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*DOOS 2 > Cardio from Prep Book > Flashcards

Cardio from Prep Book Flashcards

1
Q

Name the NYHA classification: no limitation of physical activity, ordinary physical activity does not cause fatigue, dyspnea, or anginal pain

A

Class I

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2
Q

Name the NYHA classification: marked limitation of physical activity; comfortable at rest, but less than ordinary activity causes symptoms

A

Class III

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3
Q

Name the NYHA classification: Slight limitation of physical activity, ordinary physical activity results in sx

A

II

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4
Q

Name the NYHA classification: Unable to engage in any physical activity w/o discomfort; sx may be present even at rest

A

IV

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5
Q

___________ may be related to reduced CO, paroxysmal cardiac dysrhythmias, low blood volume, meds, and various endocrine/metabolic disorders

A

Postural hypotension

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6
Q

Postural hypotension is > ______mmHg drop in SBP b/t supine and sitting and/or standing measurements

A

20

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7
Q

What can exacerbate HTN?

A

excessive ETOH, smoking, lack of exercise, polycythemia, NSAIDs, low K intake

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8
Q

What are causes of secondary HTN?

A

sleep apnea, estrogen, pheochromocytoma, coarctation of aorta, pseudotumor cerebri, parenchymal renal disease, renal artery stenosis, chronic steroid therapy, Cushing’s, thyroid/parathyroid disease, primary hyperaldosteronism, pregnancy

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9
Q

Stage 1 HTN

A

SBP 140-159

DBP 90-99

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10
Q

PreHTN

A

SBP 120-139

DBP 80-99

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11
Q

Stage 2 HTN

A

SBP >160

DBP >100

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12
Q

What is a hypertensive urgency?

A

reflects BP that must be reduced w/in hours; SBP>220, DBP >125

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13
Q

What is hypertensive emergency?

A

Reflects BP that must be reduced w/in 1 hour to prevent progression to end-organ damage or death; DBP >130; optic disc edema indicates end organ damage; complications include HTN encephalopathy, nephropathy, intracranial hemorrhage, aortic dissection, preeclampsia, eclampsia, pulmonary edema, unstable angina, MI

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14
Q

What is malignant HTN?

A

Elevated BP associated with papilledema and encephalopathy or nephropathy; if untreated, progressive renal failure occurs

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15
Q

End organ damage in untreated HTN

A

HF, RF, stroke, dementia, aortic dissection, atherosclerosis, retinal hemorrhage

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16
Q

What will EKG show for HTN?

A

LVH or HF; strain failure if poor prognosis

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17
Q

HTN Treatment

A

DASH diet, diuretics, Beta blockers, ACEI, ARB, CCB, Renin inhibitor

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18
Q

When should loop diuretics be used?

A

Only in those with renal dysfunction and when close electrolyte monitoring is assured

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19
Q

What is the initial HTN DOC for diabetics?

A

ACEI

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20
Q

What HTN drug is used for men with symptomatic prostatic hyperplasia?

A

alpha adrenergic antagonists

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21
Q

What is preferred agent to treat hypertensive urgencies or emergencies?

A

sodium nitroprusside

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22
Q

CHF results from changes in 1 of what 3 areas

A

contractile ability of heart muscle
preload and afterload of ventricle
heart rate

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23
Q

Characteristics of left sided heart failure

A

exertional dyspnea plus nonproductive cough, fatigue, orthopnea, paroxysmal noctural dyspnea, basilar rales, gallops, exercise intolerance

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24
Q

Characteristics of right sided heart failure

A

Distended neck veins, tender or nontender hepatic congestion, N, dependent pitting edema, hepatomegaly, edema

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25
Q

Cardiac PE signs of CHF

A

Parasternal lift, enlarged apical impulse, diminished first heart sound, S3 gallop

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26
Q

What is a common nightime sx of CHF?

A

nocturia

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27
Q

CXR of CHF

A

cardiomegaly and b/l or right sided pulmonary effusions, perivascular or interstitial edema (Kerley B lines), venous dilation, alveolar fluid

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28
Q

What lab may be elevated with heart failure?

