Aaron: Cardiology Flashcards
LVEF under 60% is considered normal or abnormal?
Abnormal
Intense aortic stenosis has what characteristic?
Single second heart sound during inspiration
Asymmetric swelling is code for what disease?
DVT most of the time
Acute Decompensated Heart Failure, what drug should be avoided?
Metroprolol
If I have a heart attack and a history of an Upper GI bleed 2/2 H. Pylori, does this disqualify me from getting aspirin?
No, if it has resolved, all good
85% of open-heart surgery cases can have what un-intended consequence?
Constrictive pericarditis, EKG may not show ST elevation in all leads
Sine wave pattern, after receiving chemotherapy can cause what?
Arrythmia 2/2 hyperkalemia
Persistent Multifocal Atrial Tachycardia usually occurs why?
How many P wave Morphologies are needed to make this diagnosis?
Underlying disease such as Electrolytes and Pulmonary Disease
3 p-wave morphologies
Sudden death upon exercise in young adults, most likely is what underlying problem?
Anomalous Coronary Artery
What is the worse risk factor in an aging individual via Coronary Artery Disease?
Diabetes Mellitus
Bicuspid Aortic Valve disease in an asymptomatic young adult, what is the next best step?
Screen First Degree Relatives
All new unexplained heart failure patients get what test?
Treadmill Stress Test
Young male with unexplained foot pain, sudden blood clot in leg, apical diastolic murmur, what is the most likely cause?
Left Atrial Myxoma
What age do men have secondary hypertension 2/2 renal stenosis?
60-65 years old
What is the underlying cause of secondary hypertension in a 28 year old male?
Renal Parenchymal Disease
Can Mechanical Valve patients be switched from warfarin to DOAC instead?
No, studies do not show that a DOAC is as safe as Warfarin
Regardless of PAD feelings, what is the first medication addition regardless of the lab status?
Cholesterol medication
In the PAD algorithm, where is Cilastozol?
After statin/aspirin addition, supervised exercise program
Cannot jump right to this despite what might be thought
Will heart function return after Trastuzumab is removed?
Yes
Chest pain, but no ST elevations, some ST inversions, what is the best treatment?
Medical Management, no Cath Lab right away
Medication for Heart Failure stage 1 is ACE, Beta Blocker, Diuretics. What is the next drug to add in stage 2?
Spironolactone
Help improve mortality
Must be careful with K, dont give with a K over 5 or CKD and elevated K
Post STEMI Pericarditis, what is the first drug to be given?
Aspirin, no naproxen and colchicine (other NSAIDs besides Aspirin do not help with heart healing)
With Pericarditis, will ST elevation and PR depression in all leads always be there? Even with a friction rub?
NO!!!!!!!!!!!!!!!!!!!!!!!!!!!!
62 year old female with chest pain, negative stress test means what?
Less than a 1% chance of CV problems in the next year
A-fib with RVR, what is the DOC?
Metoprolol or Verapamil (non-dihydropyridine Calcium channel blocker)
Young female recent cocaine use, left arm pain, negative EKG, negative CT scan, BP 130/80, left arm and leg weakness, what should I think about?
Aortic Dissection
If a young male has crazy high BP, no real past medical history, what is the next best step?
Start medications, do not go hunting for Conn syndrome or anything
If a young male has crazy high BP, no real past medical history, what is the best drug combination to place him on?
Calcium Channel Blocker and ACE inhibitor
P.S. check his lipids
Recent car accident and family drama (1 day ago), chest pain, ST elevation, clean coronary Cath, what should I think about?
Takasobu Cardiomyopathy, left LV wall hypokinesis
What type of pain does an aortic dissection present with?
Tearing chest pain versus heart attack is pressure pain
Sudden Cardiac Death family history Sustained Ventricular Arrythmia Syncope 2/2 Ventricular Arrythmia LV Hypertrophy with wall thickness > 30mm LV EF < 50%
These are all indications of what?
A young individual receiving an ICD
Do you or do you not shock in PEA or asystole?
You DO NOT shock in PEA or asystole
Patient presents with Loud S1, Loud P2 Broad and Notched P wave (P-Mitrale) Mid Diastolic Rumble Dyspnea Hemoptysis
Rheumatic Heart Disease
Mitral Stenosis
Post Coronary Cath, the groin has the following, what could they be?
May or May not have a mass, no bruit?
