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468 Cards in this Set

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Q001. most common congenital cyanotic lesion in newborn; immediately vs later
A001. tetralogy of Fallow (later); transposition great arteries
Q002. cyanotic newborn or 2 week; heart failure; supracardiac shadow above enlarged heart increased pulmonary blood flow (snowman snowstorm); right heart enlargement
A002. total anomalous pulmonary venous return
Q003. straight narrow mediastium; globular heart (egg on string)
A003. transposition great arteries
Q004. severe cyanosis; heart failure once ductus closes; gray-blue color; right side predominance
A004. hypoplastic left heart
Q005. In truncus arteriosis
A005. common trunk supplying pulmonary and systemic circulations. Ventricular septal defect. Loud systolic murmur with thrill; mild cyanosis. Severe heart failure.
Q006. tricuspid atresia
A006. right ventricle hypoplasia; no tricuspid valve; usually persistent foramen ovale or atrial septal defect; cyanotic and quite ill; severe reduction in pulmonary blood flow on x-ray and left axis instead of right.
Q007. Innocent murmurs
A007. age 3 to 7; time increase cardiac output; soft vibratory or musical systolic ejections murmur at left lower midsternal boards <2/6 intensity
Q008. tall symmetric peaked T waves
A008. Hyper K
Q009. Widening of QRS complex
A009. hyper K
Q010. prolongation of P waves
A010. hyper K
Q011. Increased U wave
A011. Hypo K
Q012. ST segment depression and; T wave amplitude decreased
A012. Hypo K
Q013. Swelling of face after taking captopril or enalapril
A013. angioedema from angiotensin receptor blockers / ACE I (avoid -prils and valsartan)
Q014. Premature atrial contraction
A014. occurs 78% healthy male aviators; if symptomatic- b-blocker
Q015. Theophylline
A015. toxicity: seizures, hypotension, arrhythmias; dimethylxanthine for COPD
Q016. Ipratropium
A016. headache dryness pulmonary symptoms; Atrovent for COPD
Q017. livedo reticularis (lacy erythematous rash) peripheral ischemia (blue toes) eosinophilia; post coronary catheterization
A017. Suggestive of cholesterol emboli
Q018. Causes of renal failure; post coronary catheterization
A018. cholesterol embolization (blue toes) vs; contarast nephropathy
Q019. Coxsackie’s virus B and pregnancy
A019. mom ill, baby much more ill,; mechanical ventilation, shock hypotension, cardiogenic with ST- ECG
Q020. Parvovirus and pregnancy
A020. 5ths disease and; hydrops early in pregnancy
Q021. Myocarditis
A021. infection, toxins, granulmatous disease. febrile, coxsackie,; ST wave abnormality; Hepatic transaminase elevated; cardiomegaly with pulmonary edema
Q022. Echo instead of ECG when
A022. Left bundle branch block old; previous MI; pacemaker; digoxin
Q023. Murmurs best heard on expiration
A023. left sided
Q024. Dressler syndrome
A024. post CABG post cardioectomy pericarditis; Worse lying down better sitting up, rub
Q025. left ventricular dysfunction and hypertension
A025. concentric hypertrophy; dyspnea on exertion; treat with b blocker to improve relaxation allow better filling
Q026. equivalent right atrium, right ventricle and pulmonary wedge pressure; low blood pressure; tachycardia
A026. cardiac tamponade
Q027. SVT
A027. 180-300 bpm; tolerated well in kids; suggest underlying anomaly; Epstein and WPW; revert by dunking head in cold water
Q028. infant with no murmur,; precordial hyperactivity; loud second heart sound; grey or cyanotic
A028. hypoplastic left heart; underdevelopment of left cardiac chamber; atresia or stenosis of aortic or mitral orifices; hypoplasia of aorta; left atrium and ventricle endocardial fibroelastosis. patent foramen ovale; dilated hypertrophic right ventricle
Q029. right ventricular infarct vs cardiac tamponade
A029. hypotension; tachycardia; clear lungs; absence of pulsus paradoxus in Right ventricular infarction
Q030. lupus, contraceptive use; headache; upper extremity weakness; CT with infarct of anterior and posterior frontal lobes; parietyal lobes extending to white matter
A030. dural sinus thrombosis; superior sagital sinus; test for anti-phospholipid antibody; get cerebral venography
Q031. apical heave; thrill at second left intercostal space; loud systolic diastolic rasping murmur left sternal boarder; hyerdynamic left ventricle abnormal flow; prominence of pulmonary artery; increased pumonary vascular markings; wide pulse pressure; bounding arterial pulses; apical heave
A031. patent ductus arteriosus; failure of closure of the ductus arteriosis postnatally.
Q032. pulsus paradoxus,; hypotension; electrical alternans in pt with breast cancer; pericardial effusion; right ventricular collapse
A032. tamponade; treat pericardiocentesis
Q033. purpura, cytopenia, hemolytic anemia, neurologic signs, renal insufficiency, fever
A033. TTP
Q034. Angiomyolipoma
A034. Tuberous Sclerosis; Kidney Harmatoma: blood vessels, muscle, mature adipose tissue
Q035. Angiosarcoma
A035. Liver Angiosarcoma:; Polyvinyl chloride, arsenic, thorium dioxide
Q036. Bacillary angiomatosis
A036. Benign capillary proliferation involving skin and visceral organs in AIDs patients. Stimulates Kaposi Sarcoma in AIDS; Bartonella henselae, gram negative bacillus, causative agent
Q037. Capillary Hemangioma
A037. treatment: leave alone!; facial lesion in newborns, regresses with age
Q038. Cavernous hemangioma
A038. most common benign tumor of liver and spleen; may rupture if large
Q039. Cystic hygroma
A039. lymphangioma in neck; associated with Turner's syndrome
Q040. Glomus tumor
A040. Derive arteriovenous shunts in glomus bodies; Painful red subungual nodual in digit
Q041. Hereditary telangiectasia
A041. Dilated vessels on skin and mucous membranes in mouth and GI tract
Q042. Kaposi Sarcoma
A042. malignant tumor arising from endothelial cells or primitive mesenchymal cells; HSV type 8; raised red purple discoloration that progresses from plat lesion to a plaque to nodule that ulcerates
Q043. Lymphangiosarcoma
A043. malignancy of lymphatic vessels; arises out of longstanding chronic lymphadema after modified radial masectomy
Q044. Pyogenic granuloma
A044. vascular, red pedunculated mass that ulcerates and bleeds easily; post traumatic and associated with pregnancy
Q045. Spider telangiectasia
A045. arteriovenous fistula (disappears when compressed); associated with hyperestrinism
Q046. Sturge Weber syndrome
A046. Nevus flammeus on face in distribution of opthalamic branch of cranial nerve V (trigeminal)
Q047. VHL syndrome
A047. cavernous hemangioma in cerebellum and retina; increased incidence of pheochromocytoma and bilateral renal cell carcinomas.
Q048. What does "irregularly irregular" mean on an ECG?
A048. Irregular RR intervals
Q049. Irregularly irregular rhythm without p-waves prior to each QRS
A049. Atrial fibrillation
Q050. Etiologies of A-Fib (10)
A050. PIRATES:; Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;; Ischemic heart disease, HTN;; Rheumatic heart disease;; Anemia;; Thyrotoxicosis;; Ethanol (& cocaine), Endocarditis;; Sepsis
Q051. Signs/symptoms of A-Fib (5)
A051. A FL PT:; Asymptomatic patient;; Fatigue (most common);; Light headedness, syncope;; Palpitations, skipped beats;; Tachypnea, dyspnea
Q052. Complication of A-Fib
A052. diffuse Embolization (often to brain, leading to TIA or stroke)
Q053. One of two possible Drugs given to A-Fib to control rate in an emergent situation
A053. IV Calcium channel blocker: Diltiazem; (or); IV Beta-blocker: Metoprolol
Q054. Drugs given to A-Fib to control rate in a non-emergent situation (2)
A054. oral Beta-blocker:; Atenolol; (and); oral Calcium channel blockers:; Verapamil or Diltiazem
Q055. what are the (2) ways to cardiovert an A-Fib rhythm?; when should you not cardiovert?; what would the Tx be then?
A055. Medical: Amiodarone; Electrical: start at 100 J Do not cardiovert if patient is in A- Fib > 24 hours. Tx: Warfarin for 3-4 weeks before cardioversion
Q056. If cardioversion from A-Fib to sinus rhythm does not occur, what should patient be treated with?
A056. Long-term anticoagulants DOC:; Warfarin (1st); Aspirin (2nd)
Q057. how many seconds and boxes is a normal PR interval?
A057. 0.2 ms 5 small boxes
Q058. define:; Q-wave; When is it pathologic?
A058. when initial part of ventricular depolarization is downward; Pathologic: greater then 1 small box
Q059. normal time and boxes for QRS interval?
A059. < 0.12 ms 3 small boxes
Q060. normal sinus rate
A060. 60 - 100 bpm
Q061. define:; Junctional rhythm
A061. rhythm originating in the AV node and causing narrow QRS without P-waves
Q062. Dx:; no p-waves; all complexes are wide; no changes in height (amplitude) with each complex; > 100bpm
A062. Ventricular tachycardia
Q063. Dx:; wide QRS complexes that vary in amplitude; (2 names)
A063. Ventricular Fibrillation; Torsades de Pointes
Q064. Dx:; normal sinus rhythm with PR interval > 0.2 ms (> 5 small boxes)
A064. First-degree AV block
Q065. Dx:; PR interval elongates from beat to beat until it becomes so long that a beat drops
A065. Second-degree AV block, type 1 (Wenckebach)
Q066. Dx:; PR interval is fixed but every so often there is a P-wave without a QRS
A066. Second-degree AV block, type 2 (Mobitz)
Q067. Dx:; no relationship b/t P-waves and QRS complexes
A067. Third-degree AV block
Q068. Dx:; QRS > 0.12 (> 3 small boxes) RSR' in V1 + V2;; deep S-wave in lateral leads (I, aVL, V5 + V6)
A068. RBBB
Q069. Dx:; QRS > 0.12 (> 3 small boxes);; RSR' in V5 + V6; diffuse ST elevation
A069. LBBB
Q070. Dx:; Different shapes to 3 or more P-waves; normal rhythm; (what is it called if it is tachycardic?)
