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Step 2 Cardio
Rapid Review First Aid
| Question | Answer |
|---|---|
| Prolonged QT + syncope + sensorineural deafness | Jervell and Lange-Nielsen syndrome |
| Murmur - hypertrophic obstructive cardiomyopathy | Systolic ejection murmur heard along lateral sternal border the ↑ with ↓ preload (Valsalva maneuver) |
| Murmur - Aortic insufficiency | Austin Flint murmur, a diastolic, decrescendo, low-pitched blowing murmur that is best heard sitting up; ↑ with ↑ afterload (handgrip maneuver) |
| What maneuver is known to ↑↑ afterload? | Handgrip |
| Known maneuver to cause a ↓ in preload | Valsalva maneuver |
| Murmur - Aortic stenosis | Systolic crescendo-decrescendo murmur radiates to neck; ↑ with ↑ preload (squatting maneuver) |
| What maneuver is known to cause an ↑ in preload? | Squatting |
| Murmur- mitral regurgitation | Holosystolic murmur that radiates to axilla ↑ with ↑ afterload |
| Murmur - mitral stenosis | Diastolic, mid to late, low-pitched murmur preceded by an opening snap |
| Which murmur is known to have an "opening snap"? | Mitral stenosis |
| Classic ECG findings in A-Flutter | "Sawtooth" P waves |
| Drugs that slow heart rate | ß-blockers, Calcium channel blockers, digoxin, and amiodarone |
| Treatment for AFIB and AFFLUTER | If unstable --> cardiovert If stable or chronic --> rate control w/ CCBs or ß-blockers Anticoagulation may be indicated for stroke prevention |
| Treatment for V-FIB | Initiate CPR and immediate defibrillation |
| Shor PR-interval and slurred upstroke of QRS. What antiarrhythmics are contraindicated? | AV nodal blockers (can cause preferential conduction down accessory pathway and unstable arrhythmias) |
| MCC of cardioembolic stroke | A-FIB |
| Management of symptomatic bradycardia | Initially atropine, temporary pacing if refractory to medication |
| Only medications that reduce mortality in HF with preserved EF | Empagliflozin and Dapagliflozin |
| Medication that provides mortality benefit in HF with reduced EF | ACE inhibitors/ARBs, ARNIs, ß-blockers, spironolactone, Hydralazine + isosorbide nitrate (in Black patients) |
| Diagnostic test for hypertrophic cardiomyopathy | Echocardiogram (showing a thickened LV wall and outflow obstruction) |
| Young patient with family HX of sudden death collapses and dies while exercising | Hypertrophic cardiomyopathy |
| Young patient with angina at rest and ST-segment elevation with normal cardiac enzymes | Prinzmetal angina |
| Definition of unstable angina | Angina that is new or worsening with no ↑ in troponin level |
| 50-year-old man with stable angina can exercise to 85% of maximum predicted heart rate. What is the most appropriate diagnostic test? | Exercise stress treadmill with ECG |
| 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina. What is the most appropiate diagnostic test? | Pharmacologic stress test (e.g., dobutamine echo) |
| Sigs of active ischemia during stress test | Angina, ST-segment changes on ECG, or ↓BP |
| ECG findings suggesting MI | ST-segment elevation or depression, flattened T waves, and Q waves |
| Coronary territories in MI | Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD/Diagonal) |
| Common symptoms associated with silent MI | CHF, shock, AMS, unexplained fatigue, heartburn, SOB, discomfort in the neck or jaw, and indigestion |
| Treatment for acute coronary syndrome | ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitroglycerin, IV ß-blockers |
| Dressler syndrome | Autoimmune reaction with fever, pericarditis, and ↑ ESR occurring 2-4 weeks post-MI |
| Hypercholesterolemia treatment that leads to flushing and pruritus | Niacin |
| Metabolic syndrome | Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states |
| Antihypertensive for a diabetic patient with proteinuria | ACE inhibitor/ARB |
| Eight surgically correctable causes of HTN | RAS, coartation of the aorta, pheochromocytoma, Conn syndrome, Cushing syndrome, unilateral renal parenchymal disease, hyperthyroidism, and hyperparathyroidism |
| Beck triad for cardiac tamponade | Hypotension, distant heart sounds, and JVD |
| Pulsus paradoxus | In systolic BP of > 10 mm Hg with inspiration; seen in cardiac tamponade |
| Classic ECG in pericarditis | Low-voltage, diffuse ST-segment elevation |
| Water bottle-shaped heart | Pericardial effusion; look for pulsus paradoxus |
| Endocarditis prophylaxis regimens | Oral surgery- amoxicillin for certain situations GI or GU procedures - not recommended |
| Prolonged PR interval in infective endocarditis suggests | Possible aortic root abscess |
| Classic physical findings for endocarditis | Fever, heart murmur, Osler nodes, splinter hemorrhages, Janeway lesions, Roth spots |
| Duke criteria for endocarditis | Major: Positive blood cultures, new murmur, positive echocardiogram Minor: Risk factors, >38C, vascular or immunologic phenomena, echocardiogram, or culture evidence that does not meet major criteria |
| Patient develops endocarditis 3 weeks after receiving a prosthetic heart valve. What organism is suspected? | S aureus or S epidermidis |
| Patient develops endocarditis in a native valve after having dental cleaning | S viridans |
| IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment? | Tret existing HF, and replace the tricuspid valve |
| Evaluation of a pulsative abdominal mass and bruit | Abdominal U/S and CT (concer for AAA) |
| Indications for surgical correction of AAA | >5.5 cm, rapidly enlarging, symptomatic, or ruptured |
| Syncope with arm exercise | Subclavian Steal syndrome |
| Protamine | Reverses the effects of heparin |
| Prothrombin time | The coagulation parameter affected by Warfarin |
| Virchow triad | Stasis, hypercoagulability, endothelial damage |
| Syncope after wearing a tie | Carotid sinus syndrome |
| Figure 3 sign on CXR | Aortic coartation |
| Diagnostic test for pulmonary embolism | CT angiogram |
Created by:
rakomi
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