PNCE > Cardio > Flashcards

Cardio Flashcards

(165 cards)

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1
Q

MC cardiomyopathy

A

dilated

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2
Q

dilated cardiomyopathy causes

A

ETOH
pregnancy -> postpartum
viral myocarditisL enterovirus MC (coxsackie B)

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3
Q

dilated cardiomyopathy sx

A

dyspnea, JVD, edema, orthopnea, hepatosplenomegaly, frothy red sputum, pulses alternans
mitral or tricuspid valve regurgitation (holosystolic)
laterally displaced PMI

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4
Q

dilated cardiomyopathy test

A

BNP inc
EKG: tachycardia, LBBB, afib
echo: LV dilation and thickening
dec EF

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5
Q

dilated cardiomyopathy tx

A

low salt
short term: diuretics (furosemide)
long term: ACE (enalapril), BB (metoprolol), spironolactone
severe: LVAD or heart transplant

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6
Q

dilated cardiomyopathy complications

A

arrhythmias
CHF

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7
Q

hypertrophic cardiomyopathy type of HF

A

diastolic

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8
Q

dilated cardiomyopathy type of HF

A

systolic

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9
Q

hypertrophic cardiomyopathy MCC

A

genetic, autosomal dominant

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10
Q

hypertrophic cardiomyopathy sx

A

syncope, dyspnea on exertion, S4, bisfrens pulse (water hammer), sudden death

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11
Q

HOCM murmur sx

A

systolic crescendo decreascendo at LLSB
S4
worse w/ standing of valvalvs
dec w/ grip or swat

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12
Q

hypertrophic cardiomyopathy test

A

echo: asymmetrical wall thickness, LVH

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13
Q

hypertrophic cardiomyopathy tx

A

mainstay: BB (metoprolol), CCB (verapamil)
myomectomy for HOCM

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14
Q

hypertrophic cardiomyopathy tx CI

A

digoxin
ACE
nitrates

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15
Q

restrictive cardiomyopathy common causes

A

Amyloidosis
sarcoidosis
hemochromatosis

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16
Q

restrictive cardiomyopathy sx

A

inc JVP on inspiration (kussmaul sign)
S3, SOB, ascites
peripheral edema, hepatosplenomegaly
RHF sx

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17
Q

restrictive cardiomyopathy test

A

CXR: pulmonary congestion
EKG: low QRS, LBBB
echo: rapid diastolic filling, bilateral atrial enlargement
bx

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18
Q

restrictive cardiomyopathy tx

A

low salt diet
diuretics (furosemide), BB (carvedilol), CCB
tx underlying
heart transplant

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19
Q

takotsubo patho

A

inc sympathetic stimulation resulting in ventricular dilation
from increase of stress or acute stress event

