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Step 2 Cardio
Facts from Boards and Wards, and various qbanks
178
Medical
Graduate
05/31/2013

Additional Medical Flashcards

 


 

Cards

Term
First line Tx for Stage 1 HTN with no co-morbid dz
Definition
Thiazide Diuretic
Term
First line tx for HTN with Diabetes
Definition

ACE inhibitor or ARB

(proven to decrease vascular and renal dz)

Term
1st line Tx for HTN with CHF
Definition

ACE inhibitors, ARB, Beta-blocker, and K-sparing diuretic

(all proven to decrease mortality)

Term
1st line Tx of HTN with MI
Definition

Beta blocker and ACE inhibitor

(proven to decrease mortality)

Term
1st line Tx for HTN with Osteoporosis
Definition

Thiazide Diuretics

(decrease Ca2+ excretion)

Term

1st line Tx for HTN with Prostatic dz

(treat HTN and BPH concurrently)

Definition
Alpha blockers
Term
1st line Tx for HTN with Pregnancy
Definition
Alpha-methyldopa
Term
1st line Tx for rate control of atrial fibrillation or flutter
Definition

Diltiazem/verapamil

(can also use beta blocker)

Term
Contraindications to beta blockers
Definition
COPD
Term
Contraindications to ACE Inhibitors
Definition
Pregnancy, Renal artery stenosis, and renal failure (creatinine >1.5, due to hyperkalemia morbidity)
Term
Contraindications for K+-sparing diuretics
Definition
Renal Failure (creatinine >1.5)
Term
Contraindications of Diuretics
Definition
Gout
Term
Contraindications to Diltiazem/Verapamil
Definition

CHF

(due to depression of contractility)

Term

Tx for Severe, refractory HTN 

Must combine with Beta blocker to prevent reflex tachycardia and diuretic to counteract edema resulting from aggressive arteriolar vasodilation

Definition
Minoxidil
Term
Only for refractory HTN, particularly in renal failure pts and pts withdrawing from illicit substances
Definition
Clonidine
Term
2nd line tx for essential HTN and heart failure
Definition
Dihydropyridine calcium blocker (e.g. amlodipine)
Term
1st line tx for coronary vasospasm (Prinzmetal's angina)
Definition
Dihydropyridine Calcium Blocker (e.g. amlodipine)
Term
Major Risk Factors for CAD
Definition

1. Diabetes

2. Smoking

3. HTN

4. Hypercholesterolemia

5. FHx

6. Age (men > 45, women > 55)

7. HDL (< 40 mg/dL)

8. Chronic renal failure

SMOKING IS THE #1 PREVENTABLE RISK FACTOR

Term
Normal BP
Definition
< 120/80
Term
Prehypertension
Definition
120/80 - 139/89
Term
Stage I HTN
Definition
140/90 - 159/99
Term
Stage II HTN
Definition
> 160/100
Term
Malignant HTN
Definition
systolic > 200 or diastolic > 110
Term
TX for Hypertensive Emergency
Definition
IV drip with nitroprusside or nitroglycerin (preferred for ischemia)
Term
High BP (>200/110) without evidence of end-organ damage
Definition
Hypertensive Urgency
Term
Tx of Hypertensive Urgency
Definition
Oral BP medications with goal of slowly reduing BP over several days, does not require admission to hospital
Term
Severe HTN with evidence of end-organ compromise (eg encephalopathy, renal failure, CHF/ischemia)
Definition
Hypertensive emergency
Term
Tx for Hypertensive Emergency
Definition
IV nitroprusside or Nitroglycerin(preferred for ischemia)
Term

EKG and Labs during unstable angina

 

Definition

ST depression or T wave inversions

Labs: cardiac enzymes are negative

Term
EKG and Labs for NSTEMI
Definition

ST depression or T wave inversions

Labs: Troponin and CK-MB are elevated, but CK-MB normalizes after 72 hrs and Troponin remains elevated up to 1 wk

Term
EKG and Labs for STEMI
Definition

ST elevation (tombstone sign) and Q waves

Labs: Elevation of Troponin I or CK-MB

Term
Tx of STEMI
Definition

thrombolysis within 6 hours using tPA + heparin(first line) or streptokinase

 

Adjuvant medical therapies:

#1 ASPIRIN!

