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455 Cards in this Set
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- Back
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How to check tilt test?
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Take BP supine and then upright
If upright BP decreases >10mmHg and HR > 20 bpm |
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Significance of positive tilt test?
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Hypovolemia
Vascular Tone Problems |
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What is Kussmaul's sign?
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JVP increase w/inspiration
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What does Kussmaul's sign mean?
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Possible RSHF
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Hepatojug relfex?
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Press on liver if JVP increases RSHF
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What is tamponade?
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stopage of blood flow into a BV
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What is corpulmonale?
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RV enlargement
RSHF due to chronic PHTN |
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Grade 1 heart murmur?
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Hardly hear it
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Grade 2 heart murmur?
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Soft but readily detected
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Grade 3 heart murmur?
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prominent but not loud
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Grade 4 heart murmur?
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Loud with palpable thrill
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Grade 5 heart murmur?
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Very Loud with a thrill
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Grade 6 heart murmur?
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audible w/ stethescope off chest
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What do you use your bell for on your stethescope? Examples.
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Low frequencies
S3 S4 AI Bruits |
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What do you use your diaphram for?
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High Frequencies
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What is a thrill?
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Tactile Vibration on chest wall
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What is a click?
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Audible in diastole
Heard in Patients with artificial valve replacement |
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What is a rub?
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Leather on Leather
Systolic and Diastolic components Ass w/ pericarditis |
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What is S3 due to?
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rapid filling of a ventricle
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Can you hear S4 with A-fib?
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NO
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How to perform a general cardiac exam?
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Vital Signs
Exam of Venous system Examine Pulses Heart Tones/sounds Abdominal Exam Peripheral exam |
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What is a possibility of absent pulses?
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Peripheral Vascular Disease
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Pulses Parvus?
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small weak pulses (decreased LV stroke volume)
Narrow pulse pressure (Increased Vascular Peripheral Resistance) |
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Pulsus Tardus?
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Delayed onset to peak
Associated with aortic stenosis |
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Bisferiens Pulse?
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2 systolic peaks
Hypertrophic Cardiomyopathy Aortic Regurg or AR w/ Aortic stenosis |
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Pulsus Alternans?
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Regular alteration of amplitude
Usually has S3 Severe LV systolic dysfunction |
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Pulsus paradoxus?
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Fall in systolic pressure during inspiration
Indicates Tamponade |
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Diff DX for Pulsus Paradoxus?
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Airway obstruction
SVC obstruction Cardiac Tamponade |
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How to take a good cardiac history?
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Let pt tell story
Approp questions Get down on their level Establish Trust |
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DDX (diff. dx) for chest pain?
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Angina Pecotris
MI Pericarditis Aortic Dissection Pulm. Embolism Pulm. HTN |
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Sx of angina pecotris?
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Retrosternal pain w/ radiation
Lasting less than 10 minutes Induced by Exercise Ass with S4 or papillary dys |
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Unstable angina?
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Decreases tolerance for exertion
More pronounced S4 |
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Prinzmetal's Agina?
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Like other angina pectoris
usually occurs in the early morning |
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Angina associated with MI?
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Substernal radiates into neck and arm
Sudden onset lasting longer than 30 mins Unrelieved by Nitro or rest |
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Other symptoms associated with MI besides angina?
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SOB
Sweating weakness nausea vomiting |
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Angina associated with Pericarditis?
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Begins over sternum or cardiac apex
More localized (knife like) Lasts hours to days Worse with deep breathing Relieved by leaning forward |
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Angina associated with aortic dissection?
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Radiates into back
Knife-like pain Usually in pt w/ HTN or Marfans Pulse assymetry |
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Cardinal symptoms of CV disease?
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Angina
Dyspnea Syncope Fatigue Edema Palpitations |
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Symptoms of Cerebral Vascular Disease?
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Amaun's Fugax
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What is Amaun's Fugax?
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Transient monocular visual loss
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What are symptoms of peripheral vascular disease?
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Claudication
Vascular Ulcers |
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Angina associated with Pulm Embolism?
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Aggrevated by breathing
Dyspnea Tachypnea Rales and Pleural rubs Sometimes no chest pain |
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Angina associated with Pulm. HTN?
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Aggrevated by effort
Dyspnea Pressure |
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JNC-7 Normal BP?
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<120/70
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JNC-7 PreHTN?
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120-139/80-89
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JNC-7 stage I HTN?
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140-159/90-99
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JNC-7 Stage II HTN?
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>160/100
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Labile HTN?
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sometimes high
sometimes not |
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Accelerated HTN?
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Significant raise in BP
Ass with vascular damage |
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How to diagnose accelerated HTN?
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Fundoscopic Exam shows vascular damage but no papilledema
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Hypertensive Urgency?
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Severe BP increase w/o signs of end organ damage
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Hypertensive Emergency?
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Severe BP increase w/ signs of end organ damage
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Malignant HTN?
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Like Hypertensive Emergency
Usually ass w/ encephalopathy |
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Complications of Essential HTN?
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LVH
Neuro Disease Renal dysfunction CAD PVD |
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Secondary causes of HTN?
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Renal HTN
Endocrine HTN Aorta coarctation |
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What can cause renal HTN?
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Renal Art Stenosis
Renal Parencymal disease JG cell tumor Nephroblastoma |
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What can cause endocrine HTN?
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Primary Aldosteronism
Cushings HyperPTH Pheochromocytoma |
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Risk of MI with essential HTN?
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Double for every 20 >115 systolic and 10>100
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What factors can alter essential HTN?
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Smoking
DM Wt loss Co-morbid illness |
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Goal BP for pts with HTN and diabetes?
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<130/80
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How to treat pts with bp >140/90?
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Lifestyle modifications
Monotherapy (thiazide, ACEi, ARB, CCB, BB) |
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How to treat pts with bp>160/100
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Lifestyle mod
dual drug therapy (one has to be diuretic) |
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Goal BP for pts with no risk factors?
