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Step 3 UW /FA > Cardio > Flashcards

Cardio Flashcards

1
Q

High intensity statin

A

Atorvastatin 40, Rosuvastatin 20

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2
Q

Low intensity statin

A

simvastatin 10, pravastatin 20, lovastatin 20, fluvastatin 40

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3
Q

How soon after cardiac stenting can you resume sexual activity?

A

In the period immediately following an acute MI, the myocardium may be vulnerable to increases in demand. Nonetheless, MI patients who have undergone successful revascularization or have no evidence of ischemia on exercise testing can be considered low-risk. They may safely resume sexual intercourse soon after the MI, within 3-4 weeks (Princeton guidelines) and possibly as early as 1 week (American Heart Association guidelines).

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4
Q

72yo M with history of hypertension, significant smoking history who presents with unilateral head and neck pain as well as transient loss of vision that hasn’t improved. On physical exam patient has ipsilateral ptosis. Dx?

A

Carotid artery dissection

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5
Q

which side of the heart shit increases with….. inhalation

A

inhale you increase venous return to the right heart *its venous return increases bc venous = blue & when your blue you inhale

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6
Q

Amyl Nitrate will —–to the heart/

A

decrease afterload *vasodilator

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7
Q

guy comes in with ST elevation. hes already had MONA what do you do next?

A

Cath

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8
Q

tx of MS

A

diuretics then balloon valvuloplasty

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9
Q

what drug is uniquely used to tx PAD

A

cilostazol

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10
Q

what drug does a person need to be on with a 1. DES & 2. bare metal stent? how long?

A

Clopidogrel 1. DES = 12m 2. Bare metal stent = 1m

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11
Q

tx of WPW

A

procainamide

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12
Q

what murmer? water-hammer pulse, wide pulse pressure, Quinke Pulse, Hill Sign

A

AR! quinke = pulse in nail bed hill = bp in leg 40 more than arm

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13
Q

dx of pericardial tamponade

A

ECG

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14
Q

MVP murmer increase?

A

midsystolic click murmer inc: valsalva + standing

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15
Q

Peripheral Arterial disease(PAD) sx

A

claudication, smooth, shiny skin, loss of hair and sweat glands and loss of pulses in the feet

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16
Q

what is the best initial test for pt with CHF

A

echo! = tells you if its systolic dysfunction or diastolic dysfunction

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17
Q

what 2 L sided murmers are increased by standing/valsalva but decreased by squating/leg raise

A

HOCM, MVP

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18
Q

Peripartum Cardiomyopathy

A

prego women makes Ab’s to her own heart. LV dysfunctionis short term and often reversable if not need transplant. tx: ACE, BB, Diuretic, etc

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19
Q

pathogenesis of CHF?

A

infarction/ valvular heart disease/hypertension —> dilation —> regurgitation —> CHF

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20
Q

S4 means….

A

sound of atrial systole contracting against a stiff or noncompliant LV well fuck…you

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21
Q

MR dx test?

A

TEE

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22
Q

MR murmer increase? decrease?

A

pansystolic murmer caused by dilation of the heart that radiates to the axilla . inc:leg raise, squat, handgrop dec: standing, valsalva and amyl nitrate

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23
Q

when do you give biventricular pacemaker?

A

EF <35% + QRS >120ms

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24
Q

tx of MVP

A

BB > valve repair

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25
Q

AS murmer increases? decreases?

A

crescendo-decrescendo systolic murmer inc: leg raising, squatting + amyl nitrate dec: valsalva, standing, handgrip

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26
Q

if you see electrical alternans on ECG you shoudl be thinking….

A

pericardial tamponade, QRS height alternates between leads

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27
Q

causes of pleuritic pain

A

PE, pneumonia, pleuritis, pericarditis, pneumothorax

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28
Q

you do a nuc stress tests & see low uptake. what do you do next?

A

ANGIOGRAPHY to determine what vessels are involved.

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29
Q

how do you differentiate from 3rd degree block vs sinus brady?

A

3rd degree block will have “cannon a-waves” = atrial contracting againsted a closed tricuspid = ventricular diassociation

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30
Q

Squatting will —– to the heart.

A

increase venous return *pushes blood from legs to heart via M contractions

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31
Q

lifting legs in the air with ——ot the heart.

