Medicine-Cardio Flashcards
(233 cards)
1
Q
Which pt demographics are most at risk for anaphylaxis 2nd to Latex allergy?-3
image: mottled acute limb ischemia from arterial emboli s/p surgery
A
Health Care Workers
[Abd Surgery pts]
[GU Surgery pts]
2
Q
Epigastric burning worst with exertion and not relieved with antacids is concerning for ______. Next step?
A
[Atypical Stable Angina]; Exercise Stress EKG
3
Q
How is SLE associated with CAD
A
SLE accelerates atherosclerosis –> premature CAD
4
Q
Which EKG leads are Lateral
A
aVL, Lead 1, V5, V6
5
Q
Which EKG leads are Anterior
A
V2, V3, V4
6
Q
What Px medication is given to prevent [Coronary Artery Stent Thrombosis]-2?
What’s the biggest predictor of Stent Thrombosis?
A
ASA + [Platelet R Blocker (Clopidogrel,Prasugrel,Ticagrelor)]
DC/noncompliance of this therapy = BIGGEST PREDICTOR of Stent Thrombosis
7
Q
Initial Mngmt for [Peripheral Arterial Dz]-4
A
- Smoking Cessation
- Dual Lipid lowering therapy (ASA + Statin)
- Mnge DM/HTN
- Supervised Exercise (reproduces and reduce sx)
8
Q
____, ___ and ____ are 3 drugs that should be held ___ hrs prior to [Stress EKG].
When are these drugs actually continued during [Stress EKG]?
A
Beta blockers/CCB/Nitrates; 48 hours
These are continued during [Stress EKG] if the test is determining their efficacy in pts
9
Q
What is [Pulsus parvus et tardus] and what dz is it related to
A
Delayed and diminished carotid pulse; Aortic Stenosis
10
Q
PE findings for Aortic Stenosis-3
A
- Pulsus parvus et tardus (delayed carotid pulse)
- S4 (from LV Hypertrophy)
- [Crescendo Decrescendo Systolic murmur w/radiation to Carotids @ R 2nd ICS]
11
Q
Which Murmur?
(Auscultation Site is attached)
B: Maneuvers that INC (2)
A
Mitral Regurgitation
[Holosystolic High-Pitched Blowing Murmur] w/radiation to axilla
“MR. Hand me a Squat”
B: INC with…
1) Hand Grip
2) Squatting
12
Q
Which Murmur? (Is Not VSD)
(Auscultation Site is attached)
B: Maneuvers that INC
A
Tricuspid Regurgitation
[Holosystolic High-Pitched Blowing Murmur]
B: INC with… Inspiration
13
Q
Which Murmur?
(Auscultation Site is attached)
B: Maneuvers that INC (2)
C: Maneuvers that DEC
A
Aortic Stenosis
[Crescendo-Descrescendo Systolic Ejection Murmur]
“Lean forward…& then Squat with that Ass, that’ll turn it up!”
B: INC with…
- Leaning Forward
2) Squatting
C: DEC with…handgrip (INC afterload)
14
Q
Mitral Valve Prolapse
Murmur
A
“He was MVP…OF COURSE he had a Mid Clique to hang with”
[MidSystolic Click –> Late Systolic Crescendo Mumur] @ Apex
Sound Caused by Tendinae tightening and lips of the valve closing AFTER the preload has been ejected
15
Q
Which Murmur?
(Auscultation Site is attached)
A
Mitral Valve Prolapse
[Late Systolic Crescendo Murmur + MidSystolic Click]
16
Q
Which Murmur?
B: Name the Auscultation Site
C: Maneuvers that INC sound
A
Mitral Stenosis
[Delayed Rumbling Diastolic murmur that follows an Opening Snap]
B: [Apex + LLDP (L Lateral Decubitus Position)]
C: Maneuvers that [INC Afterload]
-handgrip
17
Q
Which Murmur?
(Auscultation Site is attached)
A
Hypertrophic Cardiomyopathy
[Holosystolic Harsh Murmur] auscultated @ [L Sternal 2nd/3rd ICS]
18
Q
Which Murmur?
(Auscultation Site is attached)
A
Ventricular Septal Defect
[Holosystolic Harsh Blowing Murmur]
19
Q
Which Murmur?
(Auscultation site is attached)
A
Patent Ductus Arteriosus
[Machinery Continuous Murmur] ausculated over [L infraclavicular region]
20
Q
In regard to renal arterioles, how do kidneys respond to CHF
A
Constrict Efferent Arterioles –> INC intraglomerular pressure
21
Q
What are clinical parameters for Orthostatic hypOtension?-3
A
- ⬇︎ in Systolic BP > 20 when standing
- ⬇︎ in Diastolic BP > 10 when standing
- INC HR > 10
insufficient constriction of capacitance blood vessels in LE
22
Q
Presentation for Aortic Coarctation-2
A
- Asx HTN sometimes w/[epistaxis/HA/aortic dissection/cp]
- UE HTN with LE hypotension
- Delayed femoral pulses
23
Q
Dx for Aortic Coarctation?-4
A
- EKG: L Vt Hypertrophy
- CXR: Notching of 3rd-8th enlarged intercostal arteries
- CXR: “3” sign from aortic indentation
- Echocardiography
24
Q
What Disorders is Aortic Coarctation associated with?-3
A
- Bicuspid Aortic Valve
- Vt Septal Defect
- Turner Syndrome
25
Pt with vague chest pain. Dx?
*Descending* Thoracic Aortic Aneurysm
26
Describe Etiologies for both Thoracic Aortic Aneurysms: *Ascending-2* and *Descending-2*
* Ascending [Cystic medial necrosis from aging] vs [Connective Tissue DO (Ehlers Danlos, Marfan - pts under 40 yo)]*
* Descending*
27
What value of BNP indicates CHF dx
≥ 100 pg/mL
## Footnote
*Note: BNP is excreted by Kidneys = Naturally Elevated in Renal Failure pts!*
28
Describe [Hypertensive Urgency]
**ONLY** HTN ≥ 180/120
29
Describe [Malignant HTN Emergency] - 2
[Hypertensive Urgency (BP\>180/120)]
+
Papilledema/Retinal Hemorrhages
30
Describe [Hypertensive Encephalopathy] - 2
[Hypertensive Urgency (BP\>180/120)]
+
Cerebral Edema --\> General Neuro signs
31
EKG manifestation for Acute Fibrinous Pericarditis-2
**DIFFUSE** ST elevations + sometimes PR depressions
## Footnote
*Pericarditis gave **HIM A UTI***
32
What is usually the cause of pericardial effusion
recent viral infection --\> pericarditis --\> pericardial effusion
## Footnote
* Pericarditis gave **HIM A UTI***
* EKG showing electrical alternans*
33
Describe **Pulsus Paradoxus**
[Systolic BP] ⬇︎more than 10 **during inspiration**
## Footnote
"Pulsus for **CAPOT**"
34
What conditions cause Pulsus Paradoxus (5)
"Pulsus for **CAPOT**"
## Footnote
- **C**roup
- **A**sthma
- **P**ericarditis
- **O**bstructive Sleep Apnea
- **T**amponade
35
What 2 heart conditions are Marfan pts at risk for
**AORTIC DISSECTION** & [Ascending Aortic Aneurysm]
36
What should you suspect in an [Aortic Dissection pt] who also has distended neck veins & pulsus paradoxus? Why?
