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Cardiology High Yield Flashcards

(97 cards)

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1
Q

What is Aortic Stenosis

A

LV outflow obstruction

Leads to LVH

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2
Q

What murmur is heard with Aortic Stenosis

A

Systolic Ejection Crescendo-Decrescnedo at RUSB

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3
Q

Where does an Aortic Stenosis murmur radiate

A

Carotid Arteries

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4
Q

How can you increase the sound of an aortic stenosis murmur

A

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

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5
Q

How can you decrease the sound of an aortic stenosis murmur

A

Decrease venous return to heart with Valsalva and Standing

Inspiration decreases venous return to left side of heart

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6
Q

Tx for Aortic Stenosis

A

Once symptomatic, valve replacement

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7
Q

What is Mitral Regugitation

A

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

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8
Q

What type of murmur is heard with Mitral Regurgitation

A

Holostystolic BLOWING murmur heard best at apex

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9
Q

Where does a Mitral Regurgitation murmur radiate

A

Axilla

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10
Q

How can you increase the sound of a Mitral Regurgitation murmur

A

Handgrip

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11
Q

How can you decrease the sound of a Mitral Regurgitation mumrur

A

Amyl Nitrate

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12
Q

Tx for Mitral Regurgitation

A

Vasodilators (Ace-I)

Surgery: Valve Repair

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13
Q

What is Aortic Regurgitation

A

Backflow from Aorta to LV

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14
Q

What type of murmur is heard with Aortic Regurgitation

A

Diastolic Decrescendo BLOWING murmur heard best at LUSB

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15
Q

Where does an Aortic Regurgitation Murmur raidate

A

Along Left Sternal Border

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16
Q

How can you increase the sound of an Aortic Regurgitation murmur

A

Handgrip

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17
Q

How can you decrease the sound of an Aortic regurgitation murmur

A

Amyl Nitrate

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18
Q

Tx for Aortic Regurgitation murmur

A

Vasodilators

Srugery if sx

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19
Q

What is Mitral Stenosis

A

Obstruction of flow from LA to LV

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20
Q

What type of murmur is heard with Mitral Stenosis

A

Diastolic RUMBLE heard at the apex

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21
Q

Where does a Mitral Stenosis murmur radiate

A

No radiation

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22
Q

How can you increase the sound of a Mitral Stenosis murmur

A

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

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23
Q

How can you decrease the sound of a Mitral Stenosis Murmur

A

Decrease venous return to heart with Valsalva or Standing

Inspiration decreases flow through left side of heart, so will decrease murmur

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24
Q

What is Mitral Valve Prolapse

A

Degeneration of mitral valve

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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

Internal Medicine (16 decks)

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