Cardiovascular Exam 3 Cards Flashcards

Question

Calcium channels blockers for arrhythmias

Answer 1

Class IV Verapamil and Diltiazem Decrease automaticity and AV conduction Neg ionotropic effects - Not for LV dysfunction

Answer 2

Other drug Blocks AV node for high atrial rates - slows conduction and prolongs refractory period EKG - Long PR with ST depression Dose in mcg/mL!!! Causes a yellow tint Toxicity can cause ANY arrhythmia w/o preference

Answer 3

36 hour half life - daily MICROGRAMS

Answer 4

Used for cardiac stress test Inhibits AV and SA nodes Used for SVT Very short half life - causes "death" Allows the SA note to pick back up 6,6,12

Answer 5

Other Parasympatholytic drug for symptomatic bradycardia Blocks acetylcholine Tachy and poor outcomes in MI [atients Slows HR in Mobitz II or third degree heart block ACLS drug!!

Answer 6

At a vessel bifurcation

Answer 7

Smoking - Strongest HLD HTN Alcohol Fam Hx Prior MI Renal insufficiency DM - Strongest

Answer 8

70+ y/o 50-69 w/ hx of smoking 40-49 w/ DM and 1+ risk factor for atherosclerosis Known athersclerosis at other sites

Answer 9

Popliteal/Femoral - MC - frequent in black patients Aorta in white, male smokers 50-60 Tibial in diabetics

Answer 10

20-50% w/ no symptoms Atypical leg pain - no sense Classic claudication 10-35% = More work =more pain Critical limb ischemia Limb ulcer - pressure points Hanging limb off the bed improves symptoms

Answer 11

Hurts with exercise Should be reproducible Goes away 10 minutes after exercise

Answer 12

Test pulses

Answer 13

Numbness, tingling, burning Takes longer to go away than actual claudication

Answer 14

Gangrenous, black extremities - lower Wet or dry gangrene

Answer 15

MC used classification system for PAD

Answer 16

Listen to heart Peripheral pulses Listen for bruits BP in BOTH arms Aorta size

Answer 17

3+ Bounding 2+ Brisk-normal 1+ Diminished 0 Absent pulses

Answer 18

Cold, tight, blue or white, Loss of hair distally, Thick dead nails, Calf atrophy is SEVERE

Answer 19

Lift foot up and it turns white, hang it down in turns red (dependant rubor)

Answer 20

Thick black eschar - may NOT be on a pressure point

Answer 21

Sign of PAD - Convex foot dorsum

Answer 22

Ankle brachial index - take BP of lower extremities Workup further if results are inconclusive - False negative

Answer 23

1.5+ - Non-compressible vessel - further testing 1.4-1 - Normal .99-.91 - Borderline .90-.70 - PAD Mild (diagnostic) .69-.40 - MOderate Less than .40 - Severe PAD Can be insensitive when there is collateral circulation

Answer 24

Get elimination pressure with US and BP cuff Highest lower extremity reading over Highest brachial reading

Answer 25

2nd to ABI .7 or lower is diagnostic Needs a toe BP

Answer 26

Defines how much their disease effects them Can use with non-diagnostic ABI if they can tolerate it

Answer 27

Uses multiple BP cuffs to determine level of blockage Drop of 30+mmHg between limbs if a red flag

Answer 28

NOT A SCREENING TEST Used to determine severity of disease and for surgery prep Increased pressure across the blockage!!

Answer 29

Surgical planning Carful in die sensitive - CKD, DM Used for surgical planning NOT first line or screening!!

