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GK PANCE > Cardio > Flashcards

Cardio Flashcards

1
Q
  • no P waves
  • irregularly irregular
  • uncoordinated atrial activity
  • most common sustained dysrhythmia
  • variable ventricular response rate
A

Atrial fibrillation

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2
Q

antithrombotics

A

prevent new clots

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3
Q

Enoxaparin

A

low molecular weight heparin

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4
Q

Apical midsystolic click

A

mitral valve prolapse (MVP)

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5
Q

nonselective Bblockers

A

propanolol, nadolol

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6
Q

MC presenting sx of hypertrophic cardiomyopathy

A

DOE

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7
Q

angina that occurs during rest, is new onset, crescendo

A

unstable angina

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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.

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9
Q

sildenafil + nitro together can cause…

A

severe hypotension

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10
Q

Tx for acute angina pectoris

A

MONA, +/- Bblockers

monitor + serial cardiac enzymes

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11
Q

What does ECG show in prinzmetal angina?

A

ST segment elevation

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12
Q

chest pain in the AM

A

prinzmetal angina

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13
Q

definitive diagnosis for angina pectoris

this is also gold standard

A

coronary angiography

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14
Q

MOA of BBlockers

A

increases diastolic time

reduces O2 requirements during exercise/stress

*neg chronotrope/inotrope*

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15
Q

CI of Nitro

A

SBP <90, RV infarction, use of sildenafil or other PDE-5 inhibitor

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16
Q

Tx for unstable a-fib

A

synchronized cardioversion

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17
Q

nitroglycerin MOA

A
  1. increases blood supply to heart by increasing O2, collateral blood flow, reduces coronary vasospasm
  2. decreases demand by decreasing cardiac work and preload by venodilation
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18
Q

unfractionated Heparin MOA

A

inactivates Factor Xa & Factor IIa

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19
Q

II, III, AvF

A

right coronary artery

inferior MI

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20
Q

1st line Tx for STEMI

A

PCI (percutaneous coronary intervention)

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21
Q

low-intensity, low-pitch extra heart sound, which occurs in early diastole

A

S3 (dilated cardiomyopathy)

indicates ventriucular dysfunction + volume overload

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22
Q

what antithrombotic do you want to use in unstable angina/NSTEMI pts with positive cardiac markers or ECG changes?

A

Unfractionated Heparin

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23
Q

Tx for stable a-fib

A

rate control w/ diltiazem or metoprolol

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24
Q

Initial test for angina pectoris

A

ECG: ST depression

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25
Q

2nd line thrombolytic for STEMI mgmt

A

streptokinase

use in pt with high risk of intracerebral hemorrhage as Alteplase has a higher rebleed risk

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26
Q

Clopidogrel MOA

A

inhibits ADP mediated platelet aggregation

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27
Q

TIMI score of 2,3, or 4

A

anti-platelet therapy (ASA + clopidogrel) + serial troponin measurement

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28
Q

When would you do PTCA instead of CABG?

A

normal ventricular function

1 or 2 vessel disease NOT involving left main coronary artery

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29
Q

anti thrombotic therapy used to tx unstable angina and NSTEMI

A

Aspirin or Clopidogrel

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30
Q

RF for coronary artery disease

A
  • DM (worst one)
  • tobacco smoking
  • HLD
  • HTN
  • males
  • age >45 M, >55 F
  • Fam hx
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31
Q

Tx when a-fib is present for > 48hrs

A

anticoagulate for 21 days prior to cardioversion

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32
Q

no P waves** vs **abnormal p waves

A

no p waves: a-fibrillation

abnormal p waves: a-flutter

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33
Q

are there elevated cardiac enzymes in prinzmetal angina?

A

no

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34
Q

vasospasm of coronary vessels

young women experience this chest pain in the AM

A

Prinzmetal’s (variant) angina

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35
Q

Pathology of CAD

A

inadequate tissue perfusion/ischemia due to increased demand and dec. supply

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36
Q

MOA of ASA

A

inhibits cyclooxygenase which decreases thromboxane A2

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37
Q

1st line drug for chronic stable angina mgmt

A

Beta Blockers

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38
Q

Best diagnostic test for unstable angina or NSTEMI

A

ECG

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39
Q

What medication is contraindicated in an inferior lead MI?

A

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
Q

1st line thrombolytic for STEMI mgmt

A

alteplase (RtPA)

41
Q

chest discomfort precipitated by activity but symptoms abate after activity

A

stabe angina

42
Q

when would you use clopidogrel in pt with unstable angina or NSTEMI?

A

if pt is allergic to ASA

43
Q

coronary spasm & transient ST elevations w/o MI

A

Prinzmetal angina

44
Q

Side effects of Low molecular weight heparin

A

thrombocytopenia

45
Q

hypertrophic cardiomyopathy murmur increases with what?

A

valsalva

standing

46
Q

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?

A

2 mm downsloping ST-segment depression is the most specific finding for myocardial ischemia during an exercise stress test.

