Usmle Ck - Cardiology

Front 1

mitral stenosis?

Back 1

- increased left atrial pressure => pulm congestion => EXERTIONAL DYSPNEA, NOCTURNAL COUGH, HEMOPTYSIS!
- increased afib => stroke
- always think whenever from underdeveloped contries => rheumatic fever

Front 2

aortic insufficiency

Back 2

- rheumatic fever, syphillis

Front 3

a fib

Back 3

- narrow QRS, irregular beat
- if heme stable = amiodarone, quinidine, digoxin
- if unstable = cardioversion

Front 4

s/p MI with cold leg

Back 4

- due to thrombus
- do ECHO

Front 5

holosystolic murmur?

Back 5

- mitral regurg, radiates to axilla => increased left atrial pressure, decreased cardiac output => fatigue, exertional dyspnea
- 2/2 rheumatic heart disease, infective endocarditis, trauma, ischemic heart disease

Front 6

Aortic aneurysm heart sound

Back 6

- aortic regurg = diastolic murmur

Front 7

tx of stable agina and HTN?

Back 7

- BB

Front 8

vasovagal syncope

Back 8

- common faint
- neuronally or neurocardiogenic syncope
- provoked by emotion, rapid recovery
- do upright tilt table test

Front 9

NE induced vasospams

Back 9

- alpha 1 agonist => vasoconstrict => increase blood flow in hypoT pts, but can cause ischemic fingers and toes, mesenteric ischemia, renal failure
- pt s/p MVA => hypoT => given NE now with blue fingers

Front 10

heart sound associated with MI?

Back 10

- 4th heart sound 2/2 diastolic dysfunction => stiff left ventricle => atrial gallop = 4th heart sound

Front 11

MI vs GERD?

Back 11

- sx of raidation, diaphoreis, N/V i.e autonomic dysfunction

Front 12

pulsus paradoxus

Back 12

- decreased SBP with inspiration = cardiac tamponade

Front 13

Conn's syndrome

Back 13

- primary aldo
- young white man with increased BP, weakness and exercise intolerance
- decreased bicarb, low K = exercise intolerance
- check renin/aldo

Front 14

tx of afib? if afib 2/2 WPW?

Back 14

- afib: nodal blockers: BB, CCB, digoxin, adenosine
- WPW: cardioversion or procainamide

Front 15

SVT vs VT

Back 15

- tachy with no p waves, regular beat NARROW QRS; tx by adenosine or carotid massage; if doesn't work = CCB, BB or cardioversion
- VT = WIDE QRS COMPLEX, use amiodarone, lidocaine

Front 16

dx of prinzmetal's angina or variant angina?

Back 16

- episodes of CP in middle of night that resolves or 2/2 exercise, hyperventilation, cocaine,
- see ST segment ELEVATIONS that resolve
- NOTE: if unstable angina, see ST segment DEPRESSIONS
- tx: CCB, nitrates

Front 17

pt with LOC while shoveling?

Back 17

- aortic stenosis
- sx of heart failure = fatigue, exertional dyspnea
- hear systolic EJ murmur that radiates to carotids
- pulsus parvus et tardus (rises slowly, delayed break)

Front 18

opening snap

Back 18

- mitral stenosis
- hear late diastolic murmur
- pulm edema, afib

Front 19

capillary pulsations

Back 19

- aortic regurg, chronic heart failure

Front 20

ACE-I is used as first line in?

