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STEP 2 CK > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What must be evaluated in a ECG?

A 
Rate
Rhythm
Axis
Intervals
Ischemia/infarction
Chamber enlargement
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2
Q

What is considered bradycardia?

A

HR < 60 bpm

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3
Q

What are the most common causes of sinus bradycardia?

A 
Physical fitness
Sick sinus syndrome
Drugs
Vasovagal attacks
Acute MI
Increased intracranial pressure
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4
Q

What is considered tachycardia?

A

HR > 100bpm

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5
Q

What are the most common causes of sinus tachycardia?

A 
Anxiety
Anemia
Pain
Fever
Sepsis
CHF
PE
Hypovolemia
Thyrotoxicosis
CO2 retention
Sympathomimetics
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6
Q

What characterizes a sinus rhythm?

A

P wave (upright in II, III, and aVF; inverted in aVR) preceding every QRS complex and a QRS complex after every P wave

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7
Q

What are the leads used to determine the ECG axis?

A

Leads I, II, and aVF

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8
Q

What is considered a normal PR interval?

A

Between 120-200 ms

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9
Q

What can cause a prolonged PR interval?

A

Delayed AV conduction

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10
Q

What can cause a shortened PR interval?

A

Fast AV conduction down accessory pathway (e.g., WPW syndrome)

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11
Q

What is considered a normal QRS duration?

A

Duration < 120ms

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12
Q

How is a left bundle branch block presented in a ECG?

A

Deep S and no R in V1

Wide, tall, and broad, or notched R wave in I, V5, and V6

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13
Q

What can a new LBBB be sign of?

A

Acute MI

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14
Q

How is a right bundle branch block presented in a ECG?

A

RSR’ complex
qR or R morphology with a wide R wave in V1
Wide S wave in I, V5 and V6

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15
Q

What is the duration of a normal corrected QT interval (QT/√RR)?

A

Between 380-440 ms

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16
Q

What are common causes of prolonged cQT?

A 
Congenital syndromes
Long QT syndrome
Jervell and Lange-Nielsen syndrome
Acute MI
Bradycardia
Myocarditis
Low K, Ca, or Mg
Head injury
Drugs
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17
Q

What is the Jervell and Lange-Nielsen syndrome?

A

Long QT syndrome due to defect K conduction, associated with sensorineural deafness

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18
Q

What is the treatment of Jervell and Lange-Nielsen syndrome?

A

Beta-blockers and pacemaker

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19
Q

What are acute ischemia signs in ECG within hours?

A

Peaked T waves and ST segment changes

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20
Q

What are acute ischemia signs in ECG within 24 hours?

A

T wave inversion and ST segment resolution

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21
Q

What are acute ischemia signs in ECG within a few days?

A

Pathologic Q waves (> 40ms or more than 1/3 of QRS amplitude)

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22
Q

What are the difference of subendocardial infarcts?

A

ST and T changes without Q waves

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23
Q

What is found in a ECG of a patient with right atrial enlargement?

A

The P wave amplitude in lead II is > 2.5mm

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24
Q

What is found in a ECG of a patient with left atrial enlargement?

A

The P wave width in lead II is > 120ms

Termina negative deflection in V1 is > 1mm in amplitude and > 40ms in duration

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25
Q

How a left ventricular hypertrophy can be shown in ECG?

A

Amplitude of S in V1 + R in V5 or V6 > 35mm

Amplitude of R in aVL + S in V3 > 28mm in men or 20mm in women

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26
Q

How a right ventricular hypertrophy can be shown in ECG?

A

Right axis deviation

R wave in V1 > 7mm

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27
Q

How to assess if there is jugular venous distention?

A

JVD > 4cm above the sternal angle

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28
Q

What is the cause of jugular venous distention?

A

Volume overload

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29
Q

What are common causes of volume overload, which presents as JVD?

A

Right heart failure

Pulmonary hypertension

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30
Q

What is the hepatojugular reflux?

