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PANRE > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Exercise stress test can not be performed

A 
Meds: digitalis, BB, CCB, Amiodarone
Aortic Stenosis (absolute contraindication)
Must use imaging for:
LBBB
LVH with strain pattern
WPW
Pacemaker
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2
Q

Kerly B lines

A

Signs of fluid accumulation in lungs with high blood pressure

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3
Q

Pharmacologic stress test indications

A

Unable to exercise
Aortic Stenosis

Dobutamine-substitution for exercise
Adenosine-vasodilator
Can only dilate “healthy” vessels, causes a “steal effect”

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4
Q

RCA inervates

A

R ventricle, R atrium, SA node, AV node, INFERIOR wall of L ventricle

Leads II, III and AVF

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5
Q

LAD inervates

A

septum, ANTERIOR wall of L ventricle

Leads V1-V4

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6
Q

Circumflex inervates

A

Lateral wall L ventricle

Leads V5, V6, I, aVL

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7
Q

Prinzmetal angina

A 
Resting angina (midnight-8AM)
Caused by focal coronary artery spasm

Treatment: CCB, stop smoking

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8
Q

Acute Coronary Syndrome:

Unstable Angina
NSTEMI
STEMI

A

UNSTABLE ANGINA: chest pain (change from normal), neg Troponin

MSTEMI: chest pain + Ischemic EKG changes (ST depression or T wave inversion), increase in cardiac enzymes. Do stress echo.
Plavix or Heparin (no Thrombolysis)

STEMI: infarct (complete occlusion), ST elevation in 2 consecutive leads.
Right to cath lab (don’t wait for Troponin). PCI within 90 min or Thrombolysis

Treatment: MONAB

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9
Q

Post MI complications

A

Myocardial rupture: new holosystolic murmur. Acute MR (papillary muscle rupture) or VSD

Cardiogenic shock/CHF

Thromboembolism

Pericardial disease: pericarditis, Dressler’s Syndrome

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10
Q

Abnormal heart sounds

A

S3= volume overload (CHF)

S4=pressure overload (longstanding HTN, LVH, acute

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11
Q

Murmur Locations

A 
RUSB: Aortic Stenosis
LUSB: Pulmonic murmurs
Erb's Point(LSB): Aortic Insufficiency, HCM
Tricuspid: TS, TR, ASD, VSD
Mitral/Apex: MS, MR
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12
Q

Murmur Pitch

A 
Low Pitch (bell of stethoscope)-
MS, TS
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13
Q

Murmur Radiation

A

Neck/Carotid=Aortic Stenosis

Back/Axilla=Mitral Regurg

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14
Q

Aortic Stenosis

A

Sx: exertional angina, syncope dyspnea

PE: CHF, narrow pulse pressure, S4 )LVH), sustained PMI

Murmur: crescendo-decrescendo SEM radiating to R clavicle and carotid heard best at RUSB

Ejection click

Rx: avoid exertion, valve replacement

Avoid nitrates, ACE, all vasodilators

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15
Q

Aortic Insufficiency/ Regurg

A

Odd pulses
Stress Test: Hypotension with exercise

Rx: treat CHF, vasodilators to reduce afterload

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16
Q

Mitral Stenosis

A

Etiology: Rheumatic Heart Disease

Sx: DOE, Orthoptera, fatigue, palpitations, peripheral edema

PE: AFib, parastatal lift, crackles

Murmur: mid diastolic RUMBLE heard at apex in LLD position, LOUD S1

Opening snap

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17
Q

Mitral Regurg

A

Etiology: acute-post MI complication
Chronic- MVP

Murmur: holosystolic at apex radiating to back/axilla with an APICAL THRILL

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18
Q

Mitral Valve Prolapse

A

Sx: short lived stabbing chest pain, anxiety, palpitations, fatigue

Heart sound: mid-systolic click

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19
Q

Hypertrophic Cardiomyopathy

A

ECH: LVH in young person, Q waves in V5, V6, I, aVL

Echo: asymmetric hypertrophy of septum

Ex: Exercise restriction & BB

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20
Q

Other Murmurs

A

Tricuspid Regurg: infective endocarditis in IV drug user

Pulmonic Stenosis: congenital, pediatric. Young child with dyspnea

PDA: continuous/ Machinery, LE cyanosis

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21
Q

Acute Pericarditis

A

Most common pathogen: coxsackie
Most common bacterial pathogen= TB
Autoimmune: SLE, RA (female)

