Kaplan Cardiology

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Name 4 CXR findings in pulmonary edema: 1) prominent pulmonary vessels; 2) cardiomegaly; 3) kerley b lines; 4) pleural effusion
Effect of valsalva on HCM: decrease preload; increase murmur
Murmur of PDA: continuous (throughout cardiac cycle)
Effect of hand grip on VSD: increase SVR; increase murmur
Three findings on physical exam in pt with angina:: 1) diaphoresis; 2) tachycardia; 3) transient S4
Sx tx for constrictive pericarditis: pericardiectomy
Effect of handgrip on HCM: increase SVR; decrease murmur
Austin flint murmur is associated with which valvular disease?: AR
What is the most commonly missed cause of syncope in the elderly? How do you make diagnosis?: subclavian steal; diagnosis by 1) measuring both L and R sided BP (difference of more than 25 mmHg = supports diagnosis); 2) confirmed by doppler US of neck vessels
What initiates torsades de pointes?: ventricular premature beat in the setting of abnormal ventricular repolarization characterized by prolonged QT
Duroziez sign is present in what valvular disease?: aortic regurgitation
What is the most common cause of heart transplants?: dilated cardiomyopathy
What BB do you give in acute MI?: metoprolol IV q5min
Indications for thrombolytic therapy for acute MI: within 12 hrs of onset of chest pain plus one of following ECG findings: 1) >1mm ST elevation in 2 contiguous leads; 2) new LBBB
Name 3 common but often missed causes of syncope in the elderly:: 1) subclavian steal; 2) carotid hypersensitivity; 3) L main or severe 3 vessel disease
Effect of squatting on HCM: increase preload; decrease murmur
Indications for IABP: 1) recurrent or persistent MI; 2) severe left or biventricular failure +/- shock
Typical duration of angina sxs:: more than 15 seconds, less than 15 minutes
What is the murmur of mitral stenosis?: mid to late low pitched diastolic murmur preceded by opening snap
How do you confirm diagnosis of pneumothorax?: CXR
Effect of amyl nitrate on austin flint murmur: decreases murmur
Maneuvers which increase preload: 1) squatting; 2) leg raising; 3) inspiration
Name 2 sxs of PVD of the internal iliac system:: 1) decreased libido; 2) pain mimicking DJD of the hip
Cardiac causes of pulmonary edema: 1) arrhythmias; 2) MI; 3) severe systemic HTN; 4) PE; 5) valvular heart dz
Effect of nitrates in high doses: increase coronary artery dilatation --> increase O2 supply
Pathophys of austin flint murmur: the result of mitral valve leaflet displacement along with turbulent mixing of antegrade mitral flow and retrograde aortic flow
Effect of inspiration on TR: increase preload; increase murmur
4 causes of acute mitral regurgitation: 1) ruptured chordae tendineae; 2) papillary muscle rupture; 3) endocarditis; 4) trauma
2 most common causes of mitral regurgitation: 1) rheumatic fever; 2) dilation of left ventricle
Duration of chest pain in acute MI:: usu longer than 20 minutes
5 diagnostic tests used to diagnose dilated CM: 1) ECG; 2) CXR; 3) echo; 4) cath; 5) stress test
Pulsus parvus et tardus is a classic findng in which disease?: AS
What is the best diagnostic test for pericardial effusion?: echo
What is the most common presenting sxs in AR?: dyspnea
JNC7 guidelines for controlling BP in pts with and without DM: without DM = <140/90; with DM = <130/80
What are the 2 goals of treatment for mitral regurgitation?: relieve sxs by 1) increasing forward output; 2) reducing pulmonary venous hypertension
How to differentiate btw constrictive pericarditis and restrictive CM on cardiac catheterization:: in constrictive pericarditis, end-diastolic pressures are equal in all 4 chambers, while in RCM, LVEDP > RVEDP
