8/27- Cardio Review 4 Flashcards
The most specific abnormality in the R atrial P waveform in constrictive pericarditis is:
A. Large a wave
B. Large c wave
C. Large v wave
D. Steep x descent
E. Steep y descent
The most specific abnormality in the R atrial P waveform in constrictive pericarditis is:
A. Large a wave
B. Large c wave
C. Large v wave
D. Steep x descent
E. Steep y descent
- Y descent represent rapid atrial emptying/rapid early ventricle filling
- In constrictive pericarditis, the Y descent is rapid/steep (enhanced early filling until it hits pericardial restriction)
- Steep X descent exists, but is not specific
What is the classic W sign in the atrial waveform? Dx?
- Steep X and steep Y descent
- Pt may have constrictive pericarditis
Cardiac tamponade is characterized by:
A. Steep x descent
B. Steep y descent
C. Dip and plateau
D. Pulsus paradoxus
E. A and D
Cardiac tamponade is characterized by:
A. Steep x descent
B. Steep y descent
C. Dip and plateau
D. Pulsus paradoxus
E. A and D
All of the following are common physical findings in constrictive pericarditis except:
A. Kussmaul sign
B. Pulsus paradoxus
C. Steep x and y descent
D. Pericardial knock
All of the following are common physical findings in constrictive pericarditis except:
A. Kussmaul sign
B. Pulsus paradoxus
C. Steep x and y descent
D. Pericardial knock
The following are signs and symptoms of left heart failure except:
A. Dypsnea on exertion
B. Orthopnea
C. Ankle edema
D. Ventricular gallop
E. Inspiratory lung rales
The following are signs and symptoms of left heart failure except:
A. Dypsnea on exertion
B. Orthopnea
C. Ankle edema
D. Ventricular gallop
E. Inspiratory lung rales
A classical finding in patients with decompensated CHF with volume overload is:
A. Atrial gallop
B. Ventricular gallop
C. Prominent S4
D. Triple apical impulse
E. Bisferians arterial pulse
A classical finding in patients with decompensated CHF with volume overload is:
A. Atrial gallop
B. Ventricular gallop
C. Prominent S4
D. Triple apical impulse
E. Bisferians arterial pulse
S3 gallop:
- Ventricular gallop- low pitched, early diastolic
- Rapid early filling
- Decompensated CHF
- Volume overload
- May occur in normals
S4 gallop
- Atrial gallop- low pitched, late diastolic
- Atrial “kick”
- HTN, AS, IHSS
- Pressure overload
- May occur in normals
All of the following drugs improve survival in heart failure except?
A. ACE inhibitors
B. ARBs
C. Digoxin
D. Aldosterone antagonists
E. Beta blockers
All of the following drugs improve survival in heart failure except?
A. ACE inhibitors
B. ARBs
C. Digoxin
D. Aldosterone antagonists
E. Beta blockers
- Digoxin reduces hospitalizations for CHF but does not improve survival
- ACEI, ARB, and BB and aldosterone antagonists do BOTH (drugs that make it easier for ventricle to eject blood)
Would you recommend ACEi, ARB, BBs, or aldosterone antagonists for a HTN patient who has CHF?
A. Yes
B. No
Yes!
Non-DHP CCB can result in all of the following effects except:
A. Lower BP
B. Reduce heart rate
C. Atrioventricular block
D. Reduce contractility
E. Improve survival in heart failure
Non-DHP CCB can result in all of the following effects except:
A. Lower BP
B. Reduce heart rate
C. Atrioventricular block
D. Reduce contractility
E. Improve survival in heart failure
- Among classes of drugs for CHF: need ACEI and/or B blocker
- None of the CCBs are preferred treatment for CHF
- Non-dihydropyridine are a particularly bad choice because they can reduce contractility
What drugs are included in the classification of Non-DHP CCBs?
- Verapamil
- Diltiazem
T/F: CCBs do NOT improve survival in CHF
True
What are the main ASEs of CCBs (Non-DHP?)?
