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STEP 2 CK > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

What must be evaluated in a ECG?

A 
Rate
Rhythm
Axis
Intervals
Ischemia/infarction
Chamber enlargement
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2
Q

What is considered bradycardia?

A

HR < 60 bpm

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3
Q

What are the most common causes of sinus bradycardia?

A 
Physical fitness
Sick sinus syndrome
Drugs
Vasovagal attacks
Acute MI
Increased intracranial pressure
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4
Q

What is considered tachycardia?

A

HR > 100bpm

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5
Q

What are the most common causes of sinus tachycardia?

A 
Anxiety
Anemia
Pain
Fever
Sepsis
CHF
PE
Hypovolemia
Thyrotoxicosis
CO2 retention
Sympathomimetics
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6
Q

What characterizes a sinus rhythm?

A

P wave (upright in II, III, and aVF; inverted in aVR) preceding every QRS complex and a QRS complex after every P wave

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7
Q

What are the leads used to determine the ECG axis?

A

Leads I, II, and aVF

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8
Q

What is considered a normal PR interval?

A

Between 120-200 ms

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9
Q

What can cause a prolonged PR interval?

A

Delayed AV conduction

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10
Q

What can cause a shortened PR interval?

A

Fast AV conduction down accessory pathway (e.g., WPW syndrome)

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11
Q

What is considered a normal QRS duration?

A

Duration < 120ms

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12
Q

How is a left bundle branch block presented in a ECG?

A

Deep S and no R in V1

Wide, tall, and broad, or notched R wave in I, V5, and V6

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13
Q

What can a new LBBB be sign of?

A

Acute MI

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14
Q

How is a right bundle branch block presented in a ECG?

A

RSR’ complex
qR or R morphology with a wide R wave in V1
Wide S wave in I, V5 and V6

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15
Q

What is the duration of a normal corrected QT interval (QT/√RR)?

A

Between 380-440 ms

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16
Q

What are common causes of prolonged cQT?

A 
Congenital syndromes
Long QT syndrome
Jervell and Lange-Nielsen syndrome
Acute MI
Bradycardia
Myocarditis
Low K, Ca, or Mg
Head injury
Drugs
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17
Q

What is the Jervell and Lange-Nielsen syndrome?

A

Long QT syndrome due to defect K conduction, associated with sensorineural deafness

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18
Q

What is the treatment of Jervell and Lange-Nielsen syndrome?

A

Beta-blockers and pacemaker

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19
Q

What are acute ischemia signs in ECG within hours?

A

Peaked T waves and ST segment changes

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20
Q

What are acute ischemia signs in ECG within 24 hours?

A

T wave inversion and ST segment resolution

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21
Q

What are acute ischemia signs in ECG within a few days?

A

Pathologic Q waves (> 40ms or more than 1/3 of QRS amplitude)

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22
Q

What are the difference of subendocardial infarcts?

A

ST and T changes without Q waves

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23
Q

What is found in a ECG of a patient with right atrial enlargement?

A

The P wave amplitude in lead II is > 2.5mm

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24
Q

What is found in a ECG of a patient with left atrial enlargement?