Answer 30

Digital subtraction angiography Catheter based performed by interventional radiology to guide therapy

Answer 31

Lifestyle - DM, HTN, HLD, Smoking Rehab with progressive exercise

Answer 32

Statin, Antiplatelet therapy - ASA or clopidegrel alone if asymptomatic with ABI under .90; dual once a stent is placed etc., SGLT-2 inhibitor, ACEI for HTN

Answer 33

Vasodilator for PAD Not first line CI in HF HA, Dizziness, Take w/o food

Answer 34

3-5 sessions per week 35-50 minutes per session Walking to near maximal claudication 6 months of rehab

Answer 35

Indicated if not resolution with other treatments or severe w/ critical limb ischemia

Answer 36

No time to for collateral flow Cool to touch, painful limb w/o pulses and abnormal neuro function - loss of light touch(TIME IS TISSUE) Severe ABI Pain at rest, Pulselessness, Palor, Paresthesia, Paralysis, Polar/Poikilothermia (Patchiness)

Answer 37

3 hours from presentation

Answer 38

A fib Figure out what caused it after the fact

Answer 39

Often clinical Doppler to confirm if wanted No CTA or MRA

Answer 40

EKG - Afib CBC, PT/INR for pre-op Echo - LATER

Answer 41

Revascularization Start heparin until we can get them to surgery - bolus and then continuous Endovascular or open surgical approach Determine source if stable

Answer 42

Greater w/ embolus

Answer 43

Usually asymptomic but palpable 5.5 cm is threshold for intervention Back pain preceding rupture

Answer 44

Dilation of 3+ cm Rare to rupture under 5cm Usually below renal arteries

Answer 45

Sacular is more of an outpouching, fusiform is more symmetrical

Answer 46

Ultrasound is study of choice - CT scan is more reliable but NOT 1st line - used for surgical planning

Answer 47

CTA with contrast once it reaches 5cm Watch serially to see dilation 3-3.4 every 2 years 3.5-4.4 - Every 12 months 4.5-5.4 - Every 6 months

Answer 48

Male smokers 65-75 have ever smoked or those with considerable risk factors Medicare will only pay for one screening

Answer 49

Elective with over 5.5 Rupture - Emergent Inflammation

Answer 50

Open - Higher mortality and comnlications, can cause an MI Endovascular - Less mortality, more likelihood of problems caused by surgery

Answer 51

Tank in BP w/ rupture Risk in Ehlers-Danlos and Marfan Bicuspid aortic valve

Answer 52

Asymptomatic sometimes Hoarseness, Back pain - restrosternal, dysphagia, dyspnea, aortic regurg

Answer 53

May pick of up CXR CT is better for diagnosis MRA can also be useful if uncertain

Answer 54

Location, Rate of growth, 5.5+ cm Endovascular only possible with descending aorta

Answer 55

No current guidelines Control BP for management

Answer 56

Pooling of blood between intima and other aortic layers - high risk of rupture

Answer 57

Sudden searing chest pain radiating to the back with hypotension Wide mediastinum on CXR Pulse discrepancy in extremities - upper vs. lower Acute aortic regurg may develop - diastolic murmur

Answer 58

Type A - Before subclavian artery Type B - After I - Just before II - Both III - Just after

Answer 59

MC in men over 50 Aging HTN Pregnancy Aortic coarctation

Answer 60

LVH on EKG Widened mediastum on CXR CT is essential for surgery w/ contrast is diagnostic of choice TEE can be used but may take too long

Answer 61

Get SBP 100-120 - Labetolol or Esmolol 2nd line - CCB - Nifedipine or Nitroprusside

Answer 62

Morphine is 1st line

Answer 63

Bergers disease Male smokers Smoking cessation is essential

Answer 64

Male under 40 Less pain/claudication with ulceration, rest pain Superficial thrombophlebitis Warm to touch May be in feet and hands

Answer 65

Corkscrew vessels on a CTA/MRA - Diagnostic

Answer 66

Tobacco Cessation is a must Hard to revascularize - Amputation NSAIDs or Opiods for pain control

Answer 67

Usually metastatic - do head and chest CT/MRI

Answer 68

Endocardial - stroke with no risk factors Valvular - CHF symptoms, Sudden death or syncope Pericardial - Arrhythmias, tamponade, cardiac effusion Myocardial - EKG changes, dysfunction, coronary involvement

Answer 69

Echo Best is cardiac MRI or gated CT scan

Answer 70

Best to do resection May do chemo radiation to reduce Cardiac transplant if candidate

Answer 71

Cardiac myxoma - MC Papillary fibroelastoma - increasingly detected Rhabdomyoma - MC in kids

