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Cardiology Flashcards

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1
Q

Substernal poorly localized exertional chest pain that is short in duration and resolves with rest or nitro
Pain may radiate to arm, teeth, or jaw
Diaphoresis

A

Stable angina

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2
Q

Levine’s sign

A

fist over heart

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3
Q

Classes of angina

A

Class I: strenuous activity
Class II: more prolonged or rigorous activity, slight limitation of physical activity
Class III: daily activity, marked limitation of physical activity
Class IV: angina at rest

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4
Q

Acute coronary syndrome diagnosis?

A

EKG = initial test of choice

Cardiac enzymes: CK/CK-MB, troponin

Coronary angiography = GOLD STANDARD

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5
Q

Stable angina tx?

A

Daily aspirin, beta blockers, nitro, and statin

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6
Q

Angina that is new in onset, occurs at rest, or lasts > 30 minutes; not relieved by nitro

A

Unstable angina (acute coronary syndrome)

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7
Q

Tx of angina, UA, or NSTEMI?

A

Nitro, aspirin, beta blockers, heparin, statin, ACEI

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8
Q

STEMI tx?

A

Nitro, aspirin, beta blockers, ACEI

+ REPROFUSION: PCI within 90 min, if not available within 120 min  fibrinolytics within 30 min (TPA- Alteplase)

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9
Q

When should you avoid nitro and morphine in ACS?

A

Inferior wall MI

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10
Q

What type of MI does V1-V4 involvement indicate?

A

Anterior/septal (LAD)

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11
Q

What type of MI does I, aVL, V5-V6 involvement indicate?

A

Lateral (LCA)

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12
Q

What type of MI does II, III, aVF involvement indicate?

A

Inferior (RCA)

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13
Q

What are the systolic murmurs?

A 
Mitral regurgitation
Tricuspid regurgitation
Mitral valve prolapse
Aortic stenosis
Pulmonary stenosis
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14
Q

What are the diastolic murmurs?

A

Tricuspid stenosis
Mitral stenosis
Pulmonary regurgitation
Aortic regurgitation

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15
Q

Harsh systolic crescendo-decrescendo murmur best heard at the right sternal border
Prominent S4
Radiates to carotid

A

Aortic stenosis

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16
Q

Blowing diastolic decrescendo murmur best heard at the left sternal border

A

Aortic regurgitation

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17
Q

MCC of rheumatic heart disease?

A

Mitral stenosis

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18
Q

Rumbling mid-diastolic murmur with a prominent S1 and opening snap best heard at the apex

A

Mitral stenosis

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19
Q

Mid-late systolic ejection click best heard at the apex

A

MVP

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20
Q

What causes an earlier and later click in MVP?

A

Earlier click: Valsalva, standing

Delayed click: leaning forward, squatting, supine

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21
Q

What is the MCC of mitral regurgitation in the US?

A

MVP

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22
Q

Blowing holosystolic murmur best heard at the apex

Radiates to the axilla

A

Mitral regurgitation

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23
Q

Mid-diastolic murmur best heard at LLSB

Increased intensity: inspiration

A

Tricuspid stenosis

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24
Q

Blowing holosystolic murmur best heard at the left sternal border
Increased intensity: inspiration

