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101 Cards in this Set
- Front
- Back
What is risk factor for CAD you should count? |
HTN DM male relative with <55 female relative with <65 high lipids |
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What is first management of person with STEMI? |
asa--> PCI/thrombolytics--> Plavix if stended -> b-blockers(metop vs atenolol)/ CCB if pt has severe asthma--> Plavix instead of asa if asa not tolerated |
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What is symptomatic relief for MI? |
morphine oxygen and nitrates |
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STEMI vs MSTEMI vs unstable angina which ones get anticoagulation? |
STEMI gets TPA if needed + asa/plavix
NSTEMI gets heparin + asa + eptifibatide/abciximab/tirofiban
unstable angina can get eptifibitad, tirofiban, and abcixiban and heparin |
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What are 4 causes of sudden drop in BP in post MI? |
RV infarct, tachycardia, ST elevation in II, III and AVF
tamponade - tachycardia loss of pulse suddenly
valvue rupture- tachycardia and murmur
septal rupture- tachycardia, murmur RA 45% O2 sats--> RV is 75% |
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What is a cannon A wave? |
tricuspid closed and you have atrial systole and blood hits tricuspid and goes backward into JVD
|
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Bradycardia+ hypotension + cannon A waves
rare situation what is it? |
complete heart block ---> only one that causes this |
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What is the most important thing to do if you have symptomatic bradycardia? |
try atropine first
pacemaker in longterm
awlways atropine over EKG |
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How do you know you have stable vs unstable angina? |
SBP<90 chest pain dyspnea confusion |
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What is mangement of Vfibb/ Vtach? |
amiodarone lidocaine procainamide if stable
else if unstable shock the patient. |
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What are the side affects of amiodarone? |
hypo/hyperthyroid
pulm fibrosis
corneal depositis
blue skin |
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Wjhat is Afibb treatment for rate control? |
Bblocker - if CAD CHF or graves
CCB if asthma or depression
digoxin if hypotensive
start anticoagulation coumadin |
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How to treat SVT? |
vagal maneuvers ice water, valsalva
adenosine if that doesn't work
BB, CCB, digoxin if that doesn't work |
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What are signs of cardiac tamponade in a patient? |
cardiac tamponade JVD, hypotension, diminished heart sounds pulsus paradoxus SBP decrease |
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what are EKg findings ffor cardiac tamponade? |
low voltage QRS and electrical alternans |
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What are echo findings for cardiac tampnade? |
right atrial and right ventricular collapse during diastole
IVC is plethoric due to back up |
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What are signs of cyanide toxicity after starting nitroprusside? |
seizures, coma, any flushing or cyanosis arryhtmias
tachypnea, depression
metabolic acidosis and renal failure |
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What is the treatment for nutroprusside cyanide toxicity? |
sodium thiosulfate |
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in what situation does baby gt CHF? |
when mom is diabetic, they get glycogen deposition in the septum and they get septal hypertrophy
|
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What is ebsteins anomaly? |
right atrium growing into right ventricle |
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Who gets ebsteins anomaly? |
fetuses of moms taking lithium
may show up as tricuspid stenosis |
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What is prognosis of baby with septal hypertrophy and CHF from diabetic mom? |
it will resolve on its own since septal deposition of glycogen will slow down after birth |
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How does hypoplastic left ventricle present? |
normal birth
ductus arteriosus closes you get sudden CHF in the baby
(so its a cyanotic heart disease) |
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When do you get sclerotherapy and when do you use surgical ligation for treatment for varicose veins? |
if failed 3-6 motnsh of compression stockings consider sclerotherapy
if failed multiple times sclerotherapy and compression stockings then try surgical ligation |
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When to give bacterial endocarditis prophylaxis? |
Who: only pts with hx of endocarditis, pts with prosthetic valves, hx of congital heart disease, or having heart transplant
when you are doing dental procedures causing bleeding
when doing resp tract procedures/ biopsies
when doing GI and GU procedure in a patient who is known to have infection already
procedures with infected skin or muscles tissue
|
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What are drugs to start in flash pulm edema? |
nitroglycerine + nitroprusside for BP control also do IV Lasix |
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What murmur do you see with young female? |
mitral valve prolapse |
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What murmur do you see with immigrant populations? |
mitral stenosis |
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What murmur do you see with turners syndrome
or with coarctation of the aorta? |
bicuspid aortic valve |
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palpitations SOB atypical chest pain with out exertion what murmur? |
mitral valve prolapse |
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What are all the systolic murmurs? |
aortic stenosis/pulmonic stenosis
mitral regurge/tricuspid regurge
mitral valprolapse
HOCM |
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What are the diastolic murmurs? |
aortic/ pulmonic regurge
mitral and tricuspid stenosis
|
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What murmurs increase with inspiration? |
all right sided murmurs + stenosis and regurge of pulmonic and tricuspid valves |
