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Flashcards in PEARLS Book Deck (77):
1

ultrasound of the heart, most useful in diagnosing heart failure**, also used in evaluating coronary artery disease

Echocardiogram

2

This type of echocardiogram is:
**primary noninvasive test for assessing cardiac anatomy and function

Transthoracic echocardiogram (TTE)

3

This type of echocardiogram is:
**more invasive but better imaging of structures*, especially posterior cardiac structures, patients w prosthetic valves or aortic disorders (i.e. aneurysms) or atrial abnormalities (i.e. thrombi)

Transesophageal echocardiogram (TEE)

4

GOLD STANDARD FOR DEFINITIVE DIAGNOSIS FOR CORONARY ARTERY DISEASE, PERIPHERAL ARTERY DZ, AND RENAL ARTERY STENOSIS****

ANGIOGRAPHY!

5

What does a positive stress test look like on EKG

ST depression

6

Most useful noninvasive test in evaluating patients w suspected coronary artery disease?

Stress test

7

Benefit of using Myocardial Perfusion Imaging (MPI)..

localization of region of ischemia

8

Adenosine or Dipyridamole

Pharmacologic stress test

9

localizes regions of ischemia***, depicts wall motion abnormalities as well as visualize structure and function of the heart (assess LV and valvular function)

Stress echo

10

risk factors=
diabetes mellitus
hyperlipidemia
smoking
HTN
males
age over 65
fam hx of CAD

Angina

11

EKG can show:
ST depression with exertion
T wave inversion
poor R wave progression

Angina

12

GOLD STANDARD** outlines coronary artery anatom, determine location and extent of CAD

Coronary angiography

13

Most common cause of an MI?

Atherosclerosis

14

Women, elderly, diabetics, obese have..

Atypical MI presentations

15

With an anterior wall MI, where will the Q waves/ST elevations be seen?

v1 through v4

16

Which artery is involved in an anterior wall MI?

LAD

17

With a lateral wall MI, where will the Q waves/ST elevations be seen?

I, aVL, V5, V6

18

Which artery is involved in a lateral wall MI?

Circumflex

19

With a anterolateral wall MI, where will the Q waves/ST elevations be seen?

I, aVL, v4, v5, v6

20

Which artery is involved in an anterolateral MI?

mid LAD or circumflex

21

With an inferior wall MI, where will the Q waves/ST elevations be seen?

II, III, aVF*

22

Which artery is involved in an inferior wall MI?

Right coronary artery

23

With a posterior wall MI, where will the Q waves/ST elevations be seen?

ST DEPRESSIONS IN:
V1-V2
(mirror image!! will be seen)

24

How often should you test cardiac markers?

3 sets Q8 hours

25

Which cardiac marker is the most sensitive and specific?

Troponin

(Troponin takes 7-10 days to return to baseline)

26

Post MI pericarditis associated with fever and pulmonary infiltrates

Dressler's syndrome

27

HF, v fib, cardiogenic shock, papillary muscle, mitral regurg, ventricular wall rupture, pericarditis, mural thrombosis

Complications of MI

28

Average pt goes home on: Aspirin, beta blocker, ACEi, statin, NTG PRN

MI pt

29

EKG shows transient ST elevations (symptoms and ST elevations rapidly resolve w CCB and nitro)

Prinzmental angina

30

Most common cause of HF?

Coronary artery disease

31

most common cause of L sided HF

CAD
HTN

32

most common cause of R sided HF

L sided HF

(also pulmonary dz)

33

1. sympathetic nervous system activation
2. myocyte hypertrophy/remodel
3. RAAS activation
cause: **fluid over load, ventricular remodeling/hypertrophy, all leading to.....

CHF!

(pulmonary and/or systemic edema)

34

Increase pulmonary venous pressure from fluid backing up into lungs:
-dyspnea
-pulmonary congestion/edema

L sided HF

35

rales, rhonchi, chronic nonproductive cough esp w pink, frothy sputum
wheezing "cardiac asthma" due to airway edema, pleural effusion
Nocturia

L sided HF

36

CHF is the most common cause of...

transudative pleural effusion

37

HTN, Cheyne Stoke's breathing
S3 and S4 can be heard

L sided HF

38

Dusky pale skin, diaphoresis, fatigue, altered mental status

HF

39

Increase systemic venous pressure leading to signs of systemic fluid retention

R sided HF

40

Peripheral edema
Jugular venous distention
GI/Hepatic congestion

R sided HF

41

most useful test to dx HF?

