CV Flashcards
(74 cards)
1
Q
Can abdominal aortic aneurysms be identified with plain film x-rays?
A
50% can be identified with plain film imaging (d/t calcification at the site of a focal bulge) however CT scan should be performed to confirm the diagnosis
US is the best at detecting
2
Q
What ECG changes are present in pericarditis?
A
- ) ST Elevation
2. ) PR Depression
3
Q
What value designates a high risk in hsCRP?
A
> 3.0mg/L
4
Q
Describe the different degrees of AV nodal heart block. What ECG findings can be noted?
A
First Degree
a. ) Consistent, Prolonged PR interval (>0.2 sec) b. ) There is a 1:1 ratio of P:QRS waves
Second Degree Mobitz Type-I
a. ) Progressive PR interval prolongation with each beat until a P wave is not conducted (Wenckebach Phenomenon) b. ) Usually asymptomatic
Second Degree Mobitz Type-II
a. ) Normal P wave intervals with intermittently absent QRS complexes b. ) Irreversible, requiring a pacemaker c. ) If left untreated, it may lead to complete heart block
Third Degree, Complete Heart Block
a. ) No action potential conducts through the AV node b. ) Ventricles never see action potentials generated by the atria. The ventricles compensate by making action potentials on their own. However, ventricles are unable to create action potentials fast enough so the ventricular rate (QRS complex) is slow (30-40 per min) in comparison to the atrial (P wave) rate (60-100 per min) b. ) AV disassociation. P waves occur at one rate and the QRS complex occurs at another
5
Q
What is the diagnostic test used for Carotid Stenosis?
A
Carotid Artery Duplex Ultrasonography
However, Carotid Magnetic Resonance Angiography is more specific and sensitive
6
Q
How can you differentiate Subendothelial MIs from Transmural MIs on an ECG?
A
- ) Subendothelial MIs are NSTEMIs demarcated by ST depression
- ) Transmural MIs are STEMIs demarcated by ST elevation & the presence of a Q wave
7
Q
What is the best screening study for vasculitis?
A
Ultrasound
However, MRA is the most sensitive test
8
Q
How does hyperkalemia and hypokalemia affect an ECG reading?
A
Hyperkalemia = Wide P, QRS & Peaked T wave Hypokalemia = Flat T wave & U wave is present
9
Q
What is a notched p wave on ECG indicative of?
A
Left Atrial Enlargement from Mitral Stenosis
10
Q
How does hypercalcemia and hypocalcemia affect an ECG?
A
Hypocalcemia = Long QT Hypercalcemia = Short QT
11
Q
What imaging modality is the gold standard in acute intracranial aneurysm identification?
A
CT Scan
12
Q
What is the most important test for infective endocarditis?
A
Blood Culture
13
Q
In the first 6 hours what test is the gold standard in identifying an MI?
A
ECG (because troponin I + T do not reach peak concentration until 12 hours)
14
Q
Endocarditis requires what testing?
A
Blood cultures and echocardiogram (shows vegetations)
15
Q
What is the best test for detecting an Aortic Dissection?
A
CT
16
Q
What are the clinical features of DVT?
A
- ) Unilateral leg edema, erythema, warmth, and tenderness
- ) Palpable cord (thrombosed vein)
- ) Phelgmasia cerulea dolens (painful blue edema) occurring with massive thrombosis
NOTE: Homan’s sign (pain with foot dorsiflexion) is unreliable
17
Q
A systemic vasculitis characterized by the deposition of IgA immune complexes. The condition generally resolves within several weeks.
A
Henoch-Schonlein Purpura
18
Q
What symptoms are very concerning in a patient with DVT?
A
Change in consciousness and dyspnea
19
Q
What pressure demarcates pulmonary hypertension?
A
> 25 mmHg
Normal pulmonary pressure is 10 mmHg
20
Q
What is polyarteritis nodosa?
A
A medium vessel vasculitis causing ischemia of tissues supplied by the respective blood vessels (skin, heart, kidneys).
