Cardiovascular Flashcards

1
Q

Treatment of primary Raynaud’s syndrome? Secondary?

A

Primary: Trigger avoidance and CCBs if necessary
Scondary: The same, plus aspirin to patients at risk for digital ischemia

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2
Q

Causes of secondary Raynaud’s syndrome (6)

A
  1. Connective tissue disease (lupus, scleroderma)
  2. Occlusive vascular disease
  3. Hyperviscosity syndromes
  4. Sympathomimetic drugs
  5. Birth control pills
  6. Smoking
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3
Q

An ICU patient on pressures has necrosis of distal fingers and toes. Likely cause?

A

Norepinephrine-induced vasospasm (can also caused mesenteric ischemia and AKI)

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4
Q

Clinical signs of cardiac tamponade

A

Beck’s triad: hypotension, elevated JVP, muffled/distant heart sounds
Pulsus paradoxus may also be seen (also seen in constrictive pericarditis, sever asthma/COPD)

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5
Q

Heart sounds in constrictive pericarditis

A

Pericardial friction rub: high-pitched grating/squeaking sound during systole (most common), diastole, or both

Pericardial knock: high-frequency mid-diastolic sound (due to abrupt cessation of diastolic filling)

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6
Q

JVP increases or stays the same with inspiration. Cause?

A

Kussmaul’s sign due to constrictive pericarditis

(Normally JVP decreases during inspiration due to blood being drawn into the chest and heart, but here it cannot take the extra volume)

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7
Q

EKG in acute pericarditis

A

Diffuse ST elevation and PR depression

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8
Q

Treatment for Dressler’s syndrome (post-MI autoimmune pericarditis)

A

High-dose aspirin

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9
Q

Type of pericarditis that does not affect the myocardium

A

Uremic pericarditis (no EKG changes)

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10
Q

Immunologic phenomena in bacterial endocarditis

A
  1. Osler nodes (painful fingertip nodules)
  2. Roth spots (retinal hemorrhage with pale centers)
  3. Glomerulonephritis
  4. Rheumatoid factor

(Janeway lesions, splinter hemorrhages, etc are embolic)

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11
Q

Embolic phenomena in bacterial endocarditis

A
  1. Septic emboli to brain (stroke), fingers (gangrene),etc
  2. Renal or splenic infarcts
  3. Splinter hemorrhages
  4. Janeway lesions (painless)
  5. Conjunctival hemorrahge

(Osler nodes, Roth spots, and glomerulonephritis are immunoloigic)

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12
Q

Subacute endocarditis associated with dental procedure or respiratory tract infection

A
  1. Strep viridans: mostly S. mutans and S. anguis (others are S. mitis and S. oralis)
  2. Less commonly, Eikenella corrodens (one of the HACEK)
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13
Q

Endocarditis associated with IBD and colon cancer

A

Strep gallolyticus (formerly named Strep bovis)

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14
Q

Endocarditis associated with prosthetic valves, implanted devices, and intravascular catheters

A

Staph epi

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15
Q

Endocarditis associated with nosocomial UTIs

A

Enterococcus

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16
Q

Right-sided endocarditis associated with IV drug use

Empiric therapy?

A

Staph aureus most commonly (can also be strep or enterococci)

Empirically treat with vancomycin

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17
Q

Medication for hyperlipidemia that leads to flushing and itching?

What can be given to help?

A

Niacin

Can give aspirin to reduce flushing (flushing is prostaglandin mediated)

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18
Q

Who should be on a statin?

A
  1. All diabetics 40-75
  2. Hyperlipidemia (e.g. LDL >190)
  3. Clinically significant atherosclerotic disease (ACS/MI, angina, stroke/TIA, PAD)
  4. ASCVD risk 7.5% or more
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19
Q

A ventilated patient has decreased CO and low RA pressure - potential cause?

A

Pneumothorax due to barotrauma on PEEP (high pressure leads to elevated intrathoracic pressure, kinda like a tension pneumothorax)

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20
Q

Causes of secondary hypertension (8)

A
Renal:
1. Renal parenchymal disease
2. Renal artery stenosis
Endocrine
3. Primary aldosteronism
4. Pheochromocytoma
5. Cushing syndrome
6. Hypothyroidism and hyperthyroidism
7. Primary hyperthyroidism
Vascular:
8. Aortic coarctation
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21
Q

Treatment-refractory systemic hypertension with recurrent flash pulmonary edema

A

Consider renal artery stenosis

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22
Q

Definition of pulmonary hypertension

A

PA pressure >25 mm Hg

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23
Q

Treatment options for idiopathic pulmonary hypertension

A
  1. Endothelin receptor blockers like bosentan
  2. PDE5 inhibitors like sildenafil
  3. Prostanoids like epoprostenol
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24
Q

Treatment for pulmonary hypertension due to left heart failure

A

Loop diuretics and ACEI/ARB

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25
Q

Most common cause of aortic regurgitation in young adults in developed countries

A

Congenital bicuspid valve

Other causes: endocarditis, rheumatic heart disease, Marfan syndrome, syphilitic aortitis

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26
Q

What is classic angina pectoris?

