Internal Medicine Cv

Front 1

What does "irregularly irregular" mean on an ECG?

Back 1

Irregular RR intervals

Front 2

Irregularly irregular rhythm without p-waves prior to each QRS

Back 2

Atrial fibrillation

Front 3

Etiologies of A-Fib
(10)

Back 3

PIRATES:
Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;
Ischemic heart dz & HTN;
Rheumatic heart dz
Anemia;
Thyrotoxicosis;
Ethanol & cocaine;
Sepsis

Front 4

Signs/symptoms of A-Fib
(5)

Back 4

A FL PT:
Asymptomatic patient;
Fatigue (most common);
Light headedness, syncope;
Palpitations, skipped beats;
Tachypnea, dyspnea

Front 5

Complication of A-Fib

Back 5

diffuse Embolization
(often to brain, leading to TIA or stroke)

Front 6

One of two possible Drugs given to A-Fib to control rate in an emergent situation

Back 6

IV Calcium channel blocker:
Diltiazem
(or)
IV Beta-blocker:
Metoprolol

Front 7

Drugs given to A-Fib to control rate in a non-emergent situation
(2)

Back 7

oral Beta-blocker:
Atenolol
(and)
oral Calcium channel blockers:
Verapamil or Diltiazem

Front 8

what are the (2) ways to cardiovert an A-Fib rhythm?

when should you not cardiovert?
what would the Tx be then?

Back 8

Medical: Amiodarone
Electrical: start @ 100 J

Do not cardiovert if patient is in A-Fib > 24 hours.
Tx: Warfarin for 3-4 weeks before cardioversion

Front 9

If cardioversion from A-Fib to sinus rhythm does not occur, what should patient be treated with?

Back 9

Long-term anticoagulants

DOC:
Warfarin (1st)
Aspirin (2nd)

Front 10

Dx:
when the heart is unable to pump sufficient amounts of blood to meet the O2 requirement of the body causing blood to backup

Back 10

Congestive Heart Failure
(CHF)

Front 11

What are the systolic dysfunctions of CHF?
(EF, Preload, LVEDP, contractility)

Back 11

Ejection Fraction < 40%
leading to Inc preload & LVEDP,
which leads to Dec contractility and Inc cardiac hypertrophy

Front 12

What causes CHF exacerbation in previously stable patients?
(10)

Back 12

FAILURE:
Forgot medication;
Arrhythmia, Anemia;
Ischemia, Infection;
Lifestyle (Inc sodium);
Upregulation (Inc cardiac output--pregnancy or hyperthyroidism);
Renal failure w/ fluid overload;
Emboli (pulmonary); Endocarditis

Front 13

What are the diastolic dysfunctions of CHF?
(compliance, contraction, recoil, LVEDP, CO, EF)

Back 13

Decreased compliance w/ normal contractile function
(ventricle either cant relax or fill properly)

leading to Inc stiffness, Dec recoil & coencentric hypertrophy.
LVEDP is Inc,
CO is nml,
EF is nml to high

Front 14

Which type of CHF dysfunction--systolic or diastolic has a normal ejection fraction and is more common in women?

Back 14

dyastolic

Front 15

What related heart conditions are seen in the systolic dysfunction of CHF that deals w/ decreased contractility?
(4)

Back 15

Ischemia(most common);
Dilated Cardiomyopathy;
Hypertensive burnout;
Valvular dz

Front 16

What related conditions are seen in the systolic dysfunction of CHF that deals w/ Inc afterload?
(3)

Back 16

Hypertension;
Aortic stenosis;
Aortic regurg

Front 17

What related conditions are seen in the diastolic dysfunction of CHF that deals w/ abnormal active relaxation?
(2)

Back 17

Ischemia;
Hypertrophic cardiomyopathy
(from disorders causing LVH)

Front 18

What related conditions are seen in the diastolic dysfunction of CHF that deals w/ abnormal passive filling?
(2)

Back 18

Restrictive cardiomyopathy;
Concentric hypertrophy from HTN

Front 19

What are the early signs of Left-sided CHF?
(2)

Back 19

Dyspnea on exertion;
Dec exercise tolerance

Front 20

What are the late sx of Left-sided CHF?
(8)

Back 20

PORNS DD Tits:
Paroxysmal Nocturnal Dyspnea;
Orthopnea;
Rales & crackles;
Nocturia;
S-3 gallop;
Diaphoresis;
Displaced PMI (laterally);
Tachycardia

Front 21

What are the early signs of Right-sided CHF?
(6)

Back 21

A Juicy CHERry:
Anorexia
JVD*
Cyanosis
Hepatomegaly
Edema in periphery
RUQ pain

Front 22

What are the late sx of Right-sided CHF?
(2)

Back 22

abnormal Hepatojugular reflex;
Ascites

Front 23

What force causes the pulmonary congestion in diastolic dysfunction?

Back 23

Increased hydrostatic pressure

Front 24

what (3) ways can CHF be diagnosed by a CXR?

Back 24

Enlargement of cardiac silhouette;
Pulmonary vascular congestion;
Kerley-B lines

Front 25

(3) lab methods of diagnosing CHF

Back 25

CXR;
Echocardiogram (function of ventricles);
Basic Natriuretic Peptide (BNP elevation)

Front 26

AHA staging guidelines for CHF (stages A-D)

Back 26

A: at risk but w/o structural heart disorder

B: no sx, w/ structural disorder

C: prior or current sx & structure disorder

D: end-stage dz

Front 27

NY Heart Assoc Functional Classes of Heart Failure (I-IV)
[measures pt activity]

Back 27

I: No limitation

II: slight limitation

III: Sx w/ minimal effort, ok at rest

IV: Sx at rest

Front 28

SOB while lying flat

Back 28

Orthopnea

Front 29

What drug classes are good versus CHF? Which ones are only helpful if patient has a diastolic dysfunction?

Back 29

Systolic or Diastolic dysfunction:
ACEIs/ARBs
Beta-blockers
diuretics

Diastolic dysfunction only:
Calcium channel blockers
Nitroglycerin

Front 30

What diuretics are used for mild CHF and (2 for) significant CHF?

