Cardiology Diseases Flashcards
1
Q
- retrosternal pressure, burning, heaviness, squeezing, indigestion that may radiate
- precipitated by exercise, cold, stress and relieved by rest or nitro
- <2-10 min
A
angina
2
Q
- retrosternal pressure, burning, heaviness, squeezing, indigestion that may radiate
- precipitated by exercise, cold, stress and relieved by rest or nitro
- usually <20 min
A
unstable angina
3
Q
- substernal heaviness, burning, pressure, constriction
- unrelieved by rest or nitro
- > 30 min
A
MI
4
Q
- sharp, stabbing, knifelike pain over sternum and may radiate
- aggravated by deep breathing, supine position
- relieved by sitting up and leaning forward
- lasts hours to days w/ waxing and waning
- pericardial friction rub heard
A
Pericarditis
5
Q
- sudden, unrelenting, excruciating, tearing, , knifelike pain in anterior chest and may radiate to back
- murmur or aortic insufficiency, pulse or BP asymmetry, neurologic deficit
A
Aortic Dissection
6
Q
- sudden or within 1 hr onset of substernal or chest pleuritic pain
- may be aggravated by breathing
- dyspnea, tachypnia, tachycardia, hypotension, rales, friction rub, hemoptysis
A
Pulmonary Embolism
7
Q
drugs for pharmacologic stress test
A
- adenosine
- persantine (dipyridamole)
- tetrofosmin
- dobutamine (commonly used w/ echo)
8
Q
indications for TEE
A
- endocarditis
- aortic dissection
- evaluation for surgical intervention
- evaluation of A-fib
9
Q
test for detection of left-to-right shunts
A
contrast echocardiography (bubble study)
10
Q
test for cardiomyopathy, CHF, coarctation of aorta
A
CXR
11
Q
GOLD standard for Dx of coronary artery Dz (and EF measurement)
A
coronary angiography aka cardiac catheterization (w/ ventriculography)
12
Q
contraindications for cardiac cath
A
- severe uncontrolled HTN
- ventricular arrhythmia
- recent acute stroke
13
Q
test to Dx pulmonary arterial HTN
A
right side heart cath
14
Q
test for burden of atherosclerotic plaque
A
cardiac CT/calcium score
15
Q
test for analyze arrhythmias and evaluate therapy
A
electrophysiologic study (EPS) w/ catheter ablation
16
Q
test for causes of syncope, orthostatic hypotension
A
tilt table test
17
Q
qualifications for ICD
A
- non-ischemic cardiomyopathy w/ EF <35
- Class II or III heart failure
- CAD w/ EF <35
- VT
- MI w/ EF <30
18
Q
GOLD standard for Dx of peripheral artery Dz
A
angiogram
19
Q
device to monitor heart at home for 24h
A
Holter monitor
20
Q
device to monitor heart at home 1-2 weeks (not for syncope)
A
event recorder
21
Q
device to monitor heart at home 2w-1m
A
external loop recorder
22
Q
device to monitor heart at home up to 3y
A
implantable loop recorder
23
Q
- transsternal or retrosternal pressure or a choking sensation or pain that may radiate to the left arm, jaw, neck, or back that is brought on in a predictable manner by exertion or by emotional upset and alleviated by sublingual nitroglycerin or cessation of exertion
- peaks in a period of just a few minutes
A
chronic stable angina
24
Q
resting EKG findings in stable angina/stable CAD
A
ST segment depression or T wave inversion
25
Tx of stable angina
- nitrates (for relief)
- Beta-blockers to lower HR ("-lols") 1st choice if MI
- non-dihydropyridine CCBs for vasodilation, vasospasm (Verapamil, Diltiazem) if B-blockers not tolerated
* dihydropyridine CCBs (Amlodipine) have greater effect on vascular smooth muscle
- Ranolazine (Ranexa) reduces O2 demand
26
Other stable angina meds
- statins for hyperlipidemia
- ACEI's reduce CV events ("-prils")
- aspirin or Clopidogrel (Plavix) if ASA not tolerated
27
Big 4 that damage blood vessels
- cholesterol
- glucose
- HTN
- tobacco
28
secondary causes of HTN
- hyperaldosterone (high K+)
- hyperparathyroid (high Ca+)
- kidney disease (high creatinine)
- estrogen
29
criteria for HTN tx after lifestyle failure
Defined: daytime OOO > 130/80
- OOO daytime BP > 135/85
- OOO mean BP > 130/80
- office BP > 140/90
- office BP > 130/80 + comorbidity
30
HTN med classes
- thiazide-type diuretics (Bendroflumethiazide, Chlorthalidone, Hydrochlorothiazide, Indapamide)
- long-acting CCBs (Amlodipine, Diltiazem, Nitrendipine)
- ACE inhibitors ("-prils")
- ARBs ("-sartans")
ACE/ARBs: check K+, Cr, not in pregnancy
31
Best HTN meds on whites vs. blacks
W: Clonidine, Atenolol
B: Diltaizem, HCTZ
32
Best HTN combination therapies
- ACE + long-acting dihydropyridine CCB
- ACE + diuretic
- ARB + long-acting dihydropyridine CCB
- ARB + diuretic
33
BP targets
- daytime OOO average < 130/80
| - office < 135/85
34
- xanthalasmas
- xanthomas (tendinous, tuberoeruptive)
- very high LDL (190-500)
- normal triglycerides
Familial Hypercholesterolemia
| confirmed by genetic test
35
- high LDL
- high triglycerides
- both high
- xanthelasmas but no xanthomas
- many relatives w/ hyperlipidemia
Familial Combined Hyperlipidemia
36
- polygenic inheritance
- high LDL (130-250)
- triglycerides normal
- no xanthomas
Polygenic Hypercholesterolemia
37
- elevation of triglycerides only (200-500 fasting, 1000+ w/ high fat meal)
- xanthelasmas but rarely eruptive xanthomas ("the butt")
- lipemia retinalis ("white retinal arteries")
Familial Hypertriglyceridemia
38
cholesterol targets
```
total: <200
LDL: w/ heart dz <70
w/ risk <100
ideal 100-129
HDL: >40 men, >50 women, >60 ideal
```
39
cholesterol lowering add-on med
Ezetimibe (cholesterol absorption inhibitor)
40
- new, worsening angina or at rest
| - NO elevated troponin or CK-MB
acute coronary syndrome: unstable angina
41
- angina
- elevated troponin (myonecrosis)
- NO ST segment elevation
acute coronary syndrome: NSTEMI
42
- angina
- elevated troponin (myonecrosis)
- persistant (>20min) ST segment elevation
acute coronary syndrome: STEMI
43
4 criteria for Dx of MI
any two:
- history of angina or equivalent
- EKG evidence of ischemia or infarction
- elevated serum biomarkers
- imaging evidence of new myocardium loss or wall motion abnormalities
44
evidence of prior MI
any one:
- new pathological Q waves
(>.04sec or >25% of R height -or- >2mm deep)
- loss of viable myocardium contraction in absence of non-ischemic cause
- pathological findings of healed or healing MI