A

The P wave width in lead II is > 120ms

Termina negative deflection in V1 is > 1mm in amplitude and > 40ms in duration

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25
How a left ventricular hypertrophy can be shown in ECG?
Amplitude of S in V1 + R in V5 or V6 > 35mm | Amplitude of R in aVL + S in V3 > 28mm in men or 20mm in women
26
How a right ventricular hypertrophy can be shown in ECG?
Right axis deviation | R wave in V1 > 7mm
27
How to assess if there is jugular venous distention?
JVD > 4cm above the sternal angle
28
What is the cause of jugular venous distention?
Volume overload
29
What are common causes of volume overload, which presents as JVD?
Right heart failure | Pulmonary hypertension
30
What is the hepatojugular reflux?
Distention of neck veins upon applying pressure to the liver
31
What is the Kussmaul sign?
An increase in jugular venous pressure with inspiration
32
What is the most common cause of the Kussmaul sign?
Constrictive pericarditis
33
What are the systolic murmurs?
Aortic stenosis Mitral regurgitation Mitral valvev prolapse Flow murmur
34
How is the aortic stenosis murmur like?
Harsh systolic ejection murmur that radiates to the carotids
35
How is the mitral regurgitation murmur like?
Holosystolic murmur that radiates to the axilla
36
How is the mitral valve prolapse murmur like?
Midsystolic or late systolic murmur with a preceding click
37
How is the flow murmur murmur like?
Soft murmur that is position-dependent
38
What are the diastolic murmurs?
Aortic regurgitation | Mitral stenosis
39
How is the aortic regurgitation murmur like?
An early decreascendo murmur
40
How is the mitral stenosis murmur like?
Mid to late low-pitched murmur
41
What is the S3 gallop sign of?
Fluid overload
42
What are common causes of S3 gallop?
Heart failure Mitral valve disease Pregnancy
43
What is the S4 gallop sign of?
Decreased compliance
44
What are common causes of S4 gallop?
Hypertension Aortic stenosis Diastolic dysfunction
45
What is the main cause of pulmonary edema?
Left heart failure
46
What are the most common causes of peripheral edema?
``` Right heart failure Nephrotic syndrome Hepatic disease Lymphedema Hypoalbuminemia Drugs ```
47
What are the main causes of finger clubbing?
Congenital cyanotic heart disease | Endocarditis
48
What are the main physical exam findings of infective endocarditis?
Splinter hemorrhages Osler nodes Janeway lesions
49
What are Osler nodes?
Painful, red, raised lesions found on the hands and feet
50
What are Janeway lesions?
Non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter
51
Which murmurs increase with inspiration?
Right-sided murmurs
52
Which murmurs increase with expiration?
Left-sided murmurs
53
What are causes of right axis deviation?
Right ventricular hypertrophy Anterolateral MI Left posterior hemiblock
54
What are causes of left axis deviation?
Ventricular tachycardia Inferior myocardial infarction Left ventricular hypertrophy Left anterior hemiblock
55
What are causes of increased peripheral pulses?
Compensated aortic regurgitation Coarctation of aorta Patent ductus arteriosus
56
What are causes of decreased peripheral pulses?
Peripheral arterial disease | Late-stage heart failure
57
What are causes of collapsing ("waterhammer") peripheral pulses?
``` Aortic incompetence AV malformations Patent ductus arteriosus Thyrotoxicosis Severe anemia ```
58
What is pulsus paradoxus?
Decrease of systolic BP > 10mmHg with inspiration
59
What are causes of pulsus paradoxus?
``` Cardiac tamponade Pericardial constriction Obstructive lung diseases Tension pneumothorax Foreign body in airway ```
60
What are causes of pulsus alternans?
Cardiomyopathy | Impaired left ventricular systolic function
61
What is the main cause of pulsus parvus et tardus?
Aortic stenosis
62
What is the main cause of a jerky peripheral pulse?
Hypertrophic obstructive cardiomyopathy
63
What are causes of pulsus bisferiens?
Aortic regurgitation Combined aortic regurgitation and stenosis Hypertrophic obstructive cardiomyopathy
64
What drugs can cause sinus bradycardia?
Beta blockers | Calcium channel blockers
65
What are the signs and symptoms of sinus bradycardia?
Generally asymptomatic | May present as lightheadedness, syncope, chest pain, or hypotension
66
What are the ECG findings of sinus bradycardia?
Sinus rhythm | HR < 60 bpm
