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Clin Med II Disease Key Notes > Cardiac (Exam #1) > Flashcards

Cardiac (Exam #1) Flashcards

1
Q

Which diagnostic test is used to detect electrical activity?

A

EKG (electrocardiography)

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2
Q

Which diagnostic test is used to evaluate acute chest pain or acute palpitations?

A

EKG (electrocardiography)

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3
Q

What is continuous EKG monitoring in an inpatient setting?

A

Telemetry

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4
Q

What is the primary/preferred biomarker of cardiac injury (lab test), and when is it used?

A

Troponin

- Diagnose/prognose acute MI

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5
Q

Besides Troponin, what two cardiac enzymes are used to evaluate cardiac injury?

A
  • Creatine Kinase (CK)

- Creatine Kinase Myocardial Band (CK-MB)

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6
Q

Which diagnostic test is the primary modality for evaluation of cardiac anatomy and function?

A

Echocardiography

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7
Q

What is US machine transmits sound pulses into tissue using crystal probe → sounds wave travels and hits tissue → some sound waves reflected back to probe → waves picked up by probe, relayed to machine/2D image made?

A

Echocardiography

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8
Q

Is TTE or TEE Echocardiography preferred?

A

TTE

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9
Q

Which diagnostic test is used to evaluate wall motion during/after MI, calculate EF/systolic function, evaluate valve structure/function?

A

TTE Echocardiography

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10
Q

Which diagnostic test is used to detect clots, valvular pathology (endocarditis), septal defects/patent foramen ovale?

A

TEE Echocardiography

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11
Q

Which diagnostic test measures the heart’s ability to respond to external stress in controlled environment?

A

Cardiac Stress Tests (EKG Stress Test, Nuclear Stress Test, Stress Echocardiogram)

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12
Q

Which diagnostic test is used to evaluate exertional chest pain, CHD with new/worse symptoms, newly diagnosed CHF/cardiomyopathy?

A

Cardiac Stress Tests (EKG Stress Test, Nuclear Stress Test, Stress Echocardiogram)

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13
Q

Which two diagnostic tests have high sensitivity, can localizes ischemia, have more information on cardiac structure/function and are good pre-op evaluation?

A
  • Nuclear Stress Test

- Stress Echocardiogram

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14
Q

Which of the cardiac stress tests prefers exercise stress to pharmacologic stress? Which two use pharmacologic?

A

EKG stress test = exercise

Nuclear Stress Test, Stress Echocardiogram = pharmacologic

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15
Q

Which diagnostic test involves rest EKG → exercise to target HR/symptoms/time limit → EKG/symptoms taken during exercise?

A

EKG stress test

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16
Q

Which diagnostic test involves Technetium-99 administered IV → waiting period to allow radioactive tracer distribution → gamma-ray scan at rest → stress induced via exercise/pharm → target HR/symptoms achieved, and another radiotracer injected IV → second waiting period → second gamma-ray scan obtained → two images compared?

A

Nuclear Stress Test

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17
Q

Which diagnostic test involves TTE at rest → stress induced via exercise/pharm → target HR/symptoms achieved → stress echo images obtained → two images compared?

A

Stress Echocardiogram

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18
Q

Which diagnostic test requires the use of vasodilators (Adenosine, Dipyridamole) or ionotropes (Dobutamine)?

A

Nuclear Stress Test

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19
Q

Which diagnostic test is indicated if abnormal resting EKG, assess areas of myocardial ischemia, determine location/size of injured muscle after MI?

A

Nuclear Stress Test

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20
Q

Which diagnostic test is indicated if known/suspected CAD, evaluate CP, SOB, exertional dyspnea, evaluate valvular abnormalities?

A

Stress Echocardiogram

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21
Q

What medication is preferred when performing a Stress Echocardiogram?

A

Dobutamine

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22
Q

Which diagnostic test involves continuous ambulatory electrocardiography over 1-2 days + symptom diary?

A

Holter Monitor

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23
Q

Which diagnostic test is indicated if DAILY palpitations, syncope?

A

Holter Monitor

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24
Q

Which diagnostic test involves NON-continuous ambulatory electrocardiography over 30-60 days + symptom diary?

A

Event Monitor

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25
Q

Which diagnostic test is indicated if WEEKLY/MONTHLY palpitations, syncope?

A

Event Monitor

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26
Q

Which diagnostic test involves a subcutaneous device that can record up to 3 years?

A

Implantable Cardiac Monitor

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27
Q

Which diagnostic test is indicated if INFREQUENT symptoms (ex. syncope 3x/year); suspected arrhythmia but testing inconclusive?

A

Implantable Cardiac Monitor

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28
Q

Which diagnostic test involves instant portable at-home EKG used PRN?

A

Fingertip Monitor

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29
Q

Which diagnostic test is indicated if symptomatic arrhythmias (A Fib) present?

A

Fingertip Monitor

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30
Q

Which diagnostic test is indicated to detect aortic dissection, stable angina, detect coronary a. calcium deposits as indicator for atherosclerosis, extent of CAD?

A

Cardiac CT Scan (Coronary CT Angiography (CCTA), Coronary CT Calcium Scan)

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31
Q

Which diagnostic involves IV contrast → CT heart to evaluate presence/extent of coronary a. occlusion?

A

Coronary CT Angiography (CCTA)

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32
Q

Which diagnostic test involves assesses for calcium deposits in coronary aa. = evaluates MI risk?

A

Coronary CT Calcium Scan

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33
Q

Which diagnostic test assesses functional and tissue properties of heart; used for complicated/advanced patients after evaluation with first-line testing like echocardiogram?