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What murmurs increase with exhalation? |
all left sided murmurs and mitral and aortic valve lesions |
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What are the only two murmurs that decrease in intensity if you increase venous return? |
HOCM
and mitral valve prolapse |
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What are ways to increase venous return to the heart? to decrease venous return? |
squatting and leg raise
to decrease venous return you need to do standing and valsalva |
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What murmurs decrease with increased afterload? |
HOCM, Mitral Valve prolapse and aortic stenosis |
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What are ways to increase afterload? decrease it? |
handgrip to increase
ace inhibitors and nitrates decrease afterload |
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What is treatment if murmur improves on standing/ valsalva? |
this decrease in venous return that is imporving the murmur
so you need to get rid of excess volume coming to the heart |
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What is treatment if ymurmur improves with nitrates? |
this is improvement with decrease in afterload
so you should give ace inhibitor for treatment |
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What is description of aortic stenosis? |
2nd and right intercoastal space space radiating to the carotids
crescendo decrescendo murmur |
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What murmur is heard in the left ;lower sternal border? |
aortic regurge tricuspid murmurs VSD HOCM
and mitral valve prolapse to apex |
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Whats VSD description? |
holosystolic murmurs in the left lower sternal border |
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Whats ASD description? |
fixed splitting of S2
signs of right heart fialure
SOB
parasternal heave |
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What's MR description? |
holosystolic murmur at the apex radiating to axilla |
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When to do repair for mitral regurge? |
EF <60% or when ventricle is >40mm size |
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When to repair aortic regurge? |
EF <55% left ventricle size>55 |
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Who gets mitral stenosis? |
rheumatic diease immigrants
pregnant patients |
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How to deal with MS in pregnant patients? |
always do surgery for MS repair even if currently pregnant |
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What are the characteristics of tetralogy of fallot? |
right ventricle out flow tract obstruction
overriding aorta over the ventricular septum
right ventricular hypertrophy
VSD |
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What is description of aortic regurgitation? |
diastolic decresndo murmur at lower left sternal bordr |
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Where can you hear in the left upper sternal border? |
pulmonic murmurs
ASD |
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What are toxicities of amniodarone? |
thyroid dysfxn, hepatotoxicity, cardiac bradyarrthmias, chronic interstitial pneumonitis, ataxia visual disturbances peripheral neuropathy |
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What are EKG and Xray findings of pericarditis? |
xray can show calcifications
ekg will show low voltage QRS complexes |
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How to decide which antiarryhtmic to use in atrial fibrillation? |
no valvular disease= felcanide
CHF : use amniodarone and dofelitidie
CAD but no CHF= sotalol and drondarone
LVH= dronedarone and amniodarone |
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What is ibutilide used for ? |
cardioversion for atrial fibrillation |
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What is narrow complex tachycardia differential? |
Sinus tachycardia -pwaves present regular >100bpm
sinus nodal reentrant tachycardia 100-150bpm normal pwaves
AVNRT(most common) narrow QRS HR 180 Pwaves are missing pseudo R wave in V1 and II
AVRT either absent Twaves, or pwave occurs right after Twave (this category inclused slurred Delata waves of wolf Parkinson white)
Atrial Tachycardia Pwaves are upside down in leads I and II and PR interval is short
Atrial Flutter beats 2:1 block regular pwaves at 300 bpm |
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What is differential for irregular narrow complex tachycardia? |
atrial fibrillation aflutter around 140-160 MAT |
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What is irregular wide complex tachycardia? |
a fibb aflutter bundle branch block |
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What is wide regular complex tachycardia? |
vtach
RBB/LBBB
atrial tachycardia
|
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Which ones are the SVTS? |
AVNRT AVRT atrial tachycardia |
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What are the charactersitiscs of wolf Parkinson white syndrome? |
PR<0.12 slurred QRS delta wave
episdoes of tachycardia >120 or 140 |
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What is peripartum tachycardia? what is treatment? |
chf during last month of prengnacy or after 5 months of delviery
if LVEF recovers after pregnancy your okay
if it doesn't don't get get pregnant, its gonna be bad for mom and shell need treatment |
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what is PR normal length? |
4 boxes |
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What is QRS normal length |
2 boxes |
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What is QT normal length |
10 boxes |
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What is treatment for wolf Parkinson white? |
they can die of afibb then vfibb, so get immediate catheter ablation for them |
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When to use a tilt table test? |
cardiac electrolytes have been ruled out for causing syncope ===> now use tilt table for investiagtion |
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What is considered severe aortic stenosis? |
area <1.0cm2
+ onset of any stmptoms |
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What is common congenital heart problems that down syndrome pts develop? |