A

Distention of neck veins upon applying pressure to the liver

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31
Q

What is the Kussmaul sign?

A

An increase in jugular venous pressure with inspiration

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32
Q

What is the most common cause of the Kussmaul sign?

A

Constrictive pericarditis

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33
Q

What are the systolic murmurs?

A

Aortic stenosis
Mitral regurgitation
Mitral valvev prolapse
Flow murmur

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34
Q

How is the aortic stenosis murmur like?

A

Harsh systolic ejection murmur that radiates to the carotids

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35
Q

How is the mitral regurgitation murmur like?

A

Holosystolic murmur that radiates to the axilla

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36
Q

How is the mitral valve prolapse murmur like?

A

Midsystolic or late systolic murmur with a preceding click

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37
Q

How is the flow murmur murmur like?

A

Soft murmur that is position-dependent

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38
Q

What are the diastolic murmurs?

A

Aortic regurgitation

Mitral stenosis

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39
Q

How is the aortic regurgitation murmur like?

A

An early decreascendo murmur

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40
Q

How is the mitral stenosis murmur like?

A

Mid to late low-pitched murmur

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41
Q

What is the S3 gallop sign of?

A

Fluid overload

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42
Q

What are common causes of S3 gallop?

A

Heart failure
Mitral valve disease
Pregnancy

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43
Q

What is the S4 gallop sign of?

A

Decreased compliance

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44
Q

What are common causes of S4 gallop?

A

Hypertension
Aortic stenosis
Diastolic dysfunction

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45
Q

What is the main cause of pulmonary edema?

A

Left heart failure

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46
Q

What are the most common causes of peripheral edema?

A 
Right heart failure
Nephrotic syndrome
Hepatic disease
Lymphedema
Hypoalbuminemia
Drugs
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47
Q

What are the main causes of finger clubbing?

A

Congenital cyanotic heart disease

Endocarditis

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48
Q

What are the main physical exam findings of infective endocarditis?

A

Splinter hemorrhages
Osler nodes
Janeway lesions

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49
Q

What are Osler nodes?

A

Painful, red, raised lesions found on the hands and feet

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50
Q

What are Janeway lesions?

A

Non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter

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51
Q

Which murmurs increase with inspiration?

A

Right-sided murmurs

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52
Q

Which murmurs increase with expiration?

A

Left-sided murmurs

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53
Q

What are causes of right axis deviation?

A

Right ventricular hypertrophy
Anterolateral MI
Left posterior hemiblock

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54
Q

What are causes of left axis deviation?

A

Ventricular tachycardia
Inferior myocardial infarction
Left ventricular hypertrophy
Left anterior hemiblock

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55
Q

What are causes of increased peripheral pulses?

A

Compensated aortic regurgitation
Coarctation of aorta
Patent ductus arteriosus

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56
Q

What are causes of decreased peripheral pulses?

A

Peripheral arterial disease

Late-stage heart failure

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57
Q

What are causes of collapsing (“waterhammer”) peripheral pulses?

A 
Aortic incompetence
AV malformations
Patent ductus arteriosus
Thyrotoxicosis
Severe anemia
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58
Q

What is pulsus paradoxus?

A

Decrease of systolic BP > 10mmHg with inspiration

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59
Q

What are causes of pulsus paradoxus?

A 
Cardiac tamponade
Pericardial constriction
Obstructive lung diseases
Tension pneumothorax
Foreign body in airway
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60
Q

What are causes of pulsus alternans?

A

Cardiomyopathy

Impaired left ventricular systolic function

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61
Q

What is the main cause of pulsus parvus et tardus?

A

Aortic stenosis

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62
Q

What is the main cause of a jerky peripheral pulse?

A

Hypertrophic obstructive cardiomyopathy

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63
Q

What are causes of pulsus bisferiens?

A

Aortic regurgitation
Combined aortic regurgitation and stenosis
Hypertrophic obstructive cardiomyopathy

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64
Q

What drugs can cause sinus bradycardia?

