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MTBs Step 3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Risk factors for CVD?

A
  • DM
  • HTN
  • Tobacco use
  • hyperlipidemia
  • PAD
  • obesity, inacitvity
  • YOUNG family history( F <65 & M <55)
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2
Q

5 clues to ischemic chest pain?

A

Dull pain, lasts 15-30 min, occurs on exertion, substernal location, radiates to the jaw or the left arm.

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3
Q

What is the mechanism of an S3 gallop?

A

rapid ventricular filling during diastole. As soon as the MV opens, blood rushes into the ventricle, causing a splash sound transmitted as an S3

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4
Q

What is the mechanism of an S4 gallop?

A

Sound of the atrial systole into a stiff or non-compliant left ventricle. S4 is the bang of the atrial systole.

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5
Q

Pt in the hospital with an MI. 3 days later he is having chest pain and you suspect another MI. Which labs do you check?

A

CK-MB!

Troponin will be elevated for 1-2 weeks. CK-MB lasts 1-2 days.

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6
Q

Which cardiac enzyme will rise first?

A

myoglobin

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7
Q

Whats the rule for thrombolytics with MI?

A
  • If PCI cannot be performed within 90min of arrive in the ED then do thrombolytics.
  • chest pain <12 hrs + ST segment elevation in 2+leads
  • new LBBB
  • thrombolytics should be given within 30 min of arrival to ED
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8
Q

6 things used in ACS that always lower mortality.

A
  1. ASA
  2. thrombolytics
  3. angioplasty
  4. metoprolol
  5. statins
  6. clopidogrel, prasugrel or ticagrelor

*this is not a ranking

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9
Q

When would you chose CCB for ACS?

A

If the patient is intolerant to BB(asthma), cocaine-induced chest pain & prinzmetal angina.

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10
Q

Tx for cardiogenic shock

A

ACEi + revascularization

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11
Q

Tx for valve rupture

A

ACEi, Nitro, intra-aortic balloon pump as bridge to surgery

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12
Q

Tx for Septal Rupture

A

ACEi + nitro, urgen surgery

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13
Q

Tx for Myocardial wall rupture

A

pericardiocentesis, urgent cardiac repair

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14
Q

Tx for sinus bradycardia

A

atropine + pacemaker if there are still symptoms

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15
Q

Tx for 3red degree heart block

A

Atropine + pacemaker even if symptoms resolve

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16
Q

Tx for Right sided MI

A

fluid loading

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17
Q

Management for NSTEMI?

A

no thrombolytics, Heparin or LMWH, GP2b/3a inhibitors lower mortality, +angioplasty

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18
Q

Do nitrates lower mortality?

A

NO!

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19
Q

Treatment for Chonic Angina?

A
  • ASA + BB = decreases mortality
  • Nitrates for pain as need
  • ACE/ARB if CHF or low EF
  • statin

(clopidogrel if cannot tolerate ASA)

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20
Q

What is the main difference between a saphenous vein graft and an internal mammary artery graph?

A

vein = ~5 years before reocclusion

artery= ~10 years before reocclusion

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21
Q

Indications for CABG?

A
  • 3 vessel disease with >70% stenosis
  • LAD stenosis 50-70%
  • 2 vessels in a diabetic
  • 2-3 vessels with a low EF
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22
Q

What is the target LDL for pt with CAD?

A

LDL <70

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23
Q

Which pt with CAD need a statin?

A

those with an LDL >100

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24
Q

Target LDL for a pt with CAD + DM?

