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PANRE 2021 - JLI > CARDS > Flashcards

CARDS Flashcards

(103 cards)

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1
Q

Dressler syndrome

  • what
  • EKG findings
  • sx
A
  • autoimmune pericarditis days to weeks after MI
  • diffuse J point or ST segement elevation is indicative of pericarditis.
  • LG temp, malaise, CP lessened by sitting up
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2
Q

Infective Endocarditis

  • sx
  • cardiac & dx
A
  • fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots.
  • vegetations - TEE
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3
Q

most commonly affected valve in endocarditis in patients with a history of IV drug use

A

tricuspid valve - first one blood hits after injection

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4
Q

Shock

  • definition
  • 3 types of shock
A

Inadequate delivery of oxygen to the tissues

Cardiogenic
Obstructive
Distributive

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5
Q

Shock causes pneumonic

A 
Sepsis
Hypovolemia
Obstructive
Cardiac
Kortisal
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6
Q

Causes of Hypovolemic shock x3

A
  • Hemorrhage
  • Volume loss (diarrhea)
  • Loss of plasma
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7
Q

Causes of Cardiogenic Shock x5

A 
MI 
Arrhythmia 
Heart failure 
Valvular disease 
Massive PE
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8
Q

Causes of Obstructive Shock x4

A

Can’t fill your heart

Tension pneumothorax
Cardiac tamponade
Obstructive valvular disease
Massive PE

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9
Q

Distributive Shock Causes x3

A

Poorly regulated distribution of blood volume

Septic shock
Anaphylactic shock
Neurogenic shock (spinal cord injury)

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10
Q

Syncope definition

A

brief loss of consciousness & postural tone with spontaneous recovery

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11
Q

Orthostatic Hypotension

A

> 20 mm drop in SBP or 10 mm DBP from supine to standing

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12
Q

PDA in utero

A

blood shunted from pulmonary artery to aorta in utero- should close at birth stopping flow from R to L atrium

Functionally closes 15 hours after birth, anatomically by 3 weeks

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13
Q

PDA defect

Risk factors X3

A

As pulm resistance increase&raquo_space; L to R shunt&raquo_space; CHF ( do become cyanotic b/c L- R shunt)

Prematurity, Hypoxia, Congenital Rubella

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14
Q

Describe Fetal circulation

A 
Mom oxygenates blood > placenta
Umbilical vein send blood to placenta
Fetus IVC to RA
RA to FO to LA to LV to aorto 
RA to RV to pulm artery
From PA some goes to oxygenate lungs
From PA, most is shunted thru ductus to aorta to body & back to IVC
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15
Q

PDA murmur

A

Continuous machinery murmur in left upper chest

Bounding pulses with wide pulse pressure

“Slapping 2nd heart sound”

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16
Q

PDA drug for medical management

A

Indomethacin - prostaglandin inhibitor to close duct i premature kids

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17
Q

Venous Hum murmur

A

also continuous murmur (like PDA), but more positional - as you move infants head

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18
Q

Cyantoic Congenital Heart diseases

A 
5 Ts & a P
Tetralogy of Fallot (MC)
Transposition of the Great Arteries
Truncus Arteriosus
Tricuspid Atresia
Total Anomalous Venous Pulmonary Return
Pulmonary Atresia
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19
Q

Tetrology of Fallot

  • 4 components
  • CXR findings x2
A

○ RVH
○ Pulmonic Stenosis (PS) causing RV outflow tract obstruction
○ VSD
○ Overriding aorta (sits atop VSD) which causes blood flow from both ventricles

CXR - Boot-shaped heart, decreased pulmonary vascular markings

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20
Q

Presentation if Large VSD with Tetrology of Fallot

A

If Large VSD
○ Mild PS
○ Presents just like a VSD
○ “Pink tet”

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21
Q

Presentation if Small VSD with Tetrology of Fallot

A

○ Large PS
○ Presents like a cyanotic congenital heart lesion
○ “Blue tet”

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22
Q

Tetrology of Fallot Murmur

A

○ Single second heart sound

○ Systolic ejection murmur at left upper sternal border ± radiation to back

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23
Q

diagnosing cyanotic congenital heart disease

A

Hyperoxia test
○ Give 100% FiO2 for 10 minutes
○ ABG: paO2 <150 mmHg concerning for CCHD