3 factors that decrease obstruction in HCM:: 1) decrease in contractility; 2) increased preload; 3) increase in afterload
Name 3 entities that mimic mitral regurgitation on physical exam: 1) VSD; 2) HCM; 3) AS
4 diagnostic tests to confirm diagnosis of papillary muscle rupture: 1) 2-d echo; 2) doppler flow study; 3) PA cath; 4) LV angiography
Mechanism of action of digoxin: inhibition of Na/K ATPase --> --> increase intracellular Ca --> inotropic effect
Hallmark of HCM: unexplained myocardial hypertrophy with thickening of the interventricular septum
What findings on CXR suggest left atrial enlargement?: 1) double-density right heart border; 2) posterior displacement of esophagus; 3) elevated left mainstem bronchus
What is the most common cause of aortic regurgitation?: rheumatic heart dz
Sxs of torsades de pointes:: recurrent dizziness or syncope
2 findings on ECG consistent with MR: 1) LV hypertrophy; 2) LA enlargement
JNC7 guidelines for controlling total cholesterol and LDL in pt with very high cardiac risk profile: T.chol <190; LDL <70
Rx tx for diastolic dysfunction:: negative inotropic agents: 1) BBs; 2) verapamil; 3) cardizem
How do you make diagnosis of prinzmetal's angina?: cardiac catheterization: shows no atherosclerosis, but ergonovine can precipitate spasm
Treatment for prinzmetal's angina?: calcium channel blockers and nitrates
At what diameter is aortic stenosis considered to be critical or severe?: <0.8cm
For how long do troponins remain elevated after acute MI?: 1-2 wks
5 general causes of non-atherosclerotic MI: 1) vasculitis; 2) congenital anomaly of coronaries; 3) coronary spas (i.e. cocaine); 4) coronary artery embolus (i.e. atrial thrombus); 5) hypercoagulable states
What does Beriberi mean?: "i can't i can't" in Singalese
Rx tx for symptomatic sinus bradycardia: atropine
Who has very high cardiac risk?: 1) ACS; 2) CAD + DM or smoker
ECG findings in acute pericarditis:: diffuse ST segment elevation, absence of reciprocal changes, upright T waves
Most common cause of AS: calcification and degeneration of a congenitally normal valve
Duroziez sign: systolic and or diastolic thrill or murmur heard over the femoral arteries; related to high pulse pressure
3 possible findings on CXR in pt with AS: 1) cardiomegaly; 2) calcified aorta; 3) pulmonary congestion
Effect of nitrates in moderate doses: increase venous and arterial dilatation --> decrease both preload and afterload
3 tests used to make diagnosis of CHF: 1) CXR; 2) echo; 3) MUGA scan or radionuclide ventriculography
What is the preferred tx in resting obstructive HCM?: goal is relief of obstruction to LV outflow; tx with disopyramide
Murmur of mitral regurgitation: holosystolic murmur heard best at apex and radiating to axilla
3 most common causes of AS: 1) degenerative (aging); 2) calcification and degeneration of a congenital bicuspid valve; 3) rheumatic heart dz
What 3 tests help make diagnosis of mitral stenosis?: 1) ECG; 2) CXR; 3) echo
Name 4 equivalents of CAD: 1) DM; 2) PVD; 3) carotid dz; 4) aortic dz
Effect of hyperkalemia on digoxin: decrease dig activity
Noncardiac causes of pulmonary edema: 1) ARDS; 2) uremia; 3) aspiration; 4) head trauma; 5) allergic reaction to rx; 6) alveolar capillary leak
Maneuvers which increase afterload:: 1) hand grip; 2) phenylephrine
3 questions to ask to determine whether chest pain is typical, atypical or nonanginal:: 1) is the pain retrosternal? 2) is the pain brought on by stress? 3) is the pain relieved with rest or NTG?
