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Cram the PANCE trigger words Cardio Flashcards

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1
Q

what kind of heart failure has decreased Ejection fraction

A

systolic heart failure

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2
Q

which heart failure has an S4 heart sound

A

Diastolic heart failure

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3
Q

Where does the blood COME from on the left side of the heart

A

the lungs

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4
Q

where does the blood COME from on the right side of the heart

A

the body

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5
Q

which heart failure presents with dyspnea, pulmonary edema and congestion

A

Left sided heart failure

because blood is backing up into the lungs

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6
Q

s/s of right sided heart failure

A

peripheral edema
jugular venous distention
hepatic congestion

beucase blood is backing up into the “R”est of the body

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7
Q

what is the MC type of cardiomyopathy

A

dilated

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8
Q

what type of heart failure happens in dilated cardiomyopathy. What will you see on PE for this

A

systolic
Will see S3 heart sound

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9
Q

what are the 6 Ds of cardiomyopathy causes

A
  • drinking
  • Dunno (idiopathic, MC)
  • deficiency (B1)
  • Drugs (cocaine)
  • doxorubicin
  • Disease (viral)
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10
Q

treatment for dilated cardiomyopathy

A

BASH that heart to make it beat harder!!
BB
ACEI
Spirinolactone
Hydralizine + Nitrate

can also add loops and digoxin for s/s but these are the only 4 that decrease mortality

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11
Q

what type of HF is restritive cardiomyopathy.

A

diastolic

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12
Q

Etiologies of restrictive cardiomyopathy

A
  • Amyloidosis (MC)
  • sarcoidosis
  • Hemachromatosis
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13
Q

what is the presenttion of restrictive cardiomyopathy

A

Restrictive = Right sided symptoms
so:
hepatomegaly
JVD
Peripheral Edema
Kussmauls sign

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14
Q

what is kussmaul sign

seen in restrictive cardiomyopathy

A

Increased JVD on inspiration

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15
Q

Trigger word: apple green birefringence on staining of biopsy

A

Restrictive cardiomyopathy.

“i am restricted from eating sour green apples”

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16
Q

Treatment for restrictive cardiomyopathy

A

treat underlying cause

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17
Q

Inheritence for HCM

A

autosomal dominant

causes mutation of sarcomere gene

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18
Q

what kind of HF is HCM

A

diastolic

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19
Q

Murmur for HCM

A

harsh SYSTOLIC murmur at LSB

LOUDER with standing/valsalva
QUIETER with squatting and leg raise

i think of a child standing and shouting (valsalva) for HCM to think of what makes it louder

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20
Q

Treatment for HCM

A
  • BB (preferred)
  • CCB (diltiazem or verapamil)

slow down the heart rate to allow complete filling of ventricle.

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21
Q

where is blood shunting to/from in CYANOTIC conditions

A

from the right to the left side of the heart

non-oxygenated to oxygenated which causes oxygen deficient blood going to the body

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22
Q

noncyanotic shunting to/from where

A

left side of heart TO right side of heart

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23
Q

what is eisenmeingr syndrome

A

when a non-cyanotic shunt becomes a cyanotic shunt secodndary to increased pressure on the right side of heart.

