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Flashcards in Cardiovascular Deck (125):
1

Treatment of atrial fibrillation in Grave's Disease

Propranolol

2

Murmurs that increase on expiration

Left sided murmurs

3

Clinical indications for surgery in aortic stenosis

Syncope
Angina
Dyspnea

4

Treatment of S3 in adult with dyspnea

Diuretics
LVH failure

5

History HTN
Tearing pain in the back
Widening mediastinum on CXR

Aortic Dissection

6

Management of Aortic Dissection

Transesophageal echocardiogram

7

Complications of Aortic Dissection

Stroke
Acute Aortic Regurgitation
Horner's
Acute MI
Pericardial effusion/tamponade
Hemothroax
Abdominal pain

8

Amiodorone toxicity

Pneumonotis
Bradycardia and or arrythmia (QT prolong, Torsades)
Hypo/hyperthyroid
Hepatitis
Optic neuropathy
Blue Grey Skin
Peripheral Neuropathy

9

Digoxin Toxicity

Diarrhea
Nausea
Vomiting
Anorexia
Confusion
visual distrubances
Arrythmias

10

Young patient
Murmur that increases with Valsalva

Crescendo-decrescendo from hypertrophic cardiomyopathy
Abnormality of mitral leaflets and hypertropy of IV septum

11

Management of acute chest pain

ABC-stabalize the patient
Chest Xray, ECG, Oxygen, IV access
Low risk of dissection give aspirin
ECG & CXR negative investigate NSTEMI,PE, dissection, acute pericarditis.

12

Management of bradycardia

Assess if causing impairment
IV atropine .5mg 3-5 mins max 3mg
No response then transcutaneous pacing, epinephrine or dopamine

13

Treatment of beta blocker or CCB toxicity

glucagon-increase adenosine monophsophate

14

Causes of bradycardia

Sick Sinus Syndrome
MI
OSA
Increased ICP
hypothyroid
Medications

15

Side effects furosemide

hypokalemia
hypomagnesia
Both can lead to ventricular tachycardia

16

hypokalemia
digoxin

Ventricular tachycardia: hypokalemia potentiates the effects of digoxin

17

Differential of chest pain

ACS
GERD
Dissection
Musculoskeletal
Pleuritic

18

Younger Female
Smoker
Chest pain at night
ST elevations

Prinzmetal angina (vasospasm)

19

Treatment of Prinzmetal angina

CCB

20

Uses for digoxin

control rate in satrial fibrillation or flutter
increase contractility in
CHF

21

Pounding sensation in the chest
Exertional dyspnea

Aortic regurgitation
The pounding is due to the apex of theheart being brough to the chest wall

22

Causes of Aortic regurgitation

Rheumatic heart disease
Aortic root dilation
congenital bicuspid vavle

23

Abrupt pulse upstroke
Rapid collapse of peripheral pulse

Aortic regurigtation

24

Young female
Headache
High Blood pressure
Renal bruit

renal vascular hyper tension secondary to renal artery stenosis

25

which murmurs need to be investigated with TTE?

diastolic murmurs and loud systolic murmurs

26

reversible causes of complete heart block

myocardial ischemia
drugs-beta blockers,CCB
increased vagal tone
AV nodal blocking agents

27

Adenosine mechanism of action

inhibits L-type calcium channels
decreasing conduction of the AV node

28

BNP

secreted in response to ventricular strecth

29

S3 indicates

tensing of the pappillary cords
elevated ventricular pressures

30

confirmatory test for vasovagal syncope

tilt table test

31

syncope without warning
structural heart disease (MI or MVP)
ectopic beats

arrythmia

32

causes of hepatojugular reflux

constrictive pericarditis
right ventricular infarct
restrictive cardiomyopthy

33

physical exam in constrictive pericarditis

elevated JVP
Kussmaul sign
pericardial knock
pericardial calcifications

34

Mananagement of STEMI

Maintain O2 above 90
Nitrates unless RV, hypotension, aortic stenosis
Antiplatelet therapy
Anticoagulation heparin, enoxaparin, bivalirudin
Beta Blockersunless bradycardia or shock
Prompt PCI
Statin therpy ASAP

35

Medications to hold 48hrs prior to stress testing

beta blockers
calcium channel blockers
digoxin
dipyrimadol in vasodilator stress test

36

pulseless electrical activity defintion

organized rhythm on cardiac monitoring but no palpable pulses or measurable blood pressure

37

causes of pulseless electrical activity.