Concomitant Cardiac Tamponade; dissection can --\> blood in pericardial sac --\> [Pulsus for CAPOT]
37
Digoxin toxicity leads to what cardiac arrhythmia?
[Atrial Tachycardia(250-350 bpm)] with AV block
38
Head bobbing with each heart beat or Head pounding is c/w \_\_\_\_\_\_
Aortic Regurgitation
## Footnote
*Head bobbing with each heart beat = de Musset sign and is sign of widened pulse pressure*
39
In Hypertensive Crisis (Urgency & Malignant Emergency), what's the rate for lowering MAP?-2
Normal MAP: 65-110
**[10-20% in 1st hour] --\> [5-15% over next 23 hours]**
Malignant HTN Emergency = [Hypertensive Urgency (BP\>180/120)] PLUS Papilledema/Retinal Hemorrhages
40
What is the normal range for Mean Arterial Pressure (MAP)?
Formula?
65-110; formula in pic
41
What is Nitroprusside commonly used for? Severe SE-3?
**Rapid** BP control (since it's a vasoDilator);
## Footnote
Cyanide Tox
1. AMS
2. Lactic Acidosis
3. Coma/Death
42
CP for Exertional Heat Stroke-3 ; What med worsens this?
**HOT**
1. **H**ead CNS dysfunction (confused/seizure/epistaxis)
2. **O**rgan Dysfunction (DIC/ARDS/Hemoconcentration/Rhabdo)
3. **T**emp \> 40C
Worst with antiCholinergics
43
Compare tx for **Exertional-2** heat stoke vs. **NonExertional-1** heat stroke
**Exertional** = Ice water immersion + fluid resuscitation
**NonExertional** (happens in kids & elderly) = Evaporative cooling (*spray lukewarm water on pt with fan blowing*)
44
How is Aortic Dissection associated with Aortic Regurgitation ; what's a possible respiratory complication of this
AD may proximally extend into the [aortic valve annulus] and stretch it --\> AR which can--\> **Acute SOB w/lung crackles** (since LV will be full and LA can't dump into it)
45
Imaging modalities for Aortic Dissection-3
1. **TEE**-unstable or renal CTX
2. [Spiral CT Angio] - Stable vitals
3. [MRI-*NonEmergency*]
## Footnote
*TEE is great because it's used in renal pts*
46
Name PE finding and what causes it-5
Livedo Reticularis;
1. Atherosclerotic Emboli into periphery s/p cardiac catheterization
2. SLE
3. Antiphospholipid Syndrome
4. Systemic Vasculitis
5. Amantadine SE
*also may see Blue Toes, [Hollenhorst retinal a. plaques]*
47
Fibromuscular Dysplasia etx ; List the manifestation-3
Noninflammatory/Nonatherosclerotic abnormal arterial wall cell dysplasia --\> Stenosis of 3 arteries...
**Renal** = ⬇︎renal perfusion--\> ⬆︎Renin = HTN
**Carotid** = amaurosis fugax
**Vertebral** = stroke
48
Fibromuscular Dysplasia dx-2
[Spiral CT angio **Abd**] vs. Duplex US
49
2nd degree AV Block: Mobitz Type 1
Describe **where** block is, **EKG** findings and describe **QRS**
[2nd degree AV Block: Mobitz Type 1]
where = AV Node
EKG = Group beating (prolonged PR leading to absent beat/nonconducted P wave)
QRS is Narrow
50
2nd degree AV Block: Mobitz Type 2
Describe **where** block is, **EKG** findings and describe **QRS**
[2nd degree AV Block: Mobitz Type 2]
where = Bundle of His
EKG = **Beat Drops Randomly** but PR stays constant
QRS is Narrow OR Wide
51
Name the 4 Medications that **Prevent LV Remodeling** in HF pts
"**BANA** helps HF pts live Loonger"
## Footnote
**B**eta Blockers (Metoprolol / Carvedilol)
[**A**CEk2 inhibitors AND ARBs]
[**N**itrates + Hydralazine]
[**A**ldosterone Blockers (Spironolactone / Eplerenone)]
52
List 7 Therapies for an Acute MI ; Give brief description of why their used
Pts with [Acute MI] **N**eed **OBAMAA**!
1. **N**TG = VasoDilates Veins and Coronary Arteries
2. **O**xygen = Minimizes ischemia
3. **B**eta Blockers = DEC HR --\> DEC Arrhythmia risk and DEC O2 demand
4. [**A**SA and Heparin] = limits thrombosis
5. **M**orphine = Pain
6. **A**CEk2 inhibitors within 24 hrs= DEC [L Ventricle Dilation/Remodeling]
7. **A**torvaSTATIN - comes later
53
What therapies are used to treat Unstable Angina?-7
Pts with Unstable Angina **N**eed **OBAMAA** too!
1. **N**TG = VasoDilates Veins and Coronary Arteries
2. **O**xygen = Minimizes ischemia
3. **B**eta Blockers = DEC HR --\> DEC Arrhythmia risk and DEC O2 demand
4. [**A**SA and Heparin] = limits thrombosis
5. **M**orphine = Pain
6. **A**CEk2 inhibitors within 24 hrs= DEC [L Ventricle Dilation/Remodeling]
7. **A**torvaSTATIN - comes later
*ASA and Beta blockers can --\> asthma exacerbation*
54
Tx for symptomatic Sinus Bradycardia-4
1st line: [**IV Atropine + Fluids**]
2nd line: IV Glucagon (⇪intracell cAMP)
Alternatives: IV Epi / IV DOPAmine / transcutaneous pacing
55
A pt with what group of sx is most concerning for **Cardiac Tamponade**
1. Distended Neck Veins
2. Muffled heart sounds
3. HypOtension
## Footnote
*THIS IS BECK'S TRIAD!*
56
Which demographic should ALWAYS be screened for AAA using \_\_\_\_\_\_\_
AAA screening/diagnosis = Abdominal US
Always Screen [**65-75 yom who smoke**]!!!! for AAA
57
Which HTN med causes isolated peripheral edema and why? How do you correct for this and why does it work?
[Dihydropyridine Ca+ Channel Blockers (*Amlodipine/Nifedipine*)] preferentially dilate **Arterioles** --\> interstitial extravasation --\> isolated peripheral edema
[ACEk2 inhibitors preferentially dilate **Veins**].
