Cardiovascular system Flashcards
(132 cards)
1
Q
Loss of palpable radial pulse on inhalation
A
Example of pulsus paradoxus (large decrease in systolic blood pressure upon inhalation)
Feature of cardiac tamponade
2
Q
- Diagnosis
- Treatment
A
- Regular wide-complex tachycardia consistent with monomorphic ventricular tachycardia
- If stable, treat with IV amiodarone
3
Q
Ankle brachial index key values
A
- 9-1.3 Normal
- 4-0.9 Peripheral arterial disease
<0.4 Severe ischemia
4
Q
Common cause of myocarditis
A
Cocksackie B
5
Q
Doppler flow tracings acquired from an apical window
A
Aortic stenosis
Blood flow toward the transducer is recorded above the baseline
Blood flow away from the transducer is recorded below the baseline
6
Q
Agents used for rate control in atrial fibrillation (with RVR)
A
1. Beta adrenergic antagonists
Metoprolol
Esmolol
2. Non-dihydropyridine calcium channel blockers
Diltiazem
Verapimil
7
Q
Cardiac auscultation in patients with ASD
A
1. Wide and fixed splitting of the second heart sound (S2): Resulting from delayed closure of the pulmonic valve due to englarged RV’s prolonged emptying (widened S2), with no difference between inspiration and expiration (fixed S2).
2. Mid-systolic or ejection murmur over the left upper sternal border: Resulting from increased flow across the pulmonic valve
3. Mid-diastolic rumble: Resulting from increased flow across the tricuspid valve
8
Q
Ventricular septal rupture
A
3-5 days after MI
Acute hemodynamic instability
Holosystolic murmur at left sternal border
9
Q
Auscultation of mitral stenosis
A
- Loud first heart sound
- Opening snap: early diastolic sound after second heart sound
- Low pitched diastolic murmur best heard at cardiac apex
10
Q
Auscultation of mild versus more severe mitral stenosis
A
Mild: Murmur in late diastole
As stenosis progresses: Diastolic murmur is heard earlier in the cardiac cycle (mid-diastolic) and eventually can be heard immediately after the opening snap.
11
Q
Effect of maneuvers on hypertrophic cardiomyopathy (physiologic effect, change in murmur intensity)
- Valsalva (straining phase)
- Abrupt standing (from sitting or supine position)
- Nitroglycerin administration
- Sustained hand grip
- Squatting (from standing position)
- Passive leg raise
A
12
Q
Hypertrophic cardiomyopathy
- Pathophysiology
- Clinical features
- Diagnostic evaluation
4. Management
- Complications
A
Beta blockers are preferred for initial therapy
Verapimil or disopyramide can be used as additional therapy in patients with persistent symptoms.
13
Q
How do nitrates relieve chest pain?
A
Venodilation reduces preload, which decreases myocardial oxygen demand
Decrease left ventricular wall stress
14
Q
Murmur of aortic regurgitation
A
Decrescendo diastolic murmur
- Due to congenital bicuspid valve: Left sternal border at the 3rd and 4th interspace with patient sitting up, leaning forward, and holding breath in full expiration.
- Due to aortic root dilation: Radiates toward the right side and is best heard along the right sternal border.
15
Q
Auscultation of chordae tendinae degeneration
A
Mitral valve prolapse: Mid systolic click over cardiac apex
Mitral regurge: Mid to late systolic murmur
16
Q
Initial treatment for hyperkalemia with EKG changes
A
Calcium gluconate to stabilize cell membrane
17
Q
Abdominal aortic aneurysm
- Risk factors
- Symptoms
- Screening
- Management
A
18
Q
Diagnosis of aortic rupture
A
Transesophageal echocardiography
CT scan
19
Q
Medication classes that improve long-term survival in patients with LV systolic dysfunction
A
ACE inhibitors
ARBs
Beta-blockers
Aldosterone antagonists
Hydralazine + nitrates (in African Americans)
20
Q
Beta blockers that improve symptoms and overall long-term survival in stable patients with heart failure and LV systolic dysfunction (<40%)
A
Metoprolol succinate
Carvedilol
Bisoprolol
21
Q
Amiodarone indication
A
Preferred antiarrhythmic drug to manage ventricular arrythmias in:
Patients with heart failure
Systolic LV dysfunction
22
Q
Evaluation of secondary amenorrhea
A
23
Q
Rapid loss of consciousness without a preceding prodrome
- Cause
- Predisposing factors
A
- Arrhythmia
- Use of anti-arrhythmic drugs
Structural heart disease
Hypokalemia
Hypomagnesemia
24
Q
Treatment for QT prolongation with risk of developing torsades de points
(In a hemodynamically stable)
A
Magnesium sulfate (even if Mg level is normal)
