Cardiology Flashcards
1
Q
You want a stress test, but the pt has heart failure, so what kind of stress test do you do?
A
Nuclear
2
Q
Wide pulse pressure, water-hammer pulses (bounding), quincke pulse (nailbeds), head bobbing, dx?
A
aortic regurgiation
3
Q
Name 4 categories of etiologies of pericardial disease
A
Infxn (viral, bacterial, fungal, TB); autoimmune (RA, SLE, Dressler’s, Uremia); Trauma (penetrating, blunt, aortic dissection); Cancer (breast, lung, esophageal, lymphoma)
4
Q
What hypertension meds can cause peripheral edema?
A
CCBs
5
Q
How do you treat a restrictive cardiomyopathy?
A
Beta blockers (diastolic heart failure)
6
Q
Which cause of syncope presents with prodrome?
A
Vasovagal
7
Q
What’s the magic time where you give tPA rather than transport for PCI in STEMI?
A
60 minutes
8
Q
ST segment elevation everywhere indicates? (other finding?)
A
pericarditis; PR depressions
9
Q
How can you prevent vasovagal?
A
beta blockers (controversial) - counter pressure techniques are better
10
Q
A cath is perforemd and there’s 3 vessel disease. What’s the next step?
A
CABG
11
Q
Teenager who gets profound dyspnea while playing a sport, dx?
A
HOCM
12
Q
What are the four medications everyone with CAD should be on?
A
Aspirin, statin, ace-inhibitor, and beta blocker (ABAS)
13
Q
Treatment for HOCM?
A
Beta blockers (avoid exercise and dehydration)
14
Q
What test do you do before replacing aortic valve?
A
Left heart cath (you may need a CABG)
15
Q
How do you check for statin hepatitis?
A
LFTs
16
Q
A pregnant woman has a rumbling systolic murmur with an opening snap. Dx?
A
Mitral valve prolapse (sounds like mitral regurg, but maneuvers are different - more blood in heart decreases MVP murmur)
17
Q
What can you use to correct orthostatic hypotension if rehydration/transfusion fails?
A
Steroids
18
Q
What is the additional tx in stage 4 HF?
A
Pressors (stage IV = severe limitaitons, pt is dyspneic at rest)
19
Q
Treatment for pericarditis with renal failure and diarrhea?
A
prednisone
20
Q
Name 4 causes of dilated cardiomyopathy
A
virus, EtOH, ischemia, chemo
21
Q
You want a stress test, but the pt has a history of a CABG, so what kind of stress test do you do?
A
Nuclear (done in pts with CABG, baseline wall defects, LBB)
22
Q
Peristernal knock with restrictive physiology indicates?
A
Constrictive pericarditis
23
Q
How do you diagnose pericardial effusion, tamponade, and constrictive pericardiits?
A
Echo
pericarditis with EKG or MRI
24
Q
Treatment for pericarditis?
A
NSAIDs (+ colchicine) (avoid steroids b/c it increases recurrence)
25
How do you tx a symptomatic sinus bradycardia?
atropine (stable), pace (unstable), and fix underlying cause
26
Squat makes which murmurs louder?
Squat increases blood in heart
| MS, MR, AR, and AS are all louder (MVP and HOCM are quieter)
27
Describe the chest pain in pericarditis (2)
pleurtic and positional
28
A pt is in 3rd degree block, what do you do?
pace (not shock)
29
Name 5 causes of restrictive cardiomyopathy?
Amyloid, sarcoid, hemochromatosis, cancer, and fibrosis
30
A person comes into the ED with chest pain; what do you give them first?
aspirin (not nitro)
31
What side effects do statins cause?
myositis, hepatitis
32
Pulsus paradoxus greater than 10 mmHg, is most likely?
Cardiac tamponade
33
Septic shock from aortic insufficiency gets?
intra aortic balloon pump
34
Aside from clinically, how can vasovagal be diagnosed?
tilt-table test
35
How do you treat SVT?
adenosine (stable), cardioversion (unstable)
36
You want a stress test, but the person has a reason they can't walk. What kind of stress test do you do?
Pharmacologic stress test (dobutamine or adenosine)
37
Aside from volume down, what is another cause of orthostatic hypotension?
Autonomic nervous system dysfunction (due to age, diabetes, Shy-Drager (Parkinsons))
38
Ezetimibe side effects?