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24
Q

which conditions are cyanotic

A
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25
what is Atrial septal defect
26
MC type of ASD
secondum ASD aka ostium secondum
27
Trigger: which congenital heart disease presents with a wide-fixed split S2
ASD
28
treatment of ASD
observation unless >5mm then surgery
29
what is the MC congenital heart disease of childhood
ventricular septal defect
30
MC type of ventricular septal defect
perimembranous VSD
31
what is the murmur for VSD
high pitched holosystolic murmur at lower left sternal border
32
Treatment for VSD
observation, surgery if large.
33
Ventricular septal defect pnuemonic
Very Sharp Dagger CHOPS a hole in your ventricular septum.
34
What is the 4 parts of tetralogy of fallot
* Righ ventricular outflow obstruction (pulm stenosis) * Right ventricular hypertrophy * overriding aorta * ventricular septal defect.
35
Key presentation of Tetralogy of fallot
tet spells (severe sudden episodes of cyanosis)
36
murmur for tetralogy of fallot
harsh systolic ejection murmur at LSB.
37
Trigger: what presents with a boot shaped heart on chest Xray
tetralogy of fallot
38
what is the treatment of tetralogy of fallot
* surgery (within 1 year) * prostaglandins until surgery to keep PDA open
39
Pneumonic for Tetralogy of fallot key points
Patients with ToF *CRRAAVE* oxygen
40
what is Coarctation of Aorta
narrowing of the aorta just past the subclavian artery
41
What are the associated defects with coarctation of the aorta
1. bicuspid aortic valve 2. turners syndrome
42
Trigger: Hypertension in upper extremities with hypotension in lower extremities | congenital heart disease
coarctation of the aorta
43
Trigger: CXR with posterior rib notching and figure 3 sign | congenital heart disease
coarctation of the aorta
44
treatment for coarctation of the aorta
* surgical intervention * prostaglandins until surgery
45
what is the patent ductus arteriosus
46
Trigger: continuous machine like murmur | congenital heart disease
patent ductus arteriosus
47
treatment for PDA
* NSAIDs (ibuprofen, indomethacin) * surgery if doesnt work
48
MC valve for endocarditis
* Mitral * UNLESS IV drug user = Tricuspid | wanna TRI drugs??
49
MC organism for endocarditis
Staph Aureus | Prosthetic valve = staph epidermitis
50
Alrighty tell me about clinical manifestations of endocarditis
FROM JANE: Fever Roth spots Osler nodes Murmur (new onset) Janeway lesions Anemia Nailbed hemmorrhages Emboli
51
Tell me what these are: Janeway lesions Osler Nodes Roth Spots
Janeway lesions: painless lesions on the palms/soles Osler nodes: painful (OW = Osler) lesions on hands/feet roth spots: pale retinal lesions/hemorrhages on fundoscopy
52
What is the diagnostic criteria for endocarditis
53
what is the tx for endocarditis
Native valve: Nafcillin + rocephin Prosthetic valves: Vanc + Gent + rifampin
54
what is the prophylaxis for endocarditis
Amoxicillin Clindamycin if PCN allergy | respiratory tract procedure, oral procedure, I&D
55
MCC of secondary HTN
Renovascular (renal artery stenosis)
56
How do you stage and diagnose HTN
Remember HTN starts at 130-139/80-89
57
Compare HTN treatment in uncomplicated/non african americans vs african americans vs diabetics vs CKD vs patients w heart failure
58
define hypertensive urgency vs emergency
BP of systolic >180 OR diastolic >120 Urgency = no end organ damage Emergency = end organ damage
59
tx of hypertensive urgency
decreased MAP by 25% in 24-48 hrs using ORAL agents (clonidine, nifedipine, captopril)
60
tx of hypertensive emergency
reduce MAP by 10-20% in first hour and then 5-15% in 24 hours using IV meds (nicardipine, labetalol, esmolol, and nitroprusside)
61
Which IV antihypertensives are preferred in cardiovascular hypertensive emergencies
esmolol or labetelol
62
which IV antihypertensives are preferred in neurovascular hypertensive emergencies
Nicardopine and clevedipine
63
What are exceptions for treatment in hypertensive emergency
1. Ischemic stroke - dont treat. want to keep BP high to increase flow to area. 2. Acute Aortic Dissection - Decrease BP rapidly to 100-120 systolic in 20 minutes. 3. intracerebral hemmorhage - decrease BP rapidly.
64
ACE's suffix
pril
65
Adverse reaction for ACEI
* cough * hyperkalemia * angioedema * hyperuricemia (GOUT)
66
what is the ACEi pneumonic
67
ARBs suffix
sartan
68
ARB adverse reactions
hyperkalemia hyperuricemia EXCEPT losartan which has been found to LOWER uric acid
69
70
what is the MC used thiazide diuretic
HCTZ
71
adverse reactions for thiazide diuretics
* hyponatremia * hypokalemia * Thiazides cause GLUCOSE to be oh so elevated (hyper glycemia, lipidemia, uricemia, and calcemia) ## Footnote electrolyte abnormalities becasue thiazides MOA is inhibit sodium uptake in kidneys
72
73
Adverse reactions for potassium sparing diuretics | spirinolactone
hyperkalemia gynecomastia decreased libido erectile dysfunction
