Cardiovascular Flashcards
(244 cards)
1
Q
62 yo male presents with CP; Labs show NML troponin; EKG shows ST segment depression – diagnosis?
A
Unstable angina
2
Q
62 yo male presents with CP; Labs show elevated troponin; EKG shows ST segment depression – diagnosis?
A
NSTEMI
3
Q
When does Troponin T begin to rise in ACS?
A
4-6 hours
4
Q
How long does Troponin T stay elevated in ACS?
A
10 days
5
Q
When does Troponin I begin to rise in ACS?
A
4-6 hours
6
Q
How long does Troponin I stay elevated in ACS?
A
10 days
7
Q
When does CK-MB begin to rise in ACS?
A
4-6 hours
8
Q
How long does CK-MB stay elevated in ACS?
A
48-72 hours
9
Q
Patient recently had MI about 3-4 days ago; Begins to experience CP again – what is best test to evaluate for repeat MI?
A
CK-MB
10
Q
Metabolic disturbance associated with PE?
A
Respiratory alkalosis
11
Q
Best management of NSTEMI and Unstable Angina?
A
Anti-ischemic medications; Anti-platelet medication; Anti-coagulant medication
12
Q
Best management of STEMI?
A
Anti-ischemic medications; Anti-platelet medication; Anti-coagulant medication + Reperfusion therapy
13
Q
4 anti-ischemic medications?
A
Morphine, O2, NTG, b-blockers
14
Q
Which anti-ischemic medication has been shown to improve survival in patients with MI?
A
b-blockers
15
Q
4 anti-platelet + anti-coagulant medications?
A
ASA, Clopidogrel, LMW Heparin, GPIIb/IIIa
16
Q
Event that will increase morality in patients with Unstable Angina + NSTEMI?
A
Thrombolytic therapy
17
Q
Which reperfusion drug is contraindicated in patients who are also treated with heparin?
A
Streptokinase
18
Q
4 absolute contraindications to fibrinolytic therapy in ACS?
A
Hemorrhagic CVA, Active bleeding, Suspected aortic dissection (order CXR), Intracranial tumor
19
Q
When does post-MI VSD typically occur?
A
3-7 days after MI
20
Q
When does post-MI papillary muscle rupture typically occur?
A
3-7 days after MI
21
Q
Test used to distinguish between post-MI VSD and papillary muscle rupture?
A
ECHO
22
Q
Next step of workup for patient who experiences massive MI, when develops pulseless legs?
A
Angiogram + Embolectomy
23
Q
Most common cause of death in acute MI?
A
Ventricular fibrillation
24
Q
Risk of giving lidocaine to patient with ventricular fibrillation in acute MI?
A
Asystole
25
3 DOC for treatment of CP in patient with HX of cocaine use?
Benzodiazepines, NTG, ASA
26
Which medication should be avoided in treatment of CP in patient with HX of cocaine use?
b blockers
27
2 aspects of clinical presentation for RV infarction?
Hypotension, JVD
28
Best treatment for RV infarction?
IV fluids
29
Which treatment is contraindicated in RV infarction?
NTG
30
Why is NTG contraindicated in patients with RV infarction?
Further decreases preload
31
Alternate name for RV infarction?
Inferior wall MI
32
3 arrhythmias that are common in patients with inferior wall MI?
Sinus bradycardia, Prolonged PR, 3rd degree AV block
33
When may patients resume sexual activity after acute MI?
6 weeks after MI
34
Patient presents with bradycardia; EKG shows no p waves – diagnosis?
SA node problem
35
Patient presents with bradycardia; EKG shows p waves – diagnosis?
AV node problem
36
Appearance of EKG in Sick Sinus Syndrome?
Loss of P wave
37
Clinical presentation for Sick Sinus Syndrome?
Syncope
38
Best treatment for Sick Sinus Syndrome?
Pacemaker
39
How can you differentiate between cardiac and vagal etiologies of syncope?
Cardiac = sudden, NO prodrome; Vagal = prodrome (fainting)
40
Description of 1st degree AV block?
Prolonged PR interval … PR > 0.20
41
Treatment for 1st degree AV block?
Observation
42
Description of 2nd degree AV block – Type 1?
Progressively prolonged PR interval
43
Treatment for 2nd degree AV block – Type 1?
Observation … discontinue digoxin
44
Condition associated with 2nd degree AV block – Type 1?
Inferior MI … affects AV node
45
Description of 2nd degree AV block – Type 2?
Unequal ratio of P waves : QRS complexes
46
Treatment for 2nd degree AV block – Type 2?
