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Flashcardlet > cardiology > Flashcards

cardiology Flashcards

1
Q

The best confirmatory test for AMI

A

Cardiac troponins

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2
Q

The most important lipid risk factor for CAD

A

Elevated LDL

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3
Q

What is the recommended energy in joules for an initial attempt at synchronized cardioversion?

A

100-200 joules for monophasic waveforms

100 joules for biphasic waveforms

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4
Q

An elevated pulses paradoxus ~14mmHg is indicative of possible

A

Cardiac tamponade

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5
Q

Options to slow AV conduction in narrow complex tachycardia

A

1) IV adenosine
2) IV B-blocker. ) 3)IV diltiazem
4) vagaries maneuvers

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6
Q

The ALLHAT study recommends the best one drug to start for hypertension is?

A

Thiazides diuretic specifically chlorthalidone

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7
Q

Sinus node disease is caused by?

A

Right or circumflex coronary artery disease
Intrinsic aging
Hypothyroidism
Superimposed drug effect

Treat symptomatic with pacemaker

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8
Q

Sinus node disease is most common in what age group?

How does it present?

A 
Episodic sinus arrest
Tachy-Brady syndrome 
Persistent sinus bradycardia 
Persistent sinus tachycardia 
Occurs in persons >60yo
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9
Q

A hypertrophied ventricle with preserved ejection fraction is associated with?

A

Diastolic dysfunction

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10
Q

Cirrhosis is usually associated with a decrease in serum

A

Cholesterol

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11
Q

Treatment of Rhabdomyolysis

A

Rapid large infusions of isotonic saline to prevent and treat acute kidney injury

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12
Q

Dysrhythmia almost always represents disease of the AV node, sometimes seen in athletes caused by

A

Inferior wall ischemia

The inferior wall is supplied by the RCA which also supplies the AV NODE

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13
Q

USPSTF recommends targeted screening in adults 20-45 if

A

Family history of cardiac disease or high cholesterol
Smoking
Diabetes

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14
Q

Elevated triglyceride level is most commonly associated with

A

Diabetics with poor glycemic control. Triglycerides are >250

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15
Q

When the standard treatment with diuretics, b blockers, and ACE-I is insufficient to control symptoms; this medication combo isparticularly effective in African Americans with NYHA class IIIor IV

A

Hydralazine plus isosorbide dinitrate

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16
Q

The basic physiologic mechanism in patients with angina pectoris due to myocardial ischemia

A

An imbalance between oxygen supply and demand due to narrowing of the coronary arteries

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17
Q

Prior to discharge after MI standard of care is to test with?

A

Sub maximal stress test, if positive refer for catheteratization
If borderline refer for radionuclide study

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18
Q

For pulmonale is the term used for

A

Right heart failure caused by diseases primarily affecting the lungs and pulmonary vasculature

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19
Q

What is the keystone of effective heart failure treatment regimen?

A

Sodium and fluid restrictions

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20
Q

The JNC 8 panel recommends a blood pressure goal for persons younger than 60yo with no co morbidities?

A

In the general population younger than 60 years, pharmacologic treatment should be initiated when the systolic pressure is 140 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. The target systolic pressure in this population is less than 140 mm Hg, and the target diastolic pressure is less than 90 mm Hg.

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21
Q

Which valves are most commonly affected by endocarditis?

A

Aortic and mitral

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22
Q

For anticoagulation in AMI, what is the dose of enoxaparin (lovenox) ?

