Origin of 1. paroxysmal supraventricular tachycardia? 2. Of Wolff-Parkinson-White? 3. Of atrial flutter? 4. Of sinus tachycardia? 5. Atrial fibrillation?

1. AV node 2. Bundle of Kent 3. Tricuspid annulus 4. SA node 5. Pulmonary veins

Use this test to r/o hypertension caused by: 1. Cushing's syndrome 2. Primary hyperaldosteronism 3. Renal artery stenosis 4. Pheochromocytoma

1. 24 hour urine cortisol excretion 2. Renin level 3. Renal ultrasound 4. Urine metanephrines

1. PDE inhibitor 2. Tromboxane inhibitor 3. Increased adenosine (decreases reuptake and breakdown)

Uworld Cardiology Flashcards by Michael Salgado

Patient with ST segment depression and T-wave inversion in leadsC4 through V6. Troponin T is normal, chest x-ray shows no acute abnormality. The pupils are dilated, nasal mucosa is atrophic, and patient is agitated and sweating. Next step in management? Contraindicated?

Acute cocaine intoxication. Give:

benzodiazepines.
Aspirin
Nitroglycerin and calcium channel blockers

Beta blockers contraindicated.

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Origin of

paroxysmal supraventricular tachycardia?
Of Wolff-Parkinson-White?
Of atrial flutter?
Of sinus tachycardia?
Atrial fibrillation?

AV node
Bundle of Kent
Tricuspid annulus
SA node
Pulmonary veins

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Metabolic conditions that can lead to AFIB?

Catecholamine surges or hyperthyroidism

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Drugs that can cause AFIB?

Caffeine, theophylline, digoxin

Cocaine, amphetamines, alcohol,

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Patient post MI who presents with wide complex tachycardia and fusion beats. Treat with?

If stable IV amiodarone

If unstable (hypertension, respiratory distress) cardioversion

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Patient presents with a regular, narrow complex tachycardia. Treat with?

Esmolol (short-acting beta blocker for Rapid rate control)
Adenosine
Carotid massage

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Hypertrophic cardiomyopathy: epidemiology? Carotid findings? murmur? Maneuver to increase murmur?

Young, African-Americans
Dual upstroke
Systolic ejection type murmur
Valsalva maneuver (decrease preload)

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Drug that can increase QRS duration? Used to treat? Mechanism?

Flecainide. Ventricular or supraventricular tachycardia. Class 1C antiarrhythmic - Blocks sodium channels

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Patient with swelling and hepatosplenomegaly. Physical exam to suggest cardiac problem?

Positive hepatojugular reflex (pressing on abdomen causes JVD)

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CHF with proteinuria and easy bruisability – most likely diagnosis?

Amyloidosis

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Drug to control essential hand tremor and hypertension?

Propranolol

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70 percent of patients with mitral stenosis will develop? Why?

AFIB. left atrial dilation

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Patient with Wolff-Parkinson-White syndrome goes into AFIB. Treatment?

Procainamide. (Beta blockers, calcium channel blockers, adenosine and digoxin should not be used for these patients because they increase AV node refractory period)

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Effect of pericardial effusion On EKG?

Electrical alternans - QRS complexes whose amplitudes vary from beat to beat

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Initial labs for hypertension work up ?

Urinalysis (four hematuria)
Chemistry and lipid profile (risk of coronary artery disease)
EKG

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Use this test to r/o hypertension caused by:

Cushing’s syndrome
Primary hyperaldosteronism
Renal artery stenosis
Pheochromocytoma

24 hour urine cortisol excretion
Renin level
Renal ultrasound
Urine metanephrines

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Type of vessels: arteries versus veins

Resistance vessels versus capacitance vessels?

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Patient comes in with MI. Should leave with what drugs? If patient underwent PCI, will also leave with?

Aspirin
ACE inhibitors
Beta blockers
Statin

Clopidogrel

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Effect of calcium channel blockers (amlodipine) in ACS?

Avoid. Increased mortality

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Treatment for type I heart block?

Type II? Type III?

Nothing
Atropine if symptomatic
Atropine if symptomatic

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Chlorthalidone?

Thiazide diuretic

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Medications to withhold prior to cardiac stress testing?

Beta blockers
calcium channel blockers
nitrates

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Dypridamole?

PDE inhibitor
Tromboxane inhibitor
Increased adenosine (decreases reuptake and breakdown)

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Heart side effect from thiazides?

Ventricular arrhythmia

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Treatment of embolic artery occlusion?

Surgical embolectomy or percutaneous thrombolysis

HOCM - murmur from?

1. Septal hypertrophy | 2. Systolic anterior motion of mitral valve

PACs usually result in what arrhythmias?

Mostly supraventricular. Sometimes ventricular.

Treatment of symptomatic PACs?

Beta blocker

Mech of niacin induced flushing? Mitigate Sx by?

Increase in prostaglandins. Taking aspirin.