Pacemaker
47
Location of defect in 2nd degree AV block – Type 1?
His-Purkinje system
48
Description of 3rd degree AV block?
Complete dissociation between P waves, QRS complexes
49
Best treatment for 3rd degree AV block?
Pacemaker
50
Location of defect in 3rd degree AV block?
His-Purkinje system
51
DOC for SVT?
Adenosine, 6 mg IV … if no response to vagal maneuvers
52
Appearance of EKG in SVT?
Tachycardia, Narrow QRS complex
53
Definitive treatment of SVT?
Catheter ablation of AV node
54
18 yo female presents for sports physical; Reports occasional palpitation – what should you look for on EKG?
Delta wave
55
In addition to delta wave, what is another EKG finding associated with WPW?
Short PR interval
56
Complication of WPW?
V-Fib
57
Location of accessory pathway in WPW?
Connects atria directly with ventricles via conduction across AV groove
58
DOC for acute management of reentrant tachycardia in WPW?
Adenosine
59
DOC for acute management of atrial fibrillation with rapid ventricular response?
Procainamide, Amiodarone
60
Treatment of choice for WPW patient who is hemodynamically unstable?
Emergent cardioversion
61
Definitive treatment for WPW?
Catheter ablation
62
1st step of treatment for A-Fib?
Anticoagulation
63
2nd step of treatment for A-Fib?
Rate control
64
2 DOC for rate control in patient with A-Fib?
b blockers, CCBs
65
DOC for patient with A-Fib, HX of COPD?
CCBs … avoid b blockers
66
Best treatment for patients with A-Fib lasting more than 48 hours?
Anticoagulation for 2-3 weeks, before attempting cardioversion
67
DOC for atrial flutter?
Same as A-Fib … b blockers, CCBs
68
Additional step of workup for patient with Atrial Flutter?
Radiofrequency ablation
69
In patient with chronic hypoxemia and decompensated COPD – what changes should you expect on EKG?
Multifocal atrial tachycardia … P waves all look different
70
Which drug is typically associated with Multifocal atrial tachycardia?
Theophylline
71
Best treatment for patient with Multifocal atrial tachycardia?
Supplemental O2
72
38 yo male presents for wellness exam; EKG shows PVCs; He is asymptomatic – next step?
Reassurance
73
Torsades de pointes is a type of …
Ventricular fibrillation
74
2 electrolyte imbalances that might lead to Toursade de pointes?
Hypo-Mg2+, Hypo-K+
75
6 medications that may lead to QT prolongation?
Fluoroquinolones, Lithium, Azoles, Macrolides, TCA, Methadone
76
Best treatment for Toursade de pointes?
Mg2+ infusion; Defibrillation
77
Description of Ebstein’s anomaly seen in setting of Lithium use during pregnancy?
Atrialization of RV
78
Change in position of Tricuspid valve in setting of Ebstein’s anomaly?
Displaced towards RV
79
3 additional AE of lithium?
Nephrogenic DM, Torsades de pointes, Hypercalcemia
80
3 AEs of quinidine?
Prolonged QT, Tinnitus, Hemolytic anemia
81
2 AEs of procainamide?
SLE, Prolonged QT
82
1 AE of lidocaine?
Seizures
83
2 AEs of b blockers?
Asthma, Decreased libido
84
5 AEs of Amiodarone?
Hyper/hypothyroidism, Corneal deposits, Pulmonary fibrosis, Gray skin, Photosensitivity
85
5 risk factors for development of coronary atherosclerosis?
LDL > 100, BP > 140/90, HBA1c > 7, Low HDL, Homocystinuria
86
Etiology of Prinzmetal angina?
Vasospasm of coronary vessels
87
Best treatment for Prinzmetal angina?
CCBs
88
EKG change associated with stable angina?
ST depression
89
56 yo male presents with intermittent CP, related to exercise; HX of smoking; Which condition is not considered to be a contraindication to workup with exercise stress test?
RBBB
90
6 conditions that contraindicate exercise stress test?
WPW, Pacemaker, LVH, LBBB, Digoxin use, T-wave abnormalities
91
Alternative workup in patients who cannot undergo exercise stress test?
ECHO
92
3 conditions that might cause resting ST elevation?
Acute MI, Pericarditis, LV aneurysm
93
5 medications that decrease risk of MI in patients with CAD?
ASA, ACEIs, b blockers, Statins, Gemfibrozil
94
Value of giving b blockers to patients with CAD?