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20
Q

takotsubo sx

A

CP, mimics STEMI w/ no true occlusion

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21
Q

takotsubo test

A

echo: apical ballooning
EKG: ST elevation

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22
Q

takotsubo tx

A

supportive care
anticoagulants

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23
Q

order of conduction system of the heart

A

SA node
AV node
bundle of his (L and R bundle)
purkinje fibers

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24
Q

indications for cardio version

A

afib
aflutter
VT w/ pulse
SVT

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25
when to shock during cardioversion
do not shock on T wave
26
defibrillation indication
VTach w/o pulse Vfib
27
when pharmacologic cardio version used
if electrocardioversion fails
28
pharmacologic cardioversion
IV ibutilide procainamide flecainide Sotalol amiodarone
29
sinus brady tx
1st line: atropine definitive: pacemaker
30
sick sinus syndrome tx
permanent pacemaker
31
1st degree AV block tx
observation
32
2nd degree type I wenkenbach tx
atropine epinephrine sx: pacemaker
33
second degree type 2 Mobitz tx
permanent pacemaker
34
third degree heart block tx
permanent pacemaker transcutaneous pacing 1st line
35
Wolff Parkinson white syndrome patho
bundle of Kent delta wave, shortened PR, wide QRS
36
Wolff Parkinson white syndrome tx
vagal wide: procainamide definitive: radio frequency ablation
37
Wolff Parkinson white syndrome meds to avoid
ABCD adenosine BB CCB digoxin
38
Wolff Parkinson white syndrome complication
A. fib
39
Wolff Parkinson white syndrome w/ afib tx
U= ibutilide
40
causes of torsades
hypomagnesemia hypocalcemia hypokalemia
41
Torsades tx
stable: IV Mg bolus unstable: defibrillation
42
PEA tx
CPR epinephrine
43
bundle branch block patho
from bundle of his (damaged) causes wide QRS
44
atrial flutter sx
pt will usually have COPD inc fatigue, palpitations can form emboli
45
atrial flutter tx
stable: rate control (CCB, BB, digoxin, vagal) unstable: cardiovert (chemical: amiodarone, procainamide) definitive: radio frequency ablasion anticoagulants
46
holiday heart syndrome
drinking ETOH and afib
47
afib complication
emboli --> stroke
48
anticoagulation for afib
NOAC: dabigatran, riveroxiban, apixiban, edoxibam warfarin dual antiplt: ASA + clopidogrel
49
afib tx
stable: CCB (IV diltiazem), BB (metoprolol), digoxin, permanent pacemaker unstable: synchronized cardio version
50
PSVT tx
stable: vagal, valsalva --> adenosine or CCB unstable: cardio version long term therapy: radio frequency catheter ablation
51
PAC tx
BB/CCB stop causative agent radiofrequency ablation
52
PAC causes
electrolyte imbalances anxiety, cocaine use, ischemic damages reentrant loop (scar tissue post MI)
53
PVC tx
reassurance BB/CCB radiofrequency ablation
54
what can cause PVC
anxiety, triggered activity hypoxia, CAD, hypokalemia
55
Vtach criteria
3+ PVC
56
V tach complication
V fib
57
V tach tx
stable: amiodarone unstable w/ pulse: sync cardioversion unstable w/o pulse: defibrillator w/ CPR
58
v fib tx
defibrillation lidocaine or procainamide CPR, epinephrine
59
MC ASD
osmium secundum
60
MC congenital heart defect in adults
ASD
61
osteum premum RF
1st septum downs fetal alcohol syndrome often related to mitral/tricuspid valve clefts and VSD
62
ASD shunt
left to right
63
ASD sx
cyanotic fixed split S2, systolic crescendo decrescendo in 2nd and 3rd LUSB parasternal heave
64
ASD test
CXR: cardiomegaly EKG: RAD, RVH, RBBB echo (diagnostic): RA, RV overload, ASD
65
ASD tx
spontaneous closure in 1st year if small surgery
66
ASD complications
paradoxical emboli -> cryptogenic stroke HF eisenmengers
67
coarctation of aorta seen in which condition
turners syndrome
68
coarctation of aorta infant type
MC: preductal
69
coarctation of aorta adult type
post ductal: distal to ductus arteriosum
70
coarctation of aorta sx
