Diseases Flashcards
(114 cards)
1
Q
This valvular disease is caused by a narrowing of the mitral orifice.
Sx include….
Dyspnea
Orthopnea
PND
Fatigue
A
MItral Valve Stenosis
2
Q
What is the most common cause of mitral valve stenosis?
What are additional causes?
A
Rheumatic Fever
Lupus
RA
3
Q
What procedure is done to correct mitral valve stenosis?
A
Valvotomy (replace valve)
4
Q
This valvular disease causes a back-flow of blood into the left atrium from the left ventricle.
Sx include…..
Fatigue
Dyspnea
Orthopnea
DOE
A
MItral Regurgitatin
5
Q
T/F: Rheumatic fever is a common cause of mitral valve regurgitation?
A
True
6
Q
In a patient with mitral regurgitation, you should agreesively manage _______ _______ symptoms and consider surgical repair or replacement of the mitral valve.
A
Heart failure
7
Q
This valvular disease is commonly associated with connective tissue disorders and can be largely asymptomatic.
Sx could include…
Pre-syncope
Chest pain
A
Mitral valve prolapse
8
Q
Prophylaxis is used in mitral valve prolapse patient to protect against _________.
A
Endocarditis
9
Q
Surgical repair is indicated in mitral valve prolapse patient is severe mitral ___________ develops.
A
Regurgitation
10
Q
This valvular disease is a narrowing of the aortic valve commonly due to degenerative calcification.
Sx include….
Angina
Syncope
Dyspnea
A
Aortic valve stenosis
11
Q
Is aortic valve stenosis more common in men or women?
A
Men
12
Q
What is a common (85%) EKG finding in patients with aortic stenosis?
A
LVH
13
Q
T/F: Aortic stenosis is primarily managed medically and surgery is only indicated in severe symptomatic cases.
A
True
14
Q
This valvular disease is results in a back-flow of blood from the aorta into the left ventricle due to an incompetent closure of the aortic valve.
Sx include…..
DOE
PND
Orthopnea
A
Aortic Valve regurgitation
15
Q
Would you see expect to see LVH or LAD on an EKG in a patient with Aortic valve regurgitation?
A _______ pattern with one of the above would be concerning.
A
Yes
Strain pattern
16
Q
T/F: Surgery is always indicated in patient with aortic regurgitation
A
False
Only in severe symptomatic cases, EX:declining EF
17
Q
This is a valvular disease in which there is a narrowing of the pulmonic valve and is commonly congenital in nature.
Sx include….
Asymptomatic
DOE
Fatigue
A
Pulmonic stenosis
18
Q
This valvular disease results from an incompetent pulmonic valve that allows blood to flow back into the right ventricle from the pulmonary artery.
Sx include
RHF
Emboli
Pulmonary HTN
A
Pulmonic Valve Regurgitation
19
Q
What are THREE common causes of pulmonic regurgitation?
A
Pulmonary HTN
Pulmonary Artery Dilation
Infectious Endocarditis
20
Q
What may be a common EKG finding in a patient with pulmonic valve regurgitation?
A
RVH
21
Q
This valvular disease results in an obstruction between the right atrium and ventricle and is almost always caused by rheumatic infection.
Sx include….
Fatigue
Edema
Mild PND
A
Tricuspid Valve Stenosis
22
Q
How is tricuspid valve stenosis medically managed?
A
Diuretics prior to valvotomy
23
Q
This valvular disease is commonly caused by right ventricular dilation and results in a back-flow of blood from the right ventricle into the right atrium
Sx include
WORSENING RHF
A
Tricuspid Valve Regurgitation
24
Q
What concerning complication should you mpnitor patients with tricuspid valve regurgitation for?
A
Pulmonary HTN
25
What are the two most common bacteria that cause infectious endocarditis?
Staph
| Strep
26
When working up a patient for suspected CAD, what is the appropriate stress test in a patient who is low probability?
Intermediate?
Low: Do nothing
Intermediate: Exercise Stress vs Radionuclide
27
T/F: An echocardiogram should be down in conjunction with a stress test in the evaluation of CAD
True
28
Is an exercise stress test the appropriate choice for an 85 y.o. who ambulates with a walker?
