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Step 2 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

CK-MB timeline

A

present: 4-6hrs
peak: 12-24hrs
gone: 3-4 days
predict re-infarction

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2
Q

CK-MB 1 vs 2

A

CK-MB 1: plasma

CK-MB 2: myocardial tissue (more specific)

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3
Q

causes for elevated troponin

A

myocardial injury
renal disease
polymyositis/dermatomyositis

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4
Q

aortic dissection, next test

A

CXR

confirmed by: TEE > CTA > MRA

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5
Q

PE signs on EKG

A

S1 Q3 T3
lead 1 shows S wave
lead 3 shows Q wave
lead 3 shows inverted T wave

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6
Q

confirm diagnosis PE

A

spiral CT
lung scan
pulmonary angiogram

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7
Q

symptoms of pericarditis

A

sharp, positional, pleuritic
relieved by leaning forward
pericardial rub

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8
Q

EKG signs pericarditis

A

diffuse ST elevation
NO elevation Q waves and CK levels normal
responds to NSAIDS

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9
Q

Posterior: leads and artery involved

A 
V1, V2: tall broad initial R wave
ST depression
Tall upright T wave 
usually occurs in a/w inferior or lateral MI 
artery: Posterior Descending
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10
Q

anteroseptal infarction: leads and artery involved

A

V1, V2, V3

LAD

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11
Q

anterior infarction: leads and artery involved

A

V2, V3, V4

LAD

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12
Q

lateral infarction: leads and artery involved

A

I, aVL, V4, V5, V6

LAD or circumflex

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13
Q

STEMI EKG

T wave inversion: onset, disappearance

A

onset: 6-24hrs
disappearance: months to years

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14
Q

criteria for a positive stress test

A

> 2mm ST depression OR

>10mmHg decrease in systolic BP

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15
Q

STEMI EKG

Q waves longer than 0.04sec: onset, disappearance

A

onset: one to several days
disappearance: years to never

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16
Q

criteria for a positive stress test

A

> 2mm ST depression OR

>10mmHg decrease in systolic BP

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17
Q

indications for CABG

A
  • L main coronary dx
  • 3 vessel dx and LV dysfunction
  • 2 vessel dx with DM
  • symptoms despite medical therapy or SE from therapy
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18
Q

indications for PCI

A

-1 or 2 vessel disease

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19
Q

what interventions lower mortality?

A 
ASA 
BB
Clopidogrel 
TPA
Statins if LDL >100 
angioplasty
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20
Q

treatment for third degree HB

A 
symptomatic = atropine
asymptomatic = pacemaker
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21
Q

treatment for first degree HB

A

nada

1st deg HB = PR > 0.12-0.20

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22
Q

treatment for V-tach

A 
stable = amniodarone, lidocaine 
unstable = shock
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23
Q

treatment for V-fib

A

shock always

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24
Q

Mitral Stenosis: who, long-term effects

A 
MC 2/2 Rheumatic Fever (immigrants) 
Rarely genetic 
2/3 Female (pregnant) 
Large LA --> A-fib --> strokes 
Large LA --> hoarseness, dysphagia
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25
Q

describe mitral stenosis murmur

A

opening snap following S2

diastolic rumble

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26
Q

MR diagnosis: EKG, CXR, ECHO

A

EKG: LVH, LAE
CXR: Cardiac enlargement, vascular congestion
ECHO: LA and/or LV dilation

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27
Q

MR treatment medical/surgical

A

Medical: vasodilator, digitalis, diuretic, anticoag
Surgical: replace valve is still symptomatic with medical therapy

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28
Q

MVP: who gets it

A

MC congenital valvular lesion

MC females, connective tissue disease

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29
Q

MVP murmur:
describe?
heard best?
Worse/better?

