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Step 2 CK > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the 2 different methods of detecting ischemia in an unclear EKG?

A

Nuclear isotope uptake or ECHO are 2 best methods for detecting ischemia and EQUAL in terms of sensitivity and specificity

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2
Q

Difference between ischemia and infarction on isotope uptake and echo?

A

Ischemia is decreased perfusion and will be detected by seeing REVERSAL of the decrease uptake or wall motion that will return to normal after a period of rest

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3
Q

Where must you avoid dipyridamole for medication stress test?

A

Asthmatics; PDE5 inhibitor–> Increase cAMP–>Increase bronchospasm

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4
Q

What is used with nuclear isotope uptake for non-exercise stress test?

A

Dipyridamole or adenosine

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5
Q

What is used with ECHO for non-exercise stress test?

A

Dobutamine

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6
Q

Cardiac test workup

A

Chest pain–> EKG–>Exercise stress test–> If EKG not clear, exercise or medication thallium or echo–>Coronary angiography determines if no catheterization or catheterization (bypass vs angioplasty vs meds alone)

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7
Q

Most accurate test for CAD

A

Angiography

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8
Q

Management for >70% stenosis on angiography:

1) 1-2 vessel disease
2) 3 vessel disease, left main or 2 vessel disease in diabetics

A

1) PCI (stent)

2) CABG

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9
Q

What is Holter monitor used for and how long?

A

Generally 24 hour period and mainly detecting rhythm disorders where it is NOT ACCURATE for evaluating ST segment or ischemia

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10
Q

Chronic stable anginal medications that lower mortality

A

Aspirin, B-blockers

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11
Q

Difference in Nitroglycerin administration in chronic stable angina vs. ACS (unstable, NSTEMI, STEMI)?

A

Chronic stable-patch or oral

ACS-sublingual, paste, IV forms

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12
Q

What should patients with ACS receive when arriving to ER?

A

2 antiplatelet medcations-combination of aspirin and P2Y12 inhibitors (prasugrel, clopidogrel, ticagrelor)

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13
Q

What P2Y12 ihibitor useful when angioplasty and stenting planned?

A

Prasugrel (best evidence) or ticagrelor (restenosis of stenting best prevented by these two compared to clopidogrel)

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14
Q

When is clopidogrel used?

A

1) ACS along with aspirin
2) Aspirin intolerance such as allergy
3) Recent angioplasty with stenting (decreases restenosis from stenting but INFERIOR to other 2 antiplatelets)

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15
Q

What population is prasugrel dangerous for?

A

> 75 b/c of hemorrhagic stroke risk

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16
Q

Use of ticlodipine?

A

Patient INTOLERANT of both aspirin and clopidogrel

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17
Q

Side effects ticlodipine?

A

Neutropenia and TTP

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18
Q

Where do ACE inhibitors have best mortality benefit?

A

Low EF/systolic dysfunction w/ CHF symptoms by decreased preload AND afterload

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19
Q

What can you switch someone to if ACE inhibitor not tolerable for CHF?

A

Hydralazine (decrease afterload) and nitrates (decrease preload)

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20
Q

When do you use statin?

A

1) CAD with ANY LDL

2) CAD with LDL>100 and CAD w/ diabetes with LDL>70

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21
Q

What are some CAD equivalents?

A

PAD, Aortic disease, carotid disease, diabetes, stroke

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22
Q

What drug provides definite mortality benefit for management of hyperlipidemia?

A

Statin

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23
Q

Niacin use?

A

Adjunct to statin to decrease LDL. Also, increases HDL and decreases triglycerides

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24
Q

Niacin side effects?

A

Hyperglycemia (glucose intolerance), Hyperuricemia, pruritis (from histamine release)

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25
Q

Fibrates use?

A

Help severely decrease triglycerides

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26
Q

Fibrates side effect?

A

Myositis (especially with statin use)

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27
Q

Bile acid resins (eg cholestyramine) use?

A

Decrease LDL secondary to decreased bile acid absorption so liver must make more cholesterol to help absorb bile

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28
Q

Bile acid resins side effects?

A

GI upset (decrease absorption of other drugs and fat soluble vitamins)

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29
Q

Ezetimide use?

A

Decrease LDL w/o any evidence of actual benefit to patient.

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30
Q

What do you use if you have statin intolerance?

A

Ezetimibe

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31
Q

Ezetimide side effects?

A

Rare increase LFT, diarrhea

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32
Q

Do DHP CCB decrease mortality in CAD?

A

No. Might actually increase mortality from reflex tachycardia leading to increase myocardial oxygen consumption specifically in DHP type

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33
Q

When should you used non-DHP CCB for CAD?

