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Step 2 CK > Cardio > Flashcards

Cardio Flashcards

1
Q

Interchangeable terms with CAD

A

Atherosclerotic heart disease

Ischemic heart disease

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2
Q

MCC of CP when source is clearly not cardiac

A

GI

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3
Q

Best initial test for CP

A

EKG (regardless of cause)

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4
Q

Why are men more at risk for MI under 50

A

Protective effect of Estrogen

This wears off at menopause and the risk becomes equal to males

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5
Q

Useful Hx in Ischemia

A 
Duration
Quality
Location
Radiation
Frequency
Alleviating
Precipitating
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6
Q

Worst RF for CAD

A

DM

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7
Q

MC RF for CAD

A

HTN

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8
Q

Unmodifiable RFs for CAD

A

Age
Sex
Heredity

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9
Q

Clear RFs for CAD

A 
DM
Smoking - Risk x2
HTN - goal 140/90, 130/80 in DM
Hyperlipidemia
FHx of premature CAD
Age > 45 men, 55 women
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10
Q

What is premature CAD

A

Males less than 55

Females less than 65

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11
Q

When is FHx of CAD relevant

A

First degree relative

Premature in family

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12
Q

Goal for LDL to prevent CAD

A

Less than 100

Less than 70 in DM

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13
Q

MCC of death in DM

A

Cardiovascular

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14
Q

Weight loss effect on BP

A

1 Kg decreased = 1 mmHg decreased

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15
Q

Best way to decrease BP

A

Weight loss

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16
Q

Best way to increase HDL

A

Exercise

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17
Q

Etiology of Takatsubo cardiomyopathy

A

Massive catecholamine discharge from emotional stress

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18
Q

These are NOT RFs for CAD

A

Chlamydia
Elevated CRP
Elevated homocysteine

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19
Q

Greatest improvement in risk for CAD

A

Stop smoking

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20
Q

Features of non-ischemic CP

A 
Pleuritic
Positional
Tender
Knife-like
Lasts a few seconds
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21
Q

Why are men more at risk for MI under 50

A

Protective effect of Estrogen

This wears off at menopause and the risk becomes equal to males

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22
Q

Useful Hx in Ischemia

A 
Duration
Quality
Location
Radiation
Frequency
Alleviating
Precipitating
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23
Q

When is FHx of CAD relevant

A

First degree relative

Premature

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24
Q

MCC of death in DM

A

Cardiovascular

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25
Q

Weight loss effect on BP

A

1 Kg decreased = 1 mmHg decreased

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26
Q

Best initial test for all forms of CP

A

EKG

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27
Q

Presentation of ischemic pain

A

Dull/sore

Squeezing

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28
Q

Features of inferior wall ischemia

A

Brady
Hypotension
+/- Dizziness

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29
Q

Nitrate effect on CP

A

↑ in GERD

↓ in Angina

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30
Q

Auscultation findings in MI

A 
Wide split S2
LBBB
New S4
S3
New AR - Aortic dissection
New MR - Papillary muscle dysfunction
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31
Q

What causes wide split S2

A

RBBB
Pulm HTN
Pulmonic stenosis
RVH

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32
Q

What causes paradoxic S2

A

LBBB
HTN
AS
LVH

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33
Q

What causes fixed split S2

A

ASD

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34
Q

What causes S4 gallop

A

LVH (atrial systole)

Long standing HTN

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35
Q

What causes S3 gallop

A

Underlying CHF

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36
Q

Causes of pleuritic CP

A 
PN
PE
Pericarditis - PR depression
PTX
Pleuritis
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37
Q

CP w/ chest wall tenderness:

Most accurate test:

A

Costochondritis

Physical exam

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38
Q

CP w/ radiation to back, unequal BP b/w arms:

Most accurate test:

A

Aortic dissection
CXR w/ widened mediastinum
CT, MRI or TEE confirms

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39
Q

CP w/ pain worse lying flat, age

A

Pericarditis

EKG w/ ST elevation everywhere, PR depression

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40
Q

CP w/ epigastric discomfort, pain better w/ eating:

Most accurate test:

A

Duodenal ulcer

Endoscopy

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41
Q

CP w/ bad taste, cough, hoarseness:

Most accurate test:

A

GERD

Resonse to PPIs, AlOH, Mg(OH)2, viscous lidocaine

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42
Q

CP w/ cough, sputum, hemoptysis:

Most accurate test:

