Cardiology Flashcards
1
Q
worst risk factor for CAD
A
DM
2
Q
most common risk factor for CAD
A
HTN
3
Q
what counts as premature CAD
A
male <65
4
Q
most dangerous part of lipid panel
A
LDL
5
Q
greatest improvement in pt outcomes with CAD from which lifestyle modification
A
smoking cessation
6
Q
chest wall tenderness is most likely d/t
A
costochondritis
7
Q
most accurate test for costochondritis
A
physical exam
8
Q
chest pain radiating to back with unequal BP between arms most likely d/t
A
aortic dissection
9
Q
most accurate test for aortic dissection
A
chest x ray (wide mediastinum) confirmed with CT, MRI or TEE
10
Q
chest pain worse when lying flat, better with sitting, in young (<40) most likely d/t
A
pericarditis
11
Q
most accurate test for pericarditis
A
EKG (ST elevation in all leads and PR depression)
12
Q
sudden onset SOB, tachycardia, hypoxia most likely d/t
A
PE
13
Q
sharp, pleuritic pain, tracheal deviation most likely d/t
A
pneumothorax
14
Q
chest pain with ____ has worst prognosis
A
SOB
15
Q
chest pain with fever suggests
A
PE or pneumonia
16
Q
when is a stress test done
A
stable pts with chest pain and unclear diagnosis
17
Q
maximum HR =
A
220 - pt age
18
Q
stress testing if EKG can’t be read
A
nuclear isotope (thallium or sestamibi) or echo
19
Q
Stress test if pt can’t exercise
A
Persantine (dipyrimadole) or adenosine with thallium or sestamibi or dobutamine echo
20
Q
adverse effect with dipyridamole
A
bronchospasm - avoid in asthmatics
21
Q
most accurate method of detecting CAD
A
angiography
22
Q
significant stenosis
A
> 70% may be surgically correctable, <50% is insignificant
23
Q
holter monitor is used to evaluate
A
rhythm
24
Q
chronic angina txs that lower mortality
A
aspirin, BB, nitroglycerin
25
med used when aspirin intolerance or recent angioplasty with stenting
clopidogrel
26
med used when chronic angina refractory to other tx
ranolazine
27
use when intolerant to both aspirin and clopidogrel
triclopidine
28
adverse effects of triclopidine
neutropenia and TTP
29
when is prasugrel used
use in those undergoing angioplasty with stenting
30
adverse effect of prasugrel
>75 increased risk of hemorrhagic stroke
31
best mortality of benefit of ACEi/ARB with EF <
40%
32
most common adverse effect of statins
elevated transaminases
33
lipid drug with best mortality benefit
statins
34
lipid drug that raises HDL
niacin
35
adverse effects of niacin
glucose intolerance, elevation of uric acid, pruritis
36
lipid drug that lowers triglycerides
genfibrozil
37
adverse effects of genfibrozil
increased risk of myositis when combined with statins
38
adverse effects of cholestyramine
GI (constipation, flatus), interacts with meds in gut preventing their absorption
39
lipid drug lowers LDL but no benefit to patient
ezetimibe
40
which CCBs do not increase HR
verapamil and diltiazem
41
CCBs used when BB not tolerated
verapamil and diltiazem
42
adverse effects of CCBs
edema, constipation, heart block
43
when are BB contraindicated
severe asthma, prinzmetal angina, cocaine induced chest pain
44
when is CABG done
3 vessels with >70% stenosis
Left main coronary artery occluded
2 vessel disease in DM
or persistent symptoms despite meds
45
how long do artery grafts last for
10yrs
46
how long do vein grafts last for
5 yrs
47
Best therapy in ACS especially if ST elevation
PCI
48
ACS is associated with what heart sound
S4 gallop – ischemia causes noncompliance of LV
49
acute myocardial damage in postmenopausal women immediately after stressful event
tako-tsubo cardiomyopathy
50
tako-tsubo cardiomyopathy pathology d/t
ballooning and LV dyskinesis
51
tx for tako-tsubo cardiomyopathy
BB and ACEi
52
MI with worst prognosis
anterior wall MI
53
ST elevation in V2 and V4
anterior wall MI
54
ST elevation in II, III, and aVF
Inferior wall MI
55
ST depression in V1 and V2
Posterior wall MI
56
tx for posterior wall MI
no additional tx needed - low mortality
57
what type of BBB is more dangerous
LBBB
58
tx of PVCs
no tx - tx worsens outcome
59
tx for stable angina
aspirin, BB, nitrates
60
ACS abnormalities show up on EKG
immediately
61
ACS abnormalities show up on myoglobin
after 1-4 hrs
62
ACS abnormalities show up on CK-MB
after 4-6hrs
63
ACS abnormalities show up on troponin
after 4-6 hrs
64
myoglobin stays elevated for
1-2 days
65
CK-MB stays elevated for
1-2 days
66
troponin stays elevated for
10-14 days
67
first tx for STEMI
aspirin
68
complications of PCI
rupture, restenosis, hematoma
69
PCI for STEMI should be done within
90 mins
70
thrombolytics for STEMI should be given within
30 mins
71
contraindications to thrombolytics
brain or bowel bleed, surgery within 2 weeks, BP >180/110, nonhemorrhagic stroke within 6 mo
72
when is heparin used in STEMI
after thrombolytics
73
STEMI, contraindication to thrombolytics, next step?
