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Awesome Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Fixed split 2nd heart sound.

A

ASD

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2
Q

Pt with fever, weight loss, and fatigue for several months. Diastolic sound with a soft rumble or pulp at the apex

A

Atrial myxoma

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3
Q

Murmurs that increase with inspiration

A

tricuspid stenosis

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4
Q

A murmur of aortic stenosis is best heard on

A

expiration

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5
Q

HOCM vs. AS. which increases with Valsalva

A

HOCM

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6
Q

16yo boy comes for a routine check-up. Murmur radiating throughout the precordium. No change with Valsalva and EKG shows mild LVH

A

VSD

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7
Q

most common murmur in adult hood on the left sternal border

A

VSD

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8
Q

pt wants to know how to decrease his risk of CAD. he’s a smoker and LDL is 80

Same pt but LDL is much higher

A

Stop smoking

statin

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9
Q

60yo women with CP on exsertion who can exercise and has no EKG changes

A

get Exercise EKG

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10
Q

Male 40 yo or over with CP. w.t.d

A

Stress test

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11
Q

Women 60 yo or over with CP

A

Stress test

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12
Q

Male < 39 yo with CP on exertion or relieving factors

A

stress test

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13
Q

Female >50 with CP on exertion or relieving factors

A

Stress test

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14
Q

Pt needs a stress test. Can exercise and ekg shows ST-T changes or LVH. what test

A

Exercise echo

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15
Q

Pt needs a stress test. Can exercise and EKG shows LBBB or V-pacing. what test

A

Vasodilator MPI or SPECT/PET

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16
Q

Pt needs a stress test. Cant exercise, and a wheeze is heard on the exam

A

Dobutamine

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17
Q

Pt needs a stress test. Cant exercise and a wheeze is NOT heard on the exam

A

Dobutamine or any vasodilator (adenosine)

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18
Q

Pt needs a stress test. Cant exercise, and a wheeze is NOT heard on the exam and EKG shows LBBB or V-pacing

A

MPI

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19
Q

50 yo Male. can exercise and has LVH on his EKG

A

stress Echo

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20
Q

60 yo male. cant exercise and has normal ekg. hx of COPD and wheeze is heard on the exam

A

Dobutamine stress test

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21
Q

65 yo woman with exertional dyspnea and occasional chest pain. EKG showed LBBB. what test

A

Adenosine or Dobutamine PET

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22
Q

btw RBBB, LBBB, and pacemaker. WHich one can undergo exercise EKG

A

RBBB

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23
Q

Where is the lesion?

ST depressions in I, aVL, V4-V6

A

Left circumflex artery stenosis

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24
Q

Where is the lesion?

ST depression in II, III, aVF

A

RCA

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25
Q

When NOT to do a stress test

A

Unstable angina or/and aortic stenosis with symptoms

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26
Q

An obese female who undergoes an exercise stress test but only can achieve a 50% increase in HR before having to stop. w.t.d

A

Repeat test but use pharmacological stress test

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27
Q

A pt with chronic angina now comes in with increased frequency. already on ASA and nitrate.

pt still has chest pain. HR 80

pt still has chest pain but HR is now 55

A

Add beta blocker

Increase the dose of beta-blocker

Angiogram with possible PCI

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28
Q

pt has increased angina but is refractory to beta-blockers, CCB and PCI shows nothing that can be stented w.t.d

A

Ranolazine.

Keep in mind this doesn’t improve mortality

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29
Q

45yo male presents with CP while shoveling snow. trops negative, EKG negative. PMHx is clean. w.t.d

A

Admit to hospital and get a stress test

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30
Q

65 yo male wakes up with severe retrosternal chest pain lasting 40mins that was accompanied by sweating and diaphoresis. in the ED–>EKG shows ST depression and T wave inversion.

Pt is started on ASA, IV nitrates, and LMWH and loaded with Plavix.

Pain gets better, but the ST depression persists.

What is this called, and how to diagnose it

A

Silent ischemia

Coronary angiogram

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31
Q

42 yo woman with retrosternal chest pain for 2 hours. no PMHx. runs 2 miles x 3 days/ week. EKG shows non-specific T wave changes and trops are elevated. w.t.d

A

Coronary angiogram

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32
Q

65 yo female has exertional SOB during exercise and relieved at rest.

