Flashcards in Uworld Cardiology Deck (65):
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
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:
3. Nitroglycerin and calcium channel blockers
Beta blockers contraindicated.
Metabolic conditions that can lead to AFIB?
Catecholamine surges or hyperthyroidism
Drugs that can cause AFIB?
Caffeine, theophylline, digoxin
Cocaine, amphetamines, alcohol,
Patient post MI who presents with wide complex tachycardia and fusion beats. Treat with?
If stable IV amiodarone
If unstable (hypertension, respiratory distress) cardioversion
Patient presents with a regular, narrow complex tachycardia. Treat with?
1. Esmolol (short-acting beta blocker for Rapid rate control)
3. Carotid massage
Hypertrophic cardiomyopathy: epidemiology? Carotid findings? murmur? Maneuver to increase murmur?
1. Young, African-Americans
2. Dual upstroke
3. Systolic ejection type murmur
4. Valsalva maneuver (decrease preload)
Drug that can increase QRS duration? Used to treat? Mechanism?
Flecainide. Ventricular or supraventricular tachycardia. Class 1C antiarrhythmic - Blocks sodium channels
Patient with swelling and hepatosplenomegaly. Physical exam to suggest cardiac problem?
Positive hepatojugular reflex (pressing on abdomen causes JVD)
CHF with proteinuria and easy bruisability – most likely diagnosis?
Drug to control essential hand tremor and hypertension?
70 percent of patients with mitral stenosis will develop? Why?
AFIB. left atrial dilation
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)
Effect of pericardial effusion On EKG?
Electrical alternans - QRS complexes whose amplitudes vary from beat to beat
Initial labs for hypertension work up ?
1. Urinalysis (four hematuria)
2. Chemistry and lipid profile (risk of coronary artery disease)
Use this test to r/o hypertension caused by:
1. Cushing's syndrome
2. Primary hyperaldosteronism
3. Renal artery stenosis
1. 24 hour urine cortisol excretion
2. Renin level
3. Renal ultrasound
4. Urine metanephrines
Type of vessels: arteries versus veins
Resistance vessels versus capacitance vessels?
Patient comes in with MI. Should leave with what drugs? If patient underwent PCI, will also leave with?
2. ACE inhibitors
3. Beta blockers
Effect of calcium channel blockers (amlodipine) in ACS?
Avoid. Increased mortality
Treatment for type I heart block?
Type II? Type III?
2. Atropine if symptomatic
3. Atropine if symptomatic
Medications to withhold prior to cardiac stress testing?
1. Beta blockers
2. calcium channel blockers
1. PDE inhibitor
2. Tromboxane inhibitor
3. Increased adenosine (decreases reuptake and breakdown)
Heart side effect from thiazides?
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?
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?
Algorithm for VF or VT?
2. Epi (every 3 min)
4. Antiarrhythmics (lidocaine, amiodarone, Mg)
Pulsus parvus et tardes observed with?
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
Amiodarone or lidocaine
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?
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?
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?
Signs of hemochromatosis?
Cardiac: dilated cardiomyopathy and conduction
Skin: bronze diabetes
Endo: diabetes, hypergonadism
Treatment for hypertrophic cardiomyopathy?
Right ventricular failure: Time course? Coronary artery involved? Clinical findings? ECHO findings?
hypertension clear lungs and kussmal sign
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?
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)
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)?
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?
Signs/Sx of AR?
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?
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