Cardiology Exam Flashcards
1
Q
total cholesterol high
A
> 240
2
Q
triglycerides high
A
200-500
3
Q
HDL low
A
<40
4
Q
LDL high
A
> 100
5
Q
triglycerides very high
A
> 500
6
Q
triglycerides borderline
A
151-199
7
Q
total cholesterol borderline
A
200-240
8
Q
total cholesterol normal
A
<200
9
Q
when to screen healthy adults for cholesterol
A
every 5 years starting at 45 (f) and 35 (m)
10
Q
when to screen diabetic adults
A
at 20 years if other risk factors
11
Q
when to use a high intensity statin
A
CAD, LDL>190 or TG>500, diabetes (over 50 or multiple risk factors), >20% CV risk calculator
12
Q
when to use a moderate intensity statin
A
all diabetes 40-50 without other risk factors, between 7.5 and 20% CV risk calculator
13
Q
when to consider statins (no firm recommendation)
A
over 75 with CAD or DM, under 40 with diabetes, between 5 and 7.5% CV risk calculator
14
Q
Contraindications to statin use
A
active liver disease, pregnancy
15
Q
adverse effects of statins
A
myopathy, rhabdo, increased LFTs, increased A1C, cognition
16
Q
what about niacin, omega-3, fibrate for hyperlipidemia
A
not recommended
17
Q
what is ezetimibe
A
inhibits cholesterol absorption at small intestine
18
Q
when to consider bile acid sequestrants
A
ezetimibe intolerant and TG<300
19
Q
when to use PCSK9 inhibitors
A
very high-risk patients
20
Q
lipid lowering effect of high-intensity statins
A
decrease LDL by 50%
21
Q
lipid lowering effect of moderate intensity statins
A
30-50%
22
Q
parasympathetic cardiac receptor
A
M2
23
Q
parasympathetic bronchial smooth muscle receptor
A
M3
24
Q
sympathetic vasodilation for skeletal muscle receptor
A
B2
25
sympathetic receptor for renin release
B1
26
toxicities of parasympathomimetics
bradycardia, bronchospasm
27
atropine mechanism of action
competitive antagonist of muscarinic receptors
28
can atropine cross BBB
yes
29
atropine toxicity
parasympatholytic effects (dry mouth, tachycardia), sedation, delirium, hyperthermia, flushing
30
what is PO atropine
oxybutinin
31
what is an alpha 1 and alpha 2 agonist used for hypotension
phenylephrine
32
what is isoproterenol
B1 B2 agonist used to stimulate the heart in AV block
33
what is dobutamine
B1 agonist used to increase cardiac output in heart failure
34
what is the only sympathomimetic used to treat hypertension and why
clonidine (alpha 2 agonist)
35
what cardiac biomarker other than troponin is sometimes used and why would it be used
CK-MB: levels return to normal faster than troponin so it is useful for re-infarction
36
when do troponin levels rise
4 hours after infarction
37
when do troponin levels peak
24 hours
38
when do CK-MB levels rise
6-12 hours
39
how long do troponin levels stay elevated
7 days
40
elements of Virchow's triad
hypercoagulable state, endothelial damage, stasis
41
class 1 antiarrhythmics
1a procainamide, 1b lidocaine, 1c flecainide
42
class 1 antiarrhythmics mechanism
fast sodium channel blockers
43
class 2 antiarrhythmics mechanism
beta blockers
44
class 3 antiarrhythmics mechanism
potassium channel blockers
45
class 4 antiarrhythmics mechanism
calcium channel blockers
46
nonspecific beta blocker
propranolol
47
cardioselective beta blocker
metoprolol/atenolol/esmolol
48
class 3 antiarrythmic prototype
amiodarone
49
class 4 antiarrhythmic prototype
verapamil
50
labetalol/carvedilol mechanism
alpha 1 and nonselective beta blocker
51
what are non-dihydropyridines used for and what are they called
antiarrhythmics, verapamil/diltiazem
52
what are dihydropyridines used for and what are they called
antihypertensives, nifedipine, amlodipine
53
what types of arrhythmias are calcium channel blockers used for
supraventricular
54
what tissues do class I and class III antiarrhythmics affect
atrial and ventricular myocytes
55
most common cause of aortic stenosis <70 y.o
bicuspid valve
56
most common cause of aortic stenosis >70 y.o
degenerative (calcific)
57
murmur of aortic stenosis
systolic ejection murmur (crescendo-decrescendo)
58
causes of acute aortic regurg
infective endocarditis, aortic dissection, trauma, prosthetic valve dysfunction
59
causes of chronic aortic regurg
bicuspid, aortic root dilatation, rheumatic disease, connective tissue disease
60
blood pressure on aortic regurg
wide pulse pressure
61
murmur of aortic regurg
diastolic decrescendo
62
most common cause of chronic mitral regurg
degenerative changes
63
most common causes of acute mitral regurg
myxomatous mitral valve with chordal rupture, papillary rupture 2/2 AMI, infective endocarditis
64
most common etiology of mitral stenosis
rheumatic disease
65
4/6 murmur
loud with thrills
66
5/6 murmur
can hear with steth partly off chest
67
6/6 murmur
can hear with steth completely off chest
68
when is auscultation used with pt in left lateral decubitus position
S3, S4, mitral stenosis (using bell)
69
S3
occurs right after S2
70
S4
occurs right before S1, blood hitting a noncompliant ventricle
71
heart sound just before the carotid pulse
S1
72
characteristics of restrictive cardiomyopathy
normal EF but severe systolic dysfunction and concentric hypertrophy
73
hypertrophic cardiomyopathy murmur
dynamic systolic ejection murmur that increases with increased preload and increased afterload
74
what causes concentric hypertrophy
chronic pressure overload (HTN, aortic stenosis)
75
what causes eccentric hypertrophy
