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INTERNAL MED IP/OP > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the retinal changes seen in HTN?

A

Narrowing of arterioles, AV nicking, and silver or copper wiring

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2
Q

How do we tx HTN without meds?

A

DASH diet (low in fat, dairy; high in fruits, veggies, and fiber), weight loss, decrease alcohol intake, Na intake (less than 2g), quit smoking, and aerobic exercise

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3
Q

HTN is a major predisposing factor to what?

A

STROKE

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4
Q

What should we always order on a newly diagnosed HTN pt and annually with patients?

A

UA, urine micro albumin, EKG, CBC, BMP, and lipid panel

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5
Q

What should always look for PE with our HTN patients?

A

Fundoscopy, thyroid assessment, carotid bruit, crackles in lungs, renal bruits, pedal edema, confusion, or weakness

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6
Q

What’s the 1st choice med for most patients with HTN?

A

Thiazides

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7
Q

What do we always watch for with diuretics?

A

Hypokalemia; abnormalities of lipids and glucose (usually minor)

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8
Q

Side effect of diuretics? Alternative med?

A

Drop in K levels Can switch to spironolactone or eplernone

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9
Q

A diabetic with HTN should be placed on what kind of med?

A

ACE/ARB

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10
Q

A patient with heart failure, ischemia, or CAD + HTN should be placed on what kind of medications?

A

Beta blocker or ACE

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11
Q

A patient with Angina or hyperthyroidism + HTN should be placed on?

A

Beta blockers

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12
Q

A patient with raynauds with HTN should use what kind of med?

A

CCB

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13
Q

At what levels do patients become stage 2 HTN? What does that mean?

A

160+/100+ They will most likely need 2 meds to treat their HTN. ONE WILL BE A DIURETIC

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14
Q

What is the drug of choice for HTN?

A

Hydrochlorothiazide

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15
Q

Can you use a dihydropyridine (verapamil and diltiazem) with a statin?

A

NO

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16
Q

What’s the DOC for HTN in pregnancy?

A

Methyldopa

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17
Q

When would we not use a thiazide?

A

someone with an MI, pregnant women, CKD

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18
Q

When would we use a BB for HTN treatment?

A

MI, CAD, and diabetes

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19
Q

What’s the biggest risk factor to CAD? What are the other factors?

A

Smoking! High LDL, low HDL, diabetes, obesity, physical inactivity, genetics, HTN.

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20
Q

What area of the heart is most commonly affected by an MI?

A

LV

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21
Q

An anterior infarct is due to blockage where?

A

left coronary artery, especially in the LAD

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22
Q

A posterior infarct involves blockage where?

A

RCA or left circumflex artery obstruction

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23
Q

What do we see on ECG with an MI?

A

ST segment elevation, greater than 1mm, in at least 2 contiguous leads Also, ST depression, T wave inversion, peaked T waves (early on)

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24
Q

If ST elevation occurs in leads II, III, and aVF – what is it?

A

Inferior MI

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25
Q

If ST elevation occurs in leads V3 and V4 – what is it?

A

Anterior

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26
Q

If ST elevation occurs in leads I, aVL, V5, V6 – what is it?

A

Lateral

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27
Q

Pathologic q waves mean what?

A

old infarct

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28
Q

Chest pain, SOB, or fatigue at rest or with little exercise makes you think of what?

A

Unstable angina

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29
Q

If a pt has deep substernal chest pain, with dyspnea, nausea, and vomiting – what do you think of?

A

NSTEMI or STEMI

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30
Q

What’s the difference between a UA and an NSTEMI?

A

NSTEMI has elevated cardiac markers

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31
Q

When do angina symptoms most commonly occur?

A

in the AM

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32
Q

What might you see on ECG during an angina attack?

A

ST depression, decreased R wave height

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33
Q

How do we treat unstable angina?

A

modify risk factors (smoking, BP, lipids) ASA Beta blockers Nitro and CCB for symptoms ACE and statins

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34
Q

If a patient had an NSTEMI, how do we treat them?