67
What is the treatment of sinus bradycardia?
If asymptomatic and HR > 40 bpm: none Atropine if symptomatic or HR < 40 bpm Pacemaker implant is the definitive treatment
68
What is the ECG finding of a first-degree AV block?
PR interval > 200ms
69
What are the causes of a first-degree AV block?
Can occur in normal individuals Associated with increased vagal tone Beta-blocker use CCB use
70
What are the signs/symptoms of a first-degree AV block?
Asymptomatic
71
What is the treatment of a first-degree AV block?
None necessary
72
What is the ECG finding of a second-degree AV block (Mobitz I/Wenckebach)?
Progressive PR lenghtening until a dropped beat occurs; the PR interval then resets
73
What are the causes of a second-degree AV block (Mobitz I/Wenckebach)?
Drugs effects (Digoxin, Beta-blockers, CCBs) Increased vagal tone Right coronary ischemia or infarction
74
What is the treatment of a second-degree AV block (Mobitz I/Wenckebach)?
None if asymptomatic Stop the offending drug Atropine as clinically indicated
75
What are the signs/symptoms of a second-degree AV block (Mobitz I/Wenckebach)?
Usually asymptomatic
76
What is the ECG finding of a second-degree AV block (Mobitz II)?
Unexpected dropped beat(s) without a change in PR interval
77
What are the signs/symptoms of a second-degree AV block (Mobitz II)?
Occasionally syncope
78
What are the main causes of a second-degree AV block (Mobitz II)?
Results from fibrotic disease of the conduction system or from acute, subacute, or prior MI
79
To what can a second-degree AV block (Mobitz II) progress to?
A third-degree AV block
80
What is the treatment of a second-degree AV block (Mobitz II)?
Pacemaker placement (even if asymptomatic)
81
What is the ECG finding of a third-degree AV block (complete)?
No relationship between P waves and QRS complexes
82
What is the cause of a third-degree AV block (complete)?
No electrical communication between the atria and ventricles
83
What are signs/symptoms of a third-degree AV block (complete)?
Syncope, dizzines, acute heart failure, hypotension, cannon A waves
84
What is the treatment of a third-degree AV block (complete)?
Pacemaker placement
85
What is the sick sinus syndrome?
Heterogenous disorder that elads to intermittent supraventricular tachyarrhythmias and bradyarrhythmias
86
How is the sick sinus syndrome also called?
Tachycardia-bradycardia syndrome
87
What are signs/symptoms of the sick sinus syndrome?
Symptoms of tachycardia and bradycardia | AF and thromboembolism may occur
88
What is the most common indication for pacemaker placement?
Sick sinus syndrome
89
What is the treatment for patients with persistent tachyarrhythmias with hemodynamic intability?
Immediate synchronized cardioversion
90
What is the ECG finding of a sinus tachycardia?
Sinus rhythm with HR > 100 bpm
91
Sinus tachycardia is usually primary or secondary to another state?
Usually secondary
92
What are signs/symptoms of sinus tachycardia?
Palpitations, shortness of breath
93
What is the treatment of sinus tachycardia?
Treat the underlying cause
94
What are the causes of acute atrial fibrillation?
``` PIRATES: Pulmonary disease Ischemia Rheumatic heart disease Anemia/Atrial myxoma Thyrotoxicosis Ethanol Sepsis ```
95
What are the causes of chronic atrial fibrillation?
Hypertension CHF Most oftern caused by ectopic foci within the pulmonary veins
96
What is the ECG finding of a atrial fibrillation?
No discernible P waves, with variable and irregular QRS response
97
What is the treatment for an unstable or new-onset (< 2 days) AF?
Cardioversion
98
What is the treatment for a new AF with > 2 days or unclear duration?
Must get TEE to rule out atrial clot
99
What is the treatment for chronic AF?
Rate control with Beta-blockers, CCBs, or Digoxin | Anticoagulate with Warfarin or NOACs for patients with CHA2DS2-VASc score >= 2
100
What is the ECG finding of a atrial flutter?
Regular rhythm, with atrial rate usually between 240-320 bpm, and ventricular rate of 150bpm "Sawtooth" appearance of P waves
101
What is the cause of the atrial flutter?
Circular movement of electrical activity around the atrium at a rate of approximately 300 bpm
102
What is the treatment of the atrial flutter?
Anticoagulation, rate control, and cardioversion guidelines as in AF
103
What is the ECG finding of a multifocal atrial tachycardia?
