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Cardiology Flashcards

1
Q

stable angina is due to

A

fixed atherosclerotic lesion

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2
Q

stable angian occurs when

A

oxygen deman exceeds available blood supply

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3
Q

7 risk factors for stable angina?

A
  1. diabetes mellitus (worst risk factor)
  2. hyperlipidemia (high LDL)
  3. hypertension (most common risk factor)
  4. smoking
  5. age (men > 45, women > 55)
  6. low level of HDL
  7. family hx of prematrue coronary artery dz (CAD) or MI in first relatives
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4
Q

5 clinical presentation for CAD?

A
  1. asymptomatic
  2. stable angina pectoris
  3. unstable angina pectoris
  4. MI (either NSTEMI or STEMI)
  5. sudden cardiac death
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5
Q

what is the goal of LDL in all CAD pts?

A

below 100 mg/dl

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6
Q

2 prognostic factors for CAD

A
  1. Lt. ventricular function (ejection fraction): less than 50% –> inc mortality
  2. vessels involved: Lt main coronary a (poor prognosis b/c it covers approximately 2/3 of the heart)
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7
Q

4 clinical features of stable angina?

A
  1. chest pain or substernal pressure sensation
  2. brought on by factors that inc myocardial oxygen deman such as exertion or emotion
  3. relieved by rest or nitroglycerin
  4. pain that does NOT change with breating nor with body position
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8
Q

3 characteristics of pain of stable angina

A
  1. last less than 10 to 15 min (usually 1 to 5 min)
  2. frightening chest discomfort, usually described as heaviness, pressure, squeezing, tightness (rarely described as sharp or stabbing pain)
  3. pain is often gradual in onset
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9
Q

best initial test for all forms of chest pain?

A

ECG

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10
Q

3 applications of stress ECG (exercise testing)?

A
  1. to confirm diagnosis of angian
  2. to evaluate response of therapy in pts with documented CAD
  3. to identify pts with CAD who may have a high risk of actue coronary events
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11
Q

4 symptoms that give the positive result for stress test?

A
  1. ST segment depression
  2. chest pain
  3. hypotension
  4. significan arrythmia
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12
Q

define metabolic syndrome X

A

any combination of hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, HTN

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13
Q

6 ways to dianogse CAD

A
  1. physical exams are normal in most pts with CAD
  2. resting ECG (usually normal)
  3. stress test (stress ECG, stress echocardiography)
  4. pharmacological stress test (if pt can’t exercise)
  5. holter monitoring (ambulatory ECG)
  6. cardiac catheterization with coronary angiography
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14
Q

what is stress test particularly useful for what pt group?

A

pts with an intermediate pretest probability of CAD based on age, gender, symptoms.

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15
Q

name 3 types of stress tests

A
  1. stress ECG
  2. stress echocardiography
  3. info gain from stress tests can be enhanced by myocardial perfusion imaging after IV administration of a radioisotope such as thallium 201 during exercise
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16
Q

what is the sensitivity of stress ECG?

A

75% if pts are able to exercise sufficiently to increase heart rate to 85% of max predicted value for age.

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17
Q

how do you calculate tat max heart rate using stress ECG?

A

220 - age

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18
Q

on ECG of a pt who is going through an exercise induced ischemia will show

A

ST segment depression (subendocardial ischemia)

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19
Q

other than ST segment depression of ECG, what is the + findings from a stress test?

A

onset of heart failure or ventricular arrhythmia during exercise

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20
Q

what is the next step for pts with a positive stress test?

A

cardiac catheterization

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21
Q

when do you perform stress echocardiography?

A

before and immediately after exercise

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22
Q

positive signs from stress echo?

A

wall motion abnormalities (eg. akinesis or dyskinesis) not present at rest

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23
Q

why is stress echo favored over stress ECG?

A

more sensitive in detecting ischemia, can assess LV size and function, can diagnose valvular dz, and can be used to identify CAD in the presence of preexisting ECG abnormaltieis

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24
Q

what is the definitive test for CAD?