HF in infant systemic HTN, BP UE>LE cyanosis of LE, ayanosis of UE LV failure, delayed/weak femoral pulse harsh systolic murmur head on back
71
coarctation of aorta test
CXR: rib notching, figure 3 sign EKG: LVH echo: diagnostic CT/MRI: coarctation
72
coarctation of aorta tx
prostaglandin E1 preop diuretics: HF sx surgery: balloon angioplasty stent
73
PDA sx
cyanotic, pulmonary HTN, L to R shunt continuous (Gibson's) machine like murmur, thrill wide pulse pressure: bounding pulses (water hammer) hyper dynamic precordium
74
PDA sx later in life
pulmonary HTN, inc pressure -> R to L shunt = eisenmengers syndrome --> cyanotic
75
PDA test
EKG: LVH CXR Echo: best MRI/CT inc BNP
76
PDA tx
indomethacin surgical correction usually close w/in 1st week of life
77
tetralogy of fallot abnormalities
pulmonary stenosis RV hypertrophy VSD overriding aorta
78
tet spells
in tetralogy of fallot acute extreme hypoxia, cyanosis, syncope, and hyperpnea worse w/ crying/feeding
79
MC cyanotic heart defect
tetralogy of fallot
80
tetralogy of fallot patho
chromosome 22 deletion digeorge syndrome maternal retinoid acid exposure
81
tetralogy of fallot murmur
crescendo decreascendo holosystolic along LLSB radiating to back
82
tetralogy of fallot sx
cyanotic clubbing failure to develop
83
tetralogy of fallot test
CXR: boot shaped heart, no interstitial lung markings echo: gold standard EKG: RAD
84
tetralogy of fallot tx
squatting during tet spell calming, O2, IV fluids IV prostaglandin E1 (keep PDA open for PE perfusion) definitive: surgery, can play sports w/ R vent pressure <50
85
IV prostaglandin E1 AE
apnea
86
MC baby heart defect of membrane MC congenital heart disease
VSD
87
VSD seen in which conditions
downs syndrome
88
VSD sx
small: cyanotic, SOB large: pulmonary HTN --> R to L shunt --> eisenmenger --> cyanotic
89
VSD murmur
loud high pitch harsh pan/holosystolic murmur @ LLSB
90
VSD test
echo: definitive
91
VSD tx
may spontaneously close in 10y larger VSD: diuretics +/- digoxin or surgical closure (sx of HF)
92
MC coronary artery to occlude
LAD
93
tx unstable angina
antithrombotic therapy: ASA, UF heparin, LMWH adjunct: BB (metoprolol), nitrates, morphine, CCB BB first line
94
AE LMWH
thrombocytopenia
95
RCA occlusion sx
affects SA and AV node --> bradycardia
96
hypertension meds safe in pregnancy
hydralazine methyldopa labetalol nifedipine
97
hypertensive urgency tx
clonidine captopril nifedipine labetalol
98
hypertensive emergency tx
sodium nitroprusside labetalol hydralazine
99
sodium nitroprusside AE
potential thiocyanate and cyanid toxicity w. prolonged use or if renal/hepatic failure
100
hypotension tx
fludrocortisone pyridostigmine dopamine
101
cardiogenic shock tx
ABC IV dobutamin, milrinone
102
orthostatic hypotension tx
fludrocortisone
103
fibric acid derivative CI
gemefibrozin, clofibrate CI in biliary disease
104
acute endocarditis MCC
S aureus
105
subacute endocarditis MCC
strep viridian's
106
acute endocarditis tx
nafcillin + gent or vanco + gent
107
subacute endocarditis tx
penicillin/ ampicillin + gent ceftriaxone/ vanco + gent
108
endocarditis IVDU MCC
pseudomonas candida
109
IVDU endocarditis tx
vanco
110
prosthetic endocarditis MCC
Staph epidermis
111
prosthetic endocarditis tx
vanco + gent + rifampin
112
MCC myocarditis
viral (coxsackie)
113
myocarditis sx
dyspnea, cough, chest fullness, fatigue, palpitations, edema, S3 murmur viral prodrome
114
myocarditis test
BIT: EKG cardiac enzymes (may be elevated) MAT: myocardial bx
115
myocarditis tx
tx like CHF until resolve do not give steroids
116
acute pericarditis MCC
viral: coxackie B
117
acute pericarditis sx
positional sharp pleuritic CP worse w/ inspiration or laying down Bette when sitting up or leaning forward friction rub conductive: pericardial knock, S3, RHF sx
118
acute pericarditis test
diffuse ST elevation PR segment depression echo: definitive inc ESR/CRP
119
acute pericarditis tx
NSAIDS (indomethacin, colchicine) w/ or w/o steroids surgical: pericardiocentesis pericardectomy definitive
120
