Cardiology Flashcards Online

Cardiology Flashcards

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["dihydropiridines","nifedipine, amlodipine, felodipine"],["nonhydropiridines","diltiazem, verapamil - can be used for rate control in atrial fibrillation"],["atrial fibrillation rate control fails with medications, next step and complication","ablation of AV junction, could cause pacemaker dependence"],["difference in pacemakers for atrial fibrillation","Paroxysmal afib - dual chamber, permanent afib - single chamber ventricular pacemaker"],["What medications can be used for rhythm control in atrial fibrillation?","Propafenone, flecainide - avoid in patients with prior heart disease. Amiodarone and doetilide - safe with prior myocardial infarction."],["How long does anticoagulation need to continue after cardioversion in atrial fibrillation?","4 weeks"],["Medication to terminate paroxysmal supraventricular tachycardia","IV adeonosine or verapamil"],["Define multifocal atrial tachycardia","3 or more atrial foci expressed by 3 different p waves and rate of 100"],["Criteria for Wolff-Parkinson-White","delta wave, pr interval less than 0.12 seconds, symptomatic tachycardia, prolonged qrs >0.12 seconds"],["worst complication of Wolff-Parkinson-White","atrial fibrillation with rapid ventricular response then ventricular fibrillation"],["EP testing in WPW - indication and what does it evaluate?","identifies pathway location, determines if arrythmia is caused by AV node reentry or accessory pathway reentry, used for catheter ablation, indicated only in symptomatic patients"],["AV nodal blocking medication avoided in WPW","Digoxin"],["Medication to slow the rate of WPW with Afib and wide complex qrs. What happens with other agents?","Procainamide slows the accessory pathway and intra-atrial conduction. Other agents - adensosine, calcium channel blockers, b-blockers or digoxin - can block av nodal conduction and lead to increaed rapid ventricular response and ventricular fibrillation"],["Causes of torsades de pointes","Prolonged qt - quinidine, procainamide, disopyramide, TCAs, sotalol. Hypokalemia. Bradycardia after MI"],["Indication for ICD after MI","Ventricular tachycardia and fibrillatiion after 24 hours"],["Treatment for recurrent ventricular tachycardi and fibrillation during acute MI","IV lidocaine or amiodarone"],["Conduction blocks after an MI","5 to 10% Mobitz I second degree or third degree block, 10-20% bundle branch block"],["Medications for vasovagal syncope","Primary is midodrine. SSRI can be tried"],["Classic triad of right ventricular myocardial infarction","hypotension, clear lung fields, elevated central venous pressure"],["Contraindications in right sided myocardial infarction","B-blocker since SA node ischemia could cause bradycardia, nitroglycerin can cause venodilation and hypotension. Volume expansion is the primary treatment."],["Indication for valve replacement instead of baloon valvuloplasty in mitral stenosis","presence of mitral regurgitation also"],["Severe mitral stenosis","Valve area less than 1.5 cm2, pulmonary pressures greater than 50 mm Hg, gradient greater than 10, enlarged left atrium"],["Indications for biventricular pacemaker-defibrillator in heart failure","NYHA Class III-IV, EF < 35%, QRS > 120-130 msec"],["EKG findings for acute pericarditis","diffuse st-segment elevation concave upward and pr segment depression"],["Prefferred medication to treat Dressler's pericarditis after STEMI","Aspirin. NSAIDS contraindicated since they impair myocardial scar formation."],["HOCM murmur","systolic murmur increases with Valsalva maneuver"],["Pulmonary hypertension auscultation","Loud S2 changes with respiration, parasternal impulse"],["Rheumatic mitral stenosis auscultation","Loud S1, variable S2, opening snap, low pitched diastolic murmur. With pulmonary hypertension, loud S2, splits with inspiration, does not split with expiration"],["Atrial septal defect exam","Fixed splitting of S2, pulmonary mid-systolic murmu, tricuspid diastolic flow murmur, right ventricular impulse"],["Idiopathic pericardial effusion persists for longer than three months","needs pericardiocentesis"],["Left subclavian artery stenosis","Low blood pressure, diminished pulses, systolic murmur in left clavicular region due to stenosis and retrograde flow in ipsilateral vertebral artery"],["Kussmaul sign","increased jugular venous pressure during inspiration"],["Two findings for constrictive pericarditis", "Kussmaul sign and pericardial knock - early diastolic sound"],["Indications for repair of an asymptomatic abdominal aortic aneurysm","Diameter greater than 5.5 cm or expanding greater than 0.5 cm per year"],["Class C antiarrhythmics","Digoxin, Diltiazem, Metoprolol, Adenosine"],["ACE inhibitors and pregnancy","congenital cardiovascular and CNS malformations, oligohydraminos, neonatal