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EOR - Internal Med > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

predictable chest pain relieved by rest and/or nitro

A

stable angina

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2
Q

previously stable/predictable chest pain that is more frequent, increasing, or present at rest

A

unstable angina

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3
Q

coronary artery vasospasm that causes transient ST segment elevations NOT associated w. ischemia/clot

A

primzmetal variant angina

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4
Q

cardiac arrhythmias/conduction d.o’s to know

A

premature beats
paroxysmal SVT
afib/flutter
sick sinus syndrome
sinus arrhythmia

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5
Q

ventricular arrhythmias to know

A

pvc’s
v tach
v fib
torsades

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6
Q

what are the 3 types of premature beats

A

pvc
pac
pjc

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7
Q

what is this showing

A

early wide, bizarre qrs
no p wave

pvc

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8
Q

what is this showing

A

abnormally shaped p wave/qrs

pac

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9
Q

what is this showing

A

narrow qrs
no p wave or inverted p wave

pjc

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10
Q

what is this showing

A

narrow, complex tachy
no discernable p wave

svt

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11
Q

what is this showing

A

irregularly irregular rhythm
disorganized/irregular atrial activity
absence of p waves

afib

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12
Q

what is this showing

A

regular, sawtooth pattern
narrow qrs

aflutter

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13
Q

what is this showing

A

alternating brady-tachy
sinus arrest
prolonged absence of sinus node activity - absent p waves > 3 seconds

sick sinus syndrome

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14
Q

normal/minimal variations in SA node pacing rate associated w. phases of respiration (increase w. inspiration, decrease w. expiration)

A

sinus arrhythmia

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15
Q

what is this showing

A

3 or more consecutive pvc’s
broad qrs tachy

v tach

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16
Q

what is this showing

A

erratic rhythm
no discernable waves

vfib

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17
Q

what is this showing

A

polymorphic v tach twisting around a baseline

torsades

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18
Q

3 cardiomyopathies to know

A

dilated
hypertrophic obstructive (hocm)
restrictive

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19
Q

mc cardiomyopathy

A

dilated

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20
Q

event or pathologic process damages the myocardium -> weakens heart muscle -> decreased ventricular contraction/strength -> dilated left ventricle

A

dilated cardiomyopathy

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21
Q

dilated cardiomyopathy causes _ heart failure

A

systolic

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22
Q

3 causes of dilated cardiomyopathy

A

CAD
MI
arrhythmia

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23
Q

4 PE findings of dilated cardiomyopathy

A

dyspnea
S3 gallop
rales
JVD

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24
Q

which abnl heart sound can be a normal finding in kids, pregnant females, and well trained athletes