Answer 72

Mushroom inside the heart 50% of tumors Mean age = 50 can be genetic Friable leading to embolus MC in left atria

Answer 73

Tumor plop - early diastolic extra heart sound Stroke w/o risk factors

Answer 74

Made via echo - continue to follow Pathology of embolus TX - Remove

Answer 75

Sea anenome of the heart May cause thrombi Older is more common but can happen from 3-86 MC in left sided valves, aortic MC

Answer 76

Echo Stroke with no risk factors

Answer 77

Easy to resect - may only need removed if they are causing problems Echo or MRI to diagnose

Answer 78

Get larger MC in pediatric population MC in left ventricle Difficult to resect Death due to mass effect

Answer 79

R for remain = Don't usually need to resect Young infant - can be seen prenatally Usually resolve

Answer 80

-Sarcoma!!

Answer 81

Sarcomas most common 20-49 year old patients Tumors are very aggressive - poor prognosis

Answer 82

Less common, more aggressive, usually found post mortem

Answer 83

Dual identity tumors - not due to asbestos if cardiac MC pericardial tumor Pericardial effusion, retrosternal pain/pericarditis May result in a heart block

Answer 84

Melanoma or Renal cell carcinoma

Answer 85

May seed in various places Symptoms depend on tumor location

Answer 86

MCC = A fib leading to blood stuck in LA Outpouching of atrium - Left atrial appendage causing a thrombus Also may see in Left ventricle with dilated cardiomyopathy or mitral stenosis - blood stuch in left atria Results in embolic events

Answer 87

LV thrombus is MORE stable

Answer 88

Warfarin is the only approved oral anticoagulat Can bridge from heparin or lovenox INR 2-3 Needs to be done until clot is resorbed - at least 3 months

Answer 89

At least 3 months

Answer 90

Planned open heart surgery for another reason Failure of anticoagulation Anticoagulation os contraindicated

Answer 91

Dilated tortuous suoerficial veins Aching pain or asymptomatic Due to high pressure in the vein and distension of valves Long standing or heavy lifting

Answer 92

Venous reflux Venous hypertension

Answer 93

Typically the great saphenous vein

Answer 94

Legs feel achy when standing for long periods Relieved by leg elevation Skin discoloration - hemociridan deposits Fibrosis Pruritis Severity is NOT correlated to number of varicosities

Answer 95

Via observation Get venous duplex if there is a clot and surgery is indicated

Answer 96

Compression hose - 20-30mmHg at all waking hours Leg elevation - above the heart

Answer 97

Sclerotherapy - Closes off the veins Endovenous laser/Radiofrequency ablation therapy - Laser destroys vein Vein stripping - Last resort!!

Answer 98

Complication of varicose veins or DVT Edema and skin hyperpigmentation Too much pressure in the venous system Obesity is a major risk factor

Answer 99

Lower extremity edema - check BNP for CHF Darkening skin color - staining Inflammation of skin - stasis dermatitis Worse with standing Taut, shiny skin

Answer 100

Cellulitis will be PAINFUL, SD will NOT BE Cellulitis will usually NOT be BILATERAL, SD will be

Answer 101

Inflammation of fatty tissue around distal lower extremity - inverse bowling pin

Answer 102

Ivory white atrophic plaques - star shaped with surrounding hyperpigmentation - CVI

Answer 103

Dialted veins around the ankle

Answer 104

Arterial - Dry, pulseless, cool, clear borders on lesion Venous - Wet, Pulses, Warm, Poor borders on lesions

Answer 105

Doppler US MDCT - not routine

Answer 106

Compression hose Patient education - raise legs Pneumatic compressions

Answer 107

Management for CVI ulceration - wrap with medication - DON'T take off

Answer 108

Sclerotherapy to prevent resurgence of ulcers

Answer 109

Raised re painful induration along the source of an IV Staph is MC May result in a clot, may not need abx if caught early d/t trauma, pregnancy, varicose veins Localized to veins

Answer 110

Palpable chord along affected vein Localized disease process - MC r/o DVT May get hemociridan deposits along length of vessel