A

full anti-coag

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35
Q

When would a patient have a false negative troponin?

A

chronic renal failure

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36
Q

If a patient was seen for angina what do they need before discharge from the hospital?

A

Stress testing (if positive they go to the cath lab)

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37
Q

If a patient who you think has unstable angina and their symptoms are not improving despite medical therapy – what do you do?

A

Either PCI (for 1-2 vessel disease) or CABAG (severe angina, localized disease, or DM)

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38
Q

How do we treat an MI?

A

PCI or CABAG “door to balloon” in under 90 minutes tPA within 30 minutes if it will be longer than 120 minutes

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39
Q

Who CANNOT receive TPA?

A

cerebrovascular hemorrhage, prior stroke (within 1 year), BP great than 180/110, active bleeding, or recent trauma/surgery

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40
Q

What do we check when we suspect an MI?

A

CBC, troponins, INR, PTT< electrolytes, Cr, BUN, Mg, glucose

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41
Q

How do we treat the pain of an MI?

A

NTG, morphine, and BB’s

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42
Q

What would be the most common cause of systolic dysfunction in HF?

A

MI, myocarditis, and dilated cardiomyopathy

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43
Q

What would be the most common cause of diastolic dysfunction in HF? What can it lead to?

A

valvular disease, impaired ventricle relaxation Leads to pulmonary HTN and congestion

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44
Q

In HF, when would we see a normal EF?

A

Diastolic dysfunction

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45
Q

What type of HF would cause dyspepsia and fatigue? Why?

A

LV failure Dyspepsia (pulmonary congestion), Fatigue (low CO)

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46
Q

What type of HF would cause abdominal distention and LE swelling?

A

RV failure

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47
Q

What would you hear on exam with HF?

A

S3 and basilar crackles or diminished breath sounds (LV failure) Pitting edema, JVD (RV failure)

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48
Q

What would we see on chest XR with HF?

A

enlarged cardiac silhouette, pleural effusion, kerley B lines

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49
Q

What’s a normal EF on echo?

A

Greater than 55%

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50
Q

What medication reduces preload?

A

Diuretics (short term management)

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51
Q

What medication reduces afterload?

A

ACE inhibitor (long term management)

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52
Q

A person in Afib is at significantly higher risks for what?

A

embolic stroke (often form atrial thrombi)

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53
Q

What does paroxysmal Afib mean?

A

classifies it as recurrent afib that lasts less than 48 hours, and spontaneously converts back to NSR

54
Q

What do we see on ECG with afib?

A

absent P waves

55
Q

How do we treat with rate control?

A

Beta blockers preferred, digoxin is least effective, amiodarone may be required

56
Q

How do we treat with rhythm control?

A

Synchronized cardiovert – rate must be controlled to less than 120 If present for more than 48 hours, need anticoag x3 weeks (due to risk of embolization with cardioversion) Continue anticoag x4 weeks after cardioversion

57
Q

What must we always consider in a patient with Afib?

A

CHADSVAS Score!! CHF, HTN, Age greater than 75, DM, Stroke, Vascular dz, Age 64-75, Female Sex

58
Q

Which categories of CHADSVASC gets you 2 points?

A

Age greater than 75 and Stroke

59
Q

If we see a sawtooth pattern think what?

A

Aflutter

60
Q

How do we treat aflutter?

A

Converison for initial episode CCB or BB – but more difficult to control in flutter

61
Q

If the PR interval is longer than normal and the pt has no symptoms, what is it?

A

Frist degree AV block

62
Q

If the PR interval gets progressively longer with each beat until the atrial pulse is not conducted and the QRS is dropped – what is it?

A

Second degree AV block – Mobitz Type 1 (wenckebach)

63
Q

If the PR interval remains the same but there’s an intermittent QRS dropped – what is it?

A

Second degree AV block , Mobitz Type 2

64
Q

If there is no relationship between the p waves and the QRS complexes and/or cardiac function is maintained by escape junctions – what is it?

A

Third degree AV block

65
Q

In general how do we treat AV block?

