Cardiology Error List Flashcards Preview

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Flashcards in Cardiology Error List Deck (80):
1

When is revascularization indicated for Coronary Artery Disease

Sx despite medical therapy
Left MAIN Coronary Artery Stenosis >50%
3-vessel disease with LV dysfunction (EF

2

What type of revascularization is indicated for Left MAIN coronary artery

CABG

3

When is a Percutaneous Transluminal Coronary Intervention used (PTCA)

1 or 2 vessels that are NOT the Left main coronary artery + normal or near normal left ventricular function

4

What intervention is used for Left Anterior Descending Artery

Beta Blockers
Ranolazine
CCB
Ivabradine

5

What is the gold standard to test for CAD

Coronary Angiongraphy (Cath)

6

What is Heart Failure

When the heart can't pump sufficient blood to meet the metabolic demands of the body at normal filling pressure

7

What causes left sided HF

CAD and HTN

8

Sx for left sided HF

Think Pulmonary back-up
Dyspnea, Pulmonary Congestion/Edema, HTN

9

What causes right sided HF

Left sided HF

10

Sx for right sided HF

Peripheral Edema
JVD
GI/Hepatic Congestion

11

Dx for HF and what does it measure

Echo is most useful, measures EF and wall motility
CXR: See Cephalization of flow, Kerly B lines, Cardiomegaly, Pleaural Effusions
Increased BNP

12

Tx for HF

Ace-I are 1st line
Beta Blockers
Diuretics
Digoxin for short term use in pts. with A.Fib

13

Which Tx for HF reduce sx vs. improve mortality

Improve Mortality: Ace-I, Beta Blockers, Spironolactone (Potassium sparing diuretic)

Treat sx: Loop diuretics (Furosemide, Bumetanide, Torsemide)

14

If a patient with CHF can't tolerate beta blocker or Ace-I what is an alternative

Hydralize + Nitrates
They do decrease mortality when used together

15

What valve is most commonly affected in Infective Endocarditis (normal valves)

Mitral Valve

16

What valve is most commonly affected in a person with IV drug use and infective endocarditis

Tricuspid Valve

17

What are the pathogens for Normal Valves, Abnormal Valves, Prosthetic Valves, IV Drug User

Normal: S. Aureus
Abnormal: S. Viridans
Prosthetic: Staph. Epidermis
IV Drug Use: MRSA, Pseudomonas, Candida

18

Sx for Infective Endocarditis

Fever, Anorexia, Weight Loss, Fatigue, EKG abnormalities, Regurgitant murmurs
Peripheral Manifestations: Janeway Lesions, Roth Spots, Petechia, Osler Nodes, Splinter Hemorrhages

19

What is the Duke Criteria for Infective Endocarditis (DX)

2 Major or 1 Major + 3 Minor, or 5 Minor
Major: 2 Positive blood cultures, Echo (Vegetations on Valves)
Minor: Predisposing factor like abnormal valves, indwelling catheter, fever, vascular and embolic phenomena (Janeway Lesions, Emboli), Immunologic Phenomena (Osler Nodes, Roth Spots, Positive RF, Acute Glomerulonephritis, Positive blood cultures not meeting major)

20

Tx for Infective Endocarditis based on valve (Native, Abnormal, Prosthetic, IV drug user, Fungal)

Native: Nafcillin + Gentamicin
Abnormal: Penicillin/Ampicillin + Gentamicin
Prosthetic: Vancomycin + Gentamycin + Rifampin
IV Drug Use: Penicillin/Ampicillin + Vancomycin
Fungal: Amphotericin B

Replace Vancomycin in any of those if pt has PCN allergy

21

What is prophylactic treatment for dental procedure in someone with infective endocarditis history

Amoxicillin 2g one hour before procedure. Clindamicin if PCN allergy

22

What is the reading for HTN

>140/90

23

Dx for HTN

More than 2 abnormal readings on 2 different visits with elevated readings

24

What are complications of HTN

CAD, HF, MI, TIA, Stroke, Retinal Hemorrhages, Blindness, Retinopathy

25

Sx of HTN

Striae, Carotid Bruits, JVD, Pheochromocytoma, Polycystic Kidneys, Bruits over renal arteries

