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Medicine > Cardio UW > Flashcards

Cardio UW Flashcards

1
Q

Moa of statins

And mehanism of statin-induced myopathy

A

Statins inhib hmg co a reductase, decreasing mevalonate hepatic cholesterol and inc hepatic LDL receptors for dec serum ldl with no change hepatic ldl

Dec coq 10 which is involved in muscle energy production… may contribute to statin-induced myopathy

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2
Q

What drugs confer survival benefit for chf and which improve sx but not survival

A

Survival - bb acei/arb spironolactone

Sx only - digoxin furosemide

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3
Q

Afib weight loss lid lag hand tremor in female think

A

Hyperthyroidism

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4
Q

How does hyperthyroidism cause afib

So what do you treat with

A

Inc beta adrenergic receptors inc sympathetic activity

So treat with propanolol or atenolol (bb’s)

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5
Q

Treat afib in hyperthyroidism

A

Propanolol or Atenolol till definitive tx with thionamides, rai, or surg

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6
Q

Adenosine moa for tx of svt

A

Transient av node block

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7
Q

Which is first line for afib, bb or amiodarone?

A

Bb

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8
Q

Most common cause of tricuspid stenosis

A

Rheumatic heart disease

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9
Q

Mechanisms of syncope in HOCM

A

Outflow obstruction

Arrhythmia

Ischemia

Ventricular baroreceptor response

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10
Q

Drugs to avoid when STEMI in leads II III aVF

How to restore hemodynamic stability if lost in this kind of stemi

A

Avoid Nitrates (sublingual nitroglycerin) Diuretics, Opiates (venous dilation) – because II III aVF are posterior wall, probably RV, and sensitive to dec preload which all these drugs do

Bolus iv fluids for RV failure if hemodynamically unstable

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11
Q

treat acute dissection of aorta

A

morphine pain control

iv bb (esmalol labetalol propanolol) to decrease wall stress

sodium nitroprusside if SBP ^120mmhg despite bb, to decrease wall stress

urgent surgical repair if Descending

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12
Q

goal bp in acute aorta dissection

how to get there

A

sbp v 120

IV BB (esmalol, propanolol, labetalol)

Sodium Nitroprusside (vasodilator) 2nd line if necessary to get to goal after bb… 2nd line because can cause reflex sympathetic stimulation which would be bad in this case eg if given before bb

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13
Q

recurrent flash pulmonary edema in setting of resistant htn think

A

renovascular htn

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14
Q

pt with Afib medically managed presents w diarrhea nausea and fatigue think…

A

digoxin toxicity

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15
Q

typical signs of digoxin toxicity

A

N V anorexia confusion weakness

visual sx scotomas, blurriness, color changes, blindness

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16
Q

digoxin is a ____ used to treat ____ and ____ and is ___ _ cleared with ____ therapeutic index

A

digoxin is a Cardiac Glycoside used to treat AFib and Heart Failure and is Renally cleared with Narrow therapeutic index

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17
Q

when aortic regurge is due to valvular disease, the early diastolic murmur is best heard…

when due to aortic root disease?

A

along LSB left sternal border (3rd and 4th intercostal spaces) when Valvular

at URSB upper right sternal border when Root

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18
Q

new conduction abnormality in pt with infective endocarditis think….

A

perivalvular abscess (extending into conduction pathway)

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19
Q

time to cardiac involvment with Lyme

common features

A

weeks to months

av block, myopericarditis

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20
Q

describe “rib notching” in coarctated aorta in a little more detail

A

inferior erosions of ribs 3 to 8

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21
Q

3 sign due to aortic indentation signifies

A

coarcted aorta, with pre and post-stenotic dilation

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22
Q

treat coarcted aorta

A

Balloon angioplasty plus minus Stent

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23
Q

murmurs of coarcted aorta

where are they heard

A

systolic murmur
continuous if collateral vessels present
S4

may be heard at left infraclavicular area or left interscapular area… or all over chest if collaterals present

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24
Q

primary antianginal mechanism of nitrates (sublingual nitroglycerin)

