Cardiology Idc

Front 1

The amplitude of the pulse is described on a scale of 0 to 4 Describe 0 to 4.

Back 1

a) 4 Bounding, aneurysmal
b) 3 Full, increased
c) 2 Expected
d) 1 Diminished, barely palpable
e) 0 Absent, not palpable

Front 2

Acute myocardial infarction or ST-segment elevated MI (STEMI) results from what?
Lack of blood flow leads to tissue ischemia and irreversible cell death.

Back 2

occlusive coronary thrombus at the site of a preexisting atherosclerotic plaque.
Coronary Artery Disease

Front 3

In the management of a patient with acute myocarditis/pericarditis that presents with normal vs with Pericardial friction rub (velcro / crunching snow) what might you see on the EKG?

Back 3

diffuse ST-segment elevations

Front 4

There are four (4) components to a heart examination and must be completed in what order?

Back 4

(a) Inspection
(b) Palpation
(c) Percussion
(d) Auscultation

Front 5

What is the likely diagnosis for the following symptoms:
1) Pain similar to angina but more severe
2) Sternal CRUSHING chest pain with radiation to shoulder, arm, neck or jaw
3) Pain commonly described as pressure on chest (elephant sitting on chest)
4) Occurs at rest, commonly in the morning
5) Diaphoresis
6) Nausea and vomiting
7) Anxiety
8) Weakness or dizziness
9) 1/3 of patients with not have typical chest pain (older, female, diabetes) and have worse outcomes due to delayed treatment

Back 5

Acute myocardial infarction AKA: Acute Coronary Syndrome (ACS)

Front 6

Up to 2/3 of patients experiencing there 1st episode of A-fib will spontaneously revert to sinus rhythm within how many hrs?

Back 6

24 hrs

Front 7

The external jugular vein drains into what?

Back 7

the subclavian vein
Check answer Chapter 16, pg 416

Front 8

How do you calculate a heart rate from a 6 sec rhythm strip?

Back 8

1. count the number of large squares between R waves with the following rates: 300 - 150 - 100 - 75 - 60 for regular QRS complexes
2. For a rough estimate on irregular rhythms add the QRS complexes in a strip

Front 9

What is the likely diagnosis for the following symptoms:
1) Claudication: cramping pain or tiredness in the thigh, calf or foot with walking or exercise and relieved by rest
2) Pain unrelieved by rest are at high risk for amputation
3) Diminished femoral, popliteal or pedal pulses
4) Tissue ulceration and gangrene, NECROSIS
5) Erectile dysfunction
6) LOSS OF HAIR
7) Thinning and cool skin
8) Atrophy of muscles

Back 9

Lower Extremity Occlusive Disease

Front 10

If the patient is in a tachy rhythm or hemodynamically unstable what is almost universally successful

Back 10

synchronized electrical cardioversion preferred over vagal manuevers

Front 11

Auscultate what in cardio exam for bruits or murmurs

Back 11

The carotid arteries
NOT the angle of the mandible

Front 12

In the chamber of the heart blood is transported by the pulmonary veins and it returns to the what?

Back 12

Left atrium

Front 13

Blood pressure measured with a patient supine tends to be higher than when measured when what?

Back 13

sitting

Blood pressure may be elevated in patients with hypertension or decreased in low output states

Anything that increases blood volume, i.e. water retention will increase blood pressure

Front 14

Complications: in chronic aflutter is the same as chronic atrial fibrillation. What complication?

Back 14

Embolic event and should not be cardioverted until anti-coagulated

Front 15

What separates the upper chambers of the heart?

Back 15

Atrial septum

Front 16

Ankle Brachial Index (ABI) Ratio of SBP at ankle
compared to brachial artery

Back 16

< 0.9 (Normal is 1.0 - 1.2)

Front 17

What is the thickest tissue of the heart?

Back 17

Myocardium

Front 18

DESCRIBE how venous blood returns to the heart

Back 18

a. Veins transport blood back to the heart via pressure generated by:
(1) Contractions of the heart.
(2) The skeletal muscle pump.
(3) The respiratory pump.
b. These pressure generated pushes blood in one direction, to the right atrium where the pressure is around O mm Hg

Front 19

What are some causes for sinus tachycardia?