No mortality benefit for patients with chronic CAD; Beneficial for patients with HTN + stable angina
95
68 yo male presents with stable CAD, EF = 40%, class 3 angina despite pharmacologic therapy – best therapy to improve survival and decrease need for later revascularization?
CABG
96
Indication for PCI in patients with CAD?
Patients with 1- or 2-vessel CAD, NML LV function
97
3 indications for CABG in patients with CAD?
Patients with 3-vessel CAD, decreased LV function, LAD disease
98
Etiology of acute Mitral Regurgitation murmur?
Rupture of papillary muscles post-MI
99
Clinical presentation of acute Mitral Regurgitation murmur?
Immediate-onset pulmonary edema in post-MI stage
100
What are the 3 types of holosystolic murmurs?
MR, TR, VSD
101
Which medication may be cause of chronic MR murmur?
Phen-Fen … used for OB
102
Most common etiology of Mitral Stenosis murmur?
Chronic rheumatic fever
103
Change to heart structure in setting of MS murmur?
LA dilation
104
Clinical presentation of Mitral Stenosis in pregnant females?
Hemoptysis … overload on L heart
105
CXR appearance of Mitral Stenosis murmur?
Straightening of L heart border
106
Best treatment of Mitral Stenosis in pregnant females?
Balloon valvotomy
107
Most common primary heart tumor?
Atrial myxoma
108
Most common location of atrial myxoma tumor?
LA
109
Heart sound associated with atrial myxoma?
Loud S1
110
Best tool for diagnosis of atrial myxoma?
ECHO
111
Best treatment for atrial myxoma?
Surgical excision
112
3 most common etiologies of AR murmur?
Bicuspid aorta, Syphilis, Marfan
113
Description of Quincke’s Sign in setting of AR?
Throbbing nailbed pulses
114
Description of Hill’s Sign in setting of AR?
Difference between popliteal-brachial pulses > 20
115
3 steps of treatment for asymptomatic patients with AR?
ACEI, Diuretics, Vasodilators (hydralazine)
116
Best treatment for symptomatic AR?
Surgery
117
Change to pulses measured in aortic dissection?
Good UE pulses; Diminished LE pulses
118
Change to pulses measured in aortic coarctation?
High BP in RUE; Low BP in LUE; Diminished pulses in LE
119
Description of pulsus paradoxus?
Systolic BP drop > 10 mmHg during inspiration
120
Pulsus paradoxus is associated with which condition?
Pericardial tamponade
121
Description of Pulsus biferiens?
Pulse with 2 systolic peaks
122
Pulsus biferiens is associated with which condition?
Aortic regurgitation
123
Pulsus tardus is associated with which condition?
Aortic stenosis
124
Pulsus alternans is associated with which condition?
PVCs, Severe LV disease
125
In which 2 conditions does standing/Valsalva increase intensity of murmur?
MVP, HCM
126
How can you distinguish between MVP and HCM murmurs?
MVP intensifies with hand squeeze; HCM softens with hand squeeze
127
Murmur associated with MVP?
Isolated mid-systolic click
128
Should patients with MVP receive endocarditis prophylaxis?
No
129
In which 5 conditions is prophylaxis recommended for endocarditis?
Prosthetic valves, Previous bacterial endocarditis, Unrepaired cyanotic heart disease, Repaired congenital heart defect (first 6 months), Cardiac transplant patients who develop valvulo-pathology
130
2 types of procedures that require endocarditis prophylaxis?
Respiratory, Dental
131
2 heart sounds associated with NML pregnancy?
S3, Increased P2 … due to increased blood volume
132
During pregnancy, any ___ murmur is considered pathologic
Diastolic
133
2 conditions that decrease intensity of S1?
Aortic regurgitation; Mitral stenosis
134
What is the physiologic splitting of S2?
A2, then P2
135
Physiologic splitting of S2 is increased with ___
Inspiration
136
Physiologic splitting of S2 is decreased with ___
Expiration
137
Condition associated with fixed splitting of S2?
ASD
138
Which PE finding has the greatest SPECIFICITY to rule out aortic stenosis?
Physiologic splitting of S2 … If there is NO splitting of S2, think aortic stenosis
139
Appearance of ASD on CXR?
Pulmonary congestion
140
3 conditions associated with paradoxical splitting of S2 (P2, then A2)?
Left BBB, Advanced HCM, Pacemaker beats from RV
141
Etiology of S3 heart sound?
Tensing of chordae tendinae
142
S3 heart sound is considered normal in which group of patients?
Pediatric
143
Condition associated with S3 heart sound?
