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Step 3- Cardiology

Jaimie Shah Step 3 cards English 5.0Average rating 5.0 out of 5 (1 rating) 150 cards

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  1. 1RF for CADDM, HTN, Tobacco use, HLD, PAD, Obesity, inactivity, Family Hx
  2. 2Significant family history for CADyoung patient and family with HD female < 65 and male relatives <55
  3. 3define pleuritic pain and what are the causes?PE, PNA, Pleuritis, Pericarditis, Pneumothorax
  4. 4what causes positional changes in pain?Pericarditis
  5. 5Chest pain on palpation?Costochondritis
  6. 6ischemic HD diagnosis and txif asked what to do first with diagnosis check an EKG...if just asked what to do first and given choice of tx v. dx test and it is clear ischemia choose treatment first
  7. 7Most accurate test for ischemic HD?CK-MB and trop, but first intial test is EKG that tells you to give ASA first
  8. 8Cardiac and muscle enzymesCKMB and trop rise 3-6hrs after start of CP, CKMB stays for 1-2d and check for reinfarct; trop will dissapear in 1-2wk; Mgb elelvates FIRST 1-4 hrs after CP start
  9. 9When do we do a chemical stress test?Patients who can't exercise to a target HR o >85% max, COPD, Amputation, Deconditioning, Weakness, prior stroke, LE ulcer, Dementia, Obesity
  10. 10When do I do a stress echo?EKG unreliable for ischemia: LBBB, Digoxin use, Pacer in place, LVH, Any baseline abn in EKG of the ST segment
  11. 11Define ACSCauses of acute chest pain, can be with exercise or rest, Can cause ST elevation or depression or normal EKG, based on hx of CP with features that suggest ischemia
  12. 12Treatment of ACSASA (oral)-lowers mortality, Nitrates and Morphine but they have no mortality effect, O2 but no benefit if pt not hypoxic; clopidogrel is added in acute MI
  13. 13Thrombolytics and primary angioplasty and mortalitythey lower mortality in STEMI but it is dependent on time. (PCI done in 90 min on arrival shows improvement to mortality; no benefit if done in stable angina over medical therapy)
  14. 14When do you do urgent angioplasty?if it asks for the single greatest efficacy in lowering mortality in STEMI, and the question includes contraindication to use of thrombolytics
  15. 15When to give thrombolytics?CP for <12hrs and has STEMI in at least 2 leads, a new LBBB; needs to be given within 30mins of arrival to ER with pain
  16. 16Do BB lower mortality and when is the best time to given them in relation to episode of CP?They do lower mortality but timinig of administration is not critical
  17. 17what type of patients do ACE/ARBs lower mortality?Should be given to all patients with an ACS but they only lower mortality if there is left ventricular dys or systolic dys
  18. 18Which medications given in ACS will lower mortality?ASA, Thrombolytics, Primary angioplasty, Metoprolol, statins, plavix
  19. 19Which ACS medications lower mortality in certain conditions?ACE/ARBs lower mortality with a low ejection fraction
  20. 20Which ACS medications do not lower mortality?O2, Morphine, Nitrates, CCB, Lidocaine, Amiodarone
  21. 21When should plavix be used?with ACS, an ASA allergy, patient to get angioplasty, acute infarction ; Ticlodipine can cause neutropenia and Prasugrel has greater efficacy than plavix but more bleed risk
  22. 22When in ACS do we use CCB instead?patient has intolerance to BB like asthma, there is cocaine induced chest pain, there is coronary vasospasm/Prinzmetal's angina
  23. 23When is a pacemaker the answer for acute MI?3rd degree heart block, Mobitz 2 heart block, bifasicular block, new LBBB, symptomatic brady
  24. 24when is lidocaine or amiodarone needed in acute MI?when there is VT/VF, not given for prevention of arrythmias
  25. 25Cardiogenic shock basicsIs a complication of Acute MI; dx: ECHO, swan; tx: ACE, urgent revascularization