MR during exercise which goes away post exercise

S4 +

The echo shows mild hypokinesia, and EF is 60%.

what’s the etiology of the chest pain

A

Ischemia

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33
Q

What is Wellens syndrome on EKG

A

Only deep T-wave inversions in leads V1-V4

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34
Q

pt comes to you without chest pain but states they had CP earlier.

EKG shows deep T wave inversions in leads V1 through V4.

w.t.d

A

Angiogram right away.

don’t need to wait for the stress test

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35
Q

pt presents with CP and EKG is negative.

A nuclear scan shows reversible ischemia.

an angiogram is negative.

What is going on and how do you treat it

A

Microvascular angina or syndrome X

Treat with CCB or Beta-blocker with nitrates

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36
Q

pt with CP at night 5-15min at rest.

EKG shows ST-T wave changes. w.t.d

A

Angiogram

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37
Q

pt with CP at night 5-15min at rest.

EKG shows ST-T wave changes and the angiogram is negative. w.t.d

A

Ambulatory EKG

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38
Q

pt with CP at night 5-15min at rest.

EKG shows ST-T wave changes and the angiogram is negative.

you do an Ambulatory EKG that is positive.

what is the diagnosis

A

Vasoplastic angina

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39
Q

pt with CP at night 5-15min at rest.

EKG and stress test is negative. w.t.d

A

Ambulatory EKG

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40
Q

pt with CP at night 5-15min at rest.

EKG and stress test is negative.

You do an amb EKG that is positive. w.t.d

A

angiogram

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41
Q

pt with CP at night 5-15min at rest.

EKG and stress test is negative.

You do an amb EKG that is positive but the angiogram is negative.

what is the diagnosis

A

Vasoplastic angina

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42
Q

An elderly man with hx of syncope. EKG is normal. He started he starts to feel dizzy after dinner. At that time his EKG shows ST depression in II, III, and aVF. 15 min later, the EKG is normal.

What’s the diagnosis and what’s the treatment

A

Postprandial ischemia

Cardiac cath and have him eat small frequent meals

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43
Q

24 yo with cocaine-induced chest pain who is found to have ST elevations.

how to treat

A

PCI

Benzo, nitrates, and ASA. In that order

Use CCB to prevent CP in the future

44
Q

pt is treated with tPA for elevation in trops and ST- revelations.

afterwards, CP and ST elevation were resolved. Trop tripled.

w.t.d

A

Nothing

45
Q

What is the cardiac enzyme that normalizes the earliest

A

Myoglobin

46
Q

65 y male. Admitted to MICU for pneumonia. EKG is normal and trop is elevated. w.t.d

A

Echo.

Trops could be from other things in a critically ill patient.

47
Q

pt presents with chest pain and low BP. what’s the next best step

A

Right-sided EKG. V3R and V4R

48
Q

What are the indications to push thrombolysis

A
  1. CP typical for infarction >30 min with LBBB
  2. ST elevation 1mm in two contiguous leads
  3. < 12 hours post-MI
  4. Pt is > 2 hours away from PCI center and NOT in shock
49
Q

Absolute contraindications for thrombolytic therapy

A
  1. Previous hemorrhagic stroke
  2. Other CVA events < 1 year
  3. Intracranial neoplasm
  4. Active internal bleed
50
Q

Relative contraindications for thrombolytic therapy

A
  1. CVA >1 year
  2. Recent internal bleed or major trauma <2-4 weeks
  3. BP >180/110
  4. Pregnant
  5. Active peptic ulcer disease
51
Q

Indications for PCI

A
  1. Acute ST elevation MI
  2. ST elevation with CP for more than 12 hours
  3. MI with shock and pt is less than 2 hours from PCI center and <75yo
  4. STEMI post-CABG
  5. if tPA is contraindicated
  6. unstable angina
52
Q

Pt is allergic to ASA. w.t.d

A

use ticagrelor or prasugrel

53
Q

Pt going for CABG, ticagrelor or prasugrel should not be used. T/F

A

True

54
Q

When is CABG used over PCI

A
  1. Left main disease
  2. Three vessel disease with decreased EF
  3. Two vessel disease with proximal LAD and decreased LVEF
  4. DM with CAD. They have diffuse lesions
55
Q

pt with CAD s/p stent. what meds on discharge

A

DAPT. with ASA and ticagrelor

56
Q

Active GI bleeding pt who underwent PCI with stent. EKG shows ST depression. GI needs to scope. Hb is very low and currently getting transfused w.t.d

A

Do the colonoscopy and stabilize pt first.

