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1.02) CARDIOVASCULAR SYSTEM > UWorld > Flashcards

UWorld Flashcards

1
Q

What are the (2) common, and typically transient Bradyarrhythmias of Acute Inferior Wall Myocardial Infarction?

A
  1. Sinus Bradycardia
  2. Atrioventricular (AV) Block
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2
Q

Patients with Acute Inferior Wall Myocardial Infarction who have Persistent Symptomatic Bradyarrhythmias (Sinus Bradycardia or Symptomatic AV Block), AFTER being given I.V. Atropine, should be Treated with what Next Step in Management?

A

Temporary Cardiac Pacing

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3
Q

Patients with Acute Inferior Wall Myocardial Infarction who have Symptomatic Bradyarrhythmias (Sinus Bradycardia or Symptomatic AV Block) should receive Initial Treatment with what?

A

Atropine (I.V.)

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4
Q

What are (4) Signs/Symptoms of Symptomatic Bradyarrhythmias?

A
  • Hypotension
  • Dizziness
  • Heart Failure
  • Syncope
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5
Q

Infants born to Mothers with Diabetes and Poor Glycemic Control During Pregnancy are at Increased Risk for what Heart Defect?

A

Transient Hypertrophic Cardiomyopathy with a Thickened Intraventricular Septum.

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6
Q

What is the Thickened Intraventricular Septum caused by in infants with Transient Hypertrophic Cardiomyopathy?

A

Excess Glycogen deposition in fetal myocardium

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7
Q

What are the (3) Atypical Anginal Symptoms in Elderly patients (> 80yo) other than chest pain?

A
  1. Shortness of Breath
  2. Lightheadedness
  3. Fatigue
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8
Q

What Initial Evaluation should patients with suspected Stable Coronary Artery Disease (CAD) undergo?

A

Noninvasive Stress Testing

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9
Q

What are (3) Causes of Multifocal Atrial Tachycardia (MAT)?

A
  1. Exacerbation of Pulmonary Disease (eg, COPD)
  2. Electrolyte Disturbance (eg, Hypokalemia)
  3. Catecholamine Surge (eg, Sepsis)

Matt, Gatorade, Fire

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10
Q

What are (2) Clinical Findings in a patient with Multifocal Atrial Tachycardia (MAT)?

A
  1. Asymptomatic (typically)
  2. Rapid, Irregular pulse
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11
Q

What is the Best Treatment for a patient with Multifocal Atrial Tachycardia (MAT)?

A

Correct the Underlying Cause (eg, COPD, Hypokalemia)

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12
Q

What is the Treatment for a patient with Persistent Multifocal Atrial Tachycardia (MAT)?

A

AV Nodal Blockade (eg, Verapamil)

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13
Q

Multifocal Atrial Tachycardia (MAT) is Most Common in which Demographic?

A

Patient Age > 70yo

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14
Q

What are (3) ECG Findings that Confirm a Diagnosis of Multifocal Atrial Tachycardia (MAT)?

A
  1. P-waves of At Least 3 different morphologies
  2. Irregular R-R Intervals
  3. Atrial Rate > 100/min
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15
Q

What are (6) Signs/Symptoms typically Characteristic of Digoxin Toxicity?

A
  1. Nausea/Vomiting
  2. Anorexia
  3. Fatigue
  4. Confusion
  5. Visual Disturbances
  6. Cardiac Abnormalities
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16
Q

What are (4) Medications that, when given to a patient on Digoxin, can Cause Digoxin Toxicity?

A
  1. Verapamil - Calcium channel blocker and antihypertensive drug
  2. Quinidine - Antiarrhythmic and anti-parasitic (eg, anti-malarial)
  3. Amiodarone - Antiarrhythmic (eg, Tx for A-Fib, A-Flutter, SVT, Cardiac Arrest)
  4. Spironolactone - Diuretic (eg, Tx for HTN, Fluid Retention, Hyperaldosteronemia)
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17
Q

What is the Mechanism of Action (MOA) for Digoxin Toxicity?

A

Verapamil, Quinidine, Amiodarone, or Spironolactone INHIBITS Renal Tubular Secretion of Digoxin (resulting in almost 70% - 100% increase in Serum Digoxin Levels)

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18
Q

What are (6) Clinical Risk Factors used in the Revised Cardiac Risk Index (RCRI) to Help Predict Major Complications with NONcardiac Surgery?