A

BNP

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29
Q

Treatment of CHF

A

stress reduction, aerobic exercise, low sodium, diuretic

Initial therapy: thiazide (or loop diuretic) + ACEI

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30
Q

What is the most common cause of cardiac related death and disability?

A

Atherosclerotic heart disease

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31
Q

What is an important marker of atherosclerosis?

A

C-reactive protein

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32
Q

Treatment of atherosclerosis

A

Smoking cessation; exercise, dietary modifications, treatment of dyslipidemias

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33
Q

What is the usual cause of ischemic heart disease?

A

atherosclerotic narrowing

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34
Q

Risk factors of ishemic heart disease

A

male, age, low estrogen, smoking, Fhx, HTN, DM, abdominal obesity, inactivity, dyslipidemias, increase ETOH, low intake of fruits/veggies

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35
Q

What is stable angina?

A

exacerbated by physical activity and is relieved by rest

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36
Q

What is variant angina (or Prinzmetal’s)?

A

Vasospasm at rest, with preservation of exercise capacity

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37
Q

What is unstable angina?

A

Increasing pattern of pain in previously stable patients. Less responsive to meds, lasts longer, occurs at rest or with less exertion

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38
Q

What is it called when a patient has a clenched fist over their sternum and clenched teeth when describing chest pain? Seen in ischemia patients

A

Levine’s sign

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39
Q

If angina pectoris lasts longer than 30 minutes what does it suggest?

A

unstable angina, MI, or another dx

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40
Q

_______ is relieved by sublingual or spray nitroglycerin

A

Acute Anginal attacks

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41
Q

During an exercise test, an ST segment depression of 1mm is considered a positive test for what?

A

ischemic heart disease

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42
Q

What is first line therapy for chronic angina?

A

Beta blockers

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43
Q

Conditions classified simply as ST-elevated or non-ST elevated events rather than unstable angina, q-wave infarction, or non-q wave infarction

A

ACS

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44
Q

Causes of MI

A

prolonged myocardial ischemia, prolonged vasospasm, reduced myocardial blood flow, excessive metabolic demand, embolic occlusion, vasculitis, aortitis, coronary artery dissection, cocaine use

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45
Q

Who are more likely to present atypically with MI?

A

Elderly, women, diabetics

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46
Q

Patient develops increasingly severe, prolonged (>30min) anterior CP at rest, usually during early morning hours

A

MI

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47
Q

Other common symptoms of MI

A

diaphoresis, weakness, anxiety, restlessness, light-headedness, syncope, cough, dyspnea, orthopnea, N/V, abdominal bloating

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48
Q

What is Dressler’s syndrome? (post-Mi syndrome)

A

pericarditis, fever, leukocytosis, pericardial or pleural effusion; usually 1-2 weeks post-MI

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49
Q

What serial cardiac enzymes are elevated in MI?

A

creatine kinase, troponin T, and troponin I

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50
Q

MRI with gadolinium contrast is one of the most sensitive tests to quantify the extent of _______

A

infarction

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51
Q

What should all patients with suspected ACS receive?

A

IV fluids, oxygen, nitroglycerin, pain management

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52
Q

If a patient with ACS WITHOUT STEMI what should they get?

A

antiplatelets (ASA and clopidrogel);

Anticoagulant (heparin, enoxaparin, fondoparinux, bivalriduin)

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53
Q

What is the drug that is started in most patients with ACS?

A

Beta Blockers

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54
Q

Patients with ACS and acute STEMI tx

A

ASA and clopidrogel = immediately; Within 90 minutes, coronary angiography, primary PCI; Within 3 hours, thrombolytic therapy (alteplase, reteplase, tenecteplase)

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55
Q

What are absolute C/I to thrombolytic therapy?