Back 30

Mild:
Thiazides

Significant CHF:
Loop diuretics
Spirolactone

Front 31

What is the difference in the signs/sx of people w/ right CHF and cirrhosis?
(2)

Back 31

Same sx, except right CHF patients have trouble lying flat & have JVD

Front 32

what are the (5) Tx for Acute Pulmonary Edema & Paroxysmal Nocturnal Dyspnea?

Back 32

NOMAD:
Nitroglycerin
Oxygen
Morphine
Aspirin
Diuretic

Front 33

What is the rule for prescribing beta-blockers for CHF?

Back 33

never give during active CHF--add beta-blockers once the patient is diuresed to dry weight and on stable doses of other medications

Front 34

Describe (2) types of Malignant HTN
(+ BP limits)

Back 34

Hypertensive URGENCY:
systolic >200 or diastolic >110
WITHOUT evidence of end-organ damage

Hypertensive EMERGENCY:
Severe HTN w/ evidence of end-organ damage
(encephalopathy, renal failure, CHF, etc)

Front 35

what is important to remember about treating a hypertensive emergency?
(2)

Back 35

1) Immediate therapy is needed
2) IV drip w/ Nitroprusside or Nitroglyerin, but do not lower BP by more then 1/4 at first, or patient can have a stroke

Front 36

DOC for HTN w/o any comorbid dz

Back 36

Thiazide

Front 37

DOC for HTN w/ CHF
(3)

Back 37

ACEI / ARBs
B-blocker,
K-sparing diuretic

Front 38

DOC for HTN w/ MI
(2)

Back 38

B-blocker & ACEI

Front 39

DOC for HTN w/ osteoporosis

Back 39

Thiazide
(dec. calcium excretion)

Front 40

DOC for HTN w/ BPH

Back 40

Terazosin
(Alpha-blocker)

Front 41

DOC for HTN w/ pregnancy

Back 41

alpha-methyldopa

Front 42

(3) contraindications for Beta-blockers

Back 42

COPD
Diabetes
HyperK

Front 43

(3) contraindications for ACEI

Back 43

Pregnancy
Renal artery stenosis
Renal Failure (creatinine >1.5)

Front 44

contraindication of all diuretics

Back 44

Gout

Front 45

(2) hypersteroidism syndromes that cause HTN w/ hyperK

Back 45

Cushing's

Conn's

Front 46

endocrine system abnormality that can lead to HTN due to episiodic autonomic bursts of epinepherine

Back 46

Pheochomocytoma

Front 47

congenital cause of HTN that leads to HTN in arms and low BP in legs

Back 47

Coartation of the Aorta

Front 48

renal artery stenosis that causes HTN in:
1) older men
2) younger women

Back 48

1) atherosclerosis

2) fibromuscular dysplasia

Front 49

valvular problem that causes HTN w/ a wide PP due to Inc SV

Back 49

Aortic Regurg

Front 50

congenital problem that causes HTN w/ a wide PP due to Inc SV

Back 50

Patent Ductus Arteriosus

Front 51

(3) drug classes that cause HTN

What metal poisoning?

Back 51

Oral contraceptives
Corticosteroids
Amphetamines

Lead poisoning

Front 52

(5) deadly causes of chest pain

Back 52

TAPUM:
Tension pneumothorax
Aortic Dissection
PE
Unstable Angina
MI

Front 53

how is the maximum HR determined?

Back 53

220-patient's age = Max HR

Front 54

(6) Major risk factors for CAD
which is most prevetable?
which is the greatest risk?

Back 54

Diabetes (greatest)
Smoking (most preventable)
HTN
Hypercholesterolemia
Family Hx
Age

Front 55

Chest pain that has an established character, timing and duration; pain is transient, reproducable and predictable.
What is cause?
What is Tx? (2)

Back 55

Stable Angina

Reduced coronary blood flow through fixed athrosclerotic plaque in vessel of heart

rest & nitroglyerin

Front 56

exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back.
N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it.
Name the types

Back 56

Angina:

Stable
Unstable
Variant (Prinzmetal's)

Front 57

Angina type that is also considered an Acute Coronary Syndrome (ACS).
What (3) factors must it have for diagnosis?

Back 57

Unstable Angina

1) New-onset
2) angina that changes or accelerates in pattern, location or severity
3) Occurs at REST

Front 58

Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis.
(2) Tx?

Back 58

Variant (Prinzmetal's) Angina

Nitrates & Calcium Channel blockers

Front 59

what (2) groups of patients may not show the classic signs pain seen in stable angina?
Why?

Back 59

Elderly & diabetics

(b/c: neuropathies)

Front 60

What does the EKG look like for the (3) angina types?

Back 60

Stable & Unstable:
- ST Depression
- T-wave Inversion

Variant:
- ST elevation

Front 61

62-yo smoker w/ 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before.
What is it?

Back 61

Unstable Angina

Front 62

62-yo man w/ frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night.
What is it?

Back 62

Variant (Prinzmetal's) Angina

Front 63

what is the alternative to an exercise Stress Test if the patient cannot get on a treadmill?

Back 63

IV Dobutamine is given to stimulate myocardial function

Front 64

What is the criteria for a "positive" Stress Test?
(5)

Back 64

either:
- ST elevation
- ST depression >1 mm in multiple leads
- Dec BP
- failure to go more than 2 minutes
- failure to complete for reason other then cardiac symptoms (i.e. arthritis)

Front 65

what does Myocardial Perfusion Imaging detect?
(3)

Back 65

- Myocardial perfusion
- Ventricular volume
- Ejection Fraction

Front 66

An ultrasound of the heart revealing abnormal wall motion due to ischemia or infarction. It also assesses left ventricular function and EF

Back 66

Echocardiography

Front 67

(5) uses for a cardiac catherization

Back 67

1) MI / Unstable angina: stent or angiography
2) Valvular disease: valvuloplasty
3) Arrhythmias: mapping bypass tracts
4) Myocardial dz Bx: glycogen storage dz or cardiomyopathies
5) Congenital heart dz identification: angiography & closure of defects

Front 68

(4) serum markers for MI

Back 68

Myoglobin
Troponin T/I
CK
Lactate Dehydrogenase

Front 69

How is the right heart accessed in a cardiac catherization? (2)

Left heart? (2)

Back 69

Right:
Femoral or Internal Jugular

Left:
Femoral or Radial artery (from right heart)

Front 70

what is the wave morphology changes sequence in a MI ECG?
(6)

Back 70

1. peaked T-waves
2. T-wave inversion
3. ST elevation
4. Q-waves
5. ST normalization
6. T-waves return upright

Front 71

which cardiac enzyme is the most sensitive and specific for acute MI?

