Rapid Review Cardiovascular Flashcards Preview

First Aid Step 2 > Rapid Review Cardiovascular > Flashcards

Flashcards in Rapid Review Cardiovascular Deck (125):
1

fClassic EKG finding in atrial flutter

Sawtooth P waves

2

Definition of unstable angina

Angina that is new, worsening, occurs at rest

3

Antihypertensive for diabetic pt w/ proteinuria

ACEI

4

Becks triad for cardiac tamponade

Hypotension
Distant heart sounds

JVD

5

Drugs that slow HR

Beta blockers

CCB

Digoxin

Amiodarine

6

Hypercholesterolemia Tx that leads to flushing and pruritis

Niacin

7

Mumur of HOCM

Systolic ejection murmur along lateral sternal border that increases with decreased preload (i.e. Valsalva)

8

Murmur of aortic insufficiency

Austin flint murmur:

Diastolic, descrescendo, low pitched, blwing murmur best heard sitting up

Increases with increased afterload (i.e. handgrip)

9

Murmur of AS

3 cases when valve replacement needed

Systolic crescendo-descrescendo radiates to neck

Increases with increased preload

Replace: ACS- angina, CHF, syncope

10

Murmur of MR

Holosystolic mumur that radiates to axilla or carotids

Increases with increased afterload (handgrip)

11

Mumur of MS

Diastolic mid to late low pitched mumur preceded by opening snap

12

Tx for aflutter and afib

Unstable - cardiovert

Stable or chronic- rate control with CCB or Beta blocker

13

Tx vfib

Immediate cardioversion

14

Dressler's syndrome

AI reaction

Fever, pericarditis, increased ESR 2-4 weeks post MI

15

IVDU with JVD and holosystolic murmur at left sternal border....Tx

Treat existing HF and replace tricuspid valve

16

Diagnostic test for HCM

Echo (shows thickened LV wall and outflow obstruction)

17

Pulsus paradoxus

Decrease in SBP >10 mmHg with inspiration

Seen in cardiac tamponade

18

Classic EKG in pericarditis

Low voltage, diffuse ST segement elevation, PR depression

19

Definition of HTN

BP >140/90 on 3 separate occassions 2 weeks apart

20

Eight surgically correctable causes of HTN

1. Renal a stenosis

2. Coarctation of the aorta

3. Pheochromocytoma

4. Conn's syndrome

5. Cushing syndrome

6. Unlateral renal parenchymal disease

7. Hyperthyroidism

8. Hyperparathyroidism

21

Evaluation of pulsatile abdominal mass and bruit

ABD US and CT

22

Indications of surgical repair of AAA

>5.5 c, rapidly enlarging, symptomatic, ruptured

23

Tx ACS

MONA: morphine, ASA, sublingual nitrogen, O2 +heparin, clopidogrel, IV beta blockers

24

Metabolic syndrome

1. Abdominal obesity

2. High TG

3. Low HDL

4. HTN

5. IR

6. Prothrombotic or proinflammatory states

25

Dx test for 50 y.o. man with stable angina that can exercise to 85% of max HR

Exercise stress treadmill with ECG

26

Dx test for 65 y.o. woman with LBBB and severe OA with unstable angina

Pharmacologic stress test (dobutamine echo)

27

Target LDL in pt w/ DM

<70

28

Signs of active ischemia during stress test

1. Angina

2. ST segment changes on EKG

3. Drop in BP

29

EKG findings suggesting MI

ST segment leevation (depression means ischemia), flattened T waves, Q waves

30

Anterior wall is suppled by which aa

LAD

Diagonal

31

Inferior wall is supplied by which aa

PDA

32

Posterior wall is supplied by which aa

LCA/oblique

RCA/marginal

33

Interventricular septum supplied by which aa

LAD/diagonal

34

Young pt with angina at rest and ST segment elevation with normal cardiac enzymes

Prinzmetal's angina

35

Common Sx associated with silent MI

CHF

Shock

Altered mental status

36

Dx test for PE

Spiral CT with contrast

37

Protamine reverses

Heparin

38

PT

Coagulation parameter effected by warfarin

Coagulation factors I, II, V, VII, X = EXTRINSIC

39

PTT

Monitor heparin

Factors: I, II, V, VIII, IX, X, XI, & XII- INTRINSIC and COMMON

Does not measure: VII and XIII

40

Youn pt with FH of sudden death collapses and dies while exercising 

HCM

41

Endocarditis prophylaxis regimens

Oral surgery: amoxicillin

GI or GU: not recommended

42

Virchow's triad

1. Stasis

2. Hypercoagulability

3. Endothelial damage

43

Most common cause HTN in women

OCP

44

Figure 3 sign

Aortic coarctation

45

Water bottle shaped heart

Pericardial effision

Look for pulsus paradoxus

46

Kussmaul's sign, causes?

