Cardio Word Association Board Review

Question Answer
DOE, PND, edema.  Echo w/ LVH or RVH, hypokinesis CHF
S3 CHF, dilagted cardiomyopathy
High output heart failure Pregnancy, thyrotoxicosis, anemia, beriberi, paget’s disease
Low output heart failure Ischemic heart disease, HTN, dilated CM, valve disease, arrhythmia
Heart failure after URI                    Myocarditis
Young athlete with syncope during athletic event or practice.  No physical exam abnormalities Hypertrophic CM or fatal arrhythmia.  Get EKG or Echo
Alcoholic with DOE, heart failure Primary dilated CM
Alcoholic with palpitations, arrhythmia Atrial fibrillation (Holiday heart)
Irregular irregular Atrial fibrillation; (if > 48 or chronic – anticoagulate)
Atrial fibrillation or prosthetic valve Warfarin (2 – 3 for Afib; 2.5 – 3.5 for valve);  Tx Warfarin OD is vitamin K
Hx angina but no acute sx.  EKG no acute changes. Do Exercise stress test
Crushing CP, dyspnea, palpitations, radiation to neck or left arm Angina (if lasts minutes), AMI if lasts > 30 minutes.  Acute Ischemia – ST elevation;  Injury – T wave depression;  Infarct – Q wave
Constant, sharp CP worse lying down, better sitting up and leaning forward Pericarditis
pulsus paradoxus Pericardial effusion/tamponade, pericarditis, asthma attack, tension PTX, SVC obstruction
Electrical alternans, narrow pulse pressure, pulsus paradoxus Pericardial effusion/tamponade
JVD, Hypotension, muffled heart sounds Pericardial effusion/tamponade (Beck’s triad)
Pericarditis post open heart surgery Dressler’s syndrome.  Tx w/ ASA
Sudden onset ripping, tearing chest pain, diminished pulses Aortic dissection
Flank pain, hypotension, pulsatile abdominal mass AAA
EKG changes, N, V, yellow-green visual disturbances Digoxin toxicity (Hypokalemia will make worse)
Hx CHF on diuretic & digoxin Suspect dig toxicity (hypokalemia from diuretic = dig toxicity)
Grossly elevated blood pressure esp. w/ signs of EOD Malignant or Urgent HTN
HTN Tx w/ meds, cough          or angioedema           ACEI is cause
DM & HTN                                       ACEI is best choice
Heart failure, LVH ACEI (improves survival, prevents development of heart failure Sx)
Post MI Beta-blockers
Tx of HTN w/ alpha-blocker SE is postural Hypotension
HTN not responsive to basic meds Think secondary HTN most likely Renal artery stenosis (infrarenal artery). 
Mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis Bacterial endocarditis (strep. Viridians) prevention
IVDA w/ new murmur Bacterial endocarditis (strep. Viridians)
Elderly w/ systolic murmur Aortic stenosis (due to calcifications – age related  (or bicuspid valve – congenital)
Diamond shaped, blowing systolic murmur.  May have angina, syncope, CHF Aortic stenosis
Lateral displaced PMI, Canon “a” waves, Quincke’s pulse, Corrigan’s pulse, Austin flint murmur, deMusset’s sign, water Aortic Regurgitation/Insufficiency:  Quincke’s pulse (subungual capillar pulsation), Corrigan (rapid rise and fall), Austin filnt (low pitch middiastolic murmur at apex)
Diastolic murmur best heart at apex without radiation Mitral stenosis (ARMS are BAD)
Systolic ejection murmur heard best at base with radiation to left clavicle Pulmonary stenosis
Female or Post MI, systolic murmur best @ apex preceded by click without radiation Mitral valve prolapse
Systolic murmur heard best at apex with radiation to left axilla (apical systolic) Mitral regurgitation
New murmur after MI (esp. if apical systolic) Mitral regurgitation (caused by papillary muscle rupture)
Murmur & Hx rheumatic heart disease Mitral stenosis
Continuous harsh, machine-like murmur PDA
Cyanotic infant with systolic thrill @ LSB, systolic ejection murmur +/- click Tetralogy of falot
Holosystolic murmur @ LSB, may have ventricular hypertrophy VSD
Infant w/ dyspnea, difficulty feeding.  Holosystolic murmur @ LSB, 3rd ICS.  LVH & RVH VSD
Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching Coarctation of aorta
Short PR, wide QRS, Delta wave Wolf-parkinson-white;  avoid Digoxin,
Young female (<30yo), palpitations, long arms & fingers, pectus excavatum, ectopic lentis, flexible joints Marfan’s Syndrome – MVP, Aortic regurgitation, Aortic dissection, Aortic root dilatation, ectopic lentis
LE rubor, no hair, brittle nails, pallor on elevation, calf or LE pain esp. with walking short distances relieved with rest or at PM Arterial insufficiency/PAD, Intermittent claudication (ABI best choice, ateriogram gold standard)
Claudication with rest pain, (ABI < 0.4) Tx is arterial bypass
LE pain after long periods of standing.  Dilated, tortuous, veins Varicose veins. Tx w/ compression stockings
Trendelenberg test of extremities Tests for veinous insufficiency. 
Blue extremities worse w/ cold exposure, improves w/ warming Acrocyanosis

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