A
  1. High-Risk Surgery (eg, Vascular)
  2. History of Ischemic Heart Disease
  3. Heart Failure
  4. History of Stroke
  5. Diabetes Mellitus TREATED with Insulin
  6. Preoperative Creatinine >2 mg/dL
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19
Q

What are the (4) Risk Factor Levels used in the Revised Cardiac Risk Index (RCRI) to Help Predict Major Complications with NONcardiac Surgery?

A
  1. Low-Risk = 0 Clinical Risk Factors (0.4% risk)
  2. Low-Risk = 1 Clinical Risk Factor (1.0% risk)
  3. Moderate-Risk = 2 Clinical Risk Factors (2.4% risk)
  4. High-Risk = 3+ Clinical Risk Factors (5.4% risk)
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20
Q

What are the (3) Major Complications that the Revised Cardiac Risk Index (RCRI) Helps Predict in patients Preparing to Undergo NONcardiac Surgery?

A
  1. Cardiac Death
  2. Nonfatal Cardiac Arrest
  3. Nonfatal Myocardial Infarction
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21
Q

What are (3) Parts to take into account during the Clinical Risk Assessment for a potential Perioperative Cardiac Event in a patient scheduled to undergo Elective NONcardiac Surgery?

A
  1. Type of Elective NONcardiac Surgery
  2. Patient Comorbidities
  3. Patient Functional Status
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22
Q

What are (2) Types of Surgeries considered High-Risk (>5%) for Major Cardiac Complications (eg, cardiac death, nonfatal cardiac arrest, nonfatal MI) in a patient Preparing to Undergo NONcardiac Surgery?

A
  1. Aortic or other Major Vascular surgery (eg, AAA Repair)
  2. Peripheral Vascular surgery
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23
Q

What are (5) Types of Surgeries considered Intermediate-Risk (1 - 5%) for Major Cardiac Complications (eg, cardiac death, nonfatal cardiac arrest, nonfatal MI) in a patient Preparing to Undergo NONcardiac Surgery?

A
  1. Carotid Endarterectomy
  2. Head & Neck surgery
  3. Intraperitoneal & Intrathoracic surgery
  4. Orthopedic surgery
  5. Prostate surgery
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24
Q

What are (4) Types of Surgeries considered Low-Risk (<1%) for Major Cardiac Complications (eg, cardiac death, nonfatal cardiac arrest, nonfatal MI) in a patient Preparing to Undergo NONcardiac Surgery?

A
  1. Ambulatory or Superficial procedures
  2. Endoscopic procedures
  3. Cataract surgery
  4. Breast surgery
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25
Q

What (2) Criteria of the Pre-NONcardiac Surgery Cardiac Risk Assessment, if both met, Requires the patient to receive Further Cardiac Workup Prior to Surgery?

A
  1. Revised Cardiac Risk Index = Moderate- or High-Risk (>1% risk)
  2. Reduced Functional Status (Exercise Capacity <4 Metabolic Equivalents [METS])
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26
Q

What are (2) Clues to the Diagnosis of Cardiogenic Syncope due to Aortic Stenosis or Hypertrophic Cardiomyopathy (HCM)?

A
  1. Exertional Syncope
  2. Systolic Murmur
27
Q

What are (2) Clues to the Diagnosis of Cardiogenic Syncope due to Ventricular Tachycardia (V-Tach)?

A
  1. No preceding symptoms
  2. Cardiomyopathy or Previous MI
28
Q

What are (2) Clues to the Diagnosis of Cardiogenic Syncope due to Sick Sinus Syndrome (SSS)?

A
  1. Preceding Fatigue or Dizziness
  2. Sinus Pauses on ECG
29
Q

What are (2) Clues to the Diagnosis of Cardiogenic Syncope due to Advanced AV-Block?

A
  1. Bifascicular Block on ECG
  2. Dropped QRS Complex of ECG
30
Q

What are (3) Clues to the Diagnosis of Cardiogenic Syncope due to Torsades de Pointes?

A
  1. No preceding symptoms
  2. Medications that Prolong QT Interval
  3. Hypokalemia or Hypomagnesemia
31
Q

What are (6) Etiologies associated with Cardiogenic Syncope?

A
  1. Aortic Stenosis
  2. Hypertrophic Cardiomyopathy (HCM)
  3. Ventricular Tachycardia (V-Tach)
  4. Sick Sinus Syndrome (SSS)
  5. Advanced AV-Block
  6. Torsades de Pointes
32
Q

Patients with Cardiogenic Syncope due to V-Tach are At-Risk for what?

A

Sudden Cardiac Death

33
Q

The Classic Wolf-Parkinson-White pattern on ECG consists of which (3) Findings?

