CARDIO-Rosh Review- Set 1
Terms in this set (85)
Acute Pericarditis SX
Pleuritic chest pain radiating to the back
Pain ↓ with leaning forward
Pericardial friction rub
Acute Pericarditis ECG
ECG: diffuse STE, PR depression and the absence of reciprical changes
Acute Pericarditis TX
Underlying pathophysiology of ventricular tachycardia?
Irritable ventricular automaticity foci
Basis of supraventricular tachycardia
Reentrant pathway between atria and ventricles
Basis of AV block
Electrical blockade thru the atrioventricular node
Underlying pathophysiology of mitral stenosis
Rheumatic fever and leaflet calcification
Treatment of hemodynamically stable Atrial fibrillation with concomitant Wolff-Parkinson-White syndrome?
The preferred therapy for the prevention of recurrent preexcited atrial fibrillation?
Ablation of the accessory pathway
In patients with a myocardial infarction, which three drugs have been shown to decrease mortality?
Aspirin, ACE-inhibitors and Beta-blockers.
In acute coronary syndrome, what could be used for pt with Aspirin allergy?
In acute coronary syndrome, what is a CI for the use of Nitroglycerin?
1) Sildenafil use within 24 hrs
2) RV infarction
3) Aortic Stenosis
4) Hypertrophic Cardiomyopathy
What is Preferred over thrombolytics in all STEMI patients?
At a PCI center, what is the GOAL minutes contact to device time?
< 90 minutes
From a non-PCI center, transfer to PCI center if contact to device time can be:
From a non-PCI center, if it takes > 120 minutes to transfer pt to a PCI center, prefer:
Thrombolytics to begin within 30 minutes of ED arrival
Most appropriate initial treatment for acute onset dizziness and palpitations caused by PSVT?
(holding your breath and bearing down)
Which vagal maneuver is relatively contraindicated in the elderly population?
Carotid massage, as the risk of embolic stroke from underlying carotid atherosclerosis is present.
Another name for AV nodal reentrant tachycardia?
Paroxysmal Supraventricular Tachycardia (PSVT)
How does Vagal Maneuver help with PSVT?
Parasympathetic activation slows down AV nodes to interrupt reentry events.
Apical mid-systolic click which may or may not be followed by a late-systolic murmur
Mitral valve prolapse (MVP)
Physical abnormalities which are associated with mitral valve prolapse?
Marfan's/Ehlers-Danlos body habitus: pectus excavatum, low BMI, scoliosis, kyphosis, straight-back, long-narrow chest and joint hypermobility.
According to JNC-8, first-line antihypertensives in the African-American population include:
thiazide-type diuretics (TTD) or
calcium channel blockers (CCB)
According to JNC-8, first-line medications in the non-African-American population include
thiazide-type diuretics (TTD) or
calcium channel blockers (CCB)
in addition to angiotensin-converting enzyme inhibitors (ACEI)
angiotensin receptor blockers (ARB).
If the blood pressure goal is not achieved during one month of treatment, clinicians should:
increase the dose of the first drug
continue the first drug and add a second drug
What should be considered first when patients are not at therapeutic blood pressure goals?
Medication compliance and lifestyle intervention adherence.
JNC 8 targets BP for:
a) < 60 yo
b) >18 yo + CKD
c) >19 + DM
JNC 8 targets BP for:
a) > 60 yo
According to JNC-7, first-line medications for most w/o other complications is:
Left sternal border systolic murmur that gets louder during a Valsalva maneuver
+/- S4 gallop
Hypertrophic cardiomyopathy (HCM)
ECG shows consecutive, large and wide QRS complexes. P waves cannot be appreciated.
Long-term prophylaxis to reduce attacks of Prinzmetal's angina is best accomplished with which of the following medications?
Calcium channel blockers, namely nifedipine and long-acting nitrates like isosorbide dinitrate.
What is a common side effect of amlodipine?
Lower extremity edema.
Most characteristic of a premature junctional contraction
Inverted P' (P-prime) wave following the QRS
Paroxysmal junctional tachycardia is usually in what range of heart rates?
150 to 250 beats per minute
Abnormal accessory conduction pathway called the bundle of Kent.
Wolff-Parkinson-White syndrome (WPW)
Capture beats and fusion beats confirm the diagnosis of which cardiac dysrhythmia?
Supraventricular tachycardia is most common in what population?
Young, healthy individuals with no underlying heart disease.
Elective surgical correction of an asymptomatic AAA is offered to patients when:
AAA ≥ 5.5 cm
AAA grows > 0.6 to 0.8 cm over 6 months.
Test that helps define a cardiac versus a pulmonary cause of dyspnea?
Beta-type (Brain) natriuretic peptide (BNP)
Due to the high negative predictability of BNP and CHF, which value of BNP makes CHF unlikely?
BNP < 100 pg/mL
(Although level does not correlate with heart failure severity)
Factors that accentuate hypertrophic cardiomyopathy murmur?
(Decrease LV blood volume)
Factors that alleviate hypertrophic cardiomyopathy murmur?
(Increase LV blood volume)
Most common organism responsible for bacterial left-sided endocarditis (Mitral Valve) in pt with significant dental disease and poor dentition?
