Cardiology Flashcards
What is a “significant” family history for CAD?
MI in female relative less than 65
Male relative less than 55
How long does angina d/t ischemia typically last?
15-30 minutes
S3 gallop signifies?
Dilated left ventricle
S4 gallop signifies?
Left ventricular hypertropy
How quickly does CK-MB rise and stay elevated?
Rises in 3-6 hrs, the same as Troponin, but stays elevated only 1-2 days. That’s why CK-MB is the best test to detect reinfarction a few days after an initial infarct.
How quickly does Troponin rise and stay elevated?
Rises in 3-6 hrs, same as CK-MB, but stays elevated for 1-2 weeks.
What is “low” “intermediate” and “high” risk Framingham scores?
Low is 0-9% 10 year CAD risk
Intermediate is 10-20%
High is >20%
What are the expected annual rates of CAD death or MI for “low”, “intermediate”, and “high” risk Framingham scores?
Low - 2%
Which patient should receive pharmacologic stress test instead of exercise stress?
Those who cannot exercise to target heart rate of >85% of maximum
Which patient should receive cardiac radionuclide stress testing? (ECHO, Cardiac CT, MRI)
Patients whose EKGs are unreadable for ischemia:
- LBBB
- Digoxin use
- Pacemaker
- Left ventricular hypertrophy
- Baseline abnormality of the ST segments on EKG
What instance does an ACEi or ARB lower mortality in acute coronary syndromes?
If their is low EF or systolic dysfunction
What are examples of GPII/IIIa inhibitors?
Eptifibatide, Tirofiban, or Abciximab
When is GPII/IIIa inhibitors shown to be beneficial in ACS?
In the setting of NSTEMI, especially when combined with angioplasty and stenting.
When should thrombolytics be used in STEMI?
When PCI cannot be performed within 90 minutes of presentation AND
- chest pain has been for less than 12 hrs
- ST segment elevation in 2 or more leads or new onset LBBB
Indications for CABG?
3 coronary vessels with >70%
Left main disease with >70%
Patient with CHF and pulmonary edema, is Wedge pressure increased or decreased?
Increased, because there is increased L atrial pressure.
Drugs used to treat diastolic dysfunction CHF?
Beta blockers and diuretics
- Spironolactone and Digoxin not shown to be beneficial
- ACE-i not definite if it helps.
CHF patient with maximal medical therapy and still symptomatic, QRS duration >120 msec, what do you do next?
Place biventricular pacemaker, aka “cardiac resynchronization therapy”
Valvular disease associated with Turner syndrome?
Bicuspid aortic valve
Valsalva and standing up do what to venous return to the heart?
Decrease venous return to the heart
Squatting and lifting legs in the air do what?
Increase venous return to the heart.
Most murmurs increase with squatting and leg raise, which are the only two murmurs to decrease with that?
Mitral Valve Prolapse and HOCM
Murmur in second right intercostal space that radiates to carotids, crescendo-decrescendo?
Aortic stenosis
Murmur in apex that radiates to axilla?
Mitral regurgitation
Best treatment for aortic stenosis?
initial therapy, but not long-term and doesn’t alter prognosis. Best tx valve replacement
Normal gradient for aortic valve?
70 severe aortic stenosis
Pulse that is bounding and forceful, rapidly increasing and subsequently collapsing is called? What does it signify?
Water-hammer or Corrigan’s pulse.
Signifies aortic regurgitation
Treatment for aortic regurgitation?
ACEs, ARBs, nifedipine or loop diuretics.
Surgery when EF is <55% or LV end systolic diameter goes above 55mm.
Diastolic rumble after an opening snap, what murmur is this?
Mitral Stenosis
Treatment for Mitral Stenosis?
Diuretics best initial therapy. Balloon valvuloplasty is most effective therapy.
Criteria for surgery for mitral regurgitation?
If LVEF 40%
Holosystolic murmur at LLSB?
Ventricular Septal Defect
Fixed splitting of S2?
ASD
Causes for dilated cardiomyopathy?
Ischemia, alcohol, radiation, adriamycin, Chagas’ disease
Causes of restrictive cardiomyopathy?
Sarcoidosis, amyloidosis, hemochromatosis, cancer, myocardial fibrosis, glycogen storage diseases
Pleuritic chest pain relieved by leaning forward and ST-segment elevation in all leads?
Pericarditis
Treatment for pericarditis?
NSAIDs. If that doesn’t work add oral Prednisone. Give it a couple days and if that doesn’t work add Colchicine.
What is pulsus paradoxus?
A drop of 10 mmHg with inspiration
Diastolic collapse of the R atrium and R ventricle signifies?
One of the earliest findings of cardiac tamponade
Do NOT give this medicine if a patient is in tamponade?
Diuretics
Kussmaul’s sign?
Increase in JVD during inspiration. It is a sign of constrictive pericarditis or restrictive cardiomyopathy.
Treatment for constrictive pericarditis?
Diuretics and surgical removal of the pericardium
Chest pain radiating to the back between the scapula, ripping type pain, and difference in BP between right and left arms. Diagnosis?
Thoracic aortic dissection.
Who should be screened for AAA and when should surgery be performed?
Screen men 65-75 who smoked. Surgery for >5cm.
Normal Ankle-Brachial index?
greater than or equal to 0.9
Cilostazol, mechanism of action and what is it used for?
PDE 3 inhibitor, reduces platelet aggregation. Used for intermittent claudication in PVD
CHADS2, what does it stand for, what’s the scoring, who needs medicines?
CHF, HTN, Age>75, DM2, Stroke/TIA (2 points)
Score 0-1 give aspirin, 2 or more anticoagulate
Multifocal Atrial Tachycardia associated with what other disease? Which medicine is contraindicated in MAT?
Associated with COPD.
Beta-blockers are contraindicated
Management of unstable patient in SVT?
Synchronized cardioversion
Stable patient in SVT, first step and then second step if refractory?
Vagal maneuvers, if that doesn’t work, adenosine IV
Best long term management for SVTs?
Radiofrequency catheter ablation
What are some types of vagal maneuvers?
Valsalva, ice immersion of the face, carotid sinus massage,
Patient with SVT given Cardizem and suddenly worsens, diagnosis?
WPW
Most accurate study to diagnose WPW?
Electrophysiologic studies
Best treatment if patient is in SVT or Vtach from WPW?
Procainamide
Best long term treatment?
Radiofrequency catheter ablation
Drugs you can use for vtach if patient stable or in conjunction with cardioversion if patient unstable?
Amiodarone, Lidocaine, Procainamide, Magnesium
4 most common causes of acute heart failure?
Papillary muscle rupture
Infective endocarditis
Chordae tendinae rupture
chest wall trauma with compromise of valvular apparatus
Most common cause of severe acute mitral regurgitation?
Rupture of chordae tendinae
