Cardio Exam 3 part 2

Question 1

Which patients need an Electrophysiology study?

Answer 1

1. Cardiac arrythmias
2. Unxeplained syncope
3. Pacemaker evaluation
4. Prior to radiofrequency ablation

Question 2

What is catheter ablation good for?

Answer 2

Superventricular tachycardia and ventricular tachycardia

Question 3

What are the contraindications of an EP study?

Answer 3

Poor ejection fraction <35%

Clear diagnosis

Question 4

Whats the most effective method of preventing sudden cardiac death?

Answer 4

An ICD

Question 5

What are some causes of secondary hypertension?

Answer 5

1. Oral contraceptives
2. Primary aldosteronism
3. Liddle’s syndrome

Question 6

What are the hemodynamic patterns to Hypertension?

Answer 6

Early: CO is high, SVR is normal
Late: CO is normal/low, SVR is high

Pressure diuresis and natriuresis are inhibited in essential hypertension

Question 7

Name some microscopic changes seen in Left sided HHD?

Answer 7

1. Mycocyte Hypertrophy
2. Interstitial fibrosis
3. Boxcar nuclei

Question 8

What is the drug of choice for pregnant women with hypertension?

Answer 8

Methyldopa

Question 9

Which antihypertensive drug can cause Steven Johnson Syndrome or TEN?

Answer 9

Aliskiren; Renin Inhibitor

Question 10

What are the JNC8 hypertension treatment goals?

Answer 10

Age < 60 = <140/90

Age > 60 = <150/90

Question 11

Discuss the recommended treatment for hypertension

Answer 11

1. Thiazide diuretics initially
2. Thiazides and CCBs for African-Americans
3. Beta blockers not recommended for initial therapy

Question 12

What is the clinical triad for pheochromocytoma

Answer 12

Headache, perspiration and palpitations

Question 13

What are the symptoms of Aldosteronism?

Answer 13

Hypertension, Hypokalemia, Alkalosis, Hypernatremia

Question 14

Discuss the pathogenesis of Atherosclerosis

Answer 14

Plaques occur at branches and non-turbulant flow protect against atherosclerosis

Question 15

How do lipids worsen atherosclerosis?

Answer 15

Cholesterol impairs endothelial function by increasing free radicals

Question 16

Discuss the inflammatory process of atherosclerosis

Answer 16

1. Endothelial cells express VCAM-1 (adhesion molecule)
2. Macrophages engulf LDL
3. Leukocytes and endothelium release growth facors (PDGF, TGF alpha) to increase smooth muscle and ECM

Question 17

What is a fatty streak?

Answer 17

Lipid filled foamy macrophages

Question 18

What part of the aorta is most susceptible to atherosclerotic plaques?

Answer 18

Abdomial aorta

Question 19

What is the criteria for metabolic syndrome?

Answer 19

1. Abdominal Obesity; Men>40; Women >35
2. Triglycerides >150
3. HDL; Men <40; Women <50
4. BP >130 systolic and >85 diastolic.
5. Fasting Glucose >110

Question 20

What is the relationship between adiponectin and obesity?

Answer 20

Inverse relationship

Question 21

How is endothelial dysfunction triggered?

Answer 21

Dyslipidemia, High BP, diabetes and smoking all lead to oxidative stress.