CARDIOLOGY Flashcards
(185 cards)
1
Q
What is the first line of treatment to reduce angina?
A
Beta blocker and/or CCB
2
Q
Chest pain that reaches its peak intensity immediately
A
- Aortic dissection (look for tall, male w/ hyperextensible joints)
- Pulmonary embolism
- Pneumothorax
3
Q
MOST frequently CITED Abnormality in PE (in addition to sinus tachycardia)
A
S1 Q3 T3 Sign AKA McGinn-White Sign
(SPECIFIC, but insensitive)
A large S wave in lead I, a Q wave in lead III and an inverted T wave in lead III together indicate acute right heart strain.
4
Q
_____ is always the best initial diagnostic test for ischemic-type pain.
A
ECG
5
Q
What is the initial test of choice in herat failure?
A
Echocardiogram
Echocardiography is unquestionably the most important of all tests for heart failure. There is no reliable way to distinguish preserved from reduced ejection fraction. Every patient with heart failure must undergo echocardiography to evaluate EF.
6
Q
A 30-year-old woman with history of rheumatic fever presents to the emergency room with dyspnea and palpitation. On auscultation, there is an opening snap followed by a low-pitched, tumbling, diastolic murmur at the apex.
A
Mitral Stenosis
7
Q
_______ is a selective sinus node inhibitor (If pacemaker current).
A
Ivabradine
8
Q
classic findings for Hypertrophic Cardiomyopathy
A
Septal hypertrophy and systolic anterior motion of the mitral valve
9
Q
Hallmarks of massive PE
A
- Dyspnea
- Syncope
- Hypotension
10
Q
FOUNDATION for successful Treatment of DVT and PE
A
Anticoagulation
11
Q
What is the best initial test for AS?
A
Transthoracic echocardiogram
12
Q
Almost all PRIMARY cardiac malignancies are
A
Sarcomas, commonly in right side (but tumors metastatic to heart are more common)
13
Q
What diagnostic test is used to distinguish unstable angina and NSTEMI?
A
Cardiac biomarkers
14
Q
Capillary pulsation at the root of the nail (Quincke’s pulse)
A
AR
15
Q
which lipid lowering agent was most likely recently started in a patient who complains of podagra
A
niacin
16
Q
Booming “pistol shot” sound over femoral arteries (Traube sign)
A
AR
17
Q
Critical narrowing of MS is defined as valve surface area of ___
A
< 1cm2
18
Q
MOST common type of PRIMARY cardiac tumor in all age groups, MOST commonly in the 3rd–6th decade, with female predilection
A
Myxoma (mostly sporadic)
19
Q
Chest pain, ST depression or normal ECG, normal biomarkers. Diagnosis?
A
Unstable Angina
20
Q
_____, an increase in JVP on inhalation, is seen in restrictive cardiomyopathy, constrictive pericarditis, restrictive cardiomyopathy, tricuspid stenosis and RV infarction.
A
Kussmaul Sign
21
Q
FUNCTIONAL CLASSIFICATION OF ANGINA
Inability to carry on any physical activity without discomfort
i.e Angina at rest
A
Class IV
22
Q
Opening snap is observed in ___
A
MS
The opening snap (OS) right after S2 is due to high LA pressure and readily audible in expiration.
23
Q
MOST common cause of DEATH in hypertensive patients
A
Cardiac
24
Q
Sildenafil when taken with ______ can result in
large and prolonged decrease in systemic blood pressure and coronary blood flow in vessels with critical stenosis.
A
Nitrates
25
Chest pain, **ST elevation** on ECG, **very elevated biomarkers**
STEMI
26
CLASSIFICATION OF MYOCARDIAL INFARCTION
## Footnote
**Myocardial infarction secondary to an ischemic imbalance**
• Coronary artery spasm, arrhythmias, anemia, respiratory failure, hypotension and hypertension with or without left ventricular hypertrophy
Type 2
27
This is seen in what condition.