A

mid-to-late systolic click, late systolic murmur, heard best at apex
worse w/ valsalva (decreased preload, less blood more murmur)
better with squatting (increased afterload, more blood less murmur)

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30
Q

MVP: complications

A

serious arrhythmia and sudden death

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31
Q

SVT arrhythmias

A

Adenosine
BB
CCB: diltazem, verapamil
Digitalis

32
Q

Multifocal Atrial Tachycardia: describe EKG findings

A

P wave morphology and PR interval varies from beat to beat (at least 3 to be diagnostic)
irregular supraventricular rhythm 100-200 bpm
each QRS is preceded by a p-wave

33
Q

Multifocal Atrial Tachycardia: treatment

A

digoxin

CCB

34
Q

Multifocal Atrial Tachycardia: cause?

A

COPD

elderly with respiratory failure

35
Q

atrial flutter: formation

A

p-waves always look the same

multiple P waves before QRS

36
Q

atrial flutter: treatment

A

BB
CCB: diltazem, verapamil
Digitalis

37
Q

when do you use adenosine

A

ONLY with SVT

38
Q

A fib: treatment

A
  • anti-coagulate! INR 2-3
  • symptomatic/unstable (rhythm control)= shock
  • asymptomatic/stable (rate control)= BB, CCB (verapamil, diltiazem), digoxin, pulse
39
Q

WPW: treatment

A

acute:

  • unstable: shock
  • stable: procainamide
    chronic:
  • ablation
40
Q

V-tach: definition

A
  • 3+ consecutive ventricular beats at >120bpm

- wide, bizarre QRS complexes

41
Q

V-tach: etiology

A
  • ischemia, post-MI
  • cardiomyopathies
  • metabolic (hyperkalemia)
42
Q

CHA2DS2-VASc Score

A 
CHF                        +1
HTN 140/90           +1
Age 75+                 +2
DM                          +1
Stroke/TIA/thromboembolism                   +2
Vascular disease: MI, PAD, aortic plaque +1
Age 65-74              +1 
Sex: female            +1

coagulation if
>1 males
>2 females

43
Q

Secondary causes of HTN

A
  • Renal parenchymal disease
  • Renovascular disease
  • Primary aldosteronism
  • Pheochromocytoma
  • Cushing’s syndrome
  • Hypothyroid
  • Primary hyperparathyroidism
  • Coarctation of the aorta
44
Q

Initial workup for HTN

A
  • UA
  • Chemistry panel
  • Lipid panel
  • Baseline EKG
45
Q

Request further workup for HTN if

A
  • Severe or malignant HTN
  • Need 3+ drugs
  • sudden rise in BP
  • started before 30yo w/o h/o HTN
46
Q

PVC: cause, definition, treatment

A

cause: normal people, MC following MI
definition: wide QRS (>120msec), bizarre morphology, compensatory pause
symptomatic Rx: BB
asymptomatic Rx: observation, treatment with arrhythmic may worsen survival

47
Q

indications for urgent dialysis

A

AEIOU
A = metabolic acidosis 6.5, EKG abn
I = ingestion: methanol, ethylene glycol, salicylate, lithium, sodium valproate, carbamazepine
O = volume overload s/p diuretics
U = uremia, symptomatic: encephalopathy, pericarditis, bleeding

48
Q

Thiazide S/E

A 
HyperGLUC
Glycemia
Lipidemia 
Uric Acid 
Calcium

electrolyte abn = low Na, low K, high Ca

49
Q

hypertrophic cardiomyopathy: EKG findings

A

aVL: tall R
V3: deep S
inverted T/repolarization changes in: I, aVL, V4-V6

50
Q

hypertrophic cardiomyopathy: murmur

A
  • Harsh crescendo-decrescendo systolic murmur heard best at the apex and lower left sternal border
  • increases with less preload: valsalva, standing
  • louder with more preload: passive leg raise
  • louder with more afterload: handgrip, squatting
51
Q

hypertrophic cardiomyopathy: mutation, cause of outflow obstruction

A

cardiac myosin binding C gene
cardiac beta-myosin heavy chain gene

hypertrophied interventricular septum
abnormal motion of mitral valve leaflets = systolic anterior motion (SAM)

52
Q

when do you do carotid endarterecomy (CEA)?

