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Clin Med-Cardio pt 2 > PEARLS Book > Flashcards

PEARLS Book Flashcards

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1
Q

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

A

Echocardiogram

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2
Q

This type of echocardiogram is:

**primary noninvasive test for assessing cardiac anatomy and function

A

Transthoracic echocardiogram (TTE)

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3
Q

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)

A

Transesophageal echocardiogram (TEE)

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4
Q

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

A

ANGIOGRAPHY!

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5
Q

What does a positive stress test look like on EKG

A

ST depression

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6
Q

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

A

Stress test

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7
Q

Benefit of using Myocardial Perfusion Imaging (MPI)..

A

localization of region of ischemia

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8
Q

Adenosine or Dipyridamole

A

Pharmacologic stress test

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9
Q

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

A

Stress echo

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10
Q 
risk factors=
diabetes mellitus
hyperlipidemia
smoking
HTN
males
age over 65
fam hx of CAD
A

Angina

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11
Q

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

A

Angina

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12
Q

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

A

Coronary angiography

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13
Q

Most common cause of an MI?

A

Atherosclerosis

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14
Q

Women, elderly, diabetics, obese have..

A

Atypical MI presentations

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15
Q

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

A

v1 through v4

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16
Q

Which artery is involved in an anterior wall MI?

A

LAD

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17
Q

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

A

I, aVL, V5, V6

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18
Q

Which artery is involved in a lateral wall MI?

A

Circumflex

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19
Q

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

A

I, aVL, v4, v5, v6

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20
Q

Which artery is involved in an anterolateral MI?

A

mid LAD or circumflex

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21
Q

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

A

II, III, aVF*

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22
Q

Which artery is involved in an inferior wall MI?

A

Right coronary artery

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23
Q

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

A

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

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24
Q

How often should you test cardiac markers?

A

3 sets Q8 hours

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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

Clin Med-Cardio pt 2 (11 decks)

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