chapter 4 cards

Question 1

becks triad

Answer 1

distended neck veins
muffled heart sounds
hypotension

alteration of QRS complexes in 2:1 = electrical alternans
increased pulsus paradoxus = mean drop of 15+ mmhg w/ inspiration
seen in cardiac tamponade

Question 2

ekg changes in MI

Answer 2

flat T waves/inverted T waves
ST elevation = infarct
depression = ischemia
q waves

Question 3

how to dx MI

Answer 3

troponin levels every 8 hours 3x
cardiomegaly/pulmonary congestion
LV motion abnormalities
diaphorectic, tachycardic, tachypneic, N/V, BL pulmonary rales, distened neck veins, new S3 or S4, new murmurs, hypotension, shock
hx of angina or chest pain, arrhythmias, murmur, hypertension , diabetes, digoxin, furosemide, other cardiac meds

Question 4

tx MI

Answer 4

admit to ICU/CCU
early reperfusion is time from onset of s/s <12 hrs
early perfusion <6 hours = fibrinolysis or baloon angioplasty or stent

EKG monitoring, if vtach - give amio.

Give O2 <90

pain control w/ morphine. which can help w/ pulm edema

aspirin + nitroglycerin + BBs + clopidogrel + LMWH + ACEI WITHIN 24 hours + statin

Question 5

when to give heparin in chest pain?

Answer 5

unstable angina
cardiac thrombus
severe CHF

don’t give if active bleeding

Question 6

achalasia
esophageal spasm

negative w/u of MI

Answer 6

botox + pneumatic dilation for achalasia

esophageal spasm - CCB

surgical myomotomy

Question 7

URI preceding chest pain
low grade fever
diffuse ST elevation
ESR is elevated
low grade fever is present!!
relieved by sitting forward

Answer 7

viral percarditis

TB uremia malignancy coxsackie lupus

Question 8

pneumonia

Answer 8

pleuritis

Question 9

severe tearing pain to back
hypertension
marfans syndrome

Answer 9

aortic dissection

Question 10

blunt chest trauma

Answer 10

aortic laceration or speudoaneurysm

Question 11

stable angina

Answer 11

exertion
reproducible
beter w/ rest
pressure/squeezing to shoulders
acc by dyspnea, diaphoresis
relieved by nitro
ST depressed
normal if no pain
relieved with SL nitroglycerin

Question 12

unstable angina

Answer 12

change from prior
at rest or in greater frequency
normal CK or minimally elevated

EKG: ST depression + prolonged chest pain W/O improvement w/ nitro
TX is similar to that for M

1) O2, nitro, aspirin
2) bb, clopidogrel, heparin, duap, aceI

if pain not resolving? emergent PT CA

Question 13

variant prinzmetal angina

Answer 13

pain at rest not related to exertion
early morning or at middle of night
ST elevations but normal CK

tx w/ nitro and LT CCB to reduce spasm

Question 14

silent MI

Answer 14

chf, CONFUSION, delirium = w/o pain

seen in old and diabetes

Question 15

MS

Answer 15

rheumatic fever

dyspnea, orthopnea, PND

Question 16

MR

Answer 16

rheumatic fever

post MI chordae tendinae rupture

Question 17

AS

Answer 17

bicuspid valves w/ sx in childhood
dyspnea on exertion
elderly only 
agina, syncope, CHF
highest mortality = if CHF present

Question 18

AR

Answer 18

congenital rheumatic
endocarditis
aortic dissection/root dilation
marfans

(cream)

dyspnea, pulm congestion, shock
DOE, orthopnea, PND

Question 19

late diastolic BLOWING murmur at apex with opening snap, loud S1
afib + pulm HTN

Answer 19

MS
tx w/ baloon valvutomy or surgery
diuretics, digoxin, BB are sx tx

Question 20

soft S1, LAE, pulm HTN, LVH

Answer 20

MR
tx if flail leaflet, or severe regurgitation
hydralazine + nitroprusside = vasodilator

Question 21

hard systolic murmur radiation to caortids
slow carotid upstroke
s3 and s4
ejection click
LVH, CM

Answer 21

AS

tx w/ TAVR if symptomatic

Question 22

early diastolic decrescendo
wide pulse pressure
S3

Answer 22

AR
tx w/ TAVR if symptomatic + chronic
or if asymptomatic w/ LV enlargement

tx w/ vasodilators

Question 23

mid systolic click, late systolic murmur

panic d/o

Answer 23

MP

Question 24

right HF

Answer 24

long standing MS

Question 25

ENDOCARDITIS PPX

Answer 25

only dental procedures if prosthetic cardiac valves, prior endocarditis, congential heart disease (cyanotic, shunts, residual defects), cardiac transplants ABX w/ amoxicillin prior to procedure only one dose

Question 26

virchows triad

Answer 26

3 findings! | endothelial damage, hypercoagulable, venous stasis

Question 27

DVT

Answer 27

surgery malignancy trauma pregnancy OCP DIC factor 5 lelilden, AT 3, P C/S, PTT mutation, hyperhomocysteinemia aps

Question 28

DVT S/S

Answer 28

UL leg swelling, tenderness homans superficial palpable cords = superficial thrombophlebitis = not a RF (erythema/tenderness) for PE = can be a/w pancreatic cancer or other malignancy. TX: nsaids + warm compress venography if not clear (as oppposed to doppler or impedence test) but invasive

Question 29

DVT TX

Answer 29

Heparin/LMWH --> warfarin bridge 3-6 mo If 1+ DVT, then for life

Question 30

DVT PPX

Answer 30

If surgery: early ambulation if low risk if moderate risk, LMWH, low dose UFH, fondaparinaux if high risk, LMWH, fondaprinaudx, or vitK antagonist if bleeding: compression stockings

Question 31

PE?

