Term
| The 3 most common causes of aortic stenosis in the general population: |
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Definition
1. Senile calcific aortic stenosis
2. Bicuspid aortic valve (majority in pts under 70 years)
3. Rheumatic heart disease |
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Term
| Acral ischemia in a pt on pressors: |
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Definition
| Norepinephrine-induced vasospasm. Vasoconstriction can result in ischemia and necrosis of the distal fingers and toes. Suggested by symmetric duskiness and coolness of all fingertips. Can also happen in the intestines and kidney. |
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Term
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Definition
| Can result in a restrictive cardiomyopathy with thickened ventricular walls and preserved ventricular dimensions, as well as involvement of the liver and kidneys. |
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Term
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Definition
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Term
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Definition
| Brain naturetic peptide. It is secreted in the ventricles in response to stretch. It is used to differentiate chest pain in heart failure from chest pain in acute MI. A low BNP rules out heart failure exacerbation with a hight negative predictive value. |
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Term
| Ischemia-reperfusion syndrome |
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Definition
| A form of compartment syndrome that can occur after 4-6 hours of ischemia. Tissues can suffer both intracellular and interstitial edema upon reperfusion. |
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Term
| CI, LVEDV, and TPR in acute systolic heart failure: |
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Definition
CI: decreased (because the heart is failing)
LVEDV: increased (because the LV is not pumping it out)
TPR: increased (RAAS) |
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Term
| 3 major mechanical complications of MI: |
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Definition
1. Mitral regurgitation due to papillary muscle rupture
2. Left ventricle free wall rupture
3. Interventricular seputm rupture |
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Term
| Classical murmur in a child with VSD: |
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Definition
-pansystolic murmur at the left lower sternal border.
-diastolic murmur at the apex because of increased blood flow across the mitral valve |
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Term
|
Definition
1. age (esp > 70 yrs)
2. diabetes
3. smoking
4. HTN
5. hyperlipidemia |
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Term
| What is the best treatment for a patient with ventricular tachycardia who is HDS? |
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Definition
| Loading with either lidocaine or amiodarone (doc). |
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Term
| What is the leading cause of lower extremity edema? |
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Definition
| Chronic venous insufficiency |
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Term
| Tell me about chronic venous insufficiency: |
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Definition
- thought to be caused by incompetence of the valves of the LE veins. Causes problems ranging from mild varicosities to leg pain, severe edema, stasis dermatitis, skin fibrosis, ulceration, and immobility.
- risk factors include age, females, obesity, h/o LE surgery, h/o DVT.
- Leg elevation, compression hose, and SVCs can help. Though skin fibrosis and ulceration requires more extensive medical mgmt. |
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Term
| Drug of choice in a hypertensive presenting with stable angina: |
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Definition
| Metoprolol: this will increase the threshold for the development of an anginal episode and control htn. Says qbank. |
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Term
| 4 drugs that have been shown to have a mortality benefit when given as secondary prevention after ACS: |
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Definition
1. ASA
2. Beta blockers
3. ACE inhibitors
4. Lipid-lowering agents. |
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Term
| What other medication should be included as secondary prevention following UA/NSTEMI for at least 12 months? |
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Definition
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Term
| Acute retrosternal chest pain and a normal ECG, plus a diastolic murmur: |
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Definition
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Term
| What test do you do when you suspect aortic dissection? |
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Definition
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Term
| In aortic dissection, what do you do even before a TEE? |
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Definition
| Control hypertension if present. |
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Term
| Rheumatic risk factor for accelerated coronary atherosclerosis: |
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Definition
| SLE (as well as corticosteroid use) |
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Term
| Pt with burning epigastric pain: |
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Definition
| Is it associated with food? Is it relieved by antacids? If not, it is probably cardiac pain. |
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Term
| How is hypertrophic cardiomyopathy inherited? |
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Definition
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Term
| Viruses commonly implicated in viral myocarditis: |
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Definition
- coxsackie B
- parvo B19
- HHV 6
- adenovirus
- enterovirus |
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Term
| Wtf is 'high output cardiac failure'? |
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Definition
| Supranormal ventricular function that still cannot meet the body's demands. Causes include anemia, hyperthyroid, beriberi, paget's, and av fistulas. |
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Term
| 3 clinical findings characteristic of aortic dissection: |
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Definition
1. acute onset 'tearing' pain in the chest or back
2. variation in pulse or bp between the right and left arms
3. widened mediastinum on CXR
- When 2 or more of these findings are present, the incidence of dissection exceeds 80% |
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Term
| DOC for Prinzmetal's angina: |
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Definition
Dilitiazem (Calcium channel blocker or nitrates)
- nonselective Beta blockers and ASA should be avoided bc they can promote vasoconstriction |
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Term
| What do you give to keep the ductus open? |
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Definition
|
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Term
| What do you give to make the ductus close? |
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Definition
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Term
| TOC to decrease embolic complications in patients with atrial fibrilation: |
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Definition
Warfarin.
