Cardiovascular System 2 Flashcards
What should be performed after 6-8 weeks in patients with suspected Kawasaki disease?
Echo (to check for coronary artery aneurysms)
How does the measles rash spread?
From head to toe
What does squatting do during Tet spells?
Increases the systemic vascular resistance
What happens in Tetralogy of Fallot when the pulmonary vascular resistance exceeds the systemic vascular resistance?
Cyanosis (R to L shunt)
What’s the tx for Vfib?
Defibrillation
When do you give Epinephrine?
Vtach
How does the cardiac contour look with acute tamponade (rather than subacute)?
Acute has a normal cardiac contour
Is anticoagulation needed in lone paroxysmal Afib?
No
What does increased QRS voltage indicate?
LVH
Tet spells are due to what VOT?
RVOT
What would you check first before performing a renal US?
Serum creatinine and urinalysis
What should be suspected in young patients with unexplained AV block?
Sarcoidosis
How does B-blocker toxicity present?
Bradycardia, hypotension, hypoglycemia, delirium, seizures, cardiogenic shock
How do you treat B-blocker toxicity?
Glucagon
How does digoxin toxicity present?
Fatigue, nausea, blurred vision, disturbed color perception, cardiac arrhythmias
What does wide splitting indicate (causes a delayed pulmonic sound)?
Pulmonic stenosis
RBBB
“Drinking PBR makes you wide”
What does paradoxical splitting indicate (eliminates the split sound)?
AS
LBBB
What does increasing hand grip increase?
Afterload
“Jerking off the afterload”
What murmurs are increased by hand grip?
MR, AR, and VSD
“Mr Arvsd loves jerking off”
What does valsalva decrease?
Preload
“To reduce pre-cum, bear down during sex”
What murmurs are increased by valsalva?
HOCM
What does rapid squatting increase? (3)
- Venous return
- Preload
- Afterload
What murmurs are increased by rapid squatting?
MR, AS, and VSD
“Mr ASSvsd loves squats”
Diastolic _____?
ARMS &
PRTS
The machine is a ____?
PDA
What are the 3 signs of LHF?
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Pulmonary edema
What are the 3 signs of RHF?
- Hepatomegaly
- JVD
- Peripheral edema
Are the following levels increased or decreased in hypovolemic shock?
PCWP (preload)
CO
SVR (afterload)
PCWP: Decreased
CO: Decreased
SVR: Increased
What protozoan can cause megacolon and cardiac disease?
T cruzi (Chagas disease)
Remember, the question stem might include a JVD but it might be a normal value! What is the normal range for JVD?
Less than 4cm above sternal angle
T/F: Turner’s syndrome can predispose to aortic dissection?
True
What is sick sinus syndrome?
Age-related degeneration of the cardiac conduction system, leading to bradycardia/tachycardia, pauses, etc
Which EKG reading has irregularly irregular beats with no P waves?
Afib
Which EKG reading has a sawtooth-like appearance?
Aflutter
Which EKG reading has completely random, drawn-appearing waves?
Vfib
Which EKG reading has a prolonged (>200ms) PR interval?
First degree AV block
Which EKG reading has a progressively longer PR interval with an eventual dropped QRS?
Second degree AV block: Mobitz type I
Which EKG reading has randomly dropped QRS?
Second degree AV block: Mobitz type II
Which EKG reading has complete dissociation of P and QRS wave?
Third degree (complete) AV block
What conditions have wide splitting?
Pulmonic stenosis
RBBB
“Many right wingers are very wide”
Which conditions have “paradoxical” aka no splitting?
AS
LBBB
“The left has some paradoxical beliefs”
Which condition has fixed splitting?
ASD
Are the following levels increased or decreased in cardiogenic and obstructive shock?
PCWP (preload)
CO
SVR (afterload)
PCWP: Increased or decreased
CO: Decreased
SVR: Increased
Are the following levels increased or decreased in distributive shock?
