The Rest

Front 1

s/sx of right HF

Back 1

perpheral edema, JVD, hepatosplenomegaly, dyspnea on exertion

Front 2

s/sx of left HF

Back 2

pulmonary crackles, orthopnea, paroxysmal nocturnal dyspnea, dyspnea on exertion

Front 3

systolic HF

Back 3

heart dilates and becomes floppy--cannot pump the blood out (most commonly due to ischemia, also EtOH, drugs)

Front 4

diastolic HF

Back 4

inability of heart to relax--poor filling (d/t pericarditis or infiltration of the heart muscle like with restrictive cardiomyopathy)

Front 5

Best dx of CHF

Back 5

Echo: decreased EF (systolic). impaired relaxation (diastolic)

Front 6

other dx of CHF

Back 6

EKG

BNP

Left heart cath

Front 7

Tx of CHF

Back 7

Limit fluid intake (<2L/day)

Limit salt intake (<2g/day)

Beta Blocker

ACE inhibitor

Furosemide

Spironolactone

If EF<35%--- AICD (automated internal cardiac defibrillator)

If dying-- inotropic support (Dobutamine)

Front 8

CHF exacerbation dx

Back 8

Echo

BNP (will be higher)

Trops and EKG

Front 9

CHF exacerbation tx

Back 9

L: lasix
M: morphine
N: nitrates
O: oxygen
P: position

Front 10

grades of murmurs

Back 10

I: S1 and S2 > murmur

II: S1 and S2 = murmur

III: S1 and S2 < murmur

IV: palpable thrill

V: hear with stethoscope just over chest

VI: hear without stethoscope

(only need to workup if a systolic murmur is > grade II, or any diastolic)

Front 11

dx of a murmur

Back 11

echo

Front 12

mitral stenosis path

Back 12

rheumatic heart disease--- inflammation

Front 13

Sx of mitral stenosis

Back 13

CHF sx

A fib

Front 14

Auscultation MS

Back 14

heard best at apex, in left lateral recumbant position.

rumbling diastolic murmur with opening snap

Front 15

tx MS

Back 15

Balloon valvuloplasty (only murmur that you can do this)

Front 16

Aortic regurgitation sx

Back 16

L HF d/t floppy aortic valve-- allows backflow

chest pain

Front 17

AR cause

Back 17

infxn (endocarditis)

infarction

aortic dissection

Front 18

AR auscultation

Back 18

Heard at 2nd intercostal space on R of sternum. With pt sitting, leaning forward.

rumbling diastolic murmur.

Front 19

Aortic stenosis sx

Back 19

CHF sx

chest pain

syncope

Front 20

AS path

Back 20

atherosclerosis--calcium deposits

(AS)--leads to AS

Front 21

AS ausculation

Back 21

heard best at 2nd intercostal at R sternal border.

Systolic, crescendo-decrescendo murmur

radiates to carotids

Front 22

AS tx

Back 22

B Blocker for sx (angina)

valve replacement

Front 23

Mitral regurgitation sx

Back 23

CHF sx

A-fib

Front 24

MR path

Back 24

backflow into L atrium d/t floppy valve, caused by infxn or infarction

Front 25

MR auscultation

Back 25

heard best at apex

holosystolic, high-pitched, blowing murmur

increases with handgrip, decreases with valsalva.

radiates to axilla

Front 26

MR tx

Back 26

valve replacement

Front 27

What increases and decrease aortic and mitral murmurs

Back 27

increases: squatting, leg lift

decreases: valsalva

Front 28

MVP path

Back 28

valves too big, so they do not close correctly--allows blood to leak through

Front 29

What improves MVP?

Back 29

Squatting

Front 30

MVP auscultation

Back 30

sounds like MR but improves with squatting.

Mid-systolic click

Front 31

MVP tx

Back 31

B-blocker

Avoid dehydration

Front 32

Pulmonic stenosis eti

Back 32

congenital, associated with Noonan's syndrome

Front 33

PS sx

Back 33

asx--> dyspnea and fatigue

Front 34

PS auscultation

Back 34

heard best at 2nd intercostal on left sternal border

Systolic, widely split S2

increases with inspiration

Front 35

PS tx

Back 35

balloon valvuloplasty

Front 36

Most common murmur in US

Back 36

MR

Front 37

Tricuspid regurg path

Back 37

pulmonary HTN--> RV dilation

Front 38

TR sx

Back 38

R HF sx

Front 39

TR auscultation

Back 39

heard at 4th intercostal space L sternal border

holosystolic, blowing.

increased with inspiration, decreased with expiration or valsalva

Front 40

TR tx

Back 40

tx underlying cause of HF

If pulmonary HTN-- surgical repair of valve

Front 41

Tricuspid stenosis path

Back 41

rheumatic heart disease, usually occurring in conjunction with MS

Front 42

Which murmur increases risk for endocarditis?