A

PN

CXR

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43
Q

CP w/ sudden onset SOB, tachy, hypoxia:

Most accurate test:

A

PE

Spiral CT, V/Q in pregnancy

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44
Q

CP w/ sharp pleuritic pain, tracheal deviation:

Most accurate test:

A

PTX

CXR

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45
Q

Worst prognostic combination with CP

A

SOB

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46
Q

Best initial test for all forms of CP

A

EKG

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47
Q

When do CKMB and Troponins begin to rise

A

4hrs

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48
Q

When do CKMB and Troponins peak

A

12-24hrs

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49
Q

How long before CKMB resolves

A

3-4 days - Makes it good to test for re-infarction

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50
Q

When to do exercise stress test in setting of CP

A

Etiology not clear

EKG not diastolic

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51
Q

When to use Prasugrel in ischemic heart disease

A

Pts undergoing angioplasty and stenting

NOT in >75 due to risk of hemorrhage and stroke

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52
Q

Calculate a pts max HR

A

220-Age

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53
Q

What indicates ischemia on EKG

A

ST depression

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54
Q

What can cause baseline EKG abnormalities

A

LBBB
LVH
Digoxin - Downsloping ST
Pacer

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55
Q

2 ways of evaluating ischemia w/o EKG

A

Thallium uptake

Echo - wall motion abnormalities

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56
Q

Contraindications to ETT

A

Cardiac instability - Current CP

Pt can’t exercise

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57
Q

MCC ischemic heart disease

A

Atherosclerosis

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58
Q

Calculate O2 delivery

A

CO x Hb/HCT x O2 sat

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59
Q

Why does normal myocardium pick up thallium

A

Looks like K

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60
Q

Differentiate infarct and ischemia on thallium uptake

A

Ischemia uptake returns to normal at rest

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61
Q

Increase myocardium O2 consumption w/o exercise

A

Dipyridamole or adenosine with Thallium

Dobutamine with ECHO

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62
Q

When to avoid dipyridamole

A

Asthmatics - Can cause bronchospasm

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63
Q

The lower the pretest likelihood of disease

A

The higher the rate of false positives

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64
Q

Why do we do angiography in ischemic heart disease

A

Determine bypass surgery vs angioplasty

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65
Q

Most accurate method of detecting CAD

A

Angiography

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66
Q

When does CABG decrease mortality

A

3 vessel disease or Left main
2 vessel disease in DM
2-3 vessel with Low EF
LV dysfunction

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67
Q

What lowers mortality in CAD

A 
Aspirin
BBs
tPA
Angioplasty
Clopidogrel
ACEIs if ↓ EF
Statins if LDL > 100
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68
Q

What is the purpose of Holter

A

Rhythm monitoring (A-fib , flutter, premature beats, V-tach)

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69
Q

What lowers mortality in ischemic heart disease

A

Aspirin
BBs
Statins if LDL > 100

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70
Q

Best mortality benefit in chronic angina

A

Aspirin

BBs

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71
Q

When to use clopidogrel in ischemic heart disease

A

Aspirin intolerance

Recent angioplasty w/ stenting

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72
Q

AE Ticlopidine

A

Neutropenia

TTP

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73
Q

What do ACEIs/ARBs do in CAD

A

Decrease EF

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74
Q

When to give ACEIs/ARBs in CAD

A

Regurgitant valvular disease (Decreased LVEF)

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75
Q

What to do in hyperkalemia with ACEIs/ARBs

A

Switch to hydralazine and nitrates

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76
Q

What are CAD equivalents (LDL goal

A

PAD
Carotid disease
Aortic disease
DM

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77
Q

MC AE statins

A

Liver dysfunction (elevated transaminases)

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78
Q

Which lipid lowering drugs lower mortality the most in CAD

A

Statins

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79
Q

AE statins

A

Elevated transaminases

Myositis

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80
Q

AE niacin

A

Elevated glucose and uric acid

Pruritis

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81
Q

AE fibrate derivatives

A

Increase risk of myositis when combined w/ statins

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82
Q

AE Cholestyramine

A

Flatus, ABD cramping

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83
Q

AE ezetimibe

A

Nearly useless but well tolerated

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84
Q

Effect of CCBs on CAD

A

May increase mortality

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85
Q

ONLY time to use CCBs in CAD

A

Severe asthma
Prinzmetal
Cocain-induced CP
Max meds don’t control pain

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86
Q

AE CCBs

A

Edema
Constipation (verapamil)
Heart block

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87
Q

What lowers mortality in CAD

A 
Aspirin
BBs
tPA
Angioplasty
Clopidogrel
ACEIs if ↓ EF
Statins if LDL > 100
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88
Q

