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115 Cards in this Set
- Front
- Back
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Sudden worsening of HTN in an elderly male with coronary artery disease (CAD) and peripheral vascular disease (PVD)
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Renal artery stenosis
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HTN in a patient with hypokalemic metabolic alkalosis.
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Hyperaldosteronism
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Select the best antihypertensive agent:
Angina pectoris |
B-blockers, Ca2+ channel blockers
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Select the best antihypertensive agent:
Diabetes |
ACEi, ARB
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Select the best antihypertensive agent:
hyperlipidemia |
ACEi, Ca2+ channel blockers
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Select the best antihypertensive agent:
CHF |
Diuretics, ACEi
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Select the best antihypertensive agent:
h/o MI |
B-blockers, ACEi
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Select the best antihypertensive agent:
chronic renal failure |
Diuretics, Ca2+ blockers
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Select the best antihypertensive agent:
asthma, COPD |
Diuretics, Ca2+ blockers
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Select the best antihypertensive agent:
BPH |
alpha1-selective antagonist
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Select the best antihypertensive agent:
Pheochromocytoma |
phenoxybenzamine, phentolamine
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Select the best antihypertensive agent:
Migraine headaches |
B-blockers, Ca2+ blockers
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Select the best antihypertensive agent:
Moderate bradycardia |
B-blockers with intrinsic sympathomimetic activity: pindolol and acebutolol
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List the antihypertensive drug that should be used with caution:
CHF |
Verapamil, alpha-blockers
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List the antihypertensive drug that should be used with caution:
Diabetes |
B-blockers, thiazides
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What are the six coronary risk factors?
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cigarettes
age (M>45 and F>55 at increased risk) DM (greatest risk factor) HTN Death from MI in family history (M<55,F<60) Increased LDL, decreased HDL (<35) |
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Which type of angina is characterized by chest pain and dyspnea at rest?
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Unstable angina
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What are the classic ECG findings during an angina episode?
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>1mm ST segment depression and T-wave inversion
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What is the gold standard for the diagnosis of CAD?
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coronary arteriography
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What medications should be given as prophylaxis for angina and MI?
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Long-acting nitrates, B-blockers, ASA, statin (and ACEi in patients w/ h/o MI)
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What is the most common side effect of nitrates?
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Headache
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What is the antianginal drug of choice for prinzmetal angina?
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Diltiazem
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What is a common phyical examination finding during an MI?
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S4 gallop
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What are the six life-threatening causes of chest pain that must be ruled out in all patients?
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MI, aortic dissection, pulmonary embolism (PE), pneumothorax(PTX), esophageal rupture, cardiac tamponade
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What are the classic ECG abnormalities in an acute MI?
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ST elevation and Q waves
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Which ECG finding is very sensitive and specifc for right ventricular infarction?
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ST elevation of 1mm in right-sided lead V4
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Which medical therapy should be avoided in patient with a right ventricular infarction?
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Nitroglycerin (initial therapy should involve IV fluids to increase preload)
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What medication is reserved for patients with MI suffereing from angina that is refractory to conventional medical management?
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Thrombolytics including tissue plasminogen activator or streptokinase
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Which coronary artery is likely to be occluded in a patient with the following ECG abnormalities?
Large R and ST segment depression in V1, V2 |
Right coronary (posterior infarction)
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Which coronary artery is likely to be occluded in a patient wit the following ECG abnormalities?
Q waves and ST segment elevation in leads V1-V4 |
left anterior descending (anterior infarction)
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Which coronary artery is likely to be occluded in a patient with the following ECG abnormalities?
Q waves in leads I, aVL, V5, V6 |
Circumflex (lateral infarction)
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Which coronary artery is likely to be occluded in a patient with the following ECG abnormalities?
Q waves and ST elevation in leads II, III, aVF |
Right coronary (inferior infarction)
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Irregularly irregular pulses and QRS complexes
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Atrial fibrillation
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Type of heart block that commonly arises as a side effect of medication including B-blockers, digoxin, and Ca channle blockers
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2 degree Mobitz type II heart block
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Usually created by conduction block within the bundle of His
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2 degree Mobitz type II heart block
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Three or more p-wave morphologies
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Multifocal atrial tachycardia (MFAT)
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Associated with cannon A waves in jugular veins and widened pulse pressure
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3 degree heart block
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Commonly caused by reentry
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Paroxysmal SVT
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Associated with COPD
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Atrial fibrillation, atrial flutter, MFAT
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Wide QRS complexes not preceded by a P wave
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premature ventricular contraction (PVC)
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Normal QRS morphology with a rate of 150-240 beats/min
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paroxysmal SVT
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Pharmocologic treatment includes amiodarone, lidocaine, and procainamide
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ventricular tachycardia
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May be treated with carotid message or Valsalva maneuver
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Paroxysmal SVT
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Common cause of palpitation caused by ectopic beats arising from multiple ventricular foci
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PVC
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Ventricular arrhythmia commonly caused by myocardial ischemia that may lead to hemodynamic instability
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ventricular tachycardia
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Fist-line therapy is defbrillation; second-line therapy is epinephrine or vasopressin
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ventricular fibrillation
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polymorphic wide complex tachycardia associated with prolonged QT interval
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Torsade de pointes
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Treated identical to ventricular fibrillation if there is no pulse
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ventricular tachycardia
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Tachyarrhythmia treated with adenosine, verapamil, cardioversion, or radiofrequency ablation
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Paroxysmal SVT
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What is the most common cause of atrial fibrillation?
