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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
if nitrates cause reflex tachycardia from fall in BP, with worsening angina how to combat
concomitant BB
26
initial treatment of symptomatic PAD with claudication on walking
``` baby ASA Statin HTN and DM treatment smoking cessation supervised Exercise therapy ```
27
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
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
28
Cilostazol class, moa
antiplatelet, vasodilator, PDE-3 inhibitor
29
what med to consider for PAD with intermittent claudication when symptoms persist despite antiplatelet therapy and adequate supervised exercise
Cilostazol | antiplatelet, vasodilator, PDE-3 inhibitor
30
when to consider Cilostazol for PAD with intermittent claudication
when symptoms persist despite antiplatelet therapy and supervised exercise
31
ladder of treatment for PAD with claudication
``` baby ASA Statin HTN and DM treatment smoking cessation Exercise therapy ``` Cilostazol bypass or stent
32
electrical alternans is a pathognomonic ECG finding for ___ so treat with ___
electrical alternans is pathognomonic for PERICARDIAL EFFUSION so EMERGENCY PERICARDIOCENTESIS
33
Treat Wolff-Parkinson-White syndrome with
Procainamide
34
mechanism of electrical alternans on ekg
swinging of heart side to side in pericardial effusion
35
how does tension pneumothorax cause hypotension expected PCWP and Cardiac Index
hypotension by IVC compression expect LOW PCWP and Cardiac Index
36
after lung biopsy patient gets severe SOB and Hypotension, Cardiac Index is low and PCWP is high think tension pneumo?
no, tension pneumo compresses IVC dec preload so PCWP would be low think MI
37
what kind of murmur in an adult does not need a workup if asymptomatic which always need workup even if asymptomatic?
low grade systolic no workup any diastolic or continuous WORKUP with TEE
38
give aspirin for MI, but avoid if this cause of chest pain may be present
avoid asa if AORTIC DISSECTION possible
39
moa of asa antiplatelet
inhibits TXA2
40
acetaminophen and oxycodone for what kind of chest pain
tylenol and oxy for msk chest pain
41
ibuprofen for what kind of chest pain, how is it positional
ibuprofen for pericarditis | -relieved when lean forward
42
pt with history of panic attacks comes to ED with angina classic for MI... treat first with aspirin or lorazepam?
aspirin
43
STE in leads II III aVF STD in I aVL V1 V2 where is the infarct
posterior wall, right coronary
44
posterior wall, right coronary infarct on ekg
STE II III aVF | STD I aVL V1 V2
45
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
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
why sinus brady or Mobitz II with inferior MI in first 24 horus
increased vagal tone RCA supplies blood to AV node via AV nodal artery 90% of the time
47
these tests good for, bad for exercise ekg adenosine or dipyridamole stress test dobutamine stress test
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
MOA of Adenosine or Dipyridamole stress test
Dilates nonobstructed coronaries relative to obstructive (without increasing HR or BP) allowing to see difference via radioactive isotype flow (antiplatelet, vasodilators)
49
dobutamine stress testing is typically used when...
can't do exercise ekg (LBBB, can't reach tHR) can't do vasodilator pharm stress test (hypotension, COPD)
50
how can hypercalcemia mainfest symptomatically
stones bones groans psychiatric overtones polyuria, polydipsia, kidney stones bone pain GI sx confusion, depression, psychosis
51
TF | hyperparathyroidism can cause htn
T mechanism not well understood if htn significant, suspect MEN2 with pheochromocytoma
52
chest pain, dyspnea, tachypnea, tachycardia in long-distance truck driver think
PE
53
systolic-diastolic abdominal bruit think..
Renal Artery Stenosis
54
what is an F wave on ekg
flutter wave, aka atrial flutter
55
describe electrical alternans
variance of QRS amplitude from beat to beat from jiggling of heart in pericardial effusion
56
pt with vtach treated with an antiarrthymic now months to years later has non-cardiogenic pulmonary edema, why?
amiodarone-induced interstitial pneumonitis
57
when does amiodarone-induced interstitial pneumonitis present?
months to years after starting drug
58
why chest pain with cocaine
coronary vasospasm
59
``` cocaine 3 clinical features 3 complications 4 drugs to use 2 drugs to avoid 1 procedure to do ```
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
Stress-induced cardiomyopathy aka pathophys
aka Takotsubo cardiomyopathy pysical or emotional stress or illness systolic dysfunction apical balooning of left ventricle in systole with hyperkinesis of basal segments
61
manage recurrent vasovagal syncope
reassurance avoidance of triggers counterpressure techniques --in prodromal phase -- supine with raised leg, cross legs and clench fists, etc... to abort syncope
62
what are "counterpressure techniques" for vasovagal syncope?
in prodromal phase -- lie down and raise legs, cross legs and clench fists, etc... to abort syncope
63
sick sinus syndrome
degeneration or fibrosis of SA node and surrounding atrial myocardium. fatigue, lightheaded, syncope, palpitations bradycardia, sinus pauses/arrests, alternating bradycardia and atrial tachyarrhythmias
64
ventricular preexcitation aka pathophys ekg
wolff-parkinson-white syndrome accessory conduction pathway a to v bypassing av node short PR, wide QRS with slurred upstroke delta wave
65
TF | AFib maintained in sinus rhythm by amiodarone does not require anticoagulation
F | rhythm control with amio does not affect thromboembolism risk so still anticoagulate per CHADS VaSc
66
akg findings consistent with LVH
high voltage QRS complexes lateral ST segment depression lateral T wave inversion
67
right sided heart failure following implanted pacemaker or cardioverter-defibbrilater, suspect..
triscuspid regurgitation due to valve damage
68
define long QTc
^450ms men ^470ms women
69
what heart sound can be heard in most patients during acute phase of MI due to ischemia induced myocardial dysfunction
S4 (decreased left ventricular compliance)

Medicine (13 decks)

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