Cardiovascular Flashcards by Lindsey Dutton

Patient presents as a 25yo with fever. hx of IVDU and periously treated for osteomyeloitis. on PE, sheis febrile and heart auscultation reveals a new systolic murmur at the LLSB.
what is the most likely diagnosis?

acute bacterial endocarditis

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what is the common pathogen associated with acute bacterial endocarditits

S. aureus

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what pathogen is associated with subacute bacterial endocarditis

S. viridans

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what is Dukes Criteria

endocarditis assessment:
major: BC 2x12 hours apart, Echo with vegitations, new regurgitant murmur
Minor: risk factor, fever 100.5, vascular pehnomena, immunologic phenomena

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what are the classic signs of infective endocarditis

Oslers nodes
janeway lesions
roth spots
splinter hemorrhages

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what are oslers nodes

tender “ouchy” nodules

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what are janeway lesions

painless macules

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what is the treatment of infective endocarditis

Empiric tx: IV Vanco or Amp/sulbactam + aminoglycoside
prosthetic valve: + Rifampim

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what is seen on a stress test with stable angina

reversible wall motion abnormalities / ST depression >1 mm

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what is the definitive diagnostic test for stable angina

angiography

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what is the treatment for stable angina

Beta blockers and nitroglycerin
if severe: angioplasty and bypass

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what is the treatment of unstable angina

admit wtih continuous cardiac monitoring (IV + O2)
pain management with NTG and morphine
ASA, clopidogrel, BB (first line), LMWH
replace electroyltes

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what are risk factors for prinzmetal variant angina

history of smoking (#1)
cocaine abuse

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what is seen on EKG with Prinzmetal variant angina

inverted U waves, ST-segment or T-wave abormalities

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what is the treatment for Prinzmetal

stress testing with myocardial perfusion imaging or coronary angiography
Nitrates (Initial)
CCB and long acting nitrates for long-term prophlyaxis

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what is atrial fibrillation

an irregular heart rate that at a high rate may cause palpitations, fatigue and SOB. occurs when upper atrial chambers of the heart beat out of rhytm and multiple atria foci

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what is atrial flutter

atria with single foci having multiple P waves before QRS is produced unlike afib which is more chaotic

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what is PSVT

paroxysmal supraventricular tachycardia
regular, fast (160-220bpm) HR that begins and ends suddently and originates in atria

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what is the most common accessory pathway tachycardia

wolff-parkinson-white syndrome

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What is the most common type of SVT

AV node reentrant tachycardia

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what are PVCs

premature ventricular contractions
extra beats from ventricles
early wide “bizarre” QRS, no p waves seen

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what is ventricular tachycardia

wide QRS complex that is regular, fast HR that arises from improper electical activity in ventricles

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what is ventricular fibrillation

ventricles merely quiver and do not contract in coordinated way. No blood is pumped from the heart, very lethal.
erractic rhythm with no discernable waves (P, QRS, or T waves)

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how should narrow tachycardic arrhythmias be treated

slowed with CCB or BB, adenosine, procainamide or cardioversion

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how should wide tachycardic arrhythmias from the ventricles be treated

cardioversion or antiarrhythmic such as amiodarone

what is a buildup of fluid between the pericardial sac and the heart causing contriction of the heart called

pericardial tamponade

patient presents as a 37yo male brought to the ED after falling off a second-story scaffolding onto his back. PE, HR is 126, BP 80/56, RR 24 and temp 99.0. glasgow coma score is 8, JVD and heart sounds are distant - what is the pateints most likely diagnosis

cardiac tamponade

what are the 3Ds associated with cardiac tamponade

Distant heart sounds Distended jugular veins Decreased atrial pressure

what is Becks Triad

cardiac tamponade - hypotension - muffled heart sounds - elevated JVD

what is pulsus paradoxus

drop 10 mmHg in systolic pressure on inspiration, narrow pulse pressure

what is seen on EKG with pulsus paradoxus

electrical alternanas and low-voltage QRS comple

what is seen on XR with pulsus paradoxus

water-bottle heart

how is cardiac tamponade diagnosed

Gold standard: ECHO - demonstating diastolic collapse of RV

what is the treatment of cardiac tamponade

pericardiocentesis

what is the difference between pericarditis and pericardial effusion and cardiac tamponade

pericarditis - inflammation of pericardium pericardial effusion - accumulation of fluid in pericardium cardiac tamponade - severe complication of pericardial effusion causing compression of the heart

in an acute settng, what are the 5 causes of chest pain that must be considered when assessing a patient