-ASA and clopidogrel are less effective |
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Term
| What is pulsus paradoxus? |
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Definition
| A fall in the systemic arterial pressure by more than 10 mmHg during inspiration; often a/w cardiac tamponade. |
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Term
| What is pulsus parvus et tardus a/w? |
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Definition
|
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Term
| early diastolic murmur at the sternal border: |
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Definition
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Term
| What is the normal central venous pressure? |
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Definition
|
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Term
| What is the normal pumonary capillary wedge pressure? |
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Definition
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Term
| What is the cause of isolated systolic hypertension in the elderly? |
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Definition
| decreased elasticity of the arterial wall |
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Term
| What drug class help to limit ventricular remodeling after MI? |
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Definition
| ACE inhibitors. ACEi's should be initiated within 24 hours of myocardial infarction in all patients wihtout a contraindication. |
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Term
| Orthostatic hypotension is common in these (3) subgroups: |
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Definition
-hypovolemic
-the elderly
-those with autonomic neuropathy (eg, diabetes and parkinsons) |
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Term
| What is the pathology leading to aortic aneuyrism formation? |
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Definition
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Term
| What is pulseless electrical activity? |
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Definition
| The presence of discernable rhythm on cardiac monitoring in a pation who is clinically in cardiac arrest with no palpable pulses. |
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Term
| What are the shock-able rhythms? |
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Definition
ventricular fibrilation
ventricular tachycardia |
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Term
| What do you do in cardiac arrest that is not VF/VT? |
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Definition
| Begin CPR including manual chest compressions, establish an airway with 100% oxygen, and obtain peripheral access. |
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Term
| Why does squatting improve oxygenation in TOF? |
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Definition
| It increases systemic vascular resistance. When you increase the afterload, you decrease the right to left shunt caused by PA stenosis, and increase bloodflow to the lungs. |
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Term
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Definition
| A test where a patient is on a table and goes from lying to a standing position by tiliting the table. It is used to diagnose orthostatic syncope in a controlled environment. |
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Term
| What is the most sensitive and specific test for a myocardial infarction? |
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Definition
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Term
| An elevation in what laboratory value would help you diagnose a new ischemia in a patient who recently had an MI? |
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Definition
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Term
| Patients with mitral stenosis are at high risk for developing what? |
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Definition
| atrial fibrillation due to left atrial dilation. This can lead to thrombosis, and stroke. |
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Term
| What is the most rapidly acting medication to relieve the symptoms of pulmonary edema? |
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Definition
|
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Term
| What is the leading risk factor for aortic dissection? |
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Definition
|
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Term
| What is the medical TOC for an aortic dissection? |
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Definition
| IV labetalol. Beta blockers are ideal because they simultaneously lower the heart rate and blood pressure, minimizing stress on the aortic wall. |
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Term
| What is a common side effect of dihydropyridine Ca channel blockers like amlodipine? |
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Definition
| peripheral edema. Think of this diagnosis in a patient who was just started on a new blood pressure medication and has no signs or symptoms of heart failure. |
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Term
| What electrolyte abnormality can be used as a measure of heart failure severity? |
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Definition
| Hyponatremia. Severe hyponatremia is a bad prognostic factor in patients with heart failure. It indicates the presence of severe heart failure and a high level of neurohumoral activation. Water restriction (not salt restriction) may help the hyponatremia. |
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Term
| What physical finding is most consistent with a diagnosis of malignant hypertension? |
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Definition
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Term
| What is the recommended treatment for 'stable' (ie, has a pulse and is conscious) ventricular tachycardia? |
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Definition
| - loading with AMIODARONE |
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Term
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Definition
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Term
| A young patient suddenly develops both right and left heart failure after a URI. Dx? |
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Definition
| - viral myocarditis. Possible future problem? Dilated cardiomyopathy. |
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Term
| Do pts with mitral valve prolapse receive prophylaxis for dental procedures? |
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Definition
| - No. Even pts with mitral valve regurg do not receive proph. |
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Term
| Wide, fixed splitting of the S2 in a child is characteristic of: |
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Definition
- ASD
- Listen for a systolic murmur heard best at the left upper sternal border from increased flow across the pulmonic valve. |
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Term
| What is a normal right ventricular pressure? |
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Definition
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Term
| What kind of cardiac cath findings do you see in PE? |
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Definition
| - an elevated RV and PA pressure with normal PCWP. |
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Term
| How often do you screen for hyperlipidemia? |
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Definition
|
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Term
| A systolic murmur heard best at the left sternal border that decreases in intensity with increased pre-load? |
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Definition
| - Hypertrophic cardiomyopathy |
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Term
| In the LBJ special, which intervention is most likely to slow the progression of a AAA? |
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Definition
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Term
| What is the treatment for aortic regurgitation? |
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Definition
| - afterload reduction with a CCB or ACEi. |
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Term
| 3 causes of pulsus paradoxus: |
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Definition
| - cardiac tamponade, tension pneumo, severe asthma |
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Term
| What arrhythmia is most specific for dig toxicity? |
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Definition
| - atrial tachycardia with AV block |
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Term
| Patient wakes up in the middle of the night with burning chest pain. He is diaphoretic and short of breath, and he had a big meal before he went to bed. Is this GERD or MI? |
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Definition
| - This scenario is MI; GERD will not cause diaphoresis or SOB. |
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