PCWP (preload)
CO
SVR (afterload)
PCWP: Decreased
CO: Increased (sepsis, anaphylaxis) or decreased (CNS injury)
Decreased
What are the 6 main causes of JVD?
- Pulmonary HTN
- Pericardial effusion/cardiac tamponade
- Tricuspid stenosis
- RHF
- SVC syndrome
- Constrictive pericarditis
What’s a complication of cardiac cath within the first 12 hours that results in sudden onset of hypotension and back pain?
Retroperitoneal hematoma
What imaging study do you do to check for retroperitoneal hematoma?
CT scan of abdomen/pelvis without contrast
What type of heart defect causes a holosystolic murmur at the left lower sternal border?
VSD
Can bradyarrhythmias have a widened QRS?
Yes
What’s the most common heart complication of rheumatic fever?
Mitral stenosis
What heart chamber can get dilated due to severe MS?
L atrium, and this can lead to Afib
If you’re having trouble determining whether or not it’s decompensated HF vs tamponade/effusion, what should you check?
BP– if it’s high then it’s HF, if it’s low then it’s tamponade/effusion
Where is the MI if there is ST elevation in leads II, III, & aVF?
Inferior MI
“inFerior”
Where is the MI if there is ST elevation or depression in leads I & aVL?
Posterior MI
Where is the MI if leads V1-V6 are involved?
Anterior MI
Where is the MI if leads I, aVL, V5&V6 or II, III, & aVF are involved?
Lateral MI
Which vessel is involved in an anterior MI (leads V1-V6)?
LAD
Which vessel is involved in an inferior MI (leads II, III, & aVF)?
RCA or LCX
Which vessel is involved in a posterior MI (leads V1-V3, I or aVL)?
LCX or RCA
Which vessel is involved in a lateral MI (I, aVL, V5 & V6, or II, III, & aVF)?
LCX
Which MI shows ST elevation in V4-V6?
R ventricle
Which vessel is involved in a R ventricle MI (ST elevation in leads V4-V6)?
RCA
What might cause chest pain in a young adult and shows prolonged QRS on EKG?
First degree AV block
Is peripheral edema or S3 more specific to HF?
S3
Which 2 mineralocorticoid receptor antagonists improve overall survival for HF in symptomatic patients with LV systolic dysfunction?
- Spironolactone
2. Eplerenone
What kind of pulses go along with AR?
Bounding “water hammer”
What type of drug is clopidogrel?
P2y12 receptor blocker
What type of drug is apixaban?
Factor Xa inhibitor
At what diameter of occlusion to AS symptoms become severe?
<1cm
What’s the best imaging study for patients with suspected aortic dissection?
CT angiography
What is a TTE used to look for?
Valvular abnormalities
T/F: renal artery stenosis can results in an upper abdominal systolic/diastolic bruit?
True
Would an AAA cause HTN?
No; it would likely just be an asymptomatic pulsatile mass
What is a common cause of LV hypertrophy?
Prolonged HTN
What’s the anti-anginal mechanism of nitrates?
Systemic vasodilation and decrease in cardiac preload, resulting in a decrease in LV end-diastolic and end-systolic volume, leading to a reduction in LV systolic wall stress which reflects afterload (and therefore a decreased O2 need)
Does aortic root dilation in Marfan’s cause an early diastolic murmur, due to AR?
Yes
What are the symptoms of digoxin toxicity?
Nausea, vomiting, diarrhea, vision changes, arrhythmia
What do urine metanephrines test for?
Pheochromocytoma
What does a 24-hour urine cortisol excretion test for?
Cushing syndrome
What does a high plasma aldosterone/renin ratio indicate?
Primary aldosteronism (Conn syndrome)
What’s the first step in diagnosing bilateral abdominal masses with HTN?
Renal US
How does acute pericarditis appear on EKG?
Diffuse ST elevations (more sloping than STEMI)
Why does Tetralogy of Fallot present with a harsh, systolic ejection murmur over the LUSB?
Due to pulmonary stenosis