A

increase venous return *gravity

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32
Q

tx of bradycardia

A

atropine

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33
Q

MS sx

A

diastolic openign snap, dilated LA pushes on esophagus causing “horseness”, increased risk of Afib, elevates Left mainstem bronchus due to dilated atrium

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34
Q

What meds lower mortality in ACS?

A

BB(only one thats not time sensitive), Aspirin & Nitro

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35
Q

pt post MI, w/oxy sat in RV > RA. dx?

A

septal rupture!

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36
Q

when do you give a implantable cardioverter/defibulator

A

EF <35%

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37
Q

Which RF of CAD can you eliminate that will provide the greatest IMMEDIATE benefit?

A

smoking

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38
Q

Which cardiac marker can be used to assess 2nd MI?

A

CKMB

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39
Q

Constrictive pericarditis sx? path?

A

heart calcifies = can be seen on xray sx: pericardial knock bc heart cant fill, edema, JVD, hepatosplenomegaly, ascites, kussmauls sign(increased JVD on inhalation)

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40
Q

sx of pericardial tamponade

A

SOB, hypotension, JVD, CLEAR LUNGS, pulsus paradoxus(>10mmhg on inhalation), ELECTRICAL ALTERNANS

41
Q

What do you give for an NSTEMI?

A

heparin

42
Q

tx of diastolic dysfunction in CHF

A

diastolic - normal EF basic: ACE, BB(metoprolol, carvedilol), Spironolactone or hydralazine+nitrates

43
Q

what are Rhonci?

A

Rhonci in the Bronchi = wheezing due to constriction/inflammation

44
Q

who gets a statin?

A
  1. anyone with CAD 2. LDL>190 3. LDL 70-189 w/DM + 40-75yoa 4. LDL 70-189 + 40-75 yoa w/calculated risk
45
Q

pt on ACE/ARB develops hyperkalemia. what do you do?

A

switch them to hydralazine + nitrates

46
Q

valsalva will ——to the heart.

A

decrease blood return = increases intrathroasic pressure = flattens IVC = decreasing flow into heart

47
Q

VSD murmer increases ?

A

holosytolic murmer at the LLstearnal boarder, SOB inc: exhalation, squat, leg raise

48
Q

pulsus paradoxus is classic for…

A

(>10mmhg on inhalation) = pericardial tamponade

49
Q

guy comes in with ST depression hes has MONA what do you do next?

A

thrombolytics! = depression = he hasnt clotted yet = bust up that clot and save the myocardium

50
Q

AR murmer increases? decreases?

A

blowing diastolic murmer = diastolic decrescendo murmer @ LLboarder inc: leg raiseing, squatting, handgrip

51
Q

stent vs bypass

A

stent = 1-2vessels bypass = 3 + vessel or main vessel dz

52
Q

causes of postional chest pain

A

pericarditis = worse when lying dwn but better when sitting up

53
Q

tx of SVT

A

adenosine

54
Q

dx of VSD

A

echo then cathe

55
Q

What would you give an asthmatic instead of a BB for CAD?

A

CCB like Vermpamil or Diltalazam *risk fo reflex tachy

56
Q

RF of Ischemic heart dz?

A

DM, HTN, Tobacco, Hyperlipidemia, PAD, Obesity, Inactivity & family History

57
Q

MS murmer increases with…

A

leg raise, squat and expiration

58
Q

ECG of pericarditis

A

global ST elevation and PR segment depression

59
Q

mechanism of Thallium in stress tests?

A

picked up by NaK ATPase = decrease uptake = dmg myocardium

60
Q

best test for PAD

A

ABI with >10% differ then angiography

61
Q

tx of hypertropic cardiomyopathy

A

BB & diuretics

62
Q

tx of MR?

A

ACE ARB, Nifedipine; if EF<60 then do surgery

63
Q

tx of AS?

A

diuretics > valve replacement

64
Q

screening for AAA

A

65-75 smokers w/U/S

65
Q

tx of pericarditis

A

NSAIDs + Colchicine

66
Q

if a patient cannot get PCI within 90 min what do you need to do for them?

A

thrombolytics

67
Q

tx for aortic dissection

A

1.ence BB 2. Nitroprusside 3. Surgical Consultation

68
Q

whats the single worst/most dangerous factor for CAD?

A

diabetes

69
Q

restrictive cardiomyopathy sx

A

SOB, Kussmauls Sign(increased JVP with inhalation), low voltage ECG

70
Q

tx of PAD

A

ASA, BP control with ACE, exercise, lipid control and CILOSTAZOL(unique)

71
Q

which nuclear stress test should be used wiht obese pt? why?