- AV block
- Reduced contractility
- Reduced heart rate
All of the following maneuvers increase the systolic murmur of IHSS except?
A. Standing up
B. Squatting
C. Sitting up
D. Valsalva
All of the following maneuvers increase the systolic murmur of IHSS except?
A. Standing up
B. Squatting
C. Sitting up
D. Valsalva
- Squatting INCREASES venous return
The most common cause of out-of-hospital cardiac arrest is:
A. Primary ventricular fibrillation
B. Secondary ventricular fibrillation
C. Asystole
D. Sinus bradycardia
E. Torsades-de-Pointes
The most common cause of out-of-hospital cardiac arrest is:
A. Primary ventricular fibrillation
B. Secondary ventricular fibrillation
C. Asystole
D. Sinus bradycardia
E. Torsades-de-Pointes
- Recall: Primary is not associated with MI
The most common valvular heart disease presenting with sudden cardiac death is:
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
E. Pulmonary stenosis
The most common valvular heart disease presenting with sudden cardiac death is:
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
E. Pulmonary stenosis
- SCD due to arrhythmia due to severe concentric LVH they have
The most common potentially curable cause of 2’ HTN is
A. Pheochromocytoma
B. Hyperaldosteronism
C. Coarctation of the aorta
D. Renal artery stenosis
E. Renal parenchymal disease
The most common potentially curable cause of 2’ HTN is
A. Pheochromocytoma
B. Hyperaldosteronism
C. Coarctation of the aorta
D. Renal artery stenosis
E. Renal parenchymal disease
Do you expect BP to become NORMAL in a 72 yo man who undergoes stenting of the right renal artery?
A. Yes
B. No
Do you expect BP to become NORMAL in a 72 yo man who undergoes stenting of the right renal artery?
A. Yes
B. No
Do you expect BP to become NORMAL in a 17 yo woman who undergoes stenting of the right renal artery?
A. Yes
B. No
Do you expect BP to become NORMAL in a 17 yo woman who undergoes stenting of the right renal artery?
A. Yes
B. No
What is the pathologic cause of renal artery stenosis commonly presenting in younger women?
A. Fibromuscular dysplasia
B. Atherosclerosis
C. Arteriosclerosis
D. Vasculitis
What is the pathologic cause of renal artery stenosis commonly presenting in younger women?
A. Fibromuscular dysplasia
B. Atherosclerosis
C. Arteriosclerosis
D. Vasculitis
- Renal a stensosi due to FMD in younger women is amenable to stenting with a high success rate in lowering BP
- If someone’s BP has been elevated for only a short time, the BP is almost entirely ascribed to that renal a stenosis and can be fixed; if long-standing HTN, renal stenosis may just be a contributing factor
The most important first step in the appraoch to a pt referred to you with a single “high BP measurement” is:
A. Confirm diagnosis of HTN
B. Reduce dietary salt and fat intake
C. Start pharmacologic therapy
D. Advise regular exercise
E. Evaluation for cardiac complications
The most important first step in the appraoch to a pt referred to you with a single “high BP measurement” is:
A. Confirm diagnosis of HTN
B. Reduce dietary salt and fat intake
C. Start pharmacologic therapy
D. Advise regular exercise
E. Evaluation for cardiac complications
A 45 yo asymptomatic woman is referred to you with a BP of 220/140; you should first:
A. Evaluate for end-organ damage
B. Start nifedipine 10 mg now
C. Admit to the hospital right away
D. Confirm diagnosis of HTN
E. Reduce dietary salt for 3-6 mo
This is in the range for hypertensive crisis!
A 45 yo asymptomatic woman is referred to you with a BP of 220/140; you should first:
A. Evaluate for end-organ damage
B. Start nifedipine 10 mg now
C. Admit to the hospital right away
D. Confirm diagnosis of HTN
E. Reduce dietary salt for 3-6 mo
MUST admit in HTN emergencies for:
- HTN encephalopathy
- Retinal hemorrhages or papilledema
- Acute pulmonary edema
- Acute MI
- Acute aortic dissection
- Acute ischemic or hemorrhagic stroke
Since asymptomatic, would want to do blood test and fundi exam
What is the range for hypertensive crisis?