Infective Endocarditis
## Footnote
**Roth Spot** - white-centered retinal hemorrhages
**Osler's Node** - PAINFUL, red papules on the hands and feet
**Janeway Lesions** - NON-TENDER erythematous macules on palms and soles
28
BEST known INDIRECT sign of PE on transthoracic
echo
**McConnell’s Sign:**
hypokinesis of the RV Free Wall with NORMAL motion of the RV Apex
29
Dihydropyridine calcium channel blocker
| (**Vascular** \> Cardiac)
Amlodipine
Nifedipine
Felodipine
30
Diagnosis of IE is established with certainty
Histologically and microbiologically
31
What is the best initial therapy for all cases of ACS?
Aspirin
32
Leg pain + Fever + chills usually indicates
Cellulitis (not DVT)
33
Chest pain, ST depression or normal ECG, **elevated biomarkers**. Diagnosis?
NSTEMI
34
MOST common **congenital** cardiovascular cause
of hypertension
Coarctation of the Aorta
35
A 7**0-year-old man** presents with **chest pain** on exertion and shortness of breath for the past 2 months. His wife recalls that her husband had an episode of **syncope** a month ago. On examination, there is a **3/6 mid-systolic murmur** at the second intercostal space at the right sternal border is auscultated and patient had a **weak and delayed pulse.**
Aortic Stenosis
36
MOST common clinical presentation of myxomas
Mimics mitral valve disease
37
MAJOR indication for Surgery in IE
Moderate to severe CHF due to valve dysfunction
38
Identify the associated murmur:
1. crescendo, midsystolic murmur
2. early diastolic murmur
3. holosystolic
4. diastolic murmur after the opening snap
1. AS
2. AR
3. MR/TR
4. MS
39
STAGES OF HEART FAILURE
Structural heart disease with **prior or current symptoms**
**i.e** Patients with abnormal cardiac structure with exertion dyspnea, fatigue, etc.
Stage C
40
Murmur heard over the femoral artery is known as \_\_\_\_\_\_
Duroziez sign.
41
MOST common acquired cause of thrombophilia
and associated with venous / arterial thrombosis
Antiphospholipid-antibody syndrome
42
FUNCTIONAL CLASSIFICATION OF ANGINA
**Ordinary physical activity, (walking and climbing stairs), does not cause angina**
i.e. Angina with strenuous or rapid or prolonged exertion at work or recreation.
Class I
43
What is the most important step in the diagnosis of endocarditis?
**Serial blood cultures** are the most important step in the diagnosis of endocarditis
44
The ONLY FDA-approved indication for PE fibrinolysis
Massive PE
45
What risk factors are associated with increased incidence of Infective endocarditis?
Structural heart disease (RHD, VHD), IV drug use, Prosthetic heart valves
46
In its MOST SEVERE form, **Postphlebitic Syndrome**
causes
Skin ulceration (especially in medial malleolus of leg)
47
Narrowed pulse pressure
AS
48
STRONGEST risk factor for stroke
Elevated BP
49
FUNCTIONAL CLASSIFICATION OF ANGINA
**Marked limitation of ordinary physical activity.**
i.e. Walking one to two blocks on the level and climbing more than one flight of stairs in normal conditions.
Class III
50
The best empiric therapy for infective endocarditis.
**Vancomycin and Gentamicin**
## Footnote
This will cover the most common organisms, which are **S. aureus, MRSA, and viridans Streptococci**.
51
MCC of **Systolic HF or HF with reduced EF** (HFrEF)
CAD
52
FUNCTIONAL CLASSIFICATION OF ANGINA
Slight limitation of ordinary activity
i.e. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, or when under emotional stress or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of stairs at a normal pace and in normal conditions.
Class II
53
Non-dihydropyridine calcium channel blockers
(**Cardiac** \> Vascular)
Verapamil
Diltiazem
54
If a patient with **acute MI presents with new murmur**, think of 2 potential conditions: _____ and \_\_\_\_\_
**free or septal wall rupture** and **acute mitral regurgitation**
55
The two most common autosomal dominant
genetic mutations for prothrombotic states
* Factor V Leiden: causes resistance to activated protein-C (which inactivates factors V and VIII)
* Prothrombin gene mutation: increases prothrombin
56
Avoid combining _____ and _____ due to risk of heart block, heart failure, and symptomatic bradycardia.
