Cardiology Flashcards

1
Q

How to calculate rate on ECG (regular)?

A

300/large squares
OR
1500/small squares

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2
Q

How to calculate rate on ECG (irregular)?

A

6 x R-R intervals on 10 sec (50 large squares)

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3
Q

Hyperkalemia on ECG?

A

Peaked T waves

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4
Q

Hypokalemia on ECG?

A

ST depression

U waves

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5
Q

Hypercalcemia on ECG?

A

Shortened QT interval

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6
Q

Hypocalcemia on ECG?

A

Prolonged QT interval

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7
Q

Heart block 1st degree?

A

Prolonged P-R in every complex, but every QRS has its own P

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8
Q

Heart block 2nd degree?

A

Mobitz I: gradual prolongation until one P is alone

Mobitz II: fixed P-R with a ratio of P dropped (e.g., 3:1, 4:1)

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9
Q

Heart block 3rd degree?

A

P-P and R-R are constant but independent

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10
Q

Enzyme to diagnose new MI?

A

Troponins

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11
Q

Enzyme to diagnose old MI?

A

CK-mb

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12
Q

Medical acute treatment of MI?

A

MONA (morphine, O2, nitrates, ASA) BASH (beta blockers, ACE inhibitors, statins, heparin) and copidogrel (if the probability of CAD is high).

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13
Q

Out-patient medical treatment of MI?

A

ABAS (ASA, betablockers, ACE inhibitors, statins)

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14
Q

Contraindication of Nitrates (MI context)?

A

Right side STEMI

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15
Q

Chest pain + normal ECG + negative troponins. Next step?

A

Stress test:
The goal is to get the patient to target heart rate (85% of their maximum)

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16
Q

Diamond classification?

A

(1) Substernal chest pain, (2) Worse with Exertion, and
(3) Better with Nitroglycerin. 3/3 is called typical, 2/3 is called
atypical, and 0-1 is called non-anginal.

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17
Q

Indications CABG

A

3 vessel disease or left mainstream disease

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18
Q

Indications angioplasty (PCI)

A

1, 2 vessel disease

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19
Q

Treatment SVT (stable)

A

Vagal maneuvers. If that doesn’t work Adenosine (6-12-12), if doesn’t work, BB/CCB

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20
Q

Causes torsade des pointes

A

Hypokalemia or hypomagnesemia
Prolonged QT

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21
Q

Treatment torsade des pointes

A

Magnesium

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22
Q

Treatment VTach

A

Amiodarone

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23
Q

Treatment A Fib (unstable)

A

Cardiovert

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24
Q

Treatment Afib, stable, new (<48h)

A
Rate control (BB/CCB)
Cardioversion
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25
Q

Treatment Afib, stable, old (>48h)

A

Anticoagulate -> TEE -> CArdioversion -> Anticoagulate

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26
Q

A Fib, valvular clot

Tx?

A

Warfarin

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27
Q

A Fib, non-valvular clot.

Anticoagulation treatment?

A

NOACs (e.g., dabigatran, apixaban and rivaroxaban)

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28
Q

Treatment AFib

A

RACE (rate control, anticoagulation, cardioversion, etiology)

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29
Q

Anticoagulation AFib

A

CHA2DS2 VASC
o Chronic heart failure: 1 pt
o Hypertension: 1 pt
o Age 65-74: 1 pt
o Age > 75: 2 pt
o Diabetes: 1 pt
o Stroke: 2 pt
o Vascular disease: 1 pt
o Femaie: 1 pt

Results 0: ASA; 1: ASA or anticoagulation; >2: anticoagulation (warfarin aiming for INR of 2-3) or NOAC

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30
Q

Door needle time (MI)

A

60 mins to give tPA

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31
Q

Time door balloon (MI)

