Cardio Flashcards
1
Q
What are the retinal changes seen in HTN?
A
Narrowing of arterioles, AV nicking, and silver or copper wiring
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
3
Q
HTN is a major predisposing factor to what?
A
STROKE
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
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
6
Q
What’s the 1st choice med for most patients with HTN?
A
Thiazides
7
Q
What do we always watch for with diuretics?
A
Hypokalemia; abnormalities of lipids and glucose (usually minor)
8
Q
Side effect of diuretics? Alternative med?
A
Drop in K levels Can switch to spironolactone or eplernone
9
Q
A diabetic with HTN should be placed on what kind of med?
A
ACE/ARB
10
Q
A patient with heart failure, ischemia, or CAD + HTN should be placed on what kind of medications?
A
Beta blocker or ACE
11
Q
A patient with Angina or hyperthyroidism + HTN should be placed on?
A
Beta blockers
12
Q
A patient with raynauds with HTN should use what kind of med?
A
CCB
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
14
Q
What is the drug of choice for HTN?
A
Hydrochlorothiazide
15
Q
Can you use a dihydropyridine (verapamil and diltiazem) with a statin?
A
NO
16
Q
What’s the DOC for HTN in pregnancy?
A
Methyldopa
17
Q
When would we not use a thiazide?
A
someone with an MI, pregnant women, CKD
18
Q
When would we use a BB for HTN treatment?
A
MI, CAD, and diabetes
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.
20
Q
What area of the heart is most commonly affected by an MI?
A
LV
21
Q
An anterior infarct is due to blockage where?
A
left coronary artery, especially in the LAD
22
Q
A posterior infarct involves blockage where?
A
RCA or left circumflex artery obstruction
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)
24
Q
If ST elevation occurs in leads II, III, and aVF – what is it?
A
Inferior MI
25
If ST elevation occurs in leads V3 and V4 – what is it?
Anterior
26
If ST elevation occurs in leads I, aVL, V5, V6 – what is it?
Lateral
27
Pathologic q waves mean what?
old infarct
28
Chest pain, SOB, or fatigue at rest or with little exercise makes you think of what?
Unstable angina
29
If a pt has deep substernal chest pain, with dyspnea, nausea, and vomiting – what do you think of?
NSTEMI or STEMI
30
What’s the difference between a UA and an NSTEMI?
NSTEMI has elevated cardiac markers
31
When do angina symptoms most commonly occur?
in the AM
32
What might you see on ECG during an angina attack?
ST depression, decreased R wave height
33
How do we treat unstable angina?
modify risk factors (smoking, BP, lipids) ASA Beta blockers Nitro and CCB for symptoms ACE and statins
34
If a patient had an NSTEMI, how do we treat them?
full anti-coag
35
When would a patient have a false negative troponin?
chronic renal failure
36
If a patient was seen for angina what do they need before discharge from the hospital?
Stress testing (if positive they go to the cath lab)
37
If a patient who you think has unstable angina and their symptoms are not improving despite medical therapy – what do you do?
Either PCI (for 1-2 vessel disease) or CABAG (severe angina, localized disease, or DM)
38
How do we treat an MI?
PCI or CABAG “door to balloon” in under 90 minutes tPA within 30 minutes if it will be longer than 120 minutes
39
Who CANNOT receive TPA?
cerebrovascular hemorrhage, prior stroke (within 1 year), BP great than 180/110, active bleeding, or recent trauma/surgery
40
What do we check when we suspect an MI?
CBC, troponins, INR, PTT\< electrolytes, Cr, BUN, Mg, glucose
41
How do we treat the pain of an MI?
NTG, morphine, and BB’s
42
What would be the most common cause of systolic dysfunction in HF?
MI, myocarditis, and dilated cardiomyopathy
43
What would be the most common cause of diastolic dysfunction in HF? What can it lead to?
valvular disease, impaired ventricle relaxation Leads to pulmonary HTN and congestion
44
In HF, when would we see a normal EF?
Diastolic dysfunction
45
What type of HF would cause dyspepsia and fatigue? Why?