Best therapy in acute coronary syndrome

A

PCI esp w/ ST elevation

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89
Q

MCC death in USA

A

Acute coronary syndrome

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90
Q

Only way to determine etiology in acute coronary syndromes

A

EKG and Enzymes

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91
Q

Features of unstable angina

A

New pain
Worse pain
Rest pain

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92
Q

What is the sequelae of unstable angina

A

NSTEMI

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93
Q

Risk factors for unstable angina to progress to NSTEMI

A 
Repetitive/Prolongued Pain
Persistent EKG changes
Hypotension
Elevated cardiac markers
Sustained V-tach
Syncope
EF
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94
Q

Heart sound in ACS

A

S4

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95
Q

What is associated with constrictive pericarditis

A

Kussmaul sign

Increased JVP on inhalation

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96
Q

Rx Dressler

A

NSAIDS and Aspirin +/- steroids

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97
Q

Displaced PMI is characteristic of

A

LVH

Dilated cardiomyopathy

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98
Q

Leads affected in Anterior wall

A

V2-4

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99
Q

Leads affected in Inferior wall

A

II, III, aVF

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100
Q

PR > 200ms associated with

A

1st degree AV block

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101
Q

Leads affected in posterior wall

A

ST depression in V1-2

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102
Q

Most important next step in ACS

A

Aspirin then Angioplasty then ICU

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103
Q

Greatest mortality benefit in ACS

A

Angioplasty

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104
Q

MCC death first several days after MI

A

Ventricular arrhythmia

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105
Q

How is PCI superior to thrombolytics

A

Survival and Mortality benefit
Fewer hemorrhage complications
Less MI complications

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106
Q

When to DEFINITELY do PCI (ie. thrombolytics are contraindicated)

A 
Recent surgery
Melena
BP > 180/110
Aortic dissection
Stroke
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107
Q

When does PCI need to be performed

A

Within 90min of pt arrival

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108
Q

PCI complications

A

Rupture
Restenosis
Hematoma

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109
Q

Most important method of preventing restenosis after PCI

A

Drug-eluting stent (paclitaxel, sirolimus)

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110
Q

When can thrombolytics be administered

A

Within 12hrs

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111
Q

Door to needle time

A

30min

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112
Q

When to do CABG in late presentation MI (>12hrs)