A
  1. Delta Wave
  2. Short P-R Interval
  3. Wide QRS Complex
34
Q

What Causes the Classic ECG Findings in a patient with Wolf Parkinson White (WPW) Syndrome?

A

Cardiac Preexcitation caused by an Accessory Pathway

35
Q

Which (2) Clinical Findings must BOTH be found on the patient workup to Constitute Wolff Parkinson White (WPW) Syndrome?

A
  1. Classic WPW ECG Findings (eg, delta wave, short P-R, wide QRS)
  2. Symptomatic Tachyarrhythmia
36
Q

What is the MOST COMMON Arrhythmia associated with WPW Syndrome?

A

Paroxysmal Supraventricular Tachycardia

37
Q

In patients with Wolff Parkinson White who develop Atrial Fibrillation (A-Fib), what is the Mechanism by which this combination (WPW + A-Fib) can result in Syncope?

A

Their Hearts can Conduct down the Accessory Pathway from the Atria to the Ventricles at a VERY Fast Rate, commonly ⇒ SYNCOPE.

38
Q

What potent Vasodilator that works on both Arterial and Venous circulation and is given to patients with Hypertensive Emergency, has a Side Effect of Cyanide Toxicity?

A

Nitroprusside

39
Q

What is the Treatment for Cyanide Toxicity due to Nitroprusside treatment?

A
  1. Discontinue Nitroprusside
  2. Give Sodium Thiosulfate
40
Q

In a patient on Nitroprusside for Hypertensive Emergency, what (2) Clinical Manifestations should cause suspicion for possible Cyanide Toxicity?

A
  1. Unexplained METABOLIC ACIDOSIS
  2. Altered Mental Status (AMS)
41
Q

In a patient on Nitroprusside for Hypertensive Emergency, what are (2) Risk Factors for developing Cyanide Toxicity?

A
  1. Chronic Renal Failure (allows for CN- accumulation)
  2. High Dose or Prolonged Infusion (infuse at < 2 μg/kg/min)
42
Q

What are the Similarities and Differences between Hypertensive Urgency vs. Hypertensive Emergency?

A

Hypertensive Urgency:

  • SBP ≥ 180 mmHg
  • DBP ≥ 120 mmHg
  • NO end organ damage

Hypertensive Emergency:

  • SBP ≥ 180 mmHg
  • DBP ≥ 120 mmHg
  • YES End Organ Damage
43
Q

What are (2) Cardiac Structural Etiologies for Acute Mitral Regurgitation?

A
  1. Ruptured Mitral Chordae Tendineae from:
    • Mitral Valve Prolapse (MVP)
      • Ehlers-Danlos
      • Marfan Syndrome
    • Infective Endocarditis
    • Rheumatic Heart Disease
    • Trauma
  2. Papillary Muscle Rupture from:
    • Myocardial Infarction
    • Trauma
44
Q

What are (3) Clinical Features of Acute Mitral Regurgitation?

A
  1. Rapid Onset of Pulmonary Edema
  2. Biventricular Heart Failure
  3. Hypotension (Cardiogenic Shock)
45
Q

What are (4) Physical Exam Findings in a patient with Acute Mitral Regurgitation?

A
  1. Diaphoresis and Cool Extremities
  2. JVD and Pulmonary Crackles
  3. Hyperdynamic Cardiac Impulse
  4. Apical Decrescendo Systolic Murmur (often absent)
46
Q

What are the (2) Management Steps for a patient with Acute Mitral Regurgitation?

A
  1. Bedside Echocardiogram
  2. Emergent Surgical Intervention
47
Q

Hypertrophic Obstructive CardioMyopathy (HOCM) is one common cause of Sudden Cardiac Death in Young Athletes. What is another common cause?

A

Anomalous Aortic Origin of a Coronary Artery (AAOCA):

48
Q

Which (2) Types of Anomalous Aortic Origin of the Coronary Artery (AAOCA) are most commonly associated with Sudden Cardiac Death (SCD)?

A
  1. LEFT Main Coronary Artery originating from the RIGHT Aortic Sinus.
  2. RIGHT Coronary Artery originating from the LEFT Aortic Sinus.
49
Q

What are (3) possible Premonitory Symptoms in a patient with Anomalous Aortic Origin of the Coronary Artery (AAOCA)?

A
  1. Exertional Angina
  2. Lightheadedness
  3. Syncope
50
Q

What Heart Condition does the following describe?:

Results from a Critical ELEVATION in Intracardiac Filling Pressures that most commonly occur due to Left Ventricular (LV) Systolic and/or Diastolic dysfunction (eg, coronary ischemia, hypertensive cardiomyopathy) and leads to Pulmonary Edema.