A

Cardiac MRI

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34
Q

Which diagnostic test is the gold standard for diagnosing CAD?

A

Cardiac Catheterization and Coronary Angiography

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35
Q

Which diagnostic test involves catheter threaded through vessel → contrast dye injected to view coronary a. patency?

A

Cardiac Catheterization and Coronary Angiography

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36
Q

Which diagnostic test is indicated if known/suspected CAD (unstable angina, angina with positive stress test, history of MI with EKG changes, post cardiac arrest)?

A

Cardiac Catheterization and Coronary Angiography

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37
Q

Unhealthy levels of cholesterol are a risk factor for what?

A

Atherosclerosis

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38
Q

Is lipid screening recommended, and if so, at what age(s)?

A

YES (9-11 and 17-21)

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39
Q

What are the borderline ranges for total cholesterol?

A

Borderline: 200-239

  • Good/Healthy: <200
  • High risk: 240+
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40
Q

What are the borderline ranges for TGs?

A

Borderline: 150-159

  • Good/Healthy: <150
  • High risk: 200-499
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41
Q

What are the borderline ranges for HDL?

A

Borderline: 35-45

  • Good/Healthy: 60
  • High risk: <35
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42
Q

What are the borderline ranges for LDL?

A

Borderline: 130-159

  • Good/Healthy: 60-130
  • High risk: 160-189
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43
Q

What can cause falsely low levels of cholesterol/LDL/HDL?

A

Acute coronary syndrome or MI

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44
Q

What are cholesterol-filled, soft, yellow plaques found in various places on body (armpit, chin, eyes, fingers)?

What two types of hypercholesterolemia are they associated with?

A

Plane Xanthomas

  • Familial
  • Secondary causes
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45
Q

What are yellow-orange nodules often on elbows, knees, tendons?

What type of hypercholesterolemia are they associated with?

A

Tuberous Xanthomas

- Familial

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46
Q

What are small red-yellow papules with abrupt onset often on extensor surfaces or buttocks?

What type of hypercholesterolemia are they associated with?

A

Eruptive Xanthomas

- Familial

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47
Q

What are white/grey ring around cornea; can be seen in patients over 40 years WITHOUT high lipids?

A

Corneal Arcus

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48
Q

Which three hypercholesterolemia medications are used ONLY to lower LDL?

A
  • Statins (HMG-CoA Reductase Inhibitors)
  • Resins (Bile Acid Sequestrants)
  • PCSK9 Inhibitors
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49
Q

Which hypercholesterolemia medication is best used in those with elevated TGs?

A

Fibric Acid Derivatives

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50
Q

With which medication is myositis/rhabdomyolysis possible, and if suspected, what should you do?

A

Statins (HMG-CoA Reductase Inhibitors)

- STOP and check CK levels

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51
Q

Which hypercholesterolemia medication is safe in pregnancy?

A

Resins (Bile Acid Sequestrants)

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52
Q

Which hypercholesterolemia medication is used to raise HDL, lower LDL?

A

Nicotinic Acid (Niacin)

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53
Q

Which hypercholesterolemia medication has a side effect of flushing?

A

Nicotinic Acid (Niacin)

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54
Q

Which hypercholesterolemia medication can increase TGs?

A

Resins (Bile Acid Sequestrants)

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55
Q

Which hypercholesterolemia medication is always combined with Statin?

A

Ezetimibe

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56
Q

A focus on ASCVD risk reduction as this will correlate with a decrease in what?

A

LDL levels

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57
Q

In what four groups should a high or moderate intensity statin regimen be used?

A
  • Clinical ASCVD (secondary)
  • LDL >190 mg/dL (primary)
  • DM aged 40-75 years with LDL >70 mg/dL (primary)
  • Without ASCVD or DM with LDL 70-189 mg/dL and estimated 10-year ASCVD risk >7.5% (primary)
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58
Q

What is “HTN, hypokalemia, metabolic alkalosis” the triad for?

A

Primary hyperaldosteronism triad

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59
Q

What is “HA, sweating, tachycardia” the triad for?

A

Pheochromocytoma triad

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60
Q

What do signs of striae, skin atrophy, proximal muscle weakness indicate?

A

Cushing syndrome

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61
Q

At what age should you being HTN screening?

A

18+ years

  • Annual if normal
  • Semi-annual if borderline
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62
Q

What can be used to confirm and diagnose elevated HTN out of office?

A

Ambulatory Blood Pressure Monitoring (ABPM)

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63
Q

Male, black, older age, FH, stress, sleep apnea, smoker, alcohol use, weight gain, sedentary, poor diet, etc. are risk factors for what?

A

HTN

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64
Q

What are the four primary systems affected by target organ damage (TOD) in HTN?

A
  • Brain
  • Heart
  • Eyes
  • Kidneys
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65
Q

What are the seven labs that should be ordered to evaluate primary HTN?

A
  • Fasting blood glucose
  • CBC
  • Lipids profile
  • Serum creatinine with eGFR
  • TSH (thyroid-stimulating hormone)
  • UA
  • EKG
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66
Q

Thiazide diuretics, CCBs AND ACE inhibitors or ARBs is 1st line treatment options for which disease?

A

HTN

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67
Q

What is considered Stage 1 HTN, and what is the recommended medication regimen?

A

Stage 1 HTN: 130-139 systolic OR 80-89 diastolic

- 1 of the following: thiazide diuretics, CCBs, ACE inhibitors/ARBs

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68
Q

What is considered Stage 2 HTN, and what is the recommended medication regimen?

A

Stage 2 HTN: 140+ systolic OR 90+ diastolic

- 2 of the following (from different classes): thiazide diuretics, CCBs, ACE inhibitors/ARBs

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69
Q

What are the big 4 HTN medications?