A

cardiac catheterization with coronary angiography

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25
Q

4 indications for cardiac catheterization with coronary angiography

A
  1. after a positive stress test
  2. in a pt with angina in any of the following situations:
    - when non-invasive tests are nondiagnostic
    - angina that occurs despite medical therapy
    - angina that occurs soon after MI
    - angina that is a diagnostic dilemma
  3. if pt is severely symptomatic and urgent diagnosis and management are necessary
  4. for evaluation of valvular dz, and to determine the need for surgical intervention
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26
Q

what is coronary angiography also called?

A

coronary arteriography

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27
Q

what is coronary angiography (arteriography)?

A

most accurate way of identifying the presence and severity of CAD

the standard test for delineating coronary anatomy

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28
Q

what is the major purpose of coronary angiography (arteriography)?

A

to identify pts with severe coronary dz to determine whether revascularization is needed

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29
Q

how is unstable angina diff from stable angina?

A

in unstable, the oxygen demand is unchanged (whereas in stable, there is inc oxygen demand)

in unstable, the supply is dec due to the 2ndary to reduced resting coronary flow

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30
Q

3 typical pts that may have unstable angina?

A
  1. pts with chronic angina with increasing freq, duration, and intensity of chest pain
  2. pts with new onset angina that is severe or worsening
  3. pts with angina at rest
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31
Q

what is the distinction btw USA and NSTEMI?

A

cardiac enzyme (only NSTEMI has elevated elevation of troponin or CK-MB)

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32
Q

what are 2 common things about USA and NSTEMI?

A
  1. no ST elevation

2. no pathologic Q wave

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33
Q

4 differential diagnosis for heart pain due to heart, pericardium, and vascular causes

A
  1. stable angina, unstable angina, and variant angina
  2. MI
  3. pericarditis
  4. aortic dissection
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34
Q

5 diff diagnosis for heart pain due to lung issues

A
  1. pulmonary embolism
  2. pneumothorax
  3. pleuritis (plueral pain)
  4. pneumonia
  5. status asthmatica
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35
Q

4 diff diagnosis for heart pain due to GI issues

A
  1. GERD
  2. diffuse esophageal spasm
  3. peptic ulcer dz
  4. esophageal rupture
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36
Q

5 diff diagnosis for heart pain due to chest wall issues?

A
  1. costochondritis
  2. muscle strain
  3. rib fracture
  4. herpes zoster
  5. thoracic outlet syndrome
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37
Q

3 diff diagnosis for heart pain due to psychiatric issues?

A
  1. panic attack
  2. anxiety
  3. somatization
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38
Q

one drug that can cause MI?

A

cocaine

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39
Q

what are 3 treatment options for stable angina (CAD)?

A
  1. risk factor modification
  2. medical therapies
  3. revascularization
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40
Q

what is acute coronary syndrome?

A
  1. clinical manifestations of atherosclerotic plaque rupture and coronary occlusion
  2. the term ACS generally refers to unstable angina, NSTEMI or STEMI
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41
Q

what are the 2 important things when you are diagnosing unstable angina?

A
  1. perform a diagnostic workup to exclude MI in all pts
  2. pts with USA have a high risk of adverse events during stress testing. These pts should be stabilized with medical management before stress testing or should undergo catheterization initially.
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42
Q

4 medical medical therapies for stable angina?

A
  1. aspirin
  2. beta blockers (1st line choices: atenolol, metoprolol)
  3. nitrates
  4. calcium channel blockers
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43
Q

what is the purpose of giving beta blockers for stable angina pts?

A

reduce HR, BP, and contractality –> dec cardiac work –> dec oxygen consumption

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44
Q

how often do you need to measure cardiac enzyme?

A

cardiac enzyme are drawn serially every 8 hrs until 3 samples are obtained.

the higher the peak and the longer enzyme levels remain elevated, the more severe the myocardial injury and the worse the prognosis.

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45
Q

in MI, what 3 drugs are shown to reduce mortality?

A

aspirin, beta blockers, ACE inhibitors

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46
Q

what CAPRICORN trial showed?

A

beta blocker carvedilol reduces risk of death in pts with post-MI LV dysfunction.

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47
Q

what is carvedilol?

A

alpha and beta antagonist

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48
Q

what is another alpha and beta antagonist other than carvedilol?

A

labetalol

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49
Q

has thrombolytic therapy and CCB have shown to prove to be beneficial for unstable angina?