A

previous hemorrhagic stroke, any stroke in last year, known intracranial neoplasm, active internal bleeding, suspected aortic dissection

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56
Q

_____ types of congential heart anomalies are R–> L shunt

A

Cyanotic (Tetralogy of Fallot, Pulmonary atresia, hypoplastic left heart syndrome, transposition of great vessels)

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57
Q

_____ types of congential heart anomalies are L–> R shunt

A

Noncyanotic (ASD, VSD, AV septal defect, PDA, Coarctation of aorta)

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58
Q

Occurs with an intact ventricular septum; pulmonary valve is closed; an open atrial septal opening and PDA are present

A

Pulmonary atresia

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59
Q

Subaortic septal defect, right ventricular outflow obstruction, overriding aorta, right ventricular hypertrophy

A

Tetralogy of Fallot

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60
Q

What is the most common ASD?

A

ostium secundum

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61
Q

Due to incomplete fusion of endocardial cushions; common in Down syndrome

A

AV septal defect

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62
Q

Failure to close or delay in closure of the channel bypassing the lungs, which allows placental gas exchange during the fetal state

A

PDA

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63
Q

What are the most frequent causes of mitral and aortic valve disorders

A

congenital defects

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64
Q

What are the common sx’s of valvular disorders?

A

Dyspnea, fatigue, decreased exercise tolerance

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65
Q

Thin females with minor chest wall deformities, midsystolic clicks, late systolic murmur

A

mitral valve prolapse

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66
Q

Is ECG useful in diagnosing valvular disorders?

A

No

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67
Q

Murmur heard in 2nd-4th left intercostal space; radiates to apex and RSB; Grade 1-3; High pitch, blowing; Better heard when patient sits and leans forward on full exhalation; murmur is systolic and diastolic decrescendo

A

Aortic regurg

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68
Q

Murmur heard at apex with little or no radiation; Grade 1-4; Low pitch; Can be heard better in left lateral position on full exhalation; S1 accentuated; opening snap follows S2; Mid-diastolic

A

Mitral Stenosis

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69
Q

Murmur heard at apex that radiates to left axilla; murmur is soft to loud and is medium to high pitch; blowing; S2 often decreased; Pansystolic

A

Mitral Regurg

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70
Q

Murmur found in 2nd Right intercostal space that radiates to neck and LSB; It is loud with a THRILL; Medium pitch and harsh; Can be heard better if patient is sitting and leaning forward; Midsystolic

A

Aortic Stenosis

71
Q

With aortic valve disorders, CXR may show?

A

left sided atrial enlargement, ventricular hypertrophy

72
Q

With mitral valve disorders, CXR may show?

A

atrial enlargement

73
Q

What are the only definitive methods for identifying structural and functional abnormalities of the heart?

A

Echocardiography, cardiac catheterization

74
Q

In all cases of tricuspid and pulmonic valve disorders, right sided pressure overload leads to ?

A

right-sided cardiomegaly, systemic venous congestion, right-sided heart failure

75
Q

How do patients with tricuspid and pulmonic valve disorders typically present?

A

Exercise intolerance

76
Q

How to treat tricuspid and pulmonic valve disorders ?

A

Sodium restrction and diuretics to decrease fluid volume and right atrial filling pressures

77
Q

Murmur at LLSB that is holosystolic and radiating to right sternum and xiphoid area; Variable intensity; Pitch/Quality is medium and blowing; Increases slightly with inspiration; JVP often elevated; Pansystolic

A

Tricuspid regurg

78
Q 
Pulmonic Stenosis Murmur:
Location
Radiation
Intensity
Pitch/Quality
Associated findings
Timing
A

Heard: 2-3rd left intercostal space, midsystolic crescendo-decrescendo murmur; Radiations to left shoulder and neck; Intensity soft to loud; Pitch/Quality: Medium/harsh; Early pulmonic ejection sound common; Timing: systolic

79
Q

What are risk factors for developing an arrhythmia?

A

electrolyte abnormalities, hormonal imbalances, hypoxia, drug effects, MI

80
Q

Heart Rate <60bpm; normal in athletes, usually represents SA node pathology, increased risk for ectopic rhythms

A

Sinus Bradycardia

81
Q

HR >100bpm occurs with fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, HF, use of many drugs

A

Sinus Tachycardia

82
Q

What is the most common paroxysmal tachycardia?

