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STEP 3 > Cardiology > Flashcards

Cardiology Flashcards

0
Q

Causes of dilated cardiomyopathy

A

Alcohol, adriamycin, radiation, Chagas’ disease

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1
Q

Diagnostic test for dilated cardiomyopathy?

A

Echo
Best initial test

MUGA or Nuclear ventriculography
Most accurate

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2
Q

Treatment for dilated cardiomyopathy?

A

ACE inhibitors, beta blockers, spirinolactone

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3
Q

Diagnostic test for HCM?

A

Echo

Shows normal ejection fraction

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4
Q

Treatment for HCM?

A

Beta blockers and diuretics

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5
Q

What kind of history do patients present with Restrictive Cardiomyopathy?

A

Sardoidosis, amyloidosis, Hemochromatosis, myocardial fibrosis

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6
Q

Diagnostic test for Restrictive cardiomyopathy?

A

Cardiac cath- rapid x and y descent
EKG- low voltage
Echo- mainstay of diagnosis
Biopsy- most accurate

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7
Q

Treatment for Restrictive cardiomyopathy?

A

Diuretics

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8
Q

Best initial test for Pericarditis?

A

EKG- ST segment elevation

- PR depression is pathognomonic

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9
Q

What is the treatment for pericarditis?

A

NSAID-best initial therapy

Oral prednisone- for persistent pain

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10
Q

What is pulsus paradoxus?

A

decrease of blood pressure greater than 10 mmHg upon inhalation

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11
Q

diagnostic test for pericardial tamponade?

A

Echo- most accurate test
- shows diastolic collapse of RA and RV
EKG- low voltage, electric alternans

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12
Q

Treatment for Pericardial tamponade?

A

Pericardiocentesis- best initial

Pericardial window- most effective

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13
Q

Unique features of Constrictive Cardiomyopathy?

A

Kussmaul’s sign- increase JVD on inhalation

Pericardial Knock- extra diastolic sound from heart hitting calcified pericardium

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14
Q

Diagnostic test for Constrictive cardiomyopathy?

A

CXR- shows calcification
EKG- low voltage
CT and MRI- thickening of pericardium

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15
Q

Treatment for constrictive cardiomyopathy?

A

diuretic- best initial

removal of pericardium- most effective

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16
Q

Best initial test for Dissecting thoracic aorta?

A

CXR- widened mediastinum

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17
Q

Most accurate test for Dissecting thoracic aorta?

A

CT angio

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18
Q

Treatment for Dissecting thoracic aorta?

A

1st order beta blocker with EKG and CXR
2nd order nitroprusside to control BP.
3rd ICU, surgery consult, and surgical correction

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19
Q

Screening tool for AAA?

A

US men over 65 who are smokers

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20
Q

Most accurate test for PAD?

A

Angiography

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21
Q

Best initial test for Peripheral Arterial disease?

A

ABI- normal greater than 0.9; if there is >10% difference, there is obstruction

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22
Q

Best initial therapy for PAD?

A

Aspirin, ACEi(BP control), Cilostazol, Lipid control

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23
Q

Patients having negative EKG for Afib should get?

A

Telemetry- inpatients

Holter monitor- outpatients

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24
Q

Other tests to order after Afib is diagnosed?

A

Echo- look for clots, valve function, L atrial size
Thyroid function- T4 and TSH levels
Electrolytes- K, Mg, Ca

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25
Q

Treatment for Afib in UNstable patient?

A

Unstable patient- SYNchonized cardioversion

Unstable- Systolic <90, CHF, confusion, chest pain

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26
Q

Treatment for Afib in Stable patient?

A

Control Ventricular rate to <120(Beta blocker, CCB, Digoxin)

Once rate is controlled- anticoagulate with warfarin for target INR 2-3

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27
Q

What is CHADS2 score?

A

Scoring system indicating need for warfarin or aspirin
C- CHF
H- HTN
A- Age (>75)
D- Diabetes
S- Stroke/TIA (2 points if this is present)

  • Score ≥ 2 –> warfarin
  • Score 0 or 1 –> aspirin
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28
Q

Best diagnostic test for SVT?

A

Holter or telemetry

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29
Q

Best initial management for UNstable patient with SVT?

A

SYNchronized cardioversion

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30
Q

Best initial management for stable patient with SVT?

A

Vagal maneuver

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31
Q

If vagal maneuvers do not work for a patient with SVT, what to try next?
HIGH YIELD

A

IV adenosine

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32
Q

Best long term management for SVT?

A

Radiofrequency ablation

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33
Q

What is Wolf Parkinson White syndrome?

A

abnormal neuralized cardiac tissue around the AV node, conduction through this tissue is increased

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34
Q

What is diagnostic finding with WPW syndrome?

A

delta wave on EKG

most accurate test- EP study

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35
Q

Best initial therapy for WPW?

