70 cardio

Question 1

valvular AF vs non valvular? 4

recommend what med for valvular AF?

Answer 1

occurs in the presence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.

non valvular - absence of above

Warfarin

Question 2

risk factors for AF ? 5

Answer 2

age
hypertension, 
myocardial infarction (MI), 
congestive heart failure
valvular heart disease

Question 3

NOAC? eg?

not good for what patients?

Answer 3

Non Vitamin K antagonist - dabigatran, rivaroxaban, apixabandibigatron

valvular AF - need warfarin

Question 4

what does CHADS stand for

Answer 4

Cardiac failure
Hypertension, 
Age,
Diabetes, 
Stroke system

Question 5

drug of choice for rate control of AF?

Answer 5

BB
non D CCB
* pts has to have no hx of MI, or Lt ventricular dysfunction

Question 6

when to consider BB over digoxin

Answer 6

BB better for active pts - improves vagal tone (vagal tone is withdrawn during exercise)
Digoxin for sedentary pts

Question 7

what age to assess for CAD risk

who else at risk? 4

Answer 7

men > 40
women > 50

fam hx
DM
HTN
CKD

Question 8

first-line intervention for CAD risk?

2nd line tx? reduction of how many %?

Answer 8

lifestyle management

statin after discussion and risk factor management- reduce 30%

Question 9

adverse affects of statin? 5

when to follow up with initiation of statin?

Answer 9

muscle pain/myopathy , rhabdomyolysis
cataracts
elevated blood glucose and diabetes
 acute renal failure
and liver injury

4-6 months

Question 10

CHADS?

when to anticoag with Afib?

Answer 10

Congestive Heart Failure 1
Hypertension 1
Age 75+ 1
Diabetes 1
Stroke - prior stroke or TIA 2
total of 6

if 0 no need for anticoag, unless with Afib and with risk factors and >65

> 1 and have Afib, need to start ASA or OralAntiCoag

Question 11

significant of Abnormal nocturnal BP differences? puts pt at risk for what?

Answer 11

– an extreme nocturnal BP dip (>20%), non/small nocturnal BP dip (<10%), or an
increase in nocturnal BP are at risk for CVD;

Question 12

if pt has MI, what meds would you use as first line for BP control?

Answer 12

BB and ACE/ARB

Question 13

Without specific indications, consider which monotherapy with one of the following first-line drugs: 4

Answer 13

• thiazide diuretic;
• long-acting calcium channel blocker (CCB);
• angiotensin converting enzyme inhibitor (ACE-I; in non-black patients); or
• angiotensin II receptor blocker (ARB).

Question 14

when would use BB as first line drug for BP

Answer 14

stable angina and >60years

Question 15

what drugs not recommended together?

Answer 15

ACE and ARBs

non-dihydropyridine CCB
(i.e., verapamil or diltiazem) and a beta-blocker

Question 16

after start of antihypertensive, when to follow up and with what? and for how long?

Answer 16

2 weeks, and with GFR to monitor kidney fx, then monthly til target reached x 2

review q 3-6 months

Monitor kidney function whenever medications are changed

Question 17

secondary cause of htn? 9

Answer 17

Aldosteronism - hypokalemia

hyperparathyroidism

hyper/hypo thyroidism

coarct

oral contraception

Pheochromocytoma - adrenal hormones cause htn

Cushings

Kidney disease

Sleep apnea

Question 18

eg of
BB
Calcium Channel Blocker

Non - DHP

ARBS

Answer 18

BB - lol, metoprolol, bisoprolol
CCB - pines, amlodipine, nifedipine

Non - DHP - verampramil, diltiazam

ARBS - artan - candesartan, losartan

Question 19

when to take bp?

what values to seek immediate tx?

Answer 19

Patients aged ≥ 45 years, record BP at least once every 5 years.

any time diastolic BP is > 130 or BP is > 180/110 with signs or symptoms,

Question 20

When to diagnosis hypertension? 2

Answer 20

, if:
o ambulatory or home BP monitoring indicates an elevated BP; or
o elevated BP at a 3rd office visit.

Question 21

When a consultation with a specialist indicated? 4

Answer 21

Hypertensive emergency;

sudden onset in the elderly; abnormal nocturnal BP differences;

signs or symptoms suggesting of secondary causes of hypertension;

and if BP is difficult to control after treating with 3 antihypertensive medications.

Question 22

what is considered mild HTN?

what does life style change include? 6

Answer 22

Recommended for mild hypertension (average BP = 140-159/90–99), low-risk for CVD and have no co-morbidities.

• It includes: 1 smoking cessation, 2 increasing physical activity, 3 obtaining or maintaining a healthy body composition, 4 eating a well-balanced diet, 5 moderate alcohol consumption and 6 monitoring salt intake.

Question 23

what is a major risk factor in women to have early onset of ischemic heart disease?

Answer 23

DM

Question 24

questions to ask anyone who has angina like pain? 5

Answer 24

pain greater than 20 minutes?
crescendo pattern?
occurs at rest or at night?
severity with activity? new onset?
dyspnea?

Question 25

if pt has ‘chest pain’ and hypotentisve think?

cp and asymmetrical bp?

Answer 25

PE - cause pressure all in the lungs leads to systemic hypo

aortic dissection