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • CCBs
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70
Q

Patient has CKD AND albuminuria, what is always 1st line HTN medication?

A

ACE inhibitor

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71
Q

Patient has DM AND albuminuria, what is always 1st line HTN medication?

A

ACE inhibitor OR ARB

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72
Q

Patient has HF and EF is reduced, which HTN medication should be avoided?

A

Nondihydropyridine CCBs

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73
Q

What is the 1st line treatment for ALL patients with essential HTN?

A

Lifestyle modifications

  • Low sodium, DASH diet, reduce alcohol
  • Exercise 3-4 times/week fo 40 minutes
  • Smoking cessation
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74
Q

Which HTN medication has side effects of gout, electrolyte imbalance?

A

Diuretics/Thiazide (Chlorthalidone)

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75
Q

Which HTN medication has side effects of cough, hyperkalemia?

A

ACE Inhibitors

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76
Q

Which two HTN medications should NOT be combined?

A

ACE Inhibitors and ARBs

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77
Q

What is the primary indication for using Diuretics/Thiazide (Chlorthalidone)?

A

Primary aldosteronism

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78
Q

Are Thiazide or Loop diuretics preferred for patients with symptomatic HF?

A

Loop diuretics

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79
Q

Which HTN medication is contraindicated if you have a Sulfa allergy?

A

Diuretics/Thiazide (Chlorthalidone)

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80
Q

What type of HTN/HF medications are “-pril”?

A

ACE Inhibitors

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81
Q

What type of HTN/HF medications are “-sartan”?

A

ARBs

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82
Q

What type of HTN medications are “-dipine”?

A

CCBs

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83
Q

What type of HTN/HF medications are “-olol”?

A

Beta Blockers

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84
Q

What type of HTN medications are “-zosin”?

A

Alpha Blockers

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85
Q

Which type of HTN medication is safe in pregnancy and often used?

A

Beta Blockers

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86
Q

With which two HTN medications should you avoid abrupt cessation?

A
  • Beta Blockers

- Central Alpha Agonists

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87
Q

Which type of HTN medication is often used to treat BPH?

A

Alpha Blockers

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88
Q

Which type of HTN medication is safe in pregnancy but rarely used due to its CNS adverse effect?

A

Methyldopa (Central Alpha Agonists)

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89
Q

Which type of HTN medication can NOT be combined with ACE inhibitor or ARB in DM?

A

Direct Renin Inhibitors

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90
Q

What is asymptomatic severe HTN, NO evidence of end-organ damage?

A

Hypertensive urgency

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91
Q

What is severe HTN WITH evidence of end-organ damage; rare?

A

Hypertensive emergency

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92
Q

In a hypertensive emergency, which medication should NOT be used?

A

Sublingual nifedipine

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93
Q

With which condition is treatment OUTPATIENT; goal is to reduce BP to <160/120 mmHg SLOWLY (rest in quiet room, increase current antihypertensive meds, add meds (diuretic), low sodium, follow up to monitor for symptoms of hyper OR hypotensive (don’t overtreat))?

A

Hypertensive urgency

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94
Q

With which condition is treatment INPATIENT (ICU hospitalization); address underlying cause and reduce BP, check neuro exam, CXR, EKG, UA, electrolytes and creatinine, CT/MRI; use IV nitrates, CCBs, adrenergic blockers or hydralazine to reduce BP no more than 25% in minutes/hours; goal is 160/110 mmHg over 2-6 hours then to normal over 1-2 days?

A

Hypertensive emergency

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95
Q

What is 20 mmHg fall in systolic or 10 mmHg fall in diastolic with 2-5 minutes of standing AFTER 5 minutes of lying supine?

A

Orthostatic Hypotension

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96
Q

What condition involves cellular/tissue hypoxia with hypotension often being first manifestation?

A

Cardiogenic Shock

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97
Q

What is the recommended treatment for Cardiogenic Shock?

A

Stabilize patient (ABCs, IV placement, fluids) and determine/treat underlying cause

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98
Q

With which condition does diet play a large role; begins in childhood?

A

Ischemic Heart Disease (IHD)

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99
Q

What is the most common cause of death/disability in women in U.S.?

A

Coronary Heart Disease (CHD)

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100
Q

In what three populations does IHD often present atypically, and what does this look like?

A
  • Women
  • Elderly
  • Patients with DM

Often present as SOB, diaphoresis induced by rest, sleep and mental stress

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101
Q

With which condition do endothelial cells produce nitric oxide (inhibits plaque formation and has anti-inflammatory properties)?

A

Ischemic Heart Disease (IHD)

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102
Q

Which condition involves substernal chest discomfort (heaviness, pressure, tightness, squeezing, smothering, choking) with radiation to shoulders/arms/neck/jaw/teeth lasting 2-10 minutes (crescendo-decrescendo)?

A

Stable Angina (Angina Pectoris) - IHD

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103
Q

Which condition involves “Levine’s sign” (fist over sternum), tachycardia, HTN, abnormal heart sounds?

A

Stable Angina (Angina Pectoris) - IHD

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104
Q

Which condition looks for EKG changes, decreased myocardial perfusion seen on nuclear imaging, drop in systolic BP >10 mmHg or any other symptoms on exercise stress test?

A

Stable Angina (Angina Pectoris) - IHD

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105
Q

Which condition utilizes the Bruce Protocol (speed/incline increased every 3 minutes until HR is at 85% maximum for age)?

A

Stable Angina (Angina Pectoris) - IHD

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106
Q

Which condition looks for a perfusion defect seen in areas of hypoperfusion on nuclear stress test?