- pericarditis - ACS - PE - pneumothorax - thoracic aneurysm/dissection

what is the typical work up for a patient presenting with chest pain

EKG Troponin I BNP CXR CBC/CMP (can be included: D-dimer, CT chest, CT angio, CT aortogram)

if you are concerened for ACS or MI what tests should be ordered

EKG and troponin

if you are concerened for pericarditis, what test are most important

EKG and ESR

if you are concerened for CHF what are the most important tests

CXR and BNP

if you are concerened for Pneumothorax, what are the most important tests

CXR and CT

if you are concerened for PE what are the most important tests

D-dimer and CTA

if you are concerened for Thoracic aneurysm what are the most important tests

CT aortogram

what conduction disorder presents with a regular, sawtooth pattern with narrow QRS complex

Aflutter

what conduction disorder presents with narrow, complex tachycardia without discernible p waves

SVT

what conduction disorder presents with three or more consecutive VPBs displaying a broad QRS complex tacharrhythmia

VTach

what conduction disorder presents with erractic rhythm with no discernable waves

vfib

what conduction disorder presents with early, wide, bizarre QRS without P waves

PVCs

what conduction disorder presents with abormal shaped p waves

PACs

what conduction disorder presents with narrow QRS complex, no p wave or inverted p waves

PJC

what conduction disorder presents with R and R in V1-V3

RBBB

what conduction disorder presents with R and R in V4-V6

LBBB

what is the most sensite cardiac monitor | when does it appear when does it peak how long does it last

Troponin ## Footnote appears at 2-4 hours peaks at 12-24 hours lasts for 7-10 days

what is the treatment of NSTEMI

BB + NTG + ASA + Clopidogral + hepatin + ACEi + Statin + reperfusion (percu intervention)

what location of the heart is affected when Q waves and ST elevation in Lead I, AVL and V2-V6

anterior wall

what location of the heart is affected when Q waves and ST elevation in lead II, III, and AVF

inferior wall

what location of the heart is affected when ST elevation is in leads I, AVL, and V5-V6. Reciprocal ST depression in leads III and AVF

Lateral wall

what location of the heart is affected when there is ST depression in V1-V3

Posterior wall

what are the contraindications for fibrinolytic use in STEMI patients?

prior intracranial hemorrhage known structural cerebral vascular lesion known malignant intracranial neoplasm ischemic stroke within 3 months suspected aortic dissection active bleeding or bleeding diastesis (excluding menses)

what are cardiac causes of dyspnea on exertion

coronary heart disease heart failure myocardidits pericarditis MI ACS

what are pulmonary causes of dypsnea on exertion

asthma COPD pneumonia pulmonary HTN obesity, kyphosis, scoliosis interstitial lung disease drugs, radiation therapy, cancer psychogenic casues

what conditions can cause edema

CHF kidney disease liver disease chronic venous disease pregnancy drugs travel

what are treatment options for edema

reduce salt intake lasix, HTCZ compression stockings body position

what is cheyne-stokes breathing

perioidc, cyclic respiration

what lab tests are ordered for heart failure

CBC, CMP, U/A, lipids, TSH Serum BNP 12-lead EKG CXR Echo (best test)

what is the treatment for systolic left heart failure

ACEi + BB + loop diuretic

what is the treatment for diastolic heart failure

ACEi + BB or CCB

what is the drug of choice for hypertensive urgency

clonidine

what is the drug of choice for hypertensive emergency

sodium nitroprusside

what are common causes of cardiogenic shock

acute MI heart failure cardiac tamponade

what is the treatment of cardiogenic shock

fluid resuscitation pressors (dopamine) treat the underlying cause

a patient presents to the ED and complains of orthopnea. what is the likely cause

