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115 Cards in this Set

  • Front
  • Back
Sudden worsening of HTN in an elderly male with coronary artery disease (CAD) and peripheral vascular disease (PVD)
Renal artery stenosis
HTN in a patient with hypokalemic metabolic alkalosis.
Hyperaldosteronism
Select the best antihypertensive agent:

Angina pectoris
B-blockers, Ca2+ channel blockers
Select the best antihypertensive agent:

Diabetes
ACEi, ARB
Select the best antihypertensive agent:

hyperlipidemia
ACEi, Ca2+ channel blockers
Select the best antihypertensive agent:

CHF
Diuretics, ACEi
Select the best antihypertensive agent:

h/o MI
B-blockers, ACEi
Select the best antihypertensive agent:

chronic renal failure
Diuretics, Ca2+ blockers
Select the best antihypertensive agent:

asthma, COPD
Diuretics, Ca2+ blockers
Select the best antihypertensive agent:

BPH
alpha1-selective antagonist
Select the best antihypertensive agent:

Pheochromocytoma
phenoxybenzamine, phentolamine
Select the best antihypertensive agent:

Migraine headaches
B-blockers, Ca2+ blockers
Select the best antihypertensive agent:

Moderate bradycardia
B-blockers with intrinsic sympathomimetic activity: pindolol and acebutolol
List the antihypertensive drug that should be used with caution:

CHF
Verapamil, alpha-blockers
List the antihypertensive drug that should be used with caution:

Diabetes
B-blockers, thiazides
What are the six coronary risk factors?
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)
Which type of angina is characterized by chest pain and dyspnea at rest?
Unstable angina
What are the classic ECG findings during an angina episode?
>1mm ST segment depression and T-wave inversion
What is the gold standard for the diagnosis of CAD?
coronary arteriography
What medications should be given as prophylaxis for angina and MI?
Long-acting nitrates, B-blockers, ASA, statin (and ACEi in patients w/ h/o MI)
What is the most common side effect of nitrates?
Headache
What is the antianginal drug of choice for prinzmetal angina?
Diltiazem
What is a common phyical examination finding during an MI?
S4 gallop
What are the six life-threatening causes of chest pain that must be ruled out in all patients?
MI, aortic dissection, pulmonary embolism (PE), pneumothorax(PTX), esophageal rupture, cardiac tamponade
What are the classic ECG abnormalities in an acute MI?
ST elevation and Q waves
Which ECG finding is very sensitive and specifc for right ventricular infarction?
ST elevation of 1mm in right-sided lead V4
Which medical therapy should be avoided in patient with a right ventricular infarction?
Nitroglycerin (initial therapy should involve IV fluids to increase preload)
What medication is reserved for patients with MI suffereing from angina that is refractory to conventional medical management?
Thrombolytics including tissue plasminogen activator or streptokinase
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)
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)
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)
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)
Irregularly irregular pulses and QRS complexes
Atrial fibrillation
Type of heart block that commonly arises as a side effect of medication including B-blockers, digoxin, and Ca channle blockers
2 degree Mobitz type II heart block
Usually created by conduction block within the bundle of His
2 degree Mobitz type II heart block
Three or more p-wave morphologies
Multifocal atrial tachycardia (MFAT)
Associated with cannon A waves in jugular veins and widened pulse pressure
3 degree heart block
Commonly caused by reentry
Paroxysmal SVT
Associated with COPD
Atrial fibrillation, atrial flutter, MFAT
Wide QRS complexes not preceded by a P wave
premature ventricular contraction (PVC)
Normal QRS morphology with a rate of 150-240 beats/min
paroxysmal SVT
Pharmocologic treatment includes amiodarone, lidocaine, and procainamide
ventricular tachycardia
May be treated with carotid message or Valsalva maneuver
Paroxysmal SVT
Common cause of palpitation caused by ectopic beats arising from multiple ventricular foci
PVC
Ventricular arrhythmia commonly caused by myocardial ischemia that may lead to hemodynamic instability
ventricular tachycardia
Fist-line therapy is defbrillation; second-line therapy is epinephrine or vasopressin
ventricular fibrillation
polymorphic wide complex tachycardia associated with prolonged QT interval
Torsade de pointes
Treated identical to ventricular fibrillation if there is no pulse
ventricular tachycardia
Tachyarrhythmia treated with adenosine, verapamil, cardioversion, or radiofrequency ablation
Paroxysmal SVT
What is the most common cause of atrial fibrillation?
HTN
What are some other important causes of atrial fibrillation?
Pulmonary disease
Ischemia of myocardium
Rheumatic heart disease
Anemia or atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
Name three clinical scenarios in which atropine is indicated for treatment of a bradyarrhythmia.
1. Bradycardia causing hemodynamic instability
2. Syncope
3. CHF
Name six common symptoms of CHF.
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
Name four common signs of left-sided CHF.
1. S3 gallop
2. Inspiratory crackles or rales
3. Laterally displaced point of maximal impulse (due to cardiomegaly)
4. Ventricular heave
Name five common signs of right-sided CHF.
1. Dependent edema
2. Jugular venous distention
3. Hepatojugular reflux and ascites
4. Atrial fibrillation
5. Cyanosis
What is the pathophysiologic basis of systolic dysfunction?
Decreased contractility
What are the two commmon causes of systolic dysfunction?
Ischemic cardiomyopathy and myocarditis
What is the pathophysiologic basis of diastolic dysfunction?
Decreased ventricular compliance
What are the four common causes of diastolic dysfunction?
1. HTN
2. Ischemic cardiomyopathy
3. Hypertrophic cardiomyopathy
4. Systemic disorders (i.e. amyloidosis, hemochromatosis)
Name four common chest x-ray abnormalities in CHF.
1. cardiomegaly
2. cephalizaiton of pulmonary vessels
3. Kerley B lines
4. Pleural effusions
Name two common echocardiographic abnormaliies in CHF.
1. Decreased ejection fraction
2. Cardiomegaly
Name the CHF drug associated with:

