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Clin Med > Cardio Final > Flashcards

Cardio Final Flashcards

1
Q

whats normal bp

A

less than 120/80

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2
Q

whats prehypertension

A

130-140 / 80-90

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3
Q

whats hypertension stage 1

A

140-160 / 90-100

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4
Q

whats hypertension stage 2

A

160+ / 100

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5
Q

how often do we screen for BP in people with normal BP?

A

every 2 years

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6
Q

how often do we screen for BP in people with prehypertension?

A

every year

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7
Q

how do we handle white coat syndrome?

A

do ambulatory BP’s, or have nurse or tech take the bp in the office

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8
Q

in what % of patients experience white coat syndrome?

A

20 - 25%

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9
Q

what are the risk factors for essential (primary) HTN?

A

sodium, alcohol, obesity, immobility, dyslipidemia, type A personality, Vitamin D deficiency, OTC meds (NSAIDS, decongestants,e tc), Family Hx, African American, Age

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10
Q

what class of BP meds slows av conduction and HR

A

Beta Blockers and non-dihydropirine CCB’s (like verapamil and diltiazem)

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11
Q

common side effects in diuretics?

K+ sparing, thiazides, loops

A

hypokalemia, hypovolemia

K sparing = gynecomastia

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12
Q

A patient coming in complaining of a fatigue and unable to maintain an erection, shows a slow heart. He is likely on what medication?

A

Beta Blockers

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13
Q

This class of drugs drops Peripheral vascular resistance and dilates coronary arteries?

A

Calcium Channel Blockers

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14
Q

do dihydropiridines or non-dihydropiridines affect the heart?

A

non-dihydropiridines

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15
Q

drugs that end in ‘-il’ are from what class?

A

Ace inhibitors

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16
Q

A patient complains to you of dizziness, you notice swelling in his lips, and complains of a dry cough, he is likely on what medication?

A

An ACE

if no S/E of the cough he would be on an ARB

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17
Q

Can you give an ACE or ARB to a pregnant woman?

A

NO

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18
Q

What HTN drug class is best for BPH

A

Alpha Blockers

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19
Q

HCTZ and chlorthalidone are what medications?

A

thiazide diuretics

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20
Q

furosemide and bumetadine are what medications?

A

loop diuretics

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21
Q

what is our favorite K+ sparing diuretic?

A

spironolactone (aldactone)

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22
Q

HTN med for Africans?

A

CCB’s and Diuretics

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23
Q

HTN med for Diabetics

A

ACE/ARB

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24
Q

HTN med for CHF

A

BB, Diuretics (Ace in LV dysfunction)

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25
Q

HTN med for CAD

A

BB, CCB

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26
Q

HTN for CKD

A

ACE/ARB

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27
Q

what is the selection of HTN meds based on?

A

CLARC

Comorbidities, Lifestyle, Age, Race, Cost

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28
Q

what is considered diagnosable hypertensive emergency?

A

> 180 / 120 with associated end-organ damage

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29
Q

in what situations does this HTN crisis usually occur?

A

abrupt d/c of meds, cocaine, RAS

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30
Q

what is the primary cause of resistant HTN?

A

Renal Artery Stenosis

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31
Q

cardiac output corrected for body size is?

A

cardiac index

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32
Q

normal cardiac output value?

A

5l/min

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33
Q

normal stroke volume?

A

70ml/beat

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34
Q

normal EF range?

A

55-65%

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35
Q

pulmonary wedge pressure measures what chamber?

A

LAP, and subsequently LVEDP

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36
Q

normal Pulmonary capillary wedge pressure is?

A

12mmhg

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37
Q

a large MI, acute MR, ventricular free wall rupture, perciardial tamponade, myocarditis, and end stage cardiomyopathy can all cause what?

A

Cardiogenic shock

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38
Q

indications for Swan Ganz catheters?

A

to differentiate between cardiogenic and septic shock, monitor hemodynamics, assesing pulmonary HTN, managing post-op open heart patients

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39
Q

values of PCWP, CO, PVR in Cardiogenic shock

A

PCWP = high
CO = low
PVR - high

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40
Q

values of PCWP, CO, PVR in septic shock

A 
PCWP = low
CO = high
PVR = low
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41
Q

autonomic dysfunction resulting in inadeqate release of norepi from sympathetic neurons can cause what?

A

orthostatic hypotension

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42
Q

what meds can cause orthostatic hypotension

A

TCA’s, alpha blockers

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43
Q

can post-prandialism cause ortho hypotension

A

oh yea

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44
Q

what particular patient type can get a Tetralogy of Fallot?