A

Paroxysmal supraventricular tachycardia

83
Q

What class of antiarrhythmic drug includes beta blockers that slow AV conduction?; esmolol, propranolol, metoprolol

A

Class II

84
Q

What class of antiarrhythmic drug includes drugs that slow calcium channel blockers?; verapamil, diltiazem

A

Class IV

85
Q

Digoxin and Adenosine are in what class?

A

Class V

86
Q

This drug slows the conduction time through the AV node and interrupts reentry pathways

A

Adenosine

87
Q

This drug directs action on cardiac muscles and indirect action on cardiovascular system via ANS

A

Digoxin

88
Q

What class of antiarrhythmics prolongs action potential?; amiodarone, sotalol, dofetilide, ibutilide

A

Class III

89
Q

What class of antiarrhythmics blocks sodium channels? They also depress phase 0 depolarization, slow conduction, and prolong repolarization. Quinidine, procainamide, disopyramide, moricizine

A

Class Ia

90
Q

What class of antiarrhythmics shortens depolarization?; lidocaine, mexiletine

A

Class IIB

91
Q

What class of antiarrhythmics depress phase 0 repolarization and slows conduction?; flecainide, propafenone

A

Class Ic

92
Q

What is the most common chronic arrhythmia?

A

A fib

93
Q

Who does A flutter typically occur in?

A

COPD, CHF, ASD, CAD

94
Q

What mechanical measures can be used to interrupt acute PSVT?

A

Valsalva maneuver, coughing, breath holding, stretching, putting head b/t knees, applying cold water to face, U/L carotid sinus massage

95
Q

What is treatment of choice for chronic A flutter?

A

amiodarone, dofetilide

96
Q

Three or more consecutive ventricular premature beats

A

V tach

97
Q

What is Brugada’s syndrome?

A

Syncope, v fib, sudden death common in Asians and men

98
Q

What is preferred pharmacologic interventions for acute V tach?

A

lidocaine, procainamide, amiodarone

99
Q

When is implantable defibrillator indicated?

A

Chronic recurrent sustained V tach w/o reversible causes, congenital long QT syndrome, Brugada’s syndrome

100
Q

Often occurs in elderly; usually asymptomatic, but may have syncope, dizziness, confusion, heart failure, palpitations, angina; can be exacerbated by digitalis, CCB, BB, sympatholytic agents, antiarrhythmic drugs

A

Sick Sinus syndrome

101
Q

How do you treat sick sinus syndrome?

A

permanent pacing

102
Q

What are the most common type of cardiomyopathy?

A

Dilated cardiomyopathy

103
Q

What are causes of dilated cardiomyopathy?

A

genetic abnormalities, excessive ETOH, postpartum state, chemo toxicity, endocrinopathies, myocarditis

104
Q

What is Takotsubo cardiomyopathy?

A

Occurs after major catecholamine discharge and is an apical left ventricular ballooning with sx indistinguishable from acute MI

105
Q

Results from fibrosis or infiltration of ventricular wall b/c of collagen-defect disease, most commonly amyloidosis, radiation, postop changes, diabetes, endomyocardial fibrossi

A

Restrictive cardiomyopathy

106
Q

Dilated cardiomyopathy sx/PE

A

Left or biventricular congestive failure; most common presentation is dyspnea; S3 gallop, rales, increased JVP

107
Q

Hypertrophic cardiomyopathy s/sx

A

Dyspnea and angina; syncope and arrhythmias; sudden death may be initial presentation

108
Q

Hypertrophic cardiomyopathy PE

A

sustained PMI, loud S4 gallop, variable systolic murmur, bisferiens carotid pulse, JVP with prominent “a” wave

109
Q

Restrictive cardiomyopathy s/sx

A

Decreased exercise tolerance; in advanced dz: right sided congestive failure; pulmonary HTN

110
Q

Tx of dilated cardiomyopathies

A

Abstinence of ETOH, underlying disease tx

111
Q

Tx of hypertrophic cardiomyopathies

A

BB or CCB; surgical or nonsurgical ablation of hypertrophic septum possibly; dual chamber pacing, implantable defibrillators, mitral valve replacement may be indicated

112
Q

What may help pts with restrictive cardiomyopathies?

