Cardio Flashcards
1
Q
- no P waves
- irregularly irregular
- uncoordinated atrial activity
- most common sustained dysrhythmia
- variable ventricular response rate
A
Atrial fibrillation
2
Q
antithrombotics
A
prevent new clots
3
Q
Enoxaparin
A
low molecular weight heparin
4
Q
Apical midsystolic click
A
mitral valve prolapse (MVP)
5
Q
nonselective Bblockers
A
propanolol, nadolol
6
Q
MC presenting sx of hypertrophic cardiomyopathy
A
DOE
7
Q
angina that occurs during rest, is new onset, crescendo
A
unstable angina
8
Q
what is unstable angina
A
angina new in onset that occurs at rest or with minimal exertion, or a worsening change in a previously-diagnosed stable angina.
9
Q
sildenafil + nitro together can cause…
A
severe hypotension
10
Q
Tx for acute angina pectoris
A
MONA, +/- Bblockers
monitor + serial cardiac enzymes
11
Q
What does ECG show in prinzmetal angina?
A
ST segment elevation
12
Q
chest pain in the AM
A
prinzmetal angina
13
Q
definitive diagnosis for angina pectoris
this is also gold standard
A
coronary angiography
14
Q
MOA of BBlockers
A
increases diastolic time
reduces O2 requirements during exercise/stress
*neg chronotrope/inotrope*
15
Q
CI of Nitro
A
SBP <90, RV infarction, use of sildenafil or other PDE-5 inhibitor
16
Q
Tx for unstable a-fib
A
synchronized cardioversion
17
Q
nitroglycerin MOA
A
- increases blood supply to heart by increasing O2, collateral blood flow, reduces coronary vasospasm
- decreases demand by decreasing cardiac work and preload by venodilation
18
Q
unfractionated Heparin MOA
A
inactivates Factor Xa & Factor IIa
19
Q
II, III, AvF
A
right coronary artery
inferior MI
20
Q
1st line Tx for STEMI
A
PCI (percutaneous coronary intervention)
21
Q
low-intensity, low-pitch extra heart sound, which occurs in early diastole
A
S3 (dilated cardiomyopathy)
indicates ventriucular dysfunction + volume overload
22
Q
what antithrombotic do you want to use in unstable angina/NSTEMI pts with positive cardiac markers or ECG changes?
A
Unfractionated Heparin
23
Q
Tx for stable a-fib
A
rate control w/ diltiazem or metoprolol
24
Q
Initial test for angina pectoris
A
ECG: ST depression
25
2nd line thrombolytic for STEMI mgmt
streptokinase
use in pt with high risk of intracerebral hemorrhage as Alteplase has a higher rebleed risk
26
Clopidogrel MOA
**inhibits ADP mediated platelet aggregation**
27
TIMI score of **2,3, or 4**
**anti-platelet therapy (ASA + clopidogrel)** + **serial troponin measurement**
28
When would you do PTCA instead of CABG?
normal ventricular function
**1 or 2** vessel disease _NOT involving left main coronary artery_
29
anti thrombotic therapy used to tx unstable angina and NSTEMI
Aspirin or Clopidogrel
30
RF for coronary artery disease
* DM (worst one)
* tobacco smoking
* HLD
* HTN
* males
* age \>45 M, \>55 F
* Fam hx
31
Tx when a-fib is present for **\> 48hrs**
anticoagulate for 21 days prior to cardioversion
32
no P **_waves**_ vs _**abnormal_** p waves
no p waves: **a-fibrillation**
abnormal p waves: **a-flutter**
33
are there elevated cardiac enzymes in prinzmetal angina?
no
34
vasospasm of coronary vessels
young women experience this chest pain in the AM
Prinzmetal's (variant) angina
35
Pathology of CAD
inadequate tissue perfusion/ischemia due to increased demand and dec. supply
36
MOA of ASA
**inhibits cyclooxygenase** which **decreases thromboxane A2**
37
1st line drug for chronic stable angina mgmt
Beta Blockers
38
Best diagnostic test for **unstable angina or NSTEMI**
ECG
39
What medication is contraindicated in an inferior lead MI?
**nitroglycerin**
Patients with an inferior STEMI _may also have right ventricular infarct_ and be _preload dependent_. In a patient with an inferior STEMI, right ventricular infarct is suggested by the presence of _ST elevation in lead III larger than that in lead II._ A right ventricular infarct can be discovered by performing a _right-sided ECG_ and looking for _ST elevation in lead “RV4._” In these patients, a **_preload reducing medication like nitroglycerin can lead to a precipitous drop in blood pressure._**
40
1st line thrombolytic for STEMI mgmt
alteplase (RtPA)
41
chest discomfort **precipitated by activity** but symptoms **abate after activity**
stabe angina
42
when would you use clopidogrel in pt with unstable angina or NSTEMI?
if pt is allergic to ASA
43
**coronary spasm** & **transient ST elevations** w/o MI
Prinzmetal angina
44
Side effects of Low molecular weight heparin
thrombocytopenia
45
hypertrophic cardiomyopathy murmur increases with what?