A

Down syndrome

45
Q

What is the most common congential heart lesions requiring intervention in the first year of life?

A

Tetralogy of Fallot

46
Q

What does TOF cause?

A

cyanosis (right to left shunting)

47
Q

what do we call the heart shape in TOF?

A

boot shaped heart

48
Q

what is the most definitive exam for TOF?

A

echo

49
Q

what is the heart sound for TOF?

A

crescendo-decrescendo systolic murmur

50
Q

Sex, age, family hx, htn, hyperlipidemia, insulin resistance, smoker, obese, alcohol, ckd, diet, lvh, hyperuricemia, cocaine, type A personality can all cause what condition?

A

Ischemic heart disease

51
Q

Treatment for Acute Coronary Syndrome

A

o2 2-4 nc
aspirin 325
nitro .4mg
morphine (if pain not relieved w/ nitro)

52
Q

in unstable angine, what else can we give?

A

IV heparin, Beta Blockers, DP IIb/IIIa inhibitor (like asa)

53
Q

if treatment of unstable angina does not improve consider….

A

thrombolytics w/in 3hr onset, or 6 hours of no cath lab. (must be no contraindication for bleeding)

54
Q

EKG criteria for a STEMI

A

St elevation > 1mm in 2 or more contiguous leads

55
Q

Drug class for Prinzmetals angina

A

CCB Non-Dihydropiridinese

Diltiazem and verapamil

56
Q

a patient presents to your ER with fever, and sharp pleuritic chest pain and leaning forward in the chair. You hear a pericardial friction rub on exam and see diffuse ST elevations with PR depressions. On echo you see pericardial effusion. He likely has…?

A

Acute Pericarditis

57
Q

the majority of pericardial effusions are due to?

A

idiopathic, viral, iatrogenic (hydralazine)

58
Q

types of pericardial effusion

A

transudative (CHF, uremia)
Exudative (TB, infection)
Hemorrhagic (trauma, aortic dissection)
Malignant

59
Q
  1. what the most confirmatory test to diagnose pericardial effusion?
  2. what is the common EKG finding?
A
  1. echocardiogram
    (and a water bottle configuration on CXR)
  2. low voltage EKG (and/or) electrical alternans
60
Q

What three symptoms are classic for tamponade

A

hypotension, muffled heart sounds, JVD

61
Q

what is that group of symptoms called in tamponade?

A

Beck’s triad

62
Q

cardiac enlargement of 1 or both ventricles without thickening, showing an EF<40% and maybe s3 or s4 with regurg.

A

dilated cardiomyopathy

63
Q

hypertrophy of the left ventricle with wall thickening often causing septal obstruction near the aortic valve.

A

HOCM

64
Q

a normal thickness and size of heart but with rigid walls, causing diastolic dysfunction and atrial enlargment

A

restrictive cardiomyopathy

65
Q

the three types of restrictive cardiomyopathy

A

amyloidosis: speckled granular apperarance on echo
sarcoidosis: chronic granuloma nodules
hemochromatosis: increased iron uptake

66
Q

Transient systolic dysfunction apical or mid sections of the left ventricle mimicking an MI, with clear coronaries (CP like prinzmetal) showing “apical ballooning” or “octopus” heart on imaging.

A

Stress Induced (Takotsubo) Cardiomyopathy

67
Q

what are some triggers of takotsubo

A

death of loved one, severe stress.
(catecholamine surge)
(supportive care)

68
Q

backward failure of the left ventricle leads to congestion in the pulmonary vasculature, this is called?

A

left sided heart failure

69
Q

what does LSHF cause?

A

pulmonary edema, orthopnea, PND

70
Q

backward failure of the right ventricle leads to congestion of the systemic capillaries

A

right sided heart failure

71
Q

what does RSHF cause?

A

peripheral edema, ascites, JVD, Hepatosplenomegaly, etc.

72
Q

TRUE OR FALSE: patients usually present with a combination of both right and left sided heart failure.

A

TRUE

73
Q

someone is diagnosed with CH and an EF<40%, they have no limits to their physical activity, and no symptoms with activity, what CHF class are they?

A

Class I

74
Q

someone is diagnosed with CH and an EF<40%, they have MODERATE/MARKED limitations, and symptoms with less than ordinary activities, what CHF class are they?