A

systemic venodilation, decrease preload

also some arterial decrease afterload effect

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25
Q

if nitrates cause reflex tachycardia from fall in BP, with worsening angina how to combat

A

concomitant BB

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26
Q

initial treatment of symptomatic PAD with claudication on walking

A 
baby ASA
Statin
HTN and DM treatment
smoking cessation
supervised Exercise therapy
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27
Q

TF
pt with PAD with claudication after 1 block will not symptomatically improve with pharm and exercise and needs stent or bypass to feel better

A

F
stent or bypass reserved for failure of exercise and pharm… exercise clinical trials have shown effectiveness

e.g.
baby ASA, Statin, HTN, DM, Exercise, Smoking cessation

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28
Q

Cilostazol class, moa

A

antiplatelet, vasodilator, PDE-3 inhibitor

29
Q

what med to consider for PAD with intermittent claudication when symptoms persist despite antiplatelet therapy and adequate supervised exercise

A

Cilostazol

antiplatelet, vasodilator, PDE-3 inhibitor

30
Q

when to consider Cilostazol for PAD with intermittent claudication

A

when symptoms persist despite antiplatelet therapy and supervised exercise

31
Q

ladder of treatment for PAD with claudication

A 
baby ASA
Statin
HTN and DM treatment
smoking cessation
Exercise therapy

Cilostazol

bypass or stent

32
Q

electrical alternans is a pathognomonic ECG finding for ___

so treat with ___

A

electrical alternans is pathognomonic for PERICARDIAL EFFUSION

so EMERGENCY PERICARDIOCENTESIS

33
Q

Treat Wolff-Parkinson-White syndrome with

A

Procainamide

34
Q

mechanism of electrical alternans on ekg

A

swinging of heart side to side in pericardial effusion

35
Q

how does tension pneumothorax cause hypotension

expected PCWP and Cardiac Index

A

hypotension by IVC compression

expect LOW PCWP and Cardiac Index

36
Q

after lung biopsy patient gets severe SOB and Hypotension, Cardiac Index is low and PCWP is high

think tension pneumo?

A

no, tension pneumo compresses IVC dec preload so PCWP would be low

think MI

37
Q

what kind of murmur in an adult does not need a workup if asymptomatic

which always need workup even if asymptomatic?

A

low grade systolic no workup

any diastolic or continuous WORKUP with TEE

38
Q

give aspirin for MI, but avoid if this cause of chest pain may be present

A

avoid asa if AORTIC DISSECTION possible

39
Q

moa of asa antiplatelet

A

inhibits TXA2

40
Q

acetaminophen and oxycodone for what kind of chest pain

A

tylenol and oxy for msk chest pain

41
Q

ibuprofen for what kind of chest pain, how is it positional

A

ibuprofen for pericarditis

-relieved when lean forward

42
Q

pt with history of panic attacks comes to ED with angina classic for MI… treat first with aspirin or lorazepam?

A

aspirin

43
Q

STE in leads II III aVF
STD in I aVL V1 V2

where is the infarct

A

posterior wall, right coronary

44
Q

posterior wall, right coronary infarct on ekg

A

STE II III aVF

STD I aVL V1 V2

45
Q

location of infarct:

STE V1-V6

STE II III aVF

STE I aVL
STD V1-V3
STD I aVL

STE I aVL V5 V6
STD II III aVF

STE V4V5V6R

A

STE V1-V6 - LAD, anterior MI

STE II III aVF - RCA or LCX, inferior MI

STE I aVL - LCX, posterior MI
STD V1-V3 - RCA or LCX, posterior MI
STD I aVL - RCA, posterior MI

STE I aVL V5 V6 - LCX/diagonal, lateral MI
STD II III aVF - LCX/diagonal, lateral MI

STE V4-6R - RCA, right ventricle MI

46
Q

why sinus brady or Mobitz II with inferior MI in first 24 horus

A

increased vagal tone

RCA supplies blood to AV node via AV nodal artery 90% of the time

47
Q

these tests good for, bad for

exercise ekg

adenosine or dipyridamole stress test

dobutamine stress test

A

Exercise ekg

  • good for able to reach tHR (85% of 220-age)
  • bad for LBBB, pacemaker, unable to reach tHR