#2 BETA BLOCKER

Term
Prinzmetal's Angina EKG and Labs
Definition

Transient ST elevation

Labs: Negative cardiac enzymes

Term
Tx of Prinzmetal's Angina
Definition

Vasodilators (nitroglycerin or Ca2+ channel blockers)

and Catheterization

Term
Medications that cause QT prolognation and possible Torasades de pointes
Definition

TCAs

Antipsychotics

Some antiarrhythmics (quinidine, procainamide)

Clarithromycin

Erythromycin

Term
Precordial pain radiating to left arm, jaw, back, relieved by rest and nitroglycerin
Definition
Stable Angina Pectoris
Term
Tx of acute angina
Definition

Sublingual Nitroglycerin

if after 3 doses, no pain relief, may be infarcting

Term
Chronic Prevention of Angina
Definition

Isordil (long-acting nitrate)

Beta blockers

Aspirin

Quit smoking

Decrease LDL, Increase HDL with diet, Increase exercise, Increase fiber, Lose weight

Term
Endovascular intervention of Angina
Definition

Percutaneous Transluminal coronary angioplasty (PTCA)

Indicated with failure of medical mgmt

Platelet GPIIb-IIIa antagonists

Term
Surgical intervention for Angina and Indications
Definition

CABG

Failure of medical tx, 3-vessel CAD, or 2-vessel dz in DM

Term
Caused by transient clotting of atherosclerotic vessels; clot spontaneously dissolves before infarction occurs
Definition
Unstable Angina
Term
Pharmacologic Stress Echocardiogram is done with what drug
Definition
Dobutamine
Term
Tx for NSTEMI
Definition

Aspirin, O2, Beta blocker, Sublingual NTG, LMW-Heparin

Nitro drip for pain

GPIIb-IIIa

Clopidogrel

Term
Infarct usually 2ndary to acute plaque rupture causing thrombosis
Definition
STEMI
Term
EKG in stable angina
Definition
ST depression and T wave inversion
Term
Junctional Rhythm
Definition
AV node starts firing, causing narrow QRS complexes in the absence of p waves
Term
Nml junctional escape rhythm rate
Definition
40-60 bpm
Term
Nml rate of ventricular rhythm
Definition
20-40 bpm
Term
Most common cause of ST elevation
Definition

"early repolarization" i.e J point elevation

concave J point on the tracing is the gentle concave upward slope of the transition from the S wave to the ST segment

Term
Exertional Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cardiomegaly, rales, S3 gallop, Renal hypoperfusion --> Increase aldosterone --> Na retention --> increase total body fluid
Definition
Left sided heart failure
Term
Signs and symptoms due to Decreased cardiac output and increased cardiac pressures
Definition
Left Sided Heart Failure
Term
Signs and symptoms because of polling "upstream"
Definition
Right sided heart failure
Term
Increased JVP, Dependent Edema, Hepatic congestion with transaminitis, fatigue, weight loss, cyanosis
Definition
Right Sided Heart Failure
Term
First line regimen for CHF
Definition

ACE inhibitors or ARBS

Beta-blocker (after pt diuresed)

Diuretics - Furosemide and Spironolactone

Term
What to use in CHF if pt is intolerant of ACE inhibitors
Definition
Hydralazine and Isosorbide nitrate
Term
Digoxin Toxicity
Definition

SVT with AV block and yellow vision

Tx: antidigitalis Fab antibodies

Term
First line for cholesterol reduction
Definition

HMG-CoA Reductase Inhibitors

-statins

Term
Raises HDL levels, reduces triglycerides
Definition
Fenofibrate
Term
Most effective at lowering TGs and raising HDL
Definition
Niacin
Term
Inhibits cholesterol absorption
Definition
Ezetimibe
Term

Inhibits VLDL production, primary effect is TG reduction

Used for Isolated hypertriglyceridemia

Do NOT add to statins due to increased risk of rhabdo

Definition
Gemfibrozil
Term

LDL goal for Low risk CAD pts

< 2 risk factors

 

LDL at drug initiation

Definition

< 160

 