Back 20

- DM, CHF, MI, CKD

Front 21

orthostatic hypoT

Back 21

- decreased constriction and resistance in lower blood vessels while standing 2/2 defect in autonomix reflexes, decreased intravascular volume, meds
- if OLD PERSON: decreased baroreceptor sensitivity, arterial stiffness, decreased NE, decreased snesitivity to sympathetic stimulation

Front 22

water hammer pulse

Back 22

- bounding pulse = aortic regurg 2/2 increased SV => increased SBP and riapid distension of peripheral arteries => low DBP b/c regurge back into LV => collapse of peripheral vessels
- pt with exertional SOB, HA, chest discomfort

Front 23

split S2

Back 23

- ASD

Front 24

pulseless VT

Back 24

- immediate cardioversion

Front 25

VFib

Back 25

- if witnessed and < 5 min = immediate defib
- if > 5 min or unwitnessed = CPR then defib
- after one round of defib, give epi and antiarrhythmias

Front 26

digoxin

Back 26

- used for atrial tachy

Front 27

what to monitor in statin use?

Back 27

- CPL for liver injury, increased LFTs

Front 28

tx of systolic dysfx heart failure?

Back 28

- always give ACE-I

Front 29

EtOH dilated cardiomyopathy

Back 29

- CHF, normal coronary arteries, thrombocytopenia, macrocytosis, increased LFTs
- STOP DRINKING

Front 30

pt tx for CAD with MONA-B now with SOB?

Back 30

- check for hx of asthma, COPD => SOB 2/2 BB

Front 31

paroxysmal SVT

Back 31

- common cause of tachy in people without structure heart disease 2/2 re-entry into AV node
- tx: vasal maneuvers e.g valsalva, carotid massage, cold water => increased vagal tone => decreased conduction through AV node => decreases HR or adenosine

Front 32

pt splashes cold water to relieve palpitations?

Back 32

- PSVT

Front 33

chat is C/I in MI?

Back 33

- CCB 2/2 vasodilation => tachy => increased ischemia
- heparin in good

Front 34

hemochromatosis

Back 34

- can present as older pt with lethargy, decreased libido, testicular atrophy, hepatomegaly
- heart diz: dilated or restrictive cardiomyopathy

Front 35

S4?

Back 35

- can be normal in young pts with LVH
- hypertensive cardiomyopathy

Front 36

Kussmaul's sign

Back 36

- increased JVP with deep inspiration
- 2/2 RV failure, constrictive pericarditis

Front 37

arrhythmia vs seizure

Back 37

- both can have myoclonic jerks
- if old man, no hx of seizure then unlikely seizure
- arrhythmia: sudden syncope without warning signs, hx structural heart dz (hx MI, heart sounds), thiazide use that causes electrolyte abnormalities

Front 38

pt with dyspnea 2/2 heart reasons?

Back 38

- symptom tx = nitroglycerin (quicker than morhpine or loop diuretic)
- e.g. pt with uncontrolled HTN now with dyspnea
- NOTE: BB may worsen b/b negative ionotrop

Front 39

- decreased systolic EJ with squatting?

Back 39

- hypertrophic cardiomyopathy
- decreased b/c increased preload stretches heart => decreases obstruction
- most murmurs increase with squatting
- AA> white, AD

Front 40

any diastolic murmur

Back 40

- get ECHO not EKG

Front 41

heart sounds
- diastolic murmur
- systolic murmur increased on inspiration
- systiolic murmur increased on standing
- paradoxical S2 splitting

Back 41

- aortic regurg
- tricuspid regurg (IVDU, IE)
- HOCM
- LBBB => delayed closure of aortic valve

Front 42

right ventricular infarction

Back 42

- 30% in MI => see increased JVP, hypoT, celar lungs (seems contradictory)
- nitrates and diuretics are C/I b/c don't want to decrease preload
- tx: IV fluids

Front 43

PCWP

Back 43

- measure of L atrium

Front 44

right heart strain

Back 44

- increased JVP, RBBB on EKG
- SEEN IN MASSIVE PE

Front 45

constrictive pericarditis

Back 45

- sharp x and y descents on central venous tracing
- early heart sound after S2 = pericardial knock
- MCC = TB in developing countries; in US = viral (40%), radiotherapy (30%), cardiac surgery (10%), CT d/o
- affects only diastole

Front 46

trpanosoma cruzi

Back 46

- chagas
- affects systolic and diastolic