Cardiology Flashcards
1
Q
Initial diagnostic test for ischemic heart disease?
A
Resting 12-lead electrocardiogram (ECG)
2
Q
Horizontal or down-sloping ST depression indicates?
A
Subendocardial Ischemia and positive ECG stress test
3
Q
Indications of a positive stress test?
A
- ST depression
- Chest pain
- Hypotension
- Arrhythmias
4
Q
Drugs with alter ECG results?
A
- Beta Blockers
- Non-dihrodpyridie CCB (Verapamil/Ditilazam)
- Anti-Arrhythmics (Amiodarone/Sotalol)
- Digoxin
- Nitrates
5
Q
What drug is used for a pharmacologic stress test?
A
Dobutamine
6
Q
What procedure tests for vessel stenosis?
A
Radionuclide myocardial perfusion imaging (rMPI)
7
Q
Major modifiable risk factors for Coronary Artery Disease?
A
- Tobacco Use
- Hypertension
- Sedentary Lifestyle
- Obesity
- Diabetes Mellitus
8
Q
LDL and HDL levels that indicate dyslipidemia?
A
- LDL > 130 mg/DL
- HDL < 40 mg/DL
9
Q
Medications that increase LDL levels?
A
- Thiazide Diurectics
- Cyclosporine (Immunosuppressant)
- Glucocorticoids
- Amiodarone
10
Q
Medical Disorders that cause increase in LDL levels?
A
REHAAB
- Renal disorders
- Endocrine Disorders
- Hepatocellular Carcinoma
- Anorexia
- Acute Intermittent Porphyria
- Biliary Stasis
11
Q
LDL level that indicates hypocholesteremia?
A
LDL Levels <50
12
Q
Etiologies of Hypocholesteremia?
A
- Abetalipoproteinemia
- Hypobetalipoprotemia
- Malignancy (Colon/Prostate)
- Malabsorptive disorders (Celiac)
13
Q
Xanthelasmas?
A
- Physical manifestations of dyslipidemia
- Lipid deposits on the eyelids
- Seen in Familial Hypercholesteremia
14
Q
Xanthomas?
A
- Physical manifestations of dyslipidemia
- Lipid deposits on trunk, extensor tendons and surfaces
15
Q
Physical manifestations of dyslipidemia?
A
- Xanthomas
- Xanthelasmas
- Retinal Cholesterol Emboli
- Corneal Arcus
16
Q
Extremely elevated triglycerides put the patient at risk for?
A
Pancreatitis
17
Q
Retinal Cholesterol Emboli have what effect on the eyes?
A
Transient Vision Loss
18
Q
Screening recommendations for dyslipidemia?
A
- Screening btwn ages 40-75
- Reassessed in 5 yr intervals (w/o risk factors)
19
Q
What heart sound abnormality is caused by dilated cardiomyopathy?
A
S3 heart sound
20
Q
Symptoms of dilated cardiomyopathy?
A
Similar to CHF:
- Orthopnea
- Dyspnea
- Weight gain
- Edema
- Weakness
21
Q
Causes of Dilated Cardiomyopathy? (8)
A
- Alcohol
- Wet Beriberi
- Peripartum Cardiomyopathy
- Cocaine
- Chagas Disease
- Coxsackie B Virus
- Doxorubicin, Daunorubicin
- Hemochromatosis
22
Q
Definitive treatment for Dilated Cardiomyopathy?
A
Heart Transplant
23
Q
Most common pathogen responsible for Acute Endocarditis?
A
S. Aureus
on normal valves
24
Q
Most common pathogens responsible for Subacute Endocarditis?
A
- Strep. Viridens
- S. epidermidis
- Enterococci
- HACEK group (
25
Sterile endocarditis is caused by?
Thrombi and platelets due to malignancy or SLE (Libman-Sacks)
26
Empiric Therapy for Infective Endocarditis?
Vancomycin
27
Treatment for Strep Viridans/Bovis Infective Endocarditis?
- Pencillin G + Gentamicin
- Ceftriaxone + Gentamicin
- Vancomycin (for Pencillin allergic patients)
*add Rifampin for prosthetic valves
28
Treatment for Sterile (non-bacterial) thrombotic Endocarditis?
Heparin
29
Clinical Presentation of Stable Angina?
- Chest pain due to exertion that lasts 5-15 mins
- Pain may radiate to jaw, neck, or shoulder
- Pain Relieved by Nitroglycerin and rest
30
Atypical Presentation of Angina in the elderly and women?
- Nausea/Vomiting
- Mid-epigastric Pain/ Sharp Chest Pain
- Weakness
- Breathlessness
31
ECG results during an angina attack?
ST-segment depression
32
Diagnostic Gold Standard for Stable Angina?
Exercise Stress Test
33
Treatment of Stable Angina?
- Lifestyle Modifications
| - Beta Blockers, Nitrates, Ca Channel Blockers
34
Clinical Presentation of Acute Mitral Regurgitation?
- Jugular Venous Distention
| - Signs of Congestive Heart Failure
35
Clinical Presentation of Chronic Mitral Regurgitation?
- Apical Thrill
| - No signs of CHF
36
Causes of Mitral Regurgitation?
- Mitral Prolapse
- MI --> Damage to Papillary Muscles
- Left Ventricle enlargement
- Valve Damage (Endocarditis, Rheumatic Fever)
37
Indications of Mitral Regurgitation on Auscultation?