  26. 26Valve rupture basicsComplication of Acute MI; dx with ECHO; tx: ACE, nitroprusside, intra aortic balloon pump as a bridge to surgery
  27. 27Septal rupture basicsComplication of Acute MI; Dx: ECHO, R heart cath showing diff in blood saturation; tx: ACE, nitroprusside and urgent surgery
  28. 28Myocardial wall rupture basicsComplications of acute MI; Dx: ECHO; Tx: pericardiocentesis, urgent cardiac repair
  29. 29Sinus brady basicsCan be a complication of MI; dx: EKG; tx: atropine and pacer if symptomatic
  30. 30Complete heart block basicsCan be a complication of acute MI; tx: EKG, canon A waves; dx: atropine and if symptoms may need a pacer
  31. 31RV infarct basicscan be a complication of Acute MI; dx: EKG; tx: fluid overloading
  32. 32How long does patient wait to have sex after an MI?2-6 weeks
  33. 33abiciximab has great benefit in STEMI (t/f)False
  34. 34Medications used in stable angina?ASA and metoprolol both provide mortality benefit; Nitrates provide symptomatic relief but no mortality benefit; ACE/ARB used in stable cases if there is CHF, systolic dys, and low EF; plavix if ASA not tolterated; statins (do not do angiography to start any of the meds but do if you consider CABG)
  35. 35what is the difference between saphenous vein graft and internal mammary artery graft?Vein graft starts to occlude in 5 years and artery graft starts to occlude in 10 years; no difference in the meds needed to be taken
  36. 36what are the indications of CABG?three coronary vessels with > 70% stenosis; Left main coronary artery stenosis > 70% stenosis
  37. 37what are the CAD equivalents?DM, PAD, Aortic disease, Carotid disease
  38. 38LDL goal in patient with CAD?LDL<100
  39. 39LDL goal in patients with DM and CADLDL<70
  40. 40Other risk factors for LDL management?tobacco use, HTN +/- BP meds, low HDL, Family hx of early CAD (female rel<65 and male rel<55), and age (male >45, female>55)
  41. 41SE of statins?liver toxicity and rhabdo; check LFTs routinely and if more than 2-3x ULN then d/c medication of if elevated this much dont start the medication
  42. 42review calculating LDL goalsreview calculating LDL goals
  43. 43Most COMMON cause of ED after MI?Anxiety more than BB
  44. 44Test that should be ordered for Pulm edema and CHF on CCS?CXR, EKG, Pulse ox +/- ABG, and ECHO (order all at same time but if you see pulm edema and asked what to do next just give lasix, o2 and nitrates cuz it is a clinical diagnosis first)
  45. 45When to use Digoxin?to slow afib, do not use in pulm edema
  46. 46Most patients with pulm edema do well with preload reduction (lasix, o2, nitrates, morphine) but if on CCS they cont have SOB after these meds what do you give?Dobutamine Amrinone, Milrinone (ionotropes or increase contractility but don't change mortality)
  47. 47Acute pulm edema assoc with new onset VT with a pulse, afib, aflutter,SVT what is the best therapy?falls under unstable tachy algorithim so needs Synchronized cardioversion
  48. 48Hemodynamic changes seen on R heart cath secondary to pulm edemadecreased CO, increased SVR, increased wedge pressure, and increased Right atrial pressure
  49. 49what should all patients with pulm edema now stabalized have done?ECHO to determine if this is systolic or diastolic failure
  50. 50What is the further management of chronic systolic CHF?ACE/ARB (Show a decrease in mortality), metoprolol/carvedilol (lower mortality), Spironolactone (lower mortality in advanced dz and give if pt originally presented with pulm edema), Diuretics, Digoxin (decreases symps and freq of hospitalization, no mortality change)
  51. 51What is the further management of diastolic CHF?Metoprolol/Carvedilol, diuretics; be careful of overuse
  52. 52when and why do we put a implantable defibrilator/cardioverter in patients?place in patients with DCM, and EF below 35% persists because the most common cause of death in CHF is sudden death from arrythmia
