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51 Cards in this Set
- Front
- Back
first-line drugs in treatment of cocaine-related cardiac ischemia
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benzos
nitrates aspirin avoid pure beta-blockers |
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conditions that lead to pulsus paradoxus
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cardiac tamponade
pericardial effusion tension pneumothorax severe asthma |
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murmur of hypertrophic cardiomyopathy
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crescendo-decrescendo along LSB without carotid radiation
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medications to withhold before exercise EKG test
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anti-ischemic medications
digoxin heart-slowing meds (e.g. beta blockers) |
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mainfestations of amyloidosis
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proteinuria (deposition in kidney)
easy bruisability (deposition in liver, inhibiting synthesis of clotting factors) restrictive cardiomyopathy with thickened ventricular walls and impaired diastolic function |
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treatment of SVT (hemodynamically stable and unstable)
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stable: vagal maneuvers then adenosine + AV nodal blockers
unstable: DC cardioversion |
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main mechanism of nitroglycerin's pain relief in patients with anginal pain
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venous dilation, leading to increased venous pooling, decreased preload, and decreased heart size/work
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mechanism of hemoptysis in mitral stenosis
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increase in LV pressure transmitted to pulmonary vasculature, resulting in dyspnea, cough, and hemoptysis
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presentation of myocarditis in children
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fever, lethargy, signs of myocardial dysfunction after a viral prodrome
monitor in ICU for arrhythmias and acute decompensation |
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treatment of VTach
both stable and unstable |
stable: amiodarone (or lidocaine)
unstable: cardioversion |
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Cushing's syndrome signs and symptoms
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high BP
high systemic cortisol leading to: hyperglycemia hypokalemia proximal muscle weakness central adiposity thinning of skin weight gain psychiatric problems |
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symptoms of digoxin toxicity
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nausea, vomiting, decreased appetite, confusion, weakness, visual changes
inciting event may be viral illness or excessive diuretic use leading to volume depletion or renal injury, acutely elevating digoxin level |
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symptoms of atrial flutter
what is the electrophysiologic anomaly? |
palpitations, chest pain, SOB, lightheadedness
re-entrant rhythm within the atria, with EKG showing 2:1, 3:1, or 4:1 heart block |
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interventricular free wall rupture v. ventricular free wall rupture v. papillary muscle rupture
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all have peak incidence 3-5 days after MI
interventricular free wall rupture: causes a VSD and new holosystolic murmur ventricular free wall rupture: results in pericardial tamponade with rapid decompensation and PEA papillary muscle rupture: may cause hypotension secondary to acute mitral regurgitation, new onset *apical* holosystolic murmur |
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physical exam finding for hypertrophic cardiomyopathy
what is the mode of inheritance? |
LLSB murmur that decreases with an increase in preload
AD |
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what medication is most effective in decreasing risk of embolic events in patients with atrial fibrillation?
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warfarin
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what is the first step in diagnosis of peripheral artery disease?
what are normal values? |
ankle-brachial index (ABI)
1-1.3 is normal; <0.9 indicates >50% occlusion of a major vessel |
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what is the treatment for patients with right ventricular infarcts?
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IV fluids to maintain a high preload (avoid nitroglycerin and diuretics)
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systolic-diastolic abdominal bruit in a patient with hypertension and atherosclerosis is highly suggestive of:
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renal artery stenosis
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EKG appearance of atrial fibrillation
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irregularly irregular, narrow complex QRS tachycardia that lacks P waves
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for what is pulmonary capillary wedge pressure a surrogate marker?
what is its value in cardiogenic shock? |
left atrial pressure, and usually LV end-diastolic pressure
elevated |
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acute treatment for aortic dissection?