A

no (do NOT give thrombolytic for NSTEMI or unstable angina!)

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50
Q

what are the 2 common things in unstable angina and NSTEMI?

A

no ST elevation and no pathologic Q waves

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51
Q

3 main treatments for unstable angina?

A
  1. hospital admission with continuous cardiac monitoring –> establish IV access and give supplemental oxygen and provide pain control with nitrate/morphine
  2. aggressive medical management (treat as in MI except for fibrinolysis)
  3. cardiac catheterization/revascularization
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52
Q

what are the 9 medical managements for unstable angina pts?

A
  1. aspirin
  2. clopidogrel (reduces the incidence of MI in pts with USA compared to with aspirin alone in CURE trial.
  3. beta blockers
  4. LMWH (keep PTT at 2 to 2.5 times normal if using LMWH, PTT is not monitored with LMWH)
  5. nitrates (1st line therapy)
  6. oxygen if pt is hypoxic
  7. glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban)
  8. morphine
  9. electrolytes to replenish K+ and Mg2+
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53
Q

what does TIMI stand for?

A

Thrombolysis in Myocardial Infarction

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54
Q

what is TIMI risk score for?

A

prognostication scheme that categorizes risk of death and ischemic events in pts with unstable angina/non-ST segment elevation MI

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55
Q

what is atrial fibrillation?

A
  1. most common arrhythmia besides sinus tachycardia

2. irregularly irregular rhythm (irregular RR intervals on ECG) with absence of P waves.

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56
Q

name 11 causes for AF?

A

PIRATES

Pulmonary (COPD, PE)
Pheochromocytoma
Pericarditis

Ischemic heart dz and HTN

Rheumatic heart dz

Anemia
Atrial myxoma

Thyrotoxicosis
hypoThyroidism

Ethanol, Cocaine

Sepsis

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57
Q

5 clinical signs for AF?

A
  1. fatigue (most common)
  2. tachypnea (rapid breathing), dyspnea
  3. palpitations, angina
  4. lightheadedness, syncope
  5. irregularly irregular rhythm palpated on physical exam
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58
Q

4 differential for AF?

A
  1. paroxysmal atrial contractions
  2. paroxysmal ventricular contractions
  3. multifocal atrial tachycardia
  4. atrial flutter with variable AV conduction
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59
Q

4 work ups for AF?

A
  1. check ECG –> narrow QRS, variable PR intervals, irregular or absent P waves
  2. check echo –> may show thrombus in the Lt. atrium but more often will show a dilated Lt. atrium
  3. check TSH, hyperthyroidism is a reversiable cause of AF
  4. perform baseline coagulation studies (INR/aPTT) prior to the initiation of anticoagulation therapy determined by the CHADS2 score for those with nonvalvular AF
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60
Q

name ( ) risk factors for CHF

A
  1. MI
  2. HTN
  3. valvular heart dz (mitral stenosis, endocarditis)
  4. pericardial dz
  5. cardiomyopathy
  6. AIDS
  7. alcohol abuse
  8. pul HTN
  9. chronic ischemic heart dz (most common)
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61
Q

how is BNP useful?

A

inc BNP can be used to distinguish dyspnea due to heart failure from other cause of dyspnea

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62
Q

5 causes for 2’ HTN?

A

Running Doesn’t Elevate Our Pressure

  1. Renal
  2. Drugs
  3. Endocrine
  4. Other
  5. Pregnancy
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63
Q

3 renal cause for 2’ HTN

A
  1. renal artery stenosis from fibromuscular dysplasia in young women
  2. atherosclerotic dz
  3. renal parenchymal dz (polycystic kidney dz, renal cell carcinoma)
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64
Q

5 causes that increase pulse pressure?

A
  1. aortic regurge
  2. aortic stiffness (aging –> calcification –> dec compliance)
  3. hyperthyroidism
  4. obstructive sleep apnea
  5. exercise
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65
Q

4 causes that dec pulse pressure?

A
  1. aortic stenosis
  2. cardiogenic shock
  3. cardiac tamponade
  4. advanced heart failure
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66
Q

the diagnosis of bundle branch block is mainly based on the widened

A

QRS (at least 3 small squares = 0.12 sec)

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67
Q

on EKG, to diagnose BBB check for

A

RR’

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68
Q

on EKG, for Rt. BBB, what leads should you be looking for RR’?

