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77 Cards in this Set

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What condition does this suggest?
Sharp stabbing chest pain left of the sternum that is worse when a patient takes a deep breath.
Pericarditis
How is chest pain from pericarditis relieved?
sitting up and leaning forward
Where does chest pain from angina occur?
retrosternal, radiating to jaw, arm & shoulder
Chest pain described as squeezing, tightness, pressure, or heaviness along with Levine's sign indicates what condition?
Angina
How is chest pain from angina relieved?
rest & nitro
Tearing chest pain with sudden onset is characteristic of what disorder?
Aortic Dissection
Systolic murmur over the left sternal border & interscapular area indicates ____________
coarctation of aorta
What are the components of the Tetralogy of Fallot?
1)Right Ventricular Outflow Obstruction
2)Membranous VSD
3)Overriding Aorta Over VSD
4)RVH
A wide fixed split S2, SOB, and fatigue are symptoms found in __________
Atrial Septal Defect
Pansystolic murmur, hyperdynamic precordium & thrill on exam is characteristic of ____________
Ventricular Septal Defect
What type of congenital cardiac defect is seen in Down's Syndrome patient?
Atrioventricular Canal VSD
A loud continuous machinery sounding murmur is characteristic of ____________
Patent Ductus Arteriosus (PDA)
What type of murmur is heard with Pulmonic Valve Stenosis?
Systolic murmur at left upper sternal border that increases with inspiration
Cyanosis, boot shaped heart on x-ray and clubbing is characteristic of ________
Tetralogy of Fallot
Upper extremity HTN and weak lower extremity pulse is indicative of ____________
Coarctation of Aorta
What is the most common congenital cardiac defect?
Ventricular Septal Defect
Pulmonic Valve Stenosis obstructs _________________
right ventricular outflow
Harsh systolic murmur radiating to the carotids and a soft or absent A2 is indicative of __________
Aortic Stenosis (AS)
Diastolic, blowing, decrescendo murmur best heard with patient leaning forward after expiration is characteristic of _____
Aortic Regurgitation (AR)
Austin Flint murmur - low pitched diastolic murmur is characteristic of ___________
Aortic Regurgitation (AR)
Diastolic low pitched murmur best heard in left lateral decubitus position with bell is characteristic of ____________
Mitral Stenosis (MS)
Holosystolic murmur radiating to axilla is characteristic of _______
Mitral Regurgitation (MR)
Midsystolic click followed by a late systolic murmur is characteristic of ___________
MVP
Diastolic murmur along the left sternal border indicates _________
Tricuspid Stenosis
Systolic murmur along the left sternal border that increases with inspiration is characteristic of _____
Tricuspid Regurgitation
Name 3 Class IA anti-arrhythmics
procainamide
disopyramide
quinidine
Name 3 Class IB anti-arrhythmics
Lidocaine
Tocainide
Phenytoin
Flecainide & Propafenone are in class ______
IC
B-blockers are in class _____
II
Amiodarone, Ibutilide, Sotalol, Bretylium & Dofetilide are class _____
III
Calcium channel blockers - Verapamil & Diltiazem are class ______
IV
Adenosine & Digoxin are class __
V
What is JVP an indicator of? What is considered abnormal?
1) right atrial pressure
2) >3-4cm above sternal angle
Increased JVP indicates _______
increased central venous pressure
An increased a-wave indicates _____________
Increased resistance to emptying right atrium

Ex: TS, RVH, HTN, anything that makes the heart work harder
ST elevation in leads II, III, and aVf indicates ___________
inferior MI
Right Coronary Artery
Patients with ______ (5) are not candidates for a stress test
unstable angina
AMI
severe AS
CHF exacerbation
uncontrolled HTN
Stress test is not useful in patients with ______, _______, or abnormal baseline EKG
LBBB
LVH
What are the cardinal symptoms of Aortic Stenosis?
Syncope
Angina
SOB (CHF)
Which valve is most often effected by rheumatic fever?
Mitral Valve
What are the major Jone's Criteria?
C--Carditis
A--Arthritis...polyarthritis
S--Sydenham's chorea
E--Erythema marginatum
S--Subcutaneous nodules
What are the minor Jone's Criteria?
P = Prolonged PR interval-EKG
E = Elevated ESR
A = Arthralgias
C = C-Reactive Protein raised
H = History rheumatic fever or strep
What is the treatment for stable angina?
aspirin
nitro
long acting nitrates
B-blockers
Ca+ channel blockers
What is the treatment for unstable angina?
aspirin
heparin/lovenox
GP IIB/IIIA
Revascularization if meds don't help (CABG, PTCA, Stents)
What is the treatment for Prinzmetal's angina?
Ca+ channel blockers
aspirin
nitrates
What are the LDL goals?
LDL < 100 for CAD/CAD equiv

