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Internal Med PAEA > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What type of dysfunction is Dilated Cardiomyopathy/

A

Systolic

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2
Q

What type of dysfunction is Takotsubo Cardiomyopathy?

A

Systolic

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3
Q

What type of dysfunction is Restrictive Cardiomyopathy?

A

Diasystolic

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4
Q

What type of dysfunction is Hypertrophic Cardiomyopathy?

A

Diasystolic

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5
Q

What type of genetic disorder is Hypertrophic cardiomyopathy?

A

Autosomal dominant

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6
Q

What are the three most common causes of Dilated cardiomyopathy?

A

Idiopathic
Viral (Enteroviruses)
Alcohol abuse

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7
Q

What type of vitamin deficiency is seen in dilated cardiomyopathy?

A

Vitamin B1 (thiamine)

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8
Q

What is the hallmark seen on physical exam for dilated cardiomyopathy?

A

S3 gallop

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9
Q

What is the diagnostic test of choice for dilated cardiomyopathy?

A

Echocardiogram

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10
Q

What two things are seen on echo for dilated cardiomyopathy?

A

left ventricular dilation

decreased ejection fraction

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11
Q

What is the txt for dilated cardiomyopathy?

A

Standard systolic heart failure txt = ACE inhibitors, Beta blockers, ARBS, Spironolactone, Diuretics

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12
Q

What is the most common Cardiomyopathy?

A

Dilated Cardiomyopathy (95%)

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13
Q

What cardiomyopathy mimics a myocardial infarction?

A

Stress “Takotsubo” Cardiomyopathy

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14
Q

What is the biggest risk factor for Takotsubo?

A

Postmenopausal women exposed to physical or emotional stress

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15
Q

What 3 symptoms due Takotsubo patients present with?

A
  • substernal chest pain
  • dyspnea
  • syncope
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16
Q

What tests are used to dx Takotsubo?

A

Coronary angiogram- 1st

Echo- 2nd

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17
Q

What is seen on cath in Takotsubo?

A

absence of acute plaque rupture or obstructive coronary dx

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18
Q

What is seen on echo in Takotsubo?

A

apical left ventricular ballooning

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19
Q

What is the initial management of Takotsubo?

A

ACS txt= Aspirin, Nitroglycerin, Beta Blocker, Heparin, coronary angiogram

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20
Q

What is the main stay treatment of Takotsubo?

A

conservative and supportive care

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21
Q

What is the most common cause of Restrictive Cardiomyopathy?

A

Amyloidosis

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22
Q

Which heart failure is greater in Restrictive cardiomyopathy?

A

Right sided

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23
Q

What is seen on echo in Restrictive cardiomyopathy?

A

non-dilated ventricles with normal thickness

marked dilation of both atria

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24
Q

What is the definitive dx of restrictive cardiomopathy?

A

endomyocardial biopsy

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25
Q

What is the txt for restrictive cardiomyopathy?

A

none, txt underlying cause, gentle diuresis

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26
Q

What is the mc sx of hypertrophic cardiomyopathy?

A

dyspnea

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27
Q

How would you describe the murmur of hypertrophic cardiomyopathy?

A

increased murmur with valsalva, standing

decreased murmur with squatting, leg, supine

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28
Q

What sounds are heard in hypertrophic cardiomyopathy?

A

S4, pulsus bisferiens

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29
Q

What is seen on echo for hypertrophic cardiomyopathy?

A

asymmetric ventricular wall thickness (septal)

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30
Q

What is the 1st line medical management for hypertrophic cardiomyopathy?

A

Beta blockers (alternative CCB)

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31
Q

What should pts with hypertrophic cardiomyopathy avoid?

A

dehydration
extreme exertion
exercise

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32
Q

What meds should pts with hypertrophic AVOID?

A

Digoxin (increase contractility)
Nitrates (decrease LV)
Diuretics (decrease LV)

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33
Q

Sudden cardiac death is seen in what?

A

Hypertrophic cardiomyopathy

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34
Q

What causes the sudden cardiac death in hypertrophic cardiomyopathy?

A

V. Fib

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35
Q

What is the mc cause of heart failure?

A

coronary artery disease

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36
Q

Mc cause of right sided heart failure?

A

left sided failure

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37
Q

What are the unique features seen in systolic heart failure?

A

decrease ejection fraction
S3 gallop
dilated heart size
thin walls

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38
Q

What is the mc heart failure?

A

systolic

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39
Q

What are the unique features seen in diastolic heart failure?

A

normal or increase ejection fraction
S4
normal heart size
thick walls

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40
Q

left sided heart failure causes fluid to back up into?

A

the lungs (L for lungs)

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41
Q

right sided heart failure cause fluid to back up into?

A

systemic ( 3 roads)

42
Q

Most important determinant of prognosis in heart failure?

A

ejection fraction (<35% increased mortalitiy)

43
Q

BNP of what is dx of CHF?

A

> 100

44
Q

What med is first line tx for CHF?

A

ACEI

45
Q

What are 4 sde effects of ACEI?

A

hyperkalemia
non-productive cough
angioedema
C/I pregnancy

46
Q

Kerley B lines is seen in?

A

CHF

47
Q

S3 is heard in what?

A

Systolic heart failure

48
Q

S4 is heard in what?

A

Diastolic heart failure

49
Q

What is BNP best used for?

A

ruling out heart failure

50
Q

What 3 beta blockers are used in CHF?

A

Metoprolol
Bisoprolol
Carvedilol

51
Q

What are 3 things that might be seen on clinical exam of a pt with hyperlipidemia?