BP > 220/120
Which of the following drugs decrease(s) the risk of sudden cardiac death in acute MI?
A. Aspirin
B. Heparin
C. Platelet GpIIb/IIIa inhibitors
D. Beta adrenergic blockers
E. Nitroglycerin
Which of the following drugs decrease(s) the risk of sudden cardiac death in acute MI?
A. Aspirin
B. Heparin
C. Platelet GpIIb/IIIa inhibitors
D. Beta adrenergic blockers
E. Nitroglycerin
- SCD is typically arrhythmia; want something that decreases risk of an arrhythmia
What increase in BP is associated with 2x greater risk of —-?
20 mmHg increase -> 2x risk
KNOW THIS
What is the sequence o fevents in atherosclerosis?
- Endothelial injury
- Monocyte adhesion (to endothelial lining)
- Monocyte migration
- Smooth muscle cell proliferation and migration
Endothelial cells -> monocytes -> smooth muscle cells
KNOW THIS SEQUENCE
The risk of recurrent SCD is highest in which of the following?
A. Primary Vfib
B. Secondary Vfib
C. Non-sustained ventricular tachycardia
D. Accelerated indioventricular arrhythmia (AIVR)
E. Asystole
The risk of recurrent SCD is highest in which of the following?
A. Primary Vfib
B. Secondary Vfib
C. Non-sustained ventricular tachycardia
D. Accelerated indioventricular arrhythmia (AIVR)
E. Asystole
- Why primary Vfib pt typically gets AICD
- Sustained VT = VT that lasts at least 30s (this is an indication for AICD as well)
- AIVR i s very benign; unlike VT, it’s rate is < 110/min
Acute ST elevation myocardial infarction is due to:
A. Progressive atherosclerotic coronary arterial narrowing
B. Vasospasm over a tight atherosclerotic lesion
C. Occlusive platelet aggregates
D. Plaque rupture triggering clot formation
Acute ST elevation myocardial infarction is due to:
A. Progressive atherosclerotic coronary arterial narrowing
B. Vasospasm over a tight atherosclerotic lesion
C. Occlusive platelet aggregates
D. Plaque rupture triggering clot formation
- A massive STEMI may be compciated by acute decompensated Left heart failure with volume overload…..
CABG improves survival in all the following except:
A. 3 vessel CAD and EF < 50%
B. 95% stenosis of proximal LAD & RCA
C. Left main artery 70% narrowing
D. 70% RCA & EF > 65%
CABG improves survival in all the following except:
A. 3 vessel CAD and EF < 50%
B. 95% stenosis of proximal LAD & RCA
C. Left main artery 70% narrowing
D. 70% RCA & EF > 65%
CABG is preferred in
- 3 vessel CAD
- 2 vessel CAD with decreased EF
- 2 vessel CAD with proximal LAD
- Left main CAD
What is left main disease?
> 50% diameter stenosis in left main artery
- This is just 1 vessel disease
For which types of CAD do we typically intervene with surgery?
- 3 vessel disease
- Proximal LAD
- Left main disease
Hibernating myocardium is characterized by:
A. Chronic myocardial ischemia due to CAD
B. Depressed LVEF
C. Improvement in LVEF after CABG surgery
D. Decrease in the myocardial metabolism in response to chronic myocardial ischemia
E. All of the above
Hibernating myocardium is characterized by:
A. Chronic myocardial ischemia due to CAD
B. Depressed LVEF
C. Improvement in LVEF after CABG surgery
D. Decrease in the myocardial metabolism in response to chronic myocardial ischemia
E. All of the above
Are you aware of medications that decrease LDL lipid levels and improve survival of pts with CAD? Which of the following are they?
A. ACEIs
B. ARBs
C. Niacins
D. Statins
Are you aware of medications that decrease LDL lipid levels and improve survival of pts with CAD? Which of the following are they?