pulmonay edema

what tests are done for the chief complaint of orthopnea

CXR CNF (for CHF) EKG Troponin I ABG

64yo female pt presents for 5 weeks of occasional SOB and pain radiating from her shoulder to her chest. pt reports pain is worse with inspiration and lying down and feels better when sitting foward. PE you note distant heart sounds. EKG with low-voltage QRS complexes and electrical alternanas - whats the most likely diagnosis

pericardial effusion

how is pericardial effusion diagnosed

EKG ECHO CXR

63yo male presents complainin gof bialteral leg pain, which has been increasing gradually over the past several months. worsens when walking and improves with rest. PMH and surgical hx is significant for HTN, hyperlipidemia, and coronary artery bypass graft 5 years ago. he has a 60 pack year smoking hx. vitals are: temp 37C, HR 70, BP 143/89, and RR 18. PE of LE reveals palpable but weake posterior tibial and dorsalis pedis pulses bilaterally; warm and well-profused and ABI on 0.7 and 0.8. What is the likely diagnosis

peripheral vascular disease

how is PVD diagnosed

doppler US ABI Angiography = gold standard

what are medical treatment options for PVD

antiplatelet antilipids manage risk factors Cilostazol ASA and plavix

what is the definitive treatment for PVD

aterial bypass

a patient presents after a syncopal episode to the ED, what test should be ordered

ECG glucose pulse ox ECHO tilt table CNS imaging (rare)

59yo male presents with chest pani, dyspnea, and presyncope. The symptoms ocurred after he climbed a flight of stairs. he has a late systolic-ejection murmur heard at the RUSB with radiation to the carotids and apex. what is the most likely diagnosis

Aortic stenosis

59yo male presents with chest pain, dyspnea, and presyncope. The symptoms ocurred after he climbed a flight of stairs. he has a late systolic-ejection murmur heard at the RUSB with radiation to the carotids and apex. what makes the murmur decrease?

valsalva

LV hypertrophy

aortic stenosis presents with what murmur

systolic ejection crescendo-decrescendo at RUSB split S2 increases with squatting and espiration decreases wtih valsalva, hand grip and standing

61yo male presents with recent hx of increased fatigue with mildly increased exertional dyspnea. the pt denies any sigificant PMH but states that he had some heart problems as a child but he was never clear as to what the problem was. on cardiac exam you hear a early diastolic, soft-blowing decrescendo murmur with a high-pitch quality. what is the likely diagnosis?

aortic regurgitation

squatting, sitting, leaning forward and hand grip.

what type of murmur is heard with aortic regurgitation

soft high pitched, blowing diastolic murmur heartd along the LLSB increases with squatting, sitting, leaning foward and hand grip decreases with valsalva and satnding

pt is a 72yo female presenting to the office for routine check up. while she otherwise feels well, it has been a long time since she recieved medical care. on exam you note an apical, rumbling diastolic murmur with a split S1 that occurs following an opening snap. this is heard best at LLSB and apex. no other PE findings or PMH. what is the most likely diagnosis

Mitral stenosis

pt is a 64yo obese pt with hx of hyperlipidemia and poorly controled T2DM who underwent percutaneous transluminal coronary angioplasty of the posterior descending artery 3 days ago for ST elevation MI. He has so far been stable since the procedure, but overnight, you are called to his bedside. he is mallid and breathing laboriously. notable vitals include a BP of 85/45, and HR of 125bpm. his lung exam is notable for bibasilar crackles. on cardiac exam you note a hyperactive precordium with new II/VI blowing holosystolic mumur at apex with a split two radiating to axilla. What is the most likely diagnosis?

Mitral regurgitation

at what measurement does a AAA need to be surgically repaired

>5.5cm or expands >0.6cm per year

what is seen on CXR wtih aortic dissection

widened mediastium

what are common cardiac causes for thrombus formation

afib and mitral stenosis

what is the gold standard test to diagnose aterial embolism/thrombus

angiography

what is the treatment of acute arterial occlusion

IV heparin if not limb-threatening then call vascular for angioplasty, graft or endartectomy

what is the presentation of phlebitis/thrombophlebitis

dull pain, erythema, induration of vein and a palpable cord

what diagnostic tests are used for phlebitis/thrombophlebitis

venous duplex is the gold standard

what is the treatment of phlebitis/thrombophlebitis

symptomatic: NSAIDS and warm compress

Cardiovascular Flashcards

(97 cards)