A070. Wandering pacemaker; MFAT: Multifocal Atrial Tachycardia
Q071. Dx:; short PR interval; slurring delta wave connecting P-wave to QRS complex
A071. Wolff-Parkinson-White syndrome
Q072. Dx:; diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR
A072. Pericarditis
Q073. drug Tx of wandering pacemaker and MFAT?
A073. Verapamil (Ca channel block)
Q074. what Tx breaks SVT (superventricular tachy) in > 90%?
A074. Adenosine (failure to break r/o SVT)
Q075. Tx for V-tach with hypotension or no pulse
A075. Emergency defibrillation @ 200 - 360 J
Q076. Tx of asymptomatic V-tach; (2 meds)
A076. Amiodarone; or; Lidocaine
Q077. Tx of V-Fib
A077. Emergent electroshock @ 200 - 360 J
Q078. how do you distinguish Paroxysmal Nocturnal Dyspnea from asthma?
A078. no improvement with bronchodilators
Q079. Dx:; SVT with AV block + yellow skin
A079. Digoxin toxicity
Q080. How do you diagnose LVH from a ECG? (2)
A080. 1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small); 2. R-wave in V5 or V6 > 25 small boxes; OR; R-wave in lead aVL > 11 small boxes
Q081. Causes of prolonged QT (8)
A081. QT WIDTH:; QT: Prolonged QT syndrome; W: WPW; I: Infarction; D: Drugs; T: Torsades de pointes; H: HypoK, HypoC, Hypomagnesium
Q082. What electrolyte disorder causes short QT segments?
A082. HyperC
Q083. Causes of Torsades de Pointes (7)*
A083. POINTES:; Phenothiazines; Other meds (TCAs); Intracranial bleed; No known cause (idiopathic); Type 1 Anti-arrhythmics; Electrolyte abnormalities; Syndrome of prolonged QT
Q084. What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?
A084. Adenosine
Q085. What drugs should not be given to someone with Wolff- Parkinson-White syndrome?; (4); What is the DOC?
A085. ABCD:; Adenosine; Beta-blockers; Calcium channel blockers; Digoxin; DOC: Procainamide
Q086. Causes of Mobitz I (3); Causes of Mobitz II (2)
A086. Mobitz I:; Inferior wall MI;; Digitalis toxicity;; Inc Vagal tone Mobitz II:; Inferior or septal wall MI;; Conduction system disease
Q087. Tx for Mobitz I & II; (2)
A087. Both:; Atropine & temporary pacing; (Mobitz II should have pacemaker)
Q088. Causes of third-degree heart block (3)
A088. Digitalis toxicity;; Inferior wall MI;; Conduction system disease
Q089. Causes of Bradycardia (6)
A089. if R-R is longer then "One INCH":; Overmedication;; Inferior MI / Inc intracranial Pressure;; Normal variant (athletes);; Carotid sinus hypersensitivity;; Hypoparathyroidism
Q090. Tx for bradycardia (3)
A090. 1. Atropine; 2. pacing; 3. pressors for hypotension
Q091. a 24-years old woman with preeclampsia Tx with IV drip of magnesium complains of difficulty breathing and has diminished reflexes. Next step? (2 together)
A091. 1. Stop magnesium; 2. give IV calcium
Q092. equation for Mean Arterial Pressure
A092. MAP = (2dBP + sBP)/3
Q093. Dilation of which heart chamber is a major cause of A-fib?
A093. Left atrium
Q094. (5)* deadly causes of chest pain
A094. TAPUM:; Tension pneumothorax;; Aortic Dissection;; PE;; Unstable Angina;; MI
Q095. how is the maximum HR determined?
A095. 220-patient's age = Max HR
Q096. (6) Major risk factors for CAD which is most preventable?; which is the greatest risk?
A096. Diabetes (greatest);; Smoking (most preventable);; HTN;; Hypercholesterolemia;; Family History;; Age
Q097. Dx:; Chest pain that has an established character, timing and duration; pain is transient, reproducible and predictable. What is cause?; What is Tx? (2 together)
A097. Dx: Stable Angina; Cause: Reduced coronary blood flow through fixed atherosclerotic plaque in vessel of heart; Tx: rest + Nitroglycerin
Q098. Exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it. Name the types
A098. Angina:; Stable; Unstable; Variant (Prinzmetal's)
Q099. Angina type that is also considered an Acute Coronary Syndrome (ACS). What (3) factors must it have for diagnosis?
A099. Unstable Angina; 1) New-onset; 2) angina that changes or accelerates in pattern, location or severity; 3) Occurs at REST
Q100. Dx:; Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. Tx? (2 drugs together)
A100. Variant (Prinzmetal's) Angina; Tx:; 1. Calcium Channel blockers +; 2. Nitrates
Q101. what (2) groups of patients may not show the classic signs pain seen in stable angina?; Why?
A101. Elderly and diabetics (b/c: neuropathies)
Q102. What does the EKG look like for the (3) angina types?
A102. Stable + Unstable:; ST Depression; T-wave Inversion; Variant: ST elevation
Q103. 62-years old smoker with 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before. What is it?
A103. Unstable Angina
Q104. 62-years old man with frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night. What is it?
A104. Variant (Prinzmetal's) Angina
Q105. what is the alternative to an exercise Stress Test if the patient cannot get on a treadmill?
A105. IV Dobutamine is given to stimulate myocardial function
Q106. What is the criteria for a "positive" Stress Test? (5)
A106. either:; ST elevation; ST depression >1 mm in multiple leads; Dec BP; failure to go more than 2 minutes; failure to complete for reason other then cardiac symptoms (i.e. arthritis)
Q107. what does Myocardial Perfusion Imaging detect? (3)
A107. - Myocardial perfusion; Ventricular volume; Ejection Fraction
Q108. An ultrasound of the heart revealing abnormal wall motion due to ischemia or infarction. It also assesses left ventricular function and EF
A108. Echocardiography
Q109. What are (5) Dx that need a cardiac catheterization?; Describe procedure for each
A109. 1) MI / Unstable angina: stent or angiography; 2) Valvular disease: valvuloplasty; 3) Arrhythmias: mapping bypass tracts; 4) Myocardial disease Bx: glycogen storage disease or cardiomyopathies; 5) Congenital heart disease identification: angiography and closure of defects
Q110. (4) serum markers for MI
A110. Myoglobin;; Troponin T/I;; CK;; Lactate Dehydrogenase
Q111. How is the right heart accessed in a cardiac catheterization? (2); Left heart? (2)
A111. Right:; Femoral or Internal Jugular; Left:; Femoral or Radial artery (from right heart)
Q112. what is the wave morphology changes sequence in a MI ECG? (6)
A112. 1. peaked T-waves; 2. T-wave inversion; 3. ST elevation; 4. Q-waves; 5. ST normalization; 6. T-waves return upright
Q113. which cardiac enzyme is the most sensitive and specific for acute MI?
A113. Troponin-I/T
Q114. which cardiac enzyme remains increased (peaked) the longest?
A114. LDH
Q115. what does ST depression mean?
A115. ST goes in the opposite direction of the QRS
Q116. what does a Q-wave on an EKG in the presence of an infarction indicate?
A116. Transmural infarction; (extends through full thickness of the myocardial wall)
Q117. Time of onset for the (4) serum markers for MI
A117. Myoglobin (1-4 hrs); Troponin-I/T (3-12); CK-MB (3-12); LDH (6-12)
Q118. which cardiac enzyme has the shortest duration?; Longest?
A118. Myoglobin (1 day); Troponin-I/T (7-10 days)
Q119. ST elevation in II, III & aVF
A119. Inferior wall MI
Q120. ST depression in II, III & aVF
A120. Cor Pulmonale; (right-sided heart failure)
Q121. ST elevation in V1, V2, V3
A121. Anterior/septal MI
Q122. ST elevation in V4, V5, V6
A122. Lateral wall MI
Q123. ST depression in V1, V2
A123. Posterior wall MI
Q124. difference b/t unstable angina & non-ST elevation MI? (2)
A124. non-ST elevation MI has:; 1. more severe lack of Oxygen (more severe myocardial damage); 2. Enzyme leakage (Unstable angina has none)
Q125. Tx for Unstable angina & MI (6)
A125. MONA has HEP B:; Morphine; Oxygen; Nitrates; Aspirin; HEParin; Beta-blockers
Q126. primary Tx (2) for the acute MI w/in 6 hours of infarct; (name 3 other drugs)
A126. Throbolytics:; 1. tPA + 2. Heparin (DOC); Urokinase; streptokinase; Alteplase
Q127. At what level should LDL be in person with MI history?; What is given to lower it?
A127. less then 100; statins
Q128. When are throbolytics indicated in MI? (3)
A128. patients < 80 years old; within 6-12 hrs of chest pain; evidence of infarct on ECG
Q129. Contra-indications of Throbolytics (9)
A129. Having Some Breaks A Blood Clot In Small Pieces:; History of intracranial bleed; stroke < 1 year - BP > 180/110; active internal bleed; bleeding disorder; CPR; Intracranial tumor; suspected aortic dissection; Peptic ulcer
Q130. drug class that is used to break up clots
A130. thrombolytics
Q131. name a specific drug that prevents future clots from forming
A131. heparin
Q132. procedure Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?