AE colchicine
diarrhea
121
cardiac tamponade tx
ASAP pericardiocentesis
122
cardiac tamponade patho
heart does not stretch fully between contractions build up fluid in pericardium puts pressure on outside of the heart
123
cardiac tamponade test
echo: diagnostic EKG: low voltage QRS + pulsus alternans
124
pericardial effusion tx
colchicine pericardiocentesis for severe effusion
125
acute rheumatic fever MCC
GABHS (S. pyogenes)
126
acute rheumatic fever patho
inflammatory dz that can damage heart tissue hx of strep infection develops after strep pharyngitis
127
acute rheumatic fever tx
rest PCN or macrolide NSAIDs/ASA
128
cardiac tamponade complication
PANDAS syndrome
129
MC valve in rheumatic heart disease
mitral valve
130
rheumatic heart disease h/o
repeated episodes of acute rheumatic fever
131
rheumatic heart disease sx
mitral stenosis or mitral regurgitation palpitation, fatigue, CP, dyspnea
132
rheumatic heart disease test
echo: confirm histology: Aschoff bodies (granulomas) previous strep infx inc ESR/ASO
133
rheumatic heart disease tx
prevent strep infection prolonged abx tx until 21yo (IM penicillin G or sulfadiazine) valve repair or replacement
134
kawasaki complication
CAD coronary artery aneurisms MI
135
harsh systolic creasendo decrescendo rad to neck/carotids dec w/ valsalva S2 split
aortic stenosis
136
aortic stenosis tx
IV fluids valve replacement definitive
137
early diastolic blowing decrescendo 3rd ICS water hammer pulse
aortic regurgitation
138
de musset sign
in aortic regurgitation head bobbing
139
quinck's sign
aortic regurgitation fingers pulsing and nail bed change to pale color
140
aortic regurgitation tx
low Na diet furosemide valve replacement prophylactic abx
141
MCC mitral stenosis
rheumatic fever
142
opening snap followed by S2 diastolic rumble low pitched murmur at apex
mitral stenosis
143
mitral stenosis tx
low Na diet pulmonary congestion -> lasix afib: digoxin and warfarin surgery: balloon valvuloplasty or replacement
144
holosystolic blowing murmur at apex radiating to axilla, loud S3
mitral regurgitation
145
mid systolic click rad to axilla w/ palpitations
MVP
146
mitral regurgitation tx
tx afib: cardiovert, warfarin pulmonary congestion: diuretic and vasodilators surgery: valve repair for prolapse, replacement BB for palpitation (propranolol)
147
ejection click harsh mid systolic crescendo decrescendo @ LUSB, wide split S2
pulmonary stenosis
148
pulmonary stenosis tx
balloon valvuloplasty
149
graham steele murmur
brief decrescendo best @ LUSB wide split S2
150
pulmonary regurgitation
graham steel murmur
151
pulmonary regurgitation tx
none, usually well tolerated valve replacement
152
tricuspid regurgitation MCC
carcinoid heart disease rheumatic heart disease
153
mid diastolic rumble @ LLSB opening snap
tricuspid stenosis
154
tricuspid stenosis tx
diuretics sodium restriction valve repair or replacement
155
LLSB holosystolic blowing radiates to R sternum and xiphoid inc w/ inspiration
tricuspid regurgitation
156
tricuspid regurgitation tx
diuretics salt restriction valve repair/replacement
157
Aortic aneurism tx
<3cm none 3-4cm US Q2-3y <4.5cm US Q6mo 4.5-5cm Q3-6mo >5.5cm surgery
158
thoracic aneurism tx
BB prevent growth >5cm repair if bicuspid aortic valve/ morfan
159
aortic dissection tx
IV BB nitroprusside definitive repair crystalloids for hypoTN
160
most important RF for aortic dissection
HTN
161
Diseases from coxsackie A
hand foot and mouth herpangina
162
diseases from coxsackie B
pericarditis myocarditis pleurodynia
163
pediatric functional murmurs
stills (MC) venous hum pulmonary ejection
164
congenital cyanotic heart diseases
truncus arteriosis transposition of great arteries tricuspid atresia Tetralogy total anomalous pulmonary venous return
165
ototoxic drugs
abx: aminoglycosides, vanco, macrolides loop: furosemide, ethacrynic acid chemotherapeutic: platinum agents, cytarabine temp: NSAIDs, aspirin, quinine
PNCE
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