A

90 mins

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32
Q

Farmaco Tx for 1º AV block

A

Generally none, but Atropine if Sx

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33
Q

Farmaco Tx for 2º AV block type I

A

Generally none, Atropine if Sx.
Review patient’s meds

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34
Q

Tx for 2º AV block type II

A

Peace, even if asx

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35
Q

Tx for 3º AV block

A

Peace

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36
Q

Tx Idioventricular rhythym

A

Peace

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37
Q

Defribilable rhythms

A

VT/VF

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38
Q

Farma TX unstable VT/VF

A

Epinephrine-Amiodarone-Epinephrine-Amiodarone

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39
Q

Farma TX PEA/Asystolia

A

Epinephrine-nothing-Epinephrine-nothing

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40
Q

Definition of Hypertensive urgency

A

> 210/120 NO target-organ damage

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41
Q

Hypertensive emergency

A

dBP > 120 + target-organ damage

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42
Q

HTN + CHF/CAD. Ideal tx for HTN?

A

BB (metropolol, carvedilol) + ACEI

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43
Q

HTN + stroke. Ideal tx for HTN?

A

ACEI + HCTZ

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44
Q

HTN + CKD. Ideal tx for HTN?

A

ACEI

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45
Q

HTN + DM. Ideal tx for HTN?

A

ACEI

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46
Q

Secondary effects of dCCB (e.g., amlodipine)

A

Peripheral edema

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47
Q

Secondary effects of ACEI

A

↑ Cr, ↑ K

Dry cough, angioedema

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48
Q

Secondary effects of ARB

A

↑ Cr, ↑ K

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49
Q

Secondary effects of HCTZ

A

↓ K, ↓ urinary calcium (used for Kidney stones)
HyperGLUC

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50
Q

Secondary effects of BB

A

↓ HR

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51
Q

Secondary effects of Aldosterone antagonists (e.g., spironolactone)

A

Gynecomastia, ↑ K

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52
Q

Secondary effects of Hydralazine

A

Drug-induced lupus

Reflex tachycardia

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53
Q

Secondary effects of Alpha-antagonists (Doxazosin, Prazosin, Terazosin)

A

Orthotastisc hypotension

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54
Q

Secondary effects of Central (clonidine)

A

Rebound hypertension

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55
Q

Emergency hypertension initial goal of BP reduction

A

↓MAP 25% in 4-6 hrs then to normal in 24 hours

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56
Q

Which anti-hypertensive shouldn’t be used with afroamerican patients?

A

ACEI unless there is a comorbility

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57
Q

Most common cause of secondary hypertension

A

CKD/End-state renal disease (ESRD)

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58
Q

Treatment of CHF exacerbation

A
If STEMI/NSTEMI: MONA BASH and cath
Not STEMI/NSTEMI 
•	L= Lasix (Furosemide) 40-500 mg IV
•	M= Morphine 2-4 mg IV
•	N= Nitrates
•	O= Oxygen
•	P= Position
•	P= Positive airway pressure (CPAD, BiPAP)
IMPORTANT: Never start or increase a Beta-Blocker during an exacerbation.
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59
Q

Tx CHF class I

No limitations of activity; no sx with normal activty

A

(BB+ACEI)

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60
Q

Tx CHF class II

Slight limitation with activity. Comfortable with rest or mild excertion

A

(BB+ACEI) + Furosemide

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61
Q

Tx CHF class III

Marked limitation of activty. Comforable only at rest

A

(BB+ACEI) + Furosemide+ [BiDil (isosorbide /hydralazine)+ Spironolactone]

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62
Q

Tx CHF class IV

Any physicial activity brings disconfort; Sx at rest

A

(BB+ACEI) + Furosemide + [BiDil (isosorbide /hydralazine) + Spironolactone] + Inotrops (e.g., dobutamine)

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63
Q

Causes of CHF

A

CAD, HTN, valvular, alcohol

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64
Q

Dressler syndrome

A

Pericaditis post MI (2-8 wk)

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65
Q

Acute pericarditis triad

A

Chest pain, friction rub, ECG changes (↓PR, diffuse ↑ST)

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66
Q

Causes of pericardial diseases

A

infectious, autoimmune, trauma, and proximate cancers (breast, lungs, esophagus, lymphoma)

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67
Q

Etiology of pericarditis

A

Viral (coxsackie) or uremia

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68
Q

Diagnosis of pericarditis

A

ECG: ↓ P-R (Pathognomonic); Diffuse ↑ S-T

Echo is not used!!!!!