A

Stable Angina (Angina Pectoris) - IHD

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107
Q

Which diagnostic test diagnoses wall motion abnormalities in Stable Angina (Angina Pectoris)?

A

Stress echocardiogram

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108
Q

What is the gold standard test used to evaluate for Stable Angina (Angina Pectoris)?

A

Coronary angiography/cardiac catheterization

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109
Q

What is the primary recommended treatment for Stable Angina (Angina Pectoris)?

A

Modifiable risk factor modification

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110
Q

What is the 1st line medication treatment for acute angina? What two things does this medication do specifically?

A

Nitrates

  • Decrease O2 demand
  • Reduce preload
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111
Q

What is the 1st line medication treatment for chronic angina? What two things does this medication do specifically?

A

Beta blockers

  • Decrease O2 demand
  • Reduce afterload
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112
Q

What type of medication is given at onset of pain and every 5 minutes for up to 3 doses?

A

Nitrates (NTG)

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113
Q

What type of medication is given to stabilize plaques (reduce clinical event, slow progression/induce regression of atherosclerosis), and for which condition is it used in this way?

A

Statins

- Treating Stable Angina (Angina Pectoris) - IHD

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114
Q

Unstable angina (UA) and MI (NSTEMI vs. STEMI) are examples of what overall condition?

A

Acute Coronary Syndrome (ACS) - IHD

115
Q

Which condition involves plaque rupture/erosion with superimposed occlusive thrombus as most common pathophysiology?

A

Acute Coronary Syndrome (ACS) - IHD

116
Q

Which condition involves ischemic symptoms due to vasospasm; chest pain at rest with transient ST-segment elevation; usually in younger patients with few risk factors?

A

Prinzmetal’s Angina

117
Q

Which condition occurs at rest OR with increasing severity, frequency, duration

A

Unstable Angina (UA) - ACS/IHD

118
Q

Which condition shows negative cardiac enzymes; usually normal EKG (may have ST depression or T wave inversion)?

A

Unstable Angina (UA) - ACS/IHD

119
Q

Which condition involves treatment of bedrest/cardiac monitoring/IV access/labs, sublingual NTG x3 every 5 minutes and beta blockers then CCBs if neither offer relief, high-intensity statins, ASA/heparin?

How does this differ from NSTEMI?

A

Unstable Angina (UA) - ACS/IHD

For NSTEMI, add anti-platelet therapy

120
Q

Which condition involves a NON-occlusive thrombus?

A

Non-ST Elevation MI (NSTEMI) - ACS/IHD

121
Q

Which condition shows positive cardiac enzymes; may have ST depression or T wave inversion on EKG?

A

Non-ST Elevation MI (NSTEMI) - ACS/IHD

122
Q

Which two conditions involve symptoms of ischemic discomfort AND occurs at rest, OR severe/new onset or crescendo/progressive pattern?

A
  • Unstable Angina (UA) - ACS/IHD

- Non-ST Elevation MI (NSTEMI) - ACS/IHD

123
Q

What two conditions utilize TIMI variables to evaluate for progression?

A
  • Unstable Angina (UA) - ACS/IHD

- Non-ST Elevation MI (NSTEMI) - ACS/IHD

124
Q

Which condition involves acute MI, occlusive thrombus; rupture of vulnerable plaque (ASCAD) → complete occlusion is most common?

A

ST Elevation MI (STEMI) - ACS/IHD

125
Q

Which condition shows positive cardiac enzymes AND ST elevation on EKG?

A

ST Elevation MI (STEMI) - ACS/IHD

126
Q

What is the leading cause of inpatient death for post-MI complications?

A

Pump failure

127
Q

Which two medications are often prescribed post-MI?

A
  • Beta Blockers

- ASA

128
Q

Which condition often involves treatment of risk stratification (angiography vs. revascularization with early PCI/CABG); possible thrombolytic/fibrinolytic therapy if PCI not available?

A

ST Elevation MI (STEMI) - ACS/IHD

129
Q

When is thrombolytic/fibrinolytic therapy recommended, and for which condition?

A

EARLY and if no contraindications (history of intracranial hemorrhage, history of stroke within 1-year, uncontrolled HTN, aortic dissection, internal bleed)
- ST Elevation MI (STEMI) - ACS/IHD

130
Q

What is the most common etiology associated with HF?

A

CAD

131
Q

What is the most common type of HF?

A

Left ventricular systolic dysfunction

132
Q

Which type of HF involves reduced ejection fraction <40%? Is it diastolic or systolic?

A

HFrEF (left-sided) - systolic

133
Q

Which type of HF involves preserved ejection fraction? Is it diastolic or systolic?

A

HFpEF (left-sided) - diastolic

134
Q

Does HFrEF or HFpEF involve volume overload?

A

HFrEF (left-sided)

135
Q

Does HFrEF or HFpEF involve pressure overload?

A

HFpEF (left-sided)

136
Q

What is the most common etiology of RIGHT HF?

A

LEFT HF!!!!!!!!

137
Q

Which condition has specific risk factors of tend to be older, overweight women with HTN; may have CAD or DM?

A

HFpEF (left-sided)

138
Q

What condition involves progressive dyspnea, fatigue/weakness, dependent edema, weight gain?

A

HF

139
Q

What specific condition involves dyspnea, diaphoresis, tachypnea, tachycardia, rales/crackles, S3/S4 heart sound?

A

LEFT HF

140
Q

What specific condition involves peripheral edema, RUQ pain/discomfort, JVD, ascites?