chronic volume overload (aortic regurg, dilated cardiomyopathy)
76
formula for ejection fraction
(EDV-ESV)/EDV
77
EF values for HF with mildly reduced EF
41-49%
78
EF values for HF with reduced EF
<40%
79
HF with reduced EF has what hypertrophy
eccentric
80
HF with preserved ejection fraction has what hypertrophy
concentric
81
role of SNS activation in HF
initially helps to maintain cardiac output but long-term increase in norepi levels leads to increase in afterload, fibrosis, arrhythmias
82
action of ACE inhibitors/ARBs/ARNIs in HF
decreases afterload and preload, decreases myocardial fibrosis
83
ARNI prototype
Sacubitril-valsartan
84
role of hydralazine-nitrate combination in heart failure
vasodilators, use in those that cannot tolerate ACE/ARB/ARNI or in conjunction with them
85
beta blockers for HF
metoprolol succinate, carvedilol, bisoprolol
86
most common cause of endocarditis
strep viridans (usually in the presence of a damaged valve) - subacute
87
most common cause of acute endocarditis (IV drug abuser)
staph aureus (tricuspid valve)
88
cause of libman-sacks endocarditis
SLE
89
when is BP medication recommended
130/80 and CVD risk 10% or more
90
pulse pressure is proportional to ____ and inversely proportional to _____
stroke volume, arterial compliance
91
MABP =
cardiac output x total peripheral resistance
92
determinants of vascular resistance
diameter, viscosity, arrangement (series vs parallel), type of flow (laminar vs turbulent)
93
turbulence is proportional to ____ and inversely proportional to ____
diameter/velocity, viscosity
94
dicrotic notch
aortic valve closes and causes a secondary pressure wave
95
T-wave in wiggers diagram
during reduced ejection
96
mitral valve closure wiggers diagram
beginning of iso. contraction
97
aortic valve closure wiggers
beginning of iso. relaxation
98
mitral valve opens wiggers
end of iso. relaxation/beginning of rapid filling
99
formula for EF
SV/EDV
100
what are the primary determinants of coronary perfusion?
aortic pressure and coronary artery compression during ventricular compression
101
what is the cholinergic neuron
sympathetic preganglionic
102
what is the adrenergic neuron
sympathetic postganglionic
103
preganglionic sympathetic neurotransmitter
ach
104
postganglionic sympathetic neurotransmitter
norepi
105
the systemic circulation is primarily innervated by ____ neurons
sympathetic
106
what do adrenergic receptors bind
norepi and epi
107
what do cholinergic receptors bind
ach
108
what is the endogenous agonist of alpha receptors
norepi
109
B1 receptors on cardiac myocytes are stimulated by
norepi/epi
110
B2 receptors in skeletal muscle are stimulated by
epi
111
nicotinic receptor function
mediate neurotransmission at autonomic ganglia and catecholamine release from medulla
112
sympathoadrenal system is mostly responsible for releasing
epinephrine
113
epinephrine has a higher affinity for what type of receptor
Beta
114
what receptor activates RAAS
B1 on juxtaglomerular cells, this releases renin
115
which SNS neurotransmitter is largely released via neuronal stimulation
norepi
116
metabolic dilators
hypoxia and adenosine
117
what accounts for decrease in TPR during strenuous exercise
local vasodilatory metabolites are overriding SNS
118
phase 0 fast response
Na channels open and there is a massive Na influx
119
phase 1 fast response
Na channels close and K leaks out of cell
120
phase 2 fast response
trigger for contraction: Ca channels open and Ca comes in while K leaks out
121
phase 3 fast response
Ca channels close and K continues to leak out
122
phase 4 fast response
Na and Ca channels are closed, -85 mv resting maintained by constant leak of K out of the cell
123
phase 4 slow response
Na slowly leaks into cell until threshold
124
phase 0 slow response
Ca channels open and Ca rushes in
125
phase 3 slow response
Ca channels close and K channels open, allowing K to leak out
126
difference in action potential between SA and AV node
in AV node, phase 4 is longer
127
SV formula
SV = EDV-ESV
128
SBP largely determined by
SV
129
DBP largely determined by
TPR
130
hypocalcemia ekg
prolonged QT
131
hypercalcemia ekg
shortened QT
132
brugada syndrome ekg
ST elevation in V1-V3 with negative T-wave
133
high-intensity statins
atorvastatin, rosuvastatin
134
statin mechanism of action
prevent cholesterol synthesis in liver
135
what medications are used to lower triglycerides
fibrates
136
EKG changes in LAD occlusion
V1-V4
137
EKG changes in circumflex artery occlusion
laterals
138
EKG changes in PDA (right-dominant)
inferiors
139
EKG changes in PDA (left-dominant)
laterals (branch of circumflex)
140
EKG changes in isolated PDA occlusion
ST depression in V1-V2
141
early post MI complications
arrhythmia, then free wall rupture, papillary rupture, tamponade, septal rupture
142
later post MI complications
CVA, aneurysm, Dresslers syndrome
143
goal BP for Pts over 60
150/90
144
goal BP for pts under 60 or DM
140/90
145
dx of endocarditis requires
2 major, 1 major/3 minor, or 5 minor (modified Duke criteria)
146
most common organism in infective endocarditis
staph aureus (vanc) strep viridans (PCN)
147
3 criteria for typical angina
worsens with exercise, relieved with rest/nitro, substernal chest discomfort
148
what counts as satisfactory workload for stress testing
4 mets or 85% of max HR
149
HAS-BLED high risk
>3