Most common organism responsible for bacterial right-sided endocarditis (Tricuspid Valve) in pt with significant IV drug abuse?
Murmurs associated with an increase in right atrial pressure?
What dysrhythmia is most commonly associated with tricuspid regurgitation?
Atrial fibrillation (80% of patients with tricuspid regurgitation).
Pansystolic murmur at left sternal border?
Common cause of syncope in the elderly population?
Most common cause of syncope in the general population?
Most common cause of syncope while assuming an upright position from supine or sitting?
Long-term treatment for paroxysmal supraventricular tachycardia (PSVT)?
Calcium channel blockers, beta-blockers and radiofrequency catheter ablation.
What is the tx for stable A-fib pt:
a) <48h duration
b) >48h duration
a) <48 hours duration: cardiovert to sinus rhthym
b) >48 hours duration: anticoagulate, echo to r/o thrombus, then cardioversion
What is the MC underlying cause of multifocal atrial tachycardia?
What is the Rhythm below: +Irregularly irregular
+≥ 3 different P waves
+Nonconducted P waves are present
Multifocal atrial tachycardia
A rare cause in America but Worldwide of Tricuspid Stenosis?
Rheumatic heart disease
Isolated tricuspid regurgitation is most often seen in which group of patients?
Intravenous drug abusers, secondary to tricuspid valve endocarditis.
Approximately one-third of patients with Wolff-Parkinson-White develop what tachydysrhythmia?
Atrial fibrillation, and if atrial fibrillation conducts rapidly down the bypass pathway, it can degenerate into ventricular fibrillation.
According to JNC-8, BP goal for all patients < 60 years of age is:
< 140/90 mm Hg
JNC-8 initial antihypertensive choice for African-Americans is:
( indapamide, hydrochlorothiazide, chlorthalidone and bendroflumethazide)
a calcium channel blocker
(amlodipine, nitrendipine and diltiazem ER)
According to JNC-8, special attention is given to which two diseases in hypertensive patients ≥ 18 years old?
Diabetes and chronic kidney disease (goal is < 140/90 mm Hg)
Inotropic drug works by which of the following mechanisms?
alter the force of myocardial contraction
Chronotropic drug works by which of the following mechanisms?
effect the heart rate
Dromotropic drug works by which of the following mechanisms?
affect the conduction velocity though the myocardium
Beta blockers, calcium channel blockers, quinidine, and flecainide share the properties of:
being negative inotropic agents
Dopamine, dobutamine, norepinephrine, epinephrine and milrinone share the properties of:
being positive inotropic agents
What is Digoxin classified as?
a positive ionotrope and negative chronotrope.
It augments pumping while decreasing heart rate.
A bicuspid aortic valve is often associated with which of the following findings?
Dilation of the ascending aorta
Patients with bicuspid aortic valve more frequently develop what aortic valvular abnormality?
Aortic stenosis occurs much more frequently than aortic regurgitation.
What is the CHA2DS2-VASc score?
includes all the elements of the CHADS2 score, plus: female sex, age 65 to 74 years, or vascular disease. (Each risk factor is 1 point.
> 75 years old is 2 points.)
To prevent arterial thromboembolism, we classify pt risks and tx by CHADS2 scores:
a) 0 point (low risk)
b) 1 point (intermediate risk)
c) 2 points (high risk)
a) No anticoagulant
b) Warfarin or Aspirin
c) Warfarin with a goal INR of 2.0-3.0
When this triad exists, pericardiocentesis is guaranteed:
2) distant heart sounds
3) increased jugular venous pressure
What is the most common etiology of ventricular fibrillation?
What is the study of choice in an unstable patient to confirm the diagnosis of aortic dissection?
Management for Stanford Classifying systems of AAA:
a) Type A (Ascending aorta)
b) Type B (Below)
b) medical management
Most common cause of death from Aortic Dissection:
What is the goal heart rate during an treadmill exercise stress test?
Goal= 85% of maximum predicted heart rate [220 - patient age]
What diagnostic test is most sensitive in detecting valvular vegetations?
Transesophageal echocardiogram (TEE).
Clinical symptoms of bacterial endocarditis?
Heart Failure Classification according to American Heart Association/American College of Cardiology staging from A to D:
Stage A: high risk without symptoms/disease
Stage B: structural disease without sx
Stage C: structural disease + sx
Stage D: refractory heart failure
Heart Failure Classification according to New York Heart Association Classification:
II: sx with ordinary activity
III: asymptomatic only at rest
IV: sx at rest
Medical treatment of symptomatic premature atrial contractions?
Calcium-channel blockers or beta-blockers.
Serious complication of mitral stenosis?
Long-standing mitral stenosis
--> left atrial dilation, a prominent risk factor
--> atrial fibrillation and thromboembolism.
Normal Pediatric Heart Rates
<1: 100-160 bpm
1-2: 90-150 bpm
2-5: 80-140 bpm
6-12: 70-120 bpm
>12: 60-100 bpm
JNC-8 recommends treating hypertensive adults > 60 years old to a goal of
< 150/90 mm Hg