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69
Q

Treatment of pericarditis

A

NSAIDS + Colchicine*

  • secondary effect: diarrhea
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70
Q

Contraindication of NSAIDs

A

CKD, thrombocytopenia or peptic ulcer disease (PUD)

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71
Q

Treatment of Pericardial effusion

A

NSAIDS + Colchicine (Tx of pericarditis) but if it doesn’t work, pericardial window is the next step

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72
Q

Diagnosis of Pericardial effusion

A

Echo

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73
Q

Sx/sg’s of Pericardial tamponade

A

Beck’s triad
* JVD
* Hypotension
* ↓ heart sounds
Clear lungs
Pulsus paradoxus > 10 mmHg

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74
Q

Tx of Pericardial tamponade

A

pericardiocentesis and bolus of IV fluids

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75
Q

Etiology of Constrictive pericarditis

A

recurrent pericarditis

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76
Q

Dyspnea, fatigue
Mimic right CHF (edema, ascites, splenomegaly)
Pericardial knock

Dx and next step?

A

Constrictive pericarditis

Best step:
- CxR: shows calcifications
- Echo

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77
Q

Tx of Constrictive pericarditis

A

Diuretics and salt retention. If this doesn’t work, pericardiotomy

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78
Q

Causes of Dilated cardiomyopathy

A

Viral
Ischemia
Valvular disease
Infectious
Metabolic
Alcoholic (wet beriberi)
Autoinmune

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79
Q

Treatment of Dilated cardiomyopathy

A

Same as CHF (BB, ACEI, diuretics)

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80
Q

Etiology of Hypertrophic cardiomyopathy (HCM)

A

Autosomal dominant mutation

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81
Q

Pathofisology of Hypertrophic cardiomyopathy (HCM)

A

Obstructs the aortic outlet

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82
Q

Differences between Hypertrophic cardiomyopathy (HCM) and Aortic Stenosis

A

Hypertrophic cardiomyopathy is found in young people

Improves with preload

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83
Q

Hypertrophic cardiomyopathy (HCM) is known for…

A

Sudden death of athletes

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84
Q

Treatment of Hypertrophic cardiomyopathy (HCM)

A

Avoid dehydration (AKA no sports), BB/CCB, myectomy, implantable defibrillator, transplant

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85
Q

Causes of Restrictive cardiomyopathy

A

Sarcoid
Amyloid
Hemochromatosis
Cancer
Fibrosis

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86
Q

Cardiomyopathy of wet beriberi

A

Dilated cardiomyopathy

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87
Q

Young patient + aortic systolic murmur + dysnea in excertion + syncope + athlete. Next step? Dx?

A

Echo; Hypertrophic cardiomyopathy (HCM)

88
Q

Restrictive cardiomyopathy + Pulmonary disease. Dx and next step?

A

Sarcoidosis. Fat pad Bx

89
Q

Restrictive cardiomyopathy + Cirrhosis/DM. Dx and next step?

A

Hemochromatosis. Cardiac MRI and myocardial Bx

90
Q

Restrictive cardiomyopathy + peripheral neuropathy. Dx and next step?

A

Amyloid. Ferritin and genetic test

91
Q

Treatment of Myocarditis

A

Prevent dehydration
Treat CHF
Anticoagulation
Treat cause

92
Q

Meds to avoid in Hypertrophic cardiomyopathy (HCM)

A

Avoid nitrates, ACEI, and diuretics as they increase left ventricular outflow tract and worsen symptoms. Also avoid digoxin and hydralazine

93
Q

Young patient, angina, SOB, systolic murmur at the base that improves with leg raise and worsens with Valsalva

A

Hypertrophic cardiomyopathy

94
Q

Young patient SOB, diastolic murmur on the apex with rumbling with opening snap. Dx, etiology, and next step?

A

Mitral stenosis, rheumatic disease, ballon valvulopasty

95
Q

Which murmurs should be treated?

A

Treat all diastolic murmurs and all greater-than-grade-III systolic murmurs

96
Q

CHF, chest pain, rumbling diastolic murmur at the base that improves with valsalva. Dx?