Atypical angina?

A

Classic angina has all three of:

  1. Typical location, quality, and duration
  2. Provoked by exercise and/or emotional upheaval
  3. Relieved with nitroglycerin or rest

Atypical angina: two out of three

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27
Q

First-line treatment of stable angina?

Alternate or adjunct?

A

First-line: Beta-blockers

Alternate/adjunct: CCBs

(May also use sublingual nitroglycerin for acute episodes, and may add long-acting nitrates)

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28
Q

Which of these do you hold and which do you continue prior to cardiac stress testing?

  1. ACEI/ARB
  2. Beta blockers
  3. CCBs
  4. Digoxin
  5. Diuretics
  6. Nitrates
  7. Statins
A

Hold beta-blockers, CCBs, and nitrates (these all immediately impact cardiac dynamics)

Continue others (ACEI/ARB, digoxin, diuretic, statins)

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29
Q

Treatment for vasospastic angina

A

CCBs (e.g. diltiazem)

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30
Q

Medications to avoid / be cautious with in vasospastic angina

A

Non-selective beta-blockers (e.g. propanolol): loss of beta2 vasodilation can worsen vasospasm

Aspirin: Inhibiting prostacyclin production can worsen vasospasm

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31
Q

Treatment of patients with MI who have decompensated HF but normal/high BP?

If they have hypotension?

A

Normal BP: Supplemental O2 and a loop diuretic

Hypotension: Supplemental O2 and a vasopressor (e.g. NE), +/- loop diuretic

32
Q

What does S4 indicate?

A

Stiff LV wall (can be seen with MI, hypertension)

33
Q

Treatment of unstable sinus bradycardia during an acute MI

A

IV atropine

34
Q

Location and vessel of MI with ST elevation in V1-V4

A

Anterior MI: LAD

35
Q

Location and vessel of MI with ST elevation in I, aVL, V5, and V6, and ST depression in II, III, and aVF

A

Lateral: LCX or diagonal artery

36
Q

Location and vessel of MI with ST depression in V1-V3

A

Posterior: RCA (if right-dominant, 70%) or L circumflex (if left-dominant, 20%)

(Other 10% are co-dominant)

37
Q

Location and vessel of MI with ST elevation in II, III, and aVF

A

Inferior MI: usually RCA (80%), sometimes L circumflex

38
Q

Location and vessel of MI with ST elevation in V1 > V2 and III > II

A

Right ventricle: RCA occlusion

39
Q

What vessel occlusion(s) can lead to SA node block?

A

RCA (60%) or L circumflex (40%)

40
Q

What vessel occlusion(s) can lead to AV node block?

A

RCA (80%), L circumflex 20%

41
Q

Treatment of pericarditis shortly after MI

A

Aspirin and/or colchicine

Avoid other NSAIDs

42
Q

MI complicated by chest pain, shock, a new holocystolic murmur, and left and right heart failure?
Type of MI seen in?

A

Intraventricular septum rupture. May be seen with LAD or RCA MI

43
Q

MI complicated by chest pain, shock, and distant heart sounds?

A

Free wall rupture. May be seen with LAD MI (the “widowmaker”)

44
Q

Late complication of MI leading to HF, arrhtyhmia, mitral regurgitation, or mural thrombus

A

Ventricular aneurysm

45
Q

Persistent ST elevation well after MI

A

Ventricular aneurysm

46
Q

Medications shown to improve morbidity and mortality in CAD patients

A
  • Dual antiplatelet therapy
  • Beta-blockers
  • ACEIs/ARBs
  • Statins
  • Aldosterone antagonists (e.g. spironolactone) w/ EF <40% and symptomatic HF or DM)
47
Q

Another cause of restrictive cardiomyopathy other than hypertension

A

Amyloid cardiomyopathy

(May also have nephrotic syndrome, hepatosplenomegaly, macroglossia, waxy skin, easy bleeding/bruising, thick LV wall but low voltage EKG)

48
Q

Initial medication for hypertrophic medication

A

Beta blockers

49
Q

Delta wave on EKG

A

WPW syndrome (accessory pathway between atria and ventricles, risk of re-entrant SVT)

50
Q

Treatment of atrial fibrillation in WPW

A

Unstable: cardioversion

Stable: Procainamide (Ia antiarrhythmic that blocks Na+ and K+ channels) (or ibutilide, class III K+ blocker)

(Do not give drugs blocking the AV node as this promotes accessory pathway and increases arrhythmia risk)

51
Q

Treatment of torsades de pointes

A

Unstable: defibrillation
Stable: IV magnesium

52
Q

Initial treatment for pulseless electrical activity

A

ACLS and epinephrine (and look for causes, e.g. with ABG)

53
Q

Reversible causes of pulseless electrical activity

A

5 H’s and T’s:
H’s: Hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyperkalemia, hypothermia
T’s: tension pneumothorax, tamponade, toxins (narcs, benzos), thrombosis (pulmonary or coronary), truma

54
Q

Pharmacologic treatment for stable sustained ventricular tachycardia?