A

Men

asym: 60+%
sym: 70+% (face-neuro symp w/i 6mo)

Women
both asym/sym: 70+% stenosis

53
Q

PAC: treatment

A

asym: stop tobacco and alcohol
sym: Beta blocker

54
Q

pulsus paradoxus: definition, when do you see it

A

Cardiac Tamponade
COPD
Asthma

drop in systolic BP >10mmHg during inspiration.

Cardiac tamponade –> increased pressure in pericardium –> RV and LV compete for space –> on inspiration RV fills and shifts LV over making it smaller –> less SV –> decreased BP on inspiration of >10

55
Q

Beck’s triad

A

hypotension
distended neck veins
muffled heart sounds

cardiac tamponade

56
Q

RF for CAD

  • worst?
  • MC?
  • correcting which RF has the most immediate benefit?
A
  • DM (worst RF)
  • smoking (most immediate benefit for stopping)
  • HTN (MC RF)
  • HLD: LDL is the most dangerous
  • FH premature CAD: M45, F>55
57
Q

what S/S exclude cardiac ischema as a D/D?

A

positional
pleuritic
tender

58
Q

When do you do a ETT?

A

chest pain, unknown etiology

EKG not diagnostic

59
Q

ETT, pt can’t exercise?

A
  • Dipyradamole/adenosine + Thalium/sestambi
  • Dobutamine + ECHO

specificity/sensitivity equal for
dipyradamole thallium = dobutamine echo

60
Q

ETT, pt has EKG baseline abn

A

Exercise with…

  • Nuclear isotope: thallium or sestambi
  • ECHO

specificity/sensitivity equal for
Exercise thallium = exercise ECHO

61
Q

when can you NOT use dipyradamole for ETT?

A

can’t use with asthma

62
Q

Treatment for lower mortality for chronic angina

A

ASA
BB (B1 specific)
Nitroglycerin

63
Q

Nitroglycerin treatments for acute vs. chronic angina

A

Chronic: oral, transdermal
Acute: sublingual, paste, IV

64
Q

Antiplatelet therapy for ACS patient

A

1) ASA
2) P2Y12 receptor: clopidogrel, prasugrel, ticagrelor

-NOTE: when angioplasty and stenting are planned DO NOT USE Clopidogrel

65
Q

When to use Clopidogrel

A
  • Combo with ASA for ACS
  • ASA intolerence like an allergy
  • Recent angioplasty with stenting
66
Q

Prasugrel: when to use and not use

A

use: antiplatelet med, before angio/stenting

don’t: can cause hemorrhagic stroke in 75yo+

67
Q

Ticlopidine: when to use and not use

A

use: anti-platelet Rx in rare pt where both ASA and clopidogrel not indicated

can’t use if ASA and clopidogrel are not indicated because of bleeding. Ticlopidine will inhibit platelets too

S/E: neutropenia, TTP

68
Q

ACE/ARB:
when to use them
when do you switch to diff class?

A
  • low EF% in systolic dysfunction
  • Regurgitant valvular disease

-switch to hydralazine + nitrates if cough, elevation in K+

69
Q

what’s the MC adverse effect of statin meds?

A 
Liver dysfunction (1% have elevated transaminases) 
must get LFTs at start and during treatment

other S/E: myositis, rhabdomyolysis

70
Q

Niacin: effect and S/E

A

raise HDL

S/E: elevate glucose and UA, pruritus

71
Q

Gemfibrozil: effect and S/E

A

lower TG

S/E: myositis when combined with statin

72
Q

Cholestyramine: effect and S/E

A

binds bile acid

S/E: flatus and abd cramping

73
Q

Ezetimbe: effect and S/E

A

lowers LDL, no evidence of benefit to pt

S/E: well tolerated and nearly useless

74
Q

Use CCB verapamil/diltiazem in CAD only in pts with:

A
  • Severe asthma preventing use of BB
  • Prinzmetal variant angina
  • Cocaine-induced chest pain (can’t use BB)
  • Can’t control pain with max medical therapy

NOTE: verapamil/diltiazem are CCB which do NOT increase HR

75
Q

CCB: adverse effects

A
  • Edema
  • Constipation (MC verapamil)
  • Heart block (rare)

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