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51 Cards in this Set

  • Front
  • Back
first-line drugs in treatment of cocaine-related cardiac ischemia
benzos
nitrates
aspirin

avoid pure beta-blockers
conditions that lead to pulsus paradoxus
cardiac tamponade
pericardial effusion

tension pneumothorax
severe asthma
murmur of hypertrophic cardiomyopathy
crescendo-decrescendo along LSB without carotid radiation
medications to withhold before exercise EKG test
anti-ischemic medications
digoxin
heart-slowing meds (e.g. beta blockers)
mainfestations of amyloidosis
proteinuria (deposition in kidney)
easy bruisability (deposition in liver, inhibiting synthesis of clotting factors)
restrictive cardiomyopathy with thickened ventricular walls and impaired diastolic function
treatment of SVT (hemodynamically stable and unstable)
stable: vagal maneuvers then adenosine + AV nodal blockers

unstable: DC cardioversion
main mechanism of nitroglycerin's pain relief in patients with anginal pain
venous dilation, leading to increased venous pooling, decreased preload, and decreased heart size/work
mechanism of hemoptysis in mitral stenosis
increase in LV pressure transmitted to pulmonary vasculature, resulting in dyspnea, cough, and hemoptysis
presentation of myocarditis in children
fever, lethargy, signs of myocardial dysfunction after a viral prodrome

monitor in ICU for arrhythmias and acute decompensation
treatment of VTach

both stable and unstable
stable: amiodarone (or lidocaine)

unstable: cardioversion
Cushing's syndrome signs and symptoms
high BP
high systemic cortisol leading to:
hyperglycemia
hypokalemia
proximal muscle weakness
central adiposity
thinning of skin
weight gain
psychiatric problems
symptoms of digoxin toxicity
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
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
interventricular free wall rupture v. ventricular free wall rupture v. papillary muscle rupture
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
physical exam finding for hypertrophic cardiomyopathy

what is the mode of inheritance?
LLSB murmur that decreases with an increase in preload

AD
what medication is most effective in decreasing risk of embolic events in patients with atrial fibrillation?
warfarin
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
what is the treatment for patients with right ventricular infarcts?
IV fluids to maintain a high preload (avoid nitroglycerin and diuretics)
systolic-diastolic abdominal bruit in a patient with hypertension and atherosclerosis is highly suggestive of:
renal artery stenosis
EKG appearance of atrial fibrillation
irregularly irregular, narrow complex QRS tachycardia that lacks P waves
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
acute treatment for aortic dissection?
labetalol (or another beta blocker), since it simultaneously lowers heart rate and blood pressure, reducing aortic wall stress
hepato-jugular reflex: positive v. negative in the setting of edema
positive: indicates elevated venous pressure due to heart disease

negative: indicates edema is due to liver disease
5 common side effects of amiodarone
pulmonary toxicity (fibrosis)
thyroid dysfunction (85% low, 15% high)
hepatotoxicity
corneal deposits (does not require discontinuation)
skin changes
characteristics of variant (Prinzmetal's) angina
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
sequelae of hemochromatosis
testicular atrophy
cirrhosis
pancreatic fibrosis
increased skin pigmentation
cardiac conduction anomalies
EKG findings in pericarditis
diffuse ST elevation, with exception of reciprocal depression in aVR
mechanism of niacin side effects

how can these be avoided?
release of histamine and prostaglandins

pre-treatment with aspirin
primary medical therapy for aortic regurgitation
vasodilators (e.g. nifedipine)
ACE inhibitors
what single medical intervention has greatest impact on decreasing likelihood of arterial aneurysm formation, enlargement, and rupture?
smoking cessation
pitting v. non-pitting edema: causes
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)
what kind of pulse?

aortic regurgitation

aortic stenosis
"water-hammer" (wide pulse pressure)

"parvus et tardus"
Beck's triad for cardiac tamponade
hypotension
JVD
muffled heart sounds
most common cause of mitral regurgitation
mitral valve prolapse
most effective lifestyle modifications to reduce systolic blood pressure
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)
mechanism of statin-induced myopathy
inhibition of HMG-CoA to mevalonate leads to paucity of mevalonate for production of CoQ10

reduced CoQ10 implicated in pathogenesis of statin-induced myopathy
vasospastic disorders
Prinzmetal's (variant) angina
Raynaud's phenomenon
migraine headache
ischemia-reperfusion syndrome: pathophysiology and characteristics
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)
X-ray appearance of pericardial effusion
"water bottle" cardiac silhouette

exam findings include diminished heart sounds, difficult-to-palpate PMI
troponin T v. CK-MB: when to use
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
elements of CHADS2 score
CHF
HTN
Age >75y
DM
Stroke, prior (2 points)
what does electrical alternans mean in the context of EKG findings?
describes QRS complexes whose amplitudes vary from beat to beat; thought to result from heart swinging back and forth within increased pericardial fluid!
CHF in young healthy patients following viral symptoms?
likely myocarditis, think Coxsackie B virus
murmur of aortic regurgitation
mild AR: early diastolic

severe AR: holodiastolic
which heart murmurs increase on expiration?
left sided heart murmurs
how does the murmur of hypertrophic cardiomyopathy vary with preload?
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
which drugs improve survival in CHF?

which do not?
ACE inhibitors
ARBs
beta-blockers
spironolactone

digoxin and loop diuretics do not
two primary manifestations of Chagas disease (protozoal infection with T. cruzi, common in Latin America)
megacolon/megaesophagus
cardiac disease
what are "non-shockable" rhythms?
anything other than V-tach or V-fib
imaging modality of choice for suspected AAA
abdominal ultrasound
criteria for Dx of malignant HTN
>200/140
papilledema on opthalmoscopy