Electrical treatment for ventricular tachycardia?

A

Pharmacological: IV amiodarone

Electrical:
Pulseless: Defibrillation
With pulse: Synchronized cardioversion

55
Q

What are capture and fusion beats?

A

Both are signs of ventricular tachycardia

Capture: SA node “captures” rhythm for a beat
Fusion: SA node and ventricular activity simultaneously trigger a beat with a hybrid pattern on EKG

56
Q

Two causes of wide-complex tachycardia

A

Ventricular tachycardia and supraventricular tachycardia with abberency (e.g. WPW, bundle branch block)

57
Q

Most common form of PSVT

A

AV node reentrant tachycardia (may see retrograde P waves, hypotension, regular HR around 180-200)

58
Q

Initial treatment for symptomatic sinus bracycardia

A

IV atropine

59
Q

Effect of TCA overdose on the heart

Treatment?

A

Sodium channel block leads to wide QRS and arrhythmias

Treat with sodium bicarbonate (if long QRS of ventricular arrhythmia)

60
Q

Score to assess thromboembolic risk in atrial fibrillation

A

CHA2DS2-VASc

CHF, HTN, Age>75 (2 pts), DM, Stroke/TIA (2 pts), Vascular disease, Age 65-74), Sex (female)

61
Q

Agent for rhythm control in paroxysmal atrial fibrillation in a structurally normal heart?

A

Class 1C antiarrhythmics like fleicainide or propafenone

(Preferentially block INa at fast heart rates)

(Other agents for rhythm control: amiodarone, sotalol, ibutilide)

62
Q

Blood test to run in all new-onset atrial fibrillation?

A

TSH + free T4 (Hyperthyroidism can lead to a-fib)

63
Q

Drug causing arrhythmia and vision changes

Classic arrhythmia associated with it?

A

Digoxin

Classic arrhythmia is atrial tachycardia with AV block (due to ectopic beats and increased vagal tone)

64
Q

Patient who overdoses on a beta-blocker or CCB remains hypotensive after airway, fluids, and IV atropine. Next step?

A

IV glucagon (stimulates Gs receptors)

65
Q

Beta1 agonist drug

A

Dobutamine

66
Q

Beta blocker and CCB overdose both lead to bradycardia and shock. How do they differ on exam?

A

Beta-blocker OD causes wheezing, CCBs do not.

67
Q

Classic side effect of hydralazine

A

Drug-induced lupus

68
Q

Potential side effect of nitroprusside

A

Cyanide toxicity (especially in CKD): HA, AMS, seizures, flushing, respiratory depression, arrhythmia

69
Q

How do NSAIDs and acetaminophen affect warfarin levels?

A

Increased warfarin levels and bleeding risk (both inhibit the CYP450s that metabolize warfarin)

70
Q

Classic extra-cardiac manifestation of amiodarone

A

Interstitial pneumonitis (restrictive lung disease)

Others: other lung effects, thyroid disease, hepatitis, eye damage (corneal microdeposits, optic neuropathy)

71
Q

Antihypertensives that can lead to peripheral edema

A

Dihydropiridine CCBs (e.g. amlodipine, nifedipine)

72
Q

Indications for carotid endarterectomy

A
  1. Symptomatic >70% stenosis in men and women

2. Asymptomatic >60% stenosis in men only

73
Q

First step in a patient with acute arterial occlusion leading to rest leg pain?

A

IV heparin (prior to any workup)

74
Q

Diagnostic test for aortic dissection

A

CTA (TEE if CTA is CI, like in CKD or contrast allergy)

75
Q

Most common cause of aortic dissection overall? In patients under 40?

A

Overall: HTN

Under 40: Marfan’s

76
Q

Common association with asscending thoracic aortic aneurysm

A

Connective tissue disease (Marfan, Ehlers-Danlos)

77
Q

Hereditary telangiectasia (a.k.a. Osler-Weber-Rendu)

A

AD disease with lip telangiectasias and AVMs of skin, mucus membranes, GI tract, and lungs that lead to nose and GI bleeds as well as pulmonary shunting and hypoxemia