A

Beta blockers

Calcium channel blockers

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65
Q

What are the signs and symptoms of sinus bradycardia?

A

Generally asymptomatic

May present as lightheadedness, syncope, chest pain, or hypotension

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66
Q

What are the ECG findings of sinus bradycardia?

A

Sinus rhythm

HR < 60 bpm

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67
Q

What is the treatment of sinus bradycardia?

A

If asymptomatic and HR > 40 bpm: none
Atropine if symptomatic or HR < 40 bpm
Pacemaker implant is the definitive treatment

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68
Q

What is the ECG finding of a first-degree AV block?

A

PR interval > 200ms

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69
Q

What are the causes of a first-degree AV block?

A

Can occur in normal individuals
Associated with increased vagal tone
Beta-blocker use
CCB use

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70
Q

What are the signs/symptoms of a first-degree AV block?

A

Asymptomatic

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71
Q

What is the treatment of a first-degree AV block?

A

None necessary

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72
Q

What is the ECG finding of a second-degree AV block (Mobitz I/Wenckebach)?

A

Progressive PR lenghtening until a dropped beat occurs; the PR interval then resets

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73
Q

What are the causes of a second-degree AV block (Mobitz I/Wenckebach)?

A

Drugs effects (Digoxin, Beta-blockers, CCBs)
Increased vagal tone
Right coronary ischemia or infarction

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74
Q

What is the treatment of a second-degree AV block (Mobitz I/Wenckebach)?

A

None if asymptomatic
Stop the offending drug
Atropine as clinically indicated

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75
Q

What are the signs/symptoms of a second-degree AV block (Mobitz I/Wenckebach)?

A

Usually asymptomatic

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76
Q

What is the ECG finding of a second-degree AV block (Mobitz II)?

A

Unexpected dropped beat(s) without a change in PR interval

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77
Q

What are the signs/symptoms of a second-degree AV block (Mobitz II)?

A

Occasionally syncope

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78
Q

What are the main causes of a second-degree AV block (Mobitz II)?

A

Results from fibrotic disease of the conduction system or from acute, subacute, or prior MI

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79
Q

To what can a second-degree AV block (Mobitz II) progress to?

A

A third-degree AV block

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80
Q

What is the treatment of a second-degree AV block (Mobitz II)?

A

Pacemaker placement (even if asymptomatic)

81
Q

What is the ECG finding of a third-degree AV block (complete)?

A

No relationship between P waves and QRS complexes

82
Q

What is the cause of a third-degree AV block (complete)?

A

No electrical communication between the atria and ventricles

83
Q

What are signs/symptoms of a third-degree AV block (complete)?

A

Syncope, dizzines, acute heart failure, hypotension, cannon A waves

84
Q

What is the treatment of a third-degree AV block (complete)?

A

Pacemaker placement

85
Q

What is the sick sinus syndrome?

A

Heterogenous disorder that elads to intermittent supraventricular tachyarrhythmias and bradyarrhythmias

86
Q

How is the sick sinus syndrome also called?

A

Tachycardia-bradycardia syndrome

87
Q

What are signs/symptoms of the sick sinus syndrome?

A

Symptoms of tachycardia and bradycardia

AF and thromboembolism may occur

88
Q

What is the most common indication for pacemaker placement?

A

Sick sinus syndrome

89
Q

What is the treatment for patients with persistent tachyarrhythmias with hemodynamic intability?

A

Immediate synchronized cardioversion

90
Q

What is the ECG finding of a sinus tachycardia?

A

Sinus rhythm with HR > 100 bpm

91
Q

Sinus tachycardia is usually primary or secondary to another state?

A

Usually secondary

92
Q

What are signs/symptoms of sinus tachycardia?

A

Palpitations, shortness of breath

93
Q

What is the treatment of sinus tachycardia?

A

Treat the underlying cause

94
Q

What are the causes of acute atrial fibrillation?

A 
PIRATES:
Pulmonary disease
Ischemia
Rheumatic heart disease
Anemia/Atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
95
Q

What are the causes of chronic atrial fibrillation?