A

Good anatomy
Cardiogenic shock
Mechanical repair

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113
Q

When to do emergency CABG

A

Failed PCI

Persistent/Recurrent ischemia refractory to meds

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114
Q

ACS, who gets Aspirin

A

Everyone

BIT

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115
Q

ACS, who gets clopidogrel

A

Aspirin not tolerated

Pt undergoing angioplasty and stenting

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116
Q

ACS, who gets BBs

A

Everyone

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117
Q

ACS, who gets ACEi/ARBs

A

Everyone

Best for EF

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118
Q

ACS, who gets statins

A

Everyone

Best for LDL>100

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119
Q

ACS, who gets O2, nitrates

A

Everyone

No mortality benefit

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120
Q

ACS, who gets Heparin

A

After thrombolytics/PCI to prevent restenosis

Initial therapy w/ ST depression and other NSTE events

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121
Q

ACS, who gets CCBs

A

Can’t use BBs
Cocaine
Prinzmetal or vasospastic variant

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122
Q

When can you give glycoprotein IIb/IIIa inhibitors

A

ACS w/ angioplasty and stenting
ST depression
NSTEMI

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123
Q

Best for NSTEMI

A

Heparin

Glycoprotein IIb/IIIa inhibitors

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124
Q

What does “not better” mean in STE ACS

A

Persistent pain
S3 gallop or CHF
Worse EKG changes or SVT
Rising troponins

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125
Q

Next step for pts in STE ACS and are not getting better

A

Angiography and possible angioplasty

126
Q

Where do you see cannon A waves

A

3rd degree AV block

127
Q

Rx Symptomatic 3rd degree AV block

A

Atropine

Then Pacemaker

128
Q

Most specific finding in Right ventricular infarction

A

STE in RV4

129
Q

What does the right coronary supply

A

RV
AV node
Inferior wall

130
Q

Rx RV infarctions

A

High volume fluid replacement

131
Q

MC complications of MI

A

V-tach

V-fib

132
Q

When to look for tamponade/free wall rupture after mI

A

Sudden loss of pulse

133
Q

Rx v-tach/v-fib

A

Cardioversion/defibrillation

Then give BBs

134
Q

Presentation of valve or septal rupture after MI

A

New onset murmur and pulm congestion

135
Q

Most accurate test for valve or septal rupture

136
Q

What to look for in septal rupture

A

Step-up in O2 sat from RA to RV

ie. sharp increase in O2 sat

137
Q

Rx stable v-tach

A

Amiodarone
Procainamide
Lidocaine

138
Q

When to use intraaortic balloon pump

A

Acute pump failure from anatomical problem fixed in OR

139
Q

What to look for in reinfarction/infarction extension after MI

A

Recurrence of pain
New Rales
New bump in CKMB
Sudden onset pulm edema

140
Q

Management of reinfarction/infarction extension after MI

A

EKG
Angioplasty
Aspirin, BBs, Nitrates, ACE, statins

141
Q

Detection of aneurysms/mural thrombus post MI

142
Q

Rx mural thrombus post MI

A

Heparin, then warfarin

143
Q

Why do stress test before d/c after MI

A

Evaluate need for angiography (residual ischemia)
Only if patient is asymptomatic
Done at 5-7 days

144
Q

Postinfarction meds

A

Aspirin
BBs
Statins
ACEIs (stop at 6wks if EF is NL)

145
Q

Alternate drugs in postinfarction

A

Clopidogrel - Aspirin intolerance
ARBs - Cough w/ ACEI
Ticlopidine - Aspirin and Clopidogrel intolerance

146
Q

MCC erectile dysfunction post-MI

147
Q

Essential feature of CHF

148
Q

Difference between systolic and diastolic dysfunction

A

EF preserved in diastolic dysfunction

Can really only tell with Echo

149
Q

MCC CHF

A

HTN causing cardiomyopathy

Myocardial muscle abnormality

150
Q

Other causes of CHF

A

Valvular heart disease

MI

151
Q

Rare causes of CHF

A 
Alcohol
Postviral
Radiation
Adriamycin
Chagas
Hemochromatosis
Thyroid disease
Peripartum
Thiamine def
152
Q

How to Dx CHF

A 
Clinical Dx
Dyspnea
Orthopnea
Rales
JVD
PND
S3
153
Q

Sudden onset dyspnea w/ clear lungs

154
Q

Sudden onset dyspnea w/ wheezing, increased expiratory phase

155
Q

Slow dyspnea w/ fever, sputum, unilateral rales/rhonchi

156
Q

Dyspnea w/ decreased breath sounds unilaterally, tracheal deviation

157
Q

Dyspnea w/ circumoral numbness, caffein use, hx anxiety

A

Panic attack

158
Q

Dyspnea w/ pallor gradual over days to weeks

159
Q

Dyspnea w/ pulsus paradoxus, decreased heart sounds, JVD

160
Q

Dyspnea w/ palpitations, syncope

A

Arrhythmia (any)

161
Q

Dyspnea w/ dullness to percussion at bases

A

Pleural effusion

162
Q

Dyspnea w/ long smoking hx, barrel chest

163
Q

Dyspnea w/ recent anesthetic use, brown blood not improved w/ O2, clear lungs, cyanosis

A

Methemoglobinemia

164
Q

Dyspnea w/ burning building/car, wood burning stove in winter, suicide attempt

A

CO poisoning

165
Q

Most important test in CHF

166
Q

Best initial test for CHF

167
Q

Most accurate test for CHF

168
Q

When would you use MUGA for CHF

A

Test for AE of doxorubicin for lymphoma Rx

169
Q

When would you check BNP in CHF

A

Acute SOB w/ unclear etiology and cannot wait for echo

Normal BNP excludes CHF

170
Q

Test if CHF etiology is from MI or heart block

171
Q

Test if CHF etiology is from dilated cardiomyopathy

172
Q

Test if CHF etiology is from paroxysmal arrhythmias

173
Q

Test if CHF etiology is from valve/septal defects

174
Q

Test if CHF etiology is from Anemia

175
Q

Test if CHF etiology is from thyroid

176
Q

Test if CHF etiology is from infiltrative disease

A

Endomyocardial bx

177
Q

Differentiate between CHF and ARDS

A

Swan-Ganz (not routine)