Adenosine/dipyridamole ekg

  • good for LBB, pacemaker, unable to reach tHR
  • bad for reactive airway disease, already on dipyridamole or theophylline

Dobutamine stress

  • good for RAD, unable to tHR
  • bad for tachyarrhythmias
48
Q

MOA of Adenosine or Dipyridamole stress test

A

Dilates nonobstructed coronaries relative to obstructive (without increasing HR or BP) allowing to see difference via radioactive isotype flow

(antiplatelet, vasodilators)

49
Q

dobutamine stress testing is typically used when…

A

can’t do exercise ekg (LBBB, can’t reach tHR)

can’t do vasodilator pharm stress test (hypotension, COPD)

50
Q

how can hypercalcemia mainfest symptomatically

A

stones bones groans psychiatric overtones

polyuria, polydipsia, kidney stones
bone pain
GI sx
confusion, depression, psychosis

51
Q

TF

hyperparathyroidism can cause htn

A

T
mechanism not well understood

if htn significant, suspect MEN2 with pheochromocytoma

52
Q

chest pain, dyspnea, tachypnea, tachycardia in long-distance truck driver think

A

PE

53
Q

systolic-diastolic abdominal bruit think..

A

Renal Artery Stenosis

54
Q

what is an F wave on ekg

A

flutter wave, aka atrial flutter

55
Q

describe electrical alternans

A

variance of QRS amplitude from beat to beat from jiggling of heart in pericardial effusion

56
Q

pt with vtach treated with an antiarrthymic now months to years later has non-cardiogenic pulmonary edema, why?

A

amiodarone-induced interstitial pneumonitis

57
Q

when does amiodarone-induced interstitial pneumonitis present?

A

months to years after starting drug

58
Q

why chest pain with cocaine

A

coronary vasospasm

59
Q 
cocaine
3 clinical features
3 complications
4 drugs to use
2 drugs to avoid
1 procedure to do
A

Sympathetics - tachyc, htn, dilated pupils
Angina from coronary spasm/demand
Psychomotor agitation, seizures

MI, aortic Dissection, intracranial Hemorrhage

Benzo for htn and anxiety
ASA
Nitroglycerin and CCBs

Avoid bbs (don’t want alpha agonism unapposed), fibrinolytics

cardiac cath with reperfusion if indicated

60
Q

Stress-induced cardiomyopathy
aka
pathophys

A

aka Takotsubo cardiomyopathy
pysical or emotional stress or illness
systolic dysfunction apical balooning of left ventricle in systole with hyperkinesis of basal segments

61
Q

manage recurrent vasovagal syncope

A

reassurance
avoidance of triggers
counterpressure techniques
–in prodromal phase – supine with raised leg, cross legs and clench fists, etc… to abort syncope

62
Q

what are “counterpressure techniques” for vasovagal syncope?

A

in prodromal phase – lie down and raise legs, cross legs and clench fists, etc… to abort syncope

63
Q

sick sinus syndrome

A

degeneration or fibrosis of SA node and surrounding atrial myocardium.

fatigue, lightheaded, syncope, palpitations

bradycardia, sinus pauses/arrests, alternating bradycardia and atrial tachyarrhythmias

64
Q

ventricular preexcitation
aka
pathophys
ekg

A

wolff-parkinson-white syndrome
accessory conduction pathway a to v bypassing av node
short PR, wide QRS with slurred upstroke delta wave

65
Q

TF

AFib maintained in sinus rhythm by amiodarone does not require anticoagulation

A

F

rhythm control with amio does not affect thromboembolism risk so still anticoagulate per CHADS VaSc

66
Q

akg findings consistent with LVH

A

high voltage QRS complexes
lateral ST segment depression
lateral T wave inversion

67
Q

right sided heart failure following implanted pacemaker or cardioverter-defibbrilater, suspect..

A

triscuspid regurgitation due to valve damage

68
Q

define long QTc

A

^450ms men ^470ms women

69
Q

what heart sound can be heard in most patients during acute phase of MI due to ischemia induced myocardial dysfunction

A

S4 (decreased left ventricular compliance)

Medicine (13 decks)

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