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Flashcards in Cardiology High Yield Deck (97):
1

What is Aortic Stenosis

LV outflow obstruction
Leads to LVH

2

What murmur is heard with Aortic Stenosis

Systolic Ejection Crescendo-Decrescnedo at RUSB

3

Where does an Aortic Stenosis murmur radiate

Carotid Arteries

4

How can you increase the sound of an aortic stenosis murmur

Increase venous return to heart Squatting, Laying Down, Fist Clench
Expiration increases venous return to left side of heart

5

How can you decrease the sound of an aortic stenosis murmur

Decrease venous return to heart with Valsalva and Standing
Inspiration decreases venous return to left side of heart

6

Tx for Aortic Stenosis

Once symptomatic, valve replacement

7

What is Mitral Regugitation

Backflow from LV to LA, usually due to Mitral Valve Prolapse

8

What type of murmur is heard with Mitral Regurgitation

Holostystolic BLOWING murmur heard best at apex

9

Where does a Mitral Regurgitation murmur radiate

Axilla

10

How can you increase the sound of a Mitral Regurgitation murmur

Handgrip

11

How can you decrease the sound of a Mitral Regurgitation mumrur

Amyl Nitrate

12

Tx for Mitral Regurgitation

Vasodilators (Ace-I)
Surgery: Valve Repair

13

What is Aortic Regurgitation

Backflow from Aorta to LV

14

What type of murmur is heard with Aortic Regurgitation

Diastolic Decrescendo BLOWING murmur heard best at LUSB

15

Where does an Aortic Regurgitation Murmur raidate

Along Left Sternal Border

16

How can you increase the sound of an Aortic Regurgitation murmur

Handgrip

17

How can you decrease the sound of an Aortic regurgitation murmur

Amyl Nitrate

18

Tx for Aortic Regurgitation murmur

Vasodilators
Srugery if sx

19

What is Mitral Stenosis

Obstruction of flow from LA to LV

20

What type of murmur is heard with Mitral Stenosis

Diastolic RUMBLE heard at the apex

21

Where does a Mitral Stenosis murmur radiate

No radiation

22

How can you increase the sound of a Mitral Stenosis murmur

Increase venous return to heard with Squatting, Laying Down, Fist Clench
Expiration increases flow through left side of heart, so will increase murmur

23

How can you decrease the sound of a Mitral Stenosis Murmur

Decrease venous return to heart with Valsalva or Standing
Inspiration decreases flow through left side of heart, so will decrease murmur

24

What is Mitral Valve Prolapse

Degeneration of mitral valve

25

What type of murmur is heard with Mitral Valve Prolapse

Midsystolic Ejection CLICK at Apex

26

Where does a mitral valve prolapse murmur radiate

No radiation

27

Tx for Mitral Valve Prolapse

Reassurance
Beta Blockers if autonomic dysfunction

28

What is Dilated Cardiomyopathy

Systolic dysfunction leads to ventricular dilation

29

What causes dilated cardiomyopathy

Viral, usually Enterovirus (Coxsackie)
Alcohol Abuse

30

Sx of Dilated Cardiomyopathy

Systolic HF, signs of Left and Right sided HF
Arrhythmias

31

Dx of Dilated Cardiomyopathy

Echo: See LV enlargement and decreased EF
CXR: Cardiomegaly

32

Tx of Dilated Cardiomyopathy

Diuretics, Ace-I, Beta-Blockers
Implantable Defibrilitaor if EF

33

What is Restrictive Cardiomyopathy

Impaired diastolic function with fairly well preserved contractility
Ventricular rigidity impedes ventricular filling

34

What causes Restrictive Cardiomyopathy

Infiltrative Diseases like Amyloidosis, Sarcoidosis

35

Sx of Restrictive Cardiomyopathy

Right sided HF is more common than Left sided HF
Kussmaul's sign

36

Dx of Restrictive Cardiomyopathy

Echo: See Ventricles nondilated with normal wall thickness, Dilated of both Atria, amyloidosis
CXR: Enlarged Atria

37

Tx for Restrictive Cardiomyopathy

Diuretics, Vasodilators

38

What is Pericarditis

Acute inflammation of the pericardium

39

What causes pericarditis

Viral: Coxsackie, Echovirus

40

What is the association between pericarditis and an MI

Dressler's Syndrome: Pericarditis 1-2 months after an MI (autoimmune related)

41

Sx of Pericarditis

Pleuritic chest pain (sharp pain worse with inspiration)
Persistent
Postural (worse with lying down, relieved with sitting/leaning forward)
Radiates to trapezius, back, neck, shoulder, arm
Pericardial friction rub (heard best upright, leaning forward)