A

RIGHT HF

141
Q

What condition involves edema, elevated JVD, crackles at bases, displaced PMI, S3/S4 gallop, hepatomegaly, hepatojugular reflex on PE?

A

HF

142
Q

What is the most useful diagnostic tool for HF?

What other two tests are often utilized?

A

Echocardiogram

- EKG, CXR (also exercise stress test, cardiac cath)

143
Q

Which condition utilizes Brain-Type Natriuretic Peptide (BNP), N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) for diagnostic purposes?

What other three tests are often utilized?

A

HF

- Cardiac enzymes, CBC, CMP

144
Q

Of the ACC/AHA Stages for HF, what stage involves risk for HF; NO structural changes or symptoms – goal is to intervene at this stage?

A

Stage A

145
Q

Of the ACC/AHA Stages for HF, what stage involves risk for HF; structural changes present but NO symptoms?

A

Stage B

146
Q

Of the ACC/AHA Stages for HF, what stage involves active HF; structural changes with prior/current symptoms?

A

Stage C

147
Q

Of the ACC/AHA Stages for HF, what stage involves active HF; refractory HF with specialized interventions?

A

Stage D

148
Q

Of the NYHA Functional Classification for HF, what class involves no limitations on physical activity?

A

Class I

149
Q

Of the NYHA Functional Classification for HF, what class involves slight limitations on physical activity?

A

Class II

150
Q

Of the NYHA Functional Classification for HF, what class involves marked limitations on physical activity?

A

Class III

151
Q

Of the NYHA Functional Classification for HF, what class involves being unable to carry on with any physical activity without discomfort/symptoms, even AT REST

A

Class IV

152
Q

What condition involves early detection/treatment of predisposing conditions and high-risk candidates?

A

Obviously a lot of them lol but this is for HF

153
Q

What is the recommended initial medication therapy for HFrEF (2)?

A
  • ACE inhibitor

- Diuretics

154
Q

What is the recommended treatment for HFpEF?

A

Identify/treat co-morbidities, diuretics for symptomatic relief

155
Q

What is the recommended starting dose for a patient beginning loop diuretics with HF?

A

Begin with 20-40 mg Lasix (Furosemide)

- Or Bumetanide/Torsemide

156
Q

For which two HF medications should you titrate dose and start low, go slow?

A
  • ACE Inhibitors

- Beta Blockers

157
Q

Carvedilol, Bisoprolol, Metoprolol are examples of which group of medications for HF?

A

Beta Blockers

158
Q

Which type of medication should be considered for use in chronic symptomatic HF? Why is this recommended over the typical 1st line options?

A

ARNI (Ernesto)

- Offers additional vasodilation compared to ACE-I or ARBs

159
Q

Spironolactone, Eplerenone are examples of which group of medications, and when are they utilized?

A

Mineralocorticoid Receptor Antagonist (MRA)

- Indicated late in HF treatment process

160
Q

What type of HF medication should be considered in black patients with no response to ACE-I or ARBs or ARNI?

A

Hydralazine

161
Q

What type of HF medication should be considered in patients with concomitant A Fib?

A

Digoxin

- Titrate dose and start low, go slow

162
Q

What type of medication is NOT recommended for systolic HF?

A

Statins

163
Q

What is a predictor for higher mortality rate in HF patients?

A

Loss of ADLs

164
Q

What is the prognosis for HF, and which two causes often lead to death from HF?

A

Poor prognosis

- Death usually due to progressive pump failure or malignant arrhythmias

165
Q

Which condition involves treatment of hospital admission with close monitoring of vitals, daily weight, I&Os, potassium changes, give O2 (sat should be 90+); diuretics and NTG?

A

Acute Decompensated HF

166
Q

What condition involves heart muscle is structurally and functionally abnormal in the absence of CAD, HTN, valvular disease and CHD?

A

Cardiomyopathy (CM)

167
Q

What are the three types of Cardiomyopathy (CM)?

A
  • Hypertrophic CM (HCM)
  • Dilated CM (DCM)
  • Restrictive CM (RCM)
168
Q

Which type of CM presents as heart muscle thins, LV dilates?

A

Dilated CM (DCM)

169
Q

Which type of CM presents as heart muscle thickens?

A

Hypertrophic CM (HCM)

170
Q

Which type of CM presents as heart muscle rigid and unable to relax/fill with blood?

A

Restrictive CM (RCM)

171
Q

Which type of CM involves systolic dysfunction; affects males = females?

A

Dilated CM (DCM)

172
Q

Which two types of CM involve diastolic dysfunction?

A
  • Hypertrophic CM (HCM)

- Restrictive CM (RCM)

173
Q

What is the most common cause of Dilated CM (DCM)?

A

Idiopathic

174
Q

Which type of CM involves viral is most common cause of infectious in U.S.; diagnose with endomyocardial biopsy?

A

Dilated CM (DCM)

175
Q

Which type of CM involves exertional intolerance with SOB, fatigue, CP, palpitations, edema; PE: mitral/tricuspid regurgitation murmur, S3 gallop, JVP, basal crackles?

A

Dilated CM (DCM)

176
Q

Which type of CM shows echocardiogram with dilated ventricles and reduced EF; non-specific EKG changes?

A

Dilated CM (DCM)

177
Q

What is the 1st line medication treatment for Dilated CM (DCM)? What can be used as alternatives if this fails (3)?

A

ACE Inhibitors

- Consider diuretics, Beta Blockers, Digoxin if failure to response to 1st line options

178
Q

Which type of CM involves LVH in absence of a cause like CAD, HTN, valvular disease, CHD?

Where is the most cause of LVH?