A

1) Severe asthma precluding use of beta blockers
2) Prinzmental angina
3) Cocaine induced chest pain
4) Inability to control pain with maximum medical therapy

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34
Q

CCB Adverse effects?

A

Edema, constipation, heart block

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35
Q

Best therapy for ACS?

A

PCI (angioplasty) provides greatest mortality benefit

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36
Q

What two treatments are equal in chronic stable angina in terms of mortality benefit?

A

PCI=Maximum medical therapy (aspirin, B-blocker, ACEi, statins)

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37
Q

Two causes of PMI displacement?

A

1) LVH

2) Dilated cardiomyopathy

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38
Q

V1, V2 leads?
II, III, aVF leads?
V2-V4 leads?

A

1) Posterior (unique cause ST depression here would be like ST elevation elsewhere–>acute infarction)
2) Inferior
3) Anterior (30-40% mortality) associated with acute MI

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39
Q

What should treatment of PVCs be when associated with acute infarction?

A

Nothing. Only worsens outcome

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40
Q

Patients with MI should be given aspirin within what time and angioplasty within what time and thrombolytics?

A
  • Aspirin 30 minutes within onset
  • Angioplasty (within 90 minutes of entering door)
  • Thrombolytics (within 30 minutes of entering door where benefit extends out to 12 hours from onset of chest pain)
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41
Q

Why is ICU monitoring for MI important?

A

Ventricular arrhythmia common post-MI and rapid performance of electrical cardioversion or defibrillation is available

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42
Q

What are complications of PCI?

A

1) Restenosis (thrombosis) of vessel after angioplasty
2) Rupture of coronary artery on inflation of the balloon
3) Hematoma at site of entry into the artery (eg femoral area hematoma)

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43
Q

What drugs are used in drug-eluting stent and how does it work?

A

Drugs-Paclitaxel, siroliumus

MOA: Inhibit local T cell response markedly reducing rate of restenosis

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44
Q

1) Warfarin is for ___

2) Aspirin is for ___

A

1) Veins

2) Arteries

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45
Q

How is angioplasty superior to thrombolytics?

A

1) Survival/mortality benefit
2) Fewer hemorrhagic complications
3) Likelihood of developing complications of MI (less arrhythmia, less CHF, fewer septum ruptures, free all (tamponade) and papillary muscles (valve rupture))

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46
Q

Absolute contraindications to thrombolytics? (4)

A

1) Major bowel bleeding (melena) or brain (any CNS bleed). Heme positive NOT contraindication
2) Surgery in last 2 weeks
3) HTN >180/110
4) Non-hemorrhagic stroke in last 6 months

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47
Q

When is heparinuse good for ACS?

A

ST depression that helps PREVENT clot forming (best next step after aspirin). LMWH>unfractionated heparin in terms of mortality benefit

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48
Q

When is tPA (thrombolytics) use good for ACS?

A

STEMI or LBBB that helps BREAK clots

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49
Q

When are GPIIb/IIIa inhibitors used?

A

NSTEMI who are to undergo angioplasty and stenting

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50
Q

When is urgent angiography and possible angioplasty in NSTEMI ACS indicated?

A
  • Persistent pain
  • S3 gallop or CHF developing
  • Worse EKG changes or sustained VTACH
  • Rising troponin levels
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51
Q

Treatment of symptomatic bradycardias post-MI?

A

1) Atropine

2) Pacemaker IF atropine ineffective

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52
Q

What areas does RCA serve?

A

1) RV
2) AV node
3) Inferior wall of heart

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53
Q

Treatment of RV infarction and what should you avoid?

A

Treat-high-volume fluid replacement

Avoid-Nitroglycerin (worsen cardiac filling)

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54
Q

Treatment of tamponade/free wall rupture?

A

Emergency pericardiocentesis

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55
Q

How can you tell about valve/septal rupture?

A

New onset of murmur (either apex (MR) or LLSternalborder(VSD) and pulmonary congestion

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56
Q

Most accurate test for valve and septal rupture?

A

Echocardiogram

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57
Q

What test can be used to determine septal rupture?

A

Oxygenation changes from right atrium increasing to right ventricle

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58
Q

What is an intraaortic balloon pump?

A

Contracts and relaxes in sync with natural heartbeat serving as a bridge to valve or transplant surgery

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59
Q

How do you differentiate 3rd degree AV block vs. sinus bradycardia?

A

Presence of cannon A waves in 3rd degree AV block

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60
Q

Why do you do post-MI stress test?

A

Determine those with residual ischemia and have opportunity to determine if angiography is needed for additional reversible revascularization

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61
Q

Do you give prophylactic antiarrhythmics post-MI?