No, a radionuclide study would be more appropriate
29
Should you hold a patients CCBs or Beta-blockers if an exercise or dobutamine stress is being preformed?
Why?
Yes, because the patient will not be able to raise their HR enough.
30
Other than inability to ambulate, what other criteria prevent a patient from preforming an exercise stress test?.
1. Abnormal EKG findings
2. LBBB
3. Baseline ST depression
4. WPW
31
What medications used in a stress test should be avoided in patients with severe asthma/COPD?
Persantine/Adenosine
32
Which of the cardiac enzymes is the most non-specific however goes up the earliest in an AMI?
Myoglobin
33
What cardiac enzyme is the most sensitive in an AMI however takes up to 6 hours to reach sensitive levels?
CKMB
34
This cardiac biomarker can be detected as soon as 2-3 hours in patients with an AMI.
Troponin
35
What is the appropriate minimal amount of time to rule out an AMI through trending/repeating cardiac enzymes?
12-16 hours
36
What additional processes/diseases may elevate Troponin levels other then an AMI?
1. Shock
2. Myocarditis/Pericarditis
3. CHF
4. Sepsis
5. PE
6. CKD/ESRD
7. Trauma
8. BUrns
9. CVA
10. Rhabdomyolysis
11. Extreme Exertion
12. Inflammatory State
37
A patient who presents with the complaint of chest pain without ST changes on EKG however does have elevated cardiac biomarkers would rule in for a _______.
NSTEMI
38
AS long as a patient diagnosed with a NSTEMI is pain free without EKG changes, is immediate PCI warranted?
No, the goal still remains to get the patient to the PCI lab within 24 hours however there is no benefit seen to immediate catheterization in NSTEMI patients like there is in STEMI patients.
39
What dose of ASA should NSTEMI patients be given in combination with O2, NTG, and Cardiac Monitoring?
What will the daily dose of ASA be in the next following days?
325 mg PO
Daily dose of 81 mg PO
40
Are Beta-Blockers withing 24 hours a core measure of treatment in patients with NSTEMI?
What if the EF is <40?
Yes
ACEi or ARB
41
If Beta-blockers are contraindicated and there is no sign of heart failure then what class of medications is the next appropriate in NSTEMI management?
Non-dihydropyridine CCB (diltiazem/verapamil)
42
T/F: Coumadin is the anticoagulant of choice in NSTEMI patient treatment while in the hospital
False (Heparin)
43
What is the primary difference in the treatment of NSTEMI vs STEMI?
Immediate PCI is indicated in STEMI patients whereas PCI is only required within the first 24 hours.
44
If a PCI lab is not within 90 minutes of your facility, what medications should be given to STEMI patients?
Thrombolytics
45
After thrombolytics are given should the patient still be transferred to a facility capable of preforming PCI?
YES!
46
What should always be considered when giving thrombo or fibrinolytics?
The patients bleeding risk
47
T/F: Cardiac Rehab is not an appropriate outpatient management step in STEMI / NSTEMI
False
| It is
48
What complications can you see in patients who are post-MI?
1. Cardiogenic Shock
2. Acute MR
3. Ventricular wall rupture
4. LV Dysfunction
5. Dressler's Syndrome
6. Restenosis / Thrombosis
7. Renal Failure
8. Bleeding
49
Following an AMI, a follow-up echo is preformed within the first 12 weeks to confirm LV revascularization to r/o ___ __________.
LV Dysfunction
50
This is the most common disorder of the pericardium and is common caused by viruses.
Sx include....
Pleuritic chest pain worse with lying flat and better when leaning forward
Pericarditis
51
What may you hear on auscultation of the heart in a patient with pericarditis?
Pericardial friction rub
52
What EKG findings may be seen in a patient with pericarditis?
Diffuse ST Elevation
| PR depression >0.8 mm
53
Pericarditis following cardiac surgery is often referred to as _______ syndrome.
Dressler's
54
Elevated troponin (or other cardiac biomarkers) or LV systolic dysfunction in the setting of acute pericarditis is indicative of __________.
