cardiology Flashcards
The best confirmatory test for AMI
Cardiac troponins
The most important lipid risk factor for CAD
Elevated LDL
What is the recommended energy in joules for an initial attempt at synchronized cardioversion?
100-200 joules for monophasic waveforms
100 joules for biphasic waveforms
An elevated pulses paradoxus ~14mmHg is indicative of possible
Cardiac tamponade
Options to slow AV conduction in narrow complex tachycardia
1) IV adenosine
2) IV B-blocker. ) 3)IV diltiazem
4) vagaries maneuvers
The ALLHAT study recommends the best one drug to start for hypertension is?
Thiazides diuretic specifically chlorthalidone
Sinus node disease is caused by?
Right or circumflex coronary artery disease
Intrinsic aging
Hypothyroidism
Superimposed drug effect
Treat symptomatic with pacemaker
Sinus node disease is most common in what age group?
How does it present?
Episodic sinus arrest Tachy-Brady syndrome Persistent sinus bradycardia Persistent sinus tachycardia Occurs in persons >60yo
A hypertrophied ventricle with preserved ejection fraction is associated with?
Diastolic dysfunction
Cirrhosis is usually associated with a decrease in serum
Cholesterol
Treatment of Rhabdomyolysis
Rapid large infusions of isotonic saline to prevent and treat acute kidney injury
Dysrhythmia almost always represents disease of the AV node, sometimes seen in athletes caused by
Inferior wall ischemia
The inferior wall is supplied by the RCA which also supplies the AV NODE
USPSTF recommends targeted screening in adults 20-45 if
Family history of cardiac disease or high cholesterol
Smoking
Diabetes
Elevated triglyceride level is most commonly associated with
Diabetics with poor glycemic control. Triglycerides are >250
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
Hydralazine plus isosorbide dinitrate
The basic physiologic mechanism in patients with angina pectoris due to myocardial ischemia
An imbalance between oxygen supply and demand due to narrowing of the coronary arteries
Prior to discharge after MI standard of care is to test with?
Sub maximal stress test, if positive refer for catheteratization
If borderline refer for radionuclide study
For pulmonale is the term used for
Right heart failure caused by diseases primarily affecting the lungs and pulmonary vasculature
What is the keystone of effective heart failure treatment regimen?
Sodium and fluid restrictions
The JNC 8 panel recommends a blood pressure goal for persons younger than 60yo with no co morbidities?
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.
Which valves are most commonly affected by endocarditis?
Aortic and mitral
For anticoagulation in AMI, what is the dose of enoxaparin (lovenox) ?
Enoxaparin 1mg/kg SQ EVERY 12 hours
Which drug class would you use first line in patient with symptomatic BPH
Alpha blocker; doxazosin
Post MI Survival is improved by which meds
Ace inhibitors
B blockers
Statins
ASA
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
Percutaneous coronary intervention
Drug of choice for treatment of isolated hypertriglyceridemia
Gemfibrozil
Decreased HDL is always associated with increased
Triglycerides as a risk factor for CAD
Risk factors for coronary artery disease?
Smoking, elevated LDL, HDL45, female>55, first degree female relative CAD
Following MI what test should be performed
Submaximal stress ECG test and echocardiogram
The JNC 8 panel recommends a goal blood pressure for 60 year old patients and older of?
150/90
Regional wall motion abnormality indicates
Ischemic heart disease
STEMI is distinguished from UA/NSTEMI by the presence of
ST- segment elevation on EKG followed by Q wave
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
Procainamide
Antihypertensive drugs that can cause prolonged hypotension when used with sildenafil?
Peripheral alpha blockers i.e.; doxasosin,tamsulosin, prazosin
Upright wide QRS on EKG
LBBB
Patient h/o COPD ON THEOPHYLLINE presents with rapid regular pulse
DX?