A

NO. They just increase mortality

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62
Q

What is most common drug to cause ED post-MI

A

B-blocker; most common cause overall is from anxiety

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63
Q

Does patient have to wait after MI to reengate in sexual activity?

A

NO may begin immediately

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64
Q

What is MCC of CHF?

A

Hypertension

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65
Q

What are vast majority (95%) of causes of systolic CHF?

A

Infarction, cardiomyopathy, and valve disease

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66
Q

What is most accurate test for CHF even though it is rarely done?

A

Endomyocardial biopsy

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67
Q

Most common presenting sign of CHF?

A

Dyspnea

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68
Q

What is the significance of S3/S4 gallop?

A

S3-rapid filling of blood backed up into LV

S4-Atrial systole into stiff or noncompliant ventricle.

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69
Q

What heart sound is present in CHF?

A

S3 gallop

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70
Q

What is circumoral numbness?

A

Numbness around mouth. Happens when you lower Ca2+ leading to premature depolarization and feeling of numbness around mouth

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71
Q

Presence of palpitations, syncope

A

Arrhythmia of almost any kind

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72
Q

Dullness to percussion at bases

A

Pleural effusion

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73
Q

What is most important test to CHF?

A

ECHO. Allows for EF evaluation

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74
Q

Best initial test for EF?

A

Transthoracic echo

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75
Q

Most accurate test for EF?

A

MUGA (multiple-gated acquisition scan) or Nuclear ventriculography

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76
Q

When should you use nuclear ventriculography?

A

Patients on chemo with doxorubicin. Need to give max chemo but don’t want to cause cardiomyopathy

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77
Q

When is BNP testing right answer for CHF?

A

Acute dyspnea with unclear etiology and can’t wait for echo to be done (normal BNP EXCLUDES pulmonary edema)

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78
Q

First line tx. for systolic CHF?

A

ACE inhibitors

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79
Q

What is MCC death in CHF?

A

Arrhythmia secondary to ischemia leading to death

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80
Q

What drug has been shown to decrease mortality in addition to ACE inhibitor?

A

Spironolactone

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81
Q

Adverse effects spironolactone?

A

Hyperkalemia/gynecomastia

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82
Q

What can you use instead of spironolactone to prevent anti-androgenic effects?

A

Eplerenone

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83
Q

Do diuretics lower mortality in CHF patients?

A

No. Spironolactone is technically a diuretic but not used at diuretic doses

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84
Q

Does digoxin lower mortality for CHF patients?

A

NO. Used to control symptoms of dyspnea and in fact no positive inotrope has been shown to lower mortality.

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85
Q

What drugs provide mortality benefit in systolic dysfunction?

A

ACE/ARB, B-blocker, Spironolactone/eplerenone, hydralazine/nitrates, implantable defibrillator

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86
Q

What is the indication of an implantable defibrillator?

A

Ischemic cardiomyopathy and EF

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87
Q

When is biventricular pacemaker indicated?

A

Dilated cardiomyopathy, EF120 ms

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88
Q

How do you manage diastolic CHF?

A

B-blockers and diuretics provide clear benefit. Digoxin and spironolactone NOT beneficial. ACE/ARB and hydralazine are uncertain.

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89
Q

What drugs can worsen HOCM?

A

Diuretics (Decrease preload–> Increase obstruction and worsening symptoms), positive inotropes, vasodilators

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90
Q

What symptom indicates worst, or most severe form of CHF?

A

Pulmonary edema

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91
Q

Why is hypoxia expected in CHF?

A

Presence of respiratory alkalosis because of hyperventilation

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92
Q

What is best test to do acutely for pulmonary edema?

A

EKG (b/c can lead to change in therapy if different underlying cause besides CHF exacerbation as cause like arrhythmias)

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93
Q

Best initial therapy for acute pulmonary edema?

A

IV furosemide

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94
Q

What other therapies for initial acute pulmonary edema?

A

Oxygen, morphine, nitrates.

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95
Q

What if initial acute pulmonary edema therapy does not work?

A

Dobutamine can be used in acute setting (increase contractility and decrease afterload).

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96
Q

Can digoxin be used for acute pulmonary edema in CHF?

A

NO. Takes several weeks to work and no role in acute setting

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97
Q

What lesions are louder with inhalation/exhalation?

A

Inhalation-Rt. sided lesions (increased venous return to right side of heart)
Exhalation-Lt. sided lesions (increased blood flow to left side of heart)

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98
Q

Best initial test for valvular heart disease?

A

Transthoracic echo, with TEE more accurate than TTE

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99
Q

Most accurate test for valvular heart disease?

A

Catheterization (precise measurement of valvular diameter and exact pressure gradient across valve)

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100
Q

Why will ALL valvular heart disease patients benefit from diuretics?

