Cardiology Flashcards
Indications for Spironolactone for Heart Failure
1) Prior hospitalization with high BNP
2) EF<35%
3) Post MI , heart failure
In asthma diagnosis, broncho dilator should increase FEV1 by ____ percent
12%
Asthma with atopy, treatment can be augmented with ____ and ____ pharmaceuticals
1) Montelukast (Leukotriene antagonist)
2) Omalizumab (IgE binder)
Fixed P2 during auscultation can be found in this common condition ______
COPD (Delayed close in pulmonic valve), ASD
Treatment for central OSA ____ and ____
acetazolamide, medroxyprogesterone
Panacinar emphysema is characteristic of ____ disease that affects lung and liver
a1 antitrypsine [excess elastase activity since antitrypsine does not negatively regulate this]
2 strategies of treating ILD
1) Steroid responsive disease with ____
2) Steroid unresponsive disease with ___
1) Azathioprine (Berylliosis, common steroid responsive)
2) Cyclophosphamide
Most ILD tend to not be steroid responsive in general
Targeted Therapies for ILD
1) Perfenidone is a ____ inhibitor
2) ______ is a growth factor EGFR inhibitor
Collagenase
______ is like an acute ILD with myalgia, fever
BOOP (bronchiolitis obliterans)
7th nerve palsy Uveitis Erythema Nodosum Restrictive Myopathy CD4:CD8 elevated Serum ACE
_____ condition
Sarcoidosis (Tx: Steroids)
Bosentan, Epoprostenol, Sildenifil, Riociguat are treatments for _____
primary hypertension
____ is a classic EKG finding of PE
S1Q3T3
When to use thrombolytics for PE _______
hemodynamic instability
2 treatment courses for latent TB
1) Isoniazid (9 months)
2) Isoniazid + Rifapentine (3 months)
_____ is a superimposed infection, usually on top of asthma/atopy. Treated with _____
ABPA
Itraconazole + oral steroids
Absolute limit for thrombolysis _____
4 hours
massive headache with indolent stroke like symptoms should be concerning for _____
cerebral venous thrombosis
Acute Seizure Medications
1) Ativan
2) ______
3) ______
2) Phosphophenytoin
3) Phenobarbital
______ is a syndrome, in which someone has Parkinson’s like symptoms + autonomic instability
Shy Drager (Tx: Fludrocortisone)
____ Parkinsons + impulsive behaviors
PSP
Parkinsons Treatment
Treatment
- Mild: Benztropine-trihyexyphenadyl/Amantadine
- Severe: Levodopa/Carbidopa , pramipexole, ropinerole, cabergoline
- 2nd line (COMT/MAO): Entacapone, selegiline
Parkinsons produces a _____ tremor
resting
cerebellar and essential tremor, tends to be a ____ tremor
intention
Natalizumab + Fingolimod + dimethyl fumarate + glatiramer, B interferon are treatments for ____
Multiple Sclerosis
_____ Parkinson’s treatment increases risk of idiopathic PML
Natalizumab
_____ produces dementia with personality/behavior changes
Fronto-temporal dementia
Incontinence + Dementia + Ataxia/wide gait is a hallmark for _______
Normal pressure hydrocephalus (Tx: shunt)
Tetrabenazine is a treatment for _____
Huntington Disease
____/month is an indication for migraine prophylaxis
4 (propranolol, verapamil)
ICP symptoms in obese person, CN palsies (double vision, headache) is indicative of _____ condition
pseudotumor cerebri
- risk : vitamin A, minocycline
- Tx: Acetazolamide, VP shunt
_____ form of meningitis needs prophylaxis of contacted individuals with Rifampin
Neisseria
Treatment of herpes meningitis/encephalitis
1) Acyclovir
2) Foscarnet (resistant organism)
Auto-immune encephalitis is associated with _____ in women
ovarian teratoma
Ring enhancing lesion in HIV : _____ and _____
1) PML
2) Toxoplasmosis : Bacterim x 14 days
Neurocystcircosis, active lesions have NO calcifications . Treatment for active lesions_______