transfer for PCI
74
what drugs should be given in STEMI but are not time dependent
BB, ACEi, statins
75
first tx in NSTEMI
heparin - prevents clot formation
76
what type of heparin is superior for NSTEMI
LMWH
77
NSTEMI undergoing angioplasty and stenting, give
Glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban, eptifibitide)
78
NSTEMI, all meds given but not better
PCI
79
what drugs are NOT given in STEMI
GPIIb/IIIa, CCBs, or warfarin
80
what drugs are NOT given in NSTEMI
thrombolytics, CCBs, or warfarin
81
most common cause of death post MI
ventricular arrhythmia (keep in ICU)
82
Recurrence of pain, new onset of rales, sudden onset pulmonary edema
reinfarction
83
suspected reinfarction, next step
EKG for new ST abnormalities, and CK-MB levels
84
tx for reinfarction
repeat angioplasty
85
tx for symptomatic sinus bradycardia
atropine if symptomatic, pacemaker if ineffective
86
sinus bradycardia post MI d/t
vascular insufficiency of SA node
87
what are Cannon A waves
bounding of jugulovenous wave bouncing into neck
88
cannon waves and Sinus bradycardia
third degree AV block
89
tx for third degree AV block
pacemaker
90
third degree AV block post MI is associated with
RV infarction
91
New inferior wall MI and clear lungs
RV infarction
92
dx of RV infarction
flip EKG, ST elevation in RV4
93
the Right coronary artery supplies
RV, AV node, inferior wall
94
tx of RV infarct
high volume fluid replacement
95
avoid ____ in RV infarct
nitroglycerine
96
Several days after MI – sudden loss of pulse
tamponade or free wall rupture
97
dx of tamponade or free wall rupture
emergency echo
98
tx for tamponade or free wall rupture
emergency pedicardiocentesis
99
tx for V tach or V fib
cardioversion/defibrillation
100
New onset murmur and pulmonary congestion post MI
valve or septal rupture
101
most accurate test for valve or septal rupture
echo
102
Step up in oxygen (from RA to RV)
septal rupture
103
mitral valve regurge is best heard
at apex with radiation to axilla
104
ventricular septal rupture is best heard
at lower left sternal border
105
pericarditis post MI
dressler syndrome
106
dx of persistent ischemia post MI
stress test before discharge
107
ACEi are best for what type of MI
anterior wall
108
should prophylactic antiarrhythmics be used post MI
no - increase mortality
109
routine post MI care
Aspirin, BB (metoprolol), statins, ACEi
110
should dipyramidamole be used post MI
NO
111
post MI erectile dysfunction is most often due to
anxiety, but can be from BB
112
how long do you have to wait post MI to have sex
you don't
113
Decrease of BP >10 on inspiration
pulsus paradoxus
114
pulsus paradoxus is associated with
cardiac tamponade
115
kussmaul sign is most often associated with
constrictive pericarditis or restrictive cardiomyopathy
116
most common cause of hospital admission
CHF
117
most common cause of death in CHF
arrhythmia
118
cause of CHF
Infarction → dilation → regurgitation → CHF
119
Dyspnea on exertion, peripheral edema, rales, JVD, PND, S3 gallop
CHF
120
CHF with low EF
systolic dysfunction
121
CHF with preserved EF
diastolic dysfunction
122
best initial test for CHF
TTE
123
most accurate test for EF
MUGA or nuclear ventriculography
124
when do u get BNP
acute SOB with unclear etiology and no time for echo
125
swan ganz cath can distinguish
CHF from ARDS (but not routinely done)
126
adverse effect of lisinopril
hyperkalemia
127
B1 specific BB
metoprolol and bisoprolol
128
nonspecific BB with a1 blockage
carvedilol
129