A

All of them associated with fluid overloaded state

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101
Q

Best treatment for stenosis?

A

Mitral stenosis-balloon because this is fibrous tissue

Aortic stenosis-surgical removal because this is calcified tissue

102
Q

Best treatment for regurgitant lesions?

A

Vasodilator therapy (ACEi/ARB, nifedipine, hydralazine)

103
Q

When does treatment of regurgitant lesions change from medical management?

A

When heart dilates excessively, 55 mm for aortic and 40 mm for mitral

104
Q

Most common symptoms in all forms of valvular heart disease

A

Dyspnea and CHF

105
Q

Symptoms of MS that are unique?

A

Dysphagia, hoarseness, AFIB and stroke (from enormously large LA), hemoptysis (from back flow of blood into lungs bursting lung blood vessels)

106
Q

What part of murmur signifies worsening MS?

A

Earlier opening snap

107
Q

EKG findings in AFIB

A

Biphasic P waves in leads V1 and V2

108
Q

Mitral stenosis treatment (4)

A

1) Diuretics and sodium restriction
2) Balloon valvuloplasty with catheter
3) Warfarin for AFIB (2-3 INR)
4) Rate control with (digoxin, B-blocker, Ca2+ channel blocker)

109
Q

Aortic stenosis triad

A

Angina (most common presentation)
Syncope
Dyspnea (CHF)

110
Q

Type of murmur in AS

A

Crescendo-decrescendo systolic ejection murmur “diamond shaped” radiating to carotid arteries

111
Q

What maneuvers decrease AS murmur?

A

Valsalva, standing (both decrease preload) or handgrip (decreases ejected blood amount)

112
Q

What maneuvers increase AS murmur?

A

Squatting/leg raising

113
Q

How is cardiac enlargement defined on CXR?

A

Heart greater than 50% of the total transthoracic diameter.

114
Q

What is underlying cause of MR?

A

Heart dilation

115
Q

What is in MR murmur?

A

Holosystolic high pitched blowing murmur that obscures both S1 and S2 with radiation to the axilla.

116
Q

What maneuvers worsen murmur?

A

Handgrip, squatting/leg raising (increased venous return), expiration (increased bloodflow to left heart)

117
Q

Treatment of MR?

A

1) ACE/ARBi best

118
Q

When do you replace valve in MR?

A

LVESD>40 mm or EF

119
Q

Explain physiology for vasodilators (ACE/ARB) used for regurgitant lesions?

A

With vasodilation–>less pressure on heart–>easier for forward flow–>less regurgitation

120
Q

Besides CHF, what other unique physical findings found for AR?

A

Wide pulse pressure (150-60/50-60), Water-hammer bounding pulse, quincke pulse (pulsations in nail bed), hill sign (BP in legs as much as 40 mmHg above arm BP), head bobbing (de musset sign)

121
Q

Murmur of AR?

A

Diastolic, decrescendo murmur

122
Q

What worsens AR murmur?

A

Handgrip

123
Q

When do you replace valve in AR?

A

LVESD>55 mm or EF

124
Q

What makes AR murmur better?

A

valsalva and standing (decreased preload)

125
Q

What is unique about symptoms of MVP murmur?

A

Symptoms of CHF usually absent. Presents with atypical chest pain, palpitations, panic attack

126
Q

Murmur of MVP?

A

Late systolic crescendo murmur with midsystolic click (due to sudden tensing of chordae dendineae)

127
Q

What makes sound of MVP better/worse?

A

Better-Squatting/handgrip/leg raising

Worsen-Valsalva and standing

128
Q

MVP treatment

A
  • B-blockers when symptomatic

- Valve repair placing clip to tighten the valve.

129
Q

Dilated cardiomyopathy has what other features?

A

Systolic dysfunction and low EF

130
Q

Hypertrophic cardiomyopathy has what other features?

A

Diastolic dysfunction

131
Q

What drug is involved in the treatment of all types of cardiomyopathy?

A

Diuretics

132
Q

Best initial and most accurate test for cardiomyopathy?

A

Echocardiography

133
Q

What drugs lower mortality in dilated cardiomyopathy?

A
  • ACE/ARB
  • B-blocker (ie metoprolol/carvedilol)
  • Spironolactone
  • Automated implantable cardioverter/defibrillator (some patients)
134
Q

Why is spironolactone given?

A

Decrease afterload and decrease RAAS; not used as a diuretic

135
Q

MCC hypertrophic cardiomyopathy?

A

HTN

136
Q

MCC dilated cardiomyopathy?

A

MI/Ischemia

137
Q

PE findings for dilated cardiomyopathy?