42

Dx of Pericarditis

Echo is used to assess complications like effusion or tamponade
EKG: Diffuse ST elevations in precordial leads and PR depression

43

Tx of Pericarditis

ASA or NSAIDS
Colchicine is 2nd line
Corticosteroids if refractory

44

What is a Pericardial Effusion

Increased fluid in the pericardial space

45

What causes a pericardial effusion

Pericarditis

46

Sx of Pericardial Effusion

Pericarditis sx
Distant heart sounds

47

Dx of Pericardial Effusion

Echo: Increased pericardial fluid
EKG: Low voltage QRS comlex, Electric Alternans (shift in QRS amplitude)
CXR: Cardiomegaly

48

Tx of Pericardial Effusion

Tx underlying cause, Observation if not big
Pericardiocentesis if tamponade or large effusion

49

What is Pericardial Tamponade

Pericardial effusion causing significant pressure on the heart
Leads to restriction of cardiac ventricular filling and decreased CO

50

Sx of Pericardial Tamponade

Beck's Triad: Distant (muffled) heart sounds, Increased JVP, Systemic Hyoptension
Pulsus Paradoxus: >10mmHg decrease in systolic BP with inspiration
Dyspnea, fatigue, peripheral edema

51

Dx of Pericardial Tamponade

Echo: See effusion and diastolic collapse of cardiac chambers

52

Tx of Pericardial Tamponade

Pericardiocentesis Immediately

53

What is a first degree AV block and tx for it

See constant prolonged PR intervals
No loss of beats
No tx

54

What is a Type I second degree block (Mobitz I/Wenckebach) and tx for it

PR intervals gradually increase with each beat until a QRS complex is dropped
Tx: Atropine, Epinephrine, +/- Pacemaker if sx
Observation if no sx

55

What is a Type II second degree block (Mobtiz II) and tx for it

PR intervals are all the same size, but a QRS is dropped
Tx: PERMANENT PACEMAKER because high risk for it to develop into 3rd degree block

56

What is a third degree block and tx for it

None of the P waves are associated with QRS complex
Tx: PERMANENT PACEMAKER is definitive

57

What is Atrial Flutter and tx for it

No P waves, rate is regular
Tx: Vagal, CCB, Beta-Blockers
DCC if unstable
Radiofrequency ablation is definitive

58

What is Atrial Fibrillation and tx for it

No P-waves
Irregularly Irregular Rhythm
Tx: Vagal, CCB, or Beta-Blockers
DC Cardioversion but you need to give anticoagulants for 3-4 weeks prior

59

What is Wolff-Parkinson-White and tx for it

Accessory Pathway that pre-excites the ventricle
See Delta waves
Tx: Vagal, Antiarrhythmics (Procainamide, Amiodarone)
Radiofrequencdy ablation is definitive

60

What is Ventricular Tachycardia and tx for it

More than 3 consecutive PVC's at rate >100 bpm
Prolonged QT interval often is the cause
Tx
If Stable Sustained: Antiarrhythmics (Amiodarone, Lidocaine, Procainamide)
If unstable with pulse: DCC (Cardiovert)
If no pulse: Defibrillator/CPR

61

What is Torsades De Pointes, what causes it and tx for it

A type of Ventricular Tachycardia that can lead to V.Fib
Usually due to Hypomagnesia
Tx: IV Magnesium

62

What is Ventricular Fibrillation and tx for it

Not compatible with life
Tx: Defibrillation and CPR

63

What is myocarditis

Inflammation of the heart muscle

64

What causes myocarditis

Viral: Enterovirus (Coxsackie and Echovirus)
Bacteria: Rickettsial
Toxins

65

Sx of Myocarditis

Viral Prodome: Fever, Myalgia, Malaise
HF sx: Dyspnea at rest, exercise intolerance, syncope, hepatomegaly
Pericarditis

66

Dx of Myocarditis

Gold standard is Endomyocardial Biopsy (see infiltrations of lymphocytes with necrosis)
CXR: Dilated Cardiomyopathy
Biomarkers: CK-MB and Troponin
Echo: Ventricular Dysfunction

67

Tx of Myocarditis

Supportive and HF tx
Diuretics, Ace-I, sometimes IVIG

68

What is Rheumatic Fever

An acute autoimmune inflammatory multi-system disease affecting children
Usually after a Group A Strep Infection