25
What diseases do you automatically give a statin for regardless of LDL?
PAD, aortic disease, CAROTID disease, CEREBROvascular disease
26
What is the mechanism of rales?
increased hydrostatic pressure develops in the pulmonary capillaries from the left heart pressure overload(CHF). This causes transdation of liquid into the alveoli. During inhalation, the alveoli open with a "popping" sounds referred to as rales.
27
Tx for acute pulmonary edema?
O2, furosemide, Nitrates, morphine
28
Pt comes in for acute pulmonary edema. You give MON + loop. 30-60min later the patient has not improved. What is the next step?
give a positive inotropic agent(dobutamine(#1) or inamrinone or milrinone)
29
Pulmonary Capillary Wedge pressure = ?
left atrial pressure! => inflated balloon blocks pressure from behind the cathether, the downstream pressure its measuring is the left atrial
30
Which drugs decrease mortality in CHF?
ACE/ARB, BB, Spironolactone/Eplerenone
31
Pt was treated for acute pulmonary edema and is now feeling much better. What must you do before you discharge them?
Echo! need to figure out if this was systolic or diastolic dysfunction.
32
What CHF medication will cause a transient excess brightness of vision?
Ivabradine
33
CHF due to diastolic dysfunction is treated with....
BB & diuretics only
34
Treatment for CHF due to systolic dysfunction?
ACE, BB, Spironolactone
35
Which BB have been proven to decrease mortality with CHF?
metoprolol, carvedilol, Bisoprolol
36
When do you recommend a implantable cardioverter/defibillator for CHF?
EF <35
37
When do you recommend a biventricular pacemaker for CHF?
EF <35 with a QRS >120 ms
38
Squat & leg raise will decrease which murmers?
HOCM & MVP
39
Stand & valsalva will increase which murmers?
HOCM & MVP
40
Which murmers will decrease with hand grip?
HOCM, MVP & MS *amyl nitrate is opposite handgrip
41
If valsalva improves the murmer you should give...
diuretics
42
If amyl nitrate improves murmer you should give...
ACEi
43
Physical exam findings of aortic regurge?
Quincke pulse, Corrigan pulse, musset sign, duroziez sign, hill sign
44
What is: Quincke Pulse?
arterial or capillary pulsation in the fingernails - seen with AR
45
What is: Corrigan Pulse?
high bounding pulses(water-hammer pulse") - see with AR
46
What is : Musset Sign?
head bobbing up and down with each pulse - seen with AR
47
What is: Duroziez Sign?
murmur head over the femoral artery - seen with AR
48
What is: Hill Sign?
blood pressure gradient much higher in the lower extremities - seen with AR
49
Physical exam sx of MS?
A-fib, dysphagia(enlarged atrium pressing on esophagus), Hoarseness(pressure on recurrent laryngeal nerve)
50
When do you see kussmauls sign?
Kussmaul Sign = increased JVD with inhalation. seen with restrictive cardiomyopathy(will also have a low voltage EKG with restrictive cardiomyopathy)
51
You pick up an EKG and see global ST elevation. Whats the first thing you think?
pericarditis
52
When would you expect to hear a pericardial knock?
PK = extra diastolic sound from the heart hitting a calcified thickened pericardium would expect this in constrictive pericarditis
53
What is a normal ABI?
normal ABI >/= 0.9
54
You have a patient who showed up with A-fib. Pt says they have never been told they had A-fib before. What labs do you need to order to further investigate this?
* Echo - looking for clots, valve function & LA size * Thyroid - T4 and TSH * Electrolytes - K, Mg, Ca * Troponin & CK-MB - lets make sure this wasnt an MI
55
What is the CHADS-VASc score? What is needed to start anticoagulation?
``` CHF HTN Age >75 Diabetes Stroke or TIA (2 points) Vascular disease Age 65-75 Sex = F ``` *score of 1 = ASA score of 2+ needs warfarin or LMWH`
56
Tx for acute A-fib?
If unstable = synchronized cardioversion If stable = rate control wiht BB, CCB, digoxin then anticoagulation if indicated
57
A patient has A-flutter and requires rate control but also has boarderline hypotension(so no BB!) what drug would you give them?
Digoxin
58
A patient has A-flutter and requires rate control but also has Asthma or Migraines(so no BB!) what drug would you give them?
CCB

MTBs Step 3 (30 decks)

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