A132. PTCA; (Percutaneous Transluminal Coronary Angioplasty)
Q133. which thrombolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?
A133. streptokinase
Q134. what should be given 48 hours post infarct if tPA was used?
A134. heparin
Q135. drug class that is excellent for late and long-term therapy for acute MI to decrease afterload and prevent remodeling?
A135. ACEi
Q136. 58-years old man discharged from hospital after MI 2 weeks ago presents with fever, chest pain and malaise. EKG shows diffuse ST-T wave changes. What is Dx?; What is Tx?; (2 possible meds)
A136. Dressler's syndrome; Tx:; 1. NSAIDs or 2. Corticosteroids
Q137. Medication orders with discharge of an ACS (post-MI) patient? (5)
A137. easy AS ABC:; Aspirin (indefinitely); Statin to lower LDL < 100; ACE-inh (if EF <40%); Beta-blocker (indefinitely); Clopidogrel for 1 - 12 mo depending on stent placement
Q138. Dx:; fever, pericarditis and possible pericardial or pleural effusions post cardiac surgery
A138. Dressler's syndrome
Q139. Most common infectious cause of Myocarditis
A139. Coxsackie B
Q140. (4) systemic diseases that causes Myocarditis
A140. KISS:; Kawasaki's; Inflammatory conditions; SLE; Sarcoidosis
Q141. (4) Parasites that cause Myocarditis
A141. Trypanosoma Cruzi (Chagas);; Toxoplasmosis;; Trichinella;; Echinococcus
Q142. (5) Bacterial causes of Myocarditis
A142. women Trick Corny Men to Strip and Lie down:; Group A beta-hemolytic Strep (rheumatic fever);; Corynebacterium;; Meningococcus;; Lyme (B. burgdorferi);; Trichinella
Q143. (8) viral causes of myocarditis
A143. Coxsackie A or B;; HIV;; Echovirus;; EBV:; CMV;; HBV;; Influenza;; Adenovirus
Q144. (3) drugs that cause pericarditis
A144. It Hurts Pericardium:; Isoniazid;; Hydralazine;; Procainamide
Q145. Etiology of Pericarditis (5)
A145. Bacterial, viral or fungal infections;; Post-MI (Dressler's);; Uremia;; Serositis from: RA or SLE; Scleroderma;
Q146. Tx for pericarditis if:; infection; pain/inflammation; Dressler's; Recurrent cases
A146. Infection - Abx;; Relieve pain + reduce inflammation - NSAIDs;; Dressler's - Steroids;; Recurrent Cases - Pericardectomy; (only of recurrent cases)
Q147. Dx:; Transient fall in BP > 10 mmHg during inspiration
A147. Pulsus Paradoxus
Q148. Dx:; Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling and reduces cardiac output
A148. Pericardial Tamponade
Q149. Etiology of Pericardial Tamponade (3)
A149. - Aortic dissection or ventricular rupture into pericardium; Pericarditis; Trauma
Q150. Beck's triad of the pericardial tamponade; (4) other signs/Sx
A150. Beck's triad:; JVD; Muffled heart sounds; Hypotension; Other Sx:; Tachycardia; Pulsus Paradoxus*;; Dyspnea;; Narrow Pulse Pressure
Q151. Tx for Pericardial Tamponade for:; 1. unstable; 2. stable; 3. both
A151. Unstable:; Immediate Pericardiocentesis;; Stable:; Pericardial window; Both:; Infuse fluids to expand volume
Q152. Failure of venous pressure to fall during inspiration
A152. Kussmaul's sign
Q153. If pericardiocentesis has clots, what is likely source of blood?
A153. Right Ventricle
Q154. Dx:; Patient has chest pain with inspiration that radiates to the left trapezial ridge; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine
A154. Pericarditis
Q155. additional signs/Sx for Constrictive pericarditis (versus pericarditis); (4)
A155. Extra fluid:; JVD; Kussmaul's sign; peripheral edema; LV failure
Q156. When a patient has VHD or previous endocarditis, what (3) procedure types must they obtain endocarditis prophylaxis medications?
A156. Dental procedures; Urologic procedures; GI procedures
Q157. Dx:; acute onset of fever, chills and rigors; new cardiac murmur, possible associated meningitis or pneumonia
A157. Acute Bacterial Endocarditis (ABE)
Q158. Infection of healthy heart valves by high-virulence organisms; MCC?; Prognosis if not treated?
A158. ABE; S. Aureus; Prognosis: fatal if not Tx w/i 6 weeks
Q159. Dx:; seeding of previously damaged heart valves by rheumatic fever, mitral prolapse, etc by low-virulence organisms; MCC?; What valve is affected the most?
A159. Subacute Bacterial Endocarditis; Strep Viridans; Mitral valve
Q160. What valve is most commonly affected with IV drug users?; What bug?
A160. Tricuspid; S. Aureus
Q161. what endocarditis bug is associated with colonic neoplasms?
A161. Strep Bovis
Q162. Dx:; gradual onset of fever, sweats, weakness, anorexia, new murmur, splenomegaly, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth spots
A162. Subacute Bacterial Endocarditis (SBE)
Q163. Name sign:; Tender violaceous subcutaneous nodules on fingers & toes
A163. Osler's nodes (SBE)
Q164. Name sign:; fine linear hemorrhages in the middle of nailbeds
A164. Splinter Hemorrhages
Q165. Name sign:; multiple hemorrhagic nontender macules or nodules on palms & soles
A165. Janeway Lesions
Q166. Name sign:; retinal hemorrhages with clear central areas seen on fundoscopy (with new murmur)
A166. Roth's spots (SBE)
Q167. What is considered Major criteria in the Duke's criteria for endocarditis?; (2)
A167. 1. Two positive blood cultures; 2. Echo showing vegetations
Q168. What are the (6) Minor criteria in the Duke's criteria for endocarditis?
A168. 1. Fever; 2. Predisposing heart abnormality; 3. Arterial emboli (Janeway); 4. Osler nodes or Roth's spots; 5. positive blood culture not meeting major criteria; 6. Echo suspicious of endocarditis, but not meeting major criteria
Q169. For the Duke's criteria of Endocarditis, what are the (3) ways to dx with major and minor signs?
A169. 1. (2) major criteria; 2. (1) major + (3) minor; 3. (5) minor criteria
Q170. Tx for endocarditis that cultures:; 1. Strep; 2. Staph; 3. MRSA
A170. 1. Ceftriaxone or Penicillin G (4 weeks); 2. Naficillin (4 weeks); 3. Vancomycin (4 weeks)
Q171. What is the Tx for patients with Valular abnormalities if they are having dental procedures, GI or GU surgery? (2 possible)
A171. Prophylactic:; 1. Amoxicillin; or; 2. Clarithromycin
Q172. Valvular dysfunction requiring surgery is common with which type of organism?
A172. Fungi (Candida or Aspergillus)
Q173. Endocarditis type:; due to cancer seeding heart valves during metastasis what can it lead to?
A173. Marantic endocarditis; leads to cerebral infarcts
Q174. Endocarditis type:; may be due to autoantibody damage of valves by SLE
A174. Libman-Sacks endocarditis
Q175. MC valve affected by RHD
A175. Mitral
Q176. Cause of Rheumatic fever?; What does it lead to?
A176. Group A Strep leads to Rheumatic Heart Disease (RHD); immune complex deposits on valves
Q177. Major criteria (JONES criteria) for Dx Rheumatic fever (5)
A177. JCNES:; Joints (arthritis); Carditis (myo-, endo- or peri-); Nodules (sub-Q); Erythema marginatum rash; Sydenham's chorea (face, tongue, upper limb)
Q178. Minor criteria for Dx Rheumatic fever (5)
A178. Pump FEAR:; Prolonged PR interval;; Fever;; Elevated ESR;; Arthralgias;; Recent Strep infection;
Q179. Tx for Rheumatic fever due to:; 1. Strep; 2. Arthritis; 3. Carditis
A179. Penicillin for strep;; ASA for arthritis;; Steroids for carditis
Q180. Etiology of Dilated Cardiomyopathy; (6)*
A180. TIMED:; Toxic (EtOH, heavy metals); Infectious / Ischemic; Metabolic / Mechanical (arrhythmia, valve disease); Endocrine; Drugs
Q181. what are the Reversible and Irreversible(2) toxic causes of Dilated Cardiomyopathy?
A181. Reversible:; prolonged EtOH use; Irreversible:; Cocaine;; heavy metal toxicity
Q182. what are the Reversible and Irreversible(2) endocrine causes of Dilated Cardiomyopathy?
A182. Reversible:; Thyroid disease; (hypo or hyper); Irreversible:; Acromegaly;; Pheochromocytoma
Q183. Reversible metabolic deficiencies that cause Dilated Cardiomyopathy? (4)
A183. HypoC;; HypoP;; Thiamine deficiency (wet beri-beri);; Selenium deficiency
Q184. Infections that cause Dilated Cardiomyopathy; (3)
A184. HIV;; Coxsackie virus;; Chagas disease
Q185. Drugs that cause Dilated Cardiomyopathy (2)
A185. Doxorubicin (Adriamycin);; AZT
Q186. Dx:; Cardiomyopathy with R + L Heart failure; A-fib; Mitral regurgitation; S-3 Gallop
A186. Dilated Cardiomyopathy
Q187. Diastolic or Systolic Disease Cardiomyopathy:; 1. Dilated; 2. Restrictive; 3. Hypertrophic
A187. Systolic:; Dilated; Diastolic:; Restrictive & Hypertrophic
Q188. Diagnostic results of Dilated cardiomyopathy; auscultation; EKG (3); CXR (2); Echo (2)
A188. Auscultation: S-3;; EKG: Vent Hypertrophy, BBB and/or A-fib;; CXR: Inc heart size; pulm congestion; Echo: low EF, large ventricles
Q189. Tx Dilated Cardiomyopathy; (3)
A189. stop any toxic agents;; Anticoagulation with coumadin (even without evidence of thrombus);; Heart transplant
Q190. Dx:; Right or left ventricular enlargement with loss of contractile function causing CHF, arrhythmia, or thrombus formation.