A

Acute Decompensated Heart Failure (ADHF):

Other causes of ADHF other than LV Systolic and/or Diastolic dysfunction include:

  • Valvular Diseases
  • Marked Elevation in Preload (eg, excessive volume resuscitation)
  • Marked Elevation in Afterload (eg, severe HTN)
51
Q

What are the First-Line and Second-Line therapies to treat Acute Decompensated Heart Failure (ADHF)?

A
  1. First-Line: I.V. Diuretics (eg, Furosemide)
  2. Second-Line: I.V. Vasodilators (eg, Nitroglycerin)
    • If Diuretics don’t work
    • Initial therapy in patients with “Flash” pulmonary edema due to severe HTN.
52
Q

What Condition results from Atherosclerotic Narrowing of Peripheral Arteries and signifies Cardiovascular Disease?

A

Peripheral Artery Disease (PAD)

53
Q

What are the (2) Types of Medications that all patients with Peripheral Artery Disease (PAD) should be started on at the time of diagnosis?

A
  1. Antiplatelet (eg, Aspirin)
  2. Statin (eg, Atorvostatin)
54
Q

What are the Steps (Steps 1A, 1B, 2, & 3) in the Treatment of Symptomatic Peripheral Artery Disease (PAD)?

A

Treatment Steps for PAD:

  • Step 1A: Risk Factor Management:
    • ​​Smoking Cessation
    • BP & Diabetes control
    • Antiplatelet & Statin therapy
  • Step 1B: Supervised Exercise Therapy
  • Step 2: Cilostazol (preferred over pentoxifylline)
  • Step 3: Revascularization for Persistent Symptoms:
    • Angioplasty +/- Stent Placement
    • Autogenous or Synthetic Bypass Graft
55
Q

What are (5) Etiologies for Constrictive Pericarditis?

A
  1. Idiopathic Pericarditis
  2. Viral Pericarditis
  3. Cardiac Surgery
  4. Radiation Therapy
  5. TB Pericarditis (endemic areas)
56
Q

What are (7) Clinical Manifestations of Constrictive Pericarditis?

A
  1. Exertional Fatigue & Dyspnea
  2. Peripheral Edema & Ascites
  3. Increased JVD (Right Heart Failure)
  4. Hepatojugular Reflux
  5. Pericardial Knock
  6. Pulses Paradoxus (≥ 10mmHg DROP in Systolic Blood Pressure on Inspiration)
  7. Kussmaul Sign (a paradoxical rise in Jugular Venous Pressure on Inspiration)
57
Q

What are (3) Diagnostic Findings with Constrictive Pericarditis?

A
  1. ECG shows:
    • Nonspecific
    • A-Fib
    • Low-voltage QRS Complex
  2. Imaging shows:
    • Pericardial Thickening
    • Calcification
  3. Jugular Venous Pulse Tracing shows (Right Heart Failure):
    • Prominent x & y descents
58
Q

What are (3) Examples of Paroxysmal Supraventricular Tachycardia’s (PSVT)?

A
  1. Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
  2. Atrioventricular Reentrant Tachycardia (AVRT)
  3. Atrial Tachycardia
59
Q

What are (3) Clinical Manifestations of a Paroxysmal Supraventricular Tachycardia (PSVT)?

A
  1. Intermittent episodes of abrupt-onset Palpitations
  2. Sensation of Racing Heartbeat
  3. ECG = Narrow-complex Tachycardia with Regular R-R Intervals & Retrograde p-waves
60
Q

What Cardiac Disorder is the Most Common Cause of Secondary Dilated Cardiomyopathy?

A

Coronary Artery Disease (CAD) / Ischemic Heart Disease (IHD)

61
Q

Which (2) Diagnostic Exams should be performed on ALL patients presenting with unexplained Heart Failure due to LV Systolic Dysfunction?

A
  1. “Stress” Test, or
  2. Coronary Angiography
62
Q

Patients with suspected Acute Coronary Syndrome (ACS) but unremarkable/normal ECG and serum Toponin levels should be managed how?

A

Serial repeat ECGs and Troponin levels to rule out MI

63
Q

What are (5) Medications that can cause DRUG-INDUCED Lupus?

A
  1. Procainamide
  2. Hydralazine
  3. Minocycline
  4. Etanercept
  5. Infliximab

1.02) CARDIOVASCULAR SYSTEM (22 decks)

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