178
Q

Decrease mortality in systolic dysfunction

A

ACEIs/ARBs
BBs
Spironolactone

179
Q

Decrease sx in systolic dysfunction

A

Diuretics

Digoxin

180
Q

Only BBs used in systolic dysfunction

A

Metoprolol
Bisoprolol
Carvedilol

181
Q

How do BBs help in systolic dysfunction

A

Anti-ischemic
Decrease HR therefore decrease O2 consumption
Antiarrhythmic

182
Q

MCC death from CHF

A

Arrhythmia

183
Q

AE spironolactone

A

Gynecomastia - switch to eplerenone

Hyperkalemia

184
Q

When to give diuretics in CHF

A

Initial therapy w/ low EF along with ACEI/ARB

185
Q

What to do w/ hyperkalemia in CHF treatment

A

Switch ACEI to hydralazine and nitroglycerin

186
Q

Sx digoxin tox

A

GI (MC)
CNS
Visual
Hyperkalemia

187
Q

When to give implantable defibrillator in CHF

A

Ischemic cardiomyopathy w/ EF

188
Q

When to give biventricular pacemaker

A

DIlated cardiomyopathy w/ EF 120ms

189
Q

Mortality benefit in systolic dysfunction

A 
ACEIs/ARBs
BBs
Spironolactone/Eplerenone
Hydralazine/Nitrates
Implantable defibrillator
190
Q

Clear mortality benefit in diastolic dysfunction

A

BBs

Diuretics

191
Q

Worst form of CHF

A

Pulmonary edema

192
Q

Presentation of Pulm edema

A 
Acute SOB
Pink frothy productive cough
Rales, JVD, S3
Orthopnea
Edema
193
Q

What are Kerley B lines on CXR

A

Fluid in septum

194
Q

When to use BNP in pulm edema

A

SOB etiology is unclear

NL rules it out

195
Q

CXR in pulm edema

A

Vascular congestion

LVH (chronic)

196
Q

ABG results in pulmonary edema

197
Q

Most important test to do acutely in pulm edema

198
Q

Fastest way to fix acute pulm edema from arrhythmia

A

Cardioversion

199
Q

Contribution of atrial systole to CO

200
Q

Contribution of atrial systole to CO in the setting of dilated cardiomyopathy, decreased EF, valvular disease

201
Q

Best initial therapy of pulmonary edema

A

Diuretics to remove large fluid volumes

202
Q

Preload reduction in pulm edema

A

Loops
O2
Morphine
Nitrates

203
Q

When to use positive inotropes in pulm edema

A

Pt in ICU and not responding to diuretics

Dobutamine, Amrinone, Milrinone

204
Q

When to give digoxin in pulm edema

A

Chronically to increase contractility esp w/ A-fib

205
Q

Acute afterload reduction in pulm edema

A

Nitroprusside

IV hydralazine

206
Q

Chronic afterload reduction in pulm edema

A

ACEIs/ ARBs

207
Q

Main causes of regurgitant diseases

A

HTN

Ischemic heart disease

208
Q

Best initial test for any valvular disease

209
Q

Most accurate test for any valvular disease

A

Catheterization

210
Q

Endocarditis PPx in valvular disease

A

Not indicated unless there has been replacement or previous endocarditis

211
Q

MCC of MS

A

Rheumatic fever

212
Q

Associations w/ MS

A

Pregnancy

Immigrants

213
Q

Unique presenting features of MS

A

Dysphagia
Hoarseness
A-fib and stroke from enlarged LA → systemic emboli
Hemoptysis

214
Q

Murmur in MS

A

Opening snap in diastole (after S2)

Loud S1

215
Q

Common EKG findings in MS

216
Q

CXR in MS

A

Straightening of left heart border
Elevation of left main-stem bronchus
Second bubble behind heart

217
Q

Rx MS

A

Diuretics, Na restriction - preload reduction
Balloon valvuloplasty - refractory/pregnant
Valve replacement - balloon contraindicated or fails
Warfarin for A-fib
Rate control for A-fib - digoxin, BBs, diltiazem/verapamil