69

Dx of Rheumatic Fever

Jones Criteria
Recent Group A Strep Infection AND
2 Major or 1 Major + 2 Minor

70

What are the major criteria for Rheumatic Fever

MAJOR JONES
J: Migratory Polyarthritis
O: Carditis
N: Sydenham's Chorea
E: Erythema Marginatum (Macular, erythematous, non-pruritic annular rash with rounded, sharply demarcated edges)
S: Subcutaneous Nodules

71

What are minor criteria for Rheumatic Fever

Fever, Arthrlagias, Increased ESR/CRP/Leukocytosis, EKG shows prolonged PR intervals

72

Tx for Rheumatic Fever

Penicillin G or Erythroycin if PCN allergy
ASA

73

What is Peripheral Artery Disease

Atherosclerosis of lower extremities

74

Sx of Peripheral Artery Disease

Intermittent Claudication (pain brought on by exercise/walking and relieved with rest)
Resting leg pain (advanced disease)
Parasthesias, Pian, Pallor, Pulselessness, Paralysis, Poikilothermia
Livedo Reticularis (rash)
Gangrene
Ulcers at points of trauma (Lateral Malleolus, toes)

75

Dx of Peripheral Artery Disease

Gold Standard is Arteriograph
AnkleBrachial Index: + if

76

Tx of Peripheral Artery Disease

Platelet Inhibitors: Cilostazol, ASA, Clopidogrel
Revascularization: PTA, Bypass Grafts, Endarterectomy
Supportive: Exercise, foot care
Amputation if gangrene

77

What is an Abdominal Aortic Aneurysm

Dilation of aortic diameter
Usually infrarenal

78

Sx of Aortic Anuerysm

Usually asymptomatic until rupture
Pulsating abdominal mass, abdominal pain with syncope or hypotension

79

Dx of Aortic Aneurysm

Gold Standard: Angiography
1st Choice: Abdominal Ultrasound
CT is 1st choice for Thoracic aneurysm

80

Tx for Aneurysms

3-4cm: Ultrasound every year
4-4.5cm: Ultrasound every 6 months
>4.5: Refer to vascular surgeon
>5.5cm: Immediate surgical repair

81

What is an Aortic Dissection

A tear in the innermost layer of the aorta (intima)

82

What is the #1 RF for aortic dissection

HTN

83

Sx of Aortic Dissection

Sudden onset of severe, tearing (ripping, knife-like) chest pain that radiates to the back
Decreased peripheral pulses
Variation in pulses between left and right arm
HTN
New onset Aortic Regurgitation murmur

84

Dx of Aortic Dissection

Gold Standard: MRI Angiography
1st Choice: CT scan with contrast
TEE
CXR: Widening of mediastinum

85

Tx of Aortic Dissection

Surgery if Type A
Beta-Blockers if Type B

86

What is Giant Cell Arteritis

Autoimmune vasculitis
Systemic, granulomatous, chronic vasculitis mostly of extracranial arteries

87

Sx of Giant Cell Arteritis

Headache (unilateral, temporal, throbbing)
Scalp Tenderness
Jaw Claudication with Mastication
Visual Loss
Thick temporal artery

88

Dx of Giant Cell Arteritis

Biopsy: see Mononuclear lymphocyte infiltration and multinucleated giant cells
Clinical dx

89

Tx of Giant Cell Arteritis

High Dose Corticosteroids

90

What rheumatological condition is associated with Giant Cell Arteritis

Polymalgia Rheumatica
*Aching/Stiffness of shoulders, hips, neck
*Difficultly combing hair, putting on coat, getting out of chair
*No severe muscle weakness

91

What are Varicose Veins

Dilated, tortuous superficial veins secondary to defective valve structures and function of superficial veins

92

Sx of Varicose Veins

Dull ache or pressure sensation worsened with prolonged standing and relieved with elevation
Venous stasis ulcers

93

Tx of Varicose Veins

Leg Elevation, Compression Stockings
Sclerotherapy, Radiofrequency or Laser ABlation

94

What is Chronic Venous Insufficiency

Vascular incompetency of either deep or superficial veins

95

Sx of Chronic Venous Insufficiency

Leg Pain
Worse with prolonged standing, warm
Better with walking and leg elevation
Leg Edema
Ulcers found at Medial Malleolus
Brownish Hyperpigmentation

96

Dx of Chronic Venous Insufficiency

Ankle/Branchial Index
Ultrasound
Trandelenburg Test

97

Tx of Chronic Venous Insufficiency

Compression stockings, Leg Elevation, Exercise
Ulcer: Wet to dry dressings, skin grafting, hyperbaric oxygen
Venous valve transplant