Answer 111

Clinical Doppler US if we are concerned about presentation

Answer 112

Pain management - NSAID/ASA Compression hose to prevent additional blood pooling Immediate IV removal

Answer 113

Anticoagulant for LARGE vessels - Arixtra, LMWH, Xarelto for 5cm+ length

Answer 114

ONLY if the patient is septic

Answer 115

Inflammation of lymph vessels - follows lymph cessel with proximal affected lymph node Abrasion distal to the site of infection

Answer 116

Hemolytic strep or staph Consider others depending on environment of acquisition (ie. Aeromonas w/ fresh water) Tenderness and tachycardia are possible

Answer 117

Formation of painful OR painless nodular swellings along the course of lymphatic channels

Answer 118

I&D of abcess for C&S Lymphangiography Treat with ABX - cover GABHS - Keflex Surgery for nodular lymphangitis

Answer 119

PAINLESS with lower extremity edema - pitting MC in young females Fam hx or malignancy or surgery No ulceration, varicosities, stasis, pigmentation Limits ADLs

Answer 120

Leg elevation Compression hose Ulcer prevention Refer to wound care is needed

Answer 121

Cancer - involved lymph node or mass

Answer 122

Serious dysrythmia hx at a young age History of syncope in self or family Structural heart disease Chest pain Prolonged QT!! - Palpitations are torsades until proven otherwise Heart block NEW Onset

Answer 123

Starts and stops on a dime

Answer 124

RED FLAG - sinus rate can't suppress the abnormal rhythm

Answer 125

Alcohol use Stimulants Sudden deaths in the family

Answer 126

24-48 hours ONLY Not good for more infrequent palpitations Monitor beat to beat Have the patient record symptoms to compare with how the patient is feeling

Answer 127

Real time monitors everything Event monitor requires the patient to record using a device

Answer 128

Implanted under the skin can be done in office If we can't detect anything on 30 month test, or if they have a cryptogenic stroke

Answer 129

Invasive approach to arrhythmia management

Answer 130

Shock via electrodes to cause a prolonged repolarization and reset the heart Indicated for - SVT, AF, VT, VF Need informed consent if the patient is able to provided

Answer 131

Myocardial necrosis Thomboembolus Hypotension - transient Skin burns

Answer 132

Map PVC cells that are misfiring and ablate them Highly invasive, and expensive Most often for PVCs - can cause esophageal issues, CI in atrial septal defects

Answer 133

Can only speed your heart rate up

Answer 134

Always includes a pacemaker Can also shock the patient back into a normal rhythm

Answer 135

Symptomatic bradycardia High grade AV block Afib with symptoms No reversible causes

Answer 136

EF 35% or less or long QT, brugada, Hypertrophic cardiomyopathy Secondary prevention after sudden cardiac arrest Put on the side of the non-dominant hand

Answer 137

One to three RV - Single chamber RA and RV - Dual chamber RV, LV +/- RA - Biventricular

Answer 138

Shock coil present!!

Answer 139

Can cause torsades

Answer 140

Causes it to pace at a set rate rather than pacing the heart

Answer 141

Sleep apnea

Answer 142

Faster breathing in, Slower breathing out

Answer 143

HR under 60, Severe under 45 Usually not symptomatic until in the 30s Sick sinus syndrome Can be due to heightened vagal tone

Answer 144

Heart rate does not increase with exercise

Answer 145

Medication - ie. Clonidine, Dig, Amiodarone Increased intercranial BP Sleep Apnea (nocturnal bradycardia and pauses) Hypothyroidism Inferior Wall MI (RCA) - Acute

Answer 146

Supraventricular arrhythmias and sinus arrest Can't reach 50% maximal HR during exercise Pacemaker is appropriate, check for medications and stop if possible first

Answer 147

If the patient is symptomatic/dying

Answer 148

HR over 100 Exercise, anger, stress, fever, volume depletion Treat underlying cause usually

Answer 149

Carotid sinus massage Vagal manuevers Deep Breathing Should make S Tach go down

Answer 150

If there is structural heart disease present esp. Mitral stenosis

Answer 151

HR jumps up randomly making the pt light headed - may be fear, etc. Similar to POTS Will usually grow out of POTS