A

V1, V2

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69
Q

on EKG, for Lt. BBB, what leads should you be looking for RR’?

A

V5, V6

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70
Q

what EKG leads should you look for MI in LAD (anterior)?

A

V1 - V4

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71
Q

what EKG leads should you look for MI in circumflex (lateral)?

A

I, avL, V4-V6

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72
Q

what EKG leads are important for MI in RCA (inferior)?

A

II, III, avF

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73
Q

what EKG leads should you look for MI in RCA in the Rt. ventricular?

A

V4 on Rt sided EKG is 100% specific

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74
Q

pt with chest pain comes in and you did EKG, what 2 things should you be looking for?

A
  1. 2 mm ST elevation

2. LBBB (wide, flat QRS)

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75
Q

name 3 contraindications for thrombolytics?

A
  1. bleeding
  2. taking anticoagulants
  3. hemorrhagic stroke
  4. recent ischemic stroke
  5. recent closed head trauma
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76
Q

when do you ST elevation if you have MI?

A

immediately

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77
Q

when do you see T wave inversion in MI?

A

6 hrs - years

78
Q

how long does Q waves last on EKG?

A

forever

79
Q

treatment for STEMI?

A

restore blood flow

  1. Cath lab
  2. give thrombolytics (within 6 hrs)
80
Q

5 Sxs for Rt. ventricular infarct?

A
  1. hypotension
  2. tachycardia
  3. clear lungs
  4. JVD
  5. no pulsus paradoxus
81
Q

do you give nitrate for Rt. ventricular infarct? why?

A

No, they need inc preload (not dec)

82
Q

what is the treatment for Rt. ventricular infarct?

A

vigorous fluid resuscitation

83
Q

pt with chest pain with normal EKG, what is the next step?

A

order cardiac enzyme (if elevated, it’s NSTEMI)

84
Q

how many cardiac enzymes should you order?

A

3 sets (every 8hrs)

85
Q

what is the most sensitive cardiac enzyme for MI?

A

myoglobin b/c it is the 1st to go up (peaks in 2 hrs)

86
Q

name 3 cardiac enzymes you want to order?

A
  1. myoglobin
  2. CKMB
  3. troponin 1
87
Q

when is the peak time for CKMB and how long does it last?

A

4-8hrs, peaks 24hrs, stays for 72 hrs

88
Q

when does troponin I peaks and how long does it last?

A

rise in 3-5 hrs, peaks 24-48 hrs, lasts 7-10 days

89
Q

the most sensitive cardiac enzyme for 2nd infarct?

A

myoglobin (b/c it peaks in 2 hrs)

90
Q

for NSTEMI what are the 6 treatments?

A
  1. morphine
  2. oxygen
  3. nitrates
  4. aspirin
  5. clopidogrel
  6. beta blockers
91
Q

for pts with NSTEMI after you give treatments, what are the next steps?

A

do coronary angiography within 48 hrs to determine need for intervention

92
Q

for pts with NSTEMI, after the coronary angiography, what are the 2 treatment (intervention) options?

A
  1. PCI (Percutaneous coronary intervention) with stenting (gold standard)
  2. CABG (coronary artery bypass grafting)
93
Q

when is CABG (coronary artery bypass grafting) preferred over PCI with stenting?

A
  1. if Lt. main dz
  2. 3 vessel dz
  3. 2 vessel dz + DM
  4. > 70% occlusion
  5. pain despite max medical tx
  6. post infarction angina
94
Q

pts with NSTEMI who got either PCI with stent or CABG, what are the 6 discharge meds?

A
  1. aspirin
  2. clopidogrel for 9-12 mo if stent placed
  3. b blocker
  4. ACE inhibitors if CHF or LV dysfxn
  5. statin
  6. nitrate for chest pain
95
Q

a pt currently having Chest pain turned out to have normal EKG and no cardiac enzyme (x3) elevation. what is the most likely dx?

A

unstable angina

96
Q

what are the work-ups for unstable angina?