Back 19

(1) AMI
(2) Cardiac Tamponade
(3) Aortic Dissection

Front 20

Identify a 3rd degree heart block

Back 20

P waves are consistant and QRS complexes are consistant but they do not communicate with each other

Front 21

What are the smallest vessels?

Back 21

Capillaries
CHECK ANSWER

Front 22

During a cardio exam what do you inspect for indication of good venous return?

Back 22

Inspect for cyanosis of the skin and cyanosis of the nailbeds and capillary refill

Front 23

What medication is treatment for bradycardia

Back 23

Administer Atropine .5mg bolus and repeat q3-5 mins, Max dose 3mg
1) If atropine is ineffective prepare for transcutaneous pacing
2) Or Dopamine IV 2-10mcg/kg min
3) Or Epinephrine IV 2-10mcg/kg min, use 1:10,000 solution

Front 24

All systemic blood vessels filter into What?

Back 24

the aorta

Front 25

What are some typical causes of a heart murmur?

Back 25

Any new onset heart murmur with fever is endocarditis until proven otherwise
Note: Obesity is NOT a primary cause of a heart murmur

Front 26

What would you identify on the EKG with the following;
(a) Irregularly, irregular (R-R interval is irregular)
(b) Atrial rate 400/mins presenting as fibrillation waves (Wavy Baseline)
(c) Ventricular varies from brady to tachy and can be up to 170-180/min

Back 26

Atrial-Fib

Front 27

What is identifed on an EKG with the following;
(a) Wide QRS complex
(b) Tachycardia, usually 160-240 beats/min
(c) Moderately regular

Back 27

Ventricular-Tach

Front 28

What has EKG with heart rate < 60 beats/min, normal and consistent P wave morphology, normal PR interval

Back 28

Bradycardia

Front 29

What has;
(a) Sawtooth flutter waves
(b) Atrial rate between 250-350 beats/min

Back 29

Atrial Flutter

Front 30

What has premature and wide QRS without preceding P-wave and are very common, even in patients without heart disease, but occur most in patients with ischemic disease and are universally found in patients with AMI

Back 30

Premature Ventricular Contraction (PVC)

Front 31

The amount of blood ejected from the left ventricle into the aorta is defined as what?
(1) NOTE: the same is ejected from the right ventricle, during ventricular contraction.
(2) Formula = stroke volume x heart rate
= 70 ml/beat x 75 beats/min
= 5250 ml/min or 5.25 L/min

Back 31

Cardiac output (CO)

Front 32

What physical exam finding would be most helpful in diagnosing Left sided Heart failure

Back 32

symptoms of low Cardiac Output and elevated pulmonary venous pressure; dyspnea

Front 33

Which blood vessels have the lowest concentration of oxygen

Back 33

Pulmonary artery

Front 34

Pertinent data when your talking to someone with cardiovascular symptoms what is going to be pertinent in their PMHx

Back 34

MI, HTN, Heart Dx, Diabetes ect...

Front 35

Cardiac arrhythmias that originate from where have the potential to be the most dangerous

Back 35

Ventricles

Front 36

What is common complication associated with atrial-fib

Back 36

coagulating blood in the atria that can cause a stroke or clot

Front 37

What is identified as an EKG with heart rate 140-240 beats/min (commonly 160-220 beats/min) and has a regular rhythm. P wave may be buried in narrow QRS.

Back 37

Paroxysmal Supraventricular Tachycardia (PSVT)

Front 38

What are some age specific findings in older adults IRT Cardiac conditions

Back 38

Generally older pts will have a slower heart rate making them less tolerable to tachycardia

Front 39

Describe how pitting edema is scaled

Back 39

a) 1+ Slight pit, disappears rapidly
b) 2+ Somewhat deep pit, disappears in 10 to 15 seconds
c) 3+ Noticeable deep pit that lasts more than a minute
d) 4+ Very deep pit that lasts 2 to 5 minutes

Front 40

What Originates in the SA node and follows the appropriate conduction pathways. The rate is 60-100 beats/min and the rhythm is regular. Every beat has a P wave, and every P wave is followed by a ventricular response and what is the treatment for it?