218
Q

Is pulm HTN a contraindication for surgery for MS

219
Q

MCC AS

A

Congenital bicuspid

Calcification from aging

220
Q

Presentation of AS

A

Angina (MC)
Syncope
CHF - poorest prognosis, 2yr survival

221
Q

Murmur in AS

A

Systolic crescendo-decrescendo

222
Q

Echo results in AS

A

Thick aortic leaflets
Decreased excursion
LVH

223
Q

CXR and EKG findings in AS

224
Q

Only true effective therapy in AS

A

Valve replacement when area

225
Q

When to do balloon valvuloplasty in AS

A

Surgery contraindicated due to instability or fragility of pt

226
Q

Cause of MR

A

Dilation of the heart

  • HTN
  • Endocarditis
  • MI
  • Papillary muscle rupture
227
Q

Only unique physical finding in MR

A

Pan(holo)systolic murmur

Rest looks like CHF

228
Q

Radiation of MR murmur

229
Q

Rx MR

A

Vasodilators - ACEIs/ARBs
Digoxin/diuretics
Valve replacement - LVSED >45 or EF

230
Q

MCC AR

231
Q

Causes of AR

A

Dilation of heart or aorta

  • HTN
  • MI
  • Endocarditis
  • Marfan, cystic medial necrosis
  • Aortic dissection
  • Ankylosing spondylitis/Reiter
  • Syphilis
232
Q

Unique PE findings in AR

A 
Wide pulse pressure
Watter hammer pulse
Pulsating nail beds
BP in legs > BP in arms
Head bobbing
233
Q

Murmur in AR

A

Diastolic decrescendo best heard at left lower sternal border

234
Q

EKG/CXR findings in AR

235
Q

Rx AR

A

Vasodilators - ACEIs/ARBs

Valve replacement - LVESD > 55, EF

236
Q

Causes of MVP

A

Normal variant W>M

Marfan, Ehlers-Danlos

237
Q

MC presentation of MVP

A

Atypical CP
Palpitations
Panic attack
Syncope

238
Q

Murmur in MVP

A

Midsystolic click

239
Q

Rx MVP

A

BBs if symptomatic

Valve repair

240
Q

Endocarditis PPx in MVP

A

Not indicated

241
Q

Murmurs increased w/ more blood to heart (Leg raise, squat)

A

MS, AS

MR, AR

242
Q

Murmurs increased w/ less blood to heart (valsalva, standing)

A

MS, AS

MR, AR

243
Q

Murmurs decreased w/ more blood to heart (Leg raise, squat)

244
Q

Murmurs decreased w/ less blood to heart (valsalva, standing)

245
Q

Murmurs that do NOT increase with expiration

246
Q

Rx for all types of cardiomyopathies

247
Q

MCC dilated cardiomyopathy

A

Previous MI and ischemia

248
Q

Other causes of dilated cardiomyopathy

A 
Alcohol - 2nd MCC
Postviral myocarditis
Radiation
Toxins
Chagas
Peripartum
249
Q

Dx dilated cardiomyopathy

A

Echo then EKG, CXR

Shows decreased EF

250
Q

Rx dilated cardiomyopathy

A

ACEIs/ARBs, BBs, spironolactone
Diuretics, digoxin
Biventricular pacemaker if QRS > 120ms

251
Q

MCC hypertrophic cardiomyopathy

252
Q

What is HOCM

A

Genetic disorder w/ abnormal shape of heart septum

253
Q

Features specific to HCM

A

S4

Fewer RHF signs

254
Q

MCC presentation of HOCM

255
Q

Other sx in HOCM

A

CP
Syncope
Sudden death

256
Q

What worsens sx in HOCM

A 
Anything increasing HR
Anything decreasing LV size
- ACEIs/ARBs
- Digoxin
- Hydralazine
- Valsalva
- Standing suddenly
257
Q

Best initial test for HCM

258
Q

Best initial therapy for HCM and HOCM

259
Q

Most accurate test for HCM

260
Q

Common EKG changes in HOCM

A

Septal Q waves

261
Q

What to give in HOCM w/ syncope

A

Implantable defibrillator

262
Q

Ultimate therapy in HOCM

A

Surgical myomectomy

Only after septal ablation is tried and meds fail

263
Q

Hand grip increases

264
Q

Hand grip decreases

265
Q

Problem in restrictive cardiomyopathy

A

Heart doesn’t contract or relax normally

266
Q

Causes of restrictive cardiomyopathy

A 
Sarcoidosis
Amyloid
Hemochromatosis
Endomyocardial fibrosis
Scleroderma
Cancer
267
Q