Three or more unique P-wave morphologies with rate > 100 bpm
104
What is the cause of multifocal atrial tachycardia?
Multiple atrial pacemakers or reentrant pathways
105
What is associated with multifocal atrial tachycardia?
COPD, hypoxemia
106
What is the treatment of multifocal atrial tachycardia?
Treat as AF, but avoid Beta-blockers if COPD
107
What is the ECG finding of a atrioventricular nodal reentry tachycardia (AVNRT)?
Rate 150-250 bpm | P wave is often buried in QRS or shortly after
108
What is the cause of a atrioventricular nodal reentry tachycardia (AVNRT)?
A reentry circuit in the AV node depolarizes the atrium and ventricle nearly simultaneously
109
What is the treatment of atrioventricular nodal reentry tachycardia (AVNRT)?
Cardiovert is hemodinamically unstable Vagal maneuvers Adenosine if vagal maneuver fails
110
What are the ECG findings of a atrioventricular reentry tachycardia (AVRT)?
A retrograde P wave is often seen after a normal QRS | A reexcitation delta wave is characteristically seen in WPW
111
What is the cause of atrioventricular reentry tachycardia (AVRT)?
An ectopic connection between the atrium and ventricle that causes a reentry circuit
112
What is the treatment of atrioventricular reentry tachycardia (AVRT)?
Cardiovert is hemodinamically unstable Vagal maneuvers Adenosine if vagal maneuver fails Except for WPW
113
What is the ECG finding of Wolff-Parkinson-White (WPW) syndrome?
Characteristic delta wave with widened QRS complex and shortened PR interval
114
What is the cause of Wolff-Parkinson-White (WPW) syndrome?
Abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent)
115
What is the treatment of Wolff-Parkinson-White (WPW) syndrome?
Observe the asymptomatics Acute therapy is Procainamide or Amiodarone Radiofrequency catheter ablation is curative SVT gets worse after CCBs or Digoxin
116
What is the ECG finding of paroxysmal atrial tachycardia?
Rate > 100bpm; P wave with an unusual axis before each normal QRS
117
What is the cause of paroxysmal atrial tachycardia?
Rapid ectopic pacemaker in the atrium (not sinus node)
118
What is the treatment of paroxysmal atrial tachycardia?
Adenosine can be used to unmask underlying atrial activity by slowing down the rate
119
What are the ECG findings of premature ventricular contraction?
Early, wide QRS not preceded by a wave | PVCs are usually followed by a compensatory pause
120
What is the cause of premature ventricular contraction?
Ectopic beats arise from ventricular foci
121
What are associated conditions to premature ventricular contraction?
``` Hypoxia Fibrosis Decreased LV function Electrolyte abnormalities Hyperthyroidism ```
122
What is the treatment of premature ventricular contraction?
Treat the underlying cause | If symptomatic, give Beta-blockers or, occasionally, other antiarrhythmics
123
What is the ECG findings of a ventricular tachycardia?
3 or more consecutive PVCs; wide QRS complexes in a regular rapid rhythm; may see AV dissociation
124
What is the associations of ventricular tachycardia?
CAD MI Structural heart disease
125
What is the treatment of ventricular tachycardia?
Cardioversion if unstable | Antiarrhythmics if stable
126
What can a ventricular tachycardia progress to?
Ventricular fibrillation
127
What is the ECG finding of a ventricular fibrillation?
Totally erratic wide-complex tracing
128
What is associated with ventricular fibrillation?
CAD | Structural heart disease
129
What is the treatment of ventricular fibrillation?
Immediate electrical defibrillation and ACLS protocol
130
What is the ECG finding of Torsades de pointes?
Polymorphous QRS; VT with rates between 150 and 250 bpm
131
What is associated with Torsades de pointes?
``` Long QT syndrome Proarrhythmic response to medications Hypokalemia Congenital deafness Alcoholism ```
132
What is the treatment of Torsades de pointes?
Magnesium initially and cardiovert if unstable | Correct hypokalemia and withdraw offending drugs if it is the cause
133
What are the classes of NYHA functional classification of CHF?
I: No limitation of activity; no symptoms (palpitations, dyspnea, and fatigue) with normal activity II: Slight limitation of activity; comfortable at rest or with mild exertion III: Marked limitation of activity; comfortable only at rest IV: Any physical activity brings on discomfort; symptoms (palpitations, dyspnea, and fatigue) present at rest