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<140/90
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What are some risk factors for HTN?
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Smoking
Obesity High CH Age Family History DM Kidney failure |
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How to Calculate BMI?
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Wt (in kg)/Ht2 (in m2)
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Significance of BMI >30
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Obese
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List the firing sequence of the nodes in the heart?
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SA node
AV node Bundle of His Bundle Branches |
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Where does the normal sinus rhythm originate from?
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SA node
Responds to autonomic stimuli |
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What are the things that can affect HR?
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age
sex physical activity |
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What is the average HR?
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60-100 BPM
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Where do narrow QRS complexes originate from?
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Above the AV node
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Where do wide QRS complexes originate from?
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Below the AV node
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What is the MCC for symptomatic sinus bradycardia?
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Medications
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How to treat symptomatic sinus bradycardia?
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Med wash out
Atropine Transvenous pacing Pacemaker |
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When is bradycardia normal?
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Athletic person
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When to use atropine?
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when CO is decreased
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When to use a pacemaker?
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Chronic Bradycardia
CHF |
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When is sinus tach normal?
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children
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MCC for sinus tach?
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Increased adrenergic tone
Decrease parasymp tone Ex. Stress, fright, illness, exercise |
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Drugs that can cause sinus tach?
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Atropine
EtOH Nicotine Caffeine Thyroid Meds |
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What do you treat with Sinus tach?
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Underlying cause
can't just treat the tach |
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What is Sick Sinus syndrome?
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Persistant spontaneous sinus bradycardia
NOT CAUSED BY DRUGS Physiological Cause |
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What can cause sick sinus syndrome?
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Sinus Arrest
Destruction of SA conduction Damage to nerves in atria wall |
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Treatment of Sick Sinus Syndrome?
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Permanent Pacemaker
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What causes tachy-brady syndrome?
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Combo of SA and AV conduction disturbances
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What can cause premature atrial complexes (PACs)?
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Infection
inflammation myocardial ischemia meds |
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Where do PACs originate? What causes increase in PACs?
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Any area of heart
Increase in frequency w/ age |
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Treatment for PACs?
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None required
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What are PACs MC associated with?
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Structural Heart disease
one of the MCCs of irregular pulse |
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What type of rhythm is atrial flutter?
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Regularly irregular
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What is the atrial HR in atrial flutter?
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2-3:1 per ventricular beat
250-350 bpm |
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Which leads will have negative flutter waves in atrial flutter?
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II
III aVF |
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What enzyme is used to determine atrial activity?
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adenosine
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What is the pattern on EKG of atrial flutter?
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Saw Tooth present in inferior leads
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Which is MC atrial flutter or A fib?
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A fib
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What can cause atrial flutter?
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Atrial Disruptions
Toxic Conditions Metabolic conditions |
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What are examples of Atrial disruptions that can lead to atrial flutter?
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Atrial Dilations
COPD Pulm Emboli Mitral Stenosis Tricuspid Stenosis Cardioversion Ablation |
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Treatment for Atrial Flutter?
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Rate control
Anticoag Treat underlying cause |
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What is the MCC cardiac dysrhythmia?
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A fib
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What is the rhythm for A fib?
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Irregularly irregular
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EKG findings of A fib?
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No obvious P-waves
Vent rates b/w 100-200 |
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Etiologies to consider with A fib?
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Thyroid problems
ischemia structural problems |
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What group of people is a fib most common?
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old men
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What must you do ASAP with a fib? Why?
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Put on anti coag
blood pulls in the atria and can clot and embolize |
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Symptoms of A fib?
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Palpitations
Tachycardia Weakness Dizziness Dyspnea Decreased Exercise Capacity |
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Goal in the treatment of A fib?
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Minimize symps
minimize stroke risk prevention |
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Risk of stroke in pts with a fib not taking anticoag?
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3-5% per year w/o anticoags
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What % of strokes are due to A fib?
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15%
In pts 80-89 24% |
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What is the lifetime stroke risk w/ untreated a fib?
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35%
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How to calculate a CHADS Score?
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CHF (1 point)
HTN (1 point) Over 65 y/o (1 point) Diabetes (1 point) Previous Stroke (2 points) |
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Treatment according to CHADS Score?
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0-ASA 81-325 mg
1-ASA or Warfarin 2+-Warfarin (INR 2-3) |
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Where is the problem with Supraventricular tach?
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Above the AV node
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Is SVT life threatening?
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Not in otherwise normal hearts
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HR for SVT?
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150-250 bpm
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EKG findings with SVT?
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No obvious P-waves
Vent rates b/w 150-250 bpm |
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Types of SVT?
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A fib
A flutter Multifocal A tach |
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When do you see multifocal A tachycardia?
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COPD patients
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Treatment for SVT>
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Vagal Maneuvers
Adenosine BB CCB DCCV |
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What are BB?
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betablockers
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What are CCb?
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Calcium Channel Blockers
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What is DCCV?
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Direct Current Cardioversion
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EKG findings in Multifocal Atrial Tachycardia?
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Irregular narrow QRS compelx
Tachycardia (100-180 bpm) 3 different P-waves in 1 lead |
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Symptoms of PVC?
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Palpitations
Angina |
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What causes PVCs?
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Infection
Inflam Hypoxia Ischemia Fever Acidosis Electrolytes |
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Prevelance of PVCs?
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MC in males
Hypokalemia Pts following AMI (usually in the morning) |
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When to treat PVCs?
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Only if symptomatic
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What is Bigeminy?
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Alternating PVC (normal, PVC, normal, PVC)
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What to check with Bigeminy?
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Electrolytes (K+ and Mg++)
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What is Trigeminy?
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normal, normal, PVC, normal, normal, PVC, etc.
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Symptoms of V tach?
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Palpitations
Dyspnea Syncope |
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EKG findings of V tach?
