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Master the Boards Step 3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

The single worst risk factor for CAD is

A

diabetes

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2
Q

The mechanism of S3 gallop is

A

rapid ventricular filling during diastole

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3
Q

S4 gallop is the sound of

A

atrial systole into a tiff or noncompliant left ventricle

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4
Q

The best initial diagnostic test for ischemic-type pain is

A

EKG

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5
Q

CK-MB stays elevated 1-2 __

A

days

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6
Q

Troponin stays elevated 1-2 ___

A

weeks

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7
Q

Myoglobin elevates as early as 1-4 ____ after the start of chest pain

A

hours

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8
Q

Which cardiac enzyme rises first in acute chest pain?

A

Myoglobin

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9
Q

Stress testing is only the answer if the case is ____ and the EKG/other dx tests are inconclusive

A

NON-ACUTE

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10
Q

Only choose angiography if

A

the stress test is normal

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11
Q

If patients cannot exercise to a target HR >85% of max, then the answer is

A

dipyridamole or adenosine thallium stress test or dobutamine echo

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12
Q

EKG will be unreadable for ischemia in which situations?

A

Left BBB, digoxin, pacemaker, LVH, any baseline ST segment abnormality

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13
Q

Obese patients might need ____ testing for ischemia

A

sestamibi nuclear stress

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14
Q

To the myocardium, thallium looks like ___

A

potassium! Na/K ATPase will recognize it! SCIENCE IS COOL

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15
Q

Stress testing should never be performed in a patient with

A

current chest pain

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16
Q

The most specific method to dx a new infarction 5 days after an MI is

A

CK-MB

*it will have returned to normal 2-3 days after that first one

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17
Q

The best initial therapy for ACS patients is

A

aspirin

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18
Q

___ or ___ are added to aspirin in patients with acute MI

A

Clopidogrel or ticagrelor

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19
Q

P2Y12 antagonists such as clopidogrel work by

A

blocking platelet aggregation (inhibiting ADP-induced activation of the P2Y12 receptor)

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20
Q

Which therapies lower mortality in STEMI?

A

thrombolytics and primary angioplasty (time-dependent)

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21
Q

Percutaneous coronary intervention MUST be performed within ___ minutes of arrival at the ED for STEMI

A

90 minutes

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22
Q

What has the single greatest efficacy in lowering mortality in STEMI?

A

Urgent angioplasty

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23
Q

Angioplasty is the answer if the question includes a contraindication to

A

thrombolytics

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24
Q

___ are indicated when the patient has chest pain for <12 hours and has ST elevation in 2+ leads

A

Thrombolytics

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25
Q

A new left BBB is an indication for

A

thrombolytics

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26
Q

Beta blockers lower mortality in STEMI, but their timing is

A

NOT critical

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27
Q

ACEi’s and ARBs only lower mortality if there is ___ or ___

A

left ventricular dysfunction or systolic dysfunction (LOW EJECTION FRACTION)

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28
Q

What is the most common cause of death in both CHF and MI?

A

Ventricular arrhythmia brought on by ischemia (beta blockers are both anti-arrhythmic and anti-ischemic!!)

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29
Q

Statins should be given to ALL patients with ___ regardless of EKG or troponin or CK-MB levels

A

ACS

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30
Q

Treat cocaine-induced chest pain with

A

calcium channel blockers

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31
Q

Treat coronary vasospasm/Prinzmetal’s angina with

A

calcium channel blockers

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32
Q

When is a pacemaker the answer for acute MI?

A 
Third-degree AV block
Mobitz II, second degree block
Bifascicular block
New LBBB
Symptomatic bradycardia
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33
Q

Lidocaine or amiodarone are the answer for acute MI ONLY when there is ___ or ____

A

ventricular tachycardia or ventricular fibrillation

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34
Q

All complications of MI result in

A

hypotension

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35
Q

Treat cardiogenic shock with

A

ACEi, urgent revascularization

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36
Q

Treat valve rupture with

A

ACEi, nitroprusside, intra-aortic balloon pump (as bridge to surgery)

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37
Q

Treat myocardial wall rupture with

A

pericardioentesis, urgent cardiac repair (surgery)