A

Aortic insufficiency

97
Q

Old patient, atero sclerosis, CHF, syncope, Systolic murmur crescendo-decrescendo murmur at the base (improves with valsava, worsens with leg raise). Dx? Tx?

A

Dx: Aortic stenosis

Tx: (Sx replacement + CABG) or TAVR*

  • Transcatheter aortic valve replacement
98
Q

Possible tx for aortic Stenosis and their complications

A

Surgical replacement + CABG
* Complications: Acute kidney injury and fribillation

Transcatheter aortic valve replacement (TAVR)
* Complications: Residual aortic regurgitation and need for pacemaker

99
Q

MI, cardiogenic shock, acute pulmonary edema, Holosystolic murmur at the apex that worsens with leg raise. Dx and pathogenesis?

A

Acute mitral insufficiency, rupture papillary muscle or chordae tendinae),

100
Q

Young woman, with holosystolic murmur at the apex that worsens with valsava improves with leg raise)

A

Mitral valve prolapse

101
Q

In addition to common Sx of CHF and SOB, which valvulopathy was
* Hoarness
* Dysphagia
* AFib
* Hemoptysis

A

Mitral stenosis

102
Q

Cough –> prodome –> syncope. Dx and next step?

A

Vasovagal syncope, tilt table (tx with BB is controversial)

103
Q

Syncope without prodome.

Most likely dx?

A

Arrhythmia

104
Q

Indications of statins

A

o Vascular disease (MI, carotid stenosis, peripheral vascular disease, cerebrovascular disease)
o LDL > 190 mg/dL (10 mmol/L)
o LDL 70 mg/dL (4 mmol/L)-190 mg/dL (10 mmol/L) + age 40-75 + DM
o LDL 70 mg/dL (4 mmol/L)-190 mg/dL (10 mmol/L) + cardiovascular risk factors (HTN, smoking, obesity, family Hx, XY > 45 y-o/XX > 55 y-o

105
Q

Secondary effects of statins

A

↑ LFTs (most common), rhabdomyolysis

106
Q

Secondary effects of Fibrates

A

myositis and ↑ LFTs (don’t give with statins)

107
Q

Secondary effects of Ezetimibe:

A

diarrhea

108
Q

Secondary effects of Bile acid sequestrants:

A

diarrhea

109
Q

Secondary effects of Niacin:

A

flushing (treat with ASA)

110
Q

Definition of metabolic syndrome

A

Central obesity: men waist circumference > 94; women waist circumference > 80
2 of the following:
* TG > 1.7 mmol (150 mg)
* HDL < 1 mmol (40 mg) in XY, 1.3 mmol (50 mg) in XX
* BP > 130/85
* Fasting glucose > 5.6 mmol (100 mg)

111
Q

Does hypertriglyceridemia increase the risk of cardiovascular disease?

A

No. However, when severe (10 mmol – 885 mg) associated with pancreatitis

112
Q

Classic ECG finding in atrial flutter.

A

“Sawtooth” P waves.

113
Q

Definition of unstable angina.

A

Angina is new, is worsening, or occurs at rest.

114
Q

Antihypertensive for a diabetic patient with proteinuria.

A

ACEI.

115
Q

Beck’s triad for cardiac tamponade.

A

Hypotension, distant heart sounds, and JVD.

116
Q

Drugs that slow AV node transmission.

A

β-blockers, digoxin, calcium channel blockers.

117
Q

Hypercholesterolemia treatment that leads to flushing and pruritus.

A

Niacin.

118
Q

Murmur—hypertrophic obstructive cardiomyopathy (HOCM).

A

Systolic ejection murmur heard along the lateral sternal border
↑ with Valsalva maneuver and standing.

119
Q

Murmur—aortic insufficiency.

A

Diastolic, decrescendo, high-pitched, blowing murmur
that is best heard sitting up; ↑ leg rise with ↓ preload (handgrip
maneuver) and valsava.

120
Q

Murmur—aortic stenosis.

A

Systolic crescendo/decrescendo murmur that radiates to the neck; ↑ with ↑ leg raise

121
Q

Murmur—mitral regurgitation.