57
Q

Pt with a stent placed 3 months ago on ASA and ticagrelor presents with GI bleed. w.t.d

A

stop ticagrelor and continue ASA.

restart ticagrelor back on ASAP

58
Q

A pt with sent place 12 months ago on ASA and ticagrelor presents with GI bleeding. w.t.d

A

D/C ticagrelor and continue ASA at 81 mg QD

59
Q

A pt with stents placed 9 months ago on ASA and ticagrelor going for knee replacement surgery. w.t.d

A

Delay surgery by 3 months

60
Q

A pt with Afib has MI and PCI. w.t.d

A

Continue DOAC and add clopidogrel for one year. After 1 year, just DOAC alone for life.

61
Q

pt now with Afib. had MI s/p PCI one year ago and is taking ASA

A

D/C ASA and start DOAC for life

62
Q

pt with retrosternal CP for >1 hour and is diaphoretic.

EKG shows LBBB and ST-elevation in the anterior leads.

Trops are pending and no prior EKG

A

take this person straight to cath lab

63
Q

Pt with CP and ST elevation get tPA and 2 hours later BP drops and the pt is SOB.

w.t.d

A

PCI NOT IABP

64
Q

Elderly pt with IWMI and gets PCI with stents in proximal RCA. pt BP drops

What is the best first step

A

Give a fluid bolus and then Dobutamine

65
Q

pt with CP for 3 hours presents to the ED with ST elevations in V II, III, avF. trops are negative

w.t.d

A

PCI and if PCI isn’t available —> tPA

66
Q

pt gets tPA for STEMI what needs to be done next

A

PCI AFTER 2 hours

BUT if the patient starts to become unstable—> PCI NOW and don’t wait the 2 hours

67
Q

pt is admitted with MI; 3 days later, presents with chest pain relieved with NTG. w.t.d

A

Cath

68
Q

A pt has a cardiac cath 6 hours ago. Now appears diaphoretic and clammy skin. BP drops, and HR increases. exam shows no erythema or swelling at the puncture site. IVF bolus is given. Hb earlier was 14 and now it’s 8.

w.t.d

A

CT scan of the abdomen looking for retroperitoneal hemorrhage.

69
Q

pt has a cardiac cath 2 days ago. no presents with pain in the groin area. exam reveals an erythematous area with mild swelling. w.t.d

A

Ultrasound looking for an expanding pseudoaneurysm

70
Q

pt with MI, 9 days later with persistent chest pain, worse on deep breath. pericardial friction rub heard. on beta blocker, as, statin and ACE. CxR with effusion

EKG show ST elevations and PR depressions

A

Post-myocardial infarction syndrome

71
Q

How to treat Post-myocardial infarction syndrome

A

high dose ASA (6-8gms/day) for 3-4 weeks with colchicine

72
Q

Factors that have been shown to improve survival in MI

A
  1. PCI
  2. Thrombolylic therapy after Q wave MI
  3. Beta-blockers
  4. ASA
  5. After load reduction (ACE or ARNI)
  6. Stop smoking
  7. Statin
  8. ICD 40 days after MI
  9. ICD 90 days after PCI
  10. Cardiac rehab
73
Q

PCI, CABG, or statin. Which one improves LONG-TERM survival

A

Statin

74
Q

What is the sequence of events for the management of ACS.

A
  1. ASA
  2. NTG
  3. Beta-blockers
  4. Atorvastatin
  5. UFH
  6. Ticagrelor
  7. PCI
75
Q

pt with unstable angina with CKD. has already received ASA, BB, and statin.

A

Unfractionated heparin

NOT LMWH

76
Q

pt with MI has acute MR

A

Papillary muscle rupture

77
Q

pt with MI has acute VSD

A

Septal wall rupture

78
Q

Pt with MI has signs of tamponade

A

Free wall rupture

79
Q

Pt presents with CP. EKG reveals an MI and is treated with tPA, heparin, nitrates, BB, and ACE. Within 24 hours, pt develops NSVT. w.t.d

A

Just observe.