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38
Q

Treat sinus bradycardia with

A

atropine, then maybe pacemaker

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39
Q

Treat third degree (complete) heart block with

A

atropine and a pacemaker for sure

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40
Q

Treat right ventricular infarction with

A

fluid loading

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41
Q

All patients post-MI should go home on

A

aspirin, clopidogrel (or prasugrel), beta blocker, statin, and an ACE inhibitor

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42
Q

Unlike STEMI, NSTEMI’s are managed with no ___ use, routine use of ___, and ___ to lower mortality

A

NO thrombolytic use
routine use of heparin
Glycoprotein IIb/IIIa inhibitors to lower mortality

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43
Q

The two medications that decrease mortality in chronic angina are

A

aspirin and metoprolol

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44
Q

Indications for CABG include ___ coronary vessels with >70% stenosis, left main coronary artery stenosis >50-70%, 2 vessels in a diabetic, and 2-3 vessels with low EF

A

three coronary vessels w/ 70% stenosis

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45
Q

___ is an anti-angina med that is added only if other meds don’t control the pain

A

Ranolazine

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46
Q

The LDL goal for patients with CAD and/or diabetes is

A

<70

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47
Q

LDL > 100 is an indication for

A

statin therapy

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48
Q

A statin is indicated if the 10-year risk of CAD is

A

> 7.5%

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49
Q

PCSK9 inhibitors (evolocumab and alirocumab) are ___ medications that do not lower mortality in familial hypercholesterolemia

A

injectable

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50
Q

What causes rales?

A

Increased hydrostatic pressure in the PULMONARY CAPILLARIES from LEFT HEART PRESSURE OVERLOAD

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51
Q

Left heart pressure overload can cause what physical exam finding?

A

rales (popping sound)

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52
Q

Rales are a sign of

A

pulmonary edema

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53
Q

The standard of care for acute pulmonary edema includes what four therapies?

A 
oxygen
furosemide
nitrates
morphine
*no concrete mortality benefit tho
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54
Q

The worst manifestation of CHF is

A

pulmonary edema

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55
Q

Carvedilol is anti-arrhythmic, anti-ischemic, AND

A

anti-hypertensive

*blocks beta1 and beta2 receptors

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56
Q

Order what four tests for suspected pulmonary edema?

A
  1. chest x-ray
  2. EKG
  3. oximeter (consider ABG)
  4. echo
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57
Q

CXR on pulmonary edema patients will show

A

cephalization of flow, pulmonary vascular congestion, effusion, and/or cardiomegaly

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58
Q

Dopamine has what effect on afterload?

A

It increases afterload by causing vasoconstriction (alpha 1 AGONIST)

59
Q

Imamrinone and milrinone are ___ inhibitors

A

phosphodiesterase inhibitors

60
Q

hypoxia causes respiratory ___

A

alkalosis

61
Q

Cases of pulmonary edema and MI should be placed in the

A

ICU

62
Q

Most patients with pulmonary edema will respond to ___ to control acute symptoms

A

preload reduction alone

63
Q

Positive inotrope agents used ____ in the ICU include dobutamine (drug of choice), inamrinone and milrinone

A

INTRAVENOUSLY

64
Q

Positive inotropes are used as further management in acute ___ after the clock is moved forward 30-60 min and there is no response to preload reduction

A

pulmonary edema

65
Q

When ventricular tachycardia is associated with acute pulmonary edema, what should you do?

A

Synchronized cardioversion (also if pulm edema is a/w afib, flutter, or supraventricular tachycardia)

66
Q

A normal BNP excludes ___

A

CHF

67
Q

Wedge pressure =

A

left atrial pressure

Left ventricular failure = increased LA pressure

68
Q

When a CHF patient is still dyspneic after using ACEi’s, beta blockers, diuretics, digoxin, and mineralocorticoid inhibitors, what’s the last resort?