Back 71

Troponin-I/T

Front 72

which cardiac enzyme remains increased (peaked) the longest?

Back 72

LDH

Front 73

what does ST depression mean?

Back 73

ST goes in the opposite direction of the QRS

Front 74

what does a Q-wave on an EKG in the presence of an infarction indicate?

Back 74

Transmural infarction
(extends through full thickness of the myocardial wall)

Front 75

Time of onset for the (4) serum markers for MI

Back 75

Myoglobin (1-4 hrs)
Troponin-I/T (3-12)
CK-MB (3-12)
LDH (6-12)

Front 76

which cardiac enzyme has the shortest duration?

Longest?

Back 76

Myoglobin (1 day)

Troponin-I/T (7-10 days)

Front 77

ST elevation in II, III & aVF

Back 77

Inferior wall MI

Front 78

ST depression in II, III & aVF

Back 78

Cor Pulmonale

Front 79

ST elevation in V1, V2, V3

Back 79

Anterior/septal MI

Front 80

ST elevation in V4, V5, V6

Back 80

Lateral wall MI

Front 81

ST depression in V1, V2

Back 81

Posterior wall MI

Front 82

difference b/t unstable angina & non-ST elevation MI?
(2)

Back 82

non-ST elevation MI has:
1. more severe lack of Oxygen (more severe myocardial damage)
2. Enzyme leakage (Unstable angina has none)

Front 83

Tx for Unstable angina & MI
(6)

Back 83

MONA has HEP B:

Morphine
Oxygen
Nitrates
Aspirin
HEParin
Beta-blockers

Front 84

primary Tx (2) for the acute MI w/in 6 hours of infarct
(name 4 drugs)

Back 84

Throbolytics:
- tPA + Heparin (DOC)
- Urokinase
- strptokinase
- Alteplase

Front 85

At what level should LDL be in person w/ MI history?
What is given to lower it?

Back 85

less then 100

statins

Front 86

When are throbolytics indicated in MI?
(3)

Back 86

- patients < 80 yo
- within 6-12 hrs of chest pain
- evidence of infarct on ECG

Front 87

Contra-indications of Throbolytics
(9)

Back 87

Having Some Breaks A Blood Clot In Small Pieces:
- Hx of intracranial bleed
- stroke < 1 year
- BP > 180/110
- active internal bleed
- bleeding disorder
- CPR
- Intracranial tumor
- suspected aortic dissection
- Peptic ulcer

Front 88

drug class that is used to break up clots

Back 88

throbolytics

Front 89

drug that prevents future clots from forming

Back 89

heparin

Front 90

Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?

Back 90

PTCA
(Percutaneous Transluminal Coronary Angioplasty)

Front 91

which throbolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?

Back 91

streptokinase

Front 92

what should be given 48 hours post infarct if tPA was used?

Back 92

heparin

Front 93

drug class that is excellent for late & long-term therapy for acute MI to decrease afterload and prevent remodeling?

Back 93

ACEi

Front 94

how many seconds & boxes is a normal PR interval?

Back 94

0.2 ms

5 small boxes

Front 95

define:

Q-wave

When is it pathologic?

Back 95

when initial part of ventricular depolarization is downward

Pathologic: greater then 1 small box

Front 96

normal time & boxes for QRS interval?

Back 96

< 0.12 ms

3 small boxes

Front 97

normal sinus rate

Back 97

60 - 100 bpm

Front 98

define:

Junctional rhythm

Back 98

rhythm originating in the AV node & causing narrow QRS w/o P-waves

Front 99

no p-waves;
all complexes are wide;
no changes in height (amplitude) w/ each complex;
> 100bpm

Back 99

Ventricular tachycardia

Front 100

wide QRS complexes that vary in amplitude
(2 names)

Back 100

Ventricular Fibrillation

Torsades de Pointes

Front 101

normal sinus rhythm w/ PR interval > 0.2 ms (> 5 small boxes)

Back 101

First-degree AV block

Front 102

PR interval elongates from beat to beat until it becomes so long that a beat drops

Back 102

Second-degree AV block, type 1
(Wenckebach)

Front 103

PR interval is fixed but every so often there is a P-wave w/o a QRS

Back 103

Second-degree AV block, type 2
(Mobitz)

Front 104

no relationship b/t P-waves and QRS complexes

Back 104

Third-degree AV block

Front 105

QRS > 0.12 (> 3 small boxes)
RSR' in V1 & V2;
deep S-wave in lateral leads (I, aVL, V5 & V6)

Back 105

RBBB

Front 106

QRS > 0.12 (> 3 small boxes);
RSR' in V5 & V6;
diffuse ST elevation

Back 106

LBBB

Front 107

Different shapes to 3 or more P-waves;
normal rhythm

(what is it called if it is tachycardic?)

Back 107

Wandering pacemaker

MFAT:
Multifocal Atrial Tachycardia

Front 108

short PR interval;
slurring delta wave connecting P-wave to QRS complex

Back 108

Wolff-Parkinson-White syndrome

Front 109

diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR

Back 109

Pericarditis

Front 110

Tx of wandering pacemaker & MFAT?
(1 drug / 1 "other")

Back 110

Verapamil (Ca channel block)
&
Tx underlying condition

Front 111

what Tx breaks SVT (superventricular tachy) in > 90%?

Back 111

Adenosine

(failure to break r/o SVT)

Front 112

Tx for V-tach w/ hypotension or no pulse

Back 112

Emergency defibrillation @
200 - 360 J

Front 113

Tx of asymptomatic V-tach
(2)

Back 113

Amiodarone

Lidocaine

Front 114

Tx of V-Fib

Back 114

Emergent electroshock @
200 - 360 J

Front 115

58-yo man discharged from hospital after MI 2 weeks ago presents w/ fever, chest pain & malaise. EKG shows diffuse ST-T wave changes.
What is Dx?
What is Tx?

