Cardiology review

• Staph aureus is the most common
• Tricuspid valve involvement (right-sided) more common than aortic
• Holosystolic murmur increases with inspiration = tricuspid involvement
• septic pulmonary emboli
• Heart failure more common in aortic valve involvement

• Cardiac: hypertension, acute ischemia, heart failure, myopericardial inflammation, valve disease, surgery
• Pulmonary: acute lung disease (pneumonia), pulmonary emboli, hypoxia
• Metabolic: Catecholamine surges, hyperthyroidism 
• drug-related: alcohol, cocaine, amphetamines, theophylline

• physical conditioning
• exaggerated vagal activity
• sick sinus syndrome
• hypoglycemia
• medications (digitalis, beta-blockers, calcium channel blockers

• dizziness, light-headedness, syncope, fatigue, worsened angina
• Tx: intravenous atropine (decreases vagal input)

• carotid pulse dual upstroke
• systolic ejection murmur along left sternal border
• Murmur: increases as preload decreases (valsalva maneuver)

• Risk factors: Marfan syndrome, connective tissue disease, hypertension
• Tearing chest/abdominal pain radiating to the back
• Perfusion deficits (pulse deficit, >20mmHg blood pressure difference between right and left arm; aortic regurgitation murmur)

• Chest X-ray or ECG (for other diagnosis)
• Imaging: TEE, chest CT with contrast, MRI (only if nonemergency)

• ventricular rates as high as 150/min
• Tx: beta blockers or calcium channel blockers (in hemodynamically stable patients)
• digoxin; only in patients with AF due to heart failure (or those who can't tolerate BBs or CCBs)
• cardioversion: only in patients who have had AF of <48hrs, or must receive rate control with 3-4 weeks anticoagulation
• common complication of CABG (40% of patients)
• tx of hemodynamically unstable (hypotension, AMS): immediate cardioversion

• autosomal dominant
• murmur decreases with increased pre-load

• coronary vasospasm
• presentation: variant angina, typically at night; transient ST elevations on ECG
• Risk factors: young females, smokers
• Tx: calcium channel blockers or nitrites

complex ventricular arrhythmias (i.e. reentry, such as vfib

• cortisol: vasoconstriction, insulin resistance, mineralocorticoid activity
• result: high BPs, hyperglycemia, hypokalemia
• proximal muscle weakness, central adiposity, thinning of the skin

weight gain, fatigue, bradycardia, depression, skin and hair changes

• COPD leads to chronic hypoxemia --> vasoconstriction
• pulmonary hypertension --> RV hypertrophy and failure
• Right heart failure: elevated JVP, congestive hepatosplenomegaly, hepatojugular reflux, lower extremity edema

• Congenital: PDA, angiomas, pulmonary AVF, CNS AVF
• Acquired: Trauma, iatrogenic (fem cath), atherosclerosis (aortocaval fistula), cancer
• Complication: increases cardiac output through increased preload
• signs: wide pulse pressure, strong peripheral arterial pulse, systolic flow murmur, tachycardia, flushed extremities
• Dx: doppler ultrasonography

• AVMs or AVFs
• thyrotoxicosis
• Paget disease
• anemia
• thiamine deficiency

• increased intensity of apical impulse
• narrow pulse pressure
• typical systolic murmur

• normal jvp
• dilated lower-extremity veins
• worse with prolonged standing
• pitting edema
• skin discoloration
• dermatitis/eczema
• lipodermatosclerosis
• skin ulceration
• tx: leg elevation, exercise, compression stockings