Second line: Temporary pacemaker and/or IV isoproterenol
25
Amyloidosis
1. Etiology
2. Clinical presentation
3. Diagnosis
26
Treatment of hypertriglyceridemia
27
Treatment for atrial premature beats
1. In asymptomatic patients: Identify and avoid reverse risk factors such as tobacco, alcohol, caffeine, and stress.
2. In symptomati patients: Consider beta blockers
28
Retroperitoneal hematoma
Local vascular complication of cardiac catheterization
Often presents with sudden hemodynamic instability and ipsilateral flank or back pain.
Non-contrast CT of abdomen and pelvis or abdominal ultrasound to diagnose.
29
Poor prognostic factors in systolic heart failure
1. Clinical
2. Laboratory
3. EKG
4. Echo
5. Associated conditions
Hyponatremia in patients with CHF parallels severity of heart failure
30
Class I antiarrhythmics
Block Sodium
Raise the threshold potental of cardiac fast response tissues
31
Class IV antiarrhythmics
Calcium blocking
Raise the threshold potential of cardiac slow response tissues.
32
Class 1B antiarrhythmic drugs
Lidocaine
Tocainide
Mexiletine
Shorten the action potential.
Have mild sodium channel blocking activity and dissociate from the sodium channel more rapidly than other class I drugs
34
Class IA antiarrhythmics
Quinidine
Prolong repolarization and increase the refractory period due to potassium-channel blocking activity
35
Class III antiarrhythmics
Amiodarone
Prolong repolarization and increase the refractory period due to potassium channel-blocking activity
36
Class I antiarrhythrmic drugs
**Block voltage-dependent sodium channels during ventricular depolarization**
Class 1A (**procainamide**): **Prolong QRS** duration and the **QT interval** due to their **moderate potassium channel blocking** activity
Class 1B (**lidocaine**): Have no significant effect on either the WRS duration or QT interval during normal sinus rhythm due to their **rapid dissociation from the receptors**.
Class IC drugs (e.g., **flecainide**, **propafenone**): **Prolong QRS duration** with **minimal effect on the QT interval** due to their **lack of potassium channel blocking activity**.
37
Procainamide
Class 1A antiarrhythmic
Blocks sodium-dependent sodium channels
Prolongs QRS duration and QT interval due to their moderate potassium channel blocking activity
38
Lidocaine
Class 1B anti-arrhythmic
Blocks sodium channels
No effect on either QRS duration or QT interval during normal sinus rhythm due to rapid dissociation from the receptor
39
Class III antiarrhythmic drugs
Amiodarone
Sotalol
Dofetilide
PRedominantly block potassium channels and inhibit the outward repolarizing currents druing phase 3 of the cardiac action potential.
Increaed action potential duration and QT interval prolongation.
40
Flecainide
Propafone
Class IC antiarrhythmic
Block sodium channels
Prolong QRS duration with minimal effect on the QT interval due to their lack of potassium channel blocking activity.
42
Amiodarone
Indications and side effects
Class III antiarrhythmic
Supraventricular (atrial, nodal, junctional) and ventricular tachyarrhythmia.
One of the broadest spectrum antiarrhythmic drug available.
**Side effects**:
Photodermatitis
Blue/grey skin discoloration
Pulmonary fibrosis
Hyper- or hypothyroidism
43
Lidocaine
Indications and side effects
Class 1B antiarrhythmic
Ventricular arrhythmias
Overdose or toxicity: neurologic symptoms
44
Procainamide
Indications and side effects
Class 1A antiarrhythmic
Drug-induced lupus
45
Verapimil (Antiarrhythmic)
Indications and side effects
Class IV antiarrhythmic
Most cardioselective of calcium cannel blockers
Potent negative ionotrope
Adverse reactions: **Constipation**, gingival hyperplasia
Constipation is a major side effect of nondihydropyridine CCBs (verapimil \> diltiazem)
46
Class I (sodium channel-blocking) antiarrhythmics
1. Specific agents
2. Inhibition of phase 0 depolarization
3. Effect on length of action potential
47
Adenosine
Indications and side effects
Drug of choice for paroxysmal supraventircular tachycardia (PVST)
PVST comes on suddently and the focus of automaticity lives above the ventricles.