A190. Dilated Cardiomyopathy
Q191. Definition:; Scarring and infiltration of the myocardium causing decreased right or left ventricular filling
A191. Restrictive Cardiomyopathy
Q192. Etiology of Restrictive Cardiomyopathy; (7)*
A192. ACHES:; Amyloidosis;; Carcinoid heart disease / Congenital;; Hemochromatosis;; Endomyocardial fibrosis; Sarcoidosis / Scleroderma
Q193. Dx:; Pulmonary HTN (right CHF); S-4 gallop; Low QRS voltage on EKG; Exercise intolerance; Diastolic disease
A193. Restrictive Cardiomyopathy
Q194. *Aside from the normal cardiac work-up, what is the gold standard Dx test for Restrictive CM?
A194. Endomyocardial Bx
Q195. Definition:; Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction
A195. Hypertrophic Cardiomyopathy
Q196. another name for Hypertrophic Cardiomyopathy
A196. IHSS; (Idiopathic Hypertrophic Subaortic Stenosis)
Q197. (3) causes of paradoxical splitting of S-2
A197. Hypertrophic cardiomyopathy (IHSS);; Aortic stenosis;; LBBB
Q198. murmur that decrease with squatting (and increases when returning to standing position)
A198. Hypertrophic CM (IHSS)
Q199. Etiology of Hypertrophic Cardiomyopathy; (2)
A199. 50% idiopathic; 50% familial (autosomal dominant, with variable penetrance)
Q200. Dx:; Angina (at rest or exercise); Syncope; Arrhythmias; CHF
A200. Hypertrophic Cardiomyopathy
Q201. sudden death from Hypertrophic CM is usually due to what?
A201. Arrhythmias
Q202. Dx:; 25-years old man becomes severly dyspneic and collapses while running laps, His father died suddenly at an early age.
A202. Hypertrophic CM (IHSS)
Q203. Diagnostic results to Dx Hypertrophic CM; Auscultation (2); EKG (4); Echo (2)
A203. Auscultation - Systolic ejection murmur, Paradoxical splitting of S2;; EKG - LVH, PVCs, A-fib, ST + Q abnormalities;; Echo - septal hypertrophy, LVH with small LV
Q204. Tx for Hypertrophic CM; (2 together); if becomes more severe?
A204. 1. No exercise; 2. Beta-blocker; More severe: implantable Cardiac Defibrillator
Q205. What is the BP limit for Malignant HTN?; Difference b/t HTN Urgency vs Emergency?
A205. Systolic >210 or diastolic >110; Hypertensive URGENCY:; WITHOUT evidence of end-organ damage; Hypertensive EMERGENCY:; Severe HTN with evidence of end-organ damage (encephalopathy, renal failure, CHF, etc)
Q206. what is important to remember about treating a hypertensive emergency?; What meds can be given for Tx? (3 possible)
A206. Do NOT lower BP by more then 1/4 at first, or patient can have a stroke; Meds:; IV drip w/; 1. Nitroprusside; 2. Nitroglyerin; 3. Beta-blocker
Q207. DOC for HTN without any comorbid disease
A207. Thiazide
Q208. DOC for HTN with CHF; (choice of 3)
A208. 1. ACEI / ARBs; 2. B-blocker; 3. Spirolactone (K-sparing)
Q209. DOC for HTN with MI; (2 together)
A209. B-blocker + ACEI
Q210. DOC for HTN with osteoporosis
A210. Thiazide (dec. calcium excretion)
Q211. DOC for HTN with BPH
A211. Terazosin (Alpha-blocker)
Q212. DOC for HTN with pregnancy
A212. alpha-methyldopa
Q213. (3) contraindications for Beta-blockers
A213. 1. COPD; 2. Diabetes; 3. HyperK
Q214. (3) contraindications for ACEI
A214. 1. Pregnancy; 2. Renal artery stenosis; 3. Renal Failure (creatinine >1.5)
Q215. contraindication of all diuretics
A215. Gout
Q216. (2) hypersteroidism syndromes that cause HTN with hyperK
A216. Cushing's; Conn's
Q217. endocrine system abnormality that can lead to HTN due to episiodic autonomic bursts of epinepherine
A217. Pheochomocytoma
Q218. congenital cause of HTN that leads to HTN in arms and low BP in legs
A218. Coartation of the Aorta
Q219. renal artery stenosis that causes HTN in:; 1) older men; 2) younger women
A219. 1) Atherosclerosis; 2) Fibromuscular dysplasia
Q220. Dx:; valvular problem that causes HTN with a wide PP; Physiologic cause?
A220. Aortic Regurgitation; cause: Inc SV
Q221. Dx:; congenital problem that causes HTN with a wide PP; Physiologic cause for HTN?
A221. Patent Ductus Arteriosus; cause: Inc SV
Q222. (3) drug classes that cause HTN; What metal poisoning?
A222. makes vessels like COAL:; Corticosteroids; Oral contraceptives; Amphetamines; Lead poisoning
Q223. (5) deadly causes of chest pain
A223. TAPUM:; Tension pneumothorax; Aortic Dissection; PE; Unstable Angina; MI
Q224. heart medication that can cause cyanide toxicity
A224. Nitroprusside
Q225. First Rx Tx for Hypertensive emergency due to pheochromocytoma
A225. Phentolamine
Q226. (2) possible Tx for a preclampsia-related hypertensive emergency
A226. Hydralazine or Magnesium
Q227. What is the most commonly seen early sign of right CHF, which is not seen in early left CHF?
A227. JVD
Q228. What are the systolic dysfunctions of CHF? (EF, Preload, LVEDP, contractility)
A228. Ejection Fraction < 40%; Preload and LVEDP: Inc; Contractility: Dec; (leads to LV hypertrophy)
Q229. What causes CHF exacerbation in previously stable patients? (10)
A229. FAILURE:; Forgot medication;; Arrhythmia, Anemia;; Ischemia, Infection;; Lifestyle (Inc sodium);; Upregulation (Inc cardiac output--pregnancy or hyperthyroidism);; Renal failure with fluid overload;; Emboli (pulmonary); Endocarditis
Q230. What are the diastolic dysfunctions of CHF? (compliance, contraction, recoil, stiffness, LVEDP, CO, EF)
A230. Compliance: Decreased; Contraction: Normal; Recoil: Decreased; Stiffness: Increased; LVEDP: Increased; CO: Normal; EF: normal to high
Q231. Which type of CHF dysfunction--systolic or diastolic has a normal ejection fraction and is more common in women?
A231. diastolic
Q232. What related heart conditions are seen in the systolic dysfunction of CHF that deals with decreased contractility? (4)
A232. Ischemia (most common);; Dilated Cardiomyopathy;; HTN;; Valvular disease
Q233. What related conditions are seen in the systolic dysfunction of CHF that deals with Inc afterload? (3)
A233. Hypertension;; Aortic stenosis;; Aortic regurgitation
Q234. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal active relaxation? (2)
A234. Ischemia;; Hypertrophic cardiomyopathy; (from disorders causing LVH)
Q235. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal passive filling? (2)
A235. Restrictive cardiomyopathy;; Concentric hypertrophy from HTN
Q236. What are the early signs of Left-sided CHF? (2)
A236. Dyspnea on exertion;; Dec exercise tolerance
Q237. What are the late sx of Left-sided CHF? (8)
A237. PORNS DD Tits:; Paroxysmal Nocturnal Dyspnea;; Orthopnea;; Rales and crackles;; Nocturia;; S-3 gallop;; Diaphoresis;; Displaced PMI (laterally);; Tachycardia
Q238. What are the early signs of Right-sided CHF? (6)
A238. A Juicy CHERry:; Anorexia; JVD*; Cyanosis; Hepatomegaly; Edema in periphery; RUQ pain
Q239. What are the late sx of Right-sided CHF? (2)
A239. abnormal Hepatojugular reflex;; Ascites
Q240. What force causes the pulmonary congestion in diastolic dysfunction?
A240. Increased hydrostatic pressure
Q241. what (3) ways can CHF be diagnosed by a CXR?
A241. Enlargement of cardiac silhouette;; Pulmonary vascular congestion;; Kerley-B lines
Q242. (3) lab methods of diagnosing CHF
A242. CXR;; Echocardiogram (function of ventricles);; Basic Natriuretic Peptide (BNP elevation)
Q243. AHA staging guidelines for CHF (stages A-D)
A243. A: at risk but without structural heart disorder; B: no sx, with structural disorder; C: prior or current sx + structure disorder; D: end-stage disease
Q244. NY Heart Assoc Functional Classes of Heart Failure (I-IV); [measures pt activity limitation]
A244. I: No limitation; II: slight limitation; III: Sx with minimal effort, ok at rest; IV: Sx at rest
Q245. SOB while lying flat
A245. Orthopnea
Q246. What drug classes are good versus CHF? (3); Which ones are only helpful if patient has a diastolic dysfunction? (2)
A246. Systolic or Diastolic dysfunction:; ACEIs/ARBs; Beta-blockers; diuretics; Diastolic dysfunction only:; Calcium channel blockers; Nitroglycerin
Q247. Name the diuretic used for mild CHF and the 2 for significant CHF
A247. Mild:; Thiazides; Significant CHF:; Loop diuretics; Spirolactone
Q248. What is the difference in the signs/sx of people with right CHF and cirrhosis? (2)
A248. Right CHF also has:; 1. JVD; 2. Orthopnea
Q249. what are the (5) Tx for Acute Pulmonary Edema and Paroxysmal Nocturnal Dyspnea?