LV failure Dyspepsia (pulmonary congestion), Fatigue (low CO)
46
What type of HF would cause abdominal distention and LE swelling?
RV failure
47
What would you hear on exam with HF?
S3 and basilar crackles or diminished breath sounds (LV failure) Pitting edema, JVD (RV failure)
48
What would we see on chest XR with HF?
enlarged cardiac silhouette, pleural effusion, kerley B lines
49
What’s a normal EF on echo?
Greater than 55%
50
What medication reduces preload?
Diuretics (short term management)
51
What medication reduces afterload?
ACE inhibitor (long term management)
52
A person in Afib is at significantly higher risks for what?
embolic stroke (often form atrial thrombi)
53
What does paroxysmal Afib mean?
classifies it as recurrent afib that lasts less than 48 hours, and spontaneously converts back to NSR
54
What do we see on ECG with afib?
absent P waves
55
How do we treat with rate control?
Beta blockers preferred, digoxin is least effective, amiodarone may be required
56
How do we treat with rhythm control?
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
What must we always consider in a patient with Afib?
CHADSVAS Score!! CHF, HTN, Age greater than 75, DM, Stroke, Vascular dz, Age 64-75, Female Sex
58
Which categories of CHADSVASC gets you 2 points?
Age greater than 75 and Stroke
59
If we see a sawtooth pattern think what?
Aflutter
60
How do we treat aflutter?
Converison for initial episode CCB or BB – but more difficult to control in flutter
61
If the PR interval is longer than normal and the pt has no symptoms, what is it?
Frist degree AV block
62
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?
Second degree AV block – Mobitz Type 1 (wenckebach)
63
If the PR interval remains the same but there’s an intermittent QRS dropped – what is it?
Second degree AV block , Mobitz Type 2
64
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?
Third degree AV block
65
In general how do we treat AV block?
pacemaker
66
If you see a wide QRS comples with a preceeding P wave, what is it?
PVC
67
Is any treatment required for PVC’s?
No, avoid triggers. BB’s for pts with symptomatic HF
68
If a patient has sudden onset of palpitations that begins and ends abruptly – what do you think of?
PSVT
69
How do we treat PSVT?
Vagal maneuvers if ineffective use Adenosine (of ND-CCB) Or cadriovert
70
If you see this on ECG, what dx?
RBBB
71
If you see this on ECG, what dx?
LBBB
72
A LBBB is often associated with what?
structural heart disease
73
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?
Sick sinus syndrome. Tx = Pacemaker
74
What is this?
Ventircular Tachycardia
75
How do you treat v tach?
Synchronized cardiovert (Acute); pacemaker (long term)
76
What rhythm is this? How do you treat?
VFIB Tx with CPR and defibrillation
77
What rhythm is this? How do you treat?
Torsades Tx = IV Mg and UNSYNCHRONIZED cardioversion
78
How do we diagnose murmurs?
Echo
79
What maneuvers make murmurs get louder?
What murmur is the exception?
Squatting, handgrip
Except for Mitral valve prolapse
80
What would cause mitral valve prolapse to get louder?
Standing from a squat or Valsalva
81
Which 2 murmurs radiate sounds – where to?
Aortic stenosis – to the carotids
Mitral Reurg – to the axilla
82
What are the 2 diastolic murmurs?
Mitral stenosis and Aortic Regurg
83
What murmur is associated with rheumatic fever?
Mitral stenosis
84
Crescendo-decrescendo ejection murmur
heard best at the right and left upper sternal borders, describes what?
Aortic stenosis
85
A diastolic, blowing decrescendo murmur
or a mid-late diastolic rumble both describe what murmur?
Aortic regurg
86
What position is aortic regurg best heard in?
sitting, leaning forward, exhale and hold
87
Mid-systolic click describes what murmur?
Mitral valve prolapse
88
A holosystolic apical murmur describes what?
Mitral regurg
89
How do we treat mitral regurg?
Replacement
90
An early diastolic opening snap, followed by a low diastolic rumble – describes what murmur?
