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- Med School Review 🔥 > Cardiology > Flashcards

Cardiology Flashcards

(100 cards)

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1
Q

Electrical alternans

A

Pericardial effusion

(2/2 pericarditis, MI, penetrating trauma, iatrogenic [Central-line placement, pacemaker insertion])

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2
Q

New-onset RBBB

A

Right heart strain

(think PE; usually +JVD)

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3
Q

Symmetric ischemia and necrosis of distal fingers/toes during vasopressor resuscitation

A

NE-induced vasospasm

Can also occur in intestines and kidneys

(mesenteric ischemia; renal failure)

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4
Q

Fingertip pain and pallor triggered by cold or stress

A

Raynaud’s phenomenon

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5
Q

Asymmetrical “blue toe syndrome”

A

cholesterol emboli

(pts with atherosclerosis)

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6
Q

Immigrant + irregular heartbeat

A

Rheumatic MS

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7
Q

Fainting after urinating, coughing, or defecating

A

Situational syncope

(triggers cause a cardioinhibitory, vasodepressor,

or mixed neural alteration in autonomic response)

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8
Q

Postural change-induced fainting

A

Orthostatic syncope

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9
Q

Fainting from prolonged standing, emotional distress, or painful stimuli

A

Vasovagal syncope

(neurally mediated)

  • Tx: Counterpressure maneuvers & trigger avoidance
    • e.g. leg crossing w/ tensing of muscles, handgrip, tensing of arm muscles w/ clenched fists, etc.
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10
Q

Exercise-induced fainting

A
  • HOCM
  • Aortic stenosis
  • Anomalous coronary arteries
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11
Q

Fainting w/ prior hx of CAD, MI, cardiomyopathy,

or decreased EF

A

Ventricular arrhythmias

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12
Q

Fainting in setting of sinus pauses, prolonged PR or prolonged QRS

A

Sick sinus syndrome, bradyarrhythmias, or AV block

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13
Q

Fainting in setting of hypokalemia, hypomag, increased QT meds

A

Torsades de points

(acquired long QT syndrome)

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14
Q

FHx of sudden death, increased QT, syncope w/ exercise/startle/sleeping

A

Congenital long QT syndrome

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15
Q

Micturition

A

Urination

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16
Q

Upper extremity HTN + lower extremity claudication

A

Aortic coarctation

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17
Q

Dilated pupils

A

Cocaine/stimulants

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18
Q

Pinpoint pupils

A

Heroin/Opioids

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19
Q

Avoid ___ in cocaine-induced ACS

A

Beta Blockers

(to avoid risk of unopposed cocaine-induced alpha agonist activity and resultant worsening vasoconstriction)

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20
Q

Digitalis (Digoxin) toxicity

A

CGN

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21
Q

Digoxin

A

Cardiac Glycoside

  • Cardiac (Atrial tachycardia with AV block)
  • GI (anorexia, N/V, abd pain)
  • Neurologic (fatigue, confusion, weakness, color vision alterations)
  • Increased ectopy in atria or ventricles —> Atrial tachycardia
  • Increased vagal tone —> Decreased AV node conduction —> Potential AV block
  • Increased with amiodarone
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22
Q

Pulsus paradoxus

A

Cardiac tamponade or severe asthma/COPD

(Respiratory variation in SBP)

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23
Q

>10mmHg SBP drop during inspiration

A

Pulsus paradoxus

(Cardiac tamponade or severe asthma/COPD)

