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Family Shelf > Cardio > Flashcards

Cardio Flashcards

1
Q

Big picture, what is the difference in the patho of STEMI vs NSTEMI, UA and SA?

A

STEMI is a 100 percent blockage so the underlying problem is a supply of blood/o2 to the heart. To intervene you need to re open the vessel.

The other 3 are demand and supply problems because the occlusion is less than 100%. This means we can try to fix, relieve, improve conditions by lowering the demand of the heart.

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2
Q

What is the diamond classification for angina?

A

Substernal and left side
Worse on exertion
Relived by NTG

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3
Q

3 important physical exam findings unique to MI chest pain?

A

Non pleuritc, meaning it doesn’t hurt more because of breathing
Non positional, meaning it doesn’t matter if they are leaning forward or back
Non tender, if you push on it, it doesn’t make it worse

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4
Q

In most cases what is the best lab for NSTEMI?

When would you want to use another lab, what setting?

A

Troponin because it peaks first and is very sensitive and specific
CKMB when it is re infarction.

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5
Q

What is the next step in management for a STEMI?

A

Cath lab immediately

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6
Q

How do you best manage a NSTEMI?

A

If troponin is elevated, CATH
If the troponin is not elevated, then you are dealing with unstable angina, so do a stress test next. If stress test is positive, cath.

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7
Q

What are the two ways to stress the heart during a stress test?
What are the three modalities to use to evaluate the patient during a stress test and when would you use each one?

A

Exercise, if not, give adenosine or dobutamine to get the heart going.
EKG, if baseline EKG is normal
ECHO, if baseline EKG is not normal
Nuclear, if previous heart grafting or heart failure

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8
Q

How do we know the results of the stress test with echo or nuclear?

A

Normal tissue moves under rest and stressed
Dead tissue doesn’t move under both
the key is at risk tissue. At rest, it moves and is fine. When stressed, it doesn’t move because of myocardial stunning.

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9
Q

Once in the cath lab, when to go CABG or stent?

A

3 or more vessels or main proximal go CABG.

1 or 2 vessels, stent

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10
Q

What meds to give in the acute setting of MI?

A

MONA BASH C

Morphine, o2, nitrates, aspirin, beta blockers, ace inhibitor, heparin, clopidogrel

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11
Q

When to use TPA for acute MI?

A

When it will take longer than 60 minutes to get to a center with a CATH lab

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12
Q

2 reasons why we give beta blockers for MI?

A

Most people who die from MI, die from ventricular arrhythmias in the first 24 hours. Beta blocker prevent this.
Reduce demand of heart

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13
Q

What are some of the main symptoms of congestive heart failure?

A

JVD, dyspnea, orthopnea, PND, peripheral edema, S3 heart sound, crackles in the lungs, big liver

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14
Q

What is the best way to diagnose heart failure?

What EF is heart failure?

A

BNP first, Echo to get EF and diastolic function, then Left Heart Cath to see if ischemic or not.
less than 50%. normal is about 55

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15
Q

What is considered the best test to diagnose heart failure? What else does it tell you?

A

Left heart cath. If the heart failure is ischemic or not

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16
Q

What is the underlying problem in systolic heart failure and diastolic heart failure?

A

Systolic is a big flaccid ventricle that cannot pump or contract, EF sucks
Diastolic is a ventricle that cannot relax and fill

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17
Q

Big picture description of class 1-4 heart failure?

A

1: no restrictions/symptoms
2. No symptoms during ADLs
3. Symptoms with ADLs
4. Symptoms at rest

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18
Q

To treat heart failure starting at class 1, what do all patients get?

A

Beta blocker and ace inhbitor

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19
Q

What do we start giving with class 2 heart failure and why?

A

Loop diuretic, like furosemide, to get fluid off

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20
Q

What two meds to add after you put them on a loop?

A

ISO hydrolazine and spironolactone

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21
Q

Class 4 patients start getting which meds?

A

Inotropes

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22
Q

How do you treat a patient with an EF less than 35 and not class 4 and why?

A

AICD

Prevent sudden death from ventricular arrhythmias

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23
Q

Every heart failure patient also gets which 2 meds?

A

Aspirin and statin

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24
Q

Let’s say you have a patient who has heart failure, come in to the ED with an exacerbation, what is the process to manage the patient.

A

CXR to look for volume overload
EKG to look for STEMI
BNP to confirm volume overload
Troponin to confirm MI

If EKG and troponin show STEMI, give MONA BASH and cath
If CXR and BNP show volume overload, then it is a true CHF exacerbation and you need to treat with LMNOP> lasix, morphine, nitrates, o2, and position.
If all 4 tests are negative, then need to figure out the underlying cause.

