1.02) CARDIOVASCULAR SYSTEM > UWorld > Flashcards

UWorld Flashcards

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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
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?
1. **Revised Cardiac Risk Index = Moderate- or High-Risk** (*\>1% risk*) 2. **Reduced Functional Status** (*Exercise Capacity \<4 Metabolic Equivalents* [METS])
26
What are (**2**) _Clues to the Diagnosis_ of ***Cardiogenic Syncope*** due to *Aortic Stenosis* or *Hypertrophic Cardiomyopathy* (HCM)?
1. **Exertional Syncope** 2. **Systolic Murmur**
27
What are (**2**) _Clues to the Diagnosis_ of ***Cardiogenic Syncope*** due to *Ventricular Tachycardia* (V-Tach)?
1. **No preceding symptoms** 2. **Cardiomyopathy or Previous MI**
28
What are (**2**) _Clues to the Diagnosis_ of ***Cardiogenic Syncope*** due to *Sick Sinus Syndrome* (SSS)?
1. **Preceding Fatigue or Dizziness** 2. **Sinus Pauses on ECG**
29
What are (**2**) _Clues to the Diagnosis_ of ***Cardiogenic Syncope*** due to *Advanced AV-Block*?
1. **Bifascicular Block on ECG** 2. **Dropped QRS Complex of ECG**
30
What are (**3**) _Clues to the Diagnosis_ of ***Cardiogenic Syncope*** due to *Torsades de Pointes*?
1. **No preceding symptoms** 2. **Medications that Prolong QT Interval** 3. **Hypokalemia or Hypomagnesemia**
31
What are (**6**) _Etiologies_ associated with ***Cardiogenic Syncope***?
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
Patients with ***Cardiogenic Syncope*** due to *V-Tach* are _At-Risk_ for what?
**Sudden Cardiac Death**
33
The Classic ***Wolf-Parkinson-White*** pattern on *ECG* consists of which (**3**) _Findings_?
1. **Delta Wave** 2. **Short P-R Interval** 3. **Wide QRS Complex**
34
What _Causes_ the Classic *ECG Findings* in a patient with ***Wolf Parkinson White (WPW) Syndrome***?
**Cardiac Preexcitation caused by an _Accessory Pathway_**
35
Which (**2**) _Clinical Findings_ must *BOTH* be found on the patient workup to *Constitute* ***Wolff Parkinson White (WPW) Syndrome***?
1. **Classic WPW ECG Findings** (eg, *delta wave, short P-R, wide QRS*) 2. **Symptomatic Tachyarrhythmia**
36
What is the *MOST COMMON* _Arrhythmia_ associated with ***WPW Syndrome***?
**Paroxysmal Supraventricular Tachycardia**
37
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**?
**Their Hearts can Conduct down the _Accessory Pathway_ from the Atria to the Ventricles at a VERY Fast Rate, commonly ⇒ SYNCOPE.**
38
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**?
**Nitroprusside**
39
What is the _Treatment_ for ***Cyanide Toxicity*** due to **Nitroprusside** treatment?
1. **Discontinue Nitroprusside** 2. Give **Sodium Thiosulfate**
40
In a patient on **Nitroprusside** for ***Hypertensive Emergency***, what (**2**) Clinical Manifestations should cause suspicion for possible ***Cyanide Toxicity***?
1. *Unexplained* **METABOLIC ACIDOSIS** 2. **Altered Mental Status** **(**AMS**)**
41
In a patient on **Nitroprusside** for ***Hypertensive Emergency***, what are (**2**) _Risk Factors_ for developing ***Cyanide Toxicity***?
1. **Chronic Renal Failure** (*allows for CN- accumulation*) 2. **High Dose or Prolonged Infusion** (infuse at \< 2 μg/kg/min)
42
What are the *Similarities and Differences* between ***Hypertensive Urgency*** vs. ***Hypertensive Emergency***?
**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
What are (**2**) _Cardiac Structural Etiologies_ for ***Acute Mitral Regurgitation***?
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
What are (**3**) _Clinical Features_ of ***Acute Mitral Regurgitation***?