Shown to decrease mortality in CHF
ACEi, B-blockers and spironolactone (decrease mortality in class IV CHF)
Name the CHF drug associated with:

Reduces afterload by causing vasodilation of both arteries and veins
ACEi
Name the CHF drug associated with:

Reduces symptoms of CHF by improving contractility
Digitalis
Name the CHF drug associated with:

vasodilators used in patients refractory to ACEi
Hydralazine and isosorbide dinitrate
Name the CHF drug associated with:

intravenous positive inotropic agnets
Dopamine, dobutamine, and nesiritide
Name the valvular defect associated with the following features:

Can be caused by papillary muscle rupture 2ndary to MI
Mitral regurgiation
Name the valvular defect associated with the following features:

may be precipitated by infective endocarditis, aortic aneurysmal dilation,and connective tissue disorder
aortic insufficiency
Name the valvular defect associated with the following features:

atrioventricular block
mitral regurgitation
Name the valvular defect associated with the following features:

increased pulse pressure
aortic insufficiency
What are the most common etiologies of dilated cardiomyopathy?
ABCDE
Alcohol abuse
Beriberi
Coxackie B myocarditis, cocaine, Chagas disease
Doxorubicin toxicity
(also: pregnancy)
Name the type of cardiomyopathy assoicated with:

Asymmetric septal hypertrophy, banana-shaped left ventrile; LV outflow obstruction
Hypertrophic
Name the type of cardiomyopathy assoicated with:

May be caused by sarcoidosis, amyloidosis, scleroderma, hereditary hemochromatosis, endocardial fibroelastosis, radiation induced fibrosis
Restrictive
Name the type of cardiomyopathy assoicated with:

ACEi has been demonstrated to decrease mortality
Dilated
Name the type of cardiomyopathy assoicated with:

Impaired left ventricular diastolic filling; may mimic constrictive pericarditis
Restrictive
Name the type of cardiomyopathy assoicated with:

Examination reveals cardiomegaly, mitral regurgitaion, and S3; balloon-shaped heart on CXR
Dilated
Name the type of cardiomyopathy assoicated with:

Mitral regurgitaion, sustained apical impulse, S4, and systolic ejction murmur, boot-shaped heart on CXR
Hypertrophic
What is the common presentation of pericarditis?
Pleuritic retrosternal chest pain (increased when supine, decreased when sitting up and leaning forward), dyspnea, cough, and fever
What are the most common etiologies of serous pericarditis?
Uremia, systemic lupus erythematous (SLE), rheumatic fever, coxsackie viral infection
What are the most common etiologies of fibrinous pericarditis?
Uremia, SLE, rheumatic fever, coxackie viral infection, MI
What are the most common etiologies of hemorrhagic pericarditis?
Trauma, malignancy, tuberculosis
What is a typical examination finding in pericarditis?
Pericardial friciton rub
What are the classic ECG findings in pericarditis?
Diffuse ST elevation
What life-threatening complication of pericarditis causes distant heart sounds, jugular venous distention, hypotension, pulsus paradoxus, and elevated central venous prssure on inspiration?
cardiac tamponade
Primary intervention for cardiac tamponade and secondary intervention?
Pericardiocentesis

Intravascular volume expansion
What are the three major categories of endocarditis?
1. Infective
2. Nonbacterial thrombotic or marantic
3. Libman-Sacks endocarditis
What is the common presentation of infective endocarditis (IE)?
Fever (high in acute endocarditis, low-grade in subacute endocarditis), constitutional symptoms, dyspnea
What are the clinical signs of IE?
"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
What criteria are typically used for diagnosing IE?
The Dukes criteria
What are the 2 major Duke criteria?
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
What are the 6 minor Duke criteria?
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
Name the type of endocarditis:

65 y/o M with metastatic colon cancer and a new murmur consistent with mitral regurgitation
Nonbacterial thrombotic endocarditis
Name the type of endocarditis:

30 y/o F with SLE
Libman-Sacks endocarditis
Which organism most often causes subacute IE?
Streptococcus viridans
Which organisms can cause endocarditis but are not typically isolated by conventional bacterial cultre?
"HACEK"
Haemophilus parainfluenza
Actinobacillus
Cardiobacterium
Eikenella
Kingella
What are some sequelae of bacterial endocarditis?
Valvular injury, renal injury (glomerulonephritis), septic emboli to brain/lungs/kidneys causing infarction or abscess
What is the most common cause of myocarditis worldwide?
Trypanosoma cruzii (Chagas disease)
What is the empiric treatment for a pt with suspected endocarditis (before an organism is isolated in blood cx)
An antistaphylococcal B-lactam antibiotic and an aminoglycoside
What is the suggested regimen of antibiotic prophylaxis for patients at incrased risk of endocarditis?
Two grams of amoxicillin prior to dental procedures
What type of infection causes rheumatic fever?
Group A streptococcal pharyngitis
How does streptococcal pharyngitis cause rheumatic heart disease?
Antistreptococcal antibodies cross-react with a caridac antigen
What serologic test is evaluated in RHD?
(2)
Antistreptolysin antibodies (ASO), DNAse B
Name the five major Jones criteria for RHD.
"JONES"
Joints (migratory polyarthritis)
O: pancarditis
N: subcutaneou nodules
E: erythema marginatum
S: sydenham's chorea
Name three minor Jones criteria for rheumatic heart disease.
1. Fever
2. Arthralgia
3. Leukocytosis
Most commonly observed valvular deformity in RHD.
Mitral stenosis
What is the critial determinant of morbidity in acute RF?
Degree of mitral and aortic valve stenosis/regurgitation
What medication is preferred for lowering BP in a patient with an aortic dissection?
Sodium nitroprusside and B-blockers
Name the PVD associated with:

Abdominal pain out of proportion to exam
Mesenteric ischemia
Name the PVD associated with:

Intermittent claudication
Chronic arterial occlusive disease
Name the PVD associated with:

Pain in buttocks and thighs with walking
Aortoiliac occlusive disease
Name the PVD associated with:

Pain in calves with walking
Femoral-popliteal occlusive disease
Name the PVD associated with:

Abdominal angina
Chronic mesenteric arterial occlusive disease
What is the source of most emboli causing acute arterial occlusion?
Cardiac mural thrombus (commonly in patient with atrial fibrillation)
What is the treatment of an acute arterial occlusion?
Surgical or percutaneous thrombectomy or medical thrombolysis
What type of therapy must be administered to all patients with a h/o acute arterial occlusion?
Warfarin