So [DHP CCB] + [ACEk2 inhibitors] concurrent = ⬇︎peripheral edema
58
ALPHA 1 RECEPTOR
Tissues - Actions (3)
"Gimme an *alpha 1* **VID**"
(1) Most **V**ascular smooth muscle- contracts (inc. vascular resistance)
(2) **Dilator** Pupillary muscle- contracts (my**D**riasis)
(3) **I**nternal Urethral Sphincter- contracts
59
ALPHA 2 RECEPTOR
Tissues- Actions (4)
"You'll find _alpha 2 receptors_ on a **PEAA**"
(1) ***A**drenergic and cholinergic nerve terminals*- inhibits NTS release--\> [**CNS-mediated BP DEC**]
(2) ***P**latelets*- stimulates aggregation
(3) ***A**dipocytes* - DEC Lipolysis
(4) ***E**ye* - DEC Intraocular pressure
60
BETA 1 RECEPTOR
Actions (2)
(1) Heart- INC rate and force *by [INC [Na+ I(f) channels] in phase 0 of AV node] --\> **shortens PR interval***
(2) JGA cells- Stimulates renin release
61
BETA 2 RECEPTOR
Tissues-Actions (4)
(1) Relaxes **RUV** - (**R**espiratory, **U**terine and **V**ascular) smooth muscle
(2) Liver- stimulates glycogenolysis
(3) Pancreatic B cells- stimulates insulin release
(4) Somatic motor nerve terminals (voluntary muscle)- causes tremor
62
What is [PEA-Pulseless Electrical Activity] and how should it first be managed-2?
Organized rhythm on cardiac monitor **BUT NO Palpable pulse** in a cardiac arrest pt; [CPR + Epi] until cause is determined!
## Footnote
*Note: VT DOES require defibrillation*
63
What are the causes of PEA (Pulseless Electrical Activity)-10
64
Describe the Approach to [Adult Cardiac Arrest] if pt is in Asystole or PEA-6
65
Describe the Approach to [Adult Cardiac Arrest] if pt is in VFib or pulseless VTach-6
66
What is the normal Jugular venous pressure
3-4 cm above sternal angle
67
Periumbilical *Systolic-Diastolic* Bruit in [HTN & Atherosclerotic pt] suggest \_\_\_\_\_\_\_
Renal Artery Stenosis
68
[Ex of Amyloidosis (primary AL) vs. (secondary AA)] and [causes of secondary AA]-5
Etx of Amyloidosis = Extracell deposition of insoluble protein in organs
(primary AL) vs. (secondary AA)
(secondary AA) caused by:
1. Inflammatory arthritis (RA)
2. Chronic infection
3. IBD
4. CA
5. Vasculitis
69
Clinically, what picture makes you suspect Amyloidosis from a cardiac standpoint?-4
1. Unexplained [Diastolic HF] with
2. echo showing **⬆︎ Vt Wall thickness** but normal L Vt Cavity dimensions and
3. EKG showing low voltage
4. Proteinuria
## Footnote
*Amyloidosis causes **Restrictive** Cardiomyopathy*
70
RBC 1/2 life
120 days
71
Common Causes of [Constrictive Pericarditis] - 4
## Footnote
*Look for the pericardial knock!*
'Ur an **Idiot** to *constrict* my **Radio** & **T-V**"
**Idio**pathic
**Radi**ation
**T**B
**V**iruses
*This is a common cause of R HF*
72
The **CHA2DS2 VASc** score is used to determine _______ risk in pts with \_\_\_\_\_\_. Decsribe the Criteria
determines Thromboemobolism risk in pts with AFib
73
Afib Pts with CHA2DS2 VASc score ≥ 2 should be Rx managed with what?-2
ASA + [PO Warfarin vs PO NOAC]
## Footnote
*[NOAC = (apixiban,rivaroxaban,dabigatraban)]*
74
Compartment Syndrome and Acute Arterial Occlusion share the same symptomotology
List the sx-6
The 6 P's
## Footnote
**P**aresthesia-early sign
**P**ain
**P**allor
**P**oikilothermia (*cool to touch*)
**P**aralysis
**P**ulseless-late sign
75
[Scleroderma renal crisis] Etx and Sx-2
INC vascular permeability--\>coagulation cascade activation AND renin secretion --\>
1. DIC
2. Malignant HTN emergency
76
High Output HF Etx ; 5 major causes
Cardiac output is \> than normal (55-70%) due to state of excess blood volume
1. Anemia-severe
2. Hyperthyroidism
3. Wet BeriBeri
4. Paget Dz
5. AV Fistulas
77
In which type of HF is ejection fraction **preserved**
Diastolic HF
78
Causes of **Pericarditis**-7
## Footnote
*image = pericardial effusion 2/2 Pericarditis*
"Pericarditis gave **HIM** **A** **UTI**"
## Footnote
- **I**nfection-Viruses (Coxsackie/ echovirus/adenovirus)
- **A**cute MI
- **I**mmune (Dressler vs SLE vs RA)
- [**HMLB** CA] - (Hodgkin's/Mesothelioma/Lung/Breast)
- **T**rauma
- **M**ediastinal Radiation
- **U**remia (BUN \> 60) - TREAT WITH HEMODIALYSIS
79
What 3 maneuvers **INCREASE** intensity of **Aortic Regurgitation**
"*AR* your **Hands** & **Breath** [**Leaning Forward**] ?
* with **Hand** Grip
* when **B****reath** is held after exhalation
* with Patient **leaning forward**
80
Describe the following parameters during **hypOvolemic** shock:
A: Systemic Vascular Resistance
B: Cardiac Output
C: BP
A: Systemic Vascular Resistance = **INC**
B: Cardiac Output = DEC
C: BP = DEC
81
Primary PCI (*PerCutaneous Intervention*) for STEMMI should be administered when in order to restore coronary blood flow? - 3
1. Within **12 Hours** of sx onset
+
2A. within 90 min from first medical contact to device at PCI instituition OR
2B. within 120 min from first medical contact to device at NON-PCI instituite (allows transport time)
82
When is Carotid Endarterectomy(CEA) indicated in Men-2 vs Women?
Men: [\> 70% occlusion and Symptomatic] or [\> 60% occlusion but Asx]
Women: [\> 70% occlusion regardless of sx]
ANY OF THESE --\> CAROTID ENDARTERECTOMY
83
Biggest RF for Aortic Dissection
HTN
## Footnote
*Marfan may also cause AD but happens in pts \< 40 yo*
84
*Arrhythmia is a complication [30 min-4 Hrs] Post MI*
**List** the 2 types of Arrhythmias, **when** they occur and **Etx** ;
Which is the most common cause of Sudden cardiac arrest?