A249. NOMAD:; Nitroglycerin; Oxygen; Morphine; Aspirin; Diuretic
Q250. What is the rule for prescribing beta-blockers for CHF?
A250. never give during active CHF--add beta-blockers once the patient is diuresed to dry weight and on stable doses of other medications
Q251. Heart valve disease almost always due to Rheumatic Fever
A251. Mitral Stenosis
Q252. Murmur type:; Dyspnea on Exertion; Cough, rales; signs of RV failure; RV precordial thrust; Hoarse voice
A252. Mitral Stenosis; (Hoarse voice is from enlarged LA on recurrent laryngeal nerve)
Q253. Diagnostic results for Mitral Stenosis; Auscultation; CXR (2); EKG (3); Echo
A253. Auscultation: mid-diastolic low-pitched rumble with opening snap;; CXR: large Left atrium and Kerely B lines; EKG: LA enlargement; RV hypertrophy; A-fib; Echo: abnormal valve
Q254. Tx for mitral stenosis with each grade:; I (4);; II (2);; III/IV (1); What should always be avoided with mitral stenosis tx?
A254. Grade:; I: Diuretics; B-Blockers; Anticoagulants; Digitalis; II: Drugs from I + Balloon valvuloplasty (if drugs dont work); III/IV: Balloon Valvuloplasty; Avoid: Inotropic Agents!
Q255. Etiology of Acute Mitral Regurgitation; (2)
A255. MI with papillary muscle rupture;; Endocarditis
Q256. Etiology of Chronic Mitral Regurgitation; (3)
A256. Rheumatic fever;; Mitral Prolapse;; LV dilation
Q257. Diagnostic tests for Mitral Regurgitation; Auscultation; EKG; Echo
A257. Auscultation: Loud, holosystolic apical murmur radiating to axilla; EKG: large LA; Echo: valve problem
Q258. Tx for Mitral Regurgitation (6)*
A258. DAVES Deal:; Diuretics;; ACEi;; Vasodilators;; Endocarditis prophylaxis;; Surgery if severe;; Digitalis
Q259. Most common valvular disorder
A259. Mitral prolapse
Q260. Asymptomatic murmur with genetic predisposition, seen most commonly in women
A260. Mitral Prolapse
Q261. What (2) murmurs are seen in Marfan's syndrome?
A261. Mitral prolapse; Aortic Regurgitation
Q262. Tx for mitral prolapse?
A262. not necessary to tx unless symptomatic
Q263. Mean survival rate for patients with Aortic Stenosis and:; 1. Angina; 2. Syncope; 3. Heart failure
A263. 1. 5 years; 2. 2 - 3 years; 3. 1 - 2 years
Q264. Etiology of Aortic Stenosis (2)
A264. - Calcific disease with age; Bicuspid valve (around age 40)
Q265. Conditions with a wide Pulse Pressure; (6)*
A265. WAH-HA-H-ide pulse pressure:; Wet beri-beri;; Aortic Regurgitation;; Hyperthyroidism;; HTN;; Anemia;; Hypertrophic Subaortic Stenosis (IHSS)
Q266. What (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation?; How are they treated?
A266. Mitral Regurgitation; Aortic Regurgitation; Tx: Emergent surgery
Q267. Classic triad* of Sx for Aortic Stenosis; (4) other signs
A267. SAD:; Syncope;; Angina;; Dyspnea on Exertion; Others:; Forceful apex beat; narrow Pulse Pressure; Paradoxical S2 split; heard in carotids
Q268. Diagnostic test results for Aortic Stenosis; Auscultation; EKG; Echo; CXR
A268. Auscultation: Loud systolic crescendo-decrescendo murmur;; EKG: LV strain; CXR: calcifications on valve; Echo: diseased valve
Q269. What is the EKG LV strain pattern seen in aortic stenosis?; (hint: affects 4 leads)
A269. ST depression + T-wave inversion in I, aVL, V5 and V6
Q270. Tx for aortic stenosis; What should be avoided?; (2)
A270. Valve replacement; AVOID Afterload reducers (ACEi & beta-blockers)
Q271. (2) main etiologies for Aortic Regurgitation
A271. Aortic root dilatation or dissection;; Valvular disease;
Q272. (3)* causes of Aortic root dilatation thereby causing Aortic Regurgitation
A272. Marfan's;; Idiopathic (but inc with HTN);; Collagen vascular disease
Q273. (2) causes of Valvular disease thereby causing Aortic Regurgitation
A273. Rheumatic heart disease;; Endocarditis
Q274. (6)* causes of proximal Aortic root dissection thereby causing Aortic Regurgitation
A274. "THE MTS":; Third Trimester Pregnancy;; HTN;; Ehlers-Danlos;; Marphans (Cystic medial necrosis);; Turner's syndrome;; Syphilis;; (Aortic arch is shaped like a mountain)
Q275. Names of the unique signs of Aortic regurgitation; (7)*
A275. Tap Water Quickly Complicates De-Murmur Designs:; 1. Traube's sign; 2. Water-Hammer pulse; 3. Quincke's sign; 4. Corrigan's pulse; 5. de Musset's sign; 6. Muller's sign; 7. Duroziez's sign
Q276. Aortic regurgitation sign:; wide pulse pressure presenting w/forceful arterial pulse upswing with rapid falloff
A276. Water-Hammer pulse
Q277. Aortic regurgitation sign:; pistol-shot bruit over femoral pulse
A277. Traube's sign
Q278. Aortic regurgitation sign:; unusually large carotid pulsations
A278. Corrigan's pulse
Q279. murmur sign:; pulsatile blanching & reddening of fingernails upon light pressure; What murmur?
A279. Quincke's sign; (Aortic Regurgitation)
Q280. Aortic regurgitation sign:; head bobbing caused by carotid pulsation
A280. de Musset's sign; (head bobs like listening to "De Mussic")
Q281. Aortic regurgitation sign:; pulsatile bobbing of the uvula
A281. Muller's sign
Q282. Aortic regurgitation sign:; to-and-fro murmur over femoral artery (heard best with mild pressure applied to artery)
A282. Duroziez's sign
Q283. Murmur presentation:; dyspnea, orthopnea, paroxysmal nocturnal dyspnea, angina, LV failure, wide pulse pressure
A283. Aortic regurgitation
Q284. Murmur presentation:; starts asymptomatic, then dyspnea, angina, syncope, heart failure
A284. Aortic stenosis
Q285. Murmur presentation:; mostly asymptomatic, atypical chest pain, SOB, fatigue
A285. Mitral Prolapse
Q286. Murmur presentation:; dyspnea, fatigue, weakness, cough, A-fib, systemic emboli
A286. Mitral Regurgitation
Q287. Murmur presentation:; DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice
A287. Mitral stenosis
Q288. What is heard on Auscultation for Aortic regurgitation?; (3)
A288. 1. High-pitched, blowing decrescendo diastolic murmur; 2. Apical diastolic rumble; (mitral stenosis without snap); 3. Midsystolic flow murmur at base
Q289. Tx for Aortic regurgitation problems; (3)
A289. Tx LV heart failure;; Endocarditis prophylaxis;; Valve replacement
Q290. Etiology of Tricuspid stenosis (3)*
A290. CCR:; Congenital;; Carcinoid;; Rheumatic heart disease
Q291. Murmur presentation:; peripheral edema, JVD, hepatomegaly, ascites, jaundice; (2)
A291. Tricuspid stenosis; or; Tricuspid Regurgitation
Q292. Auscultation results for Tricuspid stenosis?; Tx?
A292. Diastolic, rumbling low-pitched heard with Inspiration; Tx: Repair valve
Q293. Dx:; Patient with DVT has a stroke. He has a fixed S2 split
A293. Atrial-Septal Defect; (with right-to-left emboli)
Q294. Etiology of Tricuspid Regurgitation (4)
A294. Increased pulmonary artery Pressure; (from L-CHF or Mitral stenosis/regurgitation);; R-CHF;; Right papillary muscle rupture with MI;; Tricuspid valve lesions; (rheumatic heart or bacterial endocarditis)
Q295. Holosystolic murmurs; (3)*
A295. MTV; Mitral Regurgitation;; Tricuspid regurgitation;; Ventricular Septal Defect
Q296. Number 1 cause of death in CHF patients
A296. Arrhythmia
Q297. Diagnostic results for Tricuspid Regurgitation:; Auscultation; EKG (2); Echo
A297. Auscultation: Holosystolic murmur increasing with inspiration; EKG: RV enlargement; A-fib; Echo: diseased valve
Q298. Tx for Tricuspid Regurgitation; (3)*
A298. Tricuspid Dying Slowly:; Tx heart failure;; Diuresis;; Surgical repair of valve
Q299. What is done first if a patient has hyperK and peaked T- waves? Why?
A299. give Calcium to stabilize cardiac membrane
Q300. Murmur:; Diastolic apical rumble and opening snap
A300. Mitral stenosis
Q301. Murmur:; Late systolic murmur with midsystolic click; What is confirming test?
A301. Mitral Prolapse; Valsalva - click starts earlier, murmur prolonged
Q302. Murmur:; High-pitched apical blowing holosystolic murmur; where does it radiate?