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HTN
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What are some other important causes of atrial fibrillation?
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Pulmonary disease
Ischemia of myocardium Rheumatic heart disease Anemia or atrial myxoma Thyrotoxicosis Ethanol Sepsis |
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Name three clinical scenarios in which atropine is indicated for treatment of a bradyarrhythmia.
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1. Bradycardia causing hemodynamic instability
2. Syncope 3. CHF |
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Name six common symptoms of CHF.
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1. Dyspnea; exertional initially but occurs at rest as disease progresses
2. Orthopnea 3. Paroxysmal nocturnal dysnpnea 4. Cough and wheezing 5. Weight gain due to peripheral edema 6. Worsening fatigue |
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Name four common signs of left-sided CHF.
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1. S3 gallop
2. Inspiratory crackles or rales 3. Laterally displaced point of maximal impulse (due to cardiomegaly) 4. Ventricular heave |
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Name five common signs of right-sided CHF.
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1. Dependent edema
2. Jugular venous distention 3. Hepatojugular reflux and ascites 4. Atrial fibrillation 5. Cyanosis |
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What is the pathophysiologic basis of systolic dysfunction?
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Decreased contractility
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What are the two commmon causes of systolic dysfunction?
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Ischemic cardiomyopathy and myocarditis
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What is the pathophysiologic basis of diastolic dysfunction?
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Decreased ventricular compliance
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What are the four common causes of diastolic dysfunction?
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1. HTN
2. Ischemic cardiomyopathy 3. Hypertrophic cardiomyopathy 4. Systemic disorders (i.e. amyloidosis, hemochromatosis) |
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Name four common chest x-ray abnormalities in CHF.
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1. cardiomegaly
2. cephalizaiton of pulmonary vessels 3. Kerley B lines 4. Pleural effusions |
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Name two common echocardiographic abnormaliies in CHF.
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1. Decreased ejection fraction
2. Cardiomegaly |
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Name the CHF drug associated with:
Shown to decrease mortality in CHF |
ACEi, B-blockers and spironolactone (decrease mortality in class IV CHF)
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Name the CHF drug associated with:
Reduces afterload by causing vasodilation of both arteries and veins |
ACEi
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Name the CHF drug associated with:
Reduces symptoms of CHF by improving contractility |
Digitalis
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Name the CHF drug associated with:
vasodilators used in patients refractory to ACEi |
Hydralazine and isosorbide dinitrate
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Name the CHF drug associated with:
intravenous positive inotropic agnets |
Dopamine, dobutamine, and nesiritide
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Name the valvular defect associated with the following features:
Can be caused by papillary muscle rupture 2ndary to MI |
Mitral regurgiation
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Name the valvular defect associated with the following features:
may be precipitated by infective endocarditis, aortic aneurysmal dilation,and connective tissue disorder |
aortic insufficiency
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Name the valvular defect associated with the following features:
atrioventricular block |
mitral regurgitation
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Name the valvular defect associated with the following features:
increased pulse pressure |
aortic insufficiency
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What are the most common etiologies of dilated cardiomyopathy?
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ABCDE
Alcohol abuse Beriberi Coxackie B myocarditis, cocaine, Chagas disease Doxorubicin toxicity (also: pregnancy) |
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Name the type of cardiomyopathy assoicated with:
Asymmetric septal hypertrophy, banana-shaped left ventrile; LV outflow obstruction |
Hypertrophic
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Name the type of cardiomyopathy assoicated with:
May be caused by sarcoidosis, amyloidosis, scleroderma, hereditary hemochromatosis, endocardial fibroelastosis, radiation induced fibrosis |
Restrictive
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Name the type of cardiomyopathy assoicated with:
ACEi has been demonstrated to decrease mortality |
Dilated
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Name the type of cardiomyopathy assoicated with:
Impaired left ventricular diastolic filling; may mimic constrictive pericarditis |
Restrictive
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Name the type of cardiomyopathy assoicated with:
Examination reveals cardiomegaly, mitral regurgitaion, and S3; balloon-shaped heart on CXR |
Dilated
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Name the type of cardiomyopathy assoicated with:
Mitral regurgitaion, sustained apical impulse, S4, and systolic ejction murmur, boot-shaped heart on CXR |
Hypertrophic
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What is the common presentation of pericarditis?
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Pleuritic retrosternal chest pain (increased when supine, decreased when sitting up and leaning forward), dyspnea, cough, and fever
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What are the most common etiologies of serous pericarditis?
