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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?

A

LDL <70

25
Q

What diseases do you automatically give a statin for regardless of LDL?

A

PAD, aortic disease, CAROTID disease, CEREBROvascular disease

26
Q

What is the mechanism of rales?

A

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
Q

Tx for acute pulmonary edema?

A

O2, furosemide, Nitrates, morphine

28
Q

Pt comes in for acute pulmonary edema. You give MON + loop. 30-60min later the patient has not improved. What is the next step?

A

give a positive inotropic agent(dobutamine(#1) or inamrinone or milrinone)

29
Q

Pulmonary Capillary Wedge pressure = ?

A

left atrial pressure! => inflated balloon blocks pressure from behind the cathether, the downstream pressure its measuring is the left atrial

30
Q

Which drugs decrease mortality in CHF?

A

ACE/ARB, BB, Spironolactone/Eplerenone

31
Q

Pt was treated for acute pulmonary edema and is now feeling much better. What must you do before you discharge them?

A

Echo! need to figure out if this was systolic or diastolic dysfunction.

32
Q

What CHF medication will cause a transient excess brightness of vision?

A

Ivabradine

33
Q

CHF due to diastolic dysfunction is treated with….

A

BB & diuretics only

34
Q

Treatment for CHF due to systolic dysfunction?

A

ACE, BB, Spironolactone

35
Q

Which BB have been proven to decrease mortality with CHF?

A

metoprolol, carvedilol, Bisoprolol

36
Q

When do you recommend a implantable cardioverter/defibillator for CHF?

A

EF <35

37
Q

When do you recommend a biventricular pacemaker for CHF?

A

EF <35 with a QRS >120 ms

38
Q

Squat & leg raise will decrease which murmers?

A

HOCM & MVP

39
Q

Stand & valsalva will increase which murmers?

A

HOCM & MVP

40
Q

Which murmers will decrease with hand grip?

A

HOCM, MVP & MS

*amyl nitrate is opposite handgrip

41
Q

If valsalva improves the murmer you should give…

A

diuretics

42
Q

If amyl nitrate improves murmer you should give…

A

ACEi

43
Q

Physical exam findings of aortic regurge?

A

Quincke pulse, Corrigan pulse, musset sign, duroziez sign, hill sign

44
Q

What is: Quincke Pulse?

A

arterial or capillary pulsation in the fingernails - seen with AR

45
Q

What is: Corrigan Pulse?

A

high bounding pulses(water-hammer pulse”) - see with AR

46
Q

What is : Musset Sign?

A

head bobbing up and down with each pulse - seen with AR

47
Q

What is: Duroziez Sign?

A

murmur head over the femoral artery - seen with AR

48
Q

What is: Hill Sign?

A

blood pressure gradient much higher in the lower extremities - seen with AR

49
Q

Physical exam sx of MS?

A

A-fib, dysphagia(enlarged atrium pressing on esophagus), Hoarseness(pressure on recurrent laryngeal nerve)

50
Q

When do you see kussmauls sign?

A

Kussmaul Sign = increased JVD with inhalation.

seen with restrictive cardiomyopathy(will also have a low voltage EKG with restrictive cardiomyopathy)

51
Q

You pick up an EKG and see global ST elevation. Whats the first thing you think?

A

pericarditis

52
Q

When would you expect to hear a pericardial knock?

A

PK = extra diastolic sound from the heart hitting a calcified thickened pericardium

would expect this in constrictive pericarditis

53
Q

What is a normal ABI?

A

normal ABI >/= 0.9

54
Q

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?

A
  • 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
Q

What is the CHADS-VASc score? What is needed to start anticoagulation?

A 
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
Q

Tx for acute A-fib?

A

If unstable = synchronized cardioversion
If stable = rate control wiht BB, CCB, digoxin

then anticoagulation if indicated

57
Q

A patient has A-flutter and requires rate control but also has boarderline hypotension(so no BB!) what drug would you give them?

A

Digoxin

58
Q

A patient has A-flutter and requires rate control but also has Asthma or Migraines(so no BB!) what drug would you give them?

A

CCB

MTBs Step 3 (30 decks)

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