A

Hypertension
CHF
Most oftern caused by ectopic foci within the pulmonary veins

96
Q

What is the ECG finding of a atrial fibrillation?

A

No discernible P waves, with variable and irregular QRS response

97
Q

What is the treatment for an unstable or new-onset (< 2 days) AF?

A

Cardioversion

98
Q

What is the treatment for a new AF with > 2 days or unclear duration?

A

Must get TEE to rule out atrial clot

99
Q

What is the treatment for chronic AF?

A

Rate control with Beta-blockers, CCBs, or Digoxin

Anticoagulate with Warfarin or NOACs for patients with CHA2DS2-VASc score >= 2

100
Q

What is the ECG finding of a atrial flutter?

A

Regular rhythm, with atrial rate usually between 240-320 bpm, and ventricular rate of 150bpm
“Sawtooth” appearance of P waves

101
Q

What is the cause of the atrial flutter?

A

Circular movement of electrical activity around the atrium at a rate of approximately 300 bpm

102
Q

What is the treatment of the atrial flutter?

A

Anticoagulation, rate control, and cardioversion guidelines as in AF

103
Q

What is the ECG finding of a multifocal atrial tachycardia?

A

Three or more unique P-wave morphologies with rate > 100 bpm

104
Q

What is the cause of multifocal atrial tachycardia?

A

Multiple atrial pacemakers or reentrant pathways

105
Q

What is associated with multifocal atrial tachycardia?

A

COPD, hypoxemia

106
Q

What is the treatment of multifocal atrial tachycardia?

A

Treat as AF, but avoid Beta-blockers if COPD

107
Q

What is the ECG finding of a atrioventricular nodal reentry tachycardia (AVNRT)?

A

Rate 150-250 bpm

P wave is often buried in QRS or shortly after

108
Q

What is the cause of a atrioventricular nodal reentry tachycardia (AVNRT)?

A

A reentry circuit in the AV node depolarizes the atrium and ventricle nearly simultaneously

109
Q

What is the treatment of atrioventricular nodal reentry tachycardia (AVNRT)?

A

Cardiovert is hemodinamically unstable
Vagal maneuvers
Adenosine if vagal maneuver fails

110
Q

What are the ECG findings of a atrioventricular reentry tachycardia (AVRT)?

A

A retrograde P wave is often seen after a normal QRS

A reexcitation delta wave is characteristically seen in WPW

111
Q

What is the cause of atrioventricular reentry tachycardia (AVRT)?

A

An ectopic connection between the atrium and ventricle that causes a reentry circuit

112
Q

What is the treatment of atrioventricular reentry tachycardia (AVRT)?

A

Cardiovert is hemodinamically unstable
Vagal maneuvers
Adenosine if vagal maneuver fails
Except for WPW

113
Q

What is the ECG finding of Wolff-Parkinson-White (WPW) syndrome?

A

Characteristic delta wave with widened QRS complex and shortened PR interval

114
Q

What is the cause of Wolff-Parkinson-White (WPW) syndrome?

A

Abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent)

115
Q

What is the treatment of Wolff-Parkinson-White (WPW) syndrome?

A

Observe the asymptomatics
Acute therapy is Procainamide or Amiodarone
Radiofrequency catheter ablation is curative
SVT gets worse after CCBs or Digoxin

116
Q

What is the ECG finding of paroxysmal atrial tachycardia?

A

Rate > 100bpm; P wave with an unusual axis before each normal QRS

117
Q

What is the cause of paroxysmal atrial tachycardia?

A

Rapid ectopic pacemaker in the atrium (not sinus node)

118
Q

What is the treatment of paroxysmal atrial tachycardia?

A

Adenosine can be used to unmask underlying atrial activity by slowing down the rate

119
Q

What are the ECG findings of premature ventricular contraction?

A

Early, wide QRS not preceded by a wave

PVCs are usually followed by a compensatory pause

120
Q

What is the cause of premature ventricular contraction?