Myopericarditis
55
What are the two "mainstays" of pericarditis and myopericarditis treatment?
If the duration is longer than 2 weeks, what medication class should be added?
NSAIDs
Colchicine
Steroids
56
If treatment of pericarditis continues to fail and the patient develops constrictive pericarditis, what may need to be preformed?
Pericardial stripping
Partial Pericardiectomy (Last resort)
57
This disease occurs when fluid collects between the pericardial layers typically either due to infectious, neoplastic, idiopathic, or renal etiologies.
Sx include...
Tachycardia
Dsypnea
Tachypnea
Friction Rub
Pericardial Effusion
58
The pericardium can stretch and hold up to ___ L of fluid.
1
59
Exudative fluid in the pericardium is likely indicative of an ________/_________ process.
Transudative?
Hemorrhagic?
Infectious/Inflammatory
CHF
Trauma/Surgical
60
This is a hallmark sign of a pericardial effusion which is described as a >10 mm Hg drop in systolic blood pressure with inspiration
Pulsus Paradoxus
61
T/F: A patient with a pericardial effusion may also have JVD
True
62
Would the EKG in a pericardial effusion patient be high or low voltage in the precordial leads?
Low
63
What THREE things compose Beck's Triad?
What is this a sign of?
In a patient with the above, what shape may the heart be described as on CXR?
1. Elevated JVP
2. Muffled heart sounds
3. Hypotension
Cardiac Tamponade
"Bottle-shaped" heart
64
T/F: Cardiac Tamponade is NOT a medical emergency
False
| It is
65
Is cardiac tamponade more likely with rapid or slow collection of fluid?
Rapid
66
How is cardiac tamponade treated emergently?
Pericardiocentesis
Pericardial Window
67
In a patient with cardiac tamponade it is important to keep fluid pressure inside the heart _____ ____ fluid pressure outside the heart to maintain a normal BP.
Equal to
68
This disease is occurs due to bacterial or fungal growth inside the hear most commonly in the valves and patients frequently have underlying valvular disorders.
It is commonly seen following procedures and in IVD users.
Sx include....
fever
malaise
Murmur
Endocarditis
69
What specific lab test should be drawn if you suspect endocarditis?
What imaging study?
Blood Cx
Echocardiogram
70
T/F: In a patient with a history of valvular disease, are prophylactic ABx warranted prior to the patient undergoing procedures?
True
71
_____ criteria is often used in the treatment of Endocarditis
Duke
72
______ nodes are often seen in conjunction with Endocarditis and are typically found on the fingers and toes.
_______ lesions are also associated with endocarditis but can last longer and are more likely with an acute form of bacterial endocarditis.
________ hemorrhages are narrow, reddish-brown lines beneath the nails and are associated with an infection of the heart valve
Osler's Nodes
Janeway lesions
Splinter hemorrhages
73
In constrictive pericarditis, ________ ______ occurs since the amount of blood flow into one ventricle is dependent on the amount of blood flow into the other ventricle.
Ventricular Interdependence
74
Are hepatic congestion. ascites, and JVD commonly seen in patients with constirctive pericarditis.
Yes
75
What is the initial treatment of constrictive pericarditis?
What is the only definitive treatment?
Diuretics
Pericardiectomy
76
________ sign is seen in constrictive pericarditis, which is described as an elevation of JVP with inspiration.
Kussmal's Sign
77
Stab wounds, MVA, CPR, or burns are all examples of ________ _______ ____.
Traumatic heart disease
78
T/F: EKG and Echocardiogram are good screening tools in athletes if there is concerning over cardiac disease
True
79
________ _______ is a connective tissue disease with an autosomal dominant inheritance pattern that can effect the cardiovascular system namely the aorta.
Sx include....
long limbs
Sciolosis
Marfan's Syndrome
80
__________ are defined as a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction, which usually exhibit inappropriate ventricular hypertrophy or dilatation, and are due to a variety of etiologies that frequently are genetic. They are confined to the heart or are part of a generalized disorder, often leading to cardiovascular death or progressive heart failure-related disability
Cardiomyopathies
81
________ cardiomyopathies are solely or predominantly confined to the heart muscle
__________ cardiomyopathies have myocardial involvement as a prat of a generalized systemic disorder
Primary
Secondary
82
___________ cardiomyopathy is the most common cardiomyopathy and is the most common cause of sudden cardiac death in the young.