A

Pancreatitis
Xanthomas (Achilles tendon)
Xanthelasma (lipid plaques on the eyes)

52
Q

What is the initiating screening for hyperlipidemia?

A 
higher risk (>1 risk) = 20-25 males, 30-35 females
low risk = 35 males, 45 females
53
Q

Best med to lower LDL?

A

statins, bile acid seq

54
Q

Best med to lower triglycerides?

A

Fibrates

55
Q

Best med to increase HDL?

A

Niacin

56
Q

MOA for statins?

A

inhibit rate limiting step in hepatic cholesterol synthesis via HMG-CoA reductase

57
Q

What lab should be monitor before starting a statin?

A

LFT

58
Q

What are C/I to statin therapy?

A

hepatic disease, pregnancy, breastfeeding

59
Q

Sde of statins?

A

myositis, rhabdo

60
Q

Sde of niacin?

A

increased prostaglandins- flushing, warm sensation, pruritus, headache

61
Q

What is the pretreatment before starting statin therapy?

A

NSAIDS or Aspirin

62
Q

MOA of fibrates?

A

inhibit triglyceride synthesis, increase the activity of lipase

63
Q

What s the only fibrate FDA approved to use in combo with statin?

A

Fenofibric acid

64
Q

What lipid lowering drug is safe in pregnancy?

A

bile acid sequestrant

65
Q

Sde of bile acid seq?

A

increased triglycerides level

66
Q

Best drug when combined with statin to reduce LDL?

A

Ezetimibe

67
Q

Target goals for hyperlipidemic pts with CAD?

A

LDL <100
HDL > 40
Triglycerides <150

68
Q

Who gets CABG?

A

left main artery stenosis
3 vessel dx
2 vessel in diabetics
decreased left ventricular ej <40%

69
Q

Who gets PCI?

A

1 or 2 vessel in nondiabetics
non-left main artery peeps
normal or near normal ej

70
Q

Definitive dx for angina?

A

coronary angiography

71
Q

4 drugs used for angina?

A

Aspirin
Beta blocker
Nitroglycerin
Statin

72
Q

What finding is seen on ECG for angina?

A

ST depression

73
Q

Dilated Cardiomyopathy with persistent ej of <35% will get?

A

AICD (automated internal cardiac defibrillator)

74
Q

What is the common sde of Ezetimibe?

A

diarrhea

75
Q

MC valve involved in endocarditis?

A

mitral (M>A>T>P)

76
Q

MC valve involved in IV drug use endocarditis?

A

tricuspid

77
Q

MC cause of acute endocarditis?

A

Staph aureus

78
Q

MC cause of subacute endocarditis?

A

Strep virdians

79
Q

MC cause of prosthetic endocarditis?

A

Staph epidermis

80
Q

Clinical manifestations of endocarditis?

A 
Fever
New murmur
Janeway lesions
Osler nodes
Splinter hemorrhages
Roth spots
81
Q

Dx for endocarditis?

A

3 sets of blood culture

TEE

82
Q

What are the 3 major criteria for endocarditis (duke)?

A
  1. 2 + blood cultures
  2. Echo evidence
  3. new valvular regurg
83
Q

Txt for native valve endocarditis?

A

Nafcillin (Vancomycin) + Gentamicin (Ceftriaxone)

84
Q

Txt for prosthetic endocarditis?

A

Vancomycin + Gentamicin + Rifampin

85
Q

Txt for fungal endocarditis?

A

Amp B

86
Q

What are 4 conditions for endocarditis prophylaxis/

A
  • Prosthetic (artificial) heart valves
  • Heart repairs w/ prosthetic material
  • prior endocarditis
  • congenital heart dx
87
Q

Prophylaxis for endocarditis?

A

Amoxicillin 2g 30-60 min prior

Clindamycin 600 mg

88
Q

2 Mc causes of pericarditis?

A

idiopathic

Viral (Coxsach, Echovirus)

89
Q

DOC for pericarditis?

A

ECG

90
Q

ECG findings for pericarditis?

A

diffuse ST elevations in precordial leads w/ associated PR depression

91
Q

Txt for pericarditis?

A

NSAIDS or Aspirin

92
Q

What is dressler syndrome?

A

post MI pericarditis + fever + pleural effusion

93
Q

MC cause of myocarditis?

A

viral (enteroviruses)

94
Q

Gold standard DOC for myocarditis?

A

endomyocardial biopsy

95
Q

Txt for myocarditis?

A

supportive, heart failure txt

96
Q

Acute rheumatic fever is usually seen in what age?

A

5–15yr

97
Q

Organism involved in rheumatic fever?

A

Group A Strep (strep pyogenes)

98
Q

What does JONES stand for in rheumatic fever?

A 
J- migratory polyarthritis
O- active carditis
N- nodules
E- erythema marginatum
S- sydenham's chorea
99
Q

What is the most important supporting evidence for acute rheumatic fever?

A

group A strep

100
Q

Txt for rheumatic fever?

A

Aspirin + Penicillin (Erythromycin)

101
Q

What is an alternative to penicillin for rheumatic heart disease?

A

Sulfadiazine

102
Q

Prophylaxis recommendation for rheumatic heart dx?

A

No evidence of carditis- 5yrs or until age 21

Evidence of carditis w/o valvular abnormalities- 10yrs or until age 21

Evidence of carditis and valvular - 10yrs or until 40

Internal Med PAEA (9 decks)

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