**non-dihydropyridine CCB (Verapamil and Diltiazem)** and **beta blockers**
57
MOST common **primary malignant pericardial tumor**
Mesothelioma
58
reversing agent for warfarin
**Vitamin K, FFP, 4-factor prothrombin complex concentrate**
59
SECOND MOST frequent cause of DEATH in the
world
Stroke
60
The maximum protection against combined
cardiovascular endpoints is achieved with:
* SBP \<135-140 mmHg
* DBP \<80-85 mmHg
61
Definition of resistant HPN
BP persistently **\>140/90** mmHg despite taking three or more antihypertensive agents, including a diuretic
62
(+) Lung Pathology + Right sided heart failure
**Cor Pulmonale**
Ruled out if there is Left sided HF
63
What is the best initial test and often most accurate test for all types of cardiomyopathy?
Echocardiography
64
Sudden, severe calf discomfort suggests…
Ruptured Baker’s cyst
65
2D Echo finding of pulmo embolism
**McConnell’s sign** (hypokinesis of the RV free wall)
66
What is the mainstay of treatment of hypertrophic cardiomyopathy?
Beta blockers and diuretics
67
reversing agent of Heparin, Enoxaparin, Dalteparin, Fondaparinux
**Protamine:**
100% reversal of UFH
70-80% reversal of LMWH
No effect on Fondaparinux
68
MOST frequent SIGN of PE
Tachypnea
69
Most common symptom for PE
• Unexplained breathlessness
70
MOST common tumor of the pericardium
Malignant neoplasms from the mediastinum (bronchus, breast, lymphoma, melanoma)
71
The only absolute contraindications to the use of
nitrates are \_\_\_\_\_\_
**hypotension** or the recent use of **PDE-5 inhibitors**, Sildenafil or Vardenafil (w/in 24 hours) or Tadalafil (w/in 48 hours)
72
Most common type/ characteristics of myxoma
Sporadic, solitary, located in the left atrium, often pedunculated
73
first line of treatment for severe hypertriglyceridemia.
Fibrates
74
Remember **“CREST”** in acute pericarditis:
C – Chest pain
R – Rub (85% of patients)
E – Effusion
S – ST elevation
T – Tamponade (a potential complication of pericarditis)
75
STAGES OF HEART FAILURE
**Structural heart disease** but no symptoms
i.e. Patients with previous MI, LVH, asymptomatic VHD
Stage B
76
What is the most common cause of **in-hospital death** from STEMI.
Pump Failure
77
CLASSIFICATION OF MYOCARDIAL INFARCTION
## Footnote
**Myocardial Infarction Related to Percutaneous Coronary Intervention (PCI)**
Type 4a
78
In IE, the following are independently associated
with **INCREASED risk of embolization**
* Endocarditis caused by S. aureus
* Vegetations \> 10mm in diameter
* Infection involving the mitral valve
79
Jarring of the entire body and bobbing motion of the head **(De Musset sign)**
AR
80
reversing agent of Dabigatran
Idarucizumab
81
Virchow’s triad
* Endothelial injury
* Hypercoagulability
* Stasis
82
MAJOR advantage of Unfractionated Heparin
Short half-life
83
Initial goal in BP reduction in hypertensive emergency
reduce MAP by **no more than 25%** (few minutes – 2 hours) or in the range of 160/100-110.
84
The goal therapy in those with CAD is an LDL of \_\_\_\_
\<100
85
For adults with compelling condition (i.e. severe **preeclampsia, pheochromocytoma crisis**), SBP should be reduced to _______ and _______ in **aortic dissection.**
**\<140 mmHg**
**\<120 mmHg** in aortic dissection
86
MOST frequent SYMPTOM of PE
• Dyspnea
87
Type of murmur that always signify structural heart disease?
Diastolic murmurs
88
TWO principal indications for insertion inferior vena
caval (IVC) filters
* Active bleeding that precludes anticoagulation
* Recurrent venous thrombosis despite anticoagulation
89
What is the best test to detect a reinfarction a few days after the initial infarction?