A

sestamibi bc it has greater ability to penetrate tissue in fattys

72
Q

do u need to ppx pt for dental surgery if they have MVP

A

no

73
Q

MCC of death after MI?

A

Vtach or Vfib

74
Q

tx of restrictive cardiomyopathy

A

diuretics + tx underlying cause +/- pericardiocentesis

75
Q

handgrip will ——to the heart.

A

increases blood in the heart/afterload * compressing arteries in arm pushing blood back into heart

76
Q

other not so common causes of CHF

A

alcohol, post viral myocarditis, radiation, adraymycin, doxorubicin, chagus + others, hemochromatosis, thyroid dz, peripartum cardiomyopathy, thiamine deficiency

77
Q

tx of AR

A

ACE, ARB, Nifedipine to decrease afterload = push blood out then surgery if EF <55

78
Q

takotsubo cardiomyopathy tx

A

ACE, diuretics and BB

79
Q

Tx of dialated cardiomyopathy

A

ACE/ARB, BB, Spironolactone

80
Q

tx of pericardial tamponade

A

pericardiocentesis and if chronic pericardial windown placement

81
Q

what are rales?

A

Rales in the Tails = bubbling/crackling in the aveoli due to fluid

82
Q

ASD auscultation shit

A

fixed splitting of S2

83
Q

which side of the heart shit increases with….. expiration

A

exhale you evict blood from your lungs & into the LV

84
Q

RV infarction is likely to cause what complication?

A

3rd degree block!

85
Q

Which stress test drug shouldn’t be used in asthmatics?

A

Dipyridamole = can provoke bronchospams

86
Q

Complications of MI

A

shock, valve ruptures, septal rupture, myocardial wall rupture, sinus brady, 3rd degree block, RV infarction

87
Q

S3 means….

A

rapid ventricular filling during diastole fuck…your screwed

88
Q

what should you NOT do with pericardial tamponade?

A

give diuretics

89
Q

sx of pericarditis

A

pleuritic chest pain that is positional, sharp & breif, friction rub, GLOBAL ST ELEVATION & PR depression

90
Q

what bb do you give for MI? why?

A

metoprolol or esmolol = B1 selective!

91
Q

MS what might you see on ECG?

A

biphasic Pwaves

92
Q

tx of constrictive pericarditis

A

diuretics then surgical removal of the pericardium

93
Q

standing up will ——to the heart.

A

decreases blood return *gravity!

94
Q

tx of systolic dysfunction in CHF

A

systolic = decreased EF basic: ACE, BB(metoprolol, carvedilol), Spironolactone or hydralazine+nitrates unique: DIGOXIN

95
Q
A
96
Q

Dressler Syndrome VS Acute Pericarditis?

A

Dressler syndrome (post cardiac injury syndrome) is an immune-mediated pericarditis that can occur several weeks following MI.

VS

Acute Pericarditis/Peri-infarction pericarditis (PIP), which can occur due to localized inflammation typically <4 days following acute myocardial infarction (MI). Delayed coronary reperfusion following ST-elevation MI (eg, >3 hours from symptom onset) increases the risk of developing PIP.

Patients with PIP typically have pleuritic chest pain that worsens with deep inspiration and improves with sitting up. The pain is usually located retrosternally and often radiates posteriorly to the bilateral trapezius ridges (lower portion of the scapulae). Low-grade fever may be present. Cardiac auscultation should reveal a pericardial friction rub that is classically triphasic (heard in atrial systole, ventricular systole, and early ventricular diastole). ECG characteristically shows diffuse PR depression and ST elevation, but these findings are not always present and may be masked by ECG changes from recent MI.

97
Q

Treatment of Pericarditis <4days from time of MI? why?ASA

A

ASA!

Naproxen in combination with colchicine is the treatment of choice for most patients with idiopathic or viral acute pericarditis. However, it is recommended that NSAIDs other than aspirin be avoided for treatment of PIP as they may impair myocardial healing and increase the risk of ventricular septal or free wall rupture. For the same reason, glucocorticoids (eg, prednisone) should be avoided as well.

98
Q

Criteria for biventricular pacemaker?

A

*dilated heart = wide QRS = unsync contractions. Requires 3/3 criteria for pacemaker:

  1. LV EF <35%
  2. NYHA class 2+ w/sx
  3. LBBB w/QRS>150

Step 3 UW /FA (19 decks)

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