A

Diuretics

113
Q

Occurs as result of infx, autoimmune or connective tissue disease, neoplasms, RT, chemo, cardiac surgery, myxedema, TB

A

Pericarditis

114
Q

Cardiac tamponade occurs when _____ compromises cardiac filling and impairs CO

A

Fluid

115
Q

What is primary presenting sx of acute pericarditis?

A

pleuritic substernal radiating CP relieved by sitting upright and leaning forward; friction rub characteristic

116
Q

Presents with slowly progressive dyspnea, fatigue, weakness, edema, hepatomegaly, ascites

A

Constrictive pericarditis

117
Q

Presents with tachycardia, tachypnea, narrow pulse pressure, pulsus paradoxus

A

Cardiac tamponade

118
Q

What organisms typically cause infective endocarditis?

A

Staph. aureus (most common in IV drug users), Group D strep, enterococci, HACEK organisms

119
Q

Presentation of infective endocarditis

A

Fever, nonspecific sx (cough, dyspnea, arthralgias, back/flank pain, GI complaints); stable murmur

120
Q

What classic features of infective endocarditis occurs in 25%?

A

Palatal, conjunctival, subungual petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, Roth spots

121
Q

How do you diagnose infective endocarditis?

A

3 sets of blood cultures at least 1 hour apart preferable before starting ABX

122
Q

CXR on infective endocarditis

A

underlying cardiac abnormality or reveal pulmonary infiltrates if right side of heart is involved

123
Q

_______ criteria are used to establish DX of infective endocarditis

A

Duke criteria

124
Q

What is the common ABX for infective endocarditis?

A

Vancomycin + ceftriaxone

125
Q

A systemic immune response occuring usually 2-3 weeks following a Beta hemolytic strep pharyngitis infection

A

Rheumatic fever

126
Q

_______ criteria are used to establish DX of rheumatic fever

A

Jones (Need 2 major or 1 major and 1 minor)

127
Q

What are the major Jones criteria for RF?

A

Carditis, erythema marginatum, subQ nodules, chorea, polyarthritis

128
Q

What are minor Jones criteria for RF?

A

Fever, polyarthralgias, reversible prolongation of PR interval, rapid ESR, C-reactive protein

129
Q

Common age range of RF

A

5-15y/o

130
Q

What valve is most affected in RF?

A

Mitral

131
Q

Recommended tx of RF

A

Strict bed rest, salicylates, corticosteroids, IM penicillin for strep infix, prevention (early tx of strep pharyngitis)

132
Q

Lower leg pain with exercise (relieved by rest), weak or absent femoral/distal pulses; possible aortic, iliac, femoral bruit; if severe: numbness, tingling, ischemic ulcers (leads to gangrene);

A

PAD

133
Q

What is Leriche’s syndrome?

A

ED when PAD in iliac artery disease

134
Q

In PAD, extremity occlusion results in the 6 Ps. What are they?

A

pain, pallor, pulselessness, paresthesias, poikilothermia, paralysis

135
Q

An ABI of <____ indicates significant PAD

A

0.9

136
Q

What is main drug tx of PAD?

A

Cilostazol

137
Q

What are nonpharmacologic tx of PAD?

A

Stop smoking; progressive exercise

138
Q

Risk factors of Varicose veins

A

Pregnancy, Fhx, prolonged sitting/standing, hx of phlebitis

139
Q

What test differentiates saphenofemoral valve incompetence from perforator vein incompetence?

A

Brodie-Trendelenburg

140
Q

Are lab studies necessary for varicose veins?

A

No

141
Q

Tx of varicose veins

A

Graduated elastic stockings, leg elevation and exercise for sx, endovenous radiofrequency or laser ablation, compression sclerotherapy, surgical stripping

142
Q

Partial or complete occlusion of vein and inflammatory changes

A

Thrombophlebitis

143
Q

Virchow’s triad

A

stasis, vascular injury, hypercoagulability

144
Q

Presents with dull pain, erythema, tenderness, induration of involved vein or with no sx; common in long saphenous vein; palpable cord

A

Superficial thrombophlebitis

145
Q

Preferred study for DVT

A

Duplex US

146
Q

What is most accurate method for definitive diagnosis of DVT?

