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CanQB > Cardio > Flashcards

Cardio Flashcards

1
Q

Dx stable angina?

A
  1. EKG
  2. Stress test
  3. Angiography
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2
Q

When to measure cardiac enzymes in angina?

A

Acute chest pain > 1 HR

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3
Q

Drug contraindicated with quinidine?

A

Amiodrone

Decrease quinidine clearance by kidney resulting in fatal arrhythmia

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4
Q

Nitrate formulas and their rout of administration

A
  1. Isosorbide mononitrate = oral no 1st bypass metabolism (Tab)
  2. Isosorbide dinitrate = max effect in 6 min (sublingual)
  3. Glyceryl trinitrate = max effect in 4 min (sublingual)
  4. Erythrityl tetranitrate = mixed w/ lactose (sublingual)
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5
Q

MC SE of CCB? (Amlodipine)

A

Peripheral edema
Low BP
Cough
Lung edema

Due to vasodilation

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6
Q

Drugs improve mortality in MI?

A

BB
ACEI/ARB
Aspirin (time dependent)
Statins

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7
Q

Drug contraindicated in anaphylaxis?

A

Atropine if tachycardia

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8
Q

Lab monitoring with amiodrone

A

LFT
Thyroid (hypo > hyper)
Every 6 months

No need for CXR or slit lamp

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9
Q

SE of amiodrone

A

Liver + thyroid toxicity

Lung toxicity: cough and dyspnea + interstitial filtrates on CXR

ARDS

Corneal deposits don’t effect vision.

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10
Q

Drugs contraindicated with BB? Why?

A

CCB
Verapamil + diltiazem

Cause bradycardia and effect AV conduction.

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11
Q

MCC of drug induced angioedema?

A

ACEI = increase levels of bradykinin

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12
Q

ECG in inferior MI

A

ST elevation in II, III, aVF

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13
Q

What artery causes inferior MI

A

Rt coronary artery

Left circumflex artery

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14
Q

ECG findings of left circumflex artery MI?

A
  1. ST elevation in II = III and ST-depression in V1-3 or ST-elevation in I + aVF
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15
Q

ECG of Rt coronary artery MI

A

ST elevation in III > II

ST-Depression in I and aVF

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16
Q

ECG of left anterior descendant coronary artery?

A

ST elevation or Q wave in any leads V1-V6 + I and aVF

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17
Q

Drug worsen CHF? Why?

A

Vasopressin

Vasoconstricts arteries and veins causing fluid retention and worsen low Na

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18
Q

Mechanism of action of nitroglycerin

A

Dilates veins, arteries, and arterioles.

Reduce LV preload + after load

Reduce oxygen demand

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19
Q

What’s angina decubitus

A

Angina when lying down without cause.

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20
Q

Cause of angina decubitus

A

Gravity redistributes fluids and make the heart work harder.

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21
Q

Dose of aspirin given in acute MI?

A

162-325 mg uncoated aspirin. (Not enteric asa which has delayed effect).

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22
Q

What determines cardiac oxygen demand

A 
Tension 
Preload
After load 
Contractility
HR
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23
Q

DM drugs contraindicated in CHF? Why?

A

Thiazolidinediones (pio/rosiglitazone)

Cause fluid retention

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24
Q

MVP murmur

A

Midsystilic click

Late systolic murmur

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25
Q

Effect of standing + valsalva on valvular disease

A
  1. MVP: Increased

2. AS: increased

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26
Q

AS murmur? Best heard?

A

Systolic crescendo-decrescendo ejection murmur

Rt 2nd ICS w/ patient leaning forward

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27
Q

Cardiac SE of sumatriptan

A

It’s a 5HT1D + 1B agonist

Causes vasoconstriction = angina.

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28
Q

What’s cilostazol?

A

Phosphodiestrase inhibitor for intermittent claudication

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29
Q

Contraindication to cilostazol

A

CHF

Bcz increases HR

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30
Q

Beneficial effects of cilostazol

A

Increases HDL

Rx 3rd degree block.

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31
Q

Gold standard for aortic dissection

A

MRI

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32
Q

What’s aortic dissection

A

Tear in aortic intima with separation of intima and media creating false lumen and hemorrhage within media

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33
Q

What other than ST elevation indicate MI in ECG?