5Hs and 5 T
hypovolemia
hypoxia
hydrogen ions
hypo/hyperkalemia
hypothermia

tension pneumothorax
tamponade
toxins thrombosis trauma

38

mangement of pulseless electrical activity

Begin CPR
give epinephrine
find reversible causes

39

synchronized cardioversion MOA

synchronizes to the QRS complex

40

pulsus parvus and pulsus tardus

Aortic Stenosis

41

Abdominal bruits
HTN

renal artery stenosis

42

Therapy for hypertrophic cardiomyopathy

Beta blockers

43

Heart findings in MVP

Left atrial dilation and arrhythmia development

44

Causes of restorative cardiomyopathy

Amyloidosis
Sarcoidosis
Hemachromatosis (reversible)
endomyocardial fibrosis

45

Definitive diagnosis of for pulmonale

elevated pulmonary artery pressure

46

Treatment of strep mutans endocarditis

IV penicillin G
IV ceftriaxone

47

Use dependence

increased heart rate on flecainide and propafenone leads to prolonged QRS

48

Indications for carotid endarterectomy

Anyone 70-99% and symptomatic
Men 60-90% asymptomatic

49

therapy for stable angina

Aspirin
nitrates
beta blocker (or CCB)

50

cardiose;lective beta blockers

metoprolol
atenolol
bisoprolol
nebivolol

51

indications for ACEi use

blood pressure control especially in CHF, diabetes and CKD

52

Patholphysiology of aortic stenosis

bicuspid aortic valve in young patients or calcification in old causes murmur in the right intercostal space and leads to LVH -->increased oxygen demand leading to angina

53

Indications for lipid lowering therapy

Clinically atherosclerotic disease (ACS, MI, angina stroke)
LDL>190
Age 40-75 with diabetes

54

Impact of Niacin on lipids

raises HDL and lowers triglycerides

55

pressors side effect

distal necrosis
mesneteric ischemia
AKI

56

main presentations of chagas

toxic megacolon
prolonged myocarditis

57

causes and management of premature atrial beats

anxiety, caffeine, CHF, electrolyte disturbances
no concern, never dangerous

58

lidocaine uses

ventricular arrythmias

59

niacin reaction mechanism

triggers increased prostoglandin and histamine release that causes vasodilation and the flushing sensation

60

persistent ST elevation
MI 5days-3mos prior
Q waves

ventricular aneurysm

61

positional chest discomfort
pleuritic pain
friction rub

pericarditis

62

cause of pericarditis with treatment

Viral-NSAIDS and colhicine
Iatrogenic-NSAIDS and Colchicine
cardiac
Connective tissue disease
uremia-dialysis
malignancy

63

bradycardia
AV block
hypotension
Wheezing

beta blocker overdose

64

initial treatment of someone with bradycardia, hypotension

ABC
fluids
atropine
glucagon if refractory

65

Complication of CABG

atrial fibrillation
treat with cardioversion if hemodynamically unstable

66

delta wave

wolff parkinson white

67

AV nodal blocking agents

adenosine
beta blockers
Calcium channel blockers
digoxin

68

Pathophysiology of Wolf Parkinson White

accessory pathway directly transmits conduction from atria to ventricles

69

Treatment of AF in WPW

IV ibutilide
Procainamide

70

Management of peripheral arterial disease

Aspirin
Statin therapy
Exercise program

71

ECG findings in hyperkalemia

Tall peaked T waves
lengthening of PR and QRS
leading to a sine wave.

72

Types of heart block

first degree-prolonged PR interval
Mobitz 1-increasing PR interval with dropped QRS
Mobitz 2- PR interval constant with dropped QRS

73

Viral causes of myocarditis

Coxsackie B
Parvovirus B19
HSV6
adenovirus
enterovirus

74

types of amylodosis

Primary AL
Secondary AA from RA, IBD, chronic infections

75

findings in hemochromatosis

cardiomyopathy
hepatic
arthropathy
skin pigmentation
diabetes
hypogonadism

76

Findings in amyloidosis

nephrotic syndrome
restrictive cardiomyopathy
hepatomegaly
peripheral/autonomic neuropathy
macroglossia
bleeding
waxy skin

77

SE of HCTZ

hypokalemia
Hypercalcemia
Hypertriglyceridemia
Hyperglycemia

78

ECG findings in pericarditis

ST segment elevations
PR depression

79

Statin MOA

inhibition of HMG CoA reductase
decreased LDL cholesterol
increased LDL surface receptors

80

definition of resistant htn

persisting htn despite three antihypertensives one of which is a diuretic

81

vavleular disease
hemoptysis

mitral stenosis

82

mitral stenosis with stroke MOA

atrial dilation causes chronic afib

83

systemic symtpoms
stroke
diastolic rumble
mass in atria

myxoma

84

indication and treatment for patients with premature ventricular complexes

more than three beats in a row
treat with beta blockers
amiodorone is second line therapy.