- [Immediate Phase 1A Vt Arrhythmia] occurs **within 10 min post MI** and caused by Reentrant Arrhythmias = MOST COMMON CAUSE OF SUDDEN CARDIAC ARREST
- [Delayed Phase 1B Vt Arrhythmia] **occurs 10-60 min post MI** and caused by abnormal automaticity
85
**Post MI evolution**
**4-12 hours**
Complications
Arrhythmia
86
**Post MI evolution**
**1-3 DAYS**
Complications
[Fibrinous Pericarditis--\> [sharp & pleuritic Chest Pain] + friction rub] (*only with transmural infarcts*)
87
**Post MI evolution**
**3-7 _DAYS_**
A: Complications (3)
B: Lab
*_Macrophage phagocytosis_ of dead debris --\> weakens cardiac tissue*
A: Cardiac Tissue Weakning (Vt Free Wall Rupture-ANTERIOR MI) / (papillary m. rupture-INFERIOR MI) / (interventricular septal rupture)
B: [CkMB] returns to Baseline at Day 3
88
**Post MI evolution**
**7-10 Days**
A: Complications
B: Lab
No Complications
B: [Trop I] returns to baseline
89
**Post MI evolution**
**2 - 8 WEEKS**
A: Gross Changes
B: Complications (3)
**2 - 8 WEEKS**
A: White Scar w/[Type 1 Dense Collagen]
B: Aneurysm / [Mural Thrombus] / Dressler's
90
Describe the following parameters during **hypOvolemic** shock:
A: [Pulm Capillary Wedge pressure]
B: [Cardiac Index (Pump Function)]
A: [PCWP] = ⬇︎
B: Cardiac Index = ⬇︎
*Cardiac Index (pump function) = Cardiac output➗Body Surface area*
91
Define parameters for ISH (Isolated Systolic HTN) and its Etx
[Systolic \> 140] but [Diastolic\< 90]; Stiffening of Arterials walls as we age --\> inability to dampen systolic pressure --\> [INC pulse wave velocity AND reflection during systole]
THIS SHOULD BE TREATED!
92
7 common causes of **Dilated Cardiomyopathy**
"the **PIG PAID** for Dilated Cardiomyopathy"
1. **P**ost Viral Myocarditis (Coxsackie B)
2. **A**lcohol related (direct toxicity vs. nutritional deficiency)
3. [**D**oxorubicin & Daunarubicin Chemo] (dose-dependent)
4. **P**eripartum (late in pregnancy vs 5 mo. post partum)
5. **G**enetic (affects cytoskeleton)
6. **I**ron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
7. **I**diopathic
* DILATED IS MOST COMMON CARDIOMYOPATHY and _CAN BE ACUTE_*
93
Name 6 major absolute ctx(contraindications) to Thrombolytic tx
1. Bleeding
2. Aortic Dissection
3. Aneurysm
4. Ischemic stroke within past 6 mo.
5. Head trauma
6. Bleeding DO (coagulation abnormality, thrombocytopenia)
94
EKG findings for [NSTEMI & Unstable Angina]-2
1. ST **Depressions**
2. T Wave inversions
MUST OCCUR IN AT LEAST 2 LEADS
95
When should Men start QD ASA for cardiovascular px? When should Women?
Men = 45
Women = 55
96
What all labs should be ordered when concerned for Angina; and why?-6
1. CBC: Anemia contributes to ischemia
2. BMP: Electrolyte derangement
3. BUN/Creatinine: Kidney Dz --\> Heart Dz
4. TSH: Hyperthyroidism --\> ⬆︎O2 demand of heart
5. Lipid Panel: Cardiac Risk
6. ALT/AST: Obtain baseline before starting Statin
97
Criteria for Metabolic Syndrome X -4
**DIVe** --\> ASCVD
## Footnote
*≥ 3 of the following:*
**D**yslipidemia (TAG\>150 vs HDL\<50)
**I**nsulin resistance (Fasting Glucose \>110)
**V**isceral Waist Obesity (Men\>102 cm / Women\>89 cm)
Hyp**e**rtension (BP\> 130/85)
98
List the main Side Effects of HCTZ-5
* Dehydration
* hypOnatremia
* hypOKalemia
* Gout Attack (⬆︎Plasma Uric Acid)
* Renal dysfunction
99
6 major causes of Syncope
**MVC BSD**
1. ⬇︎ Cardiac Output *(Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)*
2. Bradyarrhythmia *(SA Node dysfunction/AV Block)*
3. **VAN** - **V**asovagal **A**utonomic **N**eurocardiogenic
4. Dehydration
5. Stroke
6. Metabolic *(⬇︎Glucose vs ⬇︎Na+)*
*OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!*
100
5 major causes of Atrial Fibrillation; which 3 are most common?
1. HTN (1st most common)
2. CAD (2nd most common)
3. Valvular dz (3rd most common)
4. Cardiomyopathy
5. Hyperthyroidism
101
[**HOCM** - **H**yper**O**bstructive **C**ardio**M**yopathy] MOD-2
[Beta myosin heavy-chain mutation] --\> Defective cardiosarcomeres--\> [*Hypertrophied* myocytes that are *haphazardly* arranged]
+
Abnormal [ANT motion of (ANT leaflet mitral valve) toward [Hypertrophied interventricular septum]
102
Major causes of [⬇︎ Cardiac Output]-7
1. Valvular Dz
2. HOCM
3. Pulm HTN
4. PE
5. Tamponade
6. myxoma
7. aFib
## Footnote
*⬇︎ Cardiac Output can --\> Syncope*
103
Nausea, Sweating and Dizziness are preceding sx for what **type** of syncope?
[**VAN** - **V**asovagal **A**utonomic **N**eurocardiogenic] only
104
Lactate normal range
\< 1.7
105
EKG manifestations of hypOcalcemia-2
[Prolonged QT] and [shortened PR]
106
Ruptured Popliteal Cyst MOD
Popliteal cyst...pops --\>fluid extends **DISTALLY** into POST calf m. --\>calf swelling that mimics DVT
## Footnote
*Doesn't involve thigh swelling*
107
At what times should Troponin be drawn in pt coming in with cp-3?
Now;
*And if Now is normal --\>* 6 hours later; 12 hours later
108
What is the criteria for determining functional status in HF pts?-4
109
How is NSAIDs associated with HF?
NSAIDs exacerbate CHF **BADLY** - it precipitates acute on chronic CHF
110
Name precipitants of Acute on Chronic CHF -8
1. **NSAIDs / AKI**
2. [Ischemia / Arrhythmias]
3. Infection
4. HTN
5. PE
6. Anemia
7. Thyrotoxicosis
8. Noncompliance
111
What is the Staging for HF -4
* Stage A: High Risk for HF but no structural dz
* Stage B: Structural Dz but no sx
* Stage C: Structural Dz WITH sx
* Stage D: End-Stage Dz requiring specialized tx
112
What is the W.H.O. definition of MI?
2 out of 3
EKG changes
Troponin changes
Story
113
When is a post MI pt a candidate for ICD (Implantable Cardioverter Defibrillator)? Caveat?