A

Procainamide

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36
Q

Best long term therapy for WPW?

A

Radiofrequency ablation

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37
Q

How does VT present?

A

Palpitations, syncope, chest pain, sudden death

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38
Q

Treatment for stable Vtach?

A

amiodarone, lidocaine, procainamide, Mg

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39
Q

Treatment for UNstable Vtach?

A

SYNchronized cardioversion

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40
Q

How does VFib present?

A

DEATH

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41
Q

Treatment for VFib?

A

UNsynchronized cardioversion

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42
Q

Treatment for Torsades de pointes?

A

Mg

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43
Q

What to order after syncope?

A

EKG, Chemistries(glucose), oximeter, CBC, cardiac enzymes, cardiac and neuro exam

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44
Q

On further management if diagnosis of syncope is unclear , what do you order?

A

Holter, telemetry, repeat CK-MB, Urine-tox

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45
Q

Most important thing to do in syncope is…?

A

exclude cardiac etiology, such as arrythmia

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46
Q

What is the single worst/most dangerous risk factor for CAD?

A

diabetes

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47
Q

What is the best initial diagnostic test for ischemic type chest pain?

A

EKG

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48
Q

What is the difference between troponin and CK-MB?

A

CK-MB stays elevated for 1-2 days while troponin stays elevated for 1-2 weeks. CK-MB best test for re-infarction a few days after initial infarction

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49
Q

Which cardiac enzyme will rise first during and ischemic event?

A

Myoglobin rises 1-4 hours after injury

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50
Q

When is dipyridamole or adenosine thallium stress test or dobutamine echo the answer for stress test?

A

When patients cannot exercise to a target heart rate of >85% of maximum:
COPD, Amputation, deconditioning, weakness/previous stroke, demetia, obesity

51
Q

When is exercise thallium testing or stress echo the answer for stress test?

A

EKG is unreadable for ischemia:

LBBB, digoxin use, pacemaker in place, LVH

52
Q

What is the next step after an abnormal stress test showing reversible ischemia?

A

angiography

53
Q

What is the best cardiac test to evaluate valve function?

A

echo

54
Q

What is the most accurate method to evaluate ejection fraction?

A

nuclear ventriculogram

55
Q

What is the best initial therapy for ACS?

A

aspirin

56
Q

What is the effect of aspirin for ACS?

A

inhibits platelets

57
Q

Which treatments for ACS always lowers mortality?

A 
STAMP-C
Statins
Thrombolytics
Aspirin (best initial therapy)
Metoprolol
Primary angioplasty
Clopidogrel
58
Q

What is the treatment for ACS?

A 
MONA
Morphine
Oxygen
Nitrates
Aspirin
59
Q

Primary angioplasty (PCI) is beneficial in patients with ACS when it is preformed in what time frame?

A

<90 minutes from arrival to ED

60
Q

What has the single greatest efficacy in lowering mortality for STEMI?

A

Urgent angioplasty (PCI)

61
Q

If patient can not receive PCI for ACS within 90 minutes of the arrival to the ED, what should they receive?

A

Thrombolytics

62
Q

When is thrombolytics indicated during ACS?

A

Patient must have chest pain for less than 12 hours and ST elevation in 2 or more leads.
A new LBBB is also an indication

63
Q

If there is systolic dysfunction or left ventricular dysfunction, what will lower mortality?

A

ACEi or ARBs

64
Q

What is the test and treatment for MI complication of cardiogenic shock?

A

echo, swan-ganz; ACEi and revasularization

65
Q

What is the test and treatment for MI complication of valve rupture?

A

echo; ACEi, nitroprusside, balloon pump bridging to surgery

66
Q

What is the test and treatment for MI complication of septal rupture?

A

echo; ACEi, nitroprusside, urgent surgery

67
Q

What is the test and treatment for MI complication of myocardial wall rupture?

A

echo; pericardiocentesis, cardiac repair

68
Q

What is the test and treatment for MI complication of sinus bradycardia?

A

echo; atropine

69
Q

What should patients be discharged with post-MI?

A

aspirin, clopidogrel, beta-blocker, statin, ACEi

70
Q

What are the differences in management of non-ST segment elevation?

A

no thrombolytic use, heparin used routinely(lowers mortality), glycoprotein IIb/IIIa inhibitors also lower mortality

71
Q

What are the two main medications that reduce mortality for chronic angina?

A

aspirin & metoprolol

72
Q

What test needs to be done before undergoing CABG?

A

coronary angiography

73
Q

What are the indications for CABG?

A

3 vessels with >70% stenosis
Left main stenosis >50%
2 vessels in a diabetic
2-3 vessels with low ejection fraction

74
Q

What is the indication for lipid lowering therapy for a patient with ACS?

A

LDL > 100

75
Q

What is the LDL goal in a patient who has diabetes and ACS?