- High Pitched Holosystolic Murmur
- Radiates to the Axilla
- Widely Split S2
- S3 Heart Sound
38
Complications of Mitral Regurgitation?
- Atrial Fibrillation
- Pulmonary Edema
- Right sided Heart Failure
39
Treatment of Mitral Regurgitation?
- Diuretics
- Nitrates (also reduce preload)
- ACE inhibitors or ARBs
- Beta blockers
40
What is the appropriate stress test for patients with abnormal baseline EKGs?
Nuclear stress tests
41
Clinical Presentation of Unstable Angina?
- Chest or arm pain for > 10 mins
- Occurs at rest
- Episodes get progressively worse
42
Elevation in cardiac enzymes (troponins) occurs in which Acute Coronary Syndromes?
- STEMI
| - NSTEMI
43
Pharmacologic treatment for Unstable angina, NSTEMI, or STEMI?
- β-blocker (Unless heart failure, bradycardia, heart block, cardiogenic shock)
- Enoxaparin
- Morphine (if in severe pain)
- Oxygen (if SaO2<90% or dyspnea)
- Anti-platelet: aspirin plus P2Y12 inhibitor (eg, clopidogrel)
- Nitrates (primary benefit from preload reduction; also reduces afterload)
- Statin (eg, high-dose atorvastatin)
44
Chemical Reperfusion treatment in STEMI?
- Tissue Plasminogen Activator
- Streptokinase
- Tenecteplase
- Reteplase
45
When is Chemical Reperfusion indicated?
Within 12hrs of symptom onset and if mechanical reperfusion within 120 mins is not feasible
46
When is Coronary Artery Grafting Bypass indicated?
- Occlusion of Left Main Artery
| - Severe occlusion of three vessels
47
EKG readings indicating an inferior infarct of the Posterior Descending Artery or Marginal Branch ?
ST elevation in Leads II, III, and aVF
48
EKG readings of ST elevation in Leads I, aLF, and V1-V6 indicate?
Lateral infarct of the left anterior descending artery or circumflex.
49
EKG readings of ST elevation in Leads V1-V2 indicate?
Septal infarct of LAD
50
EKG readings of ST elevation in Leads V3-V4 indicate?
Anterior infarct of LAD
51
Causes of Aortic Stenosis?
- Calcifications at old age
- Bicupid Valve at early age
- Rheumatic Fever
52
Clinical Presentation of Aortic Stenosis?
- Syncope
- Angina
- Heart Failure
53
Aortic Stenosis is associated with what heart sounds?
S4 Heart Sound
54
Indications of Aortic Stenosis on Auscultation?
- Systolic Crescendo-Decrescendo murmur best heard at the right sternal border and radiates to carotids and clavicle
55
What maneuvers cause Aortic Stenosis to increase or decrease in intensity?
Increase: Maneuvers that increase preload (Leg-raise)
Decrease: Maneuvers that decrease preload (Valsalva) or increase afterload (Isometric hand squeezing)
56
Complications of Aortic Stenosis?
- Left Bundle Branch Block
- Left atrial enlargement
- Left Ventricular hypertrophy
57
Definitive treatment for Aortic Stenosis?
Aortic Valve Replacement
58
Clinical Presentation of Left Heart Failure?
- Nocturia
- Orthopnea
- Dyspnea on exertion
- Paroxysmal nocturnal dyspnea
59
Severe breathlessness that awakens a patient from sleep?
Paroxysmal nocturnal dyspnea
60
Initial imaging for suspected Heart Failure?
Transthoracic Echocardiography
61
Which peptides indicates heart failure?
- Brain natriuretic peptides (BNP)
| - NT-pro BNP
62
Treatment for Heart Failure?
- Beta Blockers (Carvedilol, Bisoprolol)
- ACE- Inhibitors
- Diuretics (Loop or Thiazides)
63
Preferred initial treatment for volume overload in HF patients?
Sulfonamide Loop Diuretics (Torsemide, Furosemide)
64
Management for acute decompensated reduced ejection fraction Heart Failure?
- Furosemide
- Nitroglyercin
- Morphine
- Oxygen
- Upright Position
65
Implantable cardioverter-defibrillators are indicated for patients who:
- LVEF > 30% + prior MI
| - LVEF > 35% + Class II/III
66
Patients who are refractory to medical and resynchronization should consider:
Left Ventricular Assist Devices
67
Two gene mutations associated with Hypertropic Cardiomyopathy?
- MYH7 — cardiac β-myosin heavy chain
| - MYBPC3 — cardiac myosin binding protein C
68
A harsh crescendo-decrescendo systolic murmur that is best heard at the left fourth intercostal space at the sternal border indicates?
Hypertrophic Cardiomyopathy
69
Which manuevers/medicines increase the intensity of the murmur in Hypertrophic Cardiomyopathy?
- Valsalva, Rapid Standing (Decrease preload)
- CCBs (Decrease afterload)
- Dobutamine (Increase left ventricular intropy)
70
Definitive diagnositic test for Hypetrophic Cardiomyopathy?
Transthoracic Echocardiography
71
Treatment of Hypertrophic Cardiomyopathy?
- Beta Blockers
| - Non-dihydropyridine CCBs (Verapamil)
72
Neurocardiogenic syncope has the following prodrome:
- Nausea
- Diaphoresis
- Warmth
- Pallor
- Lightheadedness