Increase in JVP with inspiration

RV infarction, postop cardiac tamponade, constrictive pericarditis, TR

47

Murmur of MVP

Midsystolic or late systolic mumur with preceeding click

48

Murmur of AR

Acute causes?

History of pt in acute AR?

Early diastolic descrendo mumur, at left sternal border (Austin Flint murmur)

Acute causes: infective endocarditis, aortic dissection, trauma

Hx: rapid onset pulm congestion, cardiogenic shock, severe dyspnea

49

Murmur of MS

Diastolic mid to late low pitched murmur

50

S3 gallop - when and why

Due to high output states- normal in young kids, and pts

Dilated CMP (floppy ventricle), MV disease

51

S4 gallop

Normal in young and athletes

HTN, diastolic dysfcn (stiff ventricle), AS

52

Pulsus alternans

Alternating weak and strong pulses

Cardiac tampnade, asthma, COPD, tension pneumo, FB in airway

53

Pulsus parvus et tardus

Weak and delayed pulse

AS

54

When would peripheral pulses be increased?

Compensated AR, coarctation (UE>LE), PDA

55

Used to increase HR in bradycardia

Atropine

56

Causes afib

PIRATES = ACUTE

Pulmonary disease

Ischemia

Rheumatic heart disease

Anemia/Atrial myxoma

Thyrotoxicosis

Ethanol

Sepsis

CHRONIC- HTN, CHF

57

Tx acute CHF

LMNOP

Lasix

Morphine

Nitrates

Oxygen

Position (upright)

58

Causes dilated CMP

Most common 2nd: HTN and ischemia

Idiopathic

Alcohol

Myocarditis

Postpartum

Drugs (doxorubicin, AZT, cocaine)

Endocrinopathies (thyroid, acromegaly, pheo)

Infection (coxsackie, HIV, Chagas, parasites)

Genetics

Nutritional (wet beriberi)

 

59

Prinzmetal's angina

Mimics angina pectoris

Due to vasospasm of coronary vessels

Young women, at rest, early morning

ST elevation w/o cardiac enzyme elevation

60

Sequence of EKG changes in MI

Peak T waves

ST segmenet elevation

Q waes

T wave inversion

ST segment normalization

T wave normalization

61

St segment elevation in II, III, aVF - MI? Vessels?

Inferior MI

RCA/PDA and LCA

62

ST segment elevation in V1-V4 - MI? Vessels?

Anterior MI

LAD and diagonal

63

ST segment elevation I, aVL, V5-V6 MI? Vessels?

Lateral MI

LCA

64

ST segment depression V1-V2

Acute transmural infarct in posterior wall

65

CABG indications

Unable to perform PCI 2/2 diffuse disease

Left main coronary artery disease

Triple vessel disease

Depressed ventricular function

66

Complicatons of post MI

1. First day

2. 2-4 days

3.5-10 days

4. weeks to months

1. heart failure

2. arrhythmia, pericarditis

3. LV wall rupture (pericardial tamponade causing electrical alternans and pulseless electrical activity), papillary mm rupture (severe MR)

4. Ventricular aneurysm (CHF, arrhythmia, persistent ST elevation, MR, thrombus)

67

Rx for HTN

ABCD

ACEI/ARB

Beta blocker

CCB

Diuretics- #1

68

Causes 2nd HTN

CHAPS

Cushing syndrome

Hyperaldosteronism

Aortic coarctation

Pheo

Stenosis of renal aa

69

Triad of Conn's syndrome

Labs?