A

Enoxaparin 1mg/kg SQ EVERY 12 hours

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23
Q

Which drug class would you use first line in patient with symptomatic BPH

A

Alpha blocker; doxazosin

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24
Q

Post MI Survival is improved by which meds

A

Ace inhibitors
B blockers
Statins
ASA

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25
Q

2007 ACC/AHA GUIDELINES recommends that patients experiencing

  • recurrent angina or ischemia at rest or low level activity despite intensive medical treatment
  • elevated cardiac bio markers (TnT or Tnl)
  • new or presumably new ST segment depression
  • signs or symptoms of HF or new or worsening mitral regurgitation
  • high risk findings from noninvasive testing
A

Percutaneous coronary intervention

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26
Q

Drug of choice for treatment of isolated hypertriglyceridemia

A

Gemfibrozil

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27
Q

Decreased HDL is always associated with increased

A

Triglycerides as a risk factor for CAD

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28
Q

Risk factors for coronary artery disease?

A

Smoking, elevated LDL, HDL45, female>55, first degree female relative CAD

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29
Q

Following MI what test should be performed

A

Submaximal stress ECG test and echocardiogram

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30
Q

The JNC 8 panel recommends a goal blood pressure for 60 year old patients and older of?

A

150/90

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31
Q

Regional wall motion abnormality indicates

A

Ischemic heart disease

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32
Q

STEMI is distinguished from UA/NSTEMI by the presence of

A

ST- segment elevation on EKG followed by Q wave

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33
Q

Patients with wolf parkinson white WPW Syndrome decompensate with BB and CCB. WHAT Is drug of choice?
Clues for WPW include young age, history of tachycardia, palpitations or syncope

A

Procainamide

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34
Q

Antihypertensive drugs that can cause prolonged hypotension when used with sildenafil?

A

Peripheral alpha blockers i.e.; doxasosin,tamsulosin, prazosin

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35
Q

Upright wide QRS on EKG

A

LBBB

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36
Q

Patient h/o COPD ON THEOPHYLLINE presents with rapid regular pulse

DX?

A

Multifocal atrial tachycardia

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37
Q

First study to confirm peripheral vascular disease

A

ABI

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38
Q

Where is pain most common in patients with AAA RUPTURE

A

Abdomen, legs, flank, buttocks, groin/ testicles

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39
Q

Pain often made worse by walking downhill and better when walking uphill or leaning foward ( a kyphotic position opens up foramen) is indicative of?

A

Spinal stenosis

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40
Q

Complication of ticloplidine

A

Thrombocytopenia

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41
Q

Systolic dysfunction results ejection fraction

A
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42
Q

USPSTF RECOMMENDATION FOR AAA SCREENING

A

One Time Screening by ultrasound in men ages 65-75 who have ever smoked

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43
Q

If INR >20 most appropriate action

A

Rapid reversal withFFP and vit K

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44
Q

Name drug and dose appropriate for treatment asystole

A

Epinephrine 1 mg

45
Q

If INR is 5 or less most appropriate action

A

Hold next dose

46
Q

Biomarker of choice in the evaluation of acute coronary syndrome

A

Troponin can be detected 3-6 hours after onset of ischemic symptoms

47
Q

An enlarged aorta on physical exam should be further assessed by

A

Abdominal ultrasound study

48
Q

Type of heart failure associated with long standing uncontrolled hypertension and stiff ventricle that poorly relaxes to allow good filling during diastole

A

Diastolic dysfunction

49
Q

Mobitz type I Second degree AV block (Wenckebach)

A

PR interval progressively lengthens until a P wave fails to conduct and a beat is dropped

50
Q

If INR 15-20

A

Administer 5-10 mg of VIT K po

51
Q

Although benefits of thrombolytic therapy are greatest within the first 1-3 hours, a 10% mortality benefit can be after the onset of pain

A

12 hours

52
Q

For patients with AMI, IF 1) complete heart block develops, 2) 2nd degree lock or new LBBB with 1st degree AV block develops or symptomatic bradycardia unresponsive to atropine the proper response is to?

A

Insert a temporary pacemaker regardless of heart rate

53
Q

For patients 18years and older with diabetes or chronic kidney disease the JNC8 recommends a blood pressure of?

A

• In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age.