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25
Q

What is now considered normal, elevated, stage 1, stage 2, urgency, and emergency BP levels?

A 
Less than 120 and less than 80
Less than 130 and less than 80
Less than 140 and less than 90
Over 140 and over 90
Over 180 and 120 (no signs of end organ damage)
End organ damage
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26
Q

How to treat elevated BP?

A

LSM

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27
Q

How to treat stage 1 HTN?

A

LSM plus 1 med if there are risk factors/comorbidities

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28
Q

How to treat stage 2 HTN?

A

LSM plus 2 meds

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29
Q

How to make a diagnoses of HTN?

A

2 readings, 2 weeks apart, 2 separate visits

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30
Q

What 2 types of meds to give for someone with HTN with heart failure or CAD?

A

Beta blocker and ace

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31
Q

What two types of meds to give for someone with HTN and had a stroke?

A

Ace and thiazides

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32
Q

What med to give for HTN for someone with CKD?

A

Ace or arb except stage 4 CKD

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33
Q

What to give for HTN to someone with diabetes?

A

Ace

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34
Q

What can you give to a patient who only has HTN and no other comorbidities or risk factors?

A

Thiazides, calcium channel blocker or ace

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35
Q

What are the three main LSM for HTN and what is the recommendation for each?

A

Diet, less than 2.4 grams of salt per day
Exercise, 30 minutes a day
Weight, lose weight if BMI over 25 with HTN

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36
Q

What is the side effect to remember for Dihydropyridine calcium channel blockers for HTN?

A

Peripheral edema

37
Q

2 side effects for both ace and arbs?

2 just for ace?

A

Increase in CR, and hyperkalemia

Cough and angioedema

38
Q

2 side effects of thiazides?

A

Hypokalemia and hypercalcemia

39
Q

2 Side effect of spironolactone?

2 situations to use spironolactone?

A 
Gynocomastium and hyperkalemia 
CHF class 3 and HTN due to hyper aldosteronism
40
Q

What is the arterial and venous dilator And side effect for each?

A

Hydralazine, reflex tachy

ISO nitrate, dont use with other nitrates of PDE 5, massive hypotension

41
Q

First line therapy for high cholesterol?

A

Lifestyle modifications

42
Q

4 types of patients that get a statin?

A

Vascular dx
Really high LDL, over 190
LDL between 70 and 189, age 40-75 and diabetes
LDL between 70 and 189, age 4–75 and calculated risk

43
Q

What are the two high intensity statins and dose?

A

Atorvastatin 40 or 80 mg

Rosuvastatin 20 or 40 mg

44
Q

What are the two moderate intensity statins to know?

A

Atorvastatin 10 and 20 mg

Rosuvastatin 5 and 10 mg

45
Q

4 labs to get a baseline for before putting someone on a statin?

A

Lipids
A1C
CK
LFTs

46
Q

How often to check lipids? How often do you check CK and LFTs?

A

Yearly

Only check them when the patient is symptomatic

47
Q

What happens when a patient gets patient statin induced myositis or statin induced hepatitis?

A

Stop the statin and wait for the problem to get resolved and then put them on a lower dose statin

48
Q

What is second line treatment after statins and what is the effect?

A

Fibrates

Raise HDL

49
Q

Effect of ezetimibe and side effect to know?

A

Lower LDL

Diarhrea

50
Q

Side effect of niacin to know, how to treat it, and effect of niacin on cholesterol?

A

Flushing, aspirin, raise HDL and lower LDL

51
Q

Big difference between stable and unstable angina?

What is the big difference between unstable angina and then moving into NSTEMI and STEMI?

A

stable angina is pain with exertion and can be relived with rest. unstable is pain at rest and nothing relieves it while it lasts.

unstable angina, there is no heart damage, so no rise in biomarkers. the other two have damage and will have rise in biomarkers.

52
Q

5 risk factors for heart disease?

A

diabetes, smoking, overweight, high cholesterol, high BP

53
Q

Grade 1-6 for murmurs?
When to work up a murmur?
How to diagnose murmur?

A

1: heart sounds greater than murmur
2: heart sounds equal to murmur
3: heart sounds softer than murmur
4: palpable thrill
5: stethoscope half off chest
6: can hear murmur without stethoscope

systolic, grade 3 and above or any diastolic murmur

Echo

54
Q 
What is the most common cause of mitral stenosis?
Typical age?
What drives the symptoms of MS?
Where is it best heard?
Give away buzz word?
A 
rheumatic heart disease
younger
atrial dilation (afib) and fluid back up in lungs, basically CHF
apex
opening snap
55
Q

treatment of MS?