Albendazole, + Praziquantel , inactive can be managed purely with seizure prophylaxis
This type of syndrome is from hypertension, results in cerebral edema
PRES syndrome
Management of ICP
1) Mannitol
2) Hyperventilation: reduced ICP
3) Surgical evacuation
_____ result in cape like distribution of pain/temperature deficits in upper extremity
Syringiomyelia , Dx: MRI
______ results in ipsilateral dorsal column, contralateral pain/temp
Brown Sequard
amifampridine is a treatment for _____
LEMS
Treatment for Gulllan Barre_____
Plasmapharesis
When to use a dobutamine ECHO/Thalium stress test________
When EKG changes cannot be appropriately interpreted under stress, so you have to visualize heart through ECHO/Nuclear imaging
1) LBBB
2) Digoxin Use
3) Pacemaker
4) Baseline ST aberrance’s
Most common cause of death post MI_____
Ventricular Arythmia
For MI, when to choose Ca2+ instead of B blocker, since b-blocker is known to improve mortality
1) B agonism needed : Asthma
2) Vasospastic causes: prinzmetal, cocaine
________ is a Ca2+ blocker famously known to cause neutropenia
Ticlodipine
Indications for Pacemaker
1) Low EF HF, NYHA Class III-IV
2) LBBB
3) Mobitz II, Third Degree Heart Block
4) Bifascicular Block
5) Symptomatic bradycardia
abciximab only lowers mortality for ________
NSTEMI
Indications for IABP (Intra-aortic balloon pump)
1) Post MI Valvular Rupture
2) Unstable HFrEF, MI, Ventricular Arythmia
3) Post CABG cardiogenic shock
Ranazolin is used for ______
chronic angina, 2nd line with nitrates
LDL goals
1) ASCVD>7.5% _____
2) Diabetic _____
3) Normal ______
1) 100
2) 70
3) 190
CHF
1) Acute Management: Diuresis, O2, ______ pressor
Dobutamine (contracility, increases peripheral resistance) /Milronone (contractility)
Nesritide (ANP analog)
Ivrabradine
Side effect______
1) 3rd Line agent after B-blocker/Imdur combination for chronic management
2) If b-blocker cannot be used
3) Bright, luminous vision
Bicuspid aortic valve is associated with _____ genetic syndrome
______ is associate with mitral stenosis
Turners
Rheumatic heart disease
_______ valve is associated with young females
Mitral prolapse
Murmurs that decrease with increased venous return (squatting, valsalva, hand grip)______ and _______
HOCM
Mitral Prolapse
The oddball murmur _______, softens with hand grip (increase preload) and with amyl nitrate (decrease pre-load), physiology in valve gradient dependent
Aortic Stenosis
Difference between TAVR vs Surgery for Aortic Stenosis regarding complications :
1) TAVR______
2) Surgery______
1) Arythmia, requirement of pacemaker
2) Afib/Aki
When to do surgery for aortic regurgitation
1) _________
2) _______
EF<55%
LV diameter >5.5cm
5 and 5 rule
________ is a valvular heart disease notorious for revealing itself during pregnancy
Mitral stenosis, associated with rheumatic heart disease
When to do surgery for mitral regurgitation
1) ________
2) ________
EF<60%
LV Diameter >4cm
More strict criteria than aortic regurgitation
Causes of Fix Split S2
1) ________
2) _______
1) ASD
2) Pulm HTN: COPD
Rapid X decent on venous tracing is characteristic of _______
Constrictive disease: pericarditis, restrictive cardiomyopathy
______ is defined as an increase in JVP with inhalation
Kussmaul sign
_____ is defined as a decrease in BP by 10 during inhalation, when u expect an increase
pluses paradoxus (tamponade)
+electrical alternans
Best initial management for dissection _____, _____
B blocker, nitroprusside (artery and vein dilation)
Multifocal Atrial Tachycardia treated with ________
Ca2+ blocker
