labetalol are preferred to slow the heart rate to less than 60 bpm, lower the blood pressure, and reduce myocardial contractility
Nitroprusside should only be used in addition to beta blockers if systolic blood pressure remains above 100 to 120 after adequate beta blockade
109
Signs of pulmonary hypertension
Loud S2
Enlarged pulmonary arteries on chest x-ray
Signs of right heart strain on ECG such as right bundle branch block
110
Diagnosis of pulmonary hypertension
Echocardiogram
CT of the chest should be obtained after echocardiogram to evaluate secondary causes a pulmonary hypertension
111
Treatment of pulmonary hypertension
Positive vasoreactivity test – calcium channel blocker's
Negative vasoreactivity test – prostanoid medication such as epoprostenol, an endothelial receptor antagonist such as bosentan, or a phosphodiesterase inhibitor such as sildenafil
112
ECG findings in 2nd° AV block
Mobitz type one – progressive prolonged PR interval's lead to a nonconducted P wave
Mobitz type two –PR interval remains constant with intermittent nonconducted P waves
113
Atropine and 2nd° AV block
Improves type one AV block in worsens type two AV block
114
Risk of complete heart block in 2nd° AV block
Low risk in Mobitz type one
Higher risk in Mobitz type two AV block requiring pacemaker
115
Warfarin and amiodarone
It is recommended that the warfarin dose be reduced by 25 to 50% to compensate for the increase in serum concentration of warfarin after initiating amiodarone therapy
116
Four components of tetralogy of Fallot
VSD
Pulmonary stenosis
Aortic override
Right ventricular hypertrophy
117
Most common structural disorder that occurs following TOF repair
Pulmonary regurgitation
118
Presentation of pulmonary regurgitation
Right heart volume overload
Single S2 because the pulmonary valve is sacrificed during the procedure
119
Murmur of VSD
Systolic murmur heard at the left sternal border that often obliterates the first and second heart sound
120
Definition of intermediate risk of myocardial infarction
5 to 7.5% defined by the pooled cohort equations
121
Use of high sensitivity CRP
Useful for guiding primary prevention strategies in intermediate risk patients as you try to re-classify them into low risk or high-risk
122
Usefulness of lipid particle size and number
Not useful
123
TTE indications in a patient with a murmur
Asymptomatic patients with a system all like a murmur that his grade 3/6 or higher
A late or holosystolic murmur
Diastolic or continuous murmur
124
Indications for anticoagulation in patients with atrial fibrillation following an ablation
Oral anticoagulation for any patient with a nonvalvular atrial fibrillation and a CHADS VASc score greater than one
125
Aspirin and warfarin in patients with atrial fibrillation
Aspirin therapy with warfarin is reserved for patients with active coronary artery disease
The addition of aspirin to warfarin significantly increases the risk of bleeding
126
Use of aspirin alone in treatment of a fib
Aspirin is insufficient therapy for a patient at high risk of stroke
127
Treatment of hypertrophic cardio myopathy
Initial therapy is medication that addresses the factors that predispose towards LVOT of obstruction
Beta blockers or calcium channel blocker's are the cornerstone of therapy
128
Medications to avoid in patients with hypertrophic cardio myopathy
Need to avoid medications that decrease preload such as diuretics
Need to also avoid medications that decrease afterload such as vasodilators
All of these medicationscan lead to worsening LVOT obstruction
129
Maneuvers in hypertrophic cardio myopathy
Squat to stand decreases preload
Expiration decreases afterload
130
What is PAU
Penetrating atherosclerotic ulcer
A focal defect or lesion occurring at the site of an intimal atherosclerotic plaque
131
What category of acute aortic syndrome does PAU fit into
Type B aortic syndrome
132
Treatment of type B acute aortic syndrome
Treated medically, initially with beta blockade to decrease the heart rate below 60 bpm followed by an arterial dilator such as nitroprusside to control blood pressure
133
Three potentially lethal causes of chest pain
Acute myocardial infarction
Pulmonary embolism
Acute aortic syndrome
134
Most common location of penetrating atherosclerotic ulcer
Descending aorta
135
Candidates for high intensity Statin therapy
Patients with known atherosclerotic disease such as CHD, cerebrovascular disease, or PAD
Patient with an LDL of greater than 190
Patients with diabetes and an LDL below 190 and a calculated 10 year CHD risk of 7.5% or higher
136
Indications for moderate intensity Statin therapy
Patients with diabetes who are not receiving high intensity Statin therapy
Most patients without diabetes with an LDL below 190 and calculated 10 year CHD risk greater than 7.5%
137
Drugs considered to be high intensity Statins
Lipitor 40 to 80 mg
Rosuvastatin 20 to 40 mg
Simvastatin 80 mg
138
Low intensity Statin drugs
Fluvastatin
Lovastatin
Simvastatin 10 mg
139
Two most common causes of a nonproductive cough in patients with heart failure
Volume overload
ACEIs
140
ACE inhibitors cough on set
Can occur at any point after initiation of therapy
141
Indications for repeating echocardiograms in patients with heart failure
A decline in functional status and to reassess function after up titrating medications
142
BNP association with mortality
Higher levels associated with greater mortality
143
What is atrial septal aneurysm
Redundant atrial septal tissue that is often associated with a patent foramen ovale
144
Treatment of atrial septal aneurysm
When found incidentally, no medical treatment or intervention is needed
Antiplatelet therapy is recommended for patients with cryptogenic stroke and an isolated atrial septal aneurysm
145
Additional treatment for atrial septal aneurysm
In patients with recurrent stroke despite antiplatelet therapy, anticoagulant therapy is recommended
Rarely, surgical excision of the atrial septal aneurysm is considered in patients with stroke despite anticoagulant
146
Management of stable angina with a low risk stress test
Initiation of a long acting nitrate such as isosorbide mono nitrate is recommended
Most patients Will require beta blockers and nitrates for symptomatic relief
147
Use of calcium channel blocker's in stable angina
Second line therapy for patients who cannot tolerate beta blockers or who have continued symptoms despite beta blockers and nitrates
148
Most common congenital heart lesion
Bicuspid aortic valve
149
Murmur of bicuspid aortic stenosis
Maybe systolic or diastolic depending on if there is regurgitation
150
Complications of bicuspid aortic stenosis
Aortic regurgitation
Aortic aneurysm
Aortic dissection
151
Murmur of aortic coarctation
Systolic murmur in the left infraclavicular area and under the left scapula
152
Most characteristic finding on auscultation in patients with an atrial septal defect
Fix the splitting of the second heart sound
153
Flu vaccine and heart disease
Annual flu vaccine has been shown to reduce risk for future cardiovascular events
154
Appropriate follow-up for patients with asymptomatic severe aortic stenosis
Clinical evaluation and echocardiography every 6 to 12 months
155
Surgical treatment of aortic stenosis indications
Symptomatic patients with severe aortic stenosis
Asymptomatic patients with severe aortic stenosis and LV systolic dysfunction
Patients with severe aortic stenosis who are undergoing CABG or surgery on the aorta or other valves
156
Indications for TAVR in patients with aortic stenosis
Patients with severe aortic stenosis who are considered unsuitable for surgery due to multiple comorbidities
