Cardio Comlex Ii

Front 1

Congenital disorder predisposing one to ventricular tacharrhythmias

Back 1

Long QT syndrome (QTc > 440msec)

Front 2

JVD

Back 2

> 7cm above sternal angle.
Suggests:
Right CHF
Pulmonary HTN
Volume overload
Tricuspid regurgitation
Pericardial disease

Front 3

Kussmaul's sign

Back 3

Increased JVD with inspiration
Suggests:
R ventricular infarction
Postoperative cardiac tamponade
Tricuspid regugitation
Constrictive pericarditis

Front 4

Harsh systolic ejection murmur, radiating to carotids

Back 4

Aortic Stenosis

Front 5

Holosystolic murmur, radiating to axillae or carotids

Back 5

Mitral regugitation

Front 6

Midsystolic or late-systolic click

Back 6

Mitral valve prolapse

Front 7

Systolic murmurs (4)

Back 7

Aortic stenosis
Mitral regurgitation
Mitral valve prolapse
Flow murmur : no disease

Front 8

Diastolic murmurs (2)

Back 8

ALWAYS ABNORMAL:
Aortic regurgitation
Mitral stenosis

Front 9

Early decrescendo murmur

Back 9

Aortic regurgitation

Front 10

Mid-late low-pitched murmur

Back 10

Mitral stenosis

Front 11

S3 gallop

Back 11

Dilated cardiomyopathy (floppy ventricle), mitral valve disease, or normal in younger patients in high output states (pregnancy)

Front 12

S4 gallop

Back 12

HTN, diastolic dysfunction (stiff ventricle), aortic stenosis, normal in younger athletes

Front 13

Peripheral edema DDX (10)

Back 13

R heart failure
Biventricular failure
Peripheral venous disease
Constrictive pericarditis
Tricuspid regurgitation
Hepatic disease
Lyphedema
Nephrotic syndrome
Hypoalbuminemia
Drugs

Front 14

Peripheral pulses greater in the arms than legs

Back 14

Coarcation

Front 15

Heart problem with increased peripheral pulses (2)

Back 15

Compensated aortic regurgitation
Patent ductus arteriosus

Front 16

Pulses alternans

Back 16

Alternating weak and strong pulses. Seen in : cardiac tamponade, impaired LV systolic function. Poor prognosis

Front 17

Pulsus parvus et tardus

Back 17

Weak and delayed pulse. Seen in aortic stenosis

Front 18

Management of A-fib: ABCD

Back 18

Anticoagulate
BBs
Cardiovert/CCBs
Digoxin

Front 19

DDX for CHF: HEART FAILED

Back 19

HTN
Endocrine
Anemia
Rheumatic heart disease
Toxins
Failure to take meds
Arrhythmia
Infection
Lung (PE)
Electrolytes
Diet (Excess Na+)

Front 20

Treatment for symptomatic bradycardia

Back 20

Atropine or pacemaker

Front 21

PR interval > 200 msec

Back 21

1st Degree AV block. No treatment necessary

Front 22

Causes of 2nd Degree AV block MobitzI/Wenckebach) 6

Back 22

Digoxin
BBs
CCBs
Increased Vagal Tone
Sinoatrial conduction disease
R coronary inscemia or infarction

Front 23

Treatment for 2nd Degree AV block MobitzI/Wenckebach)

Back 23

Stop offending drug
Atropine
Pacemaker

Front 24

2nd Degree AV block Mobitz II DDX and TX

Back 24

Fibrotic disease, acute, subacute or prior infarct

Treat with pacemaker

Front 25

Progressive PR lengthening until a dropped beat occurs

Back 25

2nd degree AV block Mobitz I/Wenckebach

Front 26

Unexpected dropped beats without a change in PR interval

Back 26

2nd Degree AV block, Mobitz II

Front 27

3rd degree AV block (Complete) cause and treatment

Back 27

No commincation between atria and ventricles. Cannon A waves. Treat with pacemaker

Front 28

Disorder consisting of abnormalities in supraventricular impulse generation and conduction that lead to SVT and bradyarrhythmias

Back 28

Sick Sinus Syndrome (SSS)

Front 29

Most common indication for pacemaker placement

Back 29

Sick sinus syndrome (SSS)

Front 30

Acute A-fib DDX (PIRATES)

Back 30

Pulmonary disease
Ischemia
Rheumatic heart disease
Anemia/Atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis

Front 31

No discernible P waves, with variable and irregular QRS response

Back 31

A-fib

Treat with CCBs, BBs, amiodarone. Coumadin might be necessary.