Diarrhea
39
Guy passes out while shoveling snow. What's the cause of his syncope?
Aortic stenosis
40
A person calls EMS with chest pain and known coronary artery disease; what's the first step?
Nitro (not aspirin)
41
What defines orthostatic hypotension?
change in systolic of greater than 20, diastolic of 10, HR of 15
42
You suspect CHF; what blood test do you get?
BNP (brain natriuretic peptide)
43
Systolic BP greater than 180 sytolic, but no end organ damage = ? How do you treat?
Hypertensive urgency; oral medications
44
You come upon an unresponsive pt, what is the FIRST thing you do?
check a pulse (not airway, not arousal)
45
Passing out after a long coughing fit, lung cancer - what's the diagnosis?
vasovagal syncope
46
How long do you keep patient on clopidogrel for a bare-metal stent? Drug-eluding stent?
1 month bare metal; 1 year for drug eluting (not needed in angioplasty)
47
What hypertension medication can cause hyperkalemia?
ACE-i, ARB
48
What is the difference btwn a grade III murmur and grade IV?
III: S1, S2 are quieter than murmur
IV: there's a palpable thrill
(grade V: can still hear with 1/2 stethoscope off chest)
49
What is Beck's triad and what does it indicate?
JVD + hypotension + decreased heart sounds = cardiac tamponade
50
Which cholesterol drug decreases LDL and TG?
statins
51
What is the JNC-8 recommendation for BP levels?
Gt 60 with no disease BP under 150/90; everyone else under 140/90
52
Name 5 causes of syncope
vasovagal, orthostatic, mechanical cardiac (HOCM, AS, saddle embolus, left atrial myxoma), arrythmia, neurogenic (poor perfusion to the brain)
53
Old man passes out while shoveling snow; what's the most likely murmur?
Aortic stenosis
54
You diagnose mitral valve regurgitation; what's the most likely cause?
Papillary muscle rupture
55
What is the first test you get when considereing CHF? What is the next? What is the best?
BNP; Echo; Angiogram (LVgram - invasive and generally not needed)
56
How do you treat dilated cardiomyopathy?
beta blockers, ace-inhibitors, and diuretics (treat it like systolic dysfunction)
57
How do you treat vtach?
amiodarone (stable), cardioversion (unstable)
58
What's the next step if you find someone who is orthostatic?
IVF
59
What earns you the title of stage I hypertension? Stage II? Urgency? Emergency?
greater than 140/90; gt 160/100; gt 180/110; end organ damage
60
What are the three presentations of typical angina?
Substernal, worse w/exertion, and relieved by NTG (2/3 = atypical; 0-1/3 = non-anginal)
61
Treatment for pericarditis with renal failure?
Colchicine
62
What drugs does patient get when having MI (8)?
MONA BASH
morphine, oxygen, nitrates, aspirin
Beta-blocker, ace-inhibitor, statin, heparin
(there are exceptions!)
63
PR segment depression indicates?
pericarditis
64
SV is determined by __ and __
contractility and preload
65
Tx in stage 2 HF?
BB + ACE + loop diuretic
66
Pt has diabetes and hypertension, what type of statin does he need?
High potency statin (atorva/rosuva)
67
Cresendo-decrescendo murmur right sternal border?
Aortic stenosis
68
What hypertension med can cause hypokalemia?
Thiazide diuretics
69
How do you tx CHF exacerbation?
LMNOP
| lasix (IV), morphine, nitrates (last two are venodilators, can help with dyspnea), oxygen, position (upright)
70
What is the treatment for everyone with HF?
BB + ACE
71
Valsalva maneuver makes which murmurs louder?
valsalva decreases blood in heart
| MVP and HOCM are louder
72
A cath is perforemd and the LAD and left circumflex are blocked. What's the next step?
CABG (do CABG instead of stent when multi-vessels or left mainstem equivalent is blocked)
73
What is the door to balloon time?
90 minutes
74
Which syncopes present with sudden onset and no prodrome?
Arrythmia and neurogenic
75
Treatment for constrictive pericarditis?
Pericardiectomy
76
Dyspnea on exertion, worsening orthopnea, paroxysmal nocturnal dyspnea - diagnosis?