Back 115

Dressler's syndrome

NSAIDs

Front 116

Medication orders w/ dischsrge of an ACS (post-MI) patient?
(5)

Back 116

easy AS ABC:

- Aspirin (indefinitely)
- Statin to lower LDL < 100
- ACE-inh (if EF <40%)
- Beta-blocker (indefinitely)
- Clopidogrel for 1 - 12 mo depending on stent placement

Front 117

Dx:
fever, pericarditis & possible pericardial or pleural effusions post cardiac surgery

Back 117

Dressler's syndrome

Front 118

how do you distinguish Paroxysmal Noctournal Dyspnea from asthma?

Back 118

no improvement w/ bronchodilators

Front 119

SVT w/ AV block & yellow skin

Back 119

Digoxin toxicity

Front 120

Etiology of Dilated Cardiomyopathy
(6)

Back 120

TIMED:
- Toxic (EtOH, heavy metals)
- Infectious / Ischemic
- Metabolic / Mechanical (arrthymia, valve dz)
- Endocrine
- Drugs

Front 121

what is the Reversible & Irreversible(2) toxic causes of Dilated Cardiomyopathy?

Back 121

Reversible:
prolonged EtOH use

Irreversible:
Cocaine;
heavy metal toxicity

Front 122

what is the Reversible & Irreversible(2) endocrine causes of Dilated Cardiomyopathy?

Back 122

Reversible:
Thyroid disease (hypo or hyper)

Irreversible:
Acromegaly;
Pheochromocytoma

Front 123

Reversible metabolic causes of Dilated Cardiomyopathy?
(4)

Back 123

HypoC;
HypoP;
Thiamine deficiency (wet beri-beri);
Selenium deficiency

Front 124

Infections that cause Dilated Cardiomyopathy
(3)

Back 124

HIV;
Coxsackie virus;
Chagas disease

Front 125

Drugs that cause Dilated Cardiomyopathy
(2)

Back 125

Doxorubicin (Adriamycin);
AZT

Front 126

Signs/Sx of Dilated Cardiomyopathy

Back 126

RAMS:
R & L Heart failure;
A-fib;
Mitral regurg;
S-3 Gallop

Front 127

Diastolic or Systolic Dz Cardiomyopathy:
1. Dilated
2. Restrictive
3. Hypertrophic

Back 127

Systolic:
Dilated

Diastolic:
Restrictive &
Hypertrophic

Front 128

Diagnostic results of Dilated cardiomyopathy
- auscultation
- EKG (3)
- CXR (2)
- Echo (2)

Back 128

Auscultation: S-3;
EKG: Vent Hypertrophy, BBB &/or A-fib;
CXR: Inc heart size; pulm congestion
Echo: low EF, large ventricles

Front 129

Tx Dilated Cardiomyopathy
(3)

Back 129

- stop any toxic agents
- anticoagulation w/ coumadin (even w/o evidence of thrombus)
- heart transplant

Front 130

Right or left ventricular enlargement w/ loss of contractile function causing CHF, arrythymia, or throbus formation.

Back 130

Dilated Cardiomyopathy

Front 131

Scarring & infiltration of the myocardium causing decreased right or left ventricular filling

Back 131

Restrictive Cardiomyopathy

Front 132

Etiology of Restrictive Cardiomyopathy
(7)

Back 132

ACHES:
Amyloidosis;
Carcinoid heart dz / Congenital;
Hemochromatosis;
Endomyocardial fibrosis
Sarcoidosis / Scleroderma

Front 133

Dx:
Pulmonary HTN (right CHF);
S-4 gallop; Low QRS voltage on EKG; Exercise intolerance;
Diastolic dz

Back 133

Restrictive Cardiomyopathy

Front 134

(5) tests used to assist in the Dx of Restrictive Cardiomyopathy

Back 134

Aucsultation;
EKG;
CXR;
Echo;
Endomyocardial Bx*

Front 135

Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction

Back 135

Hypertrophic Cardiomyopathy

Front 136

another name for Hypertrophic Cardiomyopathy

Back 136

IHSS
Idiopathic Hypertrophic Subaortic Stenosis

Front 137

(3) causes of paradoxical splitting of S-2

Back 137

Hypertrophic cardiomyopathy (IHSS);
Aortic stenosis;
LBBB

Front 138

murmur that decrease with squatting (and increases when returning to standing position)

Back 138

Hypertrophic CM
(IHSS)

Front 139

etiology of Hypertrophic Cardiomyopathy

Back 139

50% idiopathic
50% familial (autosomal dominant, w/ variable penetrance)

Front 140

Dx:
Angina (at rest or exercise); Syncope; Arrhythmias; CHF

Back 140

Hypertrophic Cardiomyopathy

Front 141

sudden death from Hypertrophic CM is usually due to what?

Back 141

Arrhythmias

Front 142

25-yo man becomes severly dyspneic & collapses while running laps, His father died suddenly at an early age.

Back 142

Hypertrophic CM (IHSS)

Front 143

Diagnostic results to Dx Hypertrophic CM
- Auscultation (2)
- EKG (4)
- Echo (2)

Back 143

Auscultation - Systolic ejection murmur;
Paradoxical splitting of S2;
EKG - LVH, PVCs, A-fib, ST & Q abnormalities;
Echo - septal hypertrophy, LVH w/ small LV

Front 144

Tx for Hypertrophic CM
(3)

Back 144

- No exercise
- Beta-blocker
- implantable cardiac defibrillator

Front 145

Most common infectious cause of Myocarditis

Back 145

Coxsackie B

Front 146

(4) systemic diseases that causes Myocarditis

Back 146

KISS:
- Kawasaki's
- Inflammatory conditions
- SLE
- Sarcoidosis

Front 147

(4) Parasites that cause Myocarditis

Back 147

Trypanosoma Cruzi (Chagas);
Toxoplasmosis;
Trichinella;
Echinococcus

Front 148

(5) Bacterial causes of Myocarditis

Back 148

Group A beta-hemolytic Strep (rheumatic fever);
Corynebacterium;
Meningococcus;
Lyme (B. burgdorferi);
Trichinella