Triad of pleuritic chest pain + FRICTION RUB + EKG changes

Pain worse laying flat, better sitting up

EKG: global ST elevation, notched QRS, PR segment depression, tachycardia

Rx: NSAIDS, high dose ASA
DO NOT use steroids ( more complications)

Complications: pericardial effusion, tamponade, chronic pericarditis

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22
Q

Cardiac Tamponade

Triad
Pathognomonic signs
Treatment

A

Effusion large enough to collapse right heart

BECK’s TRIAD: hypotension, JVD, muffled heart tones

Pathognomic: Pulsus parodoxus (drop in systolic BP with inspiration) and electrical alternans (EKG)

Ex: immediate pericardiocentesis (echo guided)

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23
Q

Heart Failure

A

5 years mortality rate=50%

Stage A=at risk (pre HF)
Stage B=asymptomatic
Stage C= Symptomatic
Stage D= Marked sxs at rest (end stage)

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24
Q

Heart Failure

A

Defective pumping mechanism results in accumulation and redistribution of fluids.

RAAS:
Renal hypo perfusion causes release of renin-A-AI-AII

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25
Q

angiotensin II

A

Potent vasoconstrictor-causes increase in BP

Stimulates kidney to release aldosterone-mediates renal Na+ and H20 retention-increases arterial pressure-increase in BP

26
Q

Heart Failure Signs

A

Dyspnea with minor activity, cyanotic, cold extremities, diaphoresis

Vitals: normal or tachy, hypotn, reduced pulse pressure

PE: crackles, dullness to percussion, exp wheeze/rhonchi, enlarged liver, edema

Key cardiac PE findings:
Parasternal lift=pulmonary HTN
Enlarged, sustained LV impulse
Diminished S1 (impaired contractility)
S3 gallop
S4 (diastolic heart failure)
27
Q

Cor Pulmonale

A

Prolonged HBP in pulmonary artery

If acute, think PE
If chronic, think COPD

Labored respiratory effort with retractions, hyperresonance, diminished breath sounds, wheeze, distant heart sounds

28
Q

Dilated Cardiomyopathy

A

Most common
Poor EF, large heart, pulmonary congestion.
Thin, dysfunctional LV wall, LV dilation/dysfunction

29
Q

Restrictive Cardiomyopathy

A 
Pulmonary HTN, dyspnea
Usually caused by Amyloidosis
  -sarcoidosis
  -scleroderma
Right HF
30
Q

Hypertrophic Cardiomyopathy

A

Early adulthood, athletes-sudden cardiac death

31
Q

Heart Failure Prevention

A

Underlying causes, control Systolic HTN, prevent first MI

Initial rx= *diuretic+ ACE
Early addition of BB
Digitalis

32
Q

Abdominal Aortic Aneurysm

A 
>3cm diameter
Typically involve bifurcation
Rarely ruture until diameter > 5cm
abdominal US
Mid-abdominal pain radiating to back
33
Q

Thoracic Aortic Aneurysm

A

Pressure on trachea/esophagus/SVC: dyspnea, stridor, cough, dysphasia

Stretching of laryngeal nerve: hoarseness

Study of choice= CT

34
Q

Giant cell arteritis

A

Most frequently involves temp artery
50% also have polymyalgia rheumatica
Sxs: HA, scalp tenderness, amaurosis fugax, diplopia

