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First Aid Step 2 > Rapid Review Cardiovascular > Flashcards

Rapid Review Cardiovascular Flashcards

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1
Q

fClassic EKG finding in atrial flutter

A

Sawtooth P waves

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2
Q

Definition of unstable angina

A

Angina that is new, worsening, occurs at rest

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3
Q

Antihypertensive for diabetic pt w/ proteinuria

A

ACEI

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4
Q

Becks triad for cardiac tamponade

A

Hypotension
Distant heart sounds

JVD

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5
Q

Drugs that slow HR

A

Beta blockers

CCB

Digoxin

Amiodarine

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6
Q

Hypercholesterolemia Tx that leads to flushing and pruritis

A

Niacin

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7
Q

Mumur of HOCM

A

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

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8
Q

Murmur of aortic insufficiency

A

Austin flint murmur:

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

Increases with increased afterload (i.e. handgrip)

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9
Q

Murmur of AS

3 cases when valve replacement needed

A

Systolic crescendo-descrescendo radiates to neck

Increases with increased preload

Replace: ACS- angina, CHF, syncope

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10
Q

Murmur of MR

A

Holosystolic mumur that radiates to axilla or carotids

Increases with increased afterload (handgrip)

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11
Q

Mumur of MS

A

Diastolic mid to late low pitched mumur preceded by opening snap

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12
Q

Tx for aflutter and afib

A

Unstable - cardiovert

Stable or chronic- rate control with CCB or Beta blocker

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13
Q

Tx vfib

A

Immediate cardioversion

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14
Q

Dressler’s syndrome

A

AI reaction

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

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15
Q

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

A

Treat existing HF and replace tricuspid valve

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16
Q

Diagnostic test for HCM

A

Echo (shows thickened LV wall and outflow obstruction)

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17
Q

Pulsus paradoxus

A

Decrease in SBP >10 mmHg with inspiration

Seen in cardiac tamponade

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18
Q

Classic EKG in pericarditis

A

Low voltage, diffuse ST segement elevation, PR depression

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19
Q

Definition of HTN

A

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

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20
Q

Eight surgically correctable causes of HTN

A
  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
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21
Q

Evaluation of pulsatile abdominal mass and bruit

A

ABD US and CT

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22
Q

Indications of surgical repair of AAA

A

>5.5 c, rapidly enlarging, symptomatic, ruptured

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23
Q

Tx ACS

A

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

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24
Q

Metabolic syndrome

A
  1. Abdominal obesity
  2. High TG
  3. Low HDL
  4. HTN
  5. IR
  6. Prothrombotic or proinflammatory states
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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)

First Aid Step 2 (22 decks)

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