A

Tricuspid regurgitation

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25
Always congenital Harsh mid-systolic crescendo-decrescendo murmur beast heard at left sternal border Increased intensity: inspiration Radiates to the neck
Pulmonic stenosis
26
Always congenital Graham-Steel murmur: brief decrescendo early diastolic murmur best heard at LUSB Increased intensity: inspiration
Pulmonic regurgitation
27
Constant prolonged PR interval (>.20s), all P waves followed by QRS complexes
1st degree AV block
28
Progressive PR interval lengthening followed by dropped QRS complex
2nd degree AV block type 1
29
Constant prolonged PR interval and dropped QRS complexes
2nd degree AV block type 2
30
AV dissociation; regular P-P intervals and regular R-R interval, but they are not related to each other
3rd degree AV block
31
Sawtooth atrial waves, no discernable P waves Tx?
Atrial flutter Stable: vagal maneuvers, ΒB or CCB Unstable: direct current synchronized cardioversion
32
Irregularly irregular rhythm, no discernable P waves
Atrial fibrillation
33
A. fib tx?
Stable: rate control (ΒB or CCB) Unstable: Direct current synchronized cardioversion If present for more than 48 hrs, anticoagulate for 21 days prior to cardioversion Long- term Anticoagulation based on CHA2DS2-vasc score: Warfarin, Dabigatran, Apixaban, Rivaroxaban Rate control (BB, CCB, Digoxin, Amiodarone) *Avoid CCBs in HF
34
Regular, narrow-complex tachycardia, no discernable P waves (MC) Regular wide-complex tachycardia
Paroxysmal Supraventricular Tachycardia (PSVT)
35
Paroxysmal Supraventricular Tachycardia tx?
Stable (narrow-complex): vagal maneuvers, Adenosine Stable (wide-complex): Amiodarone Unstable: Direct current synchronized cardioversion Definitive: radiofrequency catheter ablation
36
Delta wave (slurred QRS upstroke), shortened PR interval, wide QRS complexes
Wolff-Parkinson-White (WPW)
37
Wolff-Parkinson-White (WPW) tx?
Stable: Procainamide Unstable: Direct current synchronized cardioversion Definitive: radiofrequency catheter ablation
38
Inverted or absent P wavesAV Junction Dysrhythmias
AV Junction Dysrhythmias
39
Wide bizarre QRS occurring earlier than expected; T waves in the opposite direction of the QRS complexes; associated w/ compensatory pause
Premature Ventricular Complexes (PVC)
40
Regular wide complex tachycardia with no discernable P waves Sustained VT = duration of 30+ sec Monomorphic vs polymorphic based on QRS morphology
Ventricular Tachycardia
41
Variant of polymorphic VT (Bow tie appearance) | Tx?
Torsades de pointes IV magnesium
42
VT tx?
Stable: Amiodarone Unstable (with pulse): Direct current synchronized cardioversion No pulse: Defibrillation + CPR
43
Erratic pattern of electrical impulses, no discernable P waves
Defibrillation + CPR
44
Organized rhythm but no pulse TX?
Pulseless Electrical Activity (PEA) CPR + EPI, check for shockable rhythm every 2 min
45
Dyspnea (MC) Angina, syncope, arrhythmia Sudden cardiac death
Hypertrophic cardiomyopathy
46
How to dx cardiomyopathies?
Echo
47
Hypertrophic cardiomyopathy tx?
Beta-blockers = 1st line CCB = 2nd line Avoid dehydration, extreme exertion, exercise Caution use of Digoxin, Nitrates, diuretics Surgery Septal myectomy Alcohol septal ablation
48
``` Dyspnea Paroxysmal Nocturnal Dyspnea (PND) Pulmonary congestion: cough (blood-tinged sputum), crackles, wheezes Cyanosis Cheyne-stokes breathing ```
L sided HF
49
``` Peripheral edema JVD Ascites Weight gain Hepatosplenomegaly ```
R sided HF (MCC is L sided HF)
50
MC form of HF, commonly caused by MI, dilated cardiomyopathy There are thin ventricular walls so they cannot pump as strongly to push blood out, hence reduced EF May hear an S3
Systolic HF
51
Commonly caused by HTN, LVH, old age, constrictive pericarditis Thick ventricular walls so difficult for the heart to fill with blood. However pumping capability is not impacted, hence preserved EF May hear S4
Diastolic HF