LV systolic dysfunction
144
Etiology of S4 heart sound?
Atrial contraction against non-compliant LV
145
3 conditions associated with S4 heart sound?
Aortic stenosis, Cardiac ischemia, HCM
146
2 most common infectious causes of dilated cardiomyopathy?
Coxsackievirus, Chagas disease
147
Most common hereditary disorder responsible for dilated cardiomyopathy?
Hereditary hemochromatosis
148
CTX drug associated with dilated cardiomyopathy?
Doxorubicin
149
When can peripartum cardiomyopathy occur?
3rd trimester … Up to 6 months postpartum
150
3 DOC for dilated cardiomyopathy?
ACEIs, b blockers, Diuretics
151
Patient diagnosed with dilated cardiomyopathy; PE shows no JVD, no leg edema; Labs show BP = 138/79; Currently on terazosin 4 mg for BPH – which drug should be added to regimen?
ACEI
152
What causes HCM murmur to intensify?
Valsalva
153
What causes HCM murmur to soften?
Hand grip, Squat
154
Best diagnostic tool for HCM?
ECHO
155
DOC for treatment of HCM?
b blockers
156
2 medications that should be avoided in HCM?
Diuretics, Nitrates … want to give heart a chance to fill
157
Inheritance pattern for HCM?
AD
158
Which group of patients should be screened for HCM?
All 1st-degree relatives (AD)
159
Treatment for HCM that reduces the risk of sudden cardiac death/
Cardioverter-defibrillator
160
3 contraindications to sports participation?
HCM, Infectious mononucleosis (with splenomegaly), Congenital QT prolongation
161
Patient presents with cardiac symptoms; PE shows enlarged + tender liver, neuropathy, petechiae – diagnosis?
Amyloidosis
162
Change to EKG in setting of Amyloidosis?
Reduced voltage … thick walls on ECHO
163
Change to ECHO that is characteristic for Amyloidosis?
Speckled pattern on ECHO
164
Drug that should be avoided in Amyloidosis?
Digoxin … increased risk of arrhythmias
165
Treatment in hemochromatosis that can improve cardiac function and prolong life expectancy?
Phlebotomy
166
3 indications for use of digoxin in CHF?
Severely-low EF, S3 gallop, enlarged heart
167
Contraindication to use of digoxin in CHF?
AV block
168
5 indications for implantable cardioverter-defibrillator in CHF?
EF < 30%, Syncope, Ventricular tachycardia/fibrillation, Cardiac arrest, HCM
169
Indication for cardiac transplant in patients with CHF?
End-stage CHF
170
3 examples of L-to-R shunts?
ASD, VSD, PDA
171
3 examples of R-to-L shunts?
Tetralogy of Fallot, Transposition of Great Vessels
172
L-to-R shunts are associated with ___ heart conditions
Non-Cyanotic
173
R-to-L shunts are associated with ___ heart conditions
Cyanotic
174
In setting of L-to-R shunts, movement of unoxygenated blood to systemic circulation is called …
Eisenmenger Syndrome
175
Alternate name for Eisenmenger Syndrome?
Irreversible pulmonary vascular sclerosis
176
Most common ASD etiology?
Ostium secundum
177
Location of sinus venosus ASD?
Near entrance of SVC
178
What is the most common congenital cardiac malformation at birth?
VSD
179
What is the most common congenital cardiac malformation to be first diagnosed in adults?
ASD
180
What is the most common cardiac abnormality seen in Down Syndrome?
ASD
181
What is the most common etiology of paradoxical embolism?
PFO
182
3 systemic manifestations of paradoxical embolism?
CVA, Kidney infarction, Acute limb ischemia infarct … embolisms SHOULD be going to the lungs
183
3 conditions associated with VSD?
Trisomy 13, Trisomy 18, Cri du Chat
184
Murmur associated with VSD?
Holosystolic murmur heard best over L sternal border
185
Congenital PDA is associated with which pathogen?
Rubella
186
Description of murmur heard in PDA?
Machinery murmur
187
Pattern of cyanosis seen in PDA?
LE cyanosis
188
Remnant of PDA that is present after birth?
Ligamentum arteriosus
189
What is the most common cyanotic congenital heart disease?
Tetralogy of Fallot
190
4 components of Tetralogy of Fallot?
RV outflow obstruction; VSD; RV hypertrophy; Overriding aorta
191
Condition associated with Tetralogy of Fallot?
DiGeorge Syndrome
192
DiGeorge Syndrome is associated with abnormal development of …
Pharyngeal arches 3 and 4
193
When does cyanosis typically develop in baby with Tetralogy of Fallot?