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3+ successive PVCs
HR greater than 100 bpm |
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What is associated with V tach?
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Increased risk of sudden death
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MCC of V tach?
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Ischemic Heart Disease
Followed by cardiomyopathy |
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Treatment for V tach?
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Shock (if unstable)
Antiarrhythmics Internal Cardiac Defibulators (ICD) |
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What can arrhythmias cause?
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SCD
this was just a point he made I am sure there are others |
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What is the compensation for increased preload?
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Dilation
followed by hypertrophy |
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What is the compensation for increased afterload?
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Concentric Hypertrophy
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Relationship between preload and contractility?
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Increase preload increases contractility
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Clinical Symptoms of LSHF?
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Dyspnea
Paroxysmal Nocturnal Dyspnea Orthopnea |
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Clinical Symptoms of RSHF?
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JVD
Hepatojugular reflex Peripheral Edema Ascites Rales Crackles Summation Gallop |
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What are the 3 types of dilated cardiomyopathy?
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Peripartum Cardiomyopathy
Alcoholic Cardiomyopathy Right Ventricular Dysplasia |
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What is MC COD with dilated cardiomyopathy?
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CHF
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When do most of the Peripartum cardiomyopathy occur?
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Last Trimester to 6 months postpartum
Most are last month to one month following |
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What are risk factors for peripartum cardiomyopathy?
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Multiparous
African Americans Over 30 y/o |
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How much EtOH needed to get alcoholic cardiomyopathy?
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>75 grams per day over 2 years
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Is Alcoholic cardiomyo always ass w/ liver failure?
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NO
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What are the deficiencies most evident in alcoholic cardiomyo?
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Selenium
Thiamine results from direct toxic effect of EtOH |
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What is the dysplasia that occurs with R ventricular dysplasia?
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Replacement of R vent wall w/ fatty fibrous tissue
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Type of disease is R vent dysplasia?
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Autosomal Dominant
presents with presyncope and syncope in 1st or 2nd decade |
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What % of peeps with hypertrophic cardiomyopathy have a fam history of it?
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50%
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What are the anatomical findings in hypertrophic cardiomyop?
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LVH
RVH Nondilated chamber |
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What is the hallmark symptom of hypertrophic cardiomyop?
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S4 murmur that softens when you squat (increase preload)
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Pathophys with hypertrophic cardiomyop?
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L vent outflow obstruction
Narrowing of subaortic space Midsys opposition of Ant. Leaflet (MV) |
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MC Symptoms of Hypertrophic cardiomyo?
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Dyspnea
Angina Fatigue Syncope Palpitations |
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Treatment for Hypertrophic Cardiomyo?
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Well Hydrated
Myomectomy EtOH ablation BB (angina, syncope) CCB |
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Hallmark symptom for Restrictive Cardiomyopathy?
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Diastolic dysfunction (HF symptoms)
Primary Fibrosis Hypertrophy |
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What are infiltrative diseases that cause restrictive cardiomyopathy?
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Amyloidosis
Sarcoidosis Hemochromatosis Eosinophilic Scleroderma |
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What imaging will you order for restrictive cardiomyopathy?
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MRI
Echo Endomyocardial biopsy |
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What will the images show in restrictive cardiomyopathy?
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Infiltrative appearance of myocardium
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What will have the starry sky appearance on echo?
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Amyloidosis
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What is the MC COD in Restrictive Cardiomyopathy?
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Hemochromatosis
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What should you always consider with restrictive cardiomyopathy?
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Constrictive pericarditis
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Treatment of constrictive pericarditis?
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Surgery
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Imaging for constrictive pericarditis?
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Pericardial calcifications on Xray/CT/MRI
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What is Loeffler's Endocarditis?
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Eosinophilic endomycardial infiltration
Toxic Drug Hepatosleenomegaly Infilt in other organs |
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How to Dx myocarditis?
|
RV biopsy
MRI |
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Clinical findings in Myocarditis?
|
Chest pain
CHF Elevated Erhthrocyte Sedimentation Rate (ESR) and C reative protien (CRP) Most have elevated cardiac enzymes |
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Physical exam findings for CHF?
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Recent wt gain (fluid retention)
Tachycardia Cool, clammy skin Weak pulses |
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Labs for CHF?
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Hyponatremia
Increased BUN:Cr Increased BNP |
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What are the 3 tragets for treatment of CHF?
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Decrease RAA system
Decrease Sympathetic tone Decrease Natriuretic Peptides |
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What does decreasing RAA sytem do? How to decrease it?
|
Vasodilation and Fluid Release
ACEi (decrease afterload) or BB |
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Effects of decreasing symp. Tone? How to decrease symp tone?
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Decrease HR
allows more time for diastole decrease venous return to heart (decrease pre- and afterload BB |
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Effects of decreasing Natiuretic Peptides?
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Decreases TPR
Decreases Venous Pressure Decreases Na+ and H2O retention |
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Benefits of Betablockers?
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Decrease need of O2
Decrease symp tone and RAA system Decrease ADH levels (ACEi's wear off and ADH builds up) |
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Principles of treating diastolic HF?
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Decrease preload
Increase diastole Increase Compliance Decrease TPR |
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Pharm for treatment of diastolic HF?