Answer 31

tachycpnea chest pain hemoptysis hypotension sycnope death wedge shaped defect right heart strain

Question 32

DVT cannot lead to stroke unless?

Answer 32

ASD/VSD/, PFO, Fistula ARTERIAL INFARCTS? afib, CHF, endocarditis, aneurysm can cause arteriral infarcts = renal infarcts/stroke

Question 33

If V/Q scan or CTPA is indeterminate for PE?

Answer 33

DO pulmonary angiogram conventional

Question 34

If low probability VQ but high likelihood?

Answer 34

pulmonary angiogram

Question 35

how to treat PE???

Answer 35

LMWH or IV UFH switch to oral warfarin for 3-6 mos if recurrent clots or CI: DO IVC FILTER if massive PE: do embolectomy or TPA

Question 36

most impt SE of heparin

Answer 36

non-immune thrombocytopenia (slight fall in 2 days w/ quick return) HIT type 2(AB against PF4, immune mediated, 50% drop 5-10 days post heparin therapy. arterial and venous thrombuses) Confirm w/ functional assay Measure CBCs

Question 37

aspirin - give platelets heparinLMWH - protamine warfarin - FFP, clotting factors, or vit K (longer)

Answer 37

how to reverse anticoagsss

Question 38

bleeding tendency w/ normal anticoag tests?

Answer 38

steroids + vit C def

Question 39

Chronic CHF tx

Answer 39

Na restriction ACEi BB DIURETICS DIGOXIN

Question 40

Acute CHF tx

Answer 40

inpatient: O2, diuretics, positive inotropics ``` stable = digoxin unstable = dobutamine, milrlinone ```

Question 41

what precipitators exacerbation CHF

Answer 41

noncompliance w/ diet or meds | MI, severe HTN, arrhythmia, fever, infection, PE, anemia, thyrodi issues, myocarditis

Question 42

Corpulmonale

Answer 42

``` RVH due to lung disease COPD, PE if young women = idiopathic pulm HTN sleep apnea!!!! tachypnea, cyanosis, loud P2, S4 ``` tx: prostacyclin, epoprostanal, viagra, bosentan heart lung transplant

Question 43

restriictive CM

Answer 43

AMYLOID, SARCOID, HEMOCHROMATOSIS, myocardial fibroelastosis abnormal bx

Question 44

constrict pericarditis

Answer 44

``` pericardial knock calcification normal ventricular biopsy S4, right sided HF = jvd, peripheral edema restrictive CM ``` need to remove constrictive via surgery

Question 45

dilated CM

Answer 45

chronic CAD causes it | alcohol, myocarditis, doxorubicin

Question 46

asymmetric LVH diastolic dysfunction systolic ejection murmur on LSB but increases w/ standing and valsalva due to less volume of blood in LV tx w/ BB or disopyrimide to allow more time for ventricles to fill

Answer 46

digoxin, diuretics, vasodilators are CI

Question 47

afib

Answer 47

sx: BB, CCB, digoxin if <24 hrs: cardioversion w/ amio, procainamide, or desynch if chronic: anticoagulate, then cardiovert if recurrence: warfarin + rate control meds

Question 48

if aflutter

Answer 48

tx like afib + vagal maneuvers = carotid massage

Question 49

sinus tachycardia

Answer 49

check TSH

Question 50

``` chads score chf htn age 75 2+ DM S2 - stroke or TIA 2+ v -vascular disease a - 64+ f - female ```

Answer 50

1 = asa | 2 + = oral anticoag

Question 51

WPW?

Answer 51

child becomes dyspneic and recovers transient arrhytmia via accessory pathway delta waves tx: RF catheter ablation of pathway

Question 52

PDA = constant machine like murmur LSB, dyspnea, CHF. tx = indomethacin or surgery last resort. keep open w/ PGE1L

Answer 52

seen w/ high altitude or congential rubella

Question 53

``` TOF pulm stenosis LVH overriding aorta VSD ```

Answer 53

tet spells

Question 54

upper extremity HTN radiofemoral delay systolic murmur over mid upper back rib notching on radiograph + ass w/ turner syndrome!

Answer 54

aortic coarctationsss

Question 55

non cyanotic congenital heart defects

Answer 55

L to R shunts: blood goes back to lung even though O2 VSD ASD PDA D's

Question 56

cyanotic defects

Answer 56

R to L shunts -- no oxygentation ``` truncusu arteriosus = one vessel leaving ventricles transposition of great vessels tricuspid atresia tetralogy of fallot total anamous pulm venous return ```

Question 57

what closes foramen ovale? | what closes ductus arteriosus?

Answer 57

foramen ovale = clamping of cord and decreased pulm vascular resistance due to first breath ductus arterious = oxygen causing low PGE2