Adenosine is a very rapid acting drug with a half-life \<10 seconds.
**Slows conduction through the AV node** by hyerpolarizing the nodal pacemaker and conducting cells.
Side effects: **flushing**, **chest burning** (due to bronchospasm), **hypotension**, **high grade AV block**.
Adenosine is used for chemical stress tests
48
Digoxin/digitalis (antiarrhythmic)
Slows conduction through AV node
Positive ionotrope
Toxicity: Fatigue, blurry vision, changes in color perception, nausea and vomiting, diarrhea, abdominal pain, confusion, and delirium
49
Wolff-Parkinson-White syndrome
50
Mitral stenosis
1. Clinical features
2. Physical examination
3. Diagnosis
Chest X ray
ECG
TTE
51
Acute pericarditis
1. Etiology
2. Clinical features & diagnosis
3. Treatment
Uremic pericarditis can occur in patients with BUN \>60 mg/dL.
In uremic pericarditis, the classic finding of diffuse ST elevation is typically absent due to lack of myocardial inflammation.
52
Clinical clues to diagnosis of syncope
1. Vasovagal or neurally mediated
2. Situational
3. Orthostatic
4. Aortic stenosis, HCM, anomalous coronary arteries
5. Ventricular arrhythmias
6. Sick sinus syndrome, bradyarrhythmias, atrioventricular block
7. Torsades de pointes (acquired long QT syndrome)
Congenital long QT syndrome
Situational syncope is a form of reflex (neurally mediated) with specific triggers causing an alteration in autonomic response that is **cardioinhibitory**, **vasodepressor**, or **mixed**.
53
Livedo reticularis
Skin manifestation of systemic atheroembolism
54
Cholesterol crystal embolism (atheroembolism)
1. Risk factors
2. Clinical features
Dermatologic
Renal
CNS
Ocular
GI
3. Diagnosis
Lab findings
Skin or renal biopsy
55
Aortic injury
Suspect in any patient who suffers blunt deceleration trauma (MVA or fall from \>10 feet)
56
Hemodynamic measurements in shock (**Normal**, hypovolemic shock, cardiogenic sock, septic shock)
1. RA pressure (preload)
2. PCWP (preload)
3. Cardiac index
4. SVR (afterload)
5. MvO2
57
Possible etiologies
Cardiac tamponade
Severe ashtma
COPD
58
Murmur associated with PDA
Continuous flow murmur
59
Congenital and acquired causes of AV fistulas
60
Cardiac stress tests
1. Type of stress
2. Mechanism
3. Best for
4. Not for
61
Isolated systolic hypertension
Important cause of hypertension in elderly patients
Caused by increased stiffness or decreased elasticity of arterial wall
62
Complication of dual chamber pacemaker placement
Tricuspid regurgitation
63
Vasospastic angina
1. Pathogenesis
2. Clinical presentation
3. Diagnosis
4. Treatment
64
Trisomy 18 (Edwards syndrome)
Micrognathia
Microcephaly
Rocker bottom feet
Overlapping fingers
Absent palmar creases
Commonly associated with ventricular septal defect
(Holosystolic murmur best heard at left lower sternal border).
65
Atrial septal defect
Commonly occurs in patients with trisomy 21
Systolic ejection murmur at left upper sternal border due to increased blood flow across pulmonic valve
66
Congenital heart block
Causes bradycardia
Associated with neonatal lupus (erythemaous, annular rashes on the scalp and periorbital region)
67
PDA
Conftinuous flow murur best heard in left subclavicular region
Potential complication of congenital rubella, trisomy 18
68
Cyanotic congenital heart degects
Transpostion of the great arteries
Truncus arteriosus
Associated with DiGeorge syndrome
69
Clinical features of aortic dissection
1. Risk factors/associations
2. Clinical features
3. Complications (involved structure)
Most important risk factor is systemic hypertension
70
Clinical features of fibromuscular dysplasia
1. Patients to screen
2. Clinical presentation
3. Diagnosis and follow-up
71
Normal renin-to-aldosterone ratio
\<20
72
Treatment for ductal-dependent cyanotic heart disease
Prostaglandin E1
Vasodilator that maintains flow
73
Congenital heart disease (Clinical features, examples)
1. Left-to-right shunting
2. RIght-to-left shunting
3. Interrupted left ventricular output
74
Diagnostic approach for suspected aortic dissection
75
Medical therapy shown to improve morbidity and mortality
1. **Dual antiplatelet therapy** with aspirin and P2y12 receptor blockers (clopidogrel, prasugrel, ticagrelor)
2. **Beta blockers**
3. **ACE inhibitors or ARBs**
4. **HMG-CoA reductase inhibitors (statins)**
5. **Aldosterone antagonists** (spironalactone, eplenerone) in patients with left ventricular ejection fraction \<=40% who have heart failure symptoms or diabetes mellitus.