Few weeks after delivery
194
Which cardiac defect is always present in viable baby with Transposition of Great Vessels?
PDA
195
Best treatment for Transposition of Great Vessels?
Prostaglandin E1 … keeps PDA patent
196
When does cyanosis typically develop in baby with Transposition of Great Vessels?
Immediately after delivery
197
Appearance of Transposition of Great Vessels on CXR?
“Egg on String” heart
198
Maternal exposure that increases risk of baby developing Transposition of Great Vessels?
Maternal use of anti-epileptic drugs
199
Clinical presentation of Aortic Coarctation?
HTN in UE; Reduced BP in LE
200
In setting of Aortic Coarctation, which vessels maintain circulation in UE?
Intercostal arteries
201
CXR manifestation of collateral flow through intercostal arteries in Aortic Coarctation?
Rib notching
202
Appearance of Aortic Coarctation on CXR?
Figure 3 sign
203
Description of Figure 3 sign seen in Aortic Coarctation on CXR?
Dilation of aorta above/below coarctation
204
More than 50% of patients with Aortic Coarctation also have which cardiac abnormality?
Bicuspid aorta
205
Which genetic condition is associated with Aortic Coarctation?
Turner’s Syndrome
206
Patients with Aortic Coarctation have greater risk of developing …
Berry aneurysm … Higher pressure above heart
207
Condition associated with Pulmonary Stenosis?
Noonan Syndrome
208
1 clinical manifestation of Noonan Syndrome?
Neck webbing
209
What type of coagulopathy is associated with Noonan Syndrome?
Hemophilia C
210
Hemophilia C results from deficiency in …
Factor XI
211
Clinical manifestation of Pulmonary Stenosis?
Prominent JVD
212
On JVD mapping, which portion of curve is prominent in setting of Pulmonary Stenosis?
a wave
213
Appearance of EKG in setting of Pulmonary Stenosis?
RA enlargement
214
Treatment of choice for Pulmonary Stenosis?
Balloon valvuloplasty
215
Description of cardiac changes seen in setting of Ebstein anomaly?
Atrialization of RV
216
Exposure associated with Ebstein anomaly?
Lithium
217
2 cardiac abnormalities associated with Marfan Syndrome?
Aortic dissection, AR
218
What causes aortic dissection in setting of Marfan Syndrome?
Cystic medial necrosis
219
1 cardiac abnormality associated with Ehler-Danlos Syndrome?
Aortic dissection
220
1 cardiac abnormality associated with Ehler-Cystic Fibrosis?
Aortic stenosis
221
1 cardiac abnormality associated with maternal rubella?
PDA
222
Electrolyte abnormality that might cause QT prolongation?
Hypocalcemia
223
DOC for atrial flutter?
Diltiazem
224
BP that should be diagnosed as HTN?
Sustained BP > 140/90
225
Best treatment for Conn Syndrome?
Spironolactone
226
Thyroid condition that causes HTN?
Hypothyroidism
227
Parathyroid condition that causes HTN?
Hyperparathyroidism … increased Ca2+ causes vessel constriction
228
Most common case of HTN in young females?
OCP use
229
EKG findings associated with acute pericarditis?
Diffuse ST elevations
230
Most common cause of acute pericarditis?
Viral infection
231
Which treatment for Dressler Syndrome should be avoided?
Corticosteroids
232
Best treatment for acute pericarditis?
NSAIDs, Corticosteroids
233
Best treatment for recurrent pericarditis?
Colchicine
234
Characteristic of pericardial effusion that can cause symptoms?
Rapid accumulation
235
Triad of symptoms seen in pericardial tamponade?
Pulsus paradoxus, Hypotension, JVD (jugular venous distension)
236
Change to EKG in setting of pericardial tamponade?
Decreased voltage
237
When should you collect samples of pericardial aspirate in setting of pericardial effusion?
Suspected TB
238
Appearance of pericardial tamponade on PA cath?
Equalization of pressure in RA, RV, Pulmonary artery
239
Change to JVD curve in pericardial tamponade?
Attenuated Y descent
240
Heart sound associated with constrictive pericarditis?
Pre-systolic knock
241
In setting of constrictive pericarditis, when does pericardial knock occur?
Just after S2
242
Change to JVD curve in constrictive pericarditis?
Sharp Y descent
243
Change to JVD appearance on PE in setting of constrictive pericarditis?
Kussmaul sign … Increased JVD during inspiration
244
Best treatment for constrictive pericarditis?
Pericardiectomy