A

Holosystolic murmur that obscure S1 and S2 that radiates to the axillae or carotids.

122
Q

Murmur—mitral stenosis.

A

Diastolic, opening snap, mid- to late, low-pitched murmur.

123
Q

Treatment for atrial fibrillation and atrial flutter.

A

If unstable, cardiovert. If stable or chronic, rate control with
calcium channel blockers or β-blockers.

124
Q

Treatment for ventricular fibrillation.

A

Immediate cardioversion.

125
Q

Autoimmune complication occurring 2–4 weeks post-MI.

A

Dressler’s syndrome: fever, pericarditis, ↑ ESR.

126
Q

JVD and holosystolic murmur at the left sternal border, 5th intercostal space.

Treatment?

A

Treat existing heart failure and replace the tricuspid valve.

127
Q

Diagnostic test for hypertrophic cardiomyopathy.

A

Echocardiogram (showing thickened left ventricular wall and outfl ow obstruction).

128
Q

A fall in systolic BP of > 10 mmHg with inspiration.

A

Pulsus paradoxus (seen in cardiac tamponade).

129
Q

Classic ECG findings in pericarditis.

A

Low-voltage, diffuse ST-segment elevation.

130
Q

Definition of hypertension.

A

BP > 140/90 on three separate occasions two weeks apart.

131
Q

Eight surgically correctable causes of hypertension.

A

Renal artery stenosis, coarctation of the aorta,
pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.

132
Q

Diagnostic tests for a pulsatile abdominal mass and bruit.

A

Abdominal ultrasound and CT.

133
Q

Indications for surgical repair of abdominal aortic aneurysm.

A

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured.

134
Q

Treatment for acute coronary syndrome.

A

Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers,

heparin.

135
Q

What is metabolic syndrome?

A

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or
proinflammatory states.

136
Q

Appropriate diagnostic test?

■ A 50-year-old man with angina can exercise to 85% of maximum predicted heart rate.

A

Exercise stress treadmill with ECG.

137
Q

Appropriate diagnostic test?

■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.

A

Pharmacologic stress test (e.g., dobutamine echo).

138
Q

Target LDL in a patient with diabetes.

A

< 70.

139
Q

Signs of active ischemia during stress testing.

A

Angina, ST-segment changes on ECG, or ↓ BP.

140
Q

ECG findings suggesting MI.

A

ST-segment elevation (depression means ischemia),

flattened T waves, and Q waves.

141
Q

Coronary territories in MI.

A

Anterior wall (LAD/diagonal)
Inferior (PDA)
Posterior (left circumflex/oblique, RCA/marginal)
Septum (LAD/diagonal).

142
Q

A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

Dx?

A

Prinzmetal’s angina

143
Q

Common symptoms associated with silent Mls.

A

CHF, shock, and altered mental status.

144
Q

The diagnostic test for pulmonary embolism.

A

V/Q scan.

145
Q

An agent that reverses the effects of heparin.

A

Protamine.

146
Q

The coagulation parameter affected by warfarin.

A

PT.

147
Q

A young patient with a family history of sudden death

collapses and dies while exercising.

A

Hypertrophic cardiomyopathy.

148
Q

Endocarditis prophylaxis regimens.

A

Oral surgery—amoxicillin for certain situations.
GI or GU procedures— not recommended

149
Q

The 6 P’s of ischemia due to peripheral vascular disease.

A

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia.

150
Q

Virchow’s triad.

A

Stasis, hypercoagulability, endothelial damage.

151
Q

The most common cause of hypertension in young women.

A

OCPs.

152
Q

The most common cause of hypertension in young men.

A

Excessive EtOH.