LDL < 130 w/o CAD & >2 cardiac risk factors

LDL < 160 w/o CAD & <2 cardiac risk factors
What are the absolute contraindications for thrombolytic therapy?
aortic dissection
acute pericarditis
active bleeding
intracranial neoplasm
previous cerebral hemorrhage
cerebral aneurysm
AV malformations
What are the relative contraindications for thrombolytic therapy?
bleeding diaphysis/coagulopathy
major surgery/trauma/puncture
nonhemorrhagic stroke w/in 6mo
GI bleed w/in 6mo
Severe HTN >180/95
prolonged CRP
pregnancy
proliferative retinopathy
Which cardiac enzyme peaks first and lasts the shortest length of time?
myoglobin
Which cardiac enzyme rises within 3-4 hours and lasts the longest?
Troponin
A systolic ejection murmur at the left sternal angle that increases with the Valsalva Maneuver is characteristic of __________
Hypertrophic Cardiomyopathy
____________causes thickening of the LV which results in ________
Hypertrophic Cardiomyopathy
decrease in LV outflow
SOB, tachycardia, fatigue, distended jugular veins and pulsus paradoxus are symptoms/signs found in ___________
Cardiac Tamponade
Beck's Triad is associated with Cadiac _______
Tamponade
What is Beck's Triad?
Muffled heart sounds
Distended JVD
Hypotension
What are the symptoms of Acute Arterial Embolism?
Pain
Pallor
Paresthesias
Paralysis
Poikilothermia
Pulselessness
A-Fib 60-70% of pts
What is the recommended therapeutic anti-coagulation prior to cardioversion for A-Fib?
>48 hrs or unknown time since AF

anticoagulate 3 weeks prior & 4 weeks following
Positive QRS concordance, presence of AV dissociation, capture beats or fusion beats is diagnostic of _____
VT
Atypical RBBB; monophasic R, QR, RS; triphasic QRS in V1; R to S ratio < 1 is suggestive of ____
VT
Atypical LBBB; R > 30ms or R to S; nadir or notch is suggestive of ___
VT
Shift of axis from baseline, history CAD (prior MI, ischemia, or CHF) is suggestive of ____tachycardia
Ventricular
QRS during tachycardia identical to QRS during sinus rhythm is suggestive of _____tachycardia
Supraventricular (SVT)
Termination with Adenosine is suggestive of _____tachycardia
Supraventricular
What are the abnormal values associated with ABI
ABI < 0.9 is abnormal
ABI 0.5-0.8 is claudication
ABI < 0.5 pain at rest
Abnormalities of ABI can be diagnostic of ________.
Coarctation of Aorta
What does ABI show?
Difference in upper/lower extremity pressures
What is Virchow's Triad?
What does it help to diagnose?
endothelial damage
venous stasis
hypercoagulation

-DVT
What are the lab values associated with primary aldosteronism?
*aldosterone/plasma renin >20ng/dL
*Serum aldosterone >15ng/dL
*decreased K+
*decreased renin
What are the side effects associated with thiazide diuretics?
hypokalemia
hyperuricemia
hyperglycemia
What are the side effects associated with ACE-i
angioedema
cough
hyperkalemia
rash
What are the side effects associated with b-blockers?
bradycardia
bronchospasm
depression
fatigue
sexual dysfunction
What are the side effects associated with Ca+ channel blockers?
lower extremity edema
bradycardia
constipation - verapamil
What is the JNS7 guideline for pre-HTN
systolic 120-139
diastolic 80-89
What is the JNS7 guideline for stage I HTN
systolic 140-159
diastolic 90-99
What is the JNS7 guideline for stage II HTN?
systolic >160
diastolic >100
What are the contraindications for a pacemaker?
-asymptomatic sinus bradycardia or sinus node dysfunction
-bradycardia during sleep
-1st degree AV block
-asymptomatic Mobitz I second degree AV block
-transient asymptomatic pause during A-fib
-recurrent syncope of unknown origin
When is urgent surgery indicated for aortic dissection?
-Type A aneurysms
-Type B aneurysms if dissection is continuing or aortic branch is compromised