Indication for surgery for hyper PTH:
1) Calcium>12.5
2) Renal Insufficiency
3) Symptoms: Polyuria, constipation, confusion
*Sestamibi/nuclear imaging is purely for surgical planning
When to do petrosal vein sampling for cushing syndrome______
When imaging indeterminate
Medical therapy of cushing/hypercortisol
______
____
Mifepristone
Pasireotide (somatostatin analog)
Cosyntropin is a _____ analog used to test for ______
ACTH
Addison’s
______ is a specialized scan used for pheochromocytoma. Pheo is associated with _____ genetic condition
MIBG
Men II a, b
Hirsutism, virilization, high 17-OH is characteristic of ________
21 Hydroxylase deficiency [CAH]
Pearls of CAH
21 Hydroxylase Deficiency (most common)
High androgen, 17OH progesterone levels, hirsuitism (virilization), No HTN
11B hydroxy deficiency
Both HTN and virilization
17 Hydroxylase deficiency (less common)
HTN, no virilization
Cyanotic heart diseases (D transposition, TOF), are examples of _____ shunt
R –> L
_______ is a congenital heart disease characterized by essentially total walling off, of the R atrium
Tricuspid Atresia , relies upon PDA/PFO like connection. Prostaglandins would close this
_____ is an EKG findings characteristic of abstain anomaly, caused by _____ drug
Tall p waves ( R atrial loading from giant R atrium), lithium
statin inhibit ___ enzyme
HMG-COA reductase
Use dual anti platelet therapy (Clopidogrel) for ____ months after stent placement
12 months
Lateral leads
I, AvL, V5, V6
Diastolic murmur with opening snap ______
Treated with _______
Associated with ______
mitral stenosis
balloon valvuloplasty
Rheumatic fever
Systolic murmur radiating to the axilla _____
Tx: surgery with EF
Mitral regurgitation
60%
_____ mid-systolic click, murmur increased with valsalva
mitral valve prolapse
Parvus et tardus(slow carotid upstroke), associated with ____
Aortic stenosis
wide pulse pressure, diastolic murmur radiating to axilla______
Tx: Hydralazine, ACE (after load reduction)
Associated with systemic disease: Marfan, Syphillis, _____
Aortic regurgitation
Ankylosing Spondylitis
Pacemaker indicated for EF120 seconds)
35%
Restrictive systemic diseases usually cause_____ heart failure
diastolic
Post MI pericarditis is called____
Dressler syndrome , pericarditis pain relieved sitting forward
First line BP control for Africam____
Thiazide, calcium channel blocker
Early treatment of aortic dissection with BP control using
_______
_______
Nitroprusside
B blocker
How to diagnose aortic dissection, if contrast allergy______
TEE
_____ is a 2nd line for LDL/cholestrol lowering, no clear mortality benefit
Ezetimibe
____ is a HDL improving medication that may cause flushing
Niacin
_______ is a valvular vegetation caused by Lupus
Libman-Sacks
Most common organism for acute endocarditis_____
S.Aureus
Any patient with S.Aureus needs ECHO (T/F)
Now its true
endocarditis generally needs____ time for treatment
4-6 weeks
Major Duke Criteria
- 2 different Bcx(+) 2 intervals (12 hrs)
- _____
ECHO evidence
Minor criteria
- Fever
- ____
- Osler nodes, laneway, roth spots (antibody-autoimmune complex)
- Emboli evidence
Predisposition (IV drugs, prosthetic valve)
Endocarditis diagnosis
____ major criteria
1 major ___ minor
___ minor alone
2
3
5
Indication for Endocarditis Prophylaxis
1) Congenital Heart Disease
2) _____
3) Prior endocarditis
4) Heart transplant, where transplant heart has valvulopathy
Prosthetic valve
Most common: Dental procedures, patient with heart condition
Troponin,CK-MB takes ____ hours to get elevated, thats why EKG is always the best first test
3-6 hours