A

LDL < 70

76
Q

What is the most common adverse effect of statin medications?

A

Liver toxicity

77
Q

What is the mainstay therapy for acute pulmonary edema?

A

O2, furosemide, nitrates, morphine

78
Q

What tests should be ordered when a CHF patient presents?

A

CXR, EKG, oximeter, echo.

- order these with the treatments(O2, furosemide, nitrates, morphine)

79
Q

What are the drugs that decrease mortality in CHF patients with systolic dysfunction?

A

ACEi, metoprolol/carvedilol, spirinolactone

80
Q

In patients who have CHF, who are candidates for implantable cardioverter/defibrillators?

A

Patients with dilated cardiomyopathy with an EF < 35%

- Most common cause of death with patient with CHF is sudden death from arrhythmia

81
Q

What are the systolic murmurs?

A

AS, MR, MVP, HCOM

82
Q

What are the diastolic murmurs?

A

AR, MS

83
Q

All right sided heart lesions and AS, AR, MS, MR become louder with squatting and leg raising

A

All right sided heart lesions and AS, AR, MS, MR become louder with squatting and leg raising

84
Q

What two lesions will their murmurs become softer with squatting and leg raising?

A

MVP, HCOM

- increased murmur with stand or valsalva

85
Q

What lesions will their murmurs become louder with increased hand grip (increased afterload)?

A

AR, MR, VSD

87
Q

What lesions will their murmurs become softer with increased hand grip (increased afterload)?

A

AS, HCOM, MVP

88
Q

Where is aortic stenosis heard the best?

A

2nd right intercostal space, radiates to carotids

89
Q

Where is aortic regurg, tricuspid murmur, and VSD heard the best?

A

Left lower sternal border

90
Q

Where is mitral regur murmur heard the best?

A

Apex and radiates to axilla

91
Q

What is the best initial test for valve lesions?

A

echo

92
Q

What is the most accurate test for valve lesions?

A

Left heart catheterization

93
Q

In general if handgrip makes the murmur worse, what therapy should the patient be on?

A

ACEi, ARB

afterload reduction

94
Q

How does aortic stenosis present?

A

chest pain, older patient, HTN

95
Q

What kind of murmur is in AS?

A

cresendo-decresendo systolic

heard best at 2nd right intercostal space

96
Q

What is the best inital test for AS?

A

TTE

97
Q

What is more accurate test for AS?

A

TEE

98
Q

What is the most accurate test for AS?

A

left heart catheterization

99
Q

What else should be ordered with a patient with AS?

A

EKG, CXR(LV hypertrophy)

100
Q

What is the best initial therapy for AS?

A

diuretics

101
Q

What is the treatment of choice for AS?

A

valve replacement

  • Pig valves last ~10 years, no anticoagulation
  • mechanical valves last >10 years, must be anticoagulated (INR 2-3)
102
Q

How does AR present?

A

SOB, fatigue

103
Q

What is the murmur with AR?

A

diastolic decresendo heard at L sternal border

104
Q

What is the best inital test for AR?

A

TTE

105
Q

What is more accurate test for AR?

A

TEE

106
Q

What is the most accurate test for AR?

A

L heart cath

107
Q

What is the best initial therapy for AR?

A

ACEi, ARB, nifedipine

Add furosemide for CCS case

108
Q

When is surgery for AR the correct answer?

A

When EF < 55%

LV diameter > 55mm

109
Q

How does MS present?

A

Immigrant patient with rheumatic fever, also look for preggers patient
dysphagia
hoarseness
Afib

110
Q

What is the murmur for MS?

A

diastolic rumble after opening snap

111
Q

What is the best initial test for MS?
What is the more accurate test for MS?
What is the most acurate test for MS?

A

TTE
TEE
L heart cath

112
Q

What is the best initial therapy for MS?

A

Diuretics

113
Q

What is the most effective therapy for MS?

A

balloon valvuloplasty

114
Q

How does MR present?

A

dyspnea on exertion with history of HTN, ischemic heart disease

115
Q

What is the murmur for MR?

A

holosystolic heard best at the apex and radiating to axilla

116
Q

What is the best initial test for MR?

A

TTE

117
Q

What is the more accurate test for MR?

A

TEE

118
Q

What is the best initial treatment for MR?

A

ACEi, ARB, nifedipine

119
Q

When is surgery the answer for MR?

A

When EF < 60%

LV diameter > 40mm

120
Q

What is the murmur for VSD?

A

holosystolic heard at L sternal border

121
Q

What is the first diagnostic test for VSD?

A

echo

122
Q

How can ASD present?

A

SOB

123
Q

What type of splitting will appear in ASD?

A

fixed splitting of S2

124
Q

How to diagnose ASD?

A

echo

125
Q

What is the best therapy for ASD?

A

percutaneous or catheter devices

STEP 3 (8 decks)

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