Multifocal atrial tachycardia
First study to confirm peripheral vascular disease
ABI
Where is pain most common in patients with AAA RUPTURE
Abdomen, legs, flank, buttocks, groin/ testicles
Pain often made worse by walking downhill and better when walking uphill or leaning foward ( a kyphotic position opens up foramen) is indicative of?
Spinal stenosis
Complication of ticloplidine
Thrombocytopenia
Systolic dysfunction results ejection fraction
USPSTF RECOMMENDATION FOR AAA SCREENING
One Time Screening by ultrasound in men ages 65-75 who have ever smoked
If INR >20 most appropriate action
Rapid reversal withFFP and vit K
Name drug and dose appropriate for treatment asystole
Epinephrine 1 mg
If INR is 5 or less most appropriate action
Hold next dose
Biomarker of choice in the evaluation of acute coronary syndrome
Troponin can be detected 3-6 hours after onset of ischemic symptoms
An enlarged aorta on physical exam should be further assessed by
Abdominal ultrasound study
Type of heart failure associated with long standing uncontrolled hypertension and stiff ventricle that poorly relaxes to allow good filling during diastole
Diastolic dysfunction
Mobitz type I Second degree AV block (Wenckebach)
PR interval progressively lengthens until a P wave fails to conduct and a beat is dropped
If INR 15-20
Administer 5-10 mg of VIT K po
Although benefits of thrombolytic therapy are greatest within the first 1-3 hours, a 10% mortality benefit can be after the onset of pain
12 hours
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?
Insert a temporary pacemaker regardless of heart rate
For patients 18years and older with diabetes or chronic kidney disease the JNC8 recommends a blood pressure of?
• In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age.
Thrombolytic therapy and interventional angioplasty are the cornerstone for treatment of acute ST segment elevated MI. Effective therapy limits
Myocardial necrosis, preserves left ventricular function, reduces mortality
What is the earliest marker of MI
CK-M; myoglobin can be detected as early as 2 hours after cardiac necrosis
Sensitive but not specific
Better for diagnosing reinfarction
3 Beta blockers to use in CHF
Metoprolol
Carvedilol
Bisoprolol
EKG findings consistent with LVH Should be confirmed with what test?
Echocardiogram
The distinction between unstable angina and chronic stable angina is made on the basis of
History and progression of ST wave changes
The right ventricle is dependent on filling pressure “preload”, nitroglycerin decreases preload thus hypotension after dose NTG may be indicative of?
Right ventricular infarction, which is commonly associated with inferior wall MI
Acute treatment of V-tachycardia
Lidocaine
Amiodarone
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
Cor pulmonale
Sympathomimetic meds like phenylepherine and pseudoephedrine can be problematic because they
Increase heart rate
Increase blood pressure
Worsen existing urinary obstruction
Causes of ventricular tachycardia
AV dissociation
Electrolyte disturbance
Fusion beats
Statins can be continued unless liver enzymes elevate how much?
3xs upper limit of normal
As a class CCB tend to cause
Peripheral edema
Cilostazol (pleats) and pentoxiphyline (T rental) phosphodiesterase inhibitors are contraindicated in patients with?
CHF
Stress testing is best suited for which group of individuals?
Men with an intermediate probability of cardiac disease
4 statin benefit groups
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
Patient with chronic atrial fibrillation taking dabigatran can no longer afford it what is most appropriate switch to Coumadin?
Start Coumadin now and stop dabigatran in 3 days
If a patient is not a candidate for cardioversion because >48 hours a fib, wait how long after anticoagulation to cardiovert the patient
Wait until the patient anti coagulated X 3 weeks with target INR 2-3
What is the most sensitive test for renal artery stenosis?