Boot shaped heart

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24
Q

Tet spell

A

in older infant with tetralogy of fallot

right-to-left shunting through VSD causing blood to bypass lungs unoxygenated

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25
How to temporize/treat TOF in acute setting
reopen ductus with PGE1 @ 0.1 mcg/kg/min decrease infundibular spasm (beta-blockade) decrease pulmonary resistance
26
LT risk of untreated TOF
At risk for subacute bacterial endocarditis (SBE) before and after correction Untreated, paradoxical emboli → stroke
27
Coartaction of Aorta
narrowing of proximal aorta
28
Coarctation Associations
``` Bicuspid aortic valve VSD Aortic dissection CHF SBE Hypertension Turner syndrome (15-20%) Cerebral aneurysms → can cause intracerebral hemorrhage ```
29
Coarctation - sx (early vs. late) - findings on CXR Murmur Immediate rx
early - shock & CHF late - hypertension (esp UE) - UE/LE pulse difference > 20 mm - rib notching on CXR Murmur - systolic L infraclavicular & sub scapular PGE1 to open ductus
30
MC type of ASD Shunt type
Ostium secundum: arises from an enlarged foramen ovale (90% of all ASDs) L to R initially >> pulmonary over circulation +/- CHF
31
ASD murmur ASD on EKG
FIXED widely split S2 (no vary with respiration) 2/2 delayed pulmonary valve closure RBBB
32
ASD late presentation
Diagnosis often delayed until 5th decade ● Sx: DOE, CP, fatigue, palpitations ● Signs: atrial arrhythmias, right heart failure, ischemic stroke, pulmonary HTN ● Murmur: Fixed split S2, RVOT PS ● Precipitating factors: volume (pregnancy, Mitral Regurgitation), poor left heart compliance
33
CHF pathophys - initially then over time? CO vs. Preload vs afterload
Low Cardiac Output (CO) → compensatory increased preload, increased afterload, and increased contractility → over time... ○ Low CO + increased afterload decreased renal perfusion → stimulation of RAAS and ADH system → fluid and sodium retention → fluid overload peripherally and centrally ○ Low CO + increased preload (volume overload) → ventricular dilatation
34
Left heart failure sx
○ Dyspnea, orthopnea, PND ○ Weakness/fatigue | ○ Tachy, S3, rales
35
Right heart failure sx
○ JVD (rales if left heart failure also) ○ Peripheral edema ○ RUQ pain, hepatojugular reflex, hepatomegaly ○ Ascites ○ Most common cause is severe Left heart failure
36
CHF lab abnormalities
Anemia renal insufficiency, elevated LFTs, hyponatremia secondary to excess free fluid, hypo/hyperkalemia BNP (>500 if acutely decompensated)
37
What causes mild elevations in BNP | 100-500
Chronic CHF severe COPD or RHF, PE (→ RV dysfunction) Elderly women, a-fib (→ LV dilatation)
38
CHF CXR findings in order of progression
Cardiomegaly → Cephalization (fluid going to upper lung fields)→ Kerley B lines → Alveolar fluid → Pleural effusion
39
test of choice for teasing out CHF
Echo
40
2 drugs to improve survival in CHF 2 decrease sx
ACEI (reduce after load, Inc renal perfusion) BB (decrease catecholamine levels & afterload) nitrates & diuretics
41
how to treat decompensated HF & cardiogenic pumonary edema (lung = buckets - faucet, pump, emptying hose)
``` dec preload (nitro & loop diuretic/lasix) dec afterload (nitro, ACEI) ``` inc contractility of pump (LV) - inotrope (dopamine, dopamine), only for HoTN/shocky pt:
42
best therapy for decompensated HF
Non-invasive ventilation (improves O2 & gas exchange and dec preload and afterload
43
Prinzmetal angina - Phys - Rx
- caused by coronary artery spasm, not occlusion | - CCB, such as diltiazem or verapamil are mainstay (nitrates also effective)
44
who to Screen for AAA - size - MC site
- US Preventative Services Task Force: 1x screening for AAA by US in men ages 65 to 75 years who have ever smoked - > 3cm - infrarenal
45
most common drugs that can cause SA node dysfunction or sick sinus syndrome
CCB, BB, antiarrythmics, ACh inhibitors
46
Sources of cholesterol