153
Q

Most common non-ichemic cause of chest pain

A

Gastrointestinal

154
Q

Menstruating woman
Chest pain

A

Menstruating women almost never have MI

155
Q

Risk fx of CAD

A
  • Dm: worse
  • Tobacco: most inmediate benefit if corrected
  • HTN: most common
  • Hyperlipidemia
  • Family Hx: 1st degree + premature (male <55; female <65)
  • Age (male >45; women >55)
  • Renal disease
156
Q

Woman
Chest pain after stressful event
MI
Ventricular “ballooning” on Echo

Dx and Tx

A

Takotsubo cardiomyopathy

Tx: beta blockers and ACE inhibitors

Acute myocardial damage most often occurring in postmenopausal women immediately following an overwhelming, emotionally stressful event (Massive catecholamine discharge). This leads to “ballooning” and left ventricular dyskinesis.

157
Q

Chest pain differential

A
158
Q

Best initial test for chest pain

A

ECG

159
Q

Best test when uncertain etiology of chest pain

A

Stress test

160
Q

Stress test modalities and indications

A
161
Q

Ttx for CAD

A
  • ASA
  • BB: 1st line tx. Don’t use in severe asthma, prizmental angina, and cocaine.
  • ACE-i: specially if low EF. Cough and low K as 2nd effects
  • Statin: goal LDL < 70. Liver dysfunction most common adverse effect

Dihydropyridine CCBs (nifedipine) increase mortality (don’t use). Non-Dihydropyridine CCBs may replace BB.

162
Q

Patient with CAD. High LDL despite statin at maximum dose.

Next step to treat dyslipidemia?

A

PCSK9 Inhibitors
Evolocumab and alirocumab

163
Q

ACS are associated to what on auscultation?

A

S4 gallop

164
Q

Decrease of 10 mmHg in BP on inspiration

A

Pulsus paradoxus: Tamponade

165
Q

Increase in JVD on inspiration

A

Kussmaul sign: Constrictive pericarditis

166
Q

Triphasic scratchy sound on auscultation

A

Friction rub: pericarditis

167
Q

Continuous machinery murmur

A

Shunt: patent ductur (PDA)

168
Q

Point of maximal impulse displaced to axila

A

LV hyperthrophy

169
Q

Tx of PVCs in ACS?

A

Should NOT be treated!

170
Q

You Dx a STEMI

Best initial step in management?

A

ASA + other antiplatelet
And call cath lab

Antiplatelet: clopidogrel, prasugrel, ticagrelor

Consultation almost never the right choice

171
Q

Best antiplatelet if patient undergoing angioplasty and stening

A

Prasugrel

172
Q

Contraindications of thrombolytics

A
  • Major bleeding (bowel or CNS)
  • Recent Sx (2 weeks)
  • Recent nonhemorrhagic stroke (6 momths)
  • Recent trauma/head injury
  • Severe HTN
  • Bleeding disorder
173
Q

e

Indications of ACS meds

A
174
Q

In what ACS is heparine indicated

A

NSTEMI: as part of initial therapy
STEMI: indicated but after revascularization

175
Q

Tx differences between ACS presentations

A
176
Q

When to use tPA (thrombolytics) in ACS

A

STEMI

177
Q

Glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors (antiagregation) are best for

A

NSTEMI undergoing PCI or stenning

178
Q

Complication of ACS

Patient with ACS with new murmur and Step-up in O2Sat from RV to LV in ACS

important difference in SatO2 between RV and LV

A

Septal rupture

179
Q

Complication of ACS

Patient with ACS, bradycardia and cannon A waves

A

3rd degree AV block

180
Q

Complication of ACS

Patient with ACS, bradycardia and no cannon A waves

A

Sinus bradycardia

181
Q

Complication of ACS

Patient with ACS with sudden loss of pulse and JVD

A

Tamponade vs wall rupture

182
Q

Complication of ACS

Patient with inferior MI, tachycardia, hypotension with nitro

A

RV MI

183
Q

Complication of ACS

Patient with ACS, new murmur, rales/congestion on lungs

A

Valve rupture

184
Q

Most common cause of CHF.

A

HTN resulting in a cardiomyopathy or abnormality of the myocardial muscle

185
Q

SOB
+
Sudden onset, clear lungs

Dx?

A

Pulmonary embolus

186
Q

SOB
+
Sudden onset, wheezing, increased expiratory phase

Dx?

A

Asthma

187
Q

SOB
+
Slower, fever, sputum, unilateral rales/rhonchi

Dx?