**valsalva**
**standing**
46
A patient with an intermediate risk of coronary artery disease is undergoing an exercise stress test. Which of the following is the most specific finding for myocardial ischemia?
**2 mm downsloping ST-segment depression** is the most specific finding for **myocardial ischemia** during an **exercise stress test.**
47
tx for cocaine induced MI
CCB + nitrates
48
TIMI Hx factors (4)
1. **Age ≥65y**
2. **≥3 CAD Risk Factors** (FamHx, Inc. Cholesterol, DM, smoker)
3. Known **CAD (stenosis ≥50%)**
4. **ASA use** in past 7 days
49
Thrombolytics
dissolve existing clots
50
substernal chest pain secondary to myocardial infarction
angina pectoris
51
What is the time range for STEMI from door to PCI?
90 minutes is ideal
best within 3 hrs of onset
52
I, aVL, V5, V6
circumflex artery
lateral wall MI
53
Mitral Valve Prolapse is best heart at...
apex of heart
54
CI to Beta Blocker use
severe bradycardia, hypotension, decompensated CHF, 2nd/3rd heart block, cardiogenic shock, cocaine induced MI
55
ST Elevation MI Evolution
Hyperacute T waves → J Point elevation → ST segment elevation → Q wave formation(loss of R wave) → T wave inversion
56
Obtain ECG within how many minutes of pt with UAngina, STEMI or NSTEMI?
10 mins
57
What tool do you use to calculate a patient with a fib's risk score of **stroke or embolism**?
CHA2DS2-VASc score
58
side effects of alteplase
**higher rebleed risk**
59
60
most specific and sensitive cardiac marker
troponin
61
def mgmt of angina
percutaneous transluminal coronary angioplasty **(PTCA)**
**CABG** (coronary artery bypass graft)
62
most effective form of nitro
sublingual
63
what if there is no relief w/ 1st dose of nitro?
give 2nd & 3rd dose q 5 minutes
If no relief after 3rd dose, suspect ACS
64
MC atypical presenting complaint in elderly population dx'd w/ ACS
dyspnea
65
When would you do CABG?
if there is left main artery involvement
critical stenosis \>70%
3 vessel disease
EF \<40%
66
Sildenafil MOA
inhibitor of **cyclic guanosine monophosphate (cGMP)** specific phosphodiesterase type 5
67
why should you avoid BB for cocaine induced MI
increases risk of vasospasm
68
When would you use CCB in angina pectoris?
pts unable to use **BB** & in pts w/ **prinzmetal angina**
69
I, AVL, V4, V5, V6
mid LAD or CFX
anterolateral MI
70
What is the adjunctive therapy used for unstable angina or NSTEMI?
BBlockers (metoprolol)
or
CCB
71
cardioselective BBlockers
atenolol, metoprolol
72
hypertrophic cardiomyopathy murmur decreases with what?
**squatting**
**trendelenberg**
73
What is a TIMI risk score
used to **estimate mortality in patients with _unstable angina and non-ST elevation MI’s._**
determines if this patient needs urgent revascularization.
74
most useful noninvasive test for cardiac issues
stress ECG
75
What 2 meds reduce mortality in angina pectoris?
ASA, BB
76
STEMI progressoin on ECG
peaked T waves --\> ST elevation --\> pathologic Q waves
77
sawtooth pattern
atrial **flutter**
78
atrial fibrillation induced by **excessive alcohol consumption**
holiday heart syndrome
79
MCC of CAD
atherosclerosis
80
At what TIMI score would you decide to go ahead with PCI?
**≥3**
81
S/E of nitro
tachyphylaxis after 24 h (allow nitrate free period for 8H)
82
Typical findings of angina pectoris (stable angina)
substernal chest pain precipitated by stress/exertion & relieved by nitrates
pain can radiate, SOB, N/V, diaphoresis, lightheadedness
levine's sign: clenched fist over chest
83
MOA of ASA
prevents platelet activation/aggregation
84
What is TIMI used for?
Used in pts who present with UA or NSTEMI to determine the benefit of invasive angiography to decrease mortality
85
TIMI Presentation Factors (3)
1. Recent (\<24 hrs) **severe angina**
2. **Increased Cardiac markers**
3. **ST elevation** 0.5mm
86
TIMI 5 & above
antithrombotic meds + PCI
87
What main drug classes will you use to tx Unstable angina or NSTEMI?
antithrombotics and adjunctive therapy
88
What is the goal of pharma mgmt of angina pectoris?
increase supply & decrease demand
89
nondihydropyridine CCB
**diltiazem, verapamil**
90
Troponin
Highest sensitivity and specificity
Time detectable from onset: 3-12 hours
Peak: 24-48 hours
Return to baseline: 5-14 days
91
alteplase MOA
**dissolves clot** my activating tissue plasminogen --\> plasmin
plasmin is a proteolytic enzyme that degrades fibrin
92
MRI shows **gadolinium hyperenhancement** in heart
restrictive cardiomyopathy
93
What medication can be given to a pt w/a STEMI on their way to PCI?
abciximab
platelet aggregation inhibitor
94
Chronic angina pectoris tx
nitrates, ASA, BBlockers
95
V1-V4
Left anterior descending artery
anterior septal wall MI