Front 32

Regular rhythm, sawtooth appearance of P waves, rate 240 - 300 bpm with varying degree of blockade

Back 32

Atrial flutter

Treat with anticoagulation, rate control. Cardiovert if necessary

Front 33

3 or more unique P-wave morphologies rate > 100 bpm

Back 33

Multifocal atrial thacycardia

Treat underlying disorder (COPD, hypoxemia), cerapamil, BBs

Front 34

Ectopic beats from ventricular foci. Associated with hypoxia, hyperthyroidism, electrolyte abnormalities

Back 34

Premature ventricular contraction (PVC)

Front 35

3 or more consecutive PVCs with wide QRS complexes in a regular rapid rhythm. AV dissociation. Associated with MI, CAD, and structural heart disease

Back 35

Ventricular tachycardia
Treat with cardioversion and antiarrhythmics (amiodarone, lidocaine, procainamide)

Front 36

Totally eratic wide-complex tracing associated with CAD, structural heart disease and cardiac arrest

Back 36

Ventricular fibrilation

Treat with immediate electrical cardioversion and ACLS protocol

Front 37

Polymorphous QRS; VT with rates 150 - 250 associated with long QT syndrome, proarrhythmic response to meds, hypokalemia, and congenital deafness

Back 37

Torsades de pointes

Treat with correcting cause. Give magnesium and cardiovert if unstable

Front 38

Stage A of CHF

Back 38

Have risk factors but no signs or symptoms

Manage risk factors, ACEIs for those with HTN, PAD, and DM

Front 39

Stage B of CHF

Back 39

Structural heart disease (prior MI, valvular disease, etc.) without symptoms

Treat: ACEIs and BBs

Front 40

Stage C of CHF

Back 40

Structural heart disease with symptoms of CHF

Treat: ACEIs, BBs, digitalis, and low Na+ diet

Front 41

Stage D of CHF

Back 41

Marked symptoms at rest despite maximal medical therapy

Treat: mechanical assist devises, heart transplant, continuous IV inotropic drugs, and hospice

Front 42

Diuretic that can cause hyperglycemia and hyperlipidemia

Back 42

Thiazide

Front 43

Diuretic that can cause hyperkalemia

Back 43

K+ sparing, Spironolactone, triamterene, amiloride

Front 44

Treatment for acute pulmonary congestion in CHF (PLOMN)

Back 44

Position upright
Lasix (Furosemide)
Oxygen
Morphine
Nitrates

Front 45

Indication for an implantable biventricular cardiac defibrillator (ICD)

Back 45

EF < 30%
and
CAD

Front 46

2 Most common causes of secondary dilated cardiomyopathy

Back 46

Ischemia
Long-standing HTN

others: Chagas, wet beri beri, thyroid dysfunction, acromegaly, pheo, cocaine, myocarditis, post-partum, coxackievirus, HIV, etc.

Front 47

Gradual development of CHF symptoms, displacement of left ventricular impulse, JVD, S3/S4 gallop, LBBB, sinus tachycardia, low-voltage QRS

Back 47

Dilated cardiomyopathy

Front 48

Most common cause of sudden death in young healthy athletes

Back 48

Hypertrophic obstructive cardiomyopathy. Autosomal dominant in 50%

Front 49

Syncope, dyspnea, palplitations, angina, sustained apical impulse, S4 gallop, systolic ejection crescendo-decrescendo murmur that increases with decreased preload (valsalva).

Back 49

Hypertrophic obstructive cardiomyopathy

Front 50

Asymmetrically thickened left ventricular wall and dynamic obstruction of blood flow, LVH, mitral regurgitation, left atrial enlargement

Back 50

Hypertrophic obstructive cardiomyopathy

Front 51

Treatment for hypertrophic obstructive cardiomyopathy

Back 51

BBs
CCBs 2nd line

Front 52

Causes of restrictive cardiomyopathy (4)

Back 52

Sarcoidosis
Amyloidosis
Hemochromatosis
Scarring and fibrosis (radiation or doxorubicin)

Front 53

Rapid early filling with a normal EF, LBBB, fibrosis or infiltration on biopsy

Back 53

Restrictive cardiomyopathy

Front 54

Young women at rest in the early morning, sharp pain in chest with pressure, ST-segment elevation in absence of cardiac enzyme elevation

Back 54

Prinzmetal's (variant) angina. Caused by vasospasm of coronary vessels.

Front 55

New onset chest pain, occurs with less exertion or a rest, ST-changes, no elevation in cardiac enzymes

Back 55

Unstable angina, possible impending infarction.