CHF - SOB with minimal exertion or at rest is what class
III or IV
130
adverse effects of spironolactone
hyperkalemia, gynecomastia
131
med that inhibits aldosterone but no antiandrogenic effects
eplerenone
132
implantable defribillator in CHF (systolic dysfunction) if EF
<35%
133
biventricular pacemaker for CHF (systolic dysfunction) if
Dilated cardiomyopathy and EF 120) with persistent symptoms
134
drugs with mortality benefit in CHF with systolic dysfunction
ACEi/ARBs, BB, spironolactone/eplerenone, hydralazine/nitrates, implantable defibrillator
135
routine anticoagulation for CHF (systolic dysfunction)
WRONG unless clot in heart
136
drugs with clear mortality benefit in CHF (diastolic dysfunction)
BB
137
drugs with NO clear mortality benefit in CHF (diastolic dysfunction)
digoxin and spironolactone
138
drug for symptom control in CHF (diastolic dysfunction)
diuretics - but contraindicated in HOCM
139
Rales, JVD, S3 gallop, Edema, orthopnea, ascites and hepatosplenomegaly
acute pulmonary edema
140
most important acute test for acute pulmonary edema
EKG
141
chest x ray for acute pulmonary edema shows
cephalization of flow
142
acid base disorder in acute pulmonary edema
respiratory alkalosis - from hyperventilation (CO2 leaves easier than O2 enters)
143
best initial tx for acute pulmonary edema
remove large volume with loop diuretic (furosemide, bumetinide)
oxygen, morphine, nitrates
144
IV form of atrial natriuretic peptide, only a weak diuretic so no mortality benefit
nesiritide
145
meds for acute afterload reduction
Nitroprusside and Hydralazine
146
phosphodiesterase inhibtors (amironone and milrinone) effect on heart
increase contractility and decease afterload
147
digoxin effect on heart
increases contractility, but takes several weeks
148
most common valve disease in rheumatic fever
mitral stenosis
149
valve disease associated with aging and calcification
aortic stenosis
150
regurge valve diseases most commonly from
HTN and ischemic heart disease
151
right sided valve diseases increase with
inhalation
152
left sided valve disease increases with
exhalation
153
best initial test for valvular heart disease
ech
154
most accurate test for valvular heart disease
cath
155
all valvular heart diseases benefit from
diuretics
156
which valve disease to Look for in young adult, pregnant immigrant
mitral stenosis
157
dysphagia, hoarseness, A fib and stroke, hemoptysis, murmur
mitral stenosis
158
EKG in mitral stenosis shows
LA hypertrophy shows as biphasic P wave in Leads V1 and V2
159
x ray in mitral stenosis shows
second bubble behind heart
160
Murmur – diastole, just after opening snap
mitral stenosis
161
tx for mitral stensosis
diuretics, Na restriction, Balloon valvuloplasty, warfarin for a fib, rate control
162
poorest prognosis with aortic stenosis
CHF - 2 yr survival
163
Murmur – systolic, crescendo-decrescendo. Heard best at second right intercostal space, radiates to carotid artery.
aortic stenosis
164
angina, syncope, CHF, murmur
aortic stenosis
165
EKG in aortic stenosis shows
LVH. S wave in V1 plus R wave in V5
166
tx of aortic stenosis
valve replacement
167
Murmur – pansystolic (holosystolic), obscuring S1 and S2. Radiates to axilla.
mitral regurgitation
168
tx for mitral regurgitation
ACEi/ARBs are best – decrease rate of progression
169
when is valve replacement indicated in mitral regurge
heart starts to dilate, LVESD >40 or EF <60%
170
Murmur – diastolic, decrescendo. Heard best at lower left sternal border.
