ACCSAP Systemic Disorders

Question 1

Which cardiovascular effect of tobacco smoking is most likely to be reduced by replacing cigarettes with smokeless tobacco?
A.     Myocardial infarction.
B.	Heart failure.
C.	Insulin resistance.
D.	Coronary vasoconstriction.
E.	Atrial fibrillation.

Answer 1

AFib. Not seen increased in smokeless tobacco users.

It is thought that nicotine leads to increased MI and HF regardless of route.

It is unclear if coronary vasospasm is different in smokeless or not.

Smoking leads to increased platelet activation, not typically seen in smokeless products.

Question 2

What patient factors increase the risk of ACE-inhibitor induced angioedema?

Answer 2

Female sex, smoking, aspirin use, and especially African descent all increase the risk of this condition.

Classically occurs within first 3 months after initiation. There are no specific lab tests to look for.

Question 3

What is the clinical clue for primary hyperaldosteronism?

Answer 3

Otherwise unexplained or easily provoked hypokalemia, and metabolic alkalosis and hypernatremia are often seen.

PA may be associated with resistant hypertension, defined as failure to achieve goal BP despite adherence to three drugs, including a diuretic

Question 4

What are key points about nicotine replacement and general meds for smoking cessation?

Answer 4

Nicotine patches are safe for acute nicotine withdrawal, even after ACS.

• Buproprion is given 1-2 weeks prior to the quit date to improve the quit rate. It should be avoided in anyone at risk for seizures.
• Varenicline is titrated during the first week and can be started 1-4 weeks prior to the quit date. It is centrally acting, relieves nicotine withdrawal symptoms, and blocks the reward signals from smoking.

Question 5

What is the clinical definition of the metabolic syndrome?

Answer 5

The presence of any three of the following five criteria: abdominal obesity (waist circumference in men ≥102 cm or ≥88 cm in women), elevated triglycerides (>175 mg/dL), low high-density lipoprotein (<40 mg/dL in men or <50 mg/dL in women), elevated BP ≥130/85 mm Hg, and elevated fasting plasma glucose (≥100 mg/dL)

Question 6

What are manifestations of Primary hyperparathyroidism?

Answer 6

may be associated with cardiovascular disease, including hypertension, arrhythmia, ventricular hypertrophy, and vascular and valvular calcification.

Elevated calcium and low-normal phosphorus and low-normal magnesium

Question 7

What are ECG findings of:
Digoxin
Hypercalcemia
Hypomagnesemia

Answer 7

Digoxin administration can present with downsloping ST depression on the ECG. Actual digoxin toxicity is usually associated with brady- and tachyarrhythmias, sometimes in combination with atrioventricular block

Hypercalcemia ECG findings consist primarily of QT shortening.

Hypomagnesemia ECG changes are sometimes seen and consist primarily of QT prolongation.

Question 8

What is the diagnostic evaluation for suspected primary hyperaldosteronism?

Answer 8

The first step is measurement of a morning plasma renin activity (or plasma renin concentration) and the plasma aldosterone concentration. These can be used to calculate the aldosterone/renin ratio (ARR).

The threshold to define an abnormal ARR varies with the assay methods, but an ARR >30 generally suggests PA. If the ARR suggests PA, confirmatory testing is required: oral sodium loading test, saline infusion test, fludrocortisone suppression, or captopril challenge.