  53. 53when is a biventricular pacer the answer in CHF?there is a decrease mortality seen in patients with severe CHF and QRS duration >120ms
  54. 54When do we use coumadin in CHF patients?there is no routine use in CHF no matter how low the EF in the abscence of clot or chronic afib
  55. 55what is an absolute contraindication for BB use?symptomatic Bradycardia (not PAD, Asthma, Emphysema, and diabetes)
  56. 56Valvular disease in young female in general populationMVP
  57. 57valvular heart disease in healthy young athleteHOCM
  58. 58Valvular HD in a pregnant woman or immigrantMS
  59. 59Valvular HD in turner's syndrome and with coarctation of aortaBicuspid aortic valve
  60. 60Valvular HD with palpitations, atypical chest pain not with exertionMVP
  61. 61Systolic murmursAS, MR, MVP, HOCM
  62. 62diastolic murmursAR and MS
  63. 63What increases intensity of right sided murmursinhalation (stenosis and reurg of tricuspid and pulmonic lesions)
  64. 64What increases intensity of Left sided murmursexhalation (mitral and aortic valve lesions)
  65. 65What does squatting and lifting the legs do or blood return to the heart?increases venous return to the heart
  66. 66what does valsalva and standing up do to venous return to the heartdecreases venous return to the heart
  67. 67How does valsalva decrease venous returnit increases intrathoracic pressure so venous return to the heart decreases
  68. 68which murmurs increase in intensity with squatting and leg raiseAS, AR, MS, MR, VSD
  69. 69which murmurs decrease in intensity with squatting and leg raiseHOCM and MVP
  70. 70which murmurs decrease in intensity with standing and ValsalvaAS, AR, MS, MR, VSD
  71. 71which murmurs increase in intensity with standing and valsalvaHOCM and MVP
  72. 72How does handgrip affect murmursit increases afterload, does the opposite of what ACE inhibitors do; increases intensitry of AR, VSD and MR as afterload reduction will increase flow to the aorta (with handgrip blood flow backs up into the heart)
  73. 73How does Amyl nitrate effect murmurs?it causes vasodilation so decreases afterload so it decreases intensity of AR and MR
  74. 74How does Handgrip effect MVP and HOCMlessens murmurs of MVP and HOCM (murmurs decrease when LV is more full)
  75. 75How does Amyl effect MVP and HOCMIt increases ventricular emptying so worsens murmurs of MVP and HOCM
  76. 76How does hand grip effects ASSoftens the murmur, it wont allow blood to flow past the valve and if it doesnt flow then there is no murmur
  77. 77How does amyl nitrate effect ASit decreases afterload and increases the pressure gradient between LV and aorta so makes the murmur louder
  78. 78Amyl nitrate and Handgrip effect on MSnegligible effect
  79. 79where is AS best heardSecond R intercostal space and radiates to the carotid arteries (crescendo-decrescendo)
  80. 80Where are pulmonic murmurs heard bestsecond left intercostal space
  81. 81Where best to hear AR, tricuspid Murmurs, and VSDheard best at lower left sternal border
  82. 82where is MR heard the bestheard best at apex and radiates into axilla (5th intercostal space below Left nipple)
  83. 83Murmur intensity scoring1: only heard with special maneuvers; 2+3:majority of murmurs; 4+5: palable thrill; 5+6: heard with stethescope partially off chest; 6: stethescope not needed to hear
  84. 84Dx tests of murmursBest initial test is ECHO, most accurate test is L heart cath; on CCS add EKG and CXR when evaluating a murmur
  85. 85Treatment of Regurgitant lesionsvasodilator therapy with ACE, ARBs, nifedipine (afterload reduction slows progression of murmurs)
  86. 86Treatment of stenotic lesionsbest treated with anatomic repair and diuetics can be used to decrease pulm vascular congestion
  87. 87If valsalva improves the mumur due to decreased venous return what medication is indicatedDiuretics