A

Ectopic beats arise from ventricular foci

121
Q

What are associated conditions to premature ventricular contraction?

A 
Hypoxia
Fibrosis
Decreased LV function
Electrolyte abnormalities
Hyperthyroidism
122
Q

What is the treatment of premature ventricular contraction?

A

Treat the underlying cause

If symptomatic, give Beta-blockers or, occasionally, other antiarrhythmics

123
Q

What is the ECG findings of a ventricular tachycardia?

A

3 or more consecutive PVCs; wide QRS complexes in a regular rapid rhythm; may see AV dissociation

124
Q

What is the associations of ventricular tachycardia?

A

CAD
MI
Structural heart disease

125
Q

What is the treatment of ventricular tachycardia?

A

Cardioversion if unstable

Antiarrhythmics if stable

126
Q

What can a ventricular tachycardia progress to?

A

Ventricular fibrillation

127
Q

What is the ECG finding of a ventricular fibrillation?

A

Totally erratic wide-complex tracing

128
Q

What is associated with ventricular fibrillation?

A

CAD

Structural heart disease

129
Q

What is the treatment of ventricular fibrillation?

A

Immediate electrical defibrillation and ACLS protocol

130
Q

What is the ECG finding of Torsades de pointes?

A

Polymorphous QRS; VT with rates between 150 and 250 bpm

131
Q

What is associated with Torsades de pointes?

A 
Long QT syndrome
Proarrhythmic response to medications
Hypokalemia
Congenital deafness
Alcoholism
132
Q

What is the treatment of Torsades de pointes?

A

Magnesium initially and cardiovert if unstable

Correct hypokalemia and withdraw offending drugs if it is the cause

133
Q

What are the classes of NYHA functional classification of CHF?

A

I: No limitation of activity; no symptoms (palpitations, dyspnea, and fatigue) with normal activity
II: Slight limitation of activity; comfortable at rest or with mild exertion
III: Marked limitation of activity; comfortable only at rest
IV: Any physical activity brings on discomfort; symptoms (palpitations, dyspnea, and fatigue) present at rest

134
Q

(HFrEF) Usually, what is the patient age?

A

< 65 years of age

135
Q

(HFrEF) What are the most common comorbidities?

A

Dilated cardiomyopathy
Valvular heart disease
Myocardial infacrtion

136
Q

(HFrEF) What can be found in the physical exam?

A

Displaced PMI

S3 gallop

137
Q

(HFrEF) What can be found in the CXR?

A

Pulmonary congestion

Cardiomegaly

138
Q

(HFrEF) What can be found in the ECG/echocardiography?

A 
Q waves in ECG
Decreased EF (<40%) and heart dilation in ECHO
139
Q

(HFpEF) Usually, what is the patient age?

A

> 65 years of age

140
Q

(HFpEF) What are the most common comorbidities?

A

Restrictive of hypertrophic cardiomyopathy
Renal disease
HTN

141
Q

(HFpEF) What can be found in the physical exam?

A

Sustained PMI

S4 gallop

142
Q

(HFpEF) What can be found in the CXR?

A

Pulmonary congestion

143
Q

(HFpEF) What can be found in the ECG/echocardiography?

A

LVH in ECG

Normal/preserved EF (>55%), abnormal LV diastolic indices in ECHO

144
Q

What is the most common cause of right-sided heart failure?

A

Left-sided heart failure

145
Q

What is an independent predictor of mortality in patients with heart failure?

A

Hyponatremia

146
Q

What is HFrEF characterized by?

A

Decreased EF (<40%) and increased LV end-diastolic volumes

147
Q

What is HFrEF caused by?

A

Inadequate LV contractility or increased afterload

148
Q

In HFrEF, how the heart compensates the decreased EF or increased afterload?

A

Hypertrophy and ventricular dilation

149
Q

How is the diagnosis of HFrEF made?

A

Based on signs and symptoms

150
Q

What is the treatment of acute HFrEF?