> 190

Term
LDL goal and level at drug initiation for intermediate risk pts = >2 CAD risk factors (no DM)
Definition

<130

 

>160

Term
LDL goal and level at drug initiation for High risk pts = >2 CAD risk factors but no known CAD/PVD
Definition

< 100

 

> 130

Term
LDL goal and level at initiation of drug therapy in highest risk pts = Known CAD, PVD, DM, metabolic syndrome
Definition

< 100, consider < 70

 

> 100

Term

Wide pulse pressure presenting with forceful arterial pulse upswing with rapid falloff

Classic sign of AR

Definition
Water Hammer pulse
Term

pistol-shot bruit over femoral pulse

Classic sign of AR

Definition
Traube's sign
Term

unusually large carotid pulsations

Classic sign of AR

Definition
Corrigan's pulse
Term

pulsatile blanching and reddening of fingernails upon light pressure

Classic sign of AR

Definition
Quincke's sign
Term

head bobbing caused by carotid pulsations

Classic sign of AR

Definition
de Musset's sign
Term

pulsatile bobbing of uvula

Classic sign of AR

Definition
Muller's sign
Term

to-and-fro murmur over femoral artery heard best with mile pressure applied to the artery

Classic sign of AR

Definition
Duroziez's Sign
Term
sudden decrease in perfusion that threatens limb viability and presents within 2 weeks of symptom onset
Definition
Acute Limb Ischemia
Term
What do pts with Acute Limb Ischemia classically present with
Definition

Pain

Pulselessness

Pallor

Paresthesias

Paralysis

(five P's)

Term
Most effective way to decreased the risk of embolic phenomena in pts with atrial fibrillation
Definition
Anticoagulation with WARFARIN
Term
Appear as peaked T waves, followed by lengthening of the PR and QRS intervals, eventually resulting in a sine wave on EKG.
Definition
Hyperkalemia
Term
Cardio-protective in cases of hyperkalemia
Definition
Calcium Gluconate
Term
Class III antiarrhythmic agent which inhibits inward potassium ion channels, thereby prolonging QT interval
Definition
Sotalol
Term
Class III antiarrhythmic used both for VT and AT. Also causes QT prolongation
Definition
Amiodarone
Term
used to induce transient heart block at the AV node. Useful in identifying and sometimes terminating SVT.
Definition
Adenosine
Term
Used in TCA and aspirin overdose
Definition
Sodium Bicarbonate
Term
Use in cases of bradycardia, asystole and pulseless electrical activity. Acts by competitively antagonizing muscarinic acetylcholine receptors, suppressing parasympathetic input to the heart.
Definition
Atropine
Term

Electrical Alternans - varying amplitudes of the QRS complexes from beat to beat on EKG

and Sinus Tachycardia on EKG is specific for

Definition
Large Pericardial effusion
Term
JVD, Hypotension, distant heart sounds, and pulsus Paradoxus
Definition
Cardiac Tamponade
Term
JVD, S3, ventricular heave, Hepatomegaly, Ascites, and dependent edema without evidence of pulmonary congestion
Definition

Cor Pulmonale

(right sided heart failure most commonly due to COPD)

Term
Presence of 'F' waves (flutter waves) on EKG
Definition
Atrial Flutter
Term
First line treatment for a young person with risk of cardiovascular event
Definition
Aspirin
Term
Two strong systolic peaks of the aortic pulse from Left ventricular ejection separated by a midsystolic dip that may be seen on Aortic Regurg with or without aortic stenosis and in HOCM
Definition

Pulsus Bisferiens

(biphasic pulse)

Term

Appear as an enlarged "water bottle" shape cardiac silhouette on CXR

Physical exam findings include diminished heart sounds on auscultation and difficult to palpate point of maximal impulse

Definition
Pericardial Effusion
Term
First Line Tx in Cocaine related Cardiac Ischemia
Definition

Benzodiazepines

along with aspirin and nitrates

Term
Impaired ventricular filling due to poor myocardial relaxation or diminished ventricular compliance
Definition
Diastolic Dysfunction
Term
Most effective lifestyle intervention for HTN in non-obese pts
Definition

DASH Diet

(High in fruits and vegetables and low in saturated and total fats)

Term

Within a few days of Acute MI pt presents with hypotension, clear lungs, and Kussmaul sign

ECG: ST depression in leads I and aVL with ST elevations in inferior leads.