A

S3

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25
which extra heart sound is always pathologic
S4
26
tx for dilated cardiomyopathy
no etoh ACEI diuretic
27
genetic mutation -> hypertrophic portion of ventricular septum -> thickened cardiac muscle -> narrowed LV outflow tract
HOCM
28
3 HPI clues for HOCM
young athlete positive fam hx of sudden death syncopal episode
29
HOCM causes _ heart failure
diastolic
30
3 PE findings of HOCM
sustained PMI S4 gallop mid systolic murmur
31
describe the HOCM murmur (3)
high pitched midsystolic heard best at LLSB
32
the HOCM murmur is increased with _ (2) and decreased w. _
increased: standing, valsalva decreased: squatting, handgrip
33
management of HOCM (4)
refrain from PA bb vs ccb surgery vs ablation defibrillator insertion
34
6 causes of restrictive cardiomyopathy
amyloidosis sarcoidosis hemochromatosis scleroderma fibrosis ca
35
infiltrative process -> stiff heart muscle
restrictive cardiomyopathy
36
5 echo findings of restrictive cardiomyopathy
normal EF normal heart size large atria normal LV wall early diastolic filling
37
tx for restrictive cardiomyopathy
diuretics acei ccb
38
3 PE findings of CHF
S3 crackles displaced apical impulse
39
4 mcc of CHF
CAD HTN MI DM
40
CHF leads to _ remodeling, which causes dilation, thinning, _ valve incompetence, and _ ventricle remodeling
left ventricle mitral valve right ventricle
41
6 sx of CHF
exertional dyspnea -> dyspnea at rest chronic, nonproductive cough fatigue orthopnea nocturnal dyspnea nocturia
42
PE findings associated w. CHF (8)
cheyne stokes breathing edema rales S3/S4 JVD > 8 cm cyanosis hepatomegaly jaundice
43
S4 heart sound is associated w.
diastolic HF presrved EF
44
pathologic S3 heart sound is associated w.
systolic HF reduced EF
45
NY HF classification
class 1: no PA limitation class 2: slight PA limitation, comfortable at rest class 3: marked PA limitation, comfortable at rest class 4: can't carry on PA, angina at rest
46
dx for CHF (4)
BNP EKG CXR echo
47
gs dx for CHF
echo
48
what is this showing
kerley lines -> CHF
49
tx for CHF systolic vs diastolic
systolic: ACEI, bb, diuretics diastolic: ACEI, bb, CCB
50
2 causes of CAD
vasospastic (prinzmetal) atherosclerotic dz
51
rf for CAD
smoking DM dyslipidemia HTN fam hx men > 55 women > 65
52
dx for CAD
high sensitivity CRP lipids/TG carotid US
53
primary preventive tx for CAD
PLT inhibitors: ASA, clopidogrel
54
secondary prevention for CAD
ASA bb ACEI/ARB nitro
55
atherosclerosis is due to _ cells that are attracted to lipids on the cell wall, and trigger cytokine release
foam cells (dead macrophages)
56
_ plaque is stable _ plaque is easily ruptured
thick: stable thin: easily ruptured
57
steps in plaque bulid up
1. adhesion 2. activation 3. aggregation 4. propagagion 5. PLT adherence
58
inflammation of the heart lining or heart valves caused by bacteria in the bloodstream
endocarditis
59
what 3 procedures increase risk for endocarditis
dental intestinal urinary tract
60
2 hallmark sx of endocarditis
fever PLUS new murmur
61
pathogen associated w. endocarditis: acute: subacute: IVDU: prosthetic valve:
acute: s. aureus subacute: s. viridans IVDU: s. aureus prosthetic valve: staph epidermidis
62
duke's criteria
2 major OR 1 major PLUS 3 minor OR 5 minor
63
3 major duke criteria
2 positive cultures 12 hr aprt echo findings new murmur
64
minor duke criteria
**from jane:** fever > 100.5 roth spots osler nodes murmur janeway lesions anemia nail bed hemorrhages emboli
65
valve associated w. endocarditis in IVDU vs non drug users
IVDU: tricuspid non IVDU: mitral
66
what is this showing
painless lesions on the palms/soles -> **janeway lesions**
67
what is this showing
raised, painful, tender nodule -> **osler node**
68
what is this showing
exudative lesions on the retina -> **roth spots**
69
2 nail findings of endocarditis
clubbing splinter hemorrhages
70
tx for endocarditis: empiric: prosthetic valve: pre procedure prophylaxis:
empiric: vanco OR amp/sulbactam PLUS aminoglycoside prosthetic valve: same as empiric, add rifampin pre procedure prophylaxis: amoxicillin
71
murmurs to know (7)
aortic stenosis aortic regurgitation mitral stenosis mitral regurgitation MVP tricuspid stenosis tricuspid regurgitation pulmonary regurgitation
72
harsh systolic ejection crescendo decrescendo murmur heard best at the USB
aortic stenosis
73
aortic stenosis murmur radiates to the
neck apex
74
sx of aortic stenosis
dyspnea angina **syncope w. exertion**
75
aortic stenosis murmur increases w.
squatting
76
soft, high pitched blowing crescendo decrescendo murmur best heard along LSB
aortic regurgitation
77
what increases the murmur of aortic regurgitation
leaning forward
78
water hammer pulse
large/bounding arterial pulse -> **aortic regurgitation**
79
diastolic low pitched decrescendo rubling w. an opening snap heard best at the apex
mitral stenosis
80
