Step Up Usmle World Cardiovascular

Front 1

sx of dilated cardiomyopathy

Back 1

CHF, angina

Front 2

complications of dilated cardiomyopathy

Back 2

CHF, dysrhythmias, thrombus

Front 3

causes of dilated cardiomyopathy

Back 3

- infections
- toxic (alcohol, heavy metals)
- endocrine (thyroid, pheo)
- metabolic (thiamine ==> wet beriberi, hypo ca and phos)

Front 4

tx for CHF

Back 4

- ACE inhibitor, diuretics

Front 5

first line treatment for afib? second line?

Back 5

CCB
- BB is second line
- long term: if >60y.o., add warfarin

Front 6

finding of a fib?

Back 6

- irregularly irregular rate
- ECG: irregular p waves, variable R-R interval
- Echo: clot in L. atrium

Front 7

when to cardiovert in a fib?

Back 7

- if unstable, after rate control
- note: preferred over pharm cardioversion

Front 8

Types of endocarditis?

Back 8

acute and subacte

Front 9

cause of acute endocarditis?

Back 9

s. aureus on healthy valves

Front 10

causes of subacute endocarditis?

Back 10

previously damaged valves
- strep viridians, GAS, streptococci, enterococci, candida

IV drug users
- staph aureus, GAS, enterococci

prosthetic valves
- s. aureus, viridians

Front 11

tx for strep?
- staph?
- MRSA?

Back 11

PCN G
- naficillin, oxacillin
- Vanco

Front 12

def and dx pulsus paradoxus

Back 12

- decrease in systolic BP with inspiration
caridac tamponade

Front 13

aortic stenosis hx?

Back 13

sycope with exertion

Front 14

What are the sx of hypertrophic cardiomyopathy?

Back 14

- angina at rest and exercise, unresponsive to nitro
- syncope after exercise

Front 15

describe the mumur with hypertrophic cardiomyopathy?

Back 15

- systolic ejection murmur, LSB
- decreases with squatting (increased LV blood volume), increases with higher blood velocities
- paraoxical splitting of S2 (A2 occurs after P2 ==> split during exhalation instead of inhalation)

Front 16

paradoxical splitting of S2 suggests what?

Back 16

hypertrophic cardiomyopathy

Front 17

What drugs to give in hypertrophic cardiomyopathy? What drugs to avoid in hypertrophic cardiomyatophy

Back 17

first line: beta blockers ==> decrease heart rate ==> increases filling time
second line: CCB
avoid anything that decreases preload: nitrates, diuretics, volume depletion

Front 18

which genetic dz are associated with aortic dissection?

Back 18

Marfan's, ehler's danlos, turner's

Front 19

which drug is associated with aortic dissection?

Back 19

cocaine

Front 20

which murmur may be heard with aortic dissection?

Back 20

aortic regurgitation

Front 21

CXR of aortic dissection?

Back 21

widened mediastinum

Front 22

tx for aortic dissection

Back 22

BP control!
- BB esp esmolol (short acting IV) or propranolol, nitroprusside to keep sBP < 120

Front 23

chest pain relieved by sitting up and leaning forward indicates?

Back 23

pericarditis

Front 24

diffuse ST segment elevation and ST depression in aVR indicates

Back 24

pericarditis

Front 25

ECG of pericarditis?

Back 25

diffuse ST segment elevation and ST depression in aVR indicates

Front 26

autoimmune dz associated with pericarditis?

Back 26

SLE, scleroderma i.e. collagen vascular dz

Front 27

what is dressler's syndrome?

Back 27

- sx of fever, pericarditis,
- occurs 1 wk-1 mo after MI
- immunologic
- give NSAIDs and steroids

Front 28

tx for pericarditis?

Back 28

NSAIDs for pain and inflammation
- steroids if really bad

Front 29

Causes of MR?

Back 29

acute: endocarditis, papillary rupture from MI
chronic: rheumatic fever, LV dilation, mitral prolapse

Front 30

cause of rheumatic fever

Back 30

GAS

Front 31

complications of rheumatic fever?

Back 31

mitral stenosis and a fib

Front 32

which Ab titer is found in rheumatic fever?

Back 32

antistreptolysin-O

Front 33

what is beck's triad

Back 33

hypotension, elevated JVD, muffled heart sounds = PERICARDIAL TAMPONADE

Front 34

what is electrical alternans?

Back 34

- ECG finding for pericardial tamponade
- alternating beat variation from pendular swing of heart in fluid creating motion artifact

Front 35

ECG finding for pericardial tamponade?

Back 35

electrical alternans

Front 36

diagnostic test for pericardial tamponade?

Back 36

MUST DO ECHO

Front 37

diastolic dysfx etiology?

Back 37

HTN

Front 38

pathophys of diastolic dysfx?

Back 38

- impaired ventricular filling due to poor myocardial relaxation or decreased ventricular compliance

Front 39

tx for viridians endocarditis?

Back 39

IV PCN G or IV cetriaxone

Front 40

what assessment do you have to make for vtach tx?

Back 40

- hemodynamically stable: alert, AAOx3, normal K, normal BP
- unstable

Front 41

tx for heme stable vtach?