CK MB
90
first line for symptom improvement of PAD
Cilostazol
91
Renal artery stenosis can be due to: ____ or \_\_\_\_
**atherosclerosis** or **fibromuscular dysplasia** (scarring of the renal arteries)
92
93
this complication is enhanced when you combine **statins with fibric acid derivatives**
Rhabdomyolysis
94
Bounding and forceful pulse, rapidly increasing and subsequently collapsing **(Water-Hammer or Corrigan’s pulse)**
AR
95
96
The most common adverse effect of statin medications
liver toxicity
97
Indicative of PRIMARY renal disease
Proteinuria \> 1000 mg/day and an active urine sediment
98
Indications for CABG:
* Left main coronary artery disease
* 3 vessel disease + LVEF \< 50% or diabetes
* 2 vessel disease that includes proximal left descending coronary artery
99
cornerstone of pharmacotherapy for HF
ACEI and beta blockers
100
101
**Enumerate CHA2 DS2 -VASc RISK ASSESSMENT Score**
The CHA 2 DS 2 -VASc score can be used to estimate stroke risk in these patients. Anticoagulation is recommended for a score of ≥2 and may be considered for a score of 1.
102
\_\_\_\_\_
reduce myocardial oxygen demand by inhibiting the increases in heart rate, arterial pressure, and myocardial contractility caused by adrenergic activation.
Beta Blockers
103
What is the recommended treatment of pericarditis?
Anti-inflammatory with aspirin
104
Most myocardial perfusion occurs during this time
Diastole
105
Door-to-Needle Time (Fibrinolytic Therapy)
30 minutes
106
Most common underlying cause myocardial ischemia
## Footnote
and injury
Obstruction of coronary arteries by atherosclerosis
107
What treatment should be avoided in acute condition of AR?
**Beta-blockers** because heart rate reduction could prolong the diastole, thus worsening AR.
108
A 22-year-old IV drug user presents with fatigue, shortness of breath and loss of appetite for 2 weeks. He has fever for the past 3 days. On examination, he is febrile, with **non-painful erythematous lesions on the palms, tender nodules on the fingers, and murmur.**
Infective endocarditis
109
How much fluid is necessary to produce cardiac tamponade?
May be as small as **200 mL when the fluid develops rapidly (acute)** to as much as **\>2000 mL in slowly developing effusions (chronic)**
110
Characterized as **\>10mmHg inspiratory decline**
## Footnote
in systolic arterial pressure. What condition is this observed?
**Paradoxical pulse or pulsus paradoxus.**
Cardiac Tamponade
111
MOST common cardiac tumors in infants/ children
Rhabdomyomas and Fibromas
112
What is the most common cause of **out-of-hospital death** from STEMI.
Ventribular fibrillation
113
Useful RULE-OUT Test in DVT and PE:
**D-Dimer**
## Footnote
\> 95% of patients with a normal D-dimer (\<500ng/mL) do NOT have PE
114
What are the cardinal symptoms of AS?
Syncope, angina, dyspnea
115
Most common gas exchange abnormalities in PE
• Arterial hypoxemia and an increased alveolar-arterial O 2 tension gradien
116
What is the most common type of cardiomyopathy, caused by **ischemia, alcohol, cocaine, MAP, postpartum, Doxorubicin, and Chagas disease.**
Dilated CMP
117
What is the leading cause of sudden death in young, healthy athletes?
Hypertrophic Cardiomyopathy
118
CLASSIFICATION OF MYOCARDIAL INFARCTION
**Spontaneous Myocardial Infarction**
• Severe coronary artery disease but on occasion nonobstructive or no CAD
Type I
119
MAJOR bleeding from warfarin: BEST managed
with
prothrombin complex concentrate
120
Unique features of MS at presentation:
**• Dysphagia** (enlarged LA pressing on the esophagus)
**• Hoarseness** (enlarged LA pressing on the recurrent laryngeal nerve)
**• Atrial fibrillation and stroke from enormous LA and hemoptysis** (increase LA pressure causing pulmonary venous hypertension and rupture of pulmonary-bronchial venous connections)
121
PROTOTYPIC lesion in infective endocarditis
Vegetation
122
OPTIMAL method for diagnosis of prosthetic valve endocarditis, detection of myocardial abscess, valve perforation or intracardiac fistula
Transesophageal Echocardiography
123
enlarged right descending pulmo artery. seen in pulmo embolism
124
What is the ankle brachial index ratio diagnostic of Peripheral arterial disease?