74
Trigger: which antihypertensive class has a SE of ototoxicity
loop diuretics
75
Adverse reactions for loop diurectics
OTOTOXICITY * hypokalemia, hypomagnesemia, hypocalcemia, hypochloremia, hyponatremia * hyperglycemia, hyperuricemia.
76
How do you determine which CCBs affect the AV node vs which ones only vasodilate
Diltiazem and Verapamil Decrease Velocity of the heart. other CCBs only vasodilate
77
Adverse reactions for CCB
Peripheral edema Constipation | Blockers = constipation, "P"lockers = peripheral edema
78
Where are Beta 1 receptors vs Bets 2 receptors
B1: heart (only have one heart) B2: lungs (have 2 lungs)
79
How to remember cardioselective vs non-cardioselective BBs
Cardioselective BB's are VERY selective and direct like a BEAM of light * bisoprolol * Esmolol * Atenolol * Metoprolol
80
who do you avoid nonselective BBs in
asthmatic patients COPD patients
81
which BB's affect B1+B2+alpha receptors
Carvedilol and Labetalol because they could *C*are *L*ess which receptors they affect
82
Adverse reactions of BBs
masks hypoglycemia symptoms | biggest one
83
what population is MC for alpha 1 blockers
HTN + BPH
84
what are the Alpha 1 blockers
all end in Zosin
85
what is the weird adverse reaction for alpha 1 blockers
1st dose syncope/hypotension
86
what is acute decompensated HF presentation
sudden worsening of heart failure symptoms (dyspnea, peripheral edema, fatigue)
87
what is the treatment of acute decompensated HF
LMNOP Lasix Morphine Nitro Oxygen Prop up the Patient
88
what are the two oddball murmurs that increase intensity with standing and valsalva
HCM and Mitral Valve Prolapse | everything else gets quieter
89
EKG changes in MI over time
90
MCC of mitral Stenosis
rheumatic heart disease
91
which murmur has an opening snap
mitral stenosis and tricuspid stenosis. | MSOS (mitral stenosis opening snap)
92
systolic ejection click is present in which murmur
mitral valve prolapse
93
I know theres alot more on murmurs, but i refuse.
so if youre extra like that, go off queen.
94
presentation of unstable angina
chest pain, symptoms at rest, not relieved with nitro, negative trops but some signs of ischemia on EKG like st depression or t wave inversion
95
Presentation of NSTEMI
presents like unstable angina except it has POSITIVE cardiac enzymes. ## Footnote chest pain, symptoms at rest, not relieved with nitro, some signs of ischemia on EKG like st depression or t wave inversion
96
Presentation of STEMI
chest pain, symptoms at rest, not relieved with nitro, positive cardiac enzymes and ST elevation
97
Most sensitive and specific cardiac enzyme
troponin
98
when would you use CK/CKMB over troponin
to assess for reinfarction soon after a recent MI. | CK returns to baseline after 72 hours
99
benefit of using myoglobin
peaks very fast (as little as 2 hours). | not commonly used but could be a factoid question ## Footnote "my oh my, myoglobin is fast"
100
what are the important timeframes for MI
* EKG within 10 minutes * Door to PCI in 90 minutes
101
EKG changes in MI over time
102
TX for ACS
MONA first then BASH Morphine Oxygen (if <95) Nitro (NOT IN HYPOtension) Aspirin BB ACEi Statin Heparin
102
TX for ACS
MONA first then BASH Morphine Oxygen (if <95) Nitro (NOT IN HYPOtension) Aspirin BB ACEi Statin Heparin
103
What do you call post MI pericarditis
Dressler syndrome
104
tx for dressler syndrome
Colchicine or Aspirin
105
105
what is the pneumonic for remembering what the causes of AV node blocks are?
106
Presentation of first degree AV block
Prolonged PR interval | >200ms (1 big box)
107
tx of 1st degree AV block
asymptomatic: none Symptomatic: pacemaker
108
Second degree type 1 AV block presentation
longer, longer, longer drop. now you got a wenckebach. "W"enckebach and "W"on so you know its type 1
109
tx of second degree type 1 AV block
Asymptomatic: none Unstable/symptomatic: atropine If atropine doesnt work, pace and then pacemaker. | tx underlying too
110
presentation of second degree type 2 AV block
occasional dropped beats with a normal PR interval
111
tx of second degree type 2 AV block
Stable: close monitoring, pacing pads in place Unstable: cardiac pacing, dopamine/dobutamine/epi. | will need pacemaker
112
presentaion of 3rd degree AV block
P waves and QRS complexes are beating independent of eachother.
113
tx of 3rd degree AV block
stable: pacer pads ready for unstable unstable: atropine and pacing then pacemaker
114
Describe EKG with Multifocal atrial tachycardia
>100bpm with at least 3 different P wave morphologies
115
describe the EKG of wolf parkinson white
1. Delta wave 2. short PR interval 3. Wide QRS complex
116
what is the first line pharm tx for postural/orthostatic hypotension | after ilfestyle changes
fludrocortisone
117
what is quinke's pulse
capillary pulsation in the fingertips or nailbeds seen in aortic regurgitation | "quinky in the pinky"

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