Polyarteritis nodosa can cause glomerulonephritis, MI, thrombosis, and tissue necrosis
21
Q
What is Virchow’s Triad?
A
Virchow’s Triad describes the three broad risk factors necessary for thrombus formation:
- ) Hypercoagulability
- ) Hemodynamic changes (stasis, turbulence)
- ) Endothelial injury
22
Q
Intermittent claudication has what brachial to ankle ratio?
A
< 0.6
23
Q
What are the 3 most common causes of Aortic Stenosis, in order of prevalence?
A
- ) Calcific Stenosis later in life
- ) Congenital bicuspid valve
3) Rheumatic Heart Disease
24
Q
What 3 pathologies increase HDL?
A
- ) Alcoholism
- ) Nephrotic syndrome
- ) Pancreatitis
25
Describe why cholesterol accumulates with vitamin C deficiency
Vitamin C is a cofactor for 7-alpha hydroxylase, the first and commiting step in bile formation.
No Vitamin C = No 7-alpha hydroxylase = No bile formation = No cholesterol excretion
26
Where is the most common site for a Cerebral Vascular Accident (CVA)?
Middle Cerebral Artery (causing contralateral paralysis and aphasia)
27
What are the causes of non-ANCA associated small vessel vasculitides?
1. ) Paraneoplastic Small Vessel Vasculitis
2. ) Inflammatory Bowel Disease
3. ) Immune Complex Small Vessel Vasculitis
a. ) Henoch-Schonlein Purpura & Cryglobulinemia
b. ) SLE, RA, Sjogren's Syndrome
c. ) Drug or Infection-induced immune complex vasculitis
d. ) Behcet's disease
28
1. ) What are the primary dermatologic findings associated with vasculitis?
2. ) What are the primary pulmonary findings associated with vasculitis?
1. ) Palpable Purpura & Urticaria
| 2. ) Interstitial Lung Disease & Pulmonary hemorrhage
29
What population group is most likely to experience Primary Pulmonary HTN
Young Adult Females
Note: primary pulmonary HTN is idiopathic but believed to be hereditary
30
Describe differences between Chronic Venous and Arterial Insufficiency
i. ) Pulse
ii. ) Colour
iii. ) Skin Temp
iv. ) Edema
v. ) Skin condition
vi. ) Ulceration
i.) CVI = pulses intact
CAI = pulses absent or decreased
ii.) CVI = cyanosis; brown pigmentation
CAI = pale skin (especially when raised)
iii.) CVI = normal temp
CAI = cold to touch
iv.) CVI = Pitting edema
CAI = none or mild
v.) CVI = stasis dermatitis; lichenification
CAI = thin, atrophic, shiny skin with loss of hair
vi.) CVI = medial leg ulceration, painless
CAI = points of trauma can progress to gangrene
31
What are the 2 major signs of Aortic Dissection?
1. ) Severe chest pain that lasts for many hours and is not related to anything
2. ) Blood pressure is different in both arms
32
An aneurysm of what size infers a 75% risk of rupture?
>7cm
33
An ankle-to-brachial artery index of less than _____ indicates arterial occlusive disease
<0.85
34
What is the most common arrhythmia?
Premature Ventricular Contractions
35
What fruit is good for vascular integrity because it contains anthocyanidins
Blueberries
36
What is the Diagnostic Criteria for Metabolic Syndrome (WHO)
Any one of:
i. ) DM-2
ii. ) IFG
iii. ) Insulin Resistance
Plus any 2 of:
a. ) BP >139/89 (stage 1 HTN)
b. ) Dyslipidemia (TG >1.7, HDL <0.9)
c. ) Central Obesity (waist-to-hip >0.85 in women, 0.9 in men)
d. ) Microalbuminuria >20mg/min (ACR>30)
37
What is considered a hypertensive crisis?
>180/120 mmHg
38
Premature Atrial Contraction
1. ) What is PAC? 2.) Risk Factors?
