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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
What is the txt for restrictive cardiomyopathy?
none, txt underlying cause, gentle diuresis
26
What is the mc sx of hypertrophic cardiomyopathy?
dyspnea
27
How would you describe the murmur of hypertrophic cardiomyopathy?
increased murmur with valsalva, standing | decreased murmur with squatting, leg, supine
28
What sounds are heard in hypertrophic cardiomyopathy?
S4, pulsus bisferiens
29
What is seen on echo for hypertrophic cardiomyopathy?
asymmetric ventricular wall thickness (septal)
30
What is the 1st line medical management for hypertrophic cardiomyopathy?
Beta blockers (alternative CCB)
31
What should pts with hypertrophic cardiomyopathy avoid?
dehydration extreme exertion exercise
32
What meds should pts with hypertrophic AVOID?
Digoxin (increase contractility) Nitrates (decrease LV) Diuretics (decrease LV)
33
Sudden cardiac death is seen in what?
Hypertrophic cardiomyopathy
34
What causes the sudden cardiac death in hypertrophic cardiomyopathy?
V. Fib
35
What is the mc cause of heart failure?
coronary artery disease
36
Mc cause of right sided heart failure?
left sided failure
37
What are the unique features seen in systolic heart failure?
decrease ejection fraction S3 gallop dilated heart size thin walls
38
What is the mc heart failure?
systolic
39
What are the unique features seen in diastolic heart failure?
normal or increase ejection fraction S4 normal heart size thick walls
40
left sided heart failure causes fluid to back up into?
the lungs (L for lungs)
41
right sided heart failure cause fluid to back up into?
systemic ( 3 roads)
42
Most important determinant of prognosis in heart failure?
ejection fraction (<35% increased mortalitiy)
43
BNP of what is dx of CHF?
>100
44
What med is first line tx for CHF?
ACEI
45
What are 4 sde effects of ACEI?
hyperkalemia non-productive cough angioedema C/I pregnancy
46
Kerley B lines is seen in?
CHF
47
S3 is heard in what?
Systolic heart failure
48
S4 is heard in what?
Diastolic heart failure
49
What is BNP best used for?
ruling out heart failure
50
What 3 beta blockers are used in CHF?
Metoprolol Bisoprolol Carvedilol
51
What are 3 things that might be seen on clinical exam of a pt with hyperlipidemia?
Pancreatitis Xanthomas (Achilles tendon) Xanthelasma (lipid plaques on the eyes)
52
What is the initiating screening for hyperlipidemia?
``` higher risk (>1 risk) = 20-25 males, 30-35 females low risk = 35 males, 45 females ```
53
Best med to lower LDL?
statins, bile acid seq
54
Best med to lower triglycerides?
Fibrates
55
Best med to increase HDL?
Niacin
56
MOA for statins?
inhibit rate limiting step in hepatic cholesterol synthesis via HMG-CoA reductase
57
What lab should be monitor before starting a statin?
LFT
58
What are C/I to statin therapy?
hepatic disease, pregnancy, breastfeeding
59
Sde of statins?
myositis, rhabdo
60
Sde of niacin?
increased prostaglandins- flushing, warm sensation, pruritus, headache
61
What is the pretreatment before starting statin therapy?
NSAIDS or Aspirin
62
MOA of fibrates?
inhibit triglyceride synthesis, increase the activity of lipase
63
What s the only fibrate FDA approved to use in combo with statin?
Fenofibric acid
64
What lipid lowering drug is safe in pregnancy?
bile acid sequestrant
65
Sde of bile acid seq?
increased triglycerides level
66
Best drug when combined with statin to reduce LDL?
Ezetimibe
67
Target goals for hyperlipidemic pts with CAD?
LDL <100 HDL > 40 Triglycerides <150
68
Who gets CABG?
left main artery stenosis 3 vessel dx 2 vessel in diabetics decreased left ventricular ej <40%
69
Who gets PCI?
1 or 2 vessel in nondiabetics non-left main artery peeps normal or near normal ej
70
Definitive dx for angina?
coronary angiography
71
4 drugs used for angina?
Aspirin Beta blocker Nitroglycerin Statin
72
What finding is seen on ECG for angina?
ST depression
73
Dilated Cardiomyopathy with persistent ej of <35% will get?
AICD (automated internal cardiac defibrillator)
74
What is the common sde of Ezetimibe?
diarrhea
75
MC valve involved in endocarditis?
mitral (M>A>T>P)
76
MC valve involved in IV drug use endocarditis?
tricuspid
77
MC cause of acute endocarditis?
Staph aureus
78
MC cause of subacute endocarditis?
Strep virdians
79
MC cause of prosthetic endocarditis?
Staph epidermis
80
Clinical manifestations of endocarditis?
``` Fever New murmur Janeway lesions Osler nodes Splinter hemorrhages Roth spots ```
81
Dx for endocarditis?
3 sets of blood culture | TEE
82
What are the 3 major criteria for endocarditis (duke)?
1. 2 + blood cultures 2. Echo evidence 3. new valvular regurg
83
Txt for native valve endocarditis?
Nafcillin (Vancomycin) + Gentamicin (Ceftriaxone)
84
Txt for prosthetic endocarditis?
Vancomycin + Gentamicin + Rifampin
85
Txt for fungal endocarditis?
Amp B
86
What are 4 conditions for endocarditis prophylaxis/
- Prosthetic (artificial) heart valves - Heart repairs w/ prosthetic material - prior endocarditis - congenital heart dx
87
Prophylaxis for endocarditis?
Amoxicillin 2g 30-60 min prior | Clindamycin 600 mg
88
2 Mc causes of pericarditis?
idiopathic | Viral (Coxsach, Echovirus)
89
DOC for pericarditis?
ECG
90
ECG findings for pericarditis?
diffuse ST elevations in precordial leads w/ associated PR depression
91
Txt for pericarditis?
NSAIDS or Aspirin
92
What is dressler syndrome?
post MI pericarditis + fever + pleural effusion
93
MC cause of myocarditis?
viral (enteroviruses)
94
Gold standard DOC for myocarditis?
endomyocardial biopsy
95
Txt for myocarditis?
supportive, heart failure txt
96
Acute rheumatic fever is usually seen in what age?
5--15yr
97
Organism involved in rheumatic fever?
Group A Strep (strep pyogenes)
98
What does JONES stand for in rheumatic fever?
``` J- migratory polyarthritis O- active carditis N- nodules E- erythema marginatum S- sydenham's chorea ```
99
What is the most important supporting evidence for acute rheumatic fever?
group A strep
100
Txt for rheumatic fever?
Aspirin + Penicillin (Erythromycin)
101
What is an alternative to penicillin for rheumatic heart disease?
Sulfadiazine
102
Prophylaxis recommendation for rheumatic heart dx?
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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