MC complaint in restrictive cardiomyopathy

A

Dyspnea w/ RHF signs

268
Q

Where do you see kussmaul’s sign

A

Restrictive cardiomyopathy

Constrictive pericarditis

269
Q

Best initial test for restrictive cardiomyopathy

270
Q

Most accurate test for restrictive cardiomyopathy

A

Endomyocardial Bx

271
Q

Rx restrictive cardiomyopathy

A

Treat underlying cause

Diuretics may help

272
Q

Which valvular diseases do diuretics help

A

MS, AS

MR, AR

273
Q

MC infection causing pericarditis

274
Q

MC connective tissue disease causing pericarditis

275
Q

Presentation of pericarditis

A

Sharp CP changing in intensity w/ respiration and body position
Worse lying down

276
Q

EKG in pericarditis

A

PR depression

ST elevation in all leads

277
Q

Rx pericarditis

A

Treat underlying cause

278
Q

Rx pericarditis if idiopathic cause

A

Presumed to be coxsackie B
NSAIDS - Steroids if they don’t work
Colchicine reduces recurrence

279
Q

Any cause of pericarditis can cause

A

Pericardial tamponade

280
Q

Common features of pericarditis

A

Hypotension
Tachy
Distended neck veins (not in PE)
Clear lungs

281
Q

Physical finding in tamponade

A

Pulsus paradoxus

282
Q

What is pulsus paradoxus

A

> 10mmHg decrease in BP on inspiration

283
Q

Why should echo be done over EKG in tamponade

A

EKG commonly only shows tachy

284
Q

EKG feature in tamponade

A

Electrical alternans

285
Q

CXR feature in tamponade

A

Water bottle heart

286
Q

Echo feature in tamponade

A

RA and RV diastolic collapse

287
Q

Rx tamponade

A

Pericardiocentesis
IVF
Subxyphoid window in pericardium for recurrence

288
Q

What is constrictive pericarditis

A

Any cause of pericarditis leading to calcification and fibrosis (can be from TB)

289
Q

Sx indicating constrictive pericarditis

A

Signs of RHF

  • Edema
  • Ascites
  • Hepatosplenomegaly
  • JVD
290
Q

Physical findings in constrictive pericarditis

A

Kussmaul sign - Increased JVD on inhalation

Knock - extra heart sound in diastole

291
Q

Best initial test for constrictive pericarditis

A

CXR showing calcification and fibrosis

292
Q

Rx Constrictive pericarditis

A

Diuretics FIRST

Surgical removal of pericardium

293
Q

Causitive factors for PAD

A

DM
Hyperlipidemia
HTN
Smoking

294
Q

Key sx in PAD

A

Leg pain in calves on exertion (intermittent claudication)

Pain walking up and down hills

295
Q

Differentiate PAD from spinal stenosis in Hx

A

Stenosis is pain waling down hills only

296
Q

Severe PAD is associated with loss of

A

Hair follicles
Sweat glands
Sebaceous glands

Skin looks smooth and shiny

297
Q

Best initial test for PAD

298
Q

Most accurate test for PAD

299
Q

Best initial therapy for PAD

A

Aspirin
Stop smoking
Cilostazol

300
Q

Single most effective medication for PAD

A

Cilostazol

301
Q

Sx description in aortic dissection

A

Severe, Sharp, Tearing

Radiating through to back

302
Q

Key points of aortic dissection

A

Loss of pulses +/- aortic insufficiency
BP difference b/w arms
Pain between scapulae

303
Q

CXR feature in aortic dissection

A

Widened mediastinum

304
Q

Most accurate test for aortic dissection

A

Angiography

However MRA = CTA = TEE

305
Q

Best initial test for aortic dissection

306
Q

Rx aortic dissection

A

Control BP

  • BBs
  • Nitroprusside
  • Surgical correction
307
Q

Most appropriate screening for aortic aneurysm

A

Surgical/Catheter repair when AAA > 5cm

308
Q

Who doesn’t get screened for AAAs

A

Non-smokers

Women

309
Q

Worst form of heart disease in pregnancy

A

Peripartum cardiomyopathy
- Abs against myocardium in pregnancy

If this isn’t a choice then Eisenmenger

310
Q

Rx if LV dysfunction doesn’t improve

A

Cardiac transplant

311
Q

Medical therapy of peripartum cardiomyopathy

A 
ACEIs/ARBs
BBs
Spironolactone
Diuretics
Digoxin
312
Q

Eisenmenger syndrome

A

R to L shunt from pulm HTN in people w/ VSD

Step 2 CK (21 decks)

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