Cardiology Flashcards
Correcting which risk factor for CAD will result in the most immediate benefit for the patient?
Smoking
T/F: Ischemic pain is not tender, positional, or pleuritic?
True
Dx: chest wall tenderness?
Costochondritis
Dx: radiation to back, unequal BP between arms?
Aortic dissection
Dx: pain worse with lying flat, better with sitting up?
Pericarditis
Dx: cough, sputum, hemoptysis?
Pneumonia
Dx: sudden-onset SOB, tachycardia, hypoxia?
PE
Dx: sharp pleuritic pain, tracheal deviation?
Pneumothorax
What can dipyrimadole, adenosine, or dobutamine be used for?
Non-exercise stress test
What do you need to stop before a stress test (2)?
- B-blockers
2. Caffeine
Who needs coronary angiography?
People with reversible ischemia on stress test
What diagnostic procedure determines if a patient needs surgery vs angioplasty?
Angiography
For a patient with chronic angina, which 2 drugs will lower mortality?
- Aspiring
2. B-blockers
What metabolic derangement can ACE inhibitors cause?
Hyperkalemia
What’s the first line therapy in patients with stable angina?
B-blockers
What level of intensity are Atorvastatin and Rosuvastatin?
High intensity
What level of intensity are Fluvastatin, Lovastatin, Pitavastatin, Pravastatin, and Simvastatin?
Low intensity
What’s the most common adverse effect of statin meds?
Liver dysfunction
In severe hyperlipidemia when the LDL isn’t controlled even on max dose of statin, what can you use?
PCSK9 inhibitors
Which lipid-lowering medication has the adverse effect of elevations of transaminases and myositis?
Statins
Which lipid-lowering medication has the adverse effect of elevation in glucose and uric acid, and priuritis?
Niacin
Which lipid-lowering medication has the adverse effect of increased risk of myositis when combined with statins?
Fibric acid derivatives
Which lipid-lowering medication has the adverse effect of flatus and abdominal cramping?
Cholestyramine
Which lipid-lowering medication has very few adverse effects but barely helps anything?
Ezetimibe
What are the 3 instances when you would use a calcium channel blocker in CAD?
- Asthma
- Prinzmetal angina
- Cocaine-induced chest pain
What are the 3 most common adverse effects of calcium channel blockers?
- Edema
- Constipation
- Heartblock
In which 3 instances does CABG benefit a patient?
- 3 vessel disease with at least 70% in each
- L main coronary artery occlusion
- Two vessel disease in patient with DM
Which lasts longer, internal mammary or saphenous grafts?
Internal mammary (10 vs 5 years)
What’s another word for angioplasty?
PCI
What is Dressler syndrome?
Pericarditis after MI
Which is associated with greater mortality: MI in inferior wall or anterior wall?
Anterior wall
When does myoglobin become abnormal after MI?
1-4 hours
When do troponin and CK-MB become abnormal after MI?
4-6 hours
When do myoglobin and CK-MB go back to normal after MI?
1-2 days
When does troponin go back to normal after MI?
10-14 days
What organ insufficiency can cause falsely elevated troponin?
Renal insufficiency
What are the first 2 steps to checking for re-infarction if a patient has new chest pain within a few days after an MI?
- EKG
2. CK-MB levels
What’s the best way to prevent restenosis of the coronary artery after PCI?
Drug eluting stent that inhibits local T cell response (paclitaxel or sirolimus)
The mortality benefit of thrombolytics extends out to ___ hours from the onset of chest pain?
12
If there is no ST segment elevation, is there a benefit to thrombolytics?
No; give heparin
Do you give an antiplatelet drug to a non-ST elevation coronary syndrome?
Yes
Which heparin to give: LMWH (enoxaparin) or unfractionated?
LMWH has better mortality benefit
Post-MI dx: bradycardia and cannon a waves?
Third degree AV block
Post-MI dx: sudden loss of pulse, JVD?
Tamponade/wall rupture
Post-MI dx: new murmur, rales/congestion?
Valve rupture
Post-MI dx: new murmur, increase in O2 sat on entering R ventricle?
Septal rupture
In what cases do you use spironolactone post-MI?
EF<40%
Do not use a rhythm controlling agent to prevent the development of an arhhythmia– don’t be fooled by “frequent PVC’s and ectopy”
Cool
How many months post-MI do you give P2Y12 inhibitor?
12 months
Do not combine nitrates with what drug?
Sildenafil
What’s the most-common cause of post-MI erectile dysfunction?
Anxiety; B-blockers
When should a patient wait to re-engage in sexual activity post-MI?
2-4 weeks
What heart sound is present in CHF and sounds like “I believe?”
S3
What condition might rales indicate?
CHF
Dyspnea dx: sudden onset dyspnea, clear lungs?
PE
Dyspnea dx: sudden onset dyspena, wheezing, increased expiratory phase?
Asthma
Dyspnea dx: slower onset, fever, sputum, unilateral rales/rhonchi
Pneumonia
Dyspnea dx: decreased breath sounds unilaterally, tracheal deviation?
Pneumothorax
Dyspnea dx: circumoral numbness, caffeine use, h/o anxiety?
Panic attack
Dyspnea dx: pallor, gradual over days to weeks?
Anemia
Dyspnea dx: pulsus paradoxus, decreased heart sounds, JVD?
Tamponade
Dyspnea dx: palpitations, syncope?
Arrhythmia of any kind
Dyspnea dx: dullness to percussion at bases?
Pleural effusion
Dyspnea dx: long smoking history, barrel chest?
COPD
Dyspnea dx: recent anesthetic use, brown blood not improved with oxygen, clear lungs on auscultation, cyanosis?
Methemoglobinemia
Dyspnea dx: burning building or car, wood-burning stove in winter, suicide attempt?
Carbon monoxide poisoning
Will any of those dyspnea dx questions have an S3 gallop?
No
When do you use digoxin?
Low EF (systolic HF)
What are the 3 proven B-blockers for systolic dysfunction?
- Metoprolol
- Carvedilol
- Bisoprolol
When are B-blockers contraindicated in HF?
When the patient is acutely decompensated
Do diuretics lower mortality in CHF?
No, they just control sx
Does digoxin lower mortality in CHF?
No, it just decreases the frequency of hospitalizations
Can lisinopril cause hyperkalemia?
Yes
If EF is under 35%, what’s a good treatment device?
Pacemaker or defibrillator
What are 2 treatments that are beneficial in diastolic HF?
- Spironolactone
2. Diuretics
Does pulmonary edema present with an S3 sound?
Yes
Does a normal BNP level exclude pulmonary edema?
Yes
Mitral stenosis presents during pregnancy because there is a 50% increase in _____ ______?
Plasma volume
Which valvular disease has: Dysphagia Hoarseness Afib Hemoptysis?
CHF associated with mitral stenosis
Why does hoarseness occur?
Laryngeal nerve compression from LA
The enlargement of which atrium causes elevation of the L mainstem bronchus?
Left atrium
Which atrium is enlarged in mitral stenosis?
L atrium