A

exercise EKG: avoid b-blockers and CCB before

97
Q

if a pt with angina has old LBBB or baseline ST elevation or on digoxin, can you do EKG stress test?

A

no, do echo instead.

98
Q

what if a pt with angina can’t exercise? what do you do?

A

do chemical stress test with dobutamine or adenosine

99
Q

what is MUGA?

A

multigated acquisition scan (nuclear medicine test) is a noninvasive diagnostic test used to evaluate the pumping function of the ventricles

100
Q

before MUGA test, what should a pt avoid?

A

caffeine or theophyline before

101
Q

what are the 3 indications during the stress test that should lead you to do the coronary angiography?

A
  1. chest pain is reproduced
  2. ST depression
  3. hypotension
102
Q

MC cause of death for post-MI?

A

arrhythmia (v-fib)

103
Q

new systolic murmur 5-7 days after MI?

A

papillary muscle rupture

104
Q

acute severe hypotension after MI?

A

ventricular free wall rupture

105
Q

a pt step up and O2 conc from RA –> RV?

A

ventricular septal rupture

106
Q

persistent ST elevation 1 month later + systolic murmur, what is the cause?

A

ventricular wall aneurysm

107
Q

cannon A waves?

A

AV-dissociation, either V-fib or 3rd degree heart block

108
Q

5-10 wks later pleuritic CP, low grade temp?

A

Dressler, autoimmune pericarditis

109
Q

treatments for Dressler?

A

NSAIDs and aspirin

110
Q

a young healthy pt comes in with chest pain, you do a EKG and see diffuse ST elevation, dx?

A

pericarditis

111
Q

describe the characteristics of chest pain from pericarditis?

A

worse with inspiration, better with leaning fowards, friction rub and diffuse ST elevation

112
Q

what is the major risk factor for the development of atherosclerosis and increases risk for myocardial infarction and stroke?

A

uncontrolled HTN

113
Q

primary HTN is also know as

A

essential or idiopathic HTN

114
Q

risk factors of HTN?

A
  1. family hx
  2. obesity
  3. sodium sensitivity
  4. DM
  5. metabolic syndrome
    (smoking is NOT a risk factor)
  6. alcohol
115
Q

what is the bp range of preHTN?

A

120-139, 80-89

116
Q

treatment for preHTN?

A

lifestyle modifications

117
Q

bp range for stage 1 HTN?

A

140-159, 90-99

118
Q

treatment for stage 1 HTN?

A

thiazide type diuretics

119
Q

bp range for stage 2 HTN?

A

> 160, >100

120
Q

treatment for stage 2 HTN?

A

thiazide type + another class

121
Q

10kg of weight loss can lower how much bp?

A

5-20 mmHg

122
Q

DASH diet can reduce how much bp?

A

8-14 mmHg

123
Q

reduce dietary sodium to 2.4 g per day how much bp can you lose?

A

2-8 mmHg

124
Q

after lifestyle modification, what is the 1st DOC to lower bp?

A

25 mg thiazide diuretics

125
Q

DOC for HTN pts with coronary artery dz or Lt. ventricular systolic dysfunction?

A

beta blocker

126
Q

HTN pts with significant LV systolic dysfunction should avoid what drug?

A

CCB (can exacerbate the condition)

127
Q

5 contraindications to thiazide?

A
  1. gout
  2. pregnancy
  3. electrolyte disorders
  4. incontinence
  5. BPH
128
Q

contraindications to beta blockers?

A
  1. heart block
  2. sick sinus syndrome
  3. obstructive lung dz
129
Q

beta blockers can have benefits with what types of comorbidities?

A
  1. CAD
  2. LV systolic dysfunction
  3. stable angina
  4. atrial arrhythmias
  5. prior MI
130
Q

4 contraindications to ACE inhibitors?

A
  1. pregnancy
  2. bilateral renal stenosis
  3. angioedema
  4. hyperkalemia
131
Q

7 common causes for 2’ HTN?

A
  1. renovascular
  2. renal parenchymal injury
  3. obesity
  4. pharmacologic toxic
  5. endocrine issues
  6. coarctation of aorta
  7. sleep apnea
132
Q

what is the level of significant proteinuria?

A

more than 500 mg/day

133
Q

what is the most effective known modifiable risk factor for primary HTN?