Tx: IV fluids and AVOID Nitroglycerin and Diuretics

Definition

Right Ventricular Failure or Infarct

(RCA is involved)

Term

Within 3-5 days of Acute MI, Pt presents with acute, severe pulmonary edema and New holosystolic murmur that radiates to axilla, Soft S1

 

Definition

Papillary Muscle Rupture

(RCA is typically involved, echo shows severe mitral regurg with flail leaflet)

Term
Within 3-5 days of acute MI, Pt presents with Shock and Chest pain, New holosystolic murmur best heard at the LEFT sternal board and often has an accompanying thrill, and Biventricular failure
Definition

Interventricular septum rupture/defect

(LAD -> apical septal rupture)

(RCA -> basal septal rupture)

Term

Within first 5 days to 2 weeks of acute MI, pt presents with Shock and chest pain, JVD, Distant Heart sounds, Hypotension with compensatory sinus tachycardia

 

Pt with PEA and no signs of heart failure after a recent first MI

Definition

Free Wall Rupture

(Pericardial effusion with cardiac tamponade seen)

(LAD is typically involved)

Term
Occurs within 1-3 days after acute MI, pt presents with a pericardial frcition rub with or without chest pain
Definition
Acute peri-infarct pericarditis
Term
Occurs weeks to months after MI, pt presents with pleuritic chest pain and pericardial friction rub. Usually improved with NSAIDs
Definition
Dressler Syndrome
Term
Occurs as weeks to months after Acute STEMI, pt presents with heart failure, refractory angina, ventricular arrhythmias, or systemic arterial embolism due to mural thrombus
Definition
Ventricular Aneurysm
Term
Hypotension and syncope, leading to PEA
Definition
Acute massive PE
Term

Drug Induced Hypothyroidism

Can also cause lung fibrosis and liver toxicity

Definition
Amiodarone
Term
Drug that causes salt retention, reflex tachycardia, and lupus like syndrome
Definition
Hydralazine
Term
Drug that can cause Impotence, Bradycardia, and AV node blockade
Definition
Metoprolol
Term
Most commonly associated side effects of this drug are Hyperkalemia, Cough, Decreased GFR, rash, and Angioedema
Definition
Enalapril
Term

Drug that can cause N/V, Diarrhea, blurry yellow vision, and arrhythmias.

Used to treat a fib and atrial flutter

Definition
Digoxin
Term
Viral Myocarditis of then the cause of young, healthy pt who develops CHF
Definition
Coxsackie B virus
Term
Most appropriate initial intervention for an acute aortic dissection
Definition
Beta blockers
Term
Type A dissection
Definition

Ascending Aorta

Tx: with meds and SURGERY (it's an emergency)

Term
Type B Dissection
Definition

Descending Aorta Only

Tx: Usually medical therapy alone

Term
3 Major Mechanical Complications of MI
Definition

Mitral Regurg from Papillary muscle rupture

Left ventricular free wall rupture

Interventricular septum rupture

(all 3 can result in hypotension)

Term
First line Medical Tx for HOCM
Definition

Beta Blockers

or 

cardiac acting Calcium Channel Blocker (diltiazem)

Term
Strongest Influence on Long-term prognosis following a STEMI
Definition
Duration of time that passes before coronary blood flow is restored (via PTCA or fibrinolysis)
Term
Causes PR segment depression and diffuse ST segment elevation across multiple limb and precordial leads
Definition
Acute pericarditis
Term
ST segment elevation in all precordial leads, but most commonly V1-V4. 2nd degree AV block can be seen.
Definition
Anterior Wall MI - LAD
Term

ST segment elevations in leads I, II, III, and aVL

 

Definition
Posterolateral Wall of Left Ventricle MI - LCX
Term

Used to Tx atrial and ventricular arrhythmias

Potential side effects include Nausea, drug-induced lupus, agranulocytosis, and QT prolongation

Definition
Procainamide
Term

Class IB antiarrhythmic used to tx ventricular arrhythmias

High doses cause confusion, seizures and respiratory depression

Definition
Lidocaine
Term
Class IA anti-arrhythmic agent used to tx atrial arrhytmias. Side effects include diarrhea, tinnitus, QT prolongation, torsades de pointes, hemolytic anemia and thrombocytopenia.
Definition
Quinidine
Term

Inotrop used to tx atrial arrhythmias

Can cause nausea, anorexia, AV block, and Ventricular and supraventricular arrhythmias

Definition
Digoxin
Term

Class III antiarrhythmic agent us to tx V Tach.