  88. 88If amyl nitrate improves the murmur by decreasing afterload what medication is indicatedACE/ARB
  89. 89AS dx teststhe best initial test is TTE and more accurate is TEE; L heart cath is most accurate (nl grad across the valve is 30; mod disease 30-70; severe disease>70); EKG and CXR will show LVH
  90. 90Valve replacement in ASBiprosthetic valves will last avg of 10yrs and dont need comadin; Mechanical valves dont need replacement but do require coumadin
  91. 91Causes of ARHTN, rheumatic HD, endocarditis, cystic medial necrosis, Marfan's, AS and reactive arthritis (usu presents with SOB and fatigue)
  92. 92special PE findings in ARQuincke pulse- atrial or capillary pulsations in fingernails; Corrigan pulse- high bounding pulses; Musset's sign- head bob up and down with each pulse; Duroziez sign- murmur heard over femoral artery; Hill's sign- BP gradient higher in lower ext
  93. 93Tx ARACE/ARB, nifedipine, loops; do surgery if EF less than 55% or LVED diameter >55mm- do surgery even if no symptoms
  94. 94MS causes and presentationRheumatic HD, immigrant population and common in preg women due to increased plasma vol; Dysphagia, hoarseness, Afib leading to stroke
  95. 95Murmur of MSdiastolic rumble after opening snap (extra sound in diastole) and S1 louder as MS worsens the opening snap moves closer to S2
  96. 96CXR in MSLAenlargement, straightening of the L heart border and elevation of the L mainstem bronchus, double density cardiac silohette
  97. 97Tx of MSDiuretics and surgery (preg not a contraindication to surgery)
  98. 98MR murmurholosystolic murmur that obscures S1 and S2, S3 gallop is often present (indicates vol overload and can be normal in patients under 30)
  99. 99MR treatmentACE/ARB, nifedipine, loops, surgery if LFEF less than 60% or if LVED volume>40mm --do surgery even if asymptomatic
  100. 100VSD basicsholosystolic murmur at left lower sternal border; larger defect can present with SOB; Dx test is ECHO but cath is used precisely to determine L to R shunting; +/- surgery
  101. 101ASD basicslarge defects lead to SOB or signs of RV failure with SOB and parasternal heave; assoc with fixed split S2; Dx is ECHO; Catheter device best treatment and repair needed if shunt ratio exceeds 1.5 to 1
  102. 102fixed split A2ASD
  103. 103Paradoxical, A2 delayedLBBB, AS, LVH, HTN
  104. 104Widened S2, delayed P2RBBB, PS, RVH, Pulm HTN
  105. 105DCM dxbest initial test is ECHO and MUGA is most accurate method to determine EF
  106. 106Causes and tx of DCMIschemia, alcohol, adriamycin, radiation, chaga's diseae; tx same in all CM just like CHF--ACE/ARB, BB, spironolactone, Digoxin (decrease symps not mortality)
  107. 107HOCM basicspresents with SOB on exertion and S4 gallop (indicates LVH and decreased compliance); tx is BB and diuretics
  108. 108RCM basicshx of sarcoidosis, amyloidosis, hemochromatosis, cancer, myocardial fibrosis, or glycogen storage disease; SOB is the presenting complaint and Kussmal's sign
  109. 109RCM dxCardiac cath and EKG shows low voltage; ECHO is mainstay diagnosis; Endomyocardial biopsy is most accurate diagnostic test
  110. 110Pericardial disease DxEKG best initial test with ST seg elevation in almost all leads and +/- PR seg depression
  111. 111Tx of pericarditisNSAID and advance clock 1-2days if pain persists add perdnisone orally and advance 1-2 more days +/- colchicine
  112. 112Presentation of Pericardial TamponadeSOB, hypotension and JVD, lung exam clear; pulss paradoxus present and can have electrical alternans
  113. 113Tamponade Dx and TxECHO-diastolic collapse of RA and RV (less than 50ml can be there but no collapse should be seen); EKG shows electrical alternans; R heart cath shows equalization of pressures during diastole; tx: peicardiocentesis, window placement, do not use diuretics