76
P2y12 receptor blockers
Clopidogrel
Prasurgel
Ticagrelor
77
Indications for carotid endarterectomy
1. Men
2. Women
78
Cyanotic heart disease in newborns (Diagnosis, Exam, X ray findings)
1. Transposition
2. Tetralogy of Fallot
3. Tricuspid atresia
4. Truncus arteriosus
5. Total anomalous pulmonary venous return with obstruction
79
Factors associated with poor outcome after witnessed out-of-hospital arrest
80
What is the most common cause of sudden cardiac arrest in the immediate post-infarction period in patients with acute myocardial infarction?
Reentrant ventricular arrhythmias (e.g., ventricular fibrillation)
81
Absent thymus
DiGeorge Syndrome
82
DiGeorge Syndrome
1. Pathogenesis
2. Clinical features
Depending on degree of thymic hypoplasia, patients can have T-cell lymphopenia and increased risk of viral and fungal infections.
Human immunodeficiency can also result from defective T-cell help in B-cell activation for antibody production, increasing susceptibility to bacterial infections as well.
83
Anaphylaxis
1. Triggers
2. Clinical manifestations
**3. Treatment**
84
Conditions associated with atrial fibrillation
1. Cardiac
2. Pulmonary
3. Miscellaneous
85
Clinical features of acute decompensated heart failure
1. Clinical presentation
2. Treatment
86
Hypertensive complications
1. Hypertensive urgency
2. Hypertensive emergency
87
Differential diagnosis and features of chest pain
1. Coronary artery disease
2. Pulmonary/pleuritic
3. Aortic
4. Gastrointestinal/esophageal
5. Chest wall/musculoskeletal
88
Initial stabilization of acute ST - elevation MI
89
Vascular ring
Results from abnormal development of the aortic arch
Presents with respiratory (e.g., biphasic stridor, wheezing, coughing) and esophageal (e.g., dysphagia, vomiting, difficulty feeding) symptoms. Stridor typically improves with neck extension
90
Differential diagnosis of stridor (Acute, chronic)
1. Acute
2. Chronic
91
Diastolic murmur
Continuous murmur
Usually due to an underlying pathologic cause
Follow up with transthoracic echo
Midsystolic murmurs in otherwise young, asymptomatic adults are usually benign and do not require further evaluation
92
Constrictive pericarditis
1. Etiology
2. Clinical presentation
3. Diagnostic findings
Kussmaul's sign: Lack of the typical inspiratory decline in central venous pressure
Pericardial knock: Early heart sound after S2
93
Major side effects of amiodarone
1. Cardiac
2. Pulmonary
3. Endocrine
4. Gastrointestinal/hepatic
5. Ocular
6. Dermatologic
7. Neurologic
Class III antiarrhythmic drug often used for management of ventricular arrhythmias in patients with CAD and ischemic cardiomyopathy
94
Cardiac tamponade
1. Etiology
2. Clinical signs
3. Diagnosis
Tamponade is a rare but important complication of CABG
**Urgent echo** in patients with suspected cardiac tamponade for definitive diagnosis and management
95
Clinical features of compartment syndrome
1. Common
2. Uncommon
3. Diagnosis
3. Compartment pressure \>30 mm Hg is diagnostic
96
Clinical features of pulmonary hypertension
1. Classification
2. Symptoms
3. Signs
4. Treatment
97
Treatment of pulmonary hypertension due to LV systolic or diastolic dysfunction
Loop diuretics + ACE inhibitors
98
Treatment of pulmonary hypertension due to chronic lung disease
Oxygen and/or bronchodilators
99
Treatment of pulmonary hypertension for symptomatic idiopathic pulmonary hypertension
1. Endothelin receptor antagonists: bosentan
2. Phosphodiesterase-5 inhibitors: sildenafil
3. Prostanoids: epoprostenol
100
Treatment of pulmonary hypertension due to chronic thromboembolic occlusion of pulmonary vasculature
Long-term anticoagulation
101
Coarctation of the aorta
1. Pathophysiology
2. Clinical features
3. Treatment
102
Treatment of supraventricular tachycardia
Adenosine (or vagal maneuvers)
Slows the sinus rate, increases AV nodal conduction delay, or can cause a transient block in AV node condution.
