Usmleworld Cardiology

Front 1

first-line drugs in treatment of cocaine-related cardiac ischemia

Back 1

benzos
nitrates
aspirin

avoid pure beta-blockers

Front 2

conditions that lead to pulsus paradoxus

Back 2

cardiac tamponade
pericardial effusion

tension pneumothorax
severe asthma

Front 3

murmur of hypertrophic cardiomyopathy

Back 3

crescendo-decrescendo along LSB without carotid radiation

Front 4

medications to withhold before exercise EKG test

Back 4

anti-ischemic medications
digoxin
heart-slowing meds (e.g. beta blockers)

Front 5

mainfestations of amyloidosis

Back 5

proteinuria (deposition in kidney)
easy bruisability (deposition in liver, inhibiting synthesis of clotting factors)
restrictive cardiomyopathy with thickened ventricular walls and impaired diastolic function

Front 6

treatment of SVT (hemodynamically stable and unstable)

Back 6

stable: vagal maneuvers then adenosine + AV nodal blockers

unstable: DC cardioversion

Front 7

main mechanism of nitroglycerin's pain relief in patients with anginal pain

Back 7

venous dilation, leading to increased venous pooling, decreased preload, and decreased heart size/work

Front 8

mechanism of hemoptysis in mitral stenosis

Back 8

increase in LV pressure transmitted to pulmonary vasculature, resulting in dyspnea, cough, and hemoptysis

Front 9

presentation of myocarditis in children

Back 9

fever, lethargy, signs of myocardial dysfunction after a viral prodrome

monitor in ICU for arrhythmias and acute decompensation

Front 10

treatment of VTach

both stable and unstable

Back 10

stable: amiodarone (or lidocaine)

unstable: cardioversion

Front 11

Cushing's syndrome signs and symptoms

Back 11

high BP
high systemic cortisol leading to:
hyperglycemia
hypokalemia
proximal muscle weakness
central adiposity
thinning of skin
weight gain
psychiatric problems

Front 12

symptoms of digoxin toxicity

Back 12

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

Front 13

symptoms of atrial flutter

what is the electrophysiologic anomaly?

Back 13

palpitations, chest pain, SOB, lightheadedness

re-entrant rhythm within the atria, with EKG showing 2:1, 3:1, or 4:1 heart block

Front 14

interventricular free wall rupture v. ventricular free wall rupture v. papillary muscle rupture

Back 14

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

Front 15

physical exam finding for hypertrophic cardiomyopathy

what is the mode of inheritance?

Back 15

LLSB murmur that decreases with an increase in preload

AD

Front 16

what medication is most effective in decreasing risk of embolic events in patients with atrial fibrillation?

Back 16

warfarin

Front 17

what is the first step in diagnosis of peripheral artery disease?

what are normal values?

Back 17

ankle-brachial index (ABI)

1-1.3 is normal; <0.9 indicates >50% occlusion of a major vessel

Front 18

what is the treatment for patients with right ventricular infarcts?

Back 18

IV fluids to maintain a high preload (avoid nitroglycerin and diuretics)

Front 19

systolic-diastolic abdominal bruit in a patient with hypertension and atherosclerosis is highly suggestive of:

Back 19

renal artery stenosis

Front 20

EKG appearance of atrial fibrillation

Back 20

irregularly irregular, narrow complex QRS tachycardia that lacks P waves

Front 21

for what is pulmonary capillary wedge pressure a surrogate marker?

what is its value in cardiogenic shock?

Back 21

left atrial pressure, and usually LV end-diastolic pressure

elevated

Front 22

acute treatment for aortic dissection?

Back 22

labetalol (or another beta blocker), since it simultaneously lowers heart rate and blood pressure, reducing aortic wall stress

Front 23

hepato-jugular reflex: positive v. negative in the setting of edema

Back 23

positive: indicates elevated venous pressure due to heart disease

negative: indicates edema is due to liver disease

Front 24

5 common side effects of amiodarone

Back 24

pulmonary toxicity (fibrosis)
thyroid dysfunction (85% low, 15% high)
hepatotoxicity
corneal deposits (does not require discontinuation)
skin changes

Front 25

characteristics of variant (Prinzmetal's) angina

Back 25

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

Front 26

sequelae of hemochromatosis

Back 26

testicular atrophy
cirrhosis
pancreatic fibrosis
increased skin pigmentation
cardiac conduction anomalies

Front 27

EKG findings in pericarditis

Back 27

diffuse ST elevation, with exception of reciprocal depression in aVR

Front 28

mechanism of niacin side effects

how can these be avoided?

Back 28

release of histamine and prostaglandins

pre-treatment with aspirin

Front 29

primary medical therapy for aortic regurgitation

Back 29

vasodilators (e.g. nifedipine)
ACE inhibitors

Front 30

what single medical intervention has greatest impact on decreasing likelihood of arterial aneurysm formation, enlargement, and rupture?

Back 30

smoking cessation

Front 31

pitting v. non-pitting edema: causes

Back 31

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)

Front 32

what kind of pulse?

aortic regurgitation

aortic stenosis

Back 32

"water-hammer" (wide pulse pressure)

"parvus et tardus"

Front 33

Beck's triad for cardiac tamponade

Back 33

hypotension
JVD
muffled heart sounds

Front 34

most common cause of mitral regurgitation

Back 34

mitral valve prolapse

Front 35

most effective lifestyle modifications to reduce systolic blood pressure

Back 35

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)

Front 36

mechanism of statin-induced myopathy

Back 36

inhibition of HMG-CoA to mevalonate leads to paucity of mevalonate for production of CoQ10

reduced CoQ10 implicated in pathogenesis of statin-induced myopathy

Front 37

vasospastic disorders

Back 37

Prinzmetal's (variant) angina
Raynaud's phenomenon
migraine headache

Front 38

ischemia-reperfusion syndrome: pathophysiology and characteristics

Back 38

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)

Front 39

X-ray appearance of pericardial effusion

Back 39

"water bottle" cardiac silhouette

exam findings include diminished heart sounds, difficult-to-palpate PMI

Front 40

troponin T v. CK-MB: when to use

Back 40

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

Front 41

elements of CHADS2 score

Back 41

CHF
HTN
Age >75y
DM
Stroke, prior (2 points)

Front 42

what does electrical alternans mean in the context of EKG findings?

Back 42

describes QRS complexes whose amplitudes vary from beat to beat; thought to result from heart swinging back and forth within increased pericardial fluid!

Front 43

CHF in young healthy patients following viral symptoms?

Back 43

likely myocarditis, think Coxsackie B virus

Front 44

murmur of aortic regurgitation

Back 44

mild AR: early diastolic

severe AR: holodiastolic

Front 45

which heart murmurs increase on expiration?

Back 45

left sided heart murmurs

Front 46

how does the murmur of hypertrophic cardiomyopathy vary with preload?

Back 46

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

Front 47

which drugs improve survival in CHF?

which do not?

Back 47

ACE inhibitors
ARBs
beta-blockers
spironolactone

digoxin and loop diuretics do not

Front 48

two primary manifestations of Chagas disease (protozoal infection with T. cruzi, common in Latin America)

Back 48

megacolon/megaesophagus
cardiac disease

Front 49

what are "non-shockable" rhythms?

Back 49

anything other than V-tach or V-fib

Front 50

imaging modality of choice for suspected AAA

Back 50

abdominal ultrasound

Front 51

criteria for Dx of malignant HTN

Back 51

>200/140
papilledema on opthalmoscopy