MR angiography
Early reocclusion secondary to thrombosis is more common with
Drug eluting stents, prescribe for 1 year with dug eluting stent
3 months for bare metal stent
All post MI patients should be discharged with the following meds
Asa, lipid lowering agent, BB, ACEI , NTG prn
AHA allows how much total cholesterol in daily intake
300 mg
In atrial fibrillation with rapid ventricular rate in a stable patient what should you focus your initial treatment
Rate control
Treat with beta blockers
Medication preferred for CHF due to LV systolic dysfunction because they offer greatest reduction in mortality
ACE- inhibitors
Irregularly irregular narrow complex rhythm with atrial rate >300
Atrial fibrillation
Atrial fibrillation CHADS2 parameters assesses stroke risk to indicate anticoagulation
CHF, HTN, age >75, DM, STROKE IN PAST OR TIA
The national cholesterol education program adult treatment panel III ( NCEP-ATP III) guidelines define high cholesterol as
Total cholesterol TC?
LDL.
TC 200
LDL 130
At what size in centimeters do you refer patient with AAA to vascular surgeon for surgical intervention 🤔
5-5.5cm
For STEMI, the recommended FIRST AND ONLY FIRST DOSE OF ENOXAPARIN sq dose for persons
30mg IV enoxaparin should be given WITH the first sq dose
If a patient is on theophylline the least desirable method of chemical stressing would be?
Adenosine
Dipyridamole
MC Cause secondary hypertension further supported by presence of unprovoked hypokalemia although in majority of cases potassium is normal
Hyperaldosteronism
Aldosterone increases secretion of potassium which leads to hypokalemia
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
95% likelihood CHF
Indications for CABG?
3vessel disease, left main CAD
Aortic dissection management
Start with beta blockers
Goal is to LOWER BLOOD PRESSURE
Anytime there is negative force in lead II there is neg force presence in III and aVF patient will have
Left anterior fascicular block LAFB
The most common etiology for heart failure associated with of systolic dysfunction?
Ischemic heart disease. Get an angiogram
Best screening test for suspected PVD
ABI
The only adjunctive agent that has been shown unequivocally to reduce mortality alone or in conjunction with thrombolytic agents in patients with AMI
ASA
In atrial fibrillation the most effective long term therapy for rate control at both rest and exercise?
Beta blockers
Digitalis more effective rate control at rest May not control rate with exercise
What is the most common cause hyperaldosteronism?
Adrenal adenoma
Reproducible ischemic muscle pain that occurs with exercise relieved by rest? 🤔
Claudication
The drug of choice for mild to moderate LDL Elevation
HMG-CoA reductase inhibitors ie; lovastatin, pravastatin, simvastatin rosuvastatin
Heparin has not not been found to outweigh the harms in patients receiving streptokinase, except in cases of patient
Anterior wall MI
Patients with complications prone thromboembolism such as atrial fibrillation or congestive heart failure
Cause of diastolic dysfunction
Increased ventricular stiffness and decreased ventricular compliance
What is the procedure of choice to diagnose congestive heart failure?
Echocardiogram
What Is the loading dose of clopidigrel
600mg
Am ABI > 1.4 indicates?
Calcified non compressible arteries
Contraindications beta blockers in heart failure
Hemodynamics instability
Heart block
Bradycardia
Severe asthma
The anterior wall is supplied by the
Left coronary artery which supplied the His-purkinje system
Most common cause acute Coronary syndrome
Occlusive thrombus developing on top of a disrupted atherosclerotic plaque
Treatment cocaine induced acute Coronary syndrome
NTG and CCB
Glycoprotein IIb/IIIa receptor blockers
Inhibit platelet aggregation
Abciximab
Eptifibatide
Tirofiban
Sinus bradycardia, 1 st degree AVB are commonly associated with other Derek’s of physical conditioning
Meds not contraindicated
Ate bblockers nor non dihydropyridines CCBs
According to NCEP LDL is elevated when it is higher than
130
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
Intra aortic balloon pump placement to increase coronary flow and to decrease afterload; coronary reperfusion with Percutaneous transiluminal balloon angioplasty ( the mainstay of treatment
The treatment of choice for hypercholesterolemia
Diet therapy