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Uremia, systemic lupus erythematous (SLE), rheumatic fever, coxsackie viral infection
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What are the most common etiologies of fibrinous pericarditis?
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Uremia, SLE, rheumatic fever, coxackie viral infection, MI
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What are the most common etiologies of hemorrhagic pericarditis?
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Trauma, malignancy, tuberculosis
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What is a typical examination finding in pericarditis?
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Pericardial friciton rub
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What are the classic ECG findings in pericarditis?
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Diffuse ST elevation
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What life-threatening complication of pericarditis causes distant heart sounds, jugular venous distention, hypotension, pulsus paradoxus, and elevated central venous prssure on inspiration?
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cardiac tamponade
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Primary intervention for cardiac tamponade and secondary intervention?
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Pericardiocentesis
Intravascular volume expansion |
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What are the three major categories of endocarditis?
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1. Infective
2. Nonbacterial thrombotic or marantic 3. Libman-Sacks endocarditis |
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What is the common presentation of infective endocarditis (IE)?
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Fever (high in acute endocarditis, low-grade in subacute endocarditis), constitutional symptoms, dyspnea
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What are the clinical signs of IE?
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"JR NO FAME"
1. Janeway lesions 2. Roth's spots 3. Nail bed hemorrhages 4. Osler's nodes 5. Fever 6. Anemia 7. Murmur 8. Emboli |
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What criteria are typically used for diagnosing IE?
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The Dukes criteria
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What are the 2 major Duke criteria?
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1. Two consecutive blood cultures (12 h apart) + for IE -causing organisms
2. Echocardiogram demonstrating valvular vegetaion, ring abscess or other evidence of endocardial infection |
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What are the 6 minor Duke criteria?
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1. Cardiac predisposition including valvular abnormality, congenital heart diseas, or hypertrophic cardiomyopathy
2.Fever >38 3. Signs of embolic dx including septic pulmonary emboli, mycotic cerebral abscesses, Janeway lesions 4. Immunologic phenomena including Roth's spots and Osler's nodes 5. Single + blood culture 6. Echocardiographic findings consistent with but not diagnostic for endocarditis |
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Name the type of endocarditis:
65 y/o M with metastatic colon cancer and a new murmur consistent with mitral regurgitation |
Nonbacterial thrombotic endocarditis
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Name the type of endocarditis:
30 y/o F with SLE |
Libman-Sacks endocarditis
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Which organism most often causes subacute IE?
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Streptococcus viridans
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Which organisms can cause endocarditis but are not typically isolated by conventional bacterial cultre?
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"HACEK"
Haemophilus parainfluenza Actinobacillus Cardiobacterium Eikenella Kingella |
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What are some sequelae of bacterial endocarditis?
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Valvular injury, renal injury (glomerulonephritis), septic emboli to brain/lungs/kidneys causing infarction or abscess
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What is the most common cause of myocarditis worldwide?
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Trypanosoma cruzii (Chagas disease)
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What is the empiric treatment for a pt with suspected endocarditis (before an organism is isolated in blood cx)
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An antistaphylococcal B-lactam antibiotic and an aminoglycoside
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What is the suggested regimen of antibiotic prophylaxis for patients at incrased risk of endocarditis?
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Two grams of amoxicillin prior to dental procedures
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What type of infection causes rheumatic fever?
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Group A streptococcal pharyngitis
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How does streptococcal pharyngitis cause rheumatic heart disease?
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Antistreptococcal antibodies cross-react with a caridac antigen
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What serologic test is evaluated in RHD?
(2) |
Antistreptolysin antibodies (ASO), DNAse B
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Name the five major Jones criteria for RHD.
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"JONES"
Joints (migratory polyarthritis) O: pancarditis N: subcutaneou nodules E: erythema marginatum S: sydenham's chorea |
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Name three minor Jones criteria for rheumatic heart disease.
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1. Fever
2. Arthralgia 3. Leukocytosis |
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Most commonly observed valvular deformity in RHD.
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Mitral stenosis
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What is the critial determinant of morbidity in acute RF?
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Degree of mitral and aortic valve stenosis/regurgitation
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What medication is preferred for lowering BP in a patient with an aortic dissection?
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Sodium nitroprusside and B-blockers
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Name the PVD associated with:
Abdominal pain out of proportion to exam |
Mesenteric ischemia
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Name the PVD associated with:
Intermittent claudication |
Chronic arterial occlusive disease
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Name the PVD associated with:
Pain in buttocks and thighs with walking |
Aortoiliac occlusive disease
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Name the PVD associated with:
Pain in calves with walking |
Femoral-popliteal occlusive disease
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Name the PVD associated with:
Abdominal angina |
Chronic mesenteric arterial occlusive disease
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What is the source of most emboli causing acute arterial occlusion?
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Cardiac mural thrombus (commonly in patient with atrial fibrillation)
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What is the treatment of an acute arterial occlusion?
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Surgical or percutaneous thrombectomy or medical thrombolysis
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What type of therapy must be administered to all patients with a h/o acute arterial occlusion?
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Warfarin
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