ABI \< 0.9
125
GOLD standard for evaluation and identification
of renal artery lesions
Contrast Arteriography
126
\_\_\_\_\_ are the major site of atherosclerotic disease.
epicardial coronary arteries
127
Typical pain in Pericarditis
* Retrosternal and is aggravated by coughing, deep breaths, or changes in position – all of which lead to movements of pleural surfaces
* Worse in the supine position
* Relieved by sitting upright and leaning forward
128
129
focal oligemia. seen in pulmo embolism
130
STAGES OF HEART FAILURE
**Refractory HF**
i.e. Patients with marked symptoms at rest despite optimal therapy
Stage D
131
Widened pulse pressure
AR
132
DEFINITIVE diagnosis of PE depends upon visualization of an **intraluminal filling defect** in more than one projection
Pulmonary Angiography
133
CXR finding of cardiac tamponade
“water bottle sign”
134
MOST often involved in metastasis to the heart
Pericardium \> myocardium \> endocardium or cardiac valves
135
MCC of **Diastolic HF or HF with preserved EF** (HFpEF)
Hypertension
136
hemodynamic hallmark of MS
Abnormally elevated left atrioventricular pressure gradient (hemodynamic hallmark)
137
CLASSIFICATION OF MYOCARDIAL INFARCTION
## Footnote
**Myocardial Infarction Related to Coronary Artery Bypass Grafting (CABG)**
Type 5
138
STAGES OF HEART FAILURE
**At high risk for HF.**
i.e. Patients with CAD, HPN, DM, use of cardiotoxins, family history
Stage A
139
USUAL cause of death from pulmonary embolism
Progressive right heart failure
140
CLASSIFICATION OF MYOCARDIAL INFARCTION
## Footnote
**Myocardial Infarction Related to Stent Thrombosis**
• Detected by coronary angiography or autopsy
Type 4b
141
Principal imaging test for the diagnosis of PE
Chest CT with IV contrast
142
CLASSIFICATION OF MYOCARDIAL INFARCTION
## Footnote
**Myocardial Infarction Resulting in Death When Biomarker Values Are Unavailable**
• Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic ECG changes or new left bundle branch block, but death occurring before sample could be obtained or before cardiac biomarker could rise
Type 3
143
wedge-shaped opacity at lung periphery. Seen in Pulmo embolism.
Hampton hump
144
How is the diagnosis of **endocarditis** made?
**Duke’s criteria:**
* Presence of 2 major, or
* 1 major and 3 minor, or
* 5 minor criteria
145
Lincoln sign is seen in whar valvular disease?
Aortic Regurgitation
146
Most common location of pericardial cysts
Right cardiophrenic angle
147
What is the earliest chest x-ray findings of MS?
Straightening of the upper left border of the cardiac silhouette
X ray findings:
* enlarged cardiac shadow
* straightening of left heart border
* double right heart border
* splaying of carinal angle
148
What treatment should be avoided in pericarditis?
**Anticoagulants**
## Footnote
Anticoagulants should be avoided because their use could cause bleeding into the pericardial cavity and tamponade.
Anticoagulants potentially could cause tamponade in the presence of acute pericarditis (as manifested by either pain or persistent rub) and therefore should not be used unless there is a compelling indication.
149
What are the BBs beneficial for HF?
Carvedilol, Bisoprolol and Metoprolol **succinate**
**Metoprolol and Bisoprolol** are beta-1 specific antagonists.
**Carvedilol** is a nonspecific beta-blocker that also has alpha-1 receptor blocking activity.
150
In the absence of a high risk for bleeding, patients with NSTE-ACS should receive \_\_\_\_\_\_
platelet P2Y receptor blocker **(Clopidogrel, Ticagrelor, Prasugrel)**
151
**Paradoxical / reverse splitting of S2.** Pulmonary valve then Aortic valve
AS
152
This score predicts risk of stroke in AF.
**CHA2DS2VASc score**
153
MAJOR Disadvantage of Unfractionated Heparin
Achieving target aPTT is empirical & may require repeated blood sampling and heparin
154
MOST common preventable cause of death among hospitalized patients
pulmo embolism
155
Squatting and leg raising would decrease the murmur of ____ and \_\_\_\_
Hypertrophic Obstructive Cardiomyopathy and Mitral Valve Prolapse
156
Perivalvular Infection is MOST common with
AORTIC valve infection
157
Most common symptom of DVT
Cramp or “charley horse” in the lower calf
158
What is the target LDL value in all patients with proven CAD? if the patient has diabetes?