Bulging, pulsatile mass and systolic Bruit?
No Mass, continuous Bruit?
Hematoma
Pseudoaneurysm
AV Fistula
A young woman with unexplained pulmonary hypertension, what is a strong lifestyle suggestion?
No pregnancy at this time and regular supervised aerobic activity
___________ drug inhibits digoxin tubular secretion.
Verapamil
True or False, isolated V1 T-wave inversions are normal
True
What age bracket is an S3 normal under?
40 years old
What is a second DOC in HOCM management after beta blockers?
Verapamil
Warfarin goal for Aortic Valve Replacement?
Warfarin goal for Mitral Valve Replacement?
INR 2.0-3.0
INR 2.5-3.5
Most effective way to decrease blood pressure is?
Lose weight
Best way to control CHF exacerbation blood pressure?
Why not Metoprolol?
Nitroglycerin, hit veins, decreases venous preload
If the heart is slow in this CHF episodes, a beta blocker will slow the heart down further, and the pulmonary edema can get worse
What is the best drug for an Aortic Dissection?
Beta Blocker (Esmolol)
S3 heart sound means what?
Blood fills an enlarged ventricles
S4 heart sound means what?
Stiff ventricular wall
If I am taking rivaroxaban, and I need surgery, should I stop it?
Yes, stop two days before surgery, no need to heparin bridge
Quick physical exam feature difference between Marfan’s Syndrome and Ehler’s Danlos Syndrome?
Ehler’s Danlos has skin manifestations, Marfan’s does not
If a young, 38-year-old male comes in with sudden heart failure, what is something to think about?
Autoimmune disease, Marfan’s Disease, Ehler’s Danlos, MVP, collagen problems
A young female, hx of Rheumatic fever, comes with SOB, MS, what is the first thing to rule out?
Pregnancy, can exacerbate MS/heart problems with extra fluid on board
Papillary Muscle ruptures, usually think what?
Chordiae Tendonaie, usually in young people, rupture think what?
Recent MI
Collagen problem, Marfan’s or Ehler’s Danlos Syndrome
If I have a heart problem and history of bilateral inguinal hernias (16 years old), what is something to think about?
Marfan’s or Ehler’s Danlos Syndrome
Bicuspid Aortic Valve, what is a commonly associated disease, as well?
Thoracic Aortic Aneurysm
Young male, crescendo decrescendo murmur at heart’s apex, worse with Valsalva, what am I?
HOCM
Heart Failure, low EF, but asymptomatic, no medication being taken, what drug should be started?
ACE inhibitor and eventually beta blocker
Post Heart Attack, how long does a low-risk patient have to wait to resume sexual activity?
3-4 weeks
When I give diuretics to a patient, besides getting rid of fluid, I am doing what to the heart?
Decreasing Pre-load
When I have a CHF problem, do I give Beta Blockers?
No, the goal is not to slow the heart down, the goal is to relieve fluid the heart has to move, i.e. give diuretics not beta blockers
Maybe heart attack, no ST elevations, how long does it take for a troponin to be positive?
When is the peak?
2-3 hours
12-48 hours is the peak
Heart attack
CK-MB takes how long to elevate?
How long to normalize?
4-6 hours
48-72 hours
BNP is broken down by neprilysin, what drug can affect this drug value?
ACE inhibitor, as a result, the patient has bad BNP clearance, not a reliable marker
If there is suspected CHF exacerbation, what are other signs that NEED to be there?
Fluid on lungs Elevated JVD Difficulty breathing Peripheral Swelling S3 Orthopnea Orthopnea at night, cannot lay flat
If some combination is not here, look for something else, i.e COPD
Does squatting, supine leg raising increase or decrease venous return?
Increase venous return
Does standing or Valsalva increase or decrease venous return?
Decrease venous return
Crescendo descrendo murmur in systole is code for what?
Aortic Stenosis
MVP is an ejection or non ejection murmur?
Non-ejection murmur
Do MVP/HOCM murmurs increase or decrease with increased venous return?
Do AS/AR/MS/MR murmurs increase or decrease with increased venous return?
decrease* (these are the exceptions)
increase
Atenolol is cleared by the liver or the kidney?
What disease could cause Beta blocker toxicity?
Kidney
CKD can cause problems
Calcium gluconate can treat what kind of toxicity?
Verapamil toxicity