A

Symptoms of HF, S3 systolic regurgitant murmur

138
Q

PE hypertrophic cardiomyopathy?

A

S4, systolic murmur

139
Q

PE hypertrophic OBSTRUCTIVE cardiomyopathy?

A

dyspnea, chest pain, syncope, SCD, symptoms worsened by anything that increases heart rate or decreases left ventricular chamber size

140
Q

What is best initial therapy for HOCM and ordinary HCM?

A

B-blockers (Decreasing HR is an important factor)

141
Q

EKG changes in HOCM?

A

Septal Q waves in inferior and lateral leads; tall R wave in aVL + deep S wave in V3

142
Q

Tx. of HOCM? (3 in order of best to last option)

A

1) Implantable defibrillator
2) Septum ablation
3) Surgial myomectomy

143
Q

Differences in therapy with dilated and hypertrophic cardiomyopathy?

A

Both-B-blocker and diuretics

Dilated-ACE/ARB, digoxin, spironolactone

144
Q

Symptoms of Restrictive cardiomyopathy?

A

Dyspnea. RHF symptoms (ascites, edema, JVD, liver and spleen enlargement, Kussmaul sign)

145
Q

How can you detect amyloid?

A

Speckling of septum on echo or cardiac MRI?

146
Q

standing and valsalva are similar to using what drug?

A

Diuretic. So MVP and HOCM gets worse with this drug and those maneuvers.

147
Q

Amyl nitrate acts where?

A

Arteriolar vasodilator

148
Q

Handgrip and amyl nitrate have no meanigful effect on what murmur?

A

Mitral stenosis

149
Q

Handgrip has what effect on MVP and HOCM?

A

Decreases (a bigger, fuller heart improves the symptoms)

150
Q

MCC of pericarditis?

A

Viral infection

151
Q

Tx of pericarditis and prophylaxis (for majority of cases that are viral)
Tx for other causes

A

Tx-NSAIDs
Prophylaxis-Cochicine

Tx for other causes: Underlying cause

152
Q

EKG of pericarditis

A
  • ST elevation all leads

- PR depression (most specific finding)

153
Q

What is most likely diagnosis with hypotension, tachycardia, distended neck veins and clear lungs?

A

Pericardial effusion

154
Q

EKG of cardiac tamponade?

A

Electrical alternans (different heights of QRS complexes between beats)

155
Q

What should you not give to patients during tamponade?

A

Diuretics (Decrease intracardiac filling–> increased chance of right side of heart to collapse)

156
Q

What is constrictive/restrictive pericarditis?

A

Calcification and fibrosis due to chronic pericarditis that prevents filling of the right side of the heart. (eg TB)

157
Q

What physical findings will be present for constrictive/restrictive pericarditis?

A

Kussmaul sign (increased JVD on inhalation), Pericardial knock (extra heart sound in diastole from ventricular filling against rigid pericardium), signs of RHF (peripheral edema, ascites, elevated JVP (>8 cmH20), + hepatojugular reflux )

158
Q

Best initial test and most accurate test for constrictive pericarditis?

A

Best initial: CXR

Most accurate: CT/MRI

159
Q

Why is echo not useful in constrictive pericarditis?

A

Normal movement of myocardium is present

160
Q

Tx. for constrictive pericarditis? (2)

A

1) Diuretics (decompress filling and relieve) symptomatic relief
2) Surgical removal of pericardium (pericardiectomy)

161
Q

Best initial/Most accurate for PAD

A

Best initial-ABI

Most accurate-Angiogram

162
Q

Range of tests for ABI

A

1.3-abnormal with possible calcified and incompressible vessels

163
Q

Tx. PAD

A

1) Aspirin
2) Stopping smoking
3) Cilostazol

164
Q

Most effective PAD medication

A

Cilostazol (PDE inhibitor that inhibits platelet aggregation and is a direct arterial vasodilator)

165
Q

When is surgery for PAD an option?

A

When maximum medical therapy is not effective

166
Q

Key features of presence for aortic dissection

A

1) Pain in between scapulae

2) Difference in pressure between arms (>20 mmHg pressure difference)

167
Q

Best initial test/most accurate for aortic dissection

A

Best initial-CXR

Most accurate-CT angiogram w/ contrast and TEE (if patient has ARF)

168
Q

Aortic dissection treatment

A

Stanford Type A-Surgery

Stanford Type B-B-blocker followed by nitroprusside. Needs to be in this order to prevent reflex tachy

169
Q

AAA screening guidelines

A

> 65, male, smoker; U/S 1 time screening

170
Q

What is most dangerous heart disease for pregnant women?