54
Q

Thrombolytic therapy and interventional angioplasty are the cornerstone for treatment of acute ST segment elevated MI. Effective therapy limits

A

Myocardial necrosis, preserves left ventricular function, reduces mortality

55
Q

What is the earliest marker of MI

A

CK-M; myoglobin can be detected as early as 2 hours after cardiac necrosis

Sensitive but not specific
Better for diagnosing reinfarction

56
Q

3 Beta blockers to use in CHF

A

Metoprolol

Carvedilol

Bisoprolol

57
Q

EKG findings consistent with LVH Should be confirmed with what test?

A

Echocardiogram

58
Q

The distinction between unstable angina and chronic stable angina is made on the basis of

A

History and progression of ST wave changes

59
Q

The right ventricle is dependent on filling pressure “preload”, nitroglycerin decreases preload thus hypotension after dose NTG may be indicative of?

A

Right ventricular infarction, which is commonly associated with inferior wall MI

60
Q

Acute treatment of V-tachycardia

A

Lidocaine

Amiodarone

61
Q

Right ventricular hypertrophy with paradoxical bulging of the ventricular septum into the left ventricle , right axis deviation on EKG with RBBB is a typical picture of

A

Cor pulmonale

62
Q

Sympathomimetic meds like phenylepherine and pseudoephedrine can be problematic because they

A

Increase heart rate

Increase blood pressure

Worsen existing urinary obstruction

63
Q

Causes of ventricular tachycardia

A

AV dissociation
Electrolyte disturbance
Fusion beats

64
Q

Statins can be continued unless liver enzymes elevate how much?

A

3xs upper limit of normal

65
Q

As a class CCB tend to cause

A

Peripheral edema

66
Q

Cilostazol (pleats) and pentoxiphyline (T rental) phosphodiesterase inhibitors are contraindicated in patients with?

A

CHF

67
Q

Stress testing is best suited for which group of individuals?

A

Men with an intermediate probability of cardiac disease

68
Q

4 statin benefit groups

A

Individuals with clinical ASCVD
Primary elevations of LDL-C >190mg/dL

40-75yo diabetics and LDL 70–189

Without ASCVD or diabetes, age 40-75, LDL-C 70-189 and estimated 10 year ASCVD risk of 7.5% or higher

69
Q

Patient with chronic atrial fibrillation taking dabigatran can no longer afford it what is most appropriate switch to Coumadin?

A

Start Coumadin now and stop dabigatran in 3 days

70
Q

If a patient is not a candidate for cardioversion because >48 hours a fib, wait how long after anticoagulation to cardiovert the patient

A

Wait until the patient anti coagulated X 3 weeks with target INR 2-3

71
Q

What is the most sensitive test for renal artery stenosis?

A

MR angiography

72
Q

Early reocclusion secondary to thrombosis is more common with

A

Drug eluting stents, prescribe for 1 year with dug eluting stent
3 months for bare metal stent

73
Q

All post MI patients should be discharged with the following meds

A

Asa, lipid lowering agent, BB, ACEI , NTG prn

74
Q

AHA allows how much total cholesterol in daily intake

A

300 mg

75
Q

In atrial fibrillation with rapid ventricular rate in a stable patient what should you focus your initial treatment

A

Rate control

Treat with beta blockers

76
Q

Medication preferred for CHF due to LV systolic dysfunction because they offer greatest reduction in mortality

A

ACE- inhibitors

77
Q

Irregularly irregular narrow complex rhythm with atrial rate >300

A

Atrial fibrillation

78
Q

Atrial fibrillation CHADS2 parameters assesses stroke risk to indicate anticoagulation

A

CHF, HTN, age >75, DM, STROKE IN PAST OR TIA

79
Q

The national cholesterol education program adult treatment panel III ( NCEP-ATP III) guidelines define high cholesterol as
Total cholesterol TC?
LDL.