[EF \< 35% post MI] BUT **must wait 40 days after MI**
## Footnote
*EF = most important prognostic value for pts post MI!!*
114
Serum Osmolality Formula and normal range; What does it mean when measured doesn't = calculated
Range = (280 -295); When measured is diff than calculated = something in serum is ⬆︎osmolality (ethanol, PEG)
115
What controls Ventricular rate in afib pts?
**AV node refractory period** controls Vt rate, since SA node is dysfunctional and multile foci in atria are firing
116
In Afib pt, when can you **NO LONGER** cardiovert?
\> 2 Days after onset
117
Afib tx -2
118
Criteria for Lone Atrial Fibrillation-3 ; tx-2
Lone AF (CHADS VASc of 0) =
1. **\<60 yo**
2. **no HTN**
3. **no Heart Dz** = low stroke risk
tx = ASA vs nothing
119
*[Direct Current Cardioversion] is 97% successful at restorying atrial NSR*
Why is is DC Cardioversion still risky?
Most thrombi **embolize** after [Atrial DC Cardioversion]
120
Absolute CTX for [DC Cardioversion] in aFib -3
1. hypOkalemia
2. Digitalis Toxicity
3. \> 2 Days after aFib onset
121
Mngmt for [Post-CABG related Afib] -3
This type of Afib is common
1. resolves spontaneously if rate is controlled (Beta Blockers vs Diltiazem **in HDS**)
2. Amiodarone **in HDS**
3. DC Conversion **if Hemodynamically UNSTABLE**
122
AV node ablation is most effective for which type of Afib (chronic vs paroxysmal)
**Paroxysmal**
123
Describe Grading System for Heart Murmurs
124
*Common Causes of Chest Pain are usually **C**RGMP*
Describe the **C**ardiac Causes -6
**C**RGMP
## Footnote
1. ACS (Unstable,Stable,Prinzmetal Vasospastic, MI)
2. Cocaine
3. Pericarditis
4. Aortic Dissection
5. Valvular
6. Non-ischemic Cardiomyopathy
*CRGMP = Cardiac/Respiratory/GI/Msk/Psych*
125
*Common Causes of Chest Pain are usually C**R**GMP*
Describe the **R**espiratory Causes -5
C**R**GMP
1. PE
2. PNA
3. Pleurisy
4. PTX
5. Pulm HTN/Cor Pulmonale
*CRGMP = Cardiac/Respiratory/GI/Msk/Psych*
126
*Common Causes of Chest Pain are usually CR**G**MP*
Describe the **G**astrointestinal Causes -5
CR**G**MP
1. GERD
2. PUD
3. Esophageal (dysmotility, inflammation)
4. Pancreatitis
5. Biliary (cholecystitis, cholangiits)
*CRGMP = Cardiac/Respiratory/GI/Msk/Psych*
127
*Common Causes of Chest Pain are usually CRG**M**P*
Describe the **M**usculoskeletal Causes -5
CRG**M**P
1. Costochondritis
2. Rib Fracture
3. Muscular strain
4. Herpes Zoster
5. Myofascial syndrome
*CRGMP = Cardiac/Respiratory/GI/Msk/Psych*
128
*Common Causes of Chest Pain are usually CRGM**P***
Describe the **P**sychogenic Causes -3
CRGM**P**
1. Panic DO
2. Hyperventilation
3. Somatoform DO
*CRGMP = Cardiac/Respiratory/GI/Msk/Psych*
129
When is Angina classified as **Unstable** -3
when chest pain is...
1. at rest or triggered by low exertion
2. New
3. ⬆︎ in frequency
130
*Pt with suspected Claudication 2° to [Peripheral Artery Disease]*
Dx test? Describe the test
ABI (Ankle Brachial Index) = inexpensive/noninvasive measurement of systolic BP Ankle:Brachial
[Peripheral Artery Dz] \< [0.90 - 1.3] \< [Calcified Vessels]
*Alternative is Arterial Duplex US but this is less specific & sensitive*
131
What are triggers of **VAN** (Vasovagal Autonomic Neurocardiogenic) Syncope? -6
1. Pain
2. Emotional distress
3. Prolonged Standing
4. Defecation
5. Micturition
6. Coughing
## Footnote
*VAN Syncope is preceded by nausea, sweating and dizziness*
132
*Seizures and Syncope are difficult to differentiate*
Name features that help differentiate Seizures from Syncope - 3
**Seizures** has...
1. Postictal confusion & lethargy
2. Triggered by flashing lights
3. Tongue laceration
*beware: Clonic jerks can occur during syncope associated w/cerebral hypoxia!!*
133
Name the 7 most common manifestations of **Marfan Syndrome**
etx = mutation of fibrillin 1 gene
"Marfan **BAATHES** a lot! "
1. **E**ctopia Lentis
2. **A**rm-to-Height Ratio ⬆︎
3. **H**eart issues (*MVP or [idiopathic _Aortic_ cystic medial degeneration]--\> _Aortic Dissection and Aneurysm_*)
4. **S**coliosis vs. Kyphosis
5. **B**reastbone structural abnormalities
6. **A**rachnodactyly (Steinberg thumb & wrist)
7. **T**all / slender / flat feet
etx = mutation of fibrillin 1 gene
134
Which 2 bedside maneuvers **⬆︎** **Intensity** of the HOCM mumur?
"***Val*** [***Stood Up**]* to Hulk HOCM, the MVP, which ⬆︎ his anxiety intensity"
Valsalva
[Standing Up]
(both ⬇︎ Preload **AND** Afterload)
135
DDx for T-wave inversion - 5
1. MI
2. Myocarditis
3. Myocardial Contusion
4. *OLD* Pericarditis
5. Digoxin OD
136
EKG findings of hypOkalemia - 4
1. ST Depression
2. Broad Flat T waves
3. U wave
4. PVC
137
In respects to old age, what causes Orthostatic hypOtension?-4
insufficient constriction of capacitance blood vessels in LE due to
1. DEC Baroreceptor sensitivity
2. Arterial stiffness
3. DEC NorEpi for sympathetics
4. DEC myocardium to sympathetic stimulation
138
What is Cardiac Syndrome X ; Lab findings?-3
Exertional angina-like cp usually in Women ;
1. **Normal coronary angiogram**
2. Normal EKG
3. Abnormal Exercise Stress test
139
Based on the 3 characteristics of Angina, when is Angina:
**Atypical**?
**NonAngina**?
1. Substernal \>20 min. **PRESSURE**
2. Exertional
3. relieved with NTG or rest
* [Atypical = ≥ 2 out of 3 +/- atypical sx] /// [NonAngina = \<2 out of 3]*
140
Which demographics typically have **Atypical** Angina? -3
1. Diabetics
2. Women
3. Elderly
141
In addition to smoking, being male, obesity and many others...age \> ___ years old is a risk factor for CAD
\>55 yo
142
Tx for Stable Angina -3
**Beta Blockers** \> Calcium Channel Blockers
## Footnote
+
ACE inhibitors
+
ASA
143
Some pts present with **SOB as the only sx** of cardiac ischemia
What is this called?!