134
(HFrEF) Usually, what is the patient age?
< 65 years of age
135
(HFrEF) What are the most common comorbidities?
Dilated cardiomyopathy Valvular heart disease Myocardial infacrtion
136
(HFrEF) What can be found in the physical exam?
Displaced PMI | S3 gallop
137
(HFrEF) What can be found in the CXR?
Pulmonary congestion | Cardiomegaly
138
(HFrEF) What can be found in the ECG/echocardiography?
``` Q waves in ECG Decreased EF (<40%) and heart dilation in ECHO ```
139
(HFpEF) Usually, what is the patient age?
> 65 years of age
140
(HFpEF) What are the most common comorbidities?
Restrictive of hypertrophic cardiomyopathy Renal disease HTN
141
(HFpEF) What can be found in the physical exam?
Sustained PMI | S4 gallop
142
(HFpEF) What can be found in the CXR?
Pulmonary congestion
143
(HFpEF) What can be found in the ECG/echocardiography?
LVH in ECG | Normal/preserved EF (>55%), abnormal LV diastolic indices in ECHO
144
What is the most common cause of right-sided heart failure?
Left-sided heart failure
145
What is an independent predictor of mortality in patients with heart failure?
Hyponatremia
146
What is HFrEF characterized by?
Decreased EF (<40%) and increased LV end-diastolic volumes
147
What is HFrEF caused by?
Inadequate LV contractility or increased afterload
148
In HFrEF, how the heart compensates the decreased EF or increased afterload?
Hypertrophy and ventricular dilation
149
How is the diagnosis of HFrEF made?
Based on signs and symptoms
150
What is the treatment of acute HFrEF?
Loop diuretics for aggressive diuresis ACEIs or ARBs in combination with loop diuretics Beta-blockers should be avoided during decompensated CHF Correct underlying causes Inotropic agents (eg, Dobutamine) can be used
151
What is the chronic management of HFrEF?
Lifestyle change: control comorbid conditions, and limit dietary sodium and fluid intake Beta-blockers and ACEIs/ARBs: help prevent remodeling of the heart and reduce mortality for NYHA class II-IV Low-dose Spironolactone: reduce mortality in patients with NYHA class III-IV Diuretics (most commonly loop diuretics): prevent volume overload Digoxin: symptomatic control of dyspnea and decrease frequency of hospitalizations Daily ASA and a Statim are recommended if the underlying cause is a prior MI
152
What is the definition of HFpEF?
Decreased ventricular compliance with normal systolic function
153
What is the treatment of HFpEF?
Diuretics are the best initial treatment | It is important to maintain rate and BP controle via Beta-blockers, ACEIs, ARBs, or CCBs
154
How is the CHA2DS2-VASc score calculated?
``` CHF (+1) HTN (+1) Age >= 75 (+2) Diabetes (+1) Stroke or TIA history (+2) Vascular disease (+1) Age 65-74 (+1) Sex category (female) (+1) ```
155
What are the risk factors for congestive heart failure?
``` Coronary heart disease Hypertension Cardiomyopathy Valvular heart disease Diabetes COPD (cor pulmonale) ```
156
What must be present to diagnose a dilated cardiomyopathy?
Left ventricular dilation | Decreased EF
157
What is the most common cause of dilated cardiomyopathy?
Idiopathic
158
What are known secondary causes of dilated cardiomyopathy?
``` Alcohol Postviral myocarditis Postpartum status Drugs (Doxorubicin, AZT, Cocaine) Radiation Endocrinopathies (thyrotoxicosis, acromegaly, pheochromocytoma) Infection (Coxsackievirus, HIV, Chagas disease, parasites) Genetic factors Nutritional disorders (wet beriberi) ```
159
What are the most common secondary causes of dilated cardiomyopathy?
Ischemia | Long-standing hypertension
160
What murmur is associated with dilated cardiomyopathy?
S3 gallop
161
What murmur is associated with hypertrophic cardiomyopathy?
S4 gallop
162
What is the history of the dilated cardiomyopathy?
Gradual development of CHF symptoms shuch as dyspnea on exertion, and diffuse edema of the ankles, feet, legs, and abdomen
163
What can be found in the exam of a patient with dilated cardiomyopathy?
``` Displacement of the left ventricular impulse JVD Rales S3 gallop Mitral/tricuspid regurgitation ```
164
What exam is diagnostic in the case of dilated cardiomyopathy?
Echocardiography
165
In a patient with dilated cardiomyopathy, what can be seen on a CXR?
Enlarged, "ballon-like" heart and pulmonary congestion