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Diuretics
Nitrates BB CCB ACEi |
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Treatment for systolic HF (LVSD)?
|
UNLOAD ME therapy
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What is UNLOAD ME therapy?
|
Upright
Nitrates Loop Diuretics O2 ACEi Digitalis Morphine Extras |
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Effects of Nitrates?
|
Decreases preload
|
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Effects of Loop diuretics?
|
Decreases preload
|
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Effects of O2?
|
Decreases afterload and preload
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Effects of ACEi?
|
Decreases afterload
|
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Effects of Digitalis?
|
Decrease myocardial contractility (blocks Na+/K+ ATPase)
|
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Effects of Morphine?
|
Decreases afterload and preload
Decreases Myocardial O2 demand |
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What are some Extras used in UNLOAD ME therapy?
|
Alosterone Antag
Dubutamine Dopamine |
|
|
Pathogenesis of plaque formation?
|
Fatty Streak
Lipoprotien Oxidation Leukocyte Recruitment Foam Cell formation Smooth Muscle proliferation |
|
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What is the ABCD of Angina Therapy?
|
Aspirin
BB and BP Cholesterol and Cigs Diet and Diabetes Education and Exercise |
|
|
What can be the different causes (classifications) of chest pain/
|
Nonischemic CV
Ischemic CV Pulmonary GI Chest Wall Psychiatric |
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What nonischemic CV diseases can cause chest pain?
|
Aortic Dissection
Pericarditis |
|
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What ischemic CV diseases can cause chest pain?
|
Angina
|
|
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What pulmonary disease can cause chest pain?
|
Embolism
Pneumothorax |
|
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What GI disease can cause chest pain?
|
GERD
Cholecystitis |
|
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What chest wall malfunction can cause chest pain?
|
fibrosis
Fracture |
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What psych disorders can cause chest pain?
|
Anxiety
panic attack |
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What is the initial work up for Angina pecotris?
|
UA
CBC Chem panel Fasting lipid Echo Xray |
|
|
Why would you use an exercise treadmill with Angina pectoris?
|
to dx LAD
|
|
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What are the 3 criteria for definite Agnina?
|
Substernal chest pain
Provoked by exertion Relieved with Nitroglycerin or Rest |
|
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What is Atypical (probable) Angina?
|
Meets 2 of the 3 criteria for definitive Angina
|
|
|
What is noncardiac chest pain?
|
Meets 1 or less of the typical anginal characteristics (definitive)
|
|
|
What is Class I (CCS Classification) of Angina?
|
Angina occurs w/ strenous, rapid, or prolonged exertion
Ordinary activities do not cause this |
|
|
What is Class II (CCS Classification) of Angina?
|
Slightly limits normal activity
Occurs with walking up hills, cold wind, upstairs |
|
|
What is Class III (CCS Class) of Angina?
|
Limited normal physical activity
Occurs with normal pace and normal conditions w/ walking |
|
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What is the Class IV (CCS Class) of Angina?
|
Inability to carry on any physical activity w/o discomfort
Angina may be there at rest |
|
|
What are the subtypes of Acute Coronary Syndromes?
|
Unstable Angina
non STEMI STEMI |
|
|
How to manage ACS?
|
Hospitalization
Close Monitoring |
|
|
Will nitro relieve unstable angina?
|
Yes
|
|
|
Will there be an EKG or cardiac enzyme changes?
|
Possible, but they will be very minimal
|
|
|
Management of Unstable Angina?
|
Angioplasty/Stent
High risk (high TIMI score)-cath lab Low risk-Stress Test |
|
|
Management of Non-STEMI?
|
No tobacco
Control Diabetes and HTN Increase Activity Decrease Fat and Salt Intake |
|
|
What type of thrombis will be formed in a non-STEMI?
|
Platelet Rich
|
|
|
Treatment for non-STEMI?
|
ASA
Anticoag |
|
|
What is enoxaparin?
|
Low Molecular weight heparin
|
|
|
Mech of Bivalirudin?
|
Direct thrombin inhibitor
|
|
|
What type of thrombus will be formed in a STEMI?
|
Fibrin Rich (whole blood)
|
|
|
Management of a STEMI?
|
Same as non-STEMI
PCC (stent) if within 90 minutes, after 90 use of Thrombolytics PCL (favored over CABG) |
|
|
Criteria of ACS-TIMI Risk score?
|
Age (>65)
>3 CAD risk factors known CAD Angina (w/in 24 hours) ST change Elevated Troponin ASA w/in 7 days |
|
|
LDL goals for 0-1, 2+, or known CAD?
|
0-1 under 160
2+ under 130 Known CAD under 100 |
|
|
Anatomic complications of an MI?
|
Ischemia
Arrhythmias Mural Thrombis Communicating Rupture Pap Muscle rupture Pericarditis/Dressler's syndrome |
|
|
Most common arrhythmia with MI?
|
PVCs
V tach (if during ischemia or after reprofusion) |
|
|
What type of infarct is most likely to cause a mural thrombis?
|
Apical wall
|
|
|
Where will a mural thrombis most likely emolize to?
|
brain
|
|
|
2 examples of a communicating rupture?
|
IV septum rupture
Ant. Wall rupture |
|
|
When do most communicating ruptures occur?
|
3-7 days
|
|
|
What does an IV septum rupture cause?
|
VSD
|
|
|
What does an Ant. Wall rupture cause?
|
Cardiac Effusion leading to Pericardial Tamponade
|
|
|
What are the symptoms of Pericardial Tamponade?
|
Becks triad
Hypotension JVD Muffled Heart Sounds |
|
|
What is the MC pap muscle that ruptures?
|
Posteriomedial mm
|
|
|
What Valvular malfunction will posteriomedial mm tear cause?
|
Mitral Regurg
|
|
|
Difference b/w pericarditis and dresslers syndrome?
|
Dresslers occurs around 6 weeks (3-6)
Dressler's caused by autoimmune inflam Peri occurs w/in a week |
|
|
Is pericarditis indicative or contraindicative of thrombolytics?
|
Contraindication
|
|
|
Symptoms of Pericarditis?
|
Sharp substernal pain relieved by sitting upright
Usually worse with inspiration Positive Ewart's Sign |
|
|
What is Ewart's Sign? What is assed with?
|
Dullness to percussion on Left Post. Lung field
Assed with pericarditis |
|
|
Complications of endocarditis?
|
Embolism
Hypersensitivity reactions valve incompetence AV block |
|
|
Where do emboli go that are due to endocarditis?