All animal based foods contain cholesterol in varying amounts. Major dietary sources of cholesterol include cheese, egg yolks, beef, pork, poultry, fish, and shrimp.
47
phytosterols - examples - why important
cholesterol-like compounds called maufactured by plant-based products - avocado, flax seeds, peanuts - compete with cholesterol for absorption in the intestines, reducing the absorption of both dietary and bile cholesterol.
48
electrocardiographic findings is classically associated with acute pericarditis?
Diffuse ST segment elevations
49
Causes of ST elevation x4
ST elevation MI (STEMI), early repolarization pericarditis left bundle branch block.
50
Pericardial friction rub - indicative of? - describe - enhaced by?
- pericarditis - superficial grating or squeaking sound, best heard at the left sternal border, caused by the two layers of the inflammed pericardium rubbing together - when the patient is leaning forward.
51
most common immediate complication following surgical repair of an abdominal aortic aneurysm?
MI (10%)
52
hypertensive emergency - why only lower BP slowly
blood pressure is >180/>120 mmHg + signs of acute organ damage - leave certain areas of the brain without sufficient bloodflow, resulting in watershed infarcts.
53
Atherosclerotic plaque buildup phys
plaques develop in the intima layer of the arteries. The process of plaque formation starts with intimal thickening, then proceeds to intimal xanthoma or fatty streak formation as macrophages accumulate. Building up of extracellular lipids within the intima then occurs, with progression to a fibrous cap atheroma with a lipid-rich necrotic core. When this lesion ruptures, it leads to thrombosis and possible obstruction of blood flow. The lesion can then heal with smooth muscle cells and a collagen-rich matrix.
54
I See All Leads
Inferior - II, III, aVf Septal - V1 V2 Anterior - V3, V4 Lateral - V5, V6, I, aVL, aVR
55
Na restriction in CHF
limit their sodium intake to 2-3 grams
56
PE for HTN
``` PE: ○ Funduscopic exam ○ Presence of S4 ○ Presence of carotid or renal bruits ○ Eval of peripheral pulses ```
57
LVH by EKG - why important?
deepest R in V1, 2 or 3 + Tallest S in V4, 5 or 6... if 35 or > = LVH - indicative of prolonged HTN
58
Secondary HTN - when to think about it? - causes? - MC cause
Abrupt onset ○ Age <30 ○ Uncontrolled HTN on ≥ 3 meds ○ Excessive end organ damage ``` Common etiologies: ○ Renal artery stenosis ○ Cushing syndrome ○ Hyperaldosteronism ○ Aortic coarctation ○ Pheochromocytoma ○ Obstructive sleep apnea ○ Drug induced (chronic NSAID use, OCP) ``` MC renal artery stenosis (2/2 atherosclerosis in older pots)
59
ACEI to treat RAS? Ultimate Rx
yes to unliateral disease no for BIL stenting and angio
60
CABG indications
> 50% of left main | >70% stenosis LAD, RCA
61
INR recs for mechanical valves
aortic 2-3 mitral 2.5-3.5 Aortic & mitral 2.5-3.5
62
indications for AAA repair
symptomatic despite size > 5.5 cm expansion > 0.5 in 6 mo
63
Aortic dissection Rx - Stanford Type A - Stanford Type B
- ascending = surgical emergency - descending: if HD stable q 6 mo CT - both benefit from IV BB & nitroprusside
64
Cor Pulmonale - sx - on EKG - murmur
pulmonary HTN & RHF - often 2/2 COPD - DOE, LE edema, S3 gallop, RUQ tenderness & hepatomegaly - RAD, RVH - tricuspid reg: holosystolic on L sternal border
65
STEMI
STE > 1 mm in 2 continuous leads
66
Venous insufficiency | - sx
brawny skin, pitting edema, itching, pain worse with standing, tibial or medial ulcers
67
Claudication | - sx
2/2 arterial insufficiency | - dec pulses, hair loss, pallor, thick nails
68
thromoangiitis oblierans (Beurger's disease) - what - who
non- atherosclerotic inflammatory disease in small A & V in extremities - pts < 40 with smoking hx
69
EKG changes 2/2 hyperkalemia - Mild hyperkalemia - K > 7
- peaked T | - prolonged PR, QRS, AV conduction delays and loss of P
70
EKG changes 2/2 hypokalemia x3
- prominent U waves - ST depression - T wave flattening