85

Fourth heart sound

early myocardial infarct- atrial sound
decreased left ventricular compliance

86

third heart sound

ventricular gallop sound
chf

87

complication of anterior MI

ventricular wall rupture

88

holosystolic murmur post MI

interventricular (VSD) wall rupture

89

hypotension
acute severe mitral regurg

papillary muscle rupture

90

CHADSVASc Score

Asesses risk 1-9 for thromboembolic disease
CHF
HTN
Age >75 (2 pts)
Diabietes
Stroke/TIA (2 pts)
Vascular disease
Age 65-74
Sex category
treat if greather than 2

91

PVD is predictive for....

myocardial infarct 20% 5 year risk

92

Hypotension
Elevated JVP
Acute MI

Right Ventricular Myocardial infarction
Give fluids

93

Best antithrombotic medication

Warfarin (or dabigatran, rivaroxban, apixban)

94

Beck's triad

Hypotension
Distended neck veins
muffled heart sound
Associated with cardiac tamponade

95

MOA pulses paradoxus

Inspiration lowers intrathoracic pressure
venous return to right ventricle increases
RV free wall expands to accommodate
Reduced compliance in cardiac tamponade
impingement on LV

96

Post MI arrythmias

first ten mins- reentrant ventricular fibrillation
10-60mins- abnormal automaticity
Inferior MI- AV block

97

Findings in acute and chronic mitral regurg

Acute-increased LV filling pressure
Chronic-increased left atrial compliance and size

98

Opening snap

Mitral stenosis

99

Treatment of wide complex tachycardia

Hemodynamically unstable-cardioversion
Stable ventricular tachycardia-amiodorone
Stable SVT- carotid massage/maneuver.

100

fusion beats

capture of beat through both atrium and ventricle in ventricular tachycardia

101

Half lives of cardiac enzymes

CKMB normalize in 1-2 days
Troponin up to ten days to return to normal

102

disease associated with atrial fibrillation

HTN
CAD
Valvular heart disease
CHF
Hypertrophic cardiomyopathy
Congenital heart disease
Post cardiac surgery
OSA
PE
COPD
Hypoxia

103

Three most common causes of aortic stenosis

senile calcific stenosis greater than 70
bicuspid valve less than seventy
rheumatic heart disease not americans

104

aortic stenosis murmur versus hypertrophic cardiomyopathy murmur

aortic stenosis- systolic murmur and S4 that radiates to the carotids @ right upper sternal
Hypertrophic cardiomyopathy- systolic murmur and S4 that doesn't radiated best heard at lower left sternal border.

105

MOA of clopidogrel and ticlopidine

ADP inhibitor

106

Side effects of dihydropyridines

Leg swelling
headaches
flushing
dizziness
Peripheral acting drugs are amlodipine and nifedipine
Increase capillary hydrostatic pressure

107

Alcohol withdrawal onset

24-48 hours after cessation

108

Cyanide toxicity

AMS
seizure
lactic acidosis
coma

109

Normal to decreased normal capillary wedge pressure
Increased cardiac output
Elevated mixed O2 saturation

Septic shock

110

Evaluation of AAA

ultrasound for diagnosis and follow up

111

most significant nopharmacologic measure for decreasing blood pressure

Weight loss

112

Improve mortality in CHF

ace inhibitors
beta blockers
spironolactone

113

Indications for urgent dialysis

Acidosis 6.5
Ingestion-toxins, salicylate, Li, valproate
Overload-refractory to diuretics
Uremia-symptomatic

114

Management of a STEMI

Oxygen
aspirin
clopidogrel
nitrates
beta blocker
High dose statin
Anti coagulation

Supplemental
More nitroglycerin
Morphine for extreme pain
Atropine for bradycardia
Furosemide for pulmonary edema

115

Repercussion in STEMI

Percutaneous transluminal coronary angioplasty within 90 mins
Throbolytics

116

Holocystolic murmur worsening with inspiration

Tricuspid regurg

117

Amiodorone side effects

Pulmonary fibrosis
Hyperthyroidism
Hepatotoxicity
Skin Changes
Ocular changes

118

Sideeffemts procainamide

QT prolongation
drug induced SLE
agranulocytosis anusea

119

Side effects of quinidine

diarrhea
tinnitus
QT prolongation
Torsades
hemolytic anemia
thrombocytopenia

120

Improvement with cold water

Paroxysmal supra ventricular tachycardia is treated by slowing the AV nodal conduction killing the reentrant loop

121

Indications for AAA screening

Men 65-75 who have smoked

122

Situational syncope

middle age to older male loses consciousness during urination or when coughing

123

absent P waves

atrial fibrilation

124

Anatomic pathology of atrial fib

pulmonary veins

125

Diffuse ischemia
Blue toes
lived reticularis

Cholesterol embolism post cath