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88 Cards in this Set
- Front
- Back
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Where are the EKG changes seen in an Inferior MI and what vessels are involved?
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. II, III, aVF
. Right Coronary artery |
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What's the most significant complication of a VSD?
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. Infective endocarditis
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What is pulsus tardus et parvus? What conditions is it associated with?
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. A carotid upstroke that is diminished and delayed, weak carotid upstroke.
. Associated with aortic stenosis. |
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What are some of the EKG changes seen with pericarditis?
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. Difuse ST segment elevations
. Increased ESR levels . Low grade fever |
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How do you make a diagnose of infective endocarditis?
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. Obtain 3 different blood samples for culture over a 24 hour period.
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What's the TX for cor pulmonale?
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. Pulmonary vasodilators such as prostacyclins (epoprostenol)
. Antiendothelins (Bosentant) . CCB's . Ultimate TX is heart-lung transplant |
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What do you give to penicillin allergic pts for endocarditis prophylaxis?
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. Clindamycin or
. Azythromycin or . Cephalosporins |
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How many times do you draw Troponin I or T before an MI is ruled out?
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. Every 8 hours three times before MI is ruled out
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A holosystolic murmur along the sternal border that increases with inspiration should make you think of what condition?
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. Tricuspid regurgitation
( Murmur is usually faint, this is called the Carvallo sign) |
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Which medication will decrease mortality in left ventricular systolic dysfunction and NYHA class III-IV heart failure?
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. Spironolactone
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What are some classic presentation of lyme disease?
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. Palpitations with varying degree of AV block
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What is the TX for supraventricular tachycardias?
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. IV verapamil or
. IV adenosine |
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What increases HDL levels?
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. Exercise
. Estrogen . 1-2 alcoholic drinks /day |
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What medication do you prescribe on pts with pericarditis?
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. NSAIDs (such as indomethacin to decrease inflammation)
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What do you use to decrease LDL levels?
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. Statins
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What are the characteristics of an aortic stenosis murmur?
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. Harsh systolic ejection murmur ( on the aortic area that radiates to the carotids)
. Slow pulse upstroke (pulsus tardus et parvus) . audible S3/S4 . Ejection click . LVH . Cardiomegaly . Syncope with angina and CHF |
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What are the signs of constrictive pericarditis and what is the TX?
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. Pericardial knock
. Pericardial calcification . Normal ventricular biopsy . Kussmaul sign (increased neck vein distention on inspiration) . TX by removing the pericardium |
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How does the left ventricular wall appears on echocardiograms of pts with amyloidosis?
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. With a "speckled pattern"
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What is a significant side effect of amiodarone?
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. Hypothyroidism or
. Hyperthyroidism |
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What are the lipid levels found on metabolic syndrome?
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. TG's >150 and
. HDL < 40 |
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What's the TX for CHF?
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. Sodium restriction
. ACE inhibitors (decrease mortality) . BBs (decrease mortality) . Diuretics . Digoxin (moderate to severe CHF with decreased EF) . Vasodilators |
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What are the characteristics of an aortic regurgitation murmur?
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. Early - Diastolic decrescendo murmur (apex)
. Widened pulse pressure . LVH . LV dilation . S3 . Bounding peripheral pulses |
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How does nitroprusside helps in acute MI?
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. it decreased afterload in heart failure and therefore, increases stroke output as left ventricular end-diastolic pressure falls
. It's an arterial vasodilator |
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Which pts should be started on anticoagulation with IV heparin after an MI?
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. pts with cardiac thrombus
. Large area of diskinetic ventricle . Severe congestive heart failure |
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In which 2 cardiac conditions the murmur increases with the vasalva maneuver or when the pt moves from squatting to standing?
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. Hypertrophic cardiomyopathy
. Mitral valve prolapse (they decrease with squatting to lying down and with hand grip) |
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Which medication has shown benefit for pts only in NYHA class III or class IV heart failure?
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. Spironolactone
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A persistently wide split S2 is associated with which pt?
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. RBBB pts or
. Pulmonic stenosis or . PE or . Ectopic beats in the left ventricle |
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What LDH levels would be used to determine an MI?