1. **Rapid Onset of Pulmonary Edema** 2. **Biventricular Heart Failure** 3. **Hypotension** (*Cardiogenic Shock*)
45
What are (**4**) _Physical Exam Findings_ in a patient with ***Acute Mitral Regurgitation***?
1. **Diaphoresis and Cool Extremities** 2. **JVD and Pulmonary Crackles** 3. **Hyperdynamic Cardiac Impulse** 4. **Apical Decrescendo Systolic Murmur** (*often absent*)
46
What are the (**2**) _Management Steps_ for a patient with ***Acute Mitral Regurgitation***?
1. **Bedside Echocardiogram** 2. **Emergent Surgical Intervention**
47
***Hypertrophic Obstructive*** ***CardioMyopathy*** (***HOCM***) is one common cause of **Sudden Cardiac Death in Young Athletes**. What is _another common cause_?
**Anomalous Aortic Origin of a Coronary Artery (AAOCA):**
48
Which (**2**) _Types_ of ***Anomalous Aortic Origin of the Coronary Artery*** (***AAOCA***) are _most commonly associated_ with **Sudden Cardiac Death** (**SCD**)?
1. **LEFT** **Main Coronary Artery** originating from the **RIGHT Aortic Sinus**. 2. **RIGHT Coronary Artery** originating from the **LEFT Aortic Sinus**.
49
What are (**3**) possible _Premonitory Symptoms_ in a patient with ***Anomalous Aortic Origin of the Coronary Artery*** (***AAOCA***)?
1. **Exertional Angina** 2. **Lightheadedness** 3. **Syncope**
50
**_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_.
**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
What are the _First-Line_ and _Second-Line_ therapies to treat ***Acute Decompensated Heart Failure*** (***ADHF***)?
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
What _Condition_ results from *Atherosclerotic Narrowing* of *Peripheral Arteries* and signifies ***Cardiovascular Disease***?
**Peripheral Artery Disease (PAD)**
53
What are the (**2**) _Types of Medications_ that all patients with ***Peripheral Artery Disease*** (***PAD***) should be _started on at_ the time of _diagnosis_?
1. **Antiplatelet** (eg, *Aspirin*) 2. **Statin** (eg, *Atorvostatin*)
54
What are the _Steps_ (*Steps 1A, 1B, 2, & 3*) in the *Treatment* of ***Symptomatic Peripheral Artery Disease*** (***PAD***)?
**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
What are (**5**) _Etiologies_ for ***Constrictive Pericarditis***?
1. **Idiopathic Pericarditis** 2. **Viral Pericarditis** 3. **Cardiac Surgery** 4. **Radiation Therapy** 5. **TB Pericarditis** (*endemic areas*)
56
What are (**7**) _Clinical Manifestations_ of ***Constrictive Pericarditis***?
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
What are (**3**) _Diagnostic Findings_ with ***Constrictive Pericarditis***?
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
What are (**3**) _Examples_ of ***Paroxysmal Supraventricular Tachycardia's*** (***PSVT***)?
1. **Atrioventricular Nodal Reentrant Tachycardia (**AVNRT**)** 2. **Atrioventricular Reentrant Tachycardia (**AVRT**)** 3. **Atrial Tachycardia**
59
What are (**3**) _Clinical Manifestations_ of a ***Paroxysmal Supraventricular Tachycardia*** (*PSVT*)?
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
What _Cardiac Disorder_ is the _Most Common Cause_ of ***Secondary Dilated Cardiomyopathy***?
**Coronary Artery Disease (CAD) / Ischemic Heart Disease (IHD)**
61
Which (**2**) _Diagnostic Exams_ should be performed on *ALL* patients presenting with unexplained ***Heart Failure*** due to ***LV Systolic Dysfunction***?
1. **"Stress" Test,** *or* 2. **Coronary Angiography**
62
Patients with *suspected **Acute Coronary Syndrome*** (***ACS***) but **unremarkable/normal ECG** and **serum** **Toponin** **levels** should be managed how?
**Serial repeat ECGs** and **Troponin levels** to rule out **MI**
63
What are (**5**) Medications that can cause ***DRUG-INDUCED Lupus***?
1. **Procainamide** 2. **Hydralazine** 3. **Minocycline** 4. **Etanercept** 5. **Infliximab**
1.02) CARDIOVASCULAR SYSTEM
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