A

Pneumonia

188
Q

SOB
+
Decreased breath sounds unilaterally, tracheal deviation

Dx?

A

Pneumothorax

189
Q

SOB
+
Circumoral numbness, caffeine use, history of anxiety

Dx?

A

Panic attack

190
Q

SOB
+
Pulsus paradoxus, decreased heart sounds, JVD

Dx?

A

Tamponade

191
Q

SOB
+
Palpitations, syncope

Dx?

A

Arrhythmia

192
Q

SOB
+
Dullness to percussion at bases

Dx?

A

Pleural effusion

193
Q

SOB
+
Long smoking history, barrel chest

Dx?

A

COPD

194
Q

SOB
+
Burning building or car, wood-burning stove in winter, suicide attempt

Dx?

A

Carbon monoxide poisoning

195
Q

Best initial test for CHF in the outpatient context

A

Transthoracis echo

196
Q

Patient with systolic CHF in outpatient management with ACE-i but hyperkalemia.

Management?

A

Patiromer

Magement of hyperkalemia if you want to keep using ACE-i or ARBs in any Dx

197
Q

Male patient with systolic CHF in management with spironolactone + gynecomastia

Management?

A

Switch spironolactone to eplerenone

198
Q

Which systolic CHF medications have proven mortality improvement and which have not

A

Lower mortality
* ACE-i/ARBs
* BB
* Hydralazine/nitrates (e.g., BiDil) in severe systolic CHF
* Spironolactone

Do NOT lower mortality
* Digoxine
* Furosemide

199
Q

Medications with proven benefits in dyastolic CHF

A

Spironolactone
Diruetics

Digoxine and BB have NOT proven benefits

ACE-i and ARBs are uncertain

200
Q

How do loop diuretics and thiazides change Ca++ and K+

A

Ca++
* Loops loose Calcium (hypoCalcemia)
* Thiazides take it in (hyperCalcemia)

K+: both produce hypoKalemia

Both produce hyperuricemia as well

201
Q

Side effects of thiazides

A

HyperGLUC (hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia)

HypoKalemia
HypoNatremia

202
Q

S3 vs S4 gallop

A

An S3 gallop signifies rapid ventricular filling in the setting of fluid overload and is associated with dilated cardiomyopathy.

An S4 gallop signifies a stiff, noncompliant ventricle and ↑ “atrial kick,” and may be associated with hypertrophic cardiomyopathy.

203
Q

Which medications have proven mortality benefit in chronic treatment of angina?

A

Only ASA and BB

204
Q

Complications of ACS

A

Death
Arrythmia
Rupture
Tamponade
Heart failure
Valvular disease
Aneurysm
Dressler’s syndrome
Emboli
Reinfraction

DARTH VADER

205
Q

Tx WPW

A

Acute: Procainamide Or Amiodarone

Chronic: ablation

206
Q

Possible causes of PEA

A

5H and 5 T

Hypovolemia
Hypoxia
Hydrogen
Hyper or hypo K+
Hypothermia

Tamponade
Trauma
Toxic
Thrombosis
Tension pneumothorax

207
Q

Med to reverse NOACs

Rivaroxaban, apizaban, edoxaban

A

Andexanet

208
Q

Med to revert dabigatran

A

idarucizumab

209
Q

Meds to reverse Warfarin

A

Prothrombin complex concentrate (PCC)

210
Q

If arrythmia not clear and ECG not clear either

Next step?

A

eletro physiology studies

211
Q

Tx of primary HTN in pregnant women

A

Metildopa
BB
Hydralazine

212
Q

BP in upper limb > BP in lower limb

Dx?

A

Coarctation of aorta

213
Q

Episodic HTN
Flushing

Dx?

A

Pheochromocytoma

214
Q

Patient with osteoporosis and HTN

Best initial tx for HTN?

A

Thiazides

215
Q

Patient with hyperthyroidism and HTN

Best initial tx for HTN?

A

BB

216
Q

Echo reporting: Systolic anterior motion of mitral valve

Dx?

A

Hyperthrophic obstructive cardiomyopathy (HOCM)