A

Loop diuretics for aggressive diuresis
ACEIs or ARBs in combination with loop diuretics
Beta-blockers should be avoided during decompensated CHF
Correct underlying causes
Inotropic agents (eg, Dobutamine) can be used

151
Q

What is the chronic management of HFrEF?

A

Lifestyle change: control comorbid conditions, and limit dietary sodium and fluid intake
Beta-blockers and ACEIs/ARBs: help prevent remodeling of the heart and reduce mortality for NYHA class II-IV
Low-dose Spironolactone: reduce mortality in patients with NYHA class III-IV
Diuretics (most commonly loop diuretics): prevent volume overload
Digoxin: symptomatic control of dyspnea and decrease frequency of hospitalizations
Daily ASA and a Statim are recommended if the underlying cause is a prior MI

152
Q

What is the definition of HFpEF?

A

Decreased ventricular compliance with normal systolic function

153
Q

What is the treatment of HFpEF?

A

Diuretics are the best initial treatment

It is important to maintain rate and BP controle via Beta-blockers, ACEIs, ARBs, or CCBs

154
Q

How is the CHA2DS2-VASc score calculated?

A 
CHF (+1)
HTN (+1)
Age >= 75 (+2)
Diabetes (+1)
Stroke or TIA history (+2)
Vascular disease (+1)
Age 65-74 (+1)
Sex category (female) (+1)
155
Q

What are the risk factors for congestive heart failure?

A 
Coronary heart disease
Hypertension
Cardiomyopathy
Valvular heart disease
Diabetes
COPD (cor pulmonale)
156
Q

What must be present to diagnose a dilated cardiomyopathy?

A

Left ventricular dilation

Decreased EF

157
Q

What is the most common cause of dilated cardiomyopathy?

A

Idiopathic

158
Q

What are known secondary causes of dilated cardiomyopathy?

A 
Alcohol
Postviral myocarditis
Postpartum status
Drugs (Doxorubicin, AZT, Cocaine)
Radiation
Endocrinopathies (thyrotoxicosis, acromegaly, pheochromocytoma)
Infection (Coxsackievirus, HIV, Chagas disease, parasites)
Genetic factors
Nutritional disorders (wet beriberi)
159
Q

What are the most common secondary causes of dilated cardiomyopathy?

A

Ischemia

Long-standing hypertension

160
Q

What murmur is associated with dilated cardiomyopathy?

A

S3 gallop

161
Q

What murmur is associated with hypertrophic cardiomyopathy?

A

S4 gallop

162
Q

What is the history of the dilated cardiomyopathy?

A

Gradual development of CHF symptoms shuch as dyspnea on exertion, and diffuse edema of the ankles, feet, legs, and abdomen

163
Q

What can be found in the exam of a patient with dilated cardiomyopathy?

A 
Displacement of the left ventricular impulse
JVD
Rales
S3 gallop
Mitral/tricuspid regurgitation
164
Q

What exam is diagnostic in the case of dilated cardiomyopathy?

A

Echocardiography

165
Q

In a patient with dilated cardiomyopathy, what can be seen on a CXR?

A

Enlarged, “ballon-like” heart and pulmonary congestion

166
Q

What is the treatment of dilated cardiomyopathy?

A

Address the uncrelying etiology if secondary

Treat CHF

167
Q

What is the most common cause of sudden death in young, healthy athletes?

A

HOCM

168
Q

What is the physiopathology of hypertrophic cardiomyopathy?

A

Impaired left ventricular relaxation and filling (diastolic dysfunction) due to thickened centricular walls secondary to stressors on the myocardium, shuch as HTN and aortic stenosis

169
Q

What is the most common cause of hypertrophic cardiomyopathy?

A

HTN

170
Q

What is HOCM?

A

Hypertrophic obstructive cardiomyopathy

171
Q

What is the cause of HOCM?

A

Congenital inherited autosomal dominant trait

172
Q

What is the physiopathology of HOCM?

