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49 Cards in this Set
- Front
- Back
What valvular diseases cause left sided diastolic failure?
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AS, MS, AR
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What sort of heart disease is caused by Paget's disease of bone?
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High output heart failure
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What is a skin finding in class IV heart failure?
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diaphoresis, cool extremities at rest
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What is the best location, and method of hearing an S3?
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Apex with bell
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What is are night time findings in heart failure?
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nocturia due to leg elevation
PND orthopnea |
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What is the EF cutoff for systolic vs diastolic failure?
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EF < 40 systolic
EF > 40 diastolic |
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What are tests that can be used to estimate EF?
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Radionuclide testing
Echo Cath |
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What test should be done in case of flash pulmonary edema in CHF?
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coronary angiography
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What are indications for dig in CHF?
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EF < 30
severe CHF severe a-fib |
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What drugs should always be used in heart failure, even if asymptomatic?
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ACE inhibitors
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How long must one be stable before initiating beta blockers in heart failure?
How long does it take for symptomatic improvement following administration of drug |
2-4 weeks
2-3 months before symptomatic improvement |
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Which heart failure drug dosage should be maximized?
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beta blocker
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What are alternatives if ACEI can't be used in heart failure?
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ARB
hydralazine, isosorbide dinitrates |
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In which heart failure patients should aldosterone antagonists be used?
What are some things to look out for? |
Class III/IV failure
already receviing dig, diuretic, ACE inhibitor, beta blocker Watch out for renal insufficiency Watch out for hyperkalemia with ACE inhibitor use Give only if LVEF <35%, Cr <2.5, K < 5 |
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What is a good combination of drugs to start heart failure patients on?
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ACE inhibitor, diuretic combo
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Which drug classes are useless in diastolic failure?
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vasodilators and inotropes
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Etiology of premature atrial complexes?
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Adrenergic excess
Drugs Alcohol Tobacco Electrolyte imbalances Ischemia Infection |
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Management of PACs?
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do not require meds if asymptomatic
Beta blockers if symptomatic |
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Etiology of premature ventricular complexes
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Hypoxia
Electrolyte abnormalities Stimulants Caffeine Medications |
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Management of PVCs?
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do not require meds if asymptomatic
Beta blockers if symptomatic |
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What are ventricular rates in a-fib?
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75-175
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What is holiday heart syndrome?
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a-fib due to excessive alcohol intake
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What other arrythmia does sick sinus rhythm predispose patients to?
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a-fib
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What arrythmia occurs with pheochromocytomia, hypo and hyperthyroid?
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a-fib
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Rate control in a-fib?
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Ca channel blockers are first line
Beta blockers are second line If LV systolic dysfunction consider amiodarone or dig Target rate is 60-100 |
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Cardioversion strategy in acute a-fib?
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Cardiovert only after rate is stabilized
Do within 48 hours Electrical cardioversion first If it fails try with meds: ibulitide, procainimide, flecanaide, sotalol, amiodarone |
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Cardioversion strategy in chronic a-fib?
Anticoagulation INR goal? |
anticoagulate 3 weeks before and 4 weeks afterwards
If cardioversion is to be done before hand do TEE to evaluate for thrombus and then anticoagulate for 4 weeks afterwards keep INR between 2-3 |
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Atrial flutter atrial and ventricular rate?
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250-350 atrial
one half to one third ventricular |
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Most common etiologies for atrial flutter?
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COPD
Heart Disease - rheumatic heart disease, CAD, CHF ASD |
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How should atrial flutter be treated?
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like a-fib
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Etiology of multifocal atrial tachycardia?
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Usually COPD
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Diagnosis of multifocal atrial tachycardia?
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3 different p waves needed
Vagal maneuvers or adenosine to show AV block without disrupting tachycardia |
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Treatment of multifocal atrial tachycardia?
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O2, improved ventillation
if LV function is preserved --> ca channel blockers, beta blockers, digoxin, amiodarone, IV flecanide, IV propafenone If LV function is not preserved --> digoxin Don't cardiovert, it doesn't work |
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What is the most common SVT?
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AV nodal reentrant tachycardia
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What is the bookend of a AVNRT and orthodontic AV reentrant tachycardia?
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PACs intiate and terminate AVNRT
PAC, PVC intiate and terminate ordontic AV reentrant tachycardia |
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Etiology of paroxysmal supraventricular tachycardia?
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Ischemic heart disease
Dig toxicity (paroxysmal a-tach with 2:1 block AV nodal reentry Atrial flutter with rapid ventricular response AV reciprocating tachycardia Excessive caffeine, alcohol consumption |
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Treatment of acute paroxysmal supraventricular tachycardia?
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Valsalva maneuver, carotid sinus massage, breath holding, head immersion in cold water
Acute Rx IV adenosine IV verapamil, esmolol, digoxin if preserved left ventricular function DC cardioversion if drugs are not effective, unstable |
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Prevention of paroxysmal supraventricular tachycardia?
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Digoxin is drug of choice
Verapamil, beta blockers Radiofrequency catherter ablation of AV node or accessory tract Only do this if recurrent and symptomatic |
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What is hte direction in which the current flows in an orthodromic WPW?
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anterograde AV conductance, retrograde accessory conductance
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Pharmacological therapy for WPW?
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Avoid AV nodal blocking agents
Use Type IA, IC antiarrhythics |
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Rate of ventricular tachycardia?
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100-250
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Etiology of V-tach?
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CAD with prior MI is most common cause
Active ischemia, hypotension Cardiomyopathies Congenital defects Prolonged QT Drug toxicity |
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Clinical features of Vtach?
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Cannon a waves in neck (secondary to AV dissociation - atrial contraction during ventricular contraction)
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V-tach changes with vagal maneuvers or adenosine?
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No changes. Useful in diagnosis
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Treatment of sustained v-tach?
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if hemodynamically stable, mild symptoms and systolic BP > 90 --> IV amiodarone, IV procainamide, IV sotalol
Hemodynamically unstable, symptoms --> immediate cardioversion, IV amiodarone ICD placement unless EF is normal (--> amiodarone) |
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Treatment of nonsustained v-tach?
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If no underlying heart disease and asymptomatic --> no treatment
If underlying heart disease, recent MI, LV dysfunction, symptoms --> EP study If inducible, sustained VT --> ICD placement Pahrm is second line treatment --> Amiodarone |
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What is good for v-fib prophylaxis. In what cases is it considered?
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Non MI associated v-fib recurrs very often
Amiodarone or AICD |
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Etiology of v-fib?
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ischemic heart disease
Antiarrhythmics a-fib in WPW |
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Treatment of v-fib?
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Immediate defibrillation and CPR
3 sequential shocks, assess rhythm between each Epinephrine 1 mg and then every 3-5 minutes refractory v-fib amiodarone followed by shock lidocaine, bretylium, magnesium, procainamide continue IV antiarrhythmic after successful cardioversion Implant defibrillator if continued risk |