71
Best way to dx valvular vegetation
- TEE
72
Murmurs: - MVP - AS - AR - MS - PDA - ASD - MR
- mid- late systolic click - LATE SEM radiates to carotids & apex - high pitched descrecendo in early diastole - low-pitched, mid systolic with opening snap - continuous, rough, machinery over L pulmonary artery - wide, fixed split S2 - apical holosystolic, radiates to axilla
73
S1 S2 S3 S4
- closing of mitral & tricuspid - closing of atrial & pulmonic - ventricular gallop (during LV filling, compliant LV), may be seen with SHF - atrial gallop (during LV filling in non-compliant LV), may be seen with DHF
74
CAD & Chronic HF med recs X6
``` statin BB ASA ACEI diuretic nitro ```
75
Splitting of S2 - physiologic - Paradoxical (and MC cause) - fixed split
- occurs on inspiration - occurs on expiration ( LBBB) - ASD and RV failure
76
3 drugs for diabetetic (high risk of CAD)
ASA, statin, ACEI
77
3 drugs for secondary prevention of STEMI (had prior MI)
ASA, BB, ACEI
78
diastolic dysfunction
decreased ventricular COMPLIANCE leads to inabilitiy to draw blood from LA to LV often in setting of LVH (normal EF)
79
Beck's triad 2/2
HoTN Distant heart sounds JVD -Cardiac tamponade
80
MC cause of cardiomyopathy worldwide
Chagas disease | - 2/2 protozoan parasite Trypanosoma cruzi
81
coxackie B virus
RNA enterovirus associated with acute mycoarditis & pericarditis
82
HF Classification I to IV
I - no limitation of physical activity II - mild symptoms with ordinary exertion III - Marked limitation with activity IV - Symptomatic at rest
83
drugs x2 to prevent monomorphic VT in pt with cardiac disease (if QT normal)
Amiodarone | Sotalol
84
Most toxic SE of Amiodarone - less serious SE
puomary toxicity - corneal deposits, photodermatitis, peripheral neuropathy
85
minimum target INR & duration before cardioversion
> 1.8 for 3 weeks
86
First degree Heart Block
fixed & prologed PR interval (> .2 sec)
87
Second Degree Heart Block Type I Type II
- Wenckebach long, long, drop | - fixed PR and occosainal dropped beat
88
Criteria to dx Metabolic Syndrome in men | Must have Atleast 3 of 5:
``` BP > 130/85 waist > 40 HDL < 40 Fasting BS > 100 TG > 150 ```
89
Cilostazol
Phosphodiasterase inhibitor used to manage claudication
90
indications for Holter monitoring
Suspected tachy inducuced cardiomypathy Dec systolic function after MI (to determine risk of death) asymptomatic afib to see about anticoagulant non- life threatening arrythmias if symptomatic
91
ACLs Rx for symptomatic bradycardia
Atropine | Pacing if ineffective
92
Cardiac Syndrome X
classic angina CP, treadmill test with ischemia & normal coronaries by cath
93
3 electrolyte abnormalities that increase risk of Dig toxicity
hypomag hypoK hypercalcemia Dig increase intracellular Na >> drives Calcium into heart >> inc contractility
94
Delta wave on EKG
slurring of QRS upstroke | Seen in Wolf Parkinson White
95
Most common cause of restrictive cardiomyopathy
Amyloidosis
96
Dromotropy
Conduction velocity of AV node
97
ACLS for SVT
- carotid massage or vagal - then Adensoine - then CCB or BB - cardiovert if HD unstable
98
symptoms of Dig toxicity
PVS, lifethreatening arrhythmia, symptomatic bradycardia GI - anorexia, N/V, diarrhea Neuro - lethargy, confusion, dizziness, changes in visual acuity
99
Patients with Congenital Bcuspid aortic valven have increased risk for - risk for offspring to have disease
- thoractic aortic aneurysms | - 30%
100
Explain QT interval
beginning of QRS (V depol) to end of T (V repol)
101
Torsades
Polynmorphic WIDE complex tachycardia with a twisting of the pointes
102
Venous Hum
systolic murmur over BIL upper sternal borders that disppears when jugulars compressed (benign condition)
103
Takotsubo cardiomyopathy
stress induced - presents like MI but w/o coronary stenosis - apical ballooning - treat same as MI 2/2 CAD

PANRE 2021 - JLI (12 decks)

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