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Cardio ck

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mikenakhla's version from 2016-05-19 17:29

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Question Answer
• EKG findings that make you suspect MI (3 of them)ST segment changes (elevation or depression for ischemia), Q waves in segmental distribution, and flattened or flipped T waves
• Treatment of MI if time of onset of sx is less than 12 hours?reperfusion via PCI or fibrinolysis
• What do you do if someone has an MI then develops V tach?amiodarone
• Everyone with an MI gets these 9 thingsoxygen, morphine for pain, aspirin, clopidogrel, nitro, heparin, beta blocker, ACE or ARB, and a statin
• Which drugs reduce mortality rate of an MI and reduce incidence of a second heart attack?beta blockers
• Three indications for heparin in setting of chest pain and MI?severe CHF seen on chest x ray, cardiac thrombus, or unstable angina is diagnosed
• Most common cause of pericarditis? Others?coxsackievirus infection. Others include TB, uremia, malignancy, lupus
• What is prinzmetal angina? How do you treat it? What do you see on EKG?coronary artery spasm, treat with CCB and nitro, ST segment elevation
• Which patients are more likely to develop silent MI's for some reason? What sx do they experience?Diabetic neuropathy, sx include CHF, shock, confusion/delirium esp in old people
• Late diastolic blowing murmur best heard at apexmitral stenosis
• Holosystolic murmur that radiates to axillamitral regurgitation
• Harsh systolic ejection murmur that radiates to carotidsaortic stenosis
• Early diastolic decrescendo murmur best heard at apexaortic regurgitation
• Midsystolic click, late systolic murmurmitral prolapse
• Pneumonic for aortic regurgitation causes?CrEAMCongenital Rheumatic damage, endocarditis, aortic dissection, marfan syndrome
• Prophylaxis for endocarditis, which drug is preferred for oral therapy? Those with penicillin allergy? Those unable to take oral meds?amoxicillin, cephalexin clinda azithro clarithro, otherwise ampicillin, cefazolin, ceftriaxone, clinda
• Superficial palpable cordssuperficial thrombophlebitis, may be a sign of underlying malignancy, as in pancreatic cancer
• Diagnose PE withCT angio or V/Q scan
• Heparin side effect?two types of thrombocytopenia, one that is transient and improves, and HIT, immune complex mediated disorder with heparin platelet factor 4 complex, can lead to arterial/venous thrombosis, stop immediately
• How are effects of LMWH monitored?they're not, trick question
• Antidote for heparin? Warfarin? Aspirin?protamine sulfate, FFP, platelet transfusions for aspirin
• Hereditary pattern of hemophilia A? B? vWF deficiency?X linked, X linked, auto dominant
• Slightly low levels of VIII with thisvWF deficiency
• This can cause a QUALITATIVE platelet defecturemia
• Bleeding tendency but normal coagulation tests?vitamin C deficiency and chronic steroid therapy
• Othopnea, paroxysmal nocturnal dyspnea, rales, pleural effusions, Left or Right ventricular failure?Left
• Peripheral edema, JVD, hepatomegaly, ascities, cor pulmonale possible, left or right ventricular failure?right
• Chronic CHF treatment? Acute?chronic is ACE, beta blockers, diuretics, digoxin if low EF, vasodilators. Acute is oxygen, diuretics, and positive inotropes. IV sympathomimetics are used for severe CHF (eg dobutamine)
• Cor pulmonale in old people, think of these three causes. What about young?old is COPD, PE, or sleep apnea if fat. Young is idiopathic pulmonary arterial hypertention
• How do you treat idiopathic pulmonary arterial hypertension?phosphodiesterase 5 inhibitors, CCBs, antiendothelian (bosentan) and prostacyclin (prostagandlin, so vasodilates) while waiting for lung transplant
• 4 Causes of restrictive cardiomyopathy?sarcoid, amyloidosis, hemochromatosis, myocardial fibroelastosis
• 4 causes of dilated cardiomyopathy?alcohol, doxorubicin, myocarditis (coxsackie B virus), chugs disease (MOST COMMON CAUSE IN LATIN AMERICA)
• Murmur in Hypertrophic cardiomyopathy? Treatment for HCM? systolic ejection murmur along LSB, increases with standing or Valsalva (decrease blood in L ventricle). Treat with beta blockers or disopyramide (antiarythmic agent) allow ventricle more time to fill and avoid sports.