A

pacemaker

66
Q

If you see a wide QRS comples with a preceeding P wave, what is it?

A

PVC

67
Q

Is any treatment required for PVC’s?

A

No, avoid triggers. BB’s for pts with symptomatic HF

68
Q

If a patient has sudden onset of palpitations that begins and ends abruptly – what do you think of?

A

PSVT

69
Q

How do we treat PSVT?

A

Vagal maneuvers if ineffective use Adenosine (of ND-CCB) Or cadriovert

70
Q

If you see this on ECG, what dx?

A

RBBB

71
Q

If you see this on ECG, what dx?

A

LBBB

72
Q

A LBBB is often associated with what?

A

structural heart disease

73
Q

If on ECG you see disappearance of P waves for seconds to minutes with escape beats, and the pt complains of dizziness or syncope – what diagnosis?

How do you treat?

A

Sick sinus syndrome. Tx = Pacemaker

74
Q

What is this?

A

Ventircular Tachycardia

75
Q

How do you treat v tach?

A

Synchronized cardiovert (Acute); pacemaker (long term)

76
Q

What rhythm is this? How do you treat?

A

VFIB Tx with CPR and defibrillation

77
Q

What rhythm is this? How do you treat?

A

Torsades Tx = IV Mg and UNSYNCHRONIZED cardioversion

78
Q

How do we diagnose murmurs?

A

Echo

79
Q

What maneuvers make murmurs get louder?

What murmur is the exception?

A

Squatting, handgrip

Except for Mitral valve prolapse

80
Q

What would cause mitral valve prolapse to get louder?

A

Standing from a squat or Valsalva

81
Q

Which 2 murmurs radiate sounds – where to?

A

Aortic stenosis – to the carotids

Mitral Reurg – to the axilla

82
Q

What are the 2 diastolic murmurs?

A

Mitral stenosis and Aortic Regurg

83
Q

What murmur is associated with rheumatic fever?

A

Mitral stenosis

84
Q

Crescendo-decrescendo ejection murmur

heard best at the right and left upper sternal borders, describes what?

A

Aortic stenosis

85
Q

A diastolic, blowing decrescendo murmur

or a mid-late diastolic rumble both describe what murmur?

A

Aortic regurg

86
Q

What position is aortic regurg best heard in?

A

sitting, leaning forward, exhale and hold

87
Q

Mid-systolic click describes what murmur?

A

Mitral valve prolapse

88
Q

A holosystolic apical murmur describes what?

A

Mitral regurg

89
Q

How do we treat mitral regurg?

A

Replacement

90
Q

An early diastolic opening snap, followed by a low diastolic rumble – describes what murmur?

A

Mitral stenosis

91
Q

What murmur is heard best on inspiration?

A

Tricuspid regurg

92
Q

What murmur is most often associated with dyspnea, chest pain, and syncope?

A

Aortic stenosis

93
Q

What murmur do we treat with a balloon valvulopasty?

A

Pulmonic stenosis

94
Q

What is dilated cardiomyopathy most commonly caused by?

A

CAD or alcoholism

95
Q

What PE finding is associated with dilated cardiomyopathy?

A

pulsus alternans (constant rhythm, varies with FORCE)

96
Q

What is often the cause of sudden cardiac death?

A

Hypertrophic cardiomyopathy

97
Q

What is a marker of increased risk for sudden cardiac death?

A

Syncope

98
Q

Which cardiomyopathy is associated with systolic dysfunction vs diastolic?

A

Systolic = dialated

Diastolic = hypertrophic and restrictive

99
Q

What’s the biggest risk factor to an aortic aneurysm?

A

Smoking!

100
Q

At what point do we repair an aortic aneurysm?

A

If greater than 5.5cm OR if grows more than or 0.5cm in a year

101
Q

What are the screening recommendations for aortic aneurysms?

A

65 years old and a history of smoking = abdominal ultrasound

102
Q

What are the s/s of PAD?

A

claudication (pain w/walking, relieved with rest),

abnormal hair distribution on LE’s, shiny skin.