A

Ivabradine, an SA nodal inhibitor of funny channels (slows HR)
*THERE IS MORTALITY BENEFIT

69
Q

Diastolic dysfunction is treated with ___ and ____

A

beta blockers and diuretics

70
Q

The single most important fact about further management of CHF is that

A

mortality is decreased by ACEi/ARB, beta blockers, and spironolactone

71
Q

CHF patients with persistently low EF below 35% are candidates for

A

implantable defibrillator placement

72
Q

The absolute contraindication for beta blockers is

A

symptomatic bradycardia

73
Q

All valvular heart disease presents with __ as chief complaint

A

shortness of breath

74
Q

Valvular heart dz in a young female or genpop =

A

mitral valve prolapse

75
Q

Valvular heart dz in a healthy young athelete =

A

Hypertrophic obstructive cardiomyopathy (HOCM)

76
Q

Valvular heart dz in immigrant, pregnant =

A

mitral stenosis

77
Q

Valvular heart dz in Turner’s syndrome, coarctation of aorta =

A

bicuspid aortic valve

78
Q

Valvular heart dz presenting with palpitations, atypical chest pain not with exertion =

A

mitral valve prolapse

79
Q

When valvular disease is suspected, what should you do on physical exam?

A

CV, Chest, and extremities portions! (check for peripheral edema, carotid pulse findings, and gallops)

80
Q

Systolic murmurs are most likely which four valvular dz’s?

A

Aortic stenosis
Mitral regurgitation
Mitral valve prolapse
HOCM

81
Q

Diastolic murmurs are most likely which two valvular diseases?

A

Aortic regurgitation

Mitral stenosis

82
Q

All right sided murmurs increase with

A

inhalation (both stenosis and regurgitation of tricuspid valves)

83
Q

All left sided murmurs increase with ___

A

exhalation (mitral and aortic valve lesions)

84
Q

The only two murmurs that become SOFTER with squatting and leg raise are __ and __

A

Mitral Valve Prolapse and Hypertrophic obstructive cardiomyopathy (MVP and HOCM)
*think of MVP and HOCM like with athletes who do lots of squats, squatting helps the murmur get softer in MVPs and athletes

85
Q

Handgrip, because it increases afterload, functions as the opposite of an

A

ACE inhibitor

86
Q

Aortic and mitral regurgitation are treated with ___ so their murmurs will get worse (louder) with ___

A

ACE inhibitor

handgrip

87
Q

Handgrip worsens the murmur of ____

A

VSD (also AR and MR)

88
Q

regurgitant murmurs are best treated with

A

vasodilator therapy

89
Q

If valsalva/standing improves the murmur, __ are indicated

A

diuretics

90
Q

If amyl nitrate improves murmur (aka handgrip worsens) ___ are indicated

A

ACE inhibitor

91
Q

The best initial diagnostic test for aortic stenosis is

A

TTE; TEE is more accurate, left heart cath is most

92
Q

Valsalva, standing, and amyl nitrate all worsen the murmur of

A

MVP and HOCM

93
Q

Handgrip improves the murmurs of __ and __ so ACE inhibitors will not treat them

A

MVP and HOCM

94
Q

The best initial therapy for aortic regurgitation is

A

ACEi, ARBs, and nifedipine + furosemide (loop diuretic)

95
Q

The most common cause of mitral stenosis is

A

rheumatic fever

96
Q

Balloon valvuloplasty works in mitral stenosis but not aortic stenosis because

A

in MS, the valve is fibrosed, but in AS it’s calcified

97
Q

Mitral regurg is caused by

A

dilation of the heart

98
Q

Broken heart syndrome, aka

A

Takotsubo cardiomyopathy

99
Q

The best initial therapy for pericarditis is

A

NSAIDs; have patient follow up in clinic in 1-2 days and if it persists, add prednisone then colchicine if it still doesn’t stop

100
Q

Two unique features of cardiac tamponade are __ and __

A

pulsus paradoxus and electrical alternans

101
Q

Alterations of the axis of the QRS complex on EKG =

A

electrical alternans

102
Q

Equalization of all the pressures in the heart during diastole in right heart catheterization =

A

pericardial tamponade

103
Q

Best initial therapy for cardiac tamponade =

A

pericardiocentesis; long term, do a pericardial window placement

104
Q

Do not give diuretics for cardiac ___

A

tamponade

105
Q

Constrictive pericarditis presents with SOB then signs of chronic ___

A

right heart failure

106
Q

Signs of chronic right heart failure include

A

edema, JVD, HSM, ascites

107
Q

Unique features of constrictive pericarditis include ___ and __

A 
Kussmauls sign (increase JVP on inhalation, not to be confused with Kussmaul breathing seen in DKA) 
Pericardial knock (extra diastolic sound from heart hitting a calcified pericardium)
108
Q