A

weight loss

134
Q

medications that inc bp?

A
  1. oral contraceptives
  2. ethanol
  3. NSAIDs (dec sodium excretion, but baby aspirin is fine) –> inc bp by blocking COX-2 in the kidney
135
Q

does chronic smoking lead to HTN?

A

no, smoking is NOT is associated with inc bp

136
Q

what is a major cause of HTN in obese males?

A

primary hyperaldosteronism

137
Q

4 lab findings of primary hyperaldosteronism with HTN?

A
  1. resistant HTN
  2. low serum potassium
  3. high sodium levels
  4. metabolic alkalosis
138
Q

triad symptoms of pheochromocytoma

A
  1. sweating
  2. headache
  3. tachycardia
139
Q

2 ways to diagnose pheochromocytoma?

A
  1. 24 hr urinary metanephrine collection

2. CT or MRI to localize tumor

140
Q

DOC for hypertensive crisis in pheochromocytoma?

A
  1. nitroprusside

2. phentolamine

141
Q

mech of 2’ HTN due to obstructive sleep apnea?

A
  1. inc catecholamine release at night

2. hypoxia/reperfusion leading to endothelial dysfunction

142
Q

definition of hypertensive emergency?

A

systolic > 180, diastolic > 120 + end organ damages

143
Q

medications/treatment for hypertensive emergency?

A
  1. there is no strict general guideline currently

2. slow decline in BP to 160/100 mmHg on oral therapy is generally recommended

144
Q

clinical signs for hypertensive emergency?

A
  1. retinal hemorrhage, exudates, papilledema
  2. hypertensive encephalopathy: cerebral edema with mental status changes
  3. malignant nephrosclerosis
  4. pulmonary edema
  5. aortic dissection
145
Q

treatment for hypertensive emergency?

A

gradual pressure reduction except for aortic dissection that needs an immediate reduction of bp to 120/80

146
Q

define dyslipidemia (LDL, HDL, TG)

A

LDL > 150 mg/dl

HDL 200 mg/dl

147
Q

4 risk factors for atherosclerosis?

A
  1. dyslipidemia
  2. tobacco smoking
  3. uncontrolled HTN
  4. diabetes
148
Q

3 morbidity/mortality for coronary atherosclerosis?

A
  1. heart failure
  2. arrhythmia
  3. sudden death
149
Q

3 follow ups for pts with known coronary dz?

A
  1. echo for cardiac function
  2. stress test to determine functional status
  3. coronary angiography to classify lesion location and severity
150
Q

3 DOC for pharmacologic stress test

A
  1. adenosine
  2. regadenoson
  3. dobutamine
151
Q

mech of adenosine, regadenoson?

A

dilate healthy coronary artery and monitor via nuclear imaging

152
Q

complications of rupture of aortic atherosclerosis

A
  1. livedo reticularis (skin necrosis)
  2. digital gangrene
  3. renal dysfunction
  4. retinal emboli
  5. central nervous system/ocular dysfunction, such as stroke, retinal plaques, and neuropathy
153
Q

rupture of TAA is unlikely when the TAA is less than

A

4 cm

154
Q

what is the rupture rate of TAA greater than 6 cm in diameter?

A

35% per 5 yrs

155
Q

2 clinical signs for TAA?

A
  1. pts with proximal aortic aneurysm may have aortic valve insufficiency and a diastolic murmur
  2. widened mediastinum on chest x-ray
156
Q

DOC for TAA?

A

beta blocker –> dec pulse pressure

aggressive bp control is most important

157
Q

5 indications that surgery is needed for TAA?

A
  1. symptoms are intolerable
  2. aortic diameter > 5 cm ascending or > 6 cm descending
  3. aortic diameter growth exceeds 10 mm/year
  4. aortic valve surgery for another cause is imminent and the TAA is greater than 4.5 cm
  5. dissection is present in a high risk area
158
Q

3 risk factors for TAA?

A
  1. HTN
  2. bicuspid aortic valve
  3. connective tissue dz (Marfan)
159
Q

2 cases when surgery is needed for AAA

A
  1. aneurysm bigger than 5.5 cm

2. rate of expansion exceeds 0.5 cm/6month

160
Q

what are the 2 shockable rhythm?