ESR>50mm/h
Temporal artery bx =gold standard
Rx: prednisone 60 mg/d x 1 month before tapering
Screen for thoracic aneurysm

35
Q

PAD

A

Aorto-iliac segment: extreme limb fatigue/weakness, weak/absent distal pulses, thigh/buttock pain

Femoral-popliteal: foot pain at rest, relieved by dependency
Dependent rumor (purplish), legs blanch with elevation, distal atrophic changes

Tibial segment: thin skin on foot, hairless, cool, absent pulses

ABI

36
Q

Virchow’s Triad

A

Venous stasis, vascular injury, hypercoagulanility

Increased risk of DVT

Main/serious complication is PE

37
Q

DVT

A 
Increased calf circumference by > 3cm
Measured 10cm below tibial tuberosity
Duplex US is study of choice
Spiral CT chest to R/o PE
Treatment: anti coagulation
  *LMWH or Lovenox
   Bridge to Warfarin for prolonged rx
38
Q

Arterial Disease Pearls

A 
Claudication
Cool, thin, hairless skin
Muscle atrophy
Atrophic nails
Ulcerations-painful, shallow, round, dry
Gangrene
39
Q

Venous Disease Pearls

A 
Varicose ties
Tough, thick, fibrous skin
Hemosiderin deposits
Pitting edema
Stasis ulcerations: painless, large,       irregular, wet, slow to heal
40
Q

Lipid risk factors

A

Smoking
HTN
HDL 60

41
Q

Metabolic Syndrome

A 
Risk Factors:
Waist circumference
TG > 150
Low HDL
Increased BP (>130/85)
Fasting BG > 100

3+ risk factors or DM= Metabolic Syndrome

42
Q

Lipid Treatment

A

Statins= DOC in most cases
Niacin-most effective for low HDL
Fibrates-DOC for high TG
Bile Acid Binders-pedis and Pregnancy (Welchol)

43
Q

Supra ventricular Tachycardia

A 
Regular narrow tachycardia
Usually no P waves
Commonly caused by congenital accessory pathway (AV node)
Treatment= Vagal maneuvers
Drug of choice= Adenosine
Use CCB/BB following cardioversion
44
Q

First Degree AV block

A

Long PR interval

Pathological causes: Acute rheumatic fever, Lyme carditis (hallmark), secondary syphilis

45
Q

Second Degree AV Block Type I

Wenckebach

A

Varied PR interval (normal, long, longer, dropped)

46
Q

Second Degree AV Block type II

Mobitz

A

Randomly dropped QRS complexes (extra P waves)

Treatment-stop new med
Pacemaker

47
Q

Third Degree AV Block

A

PP interval and QRS intervals constant but not communicating

Treatment-pacemaker

48
Q

V Fib

A

CPR
Defibrillated
Epinephrine followed by Amiodarone

49
Q

V Tach

A

Sawtooth pattern

Treat stable pt with Amiodarone
Unstable pt with cardioversion

50
Q

Torsades de Pointes

A

Sine wave pattern

Stop meds that prolong QT interval

51
Q

Left Axis Deviation

A

Up in I, down in AVF

Causes: inferior wall MI

52
Q

Right Axis Deviation

A

Down in I, up in AVF
Causes: RVH, COPD, ant/lay MI, PE
Normal variant in kids

53
Q

Right BBB

A

Wide QRS
Bunny ears

Causes: RVH, PE, Ischemia

54
Q

Left BBB

A

Wide QRS with ski slopes

Causes: HTN with LVH, AS, dilated cardiomyopathy, fibrosis, acute NI

55
Q

Pericarditis

A

ST elevation in all leads

56
Q

Ejection click

A

Aortic Stenosis

57
Q

Opening Snap

A

Moral Stenosis

58
Q

Mid-systolic click

A

MVP

59
Q

Fixed split S2

A

ASD

60
Q

Continuous/machinery

A

PDA

PANRE (4 decks)

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