Back 40

Normal Sinus Rhythm. No treatment neccessary

Front 41

What is defined as an abnormality in the cardiac conduction system

Back 41

arythmia

Front 42

What is the appropriate treatment for a pt with the following rhythms are unstable;
A-fib
SVT
A-Flutter
V-Tach w/pulse

Back 42

Cardio version at 100-200J for A-fib and SVT
Cardioversion at 25-50J for A-flutter and V-Tach w/pulse

Front 43

What is the most appropriate treatment for stable wide and unstable narrow bradycardia rhythms?

Back 43

Transcutanous pacing

Front 44

What is the most appropriate treatment for pulseless V-tach or V-fib

Back 44

shock
1) CPR 2 mins/IV access
2) Check rhythm if shockable: shock
3) CPR 2mins, give 1mg Epinepherine IV
4) Check rhythm if shockable: shock
5) CPR 2mins, give Amiodarone 300mg IV bolus
6) Repeat

Front 45

What is the most approriate treatment for Asystole or PEA

Back 45

1) CPR 2 mins/IV access/Epinepherine 1mg q3-5 mins
2) Check rhythm: not shockable
3) CPR 2mins, give 1mg Epinepherine IV
4) Check for reversible causes
5) Repeat

Front 46

What is defined as Heart rate faster than 100 beats/min caused by rapid impulse formation from the sinoatrial node.

Back 46

Sinus Tachycardia

Front 47

What is defined as Heart rate slower than 60 beats/min due to increased vagal tone on normal pacemaker or organic disease of the sinus node

Back 47

Sinus Bradycardia

Front 48

What is the appropriate treatment for a stable pt who has narrow tachycardia

Back 48

Vagal Maneuvers
If vagal maneuvers fail IV agents will terminate up to 90% of episodes
a) Adenosine 6mg IV push, follow with saline flush, repeat with 12mg (x2) if
required
b) Β-blocker or calcium channel blocker to decrease HR
c) Verapamil 2.5 IV over 2 mins, followed by 2.5-5mg q1-3mins up to 20mg if
BP and rhythm are stable

Front 49

What is the appropriate treatment for a pt with stable wide tachycardia

Back 49

1) Lidocaine 1mg/kg IV bolus
2) Amiodarone 150mg IV over 10 mins, then 0.5mg/for 18-24hrs
3) Amiodarone may cause cardioversion back to SR
4) Procainamide IV 20mg/min up to 1000mg followed by 20-80mcg/kg/min
infusion

Front 50

What is the appropriate treatment for a pt with A-fib or A-flutter

Back 50

Patients with AF >48hrs are at risk for cardioembolic events and should not be cardioverted until anti-coagulated, unless they are unstable
1) Metoprolol 5mg IV bolus, can repeat q5mins (x2) or PO for total daily dose 50-400mg
2) Amiodarone 150mg IV over 10 mins, then 1mg/min infusion for 1st 6 hrs

Front 51

How is a second degree type 1 heart block identified on an EKG?

Back 51

P-R interval gets longer with each beat until QRS is dropped

Front 52

When you see a rhythm strip showing a NSR what is the appropriate treatment?

Back 52

No treatment is necessary

Front 53

How is a second degree type II heart block identified

Back 53

P-R interval remains constant (<0.2) and then a dropped QRS complex

Front 54

What are some examples of metabolic syndrome

Back 54

HTN
Diabetes
Hyperlipidemia

Front 55

What would the most likely diagnosis be for the following risk factors;
(a) Hypercholesterolemia
(b) Hypertension
(c) Diabetes mellitus
(d) Male gender
(e) Smoking
(f) Family History