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24
Q

Post-CABG

A

Think cardiac tamponade ⇒ get echo

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25
Most common location of ectopic foci that cause AFib
**Pulmonary veins** (can be disrupted by catheter-based radiofrequency ablation)
26
S3
**CHF** or **Volume Overload**: * **CHF** * **MR** (chronic severe) * **AR** (chronic) * **Pregnancy** (due to high CO state) * **Thyrotoxicosis** (due to high CO state)
27
S4
"HHAA" * **H**TN * **H**OCM * **A**ortic Stenosis * **A**cute MI
28
PCWP
LA pressure; LV End-Diastolic pressure * Decreased in intravascular volume loss
29
Increased **BNP**
CHF * +**S3** sound * +/- peripheral edema (less specific for CHF)
30
Arrhythmia caused by hypokalemia and hypomagnesemia
**VT** | (such as with furosemide)
31
Tx of beta blocker or CCB toxicity
**IV Atropine + IVF** | (**IV Glucagon** if refractory)
32
Prolonged PR interval, normal QRS
First-degree AV block due to delayed impulse transmission anywhere from atria to ventricles —\> NO FURTHER EVALUATION REQUIRED (Observation only)
33
Prolonged PR + wide QRS duration
Conduction delay likely below the AV node (often in bundle branches) —\> Electrophysiological testing
34
Causes of HFpEF
* **Dilated** cardiomyopathy (beriberi/thiamine deficiency) * **Hypertrophic** cardiomyopathy * **Restrictive** cardiomyopathy (sarcoidosis, amyloidosis, hemochromatosis, endomyocardial fibrosis)
35
Lid lag
**hyperthyroidism**
36
Wt loss + lid lag + hand tremor
hyperthyroidism
37
Indication for Holter monitoring
Symptomatic pts w/ intermittent arrhythmias
38
CHF (diastolic dysfxn) + proteinuria + easy bruising
**Amyloidosis** | (in elderly)
39
**AL** amyloidosis
**primary**
40
**AA** amyloidosis
**secondary** to RA, IBD, chronic infections
41
Systolic murmur that increases on inspiration in IV drug user
Tricuspid valve endocarditis
42
HF w/ hx of cardiac surgery or radiation
**Constrictive pericarditis**
43
Mid-diastolic sound - Pericardial knock
**constrictive pericarditis**
44
Pericardial calcifications on echo
constrictive pericarditis
45
Post-MI acute limb ischemia
Arterial embolus from **LV thrombus** Tx: * **IMMEDIATE ANTICOAGULATION** * **Echo** to look for LV thrombus & fxn * Vascular surgery consult
46
Hepatojugular Reflux (JVP \>3cm w/ abd compression)
**RV Failure**
47
Avoid in RVMI
**Nitrates**, Diuretics, Opioids ## Footnote Due to high sensitivity of RV to intravascular volume depletion leading to profound hypotension (cardiogenic shock) —\> Tx: **Isotonic saline bolus**
48
Upturning of cardiac apex on CXR
**TOF** (RVH 2/2 *pulmonic stenosis*—“boot-shaped” heart)
49
Displacement of tricuspid valve w/ enlarged RA
Ebstein anomaly
50
Scoliosis + coarctation
Turner syndrome (XO)
51
Rib notching on CXR
Coarctation of Aorta | (2/2 dilated intercostal arteries)
52
“3” sign on L costal surface in CXR
Coarctation of aorta (Aortic knob —\> Actual coarctation —\> Post-stenotic dilation of aorta)
53
2:1 AST/ALT
Alcoholism
54
**Wheals**
urticaria (allergy or anaphylaxis)
55
Long bone fx + dyspnea, neurological sx, & petechial rash 12-24 hours post-injury
Fat embolism
56
Systolic murmur @ apex that radiates to axilla
MR
57
Short PR
**WPW** * "Ventricular pre-excitation syndrome" * Accessory AV conduction pathway not contained within the AV node may cause a short PR interval & a delta wave (slurred upward sloping of QRS due to pre-excitation) on EKG * AFib w/ WPW has increased risk of VF → * Stable: Procainamide * Unstable: Synchronized Cardioversion (DC)
58
Tx for 3rd degree (complete) heart block
**Temporary cardiac pacing**
59
**S4**
HHA: HTN, HOCM, Aortic Stenosis
60
Hyperthermia/HIGH fever post-syncope
**Exertional heat stroke**
61
Exertional heat stroke Tx
ICE-WATER IMMERSION
62
Nonexertional heat stroke (elderly) Tx
EVAPORATIVE COOLING MEASURES
63
**Cyproheptadine**
Serotonin antagonist used in serotonin syndrome if discontinuation + supportive measures fail.
64
Anterior MI post-MI complication
think **Free Wall Rupture** (LAD) hours-14d
65
Inferior MI post-MI complication