Back 42

PS-- PPX with amox, amp, or clinda

Front 43

TS sx

Back 43

CHF sx

Fatigue

Front 44

TS auscultation

Back 44

heard best 4th intercostal L sternal border.

Diastolic rumbling murmur.

Increased with inspiration, decreased with expiration and valsava

Front 45

TS tx

Back 45

surgical repair of valve at same time as MS repair

Front 46

Pulmonic regurgitation path

Back 46

severe pulmonary HTN--> dilates the pulmonic annulus

Front 47

PR auscultation

Back 47

Graham Steell murmur

2nd intercostal space, L sternal border

Diastolic, blowing, high-pitched, decrescendo.

Front 48

What murmur does Austin-Flint go with?

what does it sound like

Back 48

Aortic regurgitation

soft, low-pitched, rumbling diastolic murmur.

increased with handgrip

Front 49

Pericarditis presentation

Back 49

pleuritic chest pain, pain better leaning forward.

Friction rub

Front 50

Pericarditis dx

Back 50

ECHO

MRI* is best, but not done

EKG

Front 51

Pericarditis EKG

Back 51

global ST elevation

PR segment depression is pathognomic

Front 52

Pericarditis tx

Back 52

NSAIDs

Steroids

Front 53

Pericardial effusion presentation

Back 53

Pericarditis sx (pleuritic chest pain, better leaning forward)

Front 54

Dx of pericardial effusion

Back 54

seen best on ECHO

Front 55

Recurrent pericardial effusion tx

Back 55

*done if tx pericarditis did not work

Surgery to cut a pericardial window--allows drainage, but does change fluid production

Front 56

Cardiac tamponade path

Back 56

blood in the pericardial space-->heart cannot contract.

Pressure has to be >15 mmHg

Front 57

Beck's triad

Back 57

*with tamponade

JVD

distant heart sounds

Hypotension

Front 58

Dx and tx of tamponade

Back 58

ECHO and pericardial window--only done if not dying or if already going to OR.

If dying-- pericardial centesis NOW.

IVF

Front 59

Constrictive pericarditis auscultation

Back 59

Pericardial knock

Front 60

Constrictive pericarditis ECHO

Back 60

shows rigid, constrictive/fibroticness of pericardium

Front 61

Constrictive pericarditis tx

Back 61

remove pericardium

Front 62

Cholesterol screening

Back 62

at 20 and q5 yrs

Front 63

Statin side effect

Back 63

myositis, increase LFTs

Front 64

Drug best for high triglycerides

Back 64

Fibrates

SE: myositis and LFTs

Front 65

SE of Niacin

Back 65

Flushing--which can be treated with ASA

Front 66

S/sx of a left to right shunt

Back 66

increased pulmonary pressure and pulmonary HTN. R ventricular hypertrophy.

NOT cyanotic

Front 67

Atrial septal defect presentation

Back 67

*presents at any age

fixed split S2

Front 68

ASD dx and tx

Back 68

ECHO

Close the hole--by cath (if small) or surgery

Front 69

Ventricular septal defect presentation

Back 69

*baby

either loud murmur, asx.

Or: soft murmur with CHF

Front 70

VSD auscultation

Back 70

harsh holosystolic murmur (like MR).

Front 71

most common congenital defect of the heart

Back 71

VSD

Front 72

VSD tx

Back 72

if asx--wait till 1 yr, may close on it's own.

sx: reduce afterload, digoxin, diuretics.

sx or 1 yr and large--surgically close defect

Front 73

what is Patent ductus arteriosis

Back 73

path between aorta and pulmonary artery

(Left to right)

Front 74

PDA auscultation

Back 74

*infant

Machine like murmur

Front 75

PDA tx

Back 75

Indomethacin

Surgical closure

Front 76

Right to left shunt s/sx

Back 76

cyanotic defects

decreased flow to the lungs

Front 77

Transposition of the great vessels; who?