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. LDH1>LDH2
(takes 24 hours to become +) |
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What are some normal lipid levels?
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. Total cholesterol goal is <200, >240 is high
. Normal TGs is <150, >200 is high |
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What are some 2nd causes of hyperlipidemia?
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. Uncontrolled DM
. Hypothyroidism . Uremia . Nephrotic syndrome . Obstructive liver disease . Alcohol . Meds ( BBs, corticosteroids, OCPs, thiazides) |
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An increased or audible S3 and S4 represents what?
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. S3 - volume problems
. S4 - pressure problems |
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How long does the stable angina pain usually persists?
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. < 20 minutes
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Improved cardiovascular outcomes in pts with DM have been demonstrated after reduction of diastolic pressures to which levels?
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. < 80 mmHg
(recommended BP is 135/80) |
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What are the characteristics of a mitral regurgitation murmur?
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. Holosystolic murmur (radiates to the axilla)
. Soft S1 . LAE . LVH |
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A pt with normal cardiac enzymes and ST depression should make you suspect of what condition?
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. Unstable angina
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What are the lipid levels (LDL) that warrant intervention?
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. 0 CHD risks - Diet if >160, meds if >190
. 1-2 CHD risks - Diet if >130, meds if > 160 . >2 risks - Diet if >100, meds if >130 (CHD equivalents are DM, PAD, Abd aneurysm) (If CAD equivalent, then meds if >100) |
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Patients undergoing GU (GI or genitourinary) procedures should receive which prophylaxis for endocarditis?
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. Gentamycin
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What decreases HDL?
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. Smoking
. Androgens . Progesterone . Hypertriglyceridemia |
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What cardiac conditions are associated with hyperthyroidism?
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. A Fib
. Sinus tachycardia (check TSH) |
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How does a LBBB presents?
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. With a "W" pattern on V1-V4
. WILLIAM - W pattern in LBBB in V1-V4 |
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What agent is used in an MI with EF <40%?
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. ACE inhibitors
(decrease mortality, everything else give BBs) |
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What's the 1st line of TX for increased cholesterol?
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. Niacin
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How do you diagnose WPW syndrome?
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. Childhood
. Dizzy or dyspneic or syncope after playing then recovering with no other symptom . delta wave (right before QRS) |
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When do you use amiodarone or lidocaine with MIs?
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. If V tach develops
(don't use it prophylactic) |
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What are the characteristics of a mitral stenosis murmur?
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. Late-diastolic blowing murmur (at the apex)
. opening snap . Loud S1 . Atrial fibrillation . LAE . PH |
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How does a PDA presents?
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. Constant, machine like murmur in upper left border
. Dyspnea and CHF |
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How do you close and open a PDA?
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. close with indomethacin, open with PGE1
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What is a PDA associated with?
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. Congenital rubella
. High altitudes |
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How do you TX V tach?
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. Amiodarone or
. Lidocaine |
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What should you see on the EKG after an MI?
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. Flipped or flattened T waves
. ST segment elevation . Q waves |
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Pt with normal cardiac enzymes and ST segment elevation should make you suspect of what condition and what is the TX?
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. Variant (prinzmetal's ) angina
. TX acutely with nitro and long term with CCB's |
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Where are the changes seen in the EKG of an anterior MI? What vessels are involved?
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. V2-V4
. LAD |
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How often do you screen for hyperlipidemia?
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. Every 5 years starting @ 20.
(screen for LDL, HDL, cholesterol and TGs) |
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What are the characteristics of a mitral prolapse murmur?
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. Mid-systolic click or late-systolic murmur
(Associated with panic disorder) |
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What is one of the MCC of pericarditis?
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. Renal failure (uremic pericarditis)
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How is Mobitz type I also called and what is it?
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. Wenckebach phenomenon
. Progressive lengthening of the PR interval (PR>200 msec) . TX: reassurance |
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What's the most common cardiac tumor of adults and where is it located?
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. Atrial myxoma
. 90% on left atrium . TX: with resection |
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When do you consider prophylaxis on pts with MVP for endocarditis?