103
Q

What are the s/s of embolism of the LE’s?

A

6 P’s = pain, pallor, pulselessness, paralysis,

paresthesia, poikilothermia (cold limb)

104
Q

How do we diagnose PAD?

A

ABI less than 1 and doppler flow (arteriography is gold standard)

105
Q

How do we treat PAD?

A

cilostazol, ASA, or clopidogrel and *Walking Program*

106
Q

How do we treat an embolism?

A

Anticoagulation with SQ heparin

107
Q

What are the s/s of venous insufficiency?

A

burning, aching, cramping or a “heavy leg”

that is WORSE with standing or sitting

(may have ulcers on the medial aspect of the LE)

108
Q

How do we treat venous insufficiency?

A

burning, aching, cramping or a “heavy leg” that is WORSE with standing or sitting (may have ulcers on the medial aspect of the LE)

109
Q

If a patient has dull pain, tenderness, and erythema

over a superficial part of the skin – what should you always keep on ddx?

A

thrombophlebitis

110
Q

What is Virchow’s triad and what is it associated with?

A

stasis, hypercoagulability, and vascular injury.

Associated with DVT

111
Q

When do we use the ASCVD risk calculator? At what point do we treat?

A

For patients without ACVD hx but have an LDL of 70-189

If it calculates to greater than or equal to 7.5% risk = mod to high statin

Can consider a moderate statin if results are 5-7.5%

112
Q

When would we automatically use a high statin?

A

Those with clinical atherosclerotic disease

LDL greater than 190 or triglycerides greater than 500

LDL greater than 190 + family Hx

DM (aged 40-75) + LDL between 70-189 + no evidence of atherosclerotic dz (moderate intensity statin)

113
Q

In those not receiving a statin how often should we re-evaluate their risk?

A

Every 4-6 years

114
Q

What are the side effects of statins?

A

muscle cramps and watch for diabetes

115
Q

What is the most common cause of cor pulmonale?

A

COPD – causing right sided heart failure

116
Q

What’s the gold standard to dx cor pulmonale?

A

catheterization

117
Q

Mid-abdominal, tearing, unrelenting pain that radiates to the back means an aortic dissection – what are the 2 classifications?

A

Type B = extends below the L subclavian towards the abdominal aorta

Type A = before R subclavian and through the aortic arch

118
Q

For what dz must we lower the BP ASAP? How do we do it?

A

Aortic Dissection

IV Labetolol or Esmolol

119
Q

Your pt is an IV drug user with a new murmur and a fever – what dx?

A

Infective endocarditis

120
Q

How do we dx endocarditis?

A

Get 3 blood cultues (separated by time and location)

Get an echo

DUKE CRITERIA: two major, one major and 3 minor, or 5 minor

121
Q

What are the major compnenets in the Duke Criteria?

A

MAJOR = Positive blood culture, vegetations on echocardiogram,

new regurgitant murmur

122
Q

What’s the MC cause of endocarditis in a native valve?

A

Strep viridans

123
Q

What’s the MC cause of endocarditis in prosthetic vavles?

A

coagulase negative staphylococci

124
Q

What’s the MC cause of endocarditis in IV drug users?

A

Staph aureus

125
Q

How do we treat endocarditis?

A

Ceftiraxone and Vanc + Gentamicin until cultures return

126
Q

A patient has sharp pain with inspiration that’s worse when lying flat – dx?

A

Pericarditis

127
Q

What’s the cause of pericarditis?

A

Coxsackie virus

128
Q

SxS of pericarditis?

A

3 P’s = Position, palpation, pleuritic

(hurts to cough, swallow, and bumps in the road)

129
Q

What will you find on exam with pericarditis?

A

pericardial friction rub

Diffuse ST elevation

Echo = pericardial effusion

130
Q

How do we treat pericarditis?

A

NSAIDs

MUST avoid anticoags – can lead to tamponade and kill the pt

AKA truly make sure it’s NOT an MI

INTERNAL MED IP/OP (9 decks)

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