A

TC 200

LDL 130

80
Q

At what size in centimeters do you refer patient with AAA to vascular surgeon for surgical intervention 🤔

A

5-5.5cm

81
Q

For STEMI, the recommended FIRST AND ONLY FIRST DOSE OF ENOXAPARIN sq dose for persons

A

30mg IV enoxaparin should be given WITH the first sq dose

82
Q

If a patient is on theophylline the least desirable method of chemical stressing would be?

A

Adenosine

Dipyridamole

83
Q

MC Cause secondary hypertension further supported by presence of unprovoked hypokalemia although in majority of cases potassium is normal

A

Hyperaldosteronism

Aldosterone increases secretion of potassium which leads to hypokalemia

84
Q

BNP is secreted from the ventricles in response to ventricular volume expansion and pressure overload

Release is directly proportional to ventricular dysfunction and correlates with end diastolic pressure

BNP >400 confers

A

95% likelihood CHF

85
Q

Indications for CABG?

A

3vessel disease, left main CAD

86
Q

Aortic dissection management

A

Start with beta blockers

Goal is to LOWER BLOOD PRESSURE

87
Q

Anytime there is negative force in lead II there is neg force presence in III and aVF patient will have

A

Left anterior fascicular block LAFB

88
Q

The most common etiology for heart failure associated with of systolic dysfunction?

A

Ischemic heart disease. Get an angiogram

89
Q

Best screening test for suspected PVD

A

ABI

90
Q

The only adjunctive agent that has been shown unequivocally to reduce mortality alone or in conjunction with thrombolytic agents in patients with AMI

A

ASA

91
Q

In atrial fibrillation the most effective long term therapy for rate control at both rest and exercise?

A

Beta blockers

Digitalis more effective rate control at rest May not control rate with exercise

92
Q

What is the most common cause hyperaldosteronism?

A

Adrenal adenoma

93
Q

Reproducible ischemic muscle pain that occurs with exercise relieved by rest? 🤔

A

Claudication

94
Q

The drug of choice for mild to moderate LDL Elevation

A

HMG-CoA reductase inhibitors ie; lovastatin, pravastatin, simvastatin rosuvastatin

95
Q

Heparin has not not been found to outweigh the harms in patients receiving streptokinase, except in cases of patient

A

Anterior wall MI

Patients with complications prone thromboembolism such as atrial fibrillation or congestive heart failure

96
Q

Cause of diastolic dysfunction

A

Increased ventricular stiffness and decreased ventricular compliance

97
Q

What is the procedure of choice to diagnose congestive heart failure?

A

Echocardiogram

98
Q

What Is the loading dose of clopidigrel

A

600mg

99
Q

Am ABI > 1.4 indicates?

A

Calcified non compressible arteries

100
Q

Contraindications beta blockers in heart failure

A

Hemodynamics instability

Heart block

Bradycardia

Severe asthma

101
Q

The anterior wall is supplied by the

A

Left coronary artery which supplied the His-purkinje system

102
Q

Most common cause acute Coronary syndrome

A

Occlusive thrombus developing on top of a disrupted atherosclerotic plaque

103
Q

Treatment cocaine induced acute Coronary syndrome

A

NTG and CCB

104
Q

Glycoprotein IIb/IIIa receptor blockers

A

Inhibit platelet aggregation

Abciximab
Eptifibatide
Tirofiban

105
Q

Sinus bradycardia, 1 st degree AVB are commonly associated with other Derek’s of physical conditioning

Meds not contraindicated

A

Ate bblockers nor non dihydropyridines CCBs

106
Q

According to NCEP LDL is elevated when it is higher than

A

130

107
Q

Cardiogenic shock is associated with severe left ventricular dysfunction and occurs with large infarcts that produce damage to more than 40% of left ventricle treatment of choice

A

Intra aortic balloon pump placement to increase coronary flow and to decrease afterload; coronary reperfusion with Percutaneous transiluminal balloon angioplasty ( the mainstay of treatment

108
Q

The treatment of choice for hypercholesterolemia

A

Diet therapy

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