Front 149

(8) viral causes of myocarditis

Back 149

Coxsackie A or B;
Echovirus; EBV:
HIV; HBV
CMV;
Influenza;
Adenovirus

Front 150

(3) drugs that cause pericarditis

Back 150

Hydralazine;
Isoniazid;
Procainamide

Front 151

Etiology of Pericarditis
(6)

Back 151

Bacterial, viral or fungal infections;
Serositis from:
RA;
SLE;
Scleroderma;
Uremia;
post-MI (Dressler's syndrome)

Front 152

Tx for pericarditis if:
- infection
- pain/inflammation
- Dressler's
- Recurrent cases

Back 152

- Tx infection w/ Abx;
- NSAIDs to relieve pain & reduce inflammation;
- Steroids for Dressler's;
- Pericardectomy only w/ recurrent cases

Front 153

Transient fall in BP > 10 mmHg during inspiration

Back 153

Pulsus Paradoxus

Front 154

Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling & reduces cardiac output

Back 154

Pericardial Tamponade

Front 155

Etiology of Pericardial Tamponade
(3)

Back 155

- Pericarditis
- Trauma
- Aortic dissection or ventricular rupture into pericardium

Front 156

Beck's triad of the pericardial tamponade

(4) other signs/Sx

Back 156

Beck's triad:
- Hypotension
- Muffled heart sounds
- JVD

Other Sx:
Dyspnea;
Tachycardia;
Pulsus Paradoxus*
narrow Pulse Pressure

Front 157

Tx for Pericardial Tamponade for:
1. unstable
2. stable
3. both

Back 157

Unstable: Immediate Pericardiocentesis;

Stable: Pericardial window

Both: Infuse fluids to expand volume

Front 158

Failure of venous pressure to fall during inspiration

Back 158

Kussmaul's sign

Front 159

If pericardiocentesis has clots, what is likely source of blood?

Back 159

Right Ventricle

Front 160

Patient has chest pain w/ inspiration that radiates to the left trapezial ridge;
Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine

Back 160

Pericarditis

Front 161

additional signs/Sx for Constrictive pericarditis (versus pericarditis)
(4)

Back 161

- JVD
- Kussmaul's sign
- peripheral edema
- LV failure

Front 162

Heart valve dz almost always due to Rheumatic Fever

Back 162

mitral stenosis

Front 163

Murmur type:
Dyspnea on Exertion; Cough, rales; signs of RV failure;
RV precordial thrust; Hoarse voice (from enlarged LA on recurrent laryngeal nerve)

Back 163

Mitral Stenosis

Front 164

Diagnostic results for Mitral Stenosis
- Auscultation
- CXR
- EKG

Back 164

Auscultation: mid-diastolic opening snap;

CXR: large Left atrium & Kerely B lines

EKG: LA enlargement; RV hypertrophy; A-fib

Front 165

Tx for mitral stenosis w/ each grade (I-IV)

What should always be avoided w/ mitral stenosis tx?

Back 165

Grade:
I: Diuretics; B-Blockers; Anticoagulants; Digitalis
II: Drugs from I + Balloon valvuloplasty (if drugs dont work)
III/IV: Balloon Valvuloplasty

Avoid: Inotropic Agents!

Front 166

Acute etiology of Mitral Regurgitation
(2)

Back 166

MI w/ papillary muscle rupture;
Endocarditis

Front 167

Chronic etiology of Mitral Regurgitation
(3)

Back 167

Rheumatic fever;
Mitral Prolapse;
LV dilation

Front 168

Diagnostic tests for Mitral Regurgitation
- Auscultation
- EKG
- Echo

Back 168

Auscultation: Loud, holosystolic apical murmur radiating to axilla

EKG: large LA

Echo: valve problem

Front 169

Tx for Mitral Regurgitation
(6)

Back 169

ACEinh;
Diuretics;
Vasodilators;
Digitalis;
Endocarditis prophylaxis;
Surgery if severe

Front 170

Most common valvular disorder

Back 170

Mitral prolapse

Front 171

Asymptomatic murmur w/ genetic predisopositon, seen most commonly in women

Back 171

Mitral Prolapse

Front 172

What murmur is seen in Marfan's syndrome?

Back 172

Mitral prolapse

Front 173

Tx for mitral prolapse?

Back 173

not necessary to tx unless symptomatic

Front 174

Mean survival rate for patients w/ Aortic Stenosis and:
1. Angina
2. Syncope
3. Heart failure

Back 174

1. 5 years
2. 2 - 3 years
3. 1 - 2 years

Front 175

Etiology of Aortic Stenosis
(2)

Back 175

- Calcific dz w/ age
- Bicuspid valve (around age 40)

Front 176

Conditions w/ a wide Pulse Pressure
(6)

Back 176

WAH-HAH-ide pulse pressure:
Wet beri-beri
Aortic Regurgitation;
Hyperthyroidism;
Hypertension;
Anemia;
Hypertrophic Subaortic Stenosis (IHSS)

Front 177

WHat (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation.
How is it treated?

Back 177

Mitral Regurg
Aortic Regurg

Tx: Emergent surgery

Front 178

Classic triad of Sx for Aortic Stenosis

(4) other signs

Back 178

SAD:
- Syncope;
- Angina;
- Dyspna on Exertion

Others:
- Forceful apex beat
- narrow Pulse Pressure
- Paradoxical S2 split
- heard in carotids

Front 179

Diagnostic test results for Aortic Stenosis
- Auscultation
- EKG
- Echo
- CXR

Back 179

Auscultation: Loud systolic crescendo-decrescendo murmur;

EKG: LV strain

CXR: calcifications on valve

Echo: diseased valve

Front 180

What is the EKG LV strain pattern seen in aortic stenosis?