26

What are common findings in a person with HTN on a fundoscopic exam

Grades
I: Arterial Narrowing
II: A-V Nicking
III: Hemorrhage, Soft Exudates
IV: Papilledema (Malignant)

27

What is the goal for someone with HTN. Someone with Diabetes and HTN

28

What is the first line non-medical treatment for someone with HTN

Lifestyle modification, sodium restriction, dash diet, exercise

29

What is the first-line medication used in HTN

Hydrochlorothiazides (Diuretics)

30

What is the strongest diuretic

Loop Diuretic: Furosemide, Bumetadine

31

What do you want to use to treat HTN in someone with diabetes

Ace-I (Captopril, Enalapril, Ramipril, Benazepril)
If can't tolerate Ace-I, use ARB

32

What do you use to treat HTN in someone with angina

CCB (Nifedipine, Amlodipine, Verapamil, Diltiazem)

33

What do you use to treat HTN in someone with hx of MI or Angina

Beta-Blockers (Atenolol, Metoprolol, Esmolol, Propranolol, Labetalol, Carvedilol)

34

What goes under the category of an MI and what do they mean

NSTEMI and STEMI
Complete occlusion of vessels that leads to infarction

35

Sx of MI

Pain, Dyspnea, Diaphoresis, Nausea, Weakness
Tachycardia, bradycardia, CHF, Hyoptension, new murmur

36

What is a physical exam finding that can be found 24 hours after an MI. What is it called when it happens 1-2 months after an MI

24 hours: Pericarditis with friction rub
Dressler's Syndrome: Pericarditis 1-2 months after MI (autoimmune pathophysiology)

37

What EKG findings do you find with an MI

T-Wave Abnormalities
ST-Segment Depression: Ischemia
ST-Segment Elevation: Infarction
Q-Waves: Infarction (could be old or new)

38

What do the locations of the abnormalities tell you about the MI (leads)

V1-V2: Septal or Posterior
V3-V4: Anterior
V5-V6, I, aVL: Lateral
II, III, aVF: Inferior
V1-V2 with DEPRESSION: Posterior

39

What is t gold standard for dx of MI

Angiogram

40

What are some biomarkers seen with MI

Myglobin rise
CPK-MB
TROPONIN, TROPONIN, TROPONIN (but only after 4 hours)

41

When does Troponin rise, peak, and normalize

Rise: 4-6 hours
Peak: 18-24 hours
Normalizes: 7-10 days

42

What are some other imaging/tests you could use to work-up a patient with an MI

CXR: Look for CHF or aortic dissection
Echo: Identify wall abnormalities
Stress Test: Low-risk chest pain

43

Tx for MI

MONABASH
M:Morphine
O: Oxygen
N: Nitroglycerin (1st line)
A: ASA (for everyone)
B: Beta-Blocker
A: Ace-I
S: Statin
H: Heparin

44

What tx for MI improve mortality

ASA, Beta-Blocker, Ace-I, Statin

45

What is Sick Sinus Syndrome

Applied to patients with sinus arrest, sinoatrial exit block, or persistent sinus bradycardia

46

What are the arrhythmias seen with sick sinus syndrome

Supraventricular Arrhythmia and Bradyarrhythmia

47

Sx of sick sinus syndrome

Most asymptomatic
Syncope, Dizziness, Confusion, Palpitations, HF, or Angina

48

What patient do you see with sick sinus syndrome

Elderly with hx of A.Fib

49

Tx for sick sinus syndrome

Permanent pacing with dual-chamber pacemaker

50

What is Stable Angina and what causes it

A regular pattern of angina exacerbated by physical or emotional stress
Relieved with rest or NTG within minutes
Caused by Fixed Coronary Artery Stenosis

51

Sx of Stable Angina

Substernal Chest Pain, Poorly Localized, nonpleuritic, exertional
Radiates to arm, lower jaw, back, shoulder
Lasts