think **Papillary Muscle Rupture** (RCA) 2d-7d
66
Anterior/Posterior MI post-MI complication w/ RHF
Interventricular Septum Rupture (LAD or RCA) 0-5d
67
Inhibits TXA2 production
ASA
68
Anti-inflammatory that inhibits mitosis and neutrophil activity
**Colchicine** | (gout, pericarditis, Behcet’s)
69
PEA
—\> CPR + q4 Epi
70
Asystole
—\> CPR + q4 Epi
71
VF
—\> Defibrillation + q2 Epi/Amiodarone
72
Pulseless VT
—\> Defibrillation + q2 Epi/Amiodarone
73
Chest Pain DDx
Cardiac/Pulm/GERD/MSK/Psychogenic/Thyrotox/ Drugs/Pheo/VZV Pulm - PE/PTX/PNA
74
Pleuritic Chest Pain (**PPPC**)
Pericarditis, PTX, PE, Costochondritis (MSK)
75
Palpable thrill at suprasternal notch
**AS**
76
**Bounding pulses**
—\> AR | (+”pounding” heart/heartbeat awareness)
77
“Pounding” heart/Heartbeat awareness
**AR** due to chamber enlargement and myocardial hypertrophy from AR-induced increase in LVEDV, bringing ventricular apex close to chest wall; (or can be from palpitations from AFib)
78
Peripheral edema side-effect
Amlodipine (CCBs) * Especially dihydropyridines—**amlodipine,** nifedipine—due to systemic vasodilation
79
**Post-MI Blue toe syndrom**e
Cholesterol embolism (atheroembolism) - common complication following cardiac catheterization
80
CYP450 Inhibitors (Increase Warfarin effect; increase bleeding risk)
AAA RACKS IN GQ Magazine * **A**cute **A**lcohol **A**buse * **A**cetaminophen * **R**itonavir * **A**miodarone * **C**imetidine/**c**iprofloxacin - Antibiotics * **K**etoconazole -antifungal * **S**ulfonamides - Antibiotics * **IN**H * **G**rapefruit juice/Cranberry juice * **Q**uinidine * **M**acrolides (except azithromycin) - **Antibiotics** * Omeprazole * Thyroid hormone * SSRIs (e.g. fluoxetine
81
CYP450 Inducers (Decrease Warfarin effect; decrease bleeding risk):
Chronic Alcoholics Steal Phen-Phen & Never Refuse Greasy Carbs * Chronic alcohol use * St. John’s wort, Ginseng * Phenytoin * Phenobarbital * Nevirapine * Rifampin * Griseofulvin * Carbamazepine OCPs
82
Acetaminophen + Warfarin
Increased bleeding | (CYP450 inhibitor)
83
**Theophylline toxicity**
CGN (like digoxin toxicity) * Cardiac (arrhythmias) * GI (N/V) * Neuro (CNS Stimulation: HA, insomnia, seizures) * CYP450 metabolism; Narrow therapeutic index
84
Pounding heartbeat sensation in L lateral decubitus position
**AR** 2/2 LV enlargement
85
Wide pulse pressure
**AR**
86
Post-cardiac cath AKI
**Cholesterol emboli** vs. **CIN** (contrast-induced nephropathy) * CIN resolves within 3-5d * Cholesterol emboli can be immediate or delayed \>30d
87
Rheumatic Heart Disease causes AFib due to
**Mitral stenosis-induced LA dilation**
88
Torsades de pointes Tx
* **IV Magnesium** (stable) * **Defibrillation** (unstable)
89
Subauricular bruit
**FMD** * Dx: Duplex US or CTA/MRA * Tx: ACE/ARBs, PRTA, or surgery
90
Meds that can trigger bronchoconstriction in asthma pts
**ASA** & **BBs**
91
Tx for Torsades de pointes
**IV Magnesium**
92
Tx of bradycardia associated with hypothermia
**Active external rewarming + warmed IV fluids** (refractory to _atropine_ or _cardiac pacing_ during hypothermia)
93
Post-MI complication up to 3 months out
* Pericarditis (1 d-3mo) * LV aneurysm (5d-3mo)
94
Systolic-diastolic abdominal bruit in pt with HTN
Renal Artery Stenosis (RAS) (Renovascular Hypertension) * Can be heard in ~40% of RAS pts * Other clues: Malignant HTN, Resistant HTN, Severe HTN w/ diffuse atherosclerosis * +unexplained atrophic kidney * +recurrent flash pulmonary edema * +unexplained rise in Cr following ACE-I or ARB * Dx: Renal doppler, CT angiography, or MR angiography
95
Why does PCWP ↑ in MI?
**Failure of Forward Blood Flow** PCWP = Estimate of LA Pressure
96
Failure of ______ to close is PDA
**Ductus Arteriosus**
97
\_\_\_\_ closes PDA; ____ opens PDA
_NSAIDs_ **close** PDAs _Prostaglandins_ **keep open** PDAs
98
Interventricular calcifications
**Congenital CMV**
99
Periventricular Calcifications at birth
**Toxoplasma**
100
Cholesterol Screening (Lipid Panel)
Every **3-5 years** beginning at **age 40**

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