A

balloon plasty, maybe replace but these pts are younger and would need multiple placements throughout life.

56
Q

What is the only valve we do a balloon plasty on?

A

MS

57
Q

top three causes of aortic regurgitation?

A

infection, infarction, dissection

58
Q

What will be the main difference between acute or chronic aortic regurgitation?

A

acute will be like shock systems

chronic will be more CHF symptoms

59
Q

where will we hear aortic regurgitation?
description of what you hear?
Treatment?

A

right side 2nd sternal border
crescendo, decrescendo
replace

60
Q

main cause of AS?

A

atherosclerosis, calcification

61
Q

cause of MR?

A

infection and infarction

62
Q

where do you hear MR?

Buzzword for MR?

A

apex

holosystolic

63
Q

What are the 4 murmurs that follow the principle, more blood in the heart, more murmur?

A

MS, MR, AS, AR

so, if you increase venous return you increase murmur, vice versa.

64
Q

How do you increase venous return and how do you decrease venous return?

A

squat, leg lift

valsalva maneuver

65
Q

What are the two murmurs that follow the Principe, more blood in the heart, less murmur or makes it better?

A

mitral valve prolapse

hypertrophic cardiomyopathy

66
Q

What exactly is the problem with hypertrophic cardio?

A

the ventricular septum is beefy so it covers the aortic outlet causes left ventricular outlet obstruction.

67
Q

most common presenting patient and what is the pathology?

A

young athlete

sarcomere mutation

68
Q

What is HCM like and explain the difference?

A

it is basically like AS but young athlete and more blood softens the sound

69
Q

treatment for HCM? what kind of murmur is HCM?

A

avoid dehydration and beta blockers/CCB

systolic

70
Q

Pathology of MVP?
typical patient?
What is it like but difference?
treatment?

A

congenital
young woman
MR but more blood makes it better
avoid dehydration and beta blockers

71
Q

3 causes of dilated cardiomyopathy to remember?

A

virus, alcohol, and ischemia

72
Q

3 symptoms of HCM to remember?

A

DOE, syncope, and sudden death

73
Q

What essentially is concentric cardiomyopathy?

Patho of it?

A

diastolic CHF

HTN

74
Q

3 primary causes of restrictive cardiomyopathy?

A

amyloid, sarcoid, and hemachromatosis

75
Q

associated health conditon with amyloid, sarcoid and hemachromatosis?

A

peripheral neuropathy
pulmonary disease
cirrhosis or DM

76
Q

2 big causes of pericarditis?

A

viral infection

uremia

77
Q

two words to describe the pain of pericarditis?

A

pleuritic and positional

78
Q

What is the test to diagnose pericarditis and what is considered the best one but not used?

A

EKG

but best is MRI

79
Q

4 options for treatment of pericarditis and which one is the best?

A

NSAIDS and colchicine, best
nsaids alone, not in CKD, bleeding problems and PUD
colchicine alone
steroids, worst choice

80
Q

What does EKG show for pericarditis?

A

diffuse ST elevations or depressed PR

81
Q

How to best diagnose pericardial effusion?

treat if it is caused by pericarditis?

A

echo

treat pericarditis, may need to do pericardial window to drain

82
Q

becks triad of tamponade?

A

jvd, hypotension, decreased heart sounds

83
Q

if we have a pericardial knock, what are we dealing with?
How to diagnose?
treatment?

A

constrictive pericarditis
echo
cut the pericardium out. hard fibrous pericardium from chronic pericarditis

84
Q

What is the equation to deal with when we are talking about syncope?

A 
MAP = CO X SVR
CO = SV X HR
SV = contractility and pre load
85
Q

What is vasovagal syncope?

Treat?

A

vagus nerve is stimulated and dumps a bunch of ACH causing bradycardia and massive vasodilation. visceral organs, carotids, and psychogenic

86
Q

how do we diagnose orthostatic hypotension based on numbers?

A

systolic greater than 20, diastolic greater than 10 and HR greater than 15 when going from laying to standing

87
Q

What are the two most common causes of orthostatic hypotension?
treatment?

A

volume down, diarrhea, dehydration etc
dysfunctional ANS, old person
fluids

88
Q

3 mechanical heart problems causing syncope?

A

valve problem, arrhythmia,

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