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Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is a “significant” family history for CAD?

A

MI in female relative less than 65

Male relative less than 55

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2
Q

How long does angina d/t ischemia typically last?

A

15-30 minutes

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3
Q

S3 gallop signifies?

A

Dilated left ventricle

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4
Q

S4 gallop signifies?

A

Left ventricular hypertropy

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5
Q

How quickly does CK-MB rise and stay elevated?

A

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.

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6
Q

How quickly does Troponin rise and stay elevated?

A

Rises in 3-6 hrs, same as CK-MB, but stays elevated for 1-2 weeks.

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7
Q

What is “low” “intermediate” and “high” risk Framingham scores?

A

Low is 0-9% 10 year CAD risk
Intermediate is 10-20%
High is >20%

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8
Q

What are the expected annual rates of CAD death or MI for “low”, “intermediate”, and “high” risk Framingham scores?

A

Low - 2%

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9
Q

Which patient should receive pharmacologic stress test instead of exercise stress?

A

Those who cannot exercise to target heart rate of >85% of maximum

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10
Q

Which patient should receive cardiac radionuclide stress testing? (ECHO, Cardiac CT, MRI)

A

Patients whose EKGs are unreadable for ischemia:

  • LBBB
  • Digoxin use
  • Pacemaker
  • Left ventricular hypertrophy
  • Baseline abnormality of the ST segments on EKG
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11
Q

What instance does an ACEi or ARB lower mortality in acute coronary syndromes?

A

If their is low EF or systolic dysfunction

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12
Q

What are examples of GPII/IIIa inhibitors?

A

Eptifibatide, Tirofiban, or Abciximab

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13
Q

When is GPII/IIIa inhibitors shown to be beneficial in ACS?

A

In the setting of NSTEMI, especially when combined with angioplasty and stenting.

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14
Q

When should thrombolytics be used in STEMI?

A

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
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15
Q

Indications for CABG?

A

3 coronary vessels with >70%

Left main disease with >70%

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16
Q

Patient with CHF and pulmonary edema, is Wedge pressure increased or decreased?

A

Increased, because there is increased L atrial pressure.

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17
Q

Drugs used to treat diastolic dysfunction CHF?

A

Beta blockers and diuretics

  • Spironolactone and Digoxin not shown to be beneficial
  • ACE-i not definite if it helps.
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18
Q

CHF patient with maximal medical therapy and still symptomatic, QRS duration >120 msec, what do you do next?

A

Place biventricular pacemaker, aka “cardiac resynchronization therapy”

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19
Q

Valvular disease associated with Turner syndrome?

A

Bicuspid aortic valve

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20
Q

Valsalva and standing up do what to venous return to the heart?

A

Decrease venous return to the heart

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21
Q

Squatting and lifting legs in the air do what?

A

Increase venous return to the heart.

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22
Q

Most murmurs increase with squatting and leg raise, which are the only two murmurs to decrease with that?

A

Mitral Valve Prolapse and HOCM

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23
Q

Murmur in second right intercostal space that radiates to carotids, crescendo-decrescendo?

A

Aortic stenosis

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24
Q

Murmur in apex that radiates to axilla?

A

Mitral regurgitation

25
Q

Best treatment for aortic stenosis?

A

initial therapy, but not long-term and doesn’t alter prognosis. Best tx valve replacement

26
Q

Normal gradient for aortic valve?

A

70 severe aortic stenosis

27
Q

Pulse that is bounding and forceful, rapidly increasing and subsequently collapsing is called? What does it signify?

A

Water-hammer or Corrigan’s pulse.

Signifies aortic regurgitation

28
Q

Treatment for aortic regurgitation?

A

ACEs, ARBs, nifedipine or loop diuretics.

Surgery when EF is <55% or LV end systolic diameter goes above 55mm.

29
Q

Diastolic rumble after an opening snap, what murmur is this?

A

Mitral Stenosis

30
Q

Treatment for Mitral Stenosis?

A

Diuretics best initial therapy. Balloon valvuloplasty is most effective therapy.

31
Q

Criteria for surgery for mitral regurgitation?

A

If LVEF 40%

32
Q

Holosystolic murmur at LLSB?

A

Ventricular Septal Defect

33
Q

Fixed splitting of S2?

A

ASD

34
Q

Causes for dilated cardiomyopathy?

A

Ischemia, alcohol, radiation, adriamycin, Chagas’ disease

35
Q

Causes of restrictive cardiomyopathy?

A

Sarcoidosis, amyloidosis, hemochromatosis, cancer, myocardial fibrosis, glycogen storage diseases

36
Q

Pleuritic chest pain relieved by leaning forward and ST-segment elevation in all leads?

A

Pericarditis

37
Q

Treatment for pericarditis?

A

NSAIDs. If that doesn’t work add oral Prednisone. Give it a couple days and if that doesn’t work add Colchicine.

38
Q

What is pulsus paradoxus?

A

A drop of 10 mmHg with inspiration

39
Q

Diastolic collapse of the R atrium and R ventricle signifies?

A

One of the earliest findings of cardiac tamponade

40
Q

Do NOT give this medicine if a patient is in tamponade?

A

Diuretics

41
Q

Kussmaul’s sign?

A

Increase in JVD during inspiration. It is a sign of constrictive pericarditis or restrictive cardiomyopathy.

42
Q

Treatment for constrictive pericarditis?

A

Diuretics and surgical removal of the pericardium

43
Q

Chest pain radiating to the back between the scapula, ripping type pain, and difference in BP between right and left arms. Diagnosis?

A

Thoracic aortic dissection.

44
Q

Who should be screened for AAA and when should surgery be performed?

A

Screen men 65-75 who smoked. Surgery for >5cm.

45
Q

Normal Ankle-Brachial index?

A

greater than or equal to 0.9

46
Q

Cilostazol, mechanism of action and what is it used for?

A

PDE 3 inhibitor, reduces platelet aggregation. Used for intermittent claudication in PVD

47
Q

CHADS2, what does it stand for, what’s the scoring, who needs medicines?

A

CHF, HTN, Age>75, DM2, Stroke/TIA (2 points)

Score 0-1 give aspirin, 2 or more anticoagulate

48
Q

Multifocal Atrial Tachycardia associated with what other disease? Which medicine is contraindicated in MAT?

A

Associated with COPD.

Beta-blockers are contraindicated

49
Q

Management of unstable patient in SVT?

A

Synchronized cardioversion

50
Q

Stable patient in SVT, first step and then second step if refractory?

A

Vagal maneuvers, if that doesn’t work, adenosine IV

51
Q

Best long term management for SVTs?

A

Radiofrequency catheter ablation

52
Q

What are some types of vagal maneuvers?

A

Valsalva, ice immersion of the face, carotid sinus massage,

53
Q

Patient with SVT given Cardizem and suddenly worsens, diagnosis?

A

WPW

54
Q

Most accurate study to diagnose WPW?

A

Electrophysiologic studies

55
Q

Best treatment if patient is in SVT or Vtach from WPW?

A

Procainamide

56
Q

Best long term treatment?

A

Radiofrequency catheter ablation

57
Q

Drugs you can use for vtach if patient stable or in conjunction with cardioversion if patient unstable?

A

Amiodarone, Lidocaine, Procainamide, Magnesium

58
Q

4 most common causes of acute heart failure?

A

Papillary muscle rupture
Infective endocarditis
Chordae tendinae rupture
chest wall trauma with compromise of valvular apparatus

59
Q

Most common cause of severe acute mitral regurgitation?

A

Rupture of chordae tendinae

Medicine (10 decks)

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