Back 180

ST depression & T-wave inversion in I, aVL, V5 & V6

Front 181

Tx for aortic stenosis
(2)

Back 181

- avoid Afterload reducers (ACEinh & beta-blockers)
- Valve replacement

Front 182

(3) main etiologies for Aortic Regurgitation

Back 182

Aortic root dilatation;
Valvular dz;
Proximal Aortic root dissection

Front 183

(3) causes of Aortic root dilatation thereby causing Aortic Regurg

Back 183

Marfan's;
Idiopathic (but inc w/ HTN);
Collagen vascular dz

Front 184

(2) causes of Valvular dz thereby causing Aortic Regurg

Back 184

Rheumatic heart dz;
Endocarditis

Front 185

(6) causes of proximal Aortic root dissection thereby causing Aortic Regurg

Back 185

"C 3 SHET":
Cystic medial necrosis (Marfans);
3rd trimester pregnancy;
Syphilis;
HTN;
Ehlers-Danlos;
Turner's syndrome

Front 186

Names of the 7 unique signs of Aortic regurg

Back 186

1. Water-Hammer pulse
2. Traube's sign
3. Corrigan's pulse
4. Quincke's sign
5. de Musset's sign
6. Muller's sign
7. Duroziez's sign

Front 187

Aortic regurg sign:

wide pulse pressure presenting w/forceful arterial pulse upswing w/ rapid falloff

Back 187

Water-Hammer pulse

Front 188

Aortic regurg sign:

pistol-shot bruit over femoral pulse

Back 188

Traube's sign

Front 189

Aortic regurg sign:

unusually large carotid pulsations

Back 189

Corrigan's pulse

Front 190

Aortic regurg sign:

pulsatile blanching & reddening of fingernails upon light pressure

Back 190

Quincke's sign

Front 191

Aortic regurg sign:

head bobbing caused by carotid pulsation

Back 191

de Musset's sign

Front 192

Aortic regurg sign:

pulsatile bobbing of the uvula

Back 192

Muller's sign

Front 193

Aortic regurg sign:

to-&-fro murmur over femoral artery (heard best w/ mild pressure applied to artery)

Back 193

Duroziez's sign

Front 194

Murmur presentation:
dyspnea, orthopnea, paroxysmal noctournal dyspnea, angina, LV failure,
wide pulse pressure

Back 194

Aortic regurg

Front 195

Murmur presentation:
starts asymptomatic, then dyspnea, angina, syncope, heart failure

Back 195

Aortic stenosis

Front 196

Murmur presentation:
mostly asymptomatic, atypical chest pain, SOB, fatigue

Back 196

Mitral Prolapse

Front 197

Murmur presentation:
dyspnea, fatigue, weakness, cough, A-fib, systemic emboli

Back 197

Mitral Regurg

Front 198

Murmur presentation:
DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice

Back 198

Mitral stenosis

Front 199

How do you diagnose LVH from a ECG?
(2)

Back 199

1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small)

2. R-wave in V5 or V6 > 25 small boxes OR R-wave in lead aVL > 11 small boxes

Front 200

Diagnostic tests for Aortic Regurg
- Auscultation (3)
- EKG

Back 200

Auscultation:
1. Holosystolic, blowing decrescendo diastolic murmur
2. Apical diastolic rumble (mitral stenosis w/o snap)
3. Midsystolic flow murmur at base
EKG: LVH
Echo: regurgitant valve

Front 201

Tx for Aortic regurg
(3)

Back 201

Tx LV heart failure;
Endocarditis prophylaxis;
Valve replacement

Front 202

Etiology of Tricuspid stenosis
(3)

Back 202

Rheumatic heart dz;
Congenital;
Carcinoid

Front 203

Murmur presentation:
peripheral edema, JVD, hepatomegaly, ascites, jaundice
(2)

Back 203

Tricuspid stenosis

or

Tricuspid Regurg

Front 204

Diagnostic results for Tricuspid stenosis:
- auscultation
- echo

Tx?

Back 204

Dx:
Auscultation: diastolic, rumbling low-pitched heard w/ inspiration
Echo: diseased valve

Tx: surgical repair

Front 205

Dx:
Patient w/ DVT has a stroke. He has a fixed S2 split

Back 205

Atrial-septal defect
(w/ right-to-left emboli)

Front 206

Etiology of Tricuspid Regurg
(4)

Back 206

Increased pulmonary artery Pressure (from L-CHF or Mitral stenosis/regurg);
R-CHF;
Right papillary muscle rupture w/ MI;
Tricuspid valve lesions (rheumatic heart or bacterial endocarditis)

Front 207

(3) causes of a holosystolic murmur

Back 207

Mitral Regurg;
Tricuspid regurg;
Ventricular Septal Defect

Front 208

Number 1 cause of death in CHF patients

Back 208

Arrhythmia

Front 209

Diagnostic results for Tricuspid Regurg
- Auscultation
- EKG
- Echo

Back 209

Auscultation: Holosystolic murmur increasing w/ inspiration
EKG: RV enlargement; A-fib
Echo: diseased valve

Front 210

Tx for Tricuspid Regurg
(3)

Back 210

Tx heart failure;
Diuresis;
Surgical repair of valve

Front 211

What is done first if a patient has hyperK and peaked T-waves?
Why?

Back 211

give Calcium

to stabilize cardiac membrane

Front 212

Causes of prolonged QT
(8)

Back 212

QT WIDTH:

QT: Prolonged QT syndrome
W: WPW
I: Infarction
D: Drugs
T: Torsades de pointes
H: HypoK, HypoC, Hypomagnesium

Front 213

Causes short QT

Back 213

HyperC

Front 214

Causes of Torsades de Pointes
(7)

Back 214

POINTES:
Phenothiazines
Other meds (TCAs)
Intracranial bleed
No known cause (idiopathic)
Type 1 Anti-arrhthymics
Electrolyte abnormalities
Syndrome of prolonged QT

Front 215

Murmur:

Diastolic apical rumble & opening snap

Back 215

Mitral stenosis

Front 216

Murmur:

Late systolic murmur w/ midsystolic click

What is confirming test?

Back 216

Mitral Prolapse

Valsalva - click starts earlier, murmur prolonged

Front 217

Murmur:

High-pitched apical blowing holosystolic murmur

where does it radiate?