|
brain
lung kidney |
|
|
Where do the hypersensitivity reactions manifest with endocarditis?
|
Digits
Kidney |
|
|
What valves are affected with endocarditis?
|
Mitral
Aortic Rt heart |
|
|
What are AV blocks common with endocarditis?
|
Infection spreads to septum and forms abcesses
|
|
|
What are complications of endocarditis hard to treat?
|
Multilayer structure makes it hard for medicines to penetrate
|
|
|
Symptoms of Endocarditis?
|
Roth spots
Osler Nodes Janeway Lesions |
|
|
What are Roth spots?
|
Retinal Hemmorhages
|
|
|
What are Osler nodes?
|
Palpable purpura (digits)
Due to vasculitis |
|
|
What are Janeway lesions?
|
Flat, painless spots on soles of feet and palms
|
|
|
How to perform ABI?
|
Highest systolic pressure of either arm divided by systolic pressure in leg
|
|
|
Significance of ABI <.9?
|
Possible PVD
|
|
|
Major findings with Rheumatic Fever?
|
Carditis
Polyarthritis Sydenham Chorea Erythema marginatum SQ nodules |
|
|
How many major and minor criteria of Jones criteria do you need to dx RF?
|
2 majors
1 major and 2 minor |
|
|
What are the major Jones criteria for dx of RF?
|
Carditis
Polyarthritis Sydenham Chorea Erythema marginatum SQ nodules |
|
|
What are the minor Jones criteria for dx of RF?
|
Arthralgia
Fever Elevated ESR or CRP Prolonged PR interval Grp A strep Elevated ASO |
|
|
How does OK reand in CVD (cardiovascular disease) and CHD (coronary heart disease)?
|
#2 in both
|
|
|
What increase the risk of CVD?
|
Dyslipidemia
HTN Tobacco Diabetes Fam History Age (45 or 55) HDL <40 HDL >60 is protective |
|
|
Risk over 10 yr of CAD or equivalent?
|
Greater than 20 % CV risk
|
|
|
CV risk over 10 years for those who have 2+ risk factors?
|
B/w 10 and 20 %
|
|
|
CV risk over 10 years for those who have 0-1 risk factors?
|
<10% CV risk
|
|
|
What is important about the intermediate group (2+ risk factors for CV)
|
Important for prevention
Target LDL first |
|
|
What meds lower LDL?
|
Statins
|
|
|
Mech of Statins?
|
HMG CoA reductase inhibs
|
|
|
What is metabolic syndrome?
|
Any 3 of the following
Abdominal Obesity (waist:hip) TG>150 HDL-CH <40/50 BP (>130/85) Fasting glucose (>110) |
|
|
What can treat Acute Pericarditis?
|
NSAIDS
|
|
|
Primary manifestations of Pericardial Disease?
|
Pericarditis
Pericardial Effusions |
|
|
Which valve does endocarditis effect?
|
Tricuspid Valve
|
|
|
What population is endocarditis prevelant in?
|
Drug Abuser
|
|
|
What are the main Valvular heart disease?
|
Aortic Regurge
Aortic Stenosis Mitral Regurge Mitral Stenosis |
|
|
Which of the 4 main Valvular heard diseases are chronic?
|
All
|
|
|
Which of the 4 main valvular heart diseases can be both acute and chronic?
|
Aortic Regurge
Mitral Regurge |
|
|
What valves close during systole?
|
MV
TV |
|
|
What valves open during systole?
|
AV
PV |
|
|
What murmur is heard during systole?
|
Mitral regure
Aortic Stenosis |
|
|
What valves opens during diastole?
|
MV
TV |
|
|
What valves close during diastole?
|
AV
PV |
|
|
What murmur is heard during diastole?
|
Aortic regurge
mitral stenosis |
|
|
What will your physical exam show in pt with aortic stenosis?
|
Harsh Ejection murmur
S4 gallop Pulses Parvus Pulses Tardus Carotid Impulse |
|
|
What will the symptoms of aortic stenosis?
|
Angina
Syncope w/ exertion CHF |
|
|
How to diagnosis aortic stenosis?
|
w/ 2D color doppler echo
|
|
|
Treatment of aortic stenosis?
|
Valve replacement
meds only used if symptomatic |
|
|
Causes of Aortic Regurge?
|
Dilation of aortic annulus
abnormalities of leaflets |
|
|
Physical exam of aortic regurge?
|
Diastolic blowing murmur
Summation Gallop Increased LV apical impulse Austin Flint Murmur |
|
|
Symptoms of Aortic Regurge?
|
Dyspnea on exertion
fatigue decreased exercise tolerance |
|
|
How to diagnosis aortic regurge?
|
2D color Doppler Echo
|
|
|
Treatment of aortic regurge?
|
Symptomatic-Aortic valve replacement
Asympt-med therapy |
|
|
Cause of mitral regurge?
|
Alterations of leaflets, annuli, LV or LA
|
|
|
Symptoms of mitral regurge?
|
Fatigue/weakness
dyspnea/orthopnea RSHF MVP Syndrome |
|
|
Physical exam of mitral regurge?
|
Pansystolic Murmur
displaced PMI S3 |
|
|
Diagnosis of mitral regurge?
|
2D color Doppler Echo
|
|
|
Treatment of mitral regurge?
|
meds
valve replacement or repair |
|
|
Treatment of MVP?
|
BB
ASA Prophylaxis if assed w/ MV regurge |
|
|
Symptoms of MVP?
|
mid systolic click followed by murmur
|
|
|
What is the usual cause of mitral stenosis?
|
Rheumatic fever
|
|
|
Symptoms of mitral stenosis?
|
dyspnea
Fatigue Hemoptysis Can't tolerate increased HR or Volume |
|
|
Physical exam of mitral stenosis?