A

Class III

75
Q

someone is diagnosed with CH and an EF<40%, they have MILD/SLIGHT limitation, and symptoms with ordinary activity, what CHF class are they?

A

Class II

76
Q

someone is diagnosed with CH and an EF<40%, they are unable to get out of the chair or bed, what CHF class are they?

A

Class IV

77
Q

what is first line for CHF?

A

lifestyle mods

78
Q

what is second line for CHF?

A

diuretics, ACE/ARB, BB, Digoxin, Ionotropes

79
Q

what is thirst line for CHF?

A

ICD, single or biventricular

80
Q

what is last line for CHF?

A

transplant or LVAD

81
Q

what is hypotension?

A

less than 90 systolic

82
Q

Staph aureus, MRSA, and Rheumatic Heart Disease all contribute to what pathology?
also the HACEK group

A

Infective endocarditis

83
Q

What is infective endocards?

A

bacterial vegetation with fibrin and platelets in it on valvular structures causing turbulence and valvular incompetence.

84
Q

what valve is most affected

A

mitral…followed by aortic

85
Q

this type of infective endocarditis is a severe illness that occurs over days to weeks and is usually due to staph aureus, often leading to an embolic event

A

ACUTE bacterial endocarditis

86
Q

this type of infective endocarditis is a more mild-moderate illness that progresses slowly over weeks to months and is usually due to strep

A

SUBACUTE bacterial endocarditis

87
Q

What are 4 classic derm findings from infective endocards?

A

osler nodes
janeway lesions
splinter hemmorages
roth spots

88
Q

what else does infective endocards cause?

A

FEVER OF UNKNOWN ORIGIN,
night sweats/chills, new or worsening murmur.
CHF, conduction abnormalities, renal failure, embolic event to vital organs

89
Q

what is the criteria used to diagnose infective endocards?

A

duke criteria
(definitive, possible, rejected)
(+ culture, ESR up, WBC, up, anemia)

90
Q

what type of conditions warrant endocarditis prophylaxis?

A

any type of valve work, unrepaired heart defects, transplant, HOCM, MV prolapse w/ regurg.

91
Q

which patients with infective endocarditis need surgery?

A 
heart failure - valve dysfunction
severe mitral or aortic regurg
fungal endocarditis
pervalvular abscess or fistula
vegetation > 10mm
Continued bacteremia post max. abx therapy
Relapse of prosthetic valve endocarditis
92
Q

what does the ankle brachial index assess

A

degree of PVR

93
Q

what is the formula for the ankle brachial index?

A

ankle systolic / arm systolic = x

If X < .9 = Positive result

94
Q

what are risk factors for aneurysms?

A

HTN (60%), male, trauma, infection, intrinsic defect like marfans

95
Q

What does the Debakey Classification measure indicate?

A

the location of the aortic aneurysm

96
Q

This Debakey type aneurysm originates in the ascending and propogates to at least the aortic arch and often beyond

A

Type I

97
Q

This Debakey type aneurysm originates IN and IS CONFINED to the ascending aorta

A

Type II

98
Q

This Debakey type aneurysm originates in the descending aorta and extends distally and proximally

A

Type III

99
Q

In the Stanford classification of aneurysm locations, type A includes…

A

anything proximal in origin to the left subclavian

100
Q

In the Stanford classification of aneurysm locations, type B includes…

A

anything distal in origin to the left subclavian

101
Q

this type of aneurysm involves all three layers of the aorta

A

true aneurysm

102
Q

this type of aneurysm results from leakage of arterial blood from an artery into the surrounding tissue with patent communication between the two areas.

A

false (pseudo) aneurysm

103
Q

age, obesity, infection, oral contraception, smoking, travel, malignancy, hypercoaguability, trauma, pregnancy, are all risk factors for…?

A

DVT

104
Q

what does wells score evaluate?

A

the likelihood of getting a DVT.

105
Q 
a person with a wells score of 
<1
1-2
3+
has what risk?
A

<1 low risk (5% chance)
1-2 medium risk (17& chance)
2+ high risk (53% chance)

106
Q

a chronic inflammatory disease of large/medium arteries and aorta, mostly involving the cranial branches. old women, and you should suspect aortic aneurysm

A

Giant cell arteritis

107
Q

what are the manifestation of GCA?

A

fever, h/a, vision changes, aortic regurg murmur, aortic dissection.

108
Q

what is the gold standard to dx GCA?

A

tissue biopsy

109
Q

what is the gold treatment for GCA?

A

corticosteroids

Clin Med (14 decks)

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