Back 55

atherosclerotic disease

Front 56

What are some potential complications from DVT

Back 56

PE
Necrosis
Amputation if left untreated
Death

Front 57

55 y/o M w/ cc of cramping pn in L calf which pn started 3 months ago only hurts with excercise (poss lower extremity occlusion)
Now the pn comes w/rest. upon exam you note L calf smaller than R, has almost no hair, L dorsalis pedis pulse are absent. Takes Zocor for Hyperlipidemia, Smoker, Drinks every day. What is the definitive therapy

Back 57

Select appropriate answer:
a) Diet and Excercise
b) Smoking Cessation
c) Anti-coagulation
D) SURGICAL BI-PASS GRAFT

Front 58

When you have a patient with MI physiologically what are we trying to accomplish with MONA protocol

Back 58

Trying to minimize the extent of the infarction.
Infaction is dead tissue
Ischemia is tissue without oxygen

Front 59

What dose of asprin would you give a pt with an infarct

Back 59

325mg chewed up

Front 60

What does MONA stand for

Back 60

Morphine
Oxygen
Nitrogen
Asprin

Front 61

What is an example of obstructive type shock
Emergent medical conditions preventing blood flow into and out of heart

Back 61

(a) Cardiac tamponade
(b) Tension pneumothorax
(c) Pulmonary embolism

Front 62

What is the best treatment for an obstructive type shock?

Back 62

Treat reversible cause of obstructive shock

Front 63

What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypoperfusion. This leads to hypoxia, acidosis and eventual end organ damage and failure

Back 63

Shock
1) Hypovolemic
2) Cardiogenic
3) Distributive
4) Obstructive

Front 64

What is the appropriate treatment for anaphylaxis

Back 64

1) ABCs (secure airway!), O2, IV, Monitor
2) Epinephrine (Epipen) 0.1-0.5mg SC/IM repeat q 10-15 mins
a) Epipen delivers 0.3mg IM dose
3) IV fluid (LR or NS) bolus
4) Ancillary Treatments
a) Benadryl IV 50mg
b) Zantac 50mg IV
c) Solumedrol 125mg IV

Front 65

On a cellular level what is the following describe?
Massive release of histamine and other vasoactive substances cause systemic
vasodilation, potential airway compromise due to airway edema and bronchospasm

Back 65

Anaphylaxis

Front 66

Packed red blood cells raises the hemaocrit level by what?

Back 66

3%

Front 67

What is the complication for myocarditis

Back 67

Heart failure

Front 68

What is the most likely diagnosis for the following symptoms;
Substernal chest pain which is usually pleuritic (sharp), possible radiation to neck,
shoulder or arm
1) Pain is worse when supine and relieved by sitting
2) Febrile
3) Pericardial friction rub is most common sign (Sounds like: velcro/crunching snow)

Back 68

Pericarditis

Front 69

What is the treatment for pericarditis

Back 69

Aspirin 650mg q3-4hrs or NSAID (Indomethacin/Motrin) for 7 days to 3 weeks

Front 70

What is an actual ausculitory finding in Mitral Regurgitaion

Back 70

Pansystolic Murmur maximal at apex and radiating into the axilla

Front 71

What are the complications for valvular heart disease

Back 71

(1) Arrythmias
(2) Acute congestive heart failure
(3) Pulmonary edema
(4) Syncope
(5) Sudden death

Front 72

1) Acute Myocardial Infarction / Unstable Angina
2) Pulmonary Embolism (PE)
3) Pericardial Tamponade
4) Esophageal Rupture
5) Tension Pneumothorax / Pneumothorax
6) Aortic Dissection / Rupture
Why do we rule out the "Big 6 +1"

Back 72

If you can rule out these 6 etiologies, you can very likely feel that the patient will
survive the next 24 hours.

Front 73

What is the difference between stable and unstable angina?

Back 73

Stable angina: chest pain with exertion, relieved by rest

Unstable angina: chest pain while resting

Front 74

Prinzmetals angina: rare, caused by what?

Back 74

coronary vasospasm often without CAD (coronary constriction)

Front 75

What are the long acting prophylactic therapies for angina

Back 75

(a) Nitroglycrine SL or Spray
(b) Long acting nitrates
(c) Β-blocker
(d) Calcium channel blocker