47
Q

tx for cocaine induced MI

A

CCB + nitrates

48
Q

TIMI Hx factors (4)

A
  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
Q

Thrombolytics

A

dissolve existing clots

50
Q

substernal chest pain secondary to myocardial infarction

A

angina pectoris

51
Q

What is the time range for STEMI from door to PCI?

A

90 minutes is ideal

best within 3 hrs of onset

52
Q

I, aVL, V5, V6

A

circumflex artery

lateral wall MI

53
Q

Mitral Valve Prolapse is best heart at…

A

apex of heart

54
Q

CI to Beta Blocker use

A

severe bradycardia, hypotension, decompensated CHF, 2nd/3rd heart block, cardiogenic shock, cocaine induced MI

55
Q

ST Elevation MI Evolution

A

Hyperacute T waves → J Point elevation → ST segment elevation → Q wave formation(loss of R wave) → T wave inversion

56
Q

Obtain ECG within how many minutes of pt with UAngina, STEMI or NSTEMI?

A

10 mins

57
Q

What tool do you use to calculate a patient with a fib’s risk score of stroke or embolism?

A

CHA2DS2-VASc score

58
Q

side effects of alteplase

A

higher rebleed risk

59
Q
A
60
Q

most specific and sensitive cardiac marker

A

troponin

61
Q

def mgmt of angina

A

percutaneous transluminal coronary angioplasty (PTCA)

CABG (coronary artery bypass graft)

62
Q

most effective form of nitro

A

sublingual

63
Q

what if there is no relief w/ 1st dose of nitro?

A

give 2nd & 3rd dose q 5 minutes

If no relief after 3rd dose, suspect ACS

64
Q

MC atypical presenting complaint in elderly population dx’d w/ ACS

A

dyspnea

65
Q

When would you do CABG?

A

if there is left main artery involvement

critical stenosis >70%

3 vessel disease

EF <40%

66
Q

Sildenafil MOA

A

inhibitor of cyclic guanosine monophosphate (cGMP) specific phosphodiesterase type 5

67
Q

why should you avoid BB for cocaine induced MI

A

increases risk of vasospasm

68
Q

When would you use CCB in angina pectoris?

A

pts unable to use BB & in pts w/ prinzmetal angina

69
Q

I, AVL, V4, V5, V6

A

mid LAD or CFX

anterolateral MI

70
Q

What is the adjunctive therapy used for unstable angina or NSTEMI?

A

BBlockers (metoprolol)

or

CCB

71
Q

cardioselective BBlockers

A

atenolol, metoprolol

72
Q

hypertrophic cardiomyopathy murmur decreases with what?

A

squatting

trendelenberg

73
Q

What is a TIMI risk score

A

used to estimate mortality in patients with unstable angina and non-ST elevation MI’s.

determines if this patient needs urgent revascularization.

74
Q

most useful noninvasive test for cardiac issues

A

stress ECG

75
Q

What 2 meds reduce mortality in angina pectoris?

A

ASA, BB

76
Q

STEMI progressoin on ECG

A

peaked T waves –> ST elevation –> pathologic Q waves

77
Q

sawtooth pattern

A

atrial flutter

78
Q

atrial fibrillation induced by excessive alcohol consumption

A

holiday heart syndrome

79
Q

MCC of CAD

A

atherosclerosis

80
Q

At what TIMI score would you decide to go ahead with PCI?

A

≥3

81
Q

S/E of nitro

A

tachyphylaxis after 24 h (allow nitrate free period for 8H)

82
Q

Typical findings of angina pectoris (stable angina)

A

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
Q

MOA of ASA

A

prevents platelet activation/aggregation

84
Q

What is TIMI used for?

A

Used in pts who present with UA or NSTEMI to determine the benefit of invasive angiography to decrease mortality

85
Q

TIMI Presentation Factors (3)

A
  1. Recent (<24 hrs) severe angina
  2. Increased Cardiac markers
  3. ST elevation 0.5mm
86
Q

TIMI 5 & above

A

antithrombotic meds + PCI

87
Q

What main drug classes will you use to tx Unstable angina or NSTEMI?

A

antithrombotics and adjunctive therapy

88
Q

What is the goal of pharma mgmt of angina pectoris?

A

increase supply & decrease demand

89
Q

nondihydropyridine CCB

A

diltiazem, verapamil

90
Q

Troponin

A

Highest sensitivity and specificity

Time detectable from onset: 3-12 hours

Peak: 24-48 hours

Return to baseline: 5-14 days

91
Q

alteplase MOA

A

dissolves clot my activating tissue plasminogen –> plasmin

plasmin is a proteolytic enzyme that degrades fibrin

92
Q

MRI shows gadolinium hyperenhancement in heart

A

restrictive cardiomyopathy

93
Q

What medication can be given to a pt w/a STEMI on their way to PCI?

A

abciximab

platelet aggregation inhibitor

94
Q

Chronic angina pectoris tx

A

nitrates, ASA, BBlockers

95
Q

V1-V4

A

Left anterior descending artery

anterior septal wall MI

GK PANCE (26 decks)

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