Answer 152

Can try a BB - Young people may not tolerate NDHP-CCB - Verapamil and Diltaezem Ivabradine (Corlanor) - Off Label

Answer 153

Can be normal Medication related Electrolyte Lyme, Fibrosis, Infection, Ischemia (RCA)

Answer 154

ALMOST ALWAYS due to organic disease Degenerative IHD Medications Trauma Myocarditis Amyloidosis

Answer 155

Should be Asymptomatic

Answer 156

Palpitations, Dyspnea on exertion (DOE), dizziness, Irregular rhythm on auscultation

Answer 157

Worse with exertion, Bradycardia, DOE, near syncope or syncope, bradycardia, HF - look for lower extremity edema, Regular rhythm

Answer 158

Review medications 12 lead EKG Echo for structural abnormalities Cath for ischemia -NO STRESS TEST CBC CMP TSH

Answer 159

Avoid AV node blocking agents

Answer 160

Treat identifiable cause, Avoid conduction sloing drugs Rarely need a permanent pacemaker

Answer 161

Unstable rhythms - require permanent pacemaker in majority, some are transient (ie. STEMI that is resolved)

Answer 162

P wave comes in early No compensatory pause - nonregularity differentiates it from Heart block May be a precursor for A fib or A flutter May be normal

Answer 163

Should not cause SOB or syncope May feel skipped beats Beta Blockers for significant symptoms IC antiarrhythmic second line

Answer 164

May be normal if limited May be triggered by lack of sleep, lack of exercise, Caffeine, Thyroid - Keep a journal Should diminish with exercise!! (if not, red flag)

Answer 165

When lying down for a nap/at night

Answer 166

Manage underlying cause Beta Blocker - Lopressor or Metoprolol - first line Class IC or III AAD - second line Catheter ablation is an option (send to electrophysiology)

Answer 167

Echo BMP Magnesium Thyroid

Answer 168

Dilated cardiomyopathy with over 30% PVCs

Answer 169

Fast path blocks off slow path

Answer 170

PAC comes down slow pathway and goes back up the fast pathway and into the atria

Answer 171

Awareness of rapid breath, chest pain Rapid onset Narrow QRS

Answer 172

Valsalva - Bear down, Resist pressure on abdomen Cold Holding breath/ Coughing Carotid Sinus Massage - PROVIDER ONLY

Answer 173

Adenosine - FIRST LINE CCB - Verapmil, Diltaezem Beta blocker - Esmolol, Lopressor Amiodarone if Refractory Procainamide if WIDE complex Cardioversion is UNSTABLE

Answer 174

Catheter Ablation - First Line Medications - BB,CCB Send WPW patients to an EP

Answer 175

Onset and termination occur abruptly Rate 50 to 180 bpm Unifocal or Multifocal Absence of normal P waves delineates from sinus rhythm

Answer 176

May be seen in normal hearts In the elderly Can be due to structural issues Not as common with IHD Get an ECHO

Answer 177

BB or CCB - Unifocal CCB - Multifocal Ablation, Class Ic

Answer 178

Paroxysmal - Short episodes, respond to medication Persistent - Bursts don't fix themselves - have to shock or give Corvert Long Standing - Persitent for 1+ years Permanent - All the time, can't reverse

Answer 179

Paroxysmal - work to keep in sinus rhythm Permanent - Keep HR normal

Answer 180

Age CHF HTN CAD Valvular Heart disease Alcohol use - holiday heart Thyroid disease Sleep apnea

Answer 181

Young patients with NO obvious cause/family history - may have a risk of recurrence

Answer 182

Depends of phase - more prominent, less accustomed in paroxysmal Palpitations, Hypotension, SOB, chest pain, syncope Irregular rhythm on exam, CHF signs, difficult to obtain peripheral pulses