LDL **\< 100 mg/dl (\< 70 mg/dl** if the patient has diabetes)
159
A 29-year-old man with pulmonary tuberculosis presents with sharp chest pain, **aggravated by lying but relieved by sitting forward.** There’s a **high-pitched rasping sound** on cardiac auscultation. No jugular venous distention seen. An ECG shows **diffuse ST-segment elevation with PR-segment depression.**
• What is the most likely diagnosis?
Acute pericarditis (TB pericarditis)
160
most common adverse effect of Fibrates
NAUSEA
161
Has become a second- line diagnostic test for PE
Lung scanning
162
Acute limb ischemia presents with the **6P’s:**
**Pain, Pallor, Paresthesia, Paralysis, Pulselessness, Poikilothermia**
163
Minor Criteria for Endocarditis
* **Predisposing condition:** abnormal valve or abnormal risk of bacteremia
* **Fever**
* **Vascular phenomena:** septic arterial or pulmonary emboli, mycotic aneurysms, intracranial hemorrhage, Janeway lesions
**• Immune phenomena:**
Glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor
* **Positive blood cultures** not meeting major criteria
* **Positive echocardiogram** not meeting major criteria
164
Diamond-shaped crescendo-decrescendo mid-systolic murmur
Aortic Stenosis
165
Statin + Gemfibrozil = increases risk for \_\_\_\_\_\_
Myopathy
166
CLASSIC signs of PE
* Tachycardia
* Low-grade fever
* Neck vein distention
167
A 62-year-old man with history of hypertension complains of fatigue and shortness of breath. On physical examination, there’s a high-pitched, blowing, **diastolic murmur on the left sternal border** and **widened pulse pressure.** A murmur is also heard over the **femoral artery.**
AORTIC REGURGITATION
168
Door-to-Balloon Time (PCI)
90 mins
169
Consider ____ if there is deterioration of
## Footnote
renal function associated with ACEi.
Renal Artery Stenosis
170
enumerate the “Beck triad”
o Hypotension
o Soft or absent heart sounds
o Jugular venous distention
171
Examples of High output HF
* Beriberi
* Anemia
* Thyrotoxicosis
* AV fistula
172
example of Angiotensin Receptor-Neprilysin Inhibitor (ARNI). It is a new drug class used in patients who continue to be dyspneic despite using the initial pharmacologic regimen. Provides mortality benefit for systolic dysfunction.
**Sacubitril/Valsartan**
173
Treatment of pericarditis.
* Aspirin (2-4 g/d) plus gastric protection with Omeprazole.
* NSAIDs (Ibuprofen, Indomethacin),
* Colchicine and Glucocorticoid (Prednisone).
* If recurrent, frequent, and disabling, pericardial stripping may be necessary.
174
anti lipid drug safe for pregnant
Cholestyramine (Bile acid sequestrant)
175
MOST common abnormality in PE on ECG
T-Wave Inversion in Leads V1 to V4
176
50% of endocarditis cases associated with injection drug use are LIMITED to
Tricuspid valve
177
What is the most important reason is for using **statins?**
it has the greatest mortality benefit.
178
Major Criteria for infective endocarditis
* **Sustained bacteremia** by an organism known to cause endocarditis
* **Endocardial involvement** documented by either echocardiogram (vegetation, abscess, valve perforation, prosthetic dehiscence) or clearly established **new valvular regurgitation**
179
Most common cause of MS
Rheumatic Fever
180
most common etiology of secondary hypertension.
Primary renal disease
181
TWO determinants of arterial pressure
Cardiac output and peripheral resistance
182
Test of CHOICE to detect perivalvular abscess
TEE with color Doppler
183
MOST common tumors of the VALVES
Papillary Fibroelastomas
184
**Austin flint murmur** – “rumbling sound”
in severe AR (functional MS)
185
Warfarin Embryopathy = MOST Common with
exposure during
6 th to 12 th week of gestation