A 
Hypertrophic CM (HCM)
- Asymmetric LVH of septum
179
Q

What is the leading cause of sudden cardiac death (SCD) in young persons?

A

Hypertrophic CM (HCM)

180
Q

What is the etiology of Hypertrophic CM (HCM)?

A

Familial

181
Q

With Hypertrophic CM (HCM), why would the symptoms of DOE, exertional angina, fatigue, presyncope/syncope, palpitations be present (hint: think subtypes of HCM)?

A

Obstructive/LV Outflow Tract (LVOT) present

- Otherwise, often asymptomatic

182
Q

Which condition involves crescendo-decrescendo systolic ejection murmur (increases with Valsalva and standing, decreases with squat and isometric handgrip)?

A

Hypertrophic CM (HCM)

183
Q

With Hypertrophic CM (HCM), what positions can increase or decrease the sound of the crescendo-decrescendo systolic ejection murmur?

A
  • Increases with Valsalva and standing

- Decreases with squat and isometric handgrip

184
Q

Which type of CM shows echocardiogram with increased LV wall thickness?

A

Hypertrophic CM (HCM)

185
Q

Which two medications are 1st line for SYMPTOMATIC Hypertrophic CM (HCM)?

When would surgery be considered?

A

Beta Blockers OR Non-dihydropyridine CCBs

- Surgery considered if advanced HF or refractory to 1st lines

186
Q

Which condition involves risk factors of VT (prior sustained or non-sustained); young age, FH of HCM, massive LVH, unexplainable syncope, brady arrhythmias?

A

Sudden Cardiac Death

187
Q

Which of the three CM is least common?

A

Restrictive CM (RCM)

188
Q

What is the most common etiology of Restrictive CM (RCM)?

A

Amyloidosis (infiltrative)

189
Q

What two tests are diagnostic for Amyloidosis (leading cause of Restrictive CM (RCM))?

A
  • Echocardiogram

- Endomyocardial biopsy is definitive

190
Q

How does Restrictive CM (RCM) often present clinically?

A

Right HF symptoms (edema, abdominal discomfort, ascites)

191
Q

Which condition should Restrictive CM (RCM) be differentiated from (similar sxs, but different hx)?

What is different on PE?

A

Differentiate from constrictive pericarditis

- S3 gallop heard with RCM but NOT with constrictive pericarditis

192
Q

Which CM shows echocardiogram with bi-atrial enlargement and large ventricular cavity; non-specific EKG changes?

A

Restrictive CM (RCM)

193
Q

Which CM involves treatment of treat underlying cause; low-dose loop diuretics?

A

Restrictive CM (RCM)

194
Q

Which type of CM is also called stress CM, apical ballooning syndrome/broken heart syndrome?

A

Takotsubo Cardiomyopathy (TCM)

195
Q

Which type of CM is triggered by emotional or physical trigger; mainly in postmenopausal women?

A

Takotsubo Cardiomyopathy (TCM)

196
Q

Which CM type involves abrupt onset of acute MI-like symptoms (substernal CP, SOB, syncope); HF symptoms?

A

Takotsubo Cardiomyopathy (TCM)

197
Q

Which CM type involves elevated troponin and BNP; ST-segment elevation on EKG that gradually resolves; reduced EF on echocardiogram; wall motion abnormalities on cardiac MRI?

A

Takotsubo Cardiomyopathy (TCM)

198
Q

Which type of CM involves treatment of stabilize patient/immediate treatment similar to acute MI with catheterization?

A

Takotsubo Cardiomyopathy (TCM)

199
Q

Which condition involves involves HF symptoms (dyspnea, fatigue, angina, syncope, palpitations); on PE, check for heart sounds and murmurs, venous/arterial pulses?

A

Valvular Heart Disease (VHD)

200
Q

What is the test of choice for diagnosis of Valvular Heart Disease (VHD)?

A

Echocardiogram

201
Q

With valve surgery, what is there increased risk of? What should be given prophylactically to avoid this?

A

Increased risk of endocarditis

- Require abx prophylactically

202
Q

Which condition involves narrowing of aortic outflow?

At what location is this most common?

A

Aortic Stenosis

- Aortic valve most common

203
Q

Which condition involves 65+ years (valve degeneration/sclerosis); if younger, consider congenital bicuspid valve (30-65 years) OR congenital unicuspid valve (<30 years)?

A

Aortic Stenosis

204
Q

Which condition involves the triad symptoms of angina, syncope and HF with late disease?

A

Aortic Stenosis

205
Q

Which condition involves grade 3-4/6 midsystolic murmur (crescendo-decrescendo) best heard at 2nd RICS?

A

Aortic Stenosis

206
Q

Which condition involves murmur louder with squatting and radiates to neck; thrill in 2nd RICS or suprasternal notch?

A

Aortic Stenosis

207
Q

Which condition involves a small pulse pressure = severe disease?

A

Aortic Stenosis

208
Q

Which condition shows immobile/calcified leaflets and LVH on echo?

A

Aortic Stenosis

209
Q

Of Prosthetic Aortic Valves, which one lasts longer, and which one does NOT require anticoagulation treatment?

A
  • Mechanical last longer, but require lifelong anticoagulation (Warfarin with INR of 2.5-3.5)
  • Bioprosthetic do not require anticoagulation, but do not last as long
210
Q

What condition is a form of subvalvular Aortic Stenosis, and how does the aortic valve present differently (from when aortic valve itself is affected)?

A 
Hypertrophic CM (HCM)
- With HCM, the aortic valve is NOT calcified

NOTE: similar symptoms

211
Q

On PE, how does a HCM murmur differentiate from a murmur of Aortic Stenosis at the valve?