A

Asymmetric interventricular septum hypertrophy, leading to left ventricular tract outflow obstruction and impaired ejection of blood

173
Q

What are the symptoms of hypertrophic cardiomyopathy?

A 
Often asymptomatic
Syncope
Lightheadedness
Dyspnea
Palpitations
Angina
Sudden cardiac death
174
Q

What is the key finding during physical exam in a patient with hypertrophic cardiomyopathy?

A

Harsh systolic ejection crescendo-decrescendo murmur in the lower left sternal edge that increases with decreased preload and decreases with increased preload

175
Q

What can worsen the symptoms of a patient with hypertrophic cardiomyopathy?

A 
Exercise
Diuretics
Dehydration
ACEIs/ARBs
Digoxin
Hydralazine
176
Q

What is the treatment of hypertrophic cardiomyopathy?

A

Beta-blockers are first line

177
Q

What is the physiopathology of restrictive cardiomyopathy?

A

Decreased elasticity of myocardium leading to impaired diastolic filling without significant systolic dysfunction

178
Q

What are the causes of restrictive cardiomyopathy?

A

Infiltrative disease (amyloidosis, sarcoidosis, hemochromatosis)
Scleroderma
Loeffler eosinophilic endocarditis
Endomyocardial fibrosis
Scarring and fibrosis secondary to radiation

179
Q

What is the history of restrictive cardiomyopathy?

A

Signs and symptoms of right-sided heart failure often perdominate over left-sided failure, but dyspnea is the most common complaint

180
Q

What is the treatment of restricitve cardiomyopathy?

A

Treat the underlying cause

181
Q

What are the clinical manifestations of coronary artery disease?

A 
Stable and unstable angina
Shortness of breath
Dyspnea on exertion
Arrhythmias
MI
Heart failure
Sudden death
182
Q

What are the risk factors for coronary artery disease?

A 
DM
Family history of premature CAD (men < 55yo, women <65yo)
Smoking
Hyperlipidemia
Abdominal obesity
HTN
Age (men >45yo, women >55yo)
Male gender
183
Q

What is stable angina?

A

Substernal chest pain secondary to myocardial ischemia (O2 supply-and-demand mismatch)

184
Q

What is the main cause of stable angina?

A

Atherosclerosis

185
Q

What is the classical triad of stable angina?

A

Substernal chest pain
Precipitated by stress or exertion
Relieved by rest or nitrates

186
Q

What is the duration of stable angina?

A

2-10 min

187
Q

What symptoms can be associated with stable angina?

A 
Shortness of breath
Nausea/vomiting
Diaphoresis
Dizziness
Lightheadedness
188
Q

What is the best initial test for diagnosis of stable angina?

A

ECG, which is usually normal

189
Q

How are cardiac enzymes in stable angina?

A

Normal

190
Q

What test is diagnostic for stable angine?

A

Stress test

191
Q

What are noncardiac differential diagnosis of stable angina?

A

GERS
Musculoskeletal/costochondritis
Pneumonia/pleuritis
Anxiety

192
Q

What is the treatment of chronic stable angina?

A

ASA, Beta-blockers (reduce mortality)
Nitroglycerin (relieve pain)
Risk factors control

193
Q

What is the clinical picture of Prinzmetal angina?

A

Angina that classically affects young women at rest in the early morning

194
Q

What drug is associated with Prinzmetal angina?

A

Cocaine

195
Q

What can be seen in ECG during Prinzmetal angina?

A

ST-segment elevation

196
Q

What is the treatment for Prinzmetal angina?

A

CCBs with or without long-acting Nitrates
Beta-blockers can increase vasospasm
Aspirin can aggravate the ischemic attacks

197
Q

What is the main cause of TIA and embolic strokes?

A

Carotid artery stenosis

198
Q

How to diagnose carotid artery stenosis?

A

Duplex ultrasonography

199
Q

What is the treatment of carotid artery stenosis?

A

Carotid endarterectomy in men with >= 60% stenosis (>= if symptomatic) or women with >= 70% stenosis

STEP 2 CK (1 decks)

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