166
What is the treatment of dilated cardiomyopathy?
Address the uncrelying etiology if secondary | Treat CHF
167
What is the most common cause of sudden death in young, healthy athletes?
HOCM
168
What is the physiopathology of hypertrophic cardiomyopathy?
Impaired left ventricular relaxation and filling (diastolic dysfunction) due to thickened centricular walls secondary to stressors on the myocardium, shuch as HTN and aortic stenosis
169
What is the most common cause of hypertrophic cardiomyopathy?
HTN
170
What is HOCM?
Hypertrophic obstructive cardiomyopathy
171
What is the cause of HOCM?
Congenital inherited autosomal dominant trait
172
What is the physiopathology of HOCM?
Asymmetric interventricular septum hypertrophy, leading to left ventricular tract outflow obstruction and impaired ejection of blood
173
What are the symptoms of hypertrophic cardiomyopathy?
``` Often asymptomatic Syncope Lightheadedness Dyspnea Palpitations Angina Sudden cardiac death ```
174
What is the key finding during physical exam in a patient with hypertrophic cardiomyopathy?
Harsh systolic ejection crescendo-decrescendo murmur in the lower left sternal edge that increases with decreased preload and decreases with increased preload
175
What can worsen the symptoms of a patient with hypertrophic cardiomyopathy?
``` Exercise Diuretics Dehydration ACEIs/ARBs Digoxin Hydralazine ```
176
What is the treatment of hypertrophic cardiomyopathy?
Beta-blockers are first line
177
What is the physiopathology of restrictive cardiomyopathy?
Decreased elasticity of myocardium leading to impaired diastolic filling without significant systolic dysfunction
178
What are the causes of restrictive cardiomyopathy?
Infiltrative disease (amyloidosis, sarcoidosis, hemochromatosis) Scleroderma Loeffler eosinophilic endocarditis Endomyocardial fibrosis Scarring and fibrosis secondary to radiation
179
What is the history of restrictive cardiomyopathy?
Signs and symptoms of right-sided heart failure often perdominate over left-sided failure, but dyspnea is the most common complaint
180
What is the treatment of restricitve cardiomyopathy?
Treat the underlying cause
181
What are the clinical manifestations of coronary artery disease?
``` Stable and unstable angina Shortness of breath Dyspnea on exertion Arrhythmias MI Heart failure Sudden death ```
182
What are the risk factors for coronary artery disease?
``` DM Family history of premature CAD (men < 55yo, women <65yo) Smoking Hyperlipidemia Abdominal obesity HTN Age (men >45yo, women >55yo) Male gender ```
183
What is stable angina?
Substernal chest pain secondary to myocardial ischemia (O2 supply-and-demand mismatch)
184
What is the main cause of stable angina?
Atherosclerosis
185
What is the classical triad of stable angina?
Substernal chest pain Precipitated by stress or exertion Relieved by rest or nitrates
186
What is the duration of stable angina?
2-10 min
187
What symptoms can be associated with stable angina?
``` Shortness of breath Nausea/vomiting Diaphoresis Dizziness Lightheadedness ```
188
What is the best initial test for diagnosis of stable angina?
ECG, which is usually normal
189
How are cardiac enzymes in stable angina?
Normal
190
What test is diagnostic for stable angine?
Stress test
191
What are noncardiac differential diagnosis of stable angina?
GERS Musculoskeletal/costochondritis Pneumonia/pleuritis Anxiety
192
What is the treatment of chronic stable angina?
ASA, Beta-blockers (reduce mortality) Nitroglycerin (relieve pain) Risk factors control
193
What is the clinical picture of Prinzmetal angina?
Angina that classically affects young women at rest in the early morning
194
What drug is associated with Prinzmetal angina?
Cocaine
195
What can be seen in ECG during Prinzmetal angina?
ST-segment elevation
196
What is the treatment for Prinzmetal angina?
CCBs with or without long-acting Nitrates Beta-blockers can increase vasospasm Aspirin can aggravate the ischemic attacks
197
What is the main cause of TIA and embolic strokes?
Carotid artery stenosis
198
How to diagnose carotid artery stenosis?
Duplex ultrasonography
199
What is the treatment of carotid artery stenosis?
Carotid endarterectomy in men with >= 60% stenosis (>= if symptomatic) or women with >= 70% stenosis

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