A

1) Peripartum cardiomyopathy (antibodies to heart in pregnancy) with LV dysfunction most commonly after pregnancy with medical management as dilated cardiomyopathy.
2) Eisenmenger syndrome (patient who has VSD)

171
Q

What is Duke criteria for infectious endocarditis?

A

Gives definitive diagnosis:

  • 2 major + 1 minor
  • 1 major + 3 minor
  • 5 minor
172
Q

What are major criteria for Duke for endocarditis?

A

MAJOR

    • blood culture
  • typical blood culture microorganism on 2 separate cultures (S. aureus, viridans streptococci, s pidermidis, s bovis)
  • Evidence of endocardial involvement
173
Q

What are minor criteria for Duke for endocarditis?

A

MINOR

  • Predisposing heart condition or IV drug abuse
  • Fever >38 C
  • Vascular phenomenon
  • Immunologic phenomenon (glomerulonephritis, osler nodes, roth spots)
  • Microbiology evidence: + blood culture, but not meeting major criterion as previously noted
174
Q

AV block with infectious endocarditis should raise suspicion for what?

A

Perivalvular abscess extending into adjacent cardiac conduction tissues pathways

175
Q

Treatment of viridans group strep during endocarditis and duration?

A

IV penicllin or IV ceftriaxone for 4 weeks

176
Q

Best initial test endocarditis?

A

Blood culture

177
Q

Best initial empiric therapy?

A

Vancomycin and gentamicin

178
Q

S. aureus endocarditis (sensitive) tx. ?

A

Oxacillin, nafcillin, or cefazolin

179
Q

Fungal endocarditis tx.?

A

Amphotericin and valve replacement?

180
Q

S. epidermis or resistant staph endocarditis?

A

Vancomycin

181
Q

Enterococci endocarditis?

A

Ampicillin and gentamicin

182
Q

When do you most commonly see viral pericarditis?

A

After upper URI

183
Q

Cause of pericardial effusion in viral pericarditis?

A

Pericardial membrane inflammation causes extra fluid within pericardial cavity leading to effusion and compression of cardiac chambers

184
Q

What happens with pericardial effusion pathophys?

A

Decreased preload–>decrease CO–>hypotension and syncope

185
Q

Becks triad of cardiac tamponade?

A

Hypotension, distended neck veins and muffled heart sounds?

186
Q

What happens to blood pressure on inspiration in tamponade and what causes it?

A

Pulus paradoxus (>10 mm Hg drop in systolic blood pressure during inspiration) b/c interventricular septum moves toward left ventricular cavity that reduces left ventricular preload, SV, and CO.

187
Q

What is management of uremic pericarditis?

A

Urgent hemodialysis

188
Q

Most commonly presenting sign of uremic pericarditis?

A

Fever

189
Q

Cause and Clinical features of rheumatic fever?

A

Group A B-hemolytic streptococci. JONES (Joints (migratory arthritis), O (pancarditis), Nodules (subcutaneous), Erythema marginatum, Sydenham chorea

190
Q

Prophylaxis for rheumatic fever?

A

IM benzathine penicillin G every 4 weeks

191
Q

Prophylaxis (rheumatic fever w/o carditis)

A

Abx for 5 years or until 21 years old (whichever is longer)

192
Q

Prophylaxis (rheumatic fever w/ carditis but no residual heart or valvular disease)

A

Abx for 10 years or until 21 years old (whichever is longer)

193
Q

Prophylaxis (rheumatic fever with carditis and persistent heart or valvular disease)

A

Abx for 10 years or until 40 years old (whichever is longer)

194
Q

Where is pulsus paradoxus seen besides tamponade?

A

Severe asthma/COPD

195
Q

Findings on echocardiogram of viral myocarditis?

A

Dilated ventricles and diffuse hypokinesia resulting in systolic dysfunction (low EF)–>dilated cardiomyopathy

196
Q

Why don’t you see ECG changes in uremic pericarditis?

A

No involvement of epicardium

197
Q

Causes of pericarditis?

A

Idiopathic (most common; presumed viral after URI), Viral (coxsackie B virus), autoimmune (SLE, RA), neoplasia, uremia, post-MI (Dressler), radiation

198
Q

When does uremic pericarditis typically occur?

A

Patients with renal failure who have BUN>60 mg/dL

199
Q

Dressler syndrome treatment?

A

NSAIDS or corticosteroids in refractor cases when NSAIDs contraindicated

200
Q

Pain is sharp, focal, lasts for hours in center for chest and is worse with inspiration and movement?

A

Costochondritis

201
Q

What are indications for urgent dialysiss?