Indication for surgical repair of MR: severe MR with significantly limiting sxs despite optimal medical management
3 ways to confirm diagnosis of aortic dissection:: 1) CT, 2) TEE, 3) aortography
What is pulsus paradoxus a signal of?: failing cardiac output during inspiration
Effect of Hypertrophic cardiomyopathy on stroke volume and ejection fraction: stroke volume: normal to increased; ejection fraction: increased
What is the effect of chronic mitral regurgitation on preload?: increases preload (MR --> decreased CO --> RAAS --> fluid retention
Sign of posterior infarction on initial 12-lead ECG: in leads V1-V2: 1) tall, broad R waves; 2) ST depression; 3) tall peaked T wave
Effect of dilated (congestive) cardiomyopathy on ejection fraction: decreased
Typical EF in pts with HCM: 80-90%
Name 4 factors that would make ECG interpretation of MI difficult:: 1) LBBB; 2) previous MI; 3) pacemaker; 4) digoxin use
Murmur of AR: diastolic decrescendo murmur OR systolic flow murmur (secondary to greatly increased stroke volume)
How can u differentiate pericarditis from angina from the history?: pericarditis pain is sharper, worse with lying down, relieved with sitting up
What is the second most commonly missed cause of syncope in the elderly?: carotid hypersensitivity; make daignosis by carotid massage --> bradycardia
4 classes of drugs used to treat MR: 1) digitalis; 2) diuretics; 3) arteriolar vasodilators; 4) anticoagulants
Classic triad of AS: 1) angina; 2) syncope; 3) dyspnea secondary to CHF
Pathophys of chronic AR: AR --> volume overload of LV (increased LVEDV) --> LV dilatation --> dilated cardiomyopathy and volume overload
RV infarct associated with what other MI: inferior wall
What are the 2 main criteria for bypass?: 1) three vessel disease; 2) left main dz
Interstitial edema with normal to low PCWP: noncardiac cause
3 mechanisms which contribute to angina in AS: 1) LV hypertrophy; 2) high intramyocardial wall tension; 3) decreased diastolic coronary blood flow
4 DDx for dilated cardiomyopathy: 1) acute myocarditis; 2) valvular heart disease; 3) CAD; 4) hypertensive heart dz
2 factors which affect pulse pressure: 1) stroke volume (proportional) ; 2) compliance of aorta (inversely proportional)
Definition of unstable angina:: new onset CP; worsening pattern in frequency, duration or inte
Name 2 complications of thrombolysis:: 1) bleeding; 2) reperfusion arrhythmias
Signs and sxs of pulmonary edema: 1) tachypnea; 2) cough with pink frothy sputum; 3) cyanosis; 4) nocturnal dyspnea; 5) rales, rhonchi and wheezing
Why does a reduction in preload increase obstruction in HCM?: decreased venous return --> decreased size of the heart --> mitral valve brought closer to the septum
2 common causes of aortic regurgitation:: 1) rheumatic fever; 2) infective endocarditis
Contraindications to stress testing:: 1) unstable angina; 2) aortic stenosis; 3) IHSS; 4) severe COPD; 5) acute CHF; 6) acute ischemia on ECG; 7) aortic dissection; 8) severe uncontrolled HTN
Contraindications to BB in acute MI: 1) bradycardia; 2) AV block; 3) hypotension; 4) COPD
Treatment for dilated cardiomyopathy: same as for systolic dysfxn CHF: 1) decrease preload (salt restriction, diuretics); 2) digoxin; 3) decreased afterload (ACEI, hydralazine); 4) ventricular remodeling (BB) PLUS 5) anticoagulants (high freq of pulm and systemic embolism)
3 Effects of beta blockers that make them useful in treating angina: decrease 1) HR, 2) BP; 3) contractility --> decrease O2 demand of heart
3 indications for digoxin: 1) CHF; 2) afib; 3) paroxysmal atrial tachycardias
Treatment for right ventricular infarction: IV fluids
Effect of valsalva on AS: decrease preload; decrease murmur
Beriberi disease results in which type of cardiomyopathy?: dilated CM
What 2 electrolyte disturbances are associated with torsades de pointes?: 1) hypokalemia; 2) hypomagnesemia
6 conditions that may affect the ascending aorta and cause AR: 1) syphillis; 2) ankylosing spondylitis; 3) marfan's syndrome; 4) systemic htn; 5) aortic dissection; 6) aortic trauma
Treatment for AR: treat like CHF secondary to systolic dysfxn: 1) preload reduction (salt restriction and diuretics); 2) digitalis; 3) afterload reduction (ACEI)
Blood supply of the inferior wall of the left ventricle: PDA (85% from RCA; 15% from LCA)