A
  • Aortic Stenosis: louder with squatting

- HCM: louder with standing or Valsalva

212
Q

Again, what are the 1st line medication treatments for Hypertrophic CM (HCM) (2)?

A
  • Beta Blockers

- Nondihydropyridine CCBs

213
Q

What condition involves blood leaks back through aortic valve during diastole ?

A

Aortic Regurgitation

214
Q

What are the two primary causes of ACUTE Aortic Regurgitation?

A
  • Endocarditis WITH murmur

- Aortic dissection WITH murmur

215
Q

What are the three primary causes of CHRONIC Aortic Regurgitation?

A
  • Valve disease
  • Aortic root dilation
  • Combination
216
Q

Which condition involves a high-pitched/blowing diastolic decrescendo murmur best heard at 2nd-4th LICS?

A

Aortic Regurgitation

217
Q

Which condition involves a wide pulse pressure (“water hammer” or “Corrigan” pulse)?

A

Aortic Regurgitation

218
Q

Which condition involves Austin-Flint murmur (slow, low-pitched diastolic murmur at apex)?

A

Aortic Regurgitation

219
Q

Which condition shows LVH on EKG; LVH and cardiomegaly on CXR; backflow of blood and LVH on echo?

A

CHRONIC Aortic Regurgitation

- Acute often shows only backflow of blood and LVH on echo

220
Q

Which condition involves treatment of EMERGENT valve surgery within 24 hours; stabilize with IV vasodilators?

A

ACUTE Aortic Regurgitation

221
Q

Which two VHD conditions have similar treatments depending on asymptomatic (monitor sxs and echo) vs. symptomatic (surgery)?

A
  • Aortic Stenosis

- CHRONIC Aortic Regurgitation

222
Q

Which condition involves leakage of blood from LV back into LA?

A

Mitral Regurgitation

223
Q

Which VHD condition can be ischemic (papillary muscle rupture/damage) vs. non-ischemic (endocarditis, trauma, RHD)?

A

ACUTE Mitral Regurgitation

224
Q

Which two VHD conditions present as ILL/TOXIC with hypotension, pulmonary edema, shock?

A
  • ACUTE Mitral Regurgitation

- ACUTE Aortic Regurgitation

225
Q

Which condition involves holosystolic murmur loudest at apex, radiates to left axilla?

A

Mitral Regurgitation

226
Q

Which condition shows LAE, LVH and hyperdynamic LV wall motion on echo?

A

Mitral Regurgitation

227
Q

Which condition involves urgent surgical consult; stabilize with IV vasodilators (Nitroprusside)?

A

Mitral Regurgitation

228
Q

If CHRONIC Mitral Regurgitation and HTN are present, what is the recommended treatment (2)?

A
  • ACE Inhibitors

- Vasodilators (reduce afterload)

229
Q

If CHRONIC Mitral Regurgitation and hypervolemia are present, what is the recommended treatment (2)?

A
  • Diuretics

- Restrict Na+ intake (reduce preload)

230
Q

If CHRONIC Mitral Regurgitation and A Fib are present, what is the recommended treatment (2)?

A
  • Warfarin (INR 2.0-3.0)

- Digoxin/antiarrhythmic

231
Q

Which condition involves ballooning of mitral leaflets back into LA during systole; usually mild and benign?

A

Mitral Valve Prolapse

232
Q

Which condition involves atypical/non-anginal chest pain +/- other cardiac, respiratory, neuro, psych sxs?

A

Mitral Valve Prolapse

233
Q

Which condition involves mid-late systolic clicks +/- mitral regurgitation?

A

Mitral Valve Prolapse

234
Q

Which condition involves treatment of often mild so reassurance, lifestyle changes; if arrhythmias present, use Beta Blockers?

A

Mitral Valve Prolapse

235
Q

Which condition involves can be due to mitral valve narrowing, obstructed flow from LA to LV?

A

Mitral Stenosis

236
Q

Which condition involves etiology of RHD (Rheumatic Heart Disease) including ARF, pericarditis, myocarditis, valvular lesions (most common) → diffusely thickened valve leaflets or immobile/rigid leaflets?

A

Mitral Stenosis

237
Q

Which condition involves symptoms that are often precipitated by sudden exertion, excitement, fever, severe anemia, tachycardia, sexual intercourse, pregnancy, thyrotoxicosis, A Fib?

A

Mitral Stenosis

238
Q

What other condition is often associated with Mitral Stenosis?

A

A Fib

239
Q

Which condition involves opening snap; mid-late diastolic rumbling murmur best heard at apex?

A

Mitral Stenosis

240
Q

Which condition shows valve thickening, reduced valve excursion on echo?

A

Mitral Stenosis

241
Q

Which condition are Dabigatran, Rivaroxaban, Apixaban or Edoxaban used to treat?

A

A Fib

242
Q

Which condition involves treatment of prevent systemic embolization (can lead to stroke); Warfarin (INR 2.0-3.0); control rhythm and rate to improve symptoms?

A

A Fib

243
Q

Which condition involves increased pericardial fluid in closed pericardial sac → increased pressure on the heart and vessels?

A

Pericarditis

244
Q

Which condition is associated with viral (Coxsackie, Influenza) vs. idiopathic etiology?

A

Pericarditis

245
Q

Which two viruses are often the cause of viral Pericarditis?

A
  • Coxsackie

- Influenza

246
Q

Which condition involves sharp/pleuritic chest pain: VERY common; sudden onset, occurs in anterior chest?

A

Pericarditis

247
Q

Which condition involves chest pain better with sitting up and leaning forward, worse with lying flat, deep inspiration, coughing, sneezing?