A

AEIOU

  • Acidosis (ph6.5) refractory to medical therapy
  • Ingestion (toxic alcohols, salicylate, lithium, sodium valproate, carbamazepine)
  • Overload (volume overload refractory to diurectics)
  • Uremia (symptomatic (encephalopathy, pericarditis, bleeding))
202
Q

When do you repair AAA? (3 situations)

A

> 5.5 regardless of symptoms, >0.5 cm in 6 months or >1 cm in 1 year, presence of symptoms (abdominal, back, or flank) regardless of size

203
Q

Most accurate test for abdominal aneurysm?

A

CT scan

204
Q

What is cause of ascending vs. descending aortic aneurysms?

A

Ascending-cystic medial necrosis (aging) or connective tissue disorders
Descending-Atherosclerosis

205
Q

What findings will be present for aortic coarctation?

A
  • Brachial-femoral delay
  • Upper extremity HTN, lower extremity hypotension
  • Continouous cardiac murmur from large collaterals between hypertensive and hypoperfused vessels
  • Rib notching (dilation of collateral chest wall vessels)
206
Q

Tx. of aortic coarctation?

A

Balloon angio +/- stent

207
Q

What studies are done for coarctation and what is the finding?

A
  • ECG shows LVH
  • CXR-notching of 3rd-8th ribs from enlarged intercostal arteries
  • ECHO: diagnostic confirmation
208
Q

What is aortic coarctation associated with? (3)

A

Turner, Bicuspid aortic valve, VSD

209
Q

What happens to SVR, preload, CO with AV fistula?

A
  • Decreased SVR
  • Increased preload
  • Increased CO
210
Q

When is carotid endarterectomy indicated in men and women?

A

Women-70-99% for asymptomatic and symptomatic

Men-60-99% asymptmatic, 50-69% symptomatic and 70-99%

211
Q

How do you monitor patients with stenosis who don’t need an operation?

A

Annual duplex U/S

212
Q

What is PEA?

A

Rhythm on cardiac monitoring without a measurable BP or palpable pulse in a cardiac arrest patient in a cardiac arrest patient

213
Q

How do you manage PEA vs. VTACH/VFIB?

A

PEA-CPR and vasopressor therapy for adequate cerebral and coronary perfusion (eg epinephrine). NO ROLE FOR DEFIBRILLATION!
VTACH/VFIB-CPR and defibrillation

214
Q

Adult tachyarrhythmia

1) Hemodynamically stable (narrow) management
2) Hemodynamically stable (wide) management
3) Hemodynamically unstable (narrow or wide) managmenet

A

1) Vagal maneuvers (eg carotid sinus massage); IV adenosine (adenosine helps DROP) or 2nd line Ca2+ channel blockers
2) IV antiarrhythmics (amiodarone, procainaminde)
3) Immediate synchronized DC cardioversion

215
Q

Sinus bradycardia management?

A

Treat reversible causes, followed by IV atropine (atropine helps TOP) if this is inadequate

216
Q

CVP, CO, SVR in hypovolemic, cardiogenic, obstuctive, and distributive shock.

A

Hypovolemia-decrease CVP, decrease CO, increase SVR
Cardiogenic/Obstructive-increase CVP, decrease CO, increase SVR
Distributive-Decrease CVP, Increase CO, Decrease SVR

217
Q

What is cardiac index?

A

Just a measure of pump function of the heart that correlates to CO

218
Q

Management of exertional vs nonexertional heat stroke?

A
  • Exertional-rapid cooling (ice water immersion)
  • Nonexertional-evaporative cooling (spray luke warm water and blow fans); ice water immersion here may actually be associated with an increased mortality
219
Q

Tx. acute decompensated HF with normal BP and adequate end organ perfusion?

A

1) Supplemental O2
2) IV loop diuretic (eg furosemide)
3) Consider IV vasodilator (eg nitroglycerin)

220
Q

Tx. acute decompensated HF with hypotension or signs of shock?

A

1) Supplemental O2

2) IV furosemide, IV vasopressor (NE)

221
Q

What electrolyte abnormality will be seen with systolic HF?

A

Hyponatremia (parallels to severity of HF and independent predictor of adverse clinical outcomes)

222
Q

Fibromuscluar dysplasia arteries involved, diagnosis test, and treatment?

A

Arteries-Renal, carotid, vertebral
Diagnosis-CT angio abdomen or Duplex U/S
Treatment-Angioplasty w/ stent placement

223
Q

Medications to withhold for cardiac stress testing:

  • 48 hours before?
  • 48 hours before for vasodilator stress test?
  • 12 hours before for vasodilator stress test?
  • Meds to continue?
A
  • B-blockers, Nitrates, Ca2+ channel blockers
  • Dipyridamole
  • Caffeine containing foods/drinks
  • ACEi/ARB, statin, digoxin, diuretics
224
Q

Tx. of HTN in ADPKD

A

ACEi

225
Q

Renal bruit vs AAA bruit?