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labetalol (or another beta blocker), since it simultaneously lowers heart rate and blood pressure, reducing aortic wall stress
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hepato-jugular reflex: positive v. negative in the setting of edema
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positive: indicates elevated venous pressure due to heart disease
negative: indicates edema is due to liver disease |
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5 common side effects of amiodarone
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pulmonary toxicity (fibrosis)
thyroid dysfunction (85% low, 15% high) hepatotoxicity corneal deposits (does not require discontinuation) skin changes |
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characteristics of variant (Prinzmetal's) angina
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typically in younger females
episodes characteristically occur at night associated with transient ST elevation smoking is greatest risk factor; treatment with Ca-channel blockers or nitrates |
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sequelae of hemochromatosis
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testicular atrophy
cirrhosis pancreatic fibrosis increased skin pigmentation cardiac conduction anomalies |
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EKG findings in pericarditis
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diffuse ST elevation, with exception of reciprocal depression in aVR
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mechanism of niacin side effects
how can these be avoided? |
release of histamine and prostaglandins
pre-treatment with aspirin |
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primary medical therapy for aortic regurgitation
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vasodilators (e.g. nifedipine)
ACE inhibitors |
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what single medical intervention has greatest impact on decreasing likelihood of arterial aneurysm formation, enlargement, and rupture?
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smoking cessation
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pitting v. non-pitting edema: causes
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pitting: increased mov't of fluid from vascular space to interstitium
non-pitting: lymphatic obstruction or increased interstitial accumulation of albumin/other proteins with low-normal lympatic flow (think myxedema of hypothyroidism) |
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what kind of pulse?
aortic regurgitation aortic stenosis |
"water-hammer" (wide pulse pressure)
"parvus et tardus" |
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Beck's triad for cardiac tamponade
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hypotension
JVD muffled heart sounds |
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most common cause of mitral regurgitation
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mitral valve prolapse
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most effective lifestyle modifications to reduce systolic blood pressure
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intervention (mm Hg SBP decrease)
weight loss (5-20 per 10kg) DASH diet (8-14) decrease dietary Na+ (2-8) 30 min exercise, 5x/week (4-9) decrease alcohol intake (2-4) |
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mechanism of statin-induced myopathy
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inhibition of HMG-CoA to mevalonate leads to paucity of mevalonate for production of CoQ10
reduced CoQ10 implicated in pathogenesis of statin-induced myopathy |
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vasospastic disorders
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Prinzmetal's (variant) angina
Raynaud's phenomenon migraine headache |
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ischemia-reperfusion syndrome: pathophysiology and characteristics
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after 4-6 hours of ischemia, tissues may suffer intracellular and interstitial damage upon reperfusion
creates risk for compartment syndrome (if >30 mmHg, must perform fasciotomy) |
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X-ray appearance of pericardial effusion
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"water bottle" cardiac silhouette
exam findings include diminished heart sounds, difficult-to-palpate PMI |
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troponin T v. CK-MB: when to use
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troponin T: most sensitive/specific in setting of MI, but slow to return to normal
CK-MB: normalizes more rapidly (1-2 days), so useful for detecting new ischemia after initial MI |
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elements of CHADS2 score
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CHF
HTN Age >75y DM Stroke, prior (2 points) |
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what does electrical alternans mean in the context of EKG findings?
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describes QRS complexes whose amplitudes vary from beat to beat; thought to result from heart swinging back and forth within increased pericardial fluid!
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CHF in young healthy patients following viral symptoms?
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likely myocarditis, think Coxsackie B virus
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murmur of aortic regurgitation
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mild AR: early diastolic
severe AR: holodiastolic |
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which heart murmurs increase on expiration?
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left sided heart murmurs
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how does the murmur of hypertrophic cardiomyopathy vary with preload?
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increases with decreased preload, since this lessens the size of the ventricular cavity and causes increased outflow obstruction
likewise, murmur of HCM also decreases with increased afterload due to larger ventricular volume and decrease in outflow obstruction |
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which drugs improve survival in CHF?
which do not? |
ACE inhibitors
ARBs beta-blockers spironolactone digoxin and loop diuretics do not |
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two primary manifestations of Chagas disease (protozoal infection with T. cruzi, common in Latin America)
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megacolon/megaesophagus
cardiac disease |
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what are "non-shockable" rhythms?
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anything other than V-tach or V-fib
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imaging modality of choice for suspected AAA
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abdominal ultrasound
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criteria for Dx of malignant HTN
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>200/140
papilledema on opthalmoscopy |