Anginal Equivalent
## Footnote
*Example of Atypical Angina*
144
**A complication of Post MI evolution, 3-7 days is Cardiac Tissue Weakning**
How can you differentiate Vt Free Wall Rupture vs Papillary muscle rupture vs Interventricular septal rupture?
*_Macrophage phagocytosis_ of dead debris --\> weakens cardiac tissue*
## Footnote
1. Vt Free Wall Rupture = occurs with ANTERIOR MI (
2. papillary m. rupture= occurs with INFERIOR MI and has systolic murmur @ apex
3. interventricular septal rupture = systolic murmur @ 2nd/3rd L ICS
145
Why are pregnant patients with mitral stenosis at ⬆︎risk of having exacerbations?
⬆︎HR and blood volume --\> ⬆︎transmitral gradient and L atrial pressure which can --\> aFib
146
When does Peripartum Cardiomyopathy onset? What type of sx would you expect?
\> 36 WG ; Systolic HF sx (SOB, pedal edema)
147
*Primary Hyperparathyroidism is a rare cause of HTN*
What does it mean if you have **SEVERE HTN** with Primary Hyperparathyroidism
Consider Multiple Endocrine Neoplasia 2A - phenochromocytoma
148
Features of Supraventricular Tachycardia on EKG - 4 ; Tx-2?
1. **Narrow and small QRS**
2. tachycardia
3. P waves are "buried" within QRS
4. Possibly: Retrograde P waves possibly appearing as spikes at beginning/end of QRS or as inverted P waves
tx = [IV Adenosine] vs [Vagal maneuvers]--\>slows/terminates AV node conduction
149
etx of Aortic Coarctation
Tunica Media thickening near junction of [ductus arteriosus] and [aortic arch]
150
Common s/s of Mitral Stenosis - 7
*[Delayed Rumbling Diastolic murmur that follows an **Opening Snap**]*
1. **Progressive SOB**
2. Exercise intolerance
3. Fatigue
4. Orthopnea
5. Hemoptysis
6. Dry Cough
7. aFib can--\>stroke
151
CP of Wolff Parkinson White Syndrome - 2
1. most are **asx**!
2. Delta wave (UpSlurring R wave) on EKG!
## Footnote
*tx = Procainamide or cardioversion if afib develops*
152
Endocardial Cusion Defects are associated with what syndrome? Describe this defect
Down Syndrome ; CAVSD (Complete AtrioVentricular Septal Defect)--\> VSD murmur + Systolic Ejection murmur
153
What are cardiac abnormalities are associated with Williams Syndrome? - 3
1. Aortic Stenosis
2. Pulmonic Stenosis
3. Septal Defects
154
Describe **S3 gallop.** What is it associated with? - 3
A: [low-frequency sound JUST after S2]
B: Associated with:
1. **Dilated Vt** 2/2 L Systolic HF in pt\>40 yo
2. **Dilated Vt** 2/2 Mitral Regurgitation--\>⬆︎Vt filling rate in pt\>40 yo
3. Normal in [Athletes/Preggos/Pt\<40 yo] :-)
155
Auscultation Site for S3 gallop (3)
[Apex + (LLDP) + (End Exhalation)]
## Footnote
*End Exhalation brings heart closer to chest wall*
156
Best indicator for *_severity_* of valve Regurgitation?
Presence of an **additional S3** (*indicates Vt Dilitation in addition to regurgitaiton*)
157
**Aortic Regurgitation**
Mumur
[**Early Diastolic Descrescendo Murmur**-*High Pitched Blowing noise*] auscultated @ [L Sternal 2nd/3rd ICS]
158
Which murmurs are heard at the [**L Sternal 2nd/3rd ICS**] ? (3)
1. Aortic **Regurgitation**
2. Pulmonic **Regurgitation**
3. (**HOCM**) Hypertrophic Cardiomyopathy
159
3 Main Causes of Aortic Regurgitation
- [Aortic Root Dilitation]
- [Bicuspid Aortic Valve]
- Endocarditis (i.e. Rheumatic Fever)
160
*You hear a Midsystolic murmur in otherwise young, asx adult*
Next step?
**NOTHING**!
## Footnote
*These are usually benign in young adults and do NOT require further w/u. Diastolic and Continuous should be worked up*
161
Why do Class 1**C** and Class 4 antiarrhythmics work differently in faster heart rates? What is this phenomenon called?
drug has less time to dissociate from Na+ chanels --\> ⬆︎Blocked Na+ channels--\>QRS Widening = Use Dependence
## Footnote
*This is why Class 1C is effective against SVT arrhythmias*
162
Pathogensis of **Aortic Aneurysm**
[Chronic **Transmural Inflammation**] of Aortic wall ---\> [Loss of Elastin and Smooth Muscle] --\> [Abnormal Collagen remodeling] --\> [progressive Weakening of Aorta] --\> Wall Expansion
*[Chronic Transmural Inflammation*] *can come from Atherosclerosis but ⬆︎ risk of rupture comes from smoking!*
163
What are the risk factors for AAA?-5 ; Which RF is most likely to --\> aneurysm expansion and rupture?
1. **SMOKING** which --\> AAA RUPTURE!(along with large diameter & expansion rate)
2. Atherosclerosis
3. Age \> 65
4. White race
5. Fam hx of AAA
164
Which arteries are affected by Fibromuscular Dysplasia? - 2
Renal
+
Internal Carotid --\> **Recurrent HA**
165
CP of Fibromuscular dysplasia - 4
1. **RECURRENT HA** (from Internal Carotid stenosis)
2. HTN 2/2 *Secondary* Hyperaldosteronism from Renal A. Stenosis
3. **Subauricular** Systolic Bruit (from Internal Carotid stenosis)
4. Abd Bruit *possibly*
166
Dx for Fibromuscular Dysplasia
Vascular imaging (Duplex US, CT angio, MRI angio)
167
Name 3 EKG Signs of [Atrial Fibrillation]
1. **[irregularly irregular R-R intervals]** (*the already irregular R-R interval will occur at an irregular pace since atrial electrictivity is chaotic*)
2. **Absent or [low-amp fibrillatory] P-waves**
3. **Narrow QRS Complexes**
168
[Atrial Fibrillation] is the most common tachyarrhythmia. It is often precipitated by what 4 things?
"Smh, **SAME** Afib as before!"