aortic regurgitation
171
tx for aortic regurge
ACEi/ARBs or nifedipine delay progression
172
valve replacement in aortic regurge indicated when
acute valve rupture or EF 55
173
de musset sign
head bobbing (aortic regurge)
174
hill sign
BP in legs as much as 40 > than in arms (aortic regurge)
175
quinke pulse
pulsations in nail bed (aortic regurge)
176
water hammer pulse
wide, bounding (aortic regurge)
177
which conditions are associated with mitral valve prolapse
marfans and ehler danlos
178
which valvular disease is most often asymptomatic
mitral valve prolapse
179
dx of mitral valve prolapse
echo is best (cath should rarely be done)
180
murmur - midsystolic clock
mitral valve prolapse
181
tx of mitral valve prolapse
BB when symptomatic, then valve repair (with catheter)
182
Atypical chest pain, palpitations, panic attack, murmur
mitral valve prolapse
183
all forms of cardiomyopathy benefit from
diuretics
184
dilated cardiomyopathy is ___ dysfunction
systolic = low EF
185
tx for dilated cardiomyopathy
ACEi/ARBs, BB – lower mortality
Diuretics and digoxin - control symptoms
If wide QRS – biventricular pacemaker improves symptoms and survival
186
hypertrophic cardiomyopathy is ___ dysfunction
diastolic = preserved EF
187
most common cause of hypertrophic cardiomyopathy
HTN
188
heart sound associated with hypertrophic cardiomyopathy
S4 gallop
189
hypertrophic cardiomyopathy symptoms worsened by
increased HR and decreased LV size
190
best initial test for hypertrophic cardiomyopathy
echo
191
most accurate test for hypertrophic cardiomyopathy
cath
192
Septal Q waves in inferior and lateral leads
HOCM (not MI)
193
Systolic anterior motion of mitral valve
HOCM
194
best initial tx for hypertrophic cardiomyopathy
BB
195
what tx is always WRONG for hypertrophic cardiomyopathy
digoxin and spironolactone
196
increased jugulovenous pressure on inhalation
kussmaul sign
197
tx of restrictive cardiomyopathy
tx underlying cause, diuretics
198
best initial test of restrictive cardiomyopathy
echo
199
most accurate test for restrictive cardiomyopathy
endometrial biopsy
200
speckling of septum on echo or cardiac MRI
amyloidosis
201
which valve diseases do not increase with expiration
HOCM, MVP
202
All murmurs decrease with less blood except
HOCM, MVP
203
Standing and valsalva ____ venous return to heart
decrease
204
Handgrip _____ LV emptying
decreases
205
Amyl nitrate_____LV emptying
increases
206
amyl nitrate mimicks
ACEi
207
Squatting and leg raise increase, standing and valsalva decrease, handgrip decreases, amyl nitrate increases
AS
208
Squatting and leg raise increase, standing and valsalva decrease, no effect with handgrip or amyl nitrate
MS
209
Squatting and leg raise increase, standing and valsalva decrease, handgrip increases, amyl nitrate decreases
AR and MR
210
Squatting and leg raise decrease, standing and valsalva increase, handgrip decreases, amyl nitrate increases
MVP and HOCM
211
most common infection causing pericarditis
viral (coxsackie B)
212
most common connective tissue disorder causing pericarditis
SLE
213
EKG on pericarditis shows
ST elevation all leads, PR depression
214
tx of pericarditis
NSAIDs
215
tx of pericarditis that decreases recurrences
colchicine
216
in pericardial tamponade which side of heart is compressed first
right - thinner walls
217
Hypotension, tachycardia, distended neck veins, clear lungs, pulsus paradoxus
pericardial tamponade
218
most appropriate test for pericardial tamponade
echo
219
EKG in pericardial tamponade shows
electrical alternans
220
pericardial tamponade on x ray
globular heart
221
pericardial tamponade on echo
RA and RV diastolic collapse
222
right heart cath in pericardial tamponade shows
equilization of pressures in diastole
223
tx of pericardial tamponade
pericardiocentesis, IV fluids, window in pericardium if recurrent
224
what worsens pericardial tamponade
diuretics
225
heart sound with constrictive pericarditis
knock in diastole
226
tx of constrictive pericarditis
diuretics first, then surgical removal of pericardium
227
best initial test for PAD
ABI, <0.9 = disease
228
most accurate test for PAD
angiogram
229
best initial tx for PAD
aspirin, smoking cessation, cilostazol
230
single most effective med for PAD
cilostazol
231
best initial test for aortic dissection
x ray
232
Pain between scapulae, difference in BP between arms
aortic dissection
233
most accurate test for aortic dissection
angiography
234
tx of aortic dissection
control BP - BB, nitropruside, surgery
235
for aortic dissection what must be done before starting nitropruside
BB - prevents reflex tachycardia
236
heart disease most dangerous to pregnant woman
peripartum cardiomyopathy
237
heart disease second most dangerous to pregnant woman
eisenmenger
238
tx for peripartum cardiomyopathy
ACEi/ARB, BB, spironolactone, diuretics, digoxin
239
peripartum cardiomyopathy usually happens when after delivery
post partum
240
after peripartum cardiomyopathy LV dysfunction doesn't improve then
cardiac transplant, no repeat pregnancy of will provoke enormous antibody production
241
peripartum cardiomyopathy MOA
antibodies against myocardium