A

Renal-systolic diastolic abdominal bruit

AAA-systolic bruit and pulsatile abdominal mass

226
Q

Pulm systolic pressure in cor pulmonale?

A

> 25 mm Hg

227
Q

How do you differentiate liver vs heart causes of lower extremity edema?

A

Liver (cirrhosis/primary hepatic disease)-normal JVP and negative hepatojugular reflux
Heart-Elevated JVP and positive hepatojugular reflux

228
Q

What murmurs should be worked up and those that can be left alone?

A

Work up with TTE-Diastolic/continuous murmurs

No workup needed-midsystolic soft murmurs

229
Q

Where is AR heard best in valvular vs aortic root disease?

A

Valvular-best at left sternal boarder

Aortic root-best at right sternal border

230
Q

Indications of heparin in setting of chest pain/MI?

A
  • Thrombus
  • Unstable angina
  • Severe CHF
231
Q

Tx. of idiopathic pulmonary HTN?

A

Prostacyclin, antiendothelin (bosentan), PDE 5 inhibitor,s and Ca2+ channel blockers

232
Q

Murmur of HOCM?

A

Harsh crescendo-decrescendo systolic murmur

233
Q

Most common location of ectopic foci that cause afib?

A

Pulmonary veins

234
Q

Management of PVC if symptomatic?

A

B-blocker

235
Q

Tx. of hemodynamically stable vs. unstable ventricular tachycardia?

A

Stable-IV amiodarone before cardioversion

Unstable-Electrical cardioversion

236
Q

Anterior MI: Blocked vessel and EKG involved?
Inferior MI: Blocked vessel and EKG involved?
Posterior MI: Blocked vessel and EKG involved?
Lateral MI: Blocked vessel and EKG involved?
Rt ventricle MI: Blocked vessel and EKG involved?

A

Anterior: LAD, V1-V6
Inferior: LCX/RCA, II,III, avF
Posterior: LCX/RCA, ST depression V1-V3, St elevation I and aVL (LCX) and ST depression I and AvL for RCA
Lateral: LCX/diagonal, ST elevation in leads I, aVL, V5, and V6; ST depression in leads II, III, aVF
Rt ventricle MI (50% of inferior MI): RCA and ST elevation in leads V4-V6R

237
Q

What is treatment of Right ventricular MI?

A

high flow IV fluids due to preload dependence

238
Q

What should be given within 24 hours of MI to limit ventricular remodeling?

A

ACEi

239
Q

How is situational syncope different than postural hypotension?

A

No orthostatic BP changes observed in situational syncope

240
Q

Diagnosis of amyloidosis?

A

Abdominal fat pad aspiration biopsy

241
Q

What can help reduced DHP Ca2+ channel blockers peripheral edema?

A

ACEi/ARB by causing post capillary venodilation to counteract ca2+ channel blockers causing pre capillary arteriolar dilation

242
Q

What drugs improve mortality in CHF?

A

ACEi/ARB, B-blocker, spironolactone

243
Q

Digoxin MOA?

A

Rate control in rapid AFIB (decrease conduction at AV node and depression of SA node) and improve symptoms in patients with CHF (increase contractility)

244
Q

CYP450 inducers (decrease bleeding from warfarin)

A

Chronic Alcoholics Steal Phen Phen and Never Refuse Greasy Carbs (Chronic alcohol use, St. John wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine)

245
Q

CYP450 inhibitors (increase bleeding risk from warfarin)

A

AAA RACKS IN GQ (Acute alcohol use, Ritonavir, Amiodarne, Cimetidine, Ketoconazole, Sulfonamides, Isoniazid, Grapefruit juice, Quinidine, Macrolides (except azithromycin)

246
Q

Tx for WPW

A

Hemodynamically stable: Use procainamide or quinidine, radiofrequency ablation
Hemodynamically unstable: DC cardioversion

247
Q

Giving what drug to patients with RAS may percipitate acute renal failure?

A

ACE inhibitors

248
Q

HTN is the #1 modifiable risk factor what what?

A

Strokes

249
Q

What tests should be ordered for every patient with a diagnosis of HTN?

A

1) ECG-to see if heart has been affected
2) BMP
3) UA
4) Hb/Hct
5) Lipid panel

250
Q

Do you use antiarrhythmics for asymptomatic PVC?

A

NO! increased risk of MI and death

251
Q

What type of patients is multifocal atrial tachycardia seen in and what are characteristics?

A

MAT-severe pulmonary disease (eg COPD); variable P-wave morphology (>3 diff forms), PR interval variable depending on P wave foci, irregular

Step 2 CK (16 decks)

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