52

Non-Med Tx for Stable Angina

Modify RF, low fat, low cholesterol diet

53

Medication Tx for Stable Angina

Nitrates are 1st line for acute management
Beta-Blockers are 1st line for chronic management
CCB used in patients not able to tolerate beta-blockers (NOT Nifedipine because it causes reflex tachycardia)

54

What is Unstable Angina

New onset of angina
Increased intensity of stable angina
Increased frequency of stable angina

55

Sx of Unstable Angina

Retrosternal chest pain not relieved by rest or NTG, radiates to arms, neck, back, shoulders, epigastrum, lower jaw
Pain at rest usually means >90% occlusion
Anxiety, diaphoresis, tachycardia, N/V, palpitations, dizziness

56

Dx for Unstable Angina

EKG: T-wave Inversion/ST Depression

57

Tx for Unstable Angina

MONABASH (same as MI)
Nitrates for all
Antiplatelets: ASA, Clopidogren (Plavix)
Beta-Blockers for all
Anticoagulants: Heparin
Statins if elevated LDL

58

What is Coarctation of the Aorta

Narrowing of the descending aorta

59

What is Coarctation of the Aorta associated with

Bicuspid valve

60

Sx of Coarctation of Aorta

Different blood pressures between upper and lower extremities
Weak and delayed femoral pulses
Systolic murmur that radiates to back or scapula

61

Dx of Coarctation of Aorta

Angiogram is gold standard
CXR: see Rib notching
EKG: LVH
Echo

62

Tx of Coarctation of Aorta

Balloon Angioplasty or surgical correction, PGE

63

What causes a Venous Stasis Ulcer

Vascular Incompetence of either deep or superficial veins
Usually after DVT, trauma, or thrombophlebitis

64

Sx of Venous Stasis Ulcer

Leg pain, worse with prolonged sitting, improved with walking or leg elevation
Edema, Stasis Dermatitis

65

Where you see a Venous Stasis Ulcer

Medial Malleolus

66

Tx of Venous Stasis Ulcer

Compression: Leg elevation, stockings, exercise
Ulcer: Wet to dry dressings, skin grafting, hyperbaric O2
Venous valve transplant

67

What is Left Ventricular Hypertrophy

Thickened ventricles with components of both systolic and diastolic dysfunction
Septum is big and thick, portion under the aortic valve is big and thick

68

Sx of Left Ventricular Hypertrophy

Exercise induced syncope, SOB, Murmurs

69

How do you decrease the sound of a murmur in ventricular hypertrophy

Squatting, Laying Down, Fist Clench, Inspiration
To decrease the sound, you increase the venous flow to the heart
This is because the septum covers the aortic outlet as blood enters the heart chambers

70

How do you increase the sound of a murmur in ventricular hypertrophy

Valsalva and Standing
To increase the sound, you decrease the venous flow to the heart
This allows the septum to relax and move away from aortic outlet, allowing flow through and the murmur to be heard

71

What is the first choice for Dx ventricular hypertrophy

Echo

72

What are other imaging/tests you can do for ventricular hypertrophy

CXR: Normal Heart Size
EKG: LVH, Large QRS, Non-Specific T-waves
Angiography

73

Tx for Ventricular Hypertrophy

Beta Blockers
Avoid strenuous exercise
No Inotropes

74

What is Aortic Regurgitation

Backflow from aorta to LV
It leads to LV volume overload

75

Sx of Aortic Regurgitation

Left Sided HF

76

What murmur is heard with Aortic Regurgitation

Diastolic Descrescendo BLOWING murmur heard best at LUSB

77

How can you increase the sound an Aortic Regurgitation murmur

Handgrip
It increases backward flow

78

How can you decrease the sound of an Aortic Regurgitation murmur

Amyl Nitrate

79

Where does an Aortic Regurgitation murmur radiate to

Left Sternal Border

80

Tx of Aortic Regurgitation

Vasodilators, Surgery