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Cardio Flashcards

1
Q

Gold standard for assessing LV mass and volume

A

Cardiac MRI

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2
Q

Most useful index of LV function

A

EF

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3
Q

EF =

A

Stroke volume/EDV

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4
Q

Normal EF

A

> /=50 %

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5
Q

Biomarkers sensitive for presence of HF
Useful in diagnosis and establishing prognosis and severity
May inc with age, renal impairment and women but falsely low in obese

A

B type natriuretic peptide

N-terminal pro BNP

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6
Q

Diagnostics for HF (6)

A 
1 laboratory (CBC, electro, BUN, Crea, AST/ALT, UA and/or fasting glucose, OGTT, dyslipidemia, tsh)
2 ECG
3 CXR
4 2D Echo/Doppler
5 BNP, NT Pro BNP
6 Exercise testing
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7
Q

ECG in severe pulmonary hypertension (3)

A

P pulmonale
R axis deviation
RVH

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8
Q

Best for diagnosing chronic thromboembolic disease

A

Ventilation/Perfusion scan

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9
Q

Confirms diagnosis of pulmonary hypertension

A

Cardiac cath

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10
Q

Therap targets in HFpEF (3)

A

1 control congestion
2 stabilize heart rate and bp
3 improve exercise tolerance

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11
Q

Showed stat significant reduction in hosp but no diff in all cause mortality in HFpEF

A

Candesartan ARB

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12
Q

ADHF typical HTN Mx

A

Vasodilators (usually not volume overloaded)

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13
Q

ADHF Typical Normotensive

A

Diuretics (usually volume overloaded)

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14
Q

ADHF Pulmonary edema with pulmo congestion and hypoxia (4)

A

Opiates
Vasodilators
Diuretics
O2 non invasive ventilation

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15
Q

ADHF Low output hypoperfusion, with end-organ dysfunction

A

Vasodilators
Hemodynamic monitoring
Inotropic therapy

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16
Q

ADHF Cardiogenic shock hypotension, low cardiac output, EOF

A

Inotropic therapy catecholamine

Mech circ support

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17
Q

Interplay of neurohormonal factors with deteriorating function of kidney while therapy is adminstered to preserve the heart
Exacerbated by backward failure, inc intraabd pressure and impairment of venous return

A

Cardiorenal syndrome

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18
Q

In diabetics with HF, this drug demonstrated dec in CV mortality and hospitalizations for
HF

A

Empagliflazone SGLT2

induces osmotic diuresis and ketosis

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19
Q

Candidates for ICD prophylactic therapy

A

NYHA Class II and III

LVEF <35% irrespect of etiology

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20
Q

ICD is appropriate in

A

Patients with MI

Residual LVEF =30% even asymptomatic

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21
Q

Serious infection from colonization or invasion of heart valves or the mural endocardium by microbe

A

Infective endocarditis

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22
Q

IE Pathophy

A

Endothelial injury
Direct infection by virus
Development of platelet fibrin thrombus (bacterial attachment during transient bacteremia)

Organisms enter bloodstream from mucosal surface, skin or site of focal infection

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23
Q

Causes native valve endocarditis

A

S viridans

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24
Q

Endocarditis in IV drug user

A

S aureus

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25
Q

Prosthetic valve endocarditis

A

S epidermidis

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26
Q

Miscellaneous virulent organisms causing IE

A

Gram neg
Fungi
HACEK

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27
Q

Viridans, strep, staph and HACEK enter via

A

oral cavity, skin, upper respiratory tract

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28
Q

Streptococcus gallolyticus

Subspecies gallolyticus enter via

A

GI tract

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29
Q

Enterococci enter via

A

urinary tract

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30
Q

Endocarditis and Colon CA

A

strep bovis

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31
Q

The organisms causing IE contain

which adhere to nonbacterial thrombotic endocarditis NBTE sites or
injured epithelium

A

Microbial surface components recognizing adhesins matrix molecules (MSCRAMMS)

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32
Q

Normal valve
Necrotic, ulcerative, destructive in days
Fever of >/= 39.4
Mx: Surgery

A

Acute IE

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33
Q

Deformed valve
Insidious, less destructive, weeks to months
Fever of <39.4
Mx: antibiotic