Answer 183

Persistent tachycardia with CHF Stroke from clots

Answer 184

Trust the EKG monitor

Answer 185

ECHO Stress test ONLY if IHD suspected BMP, TSH, MAG

Answer 186

Rate control Rhythm control Clot control

Answer 187

If they feel fine in a fib keep them there

Answer 188

CCBs - CI in HFrEF BB - CI in asthma Digoxin - CI in CKD

Answer 189

AVN Ablation - If you cannot do ANY of those; will need a permanent pacemaker

Answer 190

FL - - Class IC - Dronedarone, Flecanide, Propafenone, Sotolol SL - - Amiodarone, Dofetalide OR catheter ablation

Answer 191

Amiodarione - - FL OR Catheter ablation

Answer 192

FL - - Dofetalide, Dronedarone, Sotalol SL - - Amiodarone OR catheter ablation

Answer 193

FL - - Amiodarone or Dofetalide SL - - Catheter ablation

Answer 194

Less good with consistent A fib

Answer 195

Cardiovert immediately if unstable regardless of duration

Answer 196

MUST BE: Less than 48 hour duration Confirmed no thrombus with Trans esophageal echo 3 weeks of therapeutic anticoagulation

Answer 197

Continue for 4 weeks

Answer 198

Congestive Heart Failure Hypertension Age >75 +2 Diabetes Mellitus Prior TIA or Stroke +2 Vascular disease - Actual MI intervention Age 65-75 Sc - Sex category, Female (+0 if ONLY criteria met, Else +1)

Answer 199

Age over 75 Prior TIA for stroke

Answer 200

Start treating at 2, stroke risk increases 0 - No antithrombic therapy 1 - ASA OR Oral anticoagulation - borderline 2 - Oral anticoagulation

Answer 201

Estimates risk of bleeding 0-9 points 5 = 9% risk of bleeding

Answer 202

Heparin inpation Warfarin - Only for valvular A fib Apixaban (Eliquis), Xarelto (Rivaroxaban) - once a day, Dabigatran (Pradaxa)

Answer 203

Educate patient on potential evolution Avoid alcohol Ambulatory monitoring Control risk factors No cure for A fib

Answer 204

Organized A fib - Saw tooth EKG pattern Same as A fib EXCEPT that an ablation can be CURATIVE

Answer 205

May be asymptomatic, may have palpitations, dizziness, syncope Treat underlying cause no need for pacemaker, etc.

Answer 206

60-120 = Accelerated Drug slowing down V Tach or Escape Rhythm May be after acute MI - BB, will go away

Answer 207

Greater than 30 seconds, does not terminate spontaneously 160-240 BPM MI, Cardiomyopathy, Catecholaminergic Polymorphic

Answer 208

SOMETHING is WRONG - May be catecholaminergic

Answer 209

Rare in US Consider meds or electrolytes first for prolonged QT Torsades triggered bby long QT 3 types of congenital: 1 and 2 - MC, Exercise and sudden auditory stimuli are triggers 3 - Most lethal, occurs during sleep at slower rates

Answer 210

ST segment in anterior precordial leads elevation with RBBB No chest pain of STEMI 3 types - MC in Asian, Presentation of syncope = syndrome

Answer 211

Beta Blocker - Propranolol and Nadolol ICD - Esp. for Brugada Avoid QT prolonging medications

Answer 212

Palpitations, Syncope, Sudden Death

Answer 213

ACLS - CPR, etc. if UNSTABLE STABLE - Sedate and shock or start on IV Amiodarone (won't have to sedate)

Answer 214

ICD if recurring/Not due to reversible cause BB Amiodarone/Sotalol Catheter ablation

Answer 215

Beta blocker indicated IF: Symptomatic OR Structural Heart Disease and Low EF

Answer 216

Leading cause of sudden death SHOCK - Unsynchronized ICD

Answer 217

Ischemia, Inflammation, Infiltrative, Invasive surgery

Answer 218

Rule out underlying ischemic heart disease LAD - Most commonly involved If new LBBB w/ symptoms- Treat as a STEMI Look for heart disease risk factors Echo Treat underlying Cause

Answer 219

Blood flow also from LAD Related to Lung Strain VSD Generally asymptomatic and do not require tx - symptomatic management

Answer 220

Usually asymptomatic Echo for structure ECG monitoring if the present with syncope - involve EP!!

Cardiovascular Exam 3 Cards Flashcards

(247 cards)