|
Loud S1
Opening Snap followed by diastolic murmur |
|
|
Med treatment for mitral stenosis?
|
Diurectics
Digitoxin BB CCB Anticoags |
|
|
Surgical treatment of Mitral stenosis?
|
Percutaneous Balloon Valvulaoplasty
MV replacement |
|
|
What are the 3 things cardiac imaging cardiac imaging can provide?
|
Anatomy
Fxn perfusion |
|
|
What does a chest Xray show you for cardio imaging?
|
Anatomy (size and calcifications)
|
|
|
What is the initial cardio image?
|
Chest Xray
|
|
|
Perks of chest Xray?
|
Fast
Cheap Easy Available |
|
|
Cons of chest Xray?
|
not definitive
|
|
|
What features do you get to see with an echo?
|
Anatomy
Fxn |
|
|
Pros of echo?
|
Portable and Easy
|
|
|
3 types of echos?
|
2D color Doppler Echo
Transesophageal (TEE) Stress echo |
|
|
What can be seen with 2D color doppler Echo?
|
Velocity of RBCs
Pressure gradients Valves Chamber size |
|
|
What can be seen with TEE?
|
Vegetations
LA appendages (clots and myxoma) |
|
|
Pros of stress echo?
|
Highly accurate
|
|
|
Cons of stress echo?
|
Expensive
Limited availability Limited with fatties Need expert to read them |
|
|
What are the types of nuclear imaging?
|
MPI
MUGA Viability Imaging Cardiac CT Cardiac MR |
|
|
What can be seen with MPI?
|
Stress Perfusion
LV function (EF) Ischemia |
|
|
Pros of MPI?
|
Very accurate for ischemia
|
|
|
Cons of MPI?
|
Sensitive
Expensive No eval of valves or pericardium |
|
|
What does MUGA evaluate?
|
LV Fxn (EF) only
|
|
|
What is the purpose of viability Imaging?
|
ID viable myocardium vs scar tissue for CABG
|
|
|
What can Cardiac CT evaluate?
|
Cardiac and Extra Cardiac Structures
Cardiac FXn Coronary Calcium |
|
|
Pros of Cardiac CT?
|
Non-invasive angiogram
Highly accurate |
|
|
Cons of Cardiac Ct?
|
Expensive
Radiation Limited availability Experts need to read |
|
|
What can be evaled with cardiac MR?
|
Cardiac structure
Valves Fxn Perfusion |
|
|
What is the gold standard to eval coronary arteries?
|
Cardiac MR
|
|
|
Pro's for Cardiac MR?
|
Gold standard
Rapid results |
|
|
What does an angiography measure?
|
Lumen size
|
|
|
What info does Cardiac Fxn give you?
|
EF
Preload Afterload CO Gradients |
|
|
What are the cons of a Cardiac Cath?
|
Invasive
Has risk |
|
|
What are the risks of cardiac cath/
|
1/1000 have MI
1/500 have MI w/ stent placement |
|
|
Which blood pressure reflects stroke volume?
|
Systolic BP
|
|
|
Which blood pressure reflects TPR of arterioles?
|
Diastolic BP
|
|
|
Which blood pressure reflects the amount of blood in the arteries during diastole?
|
Diastolic BP
|
|
|
Effect of vasoconstriction on TPR? Diastolic BP?
|
Increases both
|
|
|
Requirements to diagnose essential HTN?
|
3 or more elevated readings taken in 3 different visits
|
|
|
Effect of too small/narrow bp cuff on BP reading/
|
Falsely high readings
|
|
|
Formula for BP?
|
BP=C.O. x TPR
|
|
|
Cause of Benign Nephrosclerosis?
|
Hyaline Atherosclerosis
|
|
|
What is Benign Nephrosclerosis associated with?
|
Essential HTN
|
|
|
Symptoms of Benign Nephroslcerosis?
|
Protienuria
Hyaline casts slight increase in BUN and Creatinine Symetrical atrophy of both kidneys |
|
|
What does controlling BP decrease the risk of by the greatest?
|
Stroke
NOT AMI |
|
|
What is the MC complication of high BP?
|
AMI
|
|
|
What causes concentric hypertrophy?
|
Contraction against an increased afterload
|
|
|
What is the MCC of renovascular HTN in women?
|
Fibromuscular HTN
|
|
|
What is the MCC of renovascular HTN in men?
|
Atherscloerosis
|
|
|
Symptoms of renovascular HTN?
|
Bruits
Kidney atrophy (decreased BF) |
|
|
What willl be the renin levels in each kidney?
|
Atrophied-High
Normal-Low |
|
|
What is the most effective lifestyle for controlling BP?
|
Weight Reduction
|
|
|
What is the significance of a laterally displaced PMI?
|
LVH
|
|
|
Requirements to diagnose type II DM?
|
Fasting glucose 1X > 200 or 2X > 126
Hb A1C >6.5% |
|
|
Neutrophil pools in Negros? Cause?
|
Increased margninating pool
Decreased circulating pool Caused by increase adhesion molecules |
|
|
Do negros have increase or decrease response to infection?
|
No effect
Response is just like white peoples |
|
|
Characteristics of Metabolic Syndrome?
|
Obesity
HTN Type II DM Hyperlipidemia Hyperinsulinism |
|
|
What is the Key characteristic of Metabolic Syndrome?
|
Hyperinsulinism due to insulin resistance
|
|
|
Effect of catecolamines on BP?
|
Increase of catecolamines causes increase in BP
|
|
|
What activities will increase catecolamines?
|
Alcohol
Smoking Stress |
|
|
When you decrease the cutoff for a test what is the effect on Sensitivity? PV(-)? Specificity? PV(+)?
|
Increase
Increase Decrease Decrease |
|
|
What is white coat syndrome?
|
Pt has normal BP readings at home and elevated readings at the Dr. office
Has to be <105 |
|
|
Key symptom of tension cephalgia?