anuria, renal failure"],["Indication to use spironolactone in heart failure","NYHA Class III or IV, symptomatic with beta blocker and ACE"],["Signs of cardiac transplant rejection","new onset heart failure symptoms or atrial arrhythmias"],["Side effects of cyclosporine","Hypertension, tremor, hypertryglyceridemai, gingival hyperplasia, hirsutism, nephrotoxicity"],["Normal increase in pulmonary pressure with excercise","10 to 25 mm Hg"],["Holosystolic murmur at the apex radiates to the axilla without respiratory variation","Chronic mitral valve regurgitation"],["Holosystolic murmur at left sternal border, jugular venous pulse with a prominent v wave","tricuspid valve regurgitation"],["NSTEMI with recurrent anginal pain after ASA, Nitroglycerin, LMWH, metoprolol","Start Glycoprotein IIb/IIIa inhibitor"],["A patient with angina cannot have any further medical therapy, percutaneous intervention or surgery. What is their next option?","External enhanced counterpulsation - pneumatic cuffs around lower extremites to achieve similar effect to an aortic balloon pump."],["ICD placement after MI","Not eligible for 40 days"],["Pleuritic chest pain, fever, pericardial friction rub, diffuse st-segment elevation concave upward, lymphocytosis","Acute viral pericarditis"],["Patient presents 14 hours after chest pain started, found to have STEMI, are they a candidate for thrombolytics?","No, no benefit from thrombolytics more than 12 hours after symptoms started."],["Contraindications to thrombolytics in STEMI","Prior intracerebral hemorrhage, ischemic stroke within 3 months, suspected aortic dissection, active bleeding"],["Treatment of coronary artery spasms","Long acting nitrates and/or calcium channel blockers"],["ST segment elevation in right ventricular infarction","elevation in V4R lead"],["Patient develops cardiogenic shock after right ventricular infarctions. What is the initial treatment?","Large amounts of IV fluids and dobutamine, then reperfusion"],["Papillary muscle rupture","2-10 days after MI, sudden dyspnea and hypotension. Pulmonary artery wedge pressure shows large v wave. Needs aortic balloon bump and surgery"],["Pulmonary artery catheterization finding for ventricular septal defect","step up in oxygen satruration from the right atrium to the pulmonary artery"],["ACE inhibitor after MI","Large anterior myocardial infarction, congestivve heart failure, ef < 40%"],["Anthracycline complication","Anthracycline cardiotoxicity - can occur decades later"],["Thrombolytics or PCI in STEMI if transfer time is less than 90 minutes","Transfer to get PCI, no thrombolytics"],["Normal hemoglobin in Eisnmenger syndrome. Define anemia. Treatment if patient has anemia.","Normal hemoglobin in Eisenmenger syndrome is 18 to 20 even in women. If they have anemia with a hemoglobin of 13, then the treatment is iron therapy first for 7 to 10 days. If symptomatic after hemoglobin correction, then pulmonary vasodilators can be tried."],["Patient presents with cocaine related chest pain. Treatment options?","Nitroglycerin, calcium channel blockers, benzodiazepines"],["Treatment for initial viral or idiopathic pericarditis and recurrent pericarditis.","Initial - high dose Aspirin and NSAIDS. Recurrent - colchicine for 6 months."],["Pregnant woman with rheumatic mitral valve stenosis presents with dyspnea and palpitations. Treatment strategy?","Initial - beta blockers and diuretics. Then anticoagulation with heparin. If not relieved, the mitral balloon valvuloplasty."],["Indication to use implantable loop recorder.","Very infrequent episodes of syncope, like 3 times in 2 years, not detectable by 24 hour or event monitor for 30 days. Lasts 2 years."],["Type B acute intramural hematoma management.","Crescent shaped density in media of artery. Treat with analgesia, IV beta blocker, and parenteral arterial vasodilator like sodium nitroprusside."],["Patient with difficult to control atrial flutter, recurrent arrythmias. Treatment options.","If already on metoprolol, then next step is radiofrequency ablation with a succes rate of 90%. Digoxin, metoprolol, and amiodarone are less effective measures. Flecainde should only be used with another agent."],["Indication and preferred treatment for pulmonary stenosis.","Gradient greater than 50 mm Hg or right ventricular hypertrophy. Pulmonary balloon valvuloplasty preferred over surgery."],["Indication for defibrillator in heart failure","EF less than 35% regardless of functional status. Most common cause of death is arrythmias."],["Alternative if chf patient cannot tolerate ACE inhibitor","Hydralazine and nitrates"],["Adenosine and dipyramidole stress testing contraindications","Hypotension, sick sinus syndrome, high degree atrioventricular block, bronchospastic disease."],["Indications for aortic regurgitation surgery","EF falls below 55%, left ventricular enlargement"]

