Cardiology

Question 1

Mechanism of S3 gallop

Answer 1

Rapid ventricular filling during diastole, a splash sound

Question 2

Mechanism of S4

Answer 2

sound of atrial systole into a stiff or noncompliant left ventricle, the bang sound

Question 3

If someone is having ischemic pain, what is the VERY FIRST thing that you do?

Answer 3

give aspirin, do the tx first

Question 4

What is the main difference between CK MB and Troponin?

Answer 4

CKMB only stays elevated 1-2 days while troponin stays elevated for 1-2 weeks

Question 5

What thing will rise first in an ischemic event?

Answer 5

myoglobin, rises 1-4 hrs after start of chest pain

Question 6

What are the drugs we use to induce stress if pt cant exercise?

Answer 6

dipyridamole, adenosine, or dobutamine

Question 7

What do you do if someone shows reversible ischemia on stress test?

Answer 7

angiography!

Question 8

Mechanism of Thallium

Answer 8

gets picked up by Na/K ATPase of normal myocardium… it’s nuclear, we see it

Question 9

What else besides aspirin needs to be given in ACS?

Answer 9

Nitrates and morphine… but they DO NOT lower mortality

Question 10

What do you give with aspirin if pt is having acute MI?

Answer 10

Clopidogrel or ticagrelor (thienopyridine class)

Question 11

What is given only when angioplasty is done?

Answer 11

Prasugrel (they are all P2Y12 antagonisits, keep platelets from sticking to each other)

Question 12

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

Answer 12

Urgent angioplasty (PCI)

Question 13

When should PCI be done?

Answer 13

within 90 minutes of arrival in the ER

Question 14

What happens if a person with MI is there for more than 90 minutes and no PCI has been done?

Answer 14

thrombolytics

Question 15

When should someone receive thrombolytics?

Answer 15

chest pain for <12 hours and has ST elevation in 2 or more leads

Question 16

Mechanism of thrombolytics?

Answer 16

activate plasminogen into plasmin, which chops up fresh or newly formed fibrin stands into D dimers… after several hours, the fibrin clot has been stabilized by factor XIII… then plasmin cannot cleave it

Question 17

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

Answer 17

ventricular arrhythmia brought on by ischemia

Question 18

What are the things that always lower mortality in ACS?

Answer 18

Aspirin
Thrombolytics
Primary angioplasty
Metoprolol
Statins
Clopidogrel, prasurgrel, or ticagrelor

Question 19

How long does a guy have to wait to have sex after an MI?

Answer 19

2-6 weeks

Question 20

What are some of the predominate differences in the management of NSTEMI’s as opposed to STEMI’s

Answer 20

no thrombolytic use
heparin is used routinely (LMWH>unfractionated)
Glycoptn 2b/3a inhibitors lower mortality, particularly in those undergoing angioplasty

Question 21

Mechanism of heparin

Answer 21

heparin potentiates the effect of antithrombin. antithrombin inhibits almost every step of the clotting casade…. this is why it does not work with antithrombin deficiency… heparin only prevents new clots from forming

Question 22

When are the GP2a/3b inhibitors really useful… in combination with….

Answer 22

angioplasty and stent placement

Question 23

When is the only time thrombolytics are used?

Answer 23

if there is ST segment elevation or a new LBBB within 12 hrs of the onset of chest pain

Question 24

What is a side effect of both ACEI’s and ARBs?

Answer 24

hyperkalemia

Question 25

What drug do you use if a statin is not working and you’ve maxed out the dose?

Answer 25

PCSK9 inhibitors.. PCSK9 blocks the clearance of LDL by the liver from blood

Question 26

What is the MOA of Carvediliol?

Answer 26

B1, 2, and alpha 1 antagonists… makes it anti-arrhythmic, anti-ischemic, and antihypertensive

Question 27

Why do people with CHF have alkalosis?

Answer 27

hypoxia, hyperventilation, decreased PCO2, alkalosis

Question 28

What are some inotropic drugs to be used in the ICU?

Answer 28

Dobutamine or milrinone

Question 29

In general, how do you deal with pulmonary edema?

Answer 29

preload reduction

Question 30

What are the 3 drugs that lower mortality in CHF?

Answer 30

Ace inhibitors, Beta blockers, spironolactone

-diuretics are purely symptomatic management

Question 31

If the CHF patient is still dyspneic after using Ace inhibitors, beta blockers, and diuretics and everything else, what do we turn to?

Answer 31

Ivabradine or sacubitril/valsartan

Question 32

What CHF med causes transient excess brightness of vision?

Answer 32

Ivabradine

Question 33

When will biventricular pacemaker be good for CHF?

Answer 33

it decreases mortality in ppl with EF <35% and a QRS >120msec

Question 34

What are the systolic murmurs?

Answer 34

Aortic stenosis, mitral regurge, mitral prolapse, HOCM

Question 35

Which way of breathing increases the intesity of right sided murmurs?

Answer 35

inhalation… the opposite is true for left

Question 36

What does aquatting and lifting legs in air do to venous return?

Answer 36

increase it

Question 37

What does valsalva maneuver and standing up do?

Answer 37

decrase venous return to heart

Question 38

what does the handgrip maneuver do?

Answer 38

increase afterload… opposite of ACe inhibitor

Question 39

What does amyl nitrate do?

Answer 39

decreases afterload

Question 40

Where will you hear aortic stenosis murmur the best?

Answer 40

second right intercostal space and radiates to the carotids… crescendo decrescendo

Question 41

How are regurtitant lesion treated?

Answer 41

Vasodilator therapy

Question 42

How are stenotic lesions treated?

Answer 42

anatomic repair

Question 43

Mechanism of syncope and Angina in AS

Answer 43

a stiff valve just proximal to the entry point of the coronaries blocks the blood flo intob the vertberal and basilary ariteries and carotids….. no flow to the brain … passing out,,, thus. s causes LV hypertropby,…. LC phypertrophy equeals increased demand…..

AS… blocked fow ith increased demand…. chest pain