A302. Mitral Regurgitation; radiates: Axillae
Q303. Murmur:; Diastolic rumble louder with inspiration
A303. Tricuspid stenosis
Q304. Murmur:; High-pitched blowing holosystolic murmur heard better with inspiration; Where is it heard?; Where are pulsations seen?
A304. Tricuspid Regurgitation; heard at left sternal border; Jugular pulsations
Q305. Name sign:; Peripheral pulses that are weak and late compared to heart sounds; What murmur?
A305. Pulsus Parvus et Tardus; Aortic Stenosis
Q306. Murmur:; midsystolic crescendo-decrescendo murmur; Where does it radiate? (2); What heart sound is also heard?
A306. Aortic stenosis; radiates to: Carotids and Apex; S4 also heard
Q307. Name sign:; Double-peaked arterial pulse; what murmur?
A307. Pulsus Bisferiens; Aortic regurgitation
Q308. Murmur:; Blowing early diastolic, apical diastolic rumble, midsystolic flow murmurs
A308. Aortic Regurgitation
Q309. Dx that causes Murmur:; Systolic murmur at apex and left sternal boarder not transmitted to carotids; How is it heard better?
A309. IHSS; heard better with standing after squat
Q310. When during S1-S2 do you hear the "flow murmur" (murmur heard with any high flow state)?; What is differential dx? (5)*
A310. Midsystolic:; Aortic Regurgitation; Atrial-Septal defect (fixed split S2); Anemia; Adolescence; Pregnancy
Q311. difference b/t Type A and Type B Aortic Dissections
A311. Type A: involves the ascending aorta and can extend into the descending aorta; Type B: descending aorta only
Q312. Debakey Classification of Aortic Dissection Types I-III Which is most common?
A312. I: Ascending plus part of distal aorta (most common); II: Ascending only; III: Descending only
Q313. What is infected on the aorta when the aortic dissection is due to syphilis?
A313. Vasa Vasorum
Q314. Etiology of Aortic Dissection (7)
A314. PATC3H:; Pregnancy (3rd trimester);; Aortic Coarctation (Turners or idiopathic);; Trauma;; Congenital heart disease / CT disease (Marfans and E-D syndromes) / Cocaine;; HTN
Q315. Dx:; Severe tearing chest pain that radiates to the back, HTN, possible unequal pulses distally, possible aortic regurgitation murmur
A315. Aortic Dissection
Q316. (3) tests to confirm Dx of aortic dissection
A316. Angiogram (gold standard);; CXR - wide mediastinum;; CT with contrast
Q317. Drug Tx for Aortic dissection to stabilize BP; (2); What is the next step for Type A vs. Type B?
A317. Rx: Beta-blocker + nitroprusside to keep BP < 120; Type A: Immediate surgery; Type B: medical stabilization
Q318. Etiologies of Syncope (7)
A318. SVNCOPE:; Situational (valsalva, tight collar);; Vasovagal response (common faint);; Neurogenic;; Cardiac;; Orthostatic hypotension;; Psychiatric (faking it);; Everything else (idiopathic)
Q319. At what level is HDL cardioprotective?
A319. > 60
Q320. What "type" is all isolated hypercholesterolemia?
A320. Type IIa
Q321. What transports cholesterol from the gut to the bloodstream?
A321. Chylomicrons
Q322. What is left over after lipoprotein lipase liberates FFA from chylomicrons for use in tissues?
A322. Chylomicron remnants
Q323. What is secreted from the liver and carries endogenous cholesterol?
A323. VLDL
Q324. What is metabolized from VLDL?
A324. Intermediate-Density Lipoproteins (IDL)
Q325. What is metabolized from IDL and carries cholesterol in the bloodstream to the tissues?
A325. LDL
Q326. What takes up free cholesterol secreted by the tissues and transports it to the liver?
A326. HDL
Q327. What is the name for the (3) Type IIa Isolated Hypercholesterolemias?; What is abnormal with all of them?; What is the total cholesterol range?
A327. Familial Hypercholesterolemia;; Familial defective apo-B100;; Polygenic Hypercholesterolemia; High LDL; total cholesterol from 240 - 500
Q328. What are the (3) isolated Hypertriglyceridemias and each "Type"?; What is elevated with each?
A328. 1. familial Hypertriglyeridemia Type IV - high VLDL; 2. familial Apo-CII deficiency; 3. familial Lipoprotein Lipase deficiency; (2 and 3 are both Type I + V - high chylomicrons)
Q329. Class of drugs that that reduce LDL by binding bile acids in the gut. name (2) drugs
A329. Bile Acid Sequestrants; Cholestyramine; Colestipol
Q330. which drug class is best for reducing triglycerides in VLDL and chylomicrons?
A330. Fibrinates
Q331. Etiologies of A-Fib; (10)
A331. PIRATES:; Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;; Ischemic heart disease & HTN;; Rheumatic heart disease; Anemia;; Thyrotoxicosis;; Ethanol & cocaine;; Sepsis
Q332. Signs/symptoms of A-Fib; (5)
A332. A FL PT:; Asymptomatic patient;; Fatigue (most common);; Light headedness, syncope;; Palpitations, skipped beats;; Tachypnea, dyspnea
Q333. Drugs given to A-Fib to control rate in a non-emergent situation; (2)
A333. oral Beta-blocker:; Atenolol; (and); oral Calcium channel blockers:; Verapamil or Diltiazem
Q334. what are the (2) ways to cardiovert an A-Fib rhythm?; when should you not cardiovert?; what would the Tx be then?
A334. Medical: Amiodarone; Electrical: start @ 100 J; Do not cardiovert if patient is in A-Fib > 24 hours. Tx: Warfarin for 3-4 weeks before cardioversion
Q335. Dx:; when the heart is unable to pump sufficient amounts of blood to meet the O2 requirement of the body causing blood to backup
A335. Congestive Heart Failure; (CHF)
Q336. What are the systolic dysfunctions of CHF?; (EF, Preload, LVEDP, contractility)
A336. Ejection Fraction < 40%; leading to Inc preload & LVEDP,; which leads to Dec contractility and Inc cardiac hypertrophy
Q337. What causes CHF exacerbation in previously stable patients?; (10)
A337. FAILURE:; Forgot medication;; Arrhythmia, Anemia;; Ischemia, Infection;; Lifestyle (Inc sodium);; Upregulation (Inc cardiac output--pregnancy or hyperthyroidism);; Renal failure with fluid overload;; Emboli (pulmonary); Endocarditis
Q338. What are the diastolic dysfunctions of CHF?; (compliance, contraction, recoil, LVEDP, CO, EF)
A338. Decreased compliance with normal contractile function; (ventricle either cant relax or fill properly); leading to Inc stiffness, Dec recoil & coencentric hypertrophy. LVEDP is Inc,; CO is nml,; EF is nml to high
Q339. What related heart conditions are seen in the systolic dysfunction of CHF that deals with decreased contractility?; (4)
A339. Ischemia(most common);; Dilated Cardiomyopathy;; Hypertensive burnout;; Valvular disease
Q340. What related conditions are seen in the systolic dysfunction of CHF that deals with Inc afterload?; (3)
A340. Hypertension;; Aortic stenosis;; Aortic regurgitation
Q341. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal active relaxation?; (2)
A341. Ischemia;; Hypertrophic cardiomyopathy; (from disorders causing LVH)
Q342. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal passive filling?; (2)
A342. Restrictive cardiomyopathy;; Concentric hypertrophy from HTN
Q343. What are the early signs of Left-sided CHF?; (2)
A343. Dyspnea on exertion;; Dec exercise tolerance
Q344. What are the late sx of Left-sided CHF?; (8)
A344. PORNS DD Tits:; Paroxysmal Nocturnal Dyspnea;; Orthopnea;; Rales & crackles;; Nocturia;; S-3 gallop;; Diaphoresis;; Displaced PMI (laterally);; Tachycardia
Q345. What are the early signs of Right-sided CHF?; (6)
A345. A Juicy CHERry:; Anorexia; JVD*; Cyanosis; Hepatomegaly; Edema in periphery; RUQ pain
Q346. What are the late sx of Right-sided CHF?; (2)
A346. abnormal Hepatojugular reflex;; Ascites
Q347. NY Heart Assoc Functional Classes of Heart Failure (I-IV); [measures pt activity]
A347. I: No limitation; II: slight limitation; III: Sx with minimal effort, ok at rest; IV: Sx at rest
Q348. What drug classes are good versus CHF? Which ones are only helpful if patient has a diastolic dysfunction?
A348. Systolic or Diastolic dysfunction:; ACEIs/ARBs; Beta-blockers; diuretics; Diastolic dysfunction only:; Calcium channel blockers; Nitroglycerin
Q349. What diuretics are used for mild CHF and (2 for) significant CHF?
A349. Mild:; Thiazides; Significant CHF:; Loop diuretics; Spirolactone
Q350. What is the difference in the signs/sx of people with right CHF and cirrhosis?; (2)
A350. Same sx, except right CHF patients have trouble lying flat & have JVD
Q351. what are the (5) Tx for Acute Pulmonary Edema & Paroxysmal Nocturnal Dyspnea?