1. Unexplained hypokalemia

2. Metabolic alkalosis

3. HTN

Labs: increased aldo and decreased renin

70

Causes Cushing's syndrome 

Cuase: ACTH producing pituitary tumor or ectopic tumor, cortisol secrtion by adrenal adenoma or carcinoma, exogenous steroids

71

Causes pericarditis

CARDIAC RIND
Collagen vascular disease

Aortic dissection

Radiation

Drugs

Infections

ARF

Cardiac (MI)

Rheumatic fever

Injury

Neoplasms

Dressler's

72

73

Most common risk factor aortic aneurysm vs aortic dissection

Aneurysm: atherosclerosis

Dissection: HTN

74

Most common location aortic dissection

Above aortic valve or distal to L subclavian

75

Gold standard Dx aortic dissection

CTA

76

Stanford system of classification of aortic dissection

A: proximal or ascending (ascending is surgical emergency)

B: descending- medically manage

77

6 Ps of acute ischemia

Pain

Pallor

Paralysis

Pulse deficit

Paresthesias

Poikilothermia

 

78

ABI where pain occurs at rest in PVD

<0.4

79

Hemophilia A

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Inheritance

PTT

Low Factor VIII

X-linked

80

Hemophilia B

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Inheritance?

PTT

Low factor IX

X linked

81

vWF deficiency

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Inheritance?

BT and PTT

Normal or low factor VIII

AD

82

DIC

Which test prolonged: PT, PTT, BT?

Peripheral Smear?

Causes

PT, PTT, BT; + D-dimer or FDP

Schistocytes

Infection, postpartum, malignancy

83

Liver Disease

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

PT

All low but factor VIII

84

Vit K def

Which test prolonged: PT, PTT, BT?

Low levels of which factor?

Cause?

PT, PTT (slight)

Factors II, VII, IX, X, Protein C and S

Neonate, malabsorption, alcoholic, prolonged abx use which kills Vit K making bacteria

85

Uremia affects which component of blood?

PT, PTT, BT increased?

Tx?

Platelet

BT

Desmopresssin

86

Cor pulmonale

Tx

RV enlargement, hypertrophy, or failure due to primary lung disease (can be caused by sleep apnea)

Tx: pulmonary vasodilators -prostacyclins, antiendothelins, PDE5 inhibitors, CCB

87

Differential Dx Chest Pain

CHEST PAIN

Cocaine/Costochondritis

Hyperventilation/HSV

Esophagitis/Esophageal spasm

Stenosis of aorta

Trauma

PE/Pnuemo/Pericarditis/Pancreatitis

Angina/Aortic Dissection/ Aortic aneurysm

Infarction (MI)

Neuropsych Disease (depression)

 

88

Tx VTach

Amiodarone

89

When is the greatest risk of sudden death following an MI?

What are the 3 major causes?

First few hours

Vtach, Vfib, cardiogenic shock

90

Class IA antiarrhythmic

Drugs?

Use?

Channels?

Quinidine, proacinamide

PSVT, Afib, Aflutter, Vtach

Na+- AP prolonged

91

Class IB antiarrhythmic

Drugs?

Use?

Channels?

Lidocaine, tocainide

Vtach

Na+ blockers- shorten AP

92

Class IC antiarrhythmic

Drugs?

Use?

Channels?

Flecainide, propafenone

PSVT, Afib, Aflutter, PSVT

Na nlockers - no change AP

93

Class II antiarrhythmic

Drugs?

Use?

 

Beta blockers - propranolol, esmolol, metoprolol

PVC, PSVT, Afib, Aflutter, Vtach

94

Class III antiarrhythmic

Drugs?

Use?

Channels

Amiodarone, Sotalol, Bretylium

Afib, Aflutter, Vtach (no breytlium)

K blockers

95

Class IV antiarrhythmic

Drugs?

Use?