Front 56

Medications that have a mortality benefit in treating angina (2)

Back 56

BBs
ASA

Front 57

Indication for heparin, angiography and possible percutaneous coronary intervention (PCI) or CABG

Back 57

Chest pain refractory to meds
TIMI score >3
Troponin elevation
ST changes > 1mm

Front 58

Treatment for STEMI (6 meds)

Back 58

ASA
BBs (not if also CHF, instead use ACEIs)
Clopidogrel (plavix)
Morphine
Nitrates
O2

Front 59

Non-pharmacologic tx for STEMI

Back 59

Angiography and PCI

Front 60

Hypercholesterolemia (4)

Back 60

Total cholesterol > 200
LDL >130
HDL < 40
Triglycerides > 500

Front 61

Drug therapy for stage 1 HTN (BP 140/90)

Back 61

Thiazide diuretic - first line
ACEIs
BBs
CCBs
or combo

Front 62

Drug therapy for stage 2 HTN (BP 160/100)

Back 62

2 drug combo
Usually thiazie + ACEIs, BB, or CCB

Front 63

HTN
Unexplained hypokalemia
Metabolic alkalosis

Back 63

Conn's syndrome (Hyperaldosteronism)
Usually due to an aldosterone-producing adrenal adenoma. Remove tumor.

Front 64

Tumors causing HTN (4)

Back 64

Pheo (adrenal gland tumor)
Aldosterone-producing adrenal adenoma (Conn's syndrome)
ACTH-producing pituitary tumor (Cushing's disease)
Ectopic ACTH-producing tumor (Cushing's syndome)

Front 65

HTN
Progressive renal failure
Encephalopathy with papilledema

Back 65

Malignant HTN

Front 66

Treatment for HTN urgencies

Back 66

Oral BBs, clonidine, ACEIs
Gradually lower BP over 24 - 48 hours

Front 67

Treatment for hypertensive emergencies

Back 67

IV labetalol, nitroprusside, nicardipine. Gradually lower mean arterial pressure by no more than 25% over first 2 hours

Front 68

Signs of pericarditis (PERIC)

Back 68

Pulsus paraodxus
ECG changes
Rub
Increased JVP
Chest pain

Front 69

Causes of pericarditis CARDIAC RIND

Back 69

Collagen vascular disease
Aortic dissection
Radiation
Drugs
Infections
Acute renal failure
Cardiac (MI)
Rhematic fever
Injury
Neoplasms
Dressler's syndrome

Front 70

Pleuritic chest pain, dyspnea, cough, fever. Pain worsens in supine position with inspiration. Pericardial friction rub.

Back 70

Pericarditis

Front 71

Excess fluid in pericardial sac leading to compromised ventricular filling and decreased cardiac output.

Back 71

Cardiac tamponade

Front 72

JVD
Hypotension
Distant heart sounds

Back 72

Beck's triad for acute cardiac tamponade

Front 73

Kussmaul's sign

Back 73

JVD on inspiration

Front 74

Electrical alternans on ECG

Back 74

Diagnostic for cardiac tamponade

Front 75

Treatment for cardiac tamponade

Back 75

Volume expansion with IV fluids
Pericardiocentesis
Possible balloon pericardiotomy and pericardial window

Front 76

Aortic aneurysms most common association and location

Back 76

Atherosclerosis
Below renal arteries

Front 77

Indication for surgical repair of aortic aneurysm

Back 77

Abdominal > 5.5 cm
Thoracic > 6 cm
or rapidly enlarging

Front 78

Aortic dissection association and location

Back 78

HTN, males, 40 - 60
Above aortic valve and distal to left subclavian artery

Front 79

Pulsus parvus et tardus, single or paradoxically split S2 sound, systolic murmur radiating to carotids

Back 79

Aortic stenosis

Front 80

Blowing diastolic murmur at L sternal border, mid-diastolic rumble (Austin Flint murmur), widened pulse pressure, Musset's sign (head bob with heart beat), Corrigan's sign (water-hammer pulse), Duroziez's sign (femoral bruit)

Back 80

Aortic regurgitation

Front 81

Causes of aortic regurgitation CREAM

Back 81

Congenital
Rheumatic damage
Endocarditis
Aortic dissection/aortic root dilation
Marfan's syndrome

Front 82

Opening snap and mid-diastolic murmur at apex, pulmonary edema

Back 82

Mitral valve stenosis. Rhematic fever most common cause.

Front 83

Holosystolic murmur radiating to axillae

Back 83

Mitral valve regurgitation. Rheumatic fever or chordae tendineae rupture after MI

Front 84

DeBakey classification for aortic dissections

Back 84

I: Both ascending and descending
II: Only ascending
III: Only descending (can be treated medically)

Front 85

Stanford classification for aortic dissections

Back 85

A: Ascending aorta
B: All other types

Front 86

Virchow's Triad

Back 86

Hemostasis
Endothelial damage
Hypercoagulability

Front 87

6 P's of acute ischemia

Back 87

Pain
Pallor
Pulselessness
Paralysis
Paresthesia
Poikilothermia

Front 88

Immigrant presenting with progressive swelling of lower extremities bilaterally with no cardiac abnormalities

Back 88

Filariasis

Front 89

Treatment for lymphedema

Back 89

Exercise
Massage therapy
Pressure garments
Diuretics are relatively contraindicated