Step 2 Cs Kaplan Notes

Front 1

what is metabolic syndrome X?

Back 1

hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyeruricemia, htn.
key: insulin resistance

Front 2

what does stress ECG tell?

Back 2

is stable angina: see subendocardial ischemia, producing ST DEPRESSION, next onto cardiac catheterization

Front 3

what to use for pharmacologic stress test?

Back 3

adenosine, dipyromidole, dobutamine. first 2 are vasodilators, dobutamine increased oxygen demand by increasing HR, BP, and contractility

Front 4

stable angina

Back 4

fixed atherosclerotic lesions, due to an imbalance b/t supply and demand. In exercise, demand is UP!

Front 5

unstable angina

Back 5

demand is unchanged!
supply is decreased, stenosis enlarged via thrombosis, hemorrhage or plaque rupture. ST segment ELEVATION

Front 6

varient angina

Back 6

associated with ventricular arrhythmias
ST ELEVATION (transmural)
Coronary angiography is definitive test - see vasospasm with ergonovine

Front 7

MI ECG

Back 7

early: peaked T waves
diagnostic: ST elevation
late: Q waves for necrosis
Sensitive: T wave inversion, not specific

Front 8

when to thrombolysis

Back 8

best in 6 hrs, ok in 24 hrs
indication: ST elevation in 2 contiguous ECG leads in pt with pain and refractory to nitroglycerin

Front 9

anterior MI

Back 9

ST elevation in V1-V4
Q waves in V1-V4

Front 10

Posterior MI

Back 10

large R wave in V1 and V2
ST depression in V1 and V2
upright and prominent T waves in V1 and V2

Front 11

Lateral MI

Back 11

Q waves in leads I and AVL

Front 12

Inferior MI

Back 12

Q waves in leads II, III, AVF

Front 13

Ventricular pseudoaneurysm after MI

Back 13

incomplete free wall rupture, surgical emergency because they tend to become a free-wall rupture

Front 14

Ventricular aneurysm

Back 14

rarely ruptures, increased tachyarrhythmias, medical management, happens 1 month after with pansystolic murmur at apex radiating to axilla. persistent ST elevations, CHF, mitral regurg

Front 15

high-output heart failure

Back 15

anemia, pregnancy, hyperthyroidism, AV fistulas, wet beriberi(thiamine B1 deficiency), Paget's disease of bone, mitral regurg, aortic insufficiency

Front 16

S3

Back 16

rapid filling phase into a noncompliant LV chamber, MOST SPECIFIC SIGN OF CHF. best at apex with bell of stethoscope. ken-tuck-Y

Front 17

S4

Back 17

atrial systole into a noncompliant LV chamber. . best at LSB with bell of stethoscope. Ten-nes-see

Front 18

Multifocal Atrial Tachycardia

Back 18

severe COPD
variable P waves morphology(at least 3) and variable PR and RR interval,
improve oxygenation and ventilation.
if LV works: use CCB, B-blockers, dig, amiodarine
if LV doesnt work: use dig, diltiazem or amiodarone

Front 19

Paroxysmal Supraventricular Tachycardia

Back 19

AV nodal reentrant tachycardia, orthodromic AC reentrant tachycardia.
causes: ischemic heart disease, Digoxin toxicity, AV node reentry, atrial flutter, AV reciprocating tachycardia, excessive caffeine or alcohol consumption

Front 20

PSVT DOC

Back 20

IV adenosine

Front 21

WPW syndrome

Back 21

delta wave.
treatment: radiofrequency catheter ablation. Avoid drugs that act on the AV node like digoxin.

Front 22

hypertrophic cardiomyopathy

Back 22

loud S4
decreased with squatting, lying down, or straight leg raise (due to increased LV filling)
increased with Valsalva and standing(decreased LV filling)
best at LLSB

Front 23

restrictive Cardiomyopathy

Back 23

No PP, no Kussmauls

Front 24

constricitve pericarditis

Back 24

No PP, YES to Kussmauls (JVD fails to decreased during inspirations.
JVD - most proinent physical finding, displays prominent X and Y descents
Pericardial Knock - corresponding to the abrupt cessation of ventricular filling

Front 25

pericardial effusion

Back 25

water bottle appearance
enlarged heart without pulmonary vascular congestion
electrical alternans - QRS amplitude vary from beat to beat.

Front 26

cardiac tamponade

Back 26

elevated JVD, prominent X descent with absent y descent
narrowed pulse pressure (due to decreased stroke volume)
Pulsus paradoxus - decrease in arterila pressure during inspiration (>10 mmHg drop). distant heart sounds, hypotension.
electrical alternans - pendular swinging of the heart within the pericardial space.

Front 27

mitral stenosis

Back 27

rheumatic heart disease
opening snap with low-pitched diastolic rumble and presystolic accentuation, murmur increase in length as disease worsens.
bell in left lateral decubitus position.
distance between S2 and opening snap shortens as disease worsens

Front 28

aortic stenosis

Back 28

calcification of aortic valve (bicuspid or tricuspid), rheumatic fever.
harsh crescendo-decrescendo systolic murmur.
heard in 2nd right intercostal space, radiates to carotid
parvus et tardus - diminished and delayed carotid upstrokes, precordial thrill

Front 29

aortic regurg

Back 29

infective endocarditis, aortic dissection, rheumatic fever, Marfan's syndrome, Ehlers-Danlos, SLE, ankylosing spondylitis, syphilis, OI, Behcets, Reiters,
Widened pulse pressure, diastolic decresendo murmur best heard at LSB. Corrigan's pulse (water-hammer pulse), Austin-Flint murmur - low pitched diastolic rumble due to narrowing of mitral valve orifice by aortic reguar, resulting in relative mitral stenosis
De Musset's sing - head bobbing, Muller's sign: uvula bobs, Duroziez's sign: pistol-shot sound in femoral arteries

Front 30

mitral regurg

Back 30

endocarditis, MI complication, rheumatic fever, Marfan's,
Holosystolic murmur at apex, radiates to back or clavicular area.

Front 31

Tricuspid Regurg

Back 31

IV drug use
RVF, pulsatile liver, holosystolic murmur at LLSB

Front 32

mitral valve prolapse

Back 32

excess mitral leaflet tissue due to myxomatous deg of mitral valve leaflets or chordae tendineae.
Marfans, OI, Ehlers-Danlos syndrome
midsystolic or late systolic clicks, mid to late systolic murmur. valsalva increase murmur because reduce LV chamber size

Front 33

Rheumatic heart disease

Back 33

EMMACCN
MAJOR: erythema marginatum, migratory polyarthritis, cardiac involvement, chorea, subcu nodules
MINOR: fever, elevated ESR, polyarthralgia, prior history of rheumatic fever, prolonged PR interval, evidence of preceding strep infection.

Front 34

endocarditis

Back 34

native valve: s. viridans, staph aureus, enterococci, HACEK
prosthetic valve: staph epidermidis
IV drug: staph aureus

Front 35

Leriche's syndrome

Back 35

atheromatous occlusion of distal aorta just above bifurcation causing bilateral claudication, impotence, and absent/diminished femoral pulses.