  114. 114Constrictive pericarditis presentationSOB and Chronic RHF S/S: Edema, JVD, hepatosplenomegaly, Ascites; unique s/s- kussmaul's sign, pericardial knock (extra diastolic sound)
  115. 115Constrictive pericarditis dxCXR shows calcification, EKG shows low voltage, CT and MRI show thickened pericardium
  116. 116tx of constrictive pericarditisinitially diuretic, most effective is pericardial stripping
  117. 117Dx of dissection of thoracic aortabest initial test is CXR, most accurate test is CT angio
  118. 118Tx of aortic dissection (thorax)order BB and EKG and CXR on first seeing the patient; then either order CT angio, TEE, or MRA; order nitroprusside to control BP (these patients need ICU and Surgery consult)
  119. 119AAA screening and screening testsscreen men over age 65 who were smokers; it is first detected by US and repaired if over 5cm
  120. 120Spinal stenosis presentationpain worse when walk downhill and less with walking uphill or while cycling or sitting; pulses and skin exam normal
  121. 121Dx test for PADinitial test is ABI and most accurate test is angio
  122. 122Tx of PADASA, ACE, exercise, cilostazol, statins; marginally effective Pentoxifylline; not effective CCB
  123. 123if get a patient that presents with afib order the followingEKG, Thyroid function, lytes, trop or CKMB
  124. 124tx of afib (unstable)unstable patients need synced cardioversion, no TEE or anticoagulation (SBP<90, CHF, confusion or CP)
  125. 125tx of afib (stable)slow Ventricular rate (BB, CCB, dig), then when at goal add warfarin if lasts more than 2 days
  126. 126CHADS score (risk of stroke in patients with AFIB)CHF, HTN, AGE>75, DM, Stroke (2pts); score of 0-1 ASA and more than 2 anticoagulation
  127. 127afib and aflutter treated the same wayafib and aflutter treated the same way
  128. 128when to use BB in afib or aflutterIHD, Migraines, Graves, Pheo (coreg)
  129. 129when to use CCB in afib or aflutterMigraine or Asthma
  130. 130when to use digoxin in afib and aflutterborderline HTN
  131. 131Presentation of MATassoc with COPD and emphysema with polymorphic P waves and HR>100, and irregular; Do not use BB
  132. 132SVT presentationpalpatations and tachy (160-180), not assoc with IHD and regular rhythm
  133. 133tx of SVT (unstable)initially sync cardioversion
  134. 134tx of SVT (stable)vagal maneuvers then try adenosine; best long term mgmt is ablation
  135. 135WPW presentationSVT that can alternate with VT; worsening SVT after the use of CCB or digoxin
  136. 136WPW dxEKG and most accurate is electrophys testing
  137. 137what to give a patient is SVT or VT from WPWgive Procainamide
  138. 138best long term therapy for WPWablation
  139. 139VT presentationpalpitation, syncope, CP or sudden death; still need EKG to see VT as possible cause of no pulse (tell its not PEA)
  140. 140tx of VT (stable)Amio, Lidocaine, Procainamide, Mag
  141. 141tx of VT (unstable)sync cardioversion
  142. 142Vfib presentationsudden death; still need EKG to see vfib loss of pulse and that it's not PEA
  143. 143Tx of Vfibalways unsync cardioversion
  144. 144Sudden LOCCardiac or neuro (seizures)
  145. 145Gradual LOCtoxic-metabolic, Hypoglycemia, Drug tox/intoxication, Anemia, Hypoxia
  146. 146sudden regain of consciousnesscardiac, rhythm disorder v. structural disease
  147. 147gradual regain of conciousnessNeuro (seizures)
  148. 148Cardiac exam after LOCif normal: vent arrythmia; if abnormal: structural disease (AS, HOCM, MS, MVP)
  149. 149diagnostic tests with LOCcardiac and neuro exam, EKG, Chemistry, oximeter, CBC, trop (carotid dopplers not helpful in syncope)
  150. 150if ventricular dysrhythmia causes syncope what does the patient needICD placement

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Step 3 cards Flashcards on Step 3- Cardiology, created by Jaimie Shah on 08/09/2013.
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Jaimie Shah
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