A351. NOMAD:; Nitroglycerin; Oxygen; Morphine; Aspirin; Diuretic
Q352. Describe (2) types of Malignant HTN; (+ BP limits)
A352. Hypertensive URGENCY:; systolic >200 or diastolic >110; WITHOUT evidence of end-organ damage; Hypertensive EMERGENCY:; Severe HTN with evidence of end-organ damage; (encephalopathy, renal failure, CHF, etc)
Q353. what is important to remember about treating a hypertensive emergency?; (2)
A353. 1) Immediate therapy is needed; 2) IV drip with Nitroprusside or Nitroglyerin, but do not lower BP by more then 1/4 at first, or patient can have a stroke
Q354. DOC for HTN with CHF; (3)
A354. ACEI / ARBs; B-blocker,; K-sparing diuretic
Q355. DOC for HTN with MI; (2)
A355. B-blocker & ACEI
Q356. renal artery stenosis that causes HTN in:; 1) older men; 2) younger women
A356. 1) atherosclerosis; 2) fibromuscular dysplasia
Q357. valvular problem that causes HTN with a wide PP due to Inc SV
A357. Aortic Regurgitation
Q358. congenital problem that causes HTN with a wide PP due to Inc SV
A358. Patent Ductus Arteriosus
Q359. (3) drug classes that cause HTN; What metal poisoning?
A359. Oral contraceptives; Corticosteroids; Amphetamines; Lead poisoning
Q360. (6) Major risk factors for CAD; which is most prevetable?; which is the greatest risk?
A360. Diabetes (greatest); Smoking (most preventable); HTN; Hypercholesterolemia; Family History; Age
Q361. Chest pain that has an established character, timing and duration; pain is transient, reproducible and predictable. What is cause?; What is Tx? (2)
A361. Stable Angina; Reduced coronary blood flow through fixed atherosclerotic plaque in vessel of heart; rest & nitroglycerin
Q362. exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it. Name the types
A362. Angina:; Stable; Unstable; Variant (Prinzmetal's)
Q363. Angina type that is also considered an Acute Coronary Syndrome (ACS). What (3) factors must it have for diagnosis?
A363. Unstable Angina; 1) New-onset; 2) angina that changes or accelerates in pattern, location or severity; 3) Occurs at REST
Q364. Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. (2) Tx?
A364. Variant (Prinzmetal's) Angina; Nitrates & Calcium Channel blockers
Q365. what (2) groups of patients may not show the classic signs pain seen in stable angina?; Why?
A365. Elderly & diabetics; (b/c: neuropathies)
Q366. 62-years old smoker with 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before. What is it?
A366. Unstable Angina
Q367. 62-years old man with frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night. What is it?
A367. Variant (Prinzmetal's) Angina
Q368. What is the criteria for a "positive" Stress Test?; (5)
A368. either:; ST elevation; ST depression >1 mm in multiple leads; Dec BP; failure to go more than 2 minutes; failure to complete for reason other then cardiac symptoms (i.e. arthritis)
Q369. what does Myocardial Perfusion Imaging detect?; (3)
A369. - Myocardial perfusion; Ventricular volume; Ejection Fraction
Q370. (5) uses for a cardiac catherization
A370. 1) MI / Unstable angina: stent or angiography; 2) Valvular disease: valvuloplasty; 3) Arrhythmias: mapping bypass tracts; 4) Myocardial disease Bx: glycogen storage disease or cardiomyopathies; 5) Congenital heart disease identification: angiography & closure of defects
Q371. How is the right heart accessed in a cardiac catheterization? (2); Left heart? (2)
A371. Right:; Femoral or Internal Jugular; Left:; Femoral or Radial artery (from right heart)
Q372. what is the wave morphology changes sequence in a MI ECG?; (6)
A372. 1. peaked T-waves; 2. T-wave inversion; 3. ST elevation; 4. Q-waves; 5. ST normalization; 6. T-waves return upright
Q373. which cardiac enzyme has the shortest duration?; Longest?
A373. Myoglobin (1 day); Troponin-I/T (7-10 days)
Q374. difference b/t unstable angina & non-ST elevation MI?; (2)
A374. non-ST elevation MI has:; 1. more severe lack of Oxygen (more severe myocardial damage); 2. Enzyme leakage (Unstable angina has none)
Q375. Tx for Unstable angina & MI; (6)
A375. MONA has HEP B:; Morphine; Oxygen; Nitrates; Aspirin; HEParin; Beta-blockers
Q376. primary Tx (2) for the acute MI w/in 6 hours of infarct; (name 4 drugs)
A376. Thrombolytics:; tPA + Heparin (DOC); Urokinase; strptokinase; Alteplase
Q377. At what level should LDL be in person with MI history?; What is given to lower it?
A377. less then 100; statins
Q378. When are thrombolytics indicated in MI?; (3)
A378. - patients < 80 yo; within 6-12 hrs of chest pain; evidence of infarct on ECG
Q379. Contra-indications of Thrombolytics; (9)
A379. Having Some Breaks A Blood Clot In Small Pieces:; History of intracranial bleed; stroke < 1 year; BP > 180/110; active internal bleed; bleeding disorder; CPR; Intracranial tumor; suspected aortic dissection; Peptic ulcer
Q380. drug that prevents future clots from forming
A380. heparin
Q381. Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?
A381. PTCA; (Percutaneous Transluminal Coronary Angioplasty)
Q382. which throbolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?
A382. streptokinase
Q383. drug class that is excellent for late & long-term therapy for acute MI to decrease afterload and prevent remodeling?
A383. ACEi
Q384. how many seconds & boxes is a normal PR interval?
A384. 0.2 ms; 5 small boxes
Q385. define:; Q-wave; When is it pathologic?
A385. when initial part of ventricular depolarization is downward; Pathologic: greater then 1 small box
Q386. normal time & boxes for QRS interval?
A386. < 0.12 ms; 3 small boxes
Q387. define:; Junctional rhythm
A387. rhythm originating in the AV node & causing narrow QRS without P-waves
Q388. no p-waves;; all complexes are wide;; no changes in height (amplitude) with each complex;; > 100bpm
A388. Ventricular tachycardia
Q389. wide QRS complexes that vary in amplitude; (2 names)
A389. Ventricular Fibrillation; Torsades de Pointes
Q390. normal sinus rhythm with PR interval > 0.2 ms (> 5 small boxes)
A390. First-degree AV block
Q391. PR interval elongates from beat to beat until it becomes so long that a beat drops
A391. Second-degree AV block, type 1; (Wenckebach)
Q392. PR interval is fixed but every so often there is a P-wave without a QRS
A392. Second-degree AV block, type 2; (Mobitz)
Q393. no relationship b/t P-waves and QRS complexes
A393. Third-degree AV block
Q394. QRS > 0.12 (> 3 small boxes); RSR' in V1 & V2;; deep S-wave in lateral leads (I, aVL, V5 & V6)
A394. RBBB
Q395. QRS > 0.12 (> 3 small boxes);; RSR' in V5 & V6;; diffuse ST elevation
A395. LBBB
Q396. Different shapes to 3 or more P-waves;; normal rhythm; (what is it called if it is tachycardic?)
A396. Wandering pacemaker; MFAT:; Multifocal Atrial Tachycardia
Q397. short PR interval;; slurring delta wave connecting P-wave to QRS complex
A397. Wolff-Parkinson-White syndrome
Q398. diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR
A398. Pericarditis
Q399. Tx of wandering pacemaker & MFAT?; (1 drug / 1 "other")
A399. Verapamil (Ca channel block); &; Tx underlying condition
Q400. what Tx breaks SVT (supraventricular tach) in > 90%?
A400. Adenosine; (failure to break r/o SVT)
Q401. Tx of asymptomatic V-tach; (2)
A401. Amiodarone; Lidocaine
Q402. 58-years old man discharged from hospital after MI 2 weeks ago presents with fever, chest pain & malaise. EKG shows diffuse ST-T wave changes. What is Dx?; What is Tx?
A402. Dressler's syndrome; NSAIDs
Q403. Medication orders with dischsrge of an ACS (post-MI) patient?; (5)
A403. easy AS ABC:; Aspirin (indefinitely); Statin to lower LDL < 100; ACE-inh (if EF <40%); Beta-blocker (indefinitely); Clopidogrel for 1 - 12 mo depending on stent placement
Q404. Dx:; fever, pericarditis & possible pericardial or pleural effusions post cardiac surgery
A404. Dressler's syndrome
Q405. SVT with AV block & yellow skin
A405. Digoxin toxicity
Q406. Etiology of Dilated Cardiomyopathy; (6)
A406. TIMED:; Toxic (EtOH, heavy metals); Infectious / Ischemic; Metabolic / Mechanical (arrhythmia, valve disease); Endocrine; Drugs
Q407. what is the Reversible & Irreversible(2) toxic causes of Dilated Cardiomyopathy?
A407. Reversible:; prolonged EtOH use; Irreversible:; Cocaine;; heavy metal toxicity
Q408. what is the Reversible & Irreversible(2) endocrine causes of Dilated Cardiomyopathy?
A408. Reversible:; Thyroid disease (hypo or hyper); Irreversible:; Acromegaly;; Pheochromocytoma
Q409. Reversible metabolic causes of Dilated Cardiomyopathy?; (4)
A409. HypoC;; HypoP;; Thiamine deficiency (wet beri-beri);; Selenium deficiency
Q410. Infections that cause Dilated Cardiomyopathy; (3)
A410. HIV;; Coxsackie virus;; Chagas disease
Q411. Drugs that cause Dilated Cardiomyopathy; (2)
A411. Doxorubicin (Adriamycin);; AZT
Q412. Signs/Sx of Dilated Cardiomyopathy
A412. RAMS:; R & L Heart failure;; A-fib;; Mitral regurgitation;; S-3 Gallop
Q413. Diastolic or Systolic Disease Cardiomyopathy:; 1. Dilated; 2. Restrictive; 3. Hypertrophic
A413. Systolic:; Dilated; Diastolic:; Restrictive &; Hypertrophic
Q414. Diagnostic results of Dilated cardiomyopathy; auscultation; EKG (3); CXR (2); Echo (2)
A414. Auscultation: S-3;; EKG: Vent Hypertrophy, BBB &/or A-fib;; CXR: Inc heart size; pulm congestion; Echo: low EF, large ventricles
Q415. Tx Dilated Cardiomyopathy; (3)
A415. - stop any toxic agents; anticoagulation with coumadin (even without evidence of thrombus); heart transplant
Q416. Right or left ventricular enlargement with loss of contractile function causing CHF, arrhythmia, or throbus formation.