|
Tight pressure band encircling the head
Not accompanied by nausea May be aggrevated by light/sounds |
|
|
Significance of a patient saying they had skipped beats?
|
Can be PVCs
Can be due to excessive caffeine/stress |
|
|
What do PVC's signify?
|
prior MI
possibly from the night before |
|
|
Characteristic findings on a retinal exam of a Grade 1 hypersensitive Retinopathy?
|
Arteriolar narrowing
Mild AV nicking Flame Hemorrhages Cottonwool spots |
|
|
What does bilateral periorbital puffiness signify about the patients diet/
|
Increased Na intake
|
|
|
What causes the S4 heart sound/
|
Blood entering a volume overloaded vent
Compliance is the key |
|
|
Requirements for LVH on EKG?
|
V1/V2 + V5/V6 (take the greatest of each of the two)
Sum > 35 then LVH |
|
|
What is the effect of ACE inhibs on bradykinin? Why?
|
Increases
ACE degrades bradykinin |
|
|
What are some side effects of ACE inhibs?
|
Non-productive cough (bradykinin)
|
|
|
What can you substitue an ACE inhib for if you develop a chronic cough?
|
ARB
|
|
|
What does stimulation of J-receptors lead to/
|
Dyspnea
|
|
|
What is wheezing a sign of?
|
peribronchiolar edema around the terminal bronchioles
|
|
|
What causes MV and TV regure?
|
Stretching of the annulus (MCC is distention of ventricles b/c of volume overload
|
|
|
Significance of S3 and S4 getting louder with inspiration?
|
RSHF
|
|
|
Significance of Giant C-V wave?
|
Tricuspid Regurge
|
|
|
What causes the sound heard during tricuspid regurge?
|
Blood from R. Ventricle going into R. Atria during systole
|
|
|
Lung symptoms of LSHF?
|
Bibasilary inspiratory crackles
Pillow Orthopnea Nocturnal Dyspnea |
|
|
Significance of pitting edema?
|
RSHF
due to increase in TBNa+ |
|
|
Significance BUN/Cr > 15?
|
Prerenal azotemia
|
|
|
Effect of decreased GFR on Oncotic pressure vs Hydrostatic pressure and Na+ absorption?
|
Oncotic > Hydrostatic
Increase absorption of Na+ and urea in proximal tubule |
|
|
Does volume depletion or distention activate the release of of ANP and BNP?
|
Distention activates both
|
|
|
What is released with distention of the atria?
|
ANP
|
|
|
What is released with distention of the ventricles?
|
BNP
|
|
|
Effects of Loop Diuretics on Preload and Afterload?
|
Decreases preload
no effect on afterload |
|
|
Effects of ACE inhibs on Preload and Afterload?
|
Decreases both
|
|
|
Significance of EF < 40%? Cause?
|
Systolic dysfunction
Decreased Contractility |
|
|
Is EF effected in Diastolic Dysfunction?
|
No it is normal
|
|
|
Cause of Diastolic dysfunction?
|
Decreased compliance
|
|
|
Effect and mech of Digitoxin?
|
Increases force of contraction
Blocks Na+/K+ ATPase Allows Na+ to enter cell Opens Ca2+ channels |
|
|
What is the MCC for wt gain in the hospital?
|
Retention of Na+
|
|
|
What is the non-pharm treatment for CHF?
|
limit Na+ and H2O
|
|
|
What prevents Coronary Artery Thrombosis?
|
Aspirin
|
|
|
What prevents DVT?
|
Warfarin
|
|
|
Effects of Loop Diuretics on ions?
|
Hyponatremia
Hypocalcemia Hypokalemia decrease in Cl |
|
|
Effects of Loop Diuretics on pH?
|
Met. Alkalosis
|
|
|
What else is effected by loop diuretics?
|
Primary site for generation of free H2O
|
|
|
What supplement do you have to give when you put someone on a Loop Diuretic?
|
Potassium Supplements
|
|
|
Most noninvasive way to determine EF?
|
Echocardiogram
|
|
|
Mech of development of osteoarthritis?
|
Degeneration of Articular Cartilage
Reactive Bone Formation at Margin of Joint |
|
|
What drives the formation of spurs in osteoarthritis?
|
Increase in ALP
|
|
|
Mech of rheumatoid arthritis?
|
Inflammatory and destruction of Articular surfaces by overgrowth of Granulation tissue
|
|
|
Effect of PGE2?
|
Vasodilator of afferent arteriole
|
|
|
What blocks PGE2?
|
NSAIDS
|
|
|
Effects of ATII?
|
Vasoconstriction of efferent arterioles
|
|
|
Effects of NSAIDS on platelet Aggregation and Synthesis? Platelet Count? Bleeding time?
|
Blocks Platelet Aggregation
Bleeding Tim Prolonged No effect on platelet synthesis Normal Platelet count |
|
|
What to give patient if they are allergic to aspirin?
|
Plavix
Ticlid |
|
|
Side effect of Ticlid?
|
Neutropenia
|
|
|
MCC of Acute Renal Failure?
|
Prerenal azotemia
|
|
|
Tachypnea and Dyspnea? Which is a symptom and which is a sign?
|
Dyspnea is a symptom
Tachypnea is a sign |
|
|
Effects of nitroglycerin?
|
Veinodilator
|
|
|
Cause of hypocalcemia with serum PTH and ionized Ca++ normal?
|
hypoalbuminemia
|
|
|
A-a gradient <30?
|
Ventilation Defect
Perfusion Defect Diffusion Defect |
|
|
What does a pulse ox measure?
|
SaO2
|
|
|
Define cyanosis?
|
Sao2 <80%
|
|
|
Effects of Beta blockers on HR an systolic BP?
|
reduces HR and systolic BP
|
|
|
Mech of Betablockers?
|
decreases the myocardial O2 consumption
|
|
|
Risk factors for CAD?