3. ) Sequelae? 4.) Prognosis?
1. ) One beat occurs early, irregularly on ECG but other features are normal (PR is variable but QRS is normal)
2. ) Risk factors = Caffeine intake, Stress, Alcohol/Cocaine/Amphetamine use
3. ) Sequelae = Atrial fibrillation
4. ) Prognosis is good - often remains asymptomatic.
39
An aneurysm is a dilation in one segment of an artery that is due to a defect in the ____________, which may lead to a ____________ if ruptured.
An aneurysm is a dilation in one segment of an artery that is due to a defect in the tunica media, which may lead to a subarachnoid hemorrhage if ruptured.
It usually occurs at major branching points of arteries
40
What is the main cause of Mitral Stenosis?
Rheumatic Heart Disease
41
On auscultation, what is heard in aortic stenosis?
1. ) Systolic ejection murmur (crescendo-decrescendo) at the 2nd right intercostal space
2. ) Aortic Stenosis murmurs can also often be heard over carotid arteries
42
On auscultation, what is heard in aortic regurgitation?
A Diastolic decrescendo mumur heard with the diaphragm at the LLSB with the patient sitting forward and exhaling
43
Describe the signs and symptoms of Left Heart Failure
Orthopnea & Dyspnea with Rales & Frequent lung infections
Forward deficit = due to reduced Left ventricular emptying -> kidney hypoxia & brain hypoxia
Backward Deficit = causes fluid buildup in the lungs resulting in orthopnea, dyspnea, and frequent infections. The backload pressure may stress the right ventricle & cause RHF
44
1. ) Atrial fibrillation is almost always due to?
2. ) What are the signs and symptoms of atrial fibrillation?
3. ) What are the sequelae?
1.) A Heart pathology
2. ) Signs & Symptoms
a. ) Loss of normal atrial contraction with some irregular impulses
b. ) sawtooth atrial contraction with QRS complexes irregularly spaced but normally configured
c. ) R-R intervals change all the time
3.) Sequelae: systemic emboli
45
What are the main symptoms of Mitral Stenosis?
1. ) Shortness of Breath & Orthopnea
| 2. ) Dyspnea on exertion
46
Why do people with a ventricular septal defect have pulmonary hypertension?
Blood is shunted from the high-pressure systemic circulatory system into the normally low-pressure pulmonary circulation. This raises the overall pressure and leads to pulmonary hypertension
47
What extra-cardiac symptoms are usually present in endocarditis?
1. ) Petechiae on the conjunctiva or nail beds
| 2. ) Splinter hemorrhages
48
What heart murmur may cause hemoptysis?
Mitral stenosis
Hemoptysis is the second most common presenting symptom of mitral stenosis.
49
On auscultation, what is heard in pulmonic stenosis?
1.) A Systolic crescendo-decrescendo murmur heard in 2nd left intercostal space with diaphragm or bell
50
What are the risk factors for pulmonic stenosis?
1. ) Endocarditis
| 2. ) Pulmonary hypertension
51
What are the 4 findings of tetralogy of fallot?
1.) Pulmonary stenosis
2. ) Right Ventricular Hypertrophy
a. ) From increased pressure from pulmonary stenosis
3. ) Overriding aorta
4. ) Ventricular Septal Defect (right to left shunt)
52
1. ) What is required for the diagnosis of Rheumatic Fever?
| 2. ) What is Rheumatic fever?
1. ) Rheumatic Fever is an acute inflammatory complication associated with cross-reactivity of group A beta-hemolytic streptococcus infection (molecular mimmickry)
2. ) JONES major criteria used (2 positive) plus proof of GAS infection through antistreptolysin O titre or DNAase
Joints - polyarthritis (of large joints)
Carditis - myocarditis that can manifest as CHF with dyspnea or pericarditis with a rub
Subcutaneous nodules - painless, firm collections of collagen fibres over bones or tendons
Erythema marginatum - expanding red macules with central clearing on the trunk or arms
Syndeham's chorea - rapid movements without purpose
53
What symptoms are associated with right ventricle failure?