Always investigate what type of murmur? How?

Diastolic continuous murmurs. ECHO.

Digoxin used for?

Atrial tachycardias

Algorithm for VF or VT?

1. Defibrillation 2. Epi (every 3 min) 3. Defib 4. Antiarrhythmics (lidocaine, amiodarone, Mg)

Pulsus parvus et tardes observed with?

Aortic stenosis

Causes of increased capillary hydrostatic pressure?

1. Heart failure 2. Renal Na retention (kidney problems, pregnancy) 3. Venous obstruction (cirrhosis, venous insufficiency, pul HTN)

Causes of hypoalbuminemia?

1. Loss (GI or nephrotic) | 2. Decreased production (cirrhosis and malnutrition)

Causes of increased capillary permeability?

Burns, allergies, ARDs, malignant ascities

Treatment of narrow complex tachycardia vs wide complex tachycardia?

Vegas maneuvers or adenosine Vs Amiodarone or lidocaine

Electrical alternans?

Cardiac tamponade

Use DC cardioversion for?

AFIB, A-flutter, and monomorphic ventricular tachycardia

Use Transvenous pacemaker if?

Sick sinus syndrome and 2nd/3rd degree heart block

EKG findings in PE?

Sinus tachycardia New onset right bundle branch block S1 Q3 T3

Posterior M – see on EKG?

ST depression in V1 – V3 ST elevation in I and aVL (LCX) ST depression in I and aVL (RCA)

Prinzmetal angina presents with? Treatment?

Episodes at night EKG shows ST elevations Seen in smokers Treat with nitrates and Ca channel blockers (do not treat with aspirin or beta blockers)

Diastolic dysfunction? Caused by?

HF with preserved EF. Hypertension.

Nitrates contraindicated with?

Aortic stenosis, PDE inhibitors, RV infarction

Non-pharmacologic ways to lower HTN?

``` Weight loss Limit salt Vegetables Low fat Decrease alcohol intake ```

SVT gets better with cold water because?

cold water increases Vegal tone -> slows AV node (SVT reentrant pathway that hits AV node) SA node also affected by Vegal maneuvers, but not the main mech of SVT

Blood-pressure medications that cause lower extremity edema?

Dihydropyridines (amlodipine)

Signs of hemochromatosis?

``` Cardiac: dilated cardiomyopathy and conduction Skin: bronze diabetes Muscular: arthropathy Gastrointestinal: hepatomegaly Endo: diabetes, hypergonadism ```

Treatment for hypertrophic cardiomyopathy?

Beta blocker

Right ventricular failure: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Acute, RCA, hypertension clear lungs and kussmal sign hypokinetic RV

Papillary muscle rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Acute or within 3 to 5 days, RCA Pulmonary edema, new systolic murmur Mitral regurg with flail leaflet

Intraventricular septum rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Acute or within 3 to 5 days LAD (apical septum or RCA (basal septum) Shock, chest pain, holosystolic murmur, biventricular failure Left to right shunt at ventricle

Free wall rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Up to two weeks, LAD Shock, chest pain, JVD, distant heart sounds Pericardial effusion and tamponade

Never treat endocarditis with?

Oral antibiotics

Drug to use for: 1. Supraventricular tachycardia? 2. Ventricular tachycardia? 3. Atrial fibrillation?

1. Adenosine (to slow rate to determine exact type of supraventricular tachycardia) 2. Lidocaine, procainamide (WPW) 3. Amiodarone

Post MI: papillary muscle rupture vs septal wall rupture? In common?

In common: holosystolic murmur Murmur at apex and radiates to axilla vs murmur at left eternal border with thrill

Pt with cardiomyopathy, nephropathy, hepatomegaly and neuropathy - test?

Fat pad biopsy for amyloidosis

Signs of an arteriovenous fistula?

1. Increased preload (LVH) 2. increase in cardiac output but decreased TPR (widened pulse pressure) 3. Brisk carotid upstroke 4. tachycardia and flushed extremities

S3 indicates (most of the time)?

CHF exacerbation

Avoid amiodarone in which patients? Avoid metoprolol in which patients?

Those with existing lung disease Those with obstructive lung disease (can give to pts with restrictive lung disease)

Pulsus paradoxus - Ddx?

1. Tamponade | 2. COPD/asthma

Signs/Sx of AR? Causes?

1. Exertional dyspnea 2. Pounding heart sensation 3. Widened pulse pressure Developing world: rheumatic disease Developed world: congenital bicuspid valve; aortic root dilitation

Water hammer pulse seen in? Mech? Associated Sx?

AR; Increased SV and abrupt rise in systolic BP (quick peripheral distention) followed by abrupt drop in diastolic BP (quick peripheral artery collapse) Headaches; bobbing head

Ventricular arrhythmias - treatment options?

1. Amiodarone | 2. Lidocaine

Uworld Cardiology Flashcards

(65 cards)