Can cause Pulmonary fibrosis, thyroid dysfunction, hepatotoxicity, corneal deposits and skin discoloration.

Definition
Amiodarone
Term
Main risk factors a/w aneurysm expansion and rupture
Definition

large diameter

rate of expansion

current cigarette smoking

Term
Risk factors a/w development of AAA
Definition

older age (> 60)

cigarette smoking

Family Hx

White race

Atherosclerosis

Term
Major cause of acute infective endocarditis in IV drug abusers
Definition
Staphylococcus aureus
Term
Most frequent cause of acute infective endocarditis in pts with prosthetic valves
Definition
Staphylococcus epidermidis
Term
Frequent cause of subacute bacterial endocarditis in pts with preexisitng valvular dz
Definition
Streptococcus bovis
Term
What is the desired INR range for pts with prosthetic valves?
Definition
2.5-3.5
Term
What is the desired INR for pts with idiopathic venous thromboembolism?
Definition
2.0-3.0
Term
What are the three main approaches to placing a central line?
Definition

Internal Jugular

Subclavian

Femoral

Term
Where does the Internal Jugular vein lie in the carotid sheath in reference to the other structures?
Definition
Lies lateral to the common carotid artery and anterior to the vagus nerve
Term
Where is the correct placement of an IJ line?
Definition
SVC
Term
Syncope from exertion in the elderly, may also present with angina and dyspnea
Definition
Aortic Stenosis
Term
Syncope in diabetic with diabetic neuropathy
Definition
autonomic neuropathy
Term

syncope in young healthy individual

triggered by physical or emotional stress

sweating, palpitations, nausea, and yawning commonly occur before the episode

Definition
vasovagal
Term
Syncope at rest with no apparent trigger
Definition
Arrhythmias
Term
maneuver that increases right-sided murmurs
Definition
Inspiration
Term
maneuver increases left-sided murmurs
Definition
Expiration
Term
increases venous return and therefore increased preload to the heart
Definition
Squatting
Term
causes a decrease in venous return to the heart and therefore decreases preload
Definition
Valsalva
Term
decreases venous return because increased venous capacity, causes a reflex increase in heart rate
Definition
Abrupt standing
Term
increased venous return, but more importantly increase afterload. Decreases AS murmurs and increases MR
Definition
Handgrip
Term
Most common ECG finding with PE
Definition
Sinus Tachycardia
Term
ECG with reduced P waves and the development of peaked T waves.  As the severity increases, the QRS will become widened and the ECG complex may evolve into a sinusoidal shape.
Definition
Hyperkalemia
Term
may be associated with maternal diabetes.  It is a cause of cyanotic heart disease and is the most common cyanotic congenital heart lesion in the newborn
Definition
Transposition of the great vessels
Term
cause of cyanotic congenital heart disease and is the most common cause of cyanotic heart disease in children, not newborns.  It can be diagnosed with echocardiography which will reveal pulmonary stenosis, RVH, a VSD and an overriding aorta
Definition
Tetraology of Fallot
Term
Heart conditions classically associated with maternal lithium use
Definition
Tricuspid Atresia and Ebstein's Anomaly
Term
Tet spells are hypoxemic episodes which lead to patients squatting to increase systemic vascular resistance to increase blood flow to the heart and most commonly associated with
Definition
Tetraology of Fallot
Term
Best test for detecting a patent foramen ovale
Definition
Trans esophageal echocardiogram
Term
IV medications that can be used to hypertensive emergencies include
Definition
nitroprusside, nicardipine, clevidipine, labetalol, fenoldopam
Term
Patients who have severe hypertension (>179/119 mm Hg) without symptoms and signs of end-organ damage
Definition
Hypertensive Urgency
Term
elevated blood pressures, usually > 179/119 mm Hg.  Other clinical manifestations include: retinal hemorrhages and exudates, papilledema, malignant nephrosclerosis (leading to ARF, hematuria, and proteinuria,) and neurologic symptoms due to intracerebral or subarachnoid bleeding, lacunar infarcts, or hypertensive encephalopathy
Definition
Hypertensive Emergency
Term
Beck's triad associated with cardiac tamponade
Definition
hypotension, distant heart sounds, and distended neck veins
Term
preferred treatment for Raynaud's phenomenon in patients diagnosed with scleroderma due to its arterial vasodilatory effects
Definition
Nifedipine (Dihydropyridine CCB)
Term
Top 2 secondary causes of hypercholesteremia
Definition