103
Gastroesophageal reflux disease
1. Etiology
2. Clinical presentation
3. Initial treatment
104
Valve abnormality in HOCM
Systolic anterior motion of the mitral valve leads
Contract between the mitral valve and the thickened septum during systole leads to left ventricular outflow tract obstruction.
105
Renin-angiotensin-aldosterone system
106
Clinical features of cocaine use
1. Clinical features
2. Complications
**3. Managment of chest pain**
107
Guidelines for lipid-lowering therapy
1. Indication
2. Recommended therapy
108
Medications that can trigger bronchoconstriction in patients with asthma
Aspirin
Beta blockers
109
Thoracic aortic aneurysm
110
Hiatal hernia
111
Hilar mass
Unilateral masses near the hilum are usually malignancies
112
Dihydropyridine calcium channel blockers
SIde effect
End with -pine, e.g., amlodipine
Smooth muscle selective
Cause peripheral edema
113
Non-dihydropyridine calcium channel blockers
Diltiazem
Verapimil
114
Amyloid cardiopmyopathy
Unexplained congestive heart failure
Proteinuria
Left ventricular hypertrophy in the absence of a history of hypertension
115
Ausculation of severe aortic stenosis
1. Soft second heart sound
2. Mid to late systolic murmur with maximal intensity at second right intercostal space
116
Mechanical complications of acute MI (Time course, Coronary artery involved, Clinical Findings, Echo)
1. RV failure
2. Papillary muscle rupture
3. Interventricular septum rupture/defect
4. Free wall rupture
117
Acute pericarditis
1. Etiology
2. Clinical features & Diagnosis
3. Treatment
Anti-inflammatories are avoided in peri-infarction pericarditis, because anti-inflammatories can disrupt collagen deposition
118
Coarctation of the aorta
1. Etiology
2. Clinical features
3. Diagnostic studies
4. Treatment
Coarctation of the aorta is a potential cause of secondary hypertension in younger adults
119
Tetralogy of Fallot
Most common cyanotic congential heart defect
1. Right ventricular outflow tract obstruction (pulmonary stenosis or atresia)
2. Right ventricular hypertrophy
3. Overriding aorta
4. Ventricular septal defect (VSD)
120
Development of atrioventricular block in a patient with infective endocarditis
Perivalvular abscess with infection extending into adjacent cardiac conduction tissues
121
Wolf-Parkinson White syndrome
EKG abnormalities
122
Guidelines for lipid-lowering therapy
1. Indication
2. Recommended lipid-lowering therapy
123
Lone atrial fibrillation
Patients with atrial fibrillation and a CHA2DS2-VASc score of 0
Low risk of systemic embolization and **anticoagulant therapy is not indicated**
124
Treatment of hypertension with lifestyle modifications (Modification, recommended plan, approximate reduction in systolic BP)
1. Weight loss
2. DASH diet
3. Exercise
4. Dietary sodium
5. Alcohol intake
Weight loss is the most effective nonpharmacologic measure to reduce blood pressure in **overweight individuals**
125
Inferior wall MI
II, III, aVF
Due to occlusion of the right coronary artery promixal to the origin of the RV branches
126
Managment of STEMI
127
Cardiomegaly
Cardiothoracic ratio \> 50% (Abnormal in a child \> 1 year)
\>60% is abnormal in a child \< 1 year
128
Pediatric viral myocarditis
1. Etiology
2. Clinical presentation
3. Diagnostic studies
4. Prognosis
129
Common complications of acute myocardial infarction
1. Complication
2. Time course
Ventricular aneurysm: ECG shows **persistent ST-segment elevation** along with deep Q waves
130
Causes of left heart failure with preserved left ventricular function
131
strongest predictor of stent thrombosis after intracoronary stent implantation
Premature discontinuation of antiplatelet therapy.
Long-term dual antiplatelet therapy with aspiring and platelet P2Y12 receptor blpcker is recommended to reduce rate of stent thrombosis after intracoronary drug-eluting stent placement.
132
Basic testing for patients diagnosed with hypertension
1. Urinalysis for occult hematuria and urine protein/creatinine ratio
2. Chemistry panel
3. Lipid profile
4. Baseline electrocardiogram
133
Initial treatment for sinus bradycardia
Atropine
134
Most common etiology of atrial fibrillation
Ectopic foci within the pulmonar veins