A

v tach, v fib

161
Q

synchronized cardioversion is for pts with

A

arrhythmia with a pulse

162
Q

non synchronized cardioversion is also known as

A

defibrillation

163
Q

non synchronized cardioversion (defibrillation) is for pts with

A

arrhythmia (v fib or v tach) without a pulse

164
Q

in what cardiac situation is the 1st step is 1 mg of IV epi? (instead of shocking)

A

if pt is asystole or has pulsless electrical activity (PEA)

165
Q

v fib is always

A

pulsless

166
Q

v tach can be

A

pulsless or with pusle

167
Q

treatments for atherosclerosis of cerebral vessels?

A

best treated with antiplatelet rather than anticoagulants

  1. clpidogrel
  2. aspirin
  3. dipyridamole
  4. cilostazol (PDE3 inhibitor)
168
Q

how many hours after symptoms, is it not recommend to use thrombolytic?

A

4.5 hrs?

169
Q

signs and symptoms of peripheral arterial dz?

A
  1. diminished pulses in the leg distal to the level of blockage
  2. pallor
  3. hair loss
  4. nonhealing wounds
  5. ulcers
  6. gangrenous toes
170
Q

name of the diagnostic test for PAD?

A

ankle branchial index (ABI)

171
Q

how is ABI recorded?

A

as a ratio btw the ankle blood pressure of the leg in question and the bp in the Rt or Lt arm

172
Q

what is a normal ABI value?

A

0.91 - 1.3

173
Q

iatrogenic mesenteric ischemia may be caused by the overuse of

A

vasoconstrictors in shock states (phenylephrine, other alpha agonists)

174
Q

the aorta gives off the

A

Left main coronary arteries (LMCA)

Rt. coronary arteries

175
Q

LMCA gives off two branches?

A
  1. Lt anterior descending (LAD)

2. Lt circumflex (LCx)

176
Q

what supplies the lateral wall of the LV?

A

LCx (Lt circumflex)

177
Q

what are the 3 main coronary arteries?

A

RCA, LAD, LCx

178
Q

6 medications for stable angina/coronary artery dz?

A
  1. aspirin
  2. statin
  3. nitrates
  4. beta blockers
  5. CCB
  6. ranolazine (sodium channel blocker)
179
Q

EKG sign for USA?

A

ECG can be normal, but typically show ST depression or T wave inversions during chest pain

180
Q

7 medications for USA?

A
  1. high dose aspirin and another antiplatelet med such as clopidogrel
  2. heparin
  3. nitrates for chest pain
  4. betablockers
  5. statins
  6. oxygen
  7. morphines
181
Q

what score system is used to make the decision on which pts with USA/NSTEMI should go to the catheterization lab?

A

TIMI scoring

182
Q

USA pts should undergo cardiac catheterization and possible percutaneous intervention (PCI) with balloon angioplasty under what situations?

A
  1. two or more of the risk factors (TIMI score > 2)
  2. course complicated by
    1) ongoing pain unrelieved by meds
    2) tach or bradyarrhythmia
    3) heart failure symptoms
    4) persistent ST changes on ECG
183
Q

what is a good door to balloon time (time from presentation to PCI)?

A

90 min

184
Q

a pregnant woman with ST elevations should undergo

A

cardiac catheterization in an emergent fashion

185
Q

systemic inflammatory response syndrome are characterized by 2 or more of the following 4

A
  1. fever (>38C), hypothermia (20 bpm) or PaCO2 90bpm)

4. inc WBC count (12,000 cell/hpf)

186
Q

treatments for NSTEMI?

A
  1. dual antiplatelet therapy
  2. anticoagulant
  3. statin
  4. nitrates
  5. beta blockers if bp is stable
187
Q

for NSTEMI pts, decision to go to cardiac catheterization lab should be depend on

A

TIMI score (if higher than score 2)

188
Q

2 examples of paradoxic splitting?

A

LBBB, aortic stenosis

189
Q

in what situation is S3 considered normal?

A

in athletes and young people, indicate vigorous relaxation

younger than 3 yr old

190
Q

treatment for aortic stenosis?

A

aortic valve replacement

Step 2 CK (20 decks)

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