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Cardiology Error List Flashcards

(80 cards)

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1
Q

When is revascularization indicated for Coronary Artery Disease

A

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

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2
Q

What type of revascularization is indicated for Left MAIN coronary artery

A

CABG

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3
Q

When is a Percutaneous Transluminal Coronary Intervention used (PTCA)

A

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

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4
Q

What intervention is used for Left Anterior Descending Artery

A

Beta Blockers
Ranolazine
CCB
Ivabradine

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5
Q

What is the gold standard to test for CAD

A

Coronary Angiongraphy (Cath)

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6
Q

What is Heart Failure

A

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

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7
Q

What causes left sided HF

A

CAD and HTN

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8
Q

Sx for left sided HF

A

Think Pulmonary back-up

Dyspnea, Pulmonary Congestion/Edema, HTN

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9
Q

What causes right sided HF

A

Left sided HF

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10
Q

Sx for right sided HF

A

Peripheral Edema
JVD
GI/Hepatic Congestion

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11
Q

Dx for HF and what does it measure

A

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

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12
Q

Tx for HF

A

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

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13
Q

Which Tx for HF reduce sx vs. improve mortality

A

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

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

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14
Q

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

A

Hydralize + Nitrates

They do decrease mortality when used together

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15
Q

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

A

Mitral Valve

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16
Q

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

A

Tricuspid Valve

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17
Q

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

A

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

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18
Q

Sx for Infective Endocarditis

A

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

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19
Q

What is the Duke Criteria for Infective Endocarditis (DX)

A

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)

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20
Q

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

A

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

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21
Q

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

A

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

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22
Q

What is the reading for HTN

A

> 140/90

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23
Q

Dx for HTN

A

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

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24
Q

What are complications of HTN

A

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

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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

Internal Medicine (16 decks)

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