Hypertrophic cardiomyopathy
83
Is hypoertrophic cardiomyopathy an autosomal dominant or recessive trait?
Dominant
84
HCM is characterized by a hypertrophic ___-______ left ventricle in the absence of other causes.
non-dilated
85
T/F: Patients with HCM can be largely asymptomatic
True
86
What is the diagnostic test for HCM?
Echocardiogram
87
What composes the pathophysiology of HCM?
1. Diastolic Dysfunction
2. LV outflow tract obstruction
3. Mitral Regurgitatin
4. Myocardial Ischemia
5. Arrhythmias
88
What causes the diastolic dysfunction in HCM?
"Stiffness" of the LV requiring higher than normal LA pressure
89
In a patient with HCM, would you typically expect to see the LVOT obstruction manifest at rest or with exercise?
Exercise
90
Why would myocardial ischemia occur in a patient with HCM?
Supply and demand mismatch
91
What is the most common murmur associated with HCM?
Mitral Regurgitation
92
T/F: Patients with HCM should refrain from competitive athletics however moderate levels of activity are okay
True
93
What two classes of medications are commonly used in HCM patients?
What procedure can be down to lower the LVOT gradient in HCM patients?
CCB
Beta-blackers
Alcohol Septal Ablation
94
Can dual chamber pacing be used in HCM patients to lower the LVOT gradient?
Yes
95
What procedure is reserved for HCM patients who continue to have symptoms despite medical therapy?
Septal Myomectomy
96
____________ cardiomyopathy is a common and IRREVERSIBLE disease of the heat muscle and 20-30% may have a familial component
Dilated
97
T/F: Dilated cardiomyopathy is the most frequent indication for heart transplant
True
98
Dilated cardiomyopathy is a diagnosis of _______.
Exclusion
99
What types of things should be ruled out when assessing for dilated cardiomyopathy?
What tests/procedures should be preformed?
1. CAD
2. Valvular Disease
1. Echo
2. Stress Test
3. Cardiac Catheterization
4. Endomyocardial Biopsy
(Routine blood work is also beneficial)
100
Dilated cardiomyopathy is characterized by dilation and impaired contraction of the ventricles with an EF of _____ ____ __%
Less than 40%
101
What are common presenting symptoms of dilated cardiomyopathy?
1. CHF
2. Arrhythmia
3. Thromboembolic complications
4. Sudden Death
102
If medical management of dilated cardiomyopathy fails, what is indicated?
Heart Transplantation
103
Dr. Oaks is a ________ surgeon
SUPER
104
________ involves inflammation of the cardiac myocytes with viral being the most common cause
Myocarditis
105
_____________ cardiomyopathy is most commonly seen in obese, multiparous, black women older than 30 y.o.
Presentation is typically HF symptoms in the first 6 months of pregnancy
Peripartum Cardiomyopathy
106
_________ cardiomyopathy is associated with heavy and sustained alcohol use.
Alcoholic
107
__________ cardiomyopathy (not a true cardiomyopathy) typically results from multiple MIs and CAD.
Ischemic cardiomyopathy
108
T/F: Chemotherapy is associated cardiomyopathy
True
109
__________ cardiomyopathy is characterized by restrictive ventricular filling, reduced ventricular, and near normal ventricular function.
Restrictive cardiomyopathy
110
Patients with restrictive cardiomyopathy will present with heart failure in the absence of _____________.
Cardiomegaly
111
What is the most common cause of restrictive cardiomyopathy?
amyloidosis
112
How is restrictive cardiomyopathy diagnosed?
Serum and urine electrophoresis
Endomyocardial biopsy
113
How is restrictive cardiomyopathy treated?
Treat underlying blood dyscrasia
114
T/F: Heart transplant is indicated in patients with restrictive cardiomyopathy
False
| It is contraindicated