Chest X-ray showing calcification of pericardium =

A

constrictive pericarditis

109
Q

Best initial therapy for constrictive pericarditis =

A

diuretics; most effective is surgical removal of pericardium

110
Q

Difference in blood pressure between LEFT AND RIGHT ARMS =

A

Thoracic aorta dissection

111
Q

Widened mediastinum on CXR =

A

thoracic aortic dissection. Most accurate test is CT angio

112
Q

In suspected aortic dissection, move clock forward and order either __, __, or __ regardless of what EKG shows

A

CT angio, TEE, or MR angiography (all three equally accurate)

113
Q

Abdominal aortic aneurysms are repaired when they are __ cm

A

> 5cm

114
Q

Men age __ who are current or former smokers should be screened for AAA

A

65-75 yrs old

115
Q

Acute arterial embolus will be very sudden in onset with loss of pulse and a cold extremity. __ and __ are often in the history

A

AS and afib

116
Q

Smooth shiny skin?

A

Peripheral arterial disease

117
Q

Best initial test for peripheral arterial disease is

A

ankle-brachial index (>10% disease)

Angio is most accurate test

118
Q

Hospitalized patients with a-fib should be placed on

A

telemetry

119
Q

Other tests to order for a patient with newly diagnosed A-fib include these four:

A

Echo
Thyroid function
Electrolytes
Troponin/CKMB

120
Q

Unstable a-fib patients should undergo immediate

A

synchronized electrical cardioversion

121
Q

Long term use of ___ plus anticoagulation in a-fib patients is better than cardioversion

A

rate control medications such as metoprolol, diltiazem, or digoxin

122
Q

CHADS2 is a scoring system to indicate the need for __ in A-fib patients

A

anticoagulation

123
Q

There is NO need for ___ when anticoagulating a-fib patients

A

heparin bridging (this is because a-fib is a long term risk disease for stroke, and heparin carries an immediate bleeding risk)

124
Q

CHADS-VASc stands for:

A 
CHF
Hypertension
Age >75
Diabetes
Stroke/TIA
Vasclar disease + age 65-74
Sex (female)

Score of 2+ needs anticoag

125
Q

Bleeding with warfarin is reversible with

A

FFP

126
Q

What reverses dabigatran?

A

Idarucizumab

127
Q

Treat multifocal atrial tachycardia (MAT) with

A

oxygen first, then diltiazem

128
Q

Supraventricular tachycardia has a ___ rhythm

A

regular

129
Q

All cases of dysrhythmia should undergo ___

A

transthoracicechocardiography (TTE)

130
Q

If vagal maneuvers do not work in SVT patients, use __

A

IV adenosine

131
Q

Best long term management for SVT is

A

radiofrequency catheter ablation

132
Q

SVT that can alternate with ventricular tachycardia is

A

Wolff Parkinson White syndrome

133
Q

If SVT worsens after the use of CCBs or digoxin or beta blockers, it might be ___

A

wolff parkinson white

134
Q

Delta wave on EKG =

A

WPW

135
Q

Best initial therapy if a patient is in SVT or VT from WPW =

A

Procainamide

136
Q

Best long term tehrapy for WPW is

A

radiofraquency catheter ablation (just like SVT)

137
Q

___ should always be given in patients with

A

Torsad de pointes

138
Q

Ventricular fibrillation presents as

A

sudden death

139
Q

Always treat V-fib with

A

unsynchronized cardioversion

140
Q

Initial diagnostic testing for syncope should include these six things:

A 
Cardiac/neuro exam
EKG
Glucose
Pulse ox
CBC
Cardiac enzymes
141
Q

Patients requiring admission for syncope usually get put on a

A

Holter monitor (a 24-72 hour continous ambulatory EKG)

142
Q

The most important thing to do in syncope cases is to

A

Excluse a cardiac cause!

143
Q

For syncope you’ll usually be ordering these 4 tests:

A

EKG
Cardiac enzymes
Echo
Head CT

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