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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
Prosthetic valve endocarditis
S epidermidis
26
Miscellaneous virulent organisms causing IE
Gram neg Fungi HACEK
27
Viridans, strep, staph and HACEK enter via
oral cavity, skin, upper respiratory tract
28
Streptococcus gallolyticus | Subspecies gallolyticus enter via
GI tract
29
Enterococci enter via
urinary tract
30
Endocarditis and Colon CA
strep bovis
31
The organisms causing IE contain which adhere to nonbacterial thrombotic endocarditis NBTE sites or injured epithelium
Microbial surface components recognizing adhesins matrix molecules (MSCRAMMS)
32
Normal valve Necrotic, ulcerative, destructive in days Fever of >/= 39.4 Mx: Surgery
Acute IE
33
Deformed valve Insidious, less destructive, weeks to months Fever of <39.4 Mx: antibiotic
Subacute
34
Injection drug use associated endocarditis involves the and is caused by Occurs among injection drug users
tricuspid valve s aureus Polymicrobial endocarditis
35
Dx of IE is established only
when vegetations are examined histologically and microbiologically
36
Highly sensitive and specific diagnostic schema | Based on clinical, lab and 2D ECHO
Modified Duke Criteria
37
Duke Major Criteria
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)
38
Duke Minor Criteria
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
Definite endocarditis is defined by documentation of Perform for optimal assessment of possible valve endocarditis
Two major criteria One major and 3 minor criteria Five minor criteria Transesophageal echocardiography
40
Most common clinical manifestation of infective endocarditis Least
Fever 80-90% Heart murmur 80-85% Peripheral: osler, subgungal hemorrhage, janeway
41
Lab manifestation of IE
Anemia 70-90 Inc ESR 60-99 Inc CRP >90 Circulating immune complex 65-100
42
Acute endocarditis fever manifestation
Hectically febrile | 39.4-40
43
Subacute endocarditis follows
indolent course | rarely exceeds 39.4
44
Nephro manifestation of IE
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
Tender nodes at pulp of digit
Osler nodes
46
Painless lesions on the palm
Janeway lesion
47
Nail lesions
Splinter hemorrhage
48
Retinal hemorrhage with white or pale centers composed of coagulated fibrin in IE
Roth spot
49
Serologic tests for IE
Brucella, Bartonella, Legionella, Chlamydia
50
Empirical tx for IE Acute endocarditis in injection drug user
Vancomycin | Gentamycin
51
Emipiric Blood culture negatice subacute NVE
Gentamicin plus Ampicillin-sulbactan Ceftriaxone
52
Empirical Blood culture negative PVE
Vancomycin Gentamycin Cefepime Rifampin
53
Tx for Penicillin susceptible strep | Strep gallolyticus
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
Penicillin resistant strep and s gallolyticus Tx
Pen G Ceftriaxone Vancomycin Gentamycin For 4 weeks
55
Pen susceptible strep | S gallolyticus Tx
Pen G Ceftriaxone Vancomycin All 4 weeks
56
Enetrococci IE Tx
Pen G Ampicillin Vancomycin Ampicillin (E faecalis) For 4-6 weeks
57
Staph IE Tx MSSA
``` Nafcillin Oxacillin Flucloxacillin Cefazolin Vancomycin (only in immediate urticaria and severe penicillin allergy) ```
58
MRSA IE Tx
Vancomycin 4-6 w
59
HACEK IE Tx
Ceftriaxone Ampi-sul 4 weeks
60
Coxiella IE Tx
Doxycycline | Hydroxychloroquine
61
Bartonella IE Tx
Doxycycline | Gentamycin
62
Stage I HTN AHA JNC
130-139 | 80-89
63
Normal BP AHA JNC
<120 | <80
64
Elevated BP AHA JNC
120-129 | <80
65
Stage 2 AHA JNC
``` >/= 140 >/= 90 ```
66
Most common cause of secondary hypertension
Obstructive Sleep Apnea 25-50-% Primary renal disease or Renovascular disease 25-35% in PLE
67
Secondary cause of HTN due to Excess secretion of epinephrine and norepinephrine from tumor of adrenal medulla Test
Pheochromocytoma 24h urinary fractionated metaneprine/plasma metanephrine Urinary metabolite: VMA
68
Other secondary causes of HTN
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
Drug of choice for acromegaly
ocreotide
70
45/M BP: 150/90 | Initial diagnostic test for primary hypertension
TSH ``` Others: FBG CBC LP Serum crea with eGFR Na, K, Ca TSH UA ECG ```
71
Optional testing for Primary HTN
Echocardiogram Uric Acid Urinary albumin to creatinine ratio
72
Early marker of renal injury | Considered risk factor for renal disease progression and cardiovascular disease
Urinary albumin/creatinine ratio
73
Macroalbuminemia Random urine albumin/crea ratio
>300mg/g
74
Classic symptom of PAD
Intermittent claudication
75
Diagnostic of PAD
ABI <0.90 Compares BP in arm and ankle
76
ABI =
Ankle systolic pressure/Brachial systolic pressure
77
Interprration of ABI Normal
0.91 - 1.29
78
Mild to moderate peripheral arterial ABI
0.41-0.90
79
Severe peripheral arterial disease ABI
<0.41
80
IgA nephropathy
Berger’s
81
Nonpharmacologic intervention with highest BP lowering effect among hypertensive patients
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
BP GOAL in patient with co morbidities
<130/80
83
Thiazide diuretics | WOF
Hyperuricemia Hyponatremia Hypokalemia
84
Contraindicated if given both
ACEi + ARB
85
Risk for hyperkalemia Avoid in pregnant May cause ARF in severe bilateral RAS
ACEi / ARB
86
do not use in HFrEF
CCB nondihydro/dihydro
87
Mixing CCB nondihydro with BB will
inc bradycardia and heartblock
88
First line preferred for symptomatic HF
Loop | furosemide
89
Preferred for Primary aldosteronism and resistent hypertension
``` Eplerenone Spironolactone (gynecomastia) ``` Aldosterone antagonist
90
Avoid in reactive airway disease
Propranolol Nadolol BB noncardioselective
91
Preferred in HFrEF
Bisoprolol | Metoprolol succinate
92
Hypertensive crisis
SBP >180 | DBP > 120
93
Surface perechiae Flea bitten appearance Onion skin lesion of arteriole Fibrinoid necrosis of arteriole
Malignant hypertension
94
Metabolic syndrome
``` 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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