mitral stenosis murmur is best heard w. the pt in the _ position
left lateral decubitus
81
mcc of mitral stenosis
rheumatic fever
82
blowing holosystolic murmur heard best at the apex
mitral regurgitation
83
mitral regurgitation murmur radiates to the
left axilla
84
5 causes of mitral regurgitation
CAD HTN MVP rheumatic fever heart valve infxn
85
midsystolic ejection click heard best at the apex
MVP
86
mid diastolic rumbling murmur at LLSB w. opening snap
tricuspid stenosis
87
high pitched holosystolic murmur at LLSB that radiates to the sternum
tricuspid regurgitation
88
the murmur of tricuspid regurgitation increases w.
inspiration
89
harsh, loud medium pitched systolic murmur heard best at the 2nd/3rd intercostal space
pulmonary stenosis
90
high pitched early diastolic decrescendo murmur at LUSB that increases w. inspiration
pulmonary regurgitation
91
screening guidelines for HLD: USPSTF vs NCEP
USPSTF: start at 35 yo NCEP: start at 20 yo
92
4 groups most likely to benefit from statins
any form of ASCVD LDL > 190 DM, 40-75 yo, LDL 70-189 40-75 yo w. ASCVD >/= 7.5%
93
what are the 2 high intensity statins
atorvastatin 40, 80 mg rosuvastatin: 20, 40 mg
94
definition of primary HTN
2 readings on 2 separate visits w. no identifiable cause: SBP >/= 130 OR DBP >/= 80
95
adult HTN classifications
normal: <120/80 elevated: 120-129 AND < 80 stage 1: 130-139 OR 80-89 stage 2: >/= 140 OR >/= 90
96
ACC/AHA BP targets
<130/80
97
HTN tx based on classificaiton
-normal: lifestyle, evaluate annually -elevated: lifestyle, re-evaluate 3-6 mo -stage 1 and <10% ASCVD risk: lifestyle, re-evaluate 3-6 mos -stage 1 and >10% ASCVD risk OR CVD, DM, CKD: lifestyle PLUS 1 med, re-evaluate in 1 month -stage 2: lifestyle + 2 BP meds, re-evaluate in 1 month
98
first line pharm for HTN for non black pt
ACEI vs ARB CCB (dihydropiridine) HCTZ
99
tx for HTN for black pt's
HCTZ + CCB
100
contraindication for bb
asthma
101
major s.e consideration for bb
ED
102
best med for htn + angina
ccb
103
t/f: ACEI are contraindicated in pregnancy
t!
104
common s.e of ccb
peripheral edema
105
best med for HTN plus BPH
alpha blockers
106
2 major s.e of hydralazine
lupus like syndrome pericarditis
107
definition of htn emergency vs urgency
urgency: >180/120 w.o end organ damage emergency: >180/120 + impending or progressing end organ damage
108
definition of malignant htn
DBP > 140 PLUS papilledema, encephalopathy, or nephropathy
109
tx for htn urgency vs emergency vs malignant
urgency: clonidine emergency: sodium nitroprusside malignant: hydralazine
110
what are the 2 rate control ccb
verapamil diltiazem
111
management of MI
bb NTG ASA and plavix heparin statins reperfusion
112
door to balloon time goal for MI
90 mins
113
2 reperfusion options for MI
angioplasty thrombolytic
114
4 contraindications for fibinolytic therapy
ICH ischemic stroke in past 3 mos confirmed or suspected dissection active bleeding
115
indication for fibrinolytic therapy for MI
PCI not available
116
goal timing for fibrinolytic therapy
w.in first 3 hr
117
myocardial necrosis and rise in cardiac markers w.o complete coronary a blockage or ST elevation
NSTEMI
118
cardiac labs and when they become elevated w. MI
myoglobin: 1-4 hr troponin: 2-4 hr CK/CK-MB: 4-6 hr
119
mcc of myocarditis
viral infxn
120
3 causes of myocarditis
infxn xrt hypersensitivity
121
6 sx of myocarditis
fatigue fever chest pain dyspnea palpitations tachycardia
122
gs dx for myocarditis
endomyocardial bx
123
severe complication of myocarditis
heart failure
124
45 yo M w. T1DM and ESRD on hemodialysis - dyspnea, cough, and CP that is worse during inspiration and when lying on back
pericarditis
125
10 causes of pericarditis
SLE uremia coxsackie virus TB RA neoplasm drugs xrt scleroderma MI
126
pain w. pericarditis is relieved by (2)
sitting leaning forward
127
heart sound associated w. pericarditis
pericardial friction rub
128
what is dressler's syndrome
pericarditis 2-5 days after acute MI
129
ekg findings of pericarditis
diffuse ST elevations
130
echo findings of pericarditis
effusion +/- tamponade
131
tx for pericarditis
nsaids steroids if sx > 48 hr abx pericardiocentesis head at 45 degrees
132
atherosclerotic dz of the lower extremities and vessels outside the heart/brain
peripheral vascular dz
133
mc presentation of PVD
intermittent claudication: intermittent pain brought on w. exercise and relieved w. rest
134
what is leriche syndrome
PVD in the iliac arteries
135
leriche triad
claudication impotence decreased femoral pulses
136
mc location for PVD
femoral a: thigh/upper calf claudication
137
claudication in lower calf indications PVD in what artery
popliteal
138
5 sx of PVD
weak/absent distal pulses arterial bruits loss of hair shiny, atrophic skin pallor w. dependent rubor
139
6 p's of arterial embolism
pain pulselessness pallor paresthesias poikilothermia paralysis
140
dx for PVD: initial vs gs
initial: ABI gs: arteriography