Congestive heart failure
77
Which rhythms can you NOT shock in a code?
all rhythms that are not vtach, vfib
78
What are the JNC-8 guidelines for which medications to use in HTN (4)?
- CCB (dipines), thiazide, ACEI/ARBs
- but if old (gt 75) or black no ACE/ARB
- unless you have CKD then you get an ACE/ARB
- No beta blockers!
79
What's the difference btwn HOCM and concentric hypertorphic cardiomyopathy on echo?
```
HOCM = asymmetric hypertrophy of the septum
Concentric = concentric hypertrophy
```
80
How do you tx pericarditis? effusion? tamponade? constrictive?
anti-inflammatories (hemodialysis for uremia); pericardial window; pericardiocentesis, pericardiectomy
81
How do you check for statin myositits?
CK
82
CO = __ x ___
HR x SV
83
Patient comes in with chest pain and EKG is negative, troponins are negative, what is next step?
Stress test (could have some degree of myocardial ischemia due to unstable angina and may still need to go to cath lab electively)
84
Name 8 causes of secondary hypertension
HH HARP CO
Hypercalcemia, Hyperthryoid, Hyperaldost (Conn's), Aortic coarctation, Renovascular (2ndary), Pheocromocytoma, Cushings, OSA
85
How do you definitevely diagnose a heart murmur?
Echo!
86
Patient comes in with chest pain and EKG is negative, next step?
Troponins (could be NSTEMI)
87
You suspect CHF exacerbation, what's the first step? ANd the next 3?
ECG (to rule out arrythmia and infarction); troponins, BNP, and CXR (to look for volume overload)
88
Which murmurs need to be investigated?
Any diastolic murmur, and any systolic murmur greater than 3/6
89
Name the main cause of concentric hypertrophic cardiomyopathy?
HTN
90
Pericardial knock, dx?
constrictive pericarditis
91
What class of medication prevents death in the first 24 hours post MI?
beta blockers
92
MAP = __ x ___
CO x SVR
93
Bile-acid resins side effect?
diarrhea
94
What medications do you give if there's volume overload in a CHF patient?
Loop diuretics (IV in exacerbation, PO if not exacerbated)
95
Echo shows restrictive cardiomyopathy, what step do you take to diagnose amyloid? sarcoid? hemachromatosis?
amyloid: fat pad biopsy (or gingival bx)
sarcoid: cardiac MRI then endomyocardial bx
hemachromatosis: ferritin level, then genetics
96
Really high blood pressure with chest pain and an elevated creatinine get?
IV meds - hypertensive emergency (IV nitrates, CCBs, or BBs)
97
At what ejection fraction should someone be considered for AICD placement?
EF less than 35% (and not in stage IV HF)
98
Most common causes of pericarditis in US (2)?
viral, uremia
99
?You suspect CHF; which imaging should you order?
2D Echo (aka Echocardiogram)
100
In a question about a code, there's always one answer that's right every time. What is it?
compressions
101
How do you get rid of niacin induced flush? What is niacin's good effects?
aspirin; increases HDL and lowers LDL
102
Absence of these 3 physical signs help point to CAD induced chest pain
nonpositional, nonpleuritic, nontender
103
If your LDL is between 70-189, you have no vascular disease (CVA, PVD, CAD), and you are 40-75, name two things that would put you on a statin
diabetes; calculated 10 year risk greater than 7.5% (based on HTN, smoking, obesity, age)
104
A patient is in afib and in shock, what do you do?
shock them (even not anticoagulated)
105
Tx in stage 3 HF?
BB + ACE + loops + hydralazine/isosorbide dinitrate and spirinolactone or eplerenone
106
Diastolic murmur with opening snap?
Mitral stenosis
107
What hypertension med can cause a slow heart rate?
beta blockers
108
If you diagnose pericardial tamponade you should do what? What can you do while waiting to relieve symptoms?
Pericardiocentesis; IVF (increase preload to open up right ventricle)
109
Recurrent pericardial effusion gets what?
pericardial window (cut a piece of pericardium out so fluid can drain) (to tx pericardial effusion normally, tx the pericarditis)
110
Which cholesterol drugs increase HDL? Increase TG?
fibrates and niacin; bile acid resin
111
First line tx for mitral stenosis?
Balloon valvotomy
112
Which rhythms can you shock in a code?
pulseless vtach, vfib