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dihydropiridines - nifedipine, amlodipine, felodipine

nonhydropiridines - diltiazem, verapamil - can be used for rate control in atrial fibrillation

atrial fibrillation rate control fails with medications, next step and complication - ablation of AV junction, could cause pacemaker dependence

difference in pacemakers for atrial fibrillation - Paroxysmal afib - dual chamber, permanent afib - single chamber ventricular pacemaker

What medications can be used for rhythm control in atrial fibrillation? - Propafenone, flecainide - avoid in patients with prior heart disease. Amiodarone and doetilide - safe with prior myocardial infarction.

How long does anticoagulation need to continue after cardioversion in atrial fibrillation? - 4 weeks

Medication to terminate paroxysmal supraventricular tachycardia - IV adeonosine or verapamil

Define multifocal atrial tachycardia - 3 or more atrial foci expressed by 3 different p waves and rate of 100

Criteria for Wolff-Parkinson-White - delta wave, pr interval less than 0.12 seconds, symptomatic tachycardia, prolonged qrs >0.12 seconds

worst complication of Wolff-Parkinson-White - atrial fibrillation with rapid ventricular response then ventricular fibrillation

EP testing in WPW - indication and what does it evaluate? - identifies pathway location, determines if arrythmia is caused by AV node reentry or accessory pathway reentry, used for catheter ablation, indicated only in symptomatic patients

AV nodal blocking medication avoided in WPW - Digoxin

Medication to slow the rate of WPW with Afib and wide complex qrs. What happens with other agents? - Procainamide slows the accessory pathway and intra-atrial conduction. Other agents - adensosine, calcium channel blockers, b-blockers or digoxin - can block av nodal conduction and lead to increaed rapid ventricular response and ventricular fibrillation

Causes of torsades de pointes - Prolonged qt - quinidine, procainamide, disopyramide, TCAs, sotalol. Hypokalemia. Bradycardia after MI

Indication for ICD after MI - Ventricular tachycardia and fibrillatiion after 24 hours

Treatment for recurrent ventricular tachycardi and fibrillation during acute MI - IV lidocaine or amiodarone

Conduction blocks after an MI - 5 to 10% Mobitz I second degree or third degree block, 10-20% bundle branch block

Medications for vasovagal syncope - Primary is midodrine. SSRI can be tried

Classic triad of right ventricular myocardial infarction - hypotension, clear lung fields, elevated central venous pressure

Contraindications in right sided myocardial infarction - B-blocker since SA node ischemia could cause bradycardia, nitroglycerin can cause venodilation and hypotension. Volume expansion is the primary treatment.

Indication for valve replacement instead of baloon valvuloplasty in mitral stenosis - presence of mitral regurgitation also

Severe mitral stenosis - Valve area less than 1.5 cm2, pulmonary pressures greater than 50 mm Hg, gradient greater than 10, enlarged left atrium

Indications for biventricular pacemaker-defibrillator in heart failure - NYHA Class III-IV, EF < 35%, QRS > 120-130 msec

EKG findings for acute pericarditis - diffuse st-segment elevation concave upward and pr segment depression

Prefferred medication to treat Dressler's pericarditis after STEMI - Aspirin. NSAIDS contraindicated since they impair myocardial scar formation.

HOCM murmur - systolic murmur increases with Valsalva maneuver

Pulmonary hypertension auscultation - Loud S2 changes with respiration, parasternal impulse

Rheumatic mitral stenosis auscultation - Loud S1, variable S2, opening snap, low pitched diastolic murmur. With pulmonary hypertension, loud S2, splits with inspiration, does not split with expiration

Atrial septal defect exam - Fixed splitting of S2, pulmonary mid-systolic murmu, tricuspid diastolic flow murmur, right ventricular impulse

Idiopathic pericardial effusion persists for longer than three months - needs pericardiocentesis

Left subclavian artery stenosis - Low blood pressure, diminished pulses, systolic murmur in left clavicular region due to stenosis and retrograde flow in ipsilateral vertebral artery

Kussmaul sign - increased jugular venous pressure during inspiration

Two findings for constrictive pericarditis - Kussmaul sign and pericardial knock - early diastolic sound

Indications for repair of an asymptomatic abdominal aortic aneurysm - Diameter greater than 5.5 cm or expanding greater than 0.5 cm per year

Class C antiarrhythmics - Digoxin, Diltiazem, Metoprolol, Adenosine

ACE inhibitors and pregnancy - congenital cardiovascular and CNS malformations, oligohydraminos, neonatal anuria, renal failure

Indication to use spironolactone in heart failure - NYHA Class III or IV, symptomatic with beta blocker and ACE

Signs of cardiac transplant rejection - new onset heart failure symptoms or atrial arrhythmias

Side effects of cyclosporine - Hypertension, tremor, hypertryglyceridemai, gingival hyperplasia, hirsutism, nephrotoxicity

Normal increase in pulmonary pressure with excercise - 10 to 25 mm Hg

Holosystolic murmur at the apex radiates to the axilla without respiratory variation - Chronic mitral valve regurgitation

Holosystolic murmur at left sternal border, jugular venous pulse with a prominent v wave - tricuspid valve regurgitation

NSTEMI with recurrent anginal pain after ASA, Nitroglycerin, LMWH, metoprolol - Start Glycoprotein IIb/IIIa inhibitor

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