A. ACEIs
B. ARBs
C. Niacins
D. Statins
For any CAD manifestations, CAD, DM, anything… what is the goal LDL?
< 70 mg%!!
If no CAD or DM, what is the goal LDL?
Need to count the risk factors…. Idk
The mechanism of action of Class III anti-arrhythmic durgs is :
A. Inhibiting Na current
B. INhibiting Ca current
C. Antagonizing epinephrine/NE
D. K channel antagonists
The mechanism of action of Class III anti-arrhythmic durgs is :
A. Inhibiting Na current
B. INhibiting Ca current
C. Antagonizing epinephrine/NE
D. K channel bockers
All of the following are cardinal clinical manifestations in aortic stenosis except:
A. Syncope during stress
B. Exertional angina
C. Congestive heart failure
D. Dizziness during exercise
E. Peripheral edema or ascites
All of the following are cardinal clinical manifestations in aortic stenosis except:
A. Syncope during stress
B. Exertional angina
C. Congestive heart failure
D. Dizziness during exercise
E. Peripheral edema or ascites
LVEF is supernormal in early chronic MR because of:
A. Increased contractility
B. Decreased afterload
C. Increased preload
D. High sympathetic tone
E. Erroneous EF measurement
LVEF is supernormal in early chronic MR because of:
A. Increased contractility
B. Decreased afterload
C. Increased preload
D. High sympathetic tone
E. Erroneous EF measurement
In chronic MR, LVEF is expected to decrease after valve replacement because:
A. Afterload decreases
B. Afterload increases
C. Preload decreases
D. Preload increases
E. Contractility
In chronic MR, LVEF is expected to decrease after valve replacement because:
A. Afterload decreases
B. Afterload increases
C. Preload decreases
D. Preload increases
E. Contractility
The “new” gold standard and currently most used cardiac marker of acute MI is:
A. CK MB fraction
B. Troponin I or T
C. LDH
D. LDH cardiac specific isozyme 1
E. Renin (produced by the JGA)
The “new” gold standard and currently most used cardiac marker of acute MI is:
A. CK MB fraction
B. Troponin I or T
C. LDH
D. LDH cardiac specific isozyme 1
E. Renin (produced by the JGA)
A 90 yo man presents with left sided heart failure and has crescendo decrescendo systolic heart murmur best heard a the base radiating to the neck. What valvular heart disease does he have?
A. Mitral regurgitation due to MV anular dilatation
B. Mitral stenosis due to rheumatic heart disease
C. Aortic regurgiation due to syphilitic aortitis
D. Aortic stenosis due to senile calcific aortic stenosis
A 90 yo man presents with left sided heart failure and has crescendo decrescendo systolic heart murmur best heard a the base radiating to the neck. What valvular heart disease does he have?
A. Mitral regurgitation due to MV anular dilatation
B. Mitral stenosis due to rheumatic heart disease
C. Aortic regurgiation due to syphilitic aortitis
D. Aortic stenosis due to senile calcific aortic stenosis
A 30 yo woman presents with progressive exertional dyspnea and a hollysstolic heart murmur best heart at the apex radiation to the axialla. Standing worsens the murmur. What valvular heart disease does she have?
A. Mitral regurgitation due to MV prolapse
B. Mitral stenosis due to rheumatic heart disease
C. Aortic regurgitation due to Marfan’s syndrome
D. Aortic stenosis due to bicuspid aortic valve
A 30 yo woman presents with progressive exertional dyspnea and a hollysstolic heart murmur best heart at the apex radiation to the axialla. Standing worsens the murmur. What valvular heart disease does she have?
A. Mitral regurgitation due to MV prolapse
B. Mitral stenosis due to rheumatic heart disease
C. Aortic regurgitation due to Marfan’s syndrome
D. Aortic stenosis due to bicuspid aortic valve
What is the best anti-HTN treatment regimen for an obese diabetic HTN with stage II HTN
Didn’t get the answers..
D. All of the above