endocardial cushion defects aka ASD and VSD |
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What long term problems do downs syndrome pts develop? |
acute leukemia alzheimers autism ADHD depressive disorder seizure disorder |
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What to do when INR high during Coumadin anticoag? |
>9= hold Coumadin and give oral vitamin K
if having a life threatening bleed give Propthrombin complex concentrate factor 8a, FFP,
5-9 hold Coumadin and resume when therapeutic |
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What is ASD description? |
wide and fixed splitting of second heart sound
mid systolic ejection murmur heard in left upper sternal border
mid diastolic rumble @ left lower |
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What is HOCM murmur? |
harsh crescendo decrescendo systolic murmur @ apex
in left lower sternal border |
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What to do if a person is struck by lightning? |
autonomic dysfnxn causing signs of death liked fixed pupils
keep doing CPR until all causes of asystole can be ruled out. |
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What kind of a murmur does an atrial myxoma cause? |
low pitched diastolic murmur over apex |
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What is two murmurs over the apex? |
HOCM, atrial myxoma, mitral regurgitation |
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What are the common complications of myxoma? |
CHF Afibb clots in the heart and major arteries |
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What kind of clots does factor V leiden mutation cause? |
venous clots like DVT PE and portal vein cerebral veins mesenteric |
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What is the cause of clotting when ppl are estrogen replacement? |
it promotes active protein C resistance |
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How long to continue Coumadin on first DVT that is provoked? |
3-6 months after initial bridging with lovenox |
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What is most common causes of multifocal atrial tachycardia? |
low mag and low k+ and hypoxia are most common
|
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What is 2nd line treatment for MAT? |
Bblockers and verapamil or disopyramide |
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What is the most immediate test to do for compart syndrome? and how to interpret? |
always check for compartment pressure for >30 then do a fasciotomy
then calculate delta pressure diastolic BP- compartment pressure = normal is 20-30
if lower than that, you need to do fasciotomy |
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What are the most common causes of sudden cardiac death in young ppl? |
ventricular tachycarrythmias
anomalos cornonary artery
other structural heart disease |
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substernal chest pain in young ppl? |
ischemic disease in 20 yrs old is more likely due to anomalous coronary artery return . |
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What is characteristic brugada syndrome? |
right bundle branch block and ST segement elevation in V1 and V3
not related to exercise |
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What is the treatment for mobitz I and mobitz II AV block? |
only if they are symptomatic, they will get a permanent pacemaker
|
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B-blockers, calcium channel blockers, clonidine can be continued during surgery? |
yes they can be continued |
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How far ahead to take off raloxifene before surgery? |
4 weeks before surgery |
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when should you do high senstivity CRP testing? |
bascially when patients have 5-7.5 % scores with minimal symptoms on their ascvd scoring you should check this value multiple times to make sure their heart is not inflammed. 1.0 is considered low and 3.0 is considered high. |
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which asymptomatic patients get echos when you hear what murmurs? |
diastolic, late holosystolic, continuous, and systolic 3/6 |
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what is the treatment for post ablative atrial fibrillation, do they need anticoagulation or not? |
they need anti coagulation based on their chads score whether they had ablation or not. |
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when is it priority to repair abdominal aortic aneurysm/ ulcer? else wht to do if not urgent? |
you should check to see if all limbs have good perfusion, if not then, you should go for immediate open chest repair, else if you have just high BP , treat with b-blockade then lower BP with ggt, then take for endovascular repair( cath type) |
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who gets moderate statin therapy? |
ascvd score<7.5% or higher and LDL is <190 and is nondiabetic |
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what is considered high intensity statins? |
atorvastatin, rosuvastatin, and simvastatin 80mg ( not preferred since it causes the most rhabdo) |
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does swtiching to an ARB releive the cough that is caused by an ace ? |
yes you get less cough |
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if patient has CAD, and is on beta blockers, gets angina, gets stress test and passes it successfully, but still having symptoms what drug can u add to help with angina symptoms? |
add isosorbide monoitrate, it helps crease afterload and improve symptoms |
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what is the complications of bicuspid aortic valve? |
you get regurge, aortic aneurysm, and risk for infective endocarditis |
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what lifestyle factors are the most important in order of what changes risk of getting heart attack? |
they are dyslipidemia, smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and diet low in fruits and vegetables |
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what are indications for aortic stenosis surgical repair? |
you gotta have <1cm valve area + symtpoms or <1cm and going for cabg or heart procedure or <1cm and no symptoms but has EF<50% |