141
what ABI indicates PVD
<0.9
142
mainstay pharm for PVD
cliostazol
143
all pharm options for PVD
bb ACEI statins **cliostazol** ASA clopidogrel
144
surgical management of PVD
angioplasty/bypass endarterectomy
145
mc location for varicose veins
greater saphenous
146
describe varicose veins
turguous reticular telangiectasias
147
management of varicose veins
wt loss compression stockings leg elevation radiofrequency vs lasaer ablation sclerotherapy surgical stripping
148
what is this showing
phlebitis: inflammation of a vein near the surface of the skin
149
sx of phlebitis
dull pain erythema swelling/heat
150
PE sign associated w. phlebitis
homan's sign: pain w. dorsiflexion of the foot
151
dx for phlebitis
**US** venography d dimer
152
management of phlebitis: superficial vs deep
superficial: bed rest, local heat, elevation, NSAIDs deep: anticoagulation vs surgery
153
4 sx of chronic venous insufficiency
progressive edema itching dull pain ulcerations shiny, thin, atrophic skin
154
complications of chronic venous insufficiency
ulcerations
155
management of chronic venous insufficiency
elevation compression
156
inflammatory rxn to GAS that causes antistreptolysin abs to form
rheumatic fever
157
dx for rheumatic fever
e.o recent GAS infxn PLUS Jones criteria: 2 major OR 1 major and 2 minor
158
major jones criteria
joint pain (poly) (o) carditis nodules erythema marginatum sydenham's chorea
159
minor jones criteria
mono arthralgia elevated ESR/CRP fever prolonged PR
160
tx for rheumatic fever
ASA vs NSAIDs steroids abx
161
post rheumatic fever antistreptococcal prophylaxis guidelines
pen g -> kids w.o carditis: up to 5 yr or til 21 yo kids w. carditis w.o residual heart damage: 10 yr kids w. carditis and e.o heart damage: indefinitely
162
consequence of rheumatic fever that causes inflammation and scarring of the heart valves
rheumatic heart dz
163
rheumatic heart dz mc affects the _ valve
mitral
164
what protein is associated w. rheumatic fever/heart dz
m protein
165
rheumatic heart dz is a type __ hypersensitivity
II
166
complication of rheumatic heart dz: early vs late
early: mitral regurgitation late: mitral stenosis
167
onset of rheumatic heart dz sx occurs _ yrs after rheumatic fever
10-20
168
sx of rheumatic heart dz
palpitations dyspnea mitral regurg/stenosis aortic regurg/stenosis
169
dx for rheumatic heart dz
echo anti streptolysin O (ASO) titers histology
170
histology findings of rheumatic heart dz
aschoff bodies on heart valves (granulomas w. giant cells)
171
pharm for GAS prophylaxis if pcn allergy
sulfadiazine
172
early murmur suggests
regurgitative flow (usually aortic)
173
rumbling murmur suggests
stenosis (usually mitral)
174
mc type of murmur
midsystolic (ejection)
175
describe ejection murmurs
peak near mid systole stop before S2 gap between murmur and S2
176
4 ejection/midsystolic murmurs to know
aortic stenosis pulmonic stenosis HOCM MVP
177
systolic ejection crescendo decrescendo murmur heard best in the RUSB
aortic stenosis
178
hard midsystolic ejection crescendo decrescendo murmur w. widely split S2 at LSB
pulmonic stenosis
179
pulmonic stenosis murmur radiates to the
left shoulder neck
180
the HOCM murmur increases w. _ and decreases w. _
increases: straining decreases: squatting
181
midsystolic ejection click at the apex
MVP
182
3 pansystolic murmurs to know
mitral regurgitation tricuspid regurgitation VSD
183
blowing holosystolic murmur at the apex w. a split S2
mitral regurgitation
184
high pitched holosystolic murmur at the mid LSB
tricuspid regurgitation
185
harsh holosystolic murmur heard at LSB w. wide radiation and fixed split S2
VSD
186
who should get screened for aortic aneurysm
>65 yo male hx smoking
187
management of aortic aneurysm
>3 cm: monitor annually >4 cm: bb >5.5 cm or 0.5 cm expansion/year: surgery
188
management of aortic dissection
ascending: surgical emergency descending: bb
189
gs dx for arterial embolism
angiography
190
management of arterial embolism
IV heparin angioplasty vs graft vs endarterectomy
191
inflammation of large and medium vessels
giant cell arteritis
192
5 sx of giant cell arteritis
jaw claudication HA thickened temporal a ttp of scalp amaurosis fugax
193
amaurosis fugax is caused by
anterior ischemic optic neuritis
194
dx for giant cell arteritis
ESR > 100 temporal a bx
195
management of giant cell arteritis
prednisone ASAP
196
palpable cord makes you think of
phlebitis/thrombophlebitis
197
ulcers caused by venous insufficiency are mc located
above the medial malleolus
198
initial vs dx for venous thrombosis
initial: US gs: venography
199
tx for venous thrombosis
heparin to coumadin bridge
200
which 3 murmurs are holosystolic
mitral regurgitation tricuspid regurgitation VSD
201
which 4 murmurs are midsystolic
aortic stenosis pulmonic stenosis HOCM ASD MVP

EOR - Internal Med (13 decks)

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