1. **A**cute Systemic Illness (*Hyperthyroid / HF / HTN*)
2. **S**ympathetic Tone ⬆︎
3. **E**tOH - excess
4. **M**itral Stenosis
169
When is Transcutaneous pacing used? - 2
1. Symptomatic bradycardia
2. Complete Heart Block
170
3 classic **Clinical** Manifestations of [Tetralogy of Fallot]
A:
1. [**S**ystolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [**RVOO** -R Vt Outflow Obstruction]
2. **S**quatting relieves sx (INC afterload--\> [DEC amount of R to L shunt]
3. [**C**yanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)
"**VOIR** is to have **S**ee + **S**ight & **C**ry"
171
4 anatomic abnormalities associated with [Tetralogy of Fallot]
**VOIR**
(**V**t Septal Defect / **O**verriding Aorta / [**I**nfundibular Pulmonary Stenosis] / [**R** Vt Hypertrophy with [**R** --\> L shunt] = Boot shaped on CXR ]
"**VOIR** is to have **S**ee + **S**ight & **C**ry"
172
List the associated **cardiac pathology** which each *inherited disorder*
A: Down Syndrome
B: DiGeorge Syndrome (2)
C: Friedreich's Ataxia
D: Marfan Syndrome
E: Tuberous Sclerosis
F: Turner's Syndrome (2)
G: Edwards Syndrome
A: "Put the **cusions** *Down*" = [Endocardial **Cusion** CAVSD]
B: [Tetralogy of Fallot] + [Truncus Arteriosus]
C: Hypertrophic Cardiomyopathy ("*sweet, big heart*")
D: [Aortic Cystic Medial Dengeration]
E: [Cardiac Rhabdomyomas ---\> Valvular Obstruction]
F: [Aortic CoArctation] vs. [Biscuspid Aortic Valve]
G: VSD
*CAVSD = Complete AtrioVentricular Septal Defect*
173
CP of CAVSD (Complete AtrioVentricular Septal Defect)-3 ; When does this present? Demographic?
1. Holosystolic murmur from VSD
2. Systolic Ejection murmur from ASD
3. Loud S2 from Pulm HTN
Presents by 6 weeks old
Down Syndrome pts
174
How does [\_\_\_\_Stenosis] determine the degree of severity in [Tetrology of Fallot]
_Degree of [**I**nfundibular Pulmonary Stenosis]_ determines degree of symptoms since [INC stenosis] --\> [INC R--\>L Vt Shunt] --\> INC [Cyanotic Tet Spells]
"**VOIR** is to have **S**ee + **S**ight + **C**ry"
175
*1 of the manifestations of Tetralogy of Fallot is Cyanotic lethal Tet Spells*
What causes this? ; Tx?-2
Sudden spasm of R Vt Outflow during exertion --\> Worsening RVOO --\> Louder Systolic Ejection HARSH Murmur @ 2/3 LICS & cyanosis
(tx: Knee chest positioning + inhaled O2)
"**VOIR** is to have **S**ee + **S**ight & **C**ry"
*RVOO = R Vt Outflow Obstruction*
176
In cardio world, what is Lidocaine's indication?
Vt Arrhythmias **in HDS** pts
177
Why is it relatively contraindicated for a HTN pts to take **ORAL** Contreceptive Pills?
OCP --\>⬆︎Hepatic Angiotensinogen --\> Mild (sometimes severe) ⬆︎ BP
## Footnote
*⬆︎Risk in pts who develop HTN during pregnancy or family hx*
178
[Tachycardia-mediated LV HF] etx? ; Tx-2?
Persistent/Recurrent Tachyarrhythmia (**chronic aFib w/RVR**) --\> [Tachycardia-mediated LV HF];
## Footnote
1st: Rate or Rhythm control
Alt: Coronary Artery Revascularization if vessels occluded
179
What is a clinical predictor of how bad CHF pts are doing?
degree of **hypOnatremia**
180
Afib Pts with CHA2DS2 VASc score of 1 should be Rx managed with what?-2
ASA only **OR** NOAC only
## Footnote
[NOAC = (*apixiban,rivaroxaban,dabigatraban*)]
181
In HF pts, what process causes the ⬆︎ in SVR?
⬇︎Renal A. perfusion --\> Release of **NorEpi**, Renin, ADH --\> ⬆︎ SVR and maintainence of BP to vital organs
182
Age group for Senile Calcific Aortic Stenosis
\> 70 yo (comes from valvular calcification)
183
SE of Niacin-2 ; etx ; tx
1. Cutaneous Flushing
2. pruritus
**Prostaglandin**-induced peripheral vasoDilation
tx = Take [ASA 81] 30 min before Niacin
184
Name the location in the heart where ectopic foci that causes aFib are found
Pulmonary Veins
## Footnote
*Myocardial sleeves extends around PVs and are supposed to be a sphincter to prevent reflux during atrial systole*
185
atrial **flutter** etx
ReEntry Circuit around tricuspid annulus
186
What amount of EtOH provides coronary heart disease **protection** in Men? what about Women?
Men: 1-2 drinks/day
Women: Only 1 drink/day
*\> 2 drinks/day can --\> HTN*
187
Tricuspid valve atresia etx
infant with CHD family hx has no formation of Tricuspid valve --\> hypoplastic Pulmonary Artery and R Vt --\> **Left Axis Deviation** and **⬇︎CXR Pulmonary markings**
188
Ebstein's anomaly etx
Maternal **lithium** use during [1st trimester pregnancy] --\> malformation and displacement of tricuspid valve into R Vt --\> Tricuspid Regurgitation --\> R Atrial Enlargement and R Axis deviation --\> **HEART FAILURE**
189
In what all situations do you hear an S4? - 2
1. Hypertrophied Ventricle (HTN, Aortic Stenosis, HOCM)
2. **ACUTE** Phase of MI (ischemia --\> Vt stiffening)
190
Prinzmetal Vasospastic Angina etx ; When do these typically occur?
Hyperreactivity of Coronary A. **Tunica Intima** muscle --\> [**less than 15 min** vasospasm] ; During Sleep
191
Prinzmetal Vasospastic angina tx ; Biggest risk factor?
CCB (**Diltiazem** vs Amlodipine vs Felodipine) ; Smoking
192
Cilostazol MOA-2 ; Indication
Phosphodiesterase 3 inhibitor --\>
1. Arterial VasoDilation
2. ⬇︎Platelet Aggregation
LE Claudication
193
Ranolazine MOA ; Indication
inhibits late-phase Na+ influx --\> ⬇︎myocardial Ca+ --\> treats **Stable** Angina
Stable Angina 2/2 Atherosclerotic CAD
194
Main causes of *Secondary* HTN - 12
1. Renal Parenchymal Disease (*⬆︎creatinine*)
2. Renal artery stenosis (*Systolic \> 180, Abd bruit, \>55 yo*)
3. Primary Aldosteronism
4. Pheochromocytoma (*HA, diaphoresis, palpitations*)
5. Cushing Syndrome
6. OSA
7. hypOthyroidism
8. Primary HyperParathyroidism
9. Coarctation of Aorta
10. Excess EtOH \> 2 drinks/day
11. Stress (via release of NorEpi & Angiotensin 2)
12. Meds (OCP/Decongestants/NSAIDs/steroids)
195
*Pt just had a stroke recently and now wants px*
What are the therapy regimens for prevention of stroke? - 3
1. Give ASA vs [ASA + Clopidegrel] vs Warfarin **after** **first stroke**
2. START WARFARIN FOR SURE **after second stroke** (if warfarin contraindicated, use only ASA)
3. Give WARFARIN vs NOAC if pt has **aFib** after ANY stroke
## Footnote
*Also make sure pt is on a Statin*
196
List the common causes of **Restrictive Cardiomyopathy** (8)
**RAMILIES**
1. **R**adiation Fibrosis
2. **A**myloidosis (heterogenous misfolded proteins)
3. **S**arcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
4. **M**etastatic Tumor
5. **I**nborn metabolism errors
6. **E**ndomyocardial fibrosis= Common in [African/Tropic children]
7. [**L**oeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
8. **I**diopathic
197
Range for QT
250 - 440 (or 460 in Females)
198
What are the electrolytes that cause Prolonged QT when deranged? - 3
*MKC holds it together*
199
What are the Medication-induced causes of Prolonged QT? - 5
*MKC holds it together*
200
What are the inherited causes of Prolonged QT? - 2
*MKC holds it together*
201
What's the best initial tx for R Vt infarction? Why?
