Cardio ck 2

mikenakhla's version from 2016-05-19 21:46


Question Answer
Treatment for acute aortic dissection?beta blockers
• Treatment of Type A vs Type B dissections?A is ascending aorta, treat with medical therapy and surgery. Type B is descending aorta, treat with medical therapy alone
• Avoid beta blockers in these patientsasthma, COPD, heart block
• First-line for CHF?ACE inhibitors because they reduce mortality
• Treatment for hypertension and pregnant women?labetalol, Hydralazine, methyldopa are safe
• Physical exam findings in fibromuscular dysplasia? How do you treat it?bruit, treat with balloon angioplasty
• Hemopericardium, mediastinal widening and syncope makes you thinkacute aortic dissection, specifically type A involving the ascending aorta because of the hemopericardium.
• What diagnostic test is necessary to rapidly diagnose aortic dissectiontransesophageal echo
• Risk factor for thoracic aortic aneurysms?atherosclerosis.
• Treatment for HCM?beta blockers or diltiazem
• Cholesterol emboli following cardiac cath can causelivedo reticularis, AKI, pancreatitis, mesenteric ischemia
• Cardiac tamponade, what is reduced (eg preload, afterload etc).ventricular preload is reduced b/c venous return is decreased, therefore stroke volume and cardiac output are also reduced
• Treatment for hyperkalemia if no EKG changes?furosemide with saline to pee it out
• Electrical alternansvariations in QRS amplitude from beat to beat, suggestive of pericardial effusion.
• Patients with tachyarrhythmia treatment if hemodynamically unstable? If stable?unstable use immediate synchronized DC cardioversion. If stable, use adenosine/CCBs +/- vagal maneuvers
• Vtach (ventricular tachycardia) an hemodynamically stable vs unstable treatment?stable, amiodarone. Unstable, electrical cardioversion
• What does vtach look like?wide QRS tachycardia
• Definition of malignant hypertension?180/120 greater with retinal hemorrhages, papilledema. Without these signs, it's just urgent hypertension
• Displaced apical impulse, holosystolic murmur, third heart sound, think if thismitral regurgitation, severe. The worse it gets, the click might not be audible. Myxomatous degeneration of mitral leaflets and chordae causes this.
• Treatment for tachycardia mediated cardiomyopathy? These people can have A fib and dilated LA and LV. No clear P waves on EKGrate/rhythm control
• A fib is most commonly caused by ectopic foci where? Flutter involves a reentrant circuit where?within the pulonary veins. Flutter is reentrant circit around tricuspid annulus
• Initial treatment for claudicationexercise therapy, aspirin, and statin
• First line therapy in patients with stable anginabeta blockers. Aspirin and sublingual nitro
• Endocarditis following dental procedurestrep sanguinis (viridans group)
• Which drugs improve survival in CHF patients? Which just reduce symptoms?ACEs, ARBs, spironolactone. Digoxin and loops just do symptoms
• Adenosine is used to slowtachycardia. Blocks AV node
• Avoid which drugs in WPW patients?beta blockers, calcium channel blockers, digoxin, and adenosine because they can cause increased conduction through the accessory pathway
• Treatment for A fib with rapid ventricular rate in patients with WPW?treat them with cardioversion or antiarrhythmics. Don't try typical rate control (beta blockers, etc) so you don't push conduction through accessory pathway
• These drugs limit ventricular remodeling (dilatation and thinning of walls) after an MIACE inhibitors
• These two antihypertensives can cause depressionbeta blockers and methyldopa
• Which antiherptensive agents cause severe, first dose orthostatic hypotensionalpha 1 antagonists (zosins)
• IV drug user with aortic valve endocarditis and some sort of conduction abnormalityperivalvular abscess
• If you suspect endocarditis, what is your next step?do blood cultures before starting treatment
• Scoliosis, "hammer toes" with ataxia, dysarthria in a young personfriedreich ataxia. Die from cardiomyopathy or respiratory complications
• Rheumatic fever valve issuesmitral stenosis --> dyspnea and shit on exertion
• Bounding pulsesaortic regurg. Aka "water hammer" pulse
• Pulsus parvus and pulsus tardus?decreased pulse amplitude and delayed pulse upstroke associated with aortic stenosis
• Sx of cyanide toxicity associate with nitroprusside dripaltered mental status, agitation, lactic acidosis, seizures, and coma possible
• This is a complication of catheterization and presents with sudden hemodynamic instability and flank/back pain. What is this and how do you diagnose it? How do you treat?retroperitonal hematoma, diagnose with non contrast CT of the abdomen/pelvis or abdominal ultrasound. Treatment is supportive (iv fluids, bed rest, intensive monitoring)
• "water bottle" cardiac silhouetteeffusion
• Most common cause of sudden cardiac arrest immediately after an MIV fib aka "reentrant ventricular arrhythmias"
• A fib patient, how do you determine if you want them to take warfarin?CHADs2 VASc score.
• Arrhythmia specific to digitalis toxicity?atrial tachycardia with AV block b/c of the two effects of the drug (increased ectopy and increased vagal tone)
• Most common cause of pericarditis in developing countries?tuberculosis
• First degree heart block vs mobitz type I vs mobitz type IIFirst degree is prolonged PR, no dropped beats. Type I is prolonged PR interval that gets progressively longer till you drop a beat. Type II has no progression of PR interval (but it's still prolonged), and beat is dropped randomly.
• Other heart sound with aortic stenosis?soft S2
• Only two conditions where murmurs get softer/shorter with increased preload (eg squatting)HCM and mitral valve prolapse
• This murmur is common in young womenmitral valve prolapse. Myxomedous degeneration or whatever
• Decrescendo early diastolic murmur. What is this and what is the most common cause in developed countries?aortic regurg, bicuspid aortic valve
• Harsh crescendo-decrescendo systolic murmur, best heard at apex and lower left sternal borderHypertrophic cardiomyopathy





Question Answer
• Adenosine vs atropine?atropine increases HR, adenosine causes transient heart block to decrease HR, used with supraventricular tachycardia
• Treatment for torsades in unstable patient? Stable?unstable is immediate defibrillation, IV magnesium sulfate for stable patients. DON’T USE AMIODARONE FOR TORSADES, it has no role
• Tortuous superficial veins with lower extremity edema, what is this and how do you treat?this is chronic venous insufficiency, basically the valves are failing. Treat conservatively, leg elevation, compression etc
• A fib, what should you screen for?hyperthyroidism as an underlying cause
• Reversible cause of restrictive cardiomyopathy?hemochromatosis. Other causes are sarcoid, amyloidosis, or idiopathic.
• Cardiac findings with carcinoid syndrome?right sided valvular lesions (tricuspid regurg usually)

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