How to get EF number in obese patients___
MUGA Scan (Nuclear schintigraphy)
Aspirin is the best initial therapy for both STEMI and ____
NSTEMI
Time cutoff before TPA for STEMI____
90 minutes
ACE/ARB is mortality lowering in ACS only if _____-
Reduced EF, LV dysfunction
Prasugrel is technically better than clopidogrel for pre PCI loading, however should be avoided in age >____
75, bleeding risk
Unstable angina/NSTEMI, treatment is _________
Heparin
Treatment range for thrombolytics:
Ideal:
90 minutes - 12hours
Heparin activates ______, which is chief mechanism of anti-coag
antithrombin
CABG can be done with either internal mammary artery, or saphenous vein grafts. The lifespans
1) Mammary artery : ____
2) Saphenous Vein :____
10 years
5 years
Pacemaker indication for CHF
1) EF
35%
QRS>120s
GDMT for aortic regurgitation, mitral regurgitation___
ACE/ARB
Handgrip ____afterload, amyl nitrate _____ afterload
increases, decreases
Mitral regurgitation murmurs radiate to ______
Axilla
Best initial test for valvular lesion______. Most accurate test______
ECHO
L Heart Cath
Regurgitant heart valvulopathy are best treated with ________
ARB/ACE
Surgical Repairs
1) MS: ______
2) As:_______
1) Balloon Valvuloplasty
2) TAVR vs Open repair
Aortic Stenosis Treatment
1) Careful Diuresis: Preload dependent, due to high afterload
2) TAVR: High risk of mortality within 5 years for AS patients , bioprosthetic valve lasts____
10 years
Aortic regurgitation is associated with many systemic diseases
- Genetic : Marfan, Turner
- Structural : Bicuspid Aortic Valve
- Rheum: Reiters, Ankylosing Spondylitis, RA
Treated with _____
ACE/ARB
Surgery: EF:55%, Diameter>55mm (rule of 5s)
Most common cause of MS______, treated with :
Rheumatic Fever ; Opening snap with diastolic rumble
Diuretics, Balloon valvuloplasty , it can be done during pregnancy as the condition is revealed during pregnancy
S3 should make you think of ____ and ____
CHF, Mitral regurgitation
Mitral regurgitation treated with ______
Tx: ACE/ARB, diuresis, Nifedipine, Surgery (EF<60%, diameter>40mm
INR target for mitral valve repair_____
INR = 2.5 - 3.5
Low voltage EKG can be clue to ________ myopathy
Restrictive (Amyloid), Tamponade
EKG findings on pericarditis
1) Global , Inflecting ST elevations
2) _______, more specific but less frequent
PR depression in lead II
Medications to start for Aortic dissection______
B blocker, Nitroprusside
LDL goal for PAD
100
Drug that does not work in PAD, because outer artery (muscularis) layer is influenced rather than the intima_____
Ca2+ blocker
Rivaroxaban + Apixaban are ____ inhibitors , Dabigatran is a ______ inhibitor
Factor 10a, Thrombin
Idarucizumab is used to reverse _____
Dabigatran
_____ can look similar to Afib
MAT
_____ type of SVT is worsened with Ca2+ blocker
WPW, forced conduction down abnormal tract instead of AV node
Only kind of stroke causing syncope ______
Vertebral/Basilar (Brainstem), bilateral stroke needed for LOC, vertebral is midline
____ is used to diagnose vaso-vagal syncope
Tilt table test
If ventricular arythmia is uncovered during syncope evaluation, a _____ is needed
implantable Defib
Treatment of Vtach with pulm edema_____
synchronized cardioversion
Handgrip _____ aortic stenosis murmur, _____ increased aortic stenosis
decreased, increases
Most accurate test for aortic stenosis _____
L heart cath
TAVR increases risk of post procedural _______
heart block (requiring pacemaker), surgery increases risk of AKI, afib
Opening snap _____ is worse mitral stenosis
earlier
Treatment of dilated cardiomyopathy/HOCM_____
Spironolactone