A

Subacute

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34
Q

Injection drug use associated endocarditis involves the
and is caused by

Occurs among injection drug users

A

tricuspid valve
s aureus

Polymicrobial endocarditis

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35
Q

Dx of IE is established only

A

when vegetations are examined histologically and microbiologically

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36
Q

Highly sensitive and specific diagnostic schema

Based on clinical, lab and 2D ECHO

A

Modified Duke Criteria

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37
Q

Duke Major Criteria

A

1 Positive blood culture (2 separate)
Viridans, strep gallolyticus, HACEK, staph aureus or CA enterococci in absence of primary focus

Persistently positive

2 Evidence of endocardial involvement
Intracardiac mass on valve or structure in path of regurgitant jet new partial dehiscence of prosthetic valve in 2DECHO

3 New valvular regurgitation (sufficient inc or change in preexisting murmur)

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38
Q

Duke Minor Criteria

A

1 Predisposition (hx of heart dse or injection drug use)
2 Fever >/= 38
3 Vascular phenomenon: major arterial emboli, septic pulmonary infarct, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesion
4 immunologic phenomenon: glomerulonephritis, Osler’s nodes, Roth spots, rheumatoid factor
5 microbiologic evidence : positive blood culture but not meeting major criterion, sero evidence of active infection wih organism consistent with infective endocarditis

39
Q

Definite endocarditis is defined by documentation of

Perform for optimal assessment of possible valve endocarditis

A

Two major criteria
One major and 3 minor criteria
Five minor criteria

Transesophageal echocardiography

40
Q

Most common clinical manifestation of infective endocarditis

Least

A

Fever 80-90%
Heart murmur 80-85%

Peripheral: osler, subgungal hemorrhage, janeway

41
Q

Lab manifestation of IE

A

Anemia 70-90
Inc ESR 60-99
Inc CRP >90
Circulating immune complex 65-100

42
Q

Acute endocarditis fever manifestation

A

Hectically febrile

39.4-40

43
Q

Subacute endocarditis follows

A

indolent course

rarely exceeds 39.4

44
Q

Nephro manifestation of IE

A

1 immune complex dep on glomerular basement membrane, diffuse hypoconplementic GN, renal dysfunction
2 embolic renal infarct cause flank pain and hematuria rarely causing renal dysfunction

45
Q

Tender nodes at pulp of digit

A

Osler nodes

46
Q

Painless lesions on the palm

A

Janeway lesion

47
Q

Nail lesions

A

Splinter hemorrhage

48
Q

Retinal hemorrhage with white or pale centers composed of coagulated fibrin in IE

49
Q

Serologic tests for IE

A

Brucella, Bartonella, Legionella, Chlamydia

50
Q

Empirical tx for IE

Acute endocarditis in injection drug user

A

Vancomycin

Gentamycin

51
Q

Emipiric

Blood culture negatice subacute NVE

A

Gentamicin plus
Ampicillin-sulbactan
Ceftriaxone

52
Q

Empirical

Blood culture negative PVE

A

Vancomycin
Gentamycin
Cefepime
Rifampin

53
Q

Tx for Penicillin susceptible strep

Strep gallolyticus

A

Penicillin G 2-3 mU IV
Ceftriaxone 2g with nonimediate penicillin allergy
Vancomycin for severe or imediate b lactam allergy

all for 4 weeks

54
Q

Penicillin resistant strep and s gallolyticus Tx

A

Pen G
Ceftriaxone
Vancomycin
Gentamycin

For 4 weeks

55
Q

Pen susceptible strep

S gallolyticus Tx

A

Pen G
Ceftriaxone
Vancomycin

All 4 weeks

56
Q

Enetrococci IE Tx

A

Pen G
Ampicillin
Vancomycin

Ampicillin (E faecalis)

For 4-6 weeks

57
Q

Staph IE Tx

MSSA

A 
Nafcillin 
Oxacillin
Flucloxacillin 
Cefazolin
Vancomycin (only in immediate urticaria and severe penicillin allergy)
58
Q