Echocardiogram

42

What is the most important determinant in prognosis of HF patient?

Ejection fraction

43

decreased EF
thin ventricular walls
dilated LV chamber
S3 sound

Systolic failure

44

normal/increased EF
thick ventricular walls
small LV chambers
S4 sound

Diastolic failure

45

Kerley B lines
Butterfly pattern
Cardiomegaly infiltrates
Pleural effusion

CXR of CHF pt

46

increased _____ may identify CHF as the cause of dyspnea in the ER

BNP

47

_____ release B-type natriuretic peptides (BNP) during volume overload

ventricles

48

calcium channel blockers are helpful for which kind of HF?

Diastolic

49

Persistent, pleuritic, postural pain and pericardial friction rub (5 P's)

Acute pericarditis

50

Viral is most common cause (Enteroviruses: Coxsackie and echovirus)

Acute pericarditis

51

pericarditis that occurs 2-5 months after an MI

Dressler's syndrome

52

Pleuritic chest pain (sharp and worse w inspiration). Persistent, postural (worse with lying down and relieved by sitting/leaning forward). May radiate to trapezius*, back, neck, shoulder, arm, epigastric area.
**Fever usually present**

Acute pericarditis

53

Best heard at end of expiation with patient upright and leaning forward

Pericardial friction rub

54

EKG shows diffuse, ST elevations in precordial leads (concave up in V1 through V6) and associated with PR depression

Acute pericarditis

55

First line tx for acute pericarditis

Anti-inflammatory drugs- aspirin or NSAIDs

56

Increased fluid in pericardial space

Pericardial effusion

57

Causes include: pericarditis**, malignancy infection, radiation therapy, dialysis/uremia, collagen vascular disease

Pericardial effusion

58

Exam reveals distant heart sounds bc fluid interferes w sound conduction

Pericardial effusion

59

Low voltage QRS complexes suggest...

Large effusion (or tamponade)

60

Echocardiogram shows an increase pericardial fluid

Pericardial effusion

61

Pericardial effusion causing significant pressure on the heart, which causes a restriction of cardiac ventricular filling, which decreases cardiac output

Pericardial tamponade

62

1. distant (muffled) heart sounds
2. increased JVP
3. systemic hypotension

Beck's triad

(seen in pericardial tamponade)

63

decreased pulses with inspiration

Pulsus paradoxus (seen in pericardial tamponade)

64

Echocardiogram may show diastolic collapse of cardiac chambers

Pericardial tamponade

65

Tx of pericardial tamponade

Immediate pericardiocentesis

66

thickened, fibrotic, calcified pericardium that restricts ventricular diastolic filling

(this causes an increase in venous pressure
decrease in stroke volume
ultimately, a decreased cardiac output)

Constrictive pericarditis

67

Dyspnea***
Pulsus paradoxus
R sided HF signs, Kussmaul's sign: JVD increased during inspiration

Constrictive pericarditis

68

Pericardial knock: high-pitched 3rd heart sound due to sudden cessation of ventricular filling in early diastole from thickened inelastic pericardium

Constrictive pericarditis

69

Echocardiography shows: pericardial thickening
CXR shows: pericardial calcification

Constrictive pericarditis

70

Pericardiectomy is the management for..

Constrictive pericarditis

71

What is the most common type of cardiomyopathy

Dilated cardiomyopathy (95%)

72

systolic dysfunction leads to ventricular dilation which causes a "dilated, weak heart"

ages 20-60

Dilated cardiomyopathy

73

Most commonly idiopathic, can be cause by enteroviruses (Coxsackie B, echovirus), Parovirus B19
*Can be caused by alcohol abuse, cocaine, anthracyclines, pregnancy

Dilated cardiomyopathy

74

Echocardiogram shows left ventricular dilation (thin ventricular wall), large ventricular chamber, deceased ejection fraction, regional or global LV hypokinesis

(CXR shows cardiomegaly)

Dilated cardiomyopathy

75

You treat dilated cardiomyopathy just like...

heart failure

(ACEi, diuretics, etc)

76

Hallmark**= impaired diastolic function with relatively persevered contractility**
ventricular rigidity impedes ventricular filling

Restrive cardiomyopathy

77

infiltrative disease: amyloidosis is most common cause**, sarcoidosis

Restrictive cardiomyopathy