Treatment for torsades de pointes:: 1) magnesium sulfate; 2) isoproterenol infusion; 3) cardiac pacing; 4) cardioversion if hemodynamically unstable
Treatment for cardiac tamponade:: 1) pericardiocentesis; 2) subxiphoid surgical drainage
Effect of maneuvers on murmur of mitral valve prolapse: improves with squatting (increased venous return); worsens with valsalva (decreased venous return)
Blood supply of the posterior wall of the left ventricle: marginal branch of the left circumflex a
Maneuvers which decrease preload:: 1) valsalva; 2) standing
4 DDx whose murmurs mimic AS: 1) aortic valve sclerosis of the elderly; 2) HCM; 3) MR; 4) PS
Name 5 sxs of PE:: 1) tachypnea; 2) dyspnea; 3) cough; 4) pleuritic chest pain; 5) hemoptysis
What is the heritance pattern of HCM?: autosomal dominant
2 Medical treatment options for stable, monomorphic v.tach: 1) amiodarone; 2) lidocaine
JNC7 guidelines for LDL in pts with CAD or equivalent: LDL <100
Pulsus paradoxus: decrease in systolic BP of more than 10mmHg with normal inspiration; palpated as weakened pulse with inspiration along with more heart contractions to pulse beats
What heart sound is associated with AS: S4 (forceful atrial contraction augments filling of thick, noncompliant ventricle)
Findings of AS on ECG: LV hypertrophy
Murmur of mitral valve prolapse: mid to late systolic click and a late systolic murmur heard best at the apex
Contraindications to thrombolytic therapy:: 1) dissecting AA; 2) uncontrolled HTN (>180/110); 3) active PUD; 4) recent head trauma; 5) recent invasive procedure or sx; 6) previous CVA; 7) traumatic CPR; 8) proliferative diabetic retinopathy; 9) active internal bleeding; 10) intracranial malignancies; 11) recent IV puncture at noncompressible site
Rx tx for constrictive pericarditis:: conservative: salt restriction and diuretics
Contraindication of BBs: severe asthma (BBs cause bronchoconstriction)
Which cardiac region is most susceptible to ischemia?: left ventricular subendocardium
Treatment for pericardial effusion:: 1) fluid aspiration; 2) manage etiology
Name 3 findings of ECG consistent with mitral stenosis:: 1) LA enlargement; 2) RV hypertrophy; 3) +/- afib
Name 5 precipitating factors for acute coronary syndrome:: 1) physical exertion; 2) emotional/ mental stress; 3) anxiety; 4) cold exposure; 5) post large meal
Maneuvers which decrease afterload:: 1) amyl nitrate
In a pt with one or no risk factors, at what LDL level do u institute dietary modification? medication?: LDL >130; LDL >160
Effect of hypokalemia on digoxin: dig toxicity
Name 3 indications for cardiac catheterization in pt with angina:: 1) sxs poorly controlled with rx; 2) + stress test --> determine need for revascularization; 3) determine presence of main criteria for bypass sx
2 most common causes of dilated cardiomyopathy: 1) idiopathic (familial 20-30%); 2) alcoholic
Austin Flint murmur: a mid-diastolic, low pitched rumbling murmur best heard at the cardiac apex; seen in AR
2 causes of increased O2 demand in AS: 1) LV hypertrophy; 2) high intramyocardial wall tension
Drugs to avoid in treatment of CHF secondary to diastolic dysfunction:: 1) digoxin; 2) vasodilators
Rx Tx for HCM: negative inotropes: 1) BB; 2) CCB (verapamil, diltiazem); 3) disopyramide (sxs benefit for severely limited pts)
Name 3 mechanisms that increase obstruction in HCM:: 1) increase in contractility; 2) reduction in preload; 3) reduction in afterload
Most common cause of CHF: MI or ischemia
Maximum benefit of ACEI have been shown in what 3 clinical situations?: 1) CHF; 2) LV dysfunction (EF <40%); 3) anterior wall MI
Work up for angina:: 1) ECG; 2) stress test; 3) cardiac catheterization
Work up for pulmonary edema: 1) CXR; 2) ABG; 3) ECG
Serosanguinous pericardial effusion is classic sign in what 2 diseases?: 1) TB; 2) neoplasm
Posterior MIs generally occur in association with what other MI?: lateral or inferior
Treatment for pulmonary edema: 1) morphine; 2) lasix (to reduce preload); 3) dobutamine; 4) sit pt upright; 5) O2 with PEEP; 6) NTG to reduce preload; 7) digoxin if afib; 8) IV ACEI
CXR findings in pulmonary edema: 1) prominent pulmonary vessels; 2) enlarged cardiac silhouette; 3) Kerley B lines; 4) effusion
What is the effect of chronic mitral regurgitation on afterload?: decreased afterload as a portion of stroke volume is ejected retrograde into LA