Mitral stenosis
91
What murmur is heard best on inspiration?
Tricuspid regurg
92
What murmur is most often associated with dyspnea, chest pain, and syncope?
Aortic stenosis
93
What murmur do we treat with a balloon valvulopasty?
Pulmonic stenosis
94
What is dilated cardiomyopathy most commonly caused by?
CAD or alcoholism
95
What PE finding is associated with dilated cardiomyopathy?
pulsus alternans (constant rhythm, varies with FORCE)
96
What is often the cause of sudden cardiac death?
Hypertrophic cardiomyopathy
97
What is a marker of increased risk for sudden cardiac death?
Syncope
98
Which cardiomyopathy is associated with systolic dysfunction vs diastolic?
Systolic = dialated
Diastolic = hypertrophic and restrictive
99
What’s the biggest risk factor to an aortic aneurysm?
Smoking!
100
At what point do we repair an aortic aneurysm?
If greater than 5.5cm OR if grows more than or 0.5cm in a year
101
What are the screening recommendations for aortic aneurysms?
65 years old and a history of smoking = abdominal ultrasound
102
What are the s/s of PAD?
claudication (pain w/walking, relieved with rest),
abnormal hair distribution on LE’s, shiny skin.
103
What are the s/s of embolism of the LE’s?
6 P’s = pain, pallor, pulselessness, paralysis,
paresthesia, poikilothermia (cold limb)
104
How do we diagnose PAD?
ABI less than 1 and doppler flow (arteriography is gold standard)
105
How do we treat PAD?
cilostazol, ASA, or clopidogrel and \*Walking Program\*
106
How do we treat an embolism?
Anticoagulation with SQ heparin
107
What are the s/s of venous insufficiency?
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
How do we treat venous insufficiency?
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
If a patient has dull pain, tenderness, and erythema
over a superficial part of the skin – what should you always keep on ddx?
thrombophlebitis
110
What is Virchow’s triad and what is it associated with?
stasis, hypercoagulability, and vascular injury.
Associated with DVT
111
When do we use the ASCVD risk calculator? At what point do we treat?
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
When would we automatically use a high statin?
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
In those not receiving a statin how often should we re-evaluate their risk?
Every 4-6 years
114
What are the side effects of statins?
muscle cramps and watch for diabetes
115
What is the most common cause of cor pulmonale?
COPD – causing right sided heart failure
116
What’s the gold standard to dx cor pulmonale?
catheterization
117
Mid-abdominal, tearing, unrelenting pain that radiates to the back means an aortic dissection – what are the 2 classifications?
Type B = extends below the L subclavian towards the abdominal aorta
Type A = before R subclavian and through the aortic arch
118
For what dz must we lower the BP ASAP? How do we do it?
Aortic Dissection
IV Labetolol or Esmolol
119
Your pt is an IV drug user with a new murmur and a fever – what dx?
Infective endocarditis
120
How do we dx endocarditis?
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
What are the major compnenets in the Duke Criteria?
MAJOR = Positive blood culture, vegetations on echocardiogram,
new regurgitant murmur
122
What’s the MC cause of endocarditis in a native valve?
Strep viridans
123
What’s the MC cause of endocarditis in prosthetic vavles?
coagulase negative staphylococci
124
What’s the MC cause of endocarditis in IV drug users?
Staph aureus
125
How do we treat endocarditis?
Ceftiraxone and Vanc + Gentamicin until cultures return
126
A patient has sharp pain with inspiration that’s worse when lying flat – dx?
Pericarditis
127
What’s the cause of pericarditis?
Coxsackie virus
128
SxS of pericarditis?
3 P’s = Position, palpation, pleuritic
(hurts to cough, swallow, and bumps in the road)
129
What will you find on exam with pericarditis?
pericardial friction rub
Diffuse ST elevation
Echo = pericardial effusion
130
How do we treat pericarditis?
NSAIDs
MUST avoid anticoags – can lead to tamponade and kill the pt
AKA truly make sure it’s NOT an MI