A416. Dilated Cardiomyopathy
Q417. Scarring & infiltration of the myocardium causing decreased right or left ventricular filling
A417. Restrictive Cardiomyopathy
Q418. Etiology of Restrictive Cardiomyopathy; (7)
A418. ACHES:; Amyloidosis;; Carcinoid heart disease / Congenital;; Hemochromatosis;; Endomyocardial fibrosis; Sarcoidosis / Scleroderma
Q419. Dx:; Pulmonary HTN (right CHF);; S-4 gallop; Low QRS voltage on EKG; Exercise intolerance;; Diastolic disease
A419. Restrictive Cardiomyopathy
Q420. (5) tests used to assist in the Dx of Restrictive Cardiomyopathy
A420. Auscultation;; EKG;; CXR;; Echo;; Endomyocardial Bx*
Q421. Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction
A421. Hypertrophic Cardiomyopathy
Q422. etiology of Hypertrophic Cardiomyopathy
A422. 50% idiopathic; 50% familial (autosomal dominant, with variable penetrance)
Q423. Dx:; Angina (at rest or exercise); Syncope; Arrhythmias; CHF
A423. Hypertrophic Cardiomyopathy
Q424. 25-years old man becomes severely dyspneic & collapses while running laps, His father died suddenly at an early age.
A424. Hypertrophic CM (IHSS)
Q425. Diagnostic results to Dx Hypertrophic CM; Auscultation (2); EKG (4); Echo (2)
A425. Auscultation - Systolic ejection murmur;; Paradoxical splitting of S2;; EKG - LVH, PVCs, A-fib, ST & Q abnormalities;; Echo - septal hypertrophy, LVH with small LV
Q426. Tx for Hypertrophic CM; (3)
A426. - No exercise; Beta-blocker; implantable cardiac defibrillator
Q427. Etiology of Pericarditis; (6)
A427. Bacterial, viral or fungal infections;; Serositis from:; RA;; SLE;; Scleroderma;; Uremia;; post-MI (Dressler's syndrome)
Q428. Tx for pericarditis if:; infection; pain/inflammation; Dressler's; Recurrent cases
A428. - Tx infection with Abx;; NSAIDs to relieve pain & reduce inflammation;; Steroids for Dressler's;; Pericardectomy only with recurrent cases
Q429. Transient fall in BP > 10 mmHg during inspiration
A429. Pulsus Paradoxus
Q430. Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling & reduces cardiac output
A430. Pericardial Tamponade
Q431. Etiology of Pericardial Tamponade; (3)
A431. - Pericarditis; Trauma; Aortic dissection or ventricular rupture into pericardium
Q432. Beck's triad of the pericardial tamponade; (4) other signs/Sx
A432. Beck's triad:; Hypotension; Muffled heart sounds; JVD; Other Sx:; Dyspnea;; Tachycardia;; Pulsus Paradoxus*; narrow Pulse Pressure
Q433. Tx for Pericardial Tamponade for:; 1. unstable; 2. stable; 3. both
A433. Unstable: Immediate Pericardiocentesis;; Stable: Pericardial window; Both: Infuse fluids to expand volume
Q434. Patient has chest pain with inspiration that radiates to the left trapezial ridge;; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine
A434. Pericarditis
Q435. Murmur type:; Dyspnea on Exertion; Cough, rales; signs of RV failure;; RV precordial thrust; Hoarse voice (from enlarged LA on recurrent laryngeal nerve)
A435. Mitral Stenosis
Q436. Diagnostic results for Mitral Stenosis; Auscultation; CXR; EKG
A436. Auscultation: mid-diastolic opening snap;; CXR: large Left atrium & Kerely B lines; EKG: LA enlargement; RV hypertrophy; A-fib
Q437. Tx for mitral stenosis with each grade (I-IV); What should always be avoided with mitral stenosis tx?
A437. Grade:; I: Diuretics; B-Blockers; Anticoagulants; Digitalis; II: Drugs from I + Balloon valvuloplasty (if drugs dont work); III/IV: Balloon Valvuloplasty; Avoid: Inotropic Agents!
Q438. Acute etiology of Mitral Regurgitation; (2)
A438. MI with papillary muscle rupture;; Endocarditis
Q439. Chronic etiology of Mitral Regurgitation; (3)
A439. Rheumatic fever;; Mitral Prolapse;; LV dilation
Q440. Diagnostic tests for Mitral Regurgitation; Auscultation; EKG; Echo
A440. Auscultation: Loud, holosystolic apical murmur radiating to axilla; EKG: large LA; Echo: valve problem
Q441. Tx for Mitral Regurgitation; (6)
A441. ACEinh;; Diuretics;; Vasodilators;; Digitalis;; Endocarditis prophylaxis;; Surgery if severe
Q442. What murmur is seen in Marfan's syndrome?
A442. Mitral prolapse
Q443. Mean survival rate for patients with Aortic Stenosis and:; 1. Angina; 2. Syncope; 3. Heart failure
A443. 1. 5 years; 2. 2 - 3 years; 3. 1 - 2 years
Q444. Etiology of Aortic Stenosis; (2)
A444. - Calcific disease with age; Bicuspid valve (around age 40)
Q445. Conditions with a wide Pulse Pressure; (6)
A445. WAH-HAH-ide pulse pressure:; Wet beri-beri; Aortic Regurgitation;; Hyperthyroidism;; Hypertension;; Anemia;; Hypertrophic Subaortic Stenosis (IHSS)
Q446. WHat (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation. How is it treated?
A446. Mitral Regurgitation; Aortic Regurgitation; Tx: Emergent surgery
Q447. Classic triad of Sx for Aortic Stenosis; (4) other signs
A447. SAD:; Syncope;; Angina;; Dyspna on Exertion; Others:; Forceful apex beat; narrow Pulse Pressure; Paradoxical S2 split; heard in carotids
Q448. Diagnostic test results for Aortic Stenosis; Auscultation; EKG; Echo; CXR
A448. Auscultation: Loud systolic crescendo-decrescendo murmur;; EKG: LV strain; CXR: calcifications on valve; Echo: diseased valve
Q449. What is the EKG LV strain pattern seen in aortic stenosis?
A449. ST depression & T-wave inversion in I, aVL, V5 & V6
Q450. Tx for aortic stenosis; (2)
A450. - avoid Afterload reducers (ACEinh & beta-blockers); Valve replacement
Q451. (3) main etiologies for Aortic Regurgitation
A451. Aortic root dilatation;; Valvular disease;; Proximal Aortic root dissection
Q452. (3) causes of Aortic root dilatation thereby causing Aortic Regurgitation
A452. Marfan's;; Idiopathic (but inc with HTN);; Collagen vascular disease
Q453. (6) causes of proximal Aortic root dissection thereby causing Aortic Regurgitation
A453. "C 3 SHET":; Cystic medial necrosis (Marfans);; 3rd trimester pregnancy;; Syphilis;; HTN;; Ehlers-Danlos;; Turner's syndrome
Q454. Names of the 7 unique signs of Aortic regurgitation
A454. 1. Water-Hammer pulse; 2. Traube's sign; 3. Corrigan's pulse; 4. Quincke's sign; 5. de Musset's sign; 6. Muller's sign; 7. Duroziez's sign
Q455. Aortic regurgitation sign:; wide pulse pressure presenting w/forceful arterial pulse upswing with rapid falloff
A455. Water-Hammer pulse
Q456. Aortic regurgitation sign:; pistol-shot bruit over femoral pulse
A456. Traube's sign
Q457. Aortic regurgitation sign:; unusually large carotid pulsations
A457. Corrigan's pulse
Q458. Aortic regurgitation sign:; pulsatile blanching & reddening of fingernails upon light pressure
A458. Quincke's sign
Q459. Aortic regurgitation sign:; head bobbing caused by carotid pulsation
A459. de Musset's sign
Q460. Aortic regurgitation sign:; pulsatile bobbing of the uvula
A460. Muller's sign
Q461. Aortic regurgitation sign:; to-&-fro murmur over femoral artery (heard best with mild pressure applied to artery)
A461. Duroziez's sign
Q462. Murmur presentation:; dyspnea, orthopnea, paroxysmal noctournal dyspnea, angina, LV failure,; wide pulse pressure
A462. Aortic regurgitation
Q463. Murmur presentation:; starts asymptomatic, then dyspnea, angina, syncope, heart failure
A463. Aortic stenosis
Q464. Murmur presentation:; mostly asymptomatic, atypical chest pain, SOB, fatigue
A464. Mitral Prolapse
Q465. Murmur presentation:; dyspnea, fatigue, weakness, cough, A-fib, systemic emboli
A465. Mitral Regurgitation
Q466. Murmur presentation:; DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice
A466. Mitral stenosis
Q467. How do you diagnose LVH from a ECG?; (2)
A467. 1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small); 2. R-wave in V5 or V6 > 25 small boxes OR R-wave in lead aVL > 11 small boxes
Q468. Diagnostic tests for Aortic Regurgitation; Auscultation (3); EKG
A468. Auscultation:; 1. Holosystolic, blowing decrescendo diastolic murmur; 2. Apical diastolic rumble (mitral stenosis without snap); 3. Midsystolic flow murmur at base; EKG: LVH; Echo: regurgitant valve