• Treatment of SYMPTOMATIC a fib? Acute treatment vs chronic (they have hx of it now are in A fib) treatment?(1) rate control, slow with beta blocker or CCB. If acute, cardiovert with DC cardioversion, amiodarone or procainamide. If chronic, anticoagulate THEN cardiovert
• Avoid these drugs in first degree heart block?beta blockers/CCB
• Treatment for mobitz type I? Type II?pacemaker or atropine if symptomatic. Type II - pacemaker.
• Triad of EKG findings with WPW? Teatment of WPW?wide QRS, short PR, DELTA WAVES!!!. Treat with procainamide or quinidine or radiofrequency ablation of accessory pathway causing arrythmia
• Sx of WPW syndrome?kid is playing, passes out or is dizzy then recovers and has no other sx.
• Treatment of pulseless ventricular tachycardia? If pulse is present?pulselessis defibrilation then epinephrine, vasopressin, amiodarone, lidocaine. If pulse is present, amiodarone and synchronized cardioversion
• Think of this endocrine abnormality if patient has sinus tachy or a fib?hyperthyroid
• How do you determine if A fib patient gets anticoagulation?CHADs2 score, if they score 0, aspirin, if 1, aspirin or warfarin, if 2, warfarin
• EKG sign of first degree AV block?prolonged PR interval
• Treatment of PDA? What congenital infection is it associated with? indomethacin or surgery if that doesn't work. Rubella
• Most cases of VSD resolveon their own
• Upper extremity hypertension only? What is this associated with?Coarctation of the aorta, associated with turner syndrome
• What are the noncyanotic heart defects?three D's (VSD, ASD, PDA).
• What are the cyanotic heart defects?1 - truncus arteriosis, 2 - transposition, 3 - tricuspid atresia, 4 - tetrolagy, 5 - total anomalous pulmonary venous return
• Highest oxygen content in fetal circulation?umbilical vein) coming from mom
• PVCs vs PACs?PVCs look weird, PACs look like normal complexes but early
• Pancreatitis in the absence of gallstones or alcohol?think hypertriglyceridemia
• How can you calculate LDL?total - HDL - triglycerides/5
• If patient comes in with coronary artery disease or equivalent (eg diabetes or PVD) and LDL is > than ____, start meds immediately (not just lifestyle mods)100
• Old people with elevated systolic BP and relatively normal diastolic pressure. Due to rigid arterial wall, what is this?Isolated systolic hypertension
• Hold these antianginals prior to stress test (unless they already have known coronary artery disease)beta blockers, calcium channel blockers, nitrates
• Most common causes of superior vena cava syndrome?lung cancer or NHL
• Most significant blood pressure improvement can be achieved viaweight loss
• These two types of people get renovascular hypertensionold guys with atherosclerosis or young women with fibromuscular dysplasia
• Treatment of hyperglycemic hyperosmolar coma?fluids
• What are charcot joints?deformed joints secondary to lack of sensation in diabetics
• If patient has high glucose at 7 AM, what do you do to their NPH insulin from the night before?increase. If low, then decrease NPH
• If patient has high noon glucose, what should you do to their morning dose o regular insulin?increase
• If patient has high glucose at 5, what should you do to their morning dose of NPH?increase
• If patient has high glucose at 9PM, increase what?dinnertime dose of regular insulin
• What is the somogyi effect?body's reaction to hypoglycemia. Releases stress hormones and raises high glucose
• What is the dawn phenomenon with regards to diabetes?hyperglycemia caused by normal secretion of growth hormone early in the morning
• Why are beta blockers kinda contraindicated in diabetic patients?because they can mask the sx of hypoglycemia. Weigh risks and benefits. Eg if they have previous MI, give them a beta blocker
• All diastolic murmurs are BAD. What features of systolic murmurs can be benign?Change with position and low grade (I or II). So the answer may be reassurance in kids
• Large thymic silhouette is a normal finding in children < three years. Where is it located on X ray?opposite side of heart
• These two viruses are the most common triggers for viral myocarditiscoxsackievirus and adenovirus
• Viral prodrome then murmurviral myocarditis
• Pulsatile mass in groin or leg areaanyeursm, either femoral or popliteal if it's lower.