Choledocholithiasis

Hypothyroidism

Term
CAD risk factors that earn the patient "1" point each
Definition

Smoking

HTN

Age (male > 45, female > 55)

Family Hx of CAD (male < 55, female < 65)

HDL < 40

 

(Note: an HDL > 60 removes one risk factor, so -1 point)

Term
Risk factors that automatically place patients in the highest risk factor category for CAD and therefore, must change lifestyle at LDL > 70 and Must be prescribed medications at LDL > 100
Definition

History of:

MI

PVD

CVA

DM

Term

What type of hypothermia?

Ataxia and risk of arrhythmias

Definition

Mild Hypothermia

(<95.8 F)

Term

What type of hypothermia?

Progressive decrease of level of consciousness with increasing slurring of speech, decrease in heart rate, respiration rate, and cardiac output

Shivering mechanism disappears

Definition

Moderate hypothermia

(82.4 - 90 F)

Term

What type of hypothermia?

Loss of DTRs and loss of response to pain

Risk of ventricular fibrillation or even asystole are high

Definition

Severe hypothermia

(< 82.4 F)

Term
Tx for mild hypothermia
Definition

Passive external re-warming

(warm room with blankets)

Term
Tx for moderate to severe hypothermia
Definition

Active core re-warming along with possibly active external re-warming

(Warm GI irrigation with saline enemas and NG tube along with warmed D5 NS w/out K+)

(external rewarming is immersion in warm bath water; however only indicated in previously healthy, young persons with acute immersion hypothermia; CI in all others b/c can cause life-threatning shock)

Term
Most likely finding on CXR for patent ductus arteriosus
Definition
Increased pulmonary vascular markings
Term
CXR finding for AR
Definition
Dilated left ventricle
Term
ABI in peripheral artery disease
Definition
< 1.0
Term
diminished pulses, decreased hair, and thickened toenails on physical exam
Definition
peripheral artery disease
Term
Most common cause of prosthetic valve endocarditis > 12 months (Late PVE) after surgery
Definition
Staphylococcus epidermidis
Term
Most Common cause of prosthetic valve endocarditis < 12 mos (Early PVE) after surgery
Definition
Staph aureus
Term
2nd mcc of late PVE
Definition
Streptococcus viridans
Term
Tx of acute CHF
Definition
sodium restriction, ACE inhibitors, and furosemide
Term
Hypercalcemia causes what EKG changes
Definition
shortening of the QT interval
Term
Hypokalemia causes what EKG changes
Definition

Depressed T wave

ST segment depression

U-wave (a positive wave following the T-wave)

Term
Classic EKG changes in hyperkalemia
Definition
peaked T-waves
Term
the most common congenital heart defect and may be associated with Down's syndrome.  It leads to left to right shunting and is thus considered an acyanotic heart disease
Definition
VSD
Term

Therapeutic INR for Mechanical heart valves, post-MI, and antiphospholipid syndrome?

 

for acute PE?

Definition

2.5-3.5

 

2.0-3.0

Term
Treatment of choice for Raynaud's Phenomenon in pts diagnosed with scleroderma?
Definition
Nifedipine (CCB)
Term
Tx for Viral Pericarditis
Definition
NSAIDs (plus colchicine in combank source)
Term
Tx for pericarditis due to uremia
Definition
Dialysis
Term
Tx for pericarditis due to SLE
Definition
Corticosteroids
Term
Tx for pericarditis post MI
Definition
Aspirin
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