A

venography

147
Q

What is preferred pharmacologic tx of DVT?

A

LMWH; heparin followed by warfarin

148
Q

Loss of wall tension in veins which results in stasis of venous blood and is associated with hx of DVT, leg injury, or varicose veins

A

Chronic venous insufficiency

149
Q

Sx of chronic venous insufficiency

A

progressive edema starting at the ankle followed by skin and subQ changes; itching, dull pain w/ standing and pain with ulceration is common; skin is shiny,thin, atrophic with dark pigment changes and subQ induration

150
Q

Stasis dermatitis tx

A

wet compresses, hydrocortisone cream; chronic dermatititis add zinc oxide with ichthammol and an antifungal cream

151
Q

Causes of aortic aneurysm

A

Atherosclerosis (#1); syphillis, giant cell arteritis, vasculitis, trauma, Marfan’s syndrome, Ehlers-Danlos syndrome

152
Q

Classic person with aortic aneurysm

A

Elderly male smoke with CAD, emphysema, renal impairment

153
Q

Thoracic aortic aneurysms presentation

A

Substernal, back, neck pain; dyspnea, stridor, cough, dysphagia, hoarseness, sx of superior vena cava syndrome

154
Q

Study of choice for abdominal aneurysms

A

abdominal US, followed by contrast enhanced CT

155
Q

Tx for Aortic aneurysm

A

endovascular or open surgical repair

156
Q

What are 2 impt features of aortic dissection?

A

unequal blood pressure between arms; widened mediastinum on CXR

157
Q

Q waves in 2 or more leads means?

A

previous MI

158
Q

ST depression >1mm means?

A

ischemia

159
Q

ST elevation means?

A

acute MI or pericarditis (which will show involvement in all leads and PR depression)

160
Q

LBBB means

A

suggests underlying heart disease (ischemia, HTN)

161
Q

RBBB means

A

may indicate right heart strain (as in pulmonary embolus)

162
Q

Substernal pressure, heaviness, burning, squeezing, or choking; rarely well localized

A

angina pectoris

163
Q

Xanthomas may appear in what?

A

hyperlipidemia (fat build up under skin)

164
Q

The __________ prediction model tallies point for the major known cardiac risk factors: age, gender, diabetes, smoking, LDL, HDL, BP

A

Framingham

165
Q

When should you stop an exercise stress test?

A

Moderate to severe CP or dyspnea, dizziness, greater than 2mm ST segment depression, fall in SBP of >10mmHg (seen in ischemia), sustained ventricular tachycardia

166
Q

What are causes of false ST depressions?

A

LBBB, LVH, WPW, digoxin use

167
Q

Gold standard of diagnosing coronary artery disease

A

Coronary angiography

168
Q

Treatment of Stable Angina (Acronym: ABCDE)

A 
A: ASA, ACEI, antianginals
B: BB and BP
C: cholesterol and cigarettes
D: diet and diabetes
E: Education and exercise
169
Q

Patients with CHD should have LDL of _______

A

<90

170
Q

Are pathologic Q waves present in NSTEMI?

A

No

171
Q

The evolution of the ECG during a STEMI

A
  1. T wave increases in amplitude (several minutes after vessel occlusion)
  2. ST-segment elevation (minutes to hours)
  3. Development of Q waves (hours to days)
  4. Resolution of ST segment elevation (hours to days)
172
Q

What is Wellen’s sign?

A

deep inverted T waves in leads V1-V4 associated with severe disease in left anterior descending artery

173
Q

TIMI Risk Score (7 point system for evaluating UA or NSTEMI) components

A

Age >65
At least 3 risk factors for coronary artery disease
Known coronary artery disease with at least 50% coronary stenosis
ST segment changes
At least 2 episodes of angina in past 24 hours
ASA used in past week
Elevated CK-MB or troponin

*DOOS 2 (11 decks)

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