Dyspnea, Cough, Edema, and possibly Liver disorders
54
What murmur has a water hammer pulse?
Aortic Regurgitation
55
What type of murmur is heard in a ventricular septal defect?
Holocystolic crescendo-decrescendo on systole best heard with the diaphragm at the lower left sternal border
56
On auscultation, what is heard in Mitral stenosis?
A Diastolic opening snap followed by a low-pitch growling murmur heard at apex with BELL
NOTE: use the BELL because the murmur produces a low-pitch growling sound
57
An S4 heart sound is associated with what finding?
Ventricular hypertrophy
The atria are contracting forcefully to overcome an abnormally stiff hypertrophic ventricle
58
What murmur is best heard on inspiration?
Tricuspid stenosis
59
What are the main symptoms of Aortic Stenosis?
1. ) Angina
2. ) Syncope
3. ) Shortness of Breath
4. ) Congestive Heart Failure
60
List the two types of Myocardial Infarctions, and their respective differences
1. ) Transmural infarcts (ST elevation & Q Waves = STEMI)
a. ) Involves the entire thickness of the (generally) left ventricular wall
b. ) 15-30% of cases involve the right ventricle as well
2. ) Subendocardial infarcts (ST Depression = NSTEMI)
a. ) Focal areas of necrosis confined to the inner 1/3-1/2 of the left ventricular wall
61
What age group is most likely to present with pulmonic stenosis?
Usually children
62
On auscultation, what is heard in mitral regurgitation?
A high-pitched (blowing) Systolic murmur heard at the apex with the diaphragm
63
What are the primary causes of Pericarditis?
Infarct, Tumor, Rheumatic fever, Uremia, Bacterial/Viral, SLE, scleroderma
IT RUBS
64
What murmur is heard with the diaphragm at LLSB and the patient sitting forward and exhaling?
Aortic Regurgitation
65
What are the most common symptoms associated with pulmonic stenosis?
Patients are generally asymptomatic
66
Endocarditis is usually caused by what infectious agent?
Staph aureus
Subacute endocarditis is usually caused by streptococcus viridans
67
On auscultation, what is heard in tricuspid stenosis?
A Diastolic rumbling murmur heard at the left lower sternal border with the BELL
Note: the murmur is best heard on inspiration
68
Describe the difference between Thrombophlebitis and Phlebothrombosis
1. ) Thrombophlebitis = venous thrombosis occurring secondary to acute inflammation of the vein; thrombi are adherent to vein's wall; embolism is rare
2. ) Phlebothrombosis = venous thrombosis occurring in the absence of obvious inflammation; thrombi are loosely attached to the vein wall; embolism is common
69
What murmur increases in sound with valsalva?
Mitral Valve Prolapse
70
Describe the signs and symptoms of Right Heart Failure
RHF
a. ) Dilated jugular veins, liver enlargement, Ascites/Edema
b. ) Tachycardia/tachypnea
Forward Deficit = due to reduced right ventricular emptying -> less blood to lungs
Backward Deficit = portal hypertension (hemorrhoids, caput medusae, esophageal varices, splenomegally)
71
What are the major risk factors of aortic stenosis?
1. ) Age (elderly)
2. ) History of Rheumatic Fever
3. ) Congenital bicuspid aortic valves (50% of all cases)
72
What is the classic triad of symptoms related to a worsening aortic stenosis?
1. ) Syncope
2. ) Angina
3. ) Dyspnea on exertion
73
On auscultation, what would you expect to hear in an atrial septal defect?
Split S2 at the 2nd intercostal
There is a split S2 because blood is being shunted towards the lower-pressured pulmonic circulatory system causing a delayed closure of the pulmonary valve
74
An S3 heart sound is associated with what condition?
Congestive Heart Failure