• Unexplained congestive heart failure with echocardiogram findings of increased ventricular wall thickening with normal ventricular cavity dimensionscardiac amyloidosis
• Severe symptomatic hypertension with headaches, nose bleeds, and evidence of left ventricular hypertrophy on ECGCoarctation of the aorta
• Hereditary pattern of HCM?Autosomal dominant
• Beta agonists or antagonist used to treat hyperkalemia?B2 agonists! Like albuterol, shift potassium into cells
• "pounding" heart sensation when lying on left, "water hammer" pulseaortic regurg, causing increased LV end diastolic volume
• Most common valvular abnormality in patients with infective endocarditisMitral regurgitation
• In patients with frequent symptomatic PVCs, how do you treat them?increasing Beta blocker dose or use calcium channel blockers
• Elevated pulmonary capillary wedge pressure following trauma/accident to the chest, think this. What should you urgently order?cardiac contusion causing myocardial dysfunction. Urgent echo indicated
• Causes of ascending aortic anyeursm? Descending?ascending is connective tissue issues (marfan's or ehler's danlos). Descending is due to atherosclerosis
• Splenic abscess is associated with this heart conditioninfective endocarditis. Anything with hematogenous spread (eg IV drug use and immunosupression) can cause this.
• Treatment of septic emboli?antibiotics mainly. Don't anticoagulate
• This lab value parallels severity of heart failure and is a predictor of adverse clinical outcomeshyponatremia. It is caused by increased levels of renin, NE, and ADH. Treat with fluid restriction, ACE, and loop diuretics
• Highest rate of aneurysm expansion and rupture in patients with AAA due to what?smoking
• Tight glycemic control decrease the risk of which complications?microvascular disease (retinopathy and nephropathy)
• Patients with a history of rheumatic fever have increased risk of what? What should they be taking?recurrent episodes of infection with group A strep pharyngitis and progression of rheumatic heart disease. They should be on continuous penicillin
• Pulsus paradoxus is defined as ____. It can be seen with these three conditionsdefined as fall in systemic blood pressure > 10 during inspiration. Can be seen with tamponade, COPD, and severe asthma
• First indicator of hypovolemiapulse rate
• Treatment for dressler's syndromensaids
• Most common congenital cyanotic heart defect in the neonatal period presenting with a single loud second heart sound. What is this and what should be started for this baby?transposition. Prostaglandins to optimize intra-circulatory mixing of blood.
• Elevated JVP, hepatomegaly, lower exxtremity edema or pleural effusions, fatigue, hx of lung diseasecor pulmonale - pulmonary artery systolic pressure leading to right heart failure
• Arterial thrombosis vs embolism?thrombosis is progressive and slow onset, embolism is sudden onset of severe pain and pulselessness
• Ventricular hypertrophy heart sound?S4, just before S1, "TEN nes see". This is the atrium contracting and blood hitting a stiff ventricle
• Distant heart sounds, distended jugular veins, hypotensioncardiac tamponade.
• Management of first degree heart block (prolonged PR interval) with normal QRS duration vs prolonged QRS duration?normal QRS, observation. Prolonged have a conduction delay below AV node, need electrophysiology testing
• Rhythm on EKG but no pulse. What is this, and how do you manage it?chest compressions
• First line treatment for symptomatic sinus bradycardia?IV atropine. If not responsive, IV epinephrine or dopamine are options
• Aortic dissection with Marfan syndrome can lead to this valvular complicationaortic regurgitation, will present as an early diastolic murmur
• Treatment of right ventricular infarction, which leads would you see this in?V3 and V4, give IV normal saline
• This marker is elevated with CHFBNP
• This is a complication of cardiac catheterization and other vascular procedures, characterized by blue toes, livedo reticularis, AKI, morecholesterol embolism
• What makes hypertrophic cardiomyopathy louder? Why?anything that decreases preload - valsalva, sudden standing, nitroglycerin.
• Inheritance pattern of hypertrophic cardiomyopathy?autosomal dominant
• Over what 10 year ACVD risk do you give a statin?>/= to 7.5
• Endocarditis with dental procedures or respiratory tract? IV catheters or prosthetic valves? UTIs? Colon cancer or IBD?Viridans, Staph epidermidis, Enterococci, bovis
• "Tet" spells?tetrology of fallot, sudden spasm of right ventricle outflow during exertion. Harsh crescendo/decrescendo murmur over left upper sternal border (pulmonic artery stenosis)
• If somebody's got an MI, then you give them nitro and they get hypotensive and worse. What is this? What should they have gotten?Right ventricular MI, give them IV bolus infusion. If that doesn't work, dopamine is the initial drug of choice
• This can occur after cardiac surgery, with widened mediastinum, fever, leukocytosis. Very seriousacute mediastinitis. Treat with surgical debridement and antibiotic therapy
• Decreased pulmonary markings on X ray, cyanosis, left axis deviation on EKG. What is this and what causes the decreased markings?Tricuspid valve atresia. Hypoplasia of right ventricle and pulmonary outflow tract cause the decreased markings
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