Multiple fluid boluses ; R Vt infarction are preload dependent
202
What's the best way to differentiate cardiac tamponade from cardiogenic shock?
Cardiac tamponade will have Equalization of intracardiac diastolic pressures (RA, RV and pulm capillary wedge)
## Footnote
Tx = percardiocentesis
203
What are the major causes of **arterial** emboli?-3 ; Which type of MI predisposes to these emboli?
1. LV cardiac thrombous (**GET ECHO**!)
2. LA atrial fibrilattion thrombous (**GET ECHO**!)
3. Aortic Atherosclerosis
Large Anterior STEMMIs
204
Tx for Premature Atrial Complexes? ; What are the precipitants of PACs?-4
**NOTHING** unless sx and/or SVT is present
1. tobacco
2. EtOh
3. caffeine
4. Stress
205
Describe the murmur for VSD- 2
1. Holocystolic murmur at Tricuspid area
2. Apical Diastolic rumble from ⬆︎ flow acrossed mitral valve when Eisenmenger syndrome occurs
## Footnote
*These can cause Failure to Thrive, DOE and HF*
206
Why does Squatting ⬇︎ the sound of MVP?
Squatting ⬆︎Venous return --\> ⬆︎Preload. More preload means it'll take longer before tendinae and mitra valve lips close --\> **delays mid-systolic** click and **shortens** the time between it and S2
207
Identify Rhythm
**aFib** with RVR
Tx = Rate control
_DONT CONFUSE WITH SVT!_
208
Describe how to perform Hepatojugular reflex testing? ; What does a positive result indicate?-3
Apply R upper abd pressure for 10 seconds and watch for JVP to increase \> 3 cm
1. R Vt infarction
2. Constrictive pericarditis (think TB)
3. Restrictive cardiomyopathy
209
What is the normal Jugular Venous Pressure?
6-8 cm H20
210
3 Common signs of **CONSTRICTIVE Pericarditis**
## Footnote
*Ur an idiot to constrict my radio and T-V*
1. Pericardial Knock= **Sharp** sound heard in early diastole
2. Kussmaul Sign= Paradoxic **[⬆︎ JVP during inspiration]** since *constricted* R Vt can accomdate the INC blood
3. Pulsus Paradoxus
211
What is the most common cause of mitral stenosis?
Rheumatic fever
## Footnote
*long standing mitral stenosis --\> L atrial enlargement --\> L mainstem bronchus elevation or recurrent laryngeal n compression*
212
You hear a mumur in a patient
What are the features that indicate it is benign? - 8
213
What are the substrates of CYP450 - 4
*CYP450 Breaks these compounds APART*
214
What are the inhibitors of CYP450 - 13
**AAA RACKSS IN** **GQ M**agazine
1. **A**cute alcohol use
2. **A**miodarone
3. **A**PAP
4. **R**itonavir
5. **A**bx (metronidazole)
6. **C**imetidine
7. **K**etoconazole
8. **S**ulfonamides
9. **S**SRI
10. **I**NH
11. **N**SAIDs
12. **G**rapefruit and Cranberry
13. **M**acrolides
215
Why should you work up patients with R HF sx who've just had an AICD placed?
Transvenous lead placement through tricuspid valve can --\> tricuspid regurgitation due to leaflet damage
216
What is the most common cause of Chronic Mitral Regurgitation?
Mitral Valve Prolapse (myxomatous degeneration of valve)
## Footnote
"He was _MVP_...OF COURSE he had a **Mid Clique** to hang with"
[**MidSystolic Click** --\> Late Systolic Crescendo Mumur] @ Apex
*Sound Caused by Tendinae tightening and lips of the valve closing AFTER the preload has been ejected*
217
what type of EKG would indicate a Right Ventricular Infarction? - 2
1. Inferior STEMMI + V1 STEMI or
2. V4R STEMMI
218
what type of EKG would indicate a Posterior Ventricular Infarction?
V1 reciprocal changes (ST Depression , Tall R)
219
What's the most non-pharmalogical way to ⬇︎BP
Weight Loss (lifestyle modification like DASH and exercise)
220
What percentage of pts with Peripheral Artery Disease end up requiring limb amputation?
20%
## Footnote
[Peripheral Artery Dz] \< [0.90 - 1.3] \< [Calcified Vessels]
*Alternative is Arterial Duplex US but this is less specific & sensitive*
221
How does Amiodarone interact with Digoxin?
Amiodarone ⬆︎serum Digoxin --\> toxicity
222
Why should you use ____ to treat afib from Wolff Parkinson White Syndrome instead of beta blockers, calcium blockers or digoxin?
**Procainamide** ; the others are AV nodal blockers and may ⬆︎condution through the accessory pathway
223
Which pts should be started on statin therapy?
pts with 10 year risk of atherosclerotic CVD≥7.5% per the American College of Cardiology tool
224
Side effects of Digoxin - 3
1. Vision changes
2. NVD
3. atrial tachycardia with heart block
225
Marfan Syndrome and Ehlers Danlos can present similarly
How do you discern the two?-2 ; What is the etx for Ehlers Danlos?
"Marfan **BAATHES** a lot! "
BUT Ehlers Danlos does NOT have
1. **E**ctopia Lentis
2. **A**rm-to-Height Ratio that's INC
Ehlers Danlos etx = defective collagen production
226
Tx for Stable SVT - 2
227
Tx for Unstable SVT
228
Tx for Stable Ventricular Tachycardia
229
Tx for Unstable Ventricular Tachycardia - 2
230
Tx for Torsades De Pointe Polymorphic Ventricular Tachycardia - 2
231
MOA for Statins?
intracellular HmG-CoA reductase inhibitor which --\> ⬇︎conversion of HmGCoA to mevalonic acid
232
What are the main features of an innocent mumur - 3
1. Grade 1 or 2
2. ⬇︎ with standing
3. early or mid-systolic
233
How should Hypertriglyceridemia be managed?