|
Age (men >45, women >55)
Family History LDL >160 HTN DM HDL <40 Waist:Hip >1 |
|
|
Characteristics of an Xray of Pulmonary Edema?
|
Alveolar Infiltrates
Kerley's Lines Pulm Vessel Congestion Upper lobe vascular changes (due to Increase of Hydro. Pressure) |
|
|
What does a decrease in EABV activate? Causes?
|
RAA system
venoconstriction arterial constriction increase in ADH |
|
|
What can a decrease in HDL-CH be correlated to? What population is it common in?
|
Decrease in Estrogen
Common in Postmenopausal women |
|
|
How will an AMI manifest on an EKG (in order of appearance)?
|
Peaked T-waves
ST elevation T-wave inversion Q-waves |
|
|
What doe the abnormal T-waves represent in EKGs of a pt with an AMI?
|
Areas of ischemia
|
|
|
What does the ST elevation represent?
|
area of injury
loss of normal ion pumps Will eventually die |
|
|
Whad does a Q-wave represent?
|
Areas of infarction with cell death
|
|
|
Effects of venoconstriction on Cardiac output/
|
Increases CO
|
|
|
Effects of vasodilation on CO?
|
Increases
|
|
|
Effect of venodilation and loop diuretics on venous return to heart?
|
Decreases venous return
This decreases preload |
|
|
Non-pharm way of treating GERD?
|
Raise head
|
|
|
Heart rate sympathetic or parasympathetic?
|
Both
|
|
|
Parasympathetic nerve to heart? Effect?
|
Vagus
Decreases HR |
|
|
What does the vagus do to decrease the HR?
|
Increases the Release of Ach at the SA node
|
|
|
What is thyroxine's function in the heart?
|
Sympathetic
Increase Beta receptor synthesis Increases HR |
|
|
What are the 2 NT that are sympathetic in the heart? Origin of NT?
|
NE (directly release from nerves in cardiac muscles)
Epi (delivered to heart via circulation) |
|
|
Effect of HR >180?
|
Diastole too short for ventricular filling
Decrease preload, decrease SV, Decrease CO Coronary arteries under fill |
|
|
When do coronary arteries fill diastole or systole?
|
Diastole too short for ventricular filling
Decrease preload, decrease SV, Decrease CO Coronary arteries under fill |
|
|
Effect of Catecolamines and cortisol on neutrophil adhesion molecules?
|
Reduces
Causes Absolute Leukocytosis |
|
|
What is diaphoresis?
|
Sweating (possibly caused by chest pain)
|
|
|
What is Dresster's Syndrome?
|
Occurs 6 week post-MI
Caused by autoantibodies against pericardial tissues Same symptoms as pericarditis |
|
|
When will pericarditis rub at 1 week mean?
|
Due to Transmural Infarct
Increased vessel perm. Caused by fibrinous pericarditis not autoimmune |
|
|
What do Kerley B lines represent/
|
fluid in the interlobular septa
Perpendicular to pleura in lower lobes |
|
|
Significance of Specific Gravity >1.035?
|
Concentrating Urine
ADH is present |
|
|
Contraindications of Digitoxin?
|
Atrial Arrhythmias
|
|
|
What is the 2nd line of defense in a pt with systolic dysfunction?
|
Digitoxin
|
|
|
What med is cardio protective and is immediate use?
|
Betablockers
|
|
|
How are betablockers cardio protective?
|
reduce rates of reinfarction
limits range of damage to injured and reprofused tissue |
|
|
Effects of Nitrates on preload and afterload and veins and arterioles?
|
Venodilator
Vasodilator Decreases preload and afterload |
|
|
Why do you use morphine during an MI?
|
Vasodilator
Not for pain |
|
|
What do you need to be careful with while using Morphine?
|
Orthostatic HYPOtension
|
|
|
Effect of not fasting on LDL?
|
Falsely lowers LDL
Increases TG |
|
|
When should you start fibrinolytic therapy?
|
Within 6 hours of infarct
|
|
|
Mech of Spironolactone?
|
ADH blocker
|
|
|
Side effects of Spironolactone?
|
Gynecomastia
Impotence |
|
|
Why to use ADH blocker with an ACE inhib?
|
ACE causes build up of ADH
Spironolactone lasts longer |
|
|
Mech of Plavix?
|
inhibs fibrinogen receptors in platelets
|
|
|
What will you test with a pt on heparin to see if it is working?
|
PTT
|
|
|
What will you test in a pt on warfarin to see if it is working?
|
PT
|
|
|
Too much heparin what do you use?
|
protamine sulfate
|
|
|
Too much warfarin what do you use?
|
SubQ vitamin K
|
|
|
Possible ddiagnosis with inspiratory crackles?
|
Pneumonia
Interstitial Fibrosis Pulm Edema |
|
|
What are actinic keratosis precursor of?
|
Squamous cell carcinoma
|
|
|
When should you not give nitroglycerine?
|
If they have taken an ED med
Leads to hypotension due to big time vasodilation |
|
|
Mech of HMG-CoA reductase inhib?
|
Stabalize disrupted plaques
|
|
|
Significance of Bronchial Breath Sounds?
|
Always abnormal
Lung consolidation air bronchiograms |
|
|
Carvedilol mech and what is it used to treat?
|
Beta 1 and 2 blocker
used to treat systolic LSHF Causes Vasodilation |
|
|
What are diseases are part of Acute Coronary syndrome?
|
AMI
Unstable Angina |
|
|
What do you need to diagnose acute coronary syndrome?
|
symptoms
signs EKG findings |
|
|
Patient has MI, then sudden NV distension, hypotension, and muffled heart sounds?
|
Pericardial Tamponade secondary to ventricular rupture
|
|
|
Patient w/ previous MI, has precordial bulg, ST elevation, crackles at lung base?
|
Ventricular aneuryism causing LSHF
|