MRSA IE Tx

A

Vancomycin

4-6 w

59
Q

HACEK IE Tx

A

Ceftriaxone
Ampi-sul

4 weeks

60
Q

Coxiella IE Tx

A

Doxycycline

Hydroxychloroquine

61
Q

Bartonella IE Tx

A

Doxycycline

Gentamycin

62
Q

Stage I HTN AHA JNC

A

130-139

80-89

63
Q

Normal BP AHA JNC

64
Q

Elevated BP AHA JNC

A

120-129

<80

65
Q

Stage 2 AHA JNC

A 
>/= 140 
>/= 90
66
Q

Most common cause of secondary hypertension

A

Obstructive Sleep Apnea 25-50-%

Primary renal disease or
Renovascular disease 25-35% in PLE

67
Q

Secondary cause of HTN due to
Excess secretion of epinephrine and norepinephrine from tumor of adrenal medulla

Test

A

Pheochromocytoma

24h urinary fractionated metaneprine/plasma metanephrine

Urinary metabolite: VMA

68
Q

Other secondary causes of HTN

A

Cushing’s Dexa supression
Hypothyroidism
Hyperthyroidism
Aortic coarctation -2D ECHO, inc BP UE and low in LE
Primary Hyperparathyroidism - serum Ca
Congenital adrenal hyperplasia - HTN + Hypokalemia with low/N aldosterone and renin, genital ambiguity
Acromegaly - Gh

69
Q

Drug of choice for acromegaly

70
Q

45/M BP: 150/90

Initial diagnostic test for primary hypertension

A

TSH

Others:
FBG
CBC
LP
Serum crea with eGFR
Na, K, Ca
TSH
UA
ECG
71
Q

Optional testing for Primary HTN

A

Echocardiogram
Uric Acid
Urinary albumin to creatinine ratio

72
Q

Early marker of renal injury

Considered risk factor for renal disease progression and cardiovascular disease

A

Urinary albumin/creatinine ratio

73
Q

Macroalbuminemia

Random urine albumin/crea ratio

74
Q

Classic symptom of PAD

A

Intermittent claudication

75
Q

Diagnostic of PAD

A

ABI <0.90

Compares BP in arm and ankle

76
Q

ABI =

A

Ankle systolic pressure/Brachial systolic pressure

77
Q

Interprration of ABI

Normal

A

0.91 - 1.29

78
Q

Mild to moderate peripheral arterial

ABI

79
Q

Severe peripheral arterial disease

ABI

80
Q

IgA nephropathy

A

Berger’s

81
Q

Nonpharmacologic intervention with highest BP lowering effect among hypertensive patients

A

DASH diet

-11mmHg

more specific

Dietary approaches to stop hypertension
Eat more fruits and veg, low fat dairy food
Avoid saturated fat and trans
Eat more whole grain, fish, poultry
Limit Na 1500mg/day, sweet, sugary drink and red meat

82
Q

BP GOAL in patient with co morbidities

83
Q

Thiazide diuretics

WOF

A

Hyperuricemia
Hyponatremia
Hypokalemia

84
Q

Contraindicated if given both

A

ACEi + ARB

85
Q

Risk for hyperkalemia
Avoid in pregnant
May cause ARF in severe bilateral RAS

A

ACEi / ARB

86
Q

do not use in HFrEF

A

CCB nondihydro/dihydro

87
Q

Mixing CCB nondihydro with BB will

A

inc bradycardia and heartblock

88
Q

First line preferred for symptomatic HF

A

Loop

furosemide

89
Q

Preferred for Primary aldosteronism and resistent hypertension

A 
Eplerenone
Spironolactone (gynecomastia)

Aldosterone antagonist

90
Q

Avoid in reactive airway disease

A

Propranolol
Nadolol
BB noncardioselective

91
Q

Preferred in HFrEF

A

Bisoprolol

Metoprolol succinate

92
Q

Hypertensive crisis

A

SBP >180

DBP > 120

93
Q

Surface perechiae
Flea bitten appearance
Onion skin lesion of arteriole
Fibrinoid necrosis of arteriole

A

Malignant hypertension

94
Q

Metabolic syndrome

A 
3 out of 5:
Central obesity 102 cm M, 88 cm F
Hyper TAG >150 mg/dl
Low HDL <40 M and <50 F
BP of >/= 130/85
FBS of >100 mg/dl

Medicine (29 decks)

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