Back 77

babies from DM mothers (not gestational).

b/c the defect at 8 wks, before gest DM would occur.

Front 78

Transposition of the great vessels tx

Back 78

Prostaglandins--to keep PDA open

then surgery

Front 79

what genetic disorder is associated with Tetralogy of Fallot

Back 79

Down's syndrome

Front 80

Components of ToF

Back 80

large VSD

overriding aorta

pulmonary stenosis

R ventricular hypertrophy

Front 81

ToF presentation

Back 81

blue baby, dyspnea

Or: child with TET spells (dyspnea resolved with squatting)

Front 82

CXR of ToF

Back 82

boot shaped heart

Front 83

Coarctation of the aorta presentation

Back 83

rib notching d/t collateral circulation through costal vessels.

Claudication

High BP in upper extremities

Low BP in lower extremities

Front 84

Coarctation of the aorta dx

Back 84

angiogram

Front 85

SVT EKG

Back 85

150-250

no discernible p or t waves, chaotic baseline

Front 86

SVT tx

Back 86

adenosine

synchronized cardioversion

Front 87

A fib EKG

Back 87

irregularly irregular, no discernible p waves

Front 88

cardioversion for a fib

Back 88

if <48 hours--cardiovert

if >48 hrs--if TEE neg. can cardiovert. If pos. coumadin x4 wks before cardioversion.

Front 89

Torsades

Back 89

wide complex, irregular, big small big small.

common in preggers.

From low K, Give mag

Front 90

V tach EKG

Back 90

tombstones; wide complex, regular

Front 91

V tach tx

Back 91

amiodorone

synchronized cardioversion

Front 92

WPW EKG

Back 92

Delta wave

Front 93

arrhythmia with brady and tachycardia

Back 93

Sick sinus syndrome (SA node dysfunction)

Front 94

sinus brady tx

Back 94

atropine

Front 95

Sick sinus tx

Back 95

pacemaker

Front 96

1st degree heart block EKG

Back 96

prolonged PR interval, each one the same

Front 97

2nd degree heart block Weinckebock

Back 97

PR interval gradually lengthens, then dropped p wave

Front 98

2nd degree heart block type II

Back 98

PR interval prolonged and fixed, randomly drops p waves

Front 99

3rd degree heart block

Back 99

p wave and QRS are divorced. Each has a regular rhythm/rate but they are different from each other.

Front 100

Cardiogenic shock definition/presentation

Back 100

hypotension with normal volume, with tissue hypoxia (cold extremities, cyanosis)

usually tachycardic

Front 101

Tx thrombophlebitis

Back 101

remove IV

NSAIDs

LMWH

Front 102

most commonly affected vein in varicose veins

Back 102

greater saphenous

Front 103

stasis dermatitis

Back 103

itchy, associated with varicose veins

Front 104

venous insufficiency presentation

Back 104

brawny skin color, itchy legs, pitting edema, varicose veins, ulcers

Front 105

Osler nodes and Janeway lesions

Back 105

with bacterial endocarditis

Osler nodes: painful red, raised lesions on hands and feets

Janeway: nontender, small lesions, maculopapular on palms and soles

Front 106

Subungual splinter hemorrhages with what?

Back 106

bacterial endocarditis

Front 107

dx bacterial endocarditis

Back 107

TEE-- inflammation, vegetations, abcsess

blood cx

Front 108

tx bacterial endocarditis

Back 108

IV vanco and ceftriaxone 4-6 wks

Front 109

Pulsus paradoxis

Back 109

with Tamponade and pericarditis, OSA, croup, COPD.

abnormally large decrease in systolic BP and pulse wave amplitude during inspiration

Front 110

dx for cardiogenic shock

Back 110

Lactate levels--tells you severity

Front 111

MOA of thiazides

Back 111

inhibit Reabsorption of sodium in the distal convoluted tubule

Front 112

tx coarctation of aorta

Back 112

prostaglandins to keep PDA open until you can do surgery

Front 113

ASD tx

Back 113

Lasix

Front 114

drug for tet spells

Back 114

Propranolol

Front 115

Duke's criteria

Back 115

*infective endocarditis

Major: 2 + blood cx, echo showing vegetations, or new regurgitant murmur

*need 2 major, or 1 major and 3 minors, or 5 minors

Front 116

most common tumor in heart

Back 116

sarcoma