A

New onset Lt BBB

Left anterior descending artery

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34
Q

IE prophylaxis in VHD

A

Prosthetic valve
Underwent repair
Hx IE
Cyanotic congenital disease even with repair (tetralogy of fallout, Transposition of great vessels) Not patent foramen ovale

Give oral amoxicillin 1 HR before procedure
If allergic to penicillin:
Clindamycin
Azithromycin

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35
Q

Effect of digitalis on heart

A

Reduce filling pressure

Increase contraction force

Increase CO

Decrease HR

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36
Q

How to measure the effects of warfarin, heparin, ASA

A 
Warfarin = PT
Heparin = PTT
ASA = BT
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37
Q

Contraindication to ACEI

A

Angioedema

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38
Q

Rx of HTN

A 
1. Age
> 60 
Start thiazide 
< 60
Start CCB
  1. No benefit combine:
    Thiazide + CCB + BB + ACE/ARBs
  2. Add:
    - Central a-agonists:
    a-methyl dopa
    Clonidine
  • Peripheral a-antagonists:
    Prazosin
    Terazosin
    Doxazosin
  • vasodilator:
    Minoxidil
    Hydralazine
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39
Q

When to start combination HTN meds?

A

If > 160/100

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40
Q

HTN + co-morbidities Rx (6 conditions)

A
  1. Asthma / depression:
    No BB
  2. Black: CCB or thiazide
  3. DM: ARBs/ ACEI
  4. CAD: BB, ACEI/ARBs
  5. Hyperthyroid: BB
  6. Osteoporosis: thiazide
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41
Q

Benefit of ACEI/ARBs in CHF (systolic)

A

Improve mortality with low EF

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42
Q

Anti-HTN not used in sulfa allergy

A

Thiazides

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43
Q

BP control post stroke

A

Gradual reduction in SBP 10-20% it it’s > 220.

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44
Q

Anti-HTN contraindicated in gout?

A

Thiazide

Increase uric acid

45
Q

Anti-HTN contraindicated in diabetic nephropathy

A

Alpha blockers

46
Q

Dx VHD?

A

1st: Echo

Dx: catheterization

47
Q

Triad of AS

A

Syncope
Exertional angina
CHF

48
Q

AS murmur

A

Ejection systolic murmur at 2nd ICS

Rt to sternum
Radiates to clavicle

49
Q

Anti-HTN contraindicated in DM

A

Thiazide

Increases glucose

50
Q

Hypertrophic obstructive cardiomyopathy classic

A

Young 20-40
Healthy

PMO displaced laterally
Mid-systolic harsh murmur at left Lowe sternal

Reduced by squatting
Enhanced by standing

51
Q

SE of ASA

A

Tinnitus / ringing in ears

52
Q

Rx of Raynaud’s phenomenon

A

CCB

53
Q

Contraindicated in Raynaud’s phenomenon

A

BB
Ergotamine
Methysergide

54
Q

Appropriate BP cuff size

A

Cuff width: 40% of limbs circumference

Cuff length: bladder at 80% limbs circumference

55
Q

Placement of BP cuff

A

3 cm above elbow
Bladder on brachial artery
At heart level

56
Q

How to measure pressure manually

A
  1. Place cuff 3 cm above elbow
  2. Bladder on brachial artery
  3. Patient rest seated for 5 min
  4. Arm bare and at heart level
  5. Inc pressure to 30 mmHg rapidly above level radial pulse is extinguished.
  6. Place bell/diaphragm on brachial artery
  7. Open valve at deflation rate 2 mmHg/HR
  8. Read systolic at 1st tap
  9. Read diastolic at point sound disappear.
57
Q

How to avoid venous congestion with manual pressure reading

A

Allow >1 min between readings

58
Q

Clinical signs of AR

A

Wide pulse pressure
Quinckes pulse
Musset sign

59
Q

When is bifid pulse found

A

Hypertrophic cardiomyopathy

60
Q

When is low amplitude pulse found

A

Peripheral arteriosclerosis

61
Q

When is pulsus alternans found

A

CHF

62
Q

When is pulsus paradoxus found

A

Constrictive or restrictive cardiomyopathy

63
Q

What’s 5-HIAA when is it found

A

Break down of serotonin in urine

GI tumor in carcinoid tumors

64
Q

Define resistant HTN

A

> 140/90 if no DM or CDK

> 130/80 if DM/CKD

While adherent to 3 Rx including diuretics

65
Q

Diuretic of choice of GFR <30 ml/Min?

A

Loop > thiazide

66
Q

Drugs contraindicated in cocaine-induced chest pain

A

BB

67
Q

When is BB contraindicated in chest pain/STEMI?

