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Cardiology Flashcards

1
Q

Initial diagnostic test for ischemic heart disease?

A

Resting 12-lead electrocardiogram (ECG)

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2
Q

Horizontal or down-sloping ST depression indicates?

A

Subendocardial Ischemia and positive ECG stress test

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3
Q

Indications of a positive stress test?

A
  • ST depression
  • Chest pain
  • Hypotension
  • Arrhythmias
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4
Q

Drugs with alter ECG results?

A
  • Beta Blockers
  • Non-dihrodpyridie CCB (Verapamil/Ditilazam)
  • Anti-Arrhythmics (Amiodarone/Sotalol)
  • Digoxin
  • Nitrates
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5
Q

What drug is used for a pharmacologic stress test?

A

Dobutamine

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6
Q

What procedure tests for vessel stenosis?

A

Radionuclide myocardial perfusion imaging (rMPI)

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7
Q

Major modifiable risk factors for Coronary Artery Disease?

A
  • Tobacco Use
  • Hypertension
  • Sedentary Lifestyle
  • Obesity
  • Diabetes Mellitus
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8
Q

LDL and HDL levels that indicate dyslipidemia?

A
  • LDL > 130 mg/DL

- HDL < 40 mg/DL

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9
Q

Medications that increase LDL levels?

A
  • Thiazide Diurectics
  • Cyclosporine (Immunosuppressant)
  • Glucocorticoids
  • Amiodarone
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10
Q

Medical Disorders that cause increase in LDL levels?

A

REHAAB

  • Renal disorders
  • Endocrine Disorders
  • Hepatocellular Carcinoma
  • Anorexia
  • Acute Intermittent Porphyria
  • Biliary Stasis
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11
Q

LDL level that indicates hypocholesteremia?

A

LDL Levels <50

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12
Q

Etiologies of Hypocholesteremia?

A
  • Abetalipoproteinemia
  • Hypobetalipoprotemia
  • Malignancy (Colon/Prostate)
  • Malabsorptive disorders (Celiac)
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13
Q

Xanthelasmas?

A
  • Physical manifestations of dyslipidemia
  • Lipid deposits on the eyelids
  • Seen in Familial Hypercholesteremia
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14
Q

Xanthomas?

A
  • Physical manifestations of dyslipidemia

- Lipid deposits on trunk, extensor tendons and surfaces

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15
Q

Physical manifestations of dyslipidemia?

A
  • Xanthomas
  • Xanthelasmas
  • Retinal Cholesterol Emboli
  • Corneal Arcus
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16
Q

Extremely elevated triglycerides put the patient at risk for?

A

Pancreatitis

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17
Q

Retinal Cholesterol Emboli have what effect on the eyes?

A

Transient Vision Loss

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18
Q

Screening recommendations for dyslipidemia?

A
  • Screening btwn ages 40-75

- Reassessed in 5 yr intervals (w/o risk factors)

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19
Q

What heart sound abnormality is caused by dilated cardiomyopathy?

A

S3 heart sound

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20
Q

Symptoms of dilated cardiomyopathy?

A

Similar to CHF:

  • Orthopnea
  • Dyspnea
  • Weight gain
  • Edema
  • Weakness
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21
Q

Causes of Dilated Cardiomyopathy? (8)

A
  • Alcohol
  • Wet Beriberi
  • Peripartum Cardiomyopathy
  • Cocaine
  • Chagas Disease
  • Coxsackie B Virus
  • Doxorubicin, Daunorubicin
  • Hemochromatosis
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22
Q

Definitive treatment for Dilated Cardiomyopathy?

A

Heart Transplant

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23
Q

Most common pathogen responsible for Acute Endocarditis?

A

S. Aureus

on normal valves

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24
Q

Most common pathogens responsible for Subacute Endocarditis?

A
  • Strep. Viridens
  • S. epidermidis
  • Enterococci
  • HACEK group (
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25
Q

Sterile endocarditis is caused by?

A

Thrombi and platelets due to malignancy or SLE (Libman-Sacks)

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26
Q

Empiric Therapy for Infective Endocarditis?

A

Vancomycin

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27
Q

Treatment for Strep Viridans/Bovis Infective Endocarditis?

A
  • Pencillin G + Gentamicin
  • Ceftriaxone + Gentamicin
  • Vancomycin (for Pencillin allergic patients)

*add Rifampin for prosthetic valves

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28
Q

Treatment for Sterile (non-bacterial) thrombotic Endocarditis?

A

Heparin

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29
Q

Clinical Presentation of Stable Angina?

A
  • 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
Q

Atypical Presentation of Angina in the elderly and women?

A
  • Nausea/Vomiting
  • Mid-epigastric Pain/ Sharp Chest Pain
  • Weakness
  • Breathlessness
31
Q

ECG results during an angina attack?

A

ST-segment depression

32
Q

Diagnostic Gold Standard for Stable Angina?

A

Exercise Stress Test

33
Q

Treatment of Stable Angina?

A
  • Lifestyle Modifications

- Beta Blockers, Nitrates, Ca Channel Blockers

34
Q

Clinical Presentation of Acute Mitral Regurgitation?

A
  • Jugular Venous Distention

- Signs of Congestive Heart Failure

35
Q

Clinical Presentation of Chronic Mitral Regurgitation?

A
  • Apical Thrill

- No signs of CHF

36
Q

Causes of Mitral Regurgitation?

A
  • Mitral Prolapse
  • MI –> Damage to Papillary Muscles
  • Left Ventricle enlargement
  • Valve Damage (Endocarditis, Rheumatic Fever)
37
Q

Indications of Mitral Regurgitation on Auscultation?