Back 217

Mitral Regurg

radiates to axilla

Front 218

Murmur:

Diastolic rumble louder w/ inspiration

Back 218

Tricuspid stenosis

Front 219

Murmur:

High-pitched blowing holosystolic murmur heard better w/ inspiration

Where is it heard?
Where are pulsations seen?

Back 219

Tricuspid Regurg

- heard @ left sternal border
- Jugular pulsations

Front 220

Name sign:
Peripheral pulses that are weak & late compared to heart sounds

What murmur?

Back 220

Pulsus Parvus et Tardus

Aortic Stenosis

Front 221

Murmur:

midsystolic crescendo-decrescendo murmur

Where does it radiate? (2)
What is also heard?

Back 221

Aortic stenosis

radiates to:
Carotids & Apex

- S4 also heard

Front 222

Name sign:
Double-peaked arterial pulse

what murmur?

Back 222

Pulsus Bisferiens

Aortic regurg

Front 223

Murmur:

Blowing early diastolic, apical diastolic rumble, midsystolic flow murmurs

Back 223

Aortic Regurg

Front 224

Murmur:

Systolic murmur at apex & left sternal boarder not transmitted to carotids

How is it heard better?

Back 224

IHSS

heard better w/ standing after squat

Front 225

When do you hear the "flow murmur" (murmur heard w/ any high flow state)?
What is differential dx?
(5)

Back 225

Midsystolic:
Aortic Regurg
A-S defect (fixed split S2)
Anemia
Adolescence
Pregnancy

Front 226

What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?

Back 226

Adenosine

Front 227

What drugs should not be given to someone w/ Wolff-Parkinson-White syndrome?
(4)

What is the DOC?

Back 227

ABCD:
Adenosine
Beta-blockers
Calcium channel blockers
Digoxin

DOC:
Procainamide

Front 228

Causes of Mobitz I
(3)

Causes of Mobitz II
(2)

Back 228

Mobitz I:
Inferior wall MI
Digitalis toxicity
Inc Vagal tone

Mobitz II:
Inferior or septal wall MI
Conduction system disease

Front 229

Tx for Mobitz I & II

Back 229

Both:
Atropine & temporary pacing

(Mobitz II should have pacemaker)

Front 230

Causes of third-degree heart block
(3)

Back 230

Digitalis toxicity
Inferior wall MI
Conduction system disease

Front 231

Causes of Bradycardia
(6)

Back 231

if R-R is longer then "One INCH"
Overmedication;
Inferior MI / Inc intracranial Pressure;
Normal variant (athletes);
Carotid sinus hypersensitivity;
Hypoparathyroidism

Front 232

Tx for bradycardia
(3)

Back 232

Atropine
pacing
pressors for hypotension

Front 233

a 24-yo woman w/ preclampsia Tx w/ IV drip of magnesium complains of difficulty breathing & has diminished reflexes. Next step?

Back 233

Stop magnesium & give IV calcium

Front 234

equation for Mean Arterial Pressure

Back 234

MAP = (2dBP + sBP)/3

Front 235

heart medication that can cause cyanide toxicity

Back 235

Nitroprusside

Front 236

Tx for Hypertensive emergency due to pheochromocytoma

Back 236

Phentolamine

Front 237

(2) possible Tx for a preclampsia-related hypertensive emergency

Back 237

Hydralazine
or
Magnesium

Front 238

difference b/t Type A & Type B Aortic Dissections

Back 238

Type A:
involves the ascending aorta & can extend into the descending aorta

Type B:
descending aorta only

Front 239

Debakey Classification of Aortic Dissection Types I-III

Which is most common?

Back 239

I: Ascending plus part of distal aorta (most common)

II: Ascending only

III: Descending only

Front 240

What is infected on the aorta when the aortic dissection is due to syphilis?

Back 240

Vasa Vasorum

Front 241

Etiology of Aortic Dissection
(7)

Back 241

PATC3H:
Pregnancy (3rd trimester);
Aortic Coarctation (Turners or idiopathic);
Trauma;
Congenital heart dz / CT dz (Marfans & E-D syndromes) / Cocaine;
HTN

Front 242

Dx:
Severe tearing chest pain that radiates to the back, HTN, possible unequal pulses distally, possible aortic regurg murmur

Back 242

Aortic Dissection

Front 243

(3) tests to confirm Dx of aortic dissection

Back 243

CXR - wide mediastinum
CT w/ contrast
Angiogram (gold standard)

Front 244

Drug Tx for Aortic dissection to stabilize BP

What is the next step for Type A vs. Type B?

Back 244

Rx: Beta-blocker + nitroprusside to keep BP < 120

Type A: Immediate surgery
Type B: medical stabilization

Front 245

When a patient has VHD or previous endocarditis, what (3) procedure types must they obtain endocarditis prophylaxis medications?

Back 245

Dental procedures
Urologic procedures
GI procedures

Front 246

Dx:
acute onset of fever, chills & rigors; new cardiac murmur, possible associated meningitis or pneumonia

Back 246

Acute Bacterial Endocarditis
(ABE)

Front 247

Infection of healthy heart valves by high-virulence organisms
MCC?
Px if not treated?

Back 247

ABE

S. Aureus

Px: fatal if not Tx w/i 6 weeks

Front 248

Dx:
seeding of previously damaged heart valves by rheumatic fever, mitral prolapse, etc by low-virulence organisms
MCC?
What valve is affected the most?

Back 248

Subacute Bacterial Endocarditis

Strep Viridans

Mitral valve

Front 249

What valve is most commonly affected w/ IV drug users?
What bug?

Back 249

Tricuspid

S. Aureus

Front 250

what endocarditis bug is associated w/ colonic neoplasms?

Back 250

Strep Bovis

Front 251

Dx:
gradual onset of fever, sweats, weakness, anorexia, new murmur, splenomegaly, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth spots

Back 251

Subacute Bacterial Endocarditis (SBE)

Front 252

Name sign:
Tender violaceous subcutaneous nodules on fingers & toes

Back 252

Osler's nodes

(SBE)

Front 253

Name sign:
fine linear hemorrhages in the middle of nailbeds

Back 253

Splinter Hemorrhages

Front 254

Name sign:
multiple hemorrhagic nontender macules or nodules on palms & soles

Back 254

Janeway Lesions

Front 255

Name sign:
retinal hemorrhages w/ clear central areas seen on fundoscopy (w/ new murmur)

Back 255

Roth's spots

(SBE)

Front 256

What is considered Major criteria in the Duke's criteria for endocarditis?
(2)

Back 256

1. Two positive blood cultures

2. Echo showing vegetations

Front 257

What are the (6) Minor criteria in the Duke's criteria for endocarditis?