A

In Cocaine, amphetamine or stimulant overdose

68
Q

Why BB contraindicated in cocaine overdose

A

BB = block B2 vasodilator receptor

And cocaine activates a-1 and cause vasoconstriction

So worsening of MI

69
Q

Rx of cocaine induced chest pain

A

CCB
Hydralazine
ASA

70
Q

Common drug interacts with ACEI?

A

NSAID’s

  1. NSAIDs lead to Na retention
  2. Decrease PG which have a vasodilatory effect on kidney
71
Q

What decreases mortality in hypertrophic cardiomyopathy?

A

Defibrillator

72
Q

Effect of BB / CCB in hypertrophic cardiomyopathy

A

Sx control

73
Q

Hypocalcemia ass arrhythmia

A

QT prolongation

74
Q

Rx of STEMI (time dependent)

A

ASA + P2Y12 receptor blacker (clopidogrel, prasugrel, ticarogrelor)

75
Q

NSAIDs in STEMI?

A

Contraindicated

Weaken muscle = rupture.

76
Q

Sx of subaortic stenosis

A

Young
Systolic murmur at Rt sternal

Increased with valsalva

Decreased with hand grip

77
Q

What valvaular disease in endocarditis from IV drug use?

A

Tricuspid regurge

Systolic murmur

Increase with inspiration = inc heart filling

78
Q

Guide lines for HTN in stroke?

A

Keep SBP < 220

DBP < 120

79
Q

Why maintain BP at < 220/120 in stroke

A

Protective mechanism to increase cerebral profusion

80
Q

Replacement of ACE/ARBs in HTN of CHF?

A

Nitrates/ hydralazine

81
Q

HTN drug causes rebound if stopped?

A

Alpha-blockers:

  • Clonidine
  • Guanfacin
82
Q

T/F: BNP differentiates systolic from diastolic CHF

A

F

83
Q

When to replace in aortic stenosis?

A

Aortic area < 1 cm

84
Q

What worsen prognosis of AS?

A

If asymptomatic survival is same as normal

If symptomatic:
Angina 50% 5Yr survival
Syncope 50% 3Yr survival
CHF 50% 2Yr survival

85
Q

T/F: digoxin improve mortality in CHF

A

F

86
Q

T/F: Digoxin decreases hospital admission from CHF

A

T

87
Q

What’s diastolic HF?

A

Stiff ventricle = increased EDLV pressure

88
Q

MCC of diastolic HF?

A

HTN

89
Q

T/F: optima Rx of systolic HF necessary for diastolic HF

A

F

Worsen diastolic HF

90
Q

T/F: CCB reduce mortality in diastolic HF

A

F

91
Q

T/F: BB improve mortality in diastolic HF

A

T

Control rate allow for enough filling

92
Q

When to admit DVT?

A
  1. Massive DVT (iliofemoral)
  2. PE
  3. Risk of bleeding on anticoagulant
  4. Co-morbid conditions
93
Q

Outpatient Rx of DVT

A

LMWH + warfarin

Compression stockings for 1 years

94
Q

HTN + LV hypertrophy Rx

A

ACEI

95
Q

Pathophysiology of cocaine-chest pain

A

Dopamine-depleted state = vasospasm

96
Q

Receptors mediate cocaine induced chest pain

A

Alpha receptor

Thus BB worsen Sx

97
Q

Rx of superventricular tachy

A

Adenosine

98
Q

Amiodrone is used in what arrhythmia

A

Sustained VT regardless of hemodynamic stability

AFib ONLY in symptomatic w/ LV heart failure

99
Q

Facts about digoxin

A
  1. Not used in AV block unless Rx with pacemaker.
  2. Loading dose not necessary
  3. Serum levels are not necessary
100
Q

Period of anticoagulation after drug-eluting stent in MI?

A

12 months of
ASA 162-325
Clopidogrel 75 or prasugrel 10 mg

101
Q

DOC for SVT?

A

Adenosine

Other non-pharm: carotid massage

102
Q

Pain Drugs contraindicated in CHF

A

NSAIDs

103
Q

Effect of high-dose ASA in CHF?

A

Decrease mortality benefit by ACEI!

Use low-dose if must

104
Q

Benefit of exercise in peripheral vascular disease?

A

As beneficial as bypass or angioplasty!

Needs to be rigorous training!

105
Q

LDL level in any artery disease

MI, PVD or else?

A

< 100 or < 2.6

If diabetic < 70

106
Q

How to describe SVT?

A

Narrow QRS

107
Q

SVT resistant to adenosine?

Narrow QRS + No P

A

Verapamil
Or
BB

108
Q

Ventricular tachycardia

Rx

A

Epi + amiodrone

No improvement = lidocaine

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