A
  • High Pitched Holosystolic Murmur
  • Radiates to the Axilla
  • Widely Split S2
  • S3 Heart Sound
38
Q

Complications of Mitral Regurgitation?

A
  • Atrial Fibrillation
  • Pulmonary Edema
  • Right sided Heart Failure
39
Q

Treatment of Mitral Regurgitation?

A
  • Diuretics
  • Nitrates (also reduce preload)
  • ACE inhibitors or ARBs
  • Beta blockers
40
Q

What is the appropriate stress test for patients with abnormal baseline EKGs?

A

Nuclear stress tests

41
Q

Clinical Presentation of Unstable Angina?

A
  • Chest or arm pain for > 10 mins
  • Occurs at rest
  • Episodes get progressively worse
42
Q

Elevation in cardiac enzymes (troponins) occurs in which Acute Coronary Syndromes?

A
  • STEMI

- NSTEMI

43
Q

Pharmacologic treatment for Unstable angina, NSTEMI, or STEMI?

A
  • 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 P2Y12inhibitor (eg,clopidogrel)
  • Nitrates(primary benefit from preload reduction; also reducesafterload)
  • Statin (eg,high-dose atorvastatin)
44
Q

Chemical Reperfusion treatment in STEMI?

A
  • Tissue Plasminogen Activator
  • Streptokinase
  • Tenecteplase
  • Reteplase
45
Q

When is Chemical Reperfusion indicated?

A

Within 12hrs of symptom onset and if mechanical reperfusion within 120 mins is not feasible

46
Q

When is Coronary Artery Grafting Bypass indicated?

A
  • Occlusion of Left Main Artery

- Severe occlusion of three vessels

47
Q

EKG readings indicating an inferior infarct of the Posterior Descending Artery or Marginal Branch ?

A

ST elevation in Leads II, III, and aVF

48
Q

EKG readings of ST elevation in Leads I, aLF, and V1-V6 indicate?

A

Lateral infarct of the left anterior descending artery or circumflex.

49
Q

EKG readings of ST elevation in Leads V1-V2 indicate?

A

Septal infarct of LAD

50
Q

EKG readings of ST elevation in Leads V3-V4 indicate?

A

Anterior infarct of LAD

51
Q

Causes of Aortic Stenosis?

A
  • Calcifications at old age
  • Bicupid Valve at early age
  • Rheumatic Fever
52
Q

Clinical Presentation of Aortic Stenosis?

A
  • Syncope
  • Angina
  • Heart Failure
53
Q

Aortic Stenosis is associated with what heart sounds?

A

S4 Heart Sound

54
Q

Indications of Aortic Stenosis on Auscultation?

A
  • Systolic Crescendo-Decrescendo murmur best heard at the right sternal border and radiates to carotids and clavicle
55
Q

What maneuvers cause Aortic Stenosis to increase or decrease in intensity?

A

Increase: Maneuvers that increase preload (Leg-raise)
Decrease: Maneuvers that decrease preload (Valsalva) or increase afterload (Isometric hand squeezing)

56
Q

Complications of Aortic Stenosis?

A
  • Left Bundle Branch Block
  • Left atrial enlargement
  • Left Ventricular hypertrophy
57
Q

Definitive treatment for Aortic Stenosis?

A

Aortic Valve Replacement

58
Q

Clinical Presentation of Left Heart Failure?

A
  • Nocturia
  • Orthopnea
  • Dyspnea on exertion
  • Paroxysmal nocturnal dyspnea
59
Q

Severe breathlessness that awakens a patient from sleep?

A

Paroxysmal nocturnal dyspnea

60
Q

Initial imaging for suspected Heart Failure?

A

Transthoracic Echocardiography

61
Q

Which peptides indicates heart failure?

A
  • Brain natriuretic peptides (BNP)

- NT-pro BNP

62
Q

Treatment for Heart Failure?

A
  • Beta Blockers (Carvedilol, Bisoprolol)
  • ACE- Inhibitors
  • Diuretics (Loop or Thiazides)
63
Q

Preferred initial treatment for volume overload in HF patients?

A

Sulfonamide Loop Diuretics (Torsemide, Furosemide)

64
Q

Management for acute decompensated reduced ejection fraction Heart Failure?

A
  • Furosemide
  • Nitroglyercin
  • Morphine
  • Oxygen
  • Upright Position
65
Q

Implantable cardioverter-defibrillators are indicated for patients who:

A
  • LVEF > 30% + prior MI

- LVEF > 35% + Class II/III

66
Q

Patients who are refractory to medical and resynchronization should consider:

A

Left Ventricular Assist Devices

67
Q

Two gene mutations associated with Hypertropic Cardiomyopathy?

A
  • MYH7— cardiac β-myosin heavy chain

- MYBPC3— cardiac myosin binding protein C

68
Q

A harsh crescendo-decrescendo systolic murmur that is best heard at the left fourth intercostal space at the sternal border indicates?

A

Hypertrophic Cardiomyopathy

69
Q

Which manuevers/medicines increase the intensity of the murmur in Hypertrophic Cardiomyopathy?

A
  • Valsalva, Rapid Standing (Decrease preload)
  • CCBs (Decrease afterload)
  • Dobutamine (Increase left ventricular intropy)
70
Q

Definitive diagnositic test for Hypetrophic Cardiomyopathy?

A

Transthoracic Echocardiography

71
Q

Treatment of Hypertrophic Cardiomyopathy?

A
  • Beta Blockers

- Non-dihydropyridine CCBs (Verapamil)

72
Q

Neurocardiogenic syncope has the following prodrome:

A
  • Nausea
  • Diaphoresis
  • Warmth
  • Pallor
  • Lightheadedness

Internal Medicine (15 decks)

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