A

Pericarditis

248
Q

What is a fairly common PE finding specific to acute Pericarditis; scratchy, squeaking heart sound best heard over LSB and when patient is sitting up/leaning forward; varies in intensity

A

Pericardial friction rub

249
Q

Which condition involves EKG changes showing new DIFFUSE ST elevation or PR depression?

A

Pericarditis

250
Q

Which condition involves new pericardial effusion: fluid in pericardial sac (50+ mL)?

What diagnostic test is used to evaluate this?

A

Pericarditis

- Evaluate with echocardiogram

251
Q

In a patient with acute Pericarditis, what diagnostic test should be obtained if high fever or septic/toxic appearing?

A

Blood cultures

252
Q

What is the 1st line medication treatment for Pericarditis? What medication is often added on in conjunction?

A

NSAIDS!!!

- Colchicine often added to reduce symptoms and decrease rate of recurrent pericarditis

253
Q

What medication is controversial for treatment of Pericarditis, and why?

A

Glucocorticoids

- Can increase risk for recurrent pericarditis and unwanted side effects

254
Q

Which condition is associated with Beck’s Triad, and what are the three components?

A

Pericarditis/Cardiac Tamponade

- Beck’s Triad: hypotension, muffled heart sounds, JVD

255
Q

Which condition is associated with the triad of hypotension, muffled heart sounds, JVD, and what is this triad called?

A

Pericarditis/Cardiac Tamponade

- Beck’s Triad

256
Q

How do you treat Pericarditis/Cardiac Tamponade (2)?

A

DRAINAGE

  • Pericutaneous (pericardiocentesis)
  • Surgical (pericardiectomy/pericardial window)
257
Q

How do you treat Recurrent Pericarditis?

A

NSAIDs and Colchicine ONLY

- No Glucocorticoids

258
Q

Which condition involves scarring and loss of normal elasticity → cardiac filling impaired; often viral or idiopathic cause/chronic; can lead to pericardial tamponade; treat with pericardiectomy?

A

Constrictive Pericarditis

259
Q

Which condition involves acute pericarditis + muscle involvement; Troponin often elevated?

A

Myopericarditis

260
Q

Which condition involves infection of endocardial surface of heart (IE) due to infection of 1+ heart valves or infection of device?

A

Endocarditis

261
Q

What are the four types of Endocarditis?

A
  • Native valve IE
  • Prosthetic valve IE
  • IV drug abuse IE
  • Nosocomial IE
262
Q

What condition involves normal heart valves; rapidly progressive and often fatal?

A

ACUTE Endocarditis

263
Q

What condition involves damaged heart valves; indolent = consider fever of unknown origin (FUO)?

A

CHRONIC Endocarditis

264
Q

What condition involves “sticky” endocardium → organism introduced and adheres → invades leaflets = destroys valve?

A

Endocarditis

265
Q

What is the most common general etiology of Endocarditis, and which two organisms are primarily responsible?

What are two other possible organisms?

A

BACTERIAL

  • Staphylococci: healthcare-associated IE, IV drug abuse IE, community-acquired IE
  • Streptococci: community-acquired IE

Also,

  • Staphylococcus aureus
  • Viridians streptococci
266
Q

What is the most common symptom associated with Endocarditis?

A

Fever

267
Q

Which condition involves fever (most common) +/- chills, anorexia, weight loss; cardiac murmurs; can have cutaneous (ex. Petechiae, Splinter Hemorrhages)?

A

Endocarditis

268
Q

Which condition is associated with Janeway lesions?

A

Endocarditis

- Janeway lesions: non-tender erythematous macules on pads of palms and soles

269
Q

Which condition is associated with Osler nodes?

A

Endocarditis

- Osler nodes: tender violaceous nodules on pads of fingers and toes

270
Q

Which condition is associated with Roth spots?

A

Endocarditis

- Roth spots: rare, retinal capillary rupture (lesions of retina with pale centers)

271
Q

Which condition utilizes the Modified Duke Criteria for diagnosis?

A

Endocarditis

272
Q

Which diagnostic test is often utilized for Pericarditis because of its HIGH diagnostic yield (must get at least three sets from different puncture sites)?

A

Blood cultures

273
Q

What is 1st line diagnostic test for suspected Endocarditis (IE)?

A

Echocardiogram (TTE)

274
Q

Which condition is treated with bactericidal abx; referral to cardiac surgeon, ID and cardiology; surveillance with BCx?

A

Endocarditis

275
Q

For Native IE, what is the recommended treatment?

A

Vancomycin for 4-6 weeks

276
Q

For Prosthetic IE, what is the recommended treatment (2)?

A

May require surgical replacement of prostheses AND abx treatment for longer (may also need multiple abx)
- MUCH more difficult to treat

277
Q

Which two types of Endocarditis are associated with higher mortality rate?

A
  • Prosthetic valve IE

- IV drug abuse IE

278
Q

Which condition involves increased mortality rate if female gender, S. aureus infection, large vegetations, aortic valve infection?

A

Endocarditis

279
Q

Which Endocarditis complication etiology is most common?

A

Embolic

280
Q

What is the most common indication for cardiac surgery in Endocarditis?

A

HF!!!

281
Q

What is the most common cause of death in Endocarditis?

A

HF!!!

282
Q

Which type of procedure/surgery requires prophylactic abx if patient has prosthetic heart valves, prior IE, CHD or infected skin/MSK tissue (i.e. Endocarditis concerns)?

A

DENTAL

283
Q

How much do I hate myself for making 283 cards about the heart??????

A

A. L. O. T.

Clin Med II Disease Key Notes (4 decks)

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