• paroxysmal nocturnal dyspnea
• DOE
• peripheral edema
• hepatomegaly
• cardiomegaly
• bilateral pleural effusion
• third heart sound

viral myocarditis: coxsackie B virus

• Renal parenchymal disease: elevated Cr, abnormal UA
• Renovascular disease: severe HTN, recurrent flash pulmonary edema or resistant heart failure, abdominal bruit
• Primary aldosteronism: easily provoked hypokalemia, slight hypernatremia, hypertension with adrenal incidentaloma
• Pheochromocytoma: paroxysmal elevated blood pressures with tachycardia, pounding headache, palpitations, hypertension with adrenal incidentaloma
• Cushing's syndrome: central obesity, facial plethora, proximal muscle weakness, abdominal striae, ecchymosis
• Hypothyroidism: fatigue, dry skin, cold intolerance, constipation, weight gain
• Primary hyperparathyroidism: hypercalcemia (polyuria, polydypsia), kidney stones, neuropsychiatric
• COarctation of the aorta: differential hypertension with brachial femoral pulse delay

viridans group streptococci, enterococci, and coagulase-negative staph (staph epidermidis)

• highly specific for pericardial effusion
• can also see low voltages

• infection: viral (most common), bacterial
• Iatrogenic: surgery, trauma, radiation & drug-related
• Connective tissue disease: RA, SLE
• Cardiac: Dressler's syndrome (post-myocardial pericarditis), usually 1-6 wks after MI
• Uremic: serum BUN >60mg/dL
• Malignancy: cancer or treatemnt

• inhibit HMG-CoA reductase, rate limiting enzyme in the intracellular biosynthesis of cholesterol 
• reduces serum LDL with minimal change in liver LDL
• myalgias: 2-10% of patients, symmetric proximal muscle weakness or tenderness

• asymptomatic, or chest, back, flank, or abodminal pain
• 60% are ascending aorta aneurysms
• Ascending aortic aneurysms: associated with cystic medial necrosis or connective tissue disorders (Marfan, Ehlers-Danlos syndrome)
• Descending: 40%, arise distal to the left subclavian artery. risk factors include hypertension, hypercholesterolemia, smoking

renovascular hypertension

• elevated Cr >30% baseline after starting ACE inhibitor or ARB
• Severe hypertension in pts with recurrent flash pulmonary edema
• diffuse atherosclerosis
• severe onset after age 55
• asymmetric kidney size
• abdominal bruit

• chronic protozoal disease caused by trypanosoma cruzi
• megacolon/megaesophagus: destruction of the nerves controlling the GI smooth muscle
• cardiac disease: prolonged myocarditis

• arrhythmia: Atrial tachycardia with AV block
• slower atrial rate than atrial flutter (150-250)
• increases vagal tone, decrease conduction through AV node = potentially causing AV block

• venodilatory effect
• blood pools in the systemic venous circulation, decreasing the preload and left ventricular volume (decreases work of heart)
• also cause some arterial vasodilation

• class IB anti-arrhythmic drug
• use: ventricular arrhythmias (v-tach)
• decreases frequency of VPBs, but increases mortality in patients with acute MI
• asystole, therefore not used prophylactically in patients with ACS

• Class IC antiarrhythmic: blocks sodium channels
• elongates the period of depolarization
• use: ventricular arrhythmias, SVTs (such as a-fib)
• increases the QRS complex duration

• decreased tolerance to glucose
• increase LDL cholesterol
• Increase plasma triglycerides
• increase risk of acute gout arthritis (uric acid retention)
• hyponatremia
• hypokalemia
• hypercalcemia

• elevated JVP with hepatojugular reflux
• kussmaul's sign: lack of decrease or an increase in JVP on ispiration
• pericardial knock
• pericardial calcifications on chest radiograph

• >10mmHg fall in systolic pressure during inspiration
• Ddx: cardiac tamponade, asthma, COPD

• sx: 15-25% report syncope, chest pain on exertion
• inheritance: autosomal dominant
• murmur: systolic, left sternal border; worsens with maneuvers that decrease preload
• complication: diastolic heart failure
• Tx: beta blockers, CCB if patient cannot tolerate beta blocker

• AV dissociation, Fusion/capture beats: Ventricular tachycardia
• -stable: IV amiodarone

• No AV dissociation: SVT with aberrancy
• -Stable: Maneuvers to determine rhythm (carotid massage, rate control)

• Unstable: hypotension, AMS, respiratory distress
• - synchronized cardioversion

• occurs 6 to 48 hours post MI
• tx in stable: antiarrhythmics (amiodarone, lidocaine, procainamide)