Effect of valsalva on MVP: decrease preload; OS later and closer to S2
Pathophys in mitral stenosis: MS --> impedes LV filling --> increased LA pressure --> pulmonary congestion --> secondary pulmonary vasoconstriction --> RV failure
Indications for ACEI post-MI: pts with low EF or LV dysfunction
What is the preferred tx in latent obstructive HCM?: goal is to prevent provocation of obstruction; tx with BBs
Which vessel supplies the inferior wall of the left ventricle?: PDA of the RCA
CXR finding in pericardial effusion: water bottle configuration of the cardial silhouette
Which pts s/p acute MI will continue to receive statin therapy?: those with LDL >70
3 diagnostic tests which can be used to support diagnosis of AS: 1) ECG; 2) CXR; 3) echo
Papillary muscle rupture with acute MR is associated with which infarct?: inferoposterior infarcts (posterior papillary muscle involvement)
Blood supply of the posterior papillary muscle: septal perforators of the PDA
Indications for temporary transvenous pacing in acute MI:: 1) 2nd degree heart block, type II or greater; 2) sinus bradycardia despite atropine; 3) junctional or idioventricular rhythm w/ slow ventricular rate and hypoperfusion; 4) LBBB in acute MI; 5) bifascicular block with 1st degree AV block; 6) new bifascicular block
Beriberi is secondary to what vitamin deficiency?: thiamine (vitamin B1)
Clinical manifestations of dilated cardiomyopathy:: same as those for left and right ventricular failure
Precipitating causes of CHF: 1) increased salt intake; 2) inappropriate reduction in drug regimen; 3) excess exertion or stress; 4) arrhythmias; 5) systemic infection; 6) cardiac depressants; 7) fluid overload; 8) renal failure; 9) MI
Palpable precordial thrill associated with rupture of papillary muscle or ventricular septum?: ventricular septum
Definition of stable angina:: occurs during exertion; same amt of exercise reproduces pain; relieved by rest
Which vessel supplies the lateral wall of the left ventricle?: left circumflex a
What is the preferred treatment in nonobstructive HCM?: goal is to improve LV relaxation; tx with CCBs
Name 6 treatment options for angina: 1) nitrates; 2) BBs; 3) lipid lowering agents (i.e. statins); 4) antiplatelet agents (aspirin +/- plavix); 5) CCBs (only for prinzmetal's); 6) revascularization
Goals of medical treatment of mitral stenosis: decrease preload: 1) diuretics; 2) sodium restriction
A transudative pericardial effusion can be seen in what 3 cases?: 1) CHF; 2) hypoproteinemia; 3) overhydration
Name 3 indications for exercise stress test:: 1) to confirm diagnosis of angina; 2) to determine severity of dz; 3) post MI evaluation
How to auscultate for pericardial friction rub?: with diaphragm, as pt sits forward at forced-end expiration
3 ways to confirm diagnosis of esophageal reflux or spasm mimicking angina:: 1) upper GI series; 2) endoscopy; 3) esophageal manometry
In a pt with more than one risk factor, at what LDL level do u institute dietary modification? medication?: LDL >160; LDL >190
3 surgical procedures for HCM: 1) septal myomectomy; 2) aortotomy; 3) etoh ablation
3 main therapeutic objectives in management of CHF:: 1) reduce cardiac workload; 2) improve cardiac performance; 3) control excess salt and water
Interstitial edema with elevated PCWP: cardiac cause
Effect of hand grip on MR: increase SVR; increase murmur
Procedure of choice for constrictive pericarditis:: CT
Ventricular septal rupture is associated with which infarct?: anterior wall
Cause of increased pulse pressure in AR: AR --> initial decrease in stroke volume --> compensatory decrease in SVR to maintain CO --> drop in diastolic BP; compensatory LV dilation --> increase in SV --> increased systolic BP
Effect of nitrates in low doses: increase venous dilatation --> decrease preload
Name 4 diagnostic tests to confirm presence of MR: 1) ECG; 2) CXR; 3) Echo; 4) Cath
Pulsus parvus et tardus: upon palpation, the pulse is weak/ small (parvus) and late (tardus) in relation to contraction of the heart
What is the normal aortic valve orifice?: 2.5 to 3.5 cm
Effect of squatting on AS: increase preload; increase murmur
Effect of hand grip on AS: increase SVR; decrease murmur

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