52
CHF diagnosis?
BNP (>500 very likely) Cardiac enzymes EKG CXR: cephalization, Kerley B lines, pleural effusion Echo = GOLD STANDARD
53
CHF tx?
Wt loss, sodium <2g, fluids <2L Daily weight monitoring Loop Diuretics (furosimide) ACEI/ARB (Check for hyperkalemia) ΒB Acute LMNOP: Lasix, Morphine, O2, Nitrate, position Avoid CCBs
54
``` Leg pain worse with dependency Improved with walking/elevation Normal pulses/temp Stasis dermatitis (itchy, eczematous rash and brownish/dark purple hyperpigmentation of the skin) Ulcers (medial malleolus) Dependent pitting edema ```
Chronic venous insufficiency
55
Chronic venous insufficiency dx?
Venous duplex US Venography = GOLD STANDARD
56
``` Intermittent Claudication Intermittent claudication Worse with walking/elevation Improved with dependency/rest Decreased/absent pulses Decreased capillary refill Atrophic skin changes Ulcers (lateral malleolus) Pale with elevation, dependent rubor ```
ABI (positive if < 90) ANGIOGRAPHY = GOLD STANDARD
57
Virchow's triad
1. Venous stasis 2. Endothelial damage 3. Hypercoagulability (DVT)
58
Unilateral swelling of LE (> 2cm) WARM skin & dusky cyanosis Normal pulses Homans sign: calf pain with dorsiflexion (unreliable)
DVT
59
DVT dx?
Venous duplex US = 1st line Venography = GOLD STANDARD
60
What test is used to monitor LMWH?
PTT
61
What test is used to monitor warfarin?
PT/INR
62
LMWH antidote? | Warfarin antidote?
LMWH: protamine sulfate Warfarin: VitK, FFP
63
HTN dx?
Diagnosis: 2+ elevated readings on 2+ different visits > 140/90 Pre-HTN: 120/139/80-89 Stage I: 140-159/90-99 Stage II: >160/100
64
Types of AAA?
Fusiform: circumferential dilatation of aortic wall Saccular: outpouching of aortic wall (higher risk of rupture)
65
AAA dx?
Stable: CT w/ contrast Unstable: bedside US *Pts with known AAA who present w/ classic sx of rupture can be taken to the OR w/o preop imaging
66
AAA screening
One-time screening via abd US in men 65-75 who have ever smoked 5.5+ cm or > 0.5 cm growth in 6 mo  immediate surgical repair > 4.5 cm- surgery referral 4-4.5 cm- monitor; US q 6 mo 3-4 cm- monitor; US q year
67
Types of aortic dissection
Stanford Type A: Ascending aorta | Stanford Type B: Descending aorta
68
Aortic dissection dx
CXR: widened mediastinum | CT angiography: confirm dx, differentiate from ascending and descending
69
Aortic dissection tx
Ascending BP control + emergent open surgical repair Descending Lower SBP to 100-120 and HR to <60 bpm w/in 20 min BB (Labetalol) = first line Can add Nitroprusside after HR is controlled Pain control: morphine (pain & vasodilation)
70
Beck's triad
1. JVD 2. Muffled heart sounds 3. Hypotension (cardiac tamponade)
71
Cardiac tamponade dx
EKG: low QRS voltage, electrical alternans | Echo = test of choice; effusion + diastolic collapse of cardiac chambers
72
MCC of pericardial effusion?
Pericarditis
73
Symptoms due to coronary vasospasm triggered by cold weather, exercise, hyperventilation Chest pain at rest that is not exertional and not relieved by rest
Vasospastic angina (Variant, Prinzmetal)
74
Vasospastic angina (Variant, Prinzmetal) tx?
CCBs
75
``` Persistent fever New onset murmur Osler nodes Janeway lesions Splinter hemorrhages Roth spots ```
Endocarditis
76
What are Osler nodes?
Painful violaceous nodules on pads of digits and palms
77
What are Janeway lesions?
Painless erythematous macules on palms and soles
78
What are roth spots?
Retinal hemorrhages with pale centers
79
How to dx endocarditis?
Duke Criteria: 2 major OR 1 major + 3 minor OR 5 minor Major Bacteremia (2+ blood cultures) Endocardial involvement on echo New regurgitation murmur Minor Predisposing condition or IVDU Fever (>100.4) Vascular or embolic PNA (Janeway lesions) Immunologic phenomena (Osler nodes, Roth spots, + RF, glomerulonephritis) Blood culture not meeting major criteria Worsening of existing heart murmur

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