80
Q

What the mechanism of reperfusion arrhythmias

A

accumulated calcium causing a change in cardiac frequency

81
Q

Pt presents with CP. EKG reveals an MI and is treated with tPA, heparin, nitrates, BB, and ACE. Within 24 hours, pt develops sustained VT and is unstable. w.t.d

A

Cardiovert QRS is distinct or just defib if QRS or T is not seen.

82
Q

Pt presents with CP. EKG reveals an MI and is treated with tPA, heparin, nitrates, BB, and ACE. Within 24 hours, pt develops sustained VT and is stable. w.t.d

A

give amio or lidocaine

83
Q

If post-MI arrhythmias are less than 48 hours, what is the cause

A

ischemia

84
Q

If post-MI arrhythmias are greater than 48 hours, what is the cause?

A

Scare tissue. pt will need ICD

85
Q

Pt with ICD post-MI has 2 discharges in 2 months

A

add amio

86
Q

Pt with ICD and amio post-MI is still having discharges

A

Radiofrep cath ablation

87
Q

What patients need CRT with ICD

A

LBBB or QRS prolongation

88
Q

What pts need CRT and ICD placed at the same time

A

LBBB or QRS prolongation AND EF less than or equal to 35%

89
Q

What would you see on EKG 2-3 weeks after post-MI pericarditis

A

Deep T waves inversions

90
Q

pt has CABG or AVR 4 years ago. now has SOB for the last 3-4 months. JVD, hepatomegaly, and pedal edema. EKG and CxR look normal. whats the Dx

A

Pericarditis

91
Q

Pt presents with SOB on exertion with BMI of 40 and JVD of 14. BNP is only 160

A

IV Lasix

falsely low with obesity

This is called a type 2 error.

92
Q

You start CHF patients on ACE or ARNI. Now has Scr that jumped from 1.1–>2, and K jumped from 4–>5.6. w.t.d

A

D/C ACE or ARNI and start hydralazine and nitrates

93
Q

Pt on oral Lasix now has severe pitting edema and JVD of 12. w.t.d

A

Switch to IV Lasix and maximize the ACE. There is likely a lack of gut absorption.

94
Q

Pt is D/C from the hospital for CHF exacerbation. What’s the next best step in management?

A

Setting up follow-up visit within one week.

95
Q

Pt on spironolactone for six months and now has a left breast enlargement. w.t.d

A

Biopsy

96
Q

Pt on spironolactone for six months and now has a bilateral breast enlargement. w.t.d

A

D/C spironolactone and start eplerenone

97
Q

CHF patient on Lasix 60mg daily. All other HF meds are maxed out. The echo shows EF of 35% and EKG shows QRS 0.15 secs and LBBB

A

Start metolazone 30min before Lasix. This is part of GDMT. Don’t start ICD with CRT just yet

98
Q

CHF patient on Lasix 60mg daily. All other HF meds are maxed out. The echo shows EF of 35%, and EKG shows QRS 0.15 secs and LBBB.

You start metolazone 30min before Lasix. 3 months later nothing has changed

A

Start ICD and CRT

EF less than 35% –> start ICD

EF less than 35% and LBBB or ORS great than 15 sec –> ICD and CRT at the same time

99
Q

what drugs DONT improve survival in heart failure

A

Digoxin
CCB
Lasix

100
Q

How do you switch from ACE to ARNI

A

D/C ACE and wait 36 hours for a wash-out period, and then start ARNI.

The only exception to this rule would be if the patient is on candesartan. You can switch to ANRI after 24 hours

101
Q

You start ACE and pt has syncope. w.t.d

A

Continue ACE.

first dose syncope

102
Q

You start ACE and pt develops angioedema

A

Switch to ARB

103
Q

What sort of kidney issues are associated with ACE

A

Decreased constriction on efferent arterioles. This can cause renal failure in marginal patients

104
Q

Can ACE cause neutropenia

A

Yes

105
Q

What drugs should you not use in heart failure

A 
NSAIDS 
Glitazone 
CCB
cilostazol 
Metformin in advanced disease
106
Q

ACE and ARB combo has shown what

A

Less proteinuria and poorer renal outcomes

107
Q

Pt is a 65 yo woman who now presents with SOB on exertion that is relieved by rest. Loud S4 and soft S2. JVD of 12. EKF shows LBBB and Echo is 24%. Lasix is started, and symptoms improve. Pt had no history of heart failure before this admission. w.t.d

A

Coronary angiogram

Post-menopausal women with S4. Ischemia S4 and CHF S3.

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