Channels

Verapamil, Diltiazem

PSVT, Afib, Aflutter, MAT

Ca blockers

96

Functions of Angiotensin II

Vasoconstriction (arterial smooth mm)

Increase Aldo (at adrenal gland - increase Na reabsorption in kidney)

Increase NE release (SNS)

Stimulate thirst and vasopressin (brain)

Increase contractility and ventricular hypertrophy of heart

97

Valsalva effect on AS and HOCM

AS: decrease murmur

HOCM: increase murmur

98

Specific gravity and causes of transudate vs exudate of pericardial effusion

Exudate >1.020- high in protein; think neoplasm, fibrotic disease, TB

Transudate <1.020 - low in protein

99

Causes myocarditis

Drugs: doxorubicin, chloroquine, penicillins, sulfonamides, cocaine, radiation

Infection 

-Virus: coxsackie, parvovirus B-19, HHV-6, adenovirus, echovirus, EBV< CMV, influenza

-Bacteria

-Rickettsia

-Fungi

-Parasites

 

100

Cause myocarditis in S America, common assocaition

Chagas- Trypanosoma crzui

Achalasia

101

H/P GAS infection- acute rheumatic fever

Migratory arthritis, hot swollen joints, fever, sub1 nodules on extensor surface, Sydenham chorea, erythema marginatum (painless)

102

JONES criteria for Rheumatic Heart Disease

 

Jones Peace

Major: 
Joints (polyarticular, hot and swollen)
Heart: carditis
Nodules
Erythema marginatum
Sydenham Chorea

Minor:
Previous rheumatic fever
ECG with prolonged PR
Arthralgias
CRP and ESR elevated
Elevated T

Need 2 major or 2 minor and 1 major

103

Bugs that would result in negative culture endocarditis

HACEK

Haemophilus
Actinobacillus
Cadiobacterium
Eikenella
Kingella

104

Bugs common on prosthetic valve

Staph epidermidis

Staph aureus

105

Acute vs subacute bugs that cause endocarditis

Acute: Staph aureus, Strep pyogenes/pneumo, Neisseria gonorrhoeae

Subacute: strep viridians, Enterococcus, fungi, Staph epi

106

Tx bacterial endocarditis

4-6 weeks IV abx

Beta lactam + aminoglycoside

 penicillin, cephalosporins, monobactams, and carbapenems

 amikacin, arbekacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, rhodostreptomycin,[2] streptomycin, tobramycin, and apramycin

107

DM

Best antiHTN Rx?

Worst?

Best: ACEI for kidneys

Worst: Thiazide (impair glc tolerance) and beta blocker (mask hypoglycemia)

108

CHF

Best antiHTN Rx?

Worst?

Best: ACEI/ARB; Aldo antag; Beta blockers

Worst: CCB - reduce rate/contractility- make HF worse

109

Post MI

Best antiHTN Rx?

Worst?

Best: Beta blocker, ACE/ARB, Aldo antag

Worst???

110

BPH

Best antiHTN Rx?

Worst?

Best: selecative alpha 1 blocker

Worst:??

111

Migraine

Best antiHTN Rx?

Worst?

Best: Beta blocker

Worst: ??

112

Osteoporosis

Best antiHTN Rx?

Worst?

Best: thiazide- maintain normal/high serum Ca

113

Asthma/COPD

BEst???

Worst: Nonselective Beta blocker- bronchoconstriction

114

Pregnancy

Best antiHTN Rx?

Worst?

Best: Hydralazine, methyldopa, labetaolol. nifedipine

Worst: thiazide ( increased bv during pregancy should be maintained), ACE and ARB are teratogens

115

Gout

Best antiHTN Rx?

Worst?

Best??

Worst: Diuretic - increase uric acid in serum

116

Depression

Best antiHTN Rx?

Worst?

Best???

Worst: beta blockers - worsen Sx

117

BP of HTN urgency/ emergency

Emergency vs urgency

 

> or = 180/120

Emergency: evidence of end organ damage - progressive renal failure, pulm edema, aortic dissection, encephalopathy, papilledema

118

Tx HTN emergency

Reduce DP to 100 using IV nitroprusside, labetolol, nicardipine, fenoldopam

Then use Beta blocker or ACEI orally to reduce BP

Use diuretics for pulm edema

119

Meds used in PVD to help slow occlusion (2)

Pentoxifylline

Cilostazol

120

Nitroprusside dilates?

AA and VV

121

Nitroglycerin dilates

VV

122

Hydralazine dilates

AA

123

Alpha 1 antagonist dilates

AA

124

CCB dilates

AA

125

Secondary causes HLD

Uncontrolled DM

Hypothyroidism

Nephrotic syndrome

Obstructibe liver diseae

Excessive EtOH (raise TG)

Obesity

Meds (OCP, isotretinoin, glucocorticoids, thiazides, beta blockers)