Back 41

IV amiodarone, procainamide, sotalol, lidocaine, bretrylium

Front 42

tx for heme unstable vtach?

Back 42

electrical cardioversion

Front 43

rate for Vtach?

Back 43

100-250

Front 44

wide QRS complex versus narrow?

Back 44

wide = v tach
narrow = SVT

Front 45

carotid massage is used for what?

Back 45

resolve SVT

Front 46

causes of vtach/vifb

Back 46

torsades de pointes, WPW w/ afib and rapid ventricular rate

Front 47

def of bradycardia

Back 47

< 60 bpm

Front 48

adenosine vs atropine

Back 48

adenosine: purine nucleoside ==> inhibits SA node pacemaker current ==> good for tx of AV block in SVT

atropine: muscarinic receptor antagonist ==> inhibits vagal activation of heart ==> good for tx of bradycardia

Front 49

tx of bradycardia

Back 49

atropine

Front 50

tx of SVT

Back 50

adenosine

Front 51

drugs that cause bradycardia?

Back 51

digioxin, CCB, BB

Front 52

first line tx for PSVT prevention

Back 52

digoxin!

Front 53

tx for recurrent or sympt PSVT

Back 53

radiofrequency catheter ablation

Front 54

two different pathophys for PSVT

Back 54

- AV nodal reentrant: 2 pathways in AV node ==> reentry occurs in AV node
- orthodromic AV reentrant: accessory pathway between atria and ventricles that conducts retrogradely

Front 55

digoxin toxicity

Back 55

paroxysmal atrial tachycardia and 2:1 heart block

Front 56

first degree heart block

Back 56

increased PR interval

Front 57

2nd degree mobitz 1

Back 57

aka wenchebach
- progressive PR prolongation until beat is dropped

Front 58

2nd degree mobitz 2

Back 58

finxed prolonged PR interval followed by dropped beat at regular interval

Front 59

3rd degree block

Back 59

independent atria and ventricles

Front 60

tx for heart blocks

Back 60

1st- none
2nd type 1 - atropine, temporary pacing
2nd type 2 - PACEMAKER, can degenerate into complete heart block
3rd - PACEMAKER

- temporary pacing before pacemaker: atropine, temporary pacing

Front 61

ddx aortic stenosis vs regurg sx

Back 61

stenosis- pulsus parvus et tardus -- quet and slow

regurg: water hammer pulse worse with lying down and lying of left side (heart closer to wall)

Front 62

aortic regurg etiology

Back 62

- aortic root dilation (marfan)
- rheumatic heart disease, endocarditis
- bicuspic aortic valve
- 3rd trimester pregnancy

Front 63

3rd trimester pregnancy is associated with which heart mumur?

Back 63

aortic regurg

Front 64

collagen vascualr dz, marfan, erhlos, is associated with which valve problems?

Back 64

aortic dissection, aortic regurg, mitral valve prolapse

Front 65

demusser's sign

Back 65

bobbing of head with heart beat seen with aortic regurg

Front 66

hill's sign

Back 66

systolic pressure in legs >20 mmHg higher than in arms

Front 67

sx of wide pulse pressure?

Back 67

water hammer pulse

Front 68

sx of aortic regurg

Back 68

dyspnea, orthopnea, PND, angina, water hammer pulse, demusser's sign, quincke's sign, hill's sign

Front 69

quincke's sign

Back 69

alternating blushing and blanching of fingernails w/ gentle pressure in aortic regurg

Front 70

periumbilical diastolic - systolic bruit

Back 70

renal artery stenosis

Front 71

renal artery stenosis auscultation

Back 71

periumbilical diastolic-systolic brui

Front 72

findings in cardiogenic shock

Back 72

decreased CO, increased pulmonary wedge capillary pressure which reflects L. ventricular function and thus suggests LV failure

Front 73

findings in volume overload

Back 73

normal or increased CO and increased pulmonary wedge capillary pressure

Front 74

what indicates severe heart failure?

Back 74

hyponatremia b/c it's a sign of high neurohumoral activation ==> renin angiotensin, vasopressin, norepinephrine, etc
- indicates increased mortality

Front 75

characteristics of PVCs

Back 75

- widened QRS, compensatory pause, weird morphology

Front 76

tx for PVCs

Back 76

- asympt: observe, antiarrhyth increases mortality
- sympt: beta blocker

Front 77

what decreases murmur of mitral prolapse?

Back 77

squatting

Front 78

sx of mitral prolapse?

Back 78

atypical pain

Front 79

tx for mitral prolapse?

Back 79

endocarditis prophylaxis

Front 80

who usually has mitral prolapse?

Back 80

90% women

Front 81

BP of cardiac tamponade?

Back 81

HYPOTENSIVE

Front 82

what new heart sound can be heard with MI?

Back 82

new S4
- ischemia ==> diastolic dysfx ==> stiffened LV ==> atrial dysfx

Front 83

what is amlodipine?

Back 83

CCB, used for BP control

Front 84

which has a greater affect on BP, alcohol or smoking?

Back 84

alcohol