Back 257

1. Fever
2. Predisposing heart abnormality
3. Arterial emboli (Janeway)
4. Osler nodes or Roth's spots
5. positive blood culture not meeting major criteria
6. Echo suspicious of endocarditis, but not meeting major criteria

Front 258

For the Duke's criteria of Endocarditis, what are the (3) ways to dx w/ major and minor signs?

Back 258

1. (2) major criteria

2. (1) major + (3) minor

3. (5) minor criteria

Front 259

Tx for endocarditis that cultures:
1. Strep
2. Staph
3. MRSA

Back 259

1. Ceftriaxone or Penicillin G (4 weeks)

2. Nafcillin (4 weeks)

3. Vancomycin (4 weeks)

Front 260

What is the Tx for patients w/ Valular abnormalities if they are having dental procedures, GI or GU surgery?
(2)

Back 260

Prophylactic:
Amoxicillin
or
Clarithromycin

Front 261

Valvular dysfunction requiring surgery is common w/ which type of organism?

Back 261

Fungi
(Candida or Aspergillus)

Front 262

Endocarditis type:
due to cancer seeding heart valves during metastasis

what can it lead to?

Back 262

Marantic endocarditis

leads to cerebral infarcts

Front 263

Endocarditis type:
may be due to autoantibody damage of valves by SLE

Back 263

Libman-Sacks endocarditis

Front 264

MC valve affected by RHD

Back 264

Mitral

Front 265

Cause of Rheumatic fever?

What does it lead to?

Back 265

Group A Strep

leads to Rheumatic Heart Disease (RHD) - immune complex deposits on valves

Front 266

Major criteria (JONES criteria) for Dx Rheumatic fever
(5)

Back 266

JCNES:
Joints (arthritis)
Carditis (myo-, endo- or peri-)
Nodules (sub-Q)
Erythema marginatum rash
Sydenham's chorea (face, tongue, upper limb)

Front 267

Minor criteria for Dx Rheumatic fever
(5)

Back 267

Fever
Prolonged PR interval
Elevated ESR
Arthralgias
Recent Strep infection

Front 268

Tx for Rheumatic fever
(for strep, arthritis, carditis)

Back 268

Penicillin for strep;
ASA for arthritis;
Steroids for carditis

Front 269

Etiologies of Syncope
(7)

Back 269

SVNCOPE:
Situational (valsalva, tight collar);
Vasovagal response (common faint);
Neurogenic;
Cardiac;
Orthostatic hypotension;
Psychiatric (faking it);
Everything else (idiopathic)

Front 270

At what level is HDL cardioprotective?

Back 270

> 60

Front 271

What "type" is all isolated hypercholesterolemia?

Back 271

Type IIa

Front 272

What transports cholesterol from the gut to the bloodstream?

Back 272

Chylomicrons

Front 273

What is left over after lipoprotein lipase liberates FFA from chylomicrons for use in tissues?

Back 273

Chylomicron remnants

Front 274

What is secreted from the liver and carries endogenous cholesterol?

Back 274

VLDL

Front 275

What is metabolized from VLDL?

Back 275

Intermediate-Density Lipoproteins
(IDL)

Front 276

What is metabolized from IDL & carries cholesterol in the bloodstream to the tissues?

Back 276

LDL

Front 277

What takes up free cholesterol secreted by the tissues and transports it to the liver?

Back 277

HDL

Front 278

What is the name for the (3) Type IIa Isolated Hypercholesterolemias?

What is abnormal with all of them?

Back 278

Familial Hypercholesterolemia;
Familial defective apo-B100;
Polygenic Hypercholesterolemia

High LDL
(total cholesterol from 240 - 500)

Front 279

What are the (3) isolated Hypertriglyceridemias & each "Type"?
What is elevated w/ each?

Back 279

1. Familial Hypertriglyeridemia
Type IV - high VLDL
2. Familial Lipoprotein Lipase deficiency
3. Familial apo-CII deficiency
(both Type I & V - high chylomicrons)

Front 280

At what level is HDL cardioprotective?

Back 280

> 60

Front 281

What "type" is all isolated hypercholesterolemia?

Back 281

Type IIa

Front 282

What transports cholesterol from the gut to the bloodstream?

Back 282

Chylomicrons

Front 283

What is left over after lipoprotein lipase liberates FFA from chylomicrons for use in tissues?

Back 283

Chylomicron remnants

Front 284

What is secreted from the liver and carries endogenous cholesterol?

Back 284

VLDL

Front 285

What is metabolized from VLDL?

Back 285

Intermediate-Density Lipoproteins
(IDL)

Front 286

What is metabolized from IDL & carries cholesterol in the bloodstream to the tissues?

Back 286

LDL

Front 287

What takes up free cholesterol secreted by the tissues and transports it to the liver?

Back 287

HDL

Front 288

What is the name for the (3) Type IIa Isolated Hypercholesterolemias?

What is abnormal with all of them?

Back 288

Familial Hypercholesterolemia;
Familial defective apo-B100;
Polygenic Hypercholesterolemia

High LDL
(total cholesterol from 240 - 500)

Front 289

What are the (3) isolated Hypertriglyceridemias & each "Type"?
What is lelvated w/ each?

Back 289

1. Familial Hypertriglyeridemia
Type IV - high VLDL
2. Familial Lipoprotein Lipase deficiency
3. Familial apo-CII deficiency
(both Type I & V - high chylomicrons)

Front 290

Class of drugs that that reduce LDL by binding bile acids in the gut.

name (2) drugs

Back 290

Bile Acid Sequestrants

Cholestyramine
Colestipol

Front 291

which drug class is best for reducing triglycerides in VLDL & chylomicrons?

Back 291

Fibrinates