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. Only if a murmur is heard on PE or
. PT has a hx of endocarditis |
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What are some symptoms of digitalis toxicity?
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. Xanthopsia/verdopsia = yellow-green casts to the vision
. Bradycardia . Arrhythmia |
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What type of heart defect is associated with FA syndrome, TORCH syndrome or Down syndrome?
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. VSDs
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Where are the EKG changes seen in a lateral MI and what vessels are involved?
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. I, aVL, V5, V6
. LAD or circumflex |
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How do you treat right ventricular infarcts?
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. Give fluids
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What are some meds that have shown to improve survival in MI pts?
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. BBs
. antiplatelet agents (aspirin) . warfarin . decreasing of lipid levels |
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How do you tell CHF from BNP levels?
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. BNP <100 - CHF unlikely
. BNP 100-500 - CHF suspicious . BNP >500 - CHF or another acute or serious cardiovascular disorder |
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What is an appropriate prophylaxis for a pt undergoing a dental procedure with a MVP?
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. Amoxicillin, 3g PO 1 hour before a procedure, and 1.5g 6 hours later
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The onset of pericarditis is an absolute indication to start what tx?
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. Hemodialysis
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What are some of the risk factors for CHD?
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. Age (men >45, women >55)
. FHx of CHD (Mi-like in male <55, female <65) . smoking (>10 cigs/day) . HTN (or anti-HTN meds) . Low HDL (<40) |
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How do you diagnose/detect endocarditis?
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. TEE
(transesophageal echocardiography) |
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When do you use thrombolitics for acute MI?
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. Up to 6 hours if pt meets strict criteria
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What's a common lung phenomena that happens with administration of nitroprusside?
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. The intrinsic ability of the lungs to match ventilation with perfusion via vasoconstriction in underventilated areas is lost.
This creates large V/Q mismatch areas that lead to profound hypoxia |
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Sildenafil (viagra) is contraindicated with what other medication?
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. Any nitrogen containing medication due to profound hypotension and possible death
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What is the presentation of an ASD?
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. Asymptomatic until adulthood
. Fixed , split S2 . Palpitations (secundum type is most common - 80%) (Primum type is most common in Down's syndrome) |
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How do you TX severe sinus bradycardia?
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. Atropine
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What is metabolic syndrome?
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. Syndrome of insulin resistance or
. Pre-diabetic state . HTN + abdominal obesity + insulin resistance + dyslipidemia |
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What's the MCC of constrictive pericarditis in the USA?
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. Idiopathic
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What do you give to standard pts for endocarditis prophylaxis?
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. Amoxicillin before and after the procedure
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Is HOC a systolic or diastolic dysfunction and how do you TX?
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. Diastolic dysfunction
. TX with BBs (Digoxin, diuretics and vasodilators are contraindicated) |
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How does a VSD presents?
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. Holosystolic murmur next to sternum
. MC congenital heart defect |
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What are the clues for hypertrophic cardiomyopathy?
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. Left ventricular dysfunction
. Impaired diastolic filling . thick interventricular septum . outflow obstruction . Systolic murmur - increases with vasalva (because it decreases left ventricular filling) |
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How does a RBBB presents?
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. with a "M" pattern on V1-V2.
. MARROW - M pattern for RB on V1-V2 |
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How do you TX WPW syndrome?
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. Procainamide or
. Quinidine (avoid digoxin and verapamil) |
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Where is the murmur of MVP best heard at?
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. Over the mitral valve area
(radiates to the cardiac apex) |
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Which murmurs are accentuated during the vasalva maneuver?
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. HOCM
. MVP |
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How do you TX A. Fib?
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. Stable:
- Anticoagulation - Control rate - digoxin - BBs - CCB . Unstable: - Asynchronous cardioversion |
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When treating an MI, O2 saturation should be kept at which level?
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. >90%
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EKG showing ST segment depression with pain, that then reverts to normal when pain stops should make you think of what condition?
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. Stable Angina
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EKG showing ST segment depression with prolonged chest pain